A case report of metastasis of malignant mesothelioma to the retromolar trigone.

BACKGROUND: Malignant mesothelioma is a rare and aggressive tumor with a poor prognosis. Distant metastases are very rare, and the oral cavity metastases are exceedingly rare. Only a few cases with metastasis to oral gingiva are reported. To our knowledge, this is the first case report of pleural mesothelioma metastasized to the retromolar trigone. CASE PRESENTATION: A 59-year-old male was referred with a painless growth at retromolar trigone area. It had been present for 2 months and had increased in size during this period of time. Past medical history revealed a malignant mesothelioma. Intraoral examination showed a soft, haemorrhagic, ulcerated lesion at the right retromolar trigone area. There was no destruction of the bony architecture. An incisional biopsy was performed under local anaesthesia. Based on the histopathological and immunohistochemical findings, a final diagnosis of metastatic mesothelioma was made. The patient was informed about the possibility of multiple metastases within the body, but he succumbed after 45 days following deterioration of his medical condition. CONCLUSIONS: Biopsy, history of the patient and clinical picture were provided to the clinicians to make an efficient differential diagnosis. Differential diagnosis must be performed with other oral cancers, because the management is totally different.

Polymorphisms in the IL28B gene (rs12979860, rs8099917) and the virological response to pegylated interferon therapy in hepatitis D virus patients.

AIM: Few data are available regarding the effects of interleukin 28B (IL28B) polymorphisms in chronic hepatitis D (CHD) patients. This study investigated the relationship between IL28B poly-morphisms and the response of patients with CHD infections to pegylated interferon (PEG-IFN) therapy. MATERIALS AND METHODS: A total of 101 CHD patients were -selected, 80 of whom (46 males ; median age 41 years) satisfied the inclusion criteria and were enrolled in the study. Thirty-seven patients were treated with peg-IFNα for at least 12 months and were followed for a median of 18 months (range, 12-30 months). The primary treatment endpoint was the suppression of HDV replication, as documented by the loss of detectable HDV RNA in serum. Genotyping was used to analyse the IL28B polymorphisms rs12979860 and rs8099917 according to the virological response. RESULTS: After treatment, a sustained viral response (SVR) was achieved in 19 (51%) of the patients treated with PEG-INF. The IL28B genotypes in the 80 patients were as follows : CC in 36 (45%), CT in 33 (41%) and TT in 11 (14%) for rs12979860, and GG in 4 (5%), GT in 27 (34%) and TT in 49 (61%) for rs8099917. SVR was achieved in 5 (26%), 10 (53%) and 4 (21%) patients with CC, CT and TT at rs12979860, respectively, and one (5%), nine (47%) and nine (47%) patients with GG, GT and TT at rs8099917, respectively. There were differences in the SVR among genotypes (rs12979860 and rs8099917 ; chi-squared test, p = 0.047). CONCLUSION: IL28B predicts the PEG-IFN response in patients with CHD infection.

Mediastinitis caused by an infected mandibular cyst.

Descending necrotizing mediastinitis is a potentially fatal condition which may occur seldom as a consequence of oral infections. This report describes the management of a patient with mediastinitis due to an infected dentigerous cyst.

The effects of cigarette smoking on human gingival tissues (a histopathological study).

Gingival biopsy specimens were obtained from 9 smokers and 7 non-smokers during routine flap surgical procedure to investigate the effects of cigarette smoking on gingival epithelium and connective tissue. Although no remarkable histopathological difference was noted between gingival tissues of smokers and non-smokers, but smokers revealed relatively more epithelial keratosis, inflammatory cells, blood vessels and collagen fibres in connective tissue. Congestion of the capillaries were also more prominent in the smoker's gingival tissues.

Mandibular angle fractures during third molar removal: a report of two cases.

Although fracture of the tooth during surgical removal is common, mandibular fracture during lower third molar removal is an unusual and major complication. Possible aetiologies are age, gender, the position of the tooth, uncontrolled excessive force applied, insufficient surgical experience and improper instrumentation. Symptoms can vary widely and treatment options range from prescription of a soft diet to surgical treatment by open reduction and internal fixation. We present two cases of the treatment and follow-up of fracture of the angle region of the mandible during removal.

Do antibacterial mouthrinses affect bacteraemia in third molar surgery? A pilot study.

BACKGROUND: The aim of this pilot study was to evaluate the effects of mouthrinses containing 7.5% povidone iodine and 0.2% chlorhexidine on bacteraemia following impacted third molar surgery. METHODS: Thirty-four patients were enrolled in this study. Patients in the first group were asked to rinse their mouth with the mouthrinse containing 7.5% povidone iodine, patients in the second group were asked to rinse with the mouthrinse containing 0.2% chlorhexidine and patients in the third group were asked to rinse with 0.9% NaCl (sterile saline) solution. All rinses were used for one minute preoperatively. Peripheral venous blood samples were collected at baseline (preoperatively), 1 and 15 minutes after the completion of surgical tooth removal. Each blood sample was divided in two, placed in aerobic and anaerobic culture bottles and processed for microbiological examination. RESULTS: Bactaeremia was detected in 33% of the povidone iodine group, 33% of the chlorhexidine group and 50% of the control group. Isolated bacteria were 58% anaerobes and predominantly 92%Streptococcus species. Incidence of bacteraemia was reduced with chlorhexidine and povidone iodine mouthrinses in third molar surgery, although the difference was not statistically significant (p > 0.05). CONCLUSIONS: Bacteraemia was reduced with antibacterial mouthrinses in third molar surgery. The results of this study should be confirmed with further studies conducted on a larger patient population and with different antibacterial mouthrinses.

Intrusion of an overerupted mandibular molar using mini-screws and mini-implants: a case report.

Overeruption of mandibular molars due to the loss of antagonist teeth causes occlusal functional disturbances. To restore proper occlusion, intrusion of the overerupted molars becomes essential before multidisciplinary reconstructive dental approaches can be initiated. Treatment protocols involving prosthodontic reduction, surgical impaction, and conventional orthodontic intrusion have been introduced. Orthodontic intrusion seems to be a favourable procedure which requires calibrated anchorage support. This case illustrates the management of a complex dental and functional problem with an interdisciplinary approach through the use of orthodontic, periodontal, restorative and implant therapy. In order to intrude the overerupted molar, a partial orthodontic appliance was used in conjunction with mini-implants and mini-screws. The results showed that the biological responses of the teeth and the surrounding bony structures to the intrusion appeared normal and acceptable. Periodontal health and vitality of the teeth were maintained throughout the treatment and even after one-year follow-up.