Medication-related osteonecrosis of the jaw: Evidence for infection versus oversuppression.

e18268 Background: Antiresorptive medications are important in maintaining bone health for patients with osteoporosis, metastatic cancer and multiple myeloma. Medication-related osteonecrosis of the jaw (MRONJ) may compromise quality of life and treatment of the underlying disease. There are many controversies regarding the pathogenesis, risk and management of MRONJ. Evidence-based data that suggest osteonecrosis of the jaw (ONJ) is triggered by infection and reports of ONJ unrelated to antiresorptive therapy (ART) have confounded previous hypotheses that pathogenesis is directly attributed to ART by oversuppression of bone remodeling. The aim of this study is to determine the outcome for management of MRONJ based on eradication of infection. Methods: The investigators designed a retrospective cohort study for patients who underwent surgical management of MRONJ. Identification of infected and necrotic bone was achieved via nuclear imaging (i.e., technetium bone scan, positron emission tomography), computed tomography and/or cone beam computed tomography. Surgical techniques included bone resection (i.e., marginal, segmental), local flap, reconstruction with microvascular free flap, and/or autogenous platelet graft. Perioperative modalities included hyperbaric oxygen therapy and culture-guided antibiotic administration. We recorded medical history, location of the MRONJ lesion, type of antiresorptive therapy and duration of perioperative antiresorptive therapy. The outcome variable was postoperative healing defined by mucosal closure without signs of infection or exposed bone at the time of follow-up including cases with complications related to subsequent dental infection or treatment. Descriptive statistics were calculated for successful management, medical history and duration of perioperative antiresorptive therapy. We excluded cases treated by palliative intent, when surgery was limited or contraindicated, and/or inadequate follow-up. Results: A total of 54 patients with 59 MRONJ lesions were evaluated (40 with cancer and 14 with osteoporosis). All patients were successfully treated with 13 patients continuing ART after surgery (average follow-up 10 months) and 8 patients requiring more than 1 surgery for lesions associated with osteosclerosis. Conclusions: This study suggests that MRONJ is an infection-driven process that can be managed with various modalities to control diseased bone and facilitate healing. Patients may resume ART following successful management of MRONJ.

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The Functional Endoscopic Approach to Inflammatory Sinus Disease: Current Perspectives and Technique Modifications

American Journal of Rhinology ◽

10.2500/105065888781693078 ◽

1988 ◽

Vol 2 (3) ◽

pp. 89-96 ◽

Cited By ~ 91

Author(s):

David W. Kennedy ◽

S. James Zinreich

Keyword(s):

Computed Tomography ◽

Surgical Techniques ◽

The United States ◽

Endoscopic Examination ◽

Lessons Learned ◽

Current Status ◽

Sinus Disease ◽

Technical Modifications ◽

The Impact

Endoscopic examination and pleuridirectional polytomography provided some important insights into the pathogenesis of inflammatory sinus disease. These insights have been further refined by the increasing utilization of endoscopy in medical therapy and surgical follow-up, and by the use of computed tomography for diagnosis. The aim of this paper is to review the current status of the diagnosis of chronic inflammatory sinus disease and of functional endoscopic surgical techniques. The impact of this approach on previously held theoretical and diagnostic concepts is evaluated. Technical modifications made since the surgery was first introduced in the United States and the lessons learned from close postsurgical endoscopic examination are presented.

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A pragmatic window of opportunity to minimise the risk of MRONJ development in individuals with osteoporosis on Denosumab therapy: a hypothesis

Head & Face Medicine ◽

10.1186/s13005-021-00280-4 ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

Giuseppina Campisi ◽

Rodolfo Mauceri ◽

Francesco Bertoldo ◽

Vittorio Fusco ◽

Alberto Bedogni

Keyword(s):

Tooth Extraction ◽

Oral Surgery ◽

Metastatic Cancer ◽

Bone Fragility ◽

Osteonecrosis Of The Jaw ◽

Time Interval ◽

Dental Surgery ◽

Metabolic Bone ◽

Increased Risk

Abstract Denosumab is associated with the development of medication-related osteonecrosis of the jaw (MRONJ), an uncommon but severe oral side effect with a higher prevalence in metastatic cancer patients than in patients with metabolic bone fragility. Although several oral triggers can initiate MRONJ, invasive oral treatments and tooth extraction still remain the most common precipitating event. In general, tooth extraction and oral surgery should be avoided in patients at increased risk of MRONJ, while extraction of non-restorable teeth should be performed based on specific risk reduction protocols to eliminate dental/periodontal infections, still protecting from MRONJ onset. Based on the different pharmacological activity of denosumab and nitrogen-containing bisphosphonates, it is likely that the MRONJ risk profile of patients with osteoporosis could somewhat vary. We hypothesize the chance to maximize the pharmacokinetic of denosumab 60 mg (Prolia®) and identify a time interval in which invasive oral treatments can ideally take place without restrictions in patients with metabolic bone fragility, We propose that dental surgery (e.g. tooth extraction) may be safely performed without additional intra or peri-operative procedures in osteoporosis patients using denosumab provided that careful case selection, adequate communication among specialists, planning of a delayed dosing window (1-month deferral) and rigorous postoperative follow-up are granted. Graphical abstract

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Presacral myelolipoma as a possible parasymptom of cancer: A case report

Rare Tumors ◽

10.1177/2036361318772124 ◽

2018 ◽

Vol 10 ◽

pp. 203636131877212

Author(s):

Akio Sakamoto ◽

Iori Nagamatsu ◽

Eisuke Shiba ◽

Takeshi Okamoto ◽

Masanori Hisaoka ◽

...

Keyword(s):

Diabetes Mellitus ◽

Computed Tomography ◽

Abdominal Pain ◽

Medical History ◽

Lung Metastases ◽

High Signal ◽

Endocrine Disorders ◽

History Of ◽

T2 Weighted Images

Presacral myelolipomas are rare, benign, asymptomatic tumors composed of mature adipose tissue and hematopoietic elements. Presacral myelolipomas can occur in patients with a medical history of malignancy, steroid use, and/or endocrine disorders including diabetes mellitus. A 65-year-old man with no specific medical history experienced temporal abdominal pain without bowel symptoms that lasted a few hours. By the time he visited a hospital, the pain had diminished. Computed tomography failed to detect any abnormality in the abdominal or pelvic organs that would have caused the abdominal pain but revealed a lesion 4 cm in diameter in the frontal sacrum. Magnetic resonance imaging showed that the lesion contained fat elements with a high signal intensity on T1- and T2-weighted images, which was decreased on fat-suppression T2-weighted images. Computed tomography–guided biopsy and imaging allowed a diagnosis of presacral myelolipoma. After 3 months, hematochezia was observed, and follow-up examination revealed rectal carcinoma with multiple lung metastases. He died due to spread of the cancer despite chemotherapy, 6 months after the cancer was found. Considering the possible association between presacral myelolipoma and cancer, presacral myelolipoma might be a cancer parasymptom. Checking for possible malignancy may therefore be warranted in patients with presacral myelolipoma, especially in those without diabetes mellitus.

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Medication-Related Osteonecrosis of the Jaws: Considerations on a New Antiresorptive Therapy (Denosumab) and Treatment Outcome after a 13-Year Experience

International Journal of Dentistry ◽

10.1155/2016/1801676 ◽

2016 ◽

Vol 2016 ◽

pp. 1-9 ◽

Cited By ~ 10

Author(s):

Gianfranco Favia ◽

Angela Tempesta ◽

Luisa Limongelli ◽

Vito Crincoli ◽

Eugenio Maiorano

Keyword(s):

Staging System ◽

Osteonecrosis Of The Jaw ◽

Clinicopathological Features ◽

Antiresorptive Therapy ◽

Osteonecrosis Of The Jaws ◽

Current Series ◽

Antiresorptive Drugs ◽

Radiological Healing ◽

Invasive Surgical Approach

Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication in patients receiving antiresorptive therapies for bone neoplastic localizations and osteoporosis. The aim of this study was to evaluate the clinicopathological features of MRONJ in a cohort of patients treated by new antiresorptive drugs (denosumab) and the corresponding outcome after 13-year maximum follow-up. Overall, 244 patients affected by MRONJ were treated from 2003 to 2015. After clinical and radiological examinations, all lesions were staged according to a dimensional staging system and then surgically treated. All the denosumab-related lesions were classified as stage II or III, thus requiring a more or less invasive surgical approach, despite the results of many recent studies, which suggested a conservative medical approach with early resolution for MRONJ in patients on denosumab. In the current series, 86.9% of treated lesions showed complete clinical and radiological healing, while 13.1% recurred; all recurrences were detected in patients who could not interrupt chemotherapy, steroids, and/or antiresorptive drugs administration due to their general conditions. In conclusion, all oral specialists should be aware of the MRONJ risk among patients taking new antiresorptive drugs; moreover, our protocol based on surgical treatment guided by dimensional staging could be considered effective in view of the low recurrence rate.

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Multislice imaging of gastrointestinal stromal tumors

10.32512/jmr.1.1.2018/3.14 ◽

2018 ◽

pp. 3-14

Keyword(s):

Computed Tomography ◽

Key Words ◽

Gold Standard ◽

Gastrointestinal Stromal Tumors ◽

Mesenchymal Tumors ◽

Stromal Tumors ◽

Preferential Localization ◽

Multislice Imaging ◽

Computed Tomography Diagnosis

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the digestive tract (1%). These tumors express the CD 117 in 95% of cases. The stomach is the preferential localization (70%). Diagnosis is difficult and sometimes late. Progress of imaging has greatly improved the management and the prognosis. Computed tomography (CT) is the gold standard for diagnosis, staging, and treatment follow-up. The increasing recognition of GIST’s histopathology and the prolonged survival revealed some suggestive imaging aspects. Key words: gastro-intestinal stromal tumors; computed tomography; diagnosis

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Noninvasive Follow-Up of Coronary Artery Bypass Graft Patency Using Multi-Slice Computed Tomography

Journal of the Korean Radiological Society ◽

10.3348/jkrs.2006.55.5.451 ◽

2006 ◽

Vol 55 (5) ◽

pp. 451

Author(s):

Seung Ho Joo ◽

Byoung Wook Choi ◽

Jae Seung Seo ◽

Young Jin Kim ◽

Tae Hoon Kim ◽

...

Keyword(s):

Computed Tomography ◽

Coronary Artery ◽

Coronary Artery Bypass Graft ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Bypass Graft ◽

Graft Patency ◽

Artery Bypass Graft

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Intraoperative, postoperative and long-term oncosurgical safety of therapeutic mammaplasty

Orvosi Hetilap ◽

10.1556/oh.2013.29660 ◽

2013 ◽

Vol 154 (33) ◽

pp. 1291-1296 ◽

Cited By ~ 1

Author(s):

László Romics Jr. ◽

Sophie Barrett ◽

Sheila Stallard ◽

Eva Weiler-Mithoff

Keyword(s):

Recurrence Rate ◽

Tumour Size ◽

Breast Conservation ◽

Malignant Lesion ◽

Surgical Techniques ◽

Incomplete Resection ◽

Immediate Reconstruction ◽

Oncological Safety

Introduction: (Pre)malignant lesion in the breast requiring mastectomy conventionally may be treated with breast conservation by using oncoplastic breast surgical techniques, which is called therapeutic mammaplasty. However, no reliable data has been published so far as regards the oncological safety of this method. Aim: The aim of the authors was to analyse the oncological safety of therapeutic mammaplasty in a series of patients. Method: 99 patients were treated with therapeutic mammaplasty and data were collected in a breast surgical database prospectively. Results were analysed with respect to intraoperative, postoperative and long-term oncological safety. Results: Incomplete resection rate was 14.1%, which correlated with tumour size (p = 0.023), and multifocality (p = 0.012). Time between surgery (therapeutic mammaplasty) and chemotherapy was similar to time between conventional breast surgeries (wide excision, mastectomy, mastectomy with immediate reconstruction) and chemotherapy (mean 29–31 days; p<0.05). Overall recurrence rate was 6.1%, locoregional recurrence rate was 2% during 27 month (1–88) mean follow-up. Conclusions: Since literature data are based on relatively short follow-up and low patient number, it is highly important that all data on therapeutic mammaplasty is collected in a prospectively maintained breast surgical database in order to determine true recurrence after long-follow-up. Orv. Hetil., 2013, 154, 1291–1296.

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