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Cirurgia óssea guiada por fluorescência na osteonecrose dos maxilares relacionada com medicamentos
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Advisor(s)
Abstract(s)
Objetivos: Comparar a taxa de cura e recidiva da cirurgia guiada por fluorescência com a cirurgia convencional, na Osteonecrose dos Maxilares Relacionada com Medicamentos (MRONJ), assim como identificar potenciais vantagens, desvantagens e limitações de ambas as técnicas cirúrgicas.
Materiais e Métodos: Foram incluídos doentes com MRONJ tratados no Serviço de Estomatologia do Centro Hospitalar Universitário Lisboa Norte (Hospital de Santa Maria e Hospital Pulido Valente) entre Janeiro de 2018 a Junho de 2022. A cirurgia guiada por fluorescência foi realizada com recurso ao dispositivo VELscope®. Todas as intervenções cirúrgicas foram realizadas pelo mesmo cirurgião, minimizando a
variabilidade do tratamento. Os dados foram recolhidos a partir do processo clínico informático do Centro Hospitalar Universitário Lisboa Norte e registados em base de dados em Microsoft Excel®. A análise estatística foi realizada com recurso ao software IBM SPSS versão 23. Foram utilizados os seguintes testes estatísticos: Mann-Whitney U; teste Exato de Fisher e Qui-quadrado + Gamma. A significância estatística foi definida como r < 0.05.
Resultados: A amostra incluiu 41 doentes com MRONJ, dos quais 28 do sexo feminino e 13 do sexo masculino, com um total de 47 lesões. A idade média foi de 72,07 ± 1,45 anos. Um total de 8 doentes encontravam-se no estadio 1, 28 no estadio 2 e 5 pacientes no estadio 3. A taxa de cura global do estudo, por doente, foi de 85,4%. A taxa de cura, da cirurgia Guiada por Fluorescência (VELScope®), foi superior à cirurgia convencional (90,5% vs. 80%) (r = 0,410). A taxa de cura por lesão, foi igualmente superior na cirurgia
com VELscope® (92,3% vs. 80,9%). A taxa de recidiva, por lesão, foi superior com o VELscope® (23,1% vs. 15,4%).
Conclusão: A cirurgia óssea guiada por fluorescência parece estar associada a uma taxa de cura mais elevada da MRONJ, em comparação com a técnica cirúrgica convencional.
A amostra reduzida, a ausência de resultados estatisticamente significativos e desenho retrospetivo não aleatorizado constituem limitações do estudo. São necessários estudos adicionais para confirmar os resultados apresentados.
Objectives: Compare the cure and recurrence rate between fluorescence-guided surgery and conventional surgery in Medication-Related Osteonecrosis of the Jaw (MRONJ), as well as to identify potential advantages, disadvantages, and limitations of both surgical techniques. Materials and Methods: Patients with MRONJ treated at the Department of Stomatology in Centro Hospitalar Universitário Lisboa Norte (Hospital de Santa Maria e Hospital Pulido Valente) between January 2018 and June 2022. Fluorescence-guided surgery was performed using the VELscope® device. All surgical interventions were performed by the same surgeon, minimizing treatment variability. The data was collected by the computerized clinical record in a Microsoft Excel® database. Statistical analysis was performed using IBM SPSS software version 23. The statistical tests used were the following: Mann-Whitney U; Fisher’s Exact test and Qui-quadrado + Gamma. Statistical significance was defined as r < 0.05. Results: The sample included 41 patients with MRONJ, of which 28 were female and 13 were male, with a total of 47 lesions. The mean age was 72,07 ± 1,45 years. A total of 8 patients were stage 1, 28 in stage 2 and 5 patients’ stage 3. The overall cure rate of the study, per patient, was 85,4%. The cure rate, per patient, of Fluorescence-Guided surgerywas higher than conventional surgery (90,5% vs. 80%) (r = 0,410). The cure rate per lesion was also higher in surgery with VELscope® (92,3% vs. 80,9%). The recurrence rate, per lesion, was higher with the VELscope® (23,1% vs. 15,4%). Conclusion: Fluorescence-Guided bone surgery seems to be associated with a higher MRONJ healing rate compared to the conventional surgical technique. The small sample size, the lack of statistically significant results and the non-randomized retrospective design are limitations of the study. Further studies are needed to confirm the presented results.
Objectives: Compare the cure and recurrence rate between fluorescence-guided surgery and conventional surgery in Medication-Related Osteonecrosis of the Jaw (MRONJ), as well as to identify potential advantages, disadvantages, and limitations of both surgical techniques. Materials and Methods: Patients with MRONJ treated at the Department of Stomatology in Centro Hospitalar Universitário Lisboa Norte (Hospital de Santa Maria e Hospital Pulido Valente) between January 2018 and June 2022. Fluorescence-guided surgery was performed using the VELscope® device. All surgical interventions were performed by the same surgeon, minimizing treatment variability. The data was collected by the computerized clinical record in a Microsoft Excel® database. Statistical analysis was performed using IBM SPSS software version 23. The statistical tests used were the following: Mann-Whitney U; Fisher’s Exact test and Qui-quadrado + Gamma. Statistical significance was defined as r < 0.05. Results: The sample included 41 patients with MRONJ, of which 28 were female and 13 were male, with a total of 47 lesions. The mean age was 72,07 ± 1,45 years. A total of 8 patients were stage 1, 28 in stage 2 and 5 patients’ stage 3. The overall cure rate of the study, per patient, was 85,4%. The cure rate, per patient, of Fluorescence-Guided surgerywas higher than conventional surgery (90,5% vs. 80%) (r = 0,410). The cure rate per lesion was also higher in surgery with VELscope® (92,3% vs. 80,9%). The recurrence rate, per lesion, was higher with the VELscope® (23,1% vs. 15,4%). Conclusion: Fluorescence-Guided bone surgery seems to be associated with a higher MRONJ healing rate compared to the conventional surgical technique. The small sample size, the lack of statistically significant results and the non-randomized retrospective design are limitations of the study. Further studies are needed to confirm the presented results.
Description
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Keywords
Osteonecrose MRONJ Cirurgia VELscope®