Atypical presentation of lateral periodontal cyst associated with impacted teeth: two case reports.

BACKGROUND: Lateral periodontal cyst (LPC) is an uncommon form of developmental odontogenic cyst. LPC can be suspected when there is a round, well-circumscribed radiolucency, usually of small diameter, along the lateral surface of vital erupted teeth, predominantly in the mandibular premolar region. Histopathological analysis allows LPC to be diagnosed based on its characteristic features such as a thin cuboidal to stratified squamous non-keratinizing epithelium containing epithelial plaques and glycogen-rich clear cells. The aim of this article was to report two cases of atypical LPC associated either with an impacted lower left canine (tooth #33) or with a lower right third molar (tooth #48). CASE PRESENTATION: Case 1: A 56-year-old man was referred to us for an oro-dental assessment. Panoramic radiography revealed an impacted lower left permanent canine (tooth #33) with well-defined radiolucency on its upper cervical margin. A CT scan revealed a pericoronal radiolucency of 5 mm at its widest diameter around the impacted tooth #33. The pericoronal tissue was removed and sent for histopathological examination. The results revealed a lateral periodontal cyst. Satisfactory postoperative healing was achieved at the site. Follow-up at 12 months indicated no recurrence of the lesion. Case 2: A 54-year-old woman consulted with the main issue being pain on the lower right side of the face. Intra-oral examination revealed a vestibular swelling involving the region of the second molar (tooth #47), with obliteration of buccal sulcus. Pocket depth was determined to be 9 mm at the distal of #47. A diagnosis of gingival abscess resulting from chronic periodontitis was made. Panoramic radiography revealed a radiolucent cystic lesion associated with an impacted horizontal lower right third molar (tooth #48), suggestive of a dentigerous cyst. X-rays also revealed alveolar bone resorption on the molar (tooth #47). The cyst was removed along with the third molar and submitted for histopathological diagnosis. The diagnosis was LPC. Follow-up at 18 months indicated no recurrence of the lesion. CONCLUSION: These cases represent atypical presentations of LPC. They provide examples of the differential diagnosis of pericoronal radiolucencies involving an impacted tooth and our observations provide insights regarding the pathogenesis of LPC.

Tissue eosinophilia in oral intraepithelial neoplasia as a probable indicator of invasion.

OBJECTIVE: To investigate the presence of eosinophils in oral intraepithelial neoplasia (OIN) and oral squamous cell carcinoma (OSCC) lesions and its relation to invasion. SUBJECTS AND METHODS: Ninety-nine oral biopsies were selected and subdivided into the following: OIN-1(16 cases), OIN-2 (18 cases), OIN-3 (17 cases), microinvasive OSCC (10 cases), non-metastatic OSCC (22 cases) and metastatic OSCC (16 cases). The tissue eosinophilia was evaluated histologically in slices stained with haematoxylin and eosin. RESULTS: Eosinophil distribution was associated with diagnosis severity (p < .01). A significant difference was found between OIN-3 or microinvasive OSCC and non-metastatic or metastatic OSCC. Stromal invasion threshold was 7 eos/10 high power field (hpf) (96.1% specificity and 62.5% sensitivity). Eosinophils were absent in OIN-1; in OIN-2, two cases were positive. In OIN-3, five cases showed tissue eosinophilia, four of which had ≥3 eos/hpf or ≥7 eos/10 hpf. Three cases were suspected of invasion; two had a previous history of OSCC with elevated eosinophil infiltrate. In microinvasive OSCC, the four positive cases presented ≥3 eos/hpf and ≥7 eos/10 hpf. Although not significantly different, non-metastatic invasive OSCC had a higher number of cases (68.2%) with ≥22 eos/10 hpf contrasting with 50% in metastatic OSCC. CONCLUSION: Our results suggest that eosinophils can be considered an indicator of invasion in OIN, helping in cases of difficult diagnosis.

Analysis of the expression of heat-shock protein 27 in patients with oral lichen planus.

OBJECTIVE: Heat-shock protein 27 (hsp27) has been implicated in several biological events. In this experimental study, we aimed at analysing, for the first time, the expression of hsp27 in the diverse stages of oral lichen planus (OLP) lesions. MATERIALS AND METHODS: Thirty-six biopsy specimens of patients with OLP and 10 of healthy patients were selected. OLP specimens were divided into three groups: G1 - moderate or mildly active OLP; G2 - active or moderately active atrophic OLP; G3 - mild or inactive atrophic OLP. Hsp27 expression was analysed by immunohistochemistry (staining intensity and percentage of stained cells), and results of staining were compared between the different groups. Gender, age and anatomical location were also studied. RESULTS: In the basal layer, an increase of hsp27 expression in both G2 and G3 was observed when compared to G1 and control group. In contrast, a decrease of hsp27 expression in the superficial layer was observed in all groups when compared to control group. CONCLUSION: The increased expression of Hsp27 in the basal layer observed during the OLP evolution and the less staining in the superficial layers in all cases of OLP suggest that hsp27 may have a role in the OLP pathogenesis.

Transversal craniofacial growth evaluated on children dry skulls using V2 and V 3 canal openings as references.

PURPOSE: The aim of this study was to investigate the transversal relationships between two cephalometric landmarks and lines on the face using ovale, rotundum, greater palatine and infra-orbital foramina as references. METHOD: Thirty-four children dry skulls, 19 males and 15 females aged 0-6 years, were examined by computed tomography scanning by using constructed tomographic axial and frontal planes. The cephalometric transversal dimensions of the face skull were measured between the right and left landmarks from the orbital lateral wall and from the zygomatic arch. The cephalometric transversal dimensions of the base skull were measured between the right and left ovale, rotundum, greater palatine and infra-orbital foramina. RESULTS: Statistical analysis using partial correlations, regardless of the age, showed strong relationships (p < 0.05) among transversal measurements with nerve canal openings and transversal distances of skull face. CONCLUSION: We showed that the cranial base transversal growth was very strongly related to facial transversal growth from the postnatal period up to 6 years of age.

Oral mucosal morphea: a new variant.

Morphea is a cutaneous disorder characterized by an excessive collagen deposition. While in almost all cases the sclerosing process exclusively affects the skin, there are anecdotal cases in which associated mucosal involvement has been described. We here report the case of a woman developing a whitish indurated plaque over the left upper vestibular mucosa and hard palate leading to dental mobility and exposure of the roots of several teeth. Cone beam computed tomography of the left maxilla showed bone resorption involving the upper cuspid to the second molar region with widened periodontal ligament spaces, while light microscopy studies demonstrated epithelial atrophy and fibrosis of the dermis extending into the submucosa with hyalinization of subepithelial collagen. Our observation expands the spectrum of clinical presentations of morphea and provides the first example of isolated oral morphea. Its recognition is important to avoid significant local complications.

[Unusual location of mucous extravasation cyst: report of two cases]. / Localisation inhabituelle d'un pseudo-kyste salivaire: présentation de deux cas.

INTRODUCTION: The most common location of mucous extravasation cyst is the lower lip followed by buccal mucosa and ventral surface of the tongue. It very rarely occurs on the upper lip. OBSERVATION: A 17-year-old man consulted for a firm sub-mucosal nodule of the upper lip. The nodule was removed and the histological examination identified a pseudocyst characterized by a mucus pool without any epithelial lining, surrounded by granulation tissue. A similar observation was made in a 58-year-old woman who consulted for a recurrent translucent vesicle of the upper lip. There was no recurrence in either case. DISCUSSION: The clinical presentation of mucous extravasation cysts of the upper lip is similar to that of others lesions especially salivary gland or connective tissue tumors, or sometimes traumatic fibroma. Histological examination is mandatory to prove a definitive diagnosis and rule out a neoplasm requiring a more aggressive treatment.

[Histological analysis of dental follicles after unerupted mandibular third molar extraction]. / Analyse histologique des follicules dentaires après germectomies des troisièmes molaires mandibulaires.

INTRODUCTION: The extraction of third mandibular tooth germ (M3) is often prophylactic to avoid orthodontic treatment relapse and to prevent infectious or tumoral diseases developing from the dental sac. The purpose of this study was to screen for early histopathological modification of dental follicles (inflammatory, infiltration, or epithelial metaplasia) after extraction of third mandibular tooth germ (M3) on asymptomatic patients. The secondary objective was to study the proliferative activity of the epithelium by dosing the anti Ki-67 antibody. PATIENTS AND METHOD: Twenty dental follicles extracted from 12 boys and eight girls between 14 and 18 years of age were examined under phototonic microscopy. The proliferative activity of the epithelium was assessed by immuno-histochemistry. RESULTS: Three dental follicles presented with focal epidermoid metaplasia of the epithelium, without odontogenic tumoral proliferation. In all other cases, the cylindrical epithelial cell structure was normal. A mild chronic inflammatory infiltrate was present in 30% of the cases. Immuno-histochemical analysis revealed labeling of very rare epithelial lining cells, slightly more in cases presenting with metaplasia. DISCUSSION: The prevalence of early morphological changes of dental sac is low. This histo-morphological study does not support the systematic extraction of asymptomatic mandibular tooth germs (M3).

Endothelial diaphragmed fenestrae: in vitro modulation by phorbol myristate acetate.

Cultured microvascular endothelial cells isolated from fenestrated capillaries have been shown to express many properties of their in vivo differentiated phenotype, yet they contain very few diaphragmed fenestrae. We show here that treatment of capillary endothelial cells with the tumor promoter, 4 beta-phorbol 12-myristate 13-acetate, induces more than a fivefold increase in the frequency of fenestrae per micron 2 of cell surface, as determined from a quantitative evaluation on freeze-fracture replicas. In quick-frozen, deep-etched preparations, the endothelial fenestrae appeared to be bridged by a diaphragm composed of radial fibers interweaving in a central mesh, as previously observed in vivo. These results indicate that diaphragmed fenestrae are inducible structures, and provide an opportunity to study them in vitro.

Respiratory Epithelium Lined Cyst of the Maxilla: Differential Diagnosis.

Maxillary cysts, including the cysts lined by respiratory epithelium, can present a diagnostic challenge. We report an unusual case of a maxillary cyst on an endodontically treated tooth #16, in which the cavity was totally lined by a respiratory epithelium. The patient, a 35-year-old male, presented with a generalized chronic periodontitis and complained of a pain in the tooth #16 region. A periodontal pocket extending to the root apices with pus coming out from the gingival was found. A combined endodontic periodontal was observed on a panoramic radiography. CBCT-scan revealed a well-circumscribed radiolucent lesion at the apices of the distobuccal root of the 16. A communication with the right maxillary sinus cavity and a maxillary and ethmoidal sinusitis were also observed. The lesion was removed and histological examination revealed a cyst lined exclusively by respiratory epithelium. Ciliated and rare mucous cells were also observed. The diagnosis could evoke a surgical ciliated cyst mimicking the radicular cyst but the patient has no previous history of trauma or surgery in the maxillofacial region. It could also be an unusual radicular cyst in which the stratified squamous epithelium was destroyed by inflammation and replaced by a respiratory epithelium of the maxillary sinus.

[Bisphosphonates-related jaw osteonecrosis]. / Ostéonécrose des maxillaires chez des patients traités par bisphosphonates.

INTRODUCTION: The latest generations of bisphosphonates constitute a major advance in the management of disorders including Paget's disease, osteoporosis, and osteolytic bone tumors. Recent reports describe numerous cases of osteonecrosis of the jaw in patients treated with bisphosphonates. Some of these reports mention predisposing factors, including surgical procedures, chemotherapy, and radiotherapy. CASES: In the past 12 months, we have observed and treated 9 cases of maxillary osteonecrosis, which we present summarily. DISCUSSION: Some of our cases (3 of 9), like many of those described in literature, do not present predisposing factors. The osteonecrosis may thus be due mainly to the effect of bisphosphonates that, by blocking bone remodeling, may cause excessive bone mineralization. If this hypothesis is confirmed, these cases of osteonecrosis may be due to excess doses. Better dose adjustment should thus help prevent this complication.

[Toothache: At what point has a pontocerebellar angle tumor to be evoked?]. / Odontalgie : quand évoquer une tumeur de l'angle ponto-cérébelleux?

INTRODUCTION: Dental pain may have another origin than teeth. It may be caused by myofascial, neurovascular, cardiac, neurological, sinusal or psychological factors. We will discuss 2 rare cases of patients who presented with a cerebellopontine tumor, who initially manifested with symptoms of dental pain. OBSERVATION: The first patient, male, 44 years of age presented to his dentist with toothache (47), which led to its extraction. Five months later, a second painful episode, more characteristic, revealed the presence of a vestibular schwannoma, which was successfully treated and led to the disappearance of the pain. The second case, a 43-year-old female presented to her dentist with toothache (46), which lead the dentist perform a root filling. Two years later, with a 3rd episode of dental pain, more relevant of a trigeminal neuralgia, a epidermoid cyst of the right cerebellopontine angle was identified and successfully treated leading to the disappearance of the pain. DISCUSSION: Cerebellopontine tumors of this type may lead, in exceptional cases to symptoms of dental pain. Therefore, in face of atypical tooth or facial pain, both a detailed medical history and a detailed examination are necessary, in order to investigate any neurological signs and symptoms, before undertaking any non-essential dental treatment, which may be detrimental for the patients.

Phorbol ester induces diaphragmed fenestrae in large vessel endothelium in vitro.

The endothelium of visceral capillaries is fenestrated, whereas that of large vessels is not. We show here that the tumor promoter, 4 beta-phorbol 12-myristate 13-acetate (PMA), triggers formation of diaphragmed fenestrae in endothelial cells cultured from the calf pulmonary artery and the human umbilical vein. This demonstrates that large vessel endothelial cells have the potential to express, in response to exogenous signals, a structural specialization uniquely associated with the endothelium of visceral capillaries in vivo.

Loss of polarization of plasma membrane domains in transformed pancreatic endocrine cell lines.

Using enveloped RNA viruses that bud selectively from either the apical or basolateral surface in polarized epithelial cells, we have recently provided evidence for polarization of plasma membrane domains in cultured pancreatic islet cells. In this study, we have followed the same experimental strategy to establish whether these polarized properties are maintained in transformed pancreatic endocrine cells. We find that influenza virus and vesicular stomatitis virus emerge from both the attached and free surfaces of cultured insulinoma cells (RIN cells) and SV40-transformed beta-cells (HIT cells). This demonstrates loss of polarization in transformed pancreatic endocrine cells.

S100, alpha-smooth muscle actin and cytokeratin 19 immunohistochemistry in odontogenic and soft tissue myxomas.

AIMS: To compare the expression of S100 protein, alpha-smooth muscle actin (alpha-SMA) and keratin 19 in odontogenic myxomas and non-odontogenic myxoid lesions. METHODS: Formalin fixed, paraffin wax embedded tissue from seven odontogenic myxomas, three soft tissue myxomas, six hyperplastic myxoid dental follicles, two intramuscular myxomas, 12 cardiac myxomas, and seven normal dental follicles were examined immunocytochemically for S100 protein, alpha-SMA and cytokeratin 19 using the Streptavidin-biotin method. RESULTS: A minority of odontogenic myxomas (three of seven) were positive for S100 and the staining was of moderate intensity and in all myxofibroblasts. Soft tissue myxomas, normal dental follicles, intramuscular myxomas, and most enlarged myxoid follicles were negative. In the cardiac myxomas the cells forming cords and islands were positive in approximately half (seven of 12), but the dispersed stellate myxoblasts were positive in only two cases. A population of cells in all the odontogenic myxomas and hyperplastic dental follicles contained alpha-SMA, but such cells were sparse in cardiac myxomas and present in only four cases. Cytokeratin 19 was present in odontogenic epithelium of odontogenic myxoma and follicles. CONCLUSIONS: A minority of odontogenic myxomas, but not other oral myxoid lesions, may express S100 protein and this could cause difficulty distinguishing myxoma from myxoid nerve sheath tumours. Sparse myofibroblastic cells occurred in all types of myxoma tested. The epithelium sometimes found within jaw myxomas expresses cytokeratin 19 and this is consistent with an odontogenic origin.

The effects of a beta-2 selective adrenergic agonist and a beta-nonselective antagonist on theophylline clearance.

Beta-adrenergic agonists and antagonists have been shown to alter theophylline pharmacokinetics. It was the purpose of this study to characterize further the effects that terbutaline and propranolol have on theophylline disposition. In nine healthy male volunteers, mean parameters for theophylline disposition did not change after four days of terbutaline (5 mg q8h). Theophylline clearance, however, did change within the subjects. Clearance increased in five subjects, decreased in three, and remained unchanged in one volunteer. Pretreatment with four days of terbutaline (5 mg q8h) and propranolol (60 mg q8h) significantly decreased mean theophylline clearance (60.1 +/- 12.9 vs 40.6 +/- 9.9 mL/min/1.73m2; P less than .01) increased half-life (8.37 +/- 1.77 vs 12.32 +/- 2.70 hours; P less than .05), and increased postinfusion theophylline concentration (13.5 +/- 2.7 vs 18.95 +/- 2.5 micrograms/mL; P less than .001). In five subjects theophylline clearance increased after terbutaline pretreatment (64.6 +/- 13.0 vs 75.0 +/- 13.9 mL/min/1.73m2). The percentage increase ranged from 3.9 to 28.5%. These subjects were restudied after receiving propranolol alone (60 mg q8h). Comparison between the propranolol and terbutaline study and the propranolol alone study indicated no mean change in clearance in these five subjects (41.8 +/- 12.7 vs 36.1 +/- 5.1 mL/min/1.73m2). Thus it appears that the changes observed in these five subjects after terbutaline pretreatment may have been random in occurrence as has been shown to occur with theophylline disposition and are not related to terbutaline pretreatment. It is concluded that beta-2 adrenergic stimulation does not alter theophylline pharmacokinetics, whereas nonselective beta-adrenergic antagonism profoundly affected theophylline disposition. This is an additional reason not to use propranolol in patients who receive theophylline.

Premalignant lesions of the oral mucosa. A discussion about the place of oral intraepithelial neoplasia (OIN).

Oral precancerous lesions are traditionally classified as leukoplakia, erythroplakia, erythroleukoplakia, and distinguished from precancerous conditions. Major attention is focused on leukoplakia, and no distinction made whether dysplasia is or not present. Malignant transformation is a multistep process that should be approached also from the histological, and not merely from the clinical standpoint. Intraepithelial neoplasia, a notion created for the uterine cervix and already extended to other mucosae, should be adapted to the oral mucosa and used as diagnostic term. OIN (oral intraepithelial neoplasia) is not only a change in terminology, but also a progress in the unifying concept of precursors of squamous cell carcinoma, suppressing the useless discussion between severe dysplasia and carcinoma in situ. Furthermore, grading lesions as low or high grade OIN increases diagnostic consistency. OIN is suspected on three clinical patterns reflecting histological changes: mosaic, irregular keratosis, erythroplakia (or intermediate aspects), but dysplastic mucosa may also appear normal clinically.

Infiltrating intramuscular lipoma of the temporal muscle. A case report with molecular cytogenetic analysis.

Intramuscular lipomas are uncommon benign mesenchymal tumors which infiltrate skeletal muscle and are exceedingly rare in the head and neck region. Because of the infiltrating nature of the lesion and a high propensity for recurrence, they are sometimes difficult to distinguish from well-differentiated liposarcomas (WDLS). We report, the first case of an infiltrating lipoma of the temporal muscle in a 62-year-old white man who presented with a slow growing mass in the left temporal region. The histopathological examination showed diffuse infiltration of the striated muscle fibers by mature adipocytes. There were no lipoblasts or cells with atypical nuclei as described in WDLS. We performed interphase fluorescence in situ hybridization (FISH) analyses using painting probes for chromosome 12 and a specific probe for the MDM2 gene and comparative genomic hybridization. The results did not identify MDM2 or 12q amplification and therefore confirmed the benign nature of the lesion.

Epithelial odontogenic ghost cell tumour of the mandibular gingiva.

The epithelial odontogenic ghost cell tumour (EOGCT) is considered as a solid 'neoplastic' variant of the calcifying odontogenic cyst and is an uncommon lesion for which various names have been proposed over the years. We describe here an extraosseous case occurring on the edentulous mandibular gingiva in the right bicuspid area of a 70-year-old woman. The lesion was a painless nodule that appeared clinically as a hyperplastic mass, which was considered to be of reactive nature. Radiographic examination showed a localised resorption of the underlying mandibular bone. The tumour was excised; there was no recurrence at a 2-year follow-up examination.

The impact of intrainstitutional relocation on morbidity in an acute care setting.

This study investigated the effects on morbidity of intrainstitutional room changes among stabilized male patients in an acute care setting. Controlling for potential confounders, patients who underwent room changes did not differ post-transfer from control patients in vital sign parameters. Younger movers, however, were found to be taking fewer medications post-transfer and were more likely to be independently ambulatory at discharge than younger controls, while older movers were found to be taking more medications and were less likely to be independently ambulatory at discharge in comparison to older controls. A parallel trend appeared with regard to physician evaluation of patient improvement. These findings suggest that age moderates the impact of intramural relocation on patients' health status; while younger patients experience a room change as beneficial, older patients may find it deleterious. Suggestions are offered for future research.