Roman Rahimi-Nedjat

Malignant Lymphomas in the Head and Neck Region - a Retrospective, Single-Center Study over 41 Years

Objectives: Non-Hodgkin lymphomas are malignant neoplastic proliferations of the immune system that can manifest as nodal or extranodal lymphomas. The aim of this study was to retrospectively investigate the site of occurrence of lymphomas in the head and neck area and to analyze the typical symptoms of patients who presented at an oral and maxillofacial surgical department. Material and Methods: All patient files from1971 until 2012 from an Oral and Maxillofacial Surgery of a University were analyzed for the diagnosis non-Hodgkin lymphoma. Epidemiologic data and data regarding the localization of the malignant lymphoma were evaluated. Results: 62 patients, 34 women and 28 men with a non-Hodgkin lymphoma in the head and neck area were treated in the 41 years analyzed. In 87% of the cases the lymphoma belonged to B-cell and in 12% to the T-cell lineage. The average age at the time of diagnosis was 67 years for women (n=34) and 56 years for men. With 22 patients each, the non-Hodgkin lymphoma was localized in either the soft tissues or osseous structures. In the remaining 18 cases, multiple structures were affected. In 33 patients no accompanying nodal manifestation was noticed. In 33 cases the lymphoma was located in the oral cavity. The most common symptoms were swelling (97%), pain (40%) and the existence of an ulcer (11%). Conclusion: In the present study more than 50% of the lymphomas were located in the oral cavity. Due to the unspecific symptoms, a histopathological verification of the diagnosis is crucial.

Association between eruption state of the third molar and the occurrence of mandibular angle fractures

BACKGROUND/AIM Fractures of the mandible, especially the mandibular angle, are one of the most frequent types of injuries of the facial skeleton. In many cases, a retained third molar can be found in the line of the fracture. However, it remains unclear whether a relationship between third molars and mandibular angle fractures exists. MATERIALS AND METHODS Patients with isolated or combined fractures of the lower jaw between January 2001 and December 2007 were analyzed retrospectively. Electronic health records were investigated regarding the types of mandibular fractures, and panoramic radiographs were reviewed concerning the existence of third molars. In addition, a systematic review was performed to compare the findings of this study with existing data. RESULTS Six hundred and thirty-two patients were treated for mandibular fractures within the time frame. Two hundred and sixty-seven had a mandibular angle fracture. In 461 patients, panoramic radiographs were available, of which 45.6% did not have a third molar. About 3.8% were edentulous. There is a significant relationship between the existence of unerupted third molars and the occurrence of mandibular angle fractures (P < 0.001). No correlation exists for erupted third molars. CONCLUSIONS Fractures of the mandibular angle are more likely to appear in patients with retained third molars which might be due to the reduced bone mass. Once the wisdom teeth have erupted, the bone structure is more solid and more resistant to external forces and the development of fractures.

Concomitant dental injuries in maxillofacial fractures - a retrospective analysis of 1219 patients

BACKGROUND/AIM Traumatic dental injuries are frequently combined with maxillofacial fractures, but literature addressing this topic is rare. In a retrospective study, the frequency of dental lesions in inpatients with traumatic facial injuries was analyzed. MATERIAL AND METHODS All patients referred to the Department of Oral and Maxillofacial Surgery of the University Medical Center of the Johannes Gutenberg-University Mainz for inpatient treatment due to facial fractures between January 2001 and December 2007 were analyzed regarding the type of fracture, its localization, and potential concomitant dental injuries. In addition a systematic review was performed to compare the findings of this study with existing data. RESULTS Altogether 1219 facial trauma patients underwent inpatient treatment. 184 (15.87%) out of those had 451 injured teeth, and 4.9% were edentulous. The most frequent causes were assaults (25.1%), followed by falls (19.6%) and bike accidents (10.1%). Avulsion, especially of the upper incisors, occurred in most cases (27.9%). Assaults caused 1.29 dental fractures per patient, while traffic-related accidents led to three to four times higher injury-rates. CONCLUSIONS With almost every sixth patient having at least one kind of dental injury, this study shows that a thorough anamnesis and examination of the dental status are absolutely necessary, especially in patients who suffered from high-speed impacts or collisions with low-resilience surfaces.

Diabetes Mellitus and Its Association to the Occurrence of Medication-Related Osteonecrosis of the Jaw

To date there is no consensus on the role of diabetes in the development of medication-related osteonecrosis of the jaws (MR-ONJ). Therefore, this study aimed to investigate the prevalence of diabetes and pathological glucose metabolism in patients with MR-ONJ compared to the general population. All maxillofacial surgery inpatients in one year at our department were investigated regarding diagnosis, anamnesis, medication, and blood glucose readings. 1374 records were analyzed. 35 patients with MR-ONJ were identified. Diabetics accounted for 14.3%. No significant difference in the prevalence of known diabetes was found, except for pathological glucose metabolism in patients with MR-ONJ (p < 0.001). Diabetes does not necessarily promote the onset of MR-ONJ. Therefore, diabetes should not be considered as a standalone risk factor. On the contrary, hyperglycemia as a possible indicator for poorly managed or yet undetected diabetes is associated with MR-ONJ.

Sentinel lymph node biopsy in malignant melanoma of the head and neck

BACKGROUND The aim of this retrospective study was to investigate sentinel lymph node biopsy in patients with head and neck melanoma. MATERIALS AND METHODS Patients who underwent SLNB between 2010 and 2016 were comprised. Epidemiological, radiological, and surgical data were collected and compared to histological findings. Patients who underwent primary complete lymph node dissection were excluded. RESULTS 74 patients underwent SLNB during this period. The most common tumor localizations were the cheek (20.4%) and ears (20.4%). Overall, 256 sentinel lymph nodes (SLN) were detected and removed, most frequently in Robbins-levels IIA and IIB as well as in the surrounding of the parotid gland. 12.3% of the SLN showed a microscopic or macroscopic metastasis. In preoperative imaging all lymph nodes with macroscopic metastasis were described as suspect but only 4 of 11 lymph nodes with microscopic metastases were described as such. CONCLUSIONS SLNB is an especially good procedure for the diagnosis of microscopically metastases as disease status is an important diagnostic and prognostic factor in early-stage melanoma patients. However, due to the complex lymphatic system in head and neck melanoma, a short follow-up interval is necessary in order to prevent delayed diagnosis of a nodal recurrence due to a false-negative SLN.

Coincidence of mandibular fractures with isolated posterior maxillary sinus fractures

BACKGROUND/AIM There are no data available to show whether there is a relationship between mandibular fractures and isolated fractures of the posterior and/or lateral walls of the maxillary sinus. The aim of this study was to determine whether there is a coincidence between these fracture patterns. METHODS Four hundred large volume cone beam computed tomography scans (CBCT) of patients with a fracture of the mandible between 2008 and 2013 were analyzed retrospectively. Patients with multiple midfacial fractures were excluded. The radiographic findings were correlated with epidemiological and clinical data of the patients such as gender, age, treatment methods, or complications. RESULTS The most frequent fracture sites of the mandible were the jaw angle, the parasymphysis region, and the condyle. Nineteen of the 400 patients (4.75%) had an isolated fracture of the lateral and/or posterior maxillary sinus. Odds-ratio analysis revealed a high tendency for significant correlation of condylar process fractures with isolated maxillary sinus fractures. Chi-square test demonstrated a P-value near statistical significance (P=.054). No other fracture site of the mandible could be associated with an isolated fracture of the maxillary sinus. CONCLUSION A condylar process fracture of the mandible after trauma without any further injury of the midface may be associated with an isolated fracture of the lateral and/or posterior maxillary sinus.

Angiogenesis in the Development of Medication-Related Osteonecrosis of the Jaws: An Overview

Medication-related osteonecrosis of the jaws (MR-ONJ) is one of the most relevant side effects of bisphosphonate therapy; it is clinically defined as a non-healing wound in combination with an avascular and necrotic jaw within ongoing bisphosphonate therapy or after completed bisphosphonate therapy. Different theories concerning the development of MR-ONJ have been reported, while the exact pathophysiology is still unknown. Recent studies have increasingly focused on angiogenesis and revascularization concerning MR-ONJ pathophysiology, which seems to be a relevant factor in the development of MR-ONJ and a possible and promising point of action for MR-ONJ prevention and therapy. Therefore, and with respect to the different aspects and specific forms of angiogenesis, the enclosed review summarizes the possible role of angiogenesis and revascularization in the pathophysiology of MR-ONJ. Special focus is given to the strong negative influence of bisphosphonates on progenitor and mature endothelial cells in vitro as well as on microvessel sprouting in vitro and in vivo, which might result in overall reduced wound healing of oral soft and hard tissues, and therefore in an exposed and avascular jaw from a clinical viewpoint. Further, it will be summarized whether and in what way the aspect of angiogenesis might be used for possible MR-ONJ prevention and therapy.