Serum levels of RANKL and OPG, and the RANKL/OPG ratio in bisphosphonate-related osteonecrosis of the jaw: Are they useful biomarkers for the advanced stages of osteonecrosis?

Background: We determined whether serum levels of Receptor Activator for Nuclear Factor κ B Ligand (RANKL), Osteoprotegerin (OPG), and the RANKL/OPG ratio could be useful biomarkers for the severity of oral lesions in bisphosphonate-related osteonecrosis of the jaw (BRONJ). Material and Methods: A case-control study in which Group 1 consisted of 41 patients with BRONJ due to bisphosphonates, and Group 2 consisted of 44 healthy control cases. The plasma levels of RANKL and OPG were analyzed by an ELISA assay. The OPG/RANKL ratio was also calculated. We determined if the mean serum values differed among the different stages of BRONJ. Results: Serum levels of RANKL were lower in Group 1 than in Group 2 (p =0.01), and serum levels of OPG were higher in patients with BRONJ than in the controls (p =0.006). The ratio of RANKL/OPG was greater in the controls than in Group 1 (p >0.01). There were no significant differences in the serum levels of RANKL and OPG among the different stages of osteonecrosis (p >0.05). Conclusions: Serum levels of RANKL and OPG, and the RANKL/OPG ratio were not valuable biomarkers for determining the severity of oral lesions in patients with BRONJ (AU)

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Exposed necrotic bone in 183 patients with bisphosphonate-related osteonecrosis of the jaw: Associated clinical characteristics

Background: The main objective of our study was to identify oral symptoms and signs most likely to be associated with the exposure of necrotic bone in bisphosphonate-related osteonecrosis of the jaw (BRONJ). Material and Methods: The study group consisted of 183 patients with BRONJ. We recorded data on the underlying disease, bisphosphonate used, location of osteonecrosis, symptoms, pain, fistula development, suppuration, infection, exposed necrotic bone, and BRONJ stage. Results: The mean age of the patients was 68.22 ± 12.19 years. The sample included 118 (64.5%) women. Breast cancer and multiple myeloma were the most common underlying diseases, and 50 patients received oral bisphosphonates for osteoporosis. Dental extractions (69.4%) and mandibular location (74.3%) predominated. The only two variables influencing the possibility of necrotic bone exposure were intravenous bisphosphonate administration and the presence of an intraoral fistula (p < 0.05). Conclusions: Intravenous bisphosphonate use and intraoral fistula presence were associated with a major predisposition to bone exposure in patients with BRONJ (AU)

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Extra-nodal B-cell non-Hodgkin's lymphomas of the head and neck: a study of 68 cases.

OBJECTIVES: The objectives of this study are to describe the distinctive characteristics of extra-nodal B-cell non-Hodgkin's lymphomas (BNHLs) located in the head and neck in a series of patients, to discuss patient survival, and to compare the oral versus the non-oral locations of the extra-nodal BNHLs of the head and neck. MATERIAL AND METHODS: We studied 68 patients with BNHL of the head and neck. We analyzed the clinical and survival characteristics. Additionally, we performed Kaplan-Meier and Cox regression analyses to determine the influence of the different factors on survival. RESULTS: This study included 68 non-nodal lymphomas; 30 lymphomas (31.9%) were located intraorally, with the gingiva as the most frequent location. The oral lymphomas in stages 1 and 2 showed a prevalence of 60% (18/30). The Kaplan-Meier analysis showed that the stage of disease and the oral versus non-oral extranodal lymphomas were significant prognostic factors (p<0.05). However, the multivariate Cox analysis indicated that only complete remission and oral versus non-oral location were significant prognostic factors (p<0.01). CONCLUSIONS: The gingiva was the most common location of the intraoral lymphomas. Complete remission and non-oral location were the only significant survival factors in the multivariate Cox regression analysis.

Tumors metastasizing to the oral cavity: a study of 16 cases.

PURPOSE: An analysis was performed of the clinical and epidemiologic characteristics of a group of patients diagnosed with oral metastases of distant primary tumors or unknown primary malignancies. MATERIAL AND METHODS: The study series consisted of 16 patients with oral metastatic lesions seen in the Department of Stomatology and Maxillofacial Surgery, Valencia University General Hospital (Valencia, Spain) that had been diagnosed in the previous 15 years. A retrospective analysis was made of patient age and gender, clinical characteristics of metastatic lesions, location of the primary tumor, and time elapsed from diagnosis to the death of a patient. RESULTS: There were 13 male and 3 female patients (mean age, 58.8 years). Ten patients had been diagnosed previously and were being treated for a primary tumor; 2 patients were diagnosed with a primary malignancy in the department; and 4 patients presented with an unidentified primary tumor (metastatic disease diagnosed from biopsy study). The predominant clinical presentation was mixed soft tissue and bone metastases followed by solely soft tissue lesions and solely bone lesions. Some patients showed no apparent oral lesions. Primary malignancies originated mainly from the lung followed by the prostate, gastrointestinal tract, thyroid gland, breast, and liver. Mean survival from diagnosis of oral metastases was 8.25 months. CONCLUSION: Oral metastatic lesions are infrequent, can affect male and female patients equally, can manifest at any age, and may constitute the first manifestation of a still unidentified primary malignancy. According to the literature, bone metastases are more common than soft tissue metastases. Nevertheless, in the present series, there was a clear male predominance, and the oral metastases showed a predominance of mixed presentations followed by solely soft tissue lesions and solely bone metastases.