Epidemiology, etiopathogenesis, and management of MRONJ: A European multicenter study.

INTRODUCTION: The purpose of this European multicenter study was to describe the general characteristics and risk factors of MRONJ lesions as well as their clinical diagnosis and management at different European Oral and Maxillofacial Surgery centers, in order to minimize selections biases and provide information about the epidemiology, etiopathogenesis, and the current trends in the treatment of MRONJ across Europe. MATERIALS AND METHODS: The following data were registered for each patient: gender; age at MRONJ diagnosis; past medical history; indication for antiresorptive or antiangiogenic therapy; type of antiresorptive medication; local risk factor for MRONJ; MRONJ Stage; anatomic location and symptoms; treatment; surgical complications; recurrence. RESULTS: A total of 537 patients (375 females, 162 males) with MRONJ were included. Statistically significant associations were found between patients with metastatic bone disease and recurrences (P < 0.0005) and between advanced MRONJ stages (stages 2 and 3) and recurrences (P < 0.005). Statistically significant associations were also found between male gender and recurrences (P < 0.05), and between MRONJ maxillary sites and recurrences (P < 0.0000005). CONCLUSIONS: A longer mean duration of antiresorptive medications before MRONJ onset was observed in patients affected by osteoporosis, whereas a shorter mean duration was observed in all metastatic bone cancer patients, and in particular in those affected by prostate cancer with bone metastases or multiple myeloma. Surgery plays an important role for the management of MRONJ lesions.

Non-odontogenic maxillofacial infections - a 17-years retrospective cohort study.

PURPOSE: A retrospective 17-year review of the epidemiology, microbiological aspects, and treatment of patients hospitalized for non-odontogenic maxillofacial infections. METHODS: A retrospective study reviewed 4040 medical records of patients hospitalized at Vilnius University Hospital Zalgiris Clinic during the period of 2003 to 2019. The following data were collected: patient sociodemographic characteristics, length of hospitalization, sources of infection, affected anatomical regions, treatment modalities, microbiological findings, and sensitivity to antibiotics. RESULTS: The mean (sd) annual incidence of non-odontogenic maxillofacial infections over the past 17 years was 237 (49) cases, and the mean (sd) hospital stay was 7.3 (4.5) days. The male-to-female ratio was 1.9:1, while the mean (sd) patient age was 42.1 (19.0) years. The need for an additional incision and the involvement of multiple anatomical regions were the strongest predictors of longer hospitalization. A total of 139 microorganism species were identified, with Bacteroides, Prevotella, and Staphylococcus showing the highest resistance to penicillin. CONCLUSIONS: Longer hospital stays were associated with older age (≥ 65 years), smoking, systemic diseases, type of treatment, involvement of multiple anatomical regions, and the need for additional surgery. Most of the cultured microorganisms were Staphylococcus species.

Virtual planning, guided surgery, and digital prosthodontics in the treatment of extended mandible chondrosarcoma.

Chondrosarcoma is among the most common primary bone tumors in adults. In the mandible, chondrosarcoma is a very uncommon malignant cartilage-producing tumor. This case report shows how virtual planning combined with other digital technologies may improve masticatory function rehabilitation in patients with enlarged mandibular chondrosarcoma. The present study reports a case of a 52-year-old male patient who was initially diagnosed with a mandible chondroma, which was successfully excised with no evidence of malignant transformation. Nevertheless, the patient's symptoms recurred after 10 years, and a subsequent diagnosis of mandible chondrosarcoma was established, prompting the need for subtotal mandible resection and reconstruction with a fibula-free flap. Following a healing period, the patient underwent dental implant surgery to restore the mandibular dental arch, which was performed utilizing computer-aided design and computer-aided manufacturing technology, with fully guided implant placement facilitated by virtual planning. In this case report, the implant position data merging process is described from the digital impression and control model to ensure optimal passive fit of the full-arch zirconia prosthesis and discuss the importance of occlusal adjustments to avoid technical and biological complications. Virtual planning and digital technologies are crucial for the effective management of mandibular defects, allowing for accurate treatment and complete restoration of mandibular function. Their use leads to improved patient outcomes and quality of life. As technology advances, their importance in treating complex medical conditions is only expected to grow.

Mucosa-Associated Lymphoid Tissue Lymphoma of the Sublingual Salivary Gland: A Case Report.

Mucosa-associated lymphoid tissue (MALT) lymphoma is a type of B-cell lineage lymphoma that can affect the head and neck region. This report presents a rare case of an extra-nodal marginal zone B-cell MALT lymphoma of a sublingual gland, diagnosed in an 18-year-old male patient. The patient had a history of ranula surgical removal on the right side of the mouth. One year after surgery, the patient presented with complaints of swelling of the left parotid gland, with no significant changes found during the examination and a self-resolving outcome. Subsequently, two years later, the patient began to complain of a fast-growing cyst under the tongue. A surgical excision of the left sublingual gland and the ranula was performed, and a final diagnosis of MALT lymphoma was rendered. The patient was referred to the department of hematology for further treatment planning and follow-up.

Hybrid intercalated duct lesion of the parotid: A case report.

BACKGROUND: Intercalated duct lesions (IDLs) are considered relatively benign and rare tumors of salivary glands, that were only described recently. Their histopathological appearance may range from ductal hyperplasia to encapsulated adenoma with hybrid patterns of both variants. It is thought that IDLs may be the precursor for malignant proliferations, therefore their correct diagnosis remains crucial for proper lesion management. It is the first reported IDL case arising from the accessory parotid gland (APG), which stands for less frequent but higher malignancy rate tumor developmental area. CASE SUMMARY: A 24-years-old male with no accompanying diseases was referred to the hospital with a painless nodule on the right cheek. On physical examination, the stiff, immobile, and painless mass was palpable in the anterior portion of the right parotideomasseteric region, just superior to the parotid duct. Ultrasound examination demonstrated 1.5 cm × 1.0 cm hypoechogenic mass on the anterior part of the right parotid gland. Ultrasound-guided fine needle aspiration cytology, followed by liquid-based fine needle aspiration biopsy were performed. However, the results were uninformative. A contrast-enhanced magnetic resonance imaging (MRI) of the parotid was obtained, demonstrating a 1.5 cm × 1.0 cm × 0.5 cm tumor with high intensity capsule together with low intensity core in the very anterior part of right superficial lobe, situated in the APG. An MRI features were uncharacteristic to common parotid tumors, therefore surgical resection followed up. After histopathological examination, the final diagnosis of hybrid IDL was confirmed. CONCLUSION: Fine needle aspiration biopsy might not always be diagnostic, and given the malignant potential, the surgical resection of such lesion remains the treatment of choice.

Lips and noses in 10-year old patients with repaired complete unilateral clefts of lip, alveolus, and palate. A prospective three-centre study of the Baltic Cleft Network.

This multicenter study aimed at comparing different techniques of lip and nose repair with or without NAM and primary anterior rhinoplasty in pre-adolescent children. Patients with unilateral clefts of lip, alveolus, and palate who had undergone cleft lip and nose repair were evaluated in a prospective three-centre study using standardized monochromatic, cropped photographs. Four cleft surgeons evaluated the aesthetics of the central part of the face when the patients had reached age ten years. Seventy-six sets of photographs out of 87 patients were evaluated. The overall ratings of lips and noses did not differ much between centres. However, noses of centres 1 (mean 0.74; SD 0.57) and 2 (mean 0.76; SD 0.60) had been rated better than centre 3 (mean 1.32; SD 0.78; p = 0.0078), especially "Deformation of upper part of nostril rim or poor position of alar cartilage". Centre 3 had produced better looking scars (mean 0.33; SD 0.48); p = 0.0036. Within the limitations of the study it seems that NAM and primary anterior rhinoplasty including postoperative nasal stents should be performed whenever possible in order to achieve a favorable shape of the nose and to reduce the need for secondary corrective surgery.

Image based simulation of the low dose computed tomography images suggests 13 mAs 120 kV suitability for non-syndromic craniosynostosis diagnosis without iterative reconstruction algorithms.

OBJECTIVES: The aim of this study was to simulate low dose paediatric head CT images with different noise levels corresponding to various tube current time product values and assess simulated image suitability in non-syndromic craniosynostosis diagnostics. METHOD: 29 paediatric patients who underwent head CT examinations for cranial deformity were enrolled in the study. The low dose CT images, corresponding to 120 kV and 120 mAs, 100 mAs, 80 mAs, 50 mAs and 13 mAs settings, were synthesised by adding noise to original data. Three researchers evaluated suitability for diagnostics of original and simulated images by using questionnaire assessing image suitability. RESULT: 174 separate cases (containing 1 axial and 1 3D image) were evaluated. Percentage of images evaluated as suitable for diagnosis were 98.9% on original images, 100% on 120 mAs, 100% on 100 mAs, 97.1% on 80 mAs, 96.6% on 50 mAs and 96% on 13 mAs. CONCLUSIONS: Images registered with 120 kV 13 mAs can be used to diagnose non-syndromic craniosynostosis with statistically same accuracy as with standard protocol and correspond to decrease of effective dose from 4.98 mSv to 0.33 mSv (median values).

Medication--related osteonecrosis of the jaws. The first reported cases in the Baltic States and a literature review.

INTRODUCTION: Medication-related osteonecrosis of the jaws (MRONJ) is a severe side effect of antiresorptive or antiangiogenic therapy that manifests as an exposed bone, accompanied by clinical signs of infection, persisting for more than 8 weeks, without history of radiation therapy or metastases to the jaws. The aim of the study was to present first MRONJ cases in Lithuania and review trends in the modern research literature on the subject. MATERIALS AND METHODS: We retrospectively reviewed patient charts with a diagnosis of "Inflammatory conditions of the jaws" treated in Vilnius University Hospital Zalgiris Clinic, Department of maxillofacial surgery in 2007-2014. Patients diagnosed with MRONJ were selected for the study. Demographic data, characteristics of the disease and treatment modalities were analysed. RESULTS: Nine cases (five male and four female) of MRONJ were analysed. The mean patient age was 69±7,9 years. Predominant primary malignancy was prostate cancer. Osteonecrotic lesions were located both in maxilla and mandible. In all cases we started with a conservative treatment first. After the antibiotic therapy with or without sequestrectomy, the condition of all patients stabilized and improved to stage I MRONJ. CONCLUSION: MRONJ is a disturbing condition resulting in a severely worsened quality of life in the affected patients. This is the first case series of successfully treated patients suffering from stage II or III MRONJ in the Baltic States. A more comprehensive understanding of MRONJ will hopefully allow clinicians to enhance accuracy in risk assessment and forecast positive and negative outcomes of antiresorptive or antiangiogenic therapy.

The comparison of different surgical techniques used for repair of complete unilateral cleft lip.

Up to now, many various techniques have been proposed for the repair of complete unilateral cleft lip. The aim of this study was to compare late results of three different surgical techniques (C. Tennison, R. Millard, and J. Olekas) used for the repair of complete unilateral cleft lip and to analyze their advantages and disadvantages. Material and METHODS. Sixty-six patients with nonsyndromic complete unilateral cleft lip, alveolus, and palate were examined. For 19 patients (28.8%), cleft lip repair was performed using the Tennison technique; for 20 patients (30.3%), Millard technique; and for 27 patients (40.9%), Olekas technique. Results were assessed by score, which was given by analyzing standardized photographs of nasolabial triangles. For the assessment, the modified scale according to Mortier and Anastassov was used. Separate anatomical elements - red lip, white lip, scars, and nose - were assessed. RESULTS. The best appearance of the red lip and white lip was found after the Tennison technique. Scars and nose looked the best after Olekas cheiloplasty. There were no significant differences in the evaluation of red lip and nose appearance comparing all three analyzed surgical techniques (P>0.05). Tennison technique showed significantly better results in the appearance of the white lip (P<0.05); the appearance of scars was significantly better after the Olekas repair (P<0.001). CONCLUSIONS. Height of white lip and symmetry of the Cupid's bow were better restored by using the Tennison technique. The physiological configuration of the white lip and less visible scars were achieved by using the Olekas technique. All techniques were equal in red lip and nose formations.

Retrospective analysis of cellulitis of the floor of the mouth.

OBJECTIVES: To analyze clinical data of patients treated for mouth floor cellulitis during 2003-2006 years at the Department of Maxillofacial Surgery, Vilnius University Hospital Zalgiris Clinic and to compare the results with existing data. MATERIAL AND METHODS: Patient's gender, age, social insurance, demographic profile, preference of first visit, previous treatment, origin of inflammation, symptoms of disease, treatment protocol and outcomes were evaluated from 240 clinical records. RESULTS: The male-female ratio was 1.3:1. The mean age of patients was 43.18+/-7.56 years. 65% of patients were from urban. 47% of patients were employed, 15% retirees, 22% unemployed, 10% children, 2% students and 4% handicapped people. In 65% of cases primary diagnosis was incorrect. Majority of patients appealed to doctor on the first five days from the beginning of the disease. 93.7% of mouth floor cellulites were odontogenic origin. In 32.9% of the patients at the time of first examination the extension of inflammation into parapharyngeal, pterygomandibular spaces or neck together with mouth floor cellulitis was diagnosed. In 1.7% (in 4 out of 240) of cases infection extended into the neck and parapharyngeal spaces despite treatment. In 2% (in 5 out of 240) of cases infection extended to mediastinum. CONCLUSIONS: Despite the aggressive treatment serious complications still are possible. Delayed treatment procedures might determine poor prognosis.