HIV-associated lymphoma -- an unusual cause of pathological mandibular fracture

Despite the introduction of highly active antiretroviral therapy (HAART), diffuse large B-cell lymphoma (DLBCL) remains a common malignancy in human immunodeficiency virus (HIV)-infected patients, especially the plasmablastic variant. About 50% of lymphomas in HIV patients are extranodal and half of...

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Bibliographic Details
Published in:Mund-, Kiefer- und Gesichtschirurgie : MKG Kiefer- und Gesichtschirurgie : MKG, 2005-01, Vol.9 (1), p.48-52
Main Authors: Leiggener, C S, Kunz, Ch, Lohri, A, Fridrich, K, Honigmann, K
Format: Article
Language:ger
Subjects:
Biomarkers, Tumor - analysis
Biopsy
Bone Transplantation
Dentistry
Diagnosis, Differential
Fracture Fixation, Internal
Fractures, Spontaneous - diagnosis
Fractures, Spontaneous - pathology
Fractures, Spontaneous - surgery
Fractures, Ununited - diagnosis
Fractures, Ununited - pathology
Fractures, Ununited - surgery
Humans
Lymphoma, AIDS-Related - diagnosis
Lymphoma, AIDS-Related - pathology
Lymphoma, AIDS-Related - surgery
Male
Mandible - pathology
Mandible - surgery
Mandibular Fractures - diagnosis
Mandibular Fractures - pathology
Mandibular Fractures - surgery
Mandibular Neoplasms - diagnosis
Mandibular Neoplasms - pathology
Mandibular Neoplasms - surgery
Middle Aged
Postoperative Complications - diagnosis
Postoperative Complications - pathology
Postoperative Complications - surgery
Reoperation
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Summary:Despite the introduction of highly active antiretroviral therapy (HAART), diffuse large B-cell lymphoma (DLBCL) remains a common malignancy in human immunodeficiency virus (HIV)-infected patients, especially the plasmablastic variant. About 50% of lymphomas in HIV patients are extranodal and half of them occur in the head and neck area. The main oral symptoms are pain, swelling, numbness and tooth mobility. We report the case of a 52-year-old patient with a known HIV infection and fracture of the angular region of the mandible. The fracture did not unite following open reduction and osteosynthesis. A biopsy performed at the time of revision revealed the diagnosis of a primary lymphoma in the mandible. After chemotherapy had induced complete remission of the lymphoma and autogenous iliac crest bone grafting had been performed the fracture united. Primary lymphoma in the mandible is a disease that presents with a nonspecific radiological appearance which may mimic osteomyelitis or periodontal pathology. A rapid and accurate diagnosis is critical for the appropriate treatment. In our experience HIV-positive patients with mandibular fracture should be treated according to the guidelines established for HIV-negative patients. However, risky compromises such as intraoral approach or hazardous fracture fixation should be avoided.
ISSN:1432-9417