A case of successful treatment of medication-related osteonecrosis of the jaw with conservative treatment for pathological mandibular fracture.

INTRODUCTION: Surgical therapy is effective for medication-related osteonecrosis of the jaw. However, appropriate conservative treatment options are still important for cases in which surgery is contraindicated. We report a case of medication-related osteonecrosis of the jaw successfully treated conservatively for a pathological mandibular fracture. PRESENTATION OF CASE: An 84-year-old female patient presented to our department with a chief complaint of inadequate healing of an extraction tooth socket. She had been taking minodronic acid hydrate for approximately five years for osteoporosis. The clinical examination revealed erythema, diffuse swelling of the left mandibular angle, erythema of the buccal gingiva adjacent to the left mandibular first molar, and fistula formation. Although surgery was recommended, the patient declined to proceed. Therefore, a conservative treatment was initiated. A pathological fracture of the inferior mandibular margin was observed one month after the initial visit. Mouth opening was restricted for six months using a bandage. Two months after the pathological fracture, the inferior margin of the fracture was aligned. Five months later, the inferior margin continued. One year later, the bony union of the fracture was observed. DISCUSSION: Conservative treatment and restricting mouth opening was effective in our case. Three years and seven months after the pathological fracture, no new sequestrum formation was observed, and the patient was doing well. CONCLUSION: Conservative treatment can be effective for medication-related osteonecrosis of the jaw with severe cases.

A case of peripheral odontogenic fibroma arising in the mandibular premolar region of a teenager.

Peripheral odontogenic fibroma (POdF) is a rare, benign ectomesenchymal tumor. Herein, we report a case of a 15-year-old female patient who developed POdF in the mandible. The lesion was resected along with the periosteum. Histopathological findings revealed a small mass and cord-like epithelium. There was no recurrence 16 months postoperatively.

Elongated styloid process syndrome with prolongation of the superior cornu of the thyroid cartilage: A case report.

INTRODUCTION: Elongated styloid process syndrome represents a group of symptoms, such as recurrent throat pain and neck pain, caused by elongation of the styloid process. We report a case of elongated styloid process syndrome with prolongation of the superior cornu of the thyroid cartilage. CASE PRESENTATION: A 50-year-old man was referred to our clinic with the chief complaint of discomfort on the right side of his neck. He had no history of any disease. Extraoral findings indicated pain during neck rotation. Computed tomography showed prolongation of the styloid process beyond the mandibular plane and close to the hyoid. Moreover, prolongation of the superior cornu of the thyroid cartilage was detected. The discomfort during rotation of the neck was due to the stimulation by the styloid process. Styloid resection was performed using the extraoral approach under general anesthesia. CONCLUSION: Discomfort in the neck was resolved after operation.

Value of computed tomography findings in differentiating between intraosseous malignant tumors and osteomyelitis of the mandible affecting the masticator space.

OBJECTIVES: We sought to evaluate the diagnostic efficacy of computed tomography (CT) images in the differentiation between intraosseous malignant tumors and osteomyelitis spreading into the masticator space. STUDY DESIGN: A retrospective evaluation was carried out by using CT images from 12 patients with intraosseous malignant tumors and 9 patients with osteomyelitis involving the masticator space and accompanying mandibular bone destruction. The following CT observations are discussed: (1) bone destruction pattern subdivided into spotty, gross, or permeative; (2) cortical bone expansion; (3) diffuse osteosclerotic changes; (4) periosteal reaction; (5) masticator muscle involvement; (6) enlargement of the facial muscle; and (7) attenuation in the subcutaneous adipose tissue. RESULTS: The pattern of permeative bone destruction, cortical bone expansion, and the enlargement of both the masseter and medial pterygoid muscles were all observed in patients with malignant tumors. In contrast, diffuse sclerotic change and a periosteal reaction were significant observations in patients with osteomyelitis. CONCLUSION: The efficacy of CT in establishing a differential diagnosis of malignant tumors or osteomyelitis is supported by this study.

Regenerative treatment of serious periodontosis with grafting of cancellous iliac bone and gingival flaps and replanting of patients' teeth.

The purpose of this study was to assess the ability of serious periodontosis patients to regain satisfactory biting function, using the patients' own teeth, by regeneration of the alveolar bone. Twelve serious periodontosis patients whose alveolar bone was markedly absorbed and whose teeth were quite unstable were treated with replanting of their teeth and grafting of cancellous iliac bone and gingival flaps by the clinical team, which consisted of plastic surgeons and dentists. No patients developed postoperative complications (e.g., infections), and grafted iliac bone took in all patients. The total number of replanted teeth was 65, and only 4 of them fell off (92% take rate). Three to 4 months after surgery, the replanted teeth received prosthetic treatment so that the patients could begin biting. Ten patients were monitored for 5 months or longer, and they started to eat normal food after the fifth month. Regained biting function and satisfaction of having food were almost the same as before the periodontosis became severe in these 10 patients. Regeneration of alveolar bone was confirmed in later radiographs. To date, the maximum follow-up period is 2 years and 8 months (average = 1 year and 6 months). All patients have good biting function, and there have been no findings of absorption of reconstructed alveolar bone or of the root of replanted teeth. This treatment method would be quite useful for patients with serious periodontosis.