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ISSN : 0376-4672
비스포스포네이트와 연관된 악골괴사(bisphosphonate related osteonecrosis of jaw, 이하 BRONJ)는 2003년 경 보고되기 시작하였고, 비스포스포네이트를 장기간 경구 혹은 주사로 투여받은 환자에서 국내외에서도 많은 연구가 진행되고 있으며 증례가 증가하고 있는 추세이다. 발생을 예측하기 힘들고 일단 발생하고 나면 치료에 어려움이 있어 의사와 치과의사의 많은 관심이 필요한 질환이다. 많은 관련단체들이 예방과 진단, 그리고 치료법에 대한 지침을 내놓고 있는 가운데, 우리나라에서도 2009년도에 대한내분비학회, 대한골대사학회, 대한골다공증학회 및 대한구강악안면외과학회가 공동으로 비스포스포네이트 관련 악골(턱뼈)괴사에 대한 공동 지침(position statement)을 내놓은 바 있다. 하지만, 지침서에서는 다양한 증례에서의 고려사항을 자세히 설명할 수 없고, 일반적으로 지켜야할 확립된 사항을 제시하고 있어 실제의 치료과정에서는 치료와 관련된 의학적 근거에 대한 다양한 고려가 있어야 할 것으로 생각된다.
BRONJ(Bisphosphonate Related Osteonecrosis of Jaws) is not easy to be managed because it responds less predictably to established surgical treatment algorithms for osteomyelitis or osteoradionecrosis. The guidelines recommend that any kind of surgery should be delayed if possible. In the latest stage-dependent recommendations of the AAOMS in 2009, a conservative regime with antibiotics, antibacterial mouthe rinses and pain control in stages 0 to II. Some investigators have described the benefits of early osteotomy with primary wound closure. However, there are only a few publications with a standardized surgical concepts. In this reviews, various aspects of diagnosis and management of BRONJ will be discussed.
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