Incidence of osteoradionecrosis of the jaws: a retrospective study of 620 patients with head and neck cancer

This study aimed to assess systemic and local risk factors for the development of osteoradionecrosis (ORN) of the jaws and its incidence in patients with head and neck cancer undergoing radiotherapy (RT). This was a retrospective cohort study of 620 adults following irradiation for head and neck cancer in 2011 or 2012. Among 181 patients who did not require any tooth extractions, the incidence of ORN was 0.5%. Among 266 patients with a total of 1491 tooth extractions (mean, 5.5 teeth per patient) performed before RT, the incidence of ORN was 3.7%. In all cases, ORN was observed in extraction sites located in the field of radiation. No extractions were performed during RT. Fifteen patients underwent extractions both before and after RT. Of the 53 tooth extractions performed after RT (20 patients; mean, 2.7 teeth per patient), 15 were in the field of radiation. No case of ORN was reported in that group. Among 168 edentulous patients, the incidence of ORN was 1.8%. Within the limitations of this study, the results suggest that the incidence of ORN can be minimized with a meticulous pre-RT dental examination, a comprehensive treatment plan, and diligent post-RT follow-up examinations conducted by an experienced multidisciplinary team.

Therapeutic effect of fluvastatin on medication-related osteonecrosis of the jaw

BACKGROUND

Refractory jaw osteonecrosis that occurs in osteoporotic or cancer patients treated with bisphosphonates is called medication-related osteonecrosis of the jaw but its underlying mechanism is unclear. Statins, therapeutic agents for dyslipidemia, lower blood low-density lipoprotein cholesterol. Fluvastatin promotes the healing of tooth extraction sockets and reduces the risk of developing medication-related osteonecrosis of the jaw-like lesions. We used a rat model to investigate whether injecting fluvastatin at extraction sites promoted the healing of medication-related osteonecrosis of the jaw-like lesions.

METHODS

Upper first molars of rats administered zoledronate and dexamethasone for 2 weeks were extracted. Two weeks after tooth extraction, rats with medication-related osteonecrosis of the jaw-like lesions (bone exposure) were included in this study. A single injection of fluvastatin was administered in the vicinity of the medication-related osteonecrosis of the jaw-like onset site in rats.

RESULTS

The distance between the edges of the epithelia, the length of the necrotic bone exposed toward the oral cavity, the area of the necrotic bone, and the necrotic bone ratio were significantly smaller in the fluvastatin-administered group compared with the saline group. A single application of fluvastatin near the site of medication-related osteonecrosis of the jaw onset showed a tendency to close the epithelium, reduce necrotic bone, and form new bone, even when symptoms had already developed.

CONCLUSION

This study suggests that a single topical administration of fluvastatin may be a novel treatment for medication-related osteonecrosis of the jaw.

Central giant cell granuloma of the maxilla: Long-term follow-up of a patient treated with an adjuvant corticosteroid

BACKGROUND

Central giant cell granuloma (CGCG) is one of the most intriguing lesions of the jaws and its nature has not yet been fully elucidated. Clinically, some CGCG behave more aggressively, while others have an indolent course. In cases of aggressive CGCG of the maxilla, effective personalized therapies are worth understanding.

CASE REPORT

We report here a challenging case of aggressive CGCG in a 15-year-old girl which was misdiagnosed as an endodontic lesion. Radiographically, a large osteolytic lesion involving the hard palate from the central incisor to the second premolar, extending into the nasal cavity, with loss of the lamina dura and cortical resorption was observed. The lesion expanded aggressively after extensive curettage. With possible mutilation and defects due to a more radical approach to the lesion, treatment with systemic prednisone and intralesional triamcinolone hexacetonide associated with a calcitonin nasal spray was instituted. The decision in favor of this therapeutic strategy was made after careful immunohistochemical analysis of calcitonin and glucocorticoid receptors. The H-score for the staining of glucocorticoid and calcitonin receptors in multinucleated giant cells was 222 and 153.6, respectively. The lesion reduced in size, and no adverse effects associated with medications were observed. Another curettage was performed, and only fibrous connective tissue was found. The patient is in follow-up for 11 years without evidence of recurrence.

CONCLUSION

Pharmacological agents hold clinical promise in cases of aggressive CGCG affecting the maxilla of pediatric patients. Investigating the expression of calcitonin and glucocorticoid receptors in order to plan treatment is very helpful in the decision to manage aggressive CGCG.

Giant Cell Granulomas of Jaws: a Clinicopathologic Study

Objectives

The purpose of present study was to investigate and correlate the histological findings in central giant cell granuloma and peripheral giant cell granuloma of jaws with clinical and radiographic interpretations of the lesion.

Material and Methods

In present study, data from 14 cases of central giant cell granuloma (CGCG) and 9 cases of peripheral giant cell granuloma (PGCG) were analysed, focusing on demographic, clinical and radiographic features. For each patient, microscopic slides were assessed in terms of histologic features of giant cells i.e. number of giant cells, mean number of nuclei/giant cell, pattern of distribution, size and relative size index of giant cells, percentage fractional surface area (FSA) occupied by giant cells and stromal characteristics. Data collected was subjected to statistical analysis. Fisher-exact test, Pearson's correlation coefficient, one-way ANOVA test and Student's t-test were used for analysis.

Results

No significant difference was found between PGCG and CGCG in relation to all the traits that were evaluated. It was observed that mean number of giant cells and mean FSA was more in aggressive CGCG as compared to non-aggressive CGCG.

Conclusions

Further studies on large sample size are required to confirm the relationship between histomorphometric features of giant cells and behaviour of giant cell granulomas of jaws.

Efficacy of Core Needle Biopsy Technique for Jawbone Diseases

Core needle biopsy (CNB) has been proven useful for diagnosing bone lesions, although it is not often used for jawbone lesions. The aim of this study was to evaluate the efficacy of the CNB method in a series of cases of intramaxillary lesions. CNB was performed on 85 patients with intraosseous lesions which were grouped according to radiographic appearance as: radiopaque lesions (RO, n=13), radiolucent lesions (RL, n=39) and mixed lesions with both radiolucent and radiopaque areas (RL-RO, n=33). The technique enabled us to obtain several tissue cylinders from each lesion (average 2.5 cylinders), which were processed following routine histopathological technique and H&E stain, plus special techniques when necessary. The histopathological analysis together with clinical data enabled accurate diagnosis (AD) in 81% of the cases and descriptive diagnosis (DD) in 14%. The material obtained in 5% of the cases was not appropriate for study (ND). The difference between successful (AD) and unsuccessful (DD+ND) CNB cases is statistically significant. The highest percentage of successful CBNs was for RO and RLRO lesions (85% and 100% respectively). RL lesions were more difficult because most of them were cystic lesions with fluid content.

Cherubism: clinicoradiographic features and treatment

Objectives

Cherubism is a congenital childhood disease of autosomal dominant inheritance. This disease is characterized by painless bilateral enlargement of the jaws, in which bone is replaced with fibrous tissue. The condition has sui generis clinical, radiographic and histological features, of which the clinician should be aware for a better differential diagnosis in the presence of a fibro-osseous lesion affecting the bones of the maxillomandibular complex. The purpose of present paper was to review the literature and to report the most important aspects of cherubism in order to facilitate the study of this disease

Material and Methods

Literature was reviewed about cherubism, emphasizing the relevant clinicoradiographic features and treatment. Literature was selected through a search of PubMed and Scielo electronic databases. The keywords used for search were adolescent, cherubism, cherubism/physiopathology, cherubism/treatment, cherubism/radiography. A manual search of the reference lists of the identified articles and the authors' article files and recent reviews was conducted to identify additional publications. Those studies that described new features about cherubism were included in this review.

Results

In total 44 literature sources were obtained and reviewed. Studies that described new features about cherubism physiopathology, diagnostics and treatment were reviewed.

Conclusions

Despite the exceptions, cherubism is a clinically well-characterized disease. In cases of a suspicion of cherubism, radiographic examination is essential since the clinical presentation, the location and distribution of the lesions may define the diagnosis. Histopathological examination is complementary. Nowadays, genetic tests should be used for final diagnosis of cherubism.