RESUMEN
This retrospective cohort study aims to describe characteristics of patients with MRONJ, to identify factors associated with MRONJ development, and to examine variables associated with favourable outcome. Totally 32 patients were followed and observed: 21 females and 11 males, in the age range 35-84 in the period from 2009 to 2018. Clinical, radiological examination (Orthopantomograph and CBCT) and biopsy were performed in order to achieve diagnosis. Demographic and clinical variables were taken into consideration: sex, age, primary disease, medication type, mode of delivery, anatomic location, drug treatment duration, timing of tooth extraction, chemotherapy, presence of bone metastasis, aetiology of MRONJ, disease stage, and treatment modality. MRONJ developed under osteoporosis and malignant disease in 11 and 21 patients, respectively. MRONJ development was triggered by tooth extraction or trauma in 30 out of 32 cases, whereas the two patients developed MRONJ spontaneously. Stages I, II, and III were confirmed in 5 (16%), 18 (58%), and 9 (28%) patients, respectively. Mandible was affected in 23 (72%) patients. MRONJ was treated in our department by conservative and surgical modality. In this study we found that 65% of all patients were classified in the cured/improvement group and 35% in the stable/progression group. The female gender, osteoporosis as primary disease, oral regime intake, shorter period on BPs, earlier stage of disease, and specific anatomic localisation (frontal and premolar maxilla) were factors associated with better response to therapy and favourable clinical outcome. Comprehensive treatment protocol and further randomized studies are necessary for further improvements.
Asunto(s)
Osteonecrosis de los Maxilares Asociada a Difosfonatos/etiología , Osteonecrosis de los Maxilares Asociada a Difosfonatos/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Conservadores de la Densidad Ósea/efectos adversos , Neoplasias Óseas/fisiopatología , Difosfonatos/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteoporosis/fisiopatología , Radiografía Panorámica/efectos adversos , Estudios Retrospectivos , Factores de Riesgo , Extracción Dental/efectos adversosRESUMEN
Introduction: No consensus has been reached yet on the surgical approach for treatment of condylar fractures. Objective: The aim of this study was to present modified Risdon approach (without facial nerve identification) in the treatment of subcondylar mandibular fractures. Method: This is a retrospective study of a period 20052012. During this seven-year period, 25 condylar mandibular fractures in 22 men and three women (1968 years old) were treated by modified Risdon approach without identifying the facial nerve. The main inclusion criterion was subcondylar fracture according to Lindahl classification. Results: No additional morbidity related to postoperative complications, such as infection or salivary fistula, was observed in this series. Only two (8%) patients developed temporary weakness of the marginal branch of the facial nerve, which resolved six weeks postoperatively. Each patient achieved good mouth opening postoperatively. Scar was camouflaged in the first cervical wrinkle. Two patients developed temporomandibular joint dysfunction. No patient had postoperative occlusal disturbance. In all of the patients good aesthetic result was achieved in a two-year follow-up. Conclusion: In comparison with techniques described in the literature, the main advantages of the modified Risdon approach are the following: no need for facial vessels identification; direct, fast, and safe approach to mandibular angle and subcondylar region; relatively simple surgical technique and good cosmetic result due to aesthetically placed incision. This approach could be recommended for subcondylar fracture as a simplified and safe procedure.