Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_892_Библиотеки_им_академика_М_И_Перельмана

combination of imaging modalities such as panoramic lms, cone beam computer­ized tomography (CBCT), medical-grade computerized tomography (CT), and magnetic resonance imaging (MRI) to assess the extent of disease prior to surgery. Moreover, intraoperative assessment of bone margin quality is also performed, with resection to apparent healthy bleeding bone, in correlation with preoperative radio­graphic ndings to maximize the chances of obtaining a clear surgical margin. Despite these efforts, occasionally resection margins appear inadequate on postop­erative histopathological examination, imposing a risk of persistent and/or recurrent disease, and possible treatment failure, sometimes within 3–6months [54, 55]. As such, it is always prudent to err on the side of caution, and if an area adjacent to obvious MRONJ-aficted bone is questionable, surgeons should consider extending the resection to those regions, to decrease the risk of unresected disease. A linear margin of at least 1cm beyond visible involved bone on imaging should be planned to achieve good, negative margins [56]. As with ORN, the concept of tetracycline bone labeling has also been investigated in patients with MRONJ, to help delineate necrotic versus viable bone. Pautke etal. [57] reported their experience in a pilot study using uorescence-guided resection, with administration of tetracycline for about 10days prior to surgery. Intraoperatively, resection is performed until a clean, uniform green uorescent margin is seen at the level of the residual bone margin (Fig.12.20), and with this technique, they showed about an 85% success rate [58].