非暴露型药物相关性颌骨坏死的早期识别与鉴别诊断OA

The diagnosis of medication-related osteonecrosis of the jaw(MRONJ)currently lacks a globally unified"gold standard",with discrepancies existing among the consensus statements or guidelines of various academic societies.This diagnostic challenge is particularly pronounced for MRONJ cases without clinically evident bone exposure.According to the 2022 position paper of the American Association of Oral and Maxillofacial Surgeons(AAOMS),the diagnosis of MRONJ includes"intraoral or extraoral fistula that probes to bone"as a clinical manifestation in the absence of overt bone exposure.However,in clinical practice,MRONJ presenting with periapical fistula closely resembles periapical periodontitis,making differentiation difficult.Moreover,some MRONJ cases without bone exposure exhibit concealed drainage pathways located in periodontal pockets or the maxillary sinus,without typical fistula formation,increasing the risk of misdiagnosis or underdiagnosis.To address these issues,this article defines"non-exposed"MRONJ as a subtype of MRONJ characterized by the absence of overt bone exposure but the presence of fistulae that probe to bone or other concealed purulent drainage pathways,with non-specific symptoms and characteristic imaging changes.This article systematically analyzes the diagnostic challenges of this variant,synthesizes key differentiating features from medical history,clinical manifestations,and imaging findings to differentiate from odontogenic infections,and discusses the role of diagnostic treatment.Finally,a clinical pathway is proposed to facilitate the early identification of"non-exposed"MRONJ.It should be emphasized that"non-exposed"MRONJ is distinct from the AAOMS-defined stage 0 disease and does not represent an early phase of MRONJ.Clarifying the concept of"non-exposed"MRONJ may improve the overall diagnostic rate of MRONJ and reduce medicolegal disputes arising from misdiagnosis and inappropriate treatment.