Otodental syndrome: a case presentation in a 6-year old child.

BACKGROUND: Otodental syndrome is a rare condition characterised by globodontia, and sensorineural high frequency hearing loss. To date, only 20 cases of otodental syndrome have been reported. CASE REPORT: A 6 year-old girl presented with a chief complaint of delay in the eruption of primary canines. Following clinical, radiographic and audiologic evaluations, the patient was diagnosed with otodental syndrome. CONCLUSION: Globodontia is a diagnostic feature of the otodental syndrome, which often provides the path to discovery of the associated hearing loss. Missing teeth, arch-size discrepancies, chewing problems and teething disturbances are the other major complications.

Development of a hardened THz energy meter for use on the kilojoule-scale, short-pulse OMEGA EP laser.

A highly adaptable and robust terahertz (THz) energy meter is designed and implemented to detect energetic THz pulses from high-intensity (>1018 W/cm2) laser-plasma interactions on the OMEGA EP. THz radiation from the laser driven target is detected by a shielded pyrometer. A second identical pyrometer is used for background subtraction. The detector can be configured to detect THz pulses in the 1 mm to 30 µm (0.3- to 10-THz) range and pulse energies from joules to microjoules via changes in filtration, aperture size, and position. Additional polarization selective filtration can also be used to determine the THz pulse polarization. The design incorporates significant radiation and electromagnetic pulse shielding to survive and operate within the OMEGA EP radiation environment. We describe the design, operational principle, calibration, and testing of the THz energy meter. The pyrometers were calibrated using a benchtop laser and show linear sensitivity to up to 1000 nJ of absorbed energy. The initial results from four OMEGA EP THz experiments detected up to ∼15µJ at the detector, which can correspond to hundreds of mJ depending on THz emission and reflection models.

Ameloblastic fibro-odontoma: a clinicopathologic study of 12 cases.

OBJECTIVE: The ameloblastic fibro-odontoma (AFO) is an uncommon odontogenic tumor occurring in childhood with limited reported data on recurrence. The purpose of this AFO study was to review its clinicopathologic features, investigate treatment modalities and establish a recurrence rate. STUDY DESIGN: The clinicopathologic features of 12 new cases of AFO were analyzed and compared with those of 208 cases from the literature, with special emphasis on the clinical behavior, treatment, and recurrence rate. RESULTS: The average age was 9.4 (+/- 6.7) years with a male-to-female ratio of 1.6:1. The mandible was the site of occurrence in 59.5%. The tumor most often presented radiographically as a unilocular mixed density lesion associated with the crown of an impacted tooth. Displacement of teeth, delayed eruption and bony expansion were commonplace. There were 5 recurrences among 68 cases with adequate follow-up for a recurrence rate of 7.4%. All recurrences were attributed to incomplete removal at the time of the initial surgery. CONCLUSIONS: The AFO is a childhood tumor most often affecting the posterior jaws and frequently causing bony expansion with profound affects on the dentition. Conservative surgical removal with extraction of the associated teeth is recommended. The established recurrence rate is less than 10%.

First measurements of remaining shell areal density on the OMEGA laser using the Diagnostic for Areal Density (DAD).

A glass Cherenkov detector, called the Diagnostic for Areal Density (DAD), has been built and implemented at the OMEGA laser facility for measuring fusion gammas above 430 keV, from which remaining shell ⟨ρR⟩ abl can be determined. A proof-of-principle experiment is discussed, where signals from a surrogate gas Cherenkov detector are compared with reported values from the wedge range filter and charged particle spectrometer and found to correlate strongly. The design of the more compact port-based DAD diagnostic and results from the commissioning shots are then presented. Once absolutely calibrated, the DAD will be capable of reporting remaining shell ⟨ρR⟩ abl for plastic and glass capsules within minutes of a shot and with potentially higher precision than existing techniques.

A picosecond beam-timing system for the OMEGA laser.

A timing system is demonstrated for the OMEGA Laser System that guarantees all 60 beams will arrive on target simultaneously with a root mean square variability of 4 ps. The system relies on placing a scattering sphere at the target position to couple the ultraviolet light from each beam into a single photodetector.

Intranuclear inclusions correlate with the ultrastructural detection of herpes-type virions in oral hairy leukoplakia.

Hairy leukoplakia (HL) is an Epstein-Barr virus-associated lesion of the oral mucosa that occurs in persons infected with human immunodeficiency virus. Ultrastructural studies have demonstrated herpes-type virions in 63-100% of cases of HL. In this investigation, incisional biopsy specimens from 52 consecutive patients with oral lesions clinically suspicious for HL were analyzed by light and electron microscopy to determine which light microscopic features correlated best with the presence of herpes-type virions ultrastructurally. The predominant histopathologic features consisted of irregular hyperparakeratosis, acanthosis, koilocytoid cells, and an absence of significant inflammation. Candidal organisms and bacterial colonies were variable findings. Intranuclear inclusions, identical to Cowdry type A inclusions seen in other herpesvirus infections, were observed in 46 cases and demonstrated the best correlation with the presence of virions ultrastructurally (p less than 0.0001). Koilocytoid cells also had a statistically significant correlation with the presence of virions (p less than 0.001). We conclude that Cowdry type A inclusions are present in many cases of HL and that their presence, when combined with the other clinical and histologic findings in these lesions, is the most specific light microscopic feature of HL.

Ultrastructural detection of herpes-type virions by negative staining in oral hairy leukoplakia.

Hairy leukoplakia (HL) is a newly recognized virus-associated lesion of oral mucosa that occurs in persons infected with human immunodeficiency virus. Studies have demonstrated Epstein-Barr virus within epithelial cells of HL. The authors examined 12 cases of HL by transmission electron microscopy to compare the use of a negative staining technique versus routine plastic embedment for the detection of viruses. Herpes-type virions were identified by both methods in 11 cases. One case had negative results for viruses by both methods. Negative staining is a simple and rapid technique that compares favorably with plastic embedment in the detection of herpes-type virions in HL.

Radiation sterilization of surgical instruments with a consideration of metal shielding on sterilization efficiency.

The feasibility of the use of radiation for sterilization of surgical instruments was evaluated. Two aspects were considered: radiation biology of relevant microorganisms, that is, bacterial spores and viruses, and shielding and radiation protection by the metal of the instruments. After proper cleaning and hot water machine washing, surgical instruments carry few, if any contaminants; however, subsequent handling increases the contamination load. Although large instruments may attenuate as much as 30% of the incident radiation, spores dried on the metal are sensitized to irradiation by some 40%. A dose of 25 kGy (2.5 Mrad) is adequate to inactivate a potential contamination load of approximately 10(7) bacterial spores or approximately 10(4) viruses. Therefore, 25 kGy will provide a high sterility assurance level, and can be recommended with a considerable degree of confidence for hospital-based sterilization of surgical instruments.

Fibrolipoma of the gingiva. A case report.

A case of gingival fibrolipoma is described. The lesion presented as a tumor-like mass with a broad base arising from the attached gingiva adjacent to the mandibular left first bicuspid. Microscopic evaluation of the lesion revealed an admixture of mature adipose tissue and fibrous connective tissue. Fibrolipomas are an infrequent variant of lipomas. A review of the literature indicates that a gingival location for such lesions is rare.

Subacute necrotizing sialadenitis: report of 7 cases and a review of the literature.

Subacute necrotizing sialadenitis (SANS) is a nonspecific inflammatory condition of unknown etiology affecting oral minor salivary glands. The lesion is most often characterized by a localized palatal swelling, accompanied by an abrupt onset of pain. In this report, we describe the clinical, microscopic, and ultrastructural features of 7 new cases of SANS and combine them with those of 15 cases previously published in the English language medical literature. Patient ages ranged from 15 to 45 years, with a mean age of 21.9 years. A male to female ratio of 3.4 to 1 was observed, but probably reflects a male sampling bias because 14 of the 22 cases occurred in a military population. Seventeen cases occurred on the hard palate, 4 on the soft palate, and 1 on the tonsillar pillar. The lesions were nonulcerated swellings ranging in size from 0.3 to 2.5 cm in diameter. All lesions except one were painful, and most had been present for a week or less at the time of diagnosis. Histopathologic features included diffuse involvement of minor salivary glands by lymphocytes, histiocytes, neutrophils, and variably by eosinophils. Loss of acinar cells, early acinar cell necrosis, and atrophy of ductal cells were also observed. Although possible viral particles have been reported ultrastructurally in some cases of SANS, none were observed in our study. SANS appears to be a self-limiting process with most cases resolving 2 to 3 weeks after biopsy. SANS has been questioned as an entity by some investigators who prefer to include it within the spectrum of necrotizing sialometaplasia. However, we believe there is justification for the separation of these 2 entities based on clinical and histopathologic parameters. Although the specific etiology of SANS remains unknown, it most likely represents an infectious process or perhaps an immune response to an unknown allergen.

Oncocytoid artifact of the parotid gland: a newly reported artifact.

Electrocautery can induce significant alterations in the connective tissues and epithelium of specimens removed for diagnostic or therapeutic purposes. When electrocautery is used during parotid surgery, it can cause an oncocytoid artifact. The alterations described in this article are enlarged, tightly packed serous acinar cells with coarse to granular eosinophilic cytoplasm, distinct cell borders, and round basal nuclei that on cursory microscopic examination resemble oncocytes with respect to morphology. These changes are seen in conjunction with other, more recognized changes secondary to electrocautery and are believed to occur as a consequence of the electrothermal discharge. On the basis of our findings, this artifact is common is parotid surgical specimens and was misdiagnosed as benign oncocytic lesions in 5 cases.

Ductal papillomas of salivary gland origin: A report of 19 cases and a review of the literature.

The term ductal papilloma is used to identify a group of 3 rare benign papillary salivary gland tumors known as inverted ductal papilloma, sialadenoma papilliferum, and intraductal papilloma. They represent adenomas with unique papillary features and arise from the salivary gland duct system. We describe the clinical and microscopic features of 19 new cases of ductal papillomas and combine them with 116 cases previously published in the English-language medical literature. These 19 cases were composed of 13 inverted ductal papillomas, 3 sialadenoma papilliferums, and 3 intraductal papillomas. Collectively, these 19 ductal papillomas occurred most commonly in the sixth to eighth decade of life, with an average patient age of 54 years. Men predominated 1.37:1. The sialadenoma papilliferums presented as papillary lesions clinically with all 3 misinterpreted as squamous papillomas by the surgeons. The inverted ductal papillomas and intraductal papillomas appeared as submucosal nodules. The lip and the palate were the most common locations for inverted ductal papilloma and sialadenoma papilliferum, respectively. The sites for the 3 intraductal papillomas were the parotid papilla of the Stensen's duct, the upper lip, and the buccal mucosa. With light microscopy, inverted ductal papillomas appeared to arise from the excretory ducts near the mucosal surface, whereas intraductal papillomas appeared to arise from the excretory ducts at a deeper level. Sialadenoma papilliferum had a more complex histology, with a biphasic growth pattern of exophytic papillary and endophytic components. All 19 cases were treated by surgical excision. Follow-up information was available in only 2 cases, both inverted ductal papillomas. Neither case recurred during a 20-year period. Sialadenoma papilliferum, with a literature-derived recurrence rate of 10% to 15%, seems to assert a more significant biological behavior than inverted ductal papilloma and intraductal papilloma. Our findings justify the separation of these 3 entities based on clinical and histologic parameters. They are tumors of adulthood and, in addition, have in common their relationship to the excretory duct system, their anatomical distribution, and their general behavior.

The role of the dental hygienist in mass disasters.

The authors examine the specialty of dental hygiene and address its role in the identification of mass-disaster fatalities. Very little exists in the literature on what dental hygienists can often and what they have contributed as members of dental-identification teams. To encourage forensic dentists to seek out the valuable assistance of these highly trained professionals, the authors illustrate how their services can be used in mass disasters.

Problems in mass-disaster dental identification: a retrospective review.

A wide variety of problems may prevent or hinder a dental-identification (ID) team in its efforts to identify mass casualties. Since these problems have been infrequently reported in a comprehensive manner, the authors identified and summarized these problems to increase the awareness of dental-ID team members and to prepare them for future mass-disaster missions. The authors analyzed 50 mass disasters--ten in which the authors as members of military dental ID teams played a major role and 40 from the literature--and summarized problems that they confronted.

Tenerife revisited: the critical role of dentistry.

The authors record the contribution of dentistry to the identification of victims of one of the most significant disasters in the history of aviation-the March 1977 collision of two Boeing 747 jumbo jets in the Canary Islands, which resulted in 583 fatalities. Dental identification was the primary method of victim identification because a high percentage of the bodies were severely burned. Virtually all aspects of the U.S. identification efforts have been reported with the exception of the valuable role of dentistry. The dental team's organization, methodology, and significant contributions to forensic dentistry and a variety of remarkable problems that the team encountered are documented.

Individuality of human palatal rugae.

Investigators have implied that palatal rugae are unique to each individual. However, these researchers have disagreed as to whether or not legal identification could be based solely on palatal rugae. Previous studies used poor duplicating materials and may not have considered the effects of growth, extractions, palatal expansion, or some combination of these. The inadvertent use of other features of the cast, such as teeth, edentulous ridge morphology, muscle attachments, vestibular depth, or some combination of these, to aid in the identification, may have influenced their results. The purpose of this investigation was to determine if palatal rugae can be relied upon for identification. Twenty-five orthodontic cases were selected with pre- and post-treatment casts; orthodontic treatment had taken eighteen to sixty months. One hundred casts were randomly selected as variables. All casts were trimmed so that all areas except for the rugae area of the hard palate were removed. The twenty-five post-orthodontic casts were dispersed within 100 randomly selected casts. Nine investigators were given the twenty-five pre-orthodontic casts and asked to compare them to the other one hundred and twenty-five casts for possible matches. Data were collected as to percentage of correct matches and time required for comparison. Each set of pre- and post-orthodontic casts was properly identified (100%) by 8 investigators, and the remaining investigator correctly matched 22 out of 25 casts (88%). These conclusions were drawn.(ABSTRACT TRUNCATED AT 250 WORDS)

Dermal analogue tumours of major salivary glands.

Monomorphic adenomas of the major salivary glands manifest a histologic spectrum whose diversity rivals that of pleomorphic adenomas. In nearly all forms of monomorphic adenomas there are histologic features which recall stages in the embryonic development of salivary glands and/or adenexae of skin. A close histogenetic relationship between certain monomorphic adenomas and certain adenexal tumours of skin is suggested by the findings of this report. Within the diversity of expression found in monomorphic adenomas are subsets of tumours which are analogous and nearly homologous with dermal appendage tumours, especially the dermal eccrine cylindroma. The analogous relationship is carried further by a proposed diathesis in which patients exhibit histologically similar tumours in their salivary glands and skin.

Bilateral traumatic bone cysts of the mandible: an unusual clinical presentation.

This case report describes an unusual clinical presentation of bilateral traumatic bone cysts of the mandible. These lesions presented clinically as bilateral dentigerous cysts associated with the mandibular third molar teeth. Because of this unusual presentation, a combination of clinical examination, thorough history, radiographic studies, surgical exploration, and microscopic evaluation was necessary in order to render a definitive diagnosis on this case. Knowledge and awareness of these features are important to assist in the initial diagnosis as well as patient management and follow up.

Utilization of an oral pathology service: a professional responsibility.

The role of oral pathologists as members of the comprehensive health care team is reviewed. The importance of utilizing an Oral Pathology Service in the everyday practice of dentistry and medicine and the inherent medicolegal considerations are discussed. Standards of care for submission of surgically removed oral tissues is an issue that warrants further delineation.

Peripheral ossifying fibroma--a clinical evaluation of 134 pediatric cases.

PURPOSE: Reported clinicopathologic studies on the peripheral ossifying fibroma (POF), a reactive gingival lesion, have not addressed the pediatric population in specific detail. This study, the first devoted to children, investigated the clinical features of a large number of POFs and compared the findings to cases reported in the English language literature. METHODS: Detailed clinical and historical information of 134 surgically removed POFs in patients aged 1-19 formed the basis of this study. Clinical manifestations, histogenesis, treatment rationale with pediatric considerations, and biologic behavior were emphasized. RESULTS: The POF was found more frequently in females (60%). It had a predilection for the maxillary gingiva (60%) and for the incisor/cuspid region. The average patient age was 14 years. Only 2 (1%) POFs were found to be unequivocally associated with primary teeth. The clinician seldom included the POF in the differential diagnosis. The recurrence rate after surgical excision was 8%. CONCLUSIONS: This study revealed that a POF arising from the periodontal ligament of a primary tooth is most likely a rare event. However, the pediatric patient with a POF has special management considerations compared to the adult. Because of the POF behavior pattern, a proper treatment protocol is warranted with close postoperative follow-up.