Bisphosphonate-related osteonecrosis of the jaws: A report on 30 cases

Aim: To report a series of thirty cases of bisphosphonate-related osteonecrosis of the jaw (BRONJ). Material and Methods: For 30 patients with BRONJ, gender, age, underlying diagnosis, type of bisphosphonate (BP), administration route and duration, location and stage of osteonecrosis, symptoms and oral health status, radiological findings of the jaws, treatment and outcome, were recorded. Results: Underlying diagnoses in the series (12 male;18 female;mean age 70.50 ± 9.62) were: 12 multiple myeloma, 7 breast cancer, 3 prostate carcinoma, 1 kidney/lung/ bladder/mediastinal cancer, 1 chronic lymphocytic leukemia, 1 osteoporosis, 1 palatal osteosarcoma + osteoporosis, 1 non-Hodgkin’s lymphoma. Forty-seven osteonecrotic lesions were detected;30 localized in the mandible,17 inthe maxilla;trigger events were tooth extraction in 31 cases (66%), periodontal disease in 4 (8.50%), incongruous dentures in 3 (6.40%), perimplantitis in 1 (2.10%), unknown in 8 (17%). Twenty-nine patients had received treatment using amino bisphosphonates (25 zoledronate, 2 pamidronate, 2 alendronate) and 1 clodronate;the administration route was intravenous in 27 patients, oral in 2 and intramuscular in 1. Mean number of doses to bone exposure for patients was 34.11 for zoledronate, 50.50 for pamidronate, 146 for alendronate, and 500 for clodronate. Among statistical data the only significant finding was that panoramic dental radiography gave no concrete support for diagnosis of ONJ lesions (p ≤ 0.04). Conclusions: Our case series reflects literature data. We emphasize the insufficient role of panoramic radiography to study osteonecrotic lesions and the role of poor oral hygiene.

Characteristic Radiological and Histological Patterns of Fibrous Dysplasia and Ossifying Fibroma of the Jaws at University of Nairobi Dental Teaching Hospital

Objective: To characterize the diagnostic features of ossifying fibroma (OF) and fibrous dysplasia (FD) of the jaw bones. Study Design: A histopathological and radiological analysis with full clinical documentation. Setting: University of Nairobi Dental Teaching Hospital (UNDH). Study Population: All archival cases diagnosed as FD and OF from 1992-2006 were retrieved from the UNDH Oral Pathology Laboratory records. New cases were included as they pre-sented over a 6-month period from January to June 2007. Methodology: Information regarding the histological type of a fibro-osseous lesion (FOL) including the clinical features, demographic and radiographic data was documented for analysis;and comparison between pathological parameters and the final diagnosis was evaluated with the chi-square test. Results: FD lesions constituted 40 (27.2%) cases while 107 (72.8%) were OF. The age ranged from 1 - 72 years (mean = 24.19 ± SD 13 years). The differences in the gender distribution were not statistically significant. Radiographic analyses showed statistically significant differences between the appearances of the body (p = 0.012) and the margins (p = 0.003) of FD and OF. The microscopic differences between the two lesions were not statistically significant. Conclusion: Differentiation between FD and OF is only possible after critically analyzing the clinical, radiological and histological criteria.

Photodynamic Therapy for Medication-Related Osteonecrosis of the Jaws: A Case Report

Medication-related osteonecrosis of the jaws (MRONJ) is a relatively new disease. MARX reported first cases in 2003. MRONJ relates to oral and parenteral bisphosphonates as well as to the so-called target cancer therapies but the list of medications only grows. Although MRONJ is a relatively rare condition, it can be associated to significant morbidity with feeding limitations and intense pain. More severe cases can lead to potentially life-threatening infections. Every patient initiating bisphosphonate and/or target cancer therapy must visit a dentist before starting medication because preventive measures for MRONJ are much more effective compared to surgical management of the lesions. Surgical resolution can be especially difficult to obtain in the coexistence of certain complication factors like wider bone exposures, history of nitrogen containing bisphosphonates use (mainly zolendronate) and immunodeficiency. Recently, researchers have given attention to laser therapy associated to photosensitive agents as a possible option to management of some MRONJ lesions. Our case report demonstrates the use of photodynamic therapy in a denosumab related lesion in the mandible. It seems that denosumab related lesions are more amenable to treatment and total resolution because of the marked differences between its chemical and metabolic characteristics when compared to bisphosphonates.

《大白鲨》(Jaws,1975年):完美的杀人机器,完美的印钞机

"《大白鲨》就像是我的‘越南战争’。基本上它讲的就是:无知的人类去反抗自然,而大自然每天都在还击人类。"——斯皮尔伯格在某种意义上,票房和口碑都空前成功的《大白鲨》也让斯皮尔伯格伤痕累累——并不严重,但却刻骨铭心。"对我来说,制作《大白鲨》的经历是很可怕的。"在这之前,他作为一名年轻导演的经历可算相当典型——有轻微的挫折,也有小幅的倒退,但总体上是在稳定地朝着前方行进。不过这一次却实在不同——如此大规模的困难,意料之外的困难以及被所有目光逼视的压力——几乎是压倒性的。大部分导演在职业生涯中从未遭遇过这等压力,更别提数十年如一日了。

Posterior partially edentulous jaws, planning a rehabilitation with dental implants

AIM: To discuss important characteristics of the useof dental implants in posterior quadrants and the rehabilitation planning. METHODS: An electronic search of English articles was conducted on MEDLINE(PubM ed) from 1990 up to the period of March 2014. The key terms were dental implants and posterior jaws, dental implants/treatment planning and posterior maxilla, and dental implants/treatment planning and posterior mandible. No exclusion criteria were used for the initial search. Clinical trials, randomized and non randomized studies, classical and comparative studies, multicenter studies, in vitro and in vivo studies, case reports, longitudinal studies and reviews of the literature were included in this review. RESULTS: One hundred and fifty-two articles met the inclusion criteria of treatment planning of dental implants in posterior jaw and were read in their entirety. The selected articles were categorized with respect to their context on space for restoration, anatomic considerations(bone quantity and density), radiographic techniques, implant selection(number, position, diameter and surface), tilted and pterygoid implants, short implants, occlusal considerations, and success rates of implants placed in the posterior region. The results derived from the review process were described under several different topic headings to give readers a clear overview of the literature. In general, it was observed that the use of dental implants in posterior region requires a careful treatment plan. It is important that the practitioner has knowledge about the theme to evaluate the treatment parameters. CONCLUSION: The use of implants to restore the posterior arch presents many challenges and requires a detailed treatment planning.

Central mucoepidermoid carcinoma of the jaws:report of two cases

Central mucoepidermoid carcinoma of the jaws (CMCJ) is an extremely rare neoplasm. The clinical manifestation of CMCJ is nonspecific, which includes swelling, pain, mobile teeth and bleeding, etc. To develop the diagnosis and treatment of CMCJ. this article presents 2 cases of CMCJ treated in our hospital. Their clinical data, treatment and prognosis were analyzed retrospectively.

Kinematics ofmandibular advancement devices(MADs):Why do some MADs move the lower jaw backward duringmouth opening?

Mandibular advancement devices(MADs)are widely used treatments for obstructive sleep apnea.MADs function by advancing the lower jaw to open the upper airway.To increase patient comfort,most patients allow the mouth to be opened.However,not all systems maintain the lower jaw in a forward position during mouth opening,which results in the production of a retrusion that favors the collapse of the upper airway.Furthermore,the kinematic behavior of the mechanism formed by the mandible-device assembly depends on jaw morphology.This means that,during mouth opening,some devices cause lower jaw protrusion in some patients,but cause its retraction in others.In this study,we report the behavior of well-known devices currently on themarket.To do so,we developed a kinematic model of the lower jawdevice assembly.Thismodelwas validated for all devices analyzed using a high-resolution camera system.Our results show that some of the devices analyzed here did not produce the correct behavior during patient mouth opening.

Imaging approach for jaw and maxillofacial bone tumors with updates from the 2022 World Health Organization classification

Jaw and maxillofacial bone lesions encompass a wide variety of both neoplastic and non-neoplastic pathologies.These lesions can arise from various tissues,including bone,cartilage,and soft tissue,each presenting distinct challenges in diagnosis and treatment.While some pathologies exhibit characteristic imaging features that aid in diagnosis,many others are nonspecific.This overlap often necessitates a multimodal imaging approach,combining techniques such as radiographs,computed tomography,and magnetic resonance imaging to achieve a diagnosis or narrow the diagnostic considerations.This article provides a comprehensive review of the imaging approach to jaw and maxillofacial bone tumors,including updates on the 2022 World Health Organization classification of these tumors.The relevant anatomy of the jaw and dental structures that is important for accurate imaging interpretation is discussed.

Characterization of tumors of jaw:Additive value of contrast enhancement and dual-energy computed tomography

BACKGROUND Currently,the differentiation of jaw tumors is mainly based on the lesion’s morphology rather than the enhancement characteristics,which are important in the differentiation of neoplasms across the body.There is a paucity of literature on the enhancement characteristics of jaw tumors.This is mainly because,even though computed tomography(CT)is used to evaluate these lesions,they are often imaged without intravenous contrast.This study hypothesised that the enhancement characteristics of the solid component of jaw tumors can aid in the differentiation of these lesions in addition to their morphology by dual-energy CT,therefore improving the ability to differentiate between various pathologies.AIM To evaluate the role of contrast enhancement and dual-energy quantitative parameters in CT in the differentiation of jaw tumors.METHODS Fifty-seven patients with jaw tumors underwent contrast-enhanced dual-energy CT.Morphological analysis of the tumor,including the enhancing solid component,was done,followed by quantitative analysis of iodine concentration(IC),water concentration(WC),HU,and normalized IC.The study population was divided into four subgroups based on histopathological analysis-central giant cell granuloma(CGCG),ameloblastoma,odontogenic keratocyst(OKC),and other jaw tumors.A one-way ANOVA test for parametric variables and the Kruskal-Wallis test for nonparametric variables were used.If significant differences were found,a series of independent t-tests or Mann-Whitney U tests were used.RESULTS Ameloblastoma was the most common pathology(n=20),followed by CGCG(n=11)and OKC.CGCG showed a higher mean concentration of all quantitative parameters than ameloblastomas(P<0.05).An IC threshold of 31.35×100μg/cm^(3) had the maximum sensitivity(81.8%)and specificity(65%).Between ameloblastomas and OKC,the former showed a higher mean concentration of all quantitative parameters(P<0.001),however when comparing unilocular ameloblastomas with OKCs,the latter showed significantly higher WC.Also,ameloblastoma had a higher IC and lower WC compared to“other jaw tumors”group.CONCLUSION Enhancement characteristics of solid components combined with dual-energy parameters offer a more precise way to differentiate between jaw tumors.

Effect of Wearing a Maxillofacial Prosthesis on Masticatory Rhythm Improvement in Mandibulectomy Patients

Background: Recording jaw movement rhythms in patients with jaw defects is challenging using conventional tracking devices. However, masticatory rhythm is crucial for masticatory performance and nutritional intake. This study aimed to explore the impact of using a maxillofacial prosthesis to restore masticatory rhythm in mandibulectomy patients with a novel wearable device. Methods: Twelve patients who underwent mandibulectomy and were rehabilitated with maxillofacial prosthesis were recruited. Chewing rate, cycle durations, coefficient of variation of cycle durations (CV), changing times of skin morphology on the back of the ear pinna area (SM), and masticatory performance were measured during gum chewing without and with a denture using a wearable jaw movement rhythm tracking device. A paired t-test and the Pearson correlation coefficient were used for statistical analysis. Results: The chewing rate increased by 8.6 cycles/min with dentures (P P = 0.01). The CV and SM decreased with dentures (P = 0.004 and P = 0.01, respectively). Significant correlations were found between the CV and SM without dentures (P = 0.004). Conclusion: 1. Wearing maxillofacial prostheses can improve masticatory rhythm in patients who undergo mandibulectomy with Eichner B2 occlusal supports. 2. The wearable device is available for measuring masticatory rhythm in patients with jaw defects in clinics. 3. Changing times of the skin morphology on the back of the ear pinna indicate jaw movement stability through a simpler process than the coefficient of variation of cycle durations.

Prevalence and Risk Factors of Osteonecrosis of the Jaw in Patients with Bisphosphonate Exposure in Casablanca, Morocco: An Observational Study

Objective: To study the prevalence of bisphosphonate-related osteonecrosis of the jaw (BRONJ) and to determine the risk factors associated with the occurrence of this pathology. Method: An observational retrospective study was conducted in the Department of Oncology, Rheumatology, and Maxillofacial Surgery of Ibn Rochd University Hospital, Casablanca. The study utilized complete medical records from 2014 to 2022 and included consultations of patients receiving bisphosphonates (BPs) in July and September 2022. Statistical analysis was performed using SPSS version 16.0. Results: Our study population comprised 104 patients, of whom 91% were women and 49% were over 65 years old. Seventy-two percent of patients had a general pathology. Among them, 64 patients were treated with zoledronate, 43 with alendronate, and the remainder with risedronate, ibandronate, and pamidronate. The most common indications for treatment were bone metastasis following breast cancer (29.8%) and osteoporotic fractures (19.2%). Sixty-seven patients received intravenous (IV) treatment;only 10.5% exhibited good oral health. Fifty percent of patients underwent dental treatment, primarily tooth extractions. Osteonecrosis of the jaw (ONJ) was diagnosed in 1.9% of patients, predominantly in stages 1 and 2. Conclusion: Second and third-generation bisphosphonates are more strongly associated with the development of ONJ. Risk factors include monthly IV administration, poor oral health, comorbidities such as diabetes, medications like corticosteroids, invasive dental procedures, and not only oncological conditions but also rare indications such as bone algodystrophy. Nevertheless, our observed prevalence of 1.9% aligns with international rates ranging from 0.8% to 12%. However, most of the studies that have been carried out have been retrospective studies with insufficient numbers of patients. Further prospective epidemiological studies based on standardized protocols with rigorous and appropriate follow-up over several years are essential to determine the exact prevalence of ONJ.

Application of Personalized 3D-Printed Rehabilitation Orthotics in Postoperative Recovery of Jaw Fractures

Objective:To analyze the effectiveness of personalized 3D-printed rehabilitation orthotics in the postoperative recovery of jaw fractures.Methods:Relevant data were collected from 42 patients with jaw fractures treated at our hospital between October 2017 and May 2020.Patients were randomly divided into a traditional group(n=17)and a modified group(n=25).The traditional group received standard rehabilitation methods,while the modified group used personalized 3D-printed rehabilitation orthotics combined with improved rehabilitation methods.The temporomandibular disability index(TDI),quality of life scores,postoperative recovery excellence rate,and mouth opening were compared between the two groups at different follow-up times(before rehabilitation,and at 1 week,3 months,and 6 months post-surgery).Results:At 1 week,3 months,and 6 months post-surgery,the TDI in both the traditional and modified groups was significantly lower than before rehabilitation,with statistically significant differences(P<0.05).At 3 and 6 months post-surgery,the TDI in the modified group was lower than in the traditional group,with statistically significant differences(P<0.05).At 3 and 6 months post-surgery,pain,appearance,activity,recreation,work,chewing,swallowing,speech,shoulder function,and total quality of life scores in both groups were higher than before rehabilitation,with the modified group showing significantly higher scores in pain,appearance,chewing,swallowing,and total quality of life(P<0.05).Compared to before rehabilitation,mouth opening significantly improved in both groups at 3 and 6 months post-surgery,with the modified group showing significantly greater improvement(P<0.05).Conclusion:Personalized 3D-printed rehabilitation orthotics are highly effective in the postoperative recovery of jaw fractures.They can improve patients’quality of life after surgery,enhance the excellent rate of postoperative recovery,and increase mouth opening.

超声刀Focus刀头及Ligasure Small Jaw~刀头用于开放性甲状腺手术的对照研究

背景与目的：近年来，随着技术发展，越来越多的基于能量传递的止血工具广泛问世并应用于开放性外科手术中。超声刀Focus刀头（Harmonic Focus，HF）及Ligasure Small Jaw刀头（LSJ）都是专为开放性甲状腺手术量身定做的。本文拟对北京协和医学院中国医学科学院肿瘤医院HF及LSJ完成的开放性甲状腺手术患者的临床资料进行病例对照分析，以期比较HF及LSJ在开放性甲状腺手术中的应用效果。探讨HF及LSJ用于开放性甲状腺手术的有效性及安全性。方法：选取本院过去1年内甲状腺癌初治患者，由同一外科医师主刀使用HF或LSJ完成甲状腺全切除＋中央区清扫术，纳入HF组100例，LSJ组104例。通过比较两组手术时间及术后第1天引流量，比较两者在甲状腺手术中应用的有效性。通过比较两组术后并发症来评估安全性。结果：有效性：HF组平均手术时间为（95．8±18．0）min，LSJ组平均手术时间为（97．8±19．1）min，差异无统计学意义（P=-0．363）；术后首日引流量HF组为（35．2±20．3）mL，LSJ组为（36．3±23．8）mL，差异无统计学意义（P=0．977）。安全性：HF组出现暂时性声带麻痹者1例（1．0％），LSJ组术后伤口出现术区血肿者1例（1．0％）；暂时I生甲状旁腺功能低下者HF组18例（18．O％），LSJ组16例（15．4％）；HF组术后首日甲状旁腺素平均下降（12．3±12．8）pg／mL，LSJ组平均下降（13．9±13．4）μg／mL；血清离子钙HF组平均下降（0．20±0．13）mg／dL，LSJ组平均下降（0．20±0．16）mg／dL，差异均无统计学意义（P均〉0．05）。结论：HF及LSJ在开放性甲状腺手术中均安全、有效，手术并发症相当。

Symptom distress and interference among cancer patients with osteoradionecrosis of jaw: A cross-sectional study

Objective:Osteoradionecrosis of the jaws(ORNJ)is among the most serious oral complications of head and neck cancer treatment with radiation therapy.This study aimed to examine the level of symptom distress and interference of ORNJ in head and neck cancer patients in China.Methods:A cross-sectional study was conducted to profile patient reported symptom severity.Ninetyfive hospitalized ORNJ patients were recruited.Participants completed the MD Anderson Symptom Inventory-Head and Neck Module-Chinese version.Results:The percentage of participants who reported that they experienced at least one type of symptom was 97.9%,and 85.2%patients reported interference.The 10 most severe symptoms were as follows:limited mouth opening,problem with teeth/gums,difficulty swallowing/chewing,dry mouth,oral malodor,difficulty with voice/speech,dental ulcer,tinnitus/ear obstruction,skin pain/burning/rash,and difficulty hearing.The problem of limited mouth opening was more severe in patients with longer time to onset of ORNJ after radiotherapy.The interference of patients positively correlated with core symptoms(r=0.612),head and neck symptoms(r=0.709),and ORNJ symptoms(r=0.440)(P<0.01).The longer time to the onset of ORNJ after radiotherapy was positively and significantly correlated with symptom distress(r=0.479,P<0.001),and mouth opening correlated negatively with symptom distress(r=-0.298,P=0.003).Conclusions:ORNJ patients suffered mainly from limited mouth opening and other maxillofacial symptoms.The problem of limited mouth opening was more severe in patients with longer time to onset of ORNJ after radiotherapy.ORNJ patients commonly had symptom distress,which influenced their quality of life.

工作流驱动的Web应用快速开发框架研究

Web应用的开发周期越来越短,需求的快速变化要求Web应用能够实现持续改进和功能增强,从而产生了对Web应用快速开发框架的迫切需求。针对此,基于工作流驱动的Web应用模型,提出了一种Web应用快速开发框架WADF-Workflow。该框架支持遵循WfMC工作流规范的业务流建模,并支持基于工作流引擎的页面流控制、数据流控制和业务逻辑处理的分离。最后,给出了基于开源工作流Shark和JaWE的框架实现和应用实例。

Primary tumor prevalence has an impact on the constituent ratio of metastases to the jaw but not on metastatic sites

This article provides an overview of metastases to jaws （M J）, mainly concerning the differences between American and Chinese patients, and exploring the relationship between the primary tumors＇ prevalence （PTP） and constituent ratio of MJ. Information concerning of 399 MJ cases in 215 papers, including one new case in our hospital, was subjected to statistic analysis. The main clinical features of M J, such as constituent ratio of PTP and that of M J, metastatic sites, treatments, and prognosis were summarized. Breast, lung, kidney, prostate and thyroid （in descending order） were the leading primary sites of MJ. Furthermore, the constituent ratio of MJ was found to be correlated with that of PTP in all subjects including American and Chinese subjects in our study. As to metastatic sites in the mandible, a specific ＂M＂ shaped pattern appeared regardless of the tumor type or constituent ratio,,; of MJ were in all subjects. Almost all subjects received traditionary palliative treatments, and the prognosis was quite poor. The PTP had a significant impact on the constituent ratio of MJ. However, it was the properties of the microenvironment rather than characteristics or constituent ratios of tumor cells, that decided the metastatic sites in various tumor subjects.

基于Shark的工作流流程的实现方式研究

工作流管理系统目前处于技术发展曲线上的相对成熟阶段,不同的人对工作流的理解不同,从而也出现了众多的工作流软件,如Ofbiz、Enhydra Shark、Osworkflow、Jbpm、Obe等。结合在开发无锡机床股份有限公司客户服务中心中工作流管理系统的一些经验,力图通过对其中一种优秀的工作流引擎Shark的介绍。

基于J2ME MIDP的移动通信技术研究

文章分析了移动通信程序设计 J2ME MIDP 技术,包括 J2ME MIDP 的体系结构、开发环境、开发过程,并在此基础上开发了一个实际应用程序。

轻量级J2EE框架下工作流驱动的动态虚拟实验室

综合考虑基于构件组装技术的虚拟实验室的系统需求,分析了工作流驱动的动态虚拟实验室的业务处理模型,介绍了轻量级J2EE框架(SSH)与工作流系统(Shark和JaWE)的集成模型,提出了一种轻量级J2EE框架下工作流驱动的动态虚拟实验室的设计和实现方法,给出了虚拟实验项目的实现机制、数据流和控制流的管理方法,以及实验流程的动态组装方法,最后,以应用实例说明了本文方法的有效性。

Osseous Dysplasia Secondary Infection: A Case Report

Introduction: Osseous dysplasia is a benign tumor of the jaws predominantly occurring in melanoderm women. The pathogenesis remains unknown. Its often fortuitous discovery usually is in the fourth decade of life. Its treatment involves surgery. Our aim was to report a case of osseous dysplasia secondary infection in Senegal. Observation: The over sixty-year-old patient initially came for recurring old suppuration. A prior history of dental avulsions and self-medication was found out. The clinical features were predominant chronic osteitic manifestations. Its radiologic presentation suggested a florid form. The combination of spiramycin-metronidazole had to be given twice. The isolated sequestrum was enucleated and the anatomopathology confirmed the diagnostics. Discussion: The patient’s age conformed to late discovery due to silent progression and poor access to medical care. The prior iatrogenic avulsions can be explained by the absence of systematic radiological exploration and by the unawareness of the inconspicuous tumor. The clinical and radiological features at this stage of the osseous dysplasia secondary infection were typical. The treatment and the follow-up were dependent on the prevailing work conditions. Conclusion: The chronic osteitic manifestations are indicative of osseous dysplasia in elderly women in Senegal.