Clinical approach to rhizomicry based on a case of dentine dysplasia type 1.

Differential diagnosis of generalised rhizomicry (root dwarfism) includes many diseases and syndromes. When the patient has normal stature with no evidence of ghost teeth, no systematic diseases and no history of irradiation or chemotherapy, the dental features are pathognomonic for the diagnosis of dentine dysplasia type 1 (DD-1). In this report, we presented an adult case with DD-1 that had been left undiagnosed and the patient underwent dental implant therapy and orthodontic treatment, despite recognition of early tooth loss. The diagnosis of DD-1 was first established before an orthognathic surgery to correct the facial skeletal deformity. We also reviewed the clinicopathological aspects of this disease and clinical dental implications for this patient group.

Which characteristics can be expected from p16+-squamous cell carcinomas of the posterior oral cavity and oropharynx? - Distinctive results from Central Germany.

PURPOSE: Human papillomaviruses (HPV) link to a subset of head and neck squamous cell carcinomas (HNSCC). Our aim was to identify clinicopathological characteristics (CPC) of squamous cell carcinomas of the posterior oral cavity and oropharynx (SCCPOCO) associated with HPV p16+. METHODS: Using a retrospective cohort study design, we enrolled a sample of SCCPOCO patients treated in a Central German hospital over a 3-year period. The predictor variables: CPCs, were grouped into demographic, social, anatomic and prognostic. The main outcome variable was p16+. Appropriate statistics were computed, and P≤0.05 was considered statistically significant. RESULTS: Of 199 HNSCC patients, 23 had SCCPOCO and entered the analysis (mean age, 67±12 years; 4 females; 16 in stage I; 4 p16+; 22 underwent primary surgery). We found 8 cervical lymph node metastases (34.8%), 3 distant metastases (13%), 9 recurrences (30.1%) and 3 overall deaths (13%). With the exception of recurrence (P=0.006) and overall death (P=0.02), p16+ was not associated with predictor variables: young age, male gender, smoking, alcohol consumption, tumor location, TNM stages, time to recurrence, metastases, death from disease and survival of smokers (P>0.05). Primary brachytherapy failed to improve survival of p16+-SCCPOCO patients (P=0.04). CONCLUSIONS: The results of this study suggest that p16+- and p16--SCCPOCOs in Central Germany share similar CPCs, except recurrence and overall death. Upfront surgery with/without radio(chemo)therapy is recommended for all operable SCCPOCOs, regardless of HPV-status. Patients with p16+-SCCPOCOs require close follow-up. Future research should investigate the cause of these distinctive CPCs.

Intraoperative injection of combined fibrin sealant and methylene blue dye for surgery of branchial cleft cysts: A case report.

Differential diagnosis of a lateral neck mass, especially in paediatric patients, should include branchial cleft cysts (BrCC). It is often difficult to identify and completely resect all cystic components, especially when the lesion becomes infected and/or gigantic. Incomplete excision increases the likelihood of recurrences. We reported a simple technique to facilitate the BrCC resection. Tisseel fibrin glue (FG: Baxter AG, Vienna, Austria) was mixed with methylene blue dye in inverse portion to the cyst size and/or the FG volume before injecting into the cystic lumen. After polymerisation of the dyed glue, the lesion was better visualised and extirpated in toto with the aid of the dye colour and gelatinisation by FG. An up-to-date diagnostic and therapeutic algorithm for BrCC was also presented.

Oral lichenoid lesion related to dental amalgam: A case report.

Dental amalgam remains one of standard direct restorative materials for posterior teeth. However, direct contact of oral mucosa with this material can cause oral lichenoid lesion (OLL), albeit rare. It has been proposed that hypersensitivity reaction to mercury is responsible to the pathogenesis of OLL. In addition to clinical features and histopathological examination, allergic patch test and removing the suspected causal material are pivotal to the diagnosis. We reported a case of OLL associated with dental amalgam. The lesion subsided clinically after replacement of amalgam with resin composite material with no need of biopsy or pharmacological treatment. A concise review of clinico-pathological aspects and current recommendations on management of this disease was also presented.

Fibular flap for mandibular reconstruction: are there old tricks for an old dog?

Fibular free flap is considered as an "old dog" in reconstructive surgery because it was first described by Taylor and his colleagues in 1975, and was then introduced for mandibular reconstruction by Hidalgo in 1989. There are some "tricks" for fibular free flap that have been used and recognized in many European maxillofacial surgical units over the past decade. These include: 1) harvesting the distal fibula when recipient vessels are distant; 2) flap selection based on the anatomy of perforators; 3) use of the skin paddle for postoperative flap monitoring; 4) protection of the flap's soft-tissue cuff; 5) preventing venous thrombosis which is essential to reduce flap complications; 6) aligning fibular struts and protecting the vascular pedicle when the double-barrel technique is used; 7) minimizing the gap between the double-barrel struts and implementing a long-term follow-up of dental implants; 8) selecting osteosynthesis materials; and 9) learning curve and clinical competence in microvascular reconstruction. We also reviewed current data from the literature, which would be useful for maxillofacial reconstructive surgeons. With these tricks, one can teach an "old dog" "old tricks".

Unicystic ameloblastoma of the maxillary sinus: Pitfalls of diagnosis and management.

BACKGROUND: Ameloblastoma is a common odontogenic tumor of the jaws that comprises 3 variants: conventional (solid), unicystic and peripheral ameloblastomas. Unicystic ameloblastoma (UA) in the maxillary sinus is very rare. With a secondary infection, the clinical features may lead to incorrect diagnosis and treatment. PATIENTS AND METHODS: A 19-year-old man was referred for the management of sinusitis and a mass at the right cheek. A few weeks earlier, the patient presented with acute cellulitis at the same area and underwent an incision and drainage in a primary care unit without any appropriate investigation. A radiographic examination revealed a massive lesion in the right maxillary sinus. An unerupted tooth within the lesion was found at the level of the orbital floor. RESULTS: The patient was successfully treated by enucleation of the tumor and curettage. The specimen was sent for histopathological examination, and the definite diagnosis was UA. The patient has been followed-up periodically for 5 years without recurrence. DISCUSSION: This case report suggests that primary care doctors should pay attention to differential diagnosis of orofacial lesions. It is therefore of great benefit to organize continuing education for general physicians who initially meet oral disease patients as a 'gate keeper'. Errors of clinical diagnosis and management of orofacial lesions would be minimized. Pitfalls of diagnosis and management of UA in the maxillary sinus were briefly reviewed.

A treatment algorithm for managing giant mandibular ameloblastoma: 5-year experiences in a Paris university hospital.

AIMS: To review our experiences with giant mandibular ameloblastoma (GMA) over a 5-year period, and to formulate a treatment algorithm for managing this tumour. METHODS: We retrospectively reviewed all GMA patients who underwent segmental mandibulectomy and immediate free fibular osteoseptocutaneous flap reconstruction (SM-IFFOFR) by a single reconstructive team from 2002 to 2006. All treatment methods and outcomes were analysed. FINDINGS: Forty-four ameloblastoma patients were operated upon during this study period. Sixteen cases had GMA, of which 9 patients were included in this series (mean age: 35 years). The defects in the mandible ranged from 7 to 16 cm in length (mean: 12 cm). The average length of the harvested fibula was 11 cm, and the number of osteotomies ranged from 1 to 2. The mean ischemic time was 137 min (range: 90-180 min). Neck recipient vessels were used for flap perfusion in all cases. All but one flaps were viable without any complications, whilst partial skin-island necrosis occurred in 2 patients. Hospital stay was 2 weeks in most of the patients. No tumour recurrence was found during the follow-up period (range: 26-73 months). Dental implants were placed in 2 patients. CONCLUSIONS: Despite several limitations of this study, we suggest that a radical approach with the SM-IFFOFR is an effective treatment for GMA. Further well-designed, larger series with longer follow-up periods are still encouraged.

An analysis of studies on piezoelectric surgery in the oral and craniomaxillofacial region with regard to human subject protection and financial conflicts.

This retrospective, observational study investigated whether published studies on the use of piezoelectric surgery (PS) in the oral and craniomaxillofacial region fulfilled the requirements of the International Committee of Medical Journal Editors (ICMJE) and the Declaration of Helsinki (DoH) with respect to human subject protections (HSP) and disclosure of financial conflicts (FC). A Medline/PUBMED search was performed in April 2008 to identify all clinical studies on PS, published in English, French and German. Disclosure of HSP (obtaining ethical approval and subjects' informed consent) and FC mentioned in the retrieved articles were analysed. 29 clinical articles were identified in 18 journals, of which 14 journals (78%) required the disclosure of both HSP and FC. Ethical approval was documented in two studies (7%); patient consent was reported in four publications (14%). Four articles disclosed no FC. 21 reports (72%) mentioned neither HSP nor FC. The relationships between funding source and study outcomes could not be identified. Most studies on the use of PS hardly adhered to the regulations recommended by the ICMJE and DoH, and do not mention HSP and FC, indicating the study results with a high degree of suspicion. It is recommended that oral and craniomaxillofacial surgery journals adhere strictly to these regulations because they carry a heavy responsibility regarding the scientific integrity of publications in this specialty.

Reporting of ethical protection in recent oral and maxillofacial surgery research involving human subjects.

This retrospective observational study investigated the frequency of reporting ethical approval and informed consent in recently published oral and maxillofacial surgery (OMS) research involving human subjects. All research involving human subjects published in the International Journal of Oral and Maxillofacial Surgery, Journal of Oral and Maxillofacial Surgery, British Journal of Oral and Maxillofacial Surgery, and Journal of Cranio-Maxillofacial Surgery during January to June 2005-2007 were analysed for disclosure of ethical approval by a local ethical committee and obtaining informed consent from the subjects. 534 articles were identified; ethical approval was documented in 118 (22%) and individual patient consent in 135 (25%). 355 reports (67%) did not include a statement on ethical approval or informed consent and only 74 reports (14%) disclosed statements of both. Ethical documentation in retrospective and observational studies was scant; 12% of randomised controlled trials and 38% of non-random trials did not report both of ethical protections. Most recent OMS publications involving humans failed to mention ethical review or subjects' consent. Authors must adhere to the international research ethics guidelines and journal instructions, while editors should play a gatekeeper role to protect research participants, uphold scientific integrity and maintain public trust in the experimental process and OMS profession.

[How to avoid research misconduct - recommendations for surgeons]. / Comment éviter la non-conformité de la recherche biomédicale? Recommandations aux chirurgiens.

Research misconduct is defined by the Royal College of Physicians of Edinburgh as any behaviour by a researcher, whether intentional or not, that fails to scrupulously respect high scientific and ethical standards. Various types of research misconduct include fabrication or falsification of data, plagiarism, problematic data presentation or analysis, failure to obtain ethical approval by a research ethics committee or to obtain the subject's informed consent, inappropriate claims of authorship, duplicated publication, and undisclosed conflicts of interest. These can result in patient injury, deterioration of the patient-physician relationship, loss of public trust in biomedical research, as well as pollution/degradation of the medical literature. Surgical research malfeasance has been underreported, and no practical guidelines for good research and publication have appeared to date in French surgical journals. In an attempt to uphold the scientific integrity of our profession, we discuss research misconduct and emphasise preventive measures and considerations for surgeons.