Effects of corticopuncture (CP) and low-level laser therapy (LLLT) on the rate of tooth movement and root resorption in rats using micro-CT evaluation.

The aim of this study was to compare the rate of tooth displacement, quantity of root resorption, and alveolar bone changes in five groups: corticopuncture (CP), low-level laser therapy (LLLT), CP combined with LLLT (CP + LLLT), control (C), and negative control (NC). A total of 60 half-maxilla from 30 male Wistar rats (10 weeks old) were divided randomly into five groups: three (CP, LLLT, and CP + LLLT) test groups with different stimulation for accelerated-tooth-movement (ATM), one control (C) group, and one negative control (NC) group with no tooth movement. Nickel-titanium coil springs with 50 g of force were tied from the upper left and right first molars to micro-implants placed behind the maxillary incisors. For the CP and CP + LLLT groups, two perforations in the palate and one mesially to the molars were performed. For the LLLT and CP + LLLT groups, GaAlAs diode laser was applied every other day for 14 days (810 nm, 100 mW, 15 s). The tooth displacements were measured directly from the rat's mouth and indirectly from microcomputer (micro-CT) tomographic images. Bone responses at the tension and compression sites and root resorption were analyzed from micro-CT images. The resulting alveolar bone responses were evaluated by measuring bone mineral density (BMD), bone volume fraction (BV/TV), and trabecular thickness (TbTh). Root resorption crater volumes were measured on both compression and tension sides of mesial and distal buccal roots. The tooth displacement in the CP + LLLT group was the greatest when measured clinically, followed by the CP, LLLT, and control groups (C and NC), respectively (p <0.05). The tooth movements measured from micro-CT images showed statistically higher displacement in the CP and CP + LLLT groups compared to the LLLT and control groups. The BMD, BV/TV, and TbTh values were lower at the compression side and higher at the tension side for all three test groups compared to the control group. The root resorption crater volume of the distal buccal root was higher in the control group, followed by CP, LLLT, and CP + LLLT, mostly at the compression site. Combining corticopuncture and low-level laser therapy (CP + LLLT) produced more tooth displacement and less root resorption at the compression side. The combined technique also promoted higher alveolar bone formation at the tension side.

Laser and LED phototherapy on midpalatal suture after rapid maxilla expansion: Raman and histological analysis.

The aim of this study was to analyze the effect of laser or LED phototherapy on the acceleration of bone formation at the midpalatal suture after rapid maxilla expansion. Forty-five rats were divided into groups at 7 days (control, expansion, expansion and laser irradiation, and expansion and LED irradiation) and into 14 days (expansion, expansion and laser in the 1st week, expansion and LED in the 1st week, expansion and laser in the 1st and 2nd weeks, expansion and LED in the 1st and 2nd weeks). Laser/LED irradiation occurred every 48 h. Expansion was accomplished with a spatula and maintained with a triple helicoid of 0.020-in stainless steel orthodontic wire. A diode laser (λ780 nm, 70 mW, spot of 0.04 cm2, t = 257 s, SAEF of 18 J/cm2) or a LED (λ850 ± 10 nm, 150 ± 10 mW, spot of 0.5 cm2, t = 120 s, SAEF of 18 J/cm2) was applied in one point in the midpalatal suture immediately behind the upper incisors. Raman spectroscopy and histological analyses of the suture region were carried and data was submitted to statistical analyses (p ≤ 0.05). Raman spectrum analysis demonstrated that irradiation increases hydroxyapatite in the midpalatal suture after expansion. In the histological analysis of various inflammation, there was a higher production of collagen and osteoblastic activity and less osteoclastic activity. The results showed that LED irradiation associated to rapid maxillary expansion improves bone repair and could be an alternative to the use of laser in accelerating bone formation in the midpalatal suture.

Clinical Use of Deferoxamine in Distraction Osteogenesis of Irradiated Bone.

The deleterious effects of radiotherapy, including hypovascularity and hypocellularity, have made distraction of irradiated bones challenging. Animal studies, however, have demonstrated adjunctive measures such as the administration of deferoxamine to significantly improve bone regeneration across irradiated distraction gaps. In this report, the authors demonstrate, for the first time, enhanced bone formation following deferoxamine application in a patient following distraction of a previously irradiated maxilla. Computed tomography imaging of the pterygomaxillary buttress on the side of administration revealed significantly increased bone area and density relative to the contralateral buttress. This is the first presentation of clinical deferoxamine use to promote bone formation following irradiated bone distraction and highlights the promise for this adjunctive measure to make outcomes after distraction of irradiated bone more reliable.

The Effect of a Radiation Positioning Stent (RPS) in the Reduction of Radiation Dosage to the Opposing Jaw and Maintenance of Mouth opening after Radiation Therapy.

The effect of a radiation positioning stent (RPS) in radiation dosage reduction to the opposing jaw and maintenance of mouth opening was audited. 55 Head and Neck cancer patients who received radiotherapy were reviewed. Radiation dosages at similar points in the primary/opposing jaws were measured along with the mouth opening. Results showed a significant reduction in the radiation dosage to the opposing jaw in patients given the RPS. Mouth opening was generally maintained in patients given the RPS (77.7% improvement in mouth opening) compared to patients without RPS. Patients undergoing radiotherapy who had an RPS showed a significant reduction in radiation dosage to the opposing jaw and maintained their mouth opening in the short-term.

The effect of dosage on the efficiency of LLLT in new bone formation at the expanded suture in rats.

The aim of this study was to investigate the effect that dosage has on the efficiency of low-level laser therapy (LLLT) in bone formation in a rat study model. Twenty-eight rats were divided into four groups as only expansion (OE), expansion + low dose (0.15 J) (LD), expansion + medium dose (0.65 J) (MD), and expansion + high dose (198 J) (HD) laser therapy groups. The midpalatal suture was expanded during 5 days. Afterwards, irradiations were started and performed with an 820 nm, continuous wave, Ga-Al-As diode laser (Doris, CTL-1106MX, Warsaw, Poland). At the end of experiment, the premaxillae of the animals were dissected. The sections were transferred into PC environment and analyzed by using Image Analysis program. Number of osteoblasts, osteoclasts, fibroblasts, vessels, transforming growth factor beta (TGF-ß) expression, and new bone formation were evaluated with this program. Amount of expansion did not show any difference among the groups. All parameters except the number of osteoclasts were increased in all lased groups while that parameter was significantly decreased. Vessels, TGF-ß expression, and new bone formation were mostly increased in LD group followed by HD group. Among the lased groups, a significant difference was observed only for the amount of new bone formation, which was between the LD and the MD groups. On the other hand, the difference in this parameter was insignificant between OE and MD groups. Low-level laser therapy with both 5 and 6,300 J/cm(2) doses was found to be significantly effective, while the 20 J/cm(2) dose did not show a significant effect in increasing new bone formation. This finding reveals that the efficiency of the therapy is affected by the dosage.

Assessment of implant stability of patients with and without radiotherapy using resonance frequency analysis.

The purpose of this study was to clinically monitor the stability of dental implants in patients with and without a history of radiotherapy, using resonance frequency analysis over 1 year. The stability of patients with 80 implants was monitored with resonance frequency analysis (Osstell Mentor) over 1 year. Data were assessed with Mann-Whitney U test and correlation analysis. Irradiated maxillary implants showed statistically lower values than the mandibular implants at a significant level (P < .05).

Survival of dental implants in patients with oral cancer treated by surgery and radiotherapy: a retrospective study.

BACKGROUND: The aim of this retrospective study was to evaluate the survival of dental implants placed after ablative surgery, in patients affected by oral cancer treated with or without radiotherapy. METHODS: We collected data for 34 subjects (22 females, 12 males; mean age: 51 ± 19) with malignant oral tumors who had been treated with ablative surgery and received dental implant rehabilitation between 2007 and 2012. Postoperative radiation therapy (less than 50 Gy) was delivered before implant placement in 12 patients. A total of 144 titanium implants were placed, at a minimum interval of 12 months, in irradiated and non-irradiated residual bone. RESULTS: Implant loss was dependent on the position and location of the implants (P = 0.05-0.1). Moreover, implant survival was dependent on whether the patient had received radiotherapy. This result was highly statistically significant (P < 0.01). Whether the implant was loaded is another highly significant (P < 0.01) factor determining survival. We observed significantly better outcomes when the implant was not loaded until at least 6 months after placement. CONCLUSIONS: Although the retrospective design of this study could be affected by selection and information biases, we conclude that a delayed loading protocol will give the best chance of implant osseointegration, stability and, ultimately, effective dental rehabilitation.

Effect of frequent application of low-level laser therapy on corticotomized tooth movement in dogs: a pilot study.

PURPOSE: The purposes of the present study were to evaluate the effects of frequent applications of low-level laser therapy (LLLT) on corticotomy-assisted tooth movement in a beagle dog model and to compare the effects in the mandible and maxilla. MATERIALS AND METHODS: In 4 male beagles, the maxillary and mandibular second premolars were extracted. The third premolars were corticotomized and then protracted from the canines with a continuous force of 200 g. Daily LLLT (using an aluminum gallium indium phosphide [AlGaInP] diode) was applied at the buccal mucosa of the corticotomized premolars on 1 side only. The tooth movement was measured for 8 weeks. Fluorochromes were injected intravenously at the start of the experiment (T0) and after 2 (T2), 4 (T4), and 8 (T8) weeks to evaluate new bone formation on the tension sides. Histomorphometric and immunohistologic evaluations were performed. RESULTS: In the mandible, the movement of the corticotomized premolars in the LLLT plus corticotomy group was less than that in the corticotomy-only group, although the difference was not statistically significant. In the maxilla, no significant differences between the 2 groups were found. Osteoclastic and proliferating cell activities and the amount of new bone formation were greater in the mandibular LLLT plus corticotomy group than in the corticotomy-only group. CONCLUSIONS: The frequent application of LLLT showed no significant effect on the corticotomized tooth movement.

Effect of the laser and light-emitting diode (LED) phototherapy on midpalatal suture bone formation after rapid maxilla expansion: a Raman spectroscopy analysis.

The aim of this study was to analyze the effect of laser or light-emitting diode (LED) phototherapy on the bone formation at the midpalatal suture after rapid maxilla expansion. Twenty young adult male rats were divided into four groups with 8 days of experimental time: group 1, no treatment; group 2, expansion; group 3, expansion and laser irradiation; and group 4, expansion and LED irradiation. In groups 3 and 4, light irradiation was in the first, third, and fifth experimental days. In all groups, the expansion was accomplished with a helicoid 0.020" stainless steel orthodontic spring. A diode laser (λ780 nm, 70 mW, spot of 0.04 cm(2), t = 257 s, spatial average energy fluence (SAEF) of 18 J/cm(2)) or a LED (λ850 nm, 150 mW ± 10 mW, spot of 0.5 cm(2), t = 120 s, SAEF of 18 J/cm(2)) were used. The samples were analyzed by Raman spectroscopy carried out at midpalatal suture and at the cortical area close to the suture. Two Raman shifts were analyzed: ∼ 960 (phosphate hydroxyapatite) and ∼ 1,450 cm(-1) (lipids and protein). Data was submitted to statistical analysis. Significant statistical difference (p ≤ 0.05) was found in the hydroxyapatite (CHA) peaks among the expansion group and the expansion and laser or LED groups. The LED group presented higher mean peak values of CHA. No statistical differences were found between the treated groups as for collagen deposition, although LED also presented higher mean peak values. The results of this study using Raman spectral analysis indicate that laser and LED light irradiation improves deposition of CHA in the midpalatal suture after orthopedic expansion.

Qualitative bone CT as a tool to assess vascularization in irradiated bone: an animal study.

OBJECTIVE: The purpose of this paper was to find a correlation between laser doppler flowmetry (LDF) and the bone mineral density quotient (BMDQ) to evaluate irradiated bone quality preoperatively. MATERIALS AND METHODS: Premolars and molars were extracted from six minipigs. After a three-month healing period, three animals received irradiation at a total dose of 24 Gy. Three months after irradiation, quantitative computed tomography was performed using a calibration bone phantom to determine the 120-position BMDQ in the alveolar bone. A drill template was created to define the exact location for measurement. LDF was then recorded after osteotomy of the residual alveolar ridge. The correlation between the BMDQ and LDF was investigated. RESULTS: There was a linear negative correlation between LDF and BMDQ in non-irradiated bone (r = -0.435, P = 0.001) and less pronounced also in irradiated bone (r = -0.309, P = 0.017). In both non-irradiated and irradiated bone, we found distinct differences between the maxilla and mandible with respect to BMDQ. However, a clear difference in mandibular and maxillary vascularity was only seen in non-irradiated bone. CONCLUSION: In non-irradiated bone, LDF and BMDQ were inversely correlated. In irradiated bone, the BMDQ alone is not an adequate preoperative tool for evaluating bone quality because it was not correlated with bone perfusion.

Light-emitting diode photobiomodulation: effect on bone formation in orthopedically expanded suture in rats--early bone changes.

The aim of this experimental study was to evaluate histomorphometrically the effects of light-emitting diode (LED) photobiomodulation therapy (LPT) on bone formation in response to expansion of the interpremaxillary suture in rats. Twenty male, 50- to 60-day-old Wistar rats were divided into two equal groups (control and experimental). Both groups were subjected to expansion for 5 days, and 50 cN of force was applied to the maxillary incisors with helical spring. An OsseoPulse® LED device, 618-nm wavelength and 20-mW/cm(2) output power irradiation, was applied to the interpremaxillary suture for 10 days. Bone formation in the sutural area was histomorphometrically evaluated, including the amount of new bone formation (in square micrometers), number of osteoblasts, number of osteoclasts, and number of vessels. Mann-Whitney U test was used for statistical evaluation at p < 0.025 level. Significant differences were found between groups for all investigated histomorphometric parameters. New bone formation area (p = 0.024, 1.48-fold), number of osteoblasts (p < 0.001, 1.59-fold), number of osteoclasts (p = 0.004, 1.43-fold), and number of vessels (p = 0.007, 1.67-fold) showed higher values in the experimental group than the control. Bone histomorphometric measurements revealed that bone architecture in the LPT group was improved. The application of LPT can stimulate bone formation in the orthopedically expanded interpremaxillary suture during expansion and the early phase of the retention periods.

Comparison of adult and child radiation equivalent doses from 2 dental cone-beam computed tomography units.

INTRODUCTION: With the advent of cone-beam computed tomography (CBCT) scans, there has been a transition toward these scans' replacing traditional radiographs for orthodontic diagnosis and treatment planning. Children represent a significant proportion of orthodontic patients. Similar CBCT exposure settings are predicted to result in higher equivalent doses to the head and neck organs in children than in adults. The purpose of this study was to measure the difference in equivalent organ doses from different scanners under similar settings in children compared with adults. METHODS: Two phantom heads were used, representing a 33-year-old woman and a 5-year-old boy. Optically stimulated dosimeters were placed at 8 key head and neck organs, and equivalent doses to these organs were calculated after scanning. The manufacturers' predefined exposure settings were used. RESULTS: One scanner had a pediatric preset option; the other did not. Scanning the child's phantom head with the adult settings resulted in significantly higher equivalent radiation doses to children compared with adults, ranging from a 117% average ratio of equivalent dose to 341%. Readings at the cervical spine level were decreased significantly, down to 30% of the adult equivalent dose. When the pediatric preset was used for the scans, there was a decrease in the ratio of equivalent dose to the child mandible and thyroid. CONCLUSIONS: CBCT scans with adult settings on both phantom heads resulted in higher radiation doses to the head and neck organs in the child compared with the adult. In practice, this might result in excessive radiation to children scanned with default adult settings. Collimation should be used when possible to reduce the radiation dose to the patient. While CBCT scans offer a valuable tool, use of CBCT scans should be justified on a specific case-by-case basis.

Effect of radiation dose on the prevalence of apical periodontitis--a dosimetric analysis.

OBJECTIVES: The objective of this study is to analyse the effect of the radiation dose of oral radiotherapy for cancer on the presence of apical periodontitis in patients without dental pre-screening or specific preventive measures. MATERIALS AND METHODS: All selected patients had been diagnosed with cancer in the head and neck region and presented in the dental clinic post radiotherapy with side effects (mainly radiation caries). The panoramic radiographs of these patients were examined for several parameters, including tooth decay and apical periodontitis. The total radiation dose per tooth was determined. RESULTS: A total of 36 patient files were included, which accounted for 628 teeth to be scored. Tooth decay was present in 88.2% of teeth. Radiographic signs of apical periodontitis were found in 9.1% of the teeth. Teeth with apical periodontitis had significantly more caries present. The radiation dose was significantly higher for teeth with apical periodontitis (37.2 vs. 24.9 Gy). Binary logistic regression found the radiation dose to be the only explanatory variable in the presence of apical periodontitis. CONCLUSIONS: This study found that in zones with higher radiation dose, inflammation of the jawbone due to bacterial infection of the root canal is more likely to develop. This is probably due to bone changes post radiotherapy. CLINICAL RELEVANCE: An increase of this prevalance of apical periodontitis in irradiated bone found in this study needs to be taken into account in the dental evaluation before the start of radiotherapy.

Effect of a low-level laser on bone regeneration after rapid maxillary expansion.

INTRODUCTION: In this study, we evaluated the effects of a low-level laser on bone regeneration in rapid maxillary expansion procedures. METHODS: Twenty-seven children, aged 8 to 12 years, took part in the experiment, with a mean age of 10.2 years, divided into 2 groups: the laser group (n = 14), in which rapid maxillary expansion was performed in conjunction with laser use, and the no-laser group (n = 13), with rapid maxillary expansion only. The activation protocol of the expansion screw was 1 full turn on the first day and a half turn daily until achieving overcorrection. The laser type used was a laser diode (TWIN Laser; MMOptics, São Carlos, Brazil), according to the following protocol: 780 nm wavelength, 40 mW power, and 10 J/cm(2) density at 10 points located around the midpalatal suture. The application stages were 1 (days 1-5 of activation), 2 (at screw locking, on 3 consecutive days), 3, 4, and 5 (7, 14, and 21 days after stage 2). Occlusal radiographs of the maxilla were taken with the aid of an aluminum scale ruler as a densitometry reference at different times: T1 (initial), T2 (day of locking), T3 (3-5 days after T2), T4 (30 days after T3), and T5 (60 days after T4). The radiographs were digitized and submitted to imaging software (Image Tool; UTHSCSA, San Antonio, Tex) to measure the optic density of the previously selected areas. To perform the statistical test, analysis of covariance was used, with the time for the evaluated stage as the covariable. In all tests, a significance level of 5% (P <0.05) was adopted. RESULTS: From the evaluation of bone density, the results showed that the laser improved the opening of the midpalatal suture and accelerated the bone regeneration process. CONCLUSIONS: The low-level laser, associated with rapid maxillary expansion, provided efficient opening of the midpalatal suture and influenced the bone regeneration process of the suture, accelerating healing.

Efficacy of low-intensity laser therapy in reducing treatment time and orthodontic pain: a clinical investigation.

INTRODUCTION: The long duration of orthodontic treatment is a major concern for patients. A noninvasive method of accelerating tooth movement in a physiologic manner is needed. The aim of this study was to evaluate of the efficacy of low-intensity laser therapy in reducing orthodontic treatment duration and pain. METHODS: Twenty patients requiring extraction of first premolars were selected for this study. We used a randomly assigned incomplete block split-mouth design. Individual canine retraction by a nickel-titanium closed-coil spring was studied. The experimental side received infrared radiation from a semiconductor (aluminium gallium arsenide) diode laser with a wavelength of 810 nm. The laser regimen was applied on days 0, 3, 7, and 14 in the first month, and thereafter on every 15th day until complete canine retraction was achieved on the experimental side. Tooth movement was measured on progress models. Each patient's pain response was ranked according to a visual analog scale. RESULTS: An average increase of 30% in the rate of tooth movement was observed with the low-intensity laser therapy. Pain scores on the experimental sides were significantly lower compared with the control sides. CONCLUSIONS: Low-intensity laser therapy is a good option to reduce treatment duration and pain.

Rehabilitation of irradiated patients with modified and conventional sandblasted acid-etched implants: preliminary results of a split-mouth study.

PURPOSE: The aim of this study was to evaluate the success rate of chemically modified and conventional sandblasted acid-etched surface (SLA) titanium implants in irradiated oral squamous cell carcinoma patients. MATERIAL AND METHODS: Twenty patients with a mean age of 61.1 years were treated with dental implants after ablative surgery and radio-chemotherapy of oral cancer. All patients were non-smokers. The placement of SLA and modSLA implants was performed bilaterally according to a split-mouth design. All 102 implants (50 SLA, 52 modSLA) placed showed an unloaded healing time of 6 weeks in the mandible and 10 weeks in the maxilla. Mean crestal bone changes using standardized orthopantomographies and clinical parameters like pocket depths, mPII and mBI were evaluated. RESULTS: Of 102 implants, 55 implants (27 SLA implants, 28 modSLA) were located in the maxilla and 47 implants (23 SLA, 24 modSLA) in the mandible. The average observation period was 14.4 months. The amount of bone loss at the implant shoulder of SLA implants was 0.4 mm mesial and 0.4 mm distal. The modSLA implants displayed a bone loss of mesial 0.3 mm and distal 0.3 mm. Two SLA implants were lost resulting in a success rate of 96%. The success rate of modSLA implants was 100%. CONCLUSION: Regarding the data found in this investigation, we can conclude that implants with chemically modified and conventional SLA titanium surface show high success rates in irradiated patients. SLA implants with or without a chemically modified surface regardless of the location can be restored with a high predictability of success at least in the short time range observed.

Radiation-induced malignant fibrous histiocytoma of the maxilla.

Malignant fibrous histiocytoma (MFH) originates from primitive mesenchymal cells and has the capacity for dual histiocytic and fibroblastic differentiation. We report on an MFH of the left maxilla that developed in a 79-year old woman 20 years after surgery and radiation for squamous cell carcinoma (SCC). Postoperative radiotherapy with 70 Gy was administered for a primary neoplasm of SCC of the left maxilla to a localized field through two lateral ports. This secondary neoplasm arose at the site of tumor resection (partial maxillectomy) within the irradiated field, and was resected. The development of sarcomas is a recognized complication of radiation therapy. The final diagnosis after the operation was MFH. The patient died of tumor recurrence at the skull base and within the cranium, 19 months after the operation. Radiation-induced sarcoma is well known, but radiation-induced MFH is relatively rare in the head and neck region. The details of this case are presented with a review of literature.

Survival of turned and roughened dental implants in irradiated head and neck cancer patients: a retrospective analysis.

STATEMENT OF PROBLEM: Dental implants placed into previously radiated fields in survivors of head and neck cancer can demonstrate survival rates that are less than optimal. Understanding this behavior may assist with treatment planning in accordance with expected survival rates in these patients. PURPOSE: The purpose of this study was to compare the survival of implants with turned and roughened surfaces placed in patients who had previously received head and neck radiation, and to identify factors associated with implant failure. MATERIAL AND METHODS: The records of 48 patients who had prior head and neck radiation and had 271 dental implants placed between May 1987 and July 2008 were examined. All of the implants were placed in a previously irradiated field dosed to at least 50 Gy. Implant survival was estimated using the Kaplan-Meier method and univariate Cox models with robust standard errors were fitted to evaluate the association between patient/implant factors and implant failure. RESULTS: There were 62 implants placed in the maxilla (32 roughened, 30 turned) and 209 implants (107 roughened, 102 turned) placed in the mandible. The 5-year implant survival rate for implants placed in the maxilla was 72.6% for turned implants and 87.5% for roughened implants. For implants placed in the mandible, the 5-year survival rate was 91.7% for turned implants and 100% for roughened implants. Among implants with a turned surface, implants were more likely to fail if they were placed in the maxilla (P=.008) and if the diameter was ≤3.75 mm (P=.002). CONCLUSIONS: Implants with turned surfaces were 2.9 times more likely to fail compared to the roughened dental implants, although the difference did not reach statistical significance. For implants with turned surfaces, there was a tendency for implants in the maxilla to fail more frequently compared to the mandible. Implants with turned surfaces had a higher likelihood of failure in the posterior region than in the anterior region. For implants with roughened surface there was no significant association between implant survival and location of the implant, type of bone, or length or diameter of the implant.

A rare acantholytic variant of squamous cell carcinoma of the maxilla: A case report and literature review.

RATIONALE: Acantholytic squamous cell carcinoma (ASCC) is an uncommon histopathologic variant of squamous cell carcinoma (SCC), which is the most common malignancy of the oral cavity. Though ASCC showed poor prognosis, the exact diagnosis is challenging. PATIENTS CONCERNS: A 59-year-old female patient with 1-month long symptoms of pain and burning sensation in the right maxilla. DIAGNOSES: Incisional biopsy in the maxilla established the pathologic diagnosis of SCC. INTERVENTION: The patient underwent mass resection with near total maxillectomy. OUTCOMES: The final diagnosis through the microscopic examination was ASCC. Palliative chemotherapy was done to relive the symptoms after the recurrence, however, the patient died of the disease at 8 months after her initial presentation. LESSONS: Special attention should be paid to this variant of SCC because most patients with ASCC have a very poor prognosis.

Radiation-Induced Sarcoma on 18F-FDG PET/CT After Treatment of Gorham-Stout Disease of the Maxilla.

Gorham-Stout disease is a rare disorder characterized by proliferation of lymphatic and vascular channels within bone resulting in osteolysis. A 53-year-old man with Gorham-Stout disease involving the left maxilla underwent previous treatment including radiation therapy and intralesional chemotherapeutic injections. He later presented with anemia, facial pain, weight loss, and nasal cavity hemorrhage. CT imaging demonstrated a mass centered within the right maxillary sinus with locoregional involvement. PET/CT showed prominent FDG activity involving the mass centered in the right maxillary sinus with low-grade avidity involving the contralateral maxilla in regions of treated Gorham-Stout disease. Biopsy of the mass confirmed radiation-induced sarcoma.