ABSTRACT
T-cell lymphomas (TCLs) account for approximately 15 to 20% of all non-Hodgkin lymphomas in the United States. The most common form of TCL is cutaneous TCL (CTCL), with Sézary syndrome and mycosis fungoides being the most prevalent subtypes. Sézary syndrome is the more aggressive form and often is referred to as a late-stage variant of mycosis fungoides. Clinically, it is characterized by diffuse erythroderma, cutaneous edema, pruritus, nonhealing cutaneous ulcers, and lymphadenopathy. Patients also can present with changes to their nails, hyperpigmentation, alopecia, palmoplantar keratoderma, ectropion, and hepatosplenomegaly. The overall prognosis for patients with Sézary syndrome is poor. The literature regarding oral manifestations of CTCL mostly report those of mycosis fungoides because it is the most common subtype of CTCL. Currently, there are only 2 reports in the scientific literature of intraoral manifestations of Sézary syndrome. This case report describes a patient with Sézary syndrome who presented with rapidly progressing erythematous lesions of the gingiva and multifocal osteonecrosis of the maxilla and mandible. This is the third reported case of an intraoral manifestation of Sézary syndrome and the first reported case of osteonecrosis in the setting of CTCL.
Subject(s)
Antineoplastic Agents/therapeutic use , Gingival Diseases/etiology , Mandibular Diseases/etiology , Maxillary Diseases/etiology , Osteonecrosis/etiology , Sezary Syndrome/drug therapy , Skin Neoplasms/drug therapy , Aged , Alveolar Bone Loss/etiology , Alveolar Bone Loss/pathology , Fatal Outcome , Follow-Up Studies , Gingival Diseases/pathology , Humans , Male , Mandibular Diseases/pathology , Maxillary Diseases/pathology , Neoplasm Invasiveness , Osteonecrosis/pathology , Sezary Syndrome/complications , Sezary Syndrome/pathology , Skin Neoplasms/complicationsABSTRACT
PURPOSE: The purposes of this study were to determine the previously unreported prevalence of antral pseudocysts in an exclusively pediatric dental population, characterize their presentation, and investigate potential correlates to the presence of these lesions. METHODS: A tripartite chart review was conducted of 2,000 five- to 21-year-old pediatric dental patients at Yale-New Haven Hospital for the presence of antral pseudocysts identifiable on panoramic radiographs. Demographic, medical, and dental variables potentially influencing their pathogenesis were analyzed via descriptive statistics, odds ratios, and Fisher's exact test. RESULTS: Thirty-six antral pseudocysts were identified in the study sample (1.8 percent). They presented as asymptomatic solitary lesions with a slight male predominance and occurring with greater frequency in individuals with reported allergies. No significant relationship was found between maxillary extractions, orthodontics, obstructive sleep apnea, or history of orofacial trauma and the presence of antral pseudocysts. CONCLUSION: The prevalence of antral pseudocysts in the pediatric dental population falls among the lower end of ranges previously reported in the literature and may reflect their development over time in response to environmental exposures.
Subject(s)
Cysts/diagnosis , Adolescent , Child , Diagnosis, Differential , Female , Humans , Male , Maxilla , Prevalence , Radiography, Panoramic , Sleep Apnea, Obstructive/epidemiology , Young AdultABSTRACT
This article provides an overview of common color changes and soft tissue oral nodular abnormalities in children and adolescents. The clinical presentation and treatment options to address these conditions are presented in a concise approach, highlighting key features relevant to the oral health care professional.
Subject(s)
Mouth Diseases/diagnosis , Mouth Mucosa/pathology , Adolescent , Candidiasis, Oral/diagnosis , Child , Humans , Leukoedema, Oral/diagnosis , Leukokeratosis, Hereditary Mucosal/diagnosis , Lip Diseases/diagnosis , Mouth Diseases/therapy , Mouth Neoplasms/diagnosis , Pigmentation Disorders/diagnosis , Tongue Diseases/diagnosisABSTRACT
The bispectral index (BIS) monitor records electroencephalogram waveforms and provides an objective measure of the hypnotic effect of a sedative drug on brain activity. The aim of this pilot study was to use the BIS monitor to evaluate the depth of procedural sedation in pediatric dental patients and to assess if the BIS monitor readings correlate with a validated pediatric sedation scale, the University of Michigan Sedation Scale (UMSS), in determining the level of sedation in these patients. Thirty-five pediatric dental patients requiring sedation were studied prospectively. A baseline BIS reading was obtained and during the procedure an independent observer recorded the BIS every 5 minutes. The operator, who was blinded to the BIS results, determined the UMSS scale at the same 5-minute interval. The patients were monitored postoperatively for 1 hour. There was a significant but moderate correlation between BIS values and UMSS scores (Spearman's rank correlation r â=â -0.574, P < .0001). Percentage of agreement and kappa coefficient using all the observations were also calculated. The percentage of agreement was 37.8%, the kappa coefficient was 0.18 (P < .0001), and the weighted kappa coefficient 0.26 (P < .0001). A lack of correlation was noted between the deeper levels of UMSS sedation scores and BIS values. This study demonstrated a significant correlation between BIS values and the UMSS score in pediatric dental patients undergoing mild to moderate sedation. Based on our results, it appears that the BIS monitor may be useful during mild or moderate sedations to establish the level of sedation objectively without the need to stimulate the patient.
