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A novel intraoperative infection detecting liquid for medication-related osteonecrosis of the jaw
Masahiro Kubo1, Satomi Arimoto2, Kazuki Shigenaga1
1Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
Abstract:
Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication by antiresorptive medications and the treatment of MRONJ remains unclear. The present study developed a novel intraoperative infection-detecting liquid for MRONJ using various widely available and inexpensive dyes to detect infected bone areas. First, we performed a preliminary experiment using five dyes in a rat model of MRONJ. Eighteen female Sprague-Dawley (SD) rats were assigned to six dye groups: undyed, acid red, Brilliant Blue, phloxine, methylene blue, and Rose Bengal. Based on visual inspection and histological findings, Brilliant Blue and phloxine were selected for further evaluation. Next, twenty-eight SD rats were assigned to the control, undyed, Brilliant Blue, and phloxine groups and applied to experimentally induced MRONJ. The stained area was completely removed, and the bone defect was closed with sutures. Eight weeks after surgery, soft-tissue evaluation and histological and microcomputed tomography analyses were performed. The area of oral mucosal swelling was significantly smaller in the phloxine group than in the undyed and Brilliant Blue groups. The osteonecrosis area in the phloxine group was significantly smaller than that in the undyed group. These results suggest that phloxine staining is helpful for intraoperative differentiation of infected bone from normal bone.
Insights
Phloxine dye effectively identifies infected bone during surgery for medication-related osteonecrosis of the jaw (MRONJ). This novel staining method aids in differentiating infected bone, potentially improving MRONJ treatment outcomes.
Area of Science:
- Oral and Maxillofacial Surgery
- Oncology
- Pharmacology
Background:
- Medication-related osteonecrosis of the jaw (MRONJ) is a severe complication of antiresorptive medications.
- Current treatment strategies for MRONJ lack definitive intraoperative guidance for infection detection.
Purpose of the Study:
- To develop and evaluate a novel, inexpensive intraoperative infection-detecting liquid for MRONJ using widely available dyes.
- To assess the efficacy of selected dyes in differentiating infected bone areas during MRONJ surgery.
Main Methods:
- A rat model of MRONJ was used to screen five different dyes (acid red, Brilliant Blue, phloxine, methylene blue, Rose Bengal).
- Phloxine and Brilliant Blue were selected for further study in 28 rats with experimentally induced MRONJ.
- Surgical removal of stained areas, followed by histological and microcomputed tomography analyses after eight weeks.
Main Results:
- Phloxine staining demonstrated significant potential in differentiating infected bone from healthy bone.
- The phloxine group showed a significantly smaller area of oral mucosal swelling compared to undyed and Brilliant Blue groups.
- Osteonecrosis area was significantly reduced in the phloxine group versus the undyed group.
Conclusions:
- Phloxine staining is a promising tool for intraoperative identification of infected bone in MRONJ cases.
- This method can aid surgeons in achieving more precise debridement, potentially improving treatment efficacy for MRONJ.
