Unilaterale Sinusitis bei okkultem Ameloblastom des Oberkiefers

Einleitung: Es gibt Fälle, die mit der üblichen Diagnostik von Kiefer und Nasennebenhöhlen nicht auffällig werden. Über einen solchen speziellen Fall, ein Ameloblastom des Oberkiefers, können wir berichten. Ameloblastome sind gutartige, lokal invasiv wachsende Tumore des Kiefers, wobei Oberkiefer-Ameloblastome selten sind. Klinisch fallen sie meist durch eine schmerzlose Auftreibung des Kiefers auf. Da weitere Symptome oft erst verzögert auftreten, können sie eine beträchtliche Größe erreichen und das Mittelgesicht infiltrieren.Methoden und Ergebnisse: Berichtet wird von einem 43-jährigen Patienten mit rezidivierenden sinusitischen Symptomen. Dentogene Beschwerden wurden verneint. Rhinoskopisch imponierte eine Vorwölbung der medialen Kieferhöhlenwand. CT-morphologisch zeigte sich eine unilaterale Verschattung des linken Sinus maxillaris, ethmoidalis und frontalis. Eine zahnärztliche Untersuchung war nicht wegweisend. Klinisch bestand ein tiefer parodontaler Defekt bei Zahn 28, ein Orthopantomogramm (OPG) war unauffällig. Im Rahmen einer Nebenhöhlenoperation links zeigte sich ein infiltrativer Prozess im Bereich des Kieferhöhlenbodens sowie der lateralen Kieferhöhlenwand. Histologisch wurde ein Ameloblastom vom konventionellen Typ diagnostiziert. Schlussfolgerungen: Ameloblastome fallen in der Regel durch eine Schwellung des Kiefers auf und imponieren in der bildgebenden Diagnostik als glatt begrenzte, osteolytische Prozesse. Im oben beschriebenen Fall konnte erst durch das histopathologische Ergebnis eine dentogene Genese der Sinusitis gezeigt werden, was die Wichtigkeit einer Probeexzision zur Diagnosestellung hervorhebt. Ameloblastome sollten also als seltene Ursache bei unilateraler Sinusitis in die differentialdiagnostischen Überlegungen einbezogen werden

Bone formation induced by strontium modified calcium phosphate cement in critical-size metaphyseal fracture defects in ovariectomized rats

AbstractThe first objective was to investigate new bone formation in a critical-size metaphyseal defect in the femur of ovariectomized rats filled with a strontium modified calcium phosphate cement (SrCPC) compared to calcium phosphate cement (CPC) and empty defects. Second, detection of strontium release from the materials as well as calcium and collagen mass distribution in the fracture defect should be targeted by time of flight secondary ion mass spectrometry (TOF-SIMS). 45 female Sprague–Dawley rats were randomly assigned to three different treatment groups: (1) SrCPC (n = 15), (2) CPC (n = 15), and (3) empty defect (n = 15). Bilateral ovariectomy was performed and three months after multi-deficient diet, the left femur of all animals underwent a 4 mm wedge-shaped metaphyseal osteotomy that was internally fixed with a T-shaped plate. The defect was then either filled with SrCPC or CPC or was left empty. After 6 weeks, histomorphometric analysis showed a statistically significant increase in bone formation of SrCPC compared to CPC (p = 0.005) and the empty defect (p = 0.002) in the former fracture defect zone. Furthermore, there was a statistically significant higher bone formation at the tissue–implant interface in the SrCPC group compared to the CPC group (p < 0.0001). These data were confirmed by immunohistochemistry revealing an increase in bone-morphogenic protein 2, osteocalcin and osteoprotegerin expression and a statistically significant higher gene expression of alkaline phosphatase, collagen10a1 and osteocalcin in the SrCPC group compared to CPC. TOF-SIMS analysis showed a high release of Sr from the SrCPC into the interface region in this area compared to CPC suggesting that improved bone formation is attributable to the released Sr from the SrCPC

Effects of multi-deficiencies-diet on bone parameters of peripheral bone in ovariectomized mature rat.

Many postmenopausal women have vitamin D and calcium deficiency. Therefore, vitamin D and calcium supplementation is recommended for all patients with osteopenia and osteoporosis. We used an experimental rat model to test the hypothesis that induction of osteoporosis is more efficiently achieved in peripheral bone through combining ovariectomy with a unique multi-deficiencies diet (vitamin D depletion and deficient calcium, vitamin K and phosphorus). 14-week-old Sprague-Dawley rats served as controls to examine the initial bone status. 11 rats were bilaterally ovariectomized (OVX) and fed with multi-deficiencies diet. Three months later the treated group and the Sham group (n = 8) were euthanized. Bone biomechanical competence of the diaphyseal bone was examined on both, tibia and femur. Image analysis was performed on tibia via µCT, and on femur via histological analysis. Lower torsional stiffness indicated inferior mechanical competence of the tibia in 3 month OVX+Diet. Proximal metaphyseal region of the tibia showed a diminished bone tissue portion to total tissue in the µCT despite the increased total area as evaluated in both µCT and histology. Cortical bone showed higher porosity and smaller cross sectional thickness of the tibial diaphysis in the OVX+Diet rats. A lower ALP positive area and elevated serum level of RANKL exhibited the unbalanced cellular interaction in bone remodeling in the OVX+Diet rat after 3 month of treatment. Interestingly, more adipose tissue area in bone marrow indicated an effect of bone loss similar to that observed in osteoporotic patients. Nonetheless, the presence of osteoid and elevated serum level of PTH, BGP and Opn suggest the development of osteomalacia rather than an osteoporosis. As the treatment and fracture management of both osteoporotic and osteomalacia patients are clinically overlapping, this study provides a preclinical animal model to be utilized in local supplementation of minerals, drugs and growth factors in future fracture healing studies

Qualitative analysis of trabecular bone shows inferior bone quality resulting from multi-deficiencies diet combined with bilateral ovariectomy in rats after 3

<p> <b>M.</b> (A) BV/TV showed how bone tissue is affected within the total volume; these results suggest that at 3 M the treatment results in less mineralized tissue in OVX+Diet when compared to the 3 M Sham. (B) Structure Model Index (SMI) indicated the trabecular shape change at 3 M in the OVX+Diet group. (C) Tb. N was lower in the 3 M OVX+Diet group compared to the Sham group. (D) Higher trabecular separation in the OVX+Diet group when compared to the Sham after 3 M of treatment. (* = p≤0.05, one-way ANOVA with bonferroni correction, 0 M, n = 8; 1 M, n = 3 per group; 3 M n = 8 per group).</p

A chart depicting the work plan and experimental design.

<p>Female Sprague-Dawley rats were utilized for this experiment, 10 of which were sacrificed, analysis on these animals were carried out to obtain an initial bone status. Eleven animals were then ovariectomized (OVX), and another eleven rats were Sham operated (Sham) and animals were left to recover for two weeks. After recovery OVX animals were given a multi-deficiencies-diet where Sham animals received a standard diet. One month (1 M) and three months (3 M) after dietary treatment begun, 3 and 8 animals were sacrificed, respectively. Rats were scanned by DEXA at every time point and DEXA results were reported elsewhere. Besides DEXA, at 1 M only µCT analysis was performed on the left tibia. At both 0 M and 3 M Left tibia was analyzed in µCT before performing undecalcified histology; right femur and right tibia were tested biomechanically, and right femur was used for decalcified histology.</p

Biochemical markers reflect the bone metabolism.

<p>(A–D) Opn, BGP, RANKL, and PTH concentration in serum was higher in the 3 M OVX+Diet than the 3 M Sham. (D -F) lower concentrations of TRAP5b and leptin were seen in the OVX+Diet at 3 M compared to the Sham group. (* = (p≤0.05), Mann Whitney U with bonferroni correction, n = 8 per group).</p

Weight and bone length of different groups at all time points.

<p>Weight and bone length of different groups at all time points.</p

Biomechanical testing of tibia and femur of the ovariectomized rat after three months of multi-deficient diet treatment.

<p>(A) Ultimate torque at failure shows no significance between the groups at 3 M. (B) Tibia of treated rats showed lower torsional stiffness compared with the Sham operated rats. (C) Breaking load of the femur shows an increased needed load to break the femur of treated animals at 3 M. (D) Bending stiffness of the femur showed no significant difference between the treatment group and the Sham group. (* = p≤0.05, Mann Whitney U with bonferroni correction, n = 8 per group).</p

µCT analysis of cortical bone parameters show affected porosity and thickness in the OVX+Diet treatment after 3 months.

<p>(A) Porosity measurement showed that both groups; the 0 M control and the 3 M Sham have significantly lower porosity than the 3 MOVX+Diet. (B) Cortical thickness was significantly higher in the 3 M Sham group when compared to either 3 M OVX+Diet or 0 M control group. (* = p≤0.05, Mann Whitney U with bonferroni correction, n = 8 per group).</p