Bisphosphonate-related osteonecrosis of the jaw in metastatic breast cancer patients: a review of 25 cases / 대한악안면성형재건외과학회지

BACKGROUND: Intravenous bisphosphonates have been used in metastatic breast cancer patients to reduce pathologic bone fracture and bone pain. However, necrosis of the jaw has been reported in those who received intravenous bisphosphonates. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is caused by dental extraction, dental implant surgery, and denture wearing; however, it occurs spontaneously. The purpose of this study was to report BRONJ in metastatic breast cancer patients. METHODS: Consecutive 25 female patients were referred from the Department of Oncology from 2008 to 2014 for jaw bone discomfort. Staging of breast cancer, history of bisphosphonate infusion, etiology of BRONJ, and treatment results were reviewed. Average age of the patients was 55.4 years old (38-74). Twelve maxillae and 16 mandibles were involved. Conservative treatments such as irrigation, antibiotic medication, analgesics, and oral gargle were applied for all patients for the initial treatment. Patients who had sequestrum underwent debridement and primary closure. RESULTS: The etiologies of BRONJ were dental extraction (19 cases), dental implant (2 cases), and endodontic treatment (1 case). However, three patients did not have any risk factors to cause BRONJ. Three patients died of progression of metastasis during follow-up periods. Surgical debridement was performed in 21 patients with success in 18 patients. Three patients showed recurred bone exposure and infection after operation. CONCLUSIONS: Prevention of the BRONJ is critical in metastatic breast cancer patients. Conservative treatment to reduce pain, discomfort, and infection is recommended for the initial therapy. However, if there is a sequestrum, surgical debridement and primary closure is the key to treat the BRONJ.

Double-layered collagen graft to the radial forearm free flap donor sites without skin graft / 대한악안면성형재건외과학회지

BACKGROUND: Radial forearm free flap is the most reliable flap for intraoral soft tissue reconstruction after cancer ablation surgery. However, unesthetic scar of the donor site and the need for a second donor site for skin graft are major disadvantages of the forearm flap. The purpose of this study was to report the clinical results of double-layered collagen graft to the donor site of the forearm free flap without skin graft. METHODS: Twenty-two consecutive patients who underwent oral cancer ablation and forearm reconstruction between April 2010 and November 2013 were included in this study. Male to female ratio was 12:10, and average age was 61.0 years old (27-84). Double-layered collagen was grafted to the donor site of the forearm free flap and healed for secondary intention. Upper silicone had been trimmed at the periphery during secondary intention, and dry dressing was used. Postoperative scar healing and esthetic results and function were evaluated. RESULTS: An average follow-up period was 34.9 months. The scar area was decreased to 63.9 % in average. The complete healing was obtained between 1.5 and 3 months according to the defect size. There was no functional defect or impairment 3 months after operation. All patients were satisfied with the esthetic results. Three patients died of recurred cancer. CONCLUSIONS: Double-layered collagen graft was successfully performed in this study. Without the thigh skin graft, patients had experienced less painful postoperative healing periods and discomfort.

A Case of Ganglioneuroblastoma Presenting as Weakness of the Lower Extremities / 대한혈액학회지

Ganglioneuroblastoma is a rare tumor originating from the sympathetic chain. It is intermediate between the highly malignant neuroblastoma and the benign ganglioneuroma. The predilection sites of ganglioneuroblastoma are the retroperitoneum and mediastinum but involvement of the structures around the spinal cord is infrequent. A 4 year-old girl who had progressive weakness in both lower extremities had a tiptoe gait for 2 months. A magnetic resonance imaging (MRI) study revealed a heterogeneous enhancing mass in the right mediastinum and paraspinal areas. A biopsy of the mass confirmed a ganglioneuroblastoma with many neuroblasts and nodules of ganglion cells. This is an unusual case of a child with spastic paraplegia caused by ganglioneuroblastoma of the thoracic cavity.

Endoscopic Botulinum Toxin Injection for the Treatment of Dysphagia Caused by Cricopharyngeal Hypertonicity : A case report

Hypertonicity of the cricopharyngeal muscle often results in dysphagia. Current available treatments for this problem include the mechanical balloon dilation and cricopharyngeal myotomy. Recently, a botulinum toxin injection into the cricopharyngeal muscle has been proved to be a successful approach. The case well proved the effectiveness of botulinum toxin injections as a viable treatment for patients suffering from cricopharyngeal dysphagia. A 58 year-old man, who had right lateral medullary infarction, claimed severe difficulties in swallowing which was complicated by aspiration pneumonia. A videofluoroscopic barium swallow test indicated aspiration and cricopharyngeal hypertonicity. Botulinum toxin was injected into the cricopharyngeal muscle, through endoscopic identification. After treatment, videofluoroscopy showed a significant improvement in the cricopharyngeal muscle opening and no more silent aspiration was seen. This case implicated the effectiveness of endoscopic botulinum toxin injection treatment for cricopharyngeal dysphagia in situations where there was no response to traditional swallowing rehabilitation.