鼻内視鏡下副鼻腔手術を併施して治療を行った上顎MRONJの1例

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  • Maxillary MRONJ Treated with Sequestrectomy and Endoscopic Sinus Surgery

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Medication-related osteonecrosis of the jaw （MRONJ） arising in the maxilla can cause or exacerbate extant maxillary sinusitis. We describe osteonecrosis with maxillary sinusitis that was treated by sequestrectomy and endoscopic sinus surgery （ESS）.<br>A septuagenarian woman, who was being treated for breast cancer and metastatic bone tumor, had been intravenously administered with zoledronic acid for over one year. She presented with left maxilla pain after tooth extraction elsewhere. The sequestra were completely separated from the maxilla, then sequestrectomy and ESS proceeded. We removed the sequestra from the oral cavity, and confirmed a maxillary sinus-oral cavity fistula. The nasal cavities and maxillary sinus were opened by ESS via the nasal cavity, and defective granulation and morbid mucosa were excised from the maxillary sinus. Removal of the infective source suppressed the maxillary pain and significantly improved the patient’s quality of life compared with her preoperative status.<br>ESS seemed to be helpful to minimize invasion of the jawbone in the case of using resorption suppressant drugs, because the maxillary sinus could be accessed via the nasal cavity.

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