Human papillomavirus, oropharyngeal cancer, and the latest vaccine: considerations for oral healthcare providers.

Human papillomavirus (HPV) is associated with both benign and malignant disorders, such as genital warts and a variety of cancers, including oropharyngeal squamous cell carcinomas (OPSCCs). The current 9-valent HPV vaccine (Gardasil 9) protects against high-risk strains that have been shown to cause OPSCC, and widespread vaccination should reduce the rate of all HPV-associated cancers. HPV-related OPSCCs differ from non-HPV-related OPSCCs in their clinical presentations and responsiveness to treatment. To provide oral healthcare providers with a basis for effective com-munication with patients, this article will examine the evolution of the HPV vaccination schedule and the role of the HPV vaccine in the prevention of OPSCCs.

Herpes zoster: treatment, management, and prevention with the recombinant DNA vaccine.

Herpes zoster (HZ) is a reactivation of dormant varicella-zoster virus that most often erupts as painful vesicles in a unilateral dermatomal distribution. A sequela of HZ is postherpetic neuralgia (PHN), which is debilitating and may be persistent. Therefore, vaccination for the prevention of HZ and its sequelae is recommended for adults aged 50 years and older as well as immunocompromised adults. In 2017, the US Food and Drug Administration approved a recombinant DNA vaccine (Shingrix) that is safe to use in immunocompromised individuals and an improvement on the live-attenuated vaccine approved in 2006. This report discusses HZ, PHN, treatment of HZ and PHN, and prevention with vaccines.

Skin cancer, sunscreens, and prevention: discussions to have with patients.

With the incidence of skin cancer increasing in the United States, the role of dental providers in noting suspicious skin lesions as well as advising patients in proper sun-protective strategies is more important than ever. However, the public conversation about proper sun protection is often laden with misunderstandings and pervasive myths. This article reviews the most common types of skin cancer, elucidates the differences among the types of UV radiation, and offers updated recommendations for proper sunscreen use along with adjunctive sun-protective strategies.

Metastatic prostate cancer presenting as trigeminal nerve paresthesia in the mandible.

Metastatic disease to the oral cavity is rare and often presents with ambiguous symptoms and subtle or no radiographic changes. These factors make diagnosis challenging. This article describes a case of metastatic prostate cancer to the mandible that presented as altered sensation to the gingiva, lips, and chin without radiographic evidence of pathosis noted on standard dental imaging. At the time of presentation, the patient's prostate cancer, diagnosed 9 years previously, was thought to be well-controlled with medical therapy. With additional laboratory testing and medical imaging, widespread metastatic disease was discovered. This case reinforces the importance of including metastatic disease in the differential diagnosis as well as the utility of collaboration with providers outside dentistry.

Metastatic renal cell carcinoma to the mandible: a case report with clinical and histologic findings.

Metastatic disease to the oral cavity is rare. Patients with metastasis to the oral cavity may present with swelling, pain, and paresthesia and require evaluation by providers trained in managing pathoses of the oral cavity and surrounding structures. This report describes the case of a 78-year-old man with painful enlargement of the right posterior mandible that caused paresthesia. An open biopsy procedure resulted in significant blood loss and the need for percutaneous needle biopsy. Immunohistochemical analysis was used to make the diagnosis of metastatic clear cell renal cell carcinoma in this patient, whose primary malignancy was previously unknown. Composite resection of the metastatic lesion and reconstruction were performed with the use of virtual surgical planning, an osteomyocutaneous free tissue transfer, and a custom reconstruction plate. This case highlights the importance of dental professionals in the diagnosis and management of lesions of the head and neck and adds to the literature on metastatic lesions to the region.

Clinicopathologic correlation: mixed-density lesion in the posterior mandible.

A middle-aged man presented for evaluation of a mixed-density lesion of the left posterior mandible. This clinicopathologic correlation presents the radiographic, clinical, and histopathologic findings; differential diagnosis; and treatment plan for this case. The lesion was deemed to be of bacteriologic origin, likely a polymicrobial infection containing actinomycetes. Clinical care and follow-up for the patient are discussed.

Dental surgical management of the patient with hemophilia.

The dental surgical management of a patient with a bleeding disorder can present a challenge to the dental provider. This article reviews the clinical presentation of hemophilia and describes the management of 2 patients with hemophilia who presented for dental extractions. Each patient's hematologist was consulted to determine clotting factor replacement therapy, antifibrinolytic therapy, and local measures to obtain hemostasis perioperatively. Careful coordination with the patient's hematologist in such cases is essential to ensure safe treatment.

Clinicopathologic correlation: palatal mass interfering with seating of a maxillary denture.

This paper is a clinicopathologic correlation regarding a 61-year-old patient with an ill-fitting maxillary denture. Examination revealed a firm, nontender palatal mass. Descriptions of the clinical findings, work-up, differential diagnosis, histological observations, and diagnosis of the lesion are presented.

Management of uncommon complications in seemingly routine oral surgeries.

Major complications in outpatient oral surgeries are relatively rare. This article presents 4 cases of molar extraction with unusual complications and describes how the clinician in each case altered the treatment, resulting in a successful conclusion. The first case describes a fracture during the removal of a maxillary first molar. The second case describes a fracture after a mandibular third molar extraction. The third case describes a maxillary third molar displaced into the infratemporal space. The final case describes necrosis of the maxillary soft tissue after fracture of the tuberosity during a third molar extraction.

Comprehensive management of an orthognathic surgery patient with aggressive central giant cell granuloma of the mandible.

This article presents a case involving a 16-year-old boy who came to the Tripler Army Medical Center Oral and Maxillofacial Surgery with a central giant cell granuloma (CGCG) on the anterior mandible. Initial management consisted of surgical curettage and intralesional injection of corticosteroids. Upon completion of steroid therapy, there was clinical and radiographic evidence of remission; however, radiographic evidence of lesion recurrence was seen at a six-month follow-up visit. The CGCG was retreated with curettage and five months of systemic injections of calcitonin, both of which failed. The lesion was most likely an aggressive form of CGCG that progressed despite conservative therapy, with destruction of hard and soft tissues, root resorption, tooth displacement, and paraesthesia in the anterior mandible. The authors present a treatment algorithm with comprehensive management involving surgical resection, reconstruction, orthodontics, and orthognathic surgery with prosthodontic considerations.

Closure of difficult palatal fistulas using a "parachuting and anchoring" technique with the tongue flap.

The tongue flap has been described in reconstructing palatal defects. Nevertheless, properly securing the flap to the palatal defect has continued to pose a challenge, especially because the flap becomes mobile with normal activities (i.e., speech and swallow). For this reason, alternative fixation schemes have been discussed in literature, but do not always solve the problem. In this article, we offer an alternative method for positioning and securing the tongue flap into the palatal defect. The authors of this article believe that advantages of this technique include an increase in flap security and immobility and a decrease in postoperative maxillomandibular fixation requirement. Although unanswered questions still remain regarding improved flap retention with this method, we believe that the "parachuting and anchoring" technique provides an alternative method that can most definitely add to the surgeon's armamentarium.

Abdominal fat harvest technique and its uses in maxillofacial surgery.

Abdominal fat harvest and augmentation to the maxillofacial region is a relatively inexpensive, safe, and readily available procedure. The use of abdominal fat free transfer has been well documented for cosmetic, trauma, and temporomandibular joint reconstruction. Fat is the closest we have to an ideal filler, it is readily available and inexpensive, it is autologous and therefore lacks a host immune response, it is safe and noncarcinogenic, and it is easily acquired with a minimally invasive procedure. Abdominal fat donor site is the most commonly used owing to ease of access and availability of fat stores. Complications are rare and easily managed in the office. Free abdominal fat harvest is a predictable surgical technique that allows the maxillofacial surgeon access to autologous graft material that is ideal for multiple facial procedures.

A case of anterior maxillary radiolucency.

A 46-year-old woman sought treatment for pain in her maxillary anterior teeth. Physical examination revealed facial tenderness and an expanded anterior maxilla, with palatal swelling in the approximate midline. The lesion had eroded through the midline anterior palate and anterior nasal spine and had shifted the nasal floor in a superior direction. Teeth No. 8-10 tested nonvital to electrical stimulation. The lesion was dissected carefully and lifted off the nasal floor while the patient was under general anesthesia. Histologically, the lesion was cystic with an epithelial lining composed of respiratory and squamous epithelium. As a result, a nasopalatine duct cyst was diagnosed.

Prevention and management of trigeminal herpes zoster and postherpetic neuralgia.

Herpes zoster (HZ, also known as shingles) is caused by the reactivation of a dormant varicella zoster virus and can be a source of significant morbidity. Oral manifestations can include vesicular eruptions of the mucosa, osteonecrosis with tooth loss, and postherpetic neuralgia (PHN). This article discusses treatment for trigeminal nerve involvement with herpes zoster, as well as for the painful syndrome PHN.

The insidious nature and presentation of oral squamous cell carcinoma in the low-risk population.

Oral squamous cell carcinoma is found predominantly in patients who have a history of smoking, alcohol consumption, or betel quid use. However, some of these patients have no known risk factors for development of the lesion and sometimes are diagnosed later in life due to low clinical suspicion of squamous cell carcinoma. This article presents three such cases, including their history and treatment.

Dental rehabilitation of the patient with multiple endocrine neoplasia Type 2b.

Multiple endocrine neoplasia 2b (MEN 2b) is characterized by medullary thyroid carcinoma, pheochromocytoma, and various neuromas throughout the body, including the oral cavity and the perioral and periocular areas. The syndrome is inherited in an autosomal dominant fashion with high penetrance. This article presents a case of MEN 2b in a 24-year-old woman and discusses the medical and surgical issues that relate to the disorder. In addition, this article describes the workup, diagnosis, and treatment, along with a discussion of the pathophysiology of MEN 2b as it relates to the dental rehabilitation of a patient with the disorder.