Management of osteoradionecrosis of the jaws with pentoxifylline–tocopherol: a systematic review of the literature and meta-analysis

Osteoradionecrosis (ORN) of the jaws remains among the most commonly encountered and challenging complications of radiotherapy to the head and neck. The purpose of this study was to provide a review of the medical management for ORN and evaluate the reported outcomes with the use of pentoxifylline and tocopherol (PENTO), by means of a systematic review and meta-analysis. The predictor variable was the use of PENTO in the treatment of ORN. The outcome variable was the proportion of full recovery or significant improvement not requiring further intervention. The likelihood function was used to combine the studies and estimate the proportion and standard deviation of each outcome by the maximum likelihood estimation. Seven studies met the inclusion criteria. A total 211 patients were treated. One hundred twenty-six patients recovered fully or improved significantly not requiring further intervention. Sixty patients remained the same, 10 were lost to follow-up, and the disease progressed in 15. The current literature supports the use of PENTO in the treatment of ORN of the jaws. Additional well-designed prospective studies are needed in order to further validate the regimen that can then be employed in the treatment of ORN.     

Is there a role for pentoxifylline and tocopherol in the management of advanced osteoradionecrosis of the jaws with pathological fractures? Case reports and review of the literature

Osteoradionecrosis (ORN) is an infrequent but serious complication of radiotherapy, especially in the head and neck region. It is a slowly progressive condition, with management in the early stages focused on symptom control, and surgery usually reserved for advanced ORN. However, established ORN is difficult to treat. The role of hyperbaric oxygen therapy has recently been contested. The use of pentoxifylline in the management of ORN was first described by Delanian in 2004, but its benefits have not been replicated in other studies. In cases of advanced ORN with pathological fractures, many centres still advocate surgical resection and reconstruction. However, in this group of patients who often have multiple medical comorbidities, many of whom have previously undergone significant surgery, a resective plan is not always ideal. This paper presents two successful cases of bony union after the use of pentoxifylline and tocopherol to manage grade III ORN of the mandible. Both patients had pathological fractures and orocutaneous fistulas and were deemed unsuitable for surgery. The possible reasons for the success of pentoxifylline and tocopherol are discussed, and a review of the current literature evidence of similar cases is presented. Pentoxifylline and tocopherol should be considered for the management of advanced ORN where surgical management is not appropriate.     

Poliomyelitis causing TMJ ankylosis?—report of two intriguing cases

Introduction

Temporomandibular joint (TMJ) ankylosis is one of the common diseases which affect the TMJ especially in children. We are reporting two rare cases of TMJ ankylosis which occurred along with poliomyelitis and which are not reported in literature so far.

Discussion

In this article, we discussed about the most probable causes which resulted in TMJ ankylosis in these patients.     

Management of mandibular interforaminal fractures using 3 dimensional locking and standard titanium miniplates – A comparative preliminary report of 10 cases

PurposeThe aim of this follow up clinical study was to compare and evaluate the effectiveness of 2 mm 4 holed 3-dimensional (3D) locking titanium miniplates over standard miniplate fixation using Champy’s technique in the management of interforaminal mandibular fractures.Patients and methodsA prospective randomized double blind clinical trial was carried out in patients with well defined inclusion and exclusion criteria. Patients were followed for a period of 2 months at the intervals of 1 week, 2 weeks, 4 weeks, 6 weeks and 2 months by a blinded senior oral surgeon for wound dehiscence, infection, postoperative occlusion, significant postoperative complications, need for post-operative inter maxillary fixation and radiological evaluation of reduction, fixation.Result10 patients were enrolled in both the groups in this preliminary report with no case of clinically significant postoperative complications. In comparison, 3D locking plates were economical, easy to adapt, required less operating time, and provided better stability. However, 2 patients in group 1 (3D locking plates) with severely displaced unfavourable fractures required 6 holed plates or more for adequate stability.ConclusionBecause of its added advantages and encouraging results in comparison to standard miniplate, we suggest use of 3D 4 holed locking 2 mm titanium miniplate for the management of isolated moderately displaced mandibular fractures in inter mental foramen region.     

Imaging features of the lacrimal and salivary glands of patients with IgG4-related Mikulicz’s disease: a report of three cases

We present ultrasonographic (US) and magnetic resonance (MR) imaging features of the lacrimal and salivary glands of three patients with IgG4-related Mikulicz??s disease (IgG4-MD). US revealed punched-out, soap-bubble, or reticular patterns of parenchymal hypoechogenicity of the involved lacrimal, parotid, and submandibular glands. Conventional MR imaging features were less specific. However, apparent diffusion coefficients of many of the involved glands were reduced compared with healthy glands. We discuss possible histological changes in the affected glands that were attributable to the observed imaging features. We also discuss the differences in imaging features between IgG4-MD and Sj?gren??s syndrome (SS). We conclude that US may be a useful adjunct for diagnosing IgG4-MD and that MR sialography could effectively distinguish IgG4-MD from SS.     

Oral cancer in young non-habituè females: a report of four cases and review of the literature

Background: The aim of this study is to highlight the growing incidence of oral cancer in young females without apparent traditional risk factors. Methods: We present a case series of young female patients with histopathologically diagnosed squamous cell carcinoma of the tongue and no known exposure to major risk factors, reporting to our institution over one year. A review of the literature was carried out to find documented studies on oral cancer in young females. Results: We found an increase in the number of young female patients presenting with squamous cell carcinomas on the lateral border of the tongue who did not have any of the traditional risk factors associated with the disease, which is in contrast with the number of male patients presenting with the same disease. Conclusions: Our study highlights the increasing incidence of oral cancer in young females without apparent traditional risk factors, an area of growing concern. Published studies in this particular group are limited. Nevertheless, the situation is alarming owing to the seriousness this problem poses for the community. More research is required to determine the aetiological and risk factors associated with this outcome.     

Osteochondroma of the glenoid fossa—report of two cases with sudden onset of symptoms

Osteochondroma of the temporomandibular joint is a rare condition that most frequently affects the mandibular condyle. Fixed osteochondroma originating from the glenoid fossa is extremely rare and a literature search identified only two reported cases. The cases of two additional patients in whom osteochondroma developed in the posterior part of the glenoid fossa leading to the sudden onset of chin deviation and malocclusion are reported herein. We conclude that osteochondroma of the glenoid fossa is a slow growing benign tumour with typical clinical and radiological features. It requires surgical treatment, comprising resection of the tumour. Recurrence appears unlikely.     

Versatility of uniplanar prearthoplastic distraction osteogenesis in the correction of post-ankylosis facial deformities—a report of five different cases

Purpose

Unilateral or bilateral ankylosis can lead to severe micrognathia and facial deformity that requires multiple, often, staged surgical corrections. To date, there is no ideal treatment modality that satisfactorily corrects the complex anatomy, restores the ramal height, and corrects the micrognathia and microgenia. Distraction osteogenesis has been acclaimed as a successful modality for the treatment of such deformities. It is a cost-effective approach with low morbidity and less relapse thus providing better functional and esthetic outcomes. It allows the surgeon to correct the deformity in various planes by using various devices by changing osteotomy designs and vectors, with simultaneous hard tissue and soft tissue reconstruction.

Patients and methods

Here, we present a series of five cases where different types of distraction osteogenesis were combined with various other procedures to correct post-ankylotic facial asymmetry. In one case, simultaneous maxillo-mandibular distraction [Molina’s technique] was used.

Results

All patients showed significant improvement in function and esthetics. Outcome assessment was made using clinical photographs and radiographs.

Conclusion

Pre-arthroplastic distraction osteogenesis is a versatile cost effective approach that can be customized for every patient based on their needs.

     

Combined systemic and local antimicrobial therapy of periodontal disease in Papillon-Lefèvre syndrome. A report of 4 cases

4 patients, 2 pairs of siblings, suffering from Papillon-Lefèvre syndrome were treated for periodontal disease. Following extraction of hopeless teeth, the children received scaling and adjunctive systemic antibiotics (metronidazole and amoxicillin for 7 to 10 days). In addition, they performed supragingival pulsated jet irrigation with 0.06% chlorhexidine digluconate 1 x daily. In 2 siblings, A. actinomycetemcomitans was suppressed subgingivally below detectable levels, pocket probing depths were reduced to 4 mm or less, and plaque and bleeding indices were low. No further disease progression was seen over a 3-year-period. Another female patient also showed clinical improvement and suppression of subgingival A. actinomycetemcomitans and B. forsythus up to the 9-month-follow-up, while her sister showed further attachment loss over the course of 4 years. The present case reports indicated that in some patients suffering from Papillon-Lefèvre syndrome periodontal disease may be arrested by means of (i) oral hygiene instruction, (ii) extraction of severely diseased teeth, (iii) scaling, (iv) systemic antibiotics and (v) long-term antimicrobial irrigation.     

Efficacy of fibrin-rich platelets and leukocytes (L-PRF) in tissue repair in surgical oral procedures in patients using zoledronic acid—case–control study

Oral and Maxillofacial Surgery - Medication-related osteonecrosis of the jaws (MRONJ) is a complication that develops in patients who use or have used antiresorptive or antiangiogenic medications...     

Periodontal therapy in siblings with Papillon-Lefèvre syndrome and tinea capitis: a report of two cases

OBJECTIVE: Report of clinical and microbiological periodontal findings before and 6 months after treatment of two siblings with Papillon-Lefèvre syndrome (PLS) and tinea capitis. METHODS: Two brothers, RG 3 years and NG 5 years of age, were referred for treatment due to premature mobility of their deciduous teeth. Probing depths (PPD), attachment levels (PAL-V), and furcation involvements were examined clinically. Panoramic radiographs were taken. Subgingival plaque samples within the deepest pocket of each tooth were taken and analysed by real-time polymerase chain reaction (PCR) for Actinobacillus actinomycetemcomitans (AA), Porphyromonas gingivalis, Tannerella forsythensis, Treponema denticola, Fusobacterium nucleatum, and Prevotella intermedia. One-stage full-mouth scaling and extraction of hopeless teeth were performed under general anaesthesia, followed by systemic amoxicillin and metronidazole for 7 days. Clinical and microbiological analyses were performed 6 months after treatment. RESULTS: Before treatment, both siblings had exhibited PPD of up to 13 mm, Class III furcation defects at four teeth, and marginal suppuration. AA was detected in both patients and at all teeth at levels ranging from 3.0 x 10(2) to 5.1 x 10(6). Both patients exhibited palmar and plantar hyperkeratosis. Seven teeth were extracted from RG, and nine from NG. Six months after treatment, PPD had been reduced to 相似文献   

Langerhans cell histiocytosis in childhood – Review,symptoms in the oral cavity,differential diagnosis and report of two cases

BackgroundLangerhans cell histiocytosis is a rare disease characterized by monoclonal proliferation and migration of special dendritic cells. This disease primarily affects bones, but occurs less frequently in other organ systems or may manifest as a multisystem disease.Case reportsExtraoral and intraoral symptoms of Langerhans cell histiocytosis are described in a 13-month-old female and a 5-month-old male infant.Dermatitis was found on the scalp, abdomen, flexures and in intertrigineous areas in both patients. The intraoral examination of the 13-month-old infant showed premature eruption of all maxillary deciduous molars, loosening and significant damage of periodontal tissues (gingivitis with bleeding, swelling of palatal mucosa, periodontal pockets) resembling severe periodontitis.In the oral cavity of the 5-month-old predentate infant bilateral swellings of maxillary alveolar mucosa with deep ulcerations were seen.The oral and skin symptoms in both infants were indications for biopsy. Langerhans cell histiocytosis was confirmed histologically and immunohistochemically.ConclusionOral findings in Langerhans cell histiocytosis may be the only clinical symptom of the disease; therefore the role of dentists in establishing diagnosis is very important.     

Can recurrence of giant cell tumour occur in an allograft? A report of two cases

Giant cell tumour is a locally aggressive tumour with a high incidence of local recurrence. The choice of treatment remains to be controversial. These tumours are usually managed with extended curettage in the early stage and with resection and replacements in the advance stages. This is an illustration of two case of Giant cell tumour, one of the proximal tibia and another of the distal radius that was treated with wide resection and osteoarticular allograft. Both patients developed recurrence of the disease within the allograft.     

Surgical treatment of ankyloglossia in babies—case report

Ankyloglossia is an anomaly that is characterized by the abnormal insertion of the lingual frenulum that hinders protrusion and elevation of the tongue towards the palate, due to the short and thick composition of the frenulum. In babies it can cause inefficient nursing at the mother's breast, inadequate transfer of milk and pain in the mother's breast, resulting in early weaning and weight loss. An 8-month-old baby boy was brought to the clinic by his mother because he found it difficult to suck and consequently avoiding breast feeding, and was apparently losing weight. During the clinical exam it was observed that the patient presented little mobility of the tongue. Owing to the degree of ankyloglossia and the features of malnutrition present, it was decided to carry out complete removal of the frenulum under general anesthesia. Although this procedure might increase the risk of morbidity, the possibility of recurrence and the need to perform further procedures are avoided; the main advantage is reducing aggravation of the clinical problems.     

Transconjunctival versus subciliary approach for orbital fracture repair—an anthropometric evaluation of 221 cases

Objectives

In the literature, there is an ongoing discussion about the influence of orbital fractures and the surgical approach on the rate of eyelid deformities of the lower eyelid.

Materials and methods

We present an evaluation of a series of 221 patients 9 months after zygomaticomaxillary complex fracture repair that underwent implant removal. Reference anthropometric data were measured on standardized pre- and postoperative photographs. Analysis included eye fissure width and height, lid sulcus and upper lid height, upper and lower iris coverage, position of cornea to palpebra inferior, canthal tilt, scleral show, ectropion, and entropion. Both operated and contralateral eyelids were evaluated as well as whether a transconjunctival or a subciliary approach was performed.

Results

Time, surgery, and surgical approach presented significant effects on eye fissure index and lower iris coverage. Scleral show was significantly influenced by the surgical procedure itself as well as by the type of incision. The rate of ectropion increased significantly pre- to postoperative.

Conclusions

The subciliary approach included the highest risk of lower lid retraction. The low pre- to postoperative increase of scleral show and ectropion compared to recent studies gives us an idea about the influence of the underlying trauma on the rate of lower lid retraction. The standardized measurements described are accurately and objective to evaluate postoperative results.

Clinical relevance

The transconjunctival approach is preferable in orbital fracture repair.     

Papillon-Lefèvre syndrome: a report of two cases

Papillon-Lefèvre syndrome is a rare disease characterized by skin lesions caused by palmar-plantar hyperkeratosis, and severe periodontal destruction involving both the primary and permanent dentitions. It is transmitted as an autosomal recessive condition and consanguinity of parents is evident in about one-third of cases. This paper describes two preschool children who presented at the Paediatric Dentistry Department, Sheffield, UK, with progressively loosening teeth and discomfort during eating. The medical history revealed scaling on the hands and feet, which had been medically diagnosed as eczema. Papillon-Lefèvre syndrome was diagnosed in both cases.     

Chondroma in temporomandibular region—case report and therapeutic considerations

Purpose

Chondromas are benign tumors composed of mature hyaline cartilage. These tumors are quite common in the bones of the hands and feet but extremely rare in jaw bones, and few such cases are reported in the literature. The aim of the present study was to carry out a literature review and present a clinical case of a patient with a chondroma in the right mandibular condyle treated with excision of the tumor.

Conclusions

The importance of early diagnosis and treatment in order to impede or minimize any lasting effects is discussed.     

Comparative evaluation of three obturation techniques in primary incisors using digital intra-oral receptor and C.B.C.T—an in vitro study

Clinical Oral Investigations - Successful pulpectomy in primary teeth depends on quality of obturation. It can be evaluated using digital intra-oral receptor (D.I.O.R) and cone beam computed...