Staging of Bisphosphonate-Related Osteonecrosis of the Jaws Inpatients with Malignant Tumors according multislice Computed Tomography

Abstract

Aim of the study: the development of a classification of bisphosphonate - related osteonecrosis of the jaw (BRONJ) based on the analysis of multispiral computed tomography (MSCT), carried out during the treatment of patients with BRONJ. Materials and methods. Retrospective analysis of the results of 200 patients with bisphosphonate osteonecrosis of the jaw MSCT, which were treated at the Department of oral and maxillofacial, reconstructive and plastic surgery in the period from 2009 to 2015. All patients received therapy with bisphosphonates in the context of metastatic bone lesions, the development of osteonecrosis in the majority of cases were preceded by tooth extraction, trauma by prosthesis or the presence of chronic foci of infection. The patients underwent conservative treatment with a view to stimulating the formation of a sequestrum with a local application of UV-ozone therapy, operative therapy (sequestrectomy) performed in the presence of a sequestrum. MSCT was performed 1 time per 6 months, to determine the dynamics of treatment. Results. A new classification of BRONJ: the initial stage of a pathological increase in bone density, stage 1 - destructive lesion, stage 2 - formation of sequestration, stage 3 - progression of sequestration, stage 4 - reparation. Conclusion. The proposed classification is based on staging of the disease in the dynamics of its course. The proposed classification allows to assess a lesion of bisphosphonate osteonecrosis of the jaws in dynamics, as a basis for selection of appropriate treatment - conservative or surgical (definition of sequestrectomy).