[Generalized gingival enlargement--early clinic manifestation in acute leukemia. Case report]. / Hiperplazia gingivala generalizata-- manifestare clinica precoce în leucemia acuta. Prezentare de caz.

Leukemia is a hematological disorder arises from a hematopoietic stem cell characterized by a disordered differentiation and proliferation of neoplastic cells. Rapidly forming generalized gingival hyperplasia is usually the first sign of this disease (especially in acute forms). This case report describes a 54-year-old female who presented rapid gingival enlargement in only three weeks time, heralding the presence of acute monocytic leukemia (AML-FAB M5). The patient was immediately referred for hematologic management, but died five weeks later. Dentists and generalists should always be on guard to observe any oral manifestations that may lead to the early diagnostic of systemic diseases.

[The radial forearm free flap in oro-maxillo-facial reconstruction. Experience of a multidisciplinary team approach--maxillofacial and plastic surgery]. / Lamboul radial în reconstructia pierderilor de substanta în teritoriul oro-maxilo-facial. Experienta unei abordari în echipa mixta--chirurgie maxilofaciala, chirurgie plastica.

The treatment of extended oro-maxillofacial lesions is a difficult task. Free flaps are the optimal reconstruction method in well defined situations. Though not improving survival, they have lead to a lower morbidity and to the improvement of the patient's life quality. A great step forward was represented by the radial forearm flap. This paper reflects the experience of a team approach (oro-maxillofacial and plastic surgery). The radial forearm free flap was considered as the optimal solution for 22 patients with defects concerning the tongue and/or mouth floor (8), the lower lip (7), or other facial regions (5). The defects were due to the resection of malignant tumors spinocellular (18) or basocellular carcinoma (2), benign tumors (1) or posttraumatic (1). Flap's characteristics allow wide area coverage and high plasticity. Thus, in case of malignant tumors, surgeons may perform resections within the oncological limits, while post-resectional defects can be covered with very good functional and aesthetic results. The morbidity of the donor region is within acceptable limits. Team approach in head and neck reconstruction (oromaxillofacial surgeon-plastic surgeon) leads to superior quality results, allowing each specialist to focus on the aspects he/she is most familiar.

[A review of 15 years of experience in using the musculo-mucosal lingual flap]. / 15 ani de experienta in utilizarea lamboului musculo-mucozal lingual.

MATERIAL AND METHOD: In the past 15 years (1991-2005) we used the muscular-mucosal lingual flap with posterior pedicle for 82 patients. RESULTS: The main indication has been the reconstruction of the residual defects after resection of the mucosal mouth floor carcinomas (especially those located in the anterior third of the mouth or with gingival and alveolar invasion) or after resection of the gingival-alveolar mandible carcinomas with invasion of the mouth floor. Deglutition and phonation have been fully recovered at 14 to 20 days post-surgery, with temporary alterations during radiotherapy, due to radiation-induced mucositis. Mobility of the remaining of the tongue was acceptable and physiotherapy had a significant impact in recovering an intelligible phonation and for better mastication and deglutition due to compensatory hypertrophy of the lingual musculature. CONCLUSION: The muscular-mucosal lingual flap remains a good technical alternative for surgical reconstruction especially for advanced-age patients, heavy smokers or alcohol-consumers, patients with prior radiation therapy or patients with precarious co-operation for more advanced reconstructive techniques.

[Lipomas of the oral cavity--a retrospective study]. / Lipoamele cavitatii orale--studiu retrospectiv.

UNLABELLED: Lipomas are the most common soft tissue mesenchymal neoplasms, with 15 to 20% of the cases involving the head and neck region and 1 to 4% affecting the oral cavity. They represent 0.1 to 5% of all benign tumours of the mouth and are usually found as long-standing soft nodular asymptomatic swellings covered by normal mucosa. Few large series of intraoral lipomas and its variants are seen in literature. AIM: This study aimed to assess the clinical and histological features of intraoral lipomas. MATERIALS AND METHODS: A retrospective review was undertaken of medical records and histological studies of 19 patients with histopathologically proven intraoral lipomas, over a 15-year period (from 1992 to 2006) at the Department of Oral and Maxillofacial Surgery, Iasi. RESULTS: Most of the cases affected adults (18 cases) without gender predilection and the main involved sites were: the floor of the mouth (6 cases), the buccal mucosa (5 cases), the lips (4 cases), the tongue (3 cases) and the buccal sulcus (1 case). The histological analysis revealed 14 cases of common lipomas (3 with infiltrating features), 4 cases of fibrolipomas, and 1 myxoid lipoma. All lesions were surgically removed and none showed recurrence, regardless of the various histological subtypes. CONCLUSIONS: Lipomas should be considered in the differential diagnosis of soft-tissue head and neck masses. Even though several histological types are described, the clinical course and the surgical treatment are similar. Our study confirms the rare incidence of the oral lipomas development. Key words:

[Value of temporoparietal fasciocutaneous flaps in reconstruction of cutaneous defects at the OMF region]. / Valoarea lambourilor fasciocutanate temporo-parietale în reconstructia defectelor cutanate din teritoriul OMF.

AIMS: The authors propose the temporoparietal fasciocutaneous flaps for covering the surface skin defects from oro-maxillo-facial region. MATERIAL AND METHOD: Between 2000 and 2006 we performed 8 of this kind of flaps: 5 insular temporoparietal fasciocutaneous flaps, 2 fasciocutaneous flaps and one rotated flap. These flaps were used for reconstruction of the defects of the mouth's commissures, genian region in 1/2 superior, parotid region, upper lip and nasogenian sulcus. RESULTS: We recorded a singular case with necrosis of the insular fasciocutaneous flap; the rest of 7 were entirely survived. The cosmetic appearance was acceptable for all patients and the symmetry of the reconstructed area versus contralateral area was satisfactory. One case has cicatriceal alopecia at the donor site and in two cases, alopecia because of use of the skin graft for covering the donor defect. CONCLUSION: The fasciocutaneous temporoparietal flap is a value technique for repairing the facial skin defect.

[The utilization of Dacron as interposition material in the treatment of the temporomandibular ankylosis--retrospective study: 1993-2005]. / Utilizarea dacronului ca material de interpozitie în tratamentul anchilozei temporomandibulare studiu retrospectiv 1993-2005.

The treatment of temporomandibular ankylosis, indifferently by anatomoclinical type or etiologic factor (trauma, infection, rheumatism), is exclusively surgical. The frequent indication in the temporomandibular ankylosis of types I and II Topazian remains the neo-articular modeling osteotomy with or without interposition. A clinical and retrospective study of 25 patients diagnosed with temporomandibular ankylosis (unilateral or bilateral) was performed. The patients were operated between 1993- 2005 by interpositional arthroplasty after resection of the joint osseous block. From 32 surgical procedures in temporomandibular ankylosis, the Dacron was used for 29 interventions. The qualities of this material were confirmed by good results obtained after 1-12 years of following. The mobility of the mandible and postoperative mouth opening were in normal limits with lack of complications or recurrences. The technique is simple and the interposition material is well tolerated by the body. The Dacron texture is soft, elastic, resistant with physically and chemically stable. It is easy to be modeled, perfectly adaptable on resting osseous mass, and it is integrates intra new joint by penetration of the connective fibrous in itself. Given these facts, the interposition material of Dacron plays the role of the fibrocartilage in the temporomandibular joint.

Temporomandibular joint ankylosis. A possible complication in juvenile psoriatic rheumatism.

The authors present a rare case of bilateral temporomandibular joint ankylosis secondary to polyarticular juvenile psoriatic arthritis in a 24 year-old man. The patient first presented with arthritis of his right elbow joint at the age of 9, followed by involvement of the distal inter-phalangeal joints of his right foot and both sacroiliac joints. Serum rheumatoid factor was not detected. At the age of 16 he developed psoriatic lesions affecting his nails and skin. By the age of 20, clinical and radiological evidence of arthritis was detected in his temporomandibular joint (TMJ). Subsequently, the patient developed bilateral TMJ ankylosis over a period of 4 years. The patient was managed by bilateral resection of the ankylosis bone blocks, mobilization of the mandible and interposition of Dacron material between the two neo-articular surfaces. 10 months postoperatively the patient maintained an inter-incisal distance of 3 cm. Postoperative mechano-therapy was hindered by the limited use of the patients' hands.

[The value of radical surgical treatment in benign symmetric lipomatosis]. / Importanta tratamentului chirurgical radical în lipomatoza simetrica benigna.

Benign symmetric lipomatosis (BSL) is a rare proliferative disorder of the adipose tissue, characterized by symmetrical fat deposits, predominantly in the neck and shoulder area, upper back and arms. This study contains the analyse of a lot of ten patients with BSL, which were surgical treated in our department between 1994-2004. The followed parameters were: sex, age, heredo-collateral antecedents, associated organic diseases, the motivation of medical addressability, the sites of first lesions, the length of evolution before the admission, methods for diagnosis, number of surgical sessions necessary to extirpation of fat deposits, the results of the periodic follow-up examination. The followed patients with BSL were treated by surgery (extirpation of the cervical fat masses): one surgical session (8 cases) or two sessions (2 cases). The morphological, functional and psychic results were good. Recurrence at the site of surgery was not detected in any follow-up subjects. The elective treatment in BSL is surgical, by extirpation of the lipomatous masses; a satisfactory, lasting result can be expected only after the most radical possible extirpation (not only for cosmetic intentions).

[Urokinase-type plasminogen activator (uPA) and its inhibitor--new prognostic factors in oral squamous cell carcinoma]. / Activatorul plasminogenului tip urokinaza (uPA) si inhibitorul sau (PAI1), factori noi de prognostic în carcinomul scuamocelular al cavitatii orale.

Several cell biological studies have shown that the invasiveness of different malignant tumors (breast, renal, prostate, gastric, ovarian cancers) depends at least in part on the urokinase type plasminogen activator (uPA) and its inhibitor PAI1. uPA converts plasminogen into plasmin. Plasmin degrades tumor matrix components and starts invasion and metastasis. Our target was to see the possible prognostic relevance of the tumor-associated proteolytic factors and to compare with tumor size, nodal status and grading. Our results suggest that the invasive and metastatic potential of squamous cell carcinoma is correlated with overexpression of uPA and PAI1.

[Plunging ranula]. / Ranula plonjanta.

The plunging ranula is a relatively uncommon phenomenon which represents a mucus escape reaction occurring from disruption of the sublingual salivary gland. We present a retrospective study over a 10 years period on patients suffering of plunging ranula treated in Oral and Maxillo-Facial Clinic, resumed by a clinical example. These 7 patients with plunging ranula are related to all the patients operated for ranula in the same period of time in our clinic and were analyzed on age, sex, imaging exploration technique, treatment, and outcome. We found this kind of lesion both in children and young adults, between 10 to 40 years, more frequent on male (1.33/1). Two patients presented only the cervical form of ranula instead of the other five patients (both oral and cervical ranula). Only two of them received IRM examination. All of them received surgical treatment, the approach being cervical; it was removed both the cyst and the sublingual salivary gland. The surveying period, except the last case, was 1 year and includes no recurrences. We consider, besides esthetic loss that the cervical approach of plunging ranula seems to be the optimal access both on lesion and sublingual gland.

[Method and optical device for exactly hinge axis localization tested on original phantom]. / Metoda si dispozitive optice pentru localizarea exacta a axei balama. Verificari pe fantom original.

The quickly and exactly method of location of the hinge-axis is based on the moiré effect, produced between two superposed optical nets, one of it being moved. A face bow is fixed on the mandible to the occlusion rim. Two optical devices are mounted on the bottoms of the face bow. Two other optical nets are applied on the skin, corresponding to the TMJ. During the opening movements of the mandible when a pure rotation of the mandibular condiles take place on the TMJ, the optical nets are displaced and me exactly register the place corresponding to the rotation axe and we can note on the skin the hinge axis. The checkout was done using a phanthom achieved in our department, consisting of a skull made up of polyestheric resins and an elastic element made up of PVC.

[Temporomandibular ankylosis. A treatment method using the interposition of a Dacron device]. / L'ankylose temporo-mandibulaire. Méthode de traitement par l'interposition d'une texture de Dracron.

BACKGROUND: Temporomandibular ankylosis with its multiple anatomo-clinical forms is a relatively rare disease. Its major morphopathological, therapeutical and psychological implications rank it among severe illnesses. Its treatment is exclusively surgical. The major therapeutical indication in ankylosis of type I and II Topazian is the neoarticular modelling osteotomy with interposition. MATERIAL AND METHODS: As a material for interposition, over the last 7 years, we have used in 15 patients with 18 ankylosis, concave rectangular Dacron fragments adequately shaped after being taken from a vascular prothesis. RESULTS: The qualities of this material are confirmed by the obtained results: quick resuming of the normal mobility of the mandible, lack of postoperative complications and recurrences. The material is cheap and easy to be obtained. The technique to be used is simple. DISCUSSION: The Dacron texture is soft, elastic in all respects, thick enough, resistant, with long lasting elasticity and integrity, physically and chemically sTable, well tolerated by the body and without foreign body rejection. It is easy to be cut, shaped, modelled and adapted to the bone stump. It is sterilized by autoclaving. It is also well integrated into the host tissue being penetrated by the connective tissue which fastens it to the surface of the neocondyle preventing a relapse. It plays the role of a joint cartilage.

[The treatment of segmental fractures of the middle face]. / Tratamentul fracturilor etajului mijlociu al fetei.

During the past two decades new methods and techniques for the treatment of middle floor facial fractures have been developed. The orthopedic approach alone or associated with various procedures of internal suspension gradually became obsolete. Nowadays, a successful treatment implies the early surgical exploration and a careful restoration of bone skeletal structure. Osteosynthesis with mini-plates provides for the reduction and tridimensional stability of bone fragments. Moreover, in the communicative fractures and in those accompanied by substance loss, the titanium mini-plates are the best method for the immediate fixation of bone grafts.

[Post-therapeutic complications in mandibular fractures: a retrospective study]. / Complicatii postterapeutice în fracturile de mandibula: studiu retrospectiv.

The analysis in based on 12,096 patients with fractures of the mandible admitted to and treated in the Clinical of Oral and Maxillofacial Surgery of Iasi in the interval 1951-1995. Posttreatment complications were found in 10.52% of the cases, 9.81% of them being of inflammatory type. Anatomo-clinically these consisted in suppurations of the soft tissues, osteitis and osteomyelitis. The prejudices caused by these complications were multiple: longer hospital stay, additional suffering for the patient, temporary work inability, higher treatment costs.

Calcifying odontogenic cyst: report of two cases and review of literature.

The "Histological Typing of Odontogenic Tumours" (W.H.O., 1992) classified the Calcifying Odontogenic Cyst (C.O.C.) into two variants: the non-neoplastic cystic C.O.C. and the odontogenic ghost cell tumour, which is predominantly solid. We reported two cases of C.O.C.: a case with intraosseous development and another with extraosseous localisation, in the soft tissue of the alveolar area. The first case represents a cyst delimited by a squamous, non-keratinized epithelium, thickened in some areas through the accumulation of ghost cells (big pale-staining cells with a non-staining nuclear area). The connective tissue wall contains small ameloblastoma like islands. Dysplastic dentine islands, adjacente to the basal layer of the epithelium or in the connective tissue wall were also observed. The second case was a well-delimitated tumour consisting of ameloblastoma-like islands with numerous ghost cells inside. Islands of dysplastic dentine with psammomathous calcifications also exist. In certain histological sections microcystic aspects surrounded by ghost cells, dentinoid and ameloblastoma-like structures were noticed. The histochemical reaction for keratin and the immunohistochemical reaction for epithelial membrane antigen and for citokeratin were positive for ghost cells, suggesting their epithelial origin. Through this article we try to render pathologists sensitive with a particular and rare maxillary tumour.

[Reconstructive plastic repair in cancer of the lips]. / Plastia reconstructiva în cancerul buzelor.

Lips neoplasm represent 20% from all maxillo-facial cancers, more than 90% being localized on the inferior lip. This paper present the results of the reconstructive surgery on 208 patients treated over 10 years (1984-1993) at the Bucco-Maxillo-Facial Surgery Clinic from Iasi. The procedures were different according with the dimensions of the tumor and several other factors regarding there histopathological type, moment of the diagnostic, age etc.

[The reconstruction of the losses of substance in the floor of the mouth with split lingual flaps]. / Reconstructia pierderilor de substanta ale planseului bucal cu lambouri de limba despicata.

The loses of substance, as a result of malignant tumor removement of floor of the mouth, with or without metastasis in the afferent ganglions, have such multiple and difficult morphological complications, that need immediate and complete reconstruction. From the multiple sources with reconstructive potential of the loco-regional or distant prevention suggested in literature, authors have used lingual musculo-mucosal flap. The use of the lingual flap avoided the inconveniences and the risks of tissue transfer from another origin, offering the advantages of one and only surgery and at the same time the superior morphological and functional results.

[Infections in the oral and maxillofacial areas: their prevalence (1983-1992) and the evolution of the antibiotic sensitivity of the microbes involved]. / Infectiile în teritoriul oral si maxilo-facial: prevalenta (1983-1992), evolutia sensibilitatii la antibiotice a germenilor implicati.

A retrospective clinical study (1983-1992) was done in order to establish the frequency of etiological agents in determining peri-maxillary infections and also for evaluate the evolution of antibiotics resistance of isolated bacteria. The study group consisted of 5227 patients with different infections in maxillo-facial territory. Year distribution of cases was equilibrate. Study group particularities were synthetic analysed. Our results revealed the predominance of anaerobic streptococci (33.6%) and Staphylococcus aureus (32.5%) and also mixed infections (23.04). Etiological diagnosis of peri-maxillary infections was proved as an essential step for a correct treatment.

[Surgical prosthetic restoration after bilateral maxillectomy]. / Restaurarea chirurgical-protetica dupa maxilectomia bilaterala.

In 6 cases of tumors, two gigantic benign and four malignant in T4 having palatal and gingivo-alveolar starting point with invasive evolution into the structure of facial mass, surpassing the median alignment, the authors consider the problem concerning the indications for exeresis, possibilities of removal of healthy tissue and the reconstruction of massive losses of substance. The surgical treatment of reconstruction that completes the exeresis of the tumor is meant to sustain the ocular globe through a aponeurotic-muscular flap form the temporal muscle, with the aid of nasal septum or a skin graft also used to obtain a good coating of the cavity, and is also meant to a plastic reconstruction of the soft palate as well as to retention modelling of the cavity fields which resulted postsurgically. The main role in maxillofacial reconstruction in held by the obturator prosthesis that avoids morphofunctional prejudices and restores facial contour, without aesthetic and psychic prejudices. The results obtained in our 6 cases shown here have been fully satisfactory.