Globulomaxillary cysts--do they really exist?

OBJECTIVES: The so-called "globulomaxillary cyst", described as a fissural cyst, caused by entrapped epithelium between the nasal and maxillary process, is no longer considered for its own entity. Nevertheless, cystic lesions, which correspond to the previous image of globulomaxillary cysts, do still occur in daily practice. This raises the question to which entities pathological processes in this particular region actually belong to. MATERIALS AND METHODS: In a retrospective study, 17 cases (12 men and 5 women, 12-59 years old) of primarily diagnosed globulomaxillary cysts are analysed according to clinical, radiological and histological aspects, catamnestic processed and assigned to a new entity. The results are compared with the international literature and draws conclusions on the diagnostic and therapeutic procedure. RESULTS: Seven lateral periodontal cysts, four radicular cysts, two keratocystic odontogenic tumours, one adenomatoid odontogenic tumour, one periapical granuloma, one residual cyst and one undefined jaw cyst were determined. CONCLUSIONS: According to the results of our study and the data from the international literature, the entity globulomaxillary cyst is no longer justified.

Cancer stem cell-like cells from a single cell of oral squamous carcinoma cell lines.

Resistance of oral squamous cell carcinomas (OSCC) to conventional chemotherapy or radiation therapy might be due to cancer stem cells (CSCs). The development of novel anticancer drugs requires a simple method for the enrichment of CSCs. CSCs can be enriched from OSCC cell lines, for example, after cultivation in serum-free cell culture medium (SFM). In our study, we analyzed four OSCC cell lines for the presence of CSCs. CSC-like cells could not be enriched with SFM. However, cell lines obtained from holoclone colonies showed CSC-like properties such as a reduced rate of cell proliferation and a reduced sensitivity to Paclitaxel in comparison to cells from the parental lineage. Moreover, these cell lines differentially expressed the CSC-marker CD133, which is also upregulated in OSCC tissues. Interestingly, CD133(+) cells in OSCC tissues expressed little to no Ki67, the cell proliferation marker that also indicates reduced drug sensitivity. Our study shows a method for the isolation of CSC-like cell lines from OSCC cell lines. These CSC-like cell lines could be new targets for the development of anticancer drugs under in vitro conditions.

SAPHO syndrome with ankylosis of the temporomandibular joint.

SAPHO syndrome is a rare combination of different symptoms with unknown aetiology. A complete ankylosis of the temporomandibular joint (TMJ) in a patient with SAPHO syndrome has not been described previously. The goal of this case report is to present the disease, give an overview about the frequency of mandibular involvement and describe different therapeutic strategies. The complication of an ankylosis of the TMJ is noted and the literature is reviewed. The authors report a 42-year-old patient with SAPHO syndrome and recurrent swelling of the right mandible and the soft tissue. The persisting involvement of the mandible resulted in a complete osseous ankylosis of the right TMJ and required resection with alloplastic replacement of the right condyle. SAPHO syndrome should be suspected in some cases of 'therapy resistant osteomyelitis' of the mandible. Smaller joints, such as the TMJ may also be affected. Treatment of SAPHO syndrome should include antibiotics and NSAIDs; corticosteroids may be helpful. Surgery is the ultimate treatment.

Historical development of alloplastic temporomandibular joint replacement after 1945 and state of the art.

The variety of temporomandibular joint (TMJ) prostheses and condylar reconstruction plates available is in contradiction to their rare application. This emphasizes that alloplastic TMJ reconstruction is still evolving. This article reviews the history of TMJ reconstruction. Medline as well as public and private libraries have been searched. Current systems are reviewed. Prosthetic devices can be differentiated into fossa-eminence prostheses, ramus prostheses and condylar reconstruction plates, and total joint prostheses. Fossa and total joint prostheses are recommended when the glenoid fossa is exposed due to excessive stress (degenerative disorders, arthritis, ankylosis, multiply operated pain patients). Singular replacement of the condyle is preferred as a temporary solution in ablative surgery. The use of prosthetic devices for long-term replacement should be restricted to selected cases, taking care to retain the disk, in order to prevent penetration into the middle cranial fossa. The term 'condylar reconstruction plate' reflects this more clearly than 'ramus prosthesis' which suggests permanent reconstruction. Long-term studies comparing the functional and aesthetic results of the various prostheses and condylar reconstruction plates are not available, which leaves the choice to personal experience.

Recurrent aneurysmal bone cyst of the mandibular condyle with soft tissue extension.

The case of a 17- year-old female patient with a destructive aneurysmal bone cyst of the right mandibular condyle is presented. Surgery revealed an eggshell thin, partly perforated remaining condylar cortex with extension of the lesion into the surrounding soft tissues. Condylar resection with curettage of the adjacent soft tissues and recurrence prophylaxis with intranasal calcitonin for 1 week could not prevent recurrence after 6 months. In a second operation the ascending mandibular ramus was partly resected and immediately reconstructed with a newly developed alloplastic condylar head add-on system. This time the lesion was intraoperatively completely surrounded by solid cortical bone.

Oral cytology revisited.

During the last decade, oral cytology has once again become the focus of scientific research. This new interest is due to the introduction of a cytobrush for cell collection as well as a computer-assisted analysis (Oral CDx). Although promising, the sensitivity and specificity of conventional oral brush cytology remains limited. To circumvent the problems and improve the accuracy, various adjunctive analytical methods have been attempted. DNA analysis, immunocytochemical and molecular analysis are suggested methodological cytology approaches to improve the validity of oral brush cytology. An increase in sensitivity (up to 100%) and specificity (up to 100%) of oral brush biopsy has been reported on localized pre-malignant and malignant lesions. Oral brush biopsy probably will not replace histopathology in the definitive diagnosis of oral cancer, but it might be valuable for the prevention of misdiagnosis of clinically doubtful oral lesions and for the monitoring of lesions that might proceed on to oral cancer.

Maxillary sinus anatomy: a cadaveric study with clinical implications.

This study measured maxillary sinus volume, evaluated the location of the semilunar hiatus in correlation to the nasal floor, and the incidence, location, and height of antral septa and discusses their clinical implications. Maxillary sinus volume was quantified in 65 cadavers (130 sinuses) by water application through the semilunar hiatus and measuring the used amount. The location of the semilunar hiatus was identified as distance from the nasal floor. The septa were counted, evaluated, and the size measured from the antral floor. The medium maxillary sinus volume was 12.5 mL (range, 5-22 mL). The medium location of the semilunar hiatus was 25.6 mm above the nasal floor (range, 18-35 mm). Thirty-five septa were counted in 130 maxillary sinuses. This equals an incidence of 27%. The medium height of the septa was 5.4 mm (2.5-11 mm). The main location of the septa was the region of the first molar (29%), the second molar (23%), and the second premolar (23%). The height, location, and number of septa as well as the height of the semilunar hiatus and volume of the maxillary sinus have to be taken into consideration to correctly plan the procedure and amount of grafting material in maxillary sinus floor elevation operations.

Epidermal growth factor receptor kinase domain mutations are rare in salivary gland carcinomas.

Activating mutations within the epidermal growth factor (EGFR) tyrosine kinase domain identify non-small cell lung cancer patients with improved clinical response to tyrosine kinase inhibitor therapy. Recently, we identified two EGFR mutations in a cohort of 25 salivary gland carcinomas (SGCs) by screening the tumour samples for the both most common hotspot mutations in exons 19 and 21 by allele-specific PCR. Here, we present a comprehensive sequencing analysis of the entire critical EGFR tyrosine kinase domain in 65 SGC of the main histopathological types. We found EGFR mutations in the tyrosine kinase domain to be a rare event in SGCs. No additional mutations other than the two known exon 19 deletions (c.2235_2249del15) in a mucoepidermoid carcinoma and an adenoid cystic carcinoma have been detected. Other putative predictive markers for EGFR-targeted therapy in SGCs might be relevant and should be investigated.

Overexpression of EGFR and absence of C-KIT expression correlate with poor prognosis in salivary gland carcinomas.

AIMS: To evaluate the prognostic impact of expression of receptor tyrosine kinases epidermal growth factor receptor (EGFR), HER2, and C-KIT in relation to established clinicopathological parameters in salivary gland carcinomas. METHODS AND RESULTS: Immunohistochemistry for EGFR, HER2, C-KIT and the proliferation marker Ki67 was performed in 101 cases of salivary gland carcinoma and related to long-term clinical follow-up. Immunopositivity of C-KIT was common in adenoid cystic carcinoma (92%). Lack of C-KIT expression occurred in salivary duct carcinoma (P < 0.001) and was associated with high-grade tumours (P = 0.002), positive lymph nodes (P = 0.002) and high expression of Ki67 (P = 0.001). HER2 was typically expressed in salivary duct carcinomas (83%), but was not associated with any other parameter. EGFR overexpression occurred independently of histological type and clinical parameters. On univariate survival analysis, overexpression of EGFR (P = 0.011) and lack of C-KIT (P = 0.014) were associated with worse prognosis, whereas HER2 was of no prognostic significance. On multivariate analysis, the strongest negative predictor of survival was high proliferative activity measured by Ki67 (P = 0.002), followed by presence of residual tumour (P = 0.006), overexpression of EGFR (P = 0.026) and advanced tumour stage (P = 0.041). CONCLUSIONS: The expression of receptor tyrosine kinases confers additional prognostic impact on disease-specific survival. EGFR overexpression is an independent negative prognostic factor.

[Re-re-relapse of a MALT lymphoma of the conjunctiva]. / Re-Re-Rezidiv eines MALT-Lymphoms der Bindehaut.

BACKGROUND: The MALT lymphoma (mucosa-associated lymphoid-like tissue lymphomas) is a rare entity and belongs to the low-grade non-Hodgkin (NHL) lymphomas. In 8 % of cases it arises in the conjunctiva. In some cases a MALT lymphoma of the conjunctiva is misdiagnosed as chronic conjunctivitis. Mostly a MALT lymphoma of the conjunctiva can be cured by radiation and has a good prognosis. CASE REPORT: A 61-year-old female presented to our hospital because of alteration of the conjunctiva and worsening of her general condition. Symptoms were fatigue, lassitude, night sweat, loss of appetite and gastrointestinal problems. The medical history revealed treatment for a MALT lymphoma 4 years previously and a relapse 3 years previously. Both were resected totally. Staging at those times gave no hint for metastases. The ophthalmological examination showed an adherent prominence with conjunctival injection of the right eye at 10 - 11 o'clock. It corresponded to the localisation of the primary tumour in 2002 and the relapse in 2003. Slit lamp and fundoscopic examinations only revealed a cataracta incipiens. CLINICAL COURSE: To confirm the diagnosis a biopsy was done. The histological examination demonstrated a relapse of the MALT lymphoma. Staging gave no hint for metastases. The patient was referred to the oncological unit for chemotherapy (R-CHOP regime). CONCLUSION: This case shows that a relapse of the MALT lymphoma may arise although the previous tumour and its relapse were resected totally. In patients with tumours in their medical history suffering from unspecific discomfort, a biopsy should may be be considered despite the lack of apparent macroscopic findings.

Concepts for the treatment of adolescent patients with missing permanent teeth.

INTRODUCTION: Missing permanent teeth is observed with syndromes or is frequently hereditarily propagated in families. The treatment of these patients is a multi-task of specialists of oral surgery, orthodontics and prosthodontics. DISCUSSION: Despite functional and aesthetic considerations, the main problem of all treatment is that it had to be performed in a growing child. This article discusses the conventional and implant-driven concepts to treat patients from childhood to adolescence with selective or multiple missing permanent teeth.

The value of Allen's test in harvesting a radial forearm flap: correlation of ex-vivo angiography and histopathological findings.

The radial forearm flap is one of the most commonly raised free flaps. In most cases an Allen's test is sufficient for preoperative assessment of the palmar arch, but an intact palmar arch does not imply that the radial artery is suitable for microvascular anastomosis. For a patient operated for oral squamous cell carcinoma, reconstruction was planned with a radial forearm flap. The flap had to be discarded because of advanced atherosclerosis in the presence of a negative Allen's test. The correlation of an ex-vivo angiography and the histopathologic findings was assessed. In cases of expected vascular disease, further examinations like color flow Doppler ultrasound are recommended to ensure sufficient perfusion of the radial artery.

[Prognostic value of immunohistochemistry in salivary gland cancer]. / Immunhistochemie als Prognoseindikator bei Speicheldrüsenkarzinomen.

BACKGROUND: The diversity of salivary gland malignancies as to morphology and clinical course makes it difficult to establish prognostic factors. The aim of this study was to evaluate the prognostic significance of, a. o., immunohistochemical criteria in a retrospective study of salivary gland cancer. PATIENTS AND METHODS: Clinical and histologic data were recorded for 101 patients with carcinomas of the salivary glands. Immunohistochemistry was performed for Ki-67, P53, C-KIT, HER2, EGFR, and maspin. Correlations to disease-specific long-term survival (mean follow-up 4.7 years) were followed by univariate and multivariate analysis. RESULTS: Findings included the following: an association between loss of maspin and the presence of nodal metastasis, residual tumour, and poor overall survival for adenoid cystic carcinoma; common C-KIT expression in adenoid cystic carcinoma (92%); correlation of loss of C-KIT with high malignancy grade, nodal metastases, high proliferative activity (Ki-67>30%), and unfavourable survival in all tumours; common HER2 expression (83%) in salivary duct carcinoma but no relation to the total collective's survival. Overexpression of EGFR was associated with poor survival rates. In multivariate analysis, a high proliferation index was the strongest predictive factor, followed by the presence of residual tumour, overexpression of EGFR, and advanced clinical stage. CONCLUSIONS: The clinical stage is of higher prognostic value than histology and grade of malignancy. High proliferative activity (Ki-67>30%) is the strongest negative predictor in salivary gland cancer. Besides well-known clinicopathological factors, current immunohistochemical markers such as maspin, EGFR, and C-KIT can contribute to establish prognosis in salivary gland cancer.

[Performance of conventional oral brush biopsies]. / Wertigkeit der konventionellen oralen Bürstenbiopsie.

BACKGROUND: This study evaluated the performance of oral brush biopsies using standard morphological analysis and haematoxylin and eosin (HE) staining for detecting oral squamous cell carcinomas and their respective precursor lesions PATIENTS AND METHODS: Brush biopsies were obtained in 169 consecutive patients who underwent routine biopsies and histological examination for clinically suspicious oral lesions. Air-dried smears were processed by acetone fixation and HE staining. Cytological assessment used well-established criteria of atypia to classify the specimen as either "tumor negative" (no signs of atypia, no malignant cells) or "tumor positive" (malignant cells, any sign of atypia or doubtful cells). RESULTS: Despite a sufficient number of cells, a definite cytological diagnosis could not be established in six cases. According to the criteria specified above, these specimens were classified as "tumor positive." The cytological analysis identified 49 out of 62 oral malignancies (sensitivity 79%). Seven out of 107 benign lesions were classified as false positive (specificity 93%). The positive and negative predictive values were each 88%. CONCLUSION: Oral brush biopsies will identify only about 80% of oral malignancies when the smears are processed by routine HE stains and are analysed via standard morphological criteria. Thus, this technique should not be used for diagnostic proof or to exclude malignant cells in a lesion suspicious for cancer. However, oral brush biopsy provides a versatile back-up strategy to uncover the true nature of the disease if a lesion is clinically considered benign by mistake.

[Traumatic dislocation of the globe into the maxillary sinus--is a rehabilitation possible?]. / Ist eine Rehabilitation nach einer kompletten Bulbusluxation in die Kieferhöhle bei Orbitabodenfraktur möglich?

BACKGROUND: The complete traumatic dislocation of the globe into the maxillary sinus after orbital floor fractures is a very rare event. It results from direct transmission of a traumatic force which impinges the orbital frame or may result from an increasing pressure to the orbital contents. Diplopia or evidence of a displaced globe necessitates an exploration and reconstruction of the orbital floor. CASE REPORT: A 62-year-old male was admitted to our hospital because of a blunt injury to the orbital region caused by a machine for planing timber. On examination the patient had a massive right periorbital haematoma and no globe was visibly found. The CT scan revealed a blow-out fracture of the orbital floor with a complete dislocation of the right globe into the right maxillary sinus. Using a bright flashlight on the right maxillary region the patient reported light perception. The operative exploration showed no impaired integrity of the globe, no apparent laceration of the orbital muscles and a preserved continuity of the optic nerve. The dislocated globe was repositioned manually into the orbit and secured by an antral balloon catheter. CLINICAL COURSE: Postoperative magnetic resonance imaging showed a correct anatomic status. The muscles did not seem to be lacerated and the continuity of the optic nerve was demonstrated. Incarcerations were not existent. 9 months postoperatively the vision recovered to 1.0 p. The motility was slightly diminished (elevation and abduction 20 degrees, adduction 25 degrees and downwards 20 degrees over midline). The patient suffered from diplopia when looking 25 degrees to the right and 20 degrees upwards. The anisocoria with a slight dilation of the pupil had declined in the right eye but was still present. CONCLUSION: This case of complete dislocation of the globe into the maxillary sinus demonstrates that only few injuries may result and that after operative reconstruction of the orbital floor a good functional result can achieved.

Laminin-5 immunocytochemistry: a new tool for identifying dysplastic cells in oral brush biopsies.

BACKGROUND: The brush biopsy technique is not only a seminal technique but also a critically discussed method for detection of oral pre-cancerous stages and manifest carcinomas. The gamma2 chain of laminin-5 and its proteolytic fragments comprise an invasion factor for many carcinomas. OBJECTIVES: The aim of this study was to determine whether the immunocytochemical presentation of the laminin gamma2 chain identifies pre-invasive or invasive squamous cells in brush biopsies. METHODS: The value-based identification of atypical epithelia was analysed in 93 consecutive brush biopsies with histopathological diagnoses: standardized haematoxylin and eosin staining; standardized immunocytochemistry: monoclonal antibodies against laminin gamma2 chain: D4B5, 4G1, detection using ChemMate and Autostainer. RESULTS: Conventional cytology did not result in any false-positive cases, i.e. atypical cells in normal, inflamed or benignly hyperproliferative mucosa (specificity, 100%), whereas immunocytochemistry revealed one false-positive case (specificity, 98%). In brush biopsies of oral squamous cell carcinomas, the following immunocytochemical patterns were possible: (1) staining of the cytoplasm, (2) banded markings between clumped carcinoma cells and (3) positive hazes surrounding atypical cells. Bacterial colonies appeared as false-positive results. Four of 27 carcinomas and one of three recurrences were not cytologically identified (sensitivity of conventional cytology, 79%). Three of the five carcinomas not identified by cytology were immunocytochemically stained with laminin gamma2 chain antibody (sensitivity of laminin gamma2 chain immunocytochemistry, 93%). The positive predictive value was 100% for conventional cytology and 97% for laminin gamma2 chain immunocytochemistry. The negative predictive value attained was 92% for conventional cytology and 97% for laminin gamma2 chain immunocytochemistry. CONCLUSIONS: The high sensitivity level observed for method-enhanced brush cytology suggests that this technique be used as an initial diagnostic step.

[New condylar head system for temporary condylar reconstruction in ablative tumour surgery]. / Neu entwickeltes Kiefergelenkkopfimplantat zur temporären Kondylus-Rekonstruktion in der ablativen Tumorchirurgie.

BACKGROUND: Based on own retrospective studies a condylar head add-on system for immediate, temporary reconstruction in patients undergoing ablative surgery requiring the removal of the manibular condyle has been developed in cooperation with the Department of Oral and Maxillofacial Surgery of the University of Tennessee, USA, and the Association for the Study of Internal Fixation (AO/ASIF). PURPOSE: The design of the new condylar head add-on system and its use in an anatomical dissection study on a human cadaver are introduced and discussed. DESIGN AND FIRST EXPERIENCES: The condylar replacement is made of commercial pure titanium and is conceived as an add-on system. It consists of a reconstruction plate (2.4 Uni-LOCK-System) und an adaptable condylar head that can be fitted on either side. The offset of the condylar head in a medial direction allows anatomically correct positioning of the implant. The slanted oval head shall provide a large contact area while maintaining function of the mandibular joint. The height-adjustable positioning of the condylar head add-on with four different fixations plates facilitates an intraoperative vertical correction of the condylar head without necessary bending of a new reconstruction plate. A condylar head add-on used on both sides and combined with the frequently used 2.4 Uni-LOCK-plate benefits from reduced storekeeping and turns out to be advantageous from an economic point of view. PERSPECTIVE: An international, prospective multi-center study evaluating the intraoperative applicability of the new condylar head add-on system and its functional as well as aesthetic results during the first two postoperative years has started in September 2006.