B. Ruhin

Lambeau libre de péroné en double barre : intérêt du montage dans les reconstructions mandibulaires pour une réhabilitation prothétique sur implants (5 cas)

Introduction Lors de l’indication d’une reconstruction mandibulaire par un transfert osseux vascularise, le lambeau libre de perone constitue le meilleur choix du fait de sa longueur et de sa fiabilite. L’interet essentiel est de pouvoir y mettre ensuite des implants dentaires. La reconstruction peut etre faite par un montage en simple barre ou en double barre. Du fait de la superposition des baguettes osseuses et du gain de hauteur, le montage en double barre est le plus favorable a la mise en place d’implants dentaires. Materiel et methodes Depuis 3 ans, parmi notre serie de reconstructions mandibulaires par lambeau libre de perone destinees a la pose d’implants dentaires (11 cas), cinq cas ont beneficie d’un montage en double barre. Resultats A ce jour, trois des cinq cas ont pu etre implantes en vue d’une rehabilitation prothetique : l’etape implantaire est detaillee. Discussion La reconstruction mandibulaire en simple barre peut parfois apporter suffisamment de hauteur osseuse, mais impose parfois secondairement des greffes osseuses d’apposition pour un gain de hauteur. En definitive, nous privilegions le montage en double barre : il apporte d’emblee une hauteur osseuse satisfaisante. La technique de conformation du perone en double barre nous parait la plus efficace afin d’obtenir une hauteur osseuse suffisante pour la mise en place d’implants.

Osteonecrosis of the jaw and nonmalignant disease: is there an association with rheumatoid arthritis?

Objective. To review cases of bisphosphonate-related osteonecrosis of the jaw (BRONJ) occurring in association with benign disease and to describe and compare the clinical course and outcome for patients with BRONJ and rheumatoid arthritis (RA) or osteoporosis. Methods. We retrospectively reviewed observations of all patients referred for treatment and followup for BRONJ from January 2007 to December 2011. Only patients with malignant disease were excluded. Demographic data, medical history, maxillofacial findings, BRONJ treatment, and followup were reviewed for each case. Results. Over a 5-year period, we diagnosed 112 patients with BRONJ. Among these patients, 15 received bisphosphonate (BP) treatment for nonmalignant disease (mean age 65.7 ± 19.8 yrs, 80% women). Patients received BP for a variety of reasons: 8 (53%) to prevent osteoporosis in association with underlying RA; 6 (40%) to prevent idiopathic osteoporosis; and 1 (7%) to treat ankle algodystrophy. The mean oral BP exposure period was 48.4 months (median 36 mo). In 13 cases (86.6%), BRONJ was diagnosed following dental extraction. Of the 8 patients with RA, 5 (62.5%) were taking prednisone at the time of the discovery of BRONJ. Major surgery, sequestrectomy, or alveolectomy was performed in 9 patients (60%), all of whom healed within 3 to 36 months (mean 11.5 mo). Comparative analysis of all the variables showed no statistically significant differences between patients with RA and others. Conclusion. ONJ is a rare adverse effect of BP therapy, especially when administered orally. Within the limits of our study, we were unable to demonstrate a difference in BRONJ disease spectrum, clinical course, or outcome between patients with and those without RA.

Tumorogenèse des maxillaires. Recherche et perspective

Development and growth of odontogenic tumours depend on impairment of numerous genes and molecules. In recent years, most of the genes involved in dental development were identified. This produced a new basis for the study of oral pathology and maxillofacial carcinogenesis. A better understanding of these molecular phenomena should allow to better determine the evolution of such lesions. Research breakthroughs should facilitate the development of new molecular and genetic therapeutic perspectives.

Facts and Hypothesis on Osteolytic Lesions Related to Normal and Tumoral Epithelial Dental Cell Differentiation

Publisher Summary This chapter presents bone osteolysis associated with tumoral and cystic odontogenic lesions. It studies squamous cell carcinomas which constitute more than 90% of the malignant tumors in the oral cavity and oropharynx. Indeed, the related physiopathological pathways of epithelial cell transformation in relation to bone microenvironment are non-specific. Odontogenic epithelial tumors and cysts regarding their specificity and aggressivity on the bone structure are studied here. They grow in the jaw by active bone resorption. They can also expand in the surrounding tissues (masseterian muscles, infratemporalis fossa, orbital structures, the skull basis) and generate metastasis in distant organs such as the lung or liver. Consequently, they may result in the death of the patient. Therefore, a pluridisciplinary approach of these odontogenic tumors is essential, involving odontology, maxillofacial surgery, neurosurgery, ophthalmology, histopathology, molecular biology, genetics and medical oncology. Such a transversal approach is overviewed in this chapter.

45e Congrès de la SFSCMF – NancyTumorogenèse des maxillaires. Recherche et perspectiveMaxillary and mandibular carcinogenesis: Research and prospects

Development and growth of odontogenic tumours depend on impairment of numerous genes and molecules. In recent years, most of the genes involved in dental development were identified. This produced a new basis for the study of oral pathology and maxillofacial carcinogenesis. A better understanding of these molecular phenomena should allow to better determine the evolution of such lesions. Research breakthroughs should facilitate the development of new molecular and genetic therapeutic perspectives.

45e congrès de la SFSCMF – NancyFibrome desmoïdeDesmoplastic fibroma

Desmoplastic fibroma is a rare benign intraosseous neoplasms. They can affect the jaw. Posterior mandibular bone involvement is the most frequent localization. They are locally aggressive and recurrence is frequent. Radioclinical signs are not specific and the histological diagnosis may be difficult. Extended surgical removal is the recommended treatment.