Cutaneous Rosai-Dorfman Disease of the Face: A Comprehensive Literature Review and Case Report.

PURPOSE: Cutaneous Rosai-Dorfman disease (C-RDD) is a rare, benign, non-Langerhans cell histiocytosis that can affect any skin area. The purpose of this study was to characterize C-RDD of the face through a literature review of published case reports of this lesion and present a new case of C-RDD. MATERIALS AND METHODS: An English-language search of 3 databases (PubMed, Scopus, and EBSCO Search) was conducted for cases of C-RDD of any skin area that had been published since 1969. Repeated citations of the same article in more than 1 database were deleted. Cases of C-RDD with solely facial involvement or involving the face and other skin parts were included and analyzed. Details of C-RDD cases (demographic features, regional distribution, clinical presentation, treatment, and follow-up course) were methodically reviewed and collected in Excel spreadsheets. Simple statistical analyses were conducted using Excel. RESULTS: The literature search yielded 578 published cases of C-RDD affecting any skin area; of these, 65 cases (11.2%) had facial skin involvement. The male-to-female ratio was 1:1.5, and the average age at presentation was 43.5 years (standard deviation, 12.4 yr). The racial distribution of facial C-RDD was, in descending order, 74.5% in Asians, 20% in Caucasians, and 5.5% in blacks. The most commonly affected facial skin regions were the cheeks and periorbital area, and most lesions were multiple in number and bilaterally distributed. The vast majority of facial C-RDD lesions presented as asymptomatic, nonulcerative, red, nodular plaques with durations ranging from 1 month to a few years. Many methods have been attempted for the treatment of facial C-RDD. However, the combined cure rate for all published treatment methods was only 28.6%. Surgical excision was the most effective treatment method, and corticosteroids were the least effective. CONCLUSION: This article has tried to characterize facial C-RDD lesions for easier management by maxillofacial surgeons.

The Use of Flexible Fiberoptic Cystoscope for Difficult Endotracheal Intubation in TMJ Ankylosis Patients: A Case Series.

Background: Fiberoptic bronchoscopes might be vital for the safe performance of difficult endotracheal intubations. However, many hospitals in low or middle-income countries are unable to afford the equipment. We describe the use of a flexible fiberoptic cystoscope, as an alternative to a bronchoscope, for difficult nasoendotracheal intubation in patients with temporomandibular joint ankyloses. Methods: Eight Jordanian patients (five females and three males) with severe restriction of mouth opening, due to ankylosis of the temporomandibular joint, underwent awake nasoendotracheal intubation using a flexible fiberoptic cystoscope under local anesthesia. Results: The procedure was successful and well tolerated in all eight patients. Conclusion: A flexible cystoscope can be a successful alternative to a flexible bronchoscope, for difficult nasoendotracheal intubation in hospitals at rural areas in low-or middle-income countries with limited financial resources.

Mineralization of the stylohyoid ligament complex in a Jordanian sample: a clinicoradiographic study.

PURPOSE: To record the prevalence of anatomic variations and the associated symptoms of mineralized stylohyoid complex (MSHC) in a Jordanian sample, and to investigate the possible factors responsible for mineralization. PATIENTS AND METHODS: This study was conducted at the Dental Teaching Clinics of Jordan University of Science and Technology in patients referred for panoramic radiographs. The MSHC, on either side of panoramic radiographs, was mapped out on tracing paper, the length directly measured, and the true length calculated. The true length of the MSHC was used to classify every side into short, long, or elongated, and the radiographic type of long and elongated MSHCs was determined as elongated, pseudoarticulated, or segmented. RESULTS: A total of 867 MSHCs were traced with an overall average length of the 23.1 mm. The most frequent class and type were long (53.3%) and elongated (41.6%), respectively. There was a significantly (P < .05) progressive increase in the length of the MSHC. The frequency of both of elongated and pseudoarticulated types increased and that of the segmented type decreased with aging. The mean length of the MSHC for patients with a history of tonsillectomy (26.29 mm) was significantly higher (P < .05) than its value in patients without a history of tonsillectomy (22.70). There was also a significantly (P < .05) progressive increase in the length of the MSHC as the age when tonsillectomy was performed increased. The mean length of the MSHC for cases with history of recurrent tonsillitis (6.99 mm) was significantly higher (P < .05) than for those without (2.42 mm). The mean length of the MSHC for patients with a history of head-and-neck or whole-body trauma was not statistically significantly different (P > .05) from the value for the nontraumatized patients. The mean length of the MSHC for patients with arthritis (27.70 mm) was significantly higher (P < .05) than that in patients without arthritis (22.53 mm). The highest frequency of MSHC palpated in the tonsillar fossa was significantly (P < .05) related to the elongated class (44; 64.8%) and type (100; 52%). The mean length of the MSHC was significantly higher in patients who reported having 4 symptoms, but only 1 symptom had a significant association with the type of MSHC. CONCLUSION: History of recurrent tonsillitis has a major effect on the true length of the MSHC, and trauma is not a significant factor for the development of longer MSHC.

Immunolocalization of proteoglycans in Meckel's cartilage of the rat.

The aim of this study was to investigate the presence and distribution of proteoglycans within Meckel's cartilage of rat embryos. A standard indirect immunoperoxidase technique was used on paraffin sections of rat heads. Sections were incubated with monoclonal antibodies recognising core protein epitopes in the proteoglycans versican and CD44. Polyclonal antibodies localized the proteoglycans decorin, biglycan and lumican. Versican was expressed by chondrocytes, but very weekly by the extracellular matrix. Decorin was strongly expressed by both of chondrocytes and the ECM. Both of biglycan and lumican were moderately expressed by chondrocytes, but weakly by the extracellular matrix. CD44 was weakly expressed by chondrocytes only, without staining of the ECM. It is concluded that Meckel's cartilage chondrocytes express the proteoglycans versican, decorin, biglycan, lumican and CD44 at variable levels during development in the rat. Such data are important for a greater understanding of the changes that take place during mandibular development. Further studies are needed to elucidate the exact role of proteoglycans during Meckel's cartilage and mandibular organogenesis.

Benign oral masses in a Northern Jordanian population-a retrospective study.

The aim of this study was to evaluate the relative frequencies, types and distribution of benign oral masses in North Jordanians. The records of the Department of Pathology at Jordan University of Science & Technology were reviewed and analyzed for patients with benign oral soft tissue masses, received during an 11-year period (1991-2001). The main outcome measures were patients' age and sex, and the mass type and location. A sum of 818 benign oral soft tissue masses (4% neoplastic and 96% non-neoplastic) was analyzed. Common benign neoplasms were salivary pleomorphic adenoma and lipoma. Non-neoplastic lesions consisted of traumatic (43%) inflammatory/ infective (33%), cystic (14%) and developmental (9%) lesions. Common non-neoplastic lesions were fibroepithelial polyp, pyogenic granuloma, mucoceles, hemangioma and squamous papilloma, in a descending order. There were 330 (40%) males and 488 (60%) females with a male to female ratio of 1: 1.5. The mean age was 33 years, with the majority in the 2(nd), 3(rd) and 4(th) decades. The sites commonly affected by benign neoplasms were the palate, tongue, upper lip and buccal mucosa, in a descending order and the sites commonly affected by non-neoplastic lesions were the gingiva, buccal mucosa, lower lip and tongue in a descending order. It is concluded that some of the features of benign oral masses in north Jordanians published in this paper are similar to those from other countries, and some are different. Further nationwide population-based surveys are needed to further define the epidemiology of benign oral masses among Jordanians.

Cutaneous cysts of the head and neck.

PURPOSE: A retrospective study on the features of cutaneous cysts of the head and neck as seen in a North Jordanian population. PATIENTS AND METHODS: The records of the Department of Pathology at Jordan University of Science and Technology were reviewed for patients with cutaneous cysts of the head and neck during the 12-year period extending between 1991 and 2002. Applicable records were retrieved, reviewed, and analyzed. Primary analysis outcome measures included patient age, gender, location of the cyst, type, clinical presentation, and treatment. The records of 488 patients were available for analysis. RESULTS: Epidermoid cyst was the most frequent lesion (49%) followed by pilar cysts (27%), and dermoid cysts (22%). The site affected most frequently was the scalp (34%), predominantly with pilar cysts (96%). Epidermoid cyst was the most frequent lesion in the neck (68%), cheeks (77%), periauricular area (70%), and the nasal area (55%). Dermoid cyst was the most frequent lesion in the periorbital area (52%). Females represented 51% of the patients and males accounted for 49%. The peak of age distribution for patients with dermoid cysts was at the first decade, and both of epidermoid and pilar cysts peaked at the third decade. Infection presented in 2.5% of cases. All cysts were enucleated surgically. CONCLUSION: Maxillofacial surgeons often encounter cutaneous cysts of the head and neck, and they must be familiar with the clinicopathologic characteristics of these lesions.

Pain experience after simple tooth extraction.

PURPOSE: To assess pain experience after simple uncomplicated tooth extraction and to see if there is a need to prescribe analgesic drugs after such a procedure. PATIENTS AND METHODS: A random sample of patients presenting for tooth extraction at the Maxillofacial Unit, Jordan University of Science and Technology was included. A baseline assessment of previously experienced general and dental pains using numeric scales was done. Subsequently, tooth extractions were done and telephone interviews were made during evenings for a week. Pain intensity was assessed on a numeric scale, and use of analgesic drugs and pain quality were recorded. RESULTS: At the evening of extraction 81.8% of patients had pain. Female gender predominance in pain reporting was statistically significant on postextraction days 3 and 5. Chronically inflamed teeth caused the highest mean pain intensity scores and nonsmokers showed significantly higher mean pain intensity scores compared with smokers. Mild pain was experienced by most patients (38.6%) on the evening of extraction. It was found that 55.3% of participants (largely females) used analgesic drugs on the evening of extraction, and 6.8% of participants still used analgesic drugs on day 7 postextraction. There was a significant correlation between mean pain intensity score and previous dental injection pain. CONCLUSION: Patients, notably females, experienced pain of varying intensity after simple uncomplicated tooth extraction maximally at the evening of extraction; and greater than 50% of the patients used analgesic drugs. We recommend offering regular analgesic drugs during the first week after tooth extraction.

Congenital neck masses: a descriptive retrospective study of 252 cases.

PURPOSE: This retrospective study was conducted to analyze congenital neck masses in Jordanians compared with international findings. PATIENTS AND METHODS: The records of patients with congenital neck masses between 1991 and 2002 were retrieved from the Department of Pathology, Jordan University of Science and Technology, and analyzed for age, gender, location, clinical features, and treatment. RESULTS: Within the 12-year period of the study, a total of 2,063 neck mass lesions were found; of these, 252 (12%) were congenital masses. These cases were distributed into 166 (66%) midline, 55 (22%) lateral, and 31 (12%) entire neck masses. The most frequent mass was thyroglossal duct cyst (fistulas) (53%), followed by cysts (fistulas) of the branchial apparatus (22%), dermoid cysts (11%), hemangiomas (7%), and 1ymphangiomas (6%). The majority of branchial arch anomalies (85%) were of the second arch. The mean age of patients was 16 years, with the greatest number of cases (38%) in the first decade. The male-to-female ratio was 1:1.2, with most lesions affecting females. The majority of lesions presented with painless neck swelling, and all lesions were surgically excised. CONCLUSIONS: The overall frequency and age distribution of congenital neck masses in northern Jordanians are similar to international findings. However, the gender distribution and relative frequency of individual types of neck masses are somewhat different from those in other countries. These differences may be attributed to genetic and geographic differences.

Salivary tumors in north Jordanians: a descriptive study.

OBJECTIVE: To evaluate the types and distribution of tumors of salivary glands in north Jordanians. STUDY DESIGN: The records of the Department of Pathology at Jordan University of Science and Technology were reviewed for patients who were treated for salivary gland tumors from 1991 to 2002. The tumors were analyzed for age of patient, sex of patient, tumor site, and tumor type. RESULTS: One hundred two true neoplasms (70% benign and 30% malignant) were found. The most frequent benign and malignant neoplasms found were pleomorphic adenoma (54%) and adenoid cystic carcinoma (13%), respectively. The most common major and minor salivary gland sites were the parotid (51%) and palatal glands (20%), respectively. Although most of major gland tumors were adenomas, carcinomas of the minor glands were only slightly less frequent than adenomas. The most frequent malignant parotid tumors were adenoid cystic carcinoma and mucoepidermoid carcinoma. The most frequent minor salivary gland malignant tumors were palatal adenoid cystic carcinoma. Age ranged from 1 to 94 (mean 40) years, with a male to female ratio of 1:1.2. CONCLUSION: North Jordanians with salivary gland tumors were found to have similar characteristics with patients of other countries with regard to tumor type, tumor site distribution, and age and sex of patients.

Pilomatricoma of the maxillofacial area in the northern regional Jordanian population: Report of 31 cases.

PURPOSE: To analyze the clinicopathologic features of pilomatricoma affecting the maxillofacial area in Jordanians. PATIENTS AND METHODS: Records of the Department of Pathology at Jordan University of Science and Technology were reviewed for patients with biopsied pilomatricoma of the maxillofacial region received during the 11-year period extending between 1991 and 2001. These were retrieved, reviewed, and analyzed for age, gender, location, clinical features, and treatment. RESULTS: There were 31 cases with an age range from 4 to 48 years (mean, 16.7). The majority (74%) of patients were in their first (45%) and second (29%) decades of life with a male to female ratio of 1 to 1.4. The periorbital (36%), the periauricular (28%), and the upper cervical region (23%) were the affected areas. The majority of cases presented as a painless skin nodule with a duration varying from 2 months to 3 years. The majority (97%) of tumors were between 0.5 cm and 2 cm in diameter. Histologically, almost 50% of tumors showed shadow cells alone. All tumors were removed surgically. CONCLUSIONS: The clinicopathologic characteristics of pilomatricoma of the maxillofacial area in Jordanians are similar generally to those in other countries. Maxillofacial surgeons need to be more aware of this lesion and should consider it in the differential diagnosis of dermal masses they encounter.

Pathology associated with impacted mandibular third molars in a group of Jordanians.

PURPOSE: The aim of this study was to determine the frequency and type of a group of radiographically detectable pathologic conditions around impacted mandibular third molars in Jordanians. PATIENTS AND METHODS: A retrospective study of patients referred to the Oral and Maxillofacial Surgery unit for surgical removal of impacted mandibular molars. The analysis outcome measures were the patients' age and gender, and any radiographic lesions associated with the impacted mandibular third molars. The following radiographic lesions were recorded in relation to the impacted third molar: caries, pericoronal radiolucent areas, and periapical radiolucent areas, in addition to odontomes, caries in the adjacent second molars, and external resorption of the roots of adjacent mandibular second molars. Bony radiolucent areas were all verified histopathologically. RESULTS: Impacted mandibular third molars (N = 2,432) from 1,398 patients were examined; 46.4% of third molars showed associated radiographically detected lesions. The most common lesion seen on panoramic radiographs was dental caries. Others included pericoronal radiolucent and periapical radiolucent areas. The majority of periapical radiolucent areas were histologically proven to be chronic periapical inflammation. All pericoronal radiolucent areas were histologically found to be either cysts or tumors. The most common cyst was dentigerous cyst; the most common tumor was ameloblastoma. CONCLUSION: A high ratio of impacted mandibular third molars in this group of Jordanians had an associated pathologic lesion.