Vanishing Mandible in a 7-year Old Child: Response to Radiation Therapy.

Massive osteolysis in a 7-year old child is a rare condition. The etiology of massive osteolysis is unknown and it results in the progressive destruction of bony structures. There is no standard therapy available in the literature. Conservative treatment is often used for its management. Radiotherapy is considered as an accepted form of treatment with greater chance of success when it is used in the early course of disease. There are few case reports in the literature in which radiotherapy has been used for the treatment. This article highlights the literature update on various treatment modalities and a case managed by radiation therapy.

Intraoperative use of a gamma probe for the treatment of condylar hyperplasia: description of a new technique.

PURPOSE: The purpose of this article is to describe a new technique to perform a high condylectomy using a γ-probe. MATERIALS AND METHODS: A 15-year-old female patient presented with right condylar hyperplasia. Because the condition was active, a high condylectomy was performed to stop the abnormal growth of the affected condyle. To resect an adequate amount of bone and prevent relapse, a γ-probe was used to guide bone removal. The patient was injected with technetium-99m methylene diphosphate 25 mCi 2 hours before she was brought to the operating room. Bone was removed from the superior aspect of the right condyle until the reading with the γ-probe was equivalent to normal bone. RESULTS: Seven millimeters of bone was removed from the top of the condyle before the γ-emission from the remaining condyle was equivalent to the mandibular parasymphysis used as a control. No relapse was noted 9 months after surgery. CONCLUSION: The γ-probe may help a surgeon remove the correct amount of bone when performing a high condylectomy, especially in type II (vertical pattern) condylar hyperplasia.

[Eosinophilic granuloma of the mandible--a case report]. / Eosinophiles Granulom des Unterkiefers. Fallbericht.

BACKGROUND: Langerhans cell histiocytosis is characterized by a clonal proliferation of Langerhans cells. The clinical manifestation varies from a localized lesion (eosinophilic granuloma) to a systemic disease. The diagnosis can only be confirmed histopathologically. A comprehensive staging is necessary to determine the extent of the disease and to establish an adequate therapy. CASE REPORT: We report on a 27 years old patient who was referred to our clinic with the diagnosis of an osteomyelitis of the mandibular angle and a pathological fracture after extraction of tooth 38 one month before. Curettage and primary bone grafting were performed. In the histological examination of the specimen infiltrates of a Langerhans cell histiocytosis were found. The clinical and radiological staging demonstrated a solitary mandibular lesion (eosinophilic granuloma). After wound healing a low-dose radiotherapy with 6 Gray was performed. Two years after completion of the therapy the patient is asymptomatic and does not show any evidence of recurrence. CONCLUSION: Langerhans cell histiocytosis has to be included in the differential diagnosis of osteolytic lesions of the mandible. A low-dose radiotherapy is a reasonable and well-tolerated treatment option.

Radiotherapy for recurrent central Giant cell granuloma: a case report.

BACKGROUND: Central giant cell granuloma (CGCG) is a rare, non-neoplastic, benign lesion that exhibits expansive and osteolytic biological behavior. CGCG treatment and management is challenging for clinicians. CASE PRESENTATION: This report presents the treatment and management of recurrent, aggressive CGCG after surgical resection. After informed consent was obtained, the patient underwent radiotherapy. The lesion size was reduced significantly, with no evidence of recurrence or malignant transformation. CONCLUSIONS: This treatment experience indicates that radiotherapy can be used as a rescue treatment for complicated CGCG involving vital neurovascular structures of the cranial base.

Enamel matrix derivative and low-level laser therapy in the treatment of intra-bony defects: a randomized placebo-controlled clinical trial.

AIM: The aim of this study was to evaluate the immediate post-operative pain, wound healing and clinical results after the application of an enamel matrix protein derivative (EMD) alone or combined with a low-level laser therapy (LLLT) for the treatment of deep intra-bony defects. MATERIAL AND METHODS: This study was an intra-individual longitudinal test of 12 months' duration conducted using a blinded, split-mouth, placebo-controlled and randomized design. In 22 periodontitis patients, one intra-bony defect was randomly treated with EMD+LLLT, while EMD alone was applied to the contra-lateral defect site. LLLT was used both intra- and post-operatively. Clinical measurements were performed by a blinded periodontist at the time of surgery, in the first week and in the first, second, sixth and 12th month. Visual analogue scale (VAS) scores were recorded for pain assessment. RESULTS: The results have shown that the treatment of intra-bony defects with EMD alone or EMD+LLLT leads to probing depth reduction and attachment-level gain. In addition, EMD+LLLT had resulted in less gingival recession (p<0.05), less swelling (p<0.001) and less VAS scores (p<0.02) compared with EMD alone. CONCLUSION: This study shows that EMD is an effective, safe and predictable biomaterial for periodontal regeneration and LLLT may improve the effects of EMD by reducing post-operative complications.

Parameters Associated With Mandibular Osteoradionecrosis.

The objective of this review is to discuss factors related to the risk of osteoradionecrosis (ORN) and how to minimize the likelihood of this complication. A PubMed search for publications pertaining to ORN within the last 3 years was conducted revealing 44 publications. The bibliographies of these publications were reviewed to identify additional references spanning a longer time period. The incidence of ORN is 5% to 10% with a median latency period of 1 to 2 years or less. The likelihood of ORN depends on a number of factors including primary site and extent of disease, dental status, treatment modality, radiotherapy (RT) dose, volume of mandible included in the planning target volume, RT fractionation schedule and technique, and teeth extractions. The risk of ORN may be reduced by limiting the RT dose and volume of mandible irradiated without increasing the risk of a local-regional recurrence due to a marginal miss.

Nd:YAG laser biostimulation of bisphosphonate-associated necrosis of the jawbone with and without surgical treatment.

Bisphosphonate-associated osteonecrosis was first reported in 2003 and is getting common. Size of lesions, symptoms, and duration of time between starting bisphosphonates and the development of bone necrosis vary. There is currently no effective treatment. We describe our preliminary results with 19 patients affected by bisphosphonate-associated osteonecrosis of the jaws who were treated conventionally with surgical or medical treatment alone or in combination with neodimium: yttrium-aluminium-garnet (Nd:YAG) laser. Clinical variables such as symptoms, presence of pus, and closure of mucosal flaps before and after treatment were evaluated to establish the effect of the laser irradiation. We treated nine patients with laser biostimulation with or without surgical treatment, and in this group there were eight clinical successes and one symptomatic improvement, with a clinical finding better than ones without laser biostimulation (ten patients, five clinical successes, and one symptomatic improvement).

Doxycycline fluorescence-guided Er:YAG laser ablation combined with Nd:YAG/diode laser biostimulation for treating bisphosphonate-related osteonecrosis of the jaw.

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.

Positive 'fistula sign' with intact ear-drum in a patient with eosinophil granuloma of the mastoid.

A case is presented of a positive 'fistula sign' in a patient with an intact ear-drum and no history of previous ear-disease. The cause proved to be an eosinophil granuloma of the temporal bone which responded well to radiotherapy.

[Massive lytic osteodystrophy or Gorham-Stout disease of the craniomaxillofacial area]. / L'ostéodystrophie lytique massive ou maladie de Gorham-Stout à localisation craniomaxillofaciale.

Gorham's disease also called idiopathic massive osteolysis represents a rare affection with unknown aetiology. This disease was described in different bones of the body but its location on maxillo-facial skeleton is particular by the number of cases in the world (only 32), by morphological, functional consequences and the prognosis. The authors describe a new case of male teenager (17 years old) who had a massive osteolysis of mandibular ramus, upper maxillary, malaire, sphenoid, temporal and occipital left bone. The authors give precision about epidemiological data, methods of diagnosis and therapeutic procedures.

[Characteristics of the morphologic changes in an experimental suppurative wound of the perimandibular soft tissues treated by some types of laser radiation]. / Osobennosti morfologicheskikh izmenenii v gnoinoi rane okolocheliustnykh miagkikh tkanei v éksperimente pri lechenii nekotorymi vidami lazernogo izlucheniia.

In rabbits isolated CO2 and He-Ne laser irradiation promotes early granulation of wounds and accelerates epithelialization with more complete restitution of the regenerated skin organ specificity. The best effect was achieved when combined laser irradiation was applied. This was further corroborated by the immunohistochemical investigation.

Platelet-rich plasma, low-level laser therapy, or their combination promotes periodontal regeneration in fenestration defects: a preliminary in vivo study.

BACKGROUND: This study histomorphometrically analyzes the influence of platelet-rich plasma (PRP), low-level laser therapy (LLLT), or their combination on the healing of periodontal fenestration defects (PFDs) in rats. METHODS: PFDs were surgically created in the mandibles of 80 rats. The animals were randomly divided into four groups: 1) C (control) and 2) PRP, defects were filled with blood clot or PRP, respectively; 3) LLLT and 4) PRP/LLLT, defects received laser irradiation, were filled with blood clot or PRP, respectively, and then irradiated again. Animals were euthanized at either 10 or 30 days post-surgery. Percentage of new bone (NB), density of newly formed bone (DNB), new cementum (NC), and extension of remaining defect (ERD) were histomorphometrically evaluated. Data were statistically analyzed (analysis of variance; Tukey test, P <0.05). RESULTS: At 10 days, group PRP presented ERD significantly lower than group C. At 30 days, group PRP presented NB and DNB significantly greater than group C. Groups LLLT, PRP, and PRP/LLLT showed significant NC formation at 30 days, with collagen fibers inserted obliquely or perpendicularly to the root surface. NC formation was not observed in any group C specimen. CONCLUSIONS: LLLT, PRP, or their combination all promoted NC formation with a functional periodontal ligament. The combination PRP/LLLT did not show additional positive effects compared to the use of either therapy alone.

[Multifocal Langerhans cell histiocytosis of bone: indications for radiotherapy]. / Histiocytose langerhansienne osseuse multifocale: place de la radiothérapie. gaundong@yahoo.fr

Langerhans cell histiocytosis is a non-malignant proliferative disease of unknown etiology that can affect one or more organs. This is a rare disease, 1 to 2/100,000, affecting mainly children with a male predominance. The osseous lesions are the most frequent (60 to 90%). There is however no consensus treatment for the management of these sites. We report the cases of two patients successfully treated with radiotherapy after primary chemotherapy, at doses of 15 Gy in ten sessions of 1.5 Gy for one patient and 18 Gy in ten fractions of 1.8 Gy for the other. Single or multifocal bone Langerhans cell histiocytosis without visceral involvement is a benign, self-limiting affection in most cases. Some bone lesions could be treated by radiotherapy alone. But the high variability of doses currently given in the literature does not allow determining the lowest effective dose limiting the risk of secondary neoplasia or impaired growth in children, in whom lower doses of 6 to 8 Gy are recommended. The decision of radiotherapy must be weighed against the risk of the disease. Caution should be the rule in this non-malignant tumour pathology.

Gorham disease of the mandible: radiographic findings and radiotherapy response.

Gorham disease, a rare condition of unknown etiology, is characterized histologically by bone disintegration and endothelial proliferation. We describe serial imaging findings, the treatment course, and radiotherapy response in a patient with pathologically confirmed Gorham disease involving the right mandible. Progressive mandibular resorption was managed initially with multiple surgical resections and reconstruction, followed by external-beam radiotherapy, which was an effective treatment method in this case. The patient's reconstructed mandible is functional and he is asymptomatic. Our literature review provides further insights regarding the clinical, radiologic, and pathologic behavior of this entity and examines the available treatment strategies.

Treatment of recurrent eosinophilic granuloma of the mandible following radiation therapy.

A case of recurrent eosinophilic granuloma of the mandible following radiation therapy is presented. The lesion was curetted and immediately reconstructed with autogenous bone for strength and lower border continuity. Since radiation therapy in low doses is normally curative for this disease, few recurrences have been reported. It is emphasized that polyostotic disease may have a greater propensity for recurrence and that patients presenting with multiple lesions should be followed up closely, regardless of the mode of therapy.