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Head and Neck
Diagnosis
Mandible-Maxilla
Treatment-Related Lesions
Mandible-Maxilla Osteonecrosis
Mandible-Maxilla Osteonecrosis
Patricia A. Hudgins, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Abbreviations

              • Mandible-maxilla (Md-Mx) osteonecrosis (ON)

            • Synonyms

              • Medication-related osteonecrosis of jaws
              • Bisphosphonate-related osteonecrosis of jaws

            • Definitions

              • Necrosis of mandible or maxilla associated with medication (often bisphosphonate) use
                • Nonhealing exposed bone, after 8 weeks, in patient with no history of prior craniofacial radiation

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • MR Findings

                    • Imaging Recommendations

                      • Nuclear Medicine Findings

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            • Reporting Tips

                                              Selected References

                                              1. Bodem JP et al: Surgical management of bisphosphonate-related osteonecrosis of the jaw stages II and III. Oral Surg Oral Med Oral Pathol Oral Radiol. 121(4):367-72, 2016
                                              2. Kim HJ et al: Bisphosphonate-related osteonecrosis of the jaw in metastatic breast cancer patients: a review of 25 cases. Maxillofac Plast Reconstr Surg. 38(1):6, 2016
                                              3. Kämmerer PW et al: Surgical evaluation of panoramic radiography and cone beam computed tomography for therapy planning of bisphosphonate-related osteonecrosis of the jaws. Oral Surg Oral Med Oral Pathol Oral Radiol. 121(4):419-24, 2016
                                              4. Melville JC et al: A technique for the treatment of oral-antral fistulas resulting from medication-related osteonecrosis of the maxilla: the combined buccal fat pad flap and radical sinusotomy. Oral Surg Oral Med Oral Pathol Oral Radiol. ePub, 2016
                                              5. Rollason V et al: Interventions for treating bisphosphonate-related osteonecrosis of the jaw (BRONJ). Cochrane Database Syst Rev. 2:CD008455, 2016
                                              6. Taguchi A et al: Lack of cooperation between physicians and dentists during osteoporosis treatment may increase fractures and osteonecrosis of the jaw. Curr Med Res Opin. 32(7):1261-8, 2016
                                              7. Krstevska S et al: Osteonecrosis of the Jaw After Bisphosphonates Treatment in Patients with Multiple Myeloma. Med Arch. 69(6):367-70, 2015
                                              8. Bedogni A et al: Oral bisphosphonate-associated osteonecrosis of the jaw after implant surgery: a case report and literature review. J Oral Maxillofac Surg. 68(7):1662-6, 2010
                                              9. Chiu CT et al: Resolution of oral bisphosphonate and steroid-related osteonecrosis of the jaw--a serial case analysis. J Oral Maxillofac Surg. 68(5):1055-63, 2010
                                              10. Filleul O et al: Bisphosphonate-induced osteonecrosis of the jaw: a review of 2,400 patient cases. J Cancer Res Clin Oncol. 136(8):1117-24, 2010
                                              11. Kyrgidis A et al: Dental extractions in patients receiving bisphosphonate therapy. J Oral Maxillofac Surg. 68(7):1704-6; author reply 1706, 2010
                                              12. Lazarovici TS et al: Bisphosphonate-related osteonecrosis of the jaw associated with dental implants. J Oral Maxillofac Surg. 68(4):790-6, 2010
                                              13. Lo JC et al: Prevalence of osteonecrosis of the jaw in patients with oral bisphosphonate exposure. J Oral Maxillofac Surg. 68(2):243-53, 2010
                                              14. Saia G et al: Occurrence of bisphosphonate-related osteonecrosis of the jaw after surgical tooth extraction. J Oral Maxillofac Surg. 68(4):797-804, 2010
                                              15. Setabutr D et al: Necrotizing fasciitis secondary to bisphosphonate-induced osteonecrosis of the jaw. Am J Otolaryngol. 31(2):127-9, 2010
                                              16. Yarom N et al: Is exposure of the jawbone mandatory for establishing the diagnosis of bisphosphonate-related osteonecrosis of the jaw? J Oral Maxillofac Surg. 68(3):705, 2010
                                              17. Arrain Y et al: Bisphosphonates and osteonecrosis of the jaw--current thoughts. Dent Update. 36(7):415-9, 2009
                                              18. Kyrgidis A et al: Bisphosphonate osteonecrosis of the jaws in cancer patients. Breast. 18(5):335, 2009
                                              19. Morag Y et al: Bisphosphonate-related osteonecrosis of the jaw: a pictorial review. Radiographics. 29(7):1971-84, 2009
                                              20. Ruggiero SL et al: American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaw - 2009 update. Aust Endod J. 35(3):119-30, 2009
                                              21. Ryan P et al: Osteonecrosis of the jaw: a rare and devastating side effect of bisphosphonates. Postgrad Med J. 85(1010):674-7, 2009
                                              22. Khosla S et al: Bisphosphonate-associated osteonecrosis of the jaw: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 22(10):1479-91, 2007
                                              23. Mortensen M et al: Osteonecrosis of the jaw associated with bisphosphonate use: Presentation of seven cases and literature review. Laryngoscope. 117(1):30-4, 2007
                                              24. Carneiro E et al: Bisphosphonate-associated mandibular osteonecrosis. AJNR Am J Neuroradiol. 27(5):1096-7, 2006
                                              25. Farrugia MC et al: Osteonecrosis of the mandible or maxilla associated with the use of new generation bisphosphonates. Laryngoscope. 116(1):115-20, 2006
                                              Related Anatomy
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                                              Related Differential Diagnoses
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                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Top Differential Diagnoses

                                                    • Clinical Issues

                                                      • Diagnostic Checklist

                                                        TERMINOLOGY

                                                        • Abbreviations

                                                          • Mandible-maxilla (Md-Mx) osteonecrosis (ON)

                                                        • Synonyms

                                                          • Medication-related osteonecrosis of jaws
                                                          • Bisphosphonate-related osteonecrosis of jaws

                                                        • Definitions

                                                          • Necrosis of mandible or maxilla associated with medication (often bisphosphonate) use
                                                            • Nonhealing exposed bone, after 8 weeks, in patient with no history of prior craniofacial radiation

                                                        IMAGING

                                                        • General Features

                                                          • Radiographic Findings

                                                            • CT Findings

                                                              • MR Findings

                                                                • Imaging Recommendations

                                                                  • Nuclear Medicine Findings

                                                                    DIFFERENTIAL DIAGNOSIS

                                                                      PATHOLOGY

                                                                      • General Features

                                                                        • Gross Pathologic & Surgical Features

                                                                          • Microscopic Features

                                                                            CLINICAL ISSUES

                                                                            • Presentation

                                                                              • Demographics

                                                                                • Natural History & Prognosis

                                                                                  • Treatment

                                                                                    DIAGNOSTIC CHECKLIST

                                                                                    • Consider

                                                                                      • Image Interpretation Pearls

                                                                                        • Reporting Tips

                                                                                          Selected References

                                                                                          1. Bodem JP et al: Surgical management of bisphosphonate-related osteonecrosis of the jaw stages II and III. Oral Surg Oral Med Oral Pathol Oral Radiol. 121(4):367-72, 2016
                                                                                          2. Kim HJ et al: Bisphosphonate-related osteonecrosis of the jaw in metastatic breast cancer patients: a review of 25 cases. Maxillofac Plast Reconstr Surg. 38(1):6, 2016
                                                                                          3. Kämmerer PW et al: Surgical evaluation of panoramic radiography and cone beam computed tomography for therapy planning of bisphosphonate-related osteonecrosis of the jaws. Oral Surg Oral Med Oral Pathol Oral Radiol. 121(4):419-24, 2016
                                                                                          4. Melville JC et al: A technique for the treatment of oral-antral fistulas resulting from medication-related osteonecrosis of the maxilla: the combined buccal fat pad flap and radical sinusotomy. Oral Surg Oral Med Oral Pathol Oral Radiol. ePub, 2016
                                                                                          5. Rollason V et al: Interventions for treating bisphosphonate-related osteonecrosis of the jaw (BRONJ). Cochrane Database Syst Rev. 2:CD008455, 2016
                                                                                          6. Taguchi A et al: Lack of cooperation between physicians and dentists during osteoporosis treatment may increase fractures and osteonecrosis of the jaw. Curr Med Res Opin. 32(7):1261-8, 2016
                                                                                          7. Krstevska S et al: Osteonecrosis of the Jaw After Bisphosphonates Treatment in Patients with Multiple Myeloma. Med Arch. 69(6):367-70, 2015
                                                                                          8. Bedogni A et al: Oral bisphosphonate-associated osteonecrosis of the jaw after implant surgery: a case report and literature review. J Oral Maxillofac Surg. 68(7):1662-6, 2010
                                                                                          9. Chiu CT et al: Resolution of oral bisphosphonate and steroid-related osteonecrosis of the jaw--a serial case analysis. J Oral Maxillofac Surg. 68(5):1055-63, 2010
                                                                                          10. Filleul O et al: Bisphosphonate-induced osteonecrosis of the jaw: a review of 2,400 patient cases. J Cancer Res Clin Oncol. 136(8):1117-24, 2010
                                                                                          11. Kyrgidis A et al: Dental extractions in patients receiving bisphosphonate therapy. J Oral Maxillofac Surg. 68(7):1704-6; author reply 1706, 2010
                                                                                          12. Lazarovici TS et al: Bisphosphonate-related osteonecrosis of the jaw associated with dental implants. J Oral Maxillofac Surg. 68(4):790-6, 2010
                                                                                          13. Lo JC et al: Prevalence of osteonecrosis of the jaw in patients with oral bisphosphonate exposure. J Oral Maxillofac Surg. 68(2):243-53, 2010
                                                                                          14. Saia G et al: Occurrence of bisphosphonate-related osteonecrosis of the jaw after surgical tooth extraction. J Oral Maxillofac Surg. 68(4):797-804, 2010
                                                                                          15. Setabutr D et al: Necrotizing fasciitis secondary to bisphosphonate-induced osteonecrosis of the jaw. Am J Otolaryngol. 31(2):127-9, 2010
                                                                                          16. Yarom N et al: Is exposure of the jawbone mandatory for establishing the diagnosis of bisphosphonate-related osteonecrosis of the jaw? J Oral Maxillofac Surg. 68(3):705, 2010
                                                                                          17. Arrain Y et al: Bisphosphonates and osteonecrosis of the jaw--current thoughts. Dent Update. 36(7):415-9, 2009
                                                                                          18. Kyrgidis A et al: Bisphosphonate osteonecrosis of the jaws in cancer patients. Breast. 18(5):335, 2009
                                                                                          19. Morag Y et al: Bisphosphonate-related osteonecrosis of the jaw: a pictorial review. Radiographics. 29(7):1971-84, 2009
                                                                                          20. Ruggiero SL et al: American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaw - 2009 update. Aust Endod J. 35(3):119-30, 2009
                                                                                          21. Ryan P et al: Osteonecrosis of the jaw: a rare and devastating side effect of bisphosphonates. Postgrad Med J. 85(1010):674-7, 2009
                                                                                          22. Khosla S et al: Bisphosphonate-associated osteonecrosis of the jaw: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 22(10):1479-91, 2007
                                                                                          23. Mortensen M et al: Osteonecrosis of the jaw associated with bisphosphonate use: Presentation of seven cases and literature review. Laryngoscope. 117(1):30-4, 2007
                                                                                          24. Carneiro E et al: Bisphosphonate-associated mandibular osteonecrosis. AJNR Am J Neuroradiol. 27(5):1096-7, 2006
                                                                                          25. Farrugia MC et al: Osteonecrosis of the mandible or maxilla associated with the use of new generation bisphosphonates. Laryngoscope. 116(1):115-20, 2006
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