Jaw Metastasis from a Prostate Adenocarcinoma Associated with Numb Chin Syndrome: Case Report

Numb chin syndrome is an uncommon maxillofacial manifestation involving mental neuropathic complications of mandibular bone metastasis with prostate adenocarcinoma. We report a case of a male, 68 years, with a history of bone tibia and spinal metastatic prostate cancer, undergoing bilateral orchiectomy for hormonal blockade and chemotherapy; disease progression was confirmed by bone scintigraphy which noted no critical points but an increase in alkaline phosphatase; therapy with abiraterone and zoledronic acid quarterly was introduced 1 year after diagnosis. The patient attended a dental appointment after 10 months of bisphosphonate use, complaining of a “tingling” sensation in the right chin mental region, 6 months after tooth extraction, with diagnostic hypothesis of medication-related jaw osteonecrosis. Intra-oral exam showed edema in the right mandibular body region extending to the painless, hardened chin, with exudate drainage as compression. An incisional biopsy was performed and anatomopathological and immunohistochemical analysis showed positive staining for cytokines and NKX3, confirming the diagnosis of adenocarcinoma metastasis. The patient was referred to continue treatment with radiotherapy and, subsequently, Xofigo and zoledronic acid to improve symptomatology and control of the adenocarcinoma. Facial numbness should alert clinicians to the potential of metastatic disease in any patient who presents with chin or jaw numbness and has no other obvious cause for their complaint, and early differential diagnosis between jaw osteonecrosis and bone metastasis in the jaw is important for immediate management and improvement in treatment and quality of life.

Use of Platelet-Rich Fibrin for Jaw Osteonecrosis: A Case Report

Summary We present tooth extraction in a patient treated with bisphosphonates (BPs) for cancer and at risk of osteonecrosis of the jaw. The administration of platelet-rich fibrin (PRF) is an innovative method of promoting wound healing that allows hermetic closure at the surgical site after extraction without mucoperiosteal flaps or periosteal release sections. Here, we describe the case of a 60-year-old man who had osteonecrosis of the upper jaw and underwent surgery for prostate cancer in 2012. In 2014, bone metastases were detected, and the patient was treated with Xgeva and Zometa: a two-year therapy with Xgeva, followed by treatment with Zometa. In 2018, after extraction of a tooth in the upper right jaw, a healing wound of extraction and stripping of the maxillary bone occurred. The patient was admitted for hospital treatment and underwent surgery to remove the osteonecrotic lesion, sequester and administer PRF (platelet-rich fibrin), and sew tightly. As a result of the treatment, complete re-epithelialization of the wound without infection occurred. Generally, in more invasive surgical procedures, the use of PRF to close the wells after extraction in patients receiving BP appears to be a promising alternative. Additional clinical trials will be essential t to clarify the effectiveness of PRF in preventing BP-related osteonecrosis after tooth extraction.

The Potential Role of Angiogenic Osteoclast Inhibition in the Occurrence of Bisphosphonate-related Osteonecrosis of the Jaw

Bisphosphonate-related osteonecrosis of the jaw is a serious complication of systemic bisphosphonate administration, the mechanism of which remains unclear. Many hypotheses regarding pathophysiology are discussed, including the most commonly cited: suppression of bone remodeling and suppression of angiogenesis, but none of these would explain all the unique features of bisphosphonaterelated jaw osteonecrosis. Bisphosphonates are potent inhibitors of osteoclasts, and recent studies have shown that osteoclasts are important for bone angiogenesis. Therefore, we hypothesize that bisphosphonates inhibit osteoclastic stimulation of angiogenesis, thereby contributing to the occurrence of osteonecrosis of the jaws. This theory would partially explain the pathophysiology of bisphosphonate-related osteonecrosis of the jaw to the unfathomable.

APPLICATION OF AUTOLOGOUS PLASMA IN THE TREATMENT OF MEDICATION RELATED OSTEONECROSIS OF THE JAW

Subject. Drug-associated jaw osteonecrosis is a serious complication that can occur in patients receiving bisphosphonate therapy for bone metastases in malignant neoplasms. The studies are due to the widespread use of bisphosphonates in patients with proven bone metastases, with myeloma, and malignant neoplasms of various locations. Due to the toxic effects of bisphosphonates on soft tissues, the healing process is sluggish, often with a relapse. The task of finding optimal methods of stimulating local regenerative processes is urgent, since the use of general-action drugs can provoke continued growth of the primary tumor. The aim of the study was to develop a method for treating patients with a diagnosis of “drug-associated jaw osteonecrosis” using autologous plasma, which will further reduce the number of relapses and increase the effectiveness of treatment. Methodology. Patients with a diagnosis of “medically associated jaw osteonecrosis” underwent sequestrectomy with boundaries determined by perfusion by laser Doppler flowmetry, an APRF clot was placed on the bottom of the bone wound, and autologous plasma was injected into the wound edges in the postoperative period. Results. The result of applying this technique in the early postoperative period was a partial discrepancy of the edges of the wound, but the absence of sections of the exposed bone in the wound. After 6–8 weeks, we observed complete healing of the postoperative wound. The number of relapses was reduced from 16 to 3 (by 57.56 %). Conclusions. The use of autologous plasma in the treatment of drug-associated osteonecrosis is the most optimal way to stimulate local regenerative processes in the absence of the possibility of using general-action drugs.