SMARCB1 (INI1)-deficient sinonasal carcinoma manifesting as oral lesions: A report of two cases.

BACKGROUND: Sinonasal carcinomas represent a rare group of malignancies, accounting for less than 5% of all head and neck cancers and a worldwide incidence of less than 1 case per 100 000 inhabitants annually. Despite the restricted anatomical location, sinonasal carcinomas harbor some of the most histologically and molecularly diverse groups of tumors. SMARCB1 (INI1)-deficient sinonasal carcinomas are locally aggressive tumors commonly detected late, leading to devastating morbidity and mortality. CASE REPORT: We present two cases of SMARCB1-deficient sinonasal carcinoma involving the oral cavity and presenting as progressive radiolucent lesions with local swelling associated with maxillary dentition and alveolar bone. Both cases were initially considered odontogenic in origin and involved the destruction of the left anterior maxilla. CONCLUSION: Given the rarity and the variable presentation of these tumors, they pose a challenge for head and neck surgeons, dentists, and pathologists due to the potential overlapping features with odontogenic and non-odontogenic inflammatory and neoplastic lesions. These cases highlight the importance of a multidisciplinary team and include SMARCB1-deficient sinonasal carcinomas in the differential diagnosis of destructive lesions of the maxilla.

Radiographic Evaluation of Bone Remodeling after Additively Manufactured Subperiosteal Jaw Implantation (AMSJI) in the Maxilla: A One-Year Follow-Up Study.

Additively manufactured subperiosteal jaw implants (AMSJI) are patient-specific, 3D-printed, titanium implants that provide an alternative solution for patients with severe maxillary bone atrophy. The aim of this study was to evaluate the bony remodeling of the maxillary crest and supporting bone using AMSJI. Fifteen patients with a Cawood-Howell Class V or greater degree of maxillary atrophy were evaluated using (cone beam) computed tomography scans at set intervals: one month (T1) and twelve months (T2) after definitive masticatory loading of bilateral AMSJI implants in the maxilla. The postoperative images were segmented and superimposed on the preoperative images. Fixed evaluation points were determined in advance, and surface comparison was carried out to calculate and visualize the effects of AMSJITM on the surrounding bone. A total mean negative bone remodeling of 0.26 mm (SD 0.65 mm) was seen over six reference points on the crest. Minor bone loss (mean 0.088 mm resorption, SD 0.29 mm) was seen at the supporting bone at the wings and basal frame. We conclude that reconstruction of the severely atrophic maxilla with the AMSJI results in minimal effect on supporting bone. Reduced stress shielding with a biomechanically tuned subperiosteal implant does not induce radiographically significant crestal bone atrophy.

COMPLICATIONS OF ORAL AND MAXILLOFACIAL SURGERY UNDER GENERAL ANESTHESIA IN TUBE-FED CHILDREN: A RETROSPECTIVE ANALYSIS.

PURPOSE: To assess morbidity and mortality associated with oral and maxillofacial surgery procedures requiring general anesthesia among children with aspiration tendency requiring enteral feeding. MATERIAL AND METHODS: A retrospective chart review was conducted of children surgically treated under general anesthesia by the oral and maxillofacial surgery service at the Hospital for Sick Children in Toronto, Canada. Medical and dental records over a 9-year period (January 1, 2000 to January 1, 2010) were reviewed. Data were collected on demographics, primary illness, coexisting medical conditions, procedures performed, medications administered, type of airway management used, duration of general anesthesia, American Society of Anesthesiologists' physical status classification and adverse events. RESULTS: During the period reviewed, 28 children underwent 35 oral and maxillofacial surgery procedures under general anesthesia. The mean patient age was 12 years (range 4-17 years). No deaths occurred. Of the 35 surgeries, 10 (29%) were associated with at least 1adverse event. Adverse events included 1incident of respiratory distress, 2incidents of fever, 5incidents of bleeding, 1incident of seizure and 4incidents of oxygen saturation below 90% for more than 30s. CONCLUSIONS: Children with a history of aspiration tendency that necessitates enteral feeding, who undergo oral and maxillofacial surgery under general anesthesia, are at increased risk of morbidity. Before initiating treatment, the surgeon and parents or guardians of such children should carefully consider these risks compared with the anticipated benefit of surgery.

Complete response to tacrolimus in a child with severe aplastic anemia resistant to cyclosporin A.

Aplastic anemia (AA) is a rare disorder in children, usually treated with immunosuppressive therapy (IST) including antithymocyte globulin (ATG) and cyclosporin A. There are no current widely used alternative therapies with comparable efficacy. We describe a child with severe aplastic anemia (SAA), who developed severe gingival hyperplasia secondary to cyclosporin A, unresponsive to intensive dental intervention. When IST was changed to tacrolimus there was a significant improvement in the gingival hyperplasia, but equally important, he achieved complete response of his AA within several months. The use of tacrolimus in children with AA may be a potential modality of treatment.

Effectiveness of 2 scavenger mask systems for reducing exposure to nitrous oxide in a hospital-based pediatric dental clinic: a pilot study.

Chronic exposure to elevated ambient air levels of nitrous oxide during nitrous oxide/ oxygen (N2O/2) sedation can result in deleterious side effects to dentists and auxiliary staff. A sampling survey was done in the outpatient dental clinic at the Hospital for Sick Children to determine whether airborne nitrous oxide (N2O) gas concentrations were within established regulatory limits. The effectiveness of 2 scavenger mask systems, the Matrix Medical single-mask system and the Porter/Brown double-mask system, for reducing airborne contamination in a clinical environment during the treatment of pediatric dental patients was compared in a pilot study. The results indicated that the double-mask system more effectively minimized N2O exposure during N2O/O2 sedation of outpatients for a variety of clinical pediatric dental procedures.

Congenital epulis: a surprise in the neonate.

A newborn infant with congenital epulis can be a striking sight for both parents and health care professionals involved in neonatal care. These tumours of the infant mouth can be remarkably large, occupying much of the oral cavity and posing a risk of airway obstruction or interfering with feeding. Dentists should be able to recognize these swellings as they may be asked to consult and provide information to parents and other practitioners regarding treatment of these lesions.

In-office iliac crest bone harvesting for peri-implant jaw reconstruction.

We describe 2 minimally invasive techniques for in-office iliac crest bone harvesting. The increasingly limited access to hospital operating rooms and the increased need for bone grafting to facilitate dental implant-related reconstructions have been the major impetuses behind relocating some of these surgeries to the out-of-hospital, in-office setting.

Ambulatory in-office anterior iliac crest bone harvesting.

OBJECTIVE: A prospective study was performed to evaluate the harvesting of autologous bone within the private practice environment, using either a power-driven trephine or corticocancellous block harvesting, and to assess the clinical safety, postoperative morbidity, and patient satisfaction associated with this application. STUDY DESIGN: Thirty-nine patients requiring 40 bone harvests from the anterior iliac crest for maxillofacial reconstruction were included for study. The ages ranged from 16 to 73 years (mean 48.4 years). All surgeries were performed by a single surgeon. Patients were recovered and discharged home directly from the office. RESULTS: Forty iliac crest harvests were performed in the private practice venue from 2001 to 2004, 23 by motorized trephine and 17 by open corticocancellous block harvest. No peri-operative complications were encountered. Postoperative questionnaires were returned by 32 patients. Thirty patients reported that they would undergo hip surgery in an ambulatory environment again if required. CONCLUSION: Harvesting of bone from the anterior iliac crest is a safe and predictable surgical procedure for the private oral and maxillofacial surgical practice setting in selected cases, resulting in a low complication rate. Patient acceptance of this surgery in the private practice venue is high.

Nitrous oxide-oxygen or oral midazolam for pediatric outpatient sedation.

OBJECTIVE: A total of 1112 pediatric outpatient sedations, by either nitrous oxide-oxygen inhalation (N2O) or oral midazolam, administered over a 10-year period were reviewed. Patient responses and outcomes were evaluated to ascertain the safety of these sedation techniques. STUDY DESIGN: A total of 819 patients were included in this study. Patient health status, age, weight, behavior, treatment rendered, and length of treatment were recorded. Vital signs (heart rate, blood pressure, oxygen saturation) were recorded for the N2O group. Complications and successful completion of treatment were also noted. RESULTS: Both the N2O and midazolam groups demonstrated a low complication rate with a high rate of successful completion of treatment. Patients receiving N2O were somewhat older on average and underwent a greater number of surgical procedures than patients in the midazolam group. Vital signs recorded in the N2O group were observed to remain stable throughout treatment. CONCLUSIONS: The use of either oral midazolam or nitrous oxide-oxygen as single agents provides safe and effective conscious sedation in the pediatric outpatient population.