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P.244 Multiple endocrine neoplasia (MEN) Type 2b
Posters P.243 Maxillary necrosis associated with bisphosphonates. Diagnostic, clinical aspects and treatment J. Calvo de Mora, H. Herencia, A. del Amo, J. Acero. Oral and Maxillofacial Surgery Department, Hospital General Universitario Gregorio Mara˜no´ n, Madrid Introduction: Osteonecrosis of the jaws is an important complication in patients following radiotherapy of the head and neck tumours. Sometimes its aetiology remains unclear when it appears in patients who are not under such a treatment. Bisphosphonates are synthetic analogues of pyrophosphates and they join to hydroxyapatite inhibiting the osteoclastic action. They are used in post-menopausal women to prevent bone fractures and in myeloma, Paget disease and in tumoral hypercalcemia. Material and Methods: In this poster we present a series case of 12 patients who showed a maxillary necrosis and infection and that were being treated with bisphosphonates due to different reasons. We show its clinical presentation, the radiological aspects, the treatment methods we used, and the evolution in each different case. We discuss our experience with that of the scarce literature. Conclusions: Maxillary necrosis associated with bisphosphonates administration seems to be a new secondary effect related to these drugs. This is a potentially severe complication and should be taken into account in case of a maxillary necrosis of unknown aetiology. Oral and maxillofacial surgeons, as well as dentists and oncologists, should know this possible complication and try to avoid any dental procedure in patients under treatment with bisphosphonates. More experience and further investigations need to be performed to clarify many of the questions in relation to this new entity. P.244 Multiple endocrine neoplasia (MEN) Type 2b R. Pilcher, M.J.C. Davidson. Department of Oral & Maxillofacial Surgery, Taunton & Somerset Hospital, Taunton, Somerset, UK MEN Type 2b is a rare condition that involves the presence of medullary thyroid carcinoma and the potential to develop bilateral phaeochromocytomas. We report on a 14-year-old girl who initially presented with multiple intaoral mucosal swellings of tongue, lip and buccal mucosa. Other features of note included classical irregular dentition under a high arched palate, delayed eruption of her permanent dentition and characteristic facies. Histology reported multiple mucosal neuromas. Mutation analysis of the RET proto-oncogene was requested and a heterozygous mutation at codon 918 was identified consistent with MEN Type 2b. Further investigations revealed biochemical evidence and following total thyroidectomy, histological evidence of medullary carcinoma. Mediastinal clearance was undertaken. MRI of neck and abdomen and a non-contrast CT scan of her lungs excluded evidence of a co-existent phaeochromocytoma. Long-term review is required. P.245 Merkel cell carcinoma – Time for central registration? R. Pilcher, M.J.C. Davidson, J.F. Hamlyn. Department of Oral & Maxillofacial Surgery, Taunton & Somerset Hospital, Taunton, Somerset, UK Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine neoplasm with a tendency to metastasise early. Appearance is innocuous and differential diagnosis wide predisposing to
Oral medicine/Pathology 195 late referral. Optimal management is unclear. Five cases of MCC now diagnosed at our unit in 6 years have lead to treatment dilemmas. Each search of the then current literature has revealed inconsistencies in management. Limited numbers are reported and prospective randomized trials are missing. Our cases have demonstrated variation in natural history further complicating decision making. We propose a central register within the European Association of Cranio Maxillofacial Surgeons. A website revealed on opening any search engine for MCC would invite relevant data such as staging, management and outcome. Similarly a prospective randomized trial could be accessed. Such a pooling of all information available could lead to furthering knowledge of this rare condition and result in improved management and prognosis. P.246 Severe jaw complications after administration of bisphosphonates A.W. Eckert, P. Maurer, M.S. Kriwalsky, J. Schubert. Department of Oral and Maxillofacial Plastic Surgery, Martin-LutherUniversity Halle-Wittenberg, Germany Introduction: Bisphosphonates are analogous of organic pyrophosphates and used to prevent bony metastases of breast, prostate cancer and multiple myeloma. Avascular jaw necrosis after medication with bisphosphonates was described as an adverse effect recently. Therefore, the goal of this investigation was to summarize the treatment of avascular necroses after bisphosphonat administration. Materials and Methods: A total of 20 patients with an avascular bony necrosis was investigated. There were 13 female and 10 male patients ranging in age from 47 to 81 years (mean age 67 years). The oncologic diagnosis, oral symptoms and the therapeutical strategy were analysed. Results: The basic oncologic diagnoses were breast cancer (8), multiple myeloma (6), prostate cancer (4). The typical clinical symptoms were exposed bone as well as non-healing extraction sockets. The interval between first administration of bisphosphonates and clinical symptoms varied between 4 and 120 months. Further, a recurrence of avascular necrosis was observed in 5 patients. The histological examination showed a low activity of the osteoclasts next to necrotic bone. The GOMORI special staining demonstrated HAVERS-systems neighboured by irregular bony structures. Conclusions: Bisphosphonates are non-metabolized analogues of pyrophosphates and inhibit osteoclastic function. Based on our knowledge we recommend a check of dental status before starting a bisphosphonate therapy. Dental treatment should avoid ulcers by dental prostheses and primary closure of extraction sites should be carried out. In case of avascular jaw necroses the resection of necrotic bone with stable closure of the wound under antibiotic prophylaxis is necessary. P.247 Cocaine-induced pseudovasculitis and midline destructive lesions. Differencial diagnosis and report S. Sanchez Santolino, M.F. Garcia Reija, B. Garcia Montesinos, R. Saiz Bustillo. Department Cirug´ıa Oral y Maxilofacial, Hospital Universitario Marques de Valdecilla, Santander, Spain Introduction: Cocaine’s intense local vasoconstrictive effects,mucosal irritation and recurrent nasal infections may lead to inflammation, ulceration of the nasal mucosa, ischemic necrosis perforation of the septum, maxilla and paranasal sinuses. Pseudovasculitis is a disease process that mimics the presentations and possibly the laboratory findings of true vasculitis. Cocaine
Oral medicine/Pathology 195 late referral. Optimal management is unclear. Five cases of MCC now diagnosed at our unit in 6 years have lead to treatment dilemmas. Each search of the then current literature has revealed inconsistencies in management. Limited numbers are reported and prospective randomized trials are missing. Our cases have demonstrated variation in natural history further complicating decision making. We propose a central register within the European Association of Cranio Maxillofacial Surgeons. A website revealed on opening any search engine for MCC would invite relevant data such as staging, management and outcome. Similarly a prospective randomized trial could be accessed. Such a pooling of all information available could lead to furthering knowledge of this rare condition and result in improved management and prognosis. P.246 Severe jaw complications after administration of bisphosphonates A.W. Eckert, P. Maurer, M.S. Kriwalsky, J. Schubert. Department of Oral and Maxillofacial Plastic Surgery, Martin-LutherUniversity Halle-Wittenberg, Germany Introduction: Bisphosphonates are analogous of organic pyrophosphates and used to prevent bony metastases of breast, prostate cancer and multiple myeloma. Avascular jaw necrosis after medication with bisphosphonates was described as an adverse effect recently. Therefore, the goal of this investigation was to summarize the treatment of avascular necroses after bisphosphonat administration. Materials and Methods: A total of 20 patients with an avascular bony necrosis was investigated. There were 13 female and 10 male patients ranging in age from 47 to 81 years (mean age 67 years). The oncologic diagnosis, oral symptoms and the therapeutical strategy were analysed. Results: The basic oncologic diagnoses were breast cancer (8), multiple myeloma (6), prostate cancer (4). The typical clinical symptoms were exposed bone as well as non-healing extraction sockets. The interval between first administration of bisphosphonates and clinical symptoms varied between 4 and 120 months. Further, a recurrence of avascular necrosis was observed in 5 patients. The histological examination showed a low activity of the osteoclasts next to necrotic bone. The GOMORI special staining demonstrated HAVERS-systems neighboured by irregular bony structures. Conclusions: Bisphosphonates are non-metabolized analogues of pyrophosphates and inhibit osteoclastic function. Based on our knowledge we recommend a check of dental status before starting a bisphosphonate therapy. Dental treatment should avoid ulcers by dental prostheses and primary closure of extraction sites should be carried out. In case of avascular jaw necroses the resection of necrotic bone with stable closure of the wound under antibiotic prophylaxis is necessary. P.247 Cocaine-induced pseudovasculitis and midline destructive lesions. Differencial diagnosis and report S. Sanchez Santolino, M.F. Garcia Reija, B. Garcia Montesinos, R. Saiz Bustillo. Department Cirug´ıa Oral y Maxilofacial, Hospital Universitario Marques de Valdecilla, Santander, Spain Introduction: Cocaine’s intense local vasoconstrictive effects,mucosal irritation and recurrent nasal infections may lead to inflammation, ulceration of the nasal mucosa, ischemic necrosis perforation of the septum, maxilla and paranasal sinuses. Pseudovasculitis is a disease process that mimics the presentations and possibly the laboratory findings of true vasculitis. Cocaine