Efectividad del uso de la bolsa adiposa de bichat para la reconstrucción de defectos en el paladar: reporte de un caso / Effectiveness of the use of the bichats fat pad for the reconstructionof defects in the palate. report a case

La bolsa adiposa de Bichat está constituida por un cuerpo y tres extensiones de tejido adiposo, se localiza dentro del espacio bucal y seextiende siguiendo el borde anterosuperior del músculo masetero. En la actualidad su uso como colgajo pediculado ha demostrado excelentesresultados en el tratamiento de reconstrucción de defectos postumorales de tejido blando en el paladar. Lo anterior se debe a su gran aporte vascular, composición histológica y a la presencia de células madre en tejido adiposo que fomentan una metaplasia del tejido, convirtiéndose en tejido fibroso y superfi cialmente con epitelio en tan sólo cinco semanas. La técnica de abordaje y reposicionamiento del colgajo pediculado en paladar fue modifi cada con la extirpación de la tuberosidad del maxilar para corregir el defecto ocasionado por un adenoma pleomorfo en el paladar. Se destacan las características y cualidades de la bolsa adiposa de Bichat para su uso en reconstrucción de defectos tumorales.

Bichat’s buccal fat pad is constituted by a body and three extensions ofadipose tissue within the buccal space and extending to the anteriorsuperiorborder of the masseter muscle. To this days, the use of thebuccal fat pad as a pedicled graft has shown excellent results onoral post tumoral reconstruction treatment. This is due to its greatvascularity, histological composition and perhaps to the presenceof stem cells that promotes a metaplasia, turning adipose tissue intofi brous and superfi cially epithelized tissue within fi ve week aftersurgery. Surgical approach and repositioning technique of the pedicledgraft was modifi ed, extirpating part of the maxillary tuberosity, topreserve vascularity and cover up a hard-soft tissue defect caused by apleomorphic adenoma on a patient’s palate. Buccal fat pad’s qualitiesand characteristics are taken into consideration to demonstrate theeff ectiveness on its surgical reconstructive uses.

Histopathologic diversity of Gorlin's cyst: a study of four cases and review of literature.

AIM: The purpose of the present article is to discuss four different case reports of the so-called calcifying odontogenic cyst and highlight the histopathological diversity of the same. BACKGROUND: Calcifying odontogenic cyst was first described by Gorlin et al in 1962. Ever since, its identification as a specific odontogenic lesion, controversies and confusions have existed regarding the relationship between cystic lesions and solid tumor masses that share cellular and histomorphologic features. Although several classifications were proposed, dilemma still persists regarding the nature of these lesions as cysts, neoplasms and even malignancies. CONCLUSION AND CLINICAL SIGNIFICANCE: The classifications discussed for the so-called calcifying odontogenic cyst by various authors have only added to further confusion rather than enlightening. Though many authors state that classifications remain only an academic exercise, it definitely has significance in treatment planning. Emphasis should, therefore, be laid on a universally accepted classification.

Report of rare palatal expression of Nevus of Ota with amendment of Tanino's classification.

Nevus of Ota, a benign melanocytic pigmentary disorder with rare malignant transformation potential, affects 0.014-0.034% of the Asian and Black population and has a strong predilection for females. It occurs in the area innervated by the first and second division of the trigeminal nerve. Oral manifestation is rarely noted with only 14 cases reported till date. This report documents a case of Nevus of Ota with the infrequently noted oral involvement, in an Indian lady. Since oral manifestation is not acknowledged in Tanino's classification, the authors propose a modification to the same.

Presentación inusual de un hemangioma capilar lobulado en paciente pediátrico: reporte de un caso y revisión de la literatura / Unusual presentation of a lobular capillary hemangioma in a pediatric patient: report of a case and review of the literature

El hemangioma es un tumor benigno compuesto por vasos sanguíneos, el cual histopatologicamente presenta 2 variantes: hemangioma capilar, formado por canales capilares de pequeño diametro; hemangioma cavernoso, formado por grandes senos sanguíneos dilatados con paredes delgadas. Se presentan con mayor frecuencia en el sexo femenino y por lo general aparece pocos días después del nacimiento. La localización más frecuente en cavidad bucal es en la mucosa de los labios, lengua y carrillo. La lesión puede involucionar de forma espontanea o ser eliminada quirúrgicamente, en caso de que la lesión interfiera con alguna función del organismo. Su etiología es desconocida. Se reporta un caso de un paciente de sexo femenino de 6 años de edad que presenta lesión tumoral asintomática de color rosado con áreas ulcerativas y eritematosas de aspecto liso y brillante en el maxilar superior derecho ocasionando asimetría facial en dicha zona, dificultando la fonación y deglución. Se realizó biopsia insicional de la lesión con un diagnostico provisional de granuloma piogénico, se obtuvo como el resultado histopatológico hemangioma capilar lobular

The hemangioma is a benign tomour formed by sanguineos vases, wich present: 2 variants. Capillary Hemangioma: formed by capillary canals of small diameter; Cavernous Hemangioma: formed by great expanded sanguineous sines with thin walls. In most of the cases affect the femine sex and usually it appears after its birth. In bucal cavity the most frequently localization is in mucous of Lips, Tongue and Carrillo. The lesion can go back in spontaneous form or can be eliminated by surgery in the case that lesion affects any process of the organism. Its origin is unknown.Report of a 6 years feminine sex case, with an asymptomatic tumoral lesion and pink color, ulcerative and erythemative areas, its aspect is smooth and brilliant, located in superior right maxilar, causing facial asymmetry in this place. It was done an incisional biopsy of the lesion and the provisional diagnostic was: Granuloma Pyogenic, and the histopatologic result was: Hemangioma Capilar Lobular.

New proposal for T classification of gingival carcinomas arising in the maxilla.

When the current T classification of the UICC (1987 and 1997) is used to stage carcinomas arising the upper alveolus and gingival and hard palate, most cases are classified as T4 because of their anatomic characteristics, similar to carcinomas arising in the lower alveolus and gingiva. This study compared the following two methods for classifying the T stage of maxillary carcinomas: (1) the original T classification criteria proposed by the UICC (1987 and 1997), and (2) a new T classification criteria, called the sinus and nasal floor (SNF) criteria. We found that the SNF criteria were more closely related to tumor control and survival than were the UICC criteria in patients with carcinomas arising in the upper alveolus and gingival and hard palate. Increased use of the SNF criteria is expected to improve staging of gingival tumors arising in the maxilla and increase the accuracy of diagnosis, especially of T4 tumors.

Evaluation of T-classifications of upper gingival and hard palate carcinomas--a proposition for new criterion of T4.

Most carcinomas of upper gingiva and hard palate are classified as T4 stage on the basis of the UICC criteria, since they easily invade the underlying bone tissue. We classified 43 patients with squamous cell carcinoma of the upper gingiva in terms of three criteria: (1) the original T-classification by UICC, (2) the classification by the Japan Society for Head and Neck Cancer (JSHNC), and (3) a new classification in which the maxillary sinus or nasal floor is used as the defining borderline for T4 (MSF classification). Our study demonstrated that the new classification was superior with regard to distribution of patients by T stage, correlation with prognosis and choice of treatment method.

Low malignant intraductal carcinoma on the hard palate: a variant of salivary duct carcinoma?

A rare, minor salivary gland tumour of the hard palate in a middle-aged woman was presented. The small (1.0 X 0.5 cm in diameter) hemispherical tumour was well circumscribed with a fine papillomatous surface. Histopathologically, tumour cells with eosinophilic cytoplasm and a large nucleus were single-strand cuboidal and columnar cells, which showed intraductal growth exhibiting a cribriform pattern. The histological features were distinct from adenoid cystic carcinoma and polymorphous low-grade adenocarcinoma because the tumour lacked the neurotropic infiltration, cord-like proliferation and targetoid arrangement. The tumour could not be identified as a typical salivary-duct carcinoma because Roman bridging, papillary projection, and severe cell atypia were not found. Tumour cells were negative for PAS, Alcian blue, mucicarmine, p53, c-erbB-2, CEA, S-100 protein, alpha-smooth muscle actin, lactoferrin or vimentin. About 5% of the tumour cells were positive for proliferating cell nuclear antigen. Taking these factors into account, together with the clinical features, the name low malignant intraductal carcinoma seems appropriate.

Estudo comparativo da prevalência dos toros palatinos e mandibulares em pacientes e cabeças ósseas / The comparative study about tori palatinus and mandibularis prevalence in patients and skulls

A proposta deste trabalho foi realizar um estudo comparativo da prevalência dos toros palatinos e mandibulares em pacientes e cabeças ósseas, relacionando a informaçäo com os fatores sexo e idade. Foram examinados 4.673 pacientes e 343 cabeças ósseas, com idade compreendida entre a 1ª e 10ª década de vida. Baseados nos exames clínicos e testes estatísticos, concluiu-se que os toros palatinos säo mais freqüentes do que os mandibulares. A prevalência em cabeças ósseas (20,41 por cento) supera os pacientes (5,18 por cento); o mesmo pode ser visto com relaçäo aos toros mandibulares foi menor de 0 a 20 anos e observou-se que a prevalência de ambos näo depende do sexo

Toro palatino e mandibular / Mandibular palatal torus

O objetivo desse trabalho foi realizar um estudo comparativo a respeito da prevalência dos toros palatino e mandibular em pacientes e cabeças ósseas relacionando a informação com a morfologia. Foram examinados 4673 pacientes de três estados brasileiros e 343 cabeças ósseas com idade desde a primeira até a décima década de vida. Os toros palatinos do tipo fusiforme e os toros mandibulares do tipo bilateral único predominaram tanto em pacientes quanto em cabeças ósseas

Monomorphic adenoma of the hard palate: report of a case.

A rare case of monomorphic adenoma of the hard palate in a 69-year-old female is presented. Her complaints were a slowly growing mass and occasional pain of the palate. The tumor was located in the posterior region of the hard palate, and it was approximately 1.5 x 1.5 cm in size. Under general anesthesia, the tumor was excised with a wide margin of normal tissue. The palatal bone was intact. Histological diagnosis was monomorphic adenoma, basal cell type.

A clinicopathologic study of malignant lymphomas of the nose, paranasal sinuses, and hard palate, including cases of lethal midline granuloma.

Malignant lymphomas of the nose, paranasal sinuses, and hard palate show marked clinicopathologic, immunologic, and prognostic diversity. The clinical features and pathologic spectrum of these lesions were studied in 20 cases (11 female and 9 male cases) with a mean age of 51 years at initial presentation. Malignant lymphomas of the large cell type were most frequently encountered (11/20). The next largest category was malignant lymphoma, diffuse, mixed small and large cell type (six of 20). Two thirds, 13 of 20 cases, had morphologic features suggestive of peripheral T-cell lymphomas. Necrosis, an angiocentric growth pattern, and epitheliotropism were found in nine, eight, and three cases, respectively. Of ten cases immunophenotyped on fresh-frozen or fixed, paraffin-embedded tissue sections, eight had a T-cell phenotype and two had a B-cell phenotype. Of 17 patients with sufficient follow-up data, ten are alive (median follow-up 33 months) and seven are dead (median survival 12 months). Patients with clinical Stages IE and IIE did not have a superior 5-year survival to those with more advanced disease. Histologic type also did not correlate with survival but this may be due to the aggressive histologic grade of the majority of cases and the retrospective nature of this study. The authors conclude that, despite the overall high-grade histologic type, the pathologic spectrum of malignant lymphomas involving this anatomic region is broad. Furthermore, some cases do not fit well into the National Cancer Institute (NCI) Working Formulation but more closely resemble the histologic features of peripheral T-cell lymphomas described in Japan.

Problems in clinical assessment of palatal tumours.

This paper reviews the classification of tumours affecting the palate. The embryology and anatomy of the palate are outlined in relation to the TNM classification of the International Union Against Cancer (UICC) and American Joint Committee on Cancer (AJC) for the oral cavity and oropharynx. A series of 80 palatal tumours is reviewed to assess the adequacy of the classification schemes in providing accurate data for tumour treatment comparison. Both schemes rely on relatively crude assessment of total tumour extent and neither provides enough detail to allow valid comparisons.

Acral lentiginous melanoma of the oral cavity.

Lentiginous melanomas may be classified clinicopathologically as either lentigo maligna melanomas or acral lentiginous melanomas. Lentigo maligna melanoma is generally characterized by its slow rate of growth, lateness of metastasis, and relatively good prognosis. Acral lentiginous melanoma, while demonstrating a radial growth phase which is histologically similar to that of lentigo maligna, appears biologically more similar to superficially spreading malignant melanoma once the vertical growth phase supervenes. Mucous membrane melanomas with lentiginous characteristics are likely to be aggressive lesions with a marked propensity for metastasis and a uniformly poor prognosis, much like the acral lentiginous type of melanoma. It would seem, therefore, that superficial melanomas of the oral mucous membranes with a lentiginous pattern should best be termed acral lentiginous melanomas instead of lentigo maligna melanomas so as to more accurately predict their true biologic potential. An amelanotic case is presented which we believe illustrates this point.

STNMP: a new system for the clinico-pathological classification and identification of intra-oral carcinomata.

A new system for the notation of intra-oral carcinomata has been described. It differs from all previous TNM classifications in that both the site (S) and the pathology (P) have been taken into consideration in addition to the conventional tumour (T), node (N) and metastasis (M) generally used. Both of these additional features have been recognized as important factors in assessing the prognosis of the patient. This new system additionally functions as a means of disseminating the maximum of clinical information succinctly and in a readily communicable format. A further innovation has been the introduction of a means of quantitatively assessing the significance of particular clinical and pathological features and from these values predicting the prognosis. For comparative purposes we have defined four stages corresponding with the stages used in the conventional TNM classification. We have applied the STNMP classification to a random sample of 136 cases of intra-oral carcinomata with more than 5 years follow-up. Particularly in defining those patients with a good prognosis, i.e. 5 year plus survival, this system has proved to be considerably more accurate than the existing staging methods. We propose that for a trial period this system should be widely used in parallel with the conventional TNM classification and staging in order to evaluate its true worth in the clinical situation. With further use it will probably be necessary to adjust the numerical weighting given to particular features, but this can only be accurately assessed when a very large number of patients has been evaluated. Our figures support the clinical impression that patients with poorly differentiated squamous cell carcinomata have a shorter survival than those with well differentiated lesions and that the degree of differentiation of the tumour is directly proportional to the survival of the patient. When considering the site of the tumour we have based our grading on the known survival curves for squamous cell carcinomata at different sites.

Malignant tumours of the oral cavity. A study of 177 cases.

An unselected material of 177 patients with malignant tumours of the oral cavity is presented and classified according to the TNM system. A therapeutic classification based on the TNM system is proposed. The material is analyzed regarding the 5-year survival rate and the frequency of recurrences in different therapeutic groups.