Rev. Soc. Esp. Dolor. 2021; 28(4): 211-218 / DOI: 10.20986/resed.2021.3837/2020
Alejandra Giselle Juárez, Arlen Colín, Daniel Juárez
ABSTRACT
Introduction: The word osteonecrosis (ONC) means “dead bone”; it is a bone disease secondary to the loss of blood supply to the bone, causing its collapse and subsequent death. It can occur in any bone in the body, including those of the maxillofacial region, it is more common in the jaw. In recent years, the relationship of ONC with drugs such as bisphosphonates, antiresorptive, steroids for prolonged use, angiogenesis inhibitor agents, among others, has been found. However, despite the studies carried out by various authors, ONC continues to be an underdiagnosed entity with variable management and treatment, which is why the interest of this research arises with the main objective of reporting the cases of patients diagnosed with Pharmacological ONC.
Material and method: A descriptive, retrospective, cross-sectional, observational study was carried out for approximately 6 years (January 1, 2013 - December 31, 2019), in the Maxillofacial Surgery service of the Specialty Hospital, of National Medical Center, “Siglo XXI”, IMSS. Making a review of clinical records, collecting clinical and image controls, reporting the number of cases and the management of patients with ONC, as well as the number of cases of ONC that were related to drugs. Of 9 patients with a diagnosis of osteonecrosis (ONC), only 4 patients were Pharmacological ONC, from the Maxillofacial Surgery service.
Results: From a universe of 9 patients with ONC, 4 representative cases of patients with pharmacological ONC were presented, with management based on the protocol used in the Maxillofacial Surgery service of the National Medical Center “Siglo XXI”, IMSS; Likewise, the signs and symptoms with which the treatment was staged and determined are shown. The pharmacological treatment associated with ONC was: in 3 patients bisphosphonates (zoledronic acid) and only one patient with Denosumab. The most frequently affected site was the mandible and only one case was bimaxillary (maxilla and mandible). The treatment used as stipulated according to the case, in two ways: conservative and surgical, in both cases a 0.12 % chlorhexidine-based mouthwash was added, and only in case of the presence of infection amoxicillin-based antibiotic with clavulanic acid was given.
Discussion: The present study was carried out only in the Maxillofacial Surgery service of the National Medical Center, “Siglo XXI”, IMSS. The stages were differentiated according to the AAOMS, SICMF, and SIPMO, clinically imaging. The importance of carrying out a study exclusively of the Maxillofacial Surgery service will allow providing more specific information on the area to later study ONC jointly and in a multidisciplinary way, to later carry out more extensive reports of pharmacological osteonecrosis and/or bisphosphonates, in addition to later elaborating multicenter studies.
RESUMEN
Introducción: La palabra osteonecrosis (ONC) significa “hueso muerto”. Es una patología ósea secundaria a la pérdida de suministro de sangre al hueso, provocando su colapso y su posterior muerte. Puede presentarse en cualquier hueso del cuerpo, incluyendo los de la región maxilofacial; es más frecuente en la mandíbula. En los últimos años se ha encontrado la relación de la ONC con medicamentos tales como bifosfonatos, antirresortivos, esteroides por uso prolongado, agentes inhibidores de angiogénesis, entre otros. Sin embargo, pese a los estudios realizados por diversos autores, la ONC continúa siendo una entidad subdiagnosticada y con manejo y tratamiento variable; es por ello que surge el interés de esta investigación con el principal objetivo de reportar los casos de pacientes diagnosticados con ONC farmacológica.
Material y método: Se realizó un estudio descriptivo, retrospectivo, transversal, observacional, durante aproximadamente 6 años (1 de enero de 2013- 31 de diciembre de 2019), en el servicio de Cirugía Maxilofacial del Hospital de Especialidades, del Centro Médico Nacional, Siglo XXI, IMSS. Haciendo una revisión de expedientes clínicos, recabando controles clínicos y de imagen, reportando el número de casos y el manejo de pacientes con ONC, así como el número de casos de ONC que estuvieron relacionados a fármacos. Se obtuvo una muestra de 9 pacientes con diagnóstico de osteonecrosis (ONC) en el Servicio de Cirugía Maxilofacial.
Resultados: No se encontró predominio por algún género en específico, la edad promedio fue de 63,44 años, aproximadamente el 50 % de la muestra obtenida fueron pacientes diagnosticados con ONC farmacológica, de los cuales solo uno estuvo asociado a denosumab y 3 fueron ONC relacionada con bifosfonatos. El tratamiento empleado se estipuló acorde el caso, por dos formas: conservadora y quirúrgica; en ambos casos se agregó colutorio a base de clorhexidina al 0,12 % y solo en caso de presencia de infección se dio antibiótico a base de amoxicilina con ácido clavulánico.
Discusión: El presente estudio se realizó únicamente en el servicio de Cirugía Maxilofacial, del Centro Médico Nacional, Siglo XXI, IMSS. Se clasificaron los estadios conforme a la AAOMS, SICMF and SIPMO, clínico-imagenológicamente. La importancia de realizar un estudio exclusivamente del Servicio de Cirugía Maxilofacial brindará información más específica del área para posteriormente abordar de manera conjunta y multidisciplinariamente la ONC y poder realizar reportes más amplios de la osteonecrosis farmacológica y/o en relación a bifosfonatos, además de dar pie a realizar posteriormente estudios multicéntricos. Es por ello que en este trabajo se partió de lo específico para posteriormente ampliar el campo de estudio.
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