RESUMEN
We present the case of a 32-year-old male patient complaining of recurrent mandibular pain for 3.5 years. Panoramic radiography indicated increased cortical density of the mandibular lower border. Scintigraphy and single-photon emission computed tomography revealed metabolic hyperactivity in that region without pathologic lymph nodes. A bone biopsy specimen of the mandibular lower border did not have inflammation or cytologic atypia. Endocrinologic investigation confirmed secondary hyperparathyroidism as a result of hypovitaminosis D. Several weeks after starting therapy with oral vitamin D supplements, the symptoms completely disappeared. Increased cortical density is a rare manifestation of secondary hyperparathyroidism, which normally causes the lamina dura to vanish and produces a ground-glass appearance as a result of blurring of the trabecular bone pattern. Because focal hyperostosis can have multiple benign or malignant causes, radiologic examination of the jaw bones is indispensable for evaluating orofacial pain. Increased cortical density may be caused by metabolic diseases, requiring further investigations, including biopsy and blood analysis.
Asunto(s)
Hiperparatiroidismo Secundario/tratamiento farmacológico , Hiperparatiroidismo Secundario/etiología , Enfermedades Mandibulares/diagnóstico por imagen , Enfermedades Mandibulares/tratamiento farmacológico , Deficiencia de Vitamina D/diagnóstico por imagen , Deficiencia de Vitamina D/prevención & control , Vitamina D/uso terapéutico , Adulto , Biopsia , Densidad Ósea , Diagnóstico Diferencial , Humanos , Masculino , Dimensión del Dolor , Radiografía Panorámica , Tomografía Computarizada de Emisión de Fotón ÚnicoRESUMEN
Inflammation of bone is caused either by bacterial infection or occasionally by physical stimulus. Primary chronic osteomyelitis of mandibular bone is a chronic inflammation of an unknown cause. Pain, swelling, limited mouth opening, regional lymphadenopathy and hypaesthesia are clinical symptoms at initial presentation. Results of biopsy, computed tomography and scintigraphy reveal the diagnosis of a primary chronic osteomyelitis. Its management is long-term antibiotic therapy, hyperbaric oxygen and surgical therapy, even bisphophonate treatement may be a good option. The case report presents a primary progressive chronic osteomyelitis of the manibular bone of a ten year old boy. Clinical and radiological signs are discussed as well as diagnosis, management and follow-up.
Asunto(s)
Infecciones Bacterianas/diagnóstico por imagen , Infecciones Bacterianas/terapia , Enfermedades Mandibulares/diagnóstico por imagen , Enfermedades Mandibulares/terapia , Osteomielitis/diagnóstico por imagen , Osteomielitis/terapia , Tomografía Computarizada por Tomografía Computarizada de Emisión de Fotón Único , Combinación Amoxicilina-Clavulanato de Potasio/uso terapéutico , Niño , Enfermedad Crónica , Terapia Combinada , Estudios de Seguimiento , Humanos , Oxigenoterapia Hiperbárica , MasculinoRESUMEN
Laser therapy and fluorescence-guided surgery are highly reliable and predictable methods, but their combination has not been found to yield useful outcomes. We present a new therapeutic approach combining fluorescence-guided Er:YAG laser ablation with Nd:YAG/diode laser biostimulation for bisphosphonate-related osteonecrosis of the jaw (BRONJ). A woman was treated with zoledronic acid for bone metastasis from clear cell renal cell carcinoma and subsequently developed BRONJ in the left jaw. The management protocol included perioperative medical therapy (1% chlorhexidine gel, rifamycin, and doxycycline for 10 preoperative and 7 postoperative days), Er:YAG laser ablation guided by doxycycline fluorescence in vital bone under UV light, and Nd:YAG/diode laser biostimulation. The lesion regressed from stage 3 to stage 1 and showed nearly complete healing after laser therapy (3 and 23 cycles of ablation and biostimulation, respectively). These preliminary findings suggest the feasibility of the new approach, which is minimally invasive and biostimulative and causes very low morbidity.
Asunto(s)
Osteonecrosis de los Maxilares Asociada a Difosfonatos/radioterapia , Láseres de Estado Sólido/uso terapéutico , Terapia por Luz de Baja Intensidad/métodos , Enfermedades Mandibulares/radioterapia , Osteonecrosis de los Maxilares Asociada a Difosfonatos/diagnóstico por imagen , Femenino , Humanos , Enfermedades Mandibulares/diagnóstico por imagen , Persona de Mediana Edad , Radiografía Panorámica , Tomografía Computarizada por Rayos XRESUMEN
The purpose of this study was to radiographically analyze the effect of autologous platelet rich plasma (PRP) on the healing of fresh frozen bone allograft (FFBA) placed in surgically created resection defects in mandibles of dogs. Bilateral resection defects measuring 1.5 cm × 1 cm were surgically created on the inferior border of the mandible in 10 adult male dogs. The defects were randomly divided into three groups: C, FFBA, and FFBA/PRP. In Group C, the defect was filled by blood clot only. In Group FFBA, the defect was filled with particulate fresh frozen bone allograft. In Group FFBA/PRP, it was filled with particulate fresh frozen bone allograft combined with PRP. At 90 days postoperative, standardized radiographs of the mandibles were obtained and results were quantitatively evaluated. Analysis of digitized radiographs indicated that non-PRP grafts were significantly less dense than the PRP grafts. Group FFBA/PRP also presented a statistically greater mineralized tissue area than Groups C and FFBA. Within the limits of this study, it can be concluded that PRP enhanced the healing of FFBA in resection defects in mandibles of dogs.
Asunto(s)
Aloinjertos/trasplante , Trasplante Óseo/métodos , Enfermedades Mandibulares/cirugía , Plasma Rico en Plaquetas/fisiología , Aloinjertos/diagnóstico por imagen , Animales , Transfusión de Sangre Autóloga/métodos , Densidad Ósea/fisiología , Criopreservación/métodos , Perros , Marcadores Fiduciales , Procesamiento de Imagen Asistido por Computador/métodos , Masculino , Enfermedades Mandibulares/diagnóstico por imagen , Recuento de Plaquetas , Radiografía Dental Digital/métodos , Distribución Aleatoria , Mallas Quirúrgicas , Factores de Tiempo , Cicatrización de Heridas/fisiologíaRESUMEN
OBJECTIVES: The mandibular inferior cortex (MIC) classification that was determined by observing the mandible distally from the mental foramen in panoramic radiography can be considered to reflect bone loss in the jaws. The purpose of this 9-year study was to investigate whether there is a relationship between MIC condition and total serum calcium (TSC) in elderly Japanese people. METHODS: A total of 280 subjects aged 70 years at baseline (137 males and 143 females) took part in this longitudinal study design. TSC and dental panoramic radiographs were carried out at the baseline in 1998 and the final year in 2007. RESULTS: The results of the MIC measurement were divided into two groups according to changes in MIC after the 9-year study period, namely no change group and change group. A significant relationship was found in females but not in males between the MIC condition and the TSC. The regression showed that female subjects are 3.26 times more likely to have increased erosion of the inferior border of the mandible than male subjects after the 9-year study period. CONCLUSIONS: These results suggest that an increase in erosion of the inferior border of the mandible was significantly associated with an elevated TSC after 9 years and only in females.
Asunto(s)
Calcio/sangre , Enfermedades Mandibulares/diagnóstico por imagen , Anciano , Proteínas Sanguíneas/análisis , Dentición , Femenino , Estudios de Seguimiento , Humanos , Estudios Longitudinales , Masculino , Mandíbula/diagnóstico por imagen , Enfermedades Mandibulares/sangre , Fuerza Muscular/fisiología , Dinamómetro de Fuerza Muscular , Osteoporosis/sangre , Osteoporosis/diagnóstico por imagen , Fósforo/sangre , Radiografía Panorámica/métodos , Factores Sexuales , FumarRESUMEN
BACKGROUND: Radiation therapy can result in osteoradionecrosis (ORN) and mucosal ulceration predisposing to infection. METHODS: Fourteen patients presenting with infectious sequelae related to mandibular ORN were retrospectively reviewed. RESULTS: In most patients, infection followed diagnosis of ORN; but in 4 patients, ORN was not diagnosed until after the time of infection and imaging. An early imaging finding of ORN was lingual cortical defects near the last molar. Pain followed by erythema, purulent drainage, and subperiosteal abscess by imaging were the most common signs of infection. In most patients, conservative management eventually failed and segmental mandibulectomies were required. CONCLUSIONS: Soft tissue infection with characteristic bone findings such as subperiosteal abscess and cortical bone erosions helps to distinguish infected ORN from recurrent tumor or sterile ORN. In patients previously treated with radiation who present with infection, pain or an avid PET scan with bone involvement, the mandible should be scrutinized.
Asunto(s)
Enfermedades Óseas Infecciosas/diagnóstico por imagen , Enfermedades Mandibulares/diagnóstico por imagen , Osteorradionecrosis/complicaciones , Infecciones de los Tejidos Blandos/diagnóstico por imagen , Anciano , Anciano de 80 o más Años , Antiinfecciosos/uso terapéutico , Enfermedades Óseas Infecciosas/etiología , Enfermedades Óseas Infecciosas/terapia , Femenino , Estudios de Seguimiento , Humanos , Oxigenoterapia Hiperbárica/métodos , Masculino , Mandíbula/diagnóstico por imagen , Enfermedades Mandibulares/etiología , Enfermedades Mandibulares/terapia , Osteotomía Mandibular , Persona de Mediana Edad , Osteorradionecrosis/terapia , Dolor/etiología , Tomografía de Emisión de Positrones/métodos , Estudios Retrospectivos , Infecciones de los Tejidos Blandos/etiología , Infecciones de los Tejidos Blandos/terapia , Tomografía Computarizada por Rayos X/métodos , Resultado del TratamientoRESUMEN
OBJECTIVE: We report a case of progressive facial hemiatrophy with cervical sympathetic hyperactivity as a possible underlying aetiology, based on clinical findings, three-dimensional computed tomography and thermographic imaging. METHODS: We present a case report in which we describe the investigation and clinical course of progressive facial hemiatrophy, and we also review the world literature on this condition. RESULTS: To our knowledge, this is the first report in the world literature of progressive facial hemiatrophy with cervical sympathetic hyperactivity indicated as a possible underlying aetiology, based on clinical findings, three-dimensional computed tomography and thermographic imaging. CONCLUSION: This syndrome may lead to atrophy of the subcutaneous adipose tissue with hyperfunction of the vegetative system. Although this is a rare syndrome, otolaryngologists should be aware of its symptoms, aetiology and treatment.
Asunto(s)
Hemiatrofia Facial/etiología , Enfermedades Mandibulares/diagnóstico por imagen , Fototerapia/métodos , Ganglio Estrellado , Sistema Nervioso Simpático/fisiopatología , Anciano , Temperatura Corporal/fisiología , Resorción Ósea/diagnóstico por imagen , Resorción Ósea/etiología , Progresión de la Enfermedad , Hemiatrofia Facial/diagnóstico , Hemiatrofia Facial/terapia , Femenino , Humanos , Hiperhidrosis/diagnóstico , Hiperhidrosis/etiología , Rayos Infrarrojos/uso terapéutico , Enfermedades Mandibulares/patología , Fototerapia/instrumentación , Radiografía , Termografía , Resultado del TratamientoRESUMEN
BACKGROUND: Osteoradionecrosis (ORN) of the mandible is the most serious and severe side effect of combined treatment of head and neck tumors. Due to frequent failure of its conventional management, new methods are being sought and tested, including hyperbaric oxygen therapy (HBO); however, effective methods of monitoring HBO results are not yet available. The purpose of our study was to assess thermographic records of ORN patients in different stages of hyperbaric oxygen therapy. MATERIAL/METHODS: In the years 2003-2008, hyperbaric oxygen was used as an adjunct in the conventional management of 4 patients with progressive osteoradionecrosis of the mandible. The effects of the treatment were evaluated based on the clinical, radiological, and thermographic examinations. In each patient thermograms were obtained before and after HBO. RESULTS: Clinical examination showed ORN remission following 30 exposures in a hyperbaric chamber at 2.5 atmospheres for 90 minutes. Follow-up thermograms obtained after 35-60 exposures revealed a marked warming of the osteoradionecrotic area of the mandible resulting from an increase in blood supply and tissue metabolism increase. In 1 case of therapy cessation, just 5 sessions of HBO therapy was associated with a decrease in acute inflammation, as manifested by local cooling seen in a follow-up thermogram. CONCLUSIONS: Thermography is an effective method of monitoring HBO results in patients with osteoradionecrosis. However, thermograms should be interpreted in combination with the corresponding clinical picture and radiological findings.
Asunto(s)
Oxigenoterapia Hiperbárica/métodos , Enfermedades Mandibulares/diagnóstico , Enfermedades Mandibulares/terapia , Osteorradionecrosis/diagnóstico , Osteorradionecrosis/terapia , Termografía/métodos , Femenino , Humanos , Masculino , Enfermedades Mandibulares/complicaciones , Enfermedades Mandibulares/diagnóstico por imagen , Persona de Mediana Edad , Osteorradionecrosis/complicaciones , Osteorradionecrosis/diagnóstico por imagen , RadiografíaRESUMEN
Central giant cell granuloma (CGCG) is a benign lesion of the jaws with a sometimes locally aggressive behaviour. The most common therapy is surgical curettage which has a high recurrence rate, especially in lesions with aggressive signs and symptoms (i.e. pain, paresthesia, root-resorption and rapid growth). Alternative therapies such as interferon alpha (INFalpha) or calcitonin are described in the literature. In this study 2 patients with an aggressive CGCG are presented who were treated with INF mono-therapy. INF mono-therapy was capable of terminating the rapid growth of the lesion in both patients and induced a partial reduction. Total resolution, however, was not obtained and alternative treatment is still necessary.
Asunto(s)
Granuloma de Células Gigantes/tratamiento farmacológico , Interferón-alfa/uso terapéutico , Enfermedades Mandibulares/tratamiento farmacológico , Enfermedades Maxilares/tratamiento farmacológico , Adolescente , Adulto , Conservadores de la Densidad Ósea/administración & dosificación , Conservadores de la Densidad Ósea/uso terapéutico , Calcitonina/uso terapéutico , Femenino , Granuloma de Células Gigantes/diagnóstico por imagen , Humanos , Interferón-alfa/administración & dosificación , Masculino , Mandíbula/diagnóstico por imagen , Enfermedades Mandibulares/diagnóstico por imagen , Maxilar/diagnóstico por imagen , Enfermedades Maxilares/diagnóstico por imagen , Radiografía , Inducción de Remisión/métodos , Insuficiencia del TratamientoRESUMEN
Odontogenic keratocysts, characterized by considerable local aggressiveness and high recurrence rates, account for 5-15% of all odontogenic cysts. This paper reviews the literature and describes the most important aspects of this type of cyst, a clinical example being given as way of illustration. We also report a paleopathological case featuring an osteolytic lesion where the characteristics are consistent with a keratocyst. The aim is thus to encourage odontologists to contribute to research in the field of paleopathology.
Asunto(s)
Enfermedades Mandibulares/historia , Quistes Odontogénicos/historia , Adulto , Femenino , Historia Antigua , Humanos , Queratinas , Masculino , Enfermedades Mandibulares/diagnóstico por imagen , Quistes Odontogénicos/diagnóstico por imagen , Paleopatología , Radiografía , EspañaRESUMEN
We studied the effect of dietary supplementation with grape seed proanthocyanidins extract (GSPE) 3 mg added in 100 g high-calcium diet with a calcium content of 1697 mg 100 g(-1) on mandibular condyle bone debility, which was induced by a low-calcium diet. Forty Wistar male rats, 5 week old, were randomly divided into control (Co), low-calcium diet (LC), low-calcium/high-calcium diet (LCH), and low-calcium/high-calcium with supplementary GSPE diet (LCHG) groups for 6 wk. Bone formation of the mandibular condyle was measured using peripheral quantitative computed tomography (pQCT). Significant differences were not seen among the four groups for body weight, measured weekly. The LCHG group scored significantly higher in cortical bone density, total bone cross-sectional area, cortical bone cross-sectional area, cortical bone mineral content, total bone density, total bone mineral content, and in the stress-strain index to the reference axis x when compared with the LCH group. We concluded that a high-calcium diet combined with GSPE supplementation is more effective in reversing mandibular condyle bone debility in rats than is a low-calcium diet, standard diet, or high-calcium diet alone.
Asunto(s)
Cóndilo Mandibular/efectos de los fármacos , Enfermedades Mandibulares/tratamiento farmacológico , Osteogénesis/efectos de los fármacos , Fitoterapia , Extractos Vegetales/uso terapéutico , Proantocianidinas/uso terapéutico , Semillas , Vitis , Anatomía Transversal , Animales , Peso Corporal/efectos de los fármacos , Densidad Ósea/efectos de los fármacos , Calcio/deficiencia , Calcio de la Dieta/uso terapéutico , Elasticidad , Masculino , Cóndilo Mandibular/diagnóstico por imagen , Enfermedades Mandibulares/diagnóstico por imagen , Minerales/análisis , Distribución Aleatoria , Ratas , Ratas Wistar , Estrés Mecánico , Tomografía Computarizada por Rayos XRESUMEN
A case of transmigration of mandibular canine is presented. The importance of anesthetizing the transmigrated tooth from the side of origin is highlighted.
Asunto(s)
Diente Canino/diagnóstico por imagen , Mandíbula/diagnóstico por imagen , Erupción Ectópica de Dientes/diagnóstico por imagen , Anestesia Local , Cefalometría , Niño , Diente Canino/cirugía , Femenino , Quiste Folicular/diagnóstico por imagen , Quiste Folicular/cirugía , Humanos , Mandíbula/cirugía , Enfermedades Mandibulares/diagnóstico por imagen , Enfermedades Mandibulares/cirugía , Radiografía Panorámica , Erupción Ectópica de Dientes/cirugíaRESUMEN
We investigated the reconstruction of a surgically created critical size mandibular defect in sheep using a newly developed automatic distraction device. The device has an implantable component, which is fixed to the mandible to allow the transfer of the transport disc across the created defect, and an external component which is mounted on the activation pump and secured away from the site of bone distraction. Compression of the bellows in the external component causes fluid to be forced through the connecting tube into the distraction component. Distraction at a rate of 1 mm over 24 h was achieved in six sheep. New bone generated at the site of the created defects both anterior (compression side) and posterior (tension side) to the transport disc and had similar radiodensity to the adjacent mandibular bone eight weeks after the completion of distraction.
Asunto(s)
Mandíbula/cirugía , Osteogénesis por Distracción/instrumentación , Angiografía , Animales , Densidad Ósea , Regeneración Ósea/fisiología , Medios de Contraste , Diseño de Equipo , Estudios de Seguimiento , Fijadores Internos , Aceite Yodado , Mandíbula/diagnóstico por imagen , Mandíbula/patología , Enfermedades Mandibulares/diagnóstico por imagen , Enfermedades Mandibulares/patología , Enfermedades Mandibulares/cirugía , Fracturas Mandibulares/fisiopatología , Microcirugia/instrumentación , Osteogénesis/fisiología , Osteogénesis por Distracción/métodos , Politetrafluoroetileno , Presión , Ovinos , Estrés Mecánico , Tomografía Computarizada por Rayos XRESUMEN
We undertook a microradiographic study in osteoradionecrotic mandibular bone to estimate the number of vascular channels in the compact bone, number of resorption areas, and number of regeneration areas. Normal mandibles had a similar number of vascular channels/vision field compared with compact bone in other parts of the body. Irradiation itself did not significantly alter this number. After osteoradionecrosis had developed in the mandible, the number of vascular channels increased (p = 0.02). Treatment with hyperbaric oxygen further increased the number of vascular channels/vision field (p < 0.003). The normal mandible had no resorptive or regenerative areas, either before or after radiotherapy. The osteoradionecrotic mandible, however, had an increased number of resorptive as well as regenerative areas/vision field. Fluorescence as an indication of incorporation of tetracycline was seen in the regenerative areas of all osteoradionecrotic specimens treated with doxycycline. The process started from the vascular channels, periosteum, and endosteum. We conclude that the compact bone of mandibular osteoradionecrosis has high metabolic activity with active resorption and regeneration of bone and the limitation of the blood supply through cortical vascular channels, seems to be only one of many important factors.
Asunto(s)
Mandíbula/irrigación sanguínea , Mandíbula/efectos de la radiación , Enfermedades Mandibulares/patología , Osteorradionecrosis/patología , Adulto , Anciano , Antibacterianos/uso terapéutico , Regeneración Ósea , Resorción Ósea , Femenino , Humanos , Oxigenoterapia Hiperbárica , Masculino , Enfermedades Mandibulares/diagnóstico por imagen , Microrradiografía , Microscopía Fluorescente , Persona de Mediana Edad , Neovascularización Fisiológica , Osteorradionecrosis/diagnóstico por imagen , Osteorradionecrosis/terapia , Estadísticas no ParamétricasRESUMEN
38 skulls, belonging to inhabitants of various age groups of the Neolithic settlement of Khirokitia in Cyprus (5800-3000 BC) were studied and the alveolar bone loss was evaluated in areas where teeth still existed. It was found that the alveolar bone loss increased with age. The differences deriving from the comparison of skulls belonging to older people (the mean life-span of the inhabitants was 35.2 years), with skulls belonging to younger people suggest that our findings are not due to postmortem weathering of bones through the centuries but represent a real fact. The results of this study indicate that periodontal disease has accompanied human beings since prehistoric time without being affected by civilization.
Asunto(s)
Pérdida de Hueso Alveolar/historia , Paleodontología , Factores de Edad , Pérdida de Hueso Alveolar/diagnóstico por imagen , Pérdida de Hueso Alveolar/patología , Cefalometría , Chipre , Femenino , Historia Antigua , Humanos , Masculino , Enfermedades Mandibulares/diagnóstico por imagen , Enfermedades Mandibulares/historia , Enfermedades Mandibulares/patología , Enfermedades Maxilares/diagnóstico por imagen , Enfermedades Maxilares/historia , Enfermedades Maxilares/patología , RadiografíaRESUMEN
A cavity on the posterior buccal surface of four dry mandibles (n = 8282) is reported. The shape, size, unilaterality, and sex distribution of this phenomenon are similar to anterior and posterior idiopathic bone cavities (i.e., defects) on the lingual cortex. Posterior buccal mandibular defects differ from posterior lingual cavities in their unilateral occurrence and age distribution. The differential diagnosis for posterior buccal mandibular defects includes an anatomic variant, an aneurysmal erosion, erosion by a lymphoid nodule, and a neural neoplasm.