Terapia láser de baja frecuencia en el manejo del dolor en pacientes con osteonecrosis mandibular / Low level laser therapy in the management of pain in patients with osteonecrosis of the jaw

La terapia láser de baja frecuencia (TLBF) o fotobioestimulación es aquella que cuya luz provoca la regeneración y remodelación ósea, la restauración de la función neural, la disminución del dolor y la modulación del sistema inmune; esta terapia es un coadyuvante junto a la terapia conservadora y/o quirúrgica. Se considera un estándar de oro para el manejo del dolor en la osteonecrosis en aquellos pacientes que consumen o han consumido bifosfonatos como terapia para inhibir la resorción ósea. La Sociedad Americana de Investigación de Hueso y Minerales (SAIHM) definió la osteonecrosis mandibular como «un área de hueso expuesto en la región maxilofacial que no cicatriza dentro de las ocho semanas posteriores a la identificación, en un paciente que está recibiendo o ha estado expuesto a bifosfonatos y que no ha recibido radioterapia en la región craneofacial¼. En este reporte presentamos dos casos de pacientes con osteonecrosis mandibular relacionada a bifosfonatos tratados con TLBF. Se evaluó el dolor antes y después de la terapia con la escala visual análoga (EVA). Ambos casos tuvieron disminución del dolor al 100%. Se presentan los métodos de diagnóstico clínico y radiográfico, el tratamiento elegido y los resultados obtenidos (AU)

Low level laser therapy (LLLT) or photobiostimulation is one whose light causes bone regeneration and remodeling, restoration of neural function, reduction of pain, and modulation of the immune system; this therapy is an adjuvant together with conservative and / or surgical therapy. It is considered a gold standard for pain management in osteonecrosis in those patients who consume or have used bisphosphonates as antiresorptive therapy. The American Society for Bone and Mineral Research (ASBMR) defined osteonecrosis of the jaw as «an area of exposed bone in the maxillofacial region that does not heal within eight weeks after identification by a health care provider, in a patient who was receiving or had been exposed to a BP and who has not received radiation therapy to the craniofacial region¼. In this report we present two cases of patients with mandibular osteonecrosis related to bisphosphonates treated with LLLT. Pain before and after visual analogue scale (VAS) was evaluated. Both cases had pain reduction at 100%. The methods of clinical and radiographic diagnosis, the treatment chosen and the results obtained are presented (AU)

Mandibular periosteal (juxtacortical) chondrosarcoma

Periosteal (juxtacortical) chondrosarcoma (PC) is a well-differentiated malignant cartilage-forming tumor arising from the external bone surface, especially in long bones. The therapy of choice is en-bloc resection and, in general, its prognosis is good. This paper reports a rare case of PC affecting the mandible of a 41-year-old man. The lesion presented as a slow-growing-painless swelling that lasted 2 months. Computed tomography scan showed a tumoral mass arising from the external bone surface, extending into the adjacent soft tissue presenting patchy regions of popcorn-like calcifications. A final diagnosis of PC (grade II) was rendered after biopsy. Hemimandibulectomy was undertaken followed by complementary radiotherapy with 70 Gy. Although no episodes of recurrence or metastasis had been noticed after 18 months of follow-up, the patient died and causa mortis could not be established.

Condrossarcoma (juxtacortical) periosteal (CP) é um tumor maligno produtor de cartilagem bem diferenciado que normalmente surge na superfície externa dos ossos longos. O tratamento de escolha para esse tumor é a ressecção em bloco e, em geral, apresenta um prognóstico bom. Nesse trabalho, nós apresentamos um caso raro de CP afetando a mandíbula de um homem de 41 anos de idade. A lesão apresentava um crescimento lento e indolor de 2 meses de evolução. A tomografia computadorizada revelou a presença de uma massa tumoral surgindo na superfície externa do osso mandibular exibindo agregados de tecido calcificado no seu interior e que se estendia para os tecidos moles adjacentes. Depois de realizada uma biópsia, um diagnóstico final de CP (grau II) foi estabelecido. O tratamento de escolha foi hemimandibulectomia seguida por radioterapia complementar na dose de 70 Gy. Embora nenhum episódio de recorrência ou metástase tenha sido noticiado após 18 meses de acompanhamento, o paciente morreu e a causa mortis não pôde ser determinada.