Localized hyperplastic lesions of the gingiva: a clinicopathological study of 302 lesions.

A study was made of a series of 302 consecutive cases of localized hyperplastic lesions of the gingiva (epulides). The lesions were classified into five groups: pyogenic granuloma, calcifying fibroblastic granuloma, fibrous hyperplasia, peripheral giant cell granuloma and denture hyperplasia. The study indicates that there are some differences in age and sex distribution as well as in location between the different histological groups. Pyogenic granuloma was found to be the most common lesion on the gingiva. Pyogenic granuloma and calcifying fibroblastic granuloma occur in younger patients more often than fibrous hyperplasia, and thus may represent a stage in the development of fibrous hyperplasia. Denture hyperplasia occurs predominantly in females and it is suggested that its formation may be affected by hormonal alterations in the menopause.

Effect of facial pressure garments for burn injury in adult patients after orthodontic treatment.

Pressure garments are commonly used to prevent and control hypertrophic scar tissue. Complications are unusual, though in children with facial burns, pressure garments may lead to skeletal and dental deformities. Studies in adolescents and adults are sparse. We describe a 24-year-old woman who sustained facial burns. Prior to injury, the patient had undergone premolar extraction in preparation for orthodontic treatment. Her post-burn care consisted of application of a Jobst pressure garment. After 2 months treatment, severe deformation of the dental-alveolar structure was observed. This reports suggests that adults after dental extraction are at a high risk of dental-alveolar deformities from pressure garments and might benefit from the use of occlusal wafers.

Surgical excision of a congenital lateral fistula of the upper lip. An intra-oral approach.

A new technique for removal of a congenital lateral upper lip fistula is described, using an intra-oral approach. Previous reports of removal of such a congenital malformation have used an extra-oral approach. The technique described allows for excellent visualization of the fistula without cutaneous lip incision. Using this approach, good aesthetic results and complete removal of the fistula and associated mucous glands can be obtained.

Epidermal nevus syndrome with maxillary involvement.

A female patient with epidermal nevus syndrome is reported. There were linear epidermal nevi, hemihyperplasia of the limbs and tongue, macrocephaly, several ophthalmic malformations, and multiple radiolucent lesions in the limbs and sacroiliac region. At age 14 years, she developed a giant cell granuloma of the maxilla.

A technique for the treatment of mandibular body fractures in young children.

Mandibular body fractures in young children are uncommon, yet their treatment and management often present several difficulties. The presence of developing dental follicles may lead to irregular fracture lines and precludes the use of intraosseus wiring. In addition, treatment of fractures in children of this age requires a technique that limits the number of separate procedures that they are subjected to. The technique outlined below for the treatment of mandibular body fractures in young children, uses a plastic impression tray as a splint and provides a simple means for their reduction and fixation.

[Update review on prevention and early diagnosis in oral cancer].

Oral cancer is a major health problem in some parts of the world, especially in developing countries. Worldwide, the annual incidence exceeds 3,000,000 new cases. The main risk factors are tobacco and alcohol. However, dietary factors, viruses and possibly genetic predisposition have also been associated with oral cancer. Several oral lesions such as leukoplakia, erythroplakia and lichen planus carry an increased risk for malignant transformation in the oral cavity. Prognosis of oral cancer differs significantly between specific oral locations, with cancer of the lip for example having a much better prognosis than at the base of tongue or on the gingiva. Prognosis of intra-oral cancer is generally poor, with a five-year survival less than 50 percent. Local recurrences as well as lymph node metastases occur in a significant percentage of patients, while distant metastases are less frequent. Prognosis correlates mainly with the size of the lesion and the nodal status at the time of diagnosis, therefore early detection of small, stage-1 oral cancer can reduce mortality and morbidity. Oral lesions can be easily observed by direct visualization, however, knowledge of the differential diagnosis of oral lesions is mandatory for early diagnosis of malignant and pre-malignant lesions in the oral cavity. Use of screening and detection aids such as vital stains and Oral CDX can increase the number of cases diagnosed at an early stage, or even in the pre-malignant stage. Development of molecular markers can improve the early diagnosis and can help in predicting treatment response. New treatment modalities including tumor specific antibodies and gene therapy are emerging, giving more hope for patients with oral cancer. There is an important role for the dentist in both early diagnosis of pre-malignant and malignant lesions, and in prevention by educating the patients of the risks associated with tobacco, alcohol and dietary factors.

Radiological findings in jaws and skull of neurofibromatosis type 1 patients.

Maxillary and mandibular lesions in neurofibromatosis Type 1 (NF1) in patients are described. Radiographic manifestations include radiolucent lesions with well-defined, poorly-defined or irregular diffuse borders. Mandibular lesions were not associated with the inferior alveolar nerve as it coursed within the mandible. In three patients the lesions extended considerably into the cranial bones. The necessity for routine radiographic and CT evaluation of NF1 patients is emphasized.

Disturbed lower denture stability due to lipoma in the floor of the mouth.

An unusual case of lipoma arising in the floor of the mouth of a 70-year-old man is presented. The unusual appearance suggests that the tumour be included as a rare possibility in the differential diagnosis of swellings in the floor of the mouth that can also adversely affect lower denture stability.

Developmental arrest of tooth bud after correction of mandibular fracture.

A case of multiple fractures of the mandible following a car accident in a five-year-old patient is reported. The fracture line passed distal to the first molar tooth bud. The fracture was treated by wire osteosynthesis and skeletal fixation. During the ensuing 18 months, a gradual arrest of the development of the first molar tooth bud was radiologically observed. The eruption process had not been disturbed, and the tooth erupted at the age of 6 1/2 years. Since the distal root had completely failed to develop and the mesial roots showed a diminished size, the tooth was extracted. Histopathological examination revealed disturbed dentin apposition, there was almost complete obliteration of the pulp chamber by globular dentin, and evidence of root resorption.

Peripheral osteoma of the mandible: a study of 10 new cases and analysis of the literature.

Ten new cases of peripheral osteoma of the mandible are described. These lesions are uncommon and only 15 other cases have been reported in the English language literature over the past 30 years. There is evidence to suggest that the peripheral osteoma of the mandible is a traumatically induced reactive lesion and that muscle traction plays a role in its initiation. In view of this possibility, the term "parosteal osseous hyperplasia" may be more appropriate for those lesions in which a positive history of trauma preceded the onset.

Benign osteoblastoma of the mandible.

A rare case of benign osteoblastoma of the mandible, with clinical, radiologic, and histologic findings, is reported. The difference between benign osteoblastoma and osteoid osteoma is discussed, since these lesions share similar features that are seen in the case presented. It is suggested that both lesions should be diagnosed as one entity.

Radiological and clinical features of aneurysmal bone cyst of the jaws.

PURPOSE: To evaluate the clinical and radiological features of aneurysmal bone cyst (ABC) of the jaws. MATERIALS AND METHODS: A total of 64 cases (60 from the English-language literature and four new cases) were studied and critically evaluated with emphasis on the radiological features. RESULTS: Age at time of initial diagnosis ranged from 4-78 years, with a mean age of 21.5 years and median age of 17 years. There were no differences in gender distribution. The ratio between the mandible and maxilla was 2.4:1. Ninety-two per cent of the lesions were located in the posterior region of the jaws. Lesions were radiolucent in 87% of cases, radiopaque in 2% and mixed in 11%. Fifty-three per cent were multilocular, 43% unilocular and 3% not loculated. The border of the lesions was defined but not corticated in 39%, well defined in 33% and diffuse in 28%. CONCLUSIONS: ABC has a variable radiological appearance and should be considered in the differential diagnosis of any unilocular or multilocular radiolucent lesion of the jaws as well as any mixed radiolucent-radiopaque lesion.

Radiological features of glandular odontogenic cyst.

OBJECTIVES: To present five new cases of glandular odontogenic cyst (GOC) and to review the radiological features at presentation as reported in the English literature. METHODS: From 1993 to 2002, five patients in our department were diagnosed with GOC based on histopathological findings and supported by radiography and CT. The radiographic features of the new GOC cases were analysed in addition to 51 literature cases. RESULTS: There were 31 male and 25 female patients, aged 14-90 years (mean 50 years). The mandible was involved in 80% and the maxilla in 20%; most of the lesions were located in the anterior jaw. Radiographically, 52% of the lesions were unilocular and 48% were multilocular; 94.5% showed well defined borders, which were sclerotic in 7.7% and scalloped in 13%. Information on cortical plate integrity was available in only 24 cases: 50% showed perforation, 8.3% erosion of the cortical plates and 8.3% thinning of the cortical plates. Root resorption was reported in 22% of patients and tooth displacement in 24.4%. CONCLUSIONS: Data collected indicate that GOC has potentially aggressive behaviour, with expansion and perforation in a significant number of cases. We recommend the use of multiple plane radiographs, with CT reserved for large lesions, especially those that are multilocular or involve extragnathic structures.

The coronoid process as a cause of mandibular hypomobility--case reports.

In an attempt to draw the clinician's attention to the coronoid process site while evaluating the aetiology of the restriction of mandibular opening, four cases are illustrated. These cases represent a diversity of causes hampering the free rotational movement of the coronoid process in space during jaw function. Case 1 is an example of unilateral hyperplastic coronoid process and osteochondroma; case 2 shows unusually shaped short and divergent coronoid processes combined with a bucally displaced maxillary third molar on one side; cases 3 and 4 represent an anatomical variation of an extremely narrow vestibular space due to the close proximity of the medial aspect of the coronoid process to the distal molar. It is suggested that each clinical examination include the width of the buccal vestibular space while performing mandibular movements.

Head, neck, and maxillofacial childhood Burkitt's lymphoma: a retrospective analysis of 31 patients.

Thirty-one children with Burkitt's lymphoma of the head, neck, and maxillofacial region diagnosed between 1976 and 1988 were reviewed. The age range was 2 to 17 years (median, 7.2 years), and 77.4% were males. The most common presenting symptoms were detectable masses, floating and/or painful teeth, enlarged cervical lymph nodes, sore throat, and neurologic signs. The predominant primary tumor sites were the jaws and tonsils. All patients were staged by a clinical staging system, 17 of them having stage I-II, and 14 stage III-IV. Levels of lactate dehydrogenase and ferritin were the only significant laboratory parameters correlating with initial staging and disease-free survival. Radiologic features in the jaws were poorly circumscribed destructive lytic lesions with migration and crypt destruction of unerupted teeth buds. Complete disappearance of these findings was noted after successful chemotherapy and clinical regression of the tumor. Eighteen (58.1%) patients attained complete remission with a follow-up of 5 to 100 months. Stage was the most significant variable affecting outcome, with 90.2% disease-free survival of stage I patients, 72.4% of stage II, and 18.2% of stage III-IV. Based on these results, it is concluded that localized (stage I and II) Burkitt's lymphoma is responsive to chemotherapy and thus has a favorable prognosis.

Radiological and clinical features of calcifying epithelial odontogenic tumour.

OBJECTIVES: To analyse systematically the radiographic features of the calcifying epithelial odontogenic tumour (CEOT). METHOD: Clinical and radiological features of 67 cases of CEOT (four new and 63 from the literature) were analysed. RESULTS: There were 27 (41%) males and 39 (59%) females with a male-to-female ratio of 1 : 1.5. Age ranged from 13 - 77 years (mean 43.5 years), with a peak in the fourth and fifth decades. The mandible was involved in 74% of the cases and 69% of all lesions were in the posterior area. The mixed radiolucent-radiopaque pattern was the most frequent (65%), with 32% radiolucent and 3% radiopaque. Coronal clustering of the radiopaque material was found in 12% and in one case, a 'driven snow' pattern of the radiopaque material was clearly recognizable. Lesions were unilocular in 58%, multilocular in 27% and not loculated in 15%. The unilocular type was more frequent in the maxilla than in the mandible. Borders were well defined and corticated in 20%, defined but not corticated in 59% and diffuse in 21%. Sixty per cent were associated with impacted teeth. Lesions larger than 3 cm tended to be more frequent in the mandible, mixed radiolucent-radiopaque and to have a higher proportion of diffuse borders than the smaller lesions. CONCLUSION: Radiographic features which have been considered characteristic of CEOT, coronal clustering and 'driven snow' patterns, are seen in only a small percentage of cases.

Techniques for ensuring the lateral position of the proximal segment following intraoral vertical ramus osteotomy.

Continual refinements of the surgical technique and instrumentation for the intraoral vertical ramus osteotomy have made it a preferred procedure for mandibular setback, especially in asymmetrical cases. However, there may be intraoperative difficulty in lateral positioning of the proximal segment, which is frequently trapped medially. Three techniques for lateral relocation of the medially displaced proximal segment are described. Techniques designed to prevent this medial displacement also are presented.

Radiographic features of anterior buccal mandibular depression in modern human cadavers.

The anterior buccal mandibular depression (ABMD) becomes significant when evaluating edentulous patients prior to implant insertion. The features of the ABMD in dry mandibles from ancient populations have been reported. In the present study the prevalence and radiological appearance of the ABMD and the influence of soft tissue superposition on its radiological detectability in the jaws of modern human cadavers were evaluated. The prevalence of ABMD was 32%. The presence of soft tissue significantly influenced the radiopacity of the ABMD area and the degree of definition of the borders (p=0.0003 and 0.0001 respectively). Changes in the trabecular pattern were observed in 36% of the cases without soft tissue compared with 29% with soft tissue. The ABMD was more readily detected on CT scans than on conventional periapical or panoramic radiographs.