Authors:
K. Surlan Popovic, A. Sirnik, M. Kocar; Ljubljana/SI
DOI:
10.1594/ecr2011/C-0558
Methods and Materials
Eleven patients,
6 men and 5 women,
mean age 52 years (range 41- 76 years) who were treated with bisphosphonates were prospectively examined.
They were reffered to the Department of the Maxillofacial and Oral Surgery with pain on affected side,
nonhealing extraction sockets, purulent discharge and swelling in soft tissue.
The indication for treatment with bisphosphonates was multiple myeloma in 6 patients (55%),
breast cancer bone matastases in 3 patients (27%) and prostate cancer bone metastases in 2 patients (18%).
Nine patients were treated with zolendronic acid and two with zolendronc and pamidronic acid.
The patients had taken bisphosphonate medication for approximately 28 months ( range: 13-36 months).
The trigger factor in 8 patients was a tooth extraction and unknown in 3 patients.
Clinical examination revealed non-healed extraction sockets in the mandibula of 6 patients and in maxilla of 2 patients.
3 patients were present with pain along the mandibular nerve region and swelling of the mouth floor and in four patients palpation revealed exposed bone with irregular bone depositions.
The histology of specimens showed osteonecrosis with Actinomyces infection in all patients.
All patients underwent unenhanced CT and gadolinium-enhanced MRI of the jaw.
CT imaging was performed in a 16-section CT machine (Somatom 16,
Siemens Medical Systems,
Erlangen,
Germany; 45 eff.
mAs,
120 kV).
The CT images were reconstructed with a section thickness of 1 mm (0.6 mm increment) and multiplanar dental reconstructions were generated using commercially available dental dedicated CT software,
respectively.
The MRI images (3T unit; Magnetom Trio,
Siemens Medical Systems) included unenhanced axial TIRM (turbo inversion recovery magnitude),
T1- [repetition time (TR) 467 ms,
echo time (TE) 12 ms],
and T2-weighted imaging (TR 4140 ms,
TE 79 ms),
as well as axial STIR-weighted imaging.
After an injection of contrast medium (gadolinium; Magnevist,
Schering,
Berlin,
Germany; 0.2 mmol/kg),
using a power injector,
fat-saturated axial T1-weighted images (TR 600 ms,
TE 17 ms) were acquired.
Two radiologist reviewed all imaging studies in consensus.
In MRI studies we assessed the signal intensity change of bony structures,
pathological gadolinium enhancement and soft tissue involvement.
CT studies were reviewed for the presence of osteolytic and sclerotic changes of the jaw,
cortical bony destruction,
periostal bone proliferation and involment of inferior alveolar canal.