Clinical significance of periosteal reaction as a predictive factor for treatment outcome of medication-related osteonecrosis of the jaw.

Regarding treatment strategies for medication-related osteonecrosis of the jaw (MRONJ), surgical therapy has recently been reported to be more effective than conservative therapy. However, some patients did not achieve complete healing, even when extensive surgery was performed. Periosteal reaction in MRONJ patients is often observed by the CT examination. Tssshe purpose of this study was to investigate the relationship between periosteal reaction and treatment outcome of MRONJ. A total of 164 surgeries in 136 patients with MRONJ at two hospitals were included in the study. Correlations between various clinical and radiographic factors and treatment outcome were examined with Cox regression analysis. The results showed that the presence of periosteal reaction, as well as primary disease involving malignant tumor, were independent risk factors related to poor outcome. Furthermore, we examined factors related to the occurrence of the periosteal reaction and found that 4 variables were significantly correlated with periosteal reaction by multivariate analysis: gender (female), site (lower jaw), primary disease (malignant tumor), and osteosclerosis (severe). The present study clarified that the cure rate after surgical treatment decreased in cases with periosteal reaction, suggesting that it is necessary to review the treatment method.

Mantle cell lymphoma presenting with a tumor of the hard palate.

We report a 71-year-old man with a disseminated disease of mantle cell lymphoma (MCL). He initially noticed instability of the maxillary denture due to swelling of the hard palate. Combined positron-emission tomography and computed tomography demonstrated a marked accumulation of fluorodeoxyglucose in the palate. A biopsy of the palatine tumor disclosed diffuse infiltrates of lymphoid cells, which were positive for CD20 and cyclin D1. The peripheral blood contained lymphoma cells with the characteristic immunophenotype, and fluorescence in situ hybridization detected fusion signals indicative of t(11;14)(q13;q32). In a literature review we identified only three cases of MCL with palatine involvement to date.