Denosumab-related osteonecrosis of the jaw in a patient with bone metastases of prostate cancer: A case report and literature review.

Denosumab, a human monoclonal antibody directed against the receptor activator of nuclear factor-κß ligand (RANKL), is used for the treatment of patients with metastatic cancer of the bone or osteoporosis. Recent reports have demonstrated that denosumab can induce osteonecrosis of the jaw (ONJ), but reported cases of this are uncommon. The present study reports the case of an 86-year-old male with prostate cancer patient exhibiting bone metastases who developed ONJ whilst receiving denosumab. To elucidate the influence of denosumab on the development of ONJ, the present study also reviewed the literature, including clinical trials and case reports. In the clinical trials, the prevalence of denosumab-related ONJ was higher in patients with cancer compared with those with osteoporosis. The high risk of ONJ in patients with cancer was thought to be associated with the differing dose and frequency of denosumab administration. The prevalence of ONJ was not significantly different between patients receiving denosumab and bisphoshonate (BP). In the reported cases, denosumab-related ONJ had a similar clinical presentation to BP-related ONJ. There was also a tendency for denosumab-related ONJ to develop in the mandible of elderly patients. Previous invasive dental treatment was a commonly shared characteristic of patients with denosumab-related ONJ. A complex medical history was also suspected to affect the prevalence. No clear association between the dose or duration of denosumab treatment and the development of ONJ was observed. Although conservative treatments are given for denosumab-related ONJ, non-improving cases were managed surgically with primarily positive results. Because denosumab may offer superior results compared with BP for the treatment of metastatic cancer of the bone or osteoporosis, the use of denosumab is expected to increase in the near future. Clinicians should also be aware of the risk factors for denosumab-related ONJ, in order to aid in its diagnosis. In addition, patients treated with denosumab should receive prophylactic treatment to maintain their oral health prior to, during and after denosumab treatment.

Risk factors for postoperative hemorrhage after minor oral surgery in patients treated with antithrombotic agents.

It has been proposed that minor oral surgery can be performed safely in patients taking antithrombotic therapy without interrupting treatment; however, there is little evidence-based guidance about how to manage postoperative hemorrhage in patients taking antithrombotics, and few randomized trials that help to inform the risk-benefit ratio of continuing or suspending antithrombotic therapy. The aim of this study was to identify risk factors for postoperative hemorrhage to create a protocol for patients undergoing minor oral surgery with antithrombotic therapy. One hundred and two patients were enrolled, who subsequently underwent 142 minor oral surgical procedures while taking antithrombotic therapy. Demographic details including age and sex, laboratory coagulation investigations, and episodes of postoperative hemorrhage were recorded. The prothrombin time-international normalized ratio (PT-INR) of participants taking warfarin was <3.0 in all cases (mean 1.89 ± standard deviation 0.52; range 1.11-2.82). The activated partial thromboplastin time (APTT) was significantly associated with postoperative hemorrhage, which was significantly increased in patients taking warfarin alone or in combination with an antiplatelet agent compared with an antiplatelet agent alone. In 7 cases, postoperative hemorrhage continued for 4 days and more, requiring additional local hemostatic management. Our findings suggest that minor oral surgery can be performed under antithrombotic therapy without the need of discontinuing the antithrombotic agents. Local hemostatic materials did not suppress postoperative hemorrhage. APTT is a possible prediction factor for postoperative hemorrhage in such patients and, therefore, should be determined prior to minor oral surgery in addition to PT-INR value.

Diagnostic role of magnetic resonance imaging in assessing orofacial pain and paresthesia.

The aim of this study was to compare the efficacy of CT and MRI in evaluating orofacial pain and paresthesia. A total of 96 patients with orofacial pain and/or paresthesia were included in this study. The patients who underwent CT and/or MRI examinations were assessed, and the efficacy of CT and/or MRI examinations in detecting the causative disease of the orofacial pain and paresthesia was evaluated. Seventy (72.9%) of 96 patients underwent CT and/or MRI examinations. Whereas CT examinations detected 2 diseases (4.5%) in 44 tests, 13 diseases (37.1%) were detected in 35 MRI examinations. Seven (53.8%) of 13 diseases, which were detected by MRI, were found in elderly patients. A high percentage of patients, who claimed orofacial pain and paresthesia, have other diseases in their brain, especially in elderly patients, and MRI is more useful than CT for evaluating these patients.

Rapid growing myofibroma of the gingiva: report of a case and review of the literature.

PURPOSE: Myofibroma is a rare benign tumor of myofibroblasts that rarely exhibits rapid enlargement and is misinterpreted as a malignant lesion. The aim of this study was to investigate its growth potential and to evaluate the usefulness of preoperative immunohistochemical study for an accurate diagnosis. MATERIALS AND METHODS: A case of rapidly growing myofibroma of the lower gingiva was analyzed using 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography fused with computed tomography (PET/CT) and immunohistochemical study of Ki-67 and p53. The English-language literature from 1981 to 2012 also was reviewed. RESULTS: An 18F-FDG PET/CT image displayed a high accumulation (maximum standardized uptake value, 14.1) in the lesion. A biopsy specimen showed mitotic activity of spindle-shaped cells, but atypia was not present. The MIB-1 labeling index was 10%, and the p53 test result was negative. The preoperative diagnosis of benign tumor of smooth muscle origin was made from the histopathologic and immunohistochemical features. In a review of 94 cases, tumors involved the mandible (33%), gingiva (23%), tongue (15%), cheek or buccal mucosa (12%), palate (8%), lip (4%), and other areas (5%). Nine cases (9.6%) were described as rapidly enlarging, and 8 cases (8.5%) were suspected of malignancy at initial diagnosis. The preoperative biopsy with immunohistochemical study established an accurate diagnosis in 83% of myofibromas, and no recurrences were reported in these patients. CONCLUSIONS: Careful diagnosis is necessary because these lesions sometimes present clinical and radiologic features that resemble those of malignant tumors. Preoperative immunohistochemical analysis should be performed to avoid misdiagnosis or unnecessary aggressive therapy.