Prevalence and variations of the median maxillary labial frenum in children, adolescents, and adults in a diverse population.

The median maxillary labial frenum (MMLF) is a normal anatomic structure with inherent morphologic variations. This study sought to evaluate the prevalence of those variations in a diverse ethnic population and to educate practitioners about the prevalence of MMLF variations to prevent unnecessary biopsies. This study included adult, adolescent, and child patients at the Louisiana State University Health Science Center School of Dentistry. Among the 284 subjects examined, frenum normale was the most common frenum classification, followed by frenum with nodule and frenum with appendix. Most nodules were found in the intermediate third of the MMLF, while appendices were mainly found in the labial third. The prevalence of an appendix was significantly higher (P < 0.001) in Caucasians compared to African-Americans. The prevalence of nodules was marginally higher (P = 0.096) in Caucasians than in African-Americans. No other statistically significant differences were found with regard to ethnicity. Additionally, nodules and appendices on the MMLF were identified in all age groups, and may become more common with increasing age. The authors determined that variations of the MMLF are inherent and do not represent a pathologic condition, nor do they require biopsy for diagnostic purposes.

A clinical analysis of nine new pediatric and adolescent cases of benign minor salivary gland neoplasms and a review of the literature.

INTRODUCTION: Minor salivary gland neoplasms of epithelial origin are rare in children and adolescents and most are not well documented, except for a few small series and case reports. This study represents a retrospective clinical analysis of nine cases of benign epithelial salivary gland neoplasms accessioned over a 35-year period at the Louisiana State University School of Dentistry and combines the data with well-documented cases from the English-language literature. METHODS: A retrospective clinical analysis of nine cases of benign epithelial salivary gland neoplasms was performed over a 35-year period at the Louisiana State University School of Dentistry and combined with data of well-documented cases from the English-language literature. RESULTS: The nine benign salivary gland neoplasms in patients aged 19 months to 18 years accounted for 2.3% of the Louisiana State University School of Dentistry accessioned salivary gland tumors. These nine cases comprised eight pleomorphic adenomas and one cystadenoma. There were 40 cases in the literature, of which 34 were pleomorphic adenomas. Combining the data for the 42 pleomorphic adenomas resulted in a mean age of 12 years with a 2.8:1 female predilection. The hard palate and/or soft palate were the most common site (69.1%). The average duration and size was 2.1 years and 2.4cm, respectively. Bone involvement occurred in seven cases. Wide local excision was the treatment most often employed. Cases followed for two years or more had a recurrence rate of 13.0%. The remaining seven neoplasms in the combined data comprised myoepithelioma, cystadenoma and sialadenoma papilliferum. CONCLUSIONS: A relatively long duration (2 years) of a submucosal mass in a minor salivary gland-bearing area with or without bone involvement occurring in a child or adolescent should raise the question of a possible salivary gland neoplasm. A pleomorphic adenoma is the most common benign salivary gland neoplasm in the first and second decade of life. Complete surgical excision affords the best chance of preventing recurrence for pleomorphic adenomas. The recurrence rate of pleomorphic adenomas with two or more years follow-up is 13.0%. Other types of minor salivary gland neoplasms are exceedingly rare and therefore data is sparse, precluding any valid conclusions.

Minor salivary gland mucoepidermoid carcinoma in children and adolescents: a case series and review of the literature.

INTRODUCTION: Because well-documented cases of mucoepidermoid carcinomas that are of minor salivary gland origin and occur in children and adolescents have rarely been reported, little information regarding their clinical features and biologic behavior is available. This case report represents a retrospective clinical analysis of five minor salivary gland mucoepidermoid carcinomas accessioned from a 35-year period at the Louisiana State University School of Dentistry and combines the data with 15 well-documented cases from the English language literature. CASE PRESENTATION: The five mucoepidermoid carcinomas in patients from birth to 19 years of age accounted for 1.3% of the accessioned minor salivary gland neoplasms. There were an additional 15 well-documented cases in the literature. Combining the data for the 20 mucoepidermoid carcinomas resulted in a mean age of 13.5 years and a 2.3:1 female-to-male ratio. Collectively, the hard palate, soft palate, and hard palate/soft palate junction accounted for 85% of the cases. Thirty-five percent of the cases presented as a fluctuant submucosal swelling with surface color alterations. The average duration was five months, and bone involvement occurred in seven cases. A histologic grade of low to intermediate predominated (95%). Surgical removal was the treatment in all cases. Thirteen cases had adequate follow-up of three years or more, and recurrence was documented in only one case. There were no cases of death or metastasis in this series. CONCLUSIONS: In children and adolescents, mucoepidermoid carcinomas have a female predilection and occur most commonly on the hard or soft palate or both. A fluctuant submucosal lump with a bluish color is a helpful diagnostic clue. The histologic grades of most mucoepidermoid carcinomas in the first and second decades of life are low and, to a lesser degree, intermediate. Complete surgical excision is the treatment of choice and results in a recurrence rate of less than 10%.

Glandular odontogenic cyst: analysis of 46 cases with special emphasis on microscopic criteria for diagnosis.

The glandular odontogenic cyst (GOC) is now a relatively well-known entity with recent reviews indicating over 100 cases reported in the English literature. The GOC's importance relates to the fact that it exhibits a propensity for recurrence similar to the odontogenic keratocyst, and that it may be confused microscopically with central mucoepidermoid carcinoma (CMEC). Numerous histopathologic features for the GOC have been described, but the exact microscopic criteria necessary for diagnosis have not been universally accepted. Furthermore, some of the microscopic features of GOC may also be found in dentigerous, botryoid, radicular, and surgical ciliated cysts. The purpose of this multicenter retrospective study is to further define the clinical, radiographic, and microscopic features of GOC, to determine which microscopic features may be helpful for diagnosis in problematic cases, to determine the most appropriate treatment, and to determine if GOC and CMEC share a histopathologic spectrum. In our series of 46 cases, the mean age at diagnosis was 51 years with 71% of cases in the 5th-7th decades. No gender predilection was noted. 80% of cases occurred in the mandible, and 60% of the lesions involved the anterior regions of the jaws. Swelling/expansion was the most common presenting complaint, although some cases were asymptomatic. Radiographically, most cases presented as a well-defined unilocular or multilocular radiolucency involving the periapical area of multiple teeth. Some lesions displayed a scalloped border. Cases also presented in dentigerous, lateral periodontal, and "globulomaxillary" relationships. The canine area was a common location for maxillary cases. All cases were treated conservatively (enucleation, curettage, cystectomy, excision). Follow-up on 18 cases revealed a recurrence rate of 50% (9/18), with 6 cases recurring more than once (range of follow-up: 2 months to 20 years; average length of follow-up: 8.75 years). The mean interval from initial treatment to first recurrence was 8 years, and from first recurrence to second recurrence was 5.8 years. Two cases recurred three times and the interval from second to third recurrence was 7 years (exact interval only documented in one case). All cases exhibited eosinophilic cuboidal (hobnail) cells, a feature not specific for GOC, but necessary for diagnosis, in our opinion. Univariate analysis indicated several features that are most helpful in distinguishing GOC from GOC mimickers in problematic cases, including: (1) the presence of microcysts (P < 0.0001); (2) epithelial spheres (P < 0.0001); (3) clear cells (P = 0.0002); (4) variable thickness of the epithelial cyst lining (P = 0.0002); and (5) multiple compartments (P = 0.006). Stratified analysis indicated that when microcysts are present, epithelial spheres and multiple compartments are still significant, and clear cells are marginally significant in distinguishing GOCs from GOC mimickers. The presence of microcysts (P = 0.001), clear cells (P = 0.032), and epithelial spheres (P = 0.042) appeared to be most helpful in distinguishing GOC associated with an unerupted tooth from dentigerous cyst with metaplastic changes. There were no statistically significant differences microscopically between GOCs that recurred and those that did not. The presence of 7 or more microscopic parameters was highly predictive of a diagnosis of GOC in our series (P < 0.0001), while the presence of 5 or less microscopic parameters was highly predictive of a non-GOC diagnosis (P < 0.0001). Islands resembling mucoepidermoid carcinoma (MEC-like islands) were identified in the cyst wall of three cases, only one of which had follow-up (no evidence of disease at 74 mo.); therefore, at this time insufficient information is available to determine whether GOC and CMEC share a histopathologic spectrum or whether MEC-like islands in GOCs are associated with more aggressive or malignant behavior.

Squamous odontogenic tumor-like proliferations in radicular cysts: a clinicopathologic study of forty-two cases.

INTRODUCTION: Squamous odontogenic tumor-like epithelial islands occurring in the walls of odontogenic cysts are histologically identical to the squamous odontogenic tumor (SOT). Microscopically, the squamous odontogenic tumor-like proliferations (SOTLPs) share certain histologic features with SOT, acanthomatous and desmoplastic ameloblastoma, and well-differentiated squamous cell carcinoma. Little is known about the rarely reported SOTLPs occurring in radicular cysts. The purpose of this study was to define the clinical and histopathologic spectrum of SOTLP in radicular cysts and to investigate its histogenesis, prevalence, and biologic behavior. METHODS: A retrospective clinicopathologic study was conducted at the Louisiana State University School of Dentistry, and a total of 42 radicular cysts with SOTLPs were accepted. Clinical findings and detailed histopathologic features were documented, and follow-up information was solicited for the 42 cases. RESULTS: Forty-two cases of radicular cysts with SOTLPs were found among 1241 radicular cysts. Two thirds of the cases revealed the SOTLPs were arising from budlike extensions of the epithelial lining of the cyst. The SOT-like epithelial islands were in areas free of inflammatory cells in 73.8% of the cases. No evidence of recurrence or unexpected clinical behavior was reported in 11 cases with adequate follow-up. CONCLUSIONS: The prevalence of SOTLPs in radicular cysts at Louisiana State University School of Dentistry is 3.4%. The SOTLPs appear to originate from the epithelial lining of the cyst and do not appear to be directly associated with inflammation. The biologic behavior of the radicular cyst with SOTLP is innocuous, with no apparent potential for neoplastic transformation or recurrence.

Spontaneous regression of congenital epulis: a case report and review of the literature.

INTRODUCTION: Congenital epulis is a rare lesion found on the alveolar process of a newborn child, diagnosed soon after birth. The lesion has a site predilection for the anterior maxillary alveolar process and a 9:1 sex predilection for females. Once diagnosed the traditional management of the lesion has been surgical excision under general anesthesia. CASE PRESENTATION: The purpose of this case report is to describe spontaneous regression of congenital epulis in a three week old healthy African American female child. She presented with a 1.5 cm bilobed sessile nodular lesion in the region of the right maxillary cuspid. The clinical impression was congenital epulis. Since the lesion was not interfering with feeding and respiration, a conservative approach was taken. The child was followed-up for 18 months, during which the lesion progressively regressed. CONCLUSIONS: Conservative management prevented unnecessary surgery and anesthesia exposure in a neonate.

Peripheral odontogenic fibroma: a clinicopathologic study of 151 cases and review of the literature with special emphasis on recurrence.

OBJECTIVE: The peripheral odontogenic fibroma (POdF) is a rare benign neoplasm of odontogenic origin with limited data on recurrence. The purpose of this study was to define the clinical and histopathologic spectrum of POdF and to investigate its recurrence rate and variables associated with its recurrence. STUDY DESIGN: A total of 151 cases of POdF were accepted for this study, which documented clinical, histopathologic, and follow-up data. Multivariate stepwise logistic regression was used to investigate the association of categorical variables and recurrence. RESULTS: POdF should be considered a mixed odontogenic tumor because it is composed of active odontogenic epithelial and ectomesenchymal components. Of the 58 cases with follow-up, 29 recurred. Budding of the basal cell layer of the surface squamous epithelium was associated with higher recurrence (P=.0186); 27 cases with recurrence which exhibited this feature. The presence of calcification in direct apposition to epithelial rests was associated with lower recurrence (P=.0076); 13 cases that did not recur exhibited this feature. CONCLUSIONS: POdF has a 50% recurrence rate. Budding of the surface epithelium and calcification in apposition to odontogenic epithelial rests are histologic predictors of recurrence.

Characterization of oral biopsies from a geriatric population.

A retrospective search was performed to find the histological diagnosis for all lesions recorded by an oral pathology service for patients 65 and older from 1969-2002. The search was subcategorized into two age groups and the 20 most common diagnoses from these categories were characterized by patient gender and race. Lesions then were classified into one of seven modified etiopathogenic categories. Of the 52,774 cases recorded during this time, 7,854 involved patients aged 65-84 and 393 cases involved patients 85 and older. Inflammatory lesions were the most common category of lesion in patients over the age of 65. Among patients aged 65-84, fibroma was the most common diagnosis, while squamous cell carcinoma was the most frequent diagnosis among patients 85 and older. Neoplastic lesions (epithelial dysplasia and squamous cell carcinoma) comprised 11.7% of the diagnoses among patients aged 65-84 and 18.6% of the diagnoses among patients 85 and older. These data indicate that patients 85 and older demonstrated a statistically significant increased frequency of squamous cell carcinoma compared to patients in the 65-84 age group.

Disseminated histoplasmosis with oral manifestation.

Histoplasmosis is a fungal disease that affects humans and is caused by Histoplasma capsulatum. The presentation of the infection may be acute, chronic, or disseminated. The disseminated form has extrapulmonary manifestations which may include oral manifestations. A patient with AIDS sought treatment and he had disseminated histoplasmosis with oral manifestations. The purpose of this case report and literature review is to emphasize the role the dental team has in the diagnosis of disseminated disease when a patient presents with oral manifestations associated with the disease. This case report is clinically relevant because it is not uncommon for oral manifestations to be one of the first signs of systemic disease.

A histologic evaluation of various stages of palatal healing following subepithelial connective tissue grafting procedures: a comparison of eight cases.

BACKGROUND: It is often necessary to procure tissue from the same area of the palate in cases where connective autogenous grafting procedures are warranted due to limitations caused by anatomical features. The purpose of this study was to determine whether the length of time between a first procurement and a second would have any bearing on the quality of tissue available for recipient sites. METHODS: Eight patients requiring more than one grafting procedure underwent surgery at baseline and again at various intervals ranging from 6 weeks to 11 months. Specimens were taken from the palate and evaluated microscopically, and photographs were taken for purposes of visual comparison. RESULTS: The 6.9- to 7.7-week specimens exhibited complete reepithelialization. The lamina propriae were composed of a cellular proliferation of fibroblasts with loosely arranged collagen deposition and an occasional thin vascular channel. However, remodeling of the wound appeared complete in the specimens removed at the 9-week interval and beyond. The lamina propria was, in general, composed of thick, dense, interlacing bundles of collagen. Small-caliber blood vessels were interspersed throughout the fibrous element. CONCLUSION: Reharvesting of tissue performed earlier than at 9 weeks may result in poorer autogenous graft quality due to indications that remodeling of the connective tissue is still progressing and not as mature as specimens noted at weeks 9 to 47.

Oral granular cell tumors: an analysis of 10 new pediatric and adolescent cases and a review of the literature.

Clinicopathologic studies on the granular cell tumor, a submucosal benign soft-tissue neoplasm, have not addressed the pediatric and adolescent population. This study of patients from birth to 19 years of age describes clinically and microscopically 10 new cases and combines them with 24 well-documented pediatric cases previously published in the English-language literature. Of the 34, patient ages ranged from 3 to 19 years (mean age 14.5 years) with a female-to-male ratio of 3.3 to 1. The most common location was the tongue (50%) and lips (25%). In neoplasms whose epithelial findings were documented microscopically, a reactive pseudoepitheliomatous (pseudocarcinomatous) hyperplasia of the overlying epithelium occurred in 29%. The recurrence rate was less than 10% following conservative surgical excision. This study reveals that an oral granular cell tumor in the first decade of life is an uncommon event and discusses the importance of differentiating between squamous cell carcinoma and granular cell tumor.

The USS Iowa disaster: success of the forensic dental team.

The authors record the contributions of dentistry to the identification of the crew members who were in one of the most significant peacetime military accidents in U.S. Navy history-the April 1989 explosion in a gun turret on the battleship USS Iowa and the deaths of 47 U.S. Navy personnel. Dental identification was the primary means of identification for most because a very high percentage of the bodies were burned or fragmented. The dental-identification team's success was a direct result of its preparedness, its use of dental personnel with mass-disaster experience, and the overall excellent quality of the antemortem dental records. The dental-identification team's successful involvement in the USS Iowa tragedy was considered a model for success and therefore was instrumental in contributing to the development of the American Board of Forensic Odontology "Guidelines for the Development of a Disaster Dental Identification Team."

Proliferative verrucous leukoplakia: an aggressive form of oral leukoplakia.

Proliferative verrucous leukoplakia (PVL) is an aggressive form of oral leukoplakia that is persistent, often multifocal, and refractory to treatment with a high risk of recurrence and malignant transformation. This article describes the clinical aspects and histologic features of a case that demonstrated the typical behavior pattern in a long-standing, persistent lesion of PVL of the mandibular gingiva and that ultimately developed into squamous cell carcinoma. Prognosis is poor for this seemingly harmless-appearing white lesion of the oral mucosa.

Oncocytic mucoepidermoid carcinoma of parotid gland origin.

This article reports 3 cases of oncocytic mucoepidermoid carcinoma of the parotid gland and compares them with 9 cases from the literature with emphasis on clinical behavior, treatment, and recurrence rate. The tumor occurs most often in the middle-aged to elderly, with a decided predilection for the parotid gland. All three oncocytic mucoepidermoid carcinomas from the Armed Forces Institute of Pathology series were low grade with extensive oncocytic change. Treatment modalities consisted of superficial parotidectomy, total parotidectomy, or total parotidectomy. The mean follow-up interval was 5.5 years. Only one case from the literature, a high-grade mucoepidermoid carcinoma, recurred. Results of this study indicate that the parotid gland oncocytic mucoepidermoid carcinoma behaves in a fashion similar to typical mucoepidermoid carcinoma, with prognosis dependent on clinical stage, histopathologic grade, and adequacy of treatment. Recognizing the spectrum of oncocytic differentiation in salivary gland tumors will serve to establish appropriate diagnoses and treatment.

The gander disaster: dental identification in a military tragedy.

The authors record the contributions of dentistry to the identification of victims of one of the most significant disasters in aviation and U.S. military history--the December 1985 crash of a DC-8 charter airliner near Gander, Newfoundland (now known as Newfoundland and Labrador), Canada, which killed 248 Army personnel and 8 crewmembers. Most of the dental records of the military victims were destroyed in the crash, and, as a result, this loss hampered dental identification. Nevertheless, dental identification was the primary means of identification for many because a very high percentage of the bodies were severely burned and fragmented. Many phases of the U.S. identification efforts have been reported, but the dental-investigation aspects have been mentioned only in passing. Therefore, this article documents the dental team's organization, methodology, and a variety of remarkable problems that the team encountered.

The retrocuspid papillae: a clinical evaluation of 51 cases.

PURPOSE: This study was undertaken to increase the knowledge of dental hygienists and dentists of a normal anatomic gingival structure, the retrocuspid papillae (RCP), so that patients can avoid clinical misinterpretation and unnecessary biopsies. METHODS: In a three-part study, dental hygienists were surveyed on their knowledge of the RCP via questionnaire. Oral examinations of adult patients in a dental hygiene clinic were performed to obtain data on the RCP, and detailed clinical information from the pathology reports of surgically removed RCPs were tabulated. These findings were compared with findings from previously reported cases. RESULTS: Part one: of the dental hygienists surveyed, 2.8% knew about the RCP. Part two: of 232 adults examined, 9.1% had RCP. The age range was 20 to 63 years; 57% of the RCPs were unilateral, and 43% were bilateral. Part three: the RCP represented 16.2% of the biopsied fibrous lesions of the mandible over a 12-year period. Their histologic features contributed to their clinical morphology of a mound or sessile nodule with or without a papillary surface. CONCLUSIONS: The RCP is more prevalent in children and females and in a bilateral gingival distribution. It is a normal anatomic structure that regresses with age and requires no treatment.

Transient lingual papillitis: a papulokeratotic variant.

Transient lingual papillitis is an inflammatory disease involving the fungiform papillae of the tongue and is typically localized, accompanied by pain or tenderness, and of short duration. The unusual clinical and pathologic findings regarding a condition we identify as a recurring papulokeratotic variant of transient lingual papillitis are described. In the child whose case we present, this condition was nonpainful and florid in distribution. The etiology, clinical features, and histopathology of this heretofore-undescribed variant are discussed and compared with the findings in previously reported cases of transient lingual papillitis.