Primordial odontogenic tumour: clinicopathological analysis of six cases of a previously undescribed entity.

AIM: To describe the clinicopathological and immuno-histochemical features of six tumours that do not fulfil the criteria of any of the currently classified odontogenic tumours. METHODS AND RESULTS: The patients were three males and three females, whose ages ranged from 3 years to 18 years (mean, 11.05 years). In all cases there were well-defined radiolucencies associated with unerupted teeth apparently showing a pericoronal relationship. Microscopically, all tumours were composed of variably cellular loose fibrous tissue with areas similar to dental papilla, entirely surrounded by cuboidal to columnar epithelium resembling the internal epithelium of the enamel organ. Mesenchymal tissue was positive only for vimentin, and Ki67 expression was very low (<2%). The epithelium was positive for CK AE1/AE3, CK5, CK14, and CK19, but negative for CK18 and CK20. All cases showed clear demarcation from the surrounding bone, and were surgically removed, with no recurrences after follow-up ranging from 6 months to 20 years. CONCLUSIONS: These findings differ from those observed in other odontogenic lesions, such as ameloblastic fibroma, odontogenic myxoma, odontogenic fibroma, and hyperplastic dental follicles. The term primordial odontogenic tumour is proposed to describe this novel lesion.

Different Modalities to Record and Transfer Natural Head Position to Virtual Planning in Orthognathic Surgery: Case Reports of Asymmetric Patients.

AIM: To describe different modalities to record and transfer natural head position (NHP) to 3D facial imaging by using the virtual surgical planning software in three facial asymmetry patients. CASE REPORTS: Three patients with facial asymmetries (A, B, and C) were evaluated by means of dental and facial analysis, photographs, cone-beam computed tomography (CBCT) and digitized dental arches. Before starting the VSP workflow with Dolphin Imaging, NHP was recorded by three modalities and transferred to three-dimensional (3D) facial images as follows: (a) facial photographs taken with digital camera and the estimated NHP was transferred to 3D images by comparing lines and planes from both images; (b) cross-line level laser was used to place radiopaque markers on the face skin for recording the estimated NHP, which was transferred to 3D images by alignment of planes and markers in the software; and (c) photographs of the face were processed to generate facial surface mesh by using the Agisoft PhotoScan software, which maintained the same position of the estimated NHP in 3D for aligning the images of the soft tissue with the facial surface mesh by using superimposition. All the three patients underwent bi-maxillary orthognathic surgery. CONCLUSION: There are different modalities using simple and available technologies in the clinical routine, but whose reproducibility, reliability and validation could not be assessed nor compared to each other. There was no trend for better predictability, feasibility and efficiency because the postoperative outcomes were adequate regarding the patients' satisfaction and facial symmetry.

Avoiding condylar displacement after intraoral vertical ramus osteotomy.

The intraoral vertical osteotomy is a versatile and simple technique usually applied to correct mandibular prognathism. Its greatest advantages include ease of performance and minimum neurosensory disturbances, whereas maxillomandibular fixation is pointed as its major disadvantage. Another important concern about this technique is condylar displacement, which may lead to temporomandibular dysfunction. Technical notes to avoid condylar luxation are discussed after 15 years of experience using this osteotomy as the technique of choice to correct mandibular prognathism. Three similar cases are presented, where 1 condyle was displaced from the glenoid fossa, resulting in mandibular deviation during function in patients requiring small mandibular setback.

Surgical correction of a Class II skeletal malocclusion associated with anterior open bite and temporomandibular joint pain.

This case report describes the treatment of a 25-year-old woman with anterior open bite, Class II skeletal malocclusion, and a history of temporomandibular joint pain and sounds. She also had significant anteroposterior and vertical discrepancies and a convex profile with protrusive lips. Intraorally, she had an anterior open bite of 3 mm and an overjet of 5 mm. Mandibular surgical rotation, associated with mandibular incisor extraction, was performed to reduce the protrusion, close the open bite, and minimize the temporomandibular joint disorder.

Oral perineurioma: clinicopathologic features from two cases and review of literature.

The present study reports two cases of oral perineuriomas, including a clinicopathologic review of the 39 published cases (17 intraneural and 22 extraneural perineuriomas) in the English language literature. In the first case, the tumor occurred in an 84-year-old male as a painless, asymptomatic, 20-mm submucosal nodule on the right lower mucobuccal fold near to the premolar area. In the second case, a 46-year-old female presented with a painless, 25-mm, slow-growing, fibrous, pedunculated nodule on the right buccal mucosa. In the first case, the tumor was composed of spindle cells arranged in a storiform pattern, classified as intraneural perineurioma; and in the second, it was an extraneural perineurioma, showing a whorled myxoid stroma. Immunohistochemical analysis confirmed the diagnosis by showing positivity for vimentin, EMA, and Glut-1 in case 1 and EMA, Glut-1, Claudin-1, and CD34 (focally) in case 2. Complete surgical removal was performed for both tumors, and there was no evidence of local recurrence after a long-term follow-up.

Denosumab-related osteonecrosis of the jaws: successful management with a conservative surgical approach.

Denosumab-related osteonecrosis of the jaws (DRONJ) is a recently described entity that shares many common clinical and radiological features with bisphosphonate-related osteonecrosis of the jaws (BRONJ). The aim of the present study is to report a case of DRONJ affecting the anterior mandible of a 58-year-old male treated with denosumab to prevent skeletal-related events associated with prostate cancer. Conservative surgery in conjunction with antibiotic therapy and discontinuation of denosumab use were effective in managing the condition and the patient remains free of clinical and radiological changes after a 38 month follow-up.

Fine-needle aspiration biopsy as an auxiliary diagnostic tool on intraoral minor salivary gland adenoid cystic carcinoma.

BACKGROUND: Fine-needle aspiration biopsy (FNAB) is useful in diagnosis of major salivary gland adenoid cystic carcinoma (ACC), but it has been rarely reported on minor salivary gland ACC. OBJECTIVE: The aim of this study was to report the utility of FNAB on diagnosis of ACC involving minor salivary glands. STUDY DESIGN: Three patients presenting ACC involving the palate (2 cases) and buccal mucosa (1 case), with a mean age of 36 years and 2:1 female-to-male ratio, were included in the study. All of the patients were submitted to FNAB for diagnostic purposes. RESULTS: All smears were stained with hematoxylin-eosin, Papanicolaou, and Diff-Quik and showed the presence of small polyhedral cells with hyperchromatic nuclei and extracellular basophilic globular amorphous substance, compatible with ACC. Diagnosis of the 3 cases was subsequently confirmed through histopathology. CONCLUSION: The FNAB was easy to perform and cost-effective, and proved to be an useful adjunctive tool in diagnosis of intraoral ACC.