-
Medicina Oral, Patologia Oral Y Cirugia... May 2023Osteoradionecrosis of the jaws (ORNJ) is a severe and challenging complication of head and neck radiation therapy. Despite its aggressiveness and controversy respect to...
BACKGROUND
Osteoradionecrosis of the jaws (ORNJ) is a severe and challenging complication of head and neck radiation therapy. Despite its aggressiveness and controversy respect to its efficacy, surgical intervention remains the main treatment modality. Nevertheless, due to advances in the understanding of ORNJ physiopathology, new treatment alternatives such as the combination of pentoxifylline with tocopherol (PENTO) have emerged. The aim of this systematic review was to assess the reported efficacy of PENTO for the treatment of ORNJ. Material and Methods: Studies were search using Pubmed, The Cochrane Library, Scopus, and Web of Science data bases following the PRISMA guidelines. Inclusion criteria were cohort, case series, randomized or non-randomized clinical studies published in English including human subjects who received PENTO as treatment for ORN of the jaws. Results: Eleven articles met the inclusion criteria and were included for data analysis. All studies reported patients with complete mucosal coverage with no exposed bone (considered healthy) after PENTO treatment, ranging from 16.6% to 100% of the patients, depending on the study. Clinical improvement or disease stabilization was reported between 7.6% and 66.6% of studied individuals, while disease progression was seen in only 5 studies involving 7.6 - 32% of patients.
CONCLUSIONS
PENTO treatment achieved a complete disease control in a significant number of patients in all studies. However, there is no standardized protocol for administering the therapy. It is necessary to determine the pharmacological doses and to evaluate the benefits of adding antibiotics and clodronate. Good quality clinical trials are needed to develop a successful algorithm for the management of ORN of the jaws.
Topics: Humans; Tocopherols; Pentoxifylline; Osteoradionecrosis; Head and Neck Neoplasms; Jaw
PubMed: 36641743
DOI: 10.4317/medoral.25729 -
Journal of Racial and Ethnic Health... Feb 2024Ameloblastoma is an aggressively growing jaw tumor with high recurrent properties. Reports on global and racial distribution of ameloblastoma are variable and... (Meta-Analysis)
Meta-Analysis Review
Ameloblastoma is an aggressively growing jaw tumor with high recurrent properties. Reports on global and racial distribution of ameloblastoma are variable and inconclusive. The role of race and ethnicity on ameloblastoma growth characteristics, genetic mutational profile, and recurrence is also still unclear. The primary aim of this systematic review was to assess genetic, racial, and ethnic distribution of primary and recurrent ameloblastoma from published literature. The secondary aim was to assess potential correlations between ethnicity, genetic mutation, and disparities in ameloblastoma treatment outcomes in Afro-descendants and non-Afro-descendants. Twenty-three eligible articles were selected based on preferred reporting items for systematic review and meta-analysis (PRISMA), and a total of 169 ameloblastoma cases were evaluated. Data on patient demographics, ameloblastoma growth characteristics, and genetic status were collected for quantitative analysis. Among a total of 169 ameloblastoma cases, Afro-descendant patients had higher primary and recurrent ameloblastomas at 15.5% and 4.7% respectively compared to non-Afro-descendant at 10.7% and 1.8% respectively. Additionally, BRAF V600E was positively associated with 48.8% of all ameloblastomas and strong predilection for Afro-descendants. Despite the paucity of information on genetic profile of ameloblastomas in the Afro-descendant patient cohort, this ethnic group still accounted for 2.95% of all BRAF V600E-positive tumors. These suggest that Afro-descendants are understudied regarding ameloblastoma characteristics, genetic profile, and recurrence profile. Mutational analysis of ameloblastoma tumors in Afro-descendants should be promoted.
Topics: Humans; Ameloblastoma; Proto-Oncogene Proteins B-raf; Jaw Neoplasms; Treatment Outcome; Mutation
PubMed: 36596981
DOI: 10.1007/s40615-022-01500-6 -
Oral Surgery, Oral Medicine, Oral... Jun 2023Many options exist in the diagnosis and management of condylar osteochondroma. The purpose of this study was to provide a congregate information concerning treatment of... (Meta-Analysis)
Meta-Analysis Review
Many options exist in the diagnosis and management of condylar osteochondroma. The purpose of this study was to provide a congregate information concerning treatment of the osteochondroma involving the mandibular condyle. The search was conducted in PubMed, Google Scholar, Semantic Scholar, and Cochrane database until February 2022. Twenty-seven studies were included for the final review. The review included 439 patients who underwent surgical management for mandibular condylar osteochondroma. The position of osteochondroma was mentioned in 13 studies. Preauricular, retromandibular, endaural, submandibular, transzygomatic, and intraoral approaches were used for approaching the tumor. Surgical techniques included resection, conservative condylectomy, and total condylectomy. Concomitant orthognathic surgery was performed along with tumor resection in 19 studies. In the entire review, the recurrence rate was 0.22% (1/439). The results of the meta-analysis showed that 2 studies reported significant malocclusion events after surgical therapy. Total joint replacement after tumor resection has a higher improvement in maximal mouth opening (8 mm) compared with vertical ramus osteotomy and no reconstruction groups, which have similar improvements (6 mm). The mainstay of treatment of osteochondroma is surgical excision either as condylectomy or conservative condylectomy. Among the various reconstruction modalities, total joint replacement showed better improvement in mouth opening. Adjunct procedures like orthodontic and orthognathic surgery have an important role in holistic management of severe cases. The treating surgeon must choose the surgical procedures in a pragmatic way.
Topics: Humans; Mandibular Condyle; Mandibular Neoplasms; Osteotomy; Treatment Outcome; Osteochondroma; Facial Asymmetry
PubMed: 36529674
DOI: 10.1016/j.oooo.2022.09.039 -
Clinical and Experimental Dental... Feb 2023Antiresorptive medication has been reported to be associated with medication-related osteonecrosis of the jaw (MRONJ). This systematic review aims at investigating the... (Review)
Review
OBJECTIVES
Antiresorptive medication has been reported to be associated with medication-related osteonecrosis of the jaw (MRONJ). This systematic review aims at investigating the incidence of and risk factors for MRONJ after tooth extractions in cancer patients treated with high-dose bisphosphonate and denosumab (BP and DS). MATERIAL AND METHODS: The protocol followed the PRISMA statement list and was registered in PROSPERO. Searches were performed for literature published up to April 2021 in the electronic databases PubMed, Embase, Web of Science, and CINAHL and then supplemented by manual research.
RESULTS
The search process resulted in 771 identified articles, of which seven studies fitted the population, intervention, comparison, and outcome framework. All were observational studies and four had control groups. A total of 550 patients treated with BP and DS were identified of whom 271 had received tooth extractions after medication onset. Due to significant heterogenicity in the collected data, only a qualitative analysis was performed. The MRONJ incidence after tooth extractions varied between 11% and 50% at the patient level. MRONJ occurred up to 3 years after the tooth extraction. Teeth affected by inflammation before the extraction and additional osteotomy during the surgical procedure were identified as risk factors.
CONCLUSIONS
Reliable methods of diagnosing MRONJ and adequate follow-up periods are important factors in obtaining the actual incidence of MRONJ after tooth extractions in patients treated with high-dose BP and DS.
Topics: Humans; Bisphosphonate-Associated Osteonecrosis of the Jaw; Incidence; Diphosphonates; Tooth Extraction; Risk Factors; Neoplasms
PubMed: 36464958
DOI: 10.1002/cre2.698 -
Journal of Stomatology, Oral and... Feb 2023To summarize published information regarding malignant tumors with metastasis to the oral cavity. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To summarize published information regarding malignant tumors with metastasis to the oral cavity.
MATERIALS AND METHODS
This was a systematic review with meta-analysis. An electronic search of Pubmed, Scopus, and Google Scholar databases from inceptions to February 2022 were performed. Only case reports or case series with histopathological results demonstrating metastasis to the oral cavity were included. The main outcomes included demographics, primary site, metastatic site, clinical manifestations, and patient survival. The quality of primary articles was assessed using the Joanna Briggs Institute - University of Adelaide scorecards for case reports and case series. Descriptive analysis and a Kaplan-Meier survival curve were performed.
RESULTS
273 articles were selected (50 case series and 223 case reports), for a total of 950 cases. The mean age was 57.11 years. Males were more affected (57.5%). The most common primary sites in women and men was breast (29.8%), and lung (24.8%), respectively. In ∼1/3 of the cases, oral metastasis preceded tumor dissemination. Jawbones were more affected (56.7%) than soft tissues (37.9%), with the mandible being the most affected site (45.5%), followed by the gingiva (19.9%). The most common clinical manifestation was a mass or nodule. Most radiographic evidence was radiolucency of the jaw (60.6%). 3-year and 5-year survival rates were 14.2 and 10.7%. In the majority of cases, the primary tumor was the first to be diagnosed, while in 30.4%, metastasis was the first sign of the disseminated disease. This can be implied that the oral metastasis should be included in the differential diagnosis list of the oral diseases.
CONCLUSION
Clinicians should be aware of the possibility of, albeit uncommon, oral metastases. Because the extracted data in this review was relatively generalized, the investigators cannot develop the diagnostic clues of oral metastasis, which require further investigations.
Topics: Male; Humans; Female; Middle Aged; Mouth Neoplasms; Mandible; Gingiva; Diagnosis, Differential
PubMed: 36371023
DOI: 10.1016/j.jormas.2022.11.006 -
Clinical and Experimental Dental... Feb 2023The aim of this study is to evaluate recent evidence-based data that summarize the clinicopathological findings and treatment along with follow-up measures taken in... (Review)
Review
OBJECTIVE
The aim of this study is to evaluate recent evidence-based data that summarize the clinicopathological findings and treatment along with follow-up measures taken in terms of published cases of Juvenile psammomatoid ossifying fibroma (JPOF) of the maxilla and mandible by a systematic review. MATERIALS AND METHODS: The databases searched were PubMed, MEDLINE, Scopus, Google scholar, and Cross references. Only those case reports of JPOFs published in the English language from 2000 to 2022 were considered. All cases included confirmed JPOF lesions histopathologically. The SR-included details like clinical and radiographic data, follow-up details such as recurrence, and the presence of any adverse outcome.
RESULTS
The database search produced 595 articles from 2000 to 2022, among which 22 case reports were included in the systematic review. The mean age of JPOF occurrence in patients was 18 ± 16 years. A male predilection was noted among patients younger than 14 years of age, whereas a female predilection was noted in patients older than 14 years of age. Frequent involvement of the mandible (56%) compared to the maxilla (44%) was reported. The posterior mandible was the most commonly affected site involving numerous adjacent structures. The expansile nature of the JPOF displayed 57% buccolingual expansion, 50% downward displacement or erosion of the lower border of the mandible and 81% of involvement of the maxillary antrum/pterygoid plate/orbital floor. Among the 20 cases reported, the treatment provided included surgical excision in 45% of the patients, jaw resection in 35% of the patients, and enucleation and curettage in 18% of the patients. Follow-up details were provided in 80% of the reports that showed recurrence.
CONCLUSIONS
The diagnosis of JPOF requires correlation of the clinical and radiographic features with key histopathological features. Although long-term follow-up of the case reports has been reported, the data lack information about the long-term outcomes of JPOF.
Topics: Humans; Male; Female; Child, Preschool; Child; Adolescent; Young Adult; Adult; Maxilla; Fibroma, Ossifying; Bone Neoplasms; Mandible
PubMed: 36325758
DOI: 10.1002/cre2.687 -
The Journal of Craniofacial SurgeryThe aim was to identify whether malignant diseases increase the risk of medication-related osteonecrosis of the jaw (MRONJ) occurrence when patients are exposed to... (Meta-Analysis)
Meta-Analysis
PURPOSE
The aim was to identify whether malignant diseases increase the risk of medication-related osteonecrosis of the jaw (MRONJ) occurrence when patients are exposed to bisphosphonate, antiresorptive or antiangiogenic drugs. To analyze related factors.
METHODS
A systematic literature searching was performed in PubMed, Embase, and Google Scholar for studies with information about whether patients have malignant diseases. Patients involved must be treated with MRONJ-related drugs and at high risk of developing MRONJ.
RESULTS
A total of 6 cohort studies and 3 case-control studies were included. Analysis according 9 studies shows that malignant diseases have significant influence on MRONJ occurrence (risk ratio (RR): 2.62; 95% confidence interval (95% CI): 1.58-4.33; P =0.0002). Subgroup analysis according 6 cohort studies also shows that malignant diseases significantly affect MRONJ occurrence (RR: 3.50; 95% CI: 1.63-7.52; P =0.001). Chemotherapy have no obvious influence on MRONJ occurrence (RR: 1.64; 95% CI: 0.79-3.39; P =0.18). Intravenous drug administration significantly influences MRONJ occurrence (RR: 2.67; 95% CI: 1.27-5.58; P =0.009).
CONCLUSIONS
Patients with malignant diseases have higher risk of MRONJ occurrence when exposed to bisphosphonate, antiresorptive, or antiangiogenic drugs. Cumulative dosages from intravenous drugs administration contribute to MRONJ developing. Prevention of MRONJ in patients with malignancy should be emphasized.
Topics: Humans; Bone Density Conservation Agents; Bisphosphonate-Associated Osteonecrosis of the Jaw; Diphosphonates; Neoplasms; Angiogenesis Inhibitors
PubMed: 36184756
DOI: 10.1097/SCS.0000000000009033 -
Journal of the American Dental... Oct 2022The purpose of this systematic review was to examine whether dental intervention involving bone or soft-tissue manipulation preradiotherapy (pre-RT) is associated with... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The purpose of this systematic review was to examine whether dental intervention involving bone or soft-tissue manipulation preradiotherapy (pre-RT) is associated with lower rates of osteoradionecrosis of the jaw (ORNJ) in patients with head and neck cancer (HNC).
TYPES OF STUDIES REVIEWED
The authors included relevant studies from MEDLINE, Embase, and Cochrane Library, including observational studies published from 2007 through 2021 and involving adults who underwent dental intervention pre-RT for HNC. Authors assessed evidence certainty by using the Grading of Recommendations Assessment, Development, and Evaluation approach. Random-effects models were used to calculate pooled relative risk estimates and hazard ratios. When meta-analysis was not possible, study-level measures of association and narrative summaries of the evidence were reported.
RESULTS
Twenty-two studies were included. From the pooled, unadjusted analysis, patients undergoing pre-RT extractions may have a 55% increased risk of experiencing ORNJ (relative risk, 1.55; 95% CI, 0.85 to 2.86; very low certainty); the unadjusted pooled hazard ratio was 3.19 (95% CI, 0.99 to 10.31; very low certainty), corresponding to a possible increased hazard of developing ORNJ (very low certainty). Findings for other pre-RT procedures manipulating bone or tissue relied on limited, observational studies with low or very low certainty evidence.
CONCLUSIONS
Mostly very low certainty evidence suggests that patients with HNC who need pre-RT dental intervention may have an increased risk of developing ORNJ compared with those who do not.
PRACTICAL IMPLICATIONS
Maintaining optimal oral health may help reduce the need for urgent pre-RT dental treatment, potentially reducing ORNJ risk and minimizing delay of oncologic treatment in patients with HNC.
Topics: Adult; Head and Neck Neoplasms; Humans; Incidence; Oral Health; Osteoradionecrosis; Proportional Hazards Models
PubMed: 35985883
DOI: 10.1016/j.adaj.2022.06.003 -
Oral Surgery, Oral Medicine, Oral... Oct 2022The aim of this systematic review was to determine the computed tomographic (CT) imaging characteristics of maxillary and mandibular melanotic neuroectodermal tumor of... (Review)
Review
OBJECTIVE
The aim of this systematic review was to determine the computed tomographic (CT) imaging characteristics of maxillary and mandibular melanotic neuroectodermal tumor of infancy (MNTI). Two cases from our institution were also presented.
STUDY DESIGN
Full-text case reports and case series of histopathologically proven gnathic MNTI with CT figures of diagnostic quality were searched in PubMed, Scopus, Web of Science, Ovid, and Google Scholar databases from July 2021 to February 2022. Descriptive statistics were used to determine the frequency of each CT feature of gnathic MNTI.
RESULTS
Fifty-two published studies met the eligibility criteria, providing a total of 53 maxillary and mandibular MNTIs for analysis. In order of frequency, the CT features of gnathic MNTI that were present in over half of the study sample were bone expansion (53, 100%), a well-defined periphery (49, 92.5%), tooth displacement (45, 84.9%), and a bilocular radiolucent internal pattern (32, 60.4%).
CONCLUSIONS
The bilocular radiolucent internal pattern has not been recognized as a common CT feature of gnathic MNTI. When associated with a well-defined, expansile mass in the infantile maxilla or mandible, this imaging characteristic can support a radiologic interpretation of MNTI.
Topics: Humans; Infant; Mandible; Maxilla; Maxillary Neoplasms; Neuroectodermal Tumor, Melanotic; Tomography, X-Ray Computed
PubMed: 35970752
DOI: 10.1016/j.oooo.2022.04.053 -
International Journal of Oral and... Mar 2023Nuclear protein of the testis (NUT) carcinoma is a rare, undifferentiated carcinoma that is characterized by NUTM1 gene rearrangements. Patients with NUT carcinoma have... (Review)
Review
Nuclear protein of the testis (NUT) carcinoma is a rare, undifferentiated carcinoma that is characterized by NUTM1 gene rearrangements. Patients with NUT carcinoma have an overall survival of approximately 5% at 5 years despite a multimodal treatment approach. This report illustrates the management of mandibular NUT carcinoma in a pediatric patient, complemented by a systematic review of head and neck NUT carcinoma. A 5-year-old female presented with an enlarging jaw mass that was diagnosed as BRD4-NUTM1 carcinoma and was treated with hemimandibulectomy and chemoradiation. She remains disease-free 21 months after completion of therapy. A total of 63 patient cases reported in 34 articles were identified in the review. Only 26.9% (14/52) of tumors were correctly diagnosed initially as NUT carcinoma, whereas 73.1% (38/52) were incorrectly diagnosed as another malignancy; the initial diagnosis was not reported for 11 patients. The mandibular tumor subtype was among the rarest reported (n = 1; 1.6%). Combination therapy, including surgery and chemoradiation, was the most common treatment (55.2%). The patient case presented here is a novel case of pediatric mandibular NUT carcinoma. Due to the poor overall survival of patients with NUT carcinoma, aggressive upfront resection with 2-cm margins followed by adjuvant chemoradiation is advocated.
Topics: Male; Female; Humans; Child; Child, Preschool; Neoplasm Proteins; Nuclear Proteins; Transcription Factors; Carcinoma; Mandible; Cell Cycle Proteins
PubMed: 35868909
DOI: 10.1016/j.ijom.2022.07.002