乳癌骨転移に対するビスフォスフォネート療法に関連して発症した下顎骨壊死に対し顎下腺移動術を施行した1例

抄録

Nitrogen-containing bisphosphonates are frequently administered to patients who have breast cancer with bone metastases.
However, osteonecrosis or osteomyelitis of the jaws caused by bone exposure in the oral cavity has been recently reported as a complication of this therapy.
We report a case of osteonecrosis of the mandible associated with nitrogen-containing bisphosphonate therapy for multiple bone metastases from breast cancer.
A 69-year-old woman was given a diagnosis of breast cancer with metastatic disease affecting the lungs, brain, adrenal gland, and bone in 2003. She was referred to our clinic in October 2004 with a fistula that developed after extraction of the lower left second molar and paresthesia of the left side of the lower lip. Biopsy of the mandibular lesion was performed, and the histopathological diagnosis was osteonecrosis of the mandible. Although conservative therapy with antibiotics and antibacterial irrigation was administered, the lesion grew. We therefore performed sequestrectomy and rotation of the pedicled submandibular gland in December 2005.
The postoperative course was uneventful during a follow-up period of 11 months.
Because there is a risk of the further development of bone circulatory disturbances and osteonecrosis after surgical treatment, the treatment of choice for osteonecrosis or osteomyelitis of the jaws associated with bisphosphonate administration is conservative therapy with antibiotics and antibacterial irrigation of the lesion. When surgical treatment is required, oral surgeons should closely discuss bisphosphonate therapy with oncologists, including withdrawal and dose reductions