Intraoral minor salivary gland neoplasm: a single institution experience of 80 cases.

From March 1991 to February 2001, 80 cases of minor salivary gland tumours were diagnosed in the Department of Oral and Maxillofacial Surgery at the University of Maryland at Baltimore (Baltimore, MD, USA). Data extracted from a retrospective chart review included age, sex, symptoms, site, histological diagnosis. treatment and outcome. Pleomorphic adenoma was the most common benign tumour and makes up 89.5% of all benign tumours. The percentage of malignancy (76.3%) was much higher than that found in other studies. Of the malignant tumours, 54.1% were mucoepidermoid carcinomas. This study differs from many previous reviews that were published by pathologists rather than a surgical unit.

Ameloblastoma in children.

PURPOSE: The purpose of this report was 1) to report the experience of the University of Maryland, Department of Oral and Maxillofacial Surgery (OMS Department) in the treatment of ameloblastoma in children and 2) to review the world literature on the treatment of ameloblastoma in children from 1970 to 2001. METHODS AND MATERIALS: This study first reviews the experience of the OMS Department of the University of Maryland with ameloblastomas in children and then reviews the literature on this subject. The first part of the study was undertaken by a retrospective chart review of all patients with a diagnosis of ameloblastoma in the OMS Department between May 1991 and December 1999. The literature on ameloblastoma in Western societies and Africa was separately reviewed from 1970 through 2001. Reports earlier than 1970 were not reviewed, as the histologic diagnosis of ameloblastoma was not well defined before that period. RESULTS: In the Maryland series, 11 patients under the age of 20 years with ameloblastoma were treated. Eight patients were seen primarily, and 3 presented with recurrent lesions. The average age was 15.5 years; 5 of 11 patients were black, and 9 of 11 tumors were unicystic ameloblastomas. The literature review showed 85 children in the Western reports and 77 reported from Africa. The average ages were 14.3 and 14.7 years, respectively, but unicystic ameloblastomas accounted for 76.5% of the Western and only 19.5% of the African children, with an increased frequency of occurrence in the mandibular symphisis in African (44.2%) versus Western (5.8%) patients. Analysis of recurrence after enucleation of unicystic ameloblastomas in 20 children followed at least 5 years or until recurrence showed a recurrence of 40%. CONCLUSIONS: Ameloblastomas in children differ from adults, with a higher percentage of unicystic tumors. African children appear to resemble the adult pattern. Although enucleation has been claimed to give acceptable recurrence rates in unicystic ameloblastoma, there are no large series with long follow-up in children. The histologic pattern that exhibits mural invasion in unicystic ameloblastoma suggests that more aggressive surgery is necessary.

Surgical management of facial nerve injuries.

The comprehensive management of facial nerve injuries requires a surgeon with a number of available methods of reconstruction at his or her disposal. Comprehensive evaluation or documentation of injury is required to determine the most appropriate timing and method of surgical intervention. The majority of nerve injuries are limited, and direct repair or simple nerve grafting are the indicated treatment modalities. These procedures are easily applied to the management of the facial nerve by any well-trained microsurgeon. Accurate diagnosis and timely intervention are critical in achieving acceptable outcomes. Multidisciplinary collaboration is occasionally necessary for extremely proximal injuries wherein the skills of a lateral skull base surgeon are critical. Delayed facial reconstruction by facial reanimation requires subspecialty skills and necessitates referrals to centers experienced in such procedures.

Management of oral squamous cell carcinoma treated with inadequate excisional biopsy.

PURPOSE: When an initial "excisional biopsy" has been performed on a primary oral carcinoma, microscopic tumor may remain and the usual landmarks that enable the surgeon to plan his safe margin are destroyed. This article analyzes the impact that such a biopsy may have on treatment and patient outcome. PATIENTS AND METHODS: A retrospective chart review of a consecutive series of 350 oral cancer patients treated by 1 surgeon in an 8-year period identified 33 (9.4%) patients who originally had inadequate excisional biopsies. Exclusion criteria eliminated 7 patients who were lost to follow-up or who had undergone previous treatment with radiation therapy or chemotherapy. Data extracted included age, sex, race, primary intraoral site, estimated tumor (T) stage, method of treatment, histology, follow-up, and outcome. RESULTS: Twenty-four of the 26 patients underwent re-excision of their oral cancer. Ten of these patients (38.4%) also underwent selective neck dissection. Fifteen of the 24 patients (62.5%) had residual carcinoma identified in the re-excision specimen, and 3 of the patients who underwent elective neck dissection had micrometastasis identified. The patients were followed for an average of 35.5 months. Two of 24 (8.3%) patients had local recurrence at 36 and 84 months, respectively. Both patients were managed with re-excision and are still alive with no evidence of disease. Of the 10 patients originally treated with elective neck dissection, there has been no regional recurrence. However, of the 14 patients who underwent re-excision of the lesion without neck dissection, 3 developed regional disease at 1, 5, and 6 months, respectively, postoperatively. These patients underwent neck dissection and radiation therapy. Two patients are alive with no evidence of disease, and the third died of a second primary lung cancer. Twenty-five of the 26 patients (96.2%) are still alive and well with no evidence of disease. CONCLUSIONS: Patients who have had inadequate excisional biopsies can be effectively managed with re-excision plus neck dissection when indicated by T stage or more than 3 mm depth of invasion.

Current management of oral cancer. A multidisciplinary approach.

BACKGROUND: Recent basic science discoveries have contributed to our understanding of the etiology of oral cancer and allowed us to consider innovative approaches to therapy. METHODS: The authors evaluated and summarized current approaches to the management of oral cancer, emphasizing the multidisciplinary team approach to coordinate surgery, radiation therapy and chemotherapy. Current concepts in management, including complications of therapy, are described. RESULTS: State-of-the-art surgical techniques can spare patients with oral cancer from much of the morbidity and complications common in the past. The refinement of treatment strategies reduces complications and improves efficacy. Many exciting new clinical trials in the areas of gene therapy and immunomodulation are showing promise. CONCLUSIONS: Management of oral cancer has undergone radical change in the past 10 years and continues to evolve rapidly. Discoveries in molecular biology, diagnosis, surgery, radiation therapy and medical oncology have altered many traditional concepts and practices. CLINICAL IMPLICATIONS: General dental practitioners need to understand current treatment modalities for oral and pharyngeal cancers to determine to whom they should refer patients for the most appropriate treatment, and to make recommendations regarding complications associated with these cancers.

Management of auricular hematoma using a thermoplastic splint.

Several methods have been described in the literature for the management of acute auricular hematoma. Herein, we review the pathogenesis of auricular hematoma, describe the various treatment modalities, and report a case in which a thermoplastic splint was used to prevent recurrence of hematoma in a patient with immune thrombocytopenic purpura.

Ischemic heart disease.

Imbalances between myocardial oxygen delivery and oxygen demand result in ischemic heart disease. Accurate stratification of risk for permanent myocardial injury and appropriate choice of therapy are critical in the successful management of ischemic heart disease. Dental therapy can be performed safely for most ambulatory patients with ischemic heart disease.

Polymorphous low-grade adenocarcinoma of the sublingual gland.

A case of polymorphous low-grade adenocarcinoma occurring in the sublingual gland is described, followed by a brief discussion on the differential diagnosis. This is the first case ever reported of this entity occurring in the sublingual gland. This paper brings into question the early belief that this tumor is restricted to intraoral minor salivary glands.

Implants in the medically challenged patient.

Proper patient selection and careful technique will always be the marks of quality implant dentistry providers. The implications for therapy, of existing systemic disease or systemic therapies have been described in this article. All health care delivery provided by dental practitioners must take into account, always and foremost, the patient. Careful patient evaluation is critical. Patients' physicians may not fully appreciate the physiologic ramifications of the complex and sometimes lengthy appointments required in performing implant procedures. The final decisions regarding the prescription of therapy rest with the dentist. Through increased knowledge of the pathophysiology of diabetes mellitus, disorders of bone metabolism, radiotherapy, and chemotherapy, improved patient selection and perioperative management can benefit the dental implant team.

Vertical ramus compartment resection of the mandible for deeply invasive tumors.

PURPOSE: Vertical ramus compartment resection of the mandible is indicated in the management of pathology that originates in the ascending ramus or condyle of the mandible and invades the pterygomaxillary fossa, infratemporal space, parapharyngeal space, masseter muscle, or medial pterygoid muscle. This article describes the technique, presents a review of the relevant literature, and reports the outcome of five cases. PATIENTS AND METHODS: A retrospective review of all cases operated on by the senior author (R.A.O.) over the last 5 years at the University of Maryland was performed. The records of these cases were reviewed to identify patient sex, age, pathologic diagnosis, use of adjuvant therapy, and status after resection. RESULTS: Five surgical cases in which a vertical ramus compartment resection of the mandible was necessary were identified. The histologic diagnoses of these five cases were as follows: grade II chondrosarcoma, peripheral neuroectodermal tumor, high-grade central mucoepidermoid carcinoma, invasive squamous cell carcinoma, and odontogenic keratocyst. Four of the five patients are alive and well at follow-up of 16 to 43 months. The only death occurred in a 70-year-old man with squamous cell carcinoma that recurred intracranially by local extension. CONCLUSIONS: When indicated by local extension or tumor biology, vertical ramus compartment resection of the mandible is a viable surgical modality that allows clearance of local disease in most well-selected cases.