Osteomyelitis of the jaws: A retrospective series of 40 patients.

INTRODUCTION: The caseload of jaw osteomyelitis seem to have decreased considerably over the last fifty years thanks to the progress of oral hygiene, the appearance and the use of antibiotics, and early screening. 'Limited osteitis' remains frequent in general practice (alveolitis after dental extraction), but osteomyelitis is much rarer as evidenced by the lack of current literature and the low number of reported patients in the published series. The aim of this study was to analyze retrospectively all the cases of maxillo-mandibular osteomyelitis treated in a large academic department of Stomatology and Maxillofacial Surgery over a period of 6 years and to compare the results to data from the literature. MATERIAL AND METHOD: All patients diagnosed with maxillo-mandibular osteomyelitis by one of the staff surgeons between January 2009 and December 2015 was included. An epidemiological record (sex, age, ethnic background, risk factors, clinical, origin of disease, imaging and biology, treatments and progression) were collected for each patient. Osteomyelitis cases were classified according to the Zurich Classification System. Results were compared to data from the literature. RESULTS: Forty patients were retained. Three presented acute osteomyelitis, 26 secondary chronic osteomyelitis and 11 a primary chronic osteomyelitis. Osteomyelitis affected predominantly the mandible (87%). Dental origin was found in 90% of cases. Nine patients (22.5%) recovered and 29 (90%) were clinically improved. Ten of the 11 patients with primary chronic osteomyelitis were improved. DISCUSSION: This cohort study is one of the largest series currently available and presents results comparable to those of the literature of the last 25 years.

Early dental epithelial transcription factors distinguish ameloblastoma from keratocystic odontogenic tumor.

The aim of the study was to characterize the molecular relationship between ameloblastoma and keratocystic odontogenic tumor (KCOT) by means of a genome-wide expression analysis. Total RNA from 27 fresh tumor samples of 15 solid/multicystic intraosseous ameloblastomas and 12 sporadic KCOTs was hybridized on Affymetrix whole genome arrays. Hierarchical clustering separated ameloblastomas and KCOTs into 2 distinct groups. The gene set enrichment analysis based on 303 dental genes showed a similar separation of ameloblastomas and KCOTs. Early dental epithelial markers PITX2, MSX2, DLX2, RUNX1, and ISL1 were differentially overexpressed in ameloblastoma, indicating its dental identity. Also, PTHLH, a hormone involved in tooth eruption and invasive growth, was one of the most differentially upregulated genes in ameloblastoma. The most differentially overexpressed genes in KCOT were squamous epithelial differentiation markers SPRR1A, KRTDAP, and KRT4, as well as DSG1, a component of desmosomal cell-cell junctions. Additonally, the epithelial stem cell marker SOX2 was significantly upregulated in KCOT when compared with ameloblastoma. Taken together, the gene expression profile of ameloblastoma reflects differentiation from dental lamina toward the cap/bell stage of tooth development, as indicated by dental epithelium-specific transcription factors. In contrast, gene expression of KCOT indicates differentiation toward keratinocytes.

[Surgical devices]. / Dispositif chirurgical.

Surgical devices mean the whole surgical department i.e., working space, useful tools for its good process and respect of its rules for the users. That working space obeys to strict rules relating to its conception, its building or the behaviour of people in that space. Working tools (furniture, material and surgical tools) have to respect requirements of the surgical team and the patients. The local rules respect will warrant optimal quality and efficiency. We will successively present architectural imperative rules and will detail arrangement of the surgeons preparing room and the real surgical space.

[Jaw osteonecrosis induced by oral biphosphonates: 12 cases]. / Ostéonécroses des mâchoires induites par les biphosphonates oraux: 12 cas.

INTRODUCTION: The incidence of jaw osteonecrosis induced by oral or intravenous biphosphonates (BP) has been increasing. Two hundred cases of jaw osteonecrosis induced by oral BP (JONOBP) were reported, with an incidence of 4 % and a prevalence of 1/952. We report 12 cases of JONOBP observed from January 2007 to January 2009. MATERIAL AND METHODS: A pluridisciplinary committee including odontologists, stomatologists, and maxillofacial surgeons from two Paris hospitals was asked to manage patients treated by BP. Twelve patients presenting with JONOBP were included from January 2007 to January 2009. For each of these patients, age, sex, associated co-morbidities, any triggering factor, previous or current combination treatments, the type of BP used, its initial indication, dosage, delay before onset of JONOBP, and delay between first clinical signs and diagnosis were studied. JONOBP localization, stage (American Association of Oral and Maxillofacial Surgeons [AAOMS] classification), clinical and radiological signs, anatomopathological and bacteriological examinations (when performed) were documented. The treatment and evolution were described. RESULTS: Ten women and two men, mean age 65 years (36 to 82 years), were included. BP were taken orally once a week or daily. The mean duration of BP exposure was 39.6±2,4 months (19 to 58 months). The indication for BP was prevention or treatment of osteoporosis in 11 cases and breast with bone metastases in one case. Tooth extraction was the triggering factor in nine cases. The premolar and molar mandibular area was the most often affected. Corticosteroid therapy was combined to BP in half of the cases. There were no clinical, radiological, and histological specific signs. BP treatment was stopped in all patients. Nine patients underwent surgery. Evolution was favorable for nine patients. Six patients were cured, on average 3.8 months after beginning management (one to nine months). Three male patients improved. Three female patients were lost to follow-up. Alendronate was the most frequently implicated (six cases) and risedronate (five cases). Five patients presented with diagnosed or suspected auto-immune conditions. DISCUSSION: The duration of exposure to BP was superior to three years in most cases. The triggering factor was tooth extraction. The mean diagnostic delay was five months. There were more stage 2 and 3 patients, according to the AAOMS classification. They were the most frequent, probably because of the higher number of co-morbidities, especially corticosteroid intake. Patient management complied to Afssaps and AAOMS recommendations. The evolution was favorable for all managed patients.

[Langerhans cell histiocytosis]. / Histiocytose langerhansienne.

Langerhans cell histiocytosis (ex histiocytosis X) is usually present in children. It is a clonal proliferation of non-functional Langerhans's cells. Histological aspects are variable. The diagnosis is made in immunolabeling by anti-CD1a. Clinical presentations are variable, depending on their extension. Three syndromes are actually the same pathogenic process: eosinophilic granuloma (single or multiple osseous localizations), Hand-Schüller-Christian disease (chronic form with bone and visceral dissemination) and Abt-Letterer-Siwe disease (disseminated and acute malignant presentation).

[Desmoplastic fibroma]. / Fibrome desmoïde.

Desmoplastic fibroma is a rare benign intraosseous neoplasms. They can affect the jaw. Posterior mandibular bone involvement is the most frequent localization. They are locally aggressive and recurrence is frequent. Radioclinical signs are not specific and the histological diagnosis may be difficult. Extended surgical removal is the recommended treatment.

[Maxillary and mandibular carcinogenesis: research and prospects]. / Tumorogenèse des maxillaires. Recherche et perspective.

Development and growth of odontogenic tumours depend on impairment of numerous genes and molecules. In recent years, most of the genes involved in dental development were identified. This produced a new basis for the study of oral pathology and maxillofacial carcinogenesis. A better understanding of these molecular phenomena should allow to better determine the evolution of such lesions. Research breakthroughs should facilitate the development of new molecular and genetic therapeutic perspectives.

Mandibular bone alterations of ovariectomized rats under vitamin D insufficiency.

UNLABELLED: Experimental osteoporosis was studied in mandible bone by means of ovariectomy and vitamin D insufficiency. METHODS: 42 female Wistar rats were divided into the following four groups: (1) ovariectomized rats maintained in 12h day-night light conditions (ov-l), (2) ovariectomized rats maintained in 24h dark light conditions (ov-ob), (3) sham-operated rats maintained in 12h day-night light conditions (ch-l) and (4) sham-operated rats maintained in 24 h dark conditions (ch-ob). 12 weeks later the animals were sacrificed, the mandibles were excised, cleaned and weighed, the right side of the mandibles were histologically examined and the left side of the mandibles were prepared for mineral phase analysis by X-ray diffraction. Immunohistochemical analysis was performed to detect apoptotic cells by anti-PARP p85 antibody. RESULTS: In group 2, the weight of mandibles significantly decreased. Chondroid areas were observed in ovariectomized groups and polarized light observation validated the collagen distribution disturbance in these groups (groups 1 and 2). Apoptotic osteoblasts were localized in groups 1, 2 and 4. They were numerous in group 2. The mineral phase analysis did not find differences between the groups. CONCLUSION: This study validates a new model of osteoporotic animal associating estrogens deficiency and vitamin D insufficiency where matrix synthesis and osteoblast biology are altered, but not biomineralization.

Aggressive maxillary squamous odontogenic tumour in a child: histological dilemma and adaptative surgical behaviour.

A case of a maxillary osteolytic tumour is described in a 9-year-old boy. Histological analysis led to an initial diagnosis of benign squamous odontogenic tumour, although this was not straightforward due to swelling, and cellular pseudo-malignant and non-specific signs. Because of the young age of the patient, a local surgical tumourectomy was first chosen with respect to the mixed dentition. For 10 months, the evolution was satisfactory. Then, a very aggressive tumoural recurrence with lip and palate infiltration led to doubts as to the histologic nature of the tumour. Efficient collaboration between several specialized pathologist teams finally confirmed that this was a squamous odontogenic tumour but in a very aggressive form. Radical surgery was then carried out.

[Giant-cell tumors: three recurrent cases in young patients]. / Tumeurs à cellules géantes: à propos de trois cas récidivants chez des sujets jeunes.

INTRODUCTION: True giant-cell tumor is a rare jaw osteolytic benign tumor belonging to the larger family of giant-cell tumors. It is particular because of the risk of recurrence and potential metastatic spread. OBSERVATION: Since 1973, we have managed four cases of true giant-cell tumors in our unit. The three cases reported here concerned young patients who developed recurrence after tumorectomy-curettage. DISCUSSION: Based on a literature review we defined this entity among the other giant-cell tumors. We emphasize the importance of early definitive diagnosis based on rigorous clinical and radiological confrontations. Because of its benign nature, the most conservative surgical treatment (tumorectomy-curettage) is generally proposed for the young patient. We noted however that in the three cases presented here, more radical surgical treatment with an enlarged tumorectomy removing the adjacent bone was advisable because of the high risk of recurrence and metastasis.

[Mandibular fractures: epidemiology, therapeutic management, and complications in a series of 563 cases]. / Fractures de la mandibule: épidémiologie, prise en charge thérapeutique et complications d'une série de 563 cas.

INTRODUCTION: The Paris urban and suburban area (Ile-de-France) has the leading regional population in France. This population has specific characteristics. This study concerns mandibular fractures. MATERIAL AND METHOD: A retrospective epidemiologic, clinical, radiographical and therapeutic analysis is conducted with a series of 563 patients with mandibular fracture treated at the Pitié-Salpêtrière University Hospital, in Paris, from 1998 to 2000. RESULTS: Mandibular fracture was generally observed in young men, 40% of whom had poor oral hygiene. The brawls were the dominant etiology (57%) followed by road accidents (12%). The most frequent unifocal fractures were condylar fractures (32%) and angle fractures (32%). The most frequent bifocal mandibular fracture associated angle and symphysis fractures (32%). Osteosynthesis was performed for 73% of patients, including 30% with associated maxillary locking. Complications occurred in 4.8% of the studied cases. DISCUSSION: Despite the increase in traffic, the incidence of road injuries has declined. The first leading and progressing cause of mandibular fractures is brawls. Surgical treatment generally consists in fixation of the bone fracture. Maxillary locking is still associated in 33% of patients, but with a 50% shorter duration. Complications routinely arise because of poor bad oral hygiene.

[Double-barrel fibular free flap for mandibular reconstruction: beneficial alternative for dental implanted rehabilitation (5 cases)]. / Lambeau libre de péroné en double barre: intérêt du montage dans les reconstructions mandibulaires pour une réhabilitation prothétique sur implants (5 cas).

INTRODUCTION: As major loss of mandibular bone stock requires a vascularized transfer, fibula free flap reconstruction is considered to be the best free flap for its length and reliability. Its main advantage is to accept dental implants. Single or double-barrel reconstruction can be performed. Double-barrel reconstruction is generally preferred because the bone superposition offers enough height to allow dental implants. MATERIAL AND METHODS: We reviewed five selected cases of double-barrel fibula free flap adaptive mandibular reconstruction performed among a series of 11 oral rehabilitations with planned dental implants, focusing on the technical aspects. RESULTS: Today, dental rehabilitation has been achieved in three double-barrel fibula flaps. Details are reported concerning the implant step. DISCUSSION: In this perspective, we discuss the choice of the reconstructive technique in order to obtain adequate bone height. Early in our experience and for different reasons discussed in the text, we used a single barrel fibula flap. This technique provided sufficient height in some cases, but had to be completed by bone grafts in few patients. Our experience illustrates the usefulness of the double barrel technique which provide definitive bone height sufficient for dental implants. The double-barreled technique should be considered as the best solution.

[Retrospective study of two years of surgery for temporomandibular joint pain dysfunction syndrome]. / Etude rétrospective de deux années de chirurgie du Sadam.

BACKGROUND: Assessment of temporomandibular joint (TMJ) surgery is a controversial topic. We analyzed our long-term surgical results in a set of patients who underwent TMJ surgery in our unit from January 1995 through December 1996. We used a simple methodology based on 4 criteria: pain, mouth opening, type of feeding and patient satisfaction. MATERIAL AND METHODS: We reviewed 21 operated patients who had been managed by an orthodontist after surgery. The post-surgical follow-up was 4 years. Patient age at surgery ranged from 14 to 51 years; the sex ratio was 1/9 M/F. Seventeen patients suffered a closed-lock, 2 had fibrous ankylosis of the disc. Fifteen patients underwent bilateral TMJ arthrotomy with joint fixation and, very often, mandibulo-condylar-plasty to counteract the bony compression inside the joint. We rated outcome as "very good" if four factors were found: resolution or improvement of pain, more than 40 mm post-surgery mouth opening or at least 10 mm improvement for patients with less than 40 mm post-surgical mouth opening, normal feeding, subjective satisfaction rated as very or quite good. Outcome was thus rated as very good (4 factors), quite good (3 factors), good (2 factors), poor (1 factor), failure (0 factors). RESULTS: Resolution of pain was achieved in 55% of the patients with an improvement in the others. All patients recovered normal feeding. Mouth opening remained limited for two patients. Subjective patient satisfaction was very or quite good in 80% of the cases. Outcome was rated very good in 9 patients, quite good in 7, and good in 5. There were no patients with poor outcome or failure. Analysis of the good outcome group showed that 3 had experience a post-surgery trauma, one had not complied with rehabilitation therapy, and one suffered from undiagnosed rheumatoid polyarthritis. CONCLUSION: According to the literature, TMJ surgery is an effective means of treating pain and reducing dysfunction. We obtained good and stable outcome in patients who participated in our postoperative follow-up. The TMJ is a fragile joint particularly susceptible to trauma.

Pure ectodermal dysplasia: retrospective study of 16 cases and literature review.

OBJECTIVE: To review the possible craniomaxillofacial deformative consequences associated with ectodermal dysplasias and embryonic malformations, which include dental ageneses. SETTING: Oral and Maxillofacial Surgery Department, University Hospital, Lille, France. PATIENTS: Sixteen patients (seven boys and nine girls, aged 4 to 34 years) with pure ectodermal dysplasia (no ectodermal dysplasia syndromes). INTERVENTIONS: All patients had a clinical examination. Seven (two boys and five girls, aged 4 to 25 years) had undergone plaster casts and radiographic and Delaire's cephalometric studies before being treated. MAIN OUTCOME MEASURES: All patients had tooth ageneses (from hypodontia to anodontia), associated with cutaneous dyshidrosis and hair and nail dystrophy. Most of them had a short face, with an unusual facial concavity, a maxillary retrusion, and a relative mandibular protrusion. MANAGEMENT RESULTS AND DISCUSSION: Depending on their ages and their orthopedic abnormalities, patients underwent either dental or prosthodontic, orthodontic, orthopedic, orthognathic, or implant treatment. So as not to interfere with the growth pattern, we preferred to reserve implant and orthognathic surgery for full-grown cases. CONCLUSIONS: Oral and maxillofacial surgeons must undertake a comprehensive approach to these patients to improve their dental, masticatory, growing, and orthognathic conditions.