Introduction
Nuclear medicine has currently emerged as one of the leading and beneficial imaging technologies or modern-day studies in the oral and maxillofacial surgery field. Nuclear medicine is not only just used for the diagnosis and staging of different cancers or diseases but is also frequently used in the management strategies and post-surgical follow-up or regular follow-up protocols in cancer patients or patients suffering from systemic inflammatory diseases. Nuclear medicine has now been around for over the last decade. One of the extensive research highlights is that it occupies a special place in the treatment of both tumors arising from benign and malignant origin or benign or non-cancerous and cancerous tumors. It is important to understand that in the field of maxillofacial surgery, the practicing maxillofacial surgeon would need to have sufficient knowledge of nuclear medicine and its current potential, as well as its futuristic scope.
What Are the Applications of Nuclear Medicine in Maxillofacial Surgery and Modern-Day Oral Pathologies?
Let us now explore the important role of nuclear medicine in the diagnosis and management of oral and maxillofacial regional or local pathologies. As known, just like any other field, even nuclear medicine has its fair share of indications and limitations in the daily practice of the operating oral and maxillofacial surgeon.
Nuclear medicine would need to be intrinsically used or applied in oral and maxillofacial surgery at some point because it is one of the essential diagnostic tools in most surgical fields, which are primarily characterized by the injection of all radioactively labeled materials.
These materials injected can identify the presence and location of primary cancers, metastatic cancers, inflammatory diseases underlying immunocompromising systemic conditions, etc.
What Is the Rationale of Radionuclide Imaging and How Does It Help Detect the Extent of Oral or Head and Neck Pathologies?
The rationale at the heart of radionuclide imaging, which is an intrinsic part of nuclear medicine, is that every living organism or creature is sustained by the homeostasis condition, which allows biomolecules to always perpetually balance themselves within a dynamic process. When the homeostatic mechanisms are disrupted, this can lead to a sudden imbalance that is called a disease. This is where radionuclide imaging exerts its rationale that is when the tracers are used with similar chemical structures as of the bioactive molecules that are present in the body; they are eventually induced to study and analyze the molecular situation of the affected organ or even several organ systems as high-grade cancers and secondary metastasizing tumors.
In oral and maxillofacial surgery specifically, the cancer stages and the extent of spread are determined more accurately by the above-enlisted imaging modalities in nuclear medicine than in comparison to other modern-day morphological imaging modalities like CT (computed tomography), magnetic resonance imaging (MRI), ultrasonography, etc.
Because of the biochemical changes that are induced within the different tissues of the pathologic lesion or affected local region by radionuclide imaging, this offers an easy insight or scope into the accurate determination of the lesion upon the injection of radioactively labeled substances.
PET Scans and SPECT/CT Applications:
Single-photon emission computed tomography (SPECT/CT) is one of the other important radionuclide imaging studies used to visualize the three-dimensional patterns or the multiplanar tracer distribution with respect to the local region of interest. The technician can use an integrated CT scanner alongside a CT machine to perform this procedure.
SPECT/CT can help trace the exact anatomical location and pathological metabolism of the lesions or the local tissues affected.
Advanced imaging procedures in nuclear medicine mainly involve positron emission tomography (PET). These can be combined with computed tomography (CT) or with the imaging modality of single-photon emission computerized tomography (SPECT). Sentinel lymph node scintigraphy is another adjunct used along with PET scans.
These nuclear imaging techniques not only show increased sensitivity and precision within the surgical disciplines, but they can accurately indicate the stage or grade of cancer or systemic diseases and the extent of pathologic spread of the lesions involved in the particular organ system.
Applications of Bone Scintigraphy:
Bone scintigraphy is one of the mainline modalities used to detect Paget's disease and fibrous dysplasia accurately. In patients suffering from fibrous dysplasia that require long-term medical intervention as well as monitoring or observation, there can be a need for surgery because of bone deformation, nerve compression, severe pain, and high-grade malignancy transformation. Medical case reports have shown that in patients with a history of radiotherapy, the probability of fibrous dysplasia turning malignant or cancerous is around only one percent, but bone scintigraphy plays an important role here in the early detection and diagnosis of such tumors. Similarly, in Paget's disease of the jaw bone, bone scintigraphy can be used for early detection of lesions that have a rare potential for cancerous transformation. On the other hand, the imaging modality can also effectively trace the extent of the pathologic fracture; any abnormal bone activity, like a sudden or high osteoblastic activity spike, is a characteristic feature of this disease.
In condylar hyperplasia (excessive growth of the jaw's condylar bone region), bone scintigraphy has been used to assess osteoblastic activity morphologically for the management of the condition.
Conclusion
Nuclear medicine, hence, has innumerable applications to its benefits, with researchers studying the future scope, each modality having its fair share of limitations as of now. However, in comparison to conventional X-ray imaging modalities, with the advent of SPECT, bone scintigraphy, PET scans, etc., these hold more sensitivity and higher accuracy in determining the pathologic spread or the extent of the lesions in the local tissues or organ systems. In the field of maxillofacial surgery, the high accuracy of determining pathologic spread or staging and grading of disease, whether it is cancer or an underlying local jaw bone pathology such as Paget's disease or fibrous dysplasia or bone metabolism disorders affecting the jaw, these radionuclide imaging modalities hold great potential. With the growing incidence globally of bone mineralization diseases, cancers, and oral conditions, radionuclide imaging, an intrinsic part of nuclear medicine, can be a boon.
