Stimulated whole salivary flow rate: The most appropriate technique for assessing salivary flow in Sjögren syndrome.

BACKGROUND: We sought to determine the most appropriate method for measuring salivary flow to aid the diagnosis of Sjögren's syndrome (SS). Specifically, we compared the unstimulated whole salivary flow rate (UWSFR) with the stimulated whole salivary flow rate (SWSFR). MATERIAL AND METHODS: This case-control study comprised one group of 103 patients with SS and a control group of 50 healthy people. We measured the UWSFR and SWSFR in both groups according to the guidelines established by Navacet [1993]. RESULTS: The UWSFR and SWSFR were significantly lower in the patient group compared with the controls (p < 0.01). Among the participants in the patient group, we found a decreased UWSFR in 84 individuals (81.5%) and a decreased SWSFR in 90 individuals (87.4%). We encountered difficulties obtaining saliva in 37 (35.9%) patients during the UWSFR test, and in 12 (11.7%) patients during the SWSFR test. There was no significant statistical difference in the UWSFR or SWSFR between patients with primary and secondary SS. CONCLUSIONS: Compared with the UWSFR, the SWSFR is a more suitable and effective method for measuring salivary flow in patients with SS, as well as for qualitative analysis of the obtained saliva.

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.

Grade of sclerosis in the contralateral mandibular area in osteonecrosis of the jaws.

The objective of this study was to compare the grade of radiographic sclerosis between the area of osteonecrosis and the at-risk contralateral mandibular area without osteonecrosis. Three groups were studied: group 1 comprised 30 cases of medication-related osteonecrosis of the jaws (MRONJ); group 2 was the healthy contralateral area without osteonecrosis of the group 1 cases; group 3 comprised 30 healthy controls. ImageJ software was used to analyze the computed tomography images, and the grade of bone sclerosis was compared between the three groups. The grade of sclerosis was significantly higher in group 1 than in the other groups (P<0.05); the difference between groups 2 and 3 was not significant. Sclerosis was significantly greater in the area of bone necrosis than in the contralateral mandibular area in patients with MRONJ. No significant differences were found in the grade of sclerosis between the contralateral non-affected mandibular area of patients with MRONJ and the control patients.

The prevalence of oral leukoplakia in 138 patients with oral squamous cell carcinoma.

OBJECTIVES: To determine the relationship between oral leukoplakia (OL) and oral squamous cell carcinoma (OSCC), and to evaluate possible differences between those carcinomas with and without associated leukoplakia. MATERIAL AND METHODS: A total of 138 patients were studied at the Stomatology Service of the University General Hospital, Valencia, Spain. These patients were divided into two groups: group 1, patients with oral cancer and leukoplakia, and group 2, patients with OSCC but with no associated premalignant lesions. The relationship between this precancerous lesion and the OSCC was evaluated, as well as the possible clinical and histological differences between the tumours of the two groups. RESULTS: Leukoplakia was detected in 27 (19.56%) patients with OSCC. No differences were found between the two groups regarding age and tumour location. However, statistically significant differences were observed with respect to the form, tumour stage and the presence of adenopathies in the cancers with and without leukoplakia; in that the tumours associated with leukoplakia were diagnosed as being at a more initial stage. CONCLUSIONS: Those patients with OL associated with oral cancer presented with tumours at a less advanced stage than those where no associated leukoplakia existed.

Primary intraosseous carcinoma arising in a mandibular cyst.

Although primary intraosseous carcinoma of the mandible is an uncommon lesion, they may not be as rare as generally believed. These tumours may, in theory, arise de novo from odontogenic remnants or from the malignant transformation of the lining of odontogenic cysts or tumours. Diagnosis based on histology and radiology is difficult. The prognosis is more favorable when PIOCs arise from odontogenic cysts. These tumors are locally aggressive and metastasize to regional nodes. The case study of a 70 year-old man with a primary intraosseous squamous carcinoma arising from a mandibular cyst is given.

Mixoma parotídeo gigante / Giant mixoma of the parotid gland

La existencia del mixoma, como un tumor verdadero ha sido cuestionado por diversos autores, siendo su existencia aceptada en la actualidad. Su presentación clínica habitual es la de una masa asintomática de crecimiento lento sin tendencia a la metastatización. Presentemos el caso de una mujer joven, sin antecedentes de interés, enviada para valoración de una gran masa localizada en área preauricular derecha de varios años de evolución. Realizadas las pruebas y exploraciones habituales, se planifica el tratamiento quirúrgico para establecer el diagnóstico definitivo. Una vez analizada la masa en su totalidad (cortes<1 mm), es etiquetado como mixoma de glándula parotida. Nuestro objetivo fundamental es la presentación de un nuevo caso de mixoma en la zona preauricular, así como realizar una pequeña revisión de los criterios diagnósticos y métodos de tratamiento (AU)

Tumor pardo de localización maxilar. Elemento diagnóstico de hiperparatiroidismo primario / Primary hyperparathyroidism. Presenting as brown tumors in the maxilla

Presentamos el caso de un varón de 43 años de edad, remitido a nuestra consulta para el estudio de una masa de aspecto lítico localizada en maxilar superior. Tras la biopsia, es tipificada cómo tumor de células gigantes. Realizamos estudio completo del paciente, estableciendo el diagnóstico de hiperparatiroidismo primario. Posteriormente, se procede al tratamiento de su enfermedad de base y al control radiológico de su lesión maxilar. Por último, se procede al tratamiento quirúrgico de la lesión, ya que tras trece meses de control metabólico no se observa regresión de la enfermedad ósea. Se diagnostica como tumor pardo del maxilar, de comportamiento independiente al control metabólico de su enfermedad de base. La finalidad de la presentación de este caso es recordar el interés que para el cirujano oral y maxilofacial representan las manifestaciones orales de la patología sistémica, así como la revisión de los diversos modos de presentación, evolución y tratamiento de los tumores pardos (AU)