| Abstract | Osteonekroza čeljusti odnosi se na odumiranje koštanog dijela čeljusti, a uzrokovana je raznim stanjima. Možemo ju podijeliti na medikamentoznu osteonekrozu čeljusti, osteoradionekrozu, traumatsku, netraumatsku i spontanu osteonekrozu. Medikamentozna osteonekroza uzrokovana je antiresorptivnim ili antiangiogenim lijekovima. Nastanak ovakvog stanja posljedica je uzajamnog djelovanja lijekova, mikrobiološke kontaminacije i lokalne traume. Glavni je klinički pokazatelj kost koja je eksponirana dulje od osam tjedana, ali može doći i do otekline mekih tkiva, ograničene gnojne upale ili fistule. Terapija osteonekroze dijeli se na konzervativnu koja je usmjerena na podizanje kvalitete pacijentova života te na kiruršku kojom
se odstranjuje dio nekrotične kosti. Osteoradionekroza teška je komplikacija zračenja koja se javlja kod pacijenata oboljelih od raka glave i vrata. Definira se kao područje eksponirane kosti koje ne cijeli dulje od tri mjeseca nakon zračenja, a nema znakova primarnog tumora, recidiva ili metastaza. Klinički uz eksponiranu kost mogu se javiti i ulceracije te nekroza kože ili mukoze. Čimbenici rizika za razvoj osteonekroze su: trauma (vađenje zuba), lokalizacija tumora, ukupna doza zračenja, površina ozračene kosti, oralna higijena i drugi. Konzervativno liječenje uključuje oralnu njegu samu ili u kombinaciji s ultrazvukom ili hiperbaričnom oksigenacijom. Kirurško zbrinjavanje uključuje resekciju nekrotične kosti i mekog tkiva s raznim vrstama rekonstrukcije. U manjem broju slučajeva osteonekroza se javlja i zbog drugih stanja, a uzroke možemo podjeliti na traumatske i netraumatske. U traumatske ubrajamo osteonekrozu nastalu uslijed termičkog, mehaničkog ili kemijskog oštećenja, dok u
netraumatsku ubrajamo osteonekrozu nastalu uslijed infekcije (bakterijska, virusna, gljivična, infekcijski osteomijelitis), stečene i kongenitalne bolesti te djelovanja raznih supstanci. Uloga stomatologa u prevenciji razvoja osteonekroze izuzetno je bitna. Pravovremenom sanacijom pacijenata koji su upućeni na zračenje ili prije početka uzimanja antiresorptivne ili antiangiogene terapije moguće je spriječiti razvoj osteonekroze i time značajno poboljšati kvalitetu života ovakvim pacijentima |
| Abstract (english) | Osteonecrosis of the jaw refers to the disruption of the bone tissue of the mandible and it is caused by various conditions. We can categorize it as medication- related osteonecrosis of the jaw, osteoradionecrosis, trauma- induced, nontraumatic and spontaneous osteonecrosis. Medication- related osteonecrosis is caused by antiresorptive or antiangiogenic medication. The simultaneous impact of said medication, microbiological contamination and local trauma can cause the onset of this condition. The main clinical indicator is an exposed bone, which is present for more than 8 weeks, but soft tissue swelling, limited purulent inflammation and fistulae may also occur. Osteonecrosis treatment can be conservative, which is directed at raising the quality of the patient's life or surgical, which refers to the removal of the part of necrotic bone. Osteoradionecrosis is a severe complication of radiation which occurs in patients suffering from head and neck cancer. It is defined as the area of exposed bone which does not heal for more than three months after the radiation treatment and has no signs of primary tumor, relapses or metastasis. Clinically, other than exposed bone, ulcerations and skin necrosis or mucosae may also occur. Developmental risk factors for osteonecrosis are: trauma (tooth extraction), tumor localization, total radiation dose, irradiated bone surface, oral hygiene and others. Conservative treatment includes oral care alone or combined with ultrasound or hyperbaric oxygenation. Surgical treatment includes resection of the necrotic bone and soft tissue with various types of reconstruction. In the minority of cases, osteonecrosis may be caused by other conditions and those cases can be trauma induced or nontraumatic. Trauma induced includes osteonecrosis resulting from thermal, mechanical or chemical damage, while nontraumatic cases include osteonecrosis caused by infections (bacterial, viral, fungal, infectious osteomyelitis), acquired and congenital diseases and the impact of various substances. The dentists' role in osteonecrosis prevention is extremely important. With timely remediation of patients referred for radiation or before exposure to antiresorptive/ antiangiogenic treatment, it's possible to prevent the development of osteonecrosis and thereby
significantly improve the quality of life for such patients. |
