Lateral pterygoid muscle ultrasound-guided injection: A technical note.

BACKGROUND: Temporomandibular disorders (TMDs) are a frequent cause of orofacial pain, causing functional disability and a negative impact on quality of life. Botulinum toxin (BTX-A) injection in lateral pterygoid muscle (LPM) is one of the treatment modalities proposed, but the blind puncture guided by EMG carries a risk of vascular puncture or diffusion of the toxin to nearby muscles. We describe an ultrasound-guided approach and evaluate the spread of the injection in a fresh human cadaver. METHODS: A fresh human cadaver was injected. An out-of-plane approach was performed using a convex probe, injecting 1.0 ml of 0.25% methylene blue dye into the LPM. After, a dissection was performed to isolate the lateral pterygoid muscle and assess the spread of the dye. RESULTS: Ultrasound-guided injection allowed to visualize in real-time the spread of the dye within the LPM. The deep and superficial muscles nearby to LPM were not stained by the dye, but upper and lower head of LPM was heavily stained. CONCLUSION: Ultrasound-guided approach for the injection of BTX-A into the LPM could be considered a successful and safe treatment for myofascial pain related to TMD. Therefore, further clinical studies are needed to study the reproducibility of ultrasound guided LPM injection and to evaluate the clinical results.

Second primary tumors in proliferative verrucous leukoplakia: a series of 33 cases.

OBJECTIVES: To describe the number of second primary malignancies in a series of 33 patients with proliferative verrucous leukoplakia (PVL), detailing the mean time between primary malignancies and their clinical characteristics. MATERIALS AND METHODS: Two groups of patients were included in this study: group 1 comprised 33 PVL patients who had developed ≥ 2 oral squamous cell carcinoma (OSCC) and group 2 comprised 48 PVL patients without malignant degeneration. We compared the groups with regard to age, gender, oral location, and number of oral sites affected. For patients in group 1, we determined the locations, clinical forms, and TNM stages of oral cancers. We also recorded the intervals of time between instances of oral cancer for all patients. RESULTS: The groups did not differ significantly in age; however, group 1 included more women (p < 0.05). The follow-up period and number of oral PVL locations were greater in group 1 (p < 0.01). Moreover, in group 1, as the number of OSCCs increased, the intervals between them became shorter. The gingiva was the most common site. The mean number of cancers in group 1 was 3.15; five second primary tumors were diagnosed in one patient. CONCLUSIONS: Multiple cancers in PVL patients were more frequently located on the gingiva in the form of erythroleukoplastic areas. In addition, the interval between new cancers decreased over time. CLINICAL RELEVANCE: This is the series with the highest number of cases described with second primary tumors in PVL.

Myofascial Pain: Ultrasound Width of the Masseter Muscle.

AIMS: To determine whether subjects with temporomandibular disorders (TMD) manifesting as chronic myofascial pain (MFP) involving the masseter muscle present with significantly greater masseter muscle width, as evidenced by ultrasound, compared to individuals without MFP. METHODS: A case-control study was carried out. A total of 31 subjects presenting with MFP of the masticatory muscles involving the masseter muscle and 35 controls with TMD but no diagnosis of MFP, matched by age and sex, were included. Ultrasound was used to measure the maximum width of both masseter muscles at the intermediate point between the origin and insertion of the muscle in the light occlusal contact (LOC) position and under maximum contraction. Each side was analyzed separately. Means were compared by using single-factor analysis of variance and Mann-Whitney U test; P < .05 was considered to reflect statistical significance. RESULTS: In the study group, the right masseter muscle had a mean ± standard deviation width of 8.6 ± 1.8 mm under LOC (controls: 8.6 ± 1.6 mm; P = .85) and 11.5 ± 2.1 mm under maximum contraction (controls: 11.7 ± 1.9 mm; P = .86). The analagous measures in the left masseter muscle were 8.6 ± 1.6 mm under LOC (controls: 8.2 ± 1.5 mm; P = .42) and 11.3 ± 1.8 mm under maximum contraction (controls: 11.5 ± 1.8 mm) (P = .79), respectively. The increase in width of the right masseter muscle was 2.9 ± 2.1 mm (controls: 3.1 ± 1.2 mm; P = .67) in absolute terms and 1.4 ± 0.3 mm (controls: 1.4 ± 0.2 mm; P = .91) in relative values (width at maximum contraction/LOC width). In the case of the left masseter muscle, the respective values were 2.8 ± 1.7 mm (controls: 3.2 ± 0.9 mm; P = .25) and 1.3 ± 0.2 mm (controls: 1.4 ± 0.1 mm; P = .32). CONCLUSION: There were no statistically significant differences in masseter muscle width between MFP subjects and control subjects under LOC conditions or maximum contraction. The increase in width under maximum contraction was likewise not significantly different between the groups.

Ewing sarcoma of the oral cavity. A review.

OBJECTIVES: A review is made of the clinical, diagnostic, therapeutic and survival characteristics of Ewing sarcoma (ES) of the oral cavity. MATERIAL AND METHODS: A systematic literature search was carried out, with restrictions referred to time (1960-2014), language (English and Spanish) and type of study (case reports, letters, datasets, reviews). The following MeSH terms and boolean operators were used: Ewing AND Sarcoma AND [tongue, jaw, maxilla, cheek, condyle OR temporomandibular, floor AND mouth, gum OR gingiva, palate OR palatal, lip, uvula, head AND neck]. RESULTS: Seventy-one cases of ES of the oral cavity were documented from 53 articles. The main differences versus ES of other locations were a younger age at manifestation, a shorter time from symptoms onset to diagnosis, and swelling as the most frequent clinical manifestation versus swelling and pain in the rest of disease locations. The way in which ES manifests in the oral cavity is varied and comprises dental displacement (19.7%), dental mobility (7%), root reabsorption (5.6%), destruction of the dental follicle (4.2%), premature exfoliation (4.2%) and paresthesia of the chin (2.8%). Metastatic neck adenopathies appear in 11.3% of the cases. Significant differences in survival are observed between patients with a complete diagnosis of ES (hematoxylin-eosin staining, PAS positivity, CD99 positivity) and those with an incomplete diagnosis. CONCLUSIONS: Ewing sarcoma of the oral cavity presents a series of specific features that distinguish it from ES of other locations. Key words:Primitive neuroectodermal tumor, PNET, Ewing sarcoma, Ewing tumor, sarcoma, oral cavity.

Graft-versus-host disease affecting oral cavity. A review.

Graft versus host disease (GVHD) is one of the most frequent and serious complications of hematopoietic stem cell transplantation, and is regarded as the leading cause of late mortality unrelated to the underlying malignant disease. GVHD is an autoimmune and alloimmune disorder that usually affects multiple organs and tissues, and exhibits a variable clinical course. It can manifest in either acute or chronic form. The acute presentation of GVHD is potentially fatal and typically affects the skin, gastrointestinal tract and liver. The chronic form is characterized by the involvement of a number of organs, including the oral cavity. Indeed, the oral cavity may be the only affected location in chronic GVHD. The clinical manifestations of chronic oral GVHD comprise lichenoid lesions, hyperkeratotic plaques and limited oral aperture secondary to sclerosis. The oral condition is usually mild, though moderate to severe erosive and ulcerated lesions may also be seen. The diagnosis is established from the clinical characteristics, though confirmation through biopsy study is sometimes needed. Local corticosteroids are the treatment of choice, offering overall response rates of close to 50%. Extracorporeal photopheresis and systemic corticosteroids in turn constitute second line treatment. Oral chronic GVHD is not considered a determinant factor for patient survival, which is close to 52% five years after diagnosis of the condition. Key words:Chronic graft-versus-host disease, oral chronic graft-versus-host disease, pathogenics, management, survival.

Diagnostic validity (sensitivity and specificity) of panoramic X-rays in osteoarthrosis of the temporomandibular joint.

OBJECTIVE: To establish the diagnostic validity of panoramic X-rays (PRx) in temporomandibular osteoarthrosis (OA) using the clinical and imaging criteria (magnetic resonance imaging, MRI) of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) as gold standards. METHODS: Eighty-four patients with full clinical records (RDC/TMD), PRx, and MRI scans were selected. Two stomatologists evaluated the PRx for OA. The MRI findings were derived from the radiologist report. Intra/inter-examiner concordance was established. The diagnostic concordance between clinical signs and MRI was determined. Both were used as gold standards to calculate the validity of PRx in OA. RESULTS: The diagnostic validity of PRx with MRI as gold standard was sensitivity=69.0% and specificity=67.9%. The diagnostic validity of PRx with clinical criteria as gold standard was sensitivity=61.6% and specificity=57.9%. DISCUSSION: Panoramic X-rays have scant diagnostic validity in temporomandibular osteoarthrosis when taking MRI or clinical criteria of RDC/TMD as gold standards.

Pseudotumors and tumors of the temporomandibular joint. A review

Objective: To review the pseudotumors and tumors of the temporomandibular joint (TMJ) published in journals included in Journal Citation Reports (JCR), and to evaluate whether there are clinical and radiological signs capable of differentiating between pseudotumors and tumors and between malignant and benign tumors. Material and Methods: A systematic Medline search was made of clinical cases of tumors and pseudotumors of the TMJ covering a 20-year period and published in journals included in JCR. Only cases with histological confirmation were included. A description is provided of the general characteristics of TMJ tumors, with comparison of the clinical, diagnostic, therapeutic and evolutive variables referred to pseudotumors, benign tumors and malignant tumors. Results: We identified 285 TMJ tumors published in 181 articles of 15 journals. The most frequent lesions were pseudotumors (synovial chondromatosis, pigmented villonodular synovitis, eosinophilic granuloma and osteochondroma).The mean age was 42 years and one month ± 16 years and two months. Tumors were more common infemales. The mean time from symptoms onset to consultation was 30 months and 8 days ± 41 months and 9 days, and almost 19.6% of the cases initially had been diagnosed and treated as TMJ dysfunction. The most frequent clinical manifestations were pain, swelling and the limitation of joint movements. The most common radiological findings in the case of benign and malignant lesions were radiopacities and radio transparencies, respectively. Nopanoramic X-ray alterations were observed in 14.6% of the benign tumors and in 7.7% of the malignant lesions. Surgery was the usual form of treatment. Sequelae were recorded in 18.2% of the cases, with tumor relapse in9.1%. The four-year survival rate in the case of malignant tumors was 72.2% (AU)

Intravenous bisphosphonate-related osteonecrosis of the jaws: Influence of coadjuvant antineoplastic treatment and study of buccodental condition

Objectives: To determine whether coadjuvant antineoplastic treatment can influence the number and size of bone exposures among patients with intravenous bisphosphonate-related osteonecrosis of the jaws (iBRONJ), and to analyze the buccodental condition of these patients. Material and methods: The study sample comprised 67 patients with iBRONJ, 53 patients without iBRONJ receiving treatment with intravenous bisphosphonates, and 36 healthy subjects. In all three groups, measurements were made of the CAO index and of resting whole saliva and stimulated whole saliva. In the patients with iBRONJ, the size (cm) and number of bone exposures were recorded. The data obtained were subjected to analysis of variance (ANOVA), the Mann-Whitney U-test, and multivariate logistic regression analysis. Results: A total of 57.6% of the patients presented single bone exposure, 25.4% presented two, and 17% more than two exposures. The mean exposure size was 2.3±1.9 cm. Neither the bivariate analysis nor the multivariate multiple regression analysis found coadjuvant antineoplastic treatment to exert a statistically significant effect upon the number and size of bone exposures. On the other hand, there were statistically significant differences among the three study groups in relation to the CAO index (p=0.02) and the number of missing teeth (p=0.00). The resting whole saliva and stimulated whole saliva levels were similar in the three groups, though the patients with osteonecrosis of the jaws showed comparatively lower SWS levels. Conclusions: Coadjuvant antineoplastic treatment alone appears to exert no influence upon the size and number of bone exposures in iBRONJ. The patients with this disease show a higher CAO index and a larger number of missing teeth (AU)

Pseudotumors and tumors of the temporomandibular joint. A review.

OBJECTIVE: To review the pseudotumors and tumors of the temporomandibular joint (TMJ) published in journals included in Journal Citation Reports (JCR), and to evaluate whether there are clinical and radiological signs capable of differentiating between pseudotumors and tumors and between malignant and benign tumors. MATERIAL AND METHODS: A systematic Medline search was made of clinical cases of tumors and pseudotumors of the TMJ covering a 20-year period and published in journals included in JCR. Only cases with histological confirmation were included. A description is provided of the general characteristics of TMJ tumors, with comparison of the clinical, diagnostic, therapeutic and evolutive variables referred to pseudotumors, benign tumors and malignant tumors. RESULTS: We identified 285 TMJ tumors published in 181 articles of 15 journals. The most frequent lesions were pseudotumors (synovial chondromatosis, pigmented villonodular synovitis, eosinophilic granuloma and osteochondroma). The mean age was 42 years and one month ± 16 years and two months. Tumors were more common in females. The mean time from symptoms onset to consultation was 30 months and 8 days ± 41 months and 9 days, and almost 19.6% of the cases initially had been diagnosed and treated as TMJ dysfunction. The most frequent clinical manifestations were pain, swelling and the limitation of joint movements. The most common radiological findings in the case of benign and malignant lesions were radiopacities and radiotransparencies, respectively. No panoramic X-ray alterations were observed in 14.6% of the benign tumors and in 7.7% of the malignant lesions. Surgery was the usual form of treatment. Sequelae were recorded in 18.2% of the cases, with tumor relapse in 9.1%. The four-year survival rate in the case of malignant tumors was 72.2%.

Intravenous bisphosphonate-related osteonecrosis of the jaws: influence of coadjuvant antineoplastic treatment and study of buccodental condition.

OBJECTIVES: To determine whether coadjuvant antineoplastic treatment can influence the number and size of bone exposures among patients with intravenous bisphosphonate-related osteonecrosis of the jaws (iBRONJ), and to analyze the buccodental condition of these patients. MATERIAL AND METHODS: The study sample comprised 67 patients with iBRONJ, 53 patients without iBRONJ receiving treatment with intravenous bisphosphonates, and 36 healthy subjects. In all three groups, measurements were made of the CAO index and of resting whole saliva and stimulated whole saliva. In the patients with iBRONJ, the size (cm) and number of bone exposures were recorded. The data obtained were subjected to analysis of variance (ANOVA), the Mann-Whitney U-test, and multivariate logistic regression analysis. RESULTS: A total of 57.6% of the patients presented single bone exposure, 25.4% presented two, and 17% more than two exposures. The mean exposure size was 2.3 ± 1.9 cm. Neither the bivariate analysis nor the multivariate multiple regression analysis found coadjuvant antineoplastic treatment to exert a statistically significant effect upon the number and size of bone exposures. On the other hand, there were statistically significant differences among the three study groups in relation to the CAO index (p=0.02) and the number of missing teeth (p=0.00). The resting whole saliva and stimulated whole saliva levels were similar in the three groups, though the patients with osteonecrosis of the jaws showed comparatively lower SWS levels. CONCLUSIONS: Coadjuvant antineoplastic treatment alone appears to exert no influence upon the size and number of bone exposures in iBRONJ. The patients with this disease show a higher CAO index and a larger number of missing teeth.

Temporomandibular disorders. A case-control study.

OBJECTIVE: To compare the risk factors and clinical manifestations of patients with temporomandibular disorders (TMDs) diagnosed according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) (axis I) versus an age and gender matched control group. STUDY DESIGN: A total of 162 patients explored according to the RDC/TMD (mean age 40.6±18.8 years, range 7-90; 11.1% males and 88.9% females) were compared with 119 controls, measuring differences in TMD risk factors (sleep disturbances, stress, psychoactive medication, parafunctions, loss of posterior support, ligament hyperlaxity) and clinical variables (joint sounds, painful muscle and joint palpation, maximum aperture). RESULTS: Myofascial pain (MFP) (single or multiple diagnoses) was the most frequent diagnosis (42%). The most common diagnostic combination was MFP plus arthralgia (16.0%). Statistically significant differences were observed in clenching (OR 2.3; 95%CI: 1.4-3.8) and in maximum active aperture (MAA) on comparing the two groups both globally (TMD vs. controls) (patients 36.7±8.6 mm, controls 43.1±5.8 mm; F=45.41, p=0.000) and on comparing according to diagnostic categories. MFP explained most of the observed differences in the risk factors: stress perception (OR=1.98;I.C.:1.01-3.89), psychoactive medication (OR=2.21; I.C.:1.12-4.37), parafunctions (OR=2.14;I.C.:1.12-4.11), and ligament laxity (OR=2.6;I.C.:1.01-6.68). Joint sounds were more frequent in patients with MFP (39.7% vs. 24.0%; χ²=4.66; p=0.03), and painful joint palpation was more common in patients with disc displacement with reduction (DDWR)(15.9% vs. 5.0%; χ²= 5.2; p=0.02) and osteoarthrosis (20.8% vs. 5.0%; χ²=7.0; p=0.008). CONCLUSIONS: There is a high prevalence of signs and symptoms of TMDs in the general population. Significant differences are observed in clenching and MAA between patients and controls considered both globally and for each diagnostic category individually. The analyzed risk factors (except loss of posterior support) show a statistically significant OR for the diagnosis of MFP.

Bisphosphonate-related osteonecrosis of the jaws: study of the staging system in a series of clinical cases.

OBJECTIVE: The aim of this study was to validate the classification of bisphosphonate-related osteonecrosis of the jaws (BRONJ) published in 2009(17) in a series of cases. MATERIAL AND METHODS: This retrospective clinical study included a series of 102 cases (81%) of intravenous BRONJ (iBRONJ, group 1) and 24 cases (19%) of oral BRONJ (oBRONJ, group 2). We recorded all patients' symptoms and clinical findings and classified each patient into a BRONJ stage (0-3; stage 0=non-exposed BRONJ). RESULTS: Most BRONJ cases (n=120, 95.2%) could be classified according to the proposed stages. Exposed necrotic areas of bone were more prevalent in group 1 than in group 2 (p<0.05). In contrast, we observed more BRONJ cases without areas of exposed bone in group 2 (n=12, 50%) than in group 1 (n=14, 13.7%; p<0.05). We could not assign six cases to any of the proposed stages. These cases had no areas of exposed necrotic bone, but had mandibular fractures, extra-oral fistula or affected maxillary sinuses. CONCLUSIONS: In our series, iBRONJ cases showed more advanced stages of BRONJ than did oBRONJ cases. We found few cases that could not be classified into any proposed stage because they had findings associated with stages 0 and 3 but lacked exposed necrotic bone.

Epidermal growth factor receptor copy number in potentially malignant oral disorders and oral squamous cell carcinoma: a short communication and preliminary study.

INTRODUCTION: This preliminary study compared the epidermal growth factor receptor (EGFR) copy number in patients with potentially malignant oral disorders (PMODs) and oral squamous cell carcinoma (OSCC). MATERIAL AND METHODS: Group 1 comprised 20 patients with oral leukoplakia and group 2 comprised 19 cases of OSCC. We estimated the EGFR copy number in both groups using real-time reverse-transcription polymerase chain reaction assays. We used laser microdissection (LMD) for EGFR amplification, and overexpression was performed. RESULTS: The EGFR copy number was higher in group 2 (9.1 ± 6.2) than in group 1 (3.8 ± 1.5). The greatest copy number was found in the non-homogeneous leukoplakias, but the difference in homogeneous cases was not significant (Mann-Whitney test, P>0.05). In group 2, the EGFR copy number was higher in advanced stages than in early stages, but again lacked statistical significance. CONCLUSIONS: The EGFR copy number may be a useful biomolecular marker to differentiate PMODs from OSCC. The EGFR was higher in non-homogeneous leukoplakias and in the advanced stages of OSCC.

Malignant transformation of proliferative verrucous leukoplakia to oral squamous cell carcinoma: a series of 55 cases.

In this study, we compared clinical differences between patients with proliferative verrucous leukoplakia (PVL) who did and did not develop oral cancer. This was a retrospective study of 55 PVL cases. All patients were followed for at least 1year, with a mean follow-up of 7.53 (SD=4.18) years. The mean age of the patients was 61.69 (SD=11.76) years. There were 36 (65.5%) females and 19 (34.5%) males. Group 1 included the 28 PVL patients who did not develop oral squamous cell carcinoma (OSCC) during the period. Group 2 included the 27 PVL patients who developed at least one OSCC during the period. The latter group was subdivided into patients with PVL who developed one (Subgroup 2a; n=16) or more than one (Subgroup 2b; n=11) OSCC during follow-up. There was no statistical difference in age or oral location of the PVL between Groups 1 and 2. Females had a greater tendency to develop cancer than males (58.3% vs. 31.6%). In Group 2, only six (22.2%) were smokers. There was no difference between Subgroups 2a and b in terms of age, gender, and oral location of the PVL. Subgroup 2b included fewer smokers, had higher gingival involvement rate, and lower frequency of PVL on the tongue. The PVL patients who develop oral cancers were more commonly female and non-smokers. Those patients who developed more than one OSCC were most likely to develop lesions of the gingiva.

Changes in smoking habit among patients with a history of oral squamous cell carcinoma (OSCC)

Objective: To determine the changes in smoking habit among patients with oral squamous cell carcinoma (OSCC)diagnosed and treated in the Service of Stomatology (Valencia University General Hospital. Valencia, Spain).Material and methods: The study involved 123 patients with a history of OSCC interviewed by telephone on their smoking habits at the time of the diagnosis and modifications in habits subsequently. The mean age at diagnosis was 60 years and 9 months (standard deviation, SD ± 12 years and 2 months). Males predominated (61.8%) overfemales (38.2%). The mean time from the diagnosis of OSCC to the survey was 4 years and 6 months (SD ± 3 years and 6 months).Results: Almost one-half of the patients (45.5%) were active smokers at the time of the diagnosis, with a mean duration of the habit of 34.9 years (SD ± 12 years and 7 months). In turn, 19.5% of the patients were ex-smokers at diagnosis, with an average of 13 years and 9 months (SD ± 9 years and 4 months) from smoking cessation to the development of cancer. A total of 57.1% of the smokers abandoned the habit at diagnosis, 8.9% continued to smoke to the same extent as before, and 33.9% reduced smoking.Conclusion: A full 44.4 % of our patients diagnosed with OSCC continued to smoke despite warnings of the risks,and although the majority claimed to have reduced their smoking habit, interventional strategies would be indicated to help ensure complete smoking cessation (AU)

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Changes in smoking habit among patients with a history of oral squamous cell carcinoma (OSCC).

OBJECTIVE: To determine the changes in smoking habit among patients with oral squamous cell carcinoma (OSCC) diagnosed and treated in the Service of Stomatology (Valencia University General Hospital. Valencia, Spain). MATERIAL AND METHODS: The study involved 123 patients with a history of OSCC interviewed by telephone on their smoking habits at the time of the diagnosis and modifications in habits subsequently. The mean age at diagnosis was 60 years and 9 months (standard deviation, SD +/- 12 years and 2 months). Males predominated (61.8%) over females (38.2%). The mean time from the diagnosis of OSCC to the survey was 4 years and 6 months (SD +/- 3 years and 6 months). RESULTS: Almost one-half of the patients (45.5%) were active smokers at the time of the diagnosis, with a mean duration of the habit of 34.9 years (SD +/- 12 years and 7 months). In turn, 19.5% of the patients were ex-smokers at diagnosis, with an average of 13 years and 9 months (SD +/- 9 years and 4 months) from smoking cessation to the development of cancer. A total of 57.1% of the smokers abandoned the habit at diagnosis, 8.9% continued to smoke to the same extent as before, and 33.9% reduced smoking. CONCLUSION: A full 44.4 % of our patients diagnosed with OSCC continued to smoke despite warnings of the risks, and although the majority claimed to have reduced their smoking habit, interventional strategies would be indicated to help ensure complete smoking cessation.

Retinoids and proliferative verrucous leukoplakia (PVL). A preliminary study

Objective. A study is made of the efficacy and adverse effects of retinoid therapy applied to the white lesions ofproliferative verrucous leukoplakia (PVL). Material and methods. The results of retinoid therapy were evaluatedin 17 patients diagnosed with PVL. Topical retinoids were used in 5 patients, in the form of two daily applicationsof 0.1% 13-cis-retinoic acid in orabase for an average of 6.17+/-3.13 months. Systemic retinoids were used in 11patients, with the administration of 25 mg/day of acitretin in tablet form for an average of 5.41+/-2.02 months.One patient successively received the topical and systemic retinoid formulations. The course and results wereevaluated on a blind basis by two investigators. The adverse effects of the medication were also assessed. Results.Clinical improvement was recorded for 7 lesions (38.8%) (six involving systemic treatment and one as a resultof topical application). Clinical worsening was recorded in the same proportion (5 lesions with systemic therapyand two with topical treatment), while four lesions (22.4%) showed no changes (one lesion with systemic therapyand three with topical treatment). Adverse effects were documented in all the patients administered the systemicformulation, versus in only one patient administered topical retinoids. The most frequent problems were desquamationand pruritus. Conclusion. Although topical or systemic retinoic acid produces some improvement in aboutone-third of all patients with PVL, further studies are needed to assess the efficacy and safety of these products,in view of the important percentage of individuals who worsen despite therapy, and the frequent appearance of adverse effects (AU)

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Retinoids and proliferative verrucous leukoplakia (PVL). A preliminary study.

OBJECTIVE: A study is made of the efficacy and adverse effects of retinoid therapy applied to the white lesions of proliferative verrucous leukoplakia (PVL). MATERIAL AND METHODS: The results of retinoid therapy were evaluated in 17 patients diagnosed with PVL. Topical retinoids were used in 5 patients, in the form of two daily applications of 0.1% 13-cis-retinoic acid in orabase for an average of 6.17+/-3.13 months. Systemic retinoids were used in 11 patients, with the administration of 25 mg/day of acitretin in tablet form for an average of 5.41+/-2.02 months. One patient successively received the topical and systemic retinoid formulations. The course and results were evaluated on a blind basis by two investigators. The adverse effects of the medication were also assessed. RESULTS: Clinical improvement was recorded for 7 lesions (38.8%) (six involving systemic treatment and one as a result of topical application). Clinical worsening was recorded in the same proportion (5 lesions with systemic therapy and two with topical treatment), while four lesions (22.4%) showed no changes (one lesion with systemic therapy and three with topical treatment). Adverse effects were documented in all the patients administered the systemic formulation, versus in only one patient administered topical retinoids. The most frequent problems were desquamation and pruritus. CONCLUSION: Although topical or systemic retinoic acid produces some improvement in about one-third of all patients with PVL, further studies are needed to assess the efficacy and safety of these products, in view of the important percentage of individuals who worsen despite therapy, and the frequent appearance of adverse effects.

Retrospective study of a series of 850 patients with temporomandibulardysfunction (TMD). Clinical and radiological findings

Objective: To define the clinical and radiological characteristics of the four most common presentations of temporomandibulardysfunction-myofascial pain (MFP), disc displacement with reduction (DDWR), disc displacementwithout reduction (DDWoR), and osteoarthrosis (OR)-and to identify the differences among them.Material and methods: The study comprised a series of 850 patients (121 males and 729 females) seen betweenMay 2003 and December 2006 in Valencia University General Hospital (Spain) for temporomandibular joint disease(TMJD). An analysis was made of the possible etiological factors (stress, traumatisms, sleep disturbances,parafunctional habits, reason for consultation), possible pain sensations in response to palpation of the masticatorymuscles, joint sounds, etc. A panoramic X-ray study was made on a routine basis, and in some patients (n = 54)the study was completed with a magnetic resonance imaging scan of the temporomandibular joints and relatedtissues. The differences between qualitative variables were examined by means of the chi-square test with R x Ccontingency tables and the Z-test, while quantitative variables were contrasted by analysis of variance (ANOVA)and post hoc testing (Scheffe).Results: The variables showing statistically significant differences among the four diagnostic categories were:patient age, sleep disturbances, stress, parafunctional habits, nibbling on hard objects and “parafunctions”, reasonfor consultation, mandibular movements, “non-evaluable” molar and canine relationship, ligament hyperlaxity,and panoramic X-ray alterations (AU)

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