Hemato-Onkoloji Hastalarýnda Çenelerin Ýlaç ile Ýliþkili Osteonekrozunun (MRONJ) Konik Iþýnlý Bilgisayarlý Tomografi ile Deðerlendirilmesi: Olgu Serisi

Genel olarak antirezorptif ve antianjiyojenik ilaç kullanan hastalarda, çene kemiklerinde dental bir operasyona sekonder geliþebilen osteonekroz (Medication-Related Osteonecrosis of the Jaw, MRONJ) klinik ve radyolojik bulgularý olan, nadir ancak ciddi bir tablodur. Bu olgu serisinin amacý, MRONJ teþhisi almýþ hastalarýn demografik özellikler ve medikal anamnez bilgileri ile birlikte konik ýþýnlý bilgisayarlý tomografi (KIBT) bulgularýnýn sunulmasýdýr. Yaþ ortalamasý 62,7 olan 23 MRONJ hastasýnýn %52,2’si kadýn %47,8’i erkekti. Hastalarýn %4,3’ü denosumab kullanýrken %95,7’si bifosfonat kullanmaktaydý. Multiple myelom, prostat ve meme kanseri en sýk primer hastalýklardý (%21,7). Vakalarýn %65,2’sinde sadece mandibulada, %21,7’sinde sadece maksillada ve %8,7’sinde her iki çenede de MRONJ mevcuttu. Mandibulada sadece posteriorda gözlenen MRONJ, maksilladaki 7 olgunun 2’sinde anteriorda gözlendi. KIBT görüntülerin tümünde tespit edilen destrüksiyon, sekestrum ve osteolizis MRONJ için patognomik radyolojik bulgulardý. Mandibuladaki olgularýn %55,6’sýnda mandibular kanal, maksilladaki olgularýn ise %57,1’inde maksiller sinüs tutulumu vardý. Patolojik fraktür sadece mandibulada ve hastalarýn %26,1’inde tespit edildi. Sonuç olarak, MRONJ, genelde kanser hastalarýnda, diþ çekimi gibi travmatik cerrahi bir operasyona sekonder ve mandibular lokasyonlu, radyolojik olarak ise destrüksiyon, sekestrum ve osteolizis ile gözlenmektedir.

Evaluation of Medication-Associated Osteonecrosis of the Jaws (MRONJ) with Cone-Beam Computed Tomography in Hemato-Oncology Patients: Case Series

Osteonecrosis, which may develop secondary to a dental operation in the jaw bones in patients using antiresorptive and antiangiogenic drugs, (Medication-Related Osteonecrosis of the Jaw, MRONJ) is a rare but serious condition with clinical and radiological findings. The purpose of this case series is to present the cone beam computed tomography (CBCT) findings together with demographic characteristics and medical history information of patients diagnosed with MRONJ. 52.2% were female and 47.8% were male of 23 MRONJ patients with a mean age of 62.7 years. While 4.3% of the patients were using denosumab, 95.7% were using bisphosphonates. Multiple myeloma, prostate and breast cancer were the most common primary diseases (21.7%). MRONJ was present only in the mandible in 65.2% of the cases, in the maxilla only in 21.7%, and in both jaws in 8.7%. MRONJ, which was observed only posteriorly in the mandible, was observed anteriorly in 2 of 7 cases in the maxilla. Destruction, sequestrum, and osteolysis detected on all CBCT images were pathognomonic radiological findings for MRONJ. There was mandibular canal involvement in 55.6% of cases in the mandible, and maxillary sinus involvement in 57.1% of cases in the maxilla. Pathological fracture was detected only in the mandible and in 26.1% of the patients. In conclusion, MRONJ is generally observed in cancer patients with mandibular location secondary to a traumatic surgical operation such as tooth extraction, and radiologically with destruction, sequestrum and osteolysis.