An Unusual Clinical Presentation of Traumatic Ulcerative Granuloma With Stromal Eosinophilia.

Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) is a reactive and chronic ulcerative lesion that is most frequently found on the tongue. It appears as a large yellowish ulcer with elevated margins and central induration. TUGSEs exhibit a characteristic pattern of regression often spontaneously, following incisional biopsy, or after removal of the potential traumatic trigger. Herein, we present an unusual case of a TUGSE on the anterior maxillary gingiva of a 70-year-old male that regressed following incisional biopsy. Histopathologic evaluation revealed fragments of squamous mucosa and submucosal tissue with large atypical cells mixed with small lymphocytes, abundant eosinophils, and focal clusters of plasma cells. Immunohistochemistry was performed and the large, atypical cells were positive for CD3, CD4, CD5, and CD30 and negative for CD1a, CD8, CD20, CD56, CD117, ALK1, Langerin, and EBER ISH. To our knowledge, this is the first case of TUGSE reported in the anterior maxilla.

A rare case of unilateral double Stafne bone defects and literature review.

Stafne bone defect (SBD) is a rare developmental bone defect characterized by an asymptomatic focal concavity of the cortical bone, typically on the lingual aspect of the mandibular body, which generally contains salivary gland tissue. It can be detected during routine dental examinations and typically appears as an ovoid, well-defined, well-corticated, radiolucent depression in the posterior mandibular region below the inferior alveolar nerve (IAN) (in: Neville et al, Oral and maxillofacial pathology, Elsevier, Inc, St. Louis, MO, 2016).An 80-year-old male presented to our clinic for a routine dental examination. Panoramic radiography and cone-beam computed tomography (CBCT) displayed two well-defined, well-corticated, ovoid radiolucencies inferior to the IAN canal on the left mandibular molar region. The working diagnosis was SBD, and the patient was informed of the findings. Irregular margins on the superior aspect of the anterior defect were noted on CBCT imaging; therefore, follow-up with panoramic images at 6 months, 1 and 5 years was recommended.

Refined Topical 5-Fluorouracil Technique for the Targeted Treatment of Odontogenic Keratocysts.

PURPOSE: An innovation in the treatment of odontogenic keratocysts (OKCs) is the adjunctive application of 5-fluorouracil (5-FU). Although the original approach remains effective, it may often be a challenge for the patient to return postoperatively and/or tolerate non-resorbable packing removal. The purpose of the present study is to determine whether our refined approach, where we directly apply 5-FU-coated absorbable gelatin sponge to the surgical cavity, would be an effective treatment for OKCs with similar efficacy as with our original approach. MATERIALS AND METHODS: A retrospective case series studying the treatment efficacy of our refined topical 5-FU approach on OKCs was reviewed. The study population was composed of all patients presenting for evaluation and management of OKCs with our refined technique between September 1, 2017 and July 1, 2022 at Stony Brook University Hospital. The primary outcomes included 1) time to OKC recurrence, and 2) incidence of trigeminal nerve injury following OKC treatment with the refined topical 5% 5-FU technique. Other study variables included age, gender, tumor location, and tumor size. Data analyses included descriptive statistics reported as median [interquartile range], and Kaplan-Meier survival analysis for time to OKC recurrence. RESULTS: Thirteen patients with 15 OKCs were reviewed (6 women and 7 men). There were no OKC recurrences with a median follow-up time of 28.5 (24) months. Normal bony healing was observed in all cases and there were no adverse local or systemic events, no alterations in sinus function, and no incidences of infraorbital or inferior alveolar nerve paresthesia. CONCLUSIONS: Our case series demonstrates that this refinement further increases technical ease, decreases operating time, and precludes the need for packing removal, with similar efficacy as the original approach.

Coronavirus Disease 2019-Challenges Today and Tomorrow in Orthodontic Practice: A Review.

From the start of 2020, the world has witnessed the biggest health and humanitarian crisis in the modern century named coronavirus disease 2019. The rapid spread of infection created chaos and confusion across the globe. Like all other health professions, a timely and major reorganization of orthodontic services is challenging. Unlike other medical emergencies, an orthodontic emergency does not require immediate attention in most cases. With advances in the modern web-based communication systems, minor problems can be managed online in orthodontic practice. During an emergency, however, orthodontists have a moral obligation to treat and manage patients under the World Health Organization guidelines and protocol.

Evaluation of stability of three different mini-implants, based on thread shape factor and numerical analysis of stress around mini-implants with different insertion angle, with relation to en-masse retraction force

ABSTRACT Objectives: Assess the stability of three different mini-implants, based on thread shape factor (TSF), and evaluate stresses at the mini-implant site and surrounding cortical bone on application of retraction force, at two different insertion angles. Methods: Mini-implants of three different diameters (M1 - Orthoimplant, 1.8mm), (M2 - Tomas, 1.6mm) and (M3 - Vector TAS, 1.4mm) and length of 8mm were used. Using scanning electronic microscopy, the mean thread depth, pitch and relationship between the two (TSF) were calculated. The mini-implants were loaded into a synthetic bone block and the pull-out strength was tested. One way ANOVA and Tukey post-hoc tests were used to compare the pull-out strength of mini-implants. P values < 0.05 were considered statistically significant. Finite element models (FEM) were constructed with insertion angulation at 90° and 60°, with retraction force of 150 g. The results were analyzed using ANSYS software. Results: Statistically significant difference was found among all the three mini-implants for thread depth and pitch (< 0.001). Statistically significant higher pull-out force value was seen for Orthoimplant. The stress distribution level in mini-implant and surrounding bone was observed to be smaller for Orthoimplant. Conclusion: Orthoimplant mini-implants have more favorable geometric characteristics among the three types, and less stress with 90°angulation.

RESUMO Objetivos: Avaliar a estabilidade de três diferentes tipos de mini-implantes, com base no fator formato da rosca (thread shape factor, TSF), e avaliar a tensão no local de inserção e no osso cortical ao redor dos mini-implantes inseridos com dois ângulos diferentes, durante a aplicação de força para retração. Métodos: Foram usados três diferentes diâmetros de mini-implantes, sendo eles 1,8 mm (M1, ORTHO Implant), 1,6 mm (M2, Tomas) e 1,4 mm (M3, Vector TAS), todos com comprimento de 8 mm. Por meio da microscopia eletrônica de varredura, foram calculados a profundidade da rosca, o passo da rosca (distância entre os filetes da rosca) e a relação entre os dois (TSF). Para realização do teste de tração (pull-out), os mini-implantes foram inseridos em um bloco de osso sintético. Os testes ANOVA de uma via e post-hoc de Tukey foram usados para comparar as forças de resistência à tração dos mini-implantes, considerando-se estatisticamente significativos valores de p< 0,05. Modelos de elementos finitos (MEF) foram gerados com ângulos de inserção dos mini-implantes a 90° e 60°, com força de retração em 150g. Os resultados foram analisados usando-se o software ANSYS. Resultados: Diferenças estatisticamente significativas foram encontradas entre os três mini-implantes quanto à profundidade da rosca e o passo da rosca (p< 0,001). O ORTHO Implant apresentou a maior força de resistência à tração, com significância estatística. O nível de distribuição das tensões no mini-implante e no osso circundante também foi menor para o ORTHO Implant. Resultados: Entre os diferentes tipos de mini-implantes analisados, o ORTHO Implant apresentou as características geométricas mais favoráveis e a menor tensão com o ângulo de inserção de 90°.

Evaluation of stability of three different mini-implants, based on thread shape factor and numerical analysis of stress around mini-implants with different insertion angle, with relation to en-masse retraction force.

OBJECTIVES: Assess the stability of three different mini-implants, based on thread shape factor (TSF), and evaluate stresses at the mini-implant site and surrounding cortical bone on application of retraction force, at two different insertion angles. METHODS: Mini-implants of three different diameters (M1 - Orthoimplant, 1.8mm), (M2 - Tomas, 1.6mm) and (M3 - Vector TAS, 1.4mm) and length of 8mm were used. Using scanning electronic microscopy, the mean thread depth, pitch and relationship between the two (TSF) were calculated. The mini-implants were loaded into a synthetic bone block and the pull-out strength was tested. One way ANOVA and Tukey post-hoc tests were used to compare the pull-out strength of mini-implants. P values < 0.05 were considered statistically significant. Finite element models (FEM) were constructed with insertion angulation at 90° and 60°, with retraction force of 150 g. The results were analyzed using ANSYS software. RESULTS: Statistically significant difference was found among all the three mini-implants for thread depth and pitch (< 0.001). Statistically significant higher pull-out force value was seen for Orthoimplant. The stress distribution level in mini-implant and surrounding bone was observed to be smaller for Orthoimplant. CONCLUSION: Orthoimplant mini-implants have more favorable geometric characteristics among the three types, and less stress with 90°angulation.

Molar-incisor malformation: Eight new cases and a review of the literature.

BACKGROUND: Molar-incisor malformation (MIM) is a recently described dental abnormality. While MIM mimics dentin dysplasia, it presents in a localized pattern. Furthermore, it is speculated that MIM is caused by significant early-life medical history. AIM: The purpose of this study is to present a series of MIM cases and compare the findings with the literature. DESIGN: An extensive search of all published cases of MIM in the English-language literature was conducted. Additionally, an institutional review board-approved retrospective search was performed within the University of Florida oral pathology biopsy service archives. Radiographic consultation cases were also included. Cases lacking radiographs were excluded. RESULTS: Seventy-nine cases were identified in the literature, and eight cases were identified in our retrospective search. All but one case involved the permanent first molars. The average age at diagnosis was 9 years. Many patients reported significant early-life medical histories. CONCLUSIONS: MIM usually affects the permanent first molars and may be linked to early-life medical conditions or interventions. Oral healthcare providers, especially paediatric dentists, should be aware of MIM to avoid misdiagnosing it as dentin dysplasia. Long-term follow-up studies with thorough medical history documentation are essential to understand the pathogenesis and aetiology and to create treatment guidelines.

Oral Melanomas: A Case Series of a Deadly Neoplasm.

PURPOSE: To describe and discuss the demographic and clinical features of oral melanomas, which are relatively rare but deadly neoplasms, and list the criteria for their diagnosis to increase early detection. MATERIALS AND METHODS: An institutional review board-approved retrospective search of oral melanomas was performed in the archives of the University of Florida Oral and Maxillofacial Pathology Biopsy Service (Gainesville, FL) from 2015 through 2018. Exclusion criteria included cases with inconclusive diagnosis, skin involvement, and missing clinical data or slide material. Of 7 patients with a diagnosis of melanoma of the head and neck region, 6 (87.5%) were found to be diagnosed with oral melanomas and met the inclusion criteria. RESULTS: All 6 patients were at least 45 years (range, 45 to 87 yr). The male-to-female ratio was 4:2. Three patients were asymptomatic and 3 experienced symptoms, including pain, swelling, and tingling. Seven lesions were detected in these 6 patients. Three of these lesions were located on the maxillary gingiva, 2 were on the mandibular gingiva, and 2 involved the palate. Two lesions were diagnosed as spindle cell melanoma, 4 were diagnosed as melanoma, and 1 was diagnosed as a mucosal lentiginous melanoma. CONCLUSION: Oral melanomas should be considered in the differential diagnosis of oral pigmented lesions, especially on the gingiva or palate, in middle-age and elderly patients. Oral melanomas have a male bias. In addition, supportive criteria enabling early diagnosis of oral melanomas is addressed.

The reliability of MAML2 gene rearrangement in discriminating between histologically similar glandular odontogenic cysts and intraosseous mucoepidermoid carcinomas.

OBJECTIVE: MAML2 expression is proven in the majority of mucoepidermoid carcinomas (MECs) arising in salivary glands. MEC can also occur intraosseously (IMEC). Glandular odontogenic cyst (GOC) is an odontogenic cyst with histologic overlap with IMEC. This study aimed to determine the reliability of MAML2 in distinguishing IMEC cases from GOC cases. STUDY DESIGN: An institutional review board-approved retrospective search of IMEC, GOC, and IMEC with prior history of GOC was performed within the archives of the University of Florida and the University of Alberta Oral Pathology Biopsy Services. Nine cases from 5 patients were selected. Break-apart fluorescent in situ hybridization analysis was performed on 7 cases for the presence of MAML2 rearrangement. RESULTS: Four cases had negative MAML2 gene rearrangement, and 3 cases had positive MAML2 gene rearrangement. CONCLUSIONS: Although it can be concluded that the 3 cases with positive translocation for MAML2 were IMECs, the same conclusion could not be drawn for the 4 cases with negative translocation. Whether the cases that were negative for translocation were GOCs with MEC-like islands or were MAML2-negative IMECs could not be ascertained. Therefore, MAML2 rearrangement is not always reliable in differentiating IMECs from GOCs with overlapping histology.

NUT (Nuclear Protein in Testis) Carcinoma: A Report of Two Cases With Different Histopathologic Features.

NUT (nuclear protein in testis) carcinoma (NC) is an aggressive carcinoma characterized by rearrangements of the NUT gene on chromosome 15q14. Histologically, it is a poorly differentiated carcinoma composed of monotonous, medium-sized, round cells with scant amphophilic or eosinophilic cytoplasm. Foci of abrupt keratinization are often seen. In this report, we compare the morphology of 2 cases of NC. The first case shows characteristic features of uniform, round epithelioid cells admixed with foci of abrupt keratinization. The second case demonstrates nests of epithelioid-polygonal cells that appear to be loosely cribriform within a mucoid stroma. Although considered rare, the actual incidence of NC may be underestimated, as it is likely that many go undiagnosed because the morphology deviates from what is typical. Our report demonstrates that NC should always be considered in any case of an undifferentiated carcinoma and should not be excluded if typical histologic and immunohistochemical features of squamous differentiation are lacking.

Seventeen New Cases of Chronic Ulcerative Stomatitis with Literature Review.

Chronic ulcerative stomatitis (CUS) is a poorly understood disease with clinical and histologic overlap with lichen planus (LP). Unlike classic LP, direct immunofluorescence (DIF) studies in cases of CUS exhibit a granular pattern of IgG in nuclei of basal and parabasal cells. This study assesses the demographic, clinical, histologic, and DIF features of CUS. It is important to differentiate CUS from LP and other vesiculobullous diseases (VBD) because lesions of CUS are resistant to steroid therapy, which is typically used to control LP and VBD. A literature review and IRB-approved retrospective search of CUS was performed within the archives of the University of Florida (UF) Oral Pathology Biopsy Service from 2007 to 2017. Fifty-two cases were identified from the literature and seventeen new cases were identified in our series. All UF patients were female and the median age was 64-years. The majority of patients were Caucasian and the most common location was buccal mucosa. Frequent clinical presentations were pain, erythema, leukoplakia, and ulcerations. Histologic features included epithelial separation, atrophic epithelium, and a chronic inflammatory infiltrate. All cases were confirmed with DIF testing that showed a speckled pattern of IgG staining in basal and parabasal cell nuclei. Fibrinogen was present in eleven cases and two cases were positive for C3. The results of our series are in accordance with the literature. Since CUS has overlapping features with LP and VBD, clinicians and pathologists should consider this entity and confirm diagnosis with DIF testing when recalcitrant oral ulcerative diseases are encountered.

Dermatologic Lesions Submitted to an Oral and Maxillofacial Pathology Biopsy Service: An Analysis of 2487 Cases.

Skin lesions are often submitted to oral and maxillofacial pathology practices. The purpose of this study is to evaluate the frequency, distribution, variability, and composition of dermatologic lesions within a large oral and maxillofacial pathology biopsy service. An IRB-approved retrospective search of skin lesions diagnosed at University of Florida oral and maxillofacial pathology biopsy service between 1994 and 2015 was performed. 2487 cases were included in the study. Gender was reported in 2466 cases, of which 59% were male and 41% female. Age was provided in 2367 cases and ranged from 2 weeks to 96 years with an average of 55 years. Location was indicated in 2473 cases. Lips were the most common (41.7%), followed by face (25.3%), neck (7.4%), nose (6.5%), periorbital (5.3%), ear (4.1%), and scalp (3.8%). Of the 2487 cases, five diagnoses (actinic keratosis/cheilitis, intradermal nevus, epidermal inclusion cyst, seborrheic keratosis, and basal cell carcinoma) constituted 84.4% of the cases. 69 of 2487 cases (2.8%) resulted in dermatopathologic consultation prior to final reporting. Skin lesions accounted for ~ 1.0% of all lesions submitted to an oral and maxillofacial pathology biopsy service. This study found a large variation in the dermatologic lesions submitted to an oral pathology biopsy service. Although most were routine in complexity, dermatopathology consultation was an important tool in the diagnosis of the more challenging cases. This study may help pathologists gain a better understanding of the frequency and variability of dermatologic lesions submitted to an oral and maxillofacial pathology biopsy service and promote more interdisciplinary consultation within the field. This study evaluated the incidence and scope of dermatologic lesions submitted to a large oral and maxillofacial pathology biopsy service over a long time period. A wide scope of lesions was found, and dermatopathology consultation was important to quality assurance.

Analysis of genetic variants in never-smokers with lung cancer facilitated by an Internet-based blood collection protocol: a preliminary report.

PURPOSE: Germ line polymorphisms may confer susceptibility to lung cancer in never smokers, but studies in the United States have been limited by the low number of cases seen at single institutions. We hypothesized that we could use the Internet to bolster the accrual of appropriate patients. EXPERIMENTAL DESIGN: We established an Internet-based protocol to collect blood and information from patients throughout the United States. To illustrate the power of this approach, we used these samples, plus additional cases and age-matched controls from the Memorial Sloan-Kettering Cancer Center (New York, NY) and the Aichi Cancer Center (Nagoya, Japan), to analyze germ line DNA for genetic variants reportedly associated with lung cancer susceptibility. The genotypes for the polymorphisms rs763317 (intron 1) and T790M (exon 20) in the EGFR gene were determined by direct sequencing, and CHRNA3 nicotinic acetylcholine receptor single nucleotide polymorphisms (rs8034191 and rs1051730) were genotyped as part of a pilot genome-wide association study. RESULTS: We successfully analyzed germ line DNA from 369 cases, including 45 obtained via the Internet, and 342 controls. A germ line EGFR T790M variant was identified in 2 of the 369 cases (0.54%; 95% confidence interval, 0.21-1.29%), and in none of the 292 controls (P = 0.21). No difference was observed in EGFR rs763317 frequency between cases and controls. Similarly, neither CHRNA3 rs8034191 nor rs1051730 were associated with lung cancer risk. CONCLUSIONS: The Internet provides a way to recruit patients throughout the country for minimal risk studies. This approach could be used to facilitate studies of germ line polymorphisms in specific groups of patients with cancer.

Does marijuana use play a role in the recreational use of sildenafil?

PURPOSE: This study examined the ways by which patients obtain nonprescription sildenafil and the patient predictors associated with nonprescribed use. METHODS: We conducted this descriptive study by distributing an anonymous questionnaire to 231 male sildenafil users (ages 18 to 80) between December 1, 2002 and April 30, 2003 at outpatient Family Medicine and Urology Clinics at The Brooklyn Hospital Center, Brooklyn, NY. Patients were divided into 2 groups: those with erectile dysfunction (as defined by their physician) and those without. RESULTS: The prevalence of erectile dysfunction in our total study population of sildenafil users (n=231) was 40.3% (n=93); 59.7% (n=138) did not have erectile dysfunction. Of those without erectile dysfunction, 76% (n=105) admitted to cannabis use, compared with 7.5% (n=7) of the subjects with erectile dysfunction. Patients without erectile dysfunction and history of cannabis abuse reported obtaining sildenafil from friends and street vendors significantly more often than non-cannabis users with erectile dysfunction (54.3%, n=57 vs 9.3%, n=8; P<.0001). CONCLUSIONS: Illicit use of cannabis is a strong predictor of recreational sildenafil use among patients without erectile dysfunction.

Sudden painless unilateral vision loss caused by branch retinal artery occlusion: implications for the primary care physician.

We report a case of sudden onset visual loss caused by branch retinal artery occlusion. Systematic search for the cause of branch retinal artery occlusion revealed Factor V Leiden mutation and antiphospholipid antibody syndrome as the cause. Implications for diagnosis and management are discussed.