Journal List > J Korean Soc Radiol > v.62(1) > 1086716

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Kim, Kim, Kim, Chung, and Hong: Radiologic Findings of Oral Bisphosphonate-Related Osteonecrosis of the Maxilla, Complicated by Actinomycosis: A Case Report
Head and Neck Radiology
Case Report

Journal of the Korean Society of Radiology 2010; 62(1): 17-21.

Published online: 31 January 2010

DOI: https://doi.org/10.3348/jksr.2010.62.1.17

Radiologic Findings of Oral Bisphosphonate-Related Osteonecrosis of the Maxilla, Complicated by Actinomycosis: A Case Report

Yi Kyung Kim, M.D., Hyung-Jin Kim, M.D., Eunhee Kim, M.D., Seung-Kyu Chung, M.D.2, Jongrak Hong, DDS3

1Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea.

2Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea.

3Department of Oral and Maxillofacial Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea.

Address reprint requests to: Hyung-Jin Kim, M.D., Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul 135-710, Korea. Tel. 82-2-3410-6451, Fax. 82-2-3410-2559, hyungkim@skku.edu

Received 21 June 2009       Accepted 4 August 2009

Copyright © 2010 The Korean Society of Radiology

Abstract

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a rare, but serious complication, which has recently been more frequently reported. However, this entity is unfamiliar to radiologists. We report a case of BRONJ complicated by actinomycosis following a tooth extraction in a 68-year-old woman who has been treated with oral bisphosphonate for treatment of osteoporosis over the last 3 years and 3 months.

Keywords: Bisphosphonate, Osteonecrosis, Jaws, CT, Jaws, MR, Jaw Disease

Figures and Tables

Fig. 1

Bisphophonate-related osteonecrosis of the maxilla complicated by actinomycosis in a 66-year-old woman.

A. Coronal CT scan with bone algorithm shows irregular destruction of the alveolar bone of the left posterior maxilla. There is a large sequestrum at the area of destroyed left maxillary sinus floor, manifesting as an irregular, laminated, fragmented bone containing the mottled air densities (white arrow). Ipsilateral maxillary and ethmoid sinuses as well as the nasal cavity are opacified by the inflammatory tissues. Note the sclerotic change of the adjacent bones (black arrows).
B-D. Axial T1-weighted (B), coronal fat-suppressed T2-weighted (C), and axial contrast-enhanced fat-suppressed T1-weighted (D) MR images nicely show the findings of sequestrum, osteosclerosis, and inflammatory infiltrates to the deep neck spaces. The sequestrum shows diffuse low signal intensity on T1-weighted image, heterogeneous signal intensity on T2-weighted image (white arrows), and no significant enhancement on contrast-enhanced image, and is surrounded by the inflammatory tissue which shows isointensity on T1-weighted image, hyperintensity on T2-weighted image, and intense enhancement on contrast-enhanced image. Osteosclerosis of the adjacent bone is seen as diffuse hypointense signal on T1-weighted image, diffuse hyperintense signal on T2-weighted image, and diffuse moderate enhancement on contrast-enhanced image (asterisks), indicating the associated bone marrow infection (osteomyelitis). There is extensive soft tissue infiltration into the infratemporal fossa as well as the anterior cheek due to the spread of infection, which manifests as isointensity on T1-weighted image, hyperintensity on T2-weighted image, and moderate enhancement on contrast-enhanced image (black arrows).
jksr-62-17-g001

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