Clinical significance of periosteal reaction as a predictive factor for treatment outcome of medication-related osteonecrosis of the jaw

Kojima, Yasuyuki; Kawaoka, Yumi; Sawada, Shunsuke; Hayashida, Shinsaku; Okuyama, Kazuaki; Yutori, Hirokazu; Kawakita, Akiko; Ishida, Shiro; Soutome, Sakiko; Yanamoto, Souichi; Umeda, Masahiro; Iwai, Hiroshi

doi:10.1007/s00774-019-00994-1

Cited by 28 publications

(14 citation statements)

References 13 publications

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“…Suei reported that periosteal reaction of the jawbone was observed by CT examination in 15/25 (60%) cases of MRONJ, 2/36 (6%) cases of radiation osteomyelitis, 39/92 (42.4%) cases of suppurative osteomyelitis, and 29/34 (85%) cases of diffuse sclerosing osteomyelitis; however, the clinical significance of periosteal reaction was not mentioned [36]. We previously reported in a multicenter retrospective study on 164 MRONJ surgeries that periosteal reaction was found during preoperative CT examination in 21.3% of cases, and periosteal reaction is associated with a lower cure rate despite surgical treatment [37]. Furthermore, we classified periosteal reaction in MRONJ into three types: attached, gap, and irregular.…”

Section: Discussionmentioning

confidence: 99%

Factors Exacerbating Clinical Symptoms and CT Findings in Patients with Medication-Related Osteonecrosis of the Jaw Receiving Conservative Therapy: A Multicenter Retrospective Study of 53 Cases

Kojima

Soutome

Otsuru

et al. 2022

IJERPH

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Recent reports have shown that better treatment outcomes are obtained with surgical therapy in patients with medication-related osteonecrosis of the jaw (MRONJ) than with conservative therapy. However, conservative treatment is selected due to factors such as old age and poor general condition. Conservative therapy aims to relieve symptoms and prevent lesion exacerbation; however, the lesion may expand rapidly in some cases. This study investigated the clinical and imaging findings of 53 MRONJ patients undergoing conservative therapy, and the changes in the clinical findings and the lesion enlargement on CT imaging were examined. Improved clinical findings and no worsening of the imaging findings were considered overall comprehensive treatment successes. Among the 53 patients, the clinical symptoms disappeared or improved in 15 patients, whereas they worsened in 6. In contrast, osteolytic lesion enlargement occurred in 17 patients. The comprehensive treatment outcome of conservative therapy was successful in 12 patients and unsuccessful in 41 patients. The periosteal reaction was significantly correlated with poor comprehensive treatment outcomes (p = 0.038). MRONJ lesions may advance, even if they appear to improve clinically while undergoing conservative treatments. Patients, especially those with periosteal reactions, must be closely followed up with CT examinations, regardless of the clinical findings.

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Section: Discussionmentioning

confidence: 99%

Factors Exacerbating Clinical Symptoms and CT Findings in Patients with Medication-Related Osteonecrosis of the Jaw Receiving Conservative Therapy: A Multicenter Retrospective Study of 53 Cases

Kojima

Soutome

Otsuru

et al. 2022

IJERPH

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“…Some issues need to be clarified regarding the maxillary MRONJ. We reported that MRONJ often showed periosteal reactions on CT images and that periosteal reactions were significantly associated with postoperative recurrence [ 48 , 49 , 50 ]. However, in the maxillary cases examined in this study, the presence of periosteal reaction did not affect the prognosis of MRONJ and was not associated with the treatment outcome of maxillary sinusitis.…”

Section: Discussionmentioning

confidence: 99%

Retrospective Analysis of Treatment Outcomes of Maxillary Sinusitis Associated with Medication-Related Osteonecrosis of the Jaw

Otsuru

Hayashida

Morishita

et al. 2022

IJERPH

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Although maxillary sinusitis often occurs in patients with medication-related osteonecrosis of the jaw (MRONJ) of the upper jaw, there have been few reports on the treatment and outcomes for maxillary sinusitis associated with maxillary MRONJ. This study aimed to retrospectively investigate the treatment outcomes of maxillary sinusitis in patients with MRONJ of the upper jaw. There were 34 patients diagnosed with maxillary MRONJ and sinusitis by preoperative computed tomography who underwent surgery in our institution between January 2011 and December 2019. Age, sex, primary disease, stage of MRONJ, class and administration period of an antiresorptive agent, corticosteroid administration, preoperative leukocyte count and serum albumin level, periosteal reaction, sinusitis grade, maxillary sinus surgical procedure, and treatment outcomes of MRONJ and sinusitis were examined. There were 7 male and 27 female patients (average age, 74.7 years). Complete healing of MRONJ was obtained in 29 of 34 patients (85.3%). Maxillary sinusitis resolved or improved in 21 patients (61.8%) but did not change or worsen in 13 patients (38.2%). We found that complete resection of necrotic bone with intraoperative irrigation of the maxillary sinus may provide good treatment outcomes for maxillary sinusitis associated with MRONJ, although our findings were not statistically significant owing to the small number of patients.

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“…Periosteal reaction is a nonspecific radiographic finding that indicates periosteal irritation. To clarify the clinical significance of the periosteal reaction in wound healing, Kojima et al [ 49 ] investigated the relationship between periosteal reaction and treatment outcome of MRONJ. They found the cure rate after surgical treatment decreased in cases with periosteal reaction.…”

Section: Discussionmentioning

confidence: 99%

Investigation of the Effectiveness of Surgical Treatment on Maxillary Medication-Related Osteonecrosis of the Jaw: A Literature Review

Hsu

Hsiao

Chen

et al. 2021

JCM

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Aim: Medication-related osteonecrosis of the jaw (MRONJ) occurs after exposure to medication (antiresorptive or antiangiogenic agents) for bone-related complications. It is more common in the mandible than in the maxilla. The present study investigated maxillary MRONJ in elderly patients through a meta-analysis. Methods: Keywords, including “MRONJ”, “maxilla”, and “surgery”, were entered into databases, including Embase, PubMed/MEDLINE, Cochrane Library, and ProQuest, which were searched systematically. Results: Investigating 77 studies, we found that 18 (2 case reports and 16 case series) papers conformed to the standards. The results revealed a 2.6:1 female-to-male ratio of disease occurrence. The average age of patients was 70.6 ± 5.5 years, and most patients were in the third stage (43.6%). The average time of medication usage was 50.0 ± 20.1 months. The pooled proportion of clinical efficacy of surgery was 86%. Conclusion: To prevent and manage MRONJ, all elderly patients should maintain proper oral hygiene and receive dental examinations regularly. Risk assessment and safety management of MRONJ should be performed by medical teams.

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Clinical significance of periosteal reaction as a predictive factor for treatment outcome of medication-related osteonecrosis of the jaw

Cited by 28 publications

References 13 publications

Factors Exacerbating Clinical Symptoms and CT Findings in Patients with Medication-Related Osteonecrosis of the Jaw Receiving Conservative Therapy: A Multicenter Retrospective Study of 53 Cases

Factors Exacerbating Clinical Symptoms and CT Findings in Patients with Medication-Related Osteonecrosis of the Jaw Receiving Conservative Therapy: A Multicenter Retrospective Study of 53 Cases

Retrospective Analysis of Treatment Outcomes of Maxillary Sinusitis Associated with Medication-Related Osteonecrosis of the Jaw

Investigation of the Effectiveness of Surgical Treatment on Maxillary Medication-Related Osteonecrosis of the Jaw: A Literature Review

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