Medication-related osteonecrosis of the lower jaw without osteolysis on computed tomography images.

INTRODUCTION: Surgery is the standard treatment for medication-related osteonecrosis of the jaw (MRONJ). This study reviewed patients with mandibular MRONJ who underwent surgical treatment, and in particular the characteristics of non-osteolytic MRONJ with no evidence of osteolysis on CT were described. MATERIALS AND METHODS: We conducted a retrospective study of patients with mandibular MRONJ who underwent surgery between January 2016 and September 2022. Various clinical and imaging factors regarding treatment outcomes were investigated and analyzed. Additionally, the disease course of non-osteolytic MRONJ was examined in detail. RESULTS: This study included 55 patients (66 surgeries) with a mean age of 74.7. The primary disease was osteoporosis (24 patients) and malignancy (31 patients); the type of antiresorptive agent was bisphosphonate (BP) in 21 patients and denosumab (DMB) in 26. BP was initially administered; however, it was changed to DMB in eight patients. Preoperatively, the cumulative cure rates for all 66 surgeries were 72.8% at 1 year and 77.3% at 2 years. Cure rates were significantly lower in patients with malignancy, those without osteolysis, and those who underwent sequestrum removal or marginal mandibulectomy than those with osteoporosis, osteolysis, and segmental mandibulectomy. Non-osteolytic MRONJ was observed in eight patients, all with malignancy and receiving high-dose DMB. Only two patients were cured after the initial surgery, and most patients ultimately underwent segmental mandibulectomy. CONCLUSIONS: Surgical treatment yielded good treatment outcomes in most patients with mandibular MRONJ; however, the cure rate was lower in patients with malignancy who showed no osteolysis on CT images.

Outcome of healing after dental implant placement in patients with cancer on high-dose antiresorptive medications: a prospective feasibility study.

PURPOSE: Implant placement in patients with cancer receiving high-dose antiresorptive medication (HDAR) is considered contraindicated. This prospective, feasibility study tested the hypothesis that dental implants can be placed in such patients by applying a staged implant placement protocol with submerged healing. METHODS: Three groups of patients on HDAR were included as follows: group 1: patients who underwent tooth extraction, without the development of medication-related osteonecrosis of the jaws (MRONJ); group 2: patients with surgically treated MRONJ who had demonstrated clinical healing for at least 3 months; group 3: patients with established MRONJ who was planned for surgical resection and simultaneous implant placement. RESULTS: A total of 49 implants were placed in 27 patients (group 1: 12, group 2: 7 and group 3: 8). HDAR included bisphosphonates and denosumab. The mean HDAR time was 25 months (SD: ± 18.4, range 3-68 months). An abutment operation was performed 4 months following the implant placement (SD: ± 1.9, range 3-14 months). All patients healed uneventfully. CONCLUSIONS: This study demonstrated that it is feasible to insert dental implants and perform an abutment surgery in patients with cancer on HDAR, without the development of MRONJ. CLINICALTRIALS: gov Identifier: NCT04741906.

Incidence and risk factors for medication-related osteonecrosis after tooth extraction in cancer patients-A systematic review.

OBJECTIVES: Antiresorptive medication has been reported to be associated with medication-related osteonecrosis of the jaw (MRONJ). This systematic review aims at investigating the incidence of and risk factors for MRONJ after tooth extractions in cancer patients treated with high-dose bisphosphonate and denosumab (BP and DS). MATERIAL AND METHODS: The protocol followed the PRISMA statement list and was registered in PROSPERO. Searches were performed for literature published up to April 2021 in the electronic databases PubMed, Embase, Web of Science, and CINAHL and then supplemented by manual research. RESULTS: The search process resulted in 771 identified articles, of which seven studies fitted the population, intervention, comparison, and outcome framework. All were observational studies and four had control groups. A total of 550 patients treated with BP and DS were identified of whom 271 had received tooth extractions after medication onset. Due to significant heterogenicity in the collected data, only a qualitative analysis was performed. The MRONJ incidence after tooth extractions varied between 11% and 50% at the patient level. MRONJ occurred up to 3 years after the tooth extraction. Teeth affected by inflammation before the extraction and additional osteotomy during the surgical procedure were identified as risk factors. CONCLUSIONS: Reliable methods of diagnosing MRONJ and adequate follow-up periods are important factors in obtaining the actual incidence of MRONJ after tooth extractions in patients treated with high-dose BP and DS.

A comparative study of the clinical characteristics of patients with medication-related osteonecrosis of the jaw and osteoporosis or malignancy.

OBJECTIVE: This study aimed to compare the clinical characteristics of patients with medication-related osteonecrosis of the jaw (MRONJ) and osteoporosis vs malignancy. STUDY DESIGN: The study included patients hospitalized with MRONJ between July 2013 and April 2021. These patients were assigned to the osteoporosis or malignancy groups according to their primary disease. Characteristics and clinical variables were recorded and compared. RESULTS: Nighty-one patients (107 MRONJ lesions) were included, with 12 (14 lesions) in the osteoporosis group and 79 (93 lesions) in the malignancy group. The osteoporosis and malignancy groups differed in their respective incubation periods (57.0 ± 42.8 vs 29.3 ± 19.8 months, respectively; P = .048), bisphosphonates cumulative dose (16,487.4 ± 14,268.8 mg alendronate vs 104.0 ± 79.9 mg zoledronic; P = .014), and rate of patients receiving antiangiogenic agents (0/12, 0.0% vs 48/79, 60.8%; P = .001). The groups were similar in their treatment outcomes, measured as successful surgeries (11/12, 91.7% vs 59/79, 74.7%; P = .351). CONCLUSIONS: For stage 2 or 3 MRONJ, patients with osteoporosis (exposed to oral bisphosphonates) developed MRONJ over a longer incubation period than patients with malignancy. The groups had similar responses to surgery.

Relationship between Drug Holidays of Antiresorptive Agents and Surgical Outcomes in Cancer Patients with Medication-Related Osteonecrosis of the Jaw.

It is controversial as to whether the withdrawal of antiresorptive (AR) agents is necessary while treating medication-related osteonecrosis of the jaw (MRONJ). In this study, we investigated whether a drug holiday promoted sequestrum separation and improved the surgical outcomes of MRONJ patients with malignant tumors, who were undergoing high-dose AR therapy. In total, we included 103 MRONJ patients with malignant tumors as their primary disease who underwent surgery at Nagasaki University Hospital or Kansai Medical University Hospital from January 2009 to December 2020. We recorded the patients' age, sex, primary disease, MRONJ stage, type and administration period of the AR agent, presence of diabetes, corticosteroid use, drug holiday period, white blood cell count, serum albumin, serum creatinine, outcomes, and computed tomography findings. The relationships between a drug holiday and sequestrum separation, and between a drug holiday and outcome, were analyzed. Drug holidays of 60, 90, and 120 days were not significant factors of sequestrum separation and did not influence patients' surgical outcomes as per the univariate and multivariate analyses. MRONJ patients with cancer as their primary disease should be operated upon immediately and without drug holidays if their general condition permits surgery.

Changing trends in the microvascular reconstruction and oral rehabilitation following maxillary cancer.

PURPOSE: The maxillectomy defect is complex and the best means to achieve optimal reconstruction, and dental rehabilitation is a source of debate. The refinements in zygomatic implant techniques have altered the means and speed by which rehabilitation can be achieved and has also influenced the choice regarding ideal flap reconstruction. The aim of this study is to report on how the method of reconstruction and oral rehabilitation of the maxilla has changed since 1994 in our Institution, and to reflect on case mix and survival. METHODS: Consecutive head and neck oncology cases involving maxillary resections over a 27-year period between January 1994 and November 2020 were identified from hospital records and previous studies. Case note review focussed on clinical characteristics, reconstruction, prosthetic rehabilitation, and survival. RESULTS: There were 186 patients and the tumour sites were: alveolus for 56% (104), hard palate for 19% (35), maxillary sinus for 18% (34) and nasal for 7% (13). 52% (97) were Brown class 2 defects. Forty-five patients were managed by obturation and 78% (142/183) had free tissue transfer. The main flaps used were radial (52), anterolateral thigh (27), DCIA (22), scapula (13) and fibula (11). There were significant changes over time regarding reconstruction type, use of primary implants, type of dental restoration, and length of hospital stay. Overall survival after 24 months was 64% (SE 4%) and after 60 months was 42% (SE 4%). CONCLUSION: These data reflect a shift in the reconstruction of the maxillary defect afforded by the utilisation of zygomatic implants.

The Zygomatic Implant Perforated (ZIP) flap reconstructive technique for the management of low-level maxillary malignancy - clinical & patient related outcomes on 35 consecutively treated patients.

BACKGROUND: The zygomatic implant perforated (ZIP) flap technique provides immediate reconstruction and rapid dental rehabilitation for low-level malignant tumors. METHODS: Patients who underwent ZIP flap reconstruction between December 2015 and February 2021 were followed prospectively. RESULTS: Thirty-five consecutively treated patients were studied with 16 undergoing surgery alone and 19 undergoing surgery followed by radiotherapy. The median time to fit the prosthesis was 29 days with all patients requiring adjuvant radiotherapy receiving their fixed dental prosthesis prior to its commencement. Vascularized flap (100%), zygomatic implant (98.4%), and prosthesis (97%) survival were excellent and the ZIP flap protocol was highly rated by patient-related outcome measures especially for the chewing domain. CONCLUSIONS: The ZIP flap technique provides an excellent means of providing an autogenous oronasal seal and a foundation for immediate cortically anchored fixed dental rehabilitation. CLINICAL SIGNIFICANCE: This technique provides rapid and robust rehabilitation for patients presenting with low-level maxillary malignancy despite the use of radiotherapy.

Tooth extractions in patients with cancer receiving high-dose antiresorptive medication: a randomized clinical feasibility trial of drug holiday versus drug continuation.

OBJECTIVE: Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse reaction to high-dose antiresorptive medication (AR) in patients with cancer. A temporary discontinuation of AR (drug holiday) has been suggested to potentially reduce the risk of MRONJ after oral surgery. However, no consensus exists. The aim of the present feasibility trial was to evaluate the impact of a high-dose AR drug holiday in connection with surgical tooth extraction on the development of MRONJ and patient-reported health state. STUDY DESIGN: Patients with cancer receiving high-dose AR were randomized to a drug holiday from 1 month before to 3 months after surgical tooth extraction or drug continuation. Follow-up was scheduled at 1, 3, and 6 months postoperatively. Patient health state was evaluated using the EQ-5D-5L questionnaire. RESULTS: The study included 23 patients (11 men, 12 women). AR included denosumab (n = 13) and bisphosphonate (n = 10) with median AR durations of 9 and 17.5 months, respectively. Four denosumab patients from the drug holiday group developed MRONJ. Differences in EQ-5D-5L between the treatment groups were found in favor of drug continuation. CONCLUSIONS: The results indicate that a high-dose AR drug holiday does not prevent development of MRONJ after surgical tooth extraction and that patient-reported health state declines during a drug holiday compared with drug continuation.

A multicenter observational study on Medication-Related Osteonecrosis of the Jaw (MRONJ) in advanced cancer and myeloma patients of a cancer network in North-Western Italy / Un estudio observacional multicéntrico sobre osteonecrosis relacionada con medicamentos de la mandíbula (MRONJ) en pacientes con cáncer avanzado y mieloma de una red contra el cáncer en el noroeste de Italia

Background: Incidence of Medication-Related Osteonecrosis of the Jaw (MRONJ) related to cancer and myelomatreatments is undetermined, with scarce data varying from 2 to 7.8/million/year in limited investigated popula-tions. A 9-years [2009-2018] regional-wide survey was conducted, deploying the North-Western Italy Cancer Net-work (“Rete Oncologica Piemonte e Valle d’Aosta”), to assess number and main characteristics of MRONJ casesamong myeloma/cancer patients, within a population of 4.5 million inhabitants.Material and Methods: MRONJ cases were collected retrospectively from January 2009 to June 2015; from July2015 to December 2018, data were collected prospectively. Number of new MRONJ cases per year, underlyingdisorder, drug(s) administered, treatment duration, site and onset timing of MRONJ were detailed.Results: 459 MRONJ cases were identified. Primary diseases were breast cancer (46%), prostate cancer (21%),myeloma (19%), and other types of carcinoma (14%). Patients received antiresorptive treatment either alone (399;88.47%) or in combination with biological agents (52; 11.53%); 8 patients (1.7%) received only antiangiogenicdrugs. Zoledronic acid [388] and denosumab [59] were the most frequently administered drugs. Mandible was involved in 296 (64,5%) cases. Number of new MRONJ cases was stable from 2009 to 2015, with a mean of 51.3 casesper year (raw incidence: 11.6/million/year), declining in the 2016-2018 years to 33.3 cases per year (raw incidence:7.5/million/year).Conclusions: With such discrepancy of cases overtime being partially explicable, number of new MRONJ cases peryear are consistent with those observed in a previous study [2003-2008] in the same region, being instead higher thanthose reported in other populations.(AU)

Evaluation of segmental mandibular resection without microvascular reconstruction in patients affected by medication-related osteonecrosis of the jaw: a systematic review.

Medication-related osteonecrosis of the jaw (MRONJ) is a severe condition that affects the jaw in patients exposed to specific drugs. More often it has been described in association with bisphosphonates (BP), but nowadays it has been observed with the use of other medications, such as denosumab (a RANK ligand inhibitor and monoclonal antibody agent) and antiangiogenic drugs. Managing the condition has unfortunately proven difficult and still remains a major challenge for clinicians and surgeons. The aim of this systematic review was to identify and analyse the evidence on mandibular segmental resection in patients with advanced MRONJ. A multi-database (PubMed, MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials) systematic search was performed. Any type of study on human patients treated with antiresorptive and antiangiogenic drugs was considered. The primary aim was to understand the success of mandibular segmental resection in the short, medium, and long term, and to understand its effects before, during, and after the operation. The search yielded 11 studies that were eligible for analysis with a total of 67 patients. Of the 11 studies, seven reported no complications, and overall, postoperative complications were seen in 16 cases. Recurrence of osteonecrosis was reported in one study. The most common postoperative complication was removal of hardware (n = 11). The mean (SD) follow-up time for eight studies was 35.57 (17.73) months. According to the limited data available in the literature, mandibular segmental resection is a viable treatment that has been used successfully in patients with various stages of MRONJ. The data show a relatively high percentage of recurrence. Additional data based on a larger cohort of patients or case-control studies are necessary to justify routine use of this type of intervention in patients affected by the condition.

Mixoma odontogênico de mandíbula tratado por curetagem, osteotomia periférica e uso de solução de carnoy: relato de caso mandibular / Odontogenic myxoma treated by curettage, peripheral osteotomy and uso of carnoy's solution: case report

O mixoma odontogênico é um tumor benigno que acomete os maxilares, de rara ocorrência que tem origem a partir do componente ectomesenquimatoso de um germe dentário, seja ao nível da papila dentária, ao nível do folículo ou ainda ao nível do ligamento periodontal. Tem predileção pelo sexo feminino, podendo comprometer com mais significância a faixa etária da segunda à quarta década de vida. O tratamento dos mixomas odontogênicos pode ser conservador ou radical. Com relação à escolha do tratamento, deve o cirurgião levar em consideração principalmente a extensão do envolvimento da lesão. O tratamento conservador pode ser considerado como primeira escolha, evitando efeitos associados a morbidade, comprometimento de estruturas anatômicas nobres e diminuição da qualidade de vida. Por se tratar de lesão recidivante, métodos complementares de tratamento têm sido empregados, tais como osteotomia periférica, uso do nitrogênio líquido e a solução de Carnoy. Este trabalho teve como objetivo relatar um caso de mixoma odontogênico em corpo mandibular de paciente do sexo feminino, leucoderma, 25 anos, solteira, natural de Recife-PE- Brasil, tratado de forma conservadora através de curetagem, osteotomia periférica e uso de solução de Carnoy, que até o presente momento não ocorreu sinais de recidiva... (AU)

Odontogenic myxoma is a rare benign tumor that affects the jaws. It´s originates from the ectomesenchymatous component of a dental germ, either at the level of the dental papilla, at the level of the follicle or at the level of the periodontal ligament. It has a predilection for the female sex, being able to compromise with more significance the age group from the 2nd to the 4th. decade of life. The treatment of odontogenic myxomas can be conservative or radical. Regarding the choice of treatment, the surgeon must take into account mainly the extent of the lesion's involvement. Conservative treatment can be considered as the first choice, avoiding effects associated with morbidity, impairment of noble anatomical structures and decreased quality of life. As it is a recurrent lesion, complementary treatment methods have been used, such as peripheral osteotomy, use of liquid nitrogen and Carnoy's solution. This study aimed to report a case of odontogenic myxoma in the mandibular body of a female patient, leucoderma, 25 years old, single, born in Recife-PE- Brazil, treated conservatively through curettage, peripheral osteotomy and use of a solution of Carnoy, that until now there have been no signs of recurrence... (AU)

Effectiveness of surgery and hyperbaric oxygen for antiresorptive agent-related osteonecrosis of the jaw: A subgroup analysis by disease stage.

Antiresorptive agent-related osteonecrosis of the jaw (ARONJ) is an adverse event induced by antiresorptive agents (ARAs). The purpose of this study was to evaluate variables, mainly surgery and hyperbaric oxygen (HBO) therapy, associated with treatment outcomes in patients with a diagnosis of ARONJ at a single center. We enrolled consecutive patients who presented to our hospital for the management of stage 2 or 3 ARONJ between January 2003 and December 2019. The relationship between potentially predictive factors and outcome variables was examined using statistical analyses, along with a subgroup analysis based on disease stage. Of 252 patients included in this study, 206 had stage 2 ARONJ and 46 had stage 3 ARONJ. There were 119 patients with osteoporosis and 133 with malignant disease. In total, 139 patients were healed, and the healing rate of patients with stage 3 ARONJ was lower than that of patients with stage 2 ARONJ. With regard to the combination of surgery and HBO therapy, most patients underwent HBO before and after surgery. In the univariable analysis, surgery showed a therapeutic effect in both stage 2 and 3 ARONJ, whereas HBO showed a therapeutic effect in stage 2 ARONJ. In the multivariable analysis for stage 2 ARONJ, extensive surgery showed a stronger association with healing than conservative surgery, whereas ≥46 sessions of HBO therapy was less associated with healing than was non-HBO therapy. Our findings suggest that extensive surgery is highly effective against ARONJ regardless of disease stage if there is a sequestrum separation and systemic tolerance, whereas HBO therapy before and after surgical approach can be effective. Further studies are needed to identify treatment strategies for patients with treatment-refractory ARONJ who may be forced to undergo long-term HBO therapy with the expectation of sequestrum separation.

Cisto odontogênico calcificante: relato de caso / Calcifying Odontogenic Cyst: Case Report

Introdução: O Cisto Odontogênico Calcificante (COC), também conhecido como Cisto de Gorlin, é uma lesão odontogênica rara, descrita como neoplasia cística benigna, de origem odontogênica. Tem aspecto clínico variável e manifesta-se como lesão cística, não neoplásica, assintomática, de crescimento lento, podendo ser localmente agressivo. Não há predileção por gênero; ocorre normalmente na 2ª e na 3ª década de vida, sendo mais comum em regiões anteriores, podendo acontecer tanto na maxila quanto na mandíbula. O presente trabalho tem como objetivo o relato de um caso envolvendo uma paciente atendida na Clínica de Estomatologia da Faculdade de Odontologia da Universidade de São Paulo. Relato de caso: A paciente apresenta um COC em região anterior de maxila, caracterizado pelo aumento de volume da área paranasal à direita, sem característica dolorosa à palpação. Ao exame radiográfico, denota-se uma imagem radiolúcida, apresentando reabsorção radicular e imagens radiopacas sugestivas de calcificação interna. Considerações Finais: O tratamento realizado foi a enucleação e curetagem da loja óssea... (AU)

Introduction: The Calcifying Odontogenic Cyst (COC), also known as Gorlin cyst is a rare odontogenic lesion, described as benign cystic neoplasm of odontogenic origin. It has variable clinical appearance and manifests as a cystic lesion, non-neoplastic, asymptomatic, slow growing and may be locally aggressive. It has no gender predilection, usually occurs in the second and third decades of life, and it is more common in the anterior regions, may occur either in the maxilla or in the jaw. This study aims to report a case involving a patient treated at the Stomatology Clinic of University of São Paulo, Dentistry School. Case report: The patient has a COC in the anterior maxilla, characterized by the swelling of the paranasal area to the right without painful characteristic to palpation. On the radiographic exam is denoted a radiolucent image, showing radicular resorption and radiopaque suggestive images of internal calcification. Final considerations: The treatment provided was enucleation and curettage of bone cavity... (AU)

Long-Term Quality of Life in Patients With Maxillofacial Malignancies Who Have Undergone Craniofacial Resection: A Cross-Sectional Survivorship Study.

PURPOSE: The purposes were to investigate the postoperative, long-term quality of life (QoL) of patients with maxillofacial malignancies who underwent craniofacial resections that involved the skull base and to screen for potential predictors of QoL. PATIENTS AND METHODS: We reviewed all patients who had undergone craniofacial resections as identified by the electronic medical record system from 2013 onward; we then applied our eligibility criteria to generate the study cohort. Each patient was asked to complete the Skull Base Inventory, a questionnaire that is scored from 0 to 100, during his or her regular postoperative follow-up. All demographic information and clinicopathologic variables were then collected and analyzed. RESULTS: A total of 25 patients who received treatment between March 2013 and March 2018 were consecutively enrolled and surveyed at 6 to 42 months (median, 15 months). The age at diagnosis ranged from 23 to 81 years (median, 42 years), with a female-to-male ratio of 1.1:1.0. The mean score for QoL was 67.56 ± 16.35. Univariate analysis found that being in the subgroup aged 20 to 40 years (ß = -12.87 [95% confidence interval (CI), -25.54 to -0.21], P = .047), having the mesenchymal pathologic subtype (ß = -18.80 [95% CI, -34.05 to -3.54], P = .018), and having involvement of the middle skull base (ß = -15.00 [95% CI, -28.33 to -1.68], P = .029) could all significantly impact long-term QoL. A multiple linear regression model (R2 = 36.4%, P = .007) included the latter 2 factors (ß = -16.82 [95% CI, -31.06 to -2.59], P = .023, and ß = -13.14 [95% CI, -25.35 to -0.94], P = .036, respectively). CONCLUSIONS: The location of the involved skull base may be used as a guide for the surgical approach or incision design to improve patients' long-term QoL. However, this should not take precedence over the nature of malignancies as the pathologic subtype implied that patients with mesenchymal malignancies may pay the price of better QoL to survive.

Medication-related osteonecrosis of the jaw after tooth extraction in cancer patients: a multicenter retrospective study.

Root amputation, immunosuppressive therapy, mandibular tooth extraction, pre-existing inflammation, and longer duration of treatment with bone-modifying agents were significantly associated with an increased risk of medication-related osteonecrosis of the jaw. Hopeless teeth should be extracted without drug holiday before the development of inflammation in cancer patients receiving high-dose bone-modifying agents. INTRODUCTION: No studies have comprehensively analyzed the influence of pre-existing inflammation, surgical procedure-related factors such as primary wound closure, demographic factors, and drug holiday on the incidence of medication-related osteonecrosis of the jaw (MRONJ). The purpose of this study was to retrospectively investigate the relationships between these various factors and the development of MRONJ after tooth extraction in cancer patients receiving high-dose bone-modifying agents (BMAs) such as bisphosphonates or denosumab. METHODS: Risk factors for MRONJ after tooth extraction were evaluated with univariate and multivariate analyses. The following parameters were investigated in all patients: demographics, type and duration of BMA use, whether BMA use was discontinued before tooth extraction (drug holiday), the duration of such discontinuation, the presence of pre-existing inflammation, and whether additional surgical procedures (e.g., incision, removal of bone edges, root amputation) were performed. RESULTS: We found that root amputation (OR = 22.62), immunosuppressive therapy (OR = 16.61), extraction of mandibular teeth (OR = 12.14), extraction of teeth with pre-existing inflammation, and longer duration (≥ 8 months) of high-dose BMA (OR = 7.85) were all significantly associated with MRONJ. CONCLUSIONS: Tooth extraction should not necessarily be postponed in cancer patients receiving high-dose BMA. The effectiveness of a short-term drug holiday was not confirmed, as drug holidays had no significant impact on MRONJ incidence. Tooth extraction may be acceptable during high-dose BMA therapy until 8 months after initiation.

Mucocele de seno maxilar / Maxillary sinus mucocele

Introducción: los mucoceles de los senos paranasales son lesiones quísticas, expansivas, tapizadas por epitelio y rellenas de secreciones mucosas, causadas por obstrucción del orificio de drenaje de los senos paranasales. Aunque benignos, son potencialmente destructivos al provocar reabsorción del hueso circundante debido al incremento de presión que producen sobre él.Objetivo: presentar el caso de un paciente con mucocele de seno maxilar, debido a la infrecuente presentación de esta neoplasia, su evolución interesante desde el punto de vista médico y la dificultad de su diagnóstico clínico.Presentación del caso: paciente masculino, blanco, de 40 años de edad, con antecedentes de salud aparentes. Acudió a la consulta de cirugía maxilofacial por presentar dolor, fiebre y sensación de ocupación en la región geniana derecha. Los resultados de los exámenes de laboratorio fueron normales. En la radiografía se constató la existencia, en el seno maxilar derecho, de una imagen radiopaca, poliposa y redondeada. Durante el abordaje quirúrgico se observó una formación redondeada, de color blanco amarillento que ocupaba casi la totalidad del seno maxilar. Mediante el análisis histológico se diagnosticó un mucocele de seno maxilar. En los dos años transcurridos desde el tratamiento quirúrgico el paciente ha tenido una evolución favorable.Conclusiones: el diagnóstico temprano del mucocele de seno maxilar permite establecer el tratamiento de forma oportuna. Debido a la dificultad diagnóstica de esta neoplasia, ante la presencia de alteraciones clínicas y radiológicas de los senos paranasales o maxilares se debe tener en cuenta la posibilidad de un mucocele, no obstante ser raro(AU)

Introduction: the mucoceles of the paranasal sinuses are cystic, expansive lesions, lined by epithelium and filled with mucous secretions, caused by obstruction of the drainage orifice of the paranasal sinuses. Although benign, they are potentially destructive by causing resorption of the surrounding bone due to the increased pressure they produce on it.Objective: to present the case of a patient with maxillary sinus mucocele, due to the infrequent presentation of this neoplasm, its interesting evolution from the medical point of view and the difficulty of its clinical diagnosis.Case presentation: male patient, white, 40 years old, with apparent health history. He went to the maxillofacial surgery clinic for presenting pain, fever and feeling of occupation in the right genial region. The results of the laboratory tests were normal. The radiograph showed the presence, in the right maxillary sinus, of a radiopaque, polypoid and rounded image. During the surgical approach, a rounded, yellowish-white formation was observed that occupied almost the entire maxillary sinus. A maxillary sinus mucocele was diagnosed by histological analysis. In the two years since the surgical treatment, the patient has had a favorable evolution.Conclusions: early diagnosis of maxillary sinus mucocele allows treatment to be established in a timely manner. Due to the diagnostic difficulty of this neoplasm, in the presence of clinical and radiological alterations of the paranasal or maxillary sinuses the possibility of a mucocele should be taken into account, however it's rare(AU)

Risk-reductive dental strategies for medication related osteonecrosis of the jaw among cancer patients: A systematic review with meta-analyses.

The purpose of this systematic review with meta-analysis was to assess the effectiveness of dental interventions in preventing or reducing the incidence of medication-related osteonecrosis of the jaw (MRONJ) in cancer patients receiving antiresorptive therapy, compared to similar control groups receiving no intervention. Randomized controlled trials (RCT), case-controls and cohorts on cancer patients with primary outcome being the prevalence of MRONJ were included. Four electronic databases were searched (Cochrane Library, PubMed, EMBASE and Web of Science) up to February 12, 2018. A total of 409 abstracts were assessed and one case-control, one RCT and four cohort studies with 2332 cancer patients met our inclusion criteria. Risk of bias analysis followed Cochrane's handbook. Risk of bias was unclear for the case-control study and high risk for the RCT and all cohort studies. Five studies utilized preventive measures consisting of an initial examination and performing all necessary dental treatment before patients initiated antiresorptive therapy; one study used specialized post-extraction protocols utilizing plasma-rich in growth factors (PRGF) on cancer patients receiving antiresorptive therapy. Though dental preventive measures decreased MRONJ incidence by 77.3% in six studies with 2332 cancer patients (95% CI = 47.4-90.2%; p = .001) compared to control groups, quality of the evidence was low due to high or unclear risk of bias and the observational nature of five of the included studies. In conclusion, high-quality long-term prospective large sample size studies are needed to confirm these results due to high risk of bias and heterogeneous interventions. No funding.

National Survey on Bisphosphonate-Related Osteonecrosis of the Jaws in Japan.

PURPOSE: From 2011 to 2013, a nationwide retrospective cohort study was conducted by the Japanese Society of Oral and Maxillofacial Surgeons and the Japanese Society of Dentistry for Medically Compromised Patients to assess the development of bisphosphonate (BP)-related osteonecrosis of the jaws (BRONJ) and to elucidate the outcomes and factors associated with remission. MATERIALS AND METHODS: A written questionnaire, including clinical characteristics, management, and outcomes of patients with BRONJ, was sent to 501 institutions. RESULTS: This large-scale study included 4,797 cases with a female preponderance. BRONJ occurred twice as often in the mandible as in the maxilla. Most patients had BRONJ stage 2 (61.4%), followed by stage 1 (20.7%) and stage 3 (16.8%); stage 0 was excluded. The most common primary disease was malignant neoplasm (46.5%), followed by osteoporosis (including prevention; 45.3%). The proportion of patients on oral BPs increased, with the incidence approaching that of patients receiving parenteral BP. Surgical therapy rates of patients with BRONJ stages 1, 2, and 3 were 14.0, 37.6, and 53.5%, respectively. Outcome assessment for 936 patients with BRONJ stage 2 who underwent surgical therapy indicated remission in 46.3% of cases, improvement in 30.6%, disease progression in 5.4%, and no change in 6.1%. Good prognosis (remission or improvement) was seen in 76.9% of cases and poor prognosis (disease progression or no change) was seen in 11.5%. Analysis showed that risk factors for onset of BRONJ (P = .031), surgical procedure (P < .024), condition of the wound (P = .017), and discontinuation of BP (P < .001) were factors affecting prognosis. CONCLUSION: The number of patients with BRONJ has increased in Japan. Attention to oral BP and proper treatment is required to minimize the number of cases. Surgical therapy seems to be effective for BRONJ stage 2.

[Focus: Drug-related osteonecrosis of the jaw]. / Les médicaments inducteurs d'ostéchimionécroses des maxillaires.

Antiresorptives and antiangiogenics are treatments that have proven effective in oncology and the treatment of osteoporosis and they are increasingly prescribed. The care of these patients requires collaboration between the prescriber and the oral health professional to establish an optimized treatment plan. Therapeutic education of the patient is essential for him to understand the issues of good oral health and the adverse effects that can be caused by these treatments. The management is essentially based on the individual benefit/risk balance resulting from the general, local and inherent of the molecule risk factors. Management of drug-related osteonecrosis of the jaw should be as early as possible.