[Show abstract][Hide abstract] ABSTRACT: This case series describes the course of osteonecrosis of the jaw (ONJ) in thirteen patients with metastatic bone tumors treated solely with denosumab. Patients on denosumab may be more prone to developing ONJ even without a risk/precipitating factor and they may develop ONJ early in their denosumab therapy. The outcomes of ONJ in ten patients following a period of denosumab discontinuation after the onset of ONJ were: 3 had complete resolution of symptoms, 4 patients’ ONJ progressed, 2 patients’ ONJ was unchanged and in 1 patient there was partial ONJ resolution. The role of drug discontinuation prior to an invasive dental procedure or after the onset of ONJ still remains debatable.
Full-text · Article · Dec 2015 · Journal of cranio-maxillo-facial surgery: official publication of the European Association for Cranio-Maxillo-Facial Surgery
[Show abstract][Hide abstract] ABSTRACT: Objective
Primary Ewing sarcoma of the jaw is rare. The aim of this study is to describe new cases of primary Ewing sarcoma of the jaw, investigating reported prognostic factors of Ewing sarcoma in this series as well as treatment outcome.
Patients and Methods
Six patients with primary Ewing sarcoma of the jaw were treated at our institution between 1992 and 2013. The clinical data, pathology reports, treatment prescribed, treatment regimens, outcome and follow-up information were reviewed.
Of the 6 patients, five were females and five cases were in the mandible. No patient presented with metastatic disease at diagnosis. All cases were positive for CD99 and of the 3 patients genetically confirmed were positive for either EWS-FLI1 fusion or EWSR1 gene rearrangement. All patients received induction multiagent chemotherapy, surgical resection and 2 patients received adjuvant radiotherapy. Total (grade IV) or nearly total (grade III) tumor necrosis in 3 of 5(60%) patients assessed for histologic response to chemotherapy indicated intense sensitivity. All patients were alive and free of disease, with no history of local recurrence, at a median follow-up period of 6.5 years.
Patients with primary Ewing sarcoma of the jaw have a good prognosis and metastasis is an uncommon occurrence at initial presentation.
Ewing family of tumors, Ewing sarcoma, Primary Ewing sarcoma, Jaw
Full-text · Article · Nov 2015 · Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons
[Show abstract][Hide abstract] ABSTRACT: A technique for making a provisional nasal prosthesis for interim use after the ablation of a midface tumor is described. The technique is especially useful for the re-creation of a nasal form in an expedient and cost-effective manner. A preoperative definitive cast, or moulage, of the patient that includes a nasal form is used to fabricate a vacuum form of the midface. The vacuum form is evaluated on the patient, the extension is adjusted, and an external adhesive knit liner is applied to give the appearance of a contoured nasal bandage. The provisional nasal prosthesis is attached with medical adhesive tape and removed daily by the patient. The prosthesis is easily replaced during the course of treatment and has been found to be functional and esthetically acceptable to those patients receiving care from the Dental Service at Memorial Sloan Kettering Cancer Center.
No preview · Article · Sep 2014 · Journal of Prosthetic Dentistry
[Show abstract][Hide abstract] ABSTRACT: Objective:
We report long-term follow-up of patients with intravenous bisphosphonate-related osteonecrosis of the jaw (BRONJ).
Medical and dental histories, including type and duration of bisphosphonate treatment and comorbidities, were analyzed and compared with clinical course of 109 patients with BRONJ at Memorial Sloan-Kettering Cancer Center Dental Service.
Median onset of BRONJ in months was 21 (zoledronic acid), 30 (pamidronate), and 36 (pamidronate plus zoledronic acid), with a significant difference between the pamidronate plus zoledronic acid and zoledronic acid groups (P = .01; Kruskal-Wallis). The median number of doses for BRONJ onset was significantly less with zoledronic acid (n = 18) than pamidronte plus zoledronic acid (n = 36; P = .001), but not pamidronate alone (n = 29). An association between diabetes (P = .05), decayed-missing-filled teeth (P = .02), and smoking (P = .03) and progression of BRONJ was identified through χ(2) test.
This long-term follow-up of BRONJ cases enhances the literature and contributes to the knowledge of BRONJ clinical course.
[Show abstract][Hide abstract] ABSTRACT: Osteoradionecrosis is a significant complication following head and neck radiotherapy. The purpose of this study was to determine the intensity-modulated radiation therapy (IMRT) dosages delivered to the tooth-bearing regions of the mandible.
A total of 28 patients with base of tongue cancer with the following stages: T1-2/N2-3 (n = 10), T3-4/N2-3 (n = 10), and T1-4/N0 (n = 8), treated with IMRT, were included. Average mean and maximum doses were calculated for the anterior, premolar, and molar regions.
Lower doses were seen in anterior bone with smaller tumors. Large tumors, regardless of laterality, resulted in high doses to the entire mandible, with anterior bone receiving more than 6000 cGy.
Tumor size is important in preradiation dental treatment planning. This information is important in planning pre- and postradiation dental extractions. Dosimetric analyses correlating mean and maximum point dose with clinical presentation and outcomes are needed to determine the best predictor of osteoradionecrosis risk.