1/36. Maxillofacial osteonecrosis in a patient with multiple "idiopathic" facial pains.Previous investigations have identified focal areas of alveolar bone tenderness, increased mucosal temperature, abnormal anesthetic response, radiographic abnormality, increased radioisotope uptake on bone scans, and abnormal marrow within the quadrant of pain in patients with chronic, idiopathic facial pain. The present case reports a 53-year-old man with multiple debilitating, "idiopathic" chronic facial pains, including trigeminal neuralgia and atypical facial neuralgia. At necropsy he was found to have numerous separate and distinct areas of ischemic osteonecrosis on the side affected by the pains, one immediately beneath the major trigger point for the lancinating pain of the trigeminal neuralgia. This disease, called NICO (neuralgia-inducing cavitational osteonecrosis) when the jaws are involved, is a variation of the osteonecrosis that occurs in other bones, especially the femur. The underlying problem is vascular insufficiency, with intramedullary hypertension and multiple intraosseous infarctions occurring over time. The present case report illustrates the extreme difficulties involved in the diagnosis and treatment of this disease.- - - - - - - - - - ranking = 1keywords = jaw (Clic here for more details about this article) |
2/36. Unhealed extraction sites mimicking TMJ pain.A case of unhealed extraction sites in the mandible is described, including clinical, radiographic, and biopsy findings. The subject was treated for TMJ disease in the past but still had related signs and symptoms and facial pain.- - - - - - - - - - ranking = 0.24991660875666keywords = mandible (Clic here for more details about this article) |
3/36. Use of an orthopaedic fixator for external fixation of the mandible.A patient presented with a chronically infected, non-united fracture of the mandible, with considerable bone loss. He was treated with a metacarpal fixator, the miniPennig external fixator. The fixator is stable and smaller than conventional mandibular fixators. It can be applied and removed under local anaesthesia, if necessary, requires little maintenance and produces minimal scarring. The successful outcome in this patient is encouraging and we commend the use of the fixator in similar difficult cases.- - - - - - - - - - ranking = 1.2495830437833keywords = mandible (Clic here for more details about this article) |
4/36. Bilateral oroantral fistulas following devitalization of teeth by arsenic trioxide: a case report.Although it is well known that prolonged application or leakage of arsenic trioxide can cause severe damage to the periodontal tissues, the substance is still used by some dentists. This paper describes a case of arsenical necrosis of the jaws affecting the right and the left side of the maxilla. As a result of leakage into the tissues of an arsenical paste from the pulp chamber of endodontically treated teeth, bilateral oroantral fistula (OAF) occurred. It is concluded that there is no justification, whatsoever, for the use of arsenic in modern dental practice. In the following case, buccal advancement flap and submucosal palatal island flap techniques were used for to close the OAF. The submucosal palatal island flap technique resulted in successful closure of the OAF.- - - - - - - - - - ranking = 1keywords = jaw (Clic here for more details about this article) |
5/36. Management of arsenic trioxide necrosis in the maxilla.Historically, pulp-necrotizing agents were commonly used in endodontic treatments. They act quickly and devitalize the pulp within a few days. However, they are cytotoxic to gingiva and bone. If such an agent diffuses out of the cavity, it can readily cause widespread necrosis of gingiva and bone, which can lead to osteomyelitis of the jaws. Although the use of arsenic trioxide can cause severe damage to surrounding tissues, producing complications, it is still used in certain areas in the world. This article presents and discusses two cases of tissue necrosis and their surgical management. These cases showed severe alveolar bone loss in the maxilla, which affected the patients' quality of life and limited the restorative possibilities. As dentists, we should be aware of the hazardous effects of arsenic trioxide and should abandon its use. Because of its cytotoxicity, there is no justification for the use of arsenic trioxide in the modern dental practice.- - - - - - - - - - ranking = 1keywords = jaw (Clic here for more details about this article) |
6/36. Avascular jaw osteonecrosis in association with cancer chemotherapy: series of 10 cases.BACKGROUND: We present a series of 10 patients with osteonecrosis of the jaws (ONJ) that appeared following cancer chemotherapy. MATERIAL AND methods: Of the 10 cases with ONJ, six had bone metastases from breast cancers and the other four had multiple myeloma. We analysed the location of bone metastases, as well as the characteristics of the ONJ, and the drugs with which they had been treated for their bone metastases. RESULTS: Of the 10 patients, all had ONJ in the mandible; 50% also had maxillary involvement. The average number of areas of painful exposed was 2.1 per patient (range 1-5). In seven patients a tooth extraction preceded the onset of ONJ. Two patients developed oroantral communications and another a cutaneous fistula to the neck with suppuration. In all the 10 patients the histopatholological diagnosis was of chronic osteomyelitis without evidence of metastatic disease to the jaws. All the patients had received treatment for their malignant bone disease with bisphosphonates. These were the only drugs that all patients had received. CONCLUSION: ONJ appears to have a relationship with the use of bisphosphonates.- - - - - - - - - - ranking = 6.2499166087567keywords = jaw, mandible (Clic here for more details about this article) |
7/36. osteomyelitis of the mandible during pregnancy.A 21-year-old woman who was 9 weeks pregnant presented with osteomyelitis of the mandible that resolved spontaneously after delivery. To our knowledge a link between osteomyelitis of the jaws and pregnancy has not been reported previously.- - - - - - - - - - ranking = 2.2495830437833keywords = jaw, mandible (Clic here for more details about this article) |
8/36. osteonecrosis of jaw in patient with hormone-refractory prostate cancer treated with zoledronic acid.Intravenous bisphosphonates are widely used in the management of metastatic bone disease, as well as osteoporosis. Recent published reports have documented a possible link between treatment with intravenous bisphosphonates and osteonecrosis of the jaw. We report a case of osteonecrosis of the jaw in 1 patient with prostate cancer receiving both chemotherapy and intravenous zoledronic acid (Zometa). Bisphosphonates have been demonstrated to alter the normal bone microenvironment and appear to have direct effects on tumors as well. These changes may contribute to the development of osteonecrosis of the jaw, particularly after tooth extractions or other invasive dental procedures.- - - - - - - - - - ranking = 7keywords = jaw (Clic here for more details about this article) |
9/36. Bisphosphonate-associated osteonecrosis of the jaws and endodontic treatment: two case reports.Bisphosphonates are commonly used in the management of bone diseases, such as osteoporosis and Paget's disease, and to prevent bone complications and to treat malignant hypercalcemia in certain types of cancer. Although this class of drugs has clear evidence of medical efficacy, there are an increasing number of reports of bisphosphonate-associated osteonecrosis of the jaws that have substantial implications for the patient and for the treating dentist. This case report reviews proposed possible mechanisms of bisphosphonate-associated osteonecrosis of the jaws and describes two case reports where nonsurgical and surgical root canal treatments were precipitating factors. Recommendations for prevention and treatment of the disease follow. Thorough history taking and timely consultation with the patient's oral surgeon and oncologist are emphasized.- - - - - - - - - - ranking = 6keywords = jaw (Clic here for more details about this article) |
10/36. jaw bone necrosis without previous dental extractions associated with the use of bisphosphonates (pamidronate and zoledronate): a four-case report.jaw bone necrosis is a clinical condition associated with defects in vascularization of the maxilla or the mandibular bone, usually present following head and neck radiotherapy and/or oral surgical interventions. Bisphosphonates are synthetic analogues of pyrophosphate used in the treatment of patients with hypercalcemia as a result of malignancy, bone metastasis and for the treatment of other disorders such as metabolic bone diseases, Paget's disease and osteoporosis. Over last 10 years, cases of jaw bone necrosis have been associated with the use of bisphosphonate therapy. In particular, Ruggiero et al. (J Oral Maxillofac Surg 2004; 62: 527-534) in 2004 described a large group of patients (63) with jaw bone necrosis probably related to the use of these drugs. It should be noted that all the patients in the group described either underwent head and neck radiotherapy or had a dental extraction while taking bisphosphonates. In the present study, we reported four cases of jawbone necrosis in patients taking pamidronate (Aredia) and zoledronate (Zometa) without having undergone any kind of radiotherapy or dental surgery. All the patients were females between the ages of 56 and 71 years; three were treated with bisphosphonates for bone metastasis and one for multiple myeloma. All the patients received surgical treatment with bone curettage, with partial and/or temporary improvement of the lesions. Although a treatment for bisphosphonate-induced bone lesions has not yet been established, we suggest careful evaluation of the patients' oral health before prescribing bisphosphonate treatment.- - - - - - - - - - ranking = 3keywords = jaw (Clic here for more details about this article) |
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