Jaw osteonecrosis in patients treated with bisphosphonates: MDCT evaluation.
OBJECTIVE
This study was done to evaluate the use of multidetector computed tomography (MDCT) in the evaluation of jaw osteonecrosis, a recently described medical entity in patients receiving long-term intravenous or oral bisphosphonates, and to help radiologists recognise it to enable early diagnosis and appropriate management.


METHODS
Thirty-eight patients with a history of neoplasm (breast, prostate, multiple myeloma, pancreas) or osteoporosis and bisphosphonate use and recent oral surgery who presented with pain in the mouth and temporomandibular joints, soft tissue infections, altered taste and numbness were examined with MDCT.


RESULTS
In all patients, MDCT revealed the presence of structural bony alterations referable to osteonecrosis associated with orosinusal fistula in four of them and bony intraoral spicules in 25.


CONCLUSIONS
Jaw osteonecrosis is an established medical entity discovered in patients who have undergone treatment with bisphosphonates and dental extraction or other oral surgery. MDCT with multiplanar (MPR), volume rendering (VR) and three-dimensional (3D) reconstructions allows accurate assessment of affected bone structures, enabling early diagnosis and suitable treatment planning. Radiologists should be aware of the risk of osteonecrosis in patients treated with bisphosphonates and be able to distinguish it from other bone diseases (osteomyelitis and osteoradionecrosis) with which it enters the differential diagnosis.
Milillo
P
P
Azienda Ospedaliera-Universitaria O.O.R.R. di Foggia, Radiodiagnostica Universitaria, Viale L. Pinto 1, I-71100 Foggia, Italy. paomi03@libero.it
Garribba
A P
AP
Favia
G
G
Ettorre
G C
GC
D000970:Antineoplastic Agents / Q000009:adverse effects*; D004164:Diphosphonates / Q000009:adverse effects*; D006801:Humans; D007571:Jaw Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging*; D010020:Osteonecrosis / Q000139:chemically induced* / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed
D000970:Antineoplastic Agents; D004164:Diphosphonates