骨吸収抑制薬関連顎骨壊死に対する外科的対応

Current treatments for oral and maxillo-facial diseases. Surgical treatment for anti-resorptive agents-related osteonecrosis of jaw.

　骨吸収抑制薬関連顎骨壊死（anti-resorptive agents-related osteonecrosis of jaw：ARONJ）の治療に関しては見解の統一に至っていない。従来，ARONJ治療の基本方針としては保存療法が優先されてきた。しかし特にステージ２および３の進行例において外科療法の優位性を示す報告が増加している。現時点においてARONJに対する標準治療は確立していない。また抗菌薬療法に関しても十分なevidenceの蓄積は認めない。自験例を供覧し，外科療法および抗菌薬療法の原則的な考え方を考察する。

　The mechanisms of ARONJ（anti-resorptive agents-related osteonecrosis of jaw）are not completely known. Therefore the treatment policy has been controversial between surgical and conservative approach. Recently, surgical treatment, particularly in stage 2 and 3 cases, has been increasingly reported in literature and is considered a success when oral mucosa healing is maintained without bone exposure or infection. The surgical treatment modalities were classified as follows：debridement, sequestrectomy, marginal resection（bone resection without bone defect）, bone reconstruction（free flaps）. The aim of this article is to consider the roll of surgical treatment for ARONJ.