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Osteitis is an inflammatory disease of bone tissue. Its clinical presentation varies according to the site, presence or absence of pus, duration and etiology. It represents one of the endo-periodontal diseases complication. We report the case of a mandibular osteitis having led to confusion with an ostesarcoma.A 13-year-old boy was referred to our department for a right low swelling with suspicion of mandible osteosarcoma. The lesion’s evolution was 6 weeks. With the local aggressiveness and the speed evolution, the first diagnosis proposed was a mandibular osteosarcoma. Based on the clinical and radiological data established, the diagnosis of mandibular osteitis on a periapical granuloma was made and the treatment consisted on the causal tooth extraction with curettage of the periapical lesion associated to the prescription of macrolide (ERY®). The clinical follow-up was 6 weeks, a recovery with cessation of clinical signs were noticed.The differential diagnosis facing the clinical context is an osteitis on a periapical inflammatory cyst and especially mandibular osteosarcoma. For the therapy, it’s a 3 components treatment (etiology, medical and surgical) to obtain a recovery.

The Stafne defect is a benign, asymptomatic, non-progressive and rare bone depression, mainly discovered by chance in the posterior mandibular region. It is described radiographically as an oval radiolucency located below the mandibular canal, in the molar region, close to the submandibular gland. Sialography is a traditional technique in the radiographic examination of salivary glands that involves the injection of an iodine-based contrast medium into the main salivary duct. The Cone Beam Computed Tomography (CBCT) is a 3D imaging technique that has modernized the dental and maxillofacial practice with its advantages such as high speed, good spatial resolution and low radiation exposure. The CBCT Sialography that consists in a 3D Sialography with cone beam offers the same benefits as traditional sialography and allows three-dimensional viewing. It is a new imaging test for an accurate anatomical study of the major salivary glands and their relationships with their environments. The aim of this report is to present a case of Stafne bone cavity containing right submandibular gland tissue, occurring in a 58-year-old man and diagnosed by using CBCT sialography.

Worldwide, more than a million people receive each year a curative radiotherapy. While local control and overall survival are steadily increasing, 5 to 15% of patients still develop above grade 2 late toxicities. Late toxicities treatments are complex. Hyperbaric oxygenation was shown to induce revascularization and healing of injured tissues, but indications are still debated. Through a literature review, we summarized the hyperbaric oxygenation indications in radiation-induced late toxicities. We also studied the knowledge and practice of French local radiation therapists. It seems that hyperbaric oxygen therapy can be a conservative treatment of haemorrhagic cystitis and radiation-induced pain, in case of drug therapies failure. Often associated with a significant morbidity and mortality, surgery could be avoided. The risk of complications in case of tooth extraction in irradiated tissues is also reduced. However, the role of hyperbaric oxygenation for mandibular osteoradionecrosis, radiation-induced proctitis, enteritis, lymphoedema, brachial plexopathy, skin and neurological sequelae seems more questionable since studies results are conflicting. Future outcomes of phase III studies are expected to clarify the role of hyperbaric oxygenation in the management of radio-induced toxicities, including for head and necks complications.

Central giant cell granuloma (CGCG) is a benign tumor that may be subdivided in a non-aggressive form and an aggressive form. In aggressive forms, tumor size and high recurrence risk need large surgical resections. In order to minimize surgical morbidity, especially in children, medical treatments acting on the tumor proliferation are currently being assessed: steroids (triamcinolone), anti-osteoclastic drugs (calcitonine, alendronate, denosumab), anti-angiogenic drugs (interferon α). However to date, there is no evidence for any superiority of medical over surgical treatment. Complete response is rarely obtained and additional surgery is often necessary to remove the tumor in case of tumor progression, to remove a remnant or to remodel bone. Moreover, these drugs have frequent local or systemic side effects such as osteonecrosis and growth deficiencies.

Pterygoid hamulus syndrome (PHS) is a rare cause of orofacial and oropharyngeal pain. PHS can be associated with a hamulus hypertrophy or with a bursitis of the palatosalpingeus but it has not always an anatomic cause.A 36-year-old woman was seen for a constant posterior palatal pain spreading towards oropharynx, increasing during swallowing and lasting for more than 6 months. Physical examination showed an erythema of the soft palate, medially to the hamulus. Hamulus palpation was painful and revealed hamulus hypertrophia on both sides. A bilateral PHS was evocated.This observation is typical of a PHS. We propose a review of the literature of this little-known syndrome. Treatment is initially conservative (corticosteroids) but surgery can be proposed in case of morphological anomalies of the hamulus.

Les tumeurs brunes sont des manifestations osseuses classiques des hyperparathyroïdies (HPT). Elles surviennent habituellement lors des formes sévères accompagnées de signes de résorption osseuse périostée. La mandibule en constitue une localisation habituelle mais rarement révélatrice. Leur traitement repose essentiellement sur la paratharoïdectomie. Nous décrivons un cas de tumeur brune de la mandibule chez un patient de 46 ans; ainsi que son évolution favorable après para thyroïdectomie.

Summary Introduction Mandibular asymmetries are the fulcrum of many debates among modern orthodontists and maxillofacial surgeons. The interest is even greater when facial asymmetries are correlated to the development of TMJ symptoms and temporomandibular disorders (TMD). Objective The aim of this study is to investigate how mandibular asymmetries constitute etiological or predisposing factors for the development of temporomandibular disorders (TMD). We considered patients with mandibular asymmetries associated with TMD. Using orthodontic or surgical-orthodontic treatment, patients experienced correction of their TMJ symptoms. Thus, mandibular asymmetries represent a major risk factor for the development of TMD. Material and methods We studied a sample of 16 subjects aged between 14 and 36-years-old (11 females and 5 males) with mandibular asymmetries (81% structural asymmetry, 19% functional asymmetry). These subjects presented skeletal and dental malocclusions combined with several temporomandibular disorders, mostly due to muscle tension. In 100% of cases, patients received orthodontic treatment. We compared pre- and post-treatment postero-anterior (PA) cephalometric analyses in order to evaluate asymmetry resolution. Results Comparison of measurements from pre- and post-therapy PA cephalograms showed resolution of mandibular asymmetries after treatment. The treatment resolved mandibular asymmetries and completely eliminated temporomandibular symptoms. Conclusions Orthodontic treatment of patients presenting mandibular asymmetry enables correction of all TMJ symptoms and TMD. Mandibular symmetries can therefore be considered to constitute etiological or predisposing factors for the development of TMD.

Dysosteosclerosis is a rare genetic disorder with a poor prognosis. It is an osteochondrodysplasia similar to osteopetrosis but it is typically characterized by platyspondyly and expanded metaphyses. It shows complications such as compression of cranial nerves, especially the optic nerve, hematologic complications, fractures following mild injury, abnormal dentition, neurological and psychological deterioration, in addition to osteomyelitis of the mandible. We report a new case of dysosteosclerosis complicated by osteomyelitis of the lower maxilla.

Oral bony outgrowths (OBOs) are localized bony protuberances that arise from the cortical plate. Various types of OBOs have been described, the precise designation of which depends on anatomic location such as torus palatinus, torus mandibularis, buccal exostosis, or palatal exostosis. We had for aim to determine the prevalence and clinical characteristics of OBOs in a Moroccan population.This cross-sectional study was conducted between March 15 and June 30, 2011 at the Rabat-Salé teaching hospital dental consultation and treatment center, in Morocco. Three hundred and fifty-three patients (160 female and 193 male patients), 11 to 82 years of age, were examined clinically and radiologically to determine the presence of OBO.Twenty-four patients (6.8%) presented with OBOs. The prevalence for exostosis, torus mandibularis, torus palatinus, and associated OBOs was 3.1%, 2%, 0.8%, and 0.9% respectively. There was a significant difference (P=0,01) between the average age for patients presenting with OBO (43.2±12 years of age) and the average age for patients without any OBO (36.5±16 years of age). The prevalence of OBOs in female patients (7.3%) was higher than in male patients (6.3%) but the difference was not significant (P=0.439). Patients with occlusal parafunctional activity presented with significantly more OBO (P=0.016).The reported prevalence of OBO is extremely variable, according to age, gender, and ethnic group. The occurrence of OBO could be triggered by genetic factors associated with environmental factors.

Odontogenic tumours are often benign. They are originating from dento-maxillary structures and their embryonic remnants. They represent a wide variety of lesions derived from epithelial cells, mesenchymal, or both. The series reported in literature show a distinct geographic variation. However, there has been no concrete study and detailed epidemiological profile of these tumours in the Algerian population.Our prospective study based on the classification of the World Health Organization (WHO) in 2005, focused on the epidemiological analysis of 97 cases of odontogenic tumours, collected in the department of maxillofacial surgery of the University Hospital of Constantine. This study was designed to determine the relative frequency of such tumours, their distribution by age and sex, and their histological distribution.In our series, women were most affected by the disease (64% of cases) than men (36% of cases). The population was predominantly young with an average age of 29.9 years (range from 12 to 85). The mandible was the site of choice in 74% of cases. Epithelial tumours were diagnosed in 77% of cases; almost half of these cases were ameloblastomas (44% of cases).The distribution of odontogenic tumours is different depending on the population studied. The incidence of ameloblastoma is increased in African and Asian population with a female predominance. On the other hand, the odontoma is the most recognized odontogenic tumour in North America and Europe, and more particularly in men.

International audience; Diabetes-driven cardiovascular diseases represent a high challenge for developed countries. Periodontal disease is strictly linked to the aforementioned diseases, due to its Gram negative-driven inflammation. Thus, we investigated the effects of periodontal disease on arterial pressure during the development of diabetes in mice. To this aim, C57BL/6 female mice were colonized with pathogens of periodontal tissue (Porphyromonas gingivalis, Prevotella intermedia and Fusobacterium nucleatum) for 1month, whereas another group of mice did not undergo the colonization. Subsequently, all mice were fed a high-fat carbohydrate-free diet for 3months. Then, arterial pressure was measured in vivo and a tomodensitometric analysis of mandibles was realized as well. Our results show increased mandibular bone-loss induced by colonization with periopathogens. In addition, periodontal infection augmented glucose-intolerance and systolic and diastolic arterial pressure, parameters already known to be affected by a fat-diet. In conclusion, we show here that periodontal disease amplifies metabolic troubles and deregulates arterial pressure, emerging as a new axis of metabolic investigation.

Osteopetrosis is a metabolic bone disease that leads to bone malformation and bone healing disorders. We report the case of a patient who underwent orthognathic surgery to treat a class III skeletal malocclusion.A 21-year-old patient had presented with osteopetrosis in his childhood, which had been treated by bone marrow transplantation. He presented with esthetic and functional sequels, a class III skeletal malocclusion, lateral mandibular deviation, and dental agenesis. This dysmorphism was corrected by bimaxillar osteotomy. The postoperative outcome was uneventful, with satisfactory and stable healing.The patient's lesions where after-effects of his disease, but the bone structure is normal, because osteopetrosis regressed after bone marrow transplantation. There is no risk for the consolidation. Osteopetrosis, even when treated by bone marrow transplantation, is not a contraindication for maxillomandibular osteotomy.

Bisphosphonates are involved in the occurrence of Osteonecrosis of Jaws (ONJ), which is a complication of these treatments. This osteonecrosis concern the alveolar bone and develops generally after an oral surgery. It can however occur spontaneously without preliminary dental extraction. Other risk factors could play potentiates the risk of ONJ. This osteonecrosis results in an osseous exposure in patient treated or having been treated by bisphosphonates, without any cervico-facial irradiation. Actually, no treatment has been the proof of its effectiveness. Preventives measures of ONJ in oral cavity are the best method before, during and after administration of bisphosphonates. In this article, we present the clinical case of a patient with histiocytois treated by bisphosphonates and having developed ONJ. The selection criteria of the prosthetic rehabilitation as well as the techniques used are detailed.

Lamins A and C, encoded by the LMNA gene, are nuclear proteins expressed in all post-mitotic cells. Together with B-type lamins, they form a meshwork of proteins beneath the inner nuclear membrane, the lamina, in connection with the cytoskeleton. Lamins A/C also interact with chromatin and numerous proteins, including transcription factors. Mutations in LMNA are responsible for more than ten different disorders, commonly called "laminopathies". These diseases affect tissues in a specific (striated muscle, adipose tissue, peripheral nerve) or in a systemic manner (premature ageing syndromes). This wide spectrum of phenotypes is associated to a wide variety of mutations. This large clinical and genetic heterogeneity, unique to the LMNA gene, makes genotype-phenotype relations particularly difficult to establish. However, correlations have been obtained in several cases. Hence, LMNA mutations identified in premature ageing syndromes lead to the accumulation of immature proteins with a toxic effect for cells. Mutations in laminopathies of the adipose tissue mainly localize in the Ig-like domain of the proteins, potentially affecting the interaction with the SREBP-1 transcription factor. In laminopathies of the striated muscles, the mutations are spread throughout the gene. These mutations are thought to induce structural modifications of the proteins, thereby affecting their polymerization into nuclear lamina. Such defect would lead to a mechanical weakness of the nuclear lamina and of the cells, particularly in striated muscles continuously stretching. The exploration of pathophysiological mechanisms of LMNA mutations largely benefits from the numerous mouse models created, which have been widely used to analyze affected molecular pathways and to test putative therapeutic treatments.

Actinomycosis is a rare disease. The cervicofacial region is the most frequent localization. A chronic pus discharge, sometimes tumor-like, suggests the diagnosis, which is often confirmed by anatomopathology. The treatment is surgical debridement and antibiotic therapy, frequently long-term. We report three cases of mandibular actinomycosis.A 21-year-old male patient presented with a fistulized swelling of the right jaw. A 48-year-old male patient was referred for alveolar healing delay after avulsion of teeth 32, 33, and 34. A 38-year-old female patient presented with a left mandibular swelling and restricted mouth opening. In the three cases, the diagnosis of actinomycosis was made by histology. The clinical outcome was good following alveolar curettage (and sequestrectomy for 1 patient) and antibiotic therapy.Mandibular actinomycosis is caused by Actinomyces israelii. Lesions if untreated may evolve to osteitis and sequestration. Early diagnosis is crucial.

Diffuse sclerosing osteomyelitis of the mandible may be the presenting manifestation of synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome. We report an additional case of such a presentation.

Langerhans cell histiocytosis is a non-malignant proliferative disease of unknown etiology that can affect one or more organs. This is a rare disease, 1 to 2/100,000, affecting mainly children with a male predominance. The osseous lesions are the most frequent (60 to 90%). There is however no consensus treatment for the management of these sites. We report the cases of two patients successfully treated with radiotherapy after primary chemotherapy, at doses of 15 Gy in ten sessions of 1.5 Gy for one patient and 18 Gy in ten fractions of 1.8 Gy for the other. Single or multifocal bone Langerhans cell histiocytosis without visceral involvement is a benign, self-limiting affection in most cases. Some bone lesions could be treated by radiotherapy alone. But the high variability of doses currently given in the literature does not allow determining the lowest effective dose limiting the risk of secondary neoplasia or impaired growth in children, in whom lower doses of 6 to 8 Gy are recommended. The decision of radiotherapy must be weighed against the risk of the disease. Caution should be the rule in this non-malignant tumour pathology.

The incidence of jaw osteonecrosis induced by oral or intravenous biphosphonates (BP) has been increasing. Two hundred cases of jaw osteonecrosis induced by oral BP (JONOBP) were reported, with an incidence of 4 % and a prevalence of 1/952. We report 12 cases of JONOBP observed from January 2007 to January 2009.A pluridisciplinary committee including odontologists, stomatologists, and maxillofacial surgeons from two Paris hospitals was asked to manage patients treated by BP. Twelve patients presenting with JONOBP were included from January 2007 to January 2009. For each of these patients, age, sex, associated co-morbidities, any triggering factor, previous or current combination treatments, the type of BP used, its initial indication, dosage, delay before onset of JONOBP, and delay between first clinical signs and diagnosis were studied. JONOBP localization, stage (American Association of Oral and Maxillofacial Surgeons [AAOMS] classification), clinical and radiological signs, anatomopathological and bacteriological examinations (when performed) were documented. The treatment and evolution were described.Ten women and two men, mean age 65 years (36 to 82 years), were included. BP were taken orally once a week or daily. The mean duration of BP exposure was 39.6±2,4 months (19 to 58 months). The indication for BP was prevention or treatment of osteoporosis in 11 cases and breast with bone metastases in one case. Tooth extraction was the triggering factor in nine cases. The premolar and molar mandibular area was the most often affected. Corticosteroid therapy was combined to BP in half of the cases. There were no clinical, radiological, and histological specific signs. BP treatment was stopped in all patients. Nine patients underwent surgery. Evolution was favorable for nine patients. Six patients were cured, on average 3.8 months after beginning management (one to nine months). Three male patients improved. Three female patients were lost to follow-up. Alendronate was the most frequently implicated (six cases) and risedronate (five cases). Five patients presented with diagnosed or suspected auto-immune conditions.The duration of exposure to BP was superior to three years in most cases. The triggering factor was tooth extraction. The mean diagnostic delay was five months. There were more stage 2 and 3 patients, according to the AAOMS classification. They were the most frequent, probably because of the higher number of co-morbidities, especially corticosteroid intake. Patient management complied to Afssaps and AAOMS recommendations. The evolution was favorable for all managed patients.

Florid cemento-osseous dysplasia is a benign and rare tumor of the jaws. It is more commonly seen in middle-aged black women. Most cases are asymptomatic and are found during routine radiographic examination.We report two complicated cases of florid cemento-osseous dysplasia, one with facial deformity and the other with chronic osteitis.The diagnosis of florid cemento-osseous dysplasia is based on clinical and radiological features. The lesions are commonly bilateral and symmetrical.

Reports of cases of ONJ are significantly increased during the last five years as a iatrogenic complication of therapy with bisphosphonates (BPT). The aim of this work is to present the advantages of surgery using Er:YAG laser for treatment of ONJ. Er:YAG laser can gradually reach the healthy bone without causing any heating damage of tissues. This device results very versatile and gives the possibility of choose among different surgical techniques depending by the case (e.g.: vaporization or ostectomy). Moreover, different studies have demonstrated the presence of both bactericidal and biomodulating effect on bone and surrounding tissues, with biostimulation of microcirculation and neoangiogenesis. Seventeen sites of ONJ, classified according to the staging system developed by Ruggiero and observed in 12 patients with multiple myeloma (9 patients), bone metastases (2 patients) and osteoporosis (1 patient), were treated with Er:YAG laser (Fidelis Plus, Fotona-Slovenia). Laser device was used in non-contact or near-contact way (VSP, 300 m3 30 Hz, Fluence 60 J/cm2) on 17 sites (4 Stage I and 13 Stage II) on 3 different types of surgery: sequestrectomy + debridement, sequestrectomy + corticotomy and vaporization. For an average follow-up of 9 months (SD +/- 6 months), complete healing of ONJ (Stage 0) was obtained for 13 sites (76.5%) and resolution of symptoms was obtained (Stage 1) for 3 sites (17.5%). For one site at Stage II (6%), recovery was obtained but this result was not maintained over 3 months. Positive results were independent by the anatomical area (mandible or maxilla), primary disease (osteoporosis, multiple myelomas or metastasis) and discontinuation of BPT before surgery. Er:YAG laser (2940 nm), in our experience, represents a valid therapeutic option for ONJ-BP related, especially in early stages of the disease.

The solitary maxillomandibular bone cyst is a benign bone lesion with a nontumoral osteolysis and a progressive growth potential. It is considered as a pseudocyst because of the absence of epithelium and accounts for 1% of bone cysts. Most facial solitary bone cysts are observed in the mandible, especially in the corpus, and in young patients. Its etiopathogeny is unknown. The solitary bone cyst is asymptomatic. It is often discovered accidentally by radiolucent lacuna. Adjacent teeth vitality is preserved. The differential diagnosis is that of mandibular radiolucent lacuna etiologies. The diagnosis is confirmed by the surgical approach. Treatment is based on wall cavity curettage. It is usually relatively benign but the issue is discussed in publications because of the up to 26% of recurrence, requiring radiographic follow-up.

The aneurysmal bone cyst is a rare, expansive, osteolytic, pseudocystic lesion with an unknown etiology. It usually affects long bones and the spine. Two to 5 % of cases have mandibular localization (between 75 and 100 % present on the mandible) accounting for 1 % of all mandibular cysts. Less than 200 cases have been reported in English and French literature.

The aim of this sinusonasal study was to study several locations of ENT extranodal tuberculosis.Our study focused on eight cases of tuberculosis in the cervicofacial region gathered in the ENT department of the Rabat Specialization Hospital (Morocco) between August 2004 and August 2006. They comprise two cases of rhinopharyngeal tuberculosis, two cases of tuberculosis, two cases of endobuccal tuberculosis (mandibular and lingual locations), and two cases of glandular tuberculosis (thyroid and parotid locations).These locations are rarely affected by tuberculosis. The clinical signs as well as radiology and endoscopy are not specific. The final diagnosis is based on histology. Bacillus cultures are necessary when caseum tuberculosis is not found, causing problems of differential diagnosis with granulomatous and malignant lesions. PCR provides quick bacterial antigen detection when cultures are negative. The treatment provides a quick and complete recovery while recurrences are infrequent.ENT tuberculosis is rare if excluding the nodal locations. It should be mentioned as a differential diagnosis, especially in endemic areas. Most often, this is a surprise diagnosis.

Cemento-osseous dysplasia is a benign fibro-osseous lesion of the jaws. Its complications are very rare.A panoramic x-ray was made to complete the pre-radiotherapy oral assessment of a 71-year-old female patient presenting with lung adenocarcinoma. This revealed a periapical fibro-osseous lesion on tooth n° 46. She had presented with a similar lesion on tooth n° 36, 16 years before. This had been treated by extraction and alveolar curettage. No surgical treatment was suggested for this recurrence on tooth n° 46.The diagnosis of focal cemento-osseous dysplasia is usually made on radiological and clinical data. The risk for transition to a florid form is unknown. Exeresis surgery before radiotherapy is discussed.

The odontogenic keratocyst is a benign tumor with a high recurrence rate and aggressive behavior. We analyzed the risk factors for recurrence of odontogenic keratocysts and compared our results to published ones.Thirty-two patients (36 odontogenic keratocysts) were treated in our department between 1996 and 2006. We retrospectively analyzed recurrence according to anatomoclinic, histopathological, and prognostic parameters.The patients' mean age was 41 years. The sex ratio was 1.28 with male predominance. The mandible was the most common site (30 cases). The most common radiological finding was a unilocular cyst in 75 % of cases. The primary treatment was conservative surgery for all patients. Twelve recurrences were observed in eight patients between 2 and 10 years of follow-up. All recurrences occurred in the mandible with 41 % in the angle and ramus. Multilocular cysts recurred in 55 % of cases, unilocular in 11 %. The recurrence rate of orthokeratocysts was 40 %. The presence of satellite cysts and extension to soft tissues were associated with a high rate of recurrence (60 %). Sixty-six percent of infected cysts recurred and among these, eight were enucleated in several fragments.The recurrence rate of odontogenic keratocysts is higher in case of mandibular posterior region localization and multilocular keratocysts. This might be explained by the difficult surgical accessibility. Some histological findings including the presence of satellite cysts and orthokeratocysts are associated with a higher recurrence rate. Cyst infection and treatment modalities influence the recurrence rate.

Solitary maxillary or mandibular bone cysts are rare benign lesions. They are usually localized in the mandible of young men. In some cases, a traumatic risk factor can be documented.A young 13-year-old female patient consulted in the orthodontics unit. An orthopantomogram showed a large cystic lesion in the ramus and posterior part of the left mandible corpus. No reossification of the cavity was observed one year after curettage. A second curettage was performed combined with PRF filling. Six months later, the cavity was completely reossified.Curettage is the first line treatment of isolated cystic lesions and generally followed by complete reossification of the cavity. Incomplete healing is observed in 20% of the cases. PRF may induce the healing of non-reossified cystic cavity by supplying local growth factors.

Fibrous dysplasia or Jaffe Lischtenstein's disease is sporadic and rare bone affection, mainly observed in young adults. It is characterized by a bone maturation disorder that can affect one or several bones. Fibrous dysplasia is relatively rare in the craniofacial region, (only 20% of all locations). The authors analyzed the epidemiological, anatomoclinical and evolutive features of fibrous dysplasia in a Tunisian population.The authors retrospectively studied 18 cases of craniofacial fibrous dysplasia, diagnosed at the pathology department of the Sousse F. Hached hospital, beween1990 and 2005.Most craniofacial dysplasia cases were monostotic (94% of cases). One case was polyostotic. The maxilla and the mandible were the most frequent locations (83.3%). The patients' mean age was 28.6 years, ranging from 6 to 30 years. The sex ratio was 3.5 in favor of women. Follow-up ranged from one month to 10 years with an average of 26.4 months. One case of sarcomatous transformation was observed.The authors noted epidemiological discrepancies compared to what was usually reported, especially concerning the strong female predominance, the frequency of maxillary and mandibular locations and the predominance of monostotic presentations. Larger series are needed to validate these observations.

Focal hematopoietic bone marrow defect of the mandible is a little documented benign jaw lesion. It is usually diagnosed fortuitously by orthopantomography.A 48-year-old woman was referred by her dentist for radiolucency of the molar mandibular region. This could be observed on the panoramic view as an osteoporotic lesion, located in the molar region and not well delimited. The CT scan confirmed the fact that the lesion did not affect the corticals. The biopsy confirmed the diagnosis of focal osteoporotic bone marrow defect of the mandible.These lesions have been described for more than 70 years. These benign lesions, often discovered fortuitously, mainly affect women between 40 and 60 years of age. They are mostly located in the "molar area" where tooth avulsion was previously performed, and share the same clinical and radiographic features. Nevertheless, surgical biopsy is needed to confirm the diagnosis.

Osteoradionecrosis (ORN) is a severe complication of radiation therapy (RT). A triggering factor is frequently present. It is often a dental, periodental, or surgical traumatism. We report the case of a bilateral ORN: the first lesion appeared 3months after the end of RT around the osteosynthesis plate and was treated by mandibular resection. The second lesion appeared 40months after RT on the opposite side, due to peri-implantitis. Dental implants had been inserted 10years before cancer therapy. No case of ORN in post-implantation RT had been previously reported.A 75-year-old woman was admitted for a squamous cell carcinoma of the right cheek extending to the intermaxillary commissure, the maxillary tuberosity, the soft palate, the lingual junction, and the vestibule up to the second premolar area. There was no suspicious lymph node. She had undergone dental implant procedure 15 and 10 years before, respectively, one in the second premolar position of the right maxilla and four in the premolar and molar left mandible area. All of them were osseo-integrated and charged. A trans-mandibular buccopharyngectomy with modified radical neck dissection was performed, completed by RT. The total dose of irradiation was 65Gy in the oral cavity and 45Gy on cervical and supraclavicular areas. Delayed mucosal healing was observed on the right mandible and ORN appeared in this area 3months after the end of irradiation. Mandibular resection was necessary. Later, the right maxillary implant was lost, and multiple dental extractions were required. Forty months after RT, peri-implantitis was observed on the left side of the mandible, complicated by ORN and pathological fracture. No surgical reconstruction could be performed because of the patient's age and state. The patient was carrying a complete removable maxillary prosthesis on latest follow-up.This was the first case of ORN on dental implants placed before RT. RT is a risk factor of implant failure, a relatively rare and unpredictable event. Most often, it causes implant loss and exceptionally ORN. In our case, ORN was bilateral. The first lesion was probably due to surgical trauma. The second one, on the opposite side, was caused by peri-implantitis. Irradiation overdose on the alveolar mandibular ridge, close to the implant, may have been the cause. In our case, there was no severe pain, and slow evolution led to a pathological fracture.

Eosinophilic granuloma in the jawbones can be confused with aggressive periodontitis or more rarely with inflammatory lesions of dental origin. We had for objective to analyze the various elements of clinical, radiological, and pathological differential diagnosis for this rare lesion through a clinical observation.A 26-year-old male patient consulted for loose teeth and gingivitis. The initial diagnosis was aggressive periodontitis. The ineffective periodontal treatment suggested another diagnosis, eosinophilic granuloma, requiring tooth extraction and curettage. A histological analysis confirmed the diagnosis. Bone scintigraphy revealed a second focus on the left maxilla. Complementary chemotherapy was efficient on the mandibular site but failed to prevent worsening on the maxilla, which was treated surgically. Thirty months after, the patient's condition was stable.The diagnosis of eosinophilic granuloma is difficult and relies on histology and immunolabelling with protein S100 and antigen CD1a. Treatment is surgery and conservative in case of isolated lesions.

The vascularized periosteal free flap transposes a non-irradiated soft tissue with neo-angiogenesis, bone induction, and osteogenesis qualities. Its technique and interest are studied for early osteoradionecrosis.A retrospective study was made between 1992 and 2002. Thirty-four patients were selected among the 59 cases operated for osteoradionecrosis; all patients were classified stage II and I on the Epstein scale. Twenty-six patients were reconstructed using a non-periosteum free flap (bone, muscular or cutaneous flap), and eight patients were reconstructed using a "periosteum free flap". The study was clinical, radiological, and histological.Osteoradionecrosis evolved for two of the eight patients having undergone periosteum free flap surgery. Operative morbidity and the number of reoperation were less important than for the rest of the series. The reconstruction was satisfactory on a functional and esthetic level. A bone production was noted for two patients of the "periosteum" group.Periosteum free flap surgery is an alternative for early osteoradionecrosis. The periosteum brings osteo-induction and osteogenesis, and revascularization recorded clinically, radiologically, and histologically, even on an irradiated area.

The onset of one or several diastema in adults with no link of etiology to tooth loss or to a periodontal problem can be the first evocative sign of an acromegaly or a benign or malignant tumoral process.A 40-year-old patient consulted for an implant to solve an esthetic problem caused by a diastema. The complementary exams revealed an osteolytic lesion marked by condensing areas. The biopsy proved the diagnosis of fibrous dysplasia.Etiologies of fibrous dysplasia are varied. They can be related to a congenital defect of osteo mesenchyma development or be the consequence of trauma, reaction to infection, or an endocrine or metabolic disorder.

We are reporting here, the case of a 9 years old boy with Gorlin syndrome diagnosis. Current knowledge on this syndrome is reviewed.

The physiopathology of osteoradionecrosis (ORN) is linked to vascular and cellular aspects of bone physiology. The authors had for aim to check whether the transposition of non-irradiated tissues could repair vascular and bone lesions.A retrospective study was made from 1992 to 2002 on all patients operated for a mandibular ORN (59 patients). The reconstructions performed with a bone flap (42%), bone composite flap (34%), periosteal free flap (14%), cutaneous flap (4%), or muscular flap (5%) were assessed. The radiological and clinical results and the effect of re-vascularization were analyzed.A skin paddle was required in 47% of cases, impairing dental rehabilitation. The bone flap had to be osteotomized in 25% of iliac flaps, and 75% of fibula flaps. The free flap reconstruction had a 90% success rate. Complications were observed in 60% of cases and were more frequent when the stage was higher. The analysis of the surgical technique allowed determining its interest.The analysis of results showed the feasibility of this technique in irradiated tissues. The iliac bone free flap was the best solution taking into consideration the shape, bone volume and vestibular morphology. The osteo-induction by a non-irradiated tissue transplantation was demonstrated clinically and radiologically.

Mandibular reconstruction with a microvascular free fibula flap (MFF) is an elegant solution to restore the anatomic arch, oral functions and facial esthetics. But the thin cutaneous tissue, the thickness of subcutaneous tissues, the absence of a pelvilingual and vestibular groove, and the fragility of soft tissues complicated dental prosthetic retention. Implants may restore prosthetic functionality. There is considerable publication on osteo-integration with a microvascular free fibula flap, but few studies were aimed at the prosthetic aspect, finality of any oral reconstruction. The aim of this retrospective study was to present the results of oral reconstruction with implant supported prostheses after mandibular reconstruction with a microvascular free fibula flap.Twenty-three patients underwent mandibular reconstruction: 17 men and six women with a mean age of 46 years (17-66). Fourteen patients (60.8%) underwent radiotherapy before reconstruction. Mandibular osteoradionecrosis was the indication for reconstruction in seven patients. Each patient was assessed by dentascan. Implants were placed under general anesthesia. Postoperative clinical and radiographic controls were made regularly. Transmucous abutments were placed after six postoperative months and the prosthetic phase was initiated one month later. The criteria for implant and prosthetic success were assessed.Seventy-five implants were placed, on average 3.2 per patient, with an 80% success rate. Three implants (4%) were not used for prosthesis. Ten permanent prostheses and 13 removable prostheses were placed. The mean delay before implant loading was 7.6 months (6-10) and the mean follow-up was 27.5 months (1-71). The occlusion was considered as "satisfactory" for 69.6% of patients. For 57% of patients, the quality of surrounding soft tissues was considered as "satisfactory". For 74% of patients oral reconstruction was "satisfactory".The implant supported prosthesis after MFF mandibular reconstruction, on an irradiated site or not, gives satisfactory results despite the thickness and mobility of soft tissues, and despite scar contracture and the absence of keratinization. Implant placement must be performed after a prosthetic planning. Using radio-surgical guides, despite their cost and difficult adaptation, would certainly bring important improvement to the technique.