Imaging Sci Dent.  2019 Dec;49(4):287-294. 10.5624/isd.2019.49.4.287.

Clinical and panoramic radiographic features of osteomyelitis of the jaw: A comparison between antiresorptive medication-related and medication-unrelated conditions

• Shin JW
• Kim JE
• Huh KH
• Yi WJ
• Heo MS
• Lee SS
• Choi SC

• KMID: 2466551
• DOI: http://doi.org/10.5624/isd.2019.49.4.287

Abstract

PURPOSE
This study was performed to analyze the clinical and imaging features of contemporary osteomyelitis (OM) and to investigate differences in these features on panoramic radiography according to patients' history of use of medication affecting bone metabolism.
MATERIALS AND METHODS
The records of 364 patients (241 female and 123 male, average age 66.8±14.9 years) with OM were retrospectively reviewed. Panoramic imaging features were analyzed and compared between patients with medication-related OM (m-OM) and those with conventional, medication-unrelated OM (c-OM).
RESULTS
The age of onset of OM tended to be high, with the largest number of patients experiencing onset in their 70s. The 2 most frequent presumed causes were antiresorptive medication use (44.2%) and odontogenic origin (34.6%). On panoramic radiographs, a mix of osteolysis and sclerosis was the most common lesion pattern observed (68.6%). Sequestrum, extraction socket, and periosteal new bone formation were found in 143 (42.1%), 79 (23.2%), and 24 (7.1%) cases, respectively. The m-OM group exhibited sequestrum and extraction socket more frequently and displayed significantly higher mandibular cortical index values than the c-OM group.
CONCLUSION
We observed some differences in imaging features as shown on panoramic radiography according to the history of antiresorptive medication use. This study may help elucidate the predictive imaging features of medication-related osteonecrosis of the jaw.

Keyword

Osteomyelitis; Osteonecrosis; Radiography, Panoramic

MeSH Terms

Age of Onset
Female
Humans
Jaw*
Male
Metabolism
Osteogenesis
Osteolysis
Osteomyelitis*
Osteonecrosis
Radiography, Panoramic
Retrospective Studies
Sclerosis

Figure

• 

  Fig. 1 The patterns of bone change. A. Osteolytic bone change. An ill-defined area of radiolucency (black arrow) is shown in the left premolar and molar region. B. A mixed lesion exhibiting osteolytic (black arrowheads) and sclerotic (white arrow) bone change. C. Sclerotic bone change. An ill-defined area of diffuse radiopacity (white arrow) indicates the sclerotic change of the bone marrow.

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  Fig. 2 Representative panoramic radiographs demonstrate a sequestrum (A), periosteal new bone formation (B), and an extraction socket (C).

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  Fig. 3 Age distribution. The age of onset for osteomyelitis was most frequently found in the patients' eighth decade. Women tend to predominate in older populations.

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  Fig. 4 Differences between the medication-related (m-OM) and conventional, medication-unrelated (c-OM) groups. A. The mandibular canal index was significantly higher in m-OM patients than in c-OM patients; relatively more patients had an index of C3 in the m-OM group, while more patients had an index of C1 in the c-OM group. The change in the mandibular canal cortex (B) and the extent of the lesion (C) did not differ significantly between the 2 groups.

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