Prosthetic rehabilitation after osteonecrosis of the jaws due to histiocytosis X and treatment with bisphosphonates apropos of a case

Bisphosphonates are involved in the occurrence of Osteonecrosis of Jaws (ONJ), which is a complication of these treatments. This osteonecrosis concern the alveolar bone and develops generally after an oral surgery. It can however occur spontaneously without preliminary dental extraction. Other risk factors could play potentiates the risk of ONJ. This osteonecrosis results in an osseous exposure in patient treated or having been treated by bisphosphonates, without any cervico-facial irradiation. Actually, no treatment has been the proof of its effectiveness. Preventives measures of ONJ in oral cavity are the best method before, during and after administration of bisphosphonates. In this article, we present the clinical case of a patient with histiocytois treated by bisphosphonates and having developed ONJ. The selection criteria of the prosthetic rehabilitation as well as the techniques used are detailed.     

Oral carcinoma cuniculatum in a young child

From the Department of Dental Specialties, Birmingham Children's Hospital. This case study describes a rare case of oral carcinoma cuniculatum in a 7-year-old female. She presented with an enlarged mass of the anterior maxilla arising from the gingiva. An anterior maxillectomy with immediate prosthetic replacement and obturation of the residual defect were carried out. The management of this case was challenging given the rare nature of the disease, unclear etiology, the patient's young age and the mutilating effects of surgery. The treatment involved a large multidisciplinary team. The provision of obturators was particularly difficult due to poor patient compliance and the extent of surgery carried out in a growing child. Oral cancer in children under 15 years old is extremely rare and this is the youngest case of oral carcinoma cuniculatum reported in the literature.     

The combined analgesic effect of gabapentin and transdermal fentanyl patch on acute and chronic pain after maxillary cancer surgeries

Abstract

Purpose of this study was to evaluate the combined analgesic effect of gabapentin and transdermal fentanyl patch, on acute and chronic pain after surgery for maxillary cancer.

Study design

The Study was double blind and prospective. 100 subjects belonging to ASA grade I and II, 30–50 years age group, scheduled for maxillary cancer surgery were randomized into two groups; treatment group (GT): to receive gabapentin, transdermal fentanyl patch or control group ©: two placebos. For acute postoperative pain (Visual Analogue Score) and analgesic requirements were assessed 2, 4, 8 hours and 7 days after surgery. Subjects were also assessed for chronic pain 2, 4, 6 months later.

Results

Subjects in treatment group required lesser dose of analgesic, as compared to control group, in the post operative period. Visual Analogue Scores were also significantly lower in the treatment group throughout the post operative period. Occurrence of side effects was non significant between both groups. 2, 4 and 6 months after surgery, 40, 35 and 28 subjects respectively, out of total 45 subjects of the control group, reported chronic pain. In comparison, 25, 10 and 4 subjects out of 42 subjects in the treatment group reported chronic pain 2, 4, 6 months respectively after surgery. 15, 10 and 6 out of 45 of the control group required analgesics, whereas 2, 0 and 0 out of 42 in the treatment group, required analgesics respectively 2, 4 and 6 months after surgery

Conclusion

Acute and chronic pain after maxillary cancer surgery is significantly reduced by multimodal analgesia.     

Peripheral calcifying epithelial odontogenic tumor

Most of the calcifying epithelial odontogenic tumors (CEOT) are central lesions of the jaws, but the CEOT occurs infrequently on the gingiva. A cases of peripheral CEOT arising in the right upper molar gingiva of a 31-year-old Japanese woman is presented. A direct communication between the overlying gingival epithelium and the tumor was found by examination of serial sections. As a result, it was thought that one of the sources of peripheral CEOT might be gingival epithelium with potential proliferative activity.     

Bifid mandibular nerve as a possible cause of inadequate anesthesia in the mandible

Failure to achieve complete mandibular anesthesia is a problem that often occurs. The explanations include faulty anesthetic solutions, faulty technique, and anatomic or physiologic variations. Bifurcation of the mandibular nerve, rarely mentioned in the literature, may be a cause of inadequate anesthesia in a small percentage of cases.     

Systemic bone disease in patients with mandibular atrophy

Although the etiology of alveolar ridge resorption is unclear, the labile alveolar bone may be highly sensitive to changes in systemic bone mineral content. Ten patients presenting with severe mandibular atrophy were studied by photon absorption densitometry. Four patients exhibited a significant reduction in radial midshaft mineral content. All four had systemic bone disease revealed on undecalcified histological sections although serum biochemical studies were normal. Common factors were severe mandibular atrophy, decreased bone density, and systemic bone disease. Photon absorption densitometry is suggested as a screening mechanism for systemic bone disease in patients with severe mandibular atrophy.