Extramammary Paget Disease of Oral Mucosa: Case Report with Literature Review.

Extramammary Paget disease (EPMD) of the oral mucosa is an unusual and extremely rare condition, with fewer than ten cases documented. Here, we report a case of EMPD extensively involving oral mucosa and underlying salivary ducts in a 72-year-old male and review published clinical, histologic, immunophenotypic, and prognostic features of this rare entity.

Predictors of blood loss during orthognathic surgery: outcomes from a teaching institution.

PURPOSE: The objective of the study was to correlate different orthognathic surgical procedures with operating time and blood loss, reported from an accredited resident training institution. METHODS: Ninety-five patient records were evaluated retrospectively. Individual blood volume, percent blood volume lost (BVL), and estimated blood loss (EBL) for each patient were recorded and correlated with operating time (OT). Statistics included independent t tests, one-way analysis of variance, and linear regression. RESULTS: The mean OT for all procedures was 203 min with mean blood loss 556 ml. Mean EBL for males was 676 ml versus 468 ml for females. Overall BVL was 12.4 %, while for males, BVL was 13.3 % compared to 11.8 % for females. For a single orthognathic procedure (n = 45), mean OT 145 min., EBL 414 ml, and BVL 9.0 %; two procedures (n = 41), mean OT was 239 min., EBL 659 ml, and BVL 15 %; three procedures (n = 9), mean OT 328 min, EBL 793 ml, and BVL was 17 %. CONCLUSION: Examination of individual procedures suggests a shorter OT for Le Fort I procedures with slightly greater EBL. Concomitant orthognathic procedures are associated with greater OT and EBL. Blood volume should be calculated for male and female patients separately. Percent BVL can be predicted based on OT using a basic equation.

Large cell neuroendocrine carcinoma: topic review and a unique case of metastasis to the mandible.

There are few reports of large cell neuroendocrine carcinoma (LCNEC) metastasis to the head and neck region, and no cases reporting LCNEC from lung metastasizing to the mandible. LCNEC is not well reported in the literature due to recent changes in the criteria for diagnosis, revised in 2004 by the world health organization, due to its propensity for rapid growth and low 5 year prognosis. We present a 61 year old female diagnosed with LCNEC of the lung in October, 2007 treated with radiation and chemotherapy. Our patient had a PET scan performed in March, 2009 revealing no sign of metastasis. In July, 2009 she was seen for suspected sialadenitis by another department and referred to our oral and maxillofacial surgery clinic. Her signs and symptoms were consistent with metastatic disease to the mandible confirmed by histologic and immunohistochemical examination which revealed an invasive poorly differentiated non-small cell carcinoma. Palliative care was offered. Our patient died 2 years after initial diagnosis of lung cancer and 3 months after initial finding of metastatic disease. The rapid growth and spread of this cancer was surprising and knowledge of this cancer should be included in a differential diagnosis of expanding mandibular jaw lesions.

Management of fractures of the atrophic mandible: a case series.

OBJECTIVE: This study aims to report the outcome of patients with atrophic mandible fractures. STUDY DESIGN: Atrophic mandible fractures in 11 patients (7 females and 4 males) were approached with a transcervical incision, and bone segments were stabilized with 2.7-mm reconstruction titanium plates and locking screws placed at the lateral border of the mandible. In 6 of the 11 cases, autogenous cancellous bone was used to repair a continuity defect or to augment the vertical height of the bone in the region of the fracture(s). RESULTS: No major intraoperative or postoperative complications were encountered in any patient. Two patients presented with postoperative infections that resolved with incision-drainage and antibiotics, and removal or replacement of the reconstruction plates or the bone grafts was not required. CONCLUSIONS: Treatment of atrophic mandible fractures can be performed safely and effectively with reconstruction plates, with or without bone grafting. The most conservative and predictable treatment in the long term is the definitive reconstructive surgical procedure to restore form and immediate function.

Orthognathic surgery for correction of patients with mandibular excess: don't forget to assess the gonial angle.

PURPOSE: To evaluate the gonial angle (GA) and associated factors that can contribute to stability after bilateral sagittal split ramus osteotomy setback and Le Fort I advancement osteotomy for the treatment of patients with mandibular excess. MATERIALS AND METHODS: This retrospective study included 42 randomly selected, adult patients. Lateral cephalometric radiographs were obtained before and 1 week and 1 year after surgery. Patients in group 1 (n = 18) had a GA smaller than 125° and those in group 2 (n = 24) had a GA larger than 125°. Data were analyzed by analysis of variance and Pearson correlations. Multivariate linear regression analysis was used to identify factors that influenced postsurgical stability. RESULTS: Mean surgical changes were similar in the 2 groups. The mandible was set back an average of 5.4 mm in group 1 and 6.4 mm in group 2, whereas the maxilla was advanced 2.5 mm in group 1 and 1.7 mm in group 2. Statistically significant postoperative changes were noted for group 1 only. Relapse was found at the innermost point of the contour of the mandible between the incisor tooth and bony chin and the pogonion for the horizontal landmarks; the innermost point of the contour of the maxilla between the anterior nasal spine and incisor tooth and the menton for the vertical landmarks; and the GA, the angle between the sella-nasion line and the innermost point of the contour of the mandible between the incisor tooth and bony chin, and the esthetic plane to the upper lip for the dimensional landmarks. No statistically significant changes were noted for group 2 (GA >125°). CONCLUSION: Patients with a preoperative GA smaller than 125° have a greater risk of relapse after receiving bilateral sagittal split ramus osteotomy setback and Le Fort I advancement for the treatment of mandibular excess. Patients with a preoperative GA larger than 125° appear to have a more predictable procedure.

Quantification of human beta-defensin-2 and -3 in body fluids: application for studies of innate immunity.

BACKGROUND: Human beta-defensins (hBDs) are epithelial cell-derived antimicrobial and immunoregulatory cationic peptides. Our objective was to establish an analytical tool to quantify inducible hBD-2 and -3 in body fluids. METHODS: We developed sandwich ELISAs using commercially available capture and detection antibodies and determined optimal assay conditions (with 250 mmol/L CaCl(2)) to overcome masking by endogenous components of body fluids. We used recombinant hBD as calibrators and for recovery testing. RESULTS: hBD-2 and -3 detection limits were approximately 75 ng/L and approximately 3 microg/L, respectively. Mean (SD range) values in saliva samples from healthy donors (n = 60) were 9.5 (1.2-21) microg/L for hBD-2 and 326 (50-931) microg/L for hBD-3. We did not detect hBD-3 in suction blister fluid (BF; n = 10) or bronchoalveolar lavage (BAL; n = 5) from healthy participants. We detected low hBD-2 peptide concentrations in BF and BAL, 0.16 (0.03-0.32) and 0.04 (0-0.049) microg/g total protein, respectively. We observed no correlation of hBD-2 in BF and saliva or BAL and saliva from the same person. In vaginal swabs from healthy women (n = 2), mean hBD-2 and -3 concentrations were 3.42 and 103 microg/g total protein, respectively. Cervicovaginal lavage from the same women contained mean concentrations of 1.46 and 55.5 microg/g total protein. CONCLUSION: These ELISA assays can measure inducible hBD peptide concentrations in body fluids by overcoming masking effects of anionic molecules. This approach may therefore be applicable for quantifying these peptides in health and disease.