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Imaging findings and treatment outcomes of a rare subtype of medication-related osteonecrosis of the jaw

Abstract

Introduction

In our previous study, we found a rare type of medication-related osteonecrosis of the jaw (MRONJ), which shows periosteal reaction (PR) at a site distant from osteolytic lesions or the extraction site (periosteal reaction dominant type, PRd type), even though the osteolytic lesions in the bone marrow are localized. The causes and treatment of MRONJ remain unclear; hence, this study aimed to describe the imaging and clinical features of the PRd type.

Materials and methods

MRONJ patients who visited Nagasaki University Hospital between 2009 and 2020 and received conservative therapy as initial treatment were included in this study. The PR site, imaging findings, initial symptoms, outcome, and time to progression were examined.

Results

Among 59 MRONJ patients treated with conservative therapy, 38 did not show PR (PR− type), 15 showed PR near the osteolytic region (PR + type), and 6 had the PRd type. All patients with the PRd type had submental abscesses, and computed tomography (CT) images demonstrated PR on the lingual side of the anterior mandible. Osteolytic lesions progressed in 6/6 PRd type (100%), 5/15 PR + type (33.3%), and 2/38 PR− type (5.3%) patients. Time to progression for the osteolytic region on CT was short for the PRd type, at 56–148 days (median 79 days).

Conclusion

Among the MRONJ types, the PRd type has a poor prognosis. Therefore, accumulating and analyzing more PRd cases in the future is warranted. This is the first report to describe the presence of this specific subtype of MRONJ.

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Availability of data and material

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Affiliations

Authors

Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by SH, SY, MS, YT, MS, and MU. The first draft of the manuscript was written by MO and SS, and all authors commented on the previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Mitsunobu Otsuru.

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Conflict of interest

The authors declared that they have no conflict of interest.

Ethical approval

This study was approved by the Institutional Review Board (#21021509) of Nagasaki University Hospital. Because this was a retrospective study; hence, the research plan was published on the homepage of the participating hospitals according to the instructions of the IRB in accordance with the guaranteed opt-out opportunity.

Informed consent

This was a retrospective study; hence, the research plan was published in the homepage of the participating hospitals according to the instructions of the IRB in accordance with the guaranteed opt-out opportunity.

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Otsuru, M., Soutome, S., Hayashida, S. et al. Imaging findings and treatment outcomes of a rare subtype of medication-related osteonecrosis of the jaw. J Bone Miner Metab (2021). https://doi.org/10.1007/s00774-021-01267-6

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Keywords

  • Periosteal reaction
  • Osteonecrosis
  • Outcome
  • Osteolytic
  • Prognosis