Autofluorescence-guided surgery for the treatment of medication-related osteonecrosis of the jaw (MRONJ): a retrospective single-center study

Otto, Sven; Schnödt, Eva Maria; Haidari, Selgai; T, Brunner; Aljohani, Suad; Mosleh, Mohamed; Ristow, Oliver; Troeltzsch, Matthias; Pautke, Christoph; Ehrenfeld, Michael; Fliefel, Riham

doi:10.1016/j.oooo.2020.10.018

Cited by 27 publications

(21 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Periosteal blood supply is more affected in ORNJ than MRONJ, probably explaining the worse ORNJ treatment outcomes [36]. A recent study reported a complete mucosal healing rate of 81.7% (67 of 82) after uorescence-guided bone removal in MRONJ patients [20]. However, it was only 21% in the present study.…”

Section: Discussioncontrasting

confidence: 64%

“…However, it was only 21% in the present study. From our experience and the results of several studies conducted in our institute, the outcomes of uorescence-guided surgery for ORNJ are worse than that for MRONJ [16,18,20]. This is because ORNJ is a more severe type of bone necrosis that could be associated with hypoxia, hypocellularity, and hypovascularity as direct effects of RT [7].…”

Section: Discussionmentioning

confidence: 93%

“…The technique was prospectively investigated in 15 patients with 20 MRONJ lesions, which revealed an 85% reported healing rate after a 4week follow-up [16]. Several studies also found uorescence-guided bone excision as an effective tool in discriminating between viable and necrotic bone, thereby aiding more preservative yet complete bone removal [17][18][19][20]. Another study validated histopathology the ability of the uorescence-guided surgical technique to differentiate between vital and necrotic bone based on the results of the specimen analysis of uorescent and non-uorescent bone [11].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Fluorescence-guided Surgery of Osteoradionecrosis of the Jaw: A Retrospective Study

Aljohani

T²,

Chronopoulos

et al. 2021

Preprint

Self Cite

View full text Add to dashboard Cite

BackgroundOsteoradionecrosis of the jaw (ORNJ) is one of the most severe head and neck complications in patients treated with radiotherapy (RT), and it is one of the diseases difficult to manage. The goal of the treatment is to achieve mucosal healing or suppress ORNJ progression. Currently, surgical removal of the necrotic bone is an effective management approach for advanced stages of ORNJ. This study aimed to identify the outcomes of fluorescence-guided surgery for ORNJ. MethodsNineteen ORNJ lesions in 15 hospitalized patients received fluorescence-guided surgery. Demographics, comorbidities, local preceding event, location, ORNJ stage, and treatment outcomes were retrospectively reviewed with a median follow-up period of 12 months.ResultsThe first 12 lesions (63%) were operated under tetracycline fluorescence, and 7 lesions (37%) were operated under auto-fluorescence. Overall, 4 lesions (21%) achieved complete mucosal healing, 8 lesions (42%) showed partial mucosal healing with bone exposure and no signs or symptoms of inflammation, and 7 lesions (37%) were progressive. The results showed that either healing or ORNJ stabilization was achieved in 63% of the lesions (n = 12). No significant association was observed between healing and the fluorescence technique.ConclusionFluorescence-guided surgery can be beneficial in curing or stabilizing ORNJ. Within the study limitations, autofluorescence-guided surgery seems to be as effective as tetracycline fluorescence-guided surgery for management of ORNJ. Trial registration: not applicable

show abstract

Section: Discussioncontrasting

confidence: 64%

Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Fluorescence-guided Surgery of Osteoradionecrosis of the Jaw: A Retrospective Study

Aljohani

T²,

Chronopoulos

et al. 2021

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…The surgical experience linked to imaging investigations are used to remove the bone with signs of necrosis. As a support of the practical field, autofluorescence-guided surgery (using the Velscope device) represents a reliable approach which can improve the treatment outcomes by delineating the necrotic bone [ 79 , 80 , 81 ]. Although the use of the Velscope in guiding the necrotic bone resection shows to be helpful, the postoperative results assessed by mucosal healing and quality of life indicate to be similar to conventional surgery [ 82 ].…”

Section: Discussionmentioning

confidence: 99%

Complementarity of Photo-Biomodulation, Surgical Treatment, and Antibiotherapy for Medication-Related Osteonecrosis of the Jaws (MRONJ)

et al. 2021

View full text Add to dashboard Cite

Background and Objectives: Antiresorptive or anti-angiogenic agents may induce medication-related osteonecrosis of the jaws (MRONJ), which represents a challenge for clinicians. The aim of this study is to design and apply a composed and stage-approach therapy combining antibiotherapy, surgical treatment, and photo-biomodulation (PBM) for the prevention or treatment of MRONJ lesions. Materials and Methods: The proposed treatment protocol was carried out in the Department of Oral & Maxillofacial Surgery of the “Victor Babes” University of Medicine and Farmacy of Timisoara, in 2018–2020. A total of 241 patients who were previously exposed to antiresorptive or anti-angiogenic therapy, as well as patients already diagnosed with MRONJ at different stages of the disease were treated. A preventive protocol was applied for patients in an “at risk” stage. Patients in more advanced stages received a complex treatment. Results: The healing proved to be complete, with spontaneous bone coverage in all the n = 84 cases placed in an “at risk” stage. For the n = 49 patients belonging to stage 0, pain reductions and decreases of mucosal inflammations were also obtained in all cases. For the n = 108 patients proposed for surgery (i.e., in stages 1, 2, or 3 of MRONJ), a total healing rate of 91.66% was obtained after the first surgery, while considering the downscaling to stage 1 as a treatment “success”, only one “failure” was reported. This brings the overall “success” rate to 96.68% for a complete healing, and to 99.59% when downscaling to stage 1 is included in the healing rate. Conclusions: Therefore, the clinical outcome of the present study indicates that patients with MRONJ in almost all stages of the disease can benefit from such a proposed association of methods, with superior clinical results compared to classical therapies.

show abstract

“…It is worth mentioning that the use of obturators of MRONJ cases allocated at the upper jaw has been also certified as a promising intervention [ 124 ]. There are also some pioneering experiences performed by a limited group of research groups such as the use of fluorescence-guided surgery or piezoelectric surgery which have shown promising results in terms of complete mucosal healing [ 125 , 126 ]. During surgical debridement, a fluorescence lamp can be used intraoperatively as a guide for delimiting resection margins of necrotic bone.…”

Section: Managementmentioning

confidence: 99%

Medication-Related Osteonecrosis of the Jaw: A Critical Narrative Review

Lorenzo-Pouso

Bagán

et al. 2021

JCM

View full text Add to dashboard Cite

Background: Nearly two decades have passed since a paradoxical reaction in the orofacial region to some bone modifying agents and other drugs was recognized, namely medication-related osteonecrosis of the jaw (MRONJ). Purpose: The aim of this manuscript was to critically review published data on MRONJ to provide an update on key terminology, concepts, and current trends in terms of prevention and diagnosis. In addition, our objective was to examine and evaluate the therapeutic options available for MRONJ. Methods: The authors perused the most relevant literature relating to MRONJ through a search in textbooks and published articles included in several databases for the years 2003–2021. Results and conclusions: A comprehensive update of the current understanding of these matters was elaborated, addressing these topics and identifying relevant gaps of knowledge. This review describes our updated view of the previous thematic blocks, highlights our current clinical directions, and emphasizes controversial aspects and barriers that may lead to extending the accumulating body of evidence related to this severe treatment sequela.

show abstract

Autofluorescence-guided surgery for the treatment of medication-related osteonecrosis of the jaw (MRONJ): a retrospective single-center study

Cited by 27 publications

References 24 publications

Fluorescence-guided Surgery of Osteoradionecrosis of the Jaw: A Retrospective Study

Fluorescence-guided Surgery of Osteoradionecrosis of the Jaw: A Retrospective Study

Complementarity of Photo-Biomodulation, Surgical Treatment, and Antibiotherapy for Medication-Related Osteonecrosis of the Jaws (MRONJ)

Medication-Related Osteonecrosis of the Jaw: A Critical Narrative Review

Contact Info

Product

Resources

About