Indermun Suvarna, Simpson Jessica, Pedro-Beech Kim, Alwan Julandi, van Rensburg Leon Janse
Department of Craniofacial Biology, Pathology and Radiology, Faculty of Dentistry and WHO Collaborating Centre, University of the Western Cape, Cape Town, South Africa.
Department of Maxillofacial and Oral Surgery, Faculty of Dentistry and WHO Collaborating Centre, University of the Western Cape, Cape Town, South Africa.
Radiol Case Rep. 2025 Jul 24;20(10):5107-5115. doi: 10.1016/j.radcr.2025.06.109. eCollection 2025 Oct.
Medication-related osteonecrosis of the jaw (MRONJ) is a rare side-effect of certain drugs, mainly those used in regimens treating specific cancers and in the initial treatment for non-neoplastic conditions. The first cases of jaw osteonecrosis were reported over 2 decades ago in patients taking bisphosphonates (BPs). Since its identification, the nomenclature has changed from bisphosphonate-related osteonecrosis of the jaw (BRONJ) to MRONJ, as other drugs can elicit the same reaction. Invasive dental treatments, such as extractions, are known risk factors. Therefore, the importance of routine dental care before and during such drug therapy cannot be overemphasized. MRONJ is a challenging condition to diagnose early as the radiographic features are subtle and easily overlooked. This case report presents 3 female patients with multiple myeloma, emphasizing the chronological radiologic evolution of MRONJ. Notably, 1 case illustrates a transition from Stage 0 to Stage 2 over a 17-month period, documented through serial panoramic radiographs and a positron emission tomography (PET) scan. Another case highlights the role of cone beam computed tomography (CBCT) in identifying sequestra and pathological fractures. An additional noteworthy case illustrates that conservative dental management avoided the potential development of MRONJ. While histopathology confirmed necrotic bone in 2 cases, early radiologic indicators such as sclerosis and nonhealing sockets provided key diagnostic insights. This case report underscores the importance of regular dental monitoring and interdisciplinary care in at-risk patients and contributes to the growing discourse on the critical role of radiologic evaluation in the early detection and management of MRONJ.
药物相关性颌骨坏死（MRONJ）是某些药物罕见的副作用，主要是用于治疗特定癌症的方案以及非肿瘤性疾病初始治疗中的药物。20多年前，在服用双膦酸盐（BP）的患者中首次报道了颌骨坏死病例。自其被发现以来，命名已从双膦酸盐相关性颌骨坏死（BRONJ）变为MRONJ，因为其他药物也可引发相同反应。侵入性牙科治疗，如拔牙，是已知的危险因素。因此，在这种药物治疗之前和期间进行常规牙科护理的重要性再怎么强调也不为过。MRONJ是一种难以早期诊断的疾病，因为其影像学特征不明显且容易被忽视。本病例报告介绍了3例患有多发性骨髓瘤的女性患者，强调了MRONJ的时间顺序影像学演变。值得注意的是，1例病例通过系列全景X线片和正电子发射断层扫描（PET）显示在17个月内从0期转变为2期。另一例病例突出了锥形束计算机断层扫描（CBCT）在识别死骨和病理性骨折中的作用。另一个值得注意的病例表明，保守的牙科管理避免了MRONJ的潜在发展。虽然组织病理学在2例病例中证实了坏死骨，但早期影像学指标如骨质硬化和拔牙创不愈合提供了关键的诊断线索。本病例报告强调了对高危患者进行定期牙科监测和多学科护理的重要性，并为关于影像学评估在MRONJ早期检测和管理中的关键作用的日益增多的讨论做出了贡献。
