Quantitative ultrasound at the hand phalanges in patients with bisphosphonate-related osteonecrosis of the jaws.

Patients with bisphosphonate-related osteonecrosis of the jaws (BRONJ) who received intravenous or oral bisphosphonates (BP) were selected for determination of their bone microarchitecture as a risk predictor of BRONJ development. The diagnosis of BRONJ was made based on clinical and radiographic findings. The control group consisted of healthy patients. All patients underwent quantitative and qualitative ultrasound measurements of bone at the hand phalanges carried out using the DBM Sonic BP. Ultrasound bone profile index (UBPI), amplitude-dependent speed of sound (AD-SoS), bone biophysics profile (BBP), and bone transmission time (BTT) were measured. The BRONJ group consisted of 17 patients (62 ± 4.24; range: 45-82); 10 (58.8%) were male and seven (41.1%) were female, of whom 11 (64.7%) suffered from multiple myeloma, three (17.6%) from osteoporosis, one (5.8%) from prostate cancer, one (5.8%) from kidney cancer, and one (5.8%) from leukemia. Fourteen (82.3%) of them received intravenous BP whereas three (17.6%) received oral BP. Nine (9/17; 52.9%) patients developed bone exposure: two in the maxilla and seven in the mandible. Regarding quantitative parameters, Ad-SoS was low in the BRONJ group, but not significant. The UBPI score was significantly reduced in BRONJ patients with exposed bone when compared to controls (0.47 ± 0.12 vs. 0.70 ± 0.15; p = 0.004). The present study demonstrated that quantitative ultrasound was able to show bone microarchitecture alterations in BRONJ patients, and suggests that these analyses may be an important tool for early detection of bone degeneration associated with BRONJ.

Influence of periodontitis in the development of nosocomial pneumonia: a case control study.

BACKGROUND: Although a number of studies on the role of periodontitis in the development of nosocomial pneumonia (NP) have been published, the debate surrounding the existence and nature of this association continues. The present study investigates the influence of periodontitis in NP. METHODS: This case-control study involved 315 individuals: 85 cases (with NP) and 230 controls (without NP), at a general hospital in Feira de Santana, Bahia, Brazil. Sociodemographic characteristics, health conditions, and lifestyle habits were recorded. A full-mouth periodontal examination was performed and periodontal condition assessed. The diagnosis of NP was made in accordance with established medical criteria, after physical, microbiologic, and/or radiographic examination. Logistic regression was used to calculate the strength of the association between periodontitis and NP. RESULTS: Individuals with periodontitis were three times as likely to present with NP (unadjusted odds ratio [OR unadjusted] = 3.06, 95% confidence interval [95% CI]: 1.82 to 5.15) as those without periodontal disease. After adjusting for age, time between hospitalization and data collection, last visit to dentist, smoking habit, and present occupation, the association measurement had a slight decrease (OR adjusted = 2.88, 95% CI: 1.59 to 5.19), but the results continued to be statistically significant. CONCLUSION: These findings suggest that periodontal infection may influence the development of NP, highlighting that periodontitis is a factor positively associated with this respiratory tract infection.

A comparative study of internal fixation and intermaxillary fixation on bone repair of mandibular fractures through radiographic subtraction.

Conventional radiographic evaluation of fracture healing is not a reliable method, because it depends on the examinator's experience and the quality of the exam. Therefore, serial images differing in density, contrast and geometrical projection can lead to a misdiagnosis on the postoperative fracture healing. Even in good quality images, little changes in calcified tissues often can't be visualized, because of its little sensibility and because of the limited human sight. The use of more sensitive and objective methods could increase the accuracy of this evaluation. This study intended to compare, by digitalized panoramic radiography, the mandible fracture healing after two different types of treatment: open reduction with internal fixation (group 1) and closed reduction with intermaxillary fixation (group 2). It was taken three postoperative radiographs (within a week, a month and three months after treatment), which were digitalized (600 dpi, 8 bits) and adjusted in brightness and size in Photoshop software. Then these images were evaluated by digital subtraction in ImageTool software. The results revealed greater areas of new bone formation in the internal fixation group, in all the evaluated times. Thus, open reduction with internal fixation resulted in more rapid fracture healing than closed reduction with intermaxillary fixation.

Psammomatoid juvenile ossifying fibroma: case study and a review.

BACKGROUND: The group of fibro-osseous lesions from the maxillofacial region is very heterogeneous, but what they all have in common is the substitution of normal bone by fibroblasts with the consequent formation of collagen fibers, as well as substitution by different types of mineralized tissues which may be similar to bone or cement. Within this group of lesions, the juvenile ossifying fibroma is found, considered a rare and recurrent benign fibro-osseous neoplasia. The term juvenile ossifying fibroma has been used in the literature to describe two histopathological variations of conventional ossifying fibroma. These variations are trabecular juvenile ossifying fibroma and psammomatoid juvenile ossifying fibroma. Psammomatoid juvenile ossifying fibroma is an uncommon bone-forming neoplasm with aggressive local growth. Diagnostic of this lesion occurs after the correlation of clinical, imaging, and histopathological findings. Proposed treatments range from enucleation and curettage to resection of the tumor. OBJECTIVES: The present article has as its objectives to report an uncommon case of a 4-year-old male patient treated by conservative approach and revise the literature on juvenile ossifying fibroma. CONCLUSIONS: Psammomatoid juvenile ossifying fibroma, for its being very uncommon, warrants further investigation in order to establish the best treatment, principally in children, with a view to minimizing mutilating treatments. In the case examined, a conservative treatment was chosen, where the surgeon established curette and cryotherapy, and the reintegration of the child in his social environment, without relapse during the first year of therapy.

Clinical and image findings in bisphosphonate-related osteonecrosis of the jaws.

Bisphosphonate-related osteonecrosis of the jaws (BRONJ) is characterized as exposed bone in the jaws for more than 8 weeks in patients with current or previous history of therapy with bisphosphonates (BPs) and no history of radiotherapy in the head and neck. We report a case series of 7 patients with BRONJ and analyze the variations of clinical and imaging signs, correlating them with the presence or absence of bone exposure. Among the patients, 6 were women and 1 was a man, aged 42-79 years. Five of the patients were using zoledronic acid and the other 2 alendronate. The use of BPs varied from 3 to 13 years. In 5 patients, tooth extraction was the triggering event of injuries. Panoramic radiographs and computed tomography (CT) were evaluated by a radiologist blinded to the cases. There were persistent unremodeled extraction socket even several months after tooth extraction in 3 of the cases that were consistent wit CT findings that also showed areas of osteosclerosis and osteolysis. Patients were treated according to the recommendations of the AAOMS, with surgical debridement and antibiotic coverage with amoxicillin in the symptomatic patients. The follow-up of these patients ranged from 8 to 34 months, with a good response to treatment. The image findings in this case series were not specific and showed no difference between each stages of BRONJ (AAOMS, 2009). The image features were similar in presence or absence of exposed bone.

Actinomycotic osteomyelitis of the mandible: an unusual case.

BACKGROUND: Actinomycotic osteomyelitis is an infection in soft tissues and/or bones, being associated with trauma or a previous nonspecific infection. This article presents an unusual case of mandibular osteomyelitis caused by Actinomyces. CASE REPORT: A 19-year-old male patient was referred for endodontic treatment of the lower right first molar about 16 months ago and removal of lower right third molar approximately 3 years before. The panoramic radiography showed change in bone density in the region of ill-defined mandibular angle boundaries, and the computed tomography (CT) showed mixed density image in the mandibular angle, with discreet expansion of cortical vestibular and lingual. Biopsy was performed, and content was aspirated in small quantity and purulent tissue fragments were sent to anatomical-pathological examination. The collected purulent secretion was colored for cytopathologic study, which showed infection by Actinomyces. DISCUSSION: In this case, the causative agent was Actinomyces, which makes it even more unusual. The origin of the microorganism has not been clearly established; however, the diagnosis allowed long-term treatment with antibiotics, which has resulted in the resolution of the case.