Cherubism: case reports and literature review.

Two new cherubism cases have been documented and reported. Both were relatively mild clinically, being a Grade I within Motamedi's I to V clinical grading system. Each presented with bilateral posterior mandibular lesions having a multiloculated radiolucent appearance. In each case, detection with eventual diagnosis evolved from a mandibular molar failing to erupt (tooth No. 19). The partial literature review documented the wide spectrum of clinical expression of this disease and the consequent wide variation in its treatment.

Squamous cell carcinoma in an American bison (Bison bison bison).

The following case report is, to the best of our knowledge, the first documentation of a squamous cell carcinoma in a full-blooded American bison (Bison bison bison). This female bison developed an ulcerated lesion on the left flank, at the site of a brand, in the summer of her eighth year. In the winter of her ninth year, as the lesion continued to grow, a biopsy was performed, and a diagnosis of squamous cell carcinoma was made. Ultimately, there was metastasis to the liver, a lung, and a prefemoral lymph node.

Clinical diagnosis and management of hormonally responsive oral pregnancy tumor (pyogenic granuloma).

OBJECTIVE: To present a review of our experience and that of the medical literature in the diagnosis and management of oral pregnancy tumor (pyogenic granuloma), the natural History of the disease, its hormonal etiology, histopathologic features and management strategies. STUDY DESIGN: Medical literature review. RESULTS: This common, benign, hyperplastic oral mucosal lesion is much less familiar to gynecologists and obstetricians than to dentists. CONCLUSION: For practitioners engaged in primary care obstetrics and gynecology, routine oral examination and proper identification of pyogenic granuloma are important to avoid misdiagnosis and overtreatment.

Shedding oral mucosa.

Four patients presented with asymptomatic gray-white oral mucosal tissues that sloughed and peeled away leaving a normal tissue base. This peeling phenomenon appeared unlike any known oral mucosal disease, although it somewhat resembled leukoedema and chemically irritated oral mucosa due to certain dentifrices and mouthwashes. Examination of biopsy tissue from three of the four cases along with stripped tissue from the fourth case revealed an intraepithelial cleft near the surface of each specimen. The linear cleft ran parallel to the epithelial surface. Foci of adjacent cells displayed intracellular edema, a feature commonly noted in leukoedema. There was evidence of neither acantholysis nor inflammation. The microscopic pattern was unlike the mucosal entities pemphigus vulgaris, mucosal pemphigoid, lichen planus, candidiasis, and mucosal biting. Although the authors questioned the patients in detail regarding all forms of mechanical and chemical trauma, including those from certain dentifrices and mouthwashes, they could not detect causative factors for these lesions.

Fungal infections of the oral cavity.

Although several strains of Candida can infect the oral mucosa, the most commonly encountered oral fungal infection is Candida albicans, which may be highly infective because of its greater level of pathogenicity and adherence properties. C. albicans is an oral commensal in as many as 40% to 65% of healthy adult mouths. The papillated dorsal surface of the tongue and palatal mucosa beneath a maxillary denture are favored reservoir sites. Oral candidal infection almost always involves a compromised host. The compromise may be local or systemic. Local factors include decreased salivation and the weaning of dentures. Systemic factors include diabetes mellitus, pernicious anemia, and AIDS. Some have even implicated advanced age and the female gender as being mild predisposing factors. Furthermore, the C. albicans infection itself can depress a host's immune system. A patient with oral candidiasis can present with one or more of the following clinical forms: pseudomembranous, erythematous, hyperplastic, and denture erythematous. Many investigators accept median rhomboid glossitis as a form of chronic oral candidiasis. In some patients with angular cheilitis, genesis of the lesions is secondary to monilial infestation. Because C. albicans is a normal inhabitant in many mouths, diagnostic confirmation of infection often rests with successful response (i.e., resolution of lesions) to antifungal medications. This form of diagnostic confirmation can be further enhanced by culturing the offending microbe, preparing a fungal smear, or even incisional biopsy. The microscopic demonstration of fungal hyphae is highly diagnostic of the candidal infection, whether the hyphae are demonstrated on a PAS smear or on a biopsy within surface stratified squamous epithelium. Numerous medications exist for the treatment of oral candidiasis. They include the antibiotic nystatin as well as clotrimazole, ketoconazole, and fluconazole. Nystatin is safe and is used as a topical agent in rinse or pastille forms. Clotrimazole is used as a topical agent in lozenge form; it is highly effective but can cause liver enzyme changes. Ketoconazole, which is usually prescribed systemically, is highly effective but also capable of causing adverse liver changes. Chlorhexidine can be used as an oral rinse or as a disinfectant for dentures.

The treatment of oral lichen planus.

Lichen planus is a common oral dermatosis and it is one frequently encountered by oral surgeons. Lichen planus can be very difficult to treat, particularly when symptomatic in its erosive and ulcerated forms. This article describes several treatment modalities in the control of oral lichen planus including steroids, griseofulvin, vitamin A, cyclosporine, surgical excision, et al. Other features included consist of proper biopsy site selection, the need for annual re-examination, lichen planus's malignant potential, and when "not to treat."

Relative incidence of intraoral pemphigus vulgaris, mucus membrane pemphigoid and lichen planus.

A retrospective analysis of patients was conducted in order to determine the relative incidence of oral pemphigus vulgaris, mucus membrane pemphigoid and lichen planus. The analysis yielded a relative incidence of 1:2:15 of pemphigus vulgaris, mucus membrane pemphigoid and lichen planus patients. The dangers of comparing and relating incidence statistics from one study to other studies were demonstrated.

Mucosal melanotic macule, reactive type: a simulation of melanoma.

Two patients with spontaneously resolving hyperpigmented patches of the oral mucosa are reported. Histologically, lesions in both cases showed large pigment-laden dendritic cells singly dispersed at all levels of the epidermis, which simulated in situ melanoma. The absence of such cells in the basal layer of the epidermis served to histologically distinguish these lesions from a biologically malignant melanocytic tumor. Spontaneous resolution in both patients suggests that the condition is reactive. We propose the term mucosal melanotic macule, reactive type, for this lesion, which has been described previously under the misnomer oral melanoacanthoma.

Burning mouth: an analysis of 57 patients.

The burning mouth complaint of each of fifty-seven patients was thoroughly studied. Psychogenesis was found to be the most frequent cause, followed by geographic tongue and moniliasis. Multiple causative factors, such as psychogenesis and moniliasis and psychogenesis and geographic tongue, were found in some patients. The purely psychogenic group was composed mostly of postmenopausal women. The tongue and palate were the most frequently affected sites. There were some similarities among patients in the geographic tongue and psychogenesis groups. A diagnostic protocol for patients with burning mouth is described.

Autoradiographic studies of oral lichen planus.

3H cytidine autoradiographic labeling patterns have been categorized into those characteristic for neoplastic, preneoplastic, and normal cell types. Specific differences in the patterns of transcription (RNA synthesis) revealed that the histology of a particular lesion generally correlated with (1) the percentage of cells labeled with the isotope, (2) the number of grains per cell, and (3) their intracellular distribution. When these three criteria of labeling were applied to lesions of the oral mucosa, very interesting data were collected on cases of lichen planus. The benign histologic appearance of the oral lichen planus epithelium exhibited a preneoplastic-appearing autoradiogram, an observation which is of particular interest in view of the fact that a small number of patients with this disease develop intraoral squamous cell carcinoma.