THE USE OF CONE BEAM COMPUTED TOMOGRAPHY IN THE DIAGNOSIS AND TREATMENT OF MEDICATION-RELATED OSTEONECROSIS OF THE JAW

In the diagnosis of osteonecrosis of the jaw (ONJ), imaging may have an important role in determining the extent of the disease, diagnosing early stages of osteonecrosis, identifying a potential association between metastasis of the jaw and ONJ lesions, excluding other diseases or complications of the jaws, such as fractures, and evaluating the jaw before surgical orofacial procedures. Since the appearance of ONJ at imaging is variable and very often nonspecific, imaging findings should always be related to the clinical context. The panoramic radiography is the most often used imaging technique in cases of ONJ, whereas CBCT is an adequate tool in evaluating bone involvement, in addition to offering the advantage that destructive processes can be seen at high resolution

ORAL AND MAXILLOFACIAL NON-HODGKIN’S LYMPHOMAS

Aim of the study is to assess the clinical-epidemiological and morphological features of the lymphomas located in the oral and maxillofacial territory, including the research of histopathological forms involved and anatomical sites affected. It has also been analyzed their progress and response to treatment, as well as the patients` rate of survival. Material and methods The study has been conducted within the Department of Oral and Maxillofacial Surgery – “Sf. Spiridon” Iasi for a period of 7 years (from 2010 to 2017), analyzing the data recorded in 70 patients diagnosed with oral and maxillofacial non-Hodgkin’s lymphomas. Results Oral and maxillofacial Non-Hodgkin’s lymphomas are most often diagnosed in elder people, in advanced stages (42% of the cases in stage IV). The extranodal presentation occurs in 55% of the patients, the parotid gland being the most frequent site. Conclusions Diffuse Large B-cell Lymphoma is the most common subtype. Chemotherapy is the most used therapeutic method in a multimodal treatment and the survival rate is 58%, with better results when the treatment is applied in the early stages

BROWN TUMOR OF THE JAW: A RARE ENTITY

Aim of the study The aim of this study is to present the development of brown tumors in the jaws as a consequence of secondary hyperparathyroidism (HPT). Material and methods We analysed 10 cases with brown tumor of the jaws developed in patients with HPT which presented in our Oral and Maxillofacial Clinic for evaluation and treatment of their disease. The patients were 7 females and 3 males, with ages between 13 and 58 years. Results All patients were symptomatic and bone deformation was noted in all cases. The mandible was involved in 5 patients, the maxillary bone in 4 cases and in one case the tumor was localized in both jaws. The PTH values ranged from 630 pg/ml to 2500 pg/ml. All patients were referred for parathyroidectomy and for 2 patients, local excision was performed. Conclusions Regression of brown tumors may be achieved by performing parathyroidectomy. Multidisciplinary follow-up is essential for the control of brown tumors in order to prevent rapid growth which may lead to severe deformities and functional alterations

DENTAL AND PERIODONTAL HEALTH IN END STAGE RENAL DISEASE PATIENTS

In end stage renal disease, a whole range of changes occur in the oral cavity concerning the teeth, oral mucosa, bone, periodontium, salivary glands or temporomandibular joint. Adults with chronic renal failure have more severe oral disease than the general population Material and methods 39 patients undergoing dialysis and requiring oral surgery procedures were evaluated in terms of age, gender, aetiology of renal failure, duration of dialysis, reason for admission, local status and treatment. Results 32 patients presented for complications of carious disease, from which 29 had non-restorable teeth. Severe periodontitis (attachment loss greater than 5mm) was recorded in 17,94 % of cases, while moderate periodontitis (attachment loss 3-5mm) in 54.4% cases. 61.5% of patients presented maxillary or mandibular terminal edentatulism. Conclusions Poor oral health is common among ESRD patients and regular dental consultation should be integrated into care of chronic kidney disease

MANAGEMENT OF ORBITAL TUMORS PRESENTING AS UNILATERAL EXOPHTHALMOS

Aim of the study. We aim to present our experience regarding the management of exophthalmos as the first clinical manifestation of a space-occupying orbital lesion. Material and methods. We performed a retrospective review, selecting 17 patients with orbital tumors that initially presented for proptosis. Results. Following multidisciplinary clinical and imaging evaluation, three primary orbital tumors were diagnosed, one mass pertaining to the lacrimal gland, and 13 secondary tumors. Surgical treatment was performed in 11 patients. Complete excision was performed in three benign tumors, complete removal and orbital content preservation was achieved in eight patients, orbital exenteration was necessary in two cases of orbital malignancies, and extended orbital exenteration was performed in one patient. Four cases did not have indication of surgery due to internal carotid artery invasion or extensive intracranial invasion. Two patients were diagnosed with lymphoma following biopsy and underwent oncologic treatment. Conclusion. An early diagnosis of an orbital mass presenting as proptosis involves multidisciplinary evaluation for the exclusion of other causes of exophthalmos. Orbital content and function preservation are the main goals of the surgical treatment

Balancing orbital volume reduction and redistribution for a tailored surgical treatment in Graves’ ophthalmopathy

Aim!#!The purpose of this study is to share our experience on the use of different orbital decompression techniques, as well as the principles followed for deciding the most case-appropriate procedure that ensured the most favorable outcomes.!##!Methods!#!We reviewed the Graves' ophthalmopathy cases operated over the course of 14 years, regarding the presenting signs, the imaging evaluation, the degree of exophthalmos, the type of surgical orbital decompression performed, and the postoperative outcomes.!##!Results!#!All 42 patients identified presented with proptosis, with 92.8% cases of bilateral proptosis. The main addressing concern was functional in 54.8% cases and aesthetic in 45.2% patients. CT was used for the preoperative evaluation in all cases. In total, 81 orbits were operated. The orbital decompression surgery involved only the orbital fat in 7.4% of orbits and associated fat and bone decompression in the other 92.6% of orbits. The postoperative results were favorable in all cases regarding both appearance and function, with minimal postoperative complications.!##!Conclusion!#!The adequate selection of the most suitable procedure based on the characteristics of each case is the prerequisite for a successful surgery. We found that the association of fat and bone decompression of various extents is most permissive in tailoring the degree of decompression to the existing requirements

Novel Mutation in APC Gene Associated with Multiple Osteomas in a Family and Review of Genotype-Phenotype Correlations of Extracolonic Manifestations in Gardner Syndrome

Gardner syndrome is a neoplasic disease that associates intestinal polyposis and colorectal adenocarcinoma with osteomas and soft tissue tumors determined by germline mutations in the APC gene. The early diagnosis and identification of high-risk individuals are important because patients have a 100% risk of colon cancer. We present the case of a family with Gardner syndrome. Cephalometric, panoramic X-rays and CBCT of the proband and her brother showed multiple osteomas affecting the skull bones, mandible and paranasal sinuses. The detailed family history showed an autosomal dominant transmission with the presence of the disease in the mother and maternal grandfather of the proband. Both had the typical signs of disease and died in the fourth decade of life. Based on these aspects the clinical diagnosis was Gardner syndrome. By gene sequencing, a novel pathogenic variant c.4609dup (p.Thr1537Asnfs*7) in heterozygous status was identified in the APC gene in both siblings. We reviewed literature data concerning the correlation between the localization of mutations in the APC gene and the extracolonic manifestations of familial adenomatous polyposis as well as their importance in early diagnosis and adequate oncological survey of patients and families based on abnormal genomic variants