PDF(Pubmed)
Abstract：
Medication-Related Osteonecrosis of the Jaw (MRONJ) is a challenging and evolving aspect of Oral and Maxillofacial Surgery. In recent years, several medications apart from those traditionally associated with MRONJ such as bisphosphates (BPs) and Denosumab (DMB) have been implicated in bony necrosis of the jaw. This aim of this report is to demonstrate a significant case of bone necrosis following dental extractions on a patient being treated with infliximab therapy for Crohn\'s disease. Several cases in literature have reported MRONJ associated with infliximab but very few patients have developed as significant a form of the disease as seen in this report. Previous investigators have proposed pathophysiological pathways via which TNF-α inhibitors such as infliximab have a causative mechanism for MRONJ. When osteoclastic activity is restricted via these pathways, bone healing is impaired and MRONJ can occur. However, it remains a diagnostic challenge to differentiate between antiresorptive MRONJ and chronic osteomyelitis with bone necrosis in patients with acquired immunodeficiency. This case aims to illustrate why the antiresorptive effects of TNF-α inhibitors need to be considered as a possible primary driver of bone necrosis in such patients.
摘要：
药物相关的颌骨坏死（MRONJ）是口腔颌面外科的一个具有挑战性和不断发展的方面。近年来,除传统上与MRONJ相关的药物外，还有几种药物，例如双磷酸盐（BPs）和Denosumab（DMB）与颌骨骨坏死有关。本报告的目的是证明接受英夫利昔单抗治疗克罗恩病的患者拔牙后发生骨坏死的重要病例。文献中的几个病例报道了MRONJ与英夫利昔单抗相关，但很少有患者发展为该疾病的重要形式，如本报告所示。以前的研究人员已经提出了病理生理学途径，通过这些途径，TNF-α抑制剂如英夫利昔单抗具有MRONJ的致病机制。当破骨细胞活动通过这些途径受到限制时，骨愈合受损，可发生MRONJ。然而,在获得性免疫缺陷患者中,区分抗再吸收MRONJ和慢性骨髓炎伴骨坏死仍然是一个诊断挑战.该案例旨在说明为什么需要将TNF-α抑制剂的抗再吸收作用视为此类患者中骨坏死的可能主要驱动因素。
