| Autor: |
Taketomi T; Department of Dental and Oral Surgery, St. Mary's Hospital, Kurume, Fukuoka, Japan.; Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan.; Department of Dental and Oral Surgery, Takagi Hospital, Okawa, Fukuoka, Japan., Fukuda T; Division of Oral Rehabilitation, Department of Periodontology, Faculty of Dental Science, Kyushu University, Fukuoka City, Fukuoka, Japan., Nojiri J; Department of Radiology, Takagi Hospital, Okawa, Fukuoka, Japan.; Department of Radiology, Faculty of Medicine, Saga City, Saga, Japan., Sanui T; Division of Oral Rehabilitation, Department of Periodontology, Faculty of Dental Science, Kyushu University, Fukuoka City, Fukuoka, Japan. |
| Abstrakt: |
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. |
