Clinical Management of Suppurative Osteomyelitis, Bisphosphonate-Related Osteonecrosis, and Osteoradionecrosis: Report of Three Cases and Review of the Literature

Abstract

In the past, osteomyelitis was frequent and characterized by a prolonged course, treatment response uncertainty, and occasional disfigurement. Today, the disease is less common; it is believed that the decline in prevalence may be attributed to increased availability of antibiotics and improvement of overall health patterns. Currently, more common osteomyelitis variants are seen, namely, osteoradionecrosis (ORN) and bisphosphonate-related osteonecrosis of the jaws (BRONJ). Osteomyelitis, ORN, and BRONJ can present with similar symptoms, signs, and radiographic findings. However, each condition is a separate entity, with different treatment approaches. Thus, accurate diagnosis is essential for adequate management and improved patient prognosis. The aim of this paper is to report three cases of inflammatory lesions of the jaws—osteomyelitis, ORN, and BRONJ—and to discuss their etiology, clinical aspects, radiographic findings, histopathological features, treatment options, and preventive measures.

Medication-related osteonecrosis of the jaw, osteoradionecrosis, and osteomyelitis: A comparative histopathological study

“…This study aimed to evaluate the histopathological aspects of OMJ, ORNJ, and MRONJ considering close similarities among them and, consequently, to make clinicians aware of the importance of understanding the etiopathogenesis and clinical manifestations of each disease. Few studies with the same objectives were found in a recent review of the literature; 1,3,10,11 but more information was needed in order to clarify histological differences between the diseases. It is important to emphasize that the pathologies chosen in the present study had already been diagnosed based upon the patients' clinical information given by the clinicians.…”

“…Among them, particular attention is given to osteomyelitis (OMJ), osteoradionecrosis (ORNJ), and medication-related osteonecrosis of the jaw (MRONJ). 1,2,3 However, it is important to emphasize Declaration of Interests: The authors certify that they have no commercial or associative interest that represents a conflict of interest in connection with the manuscript. that these are quite distinct clinical pathologies with different etiologies.…”

“…7 There are few pathological studies comparing OMJ, MRONJ, and ORNJ in the literature. 1,2,3,9 Therefore, the present study aimed to compare the histopathological features of these bone diseases in order to detect some common or prevalent aspects.…”

Bilateral osteoradionecrosis of the jaw – A rare case report

“…As per protocol, all the indicated teeth should be extracted 21 days before initiation of radiation therapy and patients should be instructed on meticulous oral hygiene and fluoride should be applied to the dentition daily via custom molded trays and should undergo weekly check-up during RT and monthly follow-ups for the first 6 months and then following early post-treatment patient should visit their dentists for every 4 months. [33] Osteoradionecrosis is a disease that requires excessive consideration and a multidisciplinary association, which involves the patient, general dentists, specialist in maxillofacial surgery and specialist in oncology and RT.…”

Osteoradionecrosis of the mandible: A case report

“…Other trauma, mechanical injuries, poor dental status etc. can induce the necrosis as well [1][2][3][4][5][6][7][8][9][10] . Sometimes, in less than 10%, ORN occurs spontaneously 11 .…”