Maxillary osteosarcoma: two case reports and literature review.

Osteosarcoma is a rare malignant tumor of the maxilla. Although clear surgical margin is the only predictor for the prognosis of the disease, neoadjuvent chemotherapy showed a reasonable effect on the tumor with variable degree of necrosis. In this article, we report two cases where neoadjuvent chemotherapy was used with review of the literature.

Prevalence of harassment and discrimination among residents in three training hospitals in Saudi Arabia.

BACKGROUND AND OBJECTIVES: Multiple surveys of medical residents have shown a high incidence of harassment and discrimination in academic health centers. Harassment has a negative effects on residents' health and on their ability to function. No previous study has documented the prevalence of harassment and discrimination among residents in Saudi Arabia. We aimed in this study to assess the prevalence of harassment and discrimination among residents at a tertiary care academic hospitals in Saudi Arabia. DESIGN AND SETTING: Cross-sectional survey conducted at National Guard Hospitals in Riyadh, Jeddah and Al-Ahsa'a from 27 July to 20 August 2010. SUBJECTS AND METHODS: The survey included questions on the prevalence of harassment of different types, inlcuding verbal, academic, physical and sexual harassment, as well as discrimination on the basis of gender, region of origin or physical appearance. RESULTS: Of 380 residents, 213 (56%) returned a completed questionnaire (123 male, 57.8%). At least one of type of harassment and discrimination was reported by 83.6% of respondents. The most frequently reported forms were verbal harassment and gender discrimination (61.5% and 58.3%, respectively). Sexual harassment was commonly reported (19.3%) and was experienced significantly more often by female residents than by male residents (P=.0061). CONCLUSION: Harassment and discrimination of Saudi residents is common with more than three-quarters reporting having had such an experience. Identification of the risk factors is a necessary first step in clarifying this issue and could be used when planning strategies for prevention.

Pathologic fracture of the mandible caused by metastatic follicular thyroid carcinoma.

A pathologic fracture may be an acute event or a chronic long-standing ill-defined problem, and the causes are numerous. The dental practitioner may be the first health care practitioner to see a patient with a pathologic fracture of the jaw. This case report is intended to inform dental practitioners about pathologic fractures and the need for prompt referral to minimize patient suffering.

What is the adequate margin of surgical resection in oral cancer?

OBJECTIVE: The "adequate surgical margin" has always remained an enigma in the minds of head and neck surgeons. This study systematically analyses the impact of the width of the clear surgical margin on survival in oral cancer. STUDY DESIGN: A historical cohort of 277 surgically treated patients with oral cancer were followed for a median period of 36 months. Cox proportional hazard models were used to determine the independent effect of the clear surgical margin, in millimeters, on 5-year survival. RESULTS: Patients with margins of 5 mm or more had a 5-year survival rate of 73% when compared to those with margins of 3 to 4 mm (69%) , 2 mm or less (62%), and involved margins (39%, P = .000). After controlling for confounding variables (age, gender, stage) each 1-mm increase in clear surgical margin decreased the risk of death at 5 years by 8% (HR 0.92; 95% CI 0.86, 0.99; P = .021). Based on this model, patients with positive surgical margins had a 2.5-fold increase in risk of death at 5 years and those with close (

Treatment outcomes in squamous cell carcinoma of the maxillary alveolus and palate: a population-based study.

OBJECTIVE: This population-based historical cohort study evaluates the treatment outcomes of primary squamous cell carcinoma of the maxillary alveolus and hard palate. METHODS: A historical cohort of 37 cases of previously untreated biopsy-proven squamous cell carcinoma of the upper jaw registered in the Province of Manitoba from January 1975 to January 2004 was analyzed. RESULTS: The tumor epicenter involved the maxillary alveolus in 26 patients and the hard palate in 11 patients. The mean age of the study population was 72.8 years and 67% were women with a documented tobacco use rate of 50%. Forty-one percent had stage I or II disease, 51% stage III or IV, and 8% could not be staged. Treatment included radiotherapy as a single modality (13.5%), surgery (38%), surgery and radiotherapy (24%), and palliative treatment (24%). Local recurrence was observed in 10 patients with 6 failing at the primary site. The absolute and disease-free survival at 5 years was 33% and 62% respectively. The 5-year disease-free survival was 82% for stage I and II and 48% for stage III and IV (P = .056). No patient treated with radiotherapy as a single treatment modality survived 5 years. Disease-free survival for patients treated with surgery, and surgery +/- radiotherapy, was 69% and 73% at 5 years, respectively (P = .001). CONCLUSIONS: Squamous cell carcinoma of the maxillary alveolus and palate differs from other oral cancers in that the patients are relatively older with a slight female predilection. Treatment with surgery, with or without radiotherapy, appears to improve disease control.

Relationship of the maxillary artery and lateral pterygoid muscle in a caucasian sample.

OBJECTIVE: Several studies have investigated the relationship between the maxillary artery and the lateral pterygoid muscle, yet controversy still exists regarding this relationship. The purpose of this study was to re-examine this relationship in a sample of caucasian cadavers in Canada. STUDY DESIGN: All soft tissues were removed from the mandibles of 44 caucasian cadavers. Mandibular osteotomies were performed to expose the infratemporal fossa and to dissect the maxillary artery bilaterally. Once accomplished, the relationship of the second part of the maxillary artery to the lower head of the lateral pterygoid muscle, and any variation in symmetry, was recorded. RESULTS: In the majority of cases (30/44), the artery was found lateral to the lower head of the lateral pterygoid muscle (71% in men and 65% in women). The maxillary artery was found medial to the lower head of the lateral pterygoid muscle in only 14 of the cases (29% in men and 35% in women). No variations in the course of the maxillary artery were noted between the 2 sides and between both genders. CONCLUSIONS: This study shows that the lateral or superficial course of the maxillary artery relative to the lower head of the lateral pterygoid muscle is more prevalent than the medial or deep course. This is in agreement with the majority of previously published results. There were no variations in the course of the artery between the 2 sides of the same cadaver or between cadavers of both genders.

Population-based study of treatment outcomes in squamous cell carcinoma of the retromolar trigone.

BACKGROUND: Carcinoma of the retromolar trigone is relatively uncommon. High rates of local recurrence account for a relatively poor prognosis. STUDY DESIGN: A population-based historical cohort of 76 cases with biopsy-proven squamous cell carcinoma of the retromolar trigone were studied as a case series. Kaplan-Meier survival curves and log rank test were used for statistical analysis. RESULTS: The mean age was 67.2 years. Fifty-six patients were male, 45% had T1 or T2 tumors, and 61% were staged as N0. Treatment included radiotherapy in 35%, surgery alone in 26%, surgery and radiotherapy in 23%, and 16% received palliative treatment. The absolute and disease-specific survivals at 5 years were 51.4% and 67.7%, respectively. In patients treated with surgery, the resection margin status predicted the overall 5-year survival (P = .027), with 75% of patients with negative margins surviving 5 years versus a survival of 0% of patients with involved margins. CONCLUSIONS: Squamous cell carcinoma of the retromolar trigone has a poor survival rate for early-stage disease. Adequate surgical margins can improve survival.

The lingual splint: an often forgotten method for fixating pediatric mandibular fractures.

Maxillofacial fractures are uncommon in the pediatric population, and their treatment is unique due to the psychological, physiological, developmental and anatomical characteristics of children. We present the case of a boy who was treated in an outpatient dental clinic using a lingual splint for the reduction, stabilization and fixation of a mandibular body fracture. This technique is a reliable, noninvasive procedure that dentists may consider in selected cases by referral to an oral and maxillofacial surgeon. It also limits the discomfort and morbidity that can be associated with maxillomandibular fixation or open reduction and internal fixation in pediatric patients.

The clinical significance of the positive surgical margin in oral cancer.

The objective of surgical management of squamous cell carcinoma of the oral cavity is adequate resection with a clear margin. This study examines the significance of the positive surgical margin. An historical cohort of 425 patients from the cancer registry of the Province of Manitoba with squamous cell carcinoma of the oral cavity treated with surgery +/-radiotherapy was examined. A Cox's proportional hazard model was used to examine the independent effect of surgical margins on five-year survival. Seventy-two percent of tumors involved the tongue and floor of mouth, and 43% of patients presented with Stage III and IV disease. The 5-year absolute and disease specific survivals were 62% and 74.5% respectively. Survival was related to age >65 years (P=0.0177), T-Stage (P=0.0002), and N-Stage (P=0.0465). Patients with clear margins had a survival rate of 69% at 5 yrs (median survival >60 mos) compared to 58% with close (median survival >60 mos) and 38% with involved margins (median survival 31 mos, P=.0000). After controlling for significant prognostic factors, involved surgical margins increased the risk of death at 5 years by 90% (HR 1.9, 95% CI 1.2,2.9, P=0.0026). The status of the surgical margin is an important predictor of outcome. The surgical margin, in contrast to the other prognostic indicators, is under the direct control of the surgeon.

Long-term follow-up of hydroxyapatite-coated dental implants--a clinical trial.

PURPOSE: The purpose of this study was to report the long-term (8- to 10-year) results of hydroxyapatite (HA) -coated dental implants and compare them to the 5-year results as well as to long-term results of both HA and titanium dental implants reported in the literature. MATERIALS AND METHODS: Patients were recruited, screened, and accepted or rejected sequentially based on specific inclusion/exclusion criteria. Implant placement was performed according to the manufacturer's instructions, followed by prosthetic reconstruction. Routine follow-up examinations were performed for a 5-year period. At 10 years all patients were contacted by mail and invited to participate in a longer-term follow-up of dental implants. All participants provided informed consent and underwent a complete history, including clinical and radiographic examination. The data obtained were statistically analyzed using life tables. RESULTS: A total of 302 implants were placed in 90 patients whose average age was 54.3 years (SD 13.2 years). Of these, 114 implants in 40 patients were examined at 10 years, 88 in the mandible and 26 in the maxilla. The cumulative survival rate was 85.40% in the mandible and 70.59% in the maxilla. The total survival rate was 81.97%. CONCLUSIONS: The 10-year success rate of HA-coated dental implants was 82%. The success rate is higher in the mandible as compared to the maxilla. The 10-year results are inferior to the 5-year results. (Clinical Trial)