Intraoperative detection of viable bone with fluorescence imaging using Visually Enhanced Lesion Scope in patients with bisphosphonate-related osteonecrosis of the jaw: clinical and pathological evaluation

Yoshiga, Daigo; Sasaguri, Masaaki; Matsuo, Keitaro; Kokuryou, S.; Habu, Manabu; Oda, Masafumi; Kodama, Masaaki; Tsurushima, Hiroki; Sakaguchi, Osamu; Sakurai, Tomonori; Tanaka, Jumpei; Morimoto, Yasuhiro; Yoshioka, Izumi; Tominaga, Kazuhiro

doi:10.1007/s00198-015-3096-z

Cited by 13 publications

(11 citation statements)

References 50 publications

(58 reference statements)

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“…Tetracycline-fluorescence-guided bone surgery represents a solution for this shortcoming [10,[21][22][23]. The use of tetracycline as a fluorochrome has made it possible, under the appropriate excitation light and filter (VELscope Vx system® fluorescence lamp), to improve the definition of the transition between necrotic (no fluorescence) and non-necrotic (green fluorescence) bone during surgical procedures.…”

Section: Discussionmentioning

confidence: 99%

Differences between auto-fluorescence and tetracycline-fluorescence in medication-related osteonecrosis of the jaw—a preclinical proof of concept study in the mini-pig

et al. 2020

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Objectives Fluorescence-guided bone surgery is a well-established technique in the treatment of medication-related osteonecrosis of the jaw. No histopathological evidence for bone auto-fluorescence is currently available, and thus, any differences from tetracycline-fluorescence remain unclear. Therefore, the goals of this study were to find out if macroscopic and histological differences occur between the auto- and tetracycline-fluorescence in the delineation of viable and necrotic jawbone in the mini-pig. Materials and methods According to the proof of concept, osteonecrosis was provoked in eight Göttingen minipigs. Pigs were divided into two groups (AF group: no fluorochrome label; TF group: tetracycline label). Delineation of necrosis and viable bone was evaluated in vivo and in vitro macro−/microscopically, correlated to fluorescence properties and compared between the two study groups. Results No macroscopic and microscopic clinical differences were seen in fluorescence between the AF and TF groups. Macroscopic and microscopic viable bone fluoresced green, whereas necrotic bone showed no or only pale fluorescence in both groups. The auto-fluorescence was attributable to the arrangements and structure of collagen and the cell-filled bone lacunae. Conclusion Neither in vivo nor in vitro macroscopically differences are apparent between the auto-fluorescence and the tetracycline-fluorescence of bone. The auto-fluorescence is attributable to the arrangements and structure of collagen and the cell-filled bone lacunae. Tetracycline-fluorescence is a mixture of tetracycline (at the bone edges with increased bone formation) and large components of auto-fluorescence. Clinical relevance Because auto-fluorescence is easy to apply, reproducible, and does not rely on the subjective impression of the surgeon, it promises to be an important standardized alternative to tetracycline-labeled MRONJ therapy.

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Section: Discussionmentioning

confidence: 99%

Differences between auto-fluorescence and tetracycline-fluorescence in medication-related osteonecrosis of the jaw—a preclinical proof of concept study in the mini-pig

et al. 2020

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“…On the contrary, Pautke et al (2006) reported periods that range from days to "several weeks", whereas Dahners and Bos (2002) recommend extended periods that range from 3 to 6 months in order to avoid faint labeling. Yoshiga et al (2015b) reported a series in which at least 10 d of tetracycline administration seemed enough so as to differentiate between fluorescent and nonfluorescent areas. In our experience, the most glowing tetracycline uptake was achieved in that case in which the antibiotic had been administered for 4 weeks (Table 1).…”

Section: Discussionmentioning

confidence: 99%

Fluorescent tetracycline bone labeling as an intraoperative tool to debride necrotic bone during septic hip revision: a preliminary case series

Muñoz-Mahamud

Fernández-Valencia

Combalía

et al. 2021

J. Bone Joint Infect.

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Abstract. A plausible cause of persistent infection after septic hip revision may be the presence of nonviable osteomyelitic bone. Since surgical excision of these necrotic fragments is often challenging, the use of fluorescent tetracycline bone labeling (FTBL) as an intraoperative tool may pose an additional assessment aid to provide a visual index of surgical debridement. Methods: We present a single-center study performed in a university hospital from January 2018 to June 2020, in which all consecutive cases of chronic hip periprosthetic joint infection (PJI) undergoing revision using FTBL were retrospectively reviewed. In all cases, the patient was under treatment with tetracyclines at the moment of the revision surgery. During the surgery, all bone failing to fluoresce was considered nonviable and thus removed and sent for both culture and histology. Results: We include three cases in which the FTBL technique was used. In all cases, the histopathological examinations of the nonfluorescent removed bone were consistent with chronic osteomyelitis. Conclusion: The intraoperative use of FTBL successfully aided the surgeon to detect the presence of nonviable bone in all the presented cases of chronic prosthetic hip infection.

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“…Their full text was assessed for eligibility, and 23 papers that did not conform to the main criteria were excluded. Finally, surgery was performed in the severe MRONJ in a total of 18 papers that were for the literature review [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ] ( Figure 1 ). The detailed data of elderly patients (age ≥ 60 years) were found in the 9 papers [ 20 , 21 , 22 , 23 , 25 , 26 , 27 , 28 , 29 ].…”

Section: Methodsmentioning

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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Intraoperative detection of viable bone with fluorescence imaging using Visually Enhanced Lesion Scope in patients with bisphosphonate-related osteonecrosis of the jaw: clinical and pathological evaluation

Abstract: The surgical treatments that were exactly performed using MBFT with VELscope® offered successful management of BRONJ. This bone fluorescence helped to define the margins of resection, thus improving surgical therapy for extended osteonecrosis.

Cited by 13 publications

References 50 publications

Differences between auto-fluorescence and tetracycline-fluorescence in medication-related osteonecrosis of the jaw—a preclinical proof of concept study in the mini-pig

Differences between auto-fluorescence and tetracycline-fluorescence in medication-related osteonecrosis of the jaw—a preclinical proof of concept study in the mini-pig

Fluorescent tetracycline bone labeling as an intraoperative tool to debride necrotic bone during septic hip revision: a preliminary case series

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

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