Fluorescence-guided surgery for the treatment of medication-related osteonecrosis of the jaw: A prospective cohort study.
BACKGROUND
The delineation of the necrotic bone is a crucial step in the surgical treatment of medication-related osteonecrosis of the jaw (MRONJ). Several different approaches have been described including the innovative technique of fluorescence-guided surgery. However, until now there is a lack of data regarding the outcome. Therefore, the aim of the present study is to investigate the long-term success rates of fluorescence-guided surgery in the treatment of MRONJ.


METHODS
54 Patients were prospectively assigned for surgical treatment of medication-related osteonecrosis of the jaw using fluorescence-guided surgery. Patients received doxycycline 100 mg twice a day for at least seven days preoperatively. Surgical treatment of MRONJ included complete removal of necrotic bone, which was monitored using the visual enhanced lesion scope (Velscope), followed by smoothening sharp bony edges and meticulous wound closure. Procedure success was assessed as postoperative maintenance of full mucosal coverage without pain, infection or bone exposure during regular follow-up.


RESULTS
The study included a total of 54 patients (32 female and 22 male, mean age 71.4 ± 9.2 years). In the last follow-up an intact mucosa and absence of exposed bone, pain or signs of infection was identified in 47 of 54 patients (87%) and 56 of 65 lesions (86.2%) after first surgery using fluorescence-guidance. In 4 patients with 6 lesions a second fluorescence-guided surgery was necessary to achieve complete mucosal closure. Respectively, including the case with second surgical attempt 51 of 54 patients (94.4%) and 62 of 65 lesions (95.4%) showed complete mucosal healing.


CONCLUSIONS
The study shows that fluorescence-guided surgery is a safe and successful treatment option which can be considered for all stages of MRONJ. The technique seems also promising for MRONJ cases under denosumab.
Ludwig-Maximilians University of Munich, Department of Oral and Maxillofacial Surgery (Chair: Prof. Dr. Dr. M. Ehrenfeld), Lindwurmstr. 2a, D-80336 Munich, Germany. Electronic address: Sven.Otto@med.uni-muenchen.de.
Sven
S
Otto
University of Heidelberg, Department of Oral and Maxillofacial Surgery, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany.
Oliver
O
Ristow
Ludwig-Maximilians University of Munich, Department of Oral and Maxillofacial Surgery (Chair: Prof. Dr. Dr. M. Ehrenfeld), Lindwurmstr. 2a, D-80336 Munich, Germany.
Christoph
C
Pache
Ludwig-Maximilians University of Munich, Department of Oral and Maxillofacial Surgery (Chair: Prof. Dr. Dr. M. Ehrenfeld), Lindwurmstr. 2a, D-80336 Munich, Germany.
Matthias
M
Troeltzsch
Ludwig-Maximilians University of Munich, Department of Oral and Maxillofacial Surgery (Chair: Prof. Dr. Dr. M. Ehrenfeld), Lindwurmstr. 2a, D-80336 Munich, Germany; University of Alexandria, Department of Oral and Maxillofacial Surgery, Alexandria, Egypt.
Riham
R
Fliefel
Ludwig-Maximilians University of Munich, Department of Oral and Maxillofacial Surgery (Chair: Prof. Dr. Dr. M. Ehrenfeld), Lindwurmstr. 2a, D-80336 Munich, Germany.
Michael
M
Ehrenfeld
Ludwig-Maximilians University of Munich, Department of Oral and Maxillofacial Surgery (Chair: Prof. Dr. Dr. M. Ehrenfeld), Lindwurmstr. 2a, D-80336 Munich, Germany; Medizin & Aesthetik, Clinic for Oral and Maxillofacial and Plastic Surgery, Lenbachplatz 2a, D-80333 Munich, Germany.
Christoph
C
Pautke
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D004164:Diphosphonates / Q000009:adverse effects; D005260:Female; D005453:Fluorescence; D006801:Humans; D008297:Male; D008875:Middle Aged; D061848:Optical Imaging; D019647:Oral Surgical Procedures / Q000379:methods*; D056948:Orthognathic Surgical Procedures; D011446:Prospective Studies
D004164:Diphosphonates
BRONJ; Bisphosphonate; Bone fluorescence; Denosumab; MRONJ; Osteonecrosis