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Published on: February 24, 2023
Tetracycline bone fluorescence: a valuable marker for osteonecrosis characterization and therapy
Christoph Pautke1, Florian Bauer, Oliver Bissinger
1Department of Oral and Maxillofacial Surgery, University of Munich, Munich, Germany. christoph.pautke@gmx.net
Summary
Tetracycline bone fluorescence aids in distinguishing osteoradionecrosis from bisphosphonate-related osteonecrosis of the jaw. This method helps define resection margins for improved surgical outcomes in jaw osteonecrosis.
Area of Science:
- Oral and Maxillofacial Surgery
- Oncology
- Pharmacology
Background:
- Differential diagnosis of osteoradionecrosis (ORN) and bisphosphonate-related osteonecrosis of the jaw (BRONJ) often relies on patient history.
- Histopathological differentiation between ORN and BRONJ is challenging.
- There is a need for improved diagnostic tools to characterize jaw osteonecrosis.
Observation:
- Two patients with extensive lower jaw osteonecrosis underwent partial mandibulectomy.
- Preoperative doxycycline administration was followed by intraoperative monitoring of bone fluorescence.
- Tetracycline fluorescence was used to guide surgical resection boundaries.
Findings:
- Bone fluorescence correlated with specific histopathologic features of ORN and BRONJ.
- ORN showed fluorescence in cortical bone, while BRONJ exhibited fluorescence in cancellous bone.
- Fluorescence guidance accurately identified osteonecrosis margins for resection, though bone bleeding did not correlate with fluorescence.
Implications:
- Tetracycline bone fluorescence offers a histopathologically relevant method for characterizing ORN and BRONJ.
- This technique enhances the precision of surgical therapy for extensive jaw osteonecrosis.
- Fluorescence aids in determining resection margins, potentially improving surgical outcomes.
