PIC developing from odontogenic cysts: Clinical and radiological considerations on a series of 6 cases

Abstract Purpose The purpose of this work is to describe the peculiarities of clinical and radiological behavior in SCCs arising from odontogenic cyst (PIOSCC). Material & methods Our computer based records were retrospectively reviewed looking for patients who underwent radical surgery for PIOSCC from December 2001 to January 2016 with a minimum post-operative follow-up of 2 years. Information obtained from radiological findings and treatment outcome were collected. Results From 2001 to 2016, 6 out of 560 SCC's patients (1,07%) were diagnosed PIOSCC. 5 females and 1 male, mean age was 55,2 years (range, 28–82 years). 4 PIOSCC were located in the mandible while 2 in the maxilla. Orthopantomography (OPT) has not given specific signs of malignancy. CT methods (msCT/CONE BEAM-CT/contrast-enhanced CTs) provided more information: unilocular lesions with multiple and excessive cortical interruptions, periosteal reaction far beyond the lesion in all directions, dislocation or disappearance of the IAN, intense peripheral remineralization. In all cases, the treatment involved incisional biopsy of the suspect lesions and subsequent surgical excision of the primary tumor with neck dissection in continuity in the mandibular PIOSCC and in discontinuity in PIOSCC of the maxilla. Recurrence or distant metastases was not observed until now (follow-up from 48 months to 168 months) Conclusions Carcinomas on cysts have radiological "red flag" characteristics (bone erosion, large dimension, involvement of IAN..) that must be taken into consideration in order to perform an early diagnosis and a correct treatment. Accurate radiological study can reduce misdiagnosis and improper treatment. PIOSCC have a progression of the disease and a different prognosis from real intraosseus carcinomas (PIC) and although it is a rare entity it must be considered in the differential diagnosis of larger osteolytic lesions

Different Presentation and Outcomes in the Surgical Treatment of Advanced MRONJ in Oncological and Nononcological Patients Taking or Not Corticosteroid Therapy

Medication-related osteonecrosis of the jaw (MRONJ) is a severe side effect caused by antiangiogenic antiresorptive drugs used to treat various oncological and non oncological diseases. The clinical and radiological characteristics of MRONJ depend on the type of causative drug, the time of administration, and its dosage. Proven systemic risk factors like anemia, uncontrolled diabetes, corticosteroid therapy, and chemotherapy in neoplastic diseases (e.g., high doses of methotrexate up to 30 mg daily) significantly increase the chances of acquiring MRONJ. The risk factors themselves can affect treatment outcomes. Although the main scientific societies have recently disseminated good practice rules on the patient's prevention, diagnosis, and management, there are still no guidelines on shared therapeutic strategies. In general, if conservative treatment fails, surgical treatment is considered, including local debridement, osteoplasty, and marginal or segmental osteotomy. In literature, cohorts of heterogeneous patients with MRONJ have been analyzed for a long time, resulting in a lack of uniformity of information and difficulties interpreting the data. According to the American Association of Oral and Maxillofacial Surgeons criteria, this retrospective study evaluates the surgical treatment outcomes of 64 patients with stage II-III MRONJ, evaluated at the Department of Maxillofacial Surgery of the University of Turin (Italy). The first objective of this retrospective study is to evaluate treatment results for stages II-III in all cases; the second objective is to evaluate the same results by dividing the sample into different cohorts of patients: first, based on the underlying pathology, i.e., oncological and non oncological, and secondly, based on the drug or combination of drugs they took

Difference in outcomes in surgical treatment of stage II-II MRONJ in oncological and non-oncological patients.

Medication-related osteonecrosis of the jaw (MRONJ) is a severe side effect caused by antiresorptive antiangiogenic medication for different pathologies. Although the main factors that seem to increase the risk of ONJ have been identified and the main scientific societies have recently disclosed rules of good behaviour regarding prevention, diagnosis and patient management, there are still no guidelines on therapeutic strategies to be adopted. In general, if conservative treatment fails, surgical treatment is considered, including local debridement, osteoplasty, and marginal or segmental osteotomy. To date, in literature, cohorts of heterogeneous patients with MRONJ have been analysed for a long time, with a lack of uniformity in information and difficulties in interpreting data. This retrospective study evaluates the results of surgical treatment of 62 patients with stage II-III of MRONJ according to the American Association of Oral and Maxillofacial Surgeons criteria, evaluated at the Department of Maxillofacial Surgery, in the University of Turin (Italy), by subdividing patients into different cohorts firstly according to the primary pathology, i,e. oncological and non-oncological, and secondly, according to the drug or combination of drugs taken