O. Procopio

Bisphosphonate-associated jawbone osteonecrosis: a correlation between imaging techniques and histopathology

OBJECTIVESnRecently, jawbone osteonecrosis has been reported as a potential adverse effect of bisphosphonates administration. This paper considers and highlights histopathologic and radiologic features of this condition.nnnSTUDY DESIGNnEleven patients, owing to unresponsiveness to conservative treatment and uncontrollable pain, underwent surgical resection of diseased jawbone after extensive hyperbaric oxygen therapy. A thorough clinical, laboratory, and imaging study was performed. Surgical specimens underwent histopathologic and immunohistochemical evaluation.nnnRESULTSnComputerized tomography (CT) scans showed increased bone density, periosteal reaction, and bone sequestration in advanced stages. With magnetic resonance imaging (MRI), exposed areas showed a low signal in T1- and T2-weighted and inversion recovery images, which suggests low water content and is histopathologically correlated with paucity in cells and vessels (osteonecrotic pattern). Unexposed diseased bone was characterized by T1 hypointensity and T2 and IR hyperintensity, which suggests high water content and inflammation, associated with hypercellularity, osteogenesis, and hypervascularity (osteomyelitic pattern).nnnCONCLUSIONSnDiseased bone extends beyond the limits of the bone exposed in the oral cavity. Histopathologic examination correlated well with CT and MRI, which are the choice for the evaluation of bisphosphonate-associated jawbone osteonecrosis.

Intraoral endoscopic enucleation of a solitary bone cyst of the mandibular condyle

Solitary bone cysts are benign osteolytic lesions rarely involving the mandibular condyle. They are considered pseudocysts due to the absence of epithelium and their pathogenesis is unknown. These lesions are also known with a variety of synonyms, such as traumatic bone cysts, simple bone cysts, haemorrhagic bone cysts and unicameral cysts. The authors report a case of a solitary cyst of the condylar head treated by enucleation and curettage via an intraoral endoscopic-assisted surgical approach, which avoids the risk of facial nerve injury, reduces the patients hospitalization and speeds up functional recovery.

Imaging of facial soft tissues in multislice computerized tomography: a new geometric method of analysis and its statistical validation

OBJECTIVEnThe main purpose of this preliminary study was to propose an original analysis of facial soft tissues depth to detect their topographic variability, which causes are intrinsic (depth) and extrinsic (bone shape and reciprocal correlations with soft tissues themselves). To check the utility and accuracy of the method in recognizing measures differences, other aims were comparison of two different groups of people and statistical validation.nnnSTUDY DESIGNnThe study sample was composed of 100 consecutive patients (56 females and 44 males) undergoing a routine CT scanning. The images, obtained through the reference plane of the palate, were post-processed on a PC workstation. A goniometer construction was superimposed and centered on the posterior nasal spine, where a grid of eighteen rays was developed to calculate the superficial soft tissues depths of the face. To test the validity of the method, three of the rays were measured twice, by the same as by another observer. Step-by-step procedures were attained to get maximum standard in measures reliability.nnnRESULTSnSuperficial soft tissues depths were obtained and sex differences were analyzed (Students t and Wilcoxon rank-sum test). The statistical reliability was proven with Bland-Altman statistics and the upper 95% limit of agreement was 1.459 mm for intraobserver repeatability and 1.886 mm for interobserver reproducibility. Validation of the method was proven by intraclass correlation coefficient (0.99 both for repeatability and reproducibility) and mean differences (respectively 0.6% and 0.4%).nnnCONCLUSIONnThe method appeared easy to be applied, reliable and not observer dependent, so suitable for study single as multiple patients with CT images. Future analyses shall be possible.

Surgical and orthodontic treatment of skeletal Class III featuring severe transversal and sagittal discrepancy

AIMSnAnterior cross-bite is a difficult malocclusion to treat in adult patients, especially if compounded by skeletal discrepancy. The present study describes a dentoskeletal Class III case and aims to provide the clinician with rational guidelines for presurgical orthodontic preparation and postsurgical finishing.nnnPATIENT AND METHODSnIn this case, a 20-year-old male patient, R.M, was treated for severe dental and skeletal Class III malocclusion on both the transversal and anteroposterior planes via combined orthodontics and surgery. Initially, the treatment involved surgically-assisted expansion of the upper jaw (total 1 month), followed by a fixed-orthodontics phase to decompensate for the malocclusion in preparation for movement of the osseous bases with the aim of achieving maximum coordination of the dental arches. After 19 months of orthodontic preparation, the patient underwent combined orthognathic surgery (upper and lower jaws). In the subsequent 4 months, orthodontic stabilization and finishing were performed, and debonding was carried out 24 months after the start of active treatment.nnnRESULTSnThe combined orthodontic and surgical treatment adequately corrected the severe Class III over a period of 2 years, leading to a satisfactory occlusal, functional and aesthetic result.nnnCONCLUSIONSnThorough diagnosis and close communication between the orthodontist and maxillofacial surgeon, operating as an interdisciplinary team, ensures good outcomes, even in complex orthodontic and surgical cases.