Jaw Involvement Research Articles

COVID-19 as a critical risk factor for osteonecrosis of the jaw: diagnostic challenge and surgical treatment

This case report describes a unique and complex presentation of osteonecrosis of the maxilla, complicated by Aspergillosis and Mucormycosis, developed in an immunocompetent patient recovering from COVID-19. The patient presented with a range of clinical symptoms, including facial pain, rhinorrhea, cacosmia, cough, and radiographic evidence of jaw involvement. Cytological and histological examinations revealed the presence of Aspergillus niger and mucormycosis-like fungal elements. Our report discusses the main diagnostic challenges, the different potential etiopathological hypotheses, and the alternative therapeutic and rehabilitative approaches. This atypical surgical case definitely highlights the need for heightened awareness among healthcare professionals, regarding the potential risk to discover severe opportunistic fungal infections also in COVID-19 patients; this case further sheds light on the importance of a multidisciplinary approach for an effective management of such intricate post-COVID-19 complications.

A Novel Minimally Invasive and Cost-Effective Internal Fixation of the Le Fort I Fracture by Using Intermaxillary Fixation Screw and Wire: A Technical Note.

Le Fort I fractures represent a significant proportion of craniofacial trauma, often occurring alongside other injuries to the craniomaxillofacial region. Management options include open reduction and internal fixation (ORIF) or skeletal suspension, each with its limitations and considerations. This technical note presents a novel technique for managing isolated Le Fort I fractures using intermaxillary fixation (IMF) screws, offering a minimally invasive alternative to ORIF. The technique involves the strategic placement of IMF screws in the stable zygomatic bone, coupled with arch bar fixation and wire manipulation for maxillary fragment reduction. This approach is cost-effective, can be performed under local anesthesia, and provides stability without the need for prolonged maxillomandibular fixation (MMF). The simplicity and efficacy of this technique make it suitable for emergency settings and cases where traditional approaches may not be feasible. However, this technique is only feasible in isolated Le Fort I fractures and is contraindicated in comminuted Le Fort I fractures and in edentulous patients with upper jaw involvement.

Resemblances and differences between osteoradionecrosis of the jaw and medication-related osteonecrosis of the jaw.

The aim of this retrospective study was to identify the clinical, radiological, and histological characteristics of patients diagnosed with osteonecrosis of the jaw (ONJ) and treated at the Oral and Maxillo-Facial Surgery Clinic of the Emergency Clinical County Hospital of Targu Mures between 2017 and 2022. The study aimed to analyze correlations between patient characteristics, particularly their history of bone modifying agent use or local radiotherapy during cancer treatment, in order to identify specific patient profiles that could aid in evaluating treatment response and guide individualized treatment strategies. Fifty-two patients diagnosed with ONJ were included in the study. The patients were divided into two groups based on their medical history: the bone modifying agent use group and the radiotherapy group. Clinical, radiological, and histological data were collected and analyzed. Statistical analysis, including p-values, was performed to compare patient characteristics between the two groups. Patients in the radiotherapy group were significantly older than those in the bone modifying agent use group (66 years vs. 56.9 years, p=0.001). There was a higher proportion of males in the radiotherapy group compared to the bone modifying agent use group (90% vs. 22%, p<0.001). Jaw involvement was more prevalent in the radiotherapy group compared to the bone modifying agent use group (95% vs. 66%, p=0.018). Histological analysis showed a similar frequency of Actinomyces species in both groups (50% vs. 34%, p=0.264). The findings of this study suggest the existence of two distinct patient profiles based on their treatment history (bone modifying agent use vs. radiotherapy) in ONJ. Patients in the radiotherapy group were older, predominantly male, and exhibited a higher prevalence of jaw involvement. Histological analysis revealed no significant differences in Actinomyces species frequency between the two groups. These distinct patient profiles may indicate different responses to treatment, emphasizing the need for individualized treatment strategies tailored to specific patient characteristics. Further research is warranted to validate these findings and develop personalized approaches for managing ONJ.

Tuberculous osteomyelitis of maxilla: a rare case report

Tuberculosis, caused by Mycobacterium tuberculosis can affect almost any part of the human body. Tuberculous osteomyelitis is rare and constitutes less than 2% of the skeletal tuberculosis. Jaw involvement of the maxillary bone by tuberculous infection is extremely rare. Here we document a case of tuberculous osteomyelitis of maxilla who presented with history of multiple infraorbital abscesses. The case is unique due to its rarity and diagnostic dilemma.

Does Fractal Analysis Have a Role in Diagnosis of Langerhans Cell Histiocytosis?

Langerhans cell histiocytosis (LCH) of the jaws is a rare disease and is often diagnosed at an advanced stage. This study aims to assess the trabecular pattern of jaws via fractal analysis (FA) on initial panoramic radiographs (OPG) of the patients with LCH to facilitate interpretation of the radiographic changes. A case-control study investigated LCH cases with jaw involvement retrieved from the databases of Istanbul and Kocaeli Universities between 2010 and 2021. Initial OPGs of LCH cases and OPGs of healthy sex- and age-matched controls were investigated with FA. All images were assessed using ImageJ software. On each OPG, a total of 6 regions of interest (ROIs) located on the mandible were investigated bilaterally. The independent variables were the trabecular patterns of jaws of LCH cases and their control matches. The outcome variables were the fractal dimension (FD) values obtained from the ROIs on OPGs. Data were analyzed using the Mann-Whitney U test and Student's t test. Fifteen LCH-control pairs were investigated. In one ROI located in the supracortical area above the left mandibular angle, FD values of LCH cases (1.273±112.8) were significantly lower than controls (1.308±85.3; P<.05). Lower FD values were also calculated for some of the remaining ROIs, but there was no significant difference between groups (P>.05). Regarding our results, FA was not a useful parameter to discern radiographical trabecular changes between LCH cases and controls. Multicenter studies with larger populations are needed to investigate the potential of FA in the identification of this rare disease.

Orofacial sarcoidosis: report of three cases

Introduction: Sarcoidosis is a systemic non-caseating granulomatous disorder of unknown etiology that may affect multiple organ systems. Head and neck involvement can present in unusual and often nonspecific ways. Observations: We report three cases of sarcoidosis with orofacial manifestations: one African American patient with an existing diagnosis who presented with perioral cutaneous involvement by sarcoidosis, and two Caucasian patients with cases where the initial oral presentation – diffusely affected gingiva in one and intraosseous jaw involvement with resultant dental implant failure in the other – led to workup and establishment of the diagnosis of sarcoidosis. The patients were referred to rheumatology and dermatology for appropriate treatment. Conclusion: Although oral lesions of sarcoidosis are not common, they may be the first clinical manifestation of sarcoidosis. The practitioner should be aware of the possible manifestations and be able to formulate an informed clinical differential diagnosis.

Osteonecrosis of mandible secondary to sickle cell crisis

<h3>Background</h3> Sickle cell disease (SCD) is an autosomal recessive hemoglobinopathy causing amino acid substitution in the B-hemoglobin chain of erythrocytes. SCD affects 1 in 500 African American children. SCD is associated with multiorgan morbidity and significant reduction in life expectancy. Vaso-occlusive crisis associated with SCD is characterized by acute pain and local tissue hypoxia and necrosis. The extremities, back, and chest are frequently affected, and jaw involvement is very rare. To the best of our knowledge, only 3 cases of jaw osteonecrosis secondary to SCD have been reported in the English-language literature. <h3>Case Summary</h3> A 38-year-old African American man with a history of SCD and avascular necrosis of the hips presented to an emergency department with severe pain in his back, legs, and chest due to a vaso-occlusive episode precipitated by physical overexertion. A few days later, the patient complained of left jaw pain and paresthesia. Computed tomography (CT) of the head with intravenous (IV) contrast, maxillofacial CT with IV contrast, and the remainder of the neurologic examinations were unremarkable. The oral medicine service was consulted, and physical examination of the patient demonstrated lingual gingival tissue swelling of the lower left molars. The mass was nonfluctuant with ulceration causing malalignment of tooth number 18. Bone biopsy revealed squamous mucosa with hemorrhagic foci, ulceration, and ectatic blood vessels with fragments of necrotic bone consistent with osteonecrosis. At the patient's 2-week follow-up visit, a small area of exposed necrotic bone was noted in the affected area. Maxillofacial CT without IV contrast showed mixed radiolucency and sclerosis with dehiscence along the lingual cortex of the posterior mandibular body and along the cortex of the retromolar trigone. Chlorhexidine gluconate 0.12% oral solution was prescribed, and debridement of the left posterior mandible and extraction of the lower left molars with local flap reconstruction were recommended by an oral and maxillofacial surgeon. The patient did not return for follow-up management. <h3>Conclusions</h3> Acute pain and chronic vasculopathy are significant complications of SCD. Jaw involvement in SCD is very rare, as illustrated in this case. It is important for oral health care professionals to understand the pathophysiology and clinical manifestations of SCD.

Evaluation of the Relationship Between Jaw Involvement and Systemic Involvement in Type 1 Gaucher Disease

Evaluation of the Relationship Between Jaw Involvement and Systemic Involvement in Type 1 Gaucher Disease

Odontogenic Myxoma: A 23-Year Retrospective Series of 38 Cases.

Odontogenic myxoma (OM) is an uncommon benign odontogenic tumor arising in the jaw. Though it has slight histologic overlap with other entities, definitive diagnosis is imperative considering the tumor's aggressive nature, high recurrence rate, and necessity of radical surgical intervention in large-sized lesions. With IRB approval, a retrospective search of the University of Florida College of Dentistry Oral Pathology Biopsy Service archives from 1994 to 2017 for diagnosis of OM of the jaw was performed. Biopsy reports and original slides for each case were assessed and reviewed along with any accompanying radiographs to confirm the diagnosis. Immunohistochemical staining was utilized to exclude entities with histologic overlaps, such as intraosseous myxoid neurofibroma. A total of 38 cases were included. The patients' age ranged from 6 to 84 years, with a mean age of 37.47 years. Females comprised two-thirds of the cases (n = 25) versus males (n = 13). The mandible was the most affected at 60.5% (n = 23), followed by maxilla 39.4% (n = 15). Posterior jaw involvement was higher than anterior in both the mandible (n = 20 versus n = 3) and the maxilla (n = 11 versus n = 4). Most lesions presented clinically as expansile masses with variable radiographic appearance. The clinical impression from submitting providers included "gelatinous masses", abscesses, odontogenic lesions, fibro-osseous lesions, soft tissue or bone neoplasms, and reactive gingival lesions. A consensus of odontogenic myxoma as a diagnosis was rendered for 30 cases (79%), while in 8 cases (21%) that exhibited a more fibrous stroma was identified as fibromyxoma. OM may exhibit a varied demographic and clinical profile with a wide spectrum of histologic presentations. Pathologists should be sentient of this variability in order to arrive at an accurate diagnosis and correctly manage these patients.

Pheochromocytoma Metastasing to the Jaw: Review of the Literature and New Case.

Pleochromocytoma is a benign neuroectodermal tumor of the adrenal medulla. Ten to thirty percent of these tumors become metastatic. The bone is the most frequent site for metastasis but jaw involvement is reported rarely. A case of mandibular involvement is reported and a literature review in this topic is presented. Preoperative management of these patients undergoing general anesthesia is not a routine practice in maxillofacial surgery, so this topic is also is explained.

Paget's disease of bone: A rare case report

Paget's disease of bone (PDB) is a localized bone remodeling disorder that is chronic, non-inflammatory.. It is also known as “osteodystrophia deformans” as described by Sir James Paget. PDB is the second most common bone disease after osteoporosis. This disease is found to be relatively more common in older people, occurs in approximately 3–4% of the population aged over 50 years with a slight male gender predilection. Jaw involvement is seen with the ratio of maxilla to mandible 2:1.

ODONTOGENIC MYXOMA: A 23-YEAR RETROSPECTIVE SERIES OF 38 CASES

Introduction Odontogenic myxoma (OMX) is an uncommon benign tumor arising in the jaw. Though it has some histologic overlap with other entities, correct diagnosis is imperative considering the aggressive nature, high recurrence rate, and necessity of radical surgical intervention in large sized lesions. Materials and Methods With IRB approval, a retrospective search of the University of Florida College of Dentistry Oral Pathology Biopsy Service archives from 1994-2017 for diagnosis of OMX of the mandible or maxilla was performed. Biopsy reports and original slides for each case were assessed and reviewed along with any accompanying radiographs to confirm the diagnosis. Immunohistochemical (IHC) staining was utilized to exclude entities with histologic overlap such as intraosseous myxoid neurofibroma. Results A total of 38 cases were included. The patients’ ages ranged between 13 to 82 years, with a mean age of 38.5 years. Females comprised two-thirds of the cases (n=25) versus males (n=13). The mandible was the most affected at 56% (n=21), followed by maxilla 34% (n=13) with 10% (n=4) not specified. Posterior jaw involvement was higher than anterior in both the mandible (n=17 versus n=1) and the maxilla (n=8 versus n=4). The right side was more commonly affected than the left side in both arches. Most lesions presented clinically as expansile masses with variable radiographic appearance, and the submitting providers’ clinical impressions included gelatinous masses, reactive gingival lesions, abscess, odontogenic lesions, fibro-osseous lesions, and soft tissue or bone neoplasms. In 30 cases (79%) the histologic diagnosis was compatible with OMX, while in 8 cases (21%) a more fibrous stroma was identified with diagnoses of fibromyxoma. Conclusion OMX may exhibit varied demographic and clinical profile and wide spectrum of histologic presentation. Oral and maxillofacial pathologists and surgical pathologists should be sentient of this variability of presentation for accurate diagnosis and management.

Surgical therapy for medication-related osteonecrosis of the jaw in osteoporotic patients treated with antiresorptive agents.

Medication - related osteonecrosis of the jaw (MRONJ) is a rare but serious complication of antiresorptive and/or antiangiogenic therapy. It mainly affects oncological patients, however, it can occur in patients with metabolic bone diseases, although this is less frequent. These lesions not only significantly impair the quality of life but can also have impact on the treatment of any underlying disease. In some rare cases MRONJ can be life-threatening. There is still no ideal consensus for treatment, though surgical therapy has been mostly preferred in recent years. A monocentric retrospective evaluation of surgical therapy of MRONJ in osteoporotic patients, treated in the time period 3/2014-3/2018 using the uniform department-specific protocol. 26 osteoporotic patients with 32 MRONJ lesions of stage 1 (9%), stage 2 (75%) and stage 3 (16%) were treated surgically. The maxilla: mandibula ratio was 1:2.2, in 19% of patients there was multiple jaw involvement. 69.2% of patients had received bisphosphonates, 15.4% denosumab and 15.4% had a history of both types of antiresorptive treatment. Complete healing was observed in all patients, in 9% of cases by secondary intention in the mean period of 6 weeks. The mean follow-up was 20.5 months. The presented protocol for surgical therapy was effective in the management of all MRONJ stages in the osteoporotic patients described here. The surgery is indicated as an early treatment to prevent complications and the progression of the lesions. It leads to improvement in quality of life and option to resume antiresorptive therapy if interrupted.

Extranodal intraosseous Rosai–Dorfman disease in the lower jaw: a case report and review of the literature

Rosai–Dorfman disease or sinus histiocytosis is a rare entity which may affect various lymph node groups. Extranodal form is observed in 45 % of cases, facial bone involvement is especially rare. A 62-year old male presented with complaints on dumb sensation of the chin and lower lip. After clinical assessment and surgical exploration an intraosseous extranodal Rosai–Dorfman disease was diagnosed. The patient under-went free fibula osseous graft reconstruction. After 2 years the patient is recurrent free. The purpose of this publication is to describe a rare case of lower jaw involvement in an intraosseous form with significant bone destruction. The clinical and microscopic features of the process are discussed.

Metastatic solid tumors to the jaw and oral soft tissue: A retrospective clinical analysis of 44 patients from a single institution.

Metastatic solid tumors to the oral cavity are rare, frequently indicative of an end-stage disease process, and associated with poor survival rates. We performed a 20-year retrospective clinical analysis of our institution's cases of solid metastases to the oral cavity, and investigated these patients' clinical outcomes. A retrospective study of patients with metastatic solid tumors to the oral cavity over a 20-year period (October 1996 to September 2015) was conducted at Memorial Sloan Kettering Cancer Center. Patients were selected if they had a histopathologically confirmed diagnosis. Demographic, pathologic, and clinical information were reviewed to identify patient outcomes. A total of 44 patients with metastatic non-melanocytic non-hematopoietic tumor to the oral cavity were identified: 24 males and 20 females (39 adults and 5 children) with a mean age of 54.3 years. In all, 24 cases involved the jaw and 20 cases involved the oral soft tissue. Eight patients (18.2%) had oral cavity metastases as the first indication of an occult malignancy. In adult patients, the common primary sites were the lungs (n=9, 20%), kidney (n=7, 16%), breast (n=5, 11%), and colon (n=4, 9%); and in pediatric patients the adrenal gland (3/5) was the most common site. Of the adult patients, 33 (84.6%) died of disease. From the time of metastasis diagnosis, patients with jaw metastases had a median and mean survival of 12 months and 27.7 months, respectively. In comparison, patients with oral soft tissue metastases had a median survival time of 5 months, and mean of 8 months. One pediatric patient (20%) died of disease 8 months after metastasis diagnosis. Metastatic solid tumors to the oral cavity can be the first sign of a malignancy. Pediatric patients with oral cavity metastases have a better prognosis compared to adult patients. In this series, adults with oral soft tissue involvement had shorter survival times compared to patients with jaw involvement.

Chapter 31 - Functional facial and tongue movement disorders

Functional movement disorders (FMDs) affecting the eyelids, tongue, and other facial muscles are often underrecognized because their phenomenology has not been fully characterized. Nevertheless, these disorders are more common than previously thought. In this chapter we will discuss the phenomenology as well as the clinical and instrumental diagnosis of facial FMDs. Facial FMDs should be considered when a patient exhibits any combination of the following features: (1) fixed unilateral facial contractions, especially with lower lip, with or without ipsilateral jaw involvement, of maximal severity at onset; (2) inconsistent features such as changes in side and pattern during or between examination; (3) associated somatoform or nonphysiologic sensory or motor findings; (4) reduction or abolition of facial spasm with distraction; (5) response to suggestion or psychotherapy; (6) rapid onset and/or spontaneous remissions; and (7) normal neurologic examination. Supportive features are young age, female gender, and associated medical conditions such as depression, headaches, facial pain, fibromyalgia, or irritable-bowel syndrome. Finally, the differential diagnosis with the organic counterparts will be also addressed, particularly with respect to blepharospasm, oromandibular dystonia, and hemifacial spasm.

Primary Extranodal Non-Hodgkin’s Lymphoma Mimicking a Painful Gingival Swelling: A Case Report

Diffuse large B cell lymphoma (DLBCL), the most common subtype of non-Hodgkin’s lymphoma (NHL), is an aggressive, rapidly growing neoplasm which is the most common lymphoid neoplasm affecting adults. Jaw involvement of NHL is rare, but among jaw lesions, t...

Destructive radiolucent lesion involving right maxillary alveolus: Report of a rare case

Ewing's sarcoma/primitive neuroectodermal tumor (ES/PNET) usually arises in the long bones of extremities. It is uncommon to find ES in the head and neck region, particularly in gnathic bones. It comprises 6-8% of all primary bone malignancies. Only 1% of cases is reported with jaw involvement and has mandibular predilection. Even with early intervention, patients with metastasis have approximately 20% chance of 5-year survival. Here, we report a rare case of ES involving right maxillary alveolus.

Multifocal Langerhans cell histiocytosis in an adult with a pathological fracture of the mandible and spontaneous malunion: A case report.

Langerhans cell histiocytosis (LCH) is rare in the adult population and even rarer with jaw involvement. The current study presents the case of a 39-year-old male who complained of recurrent pain, swelling of the gingiva and an occasional pus-like discharge in the right mandible for one year. The patient was previously prescribed antibiotics, but this did not resolve the problem. An initial panoramic radiograph showed an osteolytic lesion and bone fracture in the right mandible. Eight months later, a new radiograph showed the spontaneous malunion of the fractured mandible. The patient was eventually diagnosed with Langerhans cell histiocytosis by histopathology and immunohistochemistry. Further lesions were found in the ribs and ilium by nuclear bone scanning. The patient was subsequently treated with systemic chemotherapy, and the lesions are currently effectively being controlled. This study is the first to show that spontaneous intralesional bone regeneration may lead to reunification of the mandible fracture caused by LCH in an adult.

Peripheral osteoma of the angle of mandible

Osteomas are benign osseous neoplasms that show continuous but slow growth and are characterized by the proliferation of compact and/or cancellous bone. The exact cause is unknown, and they are usually considered to represent hamartomas or reactive lesions secondary to low-grade inflammation. They can be classified into central, peripheral or extra-skeletal types. Peripheral osteomas occur most frequently in the frontal and ethmoid sinuses, and jaw involvement is rare. They are usually asymptomatic and may be discovered during routine clinical and radiographic examination. Radiographically, peripheral osteomas appear as oval radiopaque well-circumscribed masses attached to the cortex by a broad base or a pedicle. This article describes a case of a peripheral osteoma of the right angle of the mandible in a 20-year-old male along with a literature review.