Chemical and Radiation-Associated Jaw Lesions

Abstract

Synopsis Osteonecrosis of the jaw, at one time considered to be infrequent has now become a major public health concern not only in the United States, but throughout the world. The wide-spread use of radiotherapy for head and neck cancer as well as bone antiresorptives and antiangiogenic agents have increased the incidence of osteonecrosis. While the exact pathophysiological process of osteonecrosis is yet to be clearly defined, there has been a much higher incidence of medication-related osteonecrosis of the jaw relative to the other types of osteonecrosis. The traditional osteoradionecrosis still occurs despite better treatment planning and shielding to minimize collateral damage to bone. There are other related necrotic lesions secondary to usage of recreation drugs and the use of steroids. This chapter will give comprehensive information about these different types of bone necrosis; provide the readers with radiographic diagnostic criteria and updates on current theories on pathophysiology of osteonecrosis.

Ameloblastoma: current etiopathological concepts and management

“…Interestingly, bone loss in ameloblastoma associated with dysregulated RANK/RANKL/OPG interactions (de Matos et al , ) has led to the suggestion that antiresorptives such as denosumab may be effective in controlling the local aggressiveness of ameloblastoma (Jhamb and Kramer, ). Unfortunately, a major side effect of antiresorptives is osteonecrosis of the jaw (Akintoye and Hersh, ; Omolehinwa and Akintoye, ), so the potential clinical benefits must be balanced with their established side effects to justify their use in ameloblastoma therapy.…”

Hyperbaric oxygen therapy and osteonecrosis

“…Inside the oral cavity, any combination of dysgeusia, pain, paresthesia, exposed bone, gingival ulceration, poor dentition, fractured teeth, pathologic mandibular fracture, xerostomia, and orocutaneous fistula with associated discharge may be found. Palpation of soft and bony tissue may elicit pain (O'Dell and Sinha, ; Turner et al , ; Omolehinwa and Akintoye, ). Soft tissue woody fibrosis may be apparent, with severe cases experiencing a reduced range of motion at the temporomandibular joint or cervical spine.…”

“…(Lyons and Ghazali, ; Lyons et al , ) (Feldmeier, ; Rice et al , ). A concurrent cascade of cytokine release, particularly transforming growth factor beta (Fleckenstein et al , ), causes additional inflammation, tissue damage, and a decreased capacity for healing (Delanian and Lefaix, ; Omolehinwa and Akintoye, ). The use of tobacco products (Freiberger et al , ) or alcohol (Oh et al , ) also impedes healing.…”

Influence of bisphosphonates on clinical features of osteoradionecrosis of the maxilla and mandible

“…Although most cases of ORN are related to high‐dose RT (5,000–7,000 cGy), ORN may also occur with lower radiation doses. Thus, it seems that dose alone is insufficient to predict absolute risk for ORN (Akintoye & Hersh, ; Danielsson et al, ; Omolehinwa & Akintoye, ; Reuther, Schuster, Mende, & Kübler, ).…”