International Journal of Oral and Maxillofacial Surgery
Research PaperClinical PathologySuppurative osteomyelitis, bisphosphonate induced osteonecrosis, osteoradionecrosis: a blinded histopathologic comparison and its implications for the mechanism of each disease
Section snippets
Materials and methods
Debrided or resected block bone specimens were obtained from 23 cases of SOJ, 37 cases of BIONJ, and 45 cases of ORNJ from 1 January 2005 to 30 December 2010. Materials were exempt from institutional review board approval as names and medical record were redacted from the study materials. Criteria for the diagnosis of SOJ were an absence of radiotherapy and bisphosphonate use; an identified source of infection; and the presence of pus, or radiographic evidence of osteolysis. Criteria for the
Suppurative osteomyelitis
All 23 cases (100%) of SOJ identified necrotic bone as evidenced by empty osteocytic lacunae, absence of osteoblastic rimming, and empty Haversian canals. All 23 cases (100%) identified inflammatory cells in the marrow space judged to be heavy 13/23 (57%), moderate 7/23 (30%), and slight 3/23 (13%). The inflammatory cells were a mixture of neutrophils, plasma cells, some histiocytes, and lymphocytes with no pattern or predominance consistently noted (Fig. 1). Osteoclasts were noted to be
Discussion
The common finding amongst the SOJ, BIONJ, and ORNJ specimens was necrotic bone with empty Haversian systems and Volkmann canals. All three evidenced an absence of normal cells in the marrow space. SOJ consistently showed viable inflammatory cells in the marrow spaces consistent with the term osteomyelitis which literally translates into inflammation of the marrow in bone. By contrast, BIONJ showed empty marrow spaces devoid of all cellular elements and normal cellular products. ORNJ showed
Funding
This study was supported by internal University of Miami Division of Oral and Maxillofacial Surgery funds.
Competing interests
The authors have no conflict of interest related to pharmaceutical companies or radiation therapy units involved in this study.
Ethical approval
Not required.
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