Intravascular papillary endothelial hyperplasia of the lower lip: surgical approach and review of the literature.

OBJECTIVE: A review of the literature for intravascular papillary endothelial hyperplasia is presented along with a case report of a geriatric patient. REVIEW OF THE LITERATURE: Intravascular papillary endothelial hyperplasia (IPEH) is a reactive benign lesion of vascular origin, which is caused by an excessive proliferation of endothelial cells. Only a few cases with IPEH in the oral cavity have been recorded in the literature, reporting the lower lip as the main site. The treatment of choice mentioned in the literature is simple excision. CASE REPORT: In this case, an IPEH of the lower lip of a 79-year-old male was treated by a sclerosing agent, which was injected into the lesion, causing compression and fibrosis of the blood vessels, followed by a careful dissection and excision. Intra-operatively no bleeding occurred. Post-operatively an excellent aesthetic result was achieved, without recurrence. CONCLUSION: The use of sclerotherapy followed by surgery in mixed type intravascular papillary endothelial hyperplasia can provide an acceptable aesthetic result with minimal intra-operative bleeding.

Cutaneous sinus tracts of dental origin.

The most common etiologic factor responsible for the intermittently suppurating cutaneous sinus tract about the face and neck is the extension of chronic infection of dental origin. Complete healing invariably follows the eradication of this source of infection. The presence of a cutaneous sinus tract about the face and neck should alert members of the profession to the necessity of routine dental examination including roentgenographic surveys of the teeth and jaws.

Severe limitation in mouth opening following transtemporal neurosurgical procedures: diagnosis, treatment, and prevention.

Five new patients and six previously described patients with severe limitation in maximum mouth opening following transtemporal neurosurgical procedures are described. Six patients underwent an operation for epidural hematoma and three for skull-base meningloma; two were treated with a pterional craniotomy for an aneurysm. Limited maximum mouth opening in these circumstances is caused by temporal muscle scarring and shortening. Aggressive physiotherapy is potentially beneficial if started early. If, however, diagnosis is delayed, the efficacy of physiotherapy declines, and surgical treatments such as temporal muscle detachment and coronoidectomy are fully indicated. The differential diagnosis, prevention, and treatment of limited maximum mouth opening following neurosurgical procedures are discussed.

Myxoid liposarcoma of the buccal vestibule. A case report.

A case of a myxoid liposarcoma in the buccal vestibule of the mandible is presented. The patient, an 86-year-old women, had 2 local recurrences after initial excision and died several months later. The literature is briefly reviewed.

Hyperostosis corticalis generalisata: surgical management and long-term follow-up of one patient.

A 24-year-old woman presented for treatment of her distorted facial appearance. She showed marked widening of the face and skull, which had first become noticeable in childhood. Significant thickening of the cortical bone was seen radiographically throughout the skeleton. Routine laboratory and endocrinological tests showed normal results. These findings, together with a family history of bone disorder, led to the diagnosis of hyperostosis corticalis generalisata. The lower border of the mandible was resected, resulting in improved facial appearance. During the 8-year follow-up, no changes were seen with regard to the mandible.

Comparison of full thickness skin graft "take" after excision with the carbon dioxide laser and scalpel.

SPECIFIC AIM. To evaluate the take of skin grafts on conventionally prepared beds and on beds prepared by a carbon dioxide laser, with and without abrasion of the bed. SIGNIFICANCE. Graft take is dependent on hemostasis, immobility, and nutrition of the graft. Scalpel excision of the skin graft can be associated with hemostatic difficulties and laser treatment of the skin graft bed can provide hemostasis. Abrasion of the bed after laser treatment may then be a means of opening small lymphatic and blood vessels to maintain the graft. Laser treatment followed by abrasion of the bed may provide an ideal graft base before suturing of the skin graft. MATERIAL AND METHODS. Full-thickness skin grafts were taken with a scalpel at three sites on the dorsal skin of 24 guinea pigs. The three beds were prepared with pressure alone to provide hemostasis, laser vaporization followed by abrasion with gauze to produce pinpoint bleeding, and laser vaporization alone. The original skin from each of the sites was then sutured back in place. At postoperative days 1, 3, 5, 10, 21, and 35 the graft sites were assessed clinically for "take." Laser Doppler measurements were also made to evaluate blood flow. Histologic sections of the three sites were prepared. Immunohistochemical analysis was performed to evaluate cell proliferation and angiogenesis. RESULTS. For the animals sacrificed through day 10 the rate of take for the sites that were not lased was 100%. For the sites that were lased alone and lased and abraded the rate of take was 71% with no difference between the two techniques. The lased sites demonstrated increased inflammatory response and graft necrosis. Immunohistochemical analysis showed increased cellular proliferation and angiogenesis in the bed. DISCUSSION. Grafts take best on a scalpel-prepared bed. Laser preparation of the bed, with or without abrasion, demonstrates decreased "take." Therefore the carbon dioxide laser is not a recommended means to take a graft or prepare the graft bed.

Iatrogenic exfoliation of teeth by the incorrect use of orthodontic elastic bands.

Four cases of improper use of elastic bands for minor orthodontic treatment are described. For all the patients, the treated teeth were damaged and local surgical intervention was necessary. To prevent complications when elastic bands are being used, the dentist must provide stabilization of the elastic bands by brackets, bands, or bonded attachments, inform the patient about the possibility of losing the rubber elastic band, and mark the elastic rubber by radiopaque material. Every effort must be made to preserve the damaged anterior teeth by fixation and surgical treatment.

Acquired toxoplasmosis of a submandibular lymph node in a 13-year-old boy: case report.

Toxoplasmosis is a parasitic infection divided into congenital and acquired forms. In the latter form, malaise, fatigue, and lymphadenopathy are commonly found, and submandibular lymphadenopathy is sometimes a manifestation. In children, cervical lymph nodes usually are affected. This is a case of a 13-year-old boy suffering from acquired toxoplasmosis, in which submandibular lymphadenopathy was the only clinical sign of the disease. Meticulous history taking, clinical examination, and specific serological tests should be performed in these cases. Positive serological results will confirm toxoplasmosis infections. Conservative treatment must be attempted initially.

Resorption of the crown in impacted maxillary canine. A clinical, radiographic and histologic study.

Thirty-six maxillary impacted canines which showed coronary resorption were selected out of 252 impacted canines. Clinical, radiographic and histologic observations were performed. In the majority of the cases (31) a local inflammatory factor was present and only in five cases was the resorption idiopathic. The incidence of resorption was highest in the later decades of life. In all cases bone replacement was found.

Modification of the muco-periosteal flap design in anterior maxillary osteotomies.

A modification of the mucoperiosteal flap planning for anterior maxillary osteotomy operations is suggested. This approach involves a total reflection of the labial mucoperiosteal flap, with the advantages of direct vision of the operative field thus providing easy and precise execution of the operative bony cuts, avoiding damage to the adjacent teeth and reduction of operating time. Sufficient blood supply to the mobilised segment is maintained through the palatal blood vessels. Corrective periodontal surgery may also be carried out at the same time.

Central hemangioma of the maxilla.

A case of central maxillary hemangioma is reported in which the only clinical symptom was spontaneous, recurrent, gingival papillary bleeding between the maxillary left premolars. The radiographic findings were inconclusive. It is strongly recommended that in cases where this diagnosis is suspected, surgical intervention be carried out under optimal conditions in an operating theater under hypotensive general anesthesia and with an ample supply of whole blood available.

Oral psoriasis: report of six new cases.

This article presents six cases of oral psoriasis originally diagnosed by means of the histological changes found on biopsies of the oral lesions. Three of the patients presented with oral and skin psoriasis. Of the remaining three, two presented with oral manifestations alone, although their follow-up was short, whilst the third showed delayed dermatological changes. Two of the cases were also complicated by psoriatic arthritis, one of them to the temporomandibular joint.

Clinical and roentgenographic evaluation of thirty-seven autotransplanted impacted maxillary canines.

Thirty-seven autotransplanted canines in thirty-one patients were observed for a period of 2 to 7 years. Transplants with less than 2 years follow-up were not included in this study. Although the surgical root canal, and fixation techniques were identical, the delayed pathophysiologic changes were different.