PDF(Pubmed)
Abstract：
BACKGROUND Bisphosphonates and anti-receptor activator of nuclear factor kappa B antibodies are used to treat bone diseases associated with increased osteoclast activity, including myeloma. However, they can cause osteonecrosis of the jaw, known as medication-related osteonecrosis of the jaw. This report presents a case of a patient with a history of myeloma who required posterior maxilla resection for bisphosphonate-related osteonecrosis of the jaw, in which preoperative embolization prevented unexpected bleeding related to vascular injury and allowed for a safe procedure with minimal bleeding. CASE REPORT An 84-year-old man presented to our department with a 3-year history of purulent drainage and bone exposure in the right maxilla. Based on the clinical findings at the initial visit, the clinical diagnosis was bisphosphonate-related osteonecrosis of the jaw, and the patient underwent a partial right maxillary osteotomy. This surgery was associated with a risk of unexpected bleeding from a branch of the maxillary artery during the posterior maxilla resection. A catheter-based embolization of the maxillary artery was performed the day before performing a partial maxillectomy to avoid unexpected bleeding risk. Thus, no abnormal bleeding occurred during partial maxillectomy, and no postoperative complications occurred for 3 years. CONCLUSIONS In the surgical treatment of medication-related osteonecrosis of the jaw, preoperative vascular embolization of the peripheral maxillary artery beyond the middle meningeal artery bifurcation is a valuable technique for safe maxillectomy involving the posterior maxilla.
摘要：
背景技术双膦酸盐和核因子κB的抗受体激活剂抗体用于治疗与破骨细胞活性增加相关的骨疾病。包括骨髓瘤.然而,它们会导致颌骨坏死，被称为药物相关的颌骨坏死。本报告介绍了一例有骨髓瘤病史的患者，该患者需要上颌骨后路切除双膦酸盐相关的颌骨坏死，术前栓塞可预防与血管损伤相关的意外出血，并允许安全手术，出血最少。病例报告一名84岁的男子到我们部门就诊，有3年的脓性引流和右上颌骨骨暴露史。根据初次就诊时的临床发现，临床诊断为双膦酸盐相关性颌骨坏死，患者接受了部分右上颌截骨术。该手术与上颌后切除术期间上颌动脉分支意外出血的风险相关。在进行上颌部分切除术的前一天进行了基于导管的上颌动脉栓塞术，以避免意外的出血风险。因此，在上颌部分切除术中没有发生异常出血，术后3年无并发症发生。结论在药物相关性颌骨坏死的手术治疗中，术前上颌外周动脉超过脑膜中动脉分叉处的血管栓塞是一种安全的上颌骨切除术的有价值的技术。
