Analysis of desquamative gingivitis using direct immunofluorescence in conjunction with histology.

Chronic desquamative gingivitis (DG) is a common condition often first recognized by periodontists. DG is characterized clinically by erythema with epithelial desquamation, ulceration, and/or the presence of vesiculobullous lesions of the free and attached gingiva. However, DG is actually a clinical manifestation of several different disease processes, particularly lichen planus and benign mucous membrane pemphigoid. Correct diagnosis in DG is critical since proper treatment and follow-up will depend on which disease is involved. However, the diseases that cause DG frequently present diagnostic problems because their lesions often resemble each other clinically and routine histological examination sometimes cannot differentiate between them. Thus, immunohistology, particularly immunofluorescence, is increasingly being used with routine histology to more accurately diagnose DG diseases. This article reviews our experience over the past 10 years in the diagnosis of 72 cases of DG using direct immunofluorescent (DIF) in conjunction with histology and clinical evaluation. Of the 72 DG cases in this study, 30 cases were diagnosed as erosive lichen planus or lichenoid mucositis; 29 cases were diagnosed as benign mucous membrane pemphigoid; 2 cases each of linear IgA disease and pemphigus vulgaris were diagnosed; there was 1 case of bullous pemphigoid; and 1 suspected case of paraneoplastic pemphigus. Even with DIF analysis, 7 cases could not be definitively assigned a particular cause. DIF analysis is not only proving very useful for differential diagnosis, but also adds insight into possible pathogenic mechanisms of DG.

Expression of estrogen receptors in desquamative gingivitis.

BACKGROUND: Most cases of chronic desquamative gingivitis (CDG) are shown by direct immunofluorescence (DIF) to be immune mediated diseases. Some patients present with similar clinical and microscopic findings as CDG but DIF staining is negative. It has been suggested that those cases of CDG may be hormone (estrogen) mediated and may be treated with estrogens with favorable results. METHODS: Gingival tissue from 24 cases of CDG and one case of ordinary gingivitis were studied for estrogen receptor (ER) expression using immunohistochemical techniques. Twenty-four of the 25 cases were female. Using standard DIF analysis, 11 of the CDG cases were diagnosed as benign mucous membrane pemphigoid, 10 as lichen planus or lichenoid mucositis (LP), and one as pemphigus. The remaining 3 cases were not diagnostic for a specific disorder (idiopathic). Five of the females had a history of estrogen substitute therapy. RESULTS: Twenty-two of 23 female CDG cases were positive for ER, although the degree of staining varied. A 32-year-old female with ordinary gingivitis, whose gingivitis varied with her menstrual cycle, did not stain for ER. A 50-year-old male and a 76-year-old female, both with gingival LP, also had negative staining for ER. CONCLUSIONS: There appears to be no correlation between diagnosed diseases (immunological versus idiopathic) and expression of ER in CDG gingiva. ER expression in the gingiva is probably not related to the presence or absence of estrogen supplementation. The results of this study do not support the use of estrogen in the treatment of idiopathic CDG.

Clinico-pathological conference 2002.

INTRODUCTION: Six cases are reported, each presented at the 11th Biennial Congress of the International Association of Oral Pathologists as an instructive case for differential diagnosis on the basis of clinical, imaging or histological features. CLINICAL PICTURE: Case diagnoses included a large, possibly intraosseous, myofibroma presenting with an oral mass; Langerhans cell histiocytosis with facial skin lesions; an intraosseous vascular hamartoma of the maxilla with worrying radiological features; an unusual mixed radiolucency of the jaw caused by cemento-ossifying fibroma; an osteosarcoma of the posterior mandible causing a well-defined radiolucency and an intraoral squamous cell carcinoma in a child.

A modified technique for obliteration of large bony defects after cystectomy.

Thirteen cysts treated by enucleation followed by collapsing an osteoperiosteal flap to eliminate dead space are presented. Four of the cysts were dentigerous and nine were radicular. The bony defects ranged in size from 3 to 7 cm in greatest dimension. Healing by primary intention occurred in all cases. This method has been found to be successful in the obliteration of large bony defects after cystectomy.

A regional approach to reconstruction of the upper lip.

PURPOSE: This articles reviews the results obtained when cheek or lower lip flaps, or a combination of these flaps, are used for the reconstruction of defects of the upper lip. PATIENTS AND METHODS: Twenty-four cases of either partial or total full-thickness defects of the upper lip were reconstructed. Four cases with lateral full-thickness partial defects were reconstructed by advancing a cheek flap using the Bernard-Burow method. In five cases, defects located at the junction of the upper lip and the cheek were reconstructed with an Estlander flap. Four patients with a tight upper lip were corrected with an Abbé flap. In two cases, a modified mucomuscular Abbé flap was used for reconstruction of a vermilion defect of the upper lip. Nine patients with subtotal or total full-thickness defects of the upper lip were reconstructed with a combination of bilateral or unilateral cheek flaps using either the Bernard-Burow or Dieffenback method and T-shaped or oblong Abbé flap. RESULTS: All regional flaps healed uneventfully, and the function of reconstructed upper lips had recovered within 2 years postoperatively. CONCLUSION: Use of regional flaps to reconstruct partial or total full-thickness defects of the upper lip can usually achieve satisfactory functional and esthetic results.

Histologic study of the fate of autogenous auricular cartilage grafts in the human temporomandibular joint.

Biopsies of 30 autogenous auricular cartilage grafts previously placed in 21 patients with ankylosis and arthropathy of the temporomandibular joint were studied. These joints were reoperated because of persistent pain and limitation of motion. Histologically, all grafts showed viability of the cartilage. Eighteen cartilage grafts placed after Proplast (Vitek, Inc, Houston, TX) or Silastic (Dow Corning, Midland, MI) implants had been removed, all showed foreign-body granuloma with coexistent intact cartilage grafts. This indicated that the autogenous auricular cartilage was resistant to the foreign-body reaction. All cartilage grafts were encased by fibrous tissue. This overgrowth of fibrous tissue may be responsible for the ankylosis. Seven grafts showed cartilaginous proliferation grossly and all showed proliferation histologically. The cartilage proliferation also may contribute to the persistent symptoms and recurrent limitation of joint motion.

A histologic evaluation of the accuracy of TMJ diagnostic arthroscopy.

Sixty-seven temporomandibular joints with internal derangement were examined with arthroscopy, and synovial biopsies were taken for histologic evaluation. Histologically, in 10 cases, the synovium appeared to be normal in appearance, 24 cases had moderate to severe synovitis, 11 cases showed hyperplastic synovitis, 13 cases showed synovial fibrosis, and foreign body granuloma was found in 9 cases. Correlation between arthroscopic observation and histologic findings disclosed an 89.1% specificity and 100% sensitivity.

Secondary closure of oroantral and oronasal fistulas: a modification of existing techniques.

Fifty-three patients, 25 with oroantral and 28 with oronasal fistulas, were treated using a modified technique of peripheral de-epithelialization and overlapping flaps. This technique was used with sliding buccal flaps, palatal rotation flaps, palatal island flaps, tongue flaps, and distant tubed pedicle flaps. The advantage of the flap is that it provides more tissue attachment, which promotes healing and resists the tendency of the flap to return to its original position. A high degree of success can be predicted. Only two failures were observed in 53 cases.

Multiple familial ossifying fibromas: relationship to other osseous lesions of the jaws.

Multiple familial ossifying fibroma is a very rare jaw lesion. A 31-year-old white woman who had this heritable condition is reported. A differential diagnosis has been discussed to delineate an entity that has not appeared in the previous literature.

Central hemangioma of the jaws.

Fifteen cases of central hemangioma of the jaws in 14 patients are reported, and considerations in diagnosis and treatment are discussed. In the management of these tumors, diagnostic considerations are of paramount importance if associated risks are to be minimized while maximizing the chances for a successful outcome. A search of the literature suggests that surgery, either alone or in combination with embolization, remains the treatment of choice for these lesions. All cases in this report were treated surgically without incident and with good results. Of special interest were two cases in which the tumor was removed from the excised mandible, which was then sterilized and used in the immediate reconstruction of the surgical defect.

African Burkitt's lymphoma: case report and light and electron microscopic findings.

An African Burkitt's lymphoma occurred in a 9-year-old American boy who had jaw tumors, proptosis, and abdominal masses. Histologically, the tumor consisted of a monotonous overgrowth of undifferentiated lymphocytes with a "starry sky" appearance. The differential diagnosis of African versus American form and Burkitt's lymphoma versus non-Burkitt's lymphoma is discussed.

Noma: report of a case resulting in bony ankylosis of the maxilla and mandible.

Noma, or cancrum oris, has been described as a gangrenous infection of the soft and hard tissues of the oronasal region. Prior to the advent of antibiotics the disease was commonly fatal. Now many survive the acute phase of the disease and present the surgeon with formidable problems of repair. This is a report of a presumed case of noma that resulted in bony ankylosis of the maxilla and mandible. Three-dimensional shaded surface CT reconstruction images were especially useful in demonstrating the architecture of the abnormal bone.