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The aim of this retrospective clinical study was to evaluate the applicability of newly developed uncalcined and unsintered hydroxyapatite (u-HA) particles and poly-L-lactide (PLLA; u-HA/PLLA) composite sheets with tack fixation for navigation-assisted orbital fracture reconstruction. Osteosynthetic bone fixation and reconstruction systems made from u-HA/PLLA composites have recently drawn attention for effective application in maxillofacial bone surgery because of their osteoconductive properties and bioresorbability. One limitation of these systems in the clinical setting, however, is the complicated drill hole tapping that is required for screw fixation. Herein, we report the feasible application of a u-HA/PLLA sheet with tack fixation for intraoperative navigation-assisted orbital wall reconstruction; this approach may be suitable for fragile and anatomically complicated periorbital-maxillofacial bony regions. The study included 9 patients (mean age, 46.6 years) with moderate and medium complexity to large and high complexity orbital wall defects (3 type II defects and 6 type III). The mean follow-up period was 8.9 months (range, 6 to 18 months). Overall, the application of the u-HA/PLLA sheet with tack fixation gave excellent stability for orbital wall reconstruction at the infraorbital rim, and produced satisfactory ophthalmologic functional results with no intraoperative or postoperative complications. This material may be an optimal bioactive, osteoconductive, and bioresorbable bone alternative for orbital wall reconstruction with fewer complications in patients with orbital fractures.

This single-center retrospective observational study aimed to identify risk factors for developing denosumab-related osteonecrosis of the jaw (DRONJ) in stage IV solid cancer patients with bone metastases. In total, 123 consecutive patients who had received 120 mg of denosumab every 4 weeks at least twice between July 2014 and October 2018 were included. We surveyed their demographics, medical history, blood test, underlying disease, and intraoral findings. Fourteen patients (11.4%) developed DRONJ within a mean denosumab administration period of 4 months (range: 2–52 months). Univariate analyses showed a statistically significant correlation between DRONJ and hormone therapy, chemotherapy/molecular target drug, apical periodontitis, periodontal disease, sex and body mass index. Multivariate analysis showed a statistically significant correlation between DRONJ and hormone therapy (odds ratio [OR], 22.07; 95% confidence interval [CI], 2.86–170.24), chemotherapy and/or molecular targeted therapy (OR, 18.61; 95% CI, 2.54–136.27), and apical periodontitis (OR, 22.75; 95% CI, 3.20–161.73). These findings imply that collaborative oral examinations by oral specialists may reduce the risk of development of DRONJ in patients treated with denosumab for bone metastases from solid cancers.

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