Department of Dentistry and Oral Surgery, Kansai Medical University Medical Center, 10-15 Fumizono-Cho, Moriguchi, Osaka, 570-8507, Japan.
Department of Dentistry and Oral Surgery and Oral Care, Kansai Medical University Hospital, Hirakata, Osaka, 573-1191, Japan.
Sci Rep. 2023 Aug 9;13(1):12890. doi: 10.1038/s41598-023-39755-6.
Medication-related osteonecrosis of the jaw (MRONJ) is a refractory osteonecrosis caused by antiresorptive agents such as bisphosphonate and denosumab (DMB). In MRONJ surgery, computed tomography (CT) is generally used to determine the extent of bone resection. However, in some recent MRONJ cases, no abnormal findings were detected on CT. Therefore, we aimed to clarify the characteristics of MRONJ without osteolysis. This retrospective and observational study included 18 patients diagnosed with MRONJ between October 2020 and October 2022 at Department of Dentistry and Oral Surgery, Kansai Medical University Medical Center. In four of 18 patients with MRONJ, no abnormal findings such as osteolysis, separation of sequestrum, and periosteal reaction were observed on CT images at the first visit. All four patients with non-osteolytic MRONJ had malignant tumors and received high-dose DMB, and in the four patients there were no preceding dental infections such as apical lesions or periodontal disease and the trigger of MRONJ was unknown. Surgery was performed in three of the four patients. The extent of bone resection was determined using magnetic resonance imaging and intraoperative gross findings. In the future, it is necessary to establish a method for diagnosing non osteolytic MRONJ and determining the extent of bone resection.
药物相关性下颌骨坏死（MRONJ）是一种由抗吸收剂（如双磷酸盐和地舒单抗）引起的难治性骨坏死。在 MRONJ 手术中，通常使用计算机断层扫描（CT）来确定骨切除的范围。然而，在最近的一些 MRONJ 病例中，CT 未检测到异常。因此，我们旨在阐明无骨质溶解的 MRONJ 的特征。本回顾性观察研究纳入了 2020 年 10 月至 2022 年 10 月在关西医科大学医疗中心口腔科诊断为 MRONJ 的 18 例患者。在 18 例 MRONJ 患者中，有 4 例在首次就诊时的 CT 图像上未观察到骨质溶解、死骨分离和骨膜反应等异常表现。这 4 例非溶骨性 MRONJ 患者均患有恶性肿瘤，并接受了高剂量地舒单抗治疗，这 4 例患者均无根尖病变或牙周病等先前的牙科感染，且 MRONJ 的诱因不明。其中 3 例患者接受了手术。骨切除的范围是通过磁共振成像和术中大体观察来确定的。在未来，有必要建立一种诊断非溶骨性 MRONJ 并确定骨切除范围的方法。
