Giant Cementoblastoma Of Left Maxilla Involving A Deciduous Molar.

Cementoblastoma is a relatively rare benign tumour. The clinicopathologic features, radiological findings, treatment and prognosis are reported here in a 10-year-old girl who presented to us from Afghanistan. The tumor was managed surgically and the histopathology confirmed the diagnosis of cementoblastoma. There was no evidence of recurrence at one year of follow up.

Granuloma de células gigantes en maxilar / Giant-cell granuloma of the jaw

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Osteonecrosis de los maxilares asociada al uso de bifosfonatos: revisión de ocho casos / Bisphosphonate-related jaw osteonecrosis: review of eight cases

Introducción: A finales de 2003 se comienzan a publicar en forma creciente los primeros casos de exposición ósea en los maxilares con evolución tórpida, asociados al uso de bifosfonatos por vía intravenosa. Estos fármacos son usados en pacientes con osteoporosis, mieloma múltiple, hipercalcemia maligna y cáncer de pulmón, mama y próstata, principalmente por su capacidad de inhibir la resorción ósea. Material y método: Estudio prospectivo de los pacientes en el Hospital Virgen Macarena que presentaban lesiones maxilares asociadas al uso de bifosfonatos desde el año 2006 hasta la actualidad. Las variables que valoramos en el paciente son: sexo, edad, tratamiento con bifosfonatos, inicio de la osteonecrosis, relación con tratamientos dentales, tratamiento realizado y evolución. Resultados: Se estudiaron 8 pacientes con osteonecrosis maxilar secundaria a tratamiento con bifosfonatos intravenosos u orales por su patología previa oncológica u osteoporótica que fueron tratados según su estadio clínico-radiológico con antibioterapia, legrado y/o exéresis del secuestro según el caso. Presentamos los resultados con un seguimiento mínimo de 15 meses. Conclusiones: El aumento en la incidencia de la osteomielitis maxilar en los pacientes asociados al uso de bifosfonatos y la dificultad para su tratamiento hacen necesario establecer pautas terapéuticas estandarizadas. En nuestra experiencia, el tratamiento conservador basado en la antibioterapia además del legrado de la zona bajo anestesia local permite el control y la curación del proceso en algunos de los pacientes con OMRB grado II(AU)

Background: In late 2003, an increasing number of case reports began to appear on bone exposure of the jaw with a torpid evolution in association with intravenous bisphosphonate use. Bisphosphonates are used to inhibit bone resorption in patients with osteoporosis, multiple myeloma, hypercalcemia of malignancy, lung cancer, breast cancer and prostate cancer. Material and methods: A prospective study was made of patients from Hospital Virgen Macarena who presented bisphosphonate associated jaw lesions from 2006 to the present. The patient variables examined were: sex, age, bisphosphonate treatment, onset of osteonecrosis and its relation to dental treatment, treatment, and outcome. Results: Eight patients with osteonecrosis of the jaw secondary to treatment with intravenous or oral bisphosphonates for oncologic or osteoporotic pathology were treated according to their clinical and radiological findings with antibiotics and curettage and/or excision of sequestered bone, as needed. Results with a minimum follow up of 15 months are reported. Conclusions: The increased incidence of maxillary osteomyelitis in patients treated with bisphosphonates and the difficulty of treatment make it necessary to establish standard therapeutic guidelines. In the authors' experience, conservative treatment based on antibiotic therapy and/or curettage of the area under local anesthesia can adequately control and resolve the process in some patients with stage II BRJO(AU)

Uso de obturadores en cirugía oral y maxilofacial. Presentación de cinco casos clínicos / Use of obturators in oral and maxillofacial surgery. A report of five cases

Los defectos creados en el maxilar, principalmente tras cirugía resectiva de tumores malignos, traumatismo o defectos congénitos, deben ser corregidos con el fin de recuperar los consecuentes déficits en el habla, la deglución, la masticación y la estética. Para ello contamos con dos amplias posibilidades: reconstrucción quirúrgica o colocación de un obturador protésico maxilar. En este artículo llevamos a cabo una revisión de la literatura reciente y clásica sobre obturadores palatinos, ilustrándola mediante 5 casos clínicos con esta opción terapéutica. Hemos encontrado descritas una amplia variedad de modificaciones para los distintos tipos de obturadores, como la fabricación de aletas nasales, colocación de obturadores de forma inmediata tras la cirugía, el hecho de ahuecar el aditamento obturador, etc. En nuestra práctica hemos observado una serie de ventajas en la colocación de este tipo de prótesis de forma posquirúrgica diferida y en estrecha colaboración con su médico responsable(AU)

Defects created in the maxillary bone, principally after surgical resection of malignant tumors, trauma or congenital defects, must be corrected to eliminate the resulting speech, swallowing, and chewing defects and restore the cosmetic appearance. Two major options available are surgical reconstruction or the placement of a maxillary obturator prosthesis. The recent and classic literature on palatal obturators is reviewed and five clinical cases treated with a palatal obturator are reported. A large variety of modifications have been reported for different types of obturators, such as nasal wings, immediate postoperative obturator prosthesis placement, etc. In the authors' experience, deferred postoperative obturator placement in close collaboration with the responsible doctor has advantages(AU)

Metastatic renal cell carcinoma to the orofacial region: A novel method to alleviate symptoms and control disease progression.

Head and neck metastatic tumours are uncommon. The primary tumors most likely to metastasize are those of the thyroid, breast, and lungs. The management of metastatic carcinoma in the orofacial region is variable. Palliative and symptomatic approaches are the mainstay in the management. The purpose of this case report is to highlight the feasibility of using PDT to alleviate nasal and visual symptoms and control the growth of metastatic renal cell carcinoma to the orofacial region.

Application of an automatic conversation intelligibility test system using computerized speech recognition technique.

PURPOSE: Subjective speech evaluation is important in maxillofacial rehabilitation. In previous research, the automatic speech intelligibility test system using monosyllables was developed using a computerized speech recognition technique, and it was suggested that the system may effectively be used in evaluated maxillectomy patients' speech. However the system showed some disadvantages such as the low sensitiveness for the mild speech disorders. In this study, the system was remodeled employing sentences as test stimuli to overcome the shortcomings. The new system was used to evaluate speech of normal adults and maxillectomy patients. METHODS: The speech of 10 normal adults and 13 maxillectomy patients was evaluated using the automatic conversation intelligibility test system that employed sentences as test stimuli. Normal subjects repeated the test for three times on different days. The patients' utterances were examined in two conditions: with and without prostheses. The results from patients with and without prostheses were compared to each other, and also compared with their corresponding conversation intelligibility obtained using a perceptual method. RESULTS: In normal subjects, there was no significant difference in their scores using the automatic conversation intelligibility test on three different days. The result of the automatic test was significantly improved in patients by wearing prostheses. There were significant correlations between the result of the automatic test and the corresponding conversation intelligibility both in patients with prostheses and without prostheses. CONCLUSION: It was indicated that the automatic conversation intelligibility test system using sentences as stimuli would be effectively used in evaluating maxillectomy patients' speech.

Recurrent calcifying epithelial odontogenic tumor of the maxilla: report of a case with cytologic diagnosis.

BACKGROUND: Calcifying epithelial odontogenic tuor (CEOT) occurs rarely in the maxilla and lacks classical clinicoradiologic features. The cytologic features in conjunction with the radiologic picture can be helpful in making a preoperative diagnosis and guiding management. CASE: A young man with a progressively increasing left cheek swelling and proptosis of the left eye was referred for fine needle aspiration cytology. The smears were paucicellular and showed clusters of mildly pleomorphic squamoid cells; abundant, amyloidlike, pink material; and occasional concentric calcification. A provisional diagnosis of CEOT was given and confirmed on histopathology. CONCLUSION: The characteristic cytologic findings in association with radiologic features can help the cytopathologist in rendering a firm preoperative diagnosis of CEOT even at atypical sites such as the maxilla.

Objective evaluation of infraorbital nerve involvement in maxillary lesions by means of the blink reflex.

OBJECTIVE: To objectively evaluate the effects of maxillary lesions on the infraorbital nerve (ION). METHODS: We investigated the latencies (R1, R2) of the blink reflex, stimulating the infraorbital foramen electrically (18 mA, 0.2 millisecond). Twenty-two patients with unilateral maxillary lesions were enrolled. RESULTS: Ten patients showed delayed or absent R1 on the lesion side. Four of 20 patients showed delayed difference in R2 latency. Ten (77%) of 13 patients with lesions along the ION pathway showed an abnormal blink reflex. Only 3 patients demonstrated a normal blink reflex despite a lesion along the pathway of the ION. All patients whose ION pathway was intact showed a normal blink reflex. CONCLUSIONS: These results suggested that lesions along the ION pathway may impair the afferent pathway of the blink reflex. The blink reflex may be valuable to evaluate maxillary lesions objectively. Furthermore, R1 is more effective than R2 in detecting ION defects.

Peripheral ossifying fibroma--a clinical evaluation of 134 pediatric cases.

PURPOSE: Reported clinicopathologic studies on the peripheral ossifying fibroma (POF), a reactive gingival lesion, have not addressed the pediatric population in specific detail. This study, the first devoted to children, investigated the clinical features of a large number of POFs and compared the findings to cases reported in the English language literature. METHODS: Detailed clinical and historical information of 134 surgically removed POFs in patients aged 1-19 formed the basis of this study. Clinical manifestations, histogenesis, treatment rationale with pediatric considerations, and biologic behavior were emphasized. RESULTS: The POF was found more frequently in females (60%). It had a predilection for the maxillary gingiva (60%) and for the incisor/cuspid region. The average patient age was 14 years. Only 2 (1%) POFs were found to be unequivocally associated with primary teeth. The clinician seldom included the POF in the differential diagnosis. The recurrence rate after surgical excision was 8%. CONCLUSIONS: This study revealed that a POF arising from the periodontal ligament of a primary tooth is most likely a rare event. However, the pediatric patient with a POF has special management considerations compared to the adult. Because of the POF behavior pattern, a proper treatment protocol is warranted with close postoperative follow-up.

Ameloblastoma: a clinical, radiographic, and histopathologic analysis of 71 cases.

OBJECTIVES: The purpose of this study was to compare the clinical, radiologic, and histopathologic features of 71 intraosseous ameloblastomas. STUDY DESIGN: Data with respect to the patients' ages, sex, tumor locations, and surgical treatment history, as well as the radiographic findings and number of recurrences, were analyzed. The histologic types of and radiologic findings regarding tumors with higher recurrence rates were also investigated. RESULTS: The patients' ages at biopsy ranged from 11 to 70 years (mean, 30.4 years). Thirty-nine (54.9%) of the 71 subjects were males, and 32 (45.1%) were females. Sixty-two (87.3%) of the 71 ameloblastomas were located in the mandible. Swelling was the most common symptom and was experienced by 27 (38.0%) patients. Radiographically, 42 (59.2%) of the 71 tumors were unilocular with a well-demarcated border. Of the remaining 29 cases, 14 were multilocular, 2 were of soap-bubble shape, and 13 were unknown in appearance. The most common histologic pattern was plexiform, rather than follicular or acanthomatous. Sixteen cases of ameloblastoma had developed in a cyst. The overall recurrence rate was 21.1%, and the average age of the patient at recurrence was 26.4 years. CONCLUSIONS: When the diagnosis of ameloblastoma in young people remains in doubt after clinical and radiologic examination, a biopsy is necessary. Long-term follow-up at regular intervals after surgery is also recommended.

Acidic environment modifies heat- or radiation-induced apoptosis in human maxillary cancer cells.

PURPOSE: The effects of hyperthermia or irradiation on cell killing and induction of apoptosis were evaluated using human maxillary carcinoma IMC-3 cells and low pH (pH 6.8) adapted cells (IMC-3-pH). METHODS AND MATERIALS: Cellular heat-sensitivity or radiosensitivity was determined using the clonogenic assay. Apoptosis was assessed on the basis of a flow cytometric determination of the DNA content, DNA fragmentation, and poly(ADP-ribose)polymerase cleavage. RESULTS: When IMC-3 cells or IMC-3-pH cells were exposed to heat at 44 degrees C in pH 6.8 medium, an increase in thermosensitivity was observed compared with when the IMC-3 cells were exposed to heat at 44 degrees C in pH 7.4 medium. However, the selective reduction in survival was not observed after irradiation. In IMC-3 cells, apoptosis after heating at 44 degrees C for 60 min in pH 7.4 medium occurred earlier than that after 8 Gy irradiation, although both thermal and irradiated doses decreased the cell count to 10%. The degree of apoptosis after heating at pH 6.8 in IMC-3 cells or IMC-3-pH cells was greater than that at pH 7.4 in IMC-3 cells. However, the degree of apoptosis after 8 Gy irradiation at pH 6.8 in IMC-3 cells or IMC-3-pH cells was smaller than that at pH 7.4 in IMC-3 cells. CONCLUSION: Hyperthermia treatment is more effective at inducing apoptosis than radiation is in tumors that contain a population of low pH adapted cells.

A new nutritional assessment in patients with oral and maxillofacial malignancies.

Combined subjective and objective nutritional assessment was performed on admission in 127 patients with oral and maxillofacial malignancies. On the basis of the nutritional assessment result, three typical nutritional parameters-body weight (BW) (X1), mid-upper-arm circumference (MAC) (X2), and hand grip strength (HGS) (X3) were used to establish a new nutritional assessment method that was developed by a computer-based discriminant analysis. The established model was as follows: Y1 = -126 + 1.09X1 + 1.34X2 + 0.23X3; Y2 = -95.63 + 0.96X1 + 1.17X2 + 0.19X3. In the model Y1 was regarded as good nutrition and Y2 as malnutrition. The larger value of Y stood for the patient's nutritional status (i.e. Y1 > Y2, well nourished; Y1 < Y2 malnourished). The new nutritional assessment correlates well with the combined subjective and objective nutritional assessment with a total agreement rate of 88.2%. With its simplicity and accuracy, the new nutritional assessment deserves a wide application in clinical situation.

Implant-supported prostheses after maxillary cancer resection: preliminary report.

A preliminary study of 4 partial maxillectomy patients who received a total of 17 endosseous implants and implant-supported prostheses after oral cancer resection is reported. The masticatory function index (chewing efficiency) after implant placement was higher than the preoperative value. Speech with an implant-supported prosthesis improved as compared with previous prostheses or without a prosthesis. All of the patients received radiation and adjunctive hyperbaric oxygen therapy. The success rate after a 2-year follow-up period was 88.2 percent.

Transforming growth factor beta 2 in epithelial differentiation of developing teeth and odontogenic tumors.

Dysregulation of TGF beta 2, a modulator of cell growth and differentiation, can result in uncontrolled growth and tumor formation. Our comparative studies on the expression of TGF beta 2 mRNA and protein indicate that TGF beta 2 may primarily be a regulator of epithelial differentiation during tooth development (between 13 and 20 gestational wk) and tumorigenesis of odontogenic neoplasms. A paracrine mode of action for TGF beta 2 in early human tooth germ (cap/early bell stage) is suggested by location of mRNA in the mesenchyme surrounding the tooth germ, whereas protein is found in the epithelial dental lamina and enamel organ. During the late bell stage, TGF beta 2 gene expression shifted from the mesenchyme to the odontogenic epithelium and was colocalized with protein, suggesting an autocrine role for the terminal differentiation of ameloblasts. In odontogenic tumors of epithelial origin (ameloblastomas) and epithelial-ectomesencymal origin (ameloblastic fibromas), TGF beta 2 mRNA was mostly located in the mesenchymal tumor component and protein in the epithelial tumor component. Odontogenic ectomesenchymal tumors (myxomas) were not associated with TGF beta 2 mRNA and protein expression. The results imply that TGF beta 2 may play an important role in epithelial-mesenchymal interactions in human tooth morphogenesis and development of odontogenic tumors.

Physiologic responses to maxillary resection and subsequent obturation.

Aerodynamic assessment of prosthetic obturation provides the clinician with important information on adequacy of the seal between the oral and nasal cavities. The technique is easy to apply and provides quantitative data on effectiveness of obturation. In addition, the pressure-flow technique provides important information on how individuals respond to changes in the integrity of oral and pharyngeal structures. This study demonstrates that individuals with large surgical defects increase respiratory effort during nonnasal consonant productions in order to maintain adequate intraoral speech pressures. Successful obturation of the defect maintains the speech pressures while dramatically reducing respiratory effort.

Aggressive (malignant?) epithelial odontogenic ghost cell tumor.

Although the calcifying odontogenic cyst (COC) is a well-established pathologic entity, it has been recognized that there is an odontogenic neoplasm with histologic features similar to the COC that has often been diagnosed as COC. Investigators have applied several terms to this neoplasm, but we prefer the term epithelial odontogenic ghost cell tumor (EOGCT). No reports have appeared previously in the literature describing either carcinoma arising in a COC or malignant EOGCT. Three cases are reported here with aggressive growth and histologic features strongly implying a malignant potential, although none is known to have metastasized. Two occurred in the maxilla and one in the mandible. One was discovered 9 years following removal of a typical COC, and another recurred rapidly after excision.

Disseminated intravascular coagulation syndrome.

This paper reports a patient with malignant fibrous histiocytoma of the maxilla who developed DIC during the 12-month observation of the hemostatic course, and a case of squamous cell cancer of the tongue associated with post-operative DIC. The triggers in these 2 cases were malignant tumor, infection, shock and operation. Heparin and aprotinin were administered in both cases. Hemostatic improvement was obtained in case 2, but neither cases were cured. The etiology, diagnosis and treatment of DIC are discussed.