Reconstruction of Complex Full-Thickness Scalp Defects After Dog-Bite Injuries Using Dermal Regeneration Template (Integra): Case Report and Literature Review.

PURPOSE: The purpose of this article is to review the current applications of dermal regeneration templates in reconstruction of full-thickness scalp defects, most commonly resulting from oncologic surgery, and show its success in reconstruction of a complex full-thickness scalp defect resulting from a dog-bite injury. MATERIALS AND METHODS: A systematic review conforming to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines was completed. A PubMed search was completed using key terms including Integra, dermal regeneration template, full-thickness scalp defects, dog-bite injuries, and scalp. Eligible articles were selected based on the characteristics of defect size, procedural protocol, and reconstruction modality. Outcomes reported were based on reports of follow-up, complications, and percentage graft take. The case report presents reconstruction of a complex full-thickness scalp defect due to a dog-bite injury with a dermal regeneration template. RESULTS: Fifteen articles were included. Reported ages ranged from 2 to 93 years. The mean defect size ranged from 6 to 610 cm2, with 67% of defects averaging more than 50 cm2. All articles reported the 2-stage approach to Integra (Integra LifeSciences, Plainsboro, NJ)-based reconstruction with follow-up ranging from 5 to 23 months, with only 2 articles reporting less than 90% graft take. CONCLUSIONS: Acellular dermal matrix provides an alternative reconstructive mechanism to free tissue transfer and flap reconstruction and offers a unique advantage in the medically complex patient, as well as in pediatric and geriatric populations. Successful Integra-based reconstruction of full-thickness complex scalp defects is well reported in the literature in relation to reconstruction of Mohs surgical defects, as well as burns of the trunk and extremities; however, reports of reconstruction of post-traumatic soft tissue defects of the head and neck are limited. On the basis of the reported successes from the reviewed literature, as well as the clinical outcome of the reported case, we believe Integra to be a valuable reconstructive tool in the algorithm for repair of post-traumatic, full-thickness, complex scalp defects when used appropriately.

Publication Incidence of Abstracts Presented at the American Association of Oral and Maxillofacial Surgeons Meeting: 2010 to 2014.

PURPOSE: The quality of national society conferences is often indirectly assessed by the full-text publication rate of the abstracts presented. The purpose of this study was to assess the full-text journal publication rate of abstracts presented at the American Association of Oral and Maxillofacial Surgeons conferences from 2010 to 2014 and determine the publication plateau best suited for the analysis. MATERIALS AND METHODS: In this retrospective cohort study, all presented abstracts from 2010 to 2014 were compiled using the published educational summaries and outlines from the Journal of Oral and Maxillofacial Surgery website. PubMed and Google Scholar searches were conducted to identify full-text journal publications. The predictor was abstract type (oral vs poster), and the outcome variable was time to publication. Descriptive, bivariate, and regression analyses were calculated; P < .05 was considered significant. RESULTS: A total of 1,053 abstracts were presented at the conferences. The full-text journal publication frequency was 34.6% (119 of 344) for oral abstracts and 26.2% (187 of 709) for posters. The incidence 24 months after presentation was 74% and 81%, respectively. A comparison of the proportions of published abstracts showed significantly higher conversion for oral presentations. The median time to publication was 12.5 months (mean, 15.7 months; range, 0 to 52 months) and 12 months (mean, 14 months; range, 0 to 53.5 months) for oral and poster abstracts, respectively. A Kaplan-Meier analysis showed no significant difference in time to publication between the presentation types (hazard ratio, 1.2; 95% confidence interval, 0.9 to 1.5; P = .14). Within 2 years of the respective conference, only 78.4% of published abstracts (240 of 306) successfully navigated the peer-review process compared with 93.1% (285 of 306) within 3 years of the conference. CONCLUSIONS: The publication incidence of abstracts presented was higher for oral presentations; however, posters had a shorter time to publication. Of those published, a large proportion were published between 2 and 3 years after presentation, suggesting that a minimum 3-year publication plateau should be used for future analyses.

Pediatric Odontogenic Tumors.

Pediatric odontogenic tumors are rare, and are often associated with impacted teeth. Although they can develop anywhere in the jaws, odontogenic tumors mainly occur in the posterior mandible. This article discusses the diagnosis and treatment of the most common pediatric odontogenic tumors, such as ameloblastoma, keratocystic odontogenic tumor, odontoma, and cementoblastoma.

Insurance Status, an Important Predictor of Oral Cancer Surgery Outcomes.

PURPOSE: Patients without insurance, or using Medicaid, generally have a lower socioeconomic status. They have less access to screening and regular medical care, resulting in later diagnosis of oral cancer. This study examined the association between insurance status and the likelihood of complications after head and neck cancer surgery. MATERIALS AND METHODS: A retrospective cross-sectional study was implemented to determine whether patients' insurance status is associated with increased complications and length of stay after oral cancer surgery. Patients were grouped into 4 cohorts: 1) private insurance, 2) Medicare, 3) Medicaid, and 4) uninsured. Patients were stratified further to consider age, gender, initial staging, pre-existing comorbidities, and social history. Data were analyzed with χ(2) test, 1-way analysis of variance, odds ratios, and binary logistic regression. RESULTS: This study consisted of 89 surgically treated patients. The uninsured and Medicaid groups had the highest incidence of postoperative complications. Uninsured patients, followed by the Medicare cohort, were the most likely to have an extended length of stay. CONCLUSION: Uninsured and Medicaid patients are at increased probability for major and minor complications after head and neck cancer surgery. Uninsured patients also showed the greatest tendency for a prolonged length of hospital stay. This could reflect their lack of preventive care, increased use of tobacco and alcohol, presentation with more advanced disease, and delays in initiating treatment.

Rapid-onset postchemoradiotherapy rhabdomyosarcoma of the maxillofacial region.

Radiation-induced sarcomas of the head and neck are rare and tend to occur decades after treatment. We report a case of rapid-onset postchemoradiotherapy rhabdomyosarcoma of the maxillofacial region and briefly review the literature.

Subcutaneous emphysema to the head and neck resulting from a dental crown preparation.

CASE REPORT: A 59-year-old African-American female presents with subcutaneous emphysema to thehead and neck region resulting from routine dental treatment with a high speed air-driven handpiece. The patient had a chief complaint of generalized edema, dysphagia and pain to her face and neck. The patient subsequently was admitted to the intensive care unit for airway monitoring. PURPOSE: To alert the dental community about the incidence of iatrogenic subcutaneous emphysema from a routine dental procedure, and how to recognize and manage its occurrence,

Maxillofacial metastases: a retrospective review of one institution's 15-year experience.

PURPOSE: Metastasis to the maxillofacial region is a rare occurrence. In our retrospective study of patients with metastasis to the maxillofacial region, the subjects were evaluated to define the clinical behavior patterns in response to the treatment given. MATERIALS AND METHODS: A retrospective record review during a 15-year period (1990 to 2005) was conducted. The patients were selected for inclusion in the present study if they had histologically confirmed maxillofacial metastases. RESULTS: In our retrospective study, during the 15-year period, 1,221 new patients with maxillofacial/oral cancer were seen and evaluated. Of these 1,221 patients, 26 (16 men and 10 women) were identified as having a histologically confirmed metastasis to the maxillofacial region, for an incidence of 2.1%. CONCLUSIONS: Patients with metastasis to the maxillofacial region are often deemed to not be surgical candidates because of the extensive nature of the metastatic disease. We believe that surgical intervention plays a beneficial role in improving quality of life in a properly selected group of patients with metastasis to the maxillofacial region. In our case series, surgery was performed in about 50% of the patients, and palliation and radiotherapy were the most commonly used modalities.

Subcutaneous emphysema to the head and neck resulting from a dental crown preparation.

CASE REPORT: A 59-year-old African-American female presents with subcutaneous emphysema to the head and neck region resulting from routine dental treatment with a high speed air-driven handpiece. The patient had a chief complaint of generalized edema, dysphagia and pain to her face and neck. The patient subsequently was admitted to the intensive care unit for airway monitoring. PURPOSE: To alert the dental community about the incidence of iatrogenic subcutaneous emphysema from a routine dental procedure, and how to recognize and manage its occurrence.

Sinus histiocytosis with massive lymphadenopathy Rosai-Dorfman disease: a unique case presentation.

Rosai and Dorfman first described sinus histiocytosis with massive lymphadenopathy (SHML) in 1969 with an article detailing 4 cases in which they differentiated this disease entity from the grouping of diseases categorized as histiocytosis X, where it was previously classified. Also known as Rosai-Dorfman disease (RDD), it is clinically characterized as massive, painless, bilateral, symmetric cervical lymphadenopathy, with fever and leukocytosis. An 11-year-old African American boy was referred to our clinic for extraction of a severely decayed tooth #30 and evaluation of a large right-sided neck mass. Initially, the patient had been seen by his general dentist who had diagnosed the mass as an odontogenic abscess. After 2 courses of different antibiotics, no changes in the mass were noted. Subsequently, the patient was sent to the emergency department where CT revealed multiple right-sided neck masses with the largest measuring 4 × 2 cm. The patient underwent an incisional biopsy by otolaryngology and a diagnosis of necrotic lymph tissue was made. Upon our examination, the carious tooth #30 was felt to be an incidental finding and fine-needle aspiration cytology of the largest mass was performed in 2 places. This also provided a diagnosis of necrotic lymph tissue. In concert with the patient and his mother, the decision was made to excise the mass because of psychosocial concerns. A massive right-sided lymph node attached to the submandibular gland was found and excised without complication. Histologic examination with S-100 stain confirmed a diagnosis of RDD. The patient healed well following surgery and has experienced no further lymphadenopathy. This case presentation and review of the literature is unique, as the patient presented with unilateral cervical lymphadenopathy only. Open biopsy and 2 fine-needle aspirations all returned as necrotic lymph tissue. Obtaining the correct diagnosis was additionally hampered by coincidental dental pathology on the affected side and final diagnosis was made only by excisional biopsy, which is not necessarily indicated in cases of RDD.

Metastatic tumors to the oral cavity: a clinical study of 18 cases.

The aim of this study was to describe the clinical features of 18 cases of metastatic tumors to the oral cavity. The files of patients seen between 1992 and 2009 with oral (soft tissue and jawbones) metastatic lesions were reviewed. Clinical features, including gender, age, site of the primary tumor, site of metastatic tumor and treatment were evaluated. Patients were 11 males and 7 females, with mean age of 64.6 years. In males, most primary tumors originated in the lungs. In females, the lung and breast were the most common sites of the primary tumors. The mandible was the main site for the development of the metastatic lesions and the most common histologic type was adenocarcinoma. Treatment modalities included radiotherapy, chemotherapy and surgical resection. Metastatic lesions should be considered in the differential diagnosis of oral lesions, particularly when a previous history of cancer is present.

Brown tumor as a result of hyperparathyroidism in an end-stage renal disease patient.

A 49-year-old male with known history of end-stage renal disease (ESRD) presents with an intraoral exophytic mass of the right mandible. This lesion was given a histologic diagnosis of a Brown tumor. Purpose. To allow physicians to include this lesion in a differential diagnosis when evaluating patients with primary, secondary, or tertiary hyperparathyroidism.

Primary histiocytic sarcoma arising in the head and neck with predominant spindle cell component.

This is the first case report of Histiocytic Sarcoma (HS) with predominant spindle cell component occurring in the head and neck region of a 41-year-old man. The tumor was composed of sheets of large round to oval cells with pleomorphic vesicular nuclei, prominent nucleoli and abundant eosinophilic cytoplasm. Multinucleated forms, numerous mitoses, and tumor necrosis were also noted. Sheets, fascicles, and whorls of spindle cells with spindled to ovoid vesicular nuclei, small to medium-sized distinct nucleoli, and eosinophilic cytoplasm were frequently observed. Immunohistochemical staining in the tumor cells was positive for CD163, CD68, lysozyme, CD45, and NSE. Focal expression of CD4 and S-100 was also noted. Electron microscopy demonstrated an abundance of lysosomes in the cytoplasm of tumor cells. Chromosome study revealed a 57-80 hyperdiploid [7]/46, XY [13] karyotype, including 3 to 4 copies of various chromosomes. The immunohistochemical and ultrastructural findings confirmed the diagnosis of HS.