Case Reports : A Case of Intravenous Pamidronate-Related Osteonecrosis of the Jaw in a Patient with Waldenstrom`s Macroglobulinemia

Abstract

비스포스포네이트로 인한 악골괴사는 심각한 비스포스포네이트의 부작용으로 구강 내 상처 치유의 지연, 구강 점막의 손실, 상악 또는 하악골의 노출 및 괴사로 지속적으로 통증과 종창, 화농성 분비물이 나타나는 질환이다. 저자 등은 비스포스포네이트 정맥 제제로 치료한 56세 남자 악성 종양 환자에게서 반복적인 소파술에도 발치 부위가 낫지 않고 악골 괴사의 소견을 보여 BRONJ로 진단한 경험을 문헌 고찰과 함께 보고하는 바이다.

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a rare, but serious, side effect of bisphosphonate therapy that produces significant morbidity in affected patients. It is characterized by poor wound healing and spontaneous intra-oral soft tissue breakdown, which lead to exposure of necrotic maxillary and mandibular bone. We report a case of BRONJ in 56-year-old man who visited Ajou University Hospital Dental Clinic in March 2007. He had been diagnosed with Waldenstrom`s macroglobulinemia in 2005 and had been treated with chemotherapeutic agents, along with concomitant pamidronate injections (45 mg monthly). The patient had clinical features of bisphosphonate-related osteonecrosis of the mandible precipitated by tooth extraction. The patient had multiple systemic risk factors, including extended duration of intravenous pamidronate therapy, chemotherapy, and glucocorticoid therapy for his malignancy. In the 6 months prior to presentation, curettage and debridement were performed repeatedly, but there was no improvement in the mandibular lesion. The patient was referred to the Endocrinology Clinic and was diagnosed with BRONJ. We discontinued pamidronate and started conservative care. BRONJ should be considered in the differential diagnosis when patients complain of poor oral wound healing or have recurrent exposure of necrotic maxillary and mandibular bone.