scholarly journals Different Presentation and Outcomes in the Surgical Treatment of Advanced MRONJ in Oncological and Nononcological Patients Taking or Not Corticosteroid Therapy

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Paolo Garzino Demo ◽  
Alessandro Bojino ◽  
Fabio Roccia ◽  
Maria Chiara Malandrino ◽  
Stefan Cocis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Surgical Treatment ◽  
Treatment Outcomes ◽  
Corticosteroid Therapy ◽  
Good Practice ◽  
Maxillofacial Surgery ◽  
Osteonecrosis Of The Jaw ◽  
Severe Side Effect ◽  
Antiresorptive Drugs

Medication-related osteonecrosis of the jaw (MRONJ) is a severe side effect caused by antiangiogenic antiresorptive drugs used to treat various oncological and non oncological diseases. The clinical and radiological characteristics of MRONJ depend on the type of causative drug, the time of administration, and its dosage. Proven systemic risk factors like anemia, uncontrolled diabetes, corticosteroid therapy, and chemotherapy in neoplastic diseases (e.g., high doses of methotrexate up to 30 mg daily) significantly increase the chances of acquiring MRONJ. The risk factors themselves can affect treatment outcomes. Although the main scientific societies have recently disseminated good practice rules on the patient’s prevention, diagnosis, and management, there are still no guidelines on shared therapeutic strategies. In general, if conservative treatment fails, surgical treatment is considered, including local debridement, osteoplasty, and marginal or segmental osteotomy. In literature, cohorts of heterogeneous patients with MRONJ have been analyzed for a long time, resulting in a lack of uniformity of information and difficulties interpreting the data. According to the American Association of Oral and Maxillofacial Surgeons criteria, this retrospective study evaluates the surgical treatment outcomes of 64 patients with stage II-III MRONJ, evaluated at the Department of Maxillofacial Surgery of the University of Turin (Italy). The first objective of this retrospective study is to evaluate treatment results for stages II-III in all cases; the second objective is to evaluate the same results by dividing the sample into different cohorts of patients: first, based on the underlying pathology, i.e., oncological and non oncological, and secondly, based on the drug or combination of drugs they took.

scholarly journals Surgical Treatment of Medication-Related Osteonecrosis of the Jaw: A Retrospective Study

2020 ◽  
Vol 17 (23) ◽  
pp. 8801
Author(s):  
Na Rae Choi ◽  
Jung Han Lee ◽  
Jin Young Park ◽  
Dae Seok Hwang
Keyword(s):  
Retrospective Study ◽  
Surgical Treatment ◽  
Treatment Outcomes ◽  
Maxillofacial Surgery ◽  
Osteonecrosis Of The Jaw ◽  
Oral And Maxillofacial Surgery ◽  
Single Institution ◽  
Patient Factors ◽  
Surgical Success ◽  
Negative Impacts

The purpose of this study was to confirm the success rate of surgical treatment of medication-related osteonecrosis of the jaw (MRONJ) in patients at a single institution (Association of Oral and Maxillofacial Surgery (AAOMS) stages 1, 2, or 3), and to identify the factors that influence treatment outcomes. As a result of analyzing the outcomes of treatment, surgical “success” was achieved in 93.97% (109) of cases, and “failure” was observed at 6.03% (7) cases. Analysis of patient factors that potentially affect treatment outcomes showed that zoledronate dose (p = 0.005) and the IV (intravenous) injection of drugs (p = 0.044) had significant negative impacts.

scholarly journals A Comparison of the Clinical and Radiological Extent of Denosumab (Xgeva®) Related Osteonecrosis of the Jaw: A Retrospective Study

2021 ◽  
Vol 10 (11) ◽  
pp. 2390
Author(s):  
Zineb Assili ◽  
Gilles Dolivet ◽  
Julia Salleron ◽  
Claire Griffaton-Tallandier ◽  
Claire Egloff-Juras ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Cumulative Incidence ◽  
Side Effect ◽  
Osteonecrosis Of The Jaw ◽  
Exposed Group ◽  
Severe Side Effect ◽  
Dental Arch ◽  
P Value ◽  
The Difference ◽  
Bone Exposure

Medication-related osteonecrosis of the jaw (MRONJ) is a severe side effect of antiresorptive medication. The aim of this study was to evaluate the incidence of denosumab-related osteonecrosis of the jaw and to compare the clinical and radiological extent of osteonecrosis. A retrospective study of patients who received Xgeva® at the Institut de Cancérologie de Lorraine (ICL) was performed. Patients for whom clinical and radiological (CBCT) data were available were divided into two groups: “exposed” for patients with bone exposure and “fistula” when only a fistula through which the bone could be probed was observed. The difference between clinical and radiological extent was assessed. The p-value was set at 0.05, and a total of 246 patients were included. The cumulative incidence of osteonecrosis was 0.9% at 6 months, 7% at 12 months, and 15% from 24 months. The clinical extent of MRONJ was significantly less than their radiological extent: in the “exposed” group, 17 areas (45%) were less extensive clinically than radiologically (p < 0.001) and respectively 6 (67%) for the “fistula” group (p < 0.031). It would seem that a CBCT is essential to know the real extent of MRONJ. Thus, it would seem interesting to systematically perform a CBCT during the diagnosis of MRONJ, exploring the entire affected dental arch.

scholarly journals A Clinical Retrospective Study of Surgical Treatment for Medication-Related Osteonecrosis of the Jaw

2016 ◽  
Vol 25 (4) ◽  
pp. 447-454 ◽  
Author(s):  
Shintaro Sukegawa ◽  
Takahiro Kanno ◽  
Hotaka Kawai ◽  
Satoko Nakamura ◽  
Akane Shibata ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Surgical Treatment ◽  
Osteonecrosis Of The Jaw

Bisphosphonate-Related Osteonecrosis of the Jaw: Clinical Features, Risk Factors, Management, and Treatment Outcomes of 26 Patients

2009 ◽  
Vol 67 (9) ◽  
pp. 1904-1913 ◽  
Author(s):  
Vivek Thumbigere-Math ◽  
Ma'Ann C. Sabino ◽  
Rajaram Gopalakrishnan ◽  
Sabrina Huckabay ◽  
Arkadiusz Z. Dudek ◽  
...  
Keyword(s):  
Risk Factors ◽  
Treatment Outcomes ◽  
Clinical Features ◽  
Osteonecrosis Of The Jaw

scholarly journals Practical Guidelines for the Prevention, Diagnosis, and Treatment of Osteonecrosis of the Jaw in Patients With Cancer

2006 ◽  
Vol 2 (1) ◽  
pp. 7-14 ◽  
Author(s):  
Salvatore Ruggiero ◽  
Julie Gralow ◽  
Robert E. Marx ◽  
Ana O. Hoff ◽  
Mark M. Schubert ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Care Professionals ◽  
Multidisciplinary Treatment ◽  
Maxillofacial Surgery ◽  
Osteonecrosis Of The Jaw ◽  
Bisphosphonate Therapy ◽  
Oral And Maxillofacial Surgery ◽  
Patients With Cancer ◽  
Dental Procedures ◽  
Practical Guidelines

PurposeThis article discusses osteonecrosis of the jaw (ONJ) and offers health care professionals practical guidelines and recommendations for the prevention, diagnosis, and management of ONJ in cancer patients receiving bisphosphonate treatment.MethodsA panel of experts representing oral and maxillofacial surgery, oral medicine, endocrinology, and medical oncology was convened to review the literature and clinical evidence, identify risk factors for ONJ, and develop clinical guidelines for the prevention, early diagnosis, and multidisciplinary treatment of ONJ in patients with cancer. The guidelines are based on experience and have not been evaluated within the context of controlled clinical trials.ResultsONJ is a clinical entity with many possible etiologies; historically identified risk factors include corticosteroids, chemotherapy, radiotherapy, trauma, infection, and cancer. With emerging concern for potential development of ONJ in patients receiving bisphosphonates, the panel recommends a dental examination before patients begin therapy with intravenous bisphosphonates. Dental treatments and procedures that require bone healing should be completed before initiating intravenous bisphosphonate therapy. Patients should be instructed on the importance of maintaining good oral hygiene and having regular dental assessments. For patients currently receiving bisphosphonates who require dental procedures, there is no evidence to suggest that interrupting bisphosphonate therapy will prevent or lower the risk of ONJ. Frequent clinical assessments and conservative dental management are suggested for these patients. For treatment of patients who develop ONJ, a conservative, nonsurgical approach is strongly recommended.ConclusionAn increased awareness of the potential risk of ONJ in patients receiving bisphosphonate therapy is needed. Close coordination between the treating physician and oral surgeon and/or a dental specialist is strongly recommended in making treatment decisions.

scholarly journals A retrospective study of suspected pyometra causing systemic illness in 348 dogs

2020 ◽  
Vol 19 (2) ◽  
pp. 141-152
Author(s):  
Surapa Rungphattanachaikul ◽  
◽  
Areerath Akatvipat ◽  
Michael Pheng Chuan Chia ◽  
Kannika Na Lampang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Mortality Rate ◽  
Treatment Outcomes ◽  
Mortality Factor ◽  
Hospital Treatment ◽  
Improve Treatment ◽  
Operative Planning ◽  
Time Periods ◽  
The Cost

A retrospective study was used to investigate the prevalence, mortality rate, treatment outcomes, risk factors for death, and accompanying costs for canine pyometra cases reported in 2016 to 2018 from a single vet teaching hospital in Thailand. The prevalence of canine pyometra was 375 cases from 35,138 of canine outpatients (1.07%) with 348 cases undergoing surgery at the hospital. Mongrel dogs were most affected (37.33%) followed by Poodles (14.67%) and Shih Tzus (12.27%). The median age of pyometra cases was 7 years (range of 11 months to 16 years). The mortality rate was 10.63 % (37/ 348 dogs). Mortalities occurred in 3 dogs prior to surgery. Post-operative mortalities were reported in 24 dogs, and 10 dogs with undefined time periods. The main contributing mortality factor was uterine rupture (adjusted OR 7.38 (95% CI =2.73,19.93)). The cost of hospital treatment per case ranged between 93 to 939 United States Dollars. Surgical ovariohysterectomy is an effective treatment and preventative procedure for pyometra. Comprehensive and careful pre-operative and sufficient post-operative planning is recommended to improve treatment outcomes.

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