Isolated bilateral macrostomia: literature review and case report.

AIM: Macrostomia, or lateral cleft lip, which is known as Tessier cleft type 7, is one of the rarest facial anomalies. The purpose of this review is to describe the main characteristics, epidemiology, aetiology and treatment of this anomaly. METHODS: We present an overview of surgical techniques as well as a review of all 36 cases of bilateral asyndromic macrostomia reported to this da in the literature. Furthermore, we report the case of a 4-month male infant with bilateral transverse cleft lip and analyse the treatment decision and the procedure itself. CONCLUSION: Early diagnosis and surgical intervention are crucial in treating children with these malformations. Adequate timely reconstruction plays a main role in both physical and psychological rehabilitation.

Significance of myofibroblast appearance in squamous cell carcinoma of the oral cavity on the occurrence of occult regional metastases, distant metastases, and survival.

The aim of the present study was to assess the frequency of appearance of stromal myofibroblasts in patients with oral squamous cell carcinoma (OSCC) and to further clarify whether myofibroblasts influence tumour suppression or progression. Surgical resection specimens from 152 patients with cT1-T3N0 OSCC were analysed. The frequency of myofibroblasts within the tumour stroma was assessed immunohistochemically and compared with other clinical and histopathological factors. The immunohistochemical reaction for alpha-smooth muscle actin showed positive cells in the stroma of 84.2% of OSCC (n=128). An increased presence of myofibroblasts in the tumour stroma was significantly correlated with T stage (P=0.019), the presence of occult neck metastasis (P<0.001), regional recurrence (P=0.037), and distant metastasis (P=0.008). There was also an association between the presence of myofibroblasts and patient survival (P=0.009). The presence of myofibroblasts was not associated with local recurrence, tumour cell differentiation, mode of invasion, or bone invasion. The results of this study suggest that myofibroblast proliferation facilitates tumour invasion, the occurrence of occult neck disease, and distant metastasis. The survival rate was poorer in patients with abundant myofibroblasts. Further investigations on tumour-associated stroma at the invasive front are needed in order to establish new diagnostic markers and therapeutic strategies.

Potentially malignant oral disorders and high-risk habits in liver cirrhosis and lung cancer patients.

OBJECTIVES: To analyze the role of smoking, drinking, and their synergistic effect in the occurrence of potentially malignant oral disorders (PMOD). SUBJECTS AND METHODS: We examined three groups: 50 patients with lung cancer, 50 patients with liver cirrhosis, and 50 patients with clear medical history. Scores were developed for drinking, smoking, drinking & smoking, and PMOD. RESULTS: All four scores were the lowest in the control group. The lung cancer group showed the highest Smoking, Alcohol & Smoking and Lesions score, while the liver cirrhosis group had the Alcohol score the highest. Compared with the control group, lung cancer group is more likely to develop a PMOD than the liver cirrhosis group (OR = 12.31/OR = 6.71). Statistical significance between the groups was found in the Lesions score (χ(2)  = 15.34; P = 0.001). CONCLUSIONS: The patients with lung cancer and liver cirrhosis represent a high-risk group for PMOD. Patients with lung cancer and liver cirrhosis have never, to our knowledge, been categorized as high-risk patients for PMOD. After diagnosed, patients with lung cancer and liver cirrhosis should have a routine oral cavity examination, as they present a high-risk group for PMOD and oral cancer.

Evaluation of sensitivity of teeth after mandibular fractures.

The sensitivity of teeth anterior to a fracture between the mental and mandibular foramina has been tested and followed up until reinnervation or 3 years has passed. This study assessed the reinnervation period, the number of denervated teeth, and their clinical importance. Fifty patients and 459 teeth were examined. Two hundred and seventy-three teeth were affected and had potentially impaired innervation. Tests after injury showed non-responsive teeth in 81% of affected teeth. Six weeks after injury, 19% of teeth were reinnervated; by 1 year after injury, 92% of initially non-responsive teeth were reinnervated. Most teeth (34%) were reinnervated from 6 weeks to 3 months. All 23/186 initially non-responsive, unaffected, contralateral corresponding teeth were reinnervated within 6 weeks. A year after injury, 95% of incisors, 91% of canines, 94% of premolars, and 82% of molars were reinnervated. Three years after injury, 8% of teeth remain denervated. During the second and third years, no reinnervation occurred, but clinical signs of pulp devitalisation of denervated teeth occurred in 18% or 1% of the initially non-responsive affected teeth. The results revealed the stability of pulp 1 year after injury. Denervated teeth should not be treated if no clinical or radiological signs of devitalisation exist.

Lipiodol ultra-fluid - foreign body in the cheek.

We report a case in which iodinated oil (lipiodol ultra-fluid (UF)) leaked from an iatrogenic perforation of Stensen's duct and constituted a foreign body in the cheek. The distribution of contrast medium near the lower border of the mandible seems unusual. 2 years following sialography, the UF was still not being resorbed. No radiological signs of reactive inflammatory changes to the soft tissue were observed. We believe the contrast agent arrived beneath the skin, but external to the platysma, through a simple perforation in either the duct and/or the mucosa.

Schwannoma with secondary erosion of mandible: case report with a review of the literature.

Schwannoma (neurilemmoma) is a common, histologically distinctive, benign, usually encapsulated, peripheral nerve tumour of Schwann cell origin. We report a case of schwannoma arising from soft tissue near the mandible. A 53-year-old female presented at our department with painless swelling of lingual mucosa of the mandible. The first molar was extracted 20 months before. Panoramic radiograph showed a suspected residual cyst. It was impossible to determine prior to surgery whether this was a peripheral nerve sheath tumour. The lesion was completely removed; the tumour appears to have originated in soft tissue and caused secondary erosion of the mandible.

Inflammatory reaction to foreign body (amalgam) in the maxillary sinus misdiagnosed as an ethmoid tumor.

A patient with chronic unilateral maxillary sinusitis caused by a foreign body (dental amalgam) and mistaken diagnosis of extensive ethmoid neoplasm is presented. The imitation of tumour symptoms was due to a long presence of foreign body in the maxillary sinus and chronic inflammation of maxillary, ethmoid and sphenoid sinuses.

Involvement of patched (PTCH) gene in Gorlin syndrome and related disorders: three family cases.

AIM: To find genetic alterations in PTC or other genes of the Shh/PTCH pathway in tumorous and non- tumorous samples from three families and to correlate them with the varying expression of disorders in presented nevoid basal cell carcinoma syndrome (NBCCS) phenotypes. METHOD: DNA was extracted from archival paraffin-embedded tissues, tumor tissue or peripheral blood leukocytes, and the loss of heterozygosity (LOH) and single strand conformational polymorphism analysis was performed using PCR with primers for polymorphic 9q22.3 markers (D9S196, D9S287, D9S180, D9S127); PTCH exons 3, 6, 8, 13, 15, 16; and smo (smoothened) exon 1. G-banding tecnique was used for cytogenetic analysis of the peripheral blood lymphocytes. RESULTS: We found a LOH for PTCH in several cases and variability in smo in one case. In one case NBCCS could reasonably be ascribed to hemizygous PTCH inactivation, while in other two families this typical correlation between the syndrome phenotype and the observed genetic alterations could not been established. CONCLUSIONS: Further analysis of relatively sparse cases of NBCCS is needed before the symptoms of the syndrome could be convincingly explained by genetic alterations in the Shh/PTCH signalling pathway.

[The Q.E.D. test--possibility for rapid determination of ethanol levels in saliva]. / Q.E.D. test--mogucnost brzog odredivanja koncentracije etanola u slini.

The present study has been undertaken to compare the Q.E.D. test, a quantitative enzymatic method for the determination of ethanol concentration in the saliva, and quantitative methods for determination of ethanol serum concentrations: UV alcohol dehydrogenase method and gas chromatography. The results of the study demonstrated a statistically significant correlation between the methods compared. We conclude that Q.E.D. test is an effective, rapid and safe method for specific quantitative determination of ethanol levels in the blood defined by ethanol concentrations in the saliva, especially in outpatient departments, initial emergency treatment as well as in differential diagnosis. Sometimes, an increased salivary viscosity caused by dehydration of an acutely drunken man as well as insufficient cooperation of the examinee may, however, aggravate the test performance. We propose the use of a test that measures ethanol concentration in the saliva up to 3.5 g/L in order to avoid repetition of the test.

Maxillofacial war injuries in civilians and servicemen during the aggression against Croatia.

Although civilian populations have been heavily involved in most of the recent wars and conflicts throughout the world, most reports analyzed casualty data of military personnel, often leaving civilian casualties excluded or underestimated. A comparison of epidemiologic and medical data for maxillofacial injuries between civilians and servicemen (policemen, soldiers, and United Nations Protection Forces) during the aggression against Croatia is attempted. Of the 220 casualties admitted to the Department of Maxillofacial Surgery in Zagreb between August 1991 and December 1992, almost one-fourth were civilians. A significant difference between civilians and servicemen was noted in age and sex distribution. The incidence and severity of maxillofacial and associated injuries is almost equal, and the pattern of injuries is of the same type for civilian and military personnel.

Evaluation of mandibular fracture treatment.

A total of 124 patients treated for mandibular fractures were analyzed. Patients were divided into three groups according to treatment: intermaxillary fixation, wire fixation and mini-plate fixation. For each method, the success of treatment was evaluated with respect to surgical approach, fracture site and injury to treatment interval. Five basic parameters were used for evaluation of the outcome: occlusion, appearance, mastication, duration of IMF and complications. The treatment was surveyed based on both the surgeon's and patient's-evaluation. All parameters were scored and average values for every parameter calculated. The most successful treatment was achieved with mini-plate fixation in symphyseal and angle fractures. Intermaxillary fixation is indicated for mandibular body fractures with or without minimal displacement and a sufficient number of teeth. However, mini-plate fixation should be used for fractures with displacement. Wire fixation has been shown to be the poorest choice for all sites. Results showed that the intraoral approach has advantages over the extraoral one. The optimal time for treatment of mandibular fractures is within 72 h from time of injury. Even in fractures older than 7 days we recommended mini-plate fixation.

[Central odontogenic fibroma of the mandible]. / Centralni odontogeni fibrom mandibule.

Central odontogenic fibroma of the jaw is not a clearly defined lesion. It is rare, asymptomatic, usually found in the mandible and equally involving both sexes. The characteristic feature of the lesion is a high histomorphologic variability, while clinical, x-ray and histologic behavior of the tumor is not specific. All this contributes to the difficulty in diagnosis. Conservative enucleation of the benign tumor is the treatment of choice. The recurrence is rare, but, those with more epithelial elements are more prone to recur.

[Comparison of clinical and histopathological diagnosis in oral surgery]. / Usporedba klinicke i patohistoloske dijagnoze u oralnoj kirurgiji.

Only a successful cooperation of an oral surgeon and the pathologist can ensure a reliable diagnosis. The authors have analyzed operations performed during 1990 at outpatient clinic of the Department of Oral and Maxillofacial Surgery, University of Zagreb, School of Dentistry. Clinical appearance of the disease and clinical diagnosis sometimes enable us to recognize the real nature of the disease. The clinical diagnosis in correlation with the histological diagnosis can be either denied or improved. The aim of this investigation was to correlate the clinical and the histological diagnosis and to find out the number of improvement. Material most often sent for histological examination was an operated cyst. Although the removed tissues were analyzed under different clinical diagnoses, approximately 70% of the clinical diagnoses corresponded to the histopathological findings. In one case the clinical diagnosis of benign lesion--hyperkeratosis-- was after histopathological examination find as carcinoma planocellulare. The authors recommend every part of the excised tissue to be sent for a histopathological examination.