Intraoperative efficiency of fluorescence imaging by Visually Enhanced Lesion Scope (VELscope(®)) in patients with bisphosphonate related osteonecrosis of the jaw (BRONJ)

OBJECTIVES: The purpose of this study was to determine the potential of tissue fluorescence imaging by using Visually Enhanced Lesion Scope (VELscope(®)) for the detection of osteonecrosis of the jaw induced by bisphosphonates (BRONJ).

METHODS: We investigated 20 patients (11 females and 9 males; mean age 74 years, standard deviation ± 6.4 years), over a period of 18 month with the diagnosis of BRONJ in this prospective cohort study. All patients received doxycycline as a fluorescending marker for osseous structures. VELscope(®) has been used intraoperatively using the loss of fluorescence to detect presence of osteonecrosis. Osseous biopsies were taken to confirm definite histopathological diagnosis of BRONJ in each case.

RESULTS: Diagnosis of BRONJ was confirmed for every patient. In all patients except one, VELscope(®) was sufficient to differentiate between healthy and necrotic bone by visual fluorescence retention (VFR) and visual fluorescence loss (VFL). 19 cases out of a total of 20 showed no signs of recurrence of BRONJ during follow-up (mean 12 months, range 4-18 months).

CONCLUSION: VELscope(®) examination is a suitable tool to visualize necrotic areas of the bone in patients with bisphosphonate related osteonecrosis of the jaw. Loss of fluorescence in necrotic bone areas is useful intraoperatively as a tool for fluorescence-guided bone resection with relevant clinical interpretation.