The 30th Annual Dr. Robert Allen Oral and Maxillofacial Surgery Lecture
Update and Controversies in the Surgical Management of Oral/Head and Neck Pathology

The surgical management of oral/head and neck pathology represents a formidable discipline in the specialty of oral and maxillofacial surgery. Such pathology is diagnostically diverse and variable in its biologic behavior, ranging from indolent benign processes to locally aggressive benign tumors to overly aggressive and fast-growing malignancies that are capable of distant spread. An appreciation for the biologic behavior of benign and malignant tumors comes to rest on our knowledge of their doubling times, their involvement of surrounding anatomic barriers, and their potential for metastatic spread, all of which assist in the development of the timing and execution of ablative surgery. The seasoned tumor surgeon is also capable of diagnosing and managing complications related to benign and malignant processes of the oral/head and neck region.
Osteonecrosis of the jaws is not a new diagnostic classification in oral and maxillofacial surgery or oral and maxillofacial pathology. Nonetheless, our specialty began learning of the association of oral and intravenous bisphosphonate medications and osteonecrosis of the jaws in 2003. Thereafter, we began to appreciate the association of RANKL inhibiters in the diagnosis of osteonecrosis of the jaws. Therein, the nomenclature of this process has changed from bisphosphonate related osteonecrosis of the jaws (BRONJ) to medication related osteonecrosis of the jaws (MRONJ). Since that time, the main controversial elements associated with these cases include the pathophysiology and cause of MRONJ as well as its proper treatment. While the medications themselves were once assigned primary blame for the development of osteonecrosis, many have pointed to the presence of osteonecrosis of the jaws in similarly physiologically compromised individuals, including those with cancer with or without metastatic disease, diabetes mellitus, alcoholism, and other diagnoses. A critical analysis of patients with MRONJ identifies numerous risk factors responsible for an aggressive form of osteomyelitis that also exist in patients not taking bisphosphonate medications.
Odontogenic cysts and tumors are time honored and formidable diagnoses of interest in oral and maxillofacial surgery practice. These processes range from indolent and serendipitously discovered cysts to large and disfiguring malignant processes capable of death of the patient. Therein, unilocular and multilocular radiolucencies of the jaws conjure a diverse and comprehensive differential diagnosis that must be mastered in oral and maxillofacial surgery training programs and continually modified throughout subsequent practice.

This session will enable participants to:
- Discuss the purported pathophysiologic mechanisms to explain MRONJ
- Enumerate the treatment options for MRONJ and their success rates
- Discuss those odontogenic tumors requiring rejection for cure and those odontogenic tumors for permitting enucleation and refuge for cure