CT Imaging Features of Antiresorptive agent-Related Osteonecrosis of the Jaw/ Medication-Related Osteonecrosis of the Jaws

Baba, Akira; Goto, Tazuko K.; Ojiri, Hiroya; Takagiwa, Mutsumi; Hiraga, Chiho; Okamura, Mitsu; Hasegawa, Sho; Okuyama, Yumi; Ogino, Nobuhiro; Yamauchi, Hideomi; Kobashi, Yuko; Yamazoe, Sadaaki; Munetomo, Yohei; Mogami, Takuji; Nomura, Takeshi

doi:10.1259/dmfr.20170323

Cited by 51 publications

(59 citation statements)

References 35 publications

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“…MRONJ of the maxilla adjacent to the maxillary sinus is known to occur mucoperiosteal thickening and fistula formation. Similar to those studies, the patients of upper MRONJ in this study showed maxillary sinusitis on the same side (16) . When MRONJ contact the mandibular canal, previous studies have shown that it needed attention as it can cause symptoms such as inferior alveolar nerve palsy (19) .…”

Section: Subjectssupporting

confidence: 90%

Characteristic Image Findings of Medication-related Osteonecrosis of the Jaw Using Computed Tomography

Okada

Hirahara

2020

Int J Oral-Med Sci

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Bisphosphonates, have been used in clinical place for about 30 years (1). Marx was the first to report osteonecrosis of the jaw due to administration of BPs in 2003. Since then, many studies have showed that bisphosphonaterelated osteonecrosis of the jaw (BRONJ) is a side effect of BP therapy (2, 3). Recently, many studies have showed that long interval use of bisphosphonates and other antiresorptive medications may cause osteonecrosis of the jaws (medicinerelated osteonecrosis of the jaws［MRONJ］) (4, 5). MRONJ has been determined as a complication associated with antiangiogenic medications and antiresorptive medications by american association of oral and maxillofacial surgeons (AAOMS) (6). And, MRONJ is defined by present or past treatment with antiresorptive or antiangiogenic agents, exposed bone or bone that can be probed through an extraoral or intraoral fistula in the maxillofacial region that has persisted for longer than 8 weeks, and no history of radiation therapy to the jaws or obvious metastatic disease to the jaws (6, 7). The incidence of MRONJ reported in past literature is 0.8% to 18.5% (8). Also, the mandible was the site most frequently influenced by MRONJ (9). Therefore, many previous studies worldwide have been reported about MRONJ (10, 11) .

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Section: Subjectssupporting

confidence: 90%

Characteristic Image Findings of Medication-related Osteonecrosis of the Jaw Using Computed Tomography

Okada

Hirahara

2020

Int J Oral-Med Sci

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“…To date, there is no evidence‐based surgical approach for BRONJ, due to the difficulty in distinguishing the boundaries of affected bones accurately in surgery. Although the preoperative imaging methods could be used to locate the affected region, the multifactorial pathogenesis and the non‐specific radiologic characteristics of BRONJ, especially in the earliest stages, may prevent from a successful surgical management (Baba et al, ; Migliorati, Brennan, & Peterson, ). Some researchers used to utilize tetracycline and its derivatives to guide surgical debridement of BRONJ (Ristow et al, ).…”

Section: Resultsmentioning

confidence: 99%

The feasibility of locating the affected bone of BRONJ with indocyanine green

et al. 2020

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The morbidity of bisphosphonate‐related osteonecrosis of the jaw (BRONJ) is also increasing with the use of bisphosphonates (BPs). Removing affected bone accurately is the most effective treatment. This study aimed to explore the feasibility of Indocyanine green (ICG)‐based Near‐Infrared fluorescence (NIF) imaging to remove BRONJ affected bone. Firstly, the rat model of BRONJ was constructed. And 5 mg/kg ICG were injected via tail vein, after 12 hr, the affected and healthy bone were dissected for ICG‐based NIF imaging and quantification detection of fluorescence intensity. Finally, all the bone samples were sent for further pathological examination. All the affected bone tissues in rat BRONJ model were fluorescence developed with ICG. And the fluorescence developed regions were further confirmed as affected bone tissues with pathological examination. The fluorescence intensity in affected bone tissues, adjacent, and opposite bone tissues was 1.93*107 ± 2.08*106, 1.19*106 ± 2.33*105, and 1.24*106 ± 1.57*105, respectively (p < .05). Conclusions It was feasible that the extent of affected bone in rat model with BRONJ could be estimated intraoperative via ICG‐based NIF imaging. This novel approach would become an auxiliary method in the treatment of patients with BRONJ in the future.

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“…Same as with femur situation, jawbones also imaging on 74 Japanese patients who su ered from ARONJ/ MRONJ showed that most lesions of ONJ were both lytic and sclerotic. Meanwhile, observative results of the same study revealed that the size of the sequestra were mostly small with some of them exhibited periosteal reaction, while cortical bone perforation was more commonly seen in buccolingual or buccal cortical bone other than lingual cortical bone [39]. Cone beam computed tomography (CBCT) analysis has also shown the lesions in MRONJ with thicker cortical bone and more sclerotic bone marrow [40,41].…”

Section: Trabecular Microarchitecturementioning

confidence: 91%

Skeletal Site-Specific Response of Jawbones and Long Bones to Surgical Interventions in Rats Treated with Zoledronic Acid

Wang

Huo

et al. 2019

BioMed Research International

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Bisphosphonates (BPs) have been extensively used for management of bone diseases with pathologically high resorption. Despite the great clinical benefits, a severe complication known as medication-related osteonecrosis of the jaw (MRONJ) has been reported. It is found that most of the reported MRONJ cases were limited in the jawbones/craniofacial bones instead of long bones. The present study aims to investigate the differential bone response to surgical procedures between jawbones and long bones exposed to BPs. Forty-eight skeletal mature Sprague Dawley female rats were administered oncologic dose of zoledronic acid (ZA) or normal saline for 4 weeks and then subjected to tooth extraction on the mandible and maxilla, and a bone defect creation on the femur. After surgical procedures, ZA or saline treatment were continued until sacrifice at week 2, week 4, and week 8, post-operatively. The samples were subjected to micro-computerized tomography (micro-CT) and histological assessment. Osteonecrosis was only found in jawbones in ZA-treated rats. ZA-treated rats showed significantly higher bone mineral density with greater bone volume in all surgical sites than that in the controls. The length of exposure of ZA did not seem to affect trabecular microstructure, and it only showed higher bone volume and BMD with longer healing time which is expected in the healing process.

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CT Imaging Features of Antiresorptive agent-Related Osteonecrosis of the Jaw/ Medication-Related Osteonecrosis of the Jaws

Abstract: ARONJ/MRONJ has characteristic CT image findings which could be useful for its assessment.

Cited by 51 publications

References 35 publications

Characteristic Image Findings of Medication-related Osteonecrosis of the Jaw Using Computed Tomography

Characteristic Image Findings of Medication-related Osteonecrosis of the Jaw Using Computed Tomography

The feasibility of locating the affected bone of BRONJ with indocyanine green

Skeletal Site-Specific Response of Jawbones and Long Bones to Surgical Interventions in Rats Treated with Zoledronic Acid

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