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Journal of Cranio-maxillo-facial... Dec 2015Osteoradionecrosis of the mandible is a devastating complication of radiotherapy in patients with head and neck cancer. Many cases present at a late stage, from months... (Review)
Review
INTRODUCTION
Osteoradionecrosis of the mandible is a devastating complication of radiotherapy in patients with head and neck cancer. Many cases present at a late stage, from months to years following completion of radiation therapy. When medical treatment fails, surgery may be required with a variety of free flaps available for microvascular reconstructive techniques.
OBJECTIVE
To conduct a systematic review of the literature investigating the outcomes of free flap reconstruction of the jaw in mandibular osteoradionecrosis and determine the failure rates of different flap tissue.
METHODS
A systematic literature search was performed using Medline (Ovid) Pubmed and Embase databases and Google Scholar. Primary outcome measures were flap failures and complications, with donor site complications representing the secondary outcome measure. Analysis of pooled outcomes was undertaken for different flaps.
RESULTS
333 articles were identified and 15 articles met the final inclusion criteria, detailing 368 primary free tissue flap transfers. There was a flap failure rate of 9.8%. There were 146 post-operative complications (39.7%), the most common being fistula formation (8.4%), hardware plate exposure (7.1%) and flap wound infections (6.5%).
CONCLUSION
The fibula is the workhorse free flap for reconstruction in mandibular osteoradionecrosis. Evidence to date is largely limited with the need for larger powered multi-institutional prospective studies to determine the ideal flap donor tissue and evaluate patient and treatment predictors of free flap outcomes in order to tailor the best patient-based surgical approach for mandibular osteoradionecrosis.
Topics: Cranial Irradiation; Free Tissue Flaps; Humans; Osteoradionecrosis; Prospective Studies; Plastic Surgery Procedures; Retrospective Studies; Treatment Outcome
PubMed: 26427619
DOI: 10.1016/j.jcms.2015.03.006 -
Oral Oncology Aug 2015Trismus is characterized by a reduced ability to open the mouth, directly affecting many aspects of daily life, such as chewing, swallowing, speaking and maintaining... (Review)
Review
Trismus is characterized by a reduced ability to open the mouth, directly affecting many aspects of daily life, such as chewing, swallowing, speaking and maintaining oral hygiene. Several studies have shown that trismus affects health related quality of life. Radiotherapy in the head and neck area is identified as one of the most frequent causes of trismus in head and neck cancer (HNC) patients. Currently, there is no standard treatment for trismus. Several stretching techniques and jaw mobilizing devices are available, but their effect in radiotherapy-induced trismus is still largely unknown. With this review we give an overview of the present relevant literature and compare the effect of exercise therapy versus no exercise therapy on jaw mobility, expressed in millimeters mouth opening, in HNC patients with radiotherapy-induced trismus. A systematic literature search in four electronic bibliographic databases was conducted in July 2014. Selected articles were critically appraised on relevance and validity. Best available evidence was analyzed and compared. Three of the four selected articles show a significant increase (p-value<0.05) in maximal interincisal opening (MIO) after exercise therapy using a jaw-mobilizing device. One article reports a significant decrease in MIO. However, this decrease is less in the intervention group, which implies a positive effect of exercise therapy. Based on this current best clinical evidence, it can be assumed that exercise therapy with a jaw-mobilizing device yields better results than no exercise, with regards to opening of the mouth in HNC patients with radiotherapy-induced trismus.
Topics: Exercise Therapy; Head and Neck Neoplasms; Humans; Jaw; Radiation Injuries; Recovery of Function; Treatment Outcome; Trismus
PubMed: 26058916
DOI: 10.1016/j.oraloncology.2015.05.001 -
Journal of Oral and Maxillofacial... Sep 2015To detect the diagnostic efficacy of emission computed tomography (ECT) in detecting mandibular invasion caused by head and neck cancers. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To detect the diagnostic efficacy of emission computed tomography (ECT) in detecting mandibular invasion caused by head and neck cancers.
MATERIALS AND METHODS
Thirteen databases were searched electronically to retrieve studies for inclusion and a manual search also was conducted. Study inclusion, data extraction, and quality assessment were completed by 2 reviewers independently. Meta-DiSc 1.4 and STATA 11.0 were used to conduct the meta-analysis.
RESULTS
Seventeen studies involving 668 participants were included. One study had a low risk of bias, 2 had a high risk, and the rest had unclear risk. Meta-analysis showed that for the diagnosis of mandibular invasion single-photon ECT (SPECT) had a mean sensitivity (SEN) of 0.96, a mean specificity (SPE) of 0.66, an area under the curve (AUC) of 0.8989, and a Q* (point on the summary reviewer operator characteristic curve when SEN equaled SPE) of 0.8300. Positron emission tomography combined with computed tomography (PET/CT) had a mean SEN of 0.83, a mean SPE of 0.90, an AUC of 0.9290, and a Q* of 0.8640. The comparison between the diagnostic efficacy of SPECT and PET/CT showed that SPECT was superior for SEN (P = .0014) and PET/CT had a significantly better SPE (P = .001). The summary diagnostic efficacy between these modalities did not differ significantly (P > .05).
CONCLUSIONS
The present clinical evidence showed that SPECT is an excellent tool to exclude patients with no mandibular invasion, but is not as good as PET/CT to confirm the diagnosis.
Topics: Head and Neck Neoplasms; Humans; Mandibular Neoplasms; Multimodal Imaging; Neoplasm Invasiveness; Positron-Emission Tomography; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed
PubMed: 26022068
DOI: 10.1016/j.joms.2015.04.041 -
European Archives of... Oct 2017Ameloblastic carcinoma is a rare locally aggressive odontogenic neoplasm. These tumors are most commonly found to arise from mandible. Because of rarity, there is... (Review)
Review
Ameloblastic carcinoma is a rare locally aggressive odontogenic neoplasm. These tumors are most commonly found to arise from mandible. Because of rarity, there is limited information about the clinical behaviour of such patients. We intended to perform this review of published literature to assess the demographic profile, pattern of care and assess survival outcomes. Two authors independently searched PubMed, Google search, and Cochrane library for eligible studies from 1950 until July 1 2016 published in English language. Data of 199 patients were retrieved from 94 publications for statistical analysis. Median age of the entire cohort was 49 years (range 7-91 years). The analysis revealed that a clear twofold higher incidence in male with male-to-female ratio was 2.4:1 (140:57). Mandible was found to be the commonest tumor location in 66.7% (n = 132) cases followed by maxilla (31.8%) (n = 64). The present analysis revealed that median PFS of 57 months (95% CI 39-120 months) with 5- and 10-year PFS was found to be 47.88 and 29.48%, respectively. Median OS for the entire cohort which was 122 months (95% CI 96-153 months) with 2- and 5-year OS for the entire cohort was 87.16 and 69.08%, respectively. In univariate analysis, patients with an R0 resection were found to have a favourable survival. In addition, patients with localized disease and younger age were found to have a better survival. Adjuvant radiation did not confer any survival advantage. The present analysis revealed excellent outcome for patients treated with an R0 resection. Older patients with high-risk factor may benefit from adjuvant radiation. Role of chemotherapy needs to be evaluated.
Topics: Adult; Aged; Ameloblastoma; Antineoplastic Protocols; Carcinoma; Child; Combined Modality Therapy; Dissection; Female; Humans; Jaw Neoplasms; Male; Prognosis; Risk Adjustment; Survival Analysis
PubMed: 28600599
DOI: 10.1007/s00405-017-4631-7 -
The Journal of Clinical Endocrinology... Oct 2023Clinical trials have investigated the role of antiresorptive agents, including bisphosphonates and denosumab, in patients with primary breast cancer receiving adjuvant... (Meta-Analysis)
Meta-Analysis
The Clinical Benefits of Antiresorptive Agents in Patients with Primary Breast Cancer Receiving Adjuvant Endocrine Therapy: A Systematic Review with Pairwise and Network Meta-analysis.
CONTEXT
Clinical trials have investigated the role of antiresorptive agents, including bisphosphonates and denosumab, in patients with primary breast cancer receiving adjuvant endocrine therapy, aiming for better bone protection and/or improving survival.
OBJECTIVE
To summarize the clinical effects of antiresorptive agents in patients with early breast cancer receiving endocrine therapy.
METHODS
We systematically reviewed and synthesized the clinical benefits and harms of antiresorptive agents in patients with early breast cancer receiving endocrine therapy by calculating the risk ratios (RRs).
RESULTS
In the pooled meta-analysis, antiresorptive agents had significant clinical benefits on disease recurrence (RR 0.78, 95% CI 0.67-0.90) and locoregional recurrence (RR 0.69, 95% CI 0.49-0.95) in patients with breast cancer receiving endocrine therapy. Early use of antiresorptive agents has a beneficial effect on secondary endocrine therapy resistance instead of primary resistance. Safety analysis revealed that potential risk for osteonecrosis of the jaw (ONJ, RR 3.29, 95% CI 1.12-9.68) with antiresorptive agents; however, there is an insignificant difference in arthralgia. The subgroup analyses revealed that intervention with bisphosphonates might have profound clinical benefits, but also increased the occurrence of ONJ. A network meta-analysis further supported the clinical effects of early antiresorptive agent use compared with delayed use or placebo.
CONCLUSION
Using antiresorptive agents early in patients with breast cancer receiving adjuvant endocrine therapy may provide additional benefits in risk reduction of recurrence, but there is a potential risk of ONJ.
Topics: Humans; Female; Bone Density Conservation Agents; Denosumab; Breast Neoplasms; Network Meta-Analysis; Neoplasm Recurrence, Local; Diphosphonates
PubMed: 37170778
DOI: 10.1210/clinem/dgad247 -
Journal of Oral and Maxillofacial... 2021Solitary plasmacytoma of bone (SPB) is a localized form of plasma cell neoplasm where jaw involvement is rare. Distinguishing SPB from other plasma cell neoplasms is...
Solitary plasmacytoma of bone (SPB) is a localized form of plasma cell neoplasm where jaw involvement is rare. Distinguishing SPB from other plasma cell neoplasms is critical for treatment and survival. Here, a case of SPB of mandible in an elderly female is reported. Histopathological diagnosis of plasma cell neoplasm was confirmed immunohistochemically with MUM1 and CD138 positivity and multiple myeloma (MM) was ruled out on performing systemic workup. Prognosis of SPB worsens when it transforms into MM. A systematic review was undertaken with the objective to determine the factors affecting conversion of SPB to MM. An electronic search was undertaken with PubMed/MEDLINE, Web of Science and Science Direct. Fifty cases of SPB of jaw from 29 publications were reviewed. SPB commonly presents as a painless swelling. Radiographically, it is commonly seen as multilocular radiolucency with well-defined borders. Follow-up data showed that nine cases turned into MM in a mean duration of 1 year 9 months and 12 patients died after median disease-free survival of 6 years 9 months. Prognosis of SPB is found to be affected by tumor size (≥5 cm), anaplasia of tumor cells, Ki-67 labeling index, vascularity of the tumor, presence of clonal bone marrow plasma cells, serum immune globulin level, dose of radiotherapy and persistence of M protein after treatment. There is a need to identify prognostic subgroups in SPB based on these factors. Furthermore, studies are necessary for standardization of treatment protocol to halt or prolong the progression of SPB to MM.
PubMed: 34349446
DOI: 10.4103/jomfp.JOMFP_251_20 -
Journal of Oral and Maxillofacial... Feb 2017Whether mandibular involvement by oral squamous cell carcinoma (OSCC) could be identified as a factor for cancer staging and prognosis prediction remains a subject of... (Comparative Study)
Comparative Study Review
PURPOSE
Whether mandibular involvement by oral squamous cell carcinoma (OSCC) could be identified as a factor for cancer staging and prognosis prediction remains a subject of debate. In addition, the influence of different types of mandibular invasion (cortical or medullary invasion) on patients' prognosis remains unclear. The aim of this systematic review was to establish whether mandibular invasion or its subset should be considered an independent prognostic factor for patients with OSCC.
MATERIALS AND METHODS
The search for eligible studies was performed according to the predesigned inclusion criteria for a systematic review. Mandibular invasion and invasion depth were considered the primary and secondary predictor variables, respectively. The electronic search was performed using 12 databases. Manual searching covered 14 related journals and references of the included studies were scanned. The risk of bias assessment was evaluated by 2 reviewers using risk-of-bias assessment tools recommended by Saltaji et al (Angle Orthod 82:1115, 2012). Two reviewers extracted the data in duplicate. RevMan 5.2 was used for meta-analysis to assess the primary outcomes (disease-free survival and overall survival) and the secondary outcomes (2- and 5-year survival rate and local control).
RESULTS
Eighteen studies (total, 3,756 participants) were included and used as the study sample. Among these included studies, 7 had an unclear risk of bias and the remaining showed a high risk. The results of the meta-analyses showed a significant relation between mandibular invasion and overall survival (P = .04) and, most importantly, that medullary involvement (P = .0001), but not cortical involvement (P = .66), could decrease overall survival. When focusing on disease-specific survival, mandibular medullary involvement predicted a poor disease-specific survival (P < .0001), but cortical involvement showed no effect (P = .66).
CONCLUSION
This review showed that OSCC mandibular medullary invasion, and not mandibular invasion or mandibular cortical invasion, could be an independent prognostic factor for patients.
Topics: Carcinoma, Squamous Cell; Humans; Mandibular Neoplasms; Mouth Neoplasms; Neoplasm Invasiveness; Prognosis
PubMed: 27621147
DOI: 10.1016/j.joms.2016.08.005 -
Journal of Cranio-maxillo-facial... Jan 2015The aim of the present study was to define and evaluate the post-treatment recurrence of unicystic and solid or multicystic ameloblastoma lesions, measured as counts of... (Meta-Analysis)
Meta-Analysis Review
Recurrence rates of intraosseous ameloblastomas of the jaws: a systematic review of conservative versus aggressive treatment approaches and meta-analysis of non-randomized studies.
BACKGROUND
The aim of the present study was to define and evaluate the post-treatment recurrence of unicystic and solid or multicystic ameloblastoma lesions, measured as counts of first time recurrences.
METHODS
A systematic review of the literature and meta-analysis was planned according to the PRISMA statement and in order to include randomized and non-randomized clinical trials and observational studies in humans. Seven electronic databases were searched from their start up to December 2013 without limitation to year, language or publication status.
RESULTS
A total of seven non-randomized studies with 229 cases of treated ameloblastoma lesions were included in the quantitative synthesis. The summary recurrence rate of ameloblastomas for the unicystic and solid or multicystic variants ranged from 0.2% to 12% and 0.8% to 38% respectively. The comparison of a conservative treatment approach versus radical in solid or multicystic ameloblastoma favored the radical.
CONCLUSIONS
The absence of studies with low risk of bias precludes the making of strong clinical recommendations while resection may be preferable in both unicystic and solid or multicystic. ameloblastomas.
Topics: Ameloblastoma; Bias; Checklist; Clinical Trials as Topic; Humans; Jaw Neoplasms; Neoplasm Recurrence, Local; Non-Randomized Controlled Trials as Topic; Observational Studies as Topic; Treatment Outcome
PubMed: 25465490
DOI: 10.1016/j.jcms.2014.10.027 -
Oral Health & Preventive Dentistry 2017To examine whether a difference exists in the relapse rate between the conservative and radical approaches after the treatment of solid/multicystic ameloblastoma (SMA),... (Comparative Study)
Comparative Study Meta-Analysis Review
PURPOSE
To examine whether a difference exists in the relapse rate between the conservative and radical approaches after the treatment of solid/multicystic ameloblastoma (SMA), a systematic review of the literature based on evidence of the last decade was performed.
MATERIALS AND METHODS
The search strategy incorporated examinations of electronic databases, supplemented by hand searches. A search of four electronic databases, including Ovid MEDLINE, PubMed, EMBASE and Web of Science, was carried out for relevant studies published in the English language from January 2005 to September 2015. Cross referencing and hand research was used to identify further articles. Relative Risk (RR) as effect estimates was calculated in both fixed and random effects models.
RESULTS
Of 4234 abstracts screened, only 26 articles met the inclusion criteria and were screened in full text. Of these, only 4 were included in the final meta-analysis.
CONCLUSION
The inverse of variance test revealed a statistical difference in the relapse rate for SMA treatment with the conservative vs radical approach. The higher recurrence rate after a conservative approach compared to the surgical approach is significant. However, this review cannot give any recommendation due to the lack of clinical evidence.
Topics: Ameloblastoma; Conservative Treatment; Humans; Jaw Neoplasms; Time Factors
PubMed: 28748232
DOI: 10.3290/j.ohpd.a38732 -
European Review For Medical and... Dec 2019Medication-related osteonecrosis of the jaw (ONJ) is an adverse, severe and debilitating effect, which although infrequent, affects patients with osteoporosis or...
OBJECTIVE
Medication-related osteonecrosis of the jaw (ONJ) is an adverse, severe and debilitating effect, which although infrequent, affects patients with osteoporosis or neoplasm who take bisphosphonates, antiresorptive drugs, and/or antiangiogenic drugs. Its etiopathogenesis is unknown, although genetic causes have been postulated.
MATERIALS AND METHODS
This review analyzed articles published to date that have studied genetic factors associated with ONJ. Fifteen case-control studies were included, published between 2008 and 2018.
RESULTS
Five set out to determine genetic causes by means of genome-centered techniques, while ten do so by investigating gene-centered variants. Nine works found statistically significant associations between one or various single nucleotide polymorphisms (SNPs) and the appearance of ONJ. None of the studies coincided as to which genes present some association.
CONCLUSIONS
The review observed the moderate impact of genetic factors on the appearance of ONJ. It also showed the heterogeneity of the studies that have investigated ONJ to date. In future studies, involving international and interhospital collaboration will be necessary to recruit sample sizes of sufficient size, elaborate adequate study designs, obtain clear results, and advance our understanding of ONJ and make it possible to single out individual patients at risk.
Topics: Angiogenesis Inhibitors; Bisphosphonate-Associated Osteonecrosis of the Jaw; Bone Density Conservation Agents; Diphosphonates; Humans
PubMed: 31841171
DOI: 10.26355/eurrev_201912_19652