Osteonecrosis of the jaws is being increasingly reported in patients with bone metastasis from a variety of solid tumors and disseminated multiple myeloma receiving intravenous bisphosphonates. Agreement exists that these drugs can initiate vascular endothelial cell damage and accelerate disturbances in the microcirculation of the jaws, possibly resulting in thrombosis of nutrient-end arteries. The role of bisphosphonates in cancer patients with previously treated jaws has yet to be elucidated. The signs and symptoms that may occur before the appearance of evident osteonecrosis include changes in the health of periodontal tissues, nonhealing mucosal ulcers, loose teeth and unexplained soft tissue infection. A series of 30 periodontally involved patients showing osteonecrosis of the jaws that appeared following the intravenous use of bisphosphonates is reported. Clinical management of the avascular necrosis of the jaws in patients treated with bisphosphonates presents several problems. An analysis of the international medical literature shows that surgical treatment of the necrotic jaws in patients treated with bisphosphonates has proven to be ineffective in stopping the pathological process. The use of hyperbaric oxygen and antibiotics are not effective, either. The authors have developed a new protocol for the management of these lesions. Compared with other therapeutic choices, this protocol has introduced the use of ozone therapy as therapeutic support.

Role of ozone therapy in the treatment of osteonecrosis of the jaws in multiple myeloma patientsCurrent treatments for bisphosphonate-associated osteonecrosis of the jaw (ONJ) in multiple myeloma patients have limited efficacy. The biological effects of ozone indicate it may be therapeutic for ONJ. We, here, report the efficacy of a 15-day course of antibiotics, surgery and ozone therapy in 12 MM patients with ONJ. Haematologica 2007; 92:1289 92: -1290 Multiple myeloma (MM) is characterized by a frequent involvement of the bone, ranging from osteoporosis to lytic lesions. Consequently, bisphosphonates such as pamidronate or zoledronic acid, which inhibit osteoclast activity, 1 are commonly prescribed for the prevention and treatment of pathological fractures in patients with MM. 2Bisphosphonates are extremely effective in reducing the symptoms and complications of bone lesions, and have been shown to have a profound positive impact on quality of life for patients with MM.3 However, since September 2003, several hundred cases of ONJ associated with bisphosphonate therapy in patients with MM or breast, prostate or lung cancer have been reported worldwide; usually, but not always, in those who have undergone head and neck radiotherapy or a dental procedure. 4These lesions result from avascular necrosis of the bone, hypothetically due to inhibition of osteoclast activity and angiogenesis by bisphosphonates, with subsequent impaired healing and exposure to infection by oral bacteria.6 Patients with bisphosphonate-associated ONJ do not respond well to surgical intervention and there are mixed results with antibiotics and/or mouthwashes and not enough data to evaluate the role of hyperbaric oxygen. 5Thus, there is a need for more effective therapies. Ozone, which has antimicrobial and wound-healing properties, has been used therapeutically in dentistry and medicine for approximately 100 years, for a variety of indications including dental caries.6,7 Consequently, we investigated the efficacy of ozone therapy in conjunction with antibiotics and surgery in patients with MM who developed ONJ following bisphosphonate therapy.Since 1998 at our institute 22 of 311 patients with MM treated with intravenous (IV) pamidronate 90 mg/month and/or IV zoledronic acid 4 mg/month were referred with toothache, impaired healing after teeth extractions, dental abscesses and bone exposure. ONJ was diagnosed by a maxillo-facial surgeon based on the following criteria: exposed bone in the maxilla or mandible, associated or not with pain and soft-tissue swelling; unhealed necrotic bone (more than one month), usually (but not necessarily) after dental work; poorly demarcated radio-opaque area of the affected bone on X-ray. Thus, the incidence of bisphosphonate-associated ONJ (7%) is similar to that reported elsewhere.8-10 After discontinuation of bisphosphonate therapy, patients received a 15-day course of treatment, consisting of antibiotic therapy (amoxicillinclavulanic acid 1 g twice daily plus metronidazole 1 g daily) and daily ozone ther...

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The submandibular glands are subject to several pathologies that require excision. The most common problem that affects these salivary glands is sialadenitis combined with sialolithiasis. This problem occurs in the submandibular gland 10 times more frequently than it does in the parotid gland. Other illnesses frequently involving the submandibular glands are represented by sialadenosis and benign, malign, and intermediate neoplasms. Diagnosis of any disturbance in the submandibular gland involves both a clinical and instrumental (echography, traditional radiography [ortopantomography] and eventually computed tomography (CT) or magnetic resonance imaging) assessment. Surgery is the usual method of treatment of both chronic sialadenitis and neoplasms in the submandibular gland. A submandibular gland surgical approach can be cervical, intraoral, or endoscopic. The authors present their clinical experience with a total of 40 patients with illnesses involving the submandibular gland treated with submandibular gland excision by a transcervical approach. Their experience suggests that this approach entails a relatively simple procedure, involves low risks for the nerve structure around the gland, permits wide resection margins for neoplasms, and incurs little aesthetic damage.