上顎洞に炎症が波及したビスフォスフォネート関連顎骨骨髄炎の治療経験

抄録

Maxillary sinusitis is a frequent complication of bisphosphonate-related osteomyelitis of the jaw （BROMJ）, which is caused by bacterial infection in the maxilla. In some cases of BROMJ with maxillary sinusitis, the infection can spread from the involved sinus and damage the orbit or intracranial structures.Therefore, early diagnosis and appropriate therapy are required.
In this study, we report a case-series of patients who had BROMJ with maxillary sinusitis who were successfully evaluated with the use of ^99m Tc-bone scintigraphy combined with panoramic radiography and computed tomography, enabling early diagnosis and surgical treatment.
We studied 13 BROMJ patients with maxillary sinusitis at the Department of Oral and Maxillofacial Surgery,Kyoto University Hospital, from March 2006 through March 2011. We classified the degree of BROMJ inflammation according to the degree of maxillary sinusitis, inflammatory changes of the maxillary bone, and abnormal uptake of ^99m Tc-hydroxymethylene diphosphonate. Among the 13 patients, the range of inflammation was limited to the maxillary sinus floor in 9 patients, who were completely cured by sequestrectomy with hyperbaric oxygenation. In the 4 remaining patients, the range of inflammation uniformly extended to the maxillary sinus. One patient showed improvement after curettage. In the other 3 patients, who were followed up with conservative therapy, there was no apparent change in their symptoms.
Our results suggest that our classification of severity based on image diagnosis and treatment by sequestrectomy for cases in which the inflammation is limited to the maxillary sinus floor are effective for the treatment of BROMJ patients with maxillary sinusitis.