PMC8281890_01
Clinical presentation of the MRONJ showing bone exposure in regions 36 to 38 and a fistula and palpable bone in region 46 (white arrow).
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In April 2018, clinically confluent exposed bone of the lower left jaw and a fistula at the right molar region was visible ( Figure 1 ).
Panoramic radiograph showing sclerosis of the left mandible (yellow arrows) surrounding the inferior alveolar canal. No evidence of sclerosis in the right mandible.
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Figure 2 ). For preoperative planning, we performed a 18F-fluorine-PET/CT of the jaw, showing stage 3 after Ruggiero ( Figure 3 ).
Baseline 18F-fluoride PET/CT VRT (Volume Rendering Technique) 3D reconstruction of the jawbone showing substantially increased 18F-fluoride uptake in the regions 38 to 47 of the mandible with a focal gap in region 36.
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Figure 2 ). For preoperative planning, we performed a 18F-fluorine-PET/CT of the jaw, showing stage 3 after Ruggiero ( Figure 3 ).
Baseline and follow-up 18F-fluoride PET/CT examination 45 days after systemic antibiotic therapy. Axial (upper row) and coronal (lower row) CT reveals diffuse medullary sclerosis and a cortical thickening with confluent periosteal reaction (regions 37 to 42) and a focal cortical erosion (yellow arrows). The inferior alveolar canal on the left side is relatively narrowed compared to the right side. PET reveals substantially increased 18F-fluoride uptake in the regions 38 to 47 with a focal gap in region 36, whereas in CT, the regions 43 to 47 were only subtly sclerotic without cortical thickening. In follow-up, no changes in both CT and PET were observed in regions 38 to 42, whereas the bony sclerosis was slightly increased in regions 43 to 47 with a slight reduction of 18F-fluoride uptake. L, left site.
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A follow-up 18F-fluorine PET/CT was performed in September 2018 at clinical stage 1 ( Figure 4 ). The first 18F-fluoride PET/CT in May 2018 showed a substantially increased 18F-fluoride uptake in the regions 38 to 47 of the mandible with a focal gap of 18F-fluoride uptake in region 36 (area of clinically exposed bone) ( Figure 4 ). Whereas no changes in both sclerosis and 18F-fluoride uptake were observed in the regions 38 to 42; the regions 43 to 47 showed a slight reduction of 18F-fluoride uptake and a slightly increasing diffuse medullary sclerosis and periosteal thickening ( Figure 4 ).