Abstract
The aim of this study was to correlate clinical and computerized tomography (CT) features of bisphosphonate-related osteonecrosis of the jaws (BRONJ). All ONJ patients for whom there was complete CT scan imaging were eligible. Selected clinical parameters retrieved from their medical records were analyzed for correlation with CT parameters. The clinical presentation of BRONJ was supported by findings in CT imaging in 78.3%. The lesion’s size on CT correlated with the presence of purulent secretion (p = 0.03). When sequestrum was present, the median lesion’s size on CT was relatively big (28 mm, range 21–43 mm). The mandibular canal cortex was never breached. CT has reasonable detection competence for diagnosing BRONJ. Purulent secretion indicates the likelihood that a more extensive involvement will be displayed on CT. A large lesion on CT should raise the index of suspicion for sequestrum. The CT appearance of a continuous cortex of the mandibular canal may serve as a differential parameter between BRONJ and metastasis to the jaw.
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References
Ruggiero SL, Mehrotra B, Rosenberg TJ et al (2004) Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases. J Oral Maxillofac Surg 62:527–534
Marx RE (2003) Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg 61:1115–1117
Migliorati CA, Siegel MA, Elting LS (2006) Bisphosphonate-associated osteonecrosis: a long-term complication of bisphosphonate treatment. Lancet Oncol 7:508–514
Bamias A, Kastritis E, Bamia C et al (2005) Osteonecrosis of the jaw in cancer after treatment with bisphosphonates: incidence and risk factors. J Clin Oncol 23:8580–8587
Woo SB, Hellstein JW, Kalmar JR (2006) Narrative [corrected] review: bisphosphonates and osteonecrosis of the jaws. Ann Intern Med 144:753–761
Wutzl A, Eisenmenger G, Hoffmann M et al (2006) Osteonecrosis of the jaws and bisphosphonate treatment in cancer patients. Wien Klin Wochenschr 118:473–478
Sanna G, Zampino MG, Pelosi G et al (2005) Jaw avascular bone necrosis associated with long-term use of biphosphonates. Ann Oncol 16:1207–1208
Wang J, Goodger NM, Pogrel MA (2003) Osteonecrosis of the jaws associated with cancer chemotherapy. J Oral Maxillofac Surg 61:1104–1107
Bianchi SD, Scoletta M, Cassione FB et al (2007) Computerized tomographic findings in bisphosphonate-associated osteonecrosis of the jaw in patients with cancer. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 104:249–258
Migliorati CA, Casiglia J, Epstein J et al (2005) Managing the care of patients with bisphosphonate-associated osteonecrosis: an American Academy of Oral Medicine position paper. J Am Dent Assoc 136:1658–1668
American Association of Oral and Maxillofacial Surgeons (2007) American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws. J Oral Maxillofac Surg 65:369–376
Durie BG, Katz M, Crowley J (2005) Osteonecrosis of the jaw and bisphosphonates. N Engl J Med 353:99–102 discussion 199–102
Hoff AO, Toth BB, Altundag K et al (2008) Frequency and risk factors associated with osteonecrosis of the jaw in cancer patients treated with intravenous bisphosphonates. J Bone Miner Res 23:826–836
American Dental Association (2006) Dental management of patients receiving oral bisphosphonate therapy: expert panel recommendations. J Am Dent Assoc 137:1144–1150
Yarom N, Yahalom R, Shoshani Y et al (2007) Osteonecrosis of the jaw induced by orally administered bisphosphonates: incidence, clinical features, predisposing factors and treatment outcome. Osteoporos Int 18:1363–1370
Mavrokokki T, Cheng A, Stein B et al (2007) Nature and frequency of bisphosphonate-associated osteonecrosis of the jaws in Australia. J Oral Maxillofac Surg 65:415–423
Phal PM, Myall RW, Assael LA et al (2007) Imaging findings of bisphosphonate-associated osteonecrosis of the jaws. AJNR Am J Neuroradiol 28:1139–1145
Bisdas S, Chambron Pinho N, Smolarz A et al (2008) Biphosphonate-induced osteonecrosis of the jaws: CT and MRI spectrum of findings in 32 patients. Clin Radiol 63:71–77
White SC, Pharoah MJ (2004) Oral radiology: principles and interpretation. Mosby, St. Louis
Marx RE, Sawatari Y, Fortin M et al (2005) Bisphosphonate-induced exposed bone (osteonecrosis/osteopetrosis) of the jaws: risk factors, recognition, prevention, and treatment. J Oral Maxillofac Surg 63:1567–1575
Badros A, Weikel D, Salama A et al (2006) Osteonecrosis of the jaw in multiple myeloma patients: clinical features and risk factors. J Clin Oncol 24:945–952
Acknowledgment
The authors thank Ms. Esther Eshkol for editorial assistance. The study was based in part on a OMD thesis of Miss Noa Ben-Ami. Dr. Noam Varom received an honorarium from Bayer Israel Ltd.
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The authors declare that they have no conflict of interest.
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Elad, S., Gomori, M.J., Ben-Ami, N. et al. Bisphosphonate-related osteonecrosis of the jaw: clinical correlations with computerized tomography presentation. Clin Oral Invest 14, 43–50 (2010). https://doi.org/10.1007/s00784-009-0311-3
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DOI: https://doi.org/10.1007/s00784-009-0311-3