Intravascular papillary endothelial hyperplasia of the lower lip: surgical approach and review of the literature.

OBJECTIVE: A review of the literature for intravascular papillary endothelial hyperplasia is presented along with a case report of a geriatric patient. REVIEW OF THE LITERATURE: Intravascular papillary endothelial hyperplasia (IPEH) is a reactive benign lesion of vascular origin, which is caused by an excessive proliferation of endothelial cells. Only a few cases with IPEH in the oral cavity have been recorded in the literature, reporting the lower lip as the main site. The treatment of choice mentioned in the literature is simple excision. CASE REPORT: In this case, an IPEH of the lower lip of a 79-year-old male was treated by a sclerosing agent, which was injected into the lesion, causing compression and fibrosis of the blood vessels, followed by a careful dissection and excision. Intra-operatively no bleeding occurred. Post-operatively an excellent aesthetic result was achieved, without recurrence. CONCLUSION: The use of sclerotherapy followed by surgery in mixed type intravascular papillary endothelial hyperplasia can provide an acceptable aesthetic result with minimal intra-operative bleeding.

Vaporization of melanin in oral tissues and skin with a carbon dioxide laser: a canine study.

PURPOSE: This study tested the efficacy of carbon dioxide (CO2) laser vaporization in ablating gingival, oral mucosal, and cutaneous melanin in dogs. MATERIALS AND METHODS: Three mongrel dogs with pigmentation of the oral mucosa, gingivae, and skin were used. Biopsy specimens from the melanin sites were obtained from all 3 dogs before laser application. Removal of the melanin sites was performed by using a 3 W continuous-wave CO2 laser. Biopsies of the treated areas were performed 1, 2, 4, and 6 weeks after laser treatment in all 3 dogs and also, at 11 weeks in 1 dog. The histologic sections were stained with hematoxylin and eosin and Masson-Fontana dye. A computerized morphometric program calculated the average percentage of the melanin layer in the Masson-Fontana-stained sections. RESULTS: Clinical and histologic examination showed the CO2 laser to be effective in eliminating the pigmented areas in all tissues treated. No recurrence of melanin was detected in either the oral mucosa or gingiva at any of the follow-up times. In the skin, however, a small amount of melanin repigmentation was noticeable. CONCLUSIONS: CO2 laser surgery proved an effective tool for obliterating superficial melanin discoloration. To prevent recurrence of the pigmentation, the area must be cleared completely of melanin, directing the laser beam carefully along the visible margins of the area.

Rhinocerebral mucormycosis treated with amphotericin B colloidal dispersion in three patients.

Rhinocerebral mucormycosis (zygomycosis) primarily affects diabetic or immunosuppressed patients and typically progresses rapidly, necessitating surgical excision and antifungal therapy with amphotericin B. Large doses of amphotericin B are required for cure, causing significant renal toxicity. Amphotericin B colloidal dispersion (ABCD; Amphocil, Sequus Pharmaceuticals, Menlo Park, CA) is a 1:1 complex of cholesteryl sulfate and amphotericin B, which results in significant reduction of toxicity, especially nephrotoxicity. We describe three patients with life-threatening rhinocerebral mucormycosis treated with ABCD. All patients had high serum creatinine levels due to prior treatment with amphotericin B; these levels reverted to normal during treatment with ABCD. Two patients with diabetes mellitus were cured after receiving a combination of surgery and ABCD therapy. The third patient, who had myelodysplastic syndrome, had an initial good response, with cure of the fungal infection; however, he eventually died of his primary illness. To the best of our knowledge, this is the first detailed clinical description of the treatment of mucormycosis with ABCD.

Comparison of full thickness skin graft "take" after excision with the carbon dioxide laser and scalpel.

SPECIFIC AIM. To evaluate the take of skin grafts on conventionally prepared beds and on beds prepared by a carbon dioxide laser, with and without abrasion of the bed. SIGNIFICANCE. Graft take is dependent on hemostasis, immobility, and nutrition of the graft. Scalpel excision of the skin graft can be associated with hemostatic difficulties and laser treatment of the skin graft bed can provide hemostasis. Abrasion of the bed after laser treatment may then be a means of opening small lymphatic and blood vessels to maintain the graft. Laser treatment followed by abrasion of the bed may provide an ideal graft base before suturing of the skin graft. MATERIAL AND METHODS. Full-thickness skin grafts were taken with a scalpel at three sites on the dorsal skin of 24 guinea pigs. The three beds were prepared with pressure alone to provide hemostasis, laser vaporization followed by abrasion with gauze to produce pinpoint bleeding, and laser vaporization alone. The original skin from each of the sites was then sutured back in place. At postoperative days 1, 3, 5, 10, 21, and 35 the graft sites were assessed clinically for "take." Laser Doppler measurements were also made to evaluate blood flow. Histologic sections of the three sites were prepared. Immunohistochemical analysis was performed to evaluate cell proliferation and angiogenesis. RESULTS. For the animals sacrificed through day 10 the rate of take for the sites that were not lased was 100%. For the sites that were lased alone and lased and abraded the rate of take was 71% with no difference between the two techniques. The lased sites demonstrated increased inflammatory response and graft necrosis. Immunohistochemical analysis showed increased cellular proliferation and angiogenesis in the bed. DISCUSSION. Grafts take best on a scalpel-prepared bed. Laser preparation of the bed, with or without abrasion, demonstrates decreased "take." Therefore the carbon dioxide laser is not a recommended means to take a graft or prepare the graft bed.

Sialolithectomy done with a CO2 laser: clinical and scintigraphic results.

PURPOSE: This study reviews the results of sialolithectomy performed with the CO2 laser. PATIENTS AND METHODS: Forty-nine patients were treated under local anesthesia at initial presentation in the outpatient clinic. RESULTS: All patients had immediate relief after surgery. Clinical and scintographic follow-up of up to 28 months on 27 patients showed that all but 1 were asymptomatic. The single exception required excision of the submandibular gland because of two recurrences of sialoliths in Wharton's duct. Although some glands had no function clinically and scintigraphically, they were asymptomatic and needed no further treatment. CONCLUSIONS: Salivary glands that are nonfunctioning clinically and scintigraphically should only be removed when there is a recurrence of symptoms.

Oral psoriasis: report of six new cases.

This article presents six cases of oral psoriasis originally diagnosed by means of the histological changes found on biopsies of the oral lesions. Three of the patients presented with oral and skin psoriasis. Of the remaining three, two presented with oral manifestations alone, although their follow-up was short, whilst the third showed delayed dermatological changes. Two of the cases were also complicated by psoriatic arthritis, one of them to the temporomandibular joint.

Acquired toxoplasmosis of a submandibular lymph node in a 13-year-old boy: case report.

Toxoplasmosis is a parasitic infection divided into congenital and acquired forms. In the latter form, malaise, fatigue, and lymphadenopathy are commonly found, and submandibular lymphadenopathy is sometimes a manifestation. In children, cervical lymph nodes usually are affected. This is a case of a 13-year-old boy suffering from acquired toxoplasmosis, in which submandibular lymphadenopathy was the only clinical sign of the disease. Meticulous history taking, clinical examination, and specific serological tests should be performed in these cases. Positive serological results will confirm toxoplasmosis infections. Conservative treatment must be attempted initially.

Pathoses of coronoid process as a cause of mouth-opening restrictions.

The mandible coronoid process is another site subject to various pathoses that may result in limited jaw movement. Six different pathoses that prevented the free rotation of the coronoid are presented. Differential diagnosis and treatment approach are emphasized.

Pemphigus neonatorum.

The diagnosis of pemphigus neonatorum in an infant girl was based on clinical, histologic, and immunofluorescence evidence. The outcome was benign, and the skin lesions resolved within two weeks.

Effect of fluoride varnish on the retentive strength of provisional crowns luted with various temporary cements.

The retention of temporary crowns was studied with the use of a fluoride varnish (Duraphat) combined with various temporary cements. The mixture of Duraphat varnish and cement improved retention, with the exception of Opotow cement. Applying Duraphat varnish to the tooth surface before cementation enhanced the retentive strength of Tempbond, weakened the retention of Freegenol, but had no effect on Opotow cement. A "transfer effect" was observed, inasmuch as the Duraphat varnish encouraged adherence of the cement to the tooth structure rather than to the temporary crown.

Severe limitation in mouth opening following transtemporal neurosurgical procedures: diagnosis, treatment, and prevention.

Five new patients and six previously described patients with severe limitation in maximum mouth opening following transtemporal neurosurgical procedures are described. Six patients underwent an operation for epidural hematoma and three for skull-base meningloma; two were treated with a pterional craniotomy for an aneurysm. Limited maximum mouth opening in these circumstances is caused by temporal muscle scarring and shortening. Aggressive physiotherapy is potentially beneficial if started early. If, however, diagnosis is delayed, the efficacy of physiotherapy declines, and surgical treatments such as temporal muscle detachment and coronoidectomy are fully indicated. The differential diagnosis, prevention, and treatment of limited maximum mouth opening following neurosurgical procedures are discussed.

Myxoid liposarcoma of the buccal vestibule. A case report.

A case of a myxoid liposarcoma in the buccal vestibule of the mandible is presented. The patient, an 86-year-old women, had 2 local recurrences after initial excision and died several months later. The literature is briefly reviewed.

Hyperostosis corticalis generalisata: surgical management and long-term follow-up of one patient.

A 24-year-old woman presented for treatment of her distorted facial appearance. She showed marked widening of the face and skull, which had first become noticeable in childhood. Significant thickening of the cortical bone was seen radiographically throughout the skeleton. Routine laboratory and endocrinological tests showed normal results. These findings, together with a family history of bone disorder, led to the diagnosis of hyperostosis corticalis generalisata. The lower border of the mandible was resected, resulting in improved facial appearance. During the 8-year follow-up, no changes were seen with regard to the mandible.

The effect of aging on tooth morphology: a study on impacted teeth.

The effect of age on dental tissues was studied on histologic sections of totally impacted teeth obtained from patients between 11 and 76 years of age. Impacted teeth were used in order to obviate the influence of the environmental effects prevalent in the oral cavity. The presence of concentric denticles and diffuse calcifications was determined, and the width of secondary dentin, predentin, and cementum was measured. The width of predentin and cementum increased linearly with age, whereas the aging process of secondary dentin formation and diffuse calcifications followed a different pattern. The incidence of concentric denticles was identical for all age groups.