Controversies in ameloblastoma management: evaluation of decision making, based on a retrospective analysis.

BACKGROUND: The ameloblastoma management is still challenging to the high recurrence rates and significant morbidity associated with radical treatment. The purpose of this 10-year retrospective study was to analyze the influence of ameloblastoma type and treatment strategy on the long-term outcomes and recurrence rates. MATERIAL AND METHODS: The retrospective analyses of 64 histologically-confirmed ameloblastoma cases was performed. The possible risk factors for recurrence and the development of complications were estimated statistically. RESULTS: The treatment strategy applied for this group of patients was the following: thirty-four patients (53.1%) were treated conservatively with enucleation or extended bone curettage. Radical treatment (bone resection) was applied in 30 (46.9%) cases. The follow-up period ranged from 2 to 10 years (mean value 4.28 ± 3,26). General recurrence rate consisted 32.8%. This study did not find significant correlations between clinical or histopathological features of the ameloblastoma and the recurrence rate. The only factor that significantly influence recurrence rate was the treatment strategy (41% in conservative treatment vs 15% in radical treatment, p<0.05). Postoperative complications were observed in 42 patients (65.6%) and included face asymmetry and disfigurement (17.2%), temporary paresthesia of the inferior alveolar nerve (IAN) - 23.4%, permanent paresthesia of IAN - 20.3%, paresis of a marginal branch of the facial nerve - 6.3%, infection 12.5%, and swelling - 20.3%. The complication rates, esthetic and functional deficiency were significantly higher in radically treated patients (p<0.05) Conclusions: Our study confirms that higher recurrence rate is associated with conservative treatment for ameloblastoma, while radical treatment leads to an increased number of postoperative complications that affect the patient's quality of life.

[Dentogenic ghost cell tumour in the mandible]. / Dentinogene ghost cell-tumor in de onderkaak.

A 67-year-old man presented with a swelling on the right side of the mandible. Histopathological investigation of a biopsy revealed a peripheral dentogenic ghost cell tumour. Treatment consisted of thorough excochleation of the abnormality and 2 years after treatment, the patient was free of recurrence. In the literature, a distinction is made between peripheral and central dentogenic ghost cell tumours, which, like calcifying odontogenic cysts, are considered to be ghost cell odontogenic lesions. These are rarely occurring abnormalities, where the chances of recurrence after proper treatment are limited. The central dentogenic ghost cell tumour has a greater chance of recurring locally.

[A woman with a painful and enlarged tongue]. / Een vrouw met een pijnlijk vergrote tong.

A 53-year-old woman presented with painful macroglossia and periorbital papules. Based on this clinical features and biopsies the diagnosis of nodular amyloidosis was established. Further analysis revealed that multiple myeloma was the underlying hematological disorder.

The value of cone beam computed tomography in the detection of salivary stones prior to sialendoscopy.

This study aimed to assess the value of cone beam computed tomography (CBCT) in the detection of salivary stones in patients with signs and symptoms of salivary gland obstruction. A total of 142 major salivary glands were analysed in a cohort of 127 patients with signs and symptoms of salivary gland obstruction. CBCT scans were performed in order to determine the presence of one or more salivary stones. All glands were also investigated by sialendoscopy. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for the submandibular gland, the parotid gland, and the whole group, based on the observers' abilities to diagnose the presence or absence of calculi in the CBCT scan using the sialendoscopy data as the gold standard. Fifty salivary stones were detected in the CBCT scans of the 142 glands analysed: 34 in the submandibular gland and 16 in the parotid gland. The sensitivity (94%), specificity (90%), positive predictive value (84%), and negative predictive value (97%) for the whole group were good to excellent, with an overall accuracy of 92%. CBCT appears to be an ideal first-line imaging modality for patients with signs and symptoms of obstructed major salivary glands.

Follow-up of oral cancer patients: three uneventful years may be enough.

OBJECTIVE: To explore the possibility of shortening the length of follow-up from 5 to 3 years in patients who have undergone curative treatment of an oral squamous cell carcinoma. STUDY DESIGN: The medical records of 225 patients who had undergone initial curative treatment at the VU University Medical Center in Amsterdam, the Netherlands, between 2004 and 2009 were analyzed. RESULTS: In 96 patients (42.7%) a secondary event occurred. Eighty-six percent of the secondary events were detected within 3 years. In the fourth and fifth years, 14% of the secondary events were found, consisting mainly of second primary tumors. CONCLUSIONS: Most secondary events occurred within the first 3 years of follow-up. Therefore, the case can be made for an altered regimen of follow-up beyond 3 years based on certain risk factors unique to the patient as well as the patient's ability to adequately report symptoms that may be associated with recurrent disease.

Complications and Risk after Mandibular Reconstruction with Fibular Free Flaps in Patients with Oral Squamous Cell Carcinoma: A Retrospective Cohort Study.

Background We retrospectively analyzed the incidence and types of postoperative complications after mandibular continuity reconstructions with fibular free flaps (FFF) in patients with oral squamous cell carcinoma (OSCC) and identified potential risk factors for postoperative complications. Methods Data were retrieved from the medical records in the Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands from April 1995 to September 2013, and were statistically analyzed. Results In this study, 85 patients were included in whom 86 FFFs were used for mandibular reconstruction. Thirty-seven patients (43%) developed ≥ 1 surgical complication and 9 patients (10.5%) developed ≥ 1 systemic complication. Three patients (3.5%) developed total flap failure and six patients (7.0%) developed partial flap failure. Surgical complications were correlated with tobacco use, partial glossectomy, type of mandibular defect, and anatomic staging. Systemic complications were associated with age > 60 years and Charlson comorbidity index > 2. Hospitalization > 30 days was associated with type of mandibular defect. Conclusions The use of the FFF for reconstructing mandibular continuity defects in OSCC patients may be associated with postoperative complications. Patients with coexisting medical conditions and anterior mandibular defects have an increased risk for developing complications. Patients who undergo segmental mandibular resection including a partial glossectomy could have a reduced risk for complications.

Mandibular trauma: a two-centre study.

The aims of this study were to assess and compare epidemiological data on mandibular fractures from two European centres and to perform a review of the literature. Between 2001 and 2010, a total of 752 patients with a total of 1167 mandibular fractures were admitted to a hospital in Turin, and 245 patients with a total of 434 mandibular fractures were admitted to a hospital in Amsterdam. The mean age in Turin was 34.8 years and in Amsterdam was 32 years. The age group 20-29 years showed the highest incidence of mandibular fractures in both centres. The fractures were mainly the result of assaults, in agreement with several articles in the recent literature, followed by falls. The continuous long-term and multicentre collection of data on the epidemiology of maxillofacial trauma is important because it provides the information necessary for the development of preventative measures aimed at reducing the incidence of facial injuries.

Incidence of symptomatic venous thromboembolism in oncological oral and maxillofacial operations: retrospective analysis.

We retrospectively analysed the incidence of symptomatic venous thromboembolism (VTE) and associated risk factors in operations under general anaesthesia for cancer of the oral cavity. To identify symptoms related to deep venous thrombosis (DVT) and pulmonary embolism (PE), together with associated risk factors, we reviewed medical records of patients operated on in the department of oral and maxillofacial surgery at the Queen Elizabeth Hospital, Birmingham, United Kingdom, between June 2007 and October 2012. All patients were categorised according to their level of risk of VTE. The incidence of VTE was calculated with univariate associations and odds ratios with related 95% confidence intervals, where possible. In total, 233 patients were included, comprising 244 operations (mean (SD) age at operation 60.9 (13) years). Almost all patients (97%) were classified as having the highest risk of VTE. Swelling of an extremity, expectoration of blood, and tightness of the chest were the most common symptoms for suspected cases. An incidence of 0.41% was found for symptomatic VTE; one man developed a PE 2 days after operation. Associations between the analysed factors and symptomatic VTE were not significant. The development of the complication in oncological oral and maxillofacial operations seems to be rare, even in patients with a high risk. We cannot recommend the use of routine thromboprophylaxis, but it could be advocated in patients with obvious serious risk factors.

Salivary stones: symptoms, aetiology, biochemical composition and treatment.

Salivary stones, also known as sialoliths, are calcified concrements in the salivary glands. Sialoliths are more frequently located in the submandibular gland (84%), than in the parotid gland (13%). The majority of the submandibular stones are located in Wharton's duct (90%), whereas parotid stones are more often located in the gland itself. Salivary stones consist of an amorphous mineralised nucleus, surrounded by concentric laminated layers of organic and inorganic substances. The organic components of salivary stones include collagen, glycoproteins, amino acids and carbohydrates. The major inorganic components are hydroxyapatite, carbonate apatite, whitlockite and brushite. The management of salivary stones is focused on removing the salivary stones and preservation of salivary gland function which depends on the size and location of the stone. Conservative management of salivary stones consists of salivary gland massage and the use of sialogogues. Other therapeutic options include removal of the stone or in some cases surgical removal of the whole salivary gland.

[Salivary stones: aetiology, composition and treatment]. / Speekselstenen: etiologie, samenstelling en behandeling.

Salivary stones or sialoliths, are calcified concrements which are most frequently located in the submandibular glands and their ducts. Their size and weight show considerable variation. The aetiology is unknown. It has been suggested that salivary stones could be related to an altered saliva composition, the anatomy of the ducts of the salivary gland and/or the fusion of microsialoliths. Salivary stones consist mainly of anorganic material such as hydroxyapatite, whitlockite and calciumphosphate, but they also contain organic components such as proteins and lipids. Treatment can consist of salivary gland massage combined with an acid diet, ultrasonic pulverisation, and surgical or sialendoscopical removal.

Treatment of cervicofacial actinomycosis: a report of 19 cases and review of literature.

OBJECTIVES: Actinomycosis is a chronic suppurative granulomatous infection caused by the Actinomyces genus. Orocervicofacial actinomycosis is the most common form of the disease, seen in up to 55% of cases. All forms of actinomycosis are treated with high doses of intravenous penicillin G over two to six weeks, followed by oral penicillin V. Large studies on cervicofacial actinomycosis are lacking. Therefore proper guidelines for treatment and treatment duration are difficult to establish. The aim of this study is to establish effective treatment and treatment duration for orocervicofacial actinomycosis. STUDY DESIGN: A Pubmed and Embase search was performed with the focus on treatment and treatment duration for cervicofacial actinomycosis. The hospital records of all patients presenting to our department with head and neck infection from January 2000 to December 2010 were reviewed, retrospectively. The following data were collected: age, gender, clinical presentation, aetiology, duration of symptoms, microbiological findings, treatment, and duration of treatment. The treatment and treatment duration is subsequently compared to the literature. RESULTS: The literature search provided 12 studies meeting the inclusion criteria. All studies were retrospective in nature. Penicillin or amoxicillin/clavulanic acid are the preferred antibiotic regimens found in the literature. Most of our patients were treated with a combination of penicillin G 12 million units/day and metronidazol 500 mg 3/day, most commonly for a duration of 1 - 4 weeks, being shorter than the 3 - 52 weeks reported in the literature. CONCLUSION: When actinomycosis is suspected, our review has shown that a surgical approach in combination with intravenous penicillin and metronidazol until clinical improvement is seen, followed by oral antibiotics for 2 - 4 weeks is generally efficient.

[The dentist's role in the case of a suspected facial melanoma]. / Een rol voor tandartsen bij verdenking op een melanoom in het aangezicht.

A 78-year-old patient was referred by her dentist to the Department of Oral and Maxillofacial Surgery because of a number of grey-blue lesions on the inferior alveolar ridge and a number of skin lesions in the face. One of the skin lesions proved to be a melanoma, which was treated with a substantial excision and sentinel node procedure. A complete anamnesis and of both intraoral and extra-oral investigation in the dental practice is very important.

[Rapid prototyping: a very promising method]. / Rapid prototyping: een veelbelovende methode.

Rapid prototyping is a method which makes it possible to produce a three-dimensional model based on two-dimensional imaging. Various rapid prototyping methods are available for modelling, such as stereolithography, selective laser sintering, direct laser metal sintering, two-photon polymerization, laminated object manufacturing, three-dimensional printing, three-dimensional plotting, polyjet inkjet technology,fused deposition modelling, vacuum casting and milling. The various methods currently being used in the biomedical sector differ in production, materials and properties of the three-dimensional model which is produced. Rapid prototyping is mainly usedforpreoperative planning, simulation, education, and research into and development of bioengineering possibilities.

Periosteal ossification of the vascular pedicle after reconstruction of continuity defects of the mandible and the maxilla with fibular free flaps: a retrospective study.

Periosteal ossification of the vascular pedicle of a fibular free flap after reconstruction of mandibular and maxillary continuity defects has been thought to be rare. The purpose of this study was to evaluate its incidence and contributory factors to its development.

Treatment results of CO2 laser vaporisation in a cohort of 35 patients with oral leukoplakia.

OBJECTIVES: The aim of the present study was to evaluate the treatment results of CO2 laser vaporisation in a well-defined cohort of patients with oral leukoplakia (OL). MATERIAL AND METHODS: The group consisted of 35 patients. Before treatment, a clinical photograph and an incisional biopsy were performed in all cases. Also posttreatment results were documented with clinical photographs. The assessment of the treatment results was performed by an independent clinician who had not performed the treatment. The mean follow-up period was 61.9 months (range 12-179 months). RESULTS: In 14/35 patients, there was a recurrence between 1 and 43 months (mean 18.7 months), the annual recurrence rate being approximately 8%. In three of these patients, malignant transformation occurred at a later stage. In two other patients, a malignancy occurred without a prior recurrence. In altogether 5 of 35 patients, malignant transformation occurred in a mean period of 54 months, the annual malignant transformation rate being approximately 3%. CONCLUSIONS: The results in the present study are worse than those reported in the literature, perhaps owing to the use of different diagnostic criteria for OL, differences in the employed laser technique and assessment of possible recurrences by an independent clinician.

[Osteoradionecrosis of the jaw, presumably caused by a removable partial denture]. / Osteoradionecrose van de mandibula, vermoedelijk veroorzaakt door een frameprothese.

An 81-years-old man developed a severe osteoradionecrosis of the mandible following surgery and radiotherapy in the head and neck area as a result of a carcinoma at the front ofthe floor of the mouth. Presumably, the osteoradionecrosis had been developed by an injury of the oral mucosa due to a removable partial denture. There are no uniform guidelines for the treatment of osteoradionecrosis of the jaw bones. Treatment modalities vary from removal of sequesters, sometimes long-term use of antibiotics, treatment with hyperbaric oxygen and wide surgical resection with or without reconstruction of the jaw.

[A man from Africa with a swelling in the head and neck region]. / Een Afrikaanse man met een zwelling in de hals.

A general dental practitioner can, in the daily practice, be confronted with a patient with a swelling in the head and neck region. For such swellings an extensive differential diagnosis exists. Often such a swelling is caused by one or more enlarged lymph nodes due to a bacterial or viral infection. If a swelling in the head and neck region has been present for some time--longer than 4 weeks--then there is a considerable chance, especially in adults, that it is the result of the metastasizing of a malignancy, such as a squamous cell carcinoma in the oral mucosa or another mucosal site in the head and neck region. In addition to lymph node swellings resulting from a malignancy, diseases are now more frequently encountered which were previously uncommon in the Netherlands, due in part to the growing number of people with a non-Western ethnic background. Tuberculosis is such a rare disease, which can in the first instance express itself in the form of a lymph node swelling in the head and neck region.

Subset of patients with verrucous carcinoma of the oral cavity who benefit from treatment with methotrexate.

Oral verrucous carcinoma (OVC) is a low-grade variant of squamous cell carcinoma (SCC) with a distinctive morphology and specific pattern of behaviour that is often diagnosed in elderly patients. Resection is the treatment of choice, with radiotherapy as a reasonable alternative. In this retrospective case review we present our experience and outcomes in a group of 12 patients with various stages of OVC who had not been treated conventionally because of the extent of their lesions and their poor general condition. All patients were given chemotherapy with methotrexate, which was given by various routes and in different doses during the period 1972-2010. In 11 patients treatment with methotrexate alone was beneficial. One patient failed to respond. Methotrexate used alone as chemotherapy may minimise morbidity and improve quality of life, particularly among elderly patients.