Cross Lip Vermilion Flap and Traumatic Upper Lip Avulsion: Reducing Donor Site Morbidity.

Using a cross lip vermilion flap for upper red lip reconstruction in cases other than whistle deformity in patients with cleft lip can lead to donor site morbidity. If the practitioner performs primary closure of the mucosa in lower vermilion after flap harvesting, the width and height of lower lip are reduced, which results in an increased lower incisor tooth show. Using free fat grafting is an effective method for reducing donor site morbidity in the lower lip following cross lip vermilion flap harvest.

Oral ulceration with bone sequestration: Retrospective study of eight cases and literature review.

OBJECTIVE: Oral ulceration with bone sequestration (OUBS) describes a site-specific intraoral ulcer that covers exposed, non-vital bone in patients lacking any etiological factor known to induce osteonecrosis. We aimed to conduct a retrospective study of eight new cases of OUBS and review the literature. SUBJECTS AND METHODS: This is a retrospective study of OUBS cases, diagnosed and managed during 2007-2017. Inclusion criteria were the presence of oral ulcer with exposed non-vital bone at sites of bone prominence and the absence of any factor known to cause osteonecrosis. The English literature was reviewed on original OUBS cases. RESULTS: Eight patients (5 males and 3 females, aged 27-75 years) were diagnosed with OUBS during years 2007-2017. Four cases involved the mandibular mylohyoid ridge, one a mandibular anterior exostosis and three the maxillary buccal/palatal exostoses. Exposed bone was removed under local anesthesia, resulting in complete healing in all cases. The literature review yielded 32 OUBS cases in the mandible. CONCLUSION: Oral ulceration with bone sequestration is a distinct, probably under-reported rather than rare clinical entity that should be regarded the provisional diagnosis in case of an oral ulcer covering exposed, non-vital bone at sites of bone prominence in patients lacking any etiological factor known to induce osteonecrosis.

Necrotising sialometaplasia: a diagnostic perplexity? An innocent entity to malignant masquerade.

OBJECTIVE: Necrotising Sialometaplasia is a benign self limiting reactive condition of major and minor salivary glands, which can arouse suspicion for malignancy, clinically and histopathologically. Here, we report a case of 38-year-old female with a painful ulcer on the palate. The case enlightens the importance of clinicopathologic correlation and diligent follow up in diagnosis and management of the case.

Traumatic ulcerative granuloma with stromal eosinophilia around mini dental implants without the protection of a denture base.

This is a report of a case of an unusual oral lesion after the placement of mini implants for the retention of a mandibular overdenture. A patient received four 2-mm-wide dental implants in the anterior mandible and had her mandibular denture relined with a soft material. After 3 months, she was not wearing her mandibular denture, and two nodular ulcerated lesions were observed near the mini implants. The lesions ceased following excision and regular denture wearing. Clinical and microscopic examination led to the diagnosis of traumatic ulcerative granuloma with stromal eosinophilia (TUGSE). TUGSE is rare lesion with a benign course that may occur following injury of the oral mucosa by mini implants under certain circumstances.

Treatment of oral ulcers in dogs using adipose tissue-derived mesenchymal stem cells.

AIM: Adipose tissue Derived Mesenchymal Stem cells (ADMSCs) represent a promising toolfor new clinical concepts in supporting cellular therapy. The goal of this study was to investigate the effects of ADMSCs transplantation on oral ulcer healing in dogs. STUDY DESIGN: Mesenchymal stem cells were isolated from adipose tissues of dogs obtained by suction-assisted lipectomy (liposuction), by dish adherence and were expanded in culture. Oral ulcers were induced by topical application of formocresol in the oral cavity of 18 dogs. The dogs were classified into 3 groups. Either autologous ADMSCs, Corticosteriod (Dexamethasone) or vehicle (saline) was injected. The healing process of the ulcer was monitored histopathologically. Gene expression of vascular endothelial growth factor (VEGF), platelets derived growth factor (PDGF), epidermal growth factor (EGF) and collagen was assessed in biopsies obtained from all ulcers "as healing markers'", by real time polymerase chain reaction (PCR). RESULTS: ADMSCs group showed significantly accelerated oral ulcer healing compared with the Dexamethasone and control groups. There was increased expression of VEGF PDGF EGF and collagen genes in ADMSCs-treated ulcers compared with Dexamethasone and controls. CONCLUSION: ADMSCs transplantation may help accelerate oral ulcer healing, possibly through the induction of angiogenesis by VEGF and PDGF as well as epithelial and connective tissue proliferation as evidenced by increased EGF and collagen gene expression.

Outcomes of pectoralis major myocutaneous flap in female patients for oral cavity defect reconstruction.

PURPOSE: Although much has been mentioned in the literature worldwide regarding the outcome of pectoralis major myocutaneous flaps (PMMFs), hardly any studies are available that mention the outcome of PMMFs in female patients. It has been presumed that complication rates after PMMF reconstruction in female patients are higher because of the presence of more adipose tissue in the flap. The objective of this study was to analyze our data regarding the outcomes of PMMFs in female patients with oral cancer undergoing reconstruction after tumor ablation. MATERIALS AND METHODS: In this retrospective study from January 2008 to May 2012, performed in a single institution in south India, we have analyzed our data on PMMFs in 140 female patients with oral cancer. The operative technique used was essentially the same as that described originally by Ariyan. However, to preserve the deltopectoral flap area, the incision was appropriately modified in a manner as described by Schuller. RESULTS: The mean age of the patients was 52.36 years, with a range from 30 to 76 years. They presented mostly with ulcers or ulceroproliferative lesions. Most of the patients had a history of tobacco and betel nut chewing. All of them underwent composite resection and reconstruction with PMMF under general anesthesia. Of the patients, 30 (21.4%) had complications, comprising infection (8), superficial flap necrosis (11), combined wound infection and superficial flap necrosis (3), total flap failure (2), and orocutaneous fistula (6). CONCLUSIONS: PMMF reconstruction is a reliable and cosmetically acceptable method of reconstruction in female patients for oral cavity defects after tumor ablation.

[Riga-Fede disease: traumatic ulceration of the tongue in an infant]. / Maladie de Riga-Fede: ulcération traumatique de la langue chez un nourrisson.

INTRODUCTION: Riga-Fede disease is rare. It is an oral mucosal ulceration due to repetitive dental trauma. We report the case of an infant for whom a quick diagnosis prevented many complications. OBSERVATION: A 45-day-old infant was brought to our consultation for pain during baby-bottle intake, preventing feeding. Oral examination revealed ulceration on the ventral surface of the tongue, associated next to a mandibular incisor present at birth. Pain stopped immediately after dental extraction of the supernumerary tooth. The infant could be fed again without any problem. The ulceration healed in less than three months. DISCUSSION: The diagnosis of Riga-Fede disease is strictly clinical. The early diagnosis in our case allowed for a quick management and normal feeding before there was any somatic consequence. Dental trauma is the most frequent cause of Riga-Fede disease. Treatment is conservative (polishing, resin) except in case of supernumerary teeth or excessive mobility. In these cases, extraction is indicated. The pathological diagnosis is required only when there is no healing after appropriate management fails, to look looking for another diagnosis.

[Oral medicine 6. Ulcerations of the oral mucosa]. / Oral medicine 6. Ulceraties van de oral mucosa.

An ulcer can be defined as a superficial defect of the skin or the mucosa, caused by tissue degeneration, and having little tendency to heal. With a careful review of the medical history and the findings of inspection of the oral cavity, including palpation of the ulcer, the dentist will in many cases be able to determine the diagnosis and also the treatment. There are, however, also ulcerations which require referral to a specialist, most often the oral and maxillofacial surgeon.

[Spontaneous exposition of a midline palatal torus]. / Exposición espontánea de un torus palatino de la línea media.

INTRODUCTION: Palatal torus, or torus palatinus, is a benign bone alteration that may cause some discomfort during phonation or swallowing. When its growth or persistent exposition produces unpleasant symptoms, it must be surgically removed. CASE PRESENTATION: We treated an 82-year-old female patient who consulted for a painful ulcerous lesion she had had for a year and which produced halitosis and discomfort when swallowing. During the oral cavity physical exam we observed a hard protuberance on the midline. It showed a perforation and ulceration of the lateral posterior palatal mucosa on the left side. We considered the following diagnosis: palatal torus, osteoma, pyogenic granuloma, or a soft-tissue neoplasia. We decided to surgically remove it and to perform a histopathological examination. Clinical evolution was satisfactory with complete resolution one month after surgery. The histopathological examination showed hyperostosis along with chronic inflammation of the soft tissues and a simple hyperplasia of the mucosa, which in turn indicated a palatal torus. DISCUSSION: We report an unusual case of spontaneous exposition of a palatal torus which took up almost all of the hard palate area. Its resection is described and we inform the histopathological findings. In the literature review, we did not find a previous report of a spontaneous exposition of a palatal torus.

Exposición espontánea de un torus palatino de la línea media / Spontaneous exposition of a midline palatal torus

Introducción. El torus , o rodete, palatino es una alteración ósea benigna que puede generar molestias en la fonación y en la deglución. Cuando su crecimiento o exposición persistente producen síntomas molestos, debe ser resecado quirúrgicamente. Presentación del caso. Se trata de una paciente de 82 años de edad, que consultó por una lesión ulcerativa de un año de evolución, que producía dolor, halitosis y molestia a la deglución. En el examen físico de la cavidad oral, se observó una prominencia de consistencia dura en la línea media, con perforación y ulceración de la mucosa palatina en su porción lateral posterior izquierda. Se consideraron los diagnósticos de torus palatino, osteoma, granuloma piógeno y neoplasia de tejidos blandos. Se decidió resecarla quirúrgicamente y hacer el estudio histopatológico. La evolución clínica fue satisfactoria, con resolución completa un mes después de la cirugía. En el estudio de histopatología se observó hiperostosis ósea con inflamación crónica de los tejidos blandos e hiperplasia simple de la mucosa, que corresponden a un torus palatino. Discusión. Se reporta un inusual caso de exposición espontánea de un torus palatino que ocupaba casi toda la bóveda palatina, se describe su resección quirúrgica y se informan los hallazgos de histopatología. En la revisión bibliográfica realizada, no se encontró un reporte previo de exposición espontánea de torus palatino.

Introduction: Palatal torus, or torus palatinus, is a benign bone alteration that may cause some discomfort during phonation or swallowing. When its growth or persistent exposition produces unpleasant symptoms, it must be surgically removed. Case presentation: We treated an 82-year-old female patient who consulted for a painful ulcerous lesion she had had for a year and which produced halitosis and discomfort when swallowing. During the oral cavity physical exam we observed a hard protuberance on the midline. It showed a perforation and ulceration of the lateral posterior palatal mucosa on the left side. We considered the following diagnosis: palatal torus, osteoma, pyogenic granuloma, or a soft-tissue neoplasia. We decided to surgically remove it and to perform a histopathological examination. Clinical evolution was satisfactory with complete resolution one month after surgery. The histopathological examination showed hyperostosis along with chronic inflammation of the soft tissues and a simple hyperplasia of the mucosa, which in turn indicated a palatal torus. Discussion: We report an unusual case of spontaneous exposition of a palatal torus which took up almost all of the hard palate area. Its resection is described and we inform the histopathological findings. In the literature review, we did not find a previous report of a spontaneous exposition of a palatal torus.

Treatment of hemimandibular paresthesia in a patient with bisphosphonate-related osteonecrosis of the jaw (BRONJ) by combining surgical resection and PRGF-Endoret.

We report a case of a 50-year-old patient with bisphosphonate-related osteonecrosis of the jaws (BRONJs) whose symptoms included severe pain and hemimandibular paraesthesia. The treatment included resection of necrotic bone and the application of plasma rich in growth factors (PRGF(®)-Endoret(®)). We closed the ulcer in the soft tissue and her pain and paraesthesia improved. One year postoperatively sensitivity was totally recovered, pain was absent and bone was partially regenerated.

Angiomatoid fibrous histiocytoma on the hard palate: case report.

BACKGROUND: Angiomatoid fibrous histiocytoma (AFH) is a rare, soft tissue sarcoma, which is slow growing with low metastatic potential. We recently had a patient present with AFH, which had a palatal perforation and it looked like a cyst in the occlusal view. Therefore, the radiological and histological features of AFH are reported herein. In addition, the differential diagnosis for this lesion is also discussed with a review of the literature. CASE REPORT: A 23-year-old woman presented with a spontaneous perforation of the palate. Clinically, a painless and ulcerative lesion was shown on the mid-palate area. Radiological findings revealed a well-demarcated, homogeneous, oval-shaped radiolucent lesion in the occlusal view. Histological examination with incisional biopsy, showed a relatively well-defined cystic-like mass including tumor cells. Taking into consideration the histological and immunohistochemical findings, the presented lesion was diagnosed as AFH. Under general anesthesia, the patient underwent a modified cylindrical partial maxillectomy including safety margins. DISCUSSION: In the present case, clinically differential diagnosis can be made with various diseases that have palatal perforations such as trauma, infection, neoplasia, collagen vascular disease, and idiopathic conditions. The treatment recommended in the literature has been radial excision. The prognosis of the tumor has been favorable.

Traumatic ulcerative granuloma with stromal eosinophilia. A case report and short literature review.

We introduce a case of 53-year-old female with rapidly developing tongue ulceration clinically mimicking squamous cell carcinoma of the oral mucosa. After a microscopic examination traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) was diagnosed. In a short literature review, we characterize this entity, analyse its aetiology and nature. Differential diagnosis is also discussed.

Maxillary osteomyelitis in two Scottish terrier dogs with chronic ulcerative paradental stomatitis.

Two Scottish terrier dogs were presented for recurrent oral problems. They were diagnosed with refractory chronic ulcerative paradental stomatitis and necrosis of the incisive and maxillary bones. Both dogs were treated with a combination of bilateral rostral maxillectomy and tooth extractions. The ostectomy was performed with a specific cutting device using piezoelectric bone surgery technology. These two cases show that a precise evaluation of dogs is essential for the diagnose of chronic ulcerative paradental stomatitis and its differentiation from mucocutaneous autoimmune diseases.

Mandibular Actinomyces osteomyelitis complicating florid cemento-osseous dysplasia: case report.

BACKGROUND: Apart from neoplastic processes, chronic disfiguring and destructive diseases of the mandible are uncommon. CASE PRESENTATION: We report, perhaps for the first time, the simultaneous occurrence of two such conditions in one patient, in a case that emphasizes the importance of bone biopsy in establishing the correct diagnosis. Florid cemento-osseous dysplasia (FCOD) is a chronic, disfiguring condition of the maxillofacial region. This relatively benign disease is primarily observed in middle-aged women of African ancestry. Cervicofacial actinomycosis is an uncommon and progressive infection caused by bacilli of the Actinomyces genus that typically involves intraoral soft tissues but may also involve bone. The accurate diagnosis of actinomycosis is critical for successful treatment. A diagnosis of osteomyelitis caused by Actinomyces bacteria was diagnosed by bone biopsy in a 53 year-old African-American woman with a longstanding history of FCOD after she presented with a new draining ulcer overlying the mandible. CONCLUSIONS: Clinicians should be aware of the possibility of actinomycosis arising in the setting of FCOD, and the importance of bone biopsy and cultures in arriving at a definitive and timely diagnosis.

Before you reach for the bleach...

Sodium hypochlorite (bleach) is advocated as an irrigant for use in endodontic therapy for its bacteriocidal and tissue dissolving properties. Extrusion of hypochlorite into the surrounding soft and hard tissues, however, can lead to severe complications, as illustrated in our four case reports. This article considers the risk benefit ratio of the different materials available and advises dental practitioners to ensure patients are aware of the potential risks of the materials used when seeking informed consent. It also aims to provide some guidance on prevention, identification and management of incidents.

Úlcera eosinófila de la mucosa oral / Eosinophilic ulcer of oral mucosa

La Úlcera Eosinófila de la Mucosa Oral, es una entidad pocofrecuente, pobremente descrita en la literatura mundial. Se define como unalesión benigna autolimitada que si bien puede presentarse en distintas áreasde la cavidad bucal, presenta una marcada predilección por la mucosa ventralde la lengua. Clínicamente, se presenta como una lesión ulcerada de bordesindurados y sobreelevados. Los hallazgos histopatológicos son característicosy consisten en un infiltrado mixto rico en eosinófilos, acompañadode una población de grandes células mononucleadas. Recientes artículosbasados en estudios inmunohistoquimicos, permiten afirmar la presencia degrandes linfocitos atípicos CD30+ y por lo tanto, incluir esta lesión en el espectrode las entidades simuladoras de desordenes linfoproliferativos.A pesar de esto, el mecanismo etiopatogenico permanece oscuro y el traumalocal juega un rol todavía no dilucidado; aunque se halla presente en lamayoría de las publicaciones, explicando el fenómeno como un mecanismoreactivo. La importancia de esta lesión, radica en su diagnostico diferencialpor su semejanza clínica al carcinoma espinocelular, histoplasmosis, chancrosifilítico, Úlcera tuberculosa, carcinoma epidermoide y otras.En nuestro trabajo se revisa la literatura y se discuten la características clínicas,histopatológicas y alternativas terapéuticas, a partir del artículo de uncaso clínico en una paciente joven, que luego de la biopsia escisión comométodo para el diagnostico de certeza, se produce una recidiva de la lesión;lo que orientó el tratamiento hacia la cirugía combinada con corticoterapialocal intralesional, logrando su remisión(AU)

Eosinophilic Ulcer of the Oral Mucosa, an entity, poorlydeciphers in world-wide literature. It is defined as a self-limited,benign injury that although it can appear in different areas of thebuccal cavity it presents a noticeable predilection via the ventralmucosa of the tongue. Clinically, one looks like an ulcer with hardand risen edges. The histo-pathological findings are typical andconsist of a rich infiltrated mix of eosinophils, as well as a populationof large mononuclear cells. Recent reports based onimmunohistochemical studies allow us to confirm the presence oflarge atypical lymphocytes CD30+ and therefore include this lesioninjury in the spectrum of lympho proliferative disorder simulators.Despite this the etiopathogenic mechanism remains unknown andlocal trauma still plays an unexplained roll; although the majorityof publications have explained the phenomena as a reactivemechanism. The importance of this injury is established by itsdifferential diagnostic because of its clinical similarity to SpinocellularCarcinoma, Histoplasmosis, syphilitic chancre, Ulcer Tuberculosis,Epidermoid Carcinoma and others. In our work the literature isreviewed and clinical characteristics, histo-pathologies and alternativetherapies are discussed. We use the case of a young patient whohas a biopsy in an effort to diagnose with certainty has a relapseof the lesion which directs the treatment towards combined surgeryand local intra lesion cortico therapy which led to successful remission(AU)