Decoding a gene expression program that accompanies the phenotype of sporadic and basal cell nevus syndrome-associated odontogenic keratocyst.

BACKGROUND: Odontogenic keratocyst is characterized by local aggressive behavior and a high recurrence rate, as well as its potential to develop in association with the basal cell nevus syndrome. The aim of this study was to decode the gene expression program accompanying odontogenic keratocyst phenotype. METHODS: 150-bp paired-end RNA-sequencing was applied on six sporadic and six basal cell nevus syndrome-associated whole-tissue odontogenic keratocyst samples in comparison to six dental follicles, coupled with bioinformatics and complemented by immunohistochemistry. RESULTS: 2654 and 2427 differentially expressed genes were captured to characterize the transcriptome of sporadic and basal cell nevus syndrome-associated odontogenic keratocysts, respectively. Gene ontologies related to "epidermis/skin development" and "keratinocyte/epidermal cell differentiation" were enriched among the upregulated genes (KRT10, NCCRP1, TP63, GRHL3, SOX21), while "extracellular matrix organization" (ITGA5, LOXL2) and "odontogenesis" (MSX1, LHX8) gene ontologies were overrepresented among the downregulated genes in odontogenic keratocyst. Interestingly, upregulation of various embryonic stem cells markers (EPHA1, SCNN1A) and genes committed in cellular reprogramming (SOX2, KLF4, OVOL1, IRF6, TACSTD2, CDH1) was found in odontogenic keratocyst. These findings were highly shared between sporadic and basal cell nevus syndrome-associated odontogenic keratocysts. Immunohistochemistry verified SOX2, KLF4, OVOL1, IRF6, TACSTD2/TROP2, CDH1/E-cadherin, and p63 expression predominantly in the odontogenic keratocyst suprabasal epithelial layers. CONCLUSION: The odontogenic keratocyst transcriptomic profile is characterized by a prominent epidermal and dental epithelial fate, a repressed dental mesenchyme fate combined with deregulated extracellular matrix organization, and enhanced stemness gene signatures. Thus, we propose a developed epidermis-like phenotype in the odontogenic keratocyst suprabasal epithelial cells, established in parallel to a significant upregulation of marker genes related to embryonic stem cells and cellular reprogramming.

The impact of glucocorticosteroids administered for systemic diseases on the osseointegration and survival of dental implants placed without bone grafting-A retrospective study in 31 patients.

PURPOSE: To evaluate the impact of glucocorticosteroids, administered for the treatment of systemic diseases, on the osseointegration and survival of dental implants placed without bone grafting. MATERIALS AND METHODS: A retrospective study was conducted in search of patients treated with dental implants while receiving glucocorticosteroid therapy for various systemic diseases. In these cases, a conventional two-stage surgical protocol was used, without bone regeneration procedures. The osseointegration was clinically and radiographically tested at the uncovering of the implants. The follow-up after loading was set at a minimum of 3 years. RESULTS: A total of 31 patients were included in the study. Of the 105 dental implants placed, 104 were osseointegrated (99%). No bone absorption was radiographically noted at the uncovering of the osseointegrated implants. All of the osseointegrated implants were successfully loaded for the prosthetic restoration. The mean follow-up period after loading was 71 months, with an implant survival rate of 99%. CONCLUSIONS: Glucocorticosteroid intake for systemic diseases does not have a significant impact on the osseointegration and the 3-year survival of dental implants placed with a conventional two-stage surgical protocol and without bone grafting. Therefore, it should not be considered a contraindication for dental implant placement.

Trismus as a Clinical Manifestation of Tetanus: A Case Report.

Although the incidence of tetanus disease has radically declined in developed countries, both dental practitioners and oral and maxillofacial surgeons should be knowledgeable about its diagnosis since initial manifestations of the disease, such as trismus and dysphagia, are observed in the orofacial region. This study reports on a case of generalized tetanus diagnosed in a middle-aged man. Before the tetanus diagnosis, the patient had sought medical advice from seven different health care professionals, including a dentist and an oral and maxillofacial surgeon. The patient reported trismus and dysphagia as his main complaints. The suspicion of tetanus emerged from the patient's manifestations in conjunction with his history of trauma and his agricultural occupation. The patient underwent successful treatment including administration of muscle relaxants, antibiotics, and booster vaccination doses of tetanus toxoid as well as a tracheostomy and aided mechanical ventilation. This case report highlights the significance of taking a meticulous medical history, thoroughly performing a physical examination, and systematically assessing orofacial signs and symptoms.

Chondrosarcoma of the mandibular condyle in a patient with Werner syndrome: a case report.

Werner syndrome, also called progeria of the adult and pangeria is a rare autosomal recessive disorder that affects connective tissue throughout the body. It is associated with premature ageing and an increased risk of cancer and other diseases. The mean survival for patients with Werner syndrome is 47 years. Death usually occurs when patients are aged 30-65 years because of atherosclerosis or malignant tumours. The purpose of this paper is to present a patient with Werner syndrome exhibiting a chondrosarcoma of the left temporomandibular joint and ramus. To the best of our knowledge this is the first case, of a Werner syndrome patient with an associated head and neck chondrosarcoma being reported. The diagnostic procedure followed and management of the patient are outlined in the paper as well.

Management of malignant parotid tumors.

INTRODUCTION: The aims of this study were to review our experience in the treatment of malignant parotid tumors in material from one center over a 12-year period and to assess treatment outcome and particularly survival. MATERIALS AND METHODS: Thirty-one patients treated primarily by surgery were included in the study. Complete data regarding the demographic details of the patients, tumor stage, presence of regional/distant metastases, treatment, tumor histology, grade, and follow up were compiled. With reference to the extent of tissue removed, partial superficial parotidectomy was performed in 11 patients, superficial parotidectomy, in 14 patients, and total radical parotidectomy, in six patients. RESULTS: The median time of follow-up was 64 months, ranging from 8 to 144 months. Eight patients developed recurrences. Six patients died within the follow-up time. The overall survival rates at 5 and 10 years were 82.2% and 76.7%, respectively. The 5- and 10-year disease-free survival rates were 74.8% and 69.8%, respectively. DISCUSSION: For patients with malignant parotid tumors, the treatment should be individualized according to the findings of each specific case, and regarding surgery, particular care and attention should be paid to maintaining all or part of the facial nerve whenever possible.

Multinodular neck recurrence of parotid gland pleomorphic adenoma: a case report.

BACKGROUND: Pleomorphic adenoma is the most common neoplasm of the parotid gland. It is a benign tumor composed of epithelial and myoepithelial cells arranged in various morphological patterns. The most common reasons contributing to a recurrent disease are obvious or underestimated tumor spillage, incomplete excision, and violation of the pseudocapsule of the tumor. CASE REPORT: This article presents a case of gross multinodular recurrence of a parotid gland pleomorphic adenoma in a 38-year-old female patient. Upon clinical examination of the homolateral neck, multiple, painless, well-defined, palpable, nontender masses and subcutaneous nodules of the right parotid and homolateral neck region were revealed. The patient was treated with surgery and subsequent radiation therapy. Histologic examination of the resected specimen was suggestive of a recurrent pleomorphic adenoma disease. There were no signs of malignant transformation in the specimen. The diagnostic procedure followed, and management of the patient is outlined in the paper. DISCUSSION: Pleomorphic adenoma is the most common tumor of the parotid gland. In spite of being a benign neoplasm, inadequate management of the lesion may lead to problems such as local recurrence or malignant transformation. Management of recurrent tumors is challenging because the probability of subsequent recurrence increases with each recurrent episode, thus making local control increasingly difficult and damage to the facial nerve more likely.

Metastases to supramandibular facial lymph nodes in patients with squamous cell carcinoma of the oral cavity.

PURPOSE: This study evaluated the frequency of metastases to supramandibular facial lymph nodes (SFLNs) in patients with squamous cell carcinoma (SCC) of the oral cavity. PATIENTS AND METHODS: SFLNs were identified and removed during neck dissection from 43 patients with oral SCC. All of them were histopathologically and immunohistochemically examined, to detect possible metastases and micrometastases. RESULTS: Metastases to SFLNs were present in 6 patients (13.95%). Metastases were much more common among patients with palpable neck nodes, larger size of the primary site, advanced TNM stage, and greater age and those in whom the primary site was located in the mucosa of the alveolar ridge of the mandible. CONCLUSIONS: Surgical procedures in the region of the SFLNs must be performed very carefully, because of their close relation with the marginal mandibular nerve. In patients with oral SCC and palpable neck nodes, those with advanced disease, and those in whom the primary site is located in the mucosa of the alveolar ridge of the mandible, removal of SFLNs must be considered.

Large olfactory neuroblastoma (esthesioneuroblastoma) surgically treated with an Altemir technique modification: a case report.

INTRODUCTION: Olfactory neuroblastomas are rare malignant tumors that usually occur in the upper nasal cavity. The purpose of this paper is to present a case of a large olfactory neuroblastoma filling the entire nasal cavity, treated with an Altemir technique modification. METHODS: A 39-year-old woman presented with a large tumor of the nasal cavity. After the laboratory examinations, the tumor was classified as a Kadish stage A olfactory neuroblastoma. The selected treatment was the surgical excision after an Altemir technique modification combined with midfacial degloving and additional radiotherapy. RESULTS: Histopathology revealed a Hyams grade III olfactory neuroblastoma completely removed. Although the patient refused the additional radiotherapy, 18 months postoperatively, there were no signs of recurrence, and the patient shows big improvement on her sense of smell. CONCLUSIONS: Large olfactory neuroblastomas filling the entire nasal cavity extending back to the postnasal space can be completely removed using a transfacial approach as the Altemir technique modification is.

Branchial cleft cysts in adults. Diagnostic procedures and treatment in a series of 18 cases.

PURPOSE: Branchial cleft anomalies may be presented as branchial cysts, fistulas, or sinuses. Purpose of this paper is to present the diagnostic procedures and the treatment in a series of branchial cleft cysts. METHODS: Eighteen patients with branchial cleft cysts were surgically treated. All of them were subjected in laboratory examinations with ultrasonography, CT or/and MRI, and fine needle aspiration cytology (FNAC). Complete excision was the treatment in all cases. RESULTS: Eight patients had Type I, seven Type II, two Type III, and one a Type IV cyst. In all cases the surgical removal was successful and after 1 to 7 years post-surgical follow-up, no recurrences have been developed. CONCLUSIONS: Branchial cleft cyst diagnostic procedure must be the same as for other neck swellings. FNAC is very useful for the diagnosis and the surgical approach must ensure safe and complete cyst removal in order to avoid intraoperative complications and recurrences.

Hypoglossal nerve palsy caused by a large vagal paraganglioma: case report.

We present a vagal paraganglioma in a 74-year-old woman, who presented with dysphagia, dysarthria and hoarseness.

Intramuscular myxoma of the masseter muscle. A case report.

PURPOSE: Myxomas are benign, locally infiltrative, connective tissue tumors that rarely occur in the head and neck region. The purpose of this paper is to describe a very rare case of an intramuscular myxoma of the masseter muscle. METHODS: A 74-year-old man presented with a 2-year history of a painless swelling over his left preauricular region. Computed tomography scan showed an intramasseter well-defined soft tissue mass. After a preauricular approach, a circumscribed solid gelatinous tumor was excised with thin margins including adjacent muscle tissue. RESULTS: Histopathology revealed an intramuscular myxoma, completely resected. The patient made an uneventful recovery, and there were no signs of recurrence 26 months after surgery. CONCLUSIONS: Intramuscular myxoma of the masseter is an extremely rare entity, but it must be considered in the differential diagnosis of the swellings of the preauricular region.