Subramanian Gayathri, Kalyoussef Evelyne, Blitz-Goldstein Meredith, Guerrero Jessenia, Ghesani Nasrin, Quek Samuel Y P
Department of Diagnostic Sciences, Rutgers School of Dental Medicine, Newark, NJ, USA.
Department of Otolaryngology and Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Mar;123(3):e106-e116. doi: 10.1016/j.oooo.2016.11.007. Epub 2016 Nov 28.
Surgical debridement of medication-related osteonecrosis of the jaw (MRONJ) lesions is far less predictable than lesion resection. Margins for surgical debridement are guided by surrogate markers of bone viability, such as bleeding and bone fluorescence, which limit debridement to visibly necrotic bone. In contrast, surgical resection is extensive, including a substantial portion of surrounding bone. The concept that the MRONJ lesion is a composite of affected but viable ("compromised") and necrotic bone is supported by histopathological data. Hence, removing only the necrotic bone during lesion debridement could inadvertently leave behind residual compromised bone in the lesion, subsequently contributing to persistence or reestablishment of the lesion. Using 2 case reports, this manuscript illustrates a novel assessment of the MRONJ lesion to enable demarcation of both the compromised and necrotic portions of the lesion. This assessment uses tumor-surveillance functional bone imaging data that may already be available for cancer patients with MRONJ and fuses these data digitally with computed tomography/cone-beam computed tomography imaging of the jaw obtained during MRONJ assessment. If validated, preoperative functional imaging-based assessment of the MRONJ lesion could enable surgeons to eliminate both the compromised and nonviable portions of the lesion precisely with conservative debridement, matching surgical resection in outcome.
与病变切除术相比，药物相关性颌骨坏死（MRONJ）病变的手术清创术的可预测性要低得多。手术清创的边界由骨活力的替代标志物引导，如出血和骨荧光，这将清创限制在可见的坏死骨范围内。相比之下，手术切除范围更广，包括大部分周围骨组织。组织病理学数据支持MRONJ病变是受影响但仍存活（“受损”）的骨组织与坏死骨组织的复合体这一概念。因此，在病变清创过程中仅去除坏死骨可能会无意中在病变中留下残留的受损骨组织，随后导致病变持续存在或复发。通过2例病例报告，本文阐述了一种对MRONJ病变的新型评估方法，以明确病变中受损和坏死部分的界限。这种评估使用肿瘤监测功能骨成像数据，这些数据可能已适用于患有MRONJ的癌症患者，并将这些数据与在MRONJ评估期间获得的颌骨计算机断层扫描/锥形束计算机断层扫描成像进行数字融合。如果得到验证，基于术前功能成像的MRONJ病变评估可以使外科医生通过保守清创精确地消除病变中受损和无活力的部分，在结果上与手术切除相匹配。
