Medication‐related osteonecrosis of the jaw (MRONJ) is a severe side effect of antiresorptive (bisphosphonates and denosumab) and anti‐angiogenic therapy used in the management of oncologic and, less ...frequently, osteoporotic patients. While there is good international agreement on the diagnostic and staging criteria of MRONJ and the cessation of antiresorptive/anti‐angiogenic treatments, the gold standard of treatment is still controversial, in particular between non‐surgical and surgical approaches. The former usually includes antiseptic mouth rinse, cyclic antibiotic therapy, low‐level laser therapy and periodic dental checks; the latter consists of surgical necrotic bone removal. The purpose of this retrospective study was to describe the therapeutic approaches and outcomes of 131 lesions from 106 MRONJ patients treated at the Policlinic of Bari. Non‐surgical treatments were chosen for 24 lesions that occurred in 21 patients who, due to comorbidities and/or the impossibility of stopping oncologic therapies, could not undergo surgical treatment. As to the outcome, all the surgically treated lesions (107) showed complete healing, with the exception of 13.5% of the lesions, all of which were stage III, which did not completely heal but showed reduction to stage I. The 24 non‐surgically treated lesions never completely healed and, rather, generally remained stable. Only two cases exhibited a reduction in staging. Based on our observations, MRONJ occurring both in neoplastic and non‐neoplastic patients benefits more from a surgical treatment approach, whenever deemed possible, as non‐surgical treatments do not seem to allow complete healing of the lesions.
Proliferative verrucous leukoplakia (PVL) is a rare and refractory form of oral mucosal leukoplakia of unknown origin, characterized by high rates of malignant transformation. Different diagnostic ...criteria, terminologies, and therapeutic approaches have been proposed since the first report in 1985. There remains no general agreement regarding the clinical and histological diagnosis, prevention, and correct management of this disease. This retrospective study investigated 48 patients affected by PVL showing at least one malignant transformation and followed up at 2-month intervals. Twenty-five were female (52.1%) and 23 (47.9%) were male; their median age was 67 years (range 40–93 years). Follow-up ranged from 18 to 240 months. Clinical examination included the use of Lugol’s solution to prevent clinical underestimation of the margins and toluidine blue for suspicious areas. Surgical excision by scalpel was the preferred treatment for suspicious lesions, with only five carcinomas surgically removed by diode laser and two by CO2 laser. All specimens were accurately mapped after formalin fixation. Fifteen patients (31.3%; 10 female, five male) developed one oral carcinoma, while 33 (68.7%) developed two or more primary tumours (range 3–12). Only four patients (8.3%), who developed between 2 and 8 oral squamous cell carcinomas (OSCCs), died of tumour-related causes. The pre-surgical clinical workup, subsequent surgical treatment, and follow-up are key to success for patients affected by PVL with malignant transformation into stage 1 OSCC and/or verrucous carcinoma, leading to a high overall survival rate.
Brain abscesses (BAs) are rare but life-threatening infections. BAs of an odontogenic origin should always be considered as a possible aetiological factor, especially when other infectious foci are ...not present. Clinical presentation in children may be ambiguous and pose a difficult differential diagnosis: the identification of causal bacteria can be difficult and odontogenic origin is often a diagnosis of exclusion. The aim of this paper was to systematically review the literature reports with particular emphasis on therapy and propose a diagnostic flowchart for odontogenic brain abscess in children. A systematic literature review was performed on PubMed, Scopus and ISI Web of Science to identify cases of BAs in children and discuss clinical management: only human research articles, published in peer-reviewed English language journals, were included. Among 109 articles, 7 publications were selected for data analysis: clinical data could be extracted for only 8 subjects; different clinical approaches are descripted in the reports, even if therapy should be started as soon as possible to prevent rapid diffusion to the rest of the central nervous system. Due to their rarity and ambiguous clinical presentation in children, BAs of odontogenic origin are difficult to diagnose. A thorough oral-maxillofacial investigation should always be performed to exclude an oral origin.
Objective The aim of this retrospective study was to describe the sonographic appearance of the posterior brain anatomy in normal fetuses at 11 to 14weeks of pregnancy and to determine the fetal ...outcome when one of the posterior brain anatomical space is not recognized. Methods Two groups of patients were included in the study: a control group of consecutive 311 healthy fetuses with a normal sonogram and a study group of 21 fetuses with absence of one of the three posterior brain spaces. In each fetus, images of the mid-sagittal view of the fetal face and brain at 11 to 14weeks of gestation were obtained. Results In all fetuses with absence of one of the three posterior brain spaces, a severe anomaly, including open spina bifida, cephalocele, Dandy-Walker complex, and chromosomal aberrations, was associated. Conclusion Our study indicates that the sonographic finding characterized by the absence of one of the three posterior brain spaces seems to facilitate not only the detection of open spina bifida, as previously reported, but also of other neural tube defects, such as cephalocele, and is an important risk factor for cystic posterior brain anomalies, and/or chromosomal abnormalities. Thus it seems a poor prognostic finding for major fetal abnormalities. What's already known about this topic? * Posterior brain anomalies are recognizable at 11 to 14weeks by using the mid-sagittal view as part of the nuchal translucency measurement. The BS/BSOB ratio can be altered in fetuses with OSB and DWM compared with normal fetuses. What does this study add?* The absence of one of the three posterior brain spaces seems to facilitate not only the detection of OSB, but also of cephalocele, and is an important risk factor for cystic posterior brain anomalies, and/or chromosomal abnormalities. The associated chromosomal anomalies are not only aneuploidies, but also genomic imbalances.
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