Nicolás Leonardi

Objective: Epidemiological and survival data on osteosarcoma of the jaws (OSJ) in Latin America remain scarce. We characterized the clinicopathological, radiographic, treatment‐related, and survival features of OSJ in Latin America. Methods: This multicenter case series involved 22 institutions from Brazil, Chile, Argentina, Colombia, Venezuela, Uruguay, and Mexico. Demographic, clinical, radiographic, histopathological, treatment, and survival data were analyzed using descriptive and inferential statistical methods. Survival outcomes were assessed using Kaplan–Meier analysis and Cox regression models. Results: A total of 119 OSJ cases were included. The median age was 33 years, with a female predominance (58%), and the mandible was the most commonly affected site (68.9%). A mixed radiographic appearance predominated and was frequently accompanied by cortical perforation and a sunburst periosteal reaction. Histologically, the osteoblastic subtype accounted for 63.5% of cases. Surgical resection was the main treatment modality (71.2%). Increasing age ( p = 0.034) and multimodal or nonsurgical management ( p = 0.023) were independently associated with poorer survival. The estimated overall survival rates were 67.5% at 12 months and 37.5% at 60 months. Conclusion: Data corroborate previous literature and demonstrate that OSJ in Latin America predominantly affects adults and exhibits aggressive patterns. Surgical management remains central to improving survival whenever it is technically feasible.

Objective: This study assessed the frequency and clinical features of MRONJ with exclusive palatal involvement at two Oral Medicine referral centers. Methods: A retrospective cross-sectional study included consecutive patients diagnosed with MRONJ between 2016 and 2025 at two referral centers in Córdoba, Argentina. Clinical records, imaging studies, and histopathological reports were reviewed. The frequency of exclusive palatal involvement was determined, and demographic, clinical, radiographic, and histopathological characteristics were analyzed descriptively. Results: Among 58 patients with MRONJ, 5 (8.6%) presented exclusive palatal involvement without concomitant maxillary or mandibular lesions. All patients were women (mean age, 78.4 years) receiving oral antiresorptive therapy for osteoporosis. Clinical findings ranged from mucosal breakdown to exposed necrotic bone with fistulization. Contributing local factors included prosthetic irritation and palatal exostoses. Imaging findings were often subtle or non-specific, whereas histopathological examination confirmed osteonecrosis when performed. Conclusion: Exclusive palatal MRONJ is an uncommon but clinically significant presentation. Awareness of this atypical location may facilitate earlier diagnosis and improve management in patients receiving antiresorptive therapy.

Background: Medication-related osteonecrosis of the jaw (MRONJ) is an adverse effect associated with the use of antiresorptive/antiangiogenic medications. Few observational studies have been conducted in South America. Our aim was to describe patients with MRONJ from Córdoba, Argentina, focusing on demographic, pharmacological, and serological variables, as well as associated risk factors. Methods: We conducted a cross-sectional study involving MRONJ patients who visited two Oral Medicine Departments between 2016 and 2022. Chi-square tests and Student t-tests were used to compare proportions in categorical and quantitative variables. Additionally, we provided a review of the literature from the last 10 years. Results: A total of 53 patients were included in the study. There was a female predominance in the osteoporosis group. The average duration of antiresorptive treatment for osteoporosis was 10.43 years. Zoledronate was statistically associated with the development of MRONJ. The mandible was more frequently affected than the maxilla. Tooth extraction was the most common triggering factor, accounting for 75% of cases. Additionally, 43.4% of the patients were diagnosed with Stage 1 MRONJ. Conclusion: This subgroup of Argentinean MRONJ patients exhibits similar characteristics to those reported in studies worldwide. The development of MRONJ in osteoporotic females may be linked to inadequate control of antiresorptive therapy. It is essential for general dentists and physicians to recognize the risk of MRONJ in these individuals.

Objetive: The aim of this study is to describe Vitamin D3 levels in patients diagnosed with MRONJ from two centers in Argentina. Methods: A cross-sectional study was conducted on patients from two Oral Medicine centers in Argentina. Patients diagnosed with Medication-related osteonecrosis of the jaw between 2016 and 2022 were included. Vitamin D3 levels were measured in plasma. The STROBE guidelines for reporting cross-sectional studies were followed. Results: The final sample consisted of 53 individuals. Among them, 60.4% had oncological-based diseases while 39.6% were diagnosed with osteoporosis. Oncological patients with Medication-related osteonecrosis showed lower vitamin D3 levels (23.9 ng/mL) compared to the osteoporosis group (32.9 ng/mL) (p=0.03). Conclusion: These preliminary findings described the levels of vitamin D3 in patients diagnosed with MRONJ, highlighting the relevance of investigating the role of vitamin D3 and its clinical outcomes in these patients. Future research in this area could provide valuable insights for a comprehensive understanding of this role.

Objetivo: La sífilis es una enfermedad de transmisión sexual con una incidencia creciente a nivel mundial. En la sífilis secundaria, las lesiones orales son frecuentes, siendo a veces la única manifestación. El objetivo de este artículo es presentar una serie de casos clínicos de sífilis con localización predominante o exclusivamente gingival, destacando las características clínicas más relevantes para su diagnóstico. Casos clínicos: Esta serie de casos clínicos incluyó nueve casos de sífilis secundaria con manifestaciones gingivales. El diagnóstico se realizó mediante pruebas serológicas (VDRL, TPPA, FTA-ABS y MHA-TP), y se describieron lesiones tanto gingivales como extragingivales. En la encía se observó sífilis secundaria afectando principalmente la región anterior —tanto superior como inferior—, presentándose placas rojas o blancas. Algunos casos también presentaban lesiones en otros sitios intraorales, tenían síntomas como dolor o sensación de ardor, o presentaban enfermedad periodontal dependiente de placa. El diagnóstico diferencial de sífilis secundaria gingival con condiciones periodontales inespecíficas es fundamental para un diagnóstico adecuado. Por lo tanto, se debe considerar el diagnóstico de sífilis secundaria cuando se enfrentan casos gíngivo-periodontales atípicos en la práctica diaria. Palabras clave: Enfermedades de transmisión sexual, enfermedades gingivales, serie de casos, sífilis. /Aim: Syphilis is a sexually transmitted disease with growing incidence worldwide. In secondary syphilis, oral lesions are common, sometimes being the only manifestation. Gingival features of syphilis are rare and usually present multiple oral lesions. The aim of this article is to present a series of clinical cases of syphilis with predominantly or exclusively gingival localization, highlighting the most relevant clinical characteristics for its diagnosis. Clinical cases: This clinical case series included nine cases of secondary syphilis with gingival manifestations. The diagnosis was made using serological tests (VDRL, TPPA, FTA-ABS, and MHA-TP), and both gingival and extragingival lesions were described. Secondary syphilis was observed in the gum, mainly affecting the anterior region —both upper and lower—, depicting red or white plaques. Some cases also presented lesions in other intraoral sites, had symptoms such as pain or burning sensation, or showed plaque induced periodontal disease. The differential diagnosis of secondary syphilis considering non-specific periodontal conditions with gingival involvement is essential for a proper diagnosis. Thus, the diagnosis of secondary syphilis should be considered when dealing with atypical gingivo-periodontal cases in everyday practice. Keywords: Case series, gingival diseases, sexually transmitted diseases, syphilis.

Introducción: La Osteonecrosis Maxilar asociada a Medicamentos (ONMAM) constituye uno de los efectos adversos más relevantes en el tratamiento con drogas antirresortivas como bifosfonatos y denosumab. Patologías oncológicas como mieloma múltiple, cáncer de mama, próstata, y alteraciones óseas-metabólicas como la osteoporosis lideran las indicaciones para estas terapias antirresortivas. El tratamiento es complejo debido a que muchas veces, la enfermedad es refractaria a la terapéutica aplicada. Se describen tratamientos farmacológicos, conservadores y quirúrgicos. Objetivo: El objetivo de este trabajo es reportar dos casos clínicos de ONMAM tratados con dos protocolos terapéuticos diferentes y el análisis de la literatura disponible en la actualidad sobre estos aspectos en base a la clasificación clínica definida por la American Association of Oral and Maxillofacial Surgeons (AAOMS). Conclusión: Los pacientes que desarrollan cuadros clínicos bucales de gran morbilidad como lo es ONMAM, pueden ver condicionada su calidad de vida y sufrir un agravamiento de su patología de base. El tratamiento de ONMAM está condicionado al estadio de la enfermedad, el éxito del mismo depende del manejo interdisciplinario y de un estricto seguimiento clínico médico y odontológico, así como también un riguroso monitoreo para evitar o detectar precozmente futuras recurrencias.

La sialometaplasia necrotizante (SN) es una patología estadísticamente infrecuente, benigna, inflamatoria, autolimitante, que afecta predominantemente a las glándulas salivales menores. Su etiología no está clara, la mayoría de los autores sugieren que una lesión química, física o biológica de los vasos sanguíneos produciría cambios isquémicos, que desencadenaría infarto del tejido glandular con necrosis, inflamación e intento de reparación. Su aspecto clínico e histológico tiene apariencia de malignidad, pudiendo inducir a un diagnóstico erróneo de neoplasia maligna de origen anexial, considerando que la SN se trata de una patología autorresolutiva, es fundamental realizar un correcto diagnóstico clínico e histopatológico para evitar tratamientos quirúrgicos innecesarios. Se presenta el caso clínico de una paciente de sexo femenino que fue derivada al Servicio de Otorrinolaringología (ORL) de la Clínica Universitaria Reina Fabiola con diagnóstico de SN, sus características clínicas, histopatológicas y la evolución de la lesión.