J Korean Soc Radiol.  2010 Jan;62(1):17-21. 10.3348/jksr.2010.62.1.17.

Radiologic Findings of Oral Bisphosphonate-Related Osteonecrosis of the Maxilla, Complicated by Actinomycosis: A Case Report

• Kim YK
• Kim HJ
• Kim E
• Chung SK
• Hong J

• KMID: 2208989
• DOI: http://doi.org/10.3348/jksr.2010.62.1.17

Abstract

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a rare, but serious complication, which has recently been more frequently reported. However, this entity is unfamiliar to radiologists. We report a case of BRONJ complicated by actinomycosis following a tooth extraction in a 68-year-old woman who has been treated with oral bisphosphonate for treatment of osteoporosis over the last 3 years and 3 months.

MeSH Terms

Actinomycosis
Aged
Bisphosphonate-Associated Osteonecrosis of the Jaw
Female
Humans
Jaw Diseases
Maxilla
Osteonecrosis
Osteoporosis
Tooth Extraction

Figure

• 

  Fig. 1 Bisphophonate-related osteonecrosis of the maxilla complicated by actinomycosis in a 66-year-old woman. A. Coronal CT scan with bone algorithm shows irregular destruction of the alveolar bone of the left posterior maxilla. There is a large sequestrum at the area of destroyed left maxillary sinus floor, manifesting as an irregular, laminated, fragmented bone containing the mottled air densities (white arrow). Ipsilateral maxillary and ethmoid sinuses as well as the nasal cavity are opacified by the inflammatory tissues. Note the sclerotic change of the adjacent bones (black arrows). B-D. Axial T1-weighted (B), coronal fat-suppressed T2-weighted (C), and axial contrast-enhanced fat-suppressed T1-weighted (D) MR images nicely show the findings of sequestrum, osteosclerosis, and inflammatory infiltrates to the deep neck spaces. The sequestrum shows diffuse low signal intensity on T1-weighted image, heterogeneous signal intensity on T2-weighted image (white arrows), and no significant enhancement on contrast-enhanced image, and is surrounded by the inflammatory tissue which shows isointensity on T1-weighted image, hyperintensity on T2-weighted image, and intense enhancement on contrast-enhanced image. Osteosclerosis of the adjacent bone is seen as diffuse hypointense signal on T1-weighted image, diffuse hyperintense signal on T2-weighted image, and diffuse moderate enhancement on contrast-enhanced image (asterisks), indicating the associated bone marrow infection (osteomyelitis). There is extensive soft tissue infiltration into the infratemporal fossa as well as the anterior cheek due to the spread of infection, which manifests as isointensity on T1-weighted image, hyperintensity on T2-weighted image, and moderate enhancement on contrast-enhanced image (black arrows).

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