Medication-related osteonecrosis of the jaw after dental clearance: Prevalence in an oncology center.

Objective: Medication-related osteonecrosis of the jaw (MRONJ), a complication of bisphosphonate therapy, has significant morbidity. This study aimed to determine the prevalence of MRONJ and compare its risks among patients who received antiresorptive or antiangiogenic therapy in King Fahad Medical City. Study design: In this retrospective study, the sample comprised data of all patients referred for dental treatment before antiresorptive and antiangiogenic therapy between 2008 and 2018. All patients were classified as at risk or having stage 0, stage 1, stage 2, or stage 3 MRONJ. Results: The sample comprised 622 patients, including 358 (249 IV route, 34 oral route, and 75 subcutaneous route) who fulfilled the inclusion criteria and 25 in stage ≥ 0. Greater risk was observed in the intravenous group (8.82%) than in the oral and subcutaneous groups (2.94% and 2.67%, respectively). The overall prevalence rate was 6%. Patients with no history of dentoalveolar surgery had an MRONJ rate of 1.03%, whereas patients who underwent dentoalveolar surgery > 3 weeks before a lower MRONJ rate of 0.96%. Patients who underwent dentoalveolar surgery < 3 weeks before starting medication, and those who underwent surgery after starting the medication had higher MRONJ rates (21.42%, and 35.85%, respectively). The risk of spontaneously developing MRONJ was low. Conclusion: Risk of developing MRONJ was found to be higher when dentoalveolar procedures performed within 3 week before starting antiresorptive medications.

Myofibroblastoma of the mandible in a 3-year-old child.

UNLABELLED: Myofibroblastoma is a rare benign tumor of the head and neck region, which is characterized by a large, rapidly growing, and destructive mass. A 3-year-old boy presented with an 8-week history of a rapidly growing swelling of the right mandible. Examination revealed a firm 13-cm mass occupying the entire right body and ramus of the mandible. The clinical and radiological features were suggestive of a sarcoma. An initial biopsy taken in the referring hospital was inconclusive, and the second biopsy showed a myofibroblastic neoplasm consistent with a desmoplastic fibroma. Progressive tumor growth necessitated a tracheostomy. Right hemimandibulectomy was performed, and the defect was reconstructed with free microvascular fibula flap. Histopathology and immunocytochemistry revealed a myofibroblastoma. This entity differs from other myofibroblasts and fibroblast tumors such as inflammatory myofibroblastic tumor (IMT), myofibroma, and desmoplastic fibroma. The child has been followed up for 2 years. CONCLUSION: Differentiation between myofibroblasts and fibroblastic tumors as well as some malignancies can be challenging. Myofibroblastoma can behave as a malignant neoplasm, and the clinical distinction of this entity lies primarily in its recognition as a benign neoplasm.