Parapharyngeal Schwannoma of the Mandibular Nerve Associated With Auditory Changes.

We present a case of a parapharyngeal schwannoma of the mandibular nerve with intraosseous extension into the mandible. The initial symptoms included decreased auditory acuity, with subsequent magnetic resonance imaging findings suggestive of Eustachian tube obstruction. This represents a rare symptom of schwannomas of the mandibular nerve. Owing to the degree of bony expansion and cortical thinning of the adjacent mandibular ramus, concern existed for a pathologic fracture. Treatment involved complete excision of the lesion using hemimandibulectomy with second stage reconstruction. The patient noted resolution of the preoperative symptoms. No sign of recurrence of the schwannoma was noted at the 2-year mark.

Fibrous Dysplasia and Medication-Related Osteonecrosis of the Jaw.

PURPOSE: Osteonecrosis of the jaw (ONJ) is an established side effect of intravenous bisphosphonates and other antiresorptive medications. Although bisphosphonates are frequently prescribed for patients with the skeletal disorder fibrous dysplasia (FD), there are no reports of ONJ in this population. This has led some to conclude that patients with FD are at low risk for the development of bisphosphonate-related ONJ. PATIENTS AND METHODS: Patients were evaluated as part of a longstanding FD natural history study at the National Institutes of Health. RESULTS: Of 76 patients with FD who were treated with bisphosphonates, 4 developed ONJ (5.4%). Three patients developed ONJ in areas of FD-affected bone and 1 in an area of normal bone. All 4 patients had features known to be associated with ONJ in the general population, including long-term high-dose intravenous bisphosphonate treatment, periodontal and endodontic infections, and dentoalveolar surgical procedures. CONCLUSIONS: These cases establish ONJ as a potential complication of bisphosphonate treatment in patients with FD. The presence of established risk factors for ONJ in this group of patients with FD suggests that high-risk patients could be identified before the development of ONJ. Clinicians should use caution in prescribing bisphosphonates to patients with FD and should do so only for established indications.

Effects of denosumab treatment and discontinuation on human growth plates.

CONTEXT: Denosumab is a humanized monoclonal antibody to receptor activator of nuclear factor-κB ligand used primarily for postmenopausal osteoporosis and skeletal-related events from metastatic cancer. Its safety in children has not been established. OBJECTIVE: The objective of the study was to investigate the effects of denosumab treatment on skeletal growth and histology. DESIGN: This was an observational case report with radiological and histopathological analyses. SETTING: The study was conducted at a clinical research center. PATIENTS: A 9-year-old boy with fibrous dysplasia treated with a 7-month course of denosumab participated in the study. INTERVENTION: Histological analyses were performed and compared on growth plates from limbs that had been amputated before and 17 months after denosumab treatment. MAIN OUTCOME MEASURES: Skeletal radiographs and bone histopathology from before and after treatment were measured. RESULTS: After initiating denosumab, sclerotic metaphyseal bands appeared on radiographs. Posttreatment radiographs revealed migration of the bands away from the growth plates, consistent with continued linear growth. Histologically, the bands were composed of horizontally arranged trabeculae containing calcified cartilage. This cartilage appeared to derive from unresorbed primary spongiosa as a result of osteoclast inhibition by denosumab, similar to what has been observed with bisphosphonates. By 17 months after treatment, active bone resorption and formation had returned, as evidenced by the presence of active osteoclasts in resorption pits and osteoid surfaces. CONCLUSIONS: Further studies are needed to determine the safety of denosumab on the growing skeleton. However, in this child there was continued epiphyseal activity both during and after treatment and reversal of bone turnover suppression after treatment discontinuation, suggesting that denosumab did not have significant adverse effects on growth.

Perioperative statin use: an update.

HMG CoA reductase inhibitors (statins) are a proven modality to reduce serum cholesterol and have been shown to reduce morbidity and mortality in cardiovascular patients. Statins have also demonstrated improvements in postoperative outcomes among patients taking them in the perioperative period. Many of the studies are limited to select patient populations and/or select surgeries. This review will give an overview of the pharmacology of statins, summarize the mechanisms of the beneficial effects of statins, and provide an overview of evidence in the use of statins in the perioperative period.