Necrotizing sialometaplasia of the parotid gland associated with facial nerve paralysis.

INTRODUCTION: Necrotizing sialometaplasia is a benign inflammatory lesion involving most frequently the minor salivary gland of the hard palate. Involvement of the parotid gland is rare, involvement of the parotid gland associated with facial palsy is exceptional. CASE REPORT: A 56-year-old male patient with Marfan syndrome presented with swelling and inflammation of the left parotid gland associated with progressively complete facial nerve paralysis. CT scan and MRI showed a parotid collection with hyper signal of the nearest tissues associated with erosion of the styloid process. A malignant tumor was suspected. The histological examination of a biopsy showed a lobulocentric process with necrosis, squamous metaplasia, and inflammation. The immunohistochemical examination supported a final diagnosis of necrotizing sialometaplasia. DISCUSSION: Necrotizing sialometaplasia of the parotid gland associated with facial nerve paralysis presents like a malignant neoplasm, both clinically and histologically. Only advanced immunohistochemical examination can really confirm the diagnosis.

[Fatty tumors of the jaws]. / Tumeurs adipeuses des mâchoires.

Intraosseous lipoma is a benign tumor of the bone. It is mostly seen in the metaphyses of the long bones and calcaneus. There are few documented cases of intraosseous lipomas in the jaw. Clinically, the lesion is usually silent and radiologically it appears as a radiolucent area rarely including some radio-opacities. Diagnosis is based on clinical, radiological and histopathological features. Surgical removal of the lesion is the recommended treatment.

[Potentially malignant character of oral lichen planus and lichenoid lesions]. / Caractère potentiellement malin du lichen plan buccal et des lésions lichénoïdes.

INTRODUCTION: Many authors have reported the possible malignant transformation of oral lichen. The incidence of this event remains controversial. Many authors make a distinction between the "true" oral lichen planus (OLP) and lichenoid lesions (LL) according to the WHO clinical and histological classification. For these authors an increased risk of development of oral cancer could occur only on LL. Our aim was to check this hypothesis on a cohort followed for 10 years. MATERIAL AND METHODS: We included patients who were referred to our team for the first time between 1995 and 1997, still followed in 2010, with a histological diagnosis of buccal lichen planus. We classified lesions as OLP or LL according to the WHO clinical and histological classification: the two clinical criteria for OLP were a reticulated aspect and bilateral and symmetric lesions. Three histological criteria were necessary for the diagnosis: dense inflammatory infiltrate in the upper lamina propria, liquefaction degeneration of basal keratinocytes, and no signs of dysplasia. The final diagnosis was OLP, when all clinical ad histological criteria were met otherwise it was LL. We studied the patient's outcome between their first consultations and May 2010. RESULTS: Thirty-two patients, whose data was available, met inclusion criteria. Eight were diagnosed with OLP and 24 with LL. The mean follow-up was 164 months [154-183]. No oral cancer was observed in the OLP group. Two patients in the LL group presented with oral cancer after 45 and 143 months of follow-up. DISCUSSION: Malignant transformations were observed only in the LL group. Our results correlate with those of Van Der Meij et al. published in 2006. The strict use of the WHO diagnostic criteria seems to allow identifying patients at risk of developing oral cancer (LL) and others with only a benign course of this chronic oral mucosal disease. These results need to be confirmed by prospective multicentric studies.

Efecto antiinflamatorio de la enoxolona en un modelo exvivo de mucosa gingival humana / Antiinflammatory effect of enoxolone in an exvivo model of human gingival mucosa

Introducción. Este estudio tenía por finalidad precisar las modalidades de utilización y el mecanismo de acción antiinflamatoria de la enoxolona contenida en un dentífrico y en una solución bucal. Material y método. Por medio de un modelo de encía humana mantenida con sobrevida, se pudo inducir una reacción inflamatoria mediante la aplicación de mediadores proinflamatorios (SP y LPS) y realizar, en doble ciego contra placebo, una evaluación de los parámetros histológicos y bioquímicos (IL8) de la inflamación previa aplicación del dentífrico. Para la solución bucal, la evaluación bioquímica se realizó por dosificación del IL 1. Resultados. El dentífrico generó una disminución significativa del edema, de la dilatación de los capilares y de la excreción del IL8. La solución generó una disminución de la excreción del IL l. Discusión. La enoxolona ejerce un efecto antiinflamatorio, cualquiera sea el vehículo utilizado.

[Anti-inflammatory and repair activity of two toothpastes in an ex-vivo human gingival mucosa model]. / Comparaison de l'effet anti-inflammatoire et réparateur de deux dentifrices sur un modèle expérimental de muqueuse gingivale humaine.

INTRODUCTION: Our aim was to compare the anti-inflammatory activity of two toothpastes, one including enoxolone 1%, the other including plant extracts and sodium bicarbonate. MATERIAL AND METHODS: Gingival fragments were kept alive ex-vivo. Inflammation, inflammatory mediators (SP and LPS) were applied to culture medium on contact with corium to induce inflammation. The effect of both toothpastes was assessed with histological and biochemical parameters (inflammatory cytokine IL8) of inflammation on the synthesis of collagen and cellular viability. RESULTS: Both toothpaste "A" including enoxolone at 1% and "P" including plant extracts and sodium bicarbonate were effective on edema and vasodilatation. "A" acted on IL8 synthesis, unlike "P". Both toothpastes boosted collagen synthesis by fibroblasts. The percentage of cellular viability for "A" was superior to the currently admitted standard (80%), unlike to "P". DISCUSSION: The mechanisms of action of each toothpaste seem to be different. "A" modulates pro-inflammatory cytokine IL8 expression, unlike "P". The toothpaste "A" seems to be better tolerated.

[Potentially malignant disorders of the oral mucosa: terminology and classification]. / Affections potentiellement malignes de la muqueuse buccale: nomenclature et classification.

The last WHO expert workgroup recommended abandoning the distinction between potentially malignant lesions and conditions. The term to use is "potentially malignant disorders". Leukoplakia is the most common of these disorders, while erythroplakia is rather rare. The diagnosis is still made by excluding other documented white or red lesions. Despite progress in molecular biology, no marker allows predicting malignant transformation. These lesions are treated surgically with or without dysplasia. It is unknown if this surgery can really prevent transformation into squamous cell carcinoma. The potential malignancy of oral lichen planus is still debated. The risk of malignant transformation is lower than that of leukoplakia. No treatment may prevent this. Other potentially malignant conditions such as oral submucous fibrosis, actinic cheilitis, lupus, and immunodeficiency are rare.

[Anti-inflammatory effect of enoxolone in an ex-vivo human gingival mucosa model]. / Effet anti-inflammatoire de l'enoxolone dans un modèle ex-vivo de muqueuse gingivale humaine.

INTRODUCTION: Our aim was to assess the modalities of use and the anti-inflammatory activity of enoxolone included in toothpaste and in a mouthwash solution. MATERIAL AND METHODS: We used gingival fragments kept alive during 3 days at 37 degrees C. To induce inflammation, inflammatory mediators (SP and LPS) were applied to culture medium on contact with corium. The toothpaste versus placebo was applied on epithelium, in double blind. Histological analysis was then performed on hematoxylin and eosin stained slides. Edema was evaluated with semi-quantitative scores. Vasodilatation was studied by counting the percentage of dilated vessels according to scores and the surface of these dilated vessels by morphometrical image analysis. An inflammatory cytokine, IL8, was measured in culture supernatants. Dosing IL1alpha tested the mouth solution. RESULTS: The toothpaste induced a significant decrease of edema, vasodilatation, and IL8 excretion. The enoxolone solution induced a decrease of IL1alpha. DISCUSSION: Enoxolone demonstrated an anti-inflammatory property whatever the carrier was.

[Jaw muscle tumors]. / Tumeurs musculaires des mâchoires.

Muscular tumors are rare. They hardly ever present in jaws. Rhabdomyoma have never been reported in this localization. Clinical and radiological features are non-specific. The diagnosis is based on histopathological features. It is difficult to make for leiomyosarcoma. Surgical excision is the recommended treatment, conservative for leiomyoma, radical for other malignant tumors. Rhabdomyosarcoma has a good prognosis unlike leiomyosarcoma.

[Nasolabial cyst]. / Kyste nasolabial.

Nasolabial cyst is a rare epithelial and non-odontogenic cyst of the jaw. It is situated behind the ala nasi, extending backwards into the inferior nasal meatus and forward into the labio-gingival sulcus. Predominant symptoms are swelling of the nasal vestibule, local pain, and nasal obstruction. Radiology is not specific and CT scan may be contributive. Surgical excision is the first line treatment; it proves the diagnosis and prevents recurrence.

[Langerhans cell histiocytosis]. / Histiocytose langerhansienne.

Langerhans cell histiocytosis (ex histiocytosis X) is usually present in children. It is a clonal proliferation of non-functional Langerhans's cells. Histological aspects are variable. The diagnosis is made in immunolabeling by anti-CD1a. Clinical presentations are variable, depending on their extension. Three syndromes are actually the same pathogenic process: eosinophilic granuloma (single or multiple osseous localizations), Hand-Schüller-Christian disease (chronic form with bone and visceral dissemination) and Abt-Letterer-Siwe disease (disseminated and acute malignant presentation).

[Nasopalatine duct cyst]. / Kyste du canal nasopalatin.

The nasopalatine cyst is the most common epithelial and non-odontogenic cyst of the maxilla. It is of embryological origin. It is different from a radicular cyst. The diagnosis is based on radiographic and histological data. The treatment is enucleation. The surgical approach depends on the size of the cyst and its anterior or posterior extension. Excision must be total to avoid relapse which may occur beyond 5 years. Long-term follow-up is essential.

[Desmoplastic fibroma]. / Fibrome desmoïde.

Desmoplastic fibroma is a rare benign intraosseous neoplasms. They can affect the jaw. Posterior mandibular bone involvement is the most frequent localization. They are locally aggressive and recurrence is frequent. Radioclinical signs are not specific and the histological diagnosis may be difficult. Extended surgical removal is the recommended treatment.

[Carcinoma of the lips]. / Carcinomes des lèvres.

Epidermoid carcinoma, that is, squamous cell carcinoma of the skin, is the most common malignant tumor of the lips. It occurs especially in men. Its primary causes are sun exposure, smoking, and chronic irritation. Leukoplakia is the most frequent precancerous lesion. Epidermoid carcinoma may appear clinically as a scaly erosion or an ulceration. Standard treatment is surgical excision with reconstruction.

[Osteoradionecrosis and dental implants]. / Ostéoradionécrose sur implants dentaires.

INTRODUCTION: Osteoradionecrosis (ORN) is a severe complication of radiation therapy (RT). A triggering factor is frequently present. It is often a dental, periodental, or surgical traumatism. We report the case of a bilateral ORN: the first lesion appeared 3months after the end of RT around the osteosynthesis plate and was treated by mandibular resection. The second lesion appeared 40months after RT on the opposite side, due to peri-implantitis. Dental implants had been inserted 10years before cancer therapy. No case of ORN in post-implantation RT had been previously reported. CASE REPORT: A 75-year-old woman was admitted for a squamous cell carcinoma of the right cheek extending to the intermaxillary commissure, the maxillary tuberosity, the soft palate, the lingual junction, and the vestibule up to the second premolar area. There was no suspicious lymph node. She had undergone dental implant procedure 15 and 10 years before, respectively, one in the second premolar position of the right maxilla and four in the premolar and molar left mandible area. All of them were osseo-integrated and charged. A trans-mandibular buccopharyngectomy with modified radical neck dissection was performed, completed by RT. The total dose of irradiation was 65Gy in the oral cavity and 45Gy on cervical and supraclavicular areas. Delayed mucosal healing was observed on the right mandible and ORN appeared in this area 3months after the end of irradiation. Mandibular resection was necessary. Later, the right maxillary implant was lost, and multiple dental extractions were required. Forty months after RT, peri-implantitis was observed on the left side of the mandible, complicated by ORN and pathological fracture. No surgical reconstruction could be performed because of the patient's age and state. The patient was carrying a complete removable maxillary prosthesis on latest follow-up. DISCUSSION: This was the first case of ORN on dental implants placed before RT. RT is a risk factor of implant failure, a relatively rare and unpredictable event. Most often, it causes implant loss and exceptionally ORN. In our case, ORN was bilateral. The first lesion was probably due to surgical trauma. The second one, on the opposite side, was caused by peri-implantitis. Irradiation overdose on the alveolar mandibular ridge, close to the implant, may have been the cause. In our case, there was no severe pain, and slow evolution led to a pathological fracture.

[Cat-scratch disease localisation in the parotid gland]. / Localisation parotidienne d'une maladie des griffes du chat.

INTRODUCTION: Cat scratch disease is an infection due to Bartonella henselae. It is one of the principal causes of benign chronic adenopathy in children or young adults. CASE REPORT: A 36-year-old woman presented with a left parotid pre-auricular swelling suggesting a pleiomorphic adenoma. The history and complementary tests (ultra sonography, MRI, cytopuncture, B. henselae serology) led to a diagnosis of cat scratch disease. Doxycilline was efficient within 15 days. DISCUSSION: The parotid localization of cat scratch disease is very rare. When a patient presents with parotid swelling, the distinction between a tumor and lymph node is not easy. Performing complementary tests can be in balance with a quicker but sometimes inappropriate surgical indication. The diagnosis is made even more difficult because of delayed specific serologic tests as for B. henselae.

[Wound healing effect of Eludril in a model of human gingival mucosa]. / L'effet cicatrisant d'Eludril sur un modèle de muqueuse gingivale humaine.

INTRODUCTION: The aim of this study was to evaluate and to compare the potential for wound healing of the buccal mucosa with the use of two mouth rinses; one containing 0.10% chlorhexidine with alcohol, the second containing 0.12% chlorhexidine without alcohol. MATERIAL AND METHOD: Using a model of human buccal mucosa kept alive ex vivo, an immunohistochemical assessment of the mitotic potential of epithelial cells and a biochemical evaluation of the capacity of the fibroblasts of the gingival mucosa to synthesize collagen was performed. RESULTS: A mouth rinse containing 0.10% chlorhexidine with alcohol (Eludril) did not alter the potential for epithelial proliferation and for collagen synthesis within the gingival chorion grown in survival conditions. The results revealed a significant difference between the two mouth rinses for each of the parameters studied. The most favourable results were obtained with the mouth rinse containing alcohol. DISCUSSION: The presence of alcohol in a mouth rinse containing 0.10% chlorhexidine has no deleterious effects on healing capacity. On the contrary, it helps stimulate wound healing. The combination of chlorhexidine plus alcohol is superior for healing, chlorhexidine alone does not show any significant difference compared with the control.