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Bettini G.,University of Padua | Blandamura S.,Institute of Pathology | Saia G.,University of Padua | Bedogni A.,Unit of Oral and Maxillofacial Surgery
BMJ Case Reports | Year: 2012

A female patient with non-small-cell lung cancer presented with a huge area of exposed bone in the mandible following spontaneous teeth loss. She was receiving multimodal chemotherapy containing bevacizumab. No previous treatment with bisphosphonates or comorbid conditions was reported. Pain medications and infection control were offered to the patient who was closely followed up. Initial imaging and histology of bone and surrounding mucosa (8 weeks after bevacizumab cessation) confirmed the clinical suspicion of avascular osteonecrosis of the mandible. Subsequent imaging and histology of bone and gingiva (12 weeks after bevacizumab cessation) revealed the initial sequestration of the mandible with a marked expansion of the mucosal vascular network. Spontaneous bone sequestration eventually occurred few months later, followed by stable and painless mucosal coverage of the mandibular bone. The patient remained disease-free up to 3 years of follow-up. Copyright 2012 BMJ Publishing Group. All rights reserved.

Hussain O.,Sheffield Teaching Hospitals | Rendon A.T.,Unit of Oral and Maxillofacial Surgery | Orr R.L.,Chesterfield Royal Hospital | Speight P.M.,Unit of Oral and Maxillofacial Pathology
Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology | Year: 2013

Sclerosing Odontogenic Carcinoma (SOC) was first described by Koutlas et al. in 2008. SOC is a low-grade odontogenic carcinoma, which presents as an expansile radiolucency that causes tooth displacement and root resorption. It is locally aggressive but reports suggest a very low probability of regional or distant metastasis. SOC contains small nests and thin cords of small cuboidal or polygonal epithelial cells with cytoplasmic clearing. Pleomorphism and mitoses are not prominent. Skeletal muscle and perineural infiltration with stromal sclerosis is characteristic. Immunohistochemically, SOC stains for cytokeratins (CK) 5/6 and 19, and e-cadherin. Nuclear staining with p63 is also positive. CK20, carcinoembryonic antigen and CAM 5.2 are negative. We report a rare entity of primary intraosseous carcinoma of the maxilla which has the clinical and histological markers of SOC. Occurrence in the maxilla has been reported only once before in the literature. © 2013 Elsevier Inc. All rights reserved.

Brisco J.,Medical Physics, Inc. | Fuller K.,Medical Physics, Inc. | Lee N.,Charles Clifford Dental Hospital | Andrew D.,Unit of Oral and Maxillofacial Surgery
British Journal of Oral and Maxillofacial Surgery | Year: 2014

We compared the image quality and radiation dose to the lens of the eye in patients with suspected orbital fractures who were imaged using cone beam computed tomography (CBCT) or conventional multislice computed tomography (CT). Although CBCT has a lower radiation dose than conventional CT, it is not known whether the image quality is comparable for diagnostic purposes. We identified fractures of the orbit (floor or roof, or both) in 6/10 patients who were scanned using CBCT and in 5/10 patients who were scanned using multislice CT (orbital floor and medial wall). Impingement of the rectus muscle on fracture lines was identified with both techniques, but retro-orbital haemorrhage was detected only on multislice CT. The mean radiation dose to the lens of the eye was 42% lower (range 23-53, SD 10) for CBCT than for multislice CT (p < 0.001), and the effective dose (a measure of the risk of developing a radiation-induced cancer) was also significantly lower. CBCT can therefore be used to diagnose orbital fractures, and is associated with a significantly lower radiation dose than multislice CT. © 2013 The British Association of Oral and Maxillofacial Surgeons.

Campisi G.,University of Palermo | Fedele S.,University College London | Fusco V.,Unit of Oncology | Pizzo G.,University of Palermo | And 2 more authors.
Future Oncology | Year: 2014

Osteonecrosis of the jaws (ONJ) is an adverse side event of bisphosphonates and denosumab, antiresorptive agents that effectively reduce the incidence of skeletal-related events in patients with metastatic bone cancer and multiple myeloma. Available data suggest that 0-27.5% of individuals exposed to antiresorptive agents can develop ONJ. There is increasing evidence that avoidance of surgical trauma and infection to the jawbones can minimize the risk of ONJ, but there are still a significant number of individuals who develop ONJ in the absence of these risk factors. Bone necrosis is almost irreversible and there is no definitive cure for ONJ with the exclusion, in certain cases, of surgical resection. However, most ONJ individuals are affected by advanced incurable cancer and are often managed with minimally invasive nonsurgical interventions in order to control jawbone infections and painful symptoms. This article summarizes current knowledge of ONJ epidemiology, manifestations, risk-reduction and therapeutic strategies. Further research is needed in order to determine individual predisposition to ONJ and clarify the effectiveness of available treatments. © 2014 Future Medicine Ltd.

Maher N.G.,Unit of Oral and Maxillofacial Surgery | Lai K.,CNRS Immunology and Infectious Disease Center | Lai K.,University of Newcastle | Loewenthal M.,CNRS Immunology and Infectious Disease Center | And 3 more authors.
Infectious Diseases in Clinical Practice | Year: 2012

A 33-year-old male presented with a perimandibular mass that ultimately conferred a diagnosis of actinomycosis in the absence of antecedent predisposition. He was a veterinary surgeon who had recently traveled to Southeast Asia, which complicated the diagnostic process. The literature pertaining to cervicofacial actinomycosis in the absence of antecedent predisposition is reviewed. Purulent fistulae/sinuses are common presentations and management involves prolonged antibiotic therapy. Copyright © 2012 by Lippincott Williams & Wilkins.

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