Imaging findings and treatment outcomes of a rare subtype of medication-related osteonecrosis of the jaw
Imaging findings and treatment outcomes of a rare subtype of medication-related osteonecrosis of the jaw
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DOI：
10.1007/s00774-021-01267-6
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发表时间：
2021-09-12
影响因子：
3.3
通讯作者：
Umeda, Masahiro
中科院分区：
文献类型：
--
作者：
Otsuru, Mitsunobu;Soutome, Sakiko;Umeda, Masahiro
在我们以前的研究中，我们发现了一种罕见的药物相关性颌骨骨坏死（MRONJ），即使骨髓中的溶骨性病变是局部的，也会在远离溶骨性病变或拔牙部位的部位出现骨膜反应（PR）（骨膜反应显性型，PRd型）。MRONJ的病因和治疗尚不清楚;因此，本研究旨在描述PRd型的影像学和临床特征。材料与方法本研究纳入了2009年至2020年间在长崎大学医院就诊并接受保守治疗作为初始治疗的MRONJ患者。检查PR部位、影像学表现、初始症状、结局和进展时间。结果59例MRONJ保守治疗患者中，无PR者38例（PR-型），溶骨性附近PR者15例（PR +型），PRd型6例。所有PRd型患者均存在颏下脓肿，计算机断层扫描（CT）图像显示前下颌骨舌侧存在PR。6/6例PRd型（100%）、5/15例PR +型（33.3%）和2/38例PR-型（5.3%）患者的溶骨性病变进展。PRd型患者CT上溶骨性区域的进展时间较短，为56-148天（中位数79天）。结论MRONJ分型中，PRd型预后较差。因此，在未来积累和分析更多的珠三角案例是必要的。这是第一份描述这种特定亚型MRONJ存在的报告。
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.