Intraoral Herniation of a Sinonasal Polyp: An Underreported Complication of Maxillary Extraction?

PURPOSE: The aim of the present study was to increase awareness of an underreported surgical complication by presenting the relevant findings of cases of herniated oroantral sinonasal polyp (OASNP) identified from our biopsy service and from previously reported cases. MATERIALS AND METHODS: The present study was a retrospective descriptive case series with a review of the reported data. Cases of OASNP were identified from our biopsy service, and the clinical, radiographic, surgical, and demographic information was retrieved. Previously reported cases of OASNP were also reviewed. RESULTS: We identified 14 cases of OASNP in our biopsy service and an additional 10 reported cases. Overall, OASNP was more prevalent in males (71%). The age range was 19 to 85 years (overall mean, 46.6 years; median, 43.5 years). OASNP typically presented as a red polypoid mass that was frequently pedunculated with a smooth or granular surface. The lesions were located on the maxillary alveolus in the molar region. The most commonly implicated tooth was a maxillary first molar (74%). In some cases, the OASNP had been mistaken for a tumor or pyogenic granuloma. Almost all were at least 1 cm in the greatest dimension, with 43% measuring at least 2 cm in size, and 1 lesion reaching 5 cm in diameter. The reported period for development of the lesion ranged from 2 days to 5 years, with 60% developing within 2 months of the extraction. All lesions had undergone surgical excision. Antibiotic use and surgical closure of the oroantral communication had been described for some of the cases. CONCLUSIONS: The results from our study suggest that herniation of a sinonasal polyp through an oroantral defect could be an underreported complication of maxillary exodontia. Additional research would help to enhance our knowledge and understanding of this interesting condition.

Should Student Evaluation of Teaching Play a Significant Role in the Formal Assessment of Dental Faculty? Two Viewpoints: Viewpoint 1: Formal Faculty Assessment Should Include Student Evaluation of Teaching and Viewpoint 2: Student Evaluation of Teaching Should Not Be Part of Formal Faculty Assessment.

Student evaluation of teaching (SET) is often used in the assessment of faculty members' job performance and promotion and tenure decisions, but debate over this use of student evaluations has centered on the validity, reliability, and application of the data in assessing teaching performance. Additionally, the fear of student criticism has the potential of influencing course content delivery and testing measures. This Point/Counterpoint article reviews the potential utility of and controversy surrounding the use of SETs in the formal assessment of dental school faculty. Viewpoint 1 supports the view that SETs are reliable and should be included in those formal assessments. Proponents of this opinion contend that SETs serve to measure a school's effectiveness in support of its core mission, are valid measures based on feedback from the recipients of educational delivery, and provide formative feedback to improve faculty accountability to the institution. Viewpoint 2 argues that SETs should not be used for promotion and tenure decisions, asserting that higher SET ratings do not correlate with improved student learning. The advocates of this viewpoint contend that faculty members may be influenced to focus on student satisfaction rather than pedagogy, resulting in grade inflation. They also argue that SETs are prone to gender and racial biases and that SET results are frequently misinterpreted by administrators. Low response rates and monotonic response patterns are other factors that compromise the reliability of SETs.

Garlic burn of the oral mucosa: A case report and review of self-treatment chemical burns.

BACKGROUND AND OVERVIEW: Inappropriate self-treatment with topically applied therapeutic or nontherapeutic agents frequently results in mucosal burns. Although such chemical burns typically are associated with misuse of analgesics, investigators also have reported them in conjunction with topical application of a variety of other agents. CASE DESCRIPTION: The authors report an unusual case of a 49-year-old man seeking care for maxillary tooth pain who had an oral mucosal burn of the maxillary vestibule caused by topical application of crushed raw garlic. The patient believed this treatment would alleviate his dental pain. Localized tissue necrosis was visible at the site of application. The authors instructed the patient to cease self-treatment with raw garlic but deemed treatment was otherwise unnecessary. To the best of the authors' knowledge, this is the second reported case of a garlic burn of the oral mucosa. The authors discuss the history of garlic as a naturopathic remedy, as well as the development of chemical burns associated with its topical use. The authors also review the literature on chemical burns caused by inappropriate self-treatment. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Dentists should consider the possibility of an oral chemical burn when a patient has a destructive or necrotic mucosal lesion located near a painful tooth. In this report, the authors highlight the importance of obtaining a detailed clinical history to establish a proper diagnosis and proper patient education to prevent future mucosal injury from inappropriate self-treatment. Awareness and early recognition of this condition also will help diminish the probability of overtreatment.

Mixed radiopaque and radiolucent lesion of the maxillary sinus: a radiographic challenge.

This article describes 3 patients, each of whom presented with an asymptomatic mixed radiopaque and radiolucent lesion of the maxillary sinus associated with a nonvital tooth. Based on the radiographic findings, a diagnosis of a collapsed (ruptured) radicular cyst was rendered in each case. A tissue biopsy was performed in 1 case, and the results supported the diagnosis. The radiographic and histopathological features, etiology, pathophysiology, and radiographic differential diagnosis of this condition are discussed.

Is Computed Tomography an Adequate Imaging Modality for the Evaluation of Juvenile Ossifying Fibroma? A Comparison of 2 Imaging Modalities (Computed Tomography and Magnetic Resonance Imaging).

PURPOSE: Given the problems of overuse of medical technology and the current burden of health care cost in the United States, it is important to establish clear imaging guidelines to diagnose conditions such as juvenile ossifying fibroma (JOF). This study compared the efficacy of computed tomography (CT) and magnetic resonance imaging (MRI) in the evaluation of JOF and thus could aid establishing such guidelines. MATERIALS AND METHODS: Radiologic criteria were established by 2 radiologists to compare the efficacy of CT and MRI in the evaluation of JOF. The following parameters were compared: presence of a well-defined corticated border, presence of a well-delineated internal calcified component, fluid-to-fluid levels, and anatomic extent of the lesion. Six patients diagnosed with JOF of the craniofacial bones from 2002 to 2013 had preoperative CT and MRI studies available for review. RESULTS: After review of CT and MRI images, fluid-to-fluid levels and anatomic extent of the lesions were comparable on CT and MRI. However, the corticated borders and the internal calcified component were better defined on CT images, which also enabled for distinction between the 2 subtypes of JOF. No MRI characteristics were identified that allowed for this distinction. CONCLUSION: Based on these findings, CT is an adequate and preferable imaging modality in the evaluation of JOF.

Psammomatoid and trabecular juvenile ossifying fibroma: two distinct radiologic entities.

OBJECTIVE: Evaluate and compare the radiologic features of psammomatoid versus trabecular variants of juvenile ossifying fibromas. STUDY DESIGN: Twelve of fifteen cases of juvenile ossifying fibroma of the craniofacial bones, retrieved from our pathology archives for the period between 2002 and 2013, had available preoperative computed tomography (CT) scans. The radiologic features of each case were analyzed and compared by two neuroradiologists and one oral and maxillofacial radiologist, each blinded to the histopathologic diagnosis. RESULTS: Juvenile psammomatoid ossifying fibroma (JPOF) exhibited a ground-glass pattern, as an outer mantle with central radiolucency, a single mural nodule, or a solid homogeneous mass. The trabecular variant presented as a radiolucent lesion with irregular, scattered calcifications. Both variants displayed a well-defined border. CONCLUSION: This study demonstrates that psammomatoid and trabecular juvenile ossifying fibromas exhibit unique radiologic features that allow for distinction between the two variants on CT studies.

Molecular and genetic aspects of odontogenic lesions.

In this article we outline the molecular findings of select odontogenic tumors. In each section, we briefly review selected the clinicoradiographic, histologic, immunologic features, focusing on the molecular findings and their applications in practice. The understanding of molecular pathobiology at various other organ sites has developed quite rapidly in recent years, however much remains unknown about the genetic profile of odontogenic tumors. Improved understanding of mutations in odontogenic tumors may clarify classification schema and elucidate targets for novel therapies. Molecular testing will no doubt improve our understanding of odontogenic tumor pathogenesis and will likely be, someday, an important component of routine clinical practice and its role will only increase in the coming years.

Interaction between IRF6 and TGFA genes contribute to the risk of nonsyndromic cleft lip/palate.

Previous evidence from tooth agenesis studies suggested IRF6 and TGFA interact. Since tooth agenesis is commonly found in individuals with cleft lip/palate (CL/P), we used four large cohorts to evaluate if IRF6 and TGFA interaction contributes to CL/P. Markers within and flanking IRF6 and TGFA genes were tested using Taqman or SYBR green chemistries for case-control analyses in 1,000 Brazilian individuals. We looked for evidence of gene-gene interaction between IRF6 and TGFA by testing if markers associated with CL/P were overtransmitted together in the case-control Brazilian dataset and in the additional family datasets. Genotypes for an additional 142 case-parent trios from South America drawn from the Latin American Collaborative Study of Congenital Malformations (ECLAMC), 154 cases from Latvia, and 8,717 individuals from several cohorts were available for replication of tests for interaction. Tgfa and Irf6 expression at critical stages during palatogenesis was analyzed in wild type and Irf6 knockout mice. Markers in and near IRF6 and TGFA were associated with CL/P in the Brazilian cohort (p<10(-6)). IRF6 was also associated with cleft palate (CP) with impaction of permanent teeth (p<10(-6)). Statistical evidence of interaction between IRF6 and TGFA was found in all data sets (p = 0.013 for Brazilians; p = 0.046 for ECLAMC; p = 10(-6) for Latvians, and p = 0.003 for the 8,717 individuals). Tgfa was not expressed in the palatal tissues of Irf6 knockout mice. IRF6 and TGFA contribute to subsets of CL/P with specific dental anomalies. Moreover, this potential IRF6-TGFA interaction may account for as much as 1% to 10% of CL/P cases. The Irf6-knockout model further supports the evidence of IRF6-TGFA interaction found in humans.

Molecular diagnostics for head and neck pathology.

Molecular diagnostic techniques are quickly finding a role in the detection and diagnosis of tumors, and in predicting their behavior. They may also prove useful in developing new therapeutic approaches to head and neck cancer. The surgeon working in the craniomaxillofacial region should have an understanding of these technologies, their availability in various settings, and how they affect various aspects of treatment, particularly in the detection and treatment of malignancies. This article offers an overview of recent advances in molecular diagnostic techniques, with their implications for diagnosis and management of head and neck tumors.