Obstructive sleep apnea syndrome in patients with class II malocclusion.

This study was designed to analyze the effect of class II malocclusion as a factor in the development of obstructive sleep apnea syndrome. Although mandibular retrusion has been reported coincidentally with obstructive sleep apnea syndrome many times, no causal relationship has been established. No previous study has analyzed the occurrence of obstructive sleep apnea syndrome in patients with class II malocclusion without sleep complaints. In this study, we selected 12 patients with class II malocclusion who required surgical mandibular-lengthening or repositioning procedures. These patients were surveyed for sleep habits or sleep complaints and then studied with overnight polysomnography for sleeping or breathing abnormalities. None of these patients had obstructive sleep apnea syndrome. From this sample population, an incidence of obstructive sleep apnea syndrome of no more than 26.5% in the surgical population of patients with class II malocclusion can be extrapolated.

Advanced giant cell granuloma: a twenty-year study.

Giant cell granuloma is a benign lesion that generally involves the mandible and maxilla. It may be locally aggressive and result in extensive tissue destruction in advanced cases. A retrospective analysis of giant cell granuloma during the interval 1970 to 1990 revealed 18 cases of advanced disease, as defined by bone destruction and a greatest dimension of 2.0 cm or more. Epidemiologic factors, physical findings, imaging studies, pathologic specimens, treatment modalities, and outcome were reviewed for each case. Eight lesions were treated by local excision and curettage, and 10 were treated by partial mandibulectomy. Five mandibular defects were reconstructed with iliac bone grafts and one with a free flap. Only one patient with maxillary giant cell granuloma who underwent curettage had regrowth of what is suspected to have been residual disease. Individualized treatment, tailoring the extent of resection to the extent of disease, provided excellent results.

[Consensus on the treatment and control of border-line tumors of the ovary in Denmark]. / Konsensus for behandling og kontrol af borderline-tumor i ovariet i Danmark.

In order to obtain an impression of the consensus in Denmark of the treatment and control of border-line tumours of the ovary (BTO), a questionnaire was sent to all 43 departments of gynaecology/obstetrics and of surgery with gynaecology/obstetrics. Thirty-seven (86%) departments replied. The results of the investigation are presented. It is concluded that about 75% (87% in stage Ia and 65% in stage Ib) perform restrictive surgery on younger patients in the early stages. Indication for chemotherapy is found only in patients with more advanced stages. Very few find an indication for radiotherapy. Treatment and control of BTO in Denmark are in agreement with current international principles.

[The role of tumor marker CA 125 in the treatment of ovarian cancer]. / Tumormarkøren CA 125's rolle i behandling af ovariecancer.

Among the gynaecological malignancies in Denmark, ovarian cancer still has the highest mortality. At diagnosis, the majority of the patients show disseminated diseases and are treated with a combination of surgery and chemotherapy. At the conclusion of treatment and at later control examinations, the patients are evaluated by pelvic examination, ultrasound scans, CT-scanning, determination of the tumor-marker CA 125 and explorative laparotomy ("second look operation"). Based on studies of the literature the utility of CA 125 as a marker for the activity of the disease in patients with ovarian cancer during and after treatment is evaluated. It is concluded that CA 125 levels above 35 E/ml are seen in 85% of women with ovarian cancer. CA 125 as a sole parameter cannot be used for the screening of women for ovarian cancer, since high CA 125 values may be seen in conditions other than ovarian cancer. Normalisation of CA 125 values is a condition but not a guarantee for regression of the disease, since patients with a normal CA 125 may have progression of the disease. A rise in CA 125 during or after treatment, however, is almost always associated with progression of the disease.

Mucocutaneous pigmented spots and oral myxomas: the oral manifestations of the complex of myxomas, spotty pigmentation, and endocrine overactivity.

The complex of myxomas, spotty pigmentation, and endocrine overactivity is a recently recognized syndrome, transmitted as an autosomal dominant trait. The most serious component of the disorder is cardiac myxoma, which has caused the death of one fourth of the affected patients and serious disability in an equal number. It is, therefore, important to recognize patients at risk from the syndrome and, in particular, to test them for cardiac myxoma. Fortunately, in many patients the myxoma complex has a clearly visible marker: mucocutaneous pigmentation. Among 58 patients with the syndrome, spotty facial pigmentation was present in 36 (62%), and 29 (50%) of these also had pigmented spots on their lips. This type and distribution of pigmentation should be a clue to the possible presence of the complex of myxomas, spotty pigmentation, and endocrine overactivity, and patients thus affected should be referred for further investigation. Oral cavity myxoma(s) occurred in four patients with the syndrome.

Preoperative donation of autologous blood: technique, experience, and community applications.

Preoperative donation of autologous blood (PDAB) is the technique of choice for the transfusion of autologous blood for the maxillofacial surgeon. The use of PDAB is increasing, but lack of preoperative planning and lack of available utilization protocols are obstacles to its more widespread use. A technique for PDAB, a review of our experience, and guidelines for community applications are presented.

Chondrosarcoma of the jaw and facial bones.

BACKGROUND: Osteosarcomas of the jaw frequently have chondroblastic differentiation, causing confusion with chondrosarcomas. METHOD: Clinicopathologic features and results of treatment were analyzed for a series of 56 patients (27 males and 29 females from 1.5 to 88 years of age) with chondrosarcoma of jaw and facial bones. Twelve patients (21.4%) were younger than 20 years. RESULTS: The major symptom was nasal obstruction or a painless mass; the median interval from the first symptom until initial treatment was 1 year. Of the 56 chondrosarcomas, 25(44.6%) involved the alveolar portion of the maxilla and maxillary sinus; 23 (41.1%) involved the nasal septum, ethmoid, and sphenoid; 6 (10.7%) involved the mandible; and 2 (3.6%) involved the nasal tip. Of the 19 patients with radiographic studies, 15 (78.9%) had an expanding soft tissue mass with varied matrix calcification and destruction of bone and 2 had a purely lytic lesion. The lesion was difficult to assess in the two others. Most tumors had a lobulated growth pattern of hyaline cartilage. Hypercellularity, nuclear pleomorphism, and binucleation were common features. Forty-three tumors were grade 1, 13 were grade 2, and none were grade 3. Modalities of treatment were known for 51 of the 56 patients. Forty-six patients (90.2%) had surgical treatment, 2 (3.9%) had combination radiation therapy and chemotherapy, 1 (2%) had radiation therapy alone, and 2 (3.9%) had biopsy only. Follow-up adequate for analysis was obtained for 42 patients. Of these, 14 (33.3%) had local recurrence; uncontrolled recurrence developed in 9 (21.4%) patients. No distant metastases were documented. Overall actuarial survival at 5, 10, and 15 years was 80.7%, 65.3%, and 56%, respectively. Survival was analyzed for location, size, and histologic grade of tumor. No statistically significant differences were found. CONCLUSIONS: Chondrosarcomas of the jaw and facial bones are extremely rare, locally aggressive tumors.

Nitrous oxide neurotoxicity studies in man and rat.

To assess the effects of chronic exposure to low levels of nitrous oxide on neural function of man, the authors evaluated the neurologic condition, motor and sensory nerve conduction, and computerized tests of sensation of approximately half of the dentists in Rochester, Minnesota. Results of scored tests of neural function were not significantly different for dentists who used nitrous oxide extensively in their practices and dentists who did not. To assess the effects of chronic exposure to high levels of nitrous oxide on neural function and structure of experimental animals, groups of rats were exposed to 70 per cent N2O in 30 per cent oxygen for four hours, five days a week, for six months. Rats exposed to N2O and control rats showed no difference in well-being, in caudal nerve conduction, in axonal content and transport of acetylcholinesterase and dopamine-beta-hydroxylase, or in number and size distribution and pathologic abnormality of teased myelinated fibers. Although these results indicate a lack of peripheral nerve neurotoxicity of N2O in the rat, one cannot assume a similar lack of neurotoxicity in man with heavy exposures.