ABSTRACT
Choristomas are rare lesions of the head and neck and may be composed of various types of tissue whose only similarity is their close association in fetal development. We present a case of a cartilaginous choristoma that was successfully treated by surgical excision. Choristomas should be included in the differential diagnosis of any lesion in the oral cavity--especially the tongue.
Subject(s)
Cartilage , Choristoma , Tongue Neoplasms , Cartilage/pathology , Child, Preschool , Choristoma/pathology , Female , Humans , Tongue Neoplasms/pathologyABSTRACT
Aggressive fibromatosis is a poorly defined, locally aggressive, yet histologically benign fibroblastic proliferative lesion that may occur in the head and neck. The lesion is highly cellular and locally infiltrative and has a propensity to invade and erode bone, compromising vital structures within the head and neck. However, it is not a true malignancy because it does not have malignant cytologic characteristics nor does it metastasize. We present two cases of aggressive fibromatosis occurring in young adult men. The first case involved a rapidly enlarging mass of the anterior maxilla that involved the upper lip, nasal alae, nasal septum, inferior turbinates, and hard palate. The patient underwent incisional biopsy to confirm the diagnosis. Because of difficulty in determining the actual margins of this extensive lesion and the significant morbidity that would have resulted from surgical resection, we elected to treat this patient with chemotherapy and radiation therapy. The second case was an extensive lesion involving the right temporal bone, pterygomaxillary space, and infratemporal, temporal, and middle cranial fossae. Incisional biopsy confirmed the diagnosis. Because of the lack of functional and cosmetic deficits and the unavoidable morbidity of a surgical resection, this patient was treated with radiation therapy. Although wide field resection is the most satisfactory form of treatment, in situations in which this modality would result in unacceptable morbidity or if surgical margins are positive, then radiation therapy and chemotherapy should be considered. Support for these therapeutic modalities is found in larger series of cases outside the head and neck.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Fibroma/therapy , Maxillary Neoplasms/therapy , Radiotherapy, High-Energy , Skull Neoplasms/therapy , Temporal Bone , Adult , Cobalt Radioisotopes/therapeutic use , Combined Modality Therapy , Fibroma/drug therapy , Fibroma/radiotherapy , Humans , Male , Maxillary Neoplasms/drug therapy , Maxillary Neoplasms/radiotherapy , Radioisotope Teletherapy , Skull Neoplasms/radiotherapyABSTRACT
Drug-induced gingival hyperplasia is a frequent complication of phenytoin anticonvulsant therapy. In severe cases, gingival hyperplasia can cause marked cosmetic deformity, phonatory abnormalities and significant occlusal changes which severely restrict masticatory function. Airway obstruction has not been previously reported with this condition. We describe a unique case of massive phenytoin-induced gingival overgrowth causing glossoptosis and subsequent upper airway obstruction. Possible medical and surgical treatment options, including laser wedge resection of the base of the tongue, are discussed.