The impact of lymph node density as a predictive factor for survival and recurrence of tongue squamous cell carcinoma.

The oral tongue is considered the most frequently involved site in cases of oral squamous cell carcinoma (OSCC). Lymph node (LN) density, defined as the number of positive LNs divided by the total number of resected LNs, is considered an important prognostic factor in OSCC; however the cut-off point remains uncertain. A retrospective study was performed involving 104 patients who underwent a glossectomy procedure for oral tongue squamous cell carcinoma (OTSCC) between the years 2008 and 2018. LN density and other related prognostic factors, including pathological N-stage (pN), extranodal extension (ENE), perineural invasion (PNI), and depth of invasion (DOI), were investigated in relation to survival and recurrence rates. pN + stage, the presence of ENE, the presence of PNI, and increased DOI were found to be associated with increased LN density values, as well as lower patient survival and higher recurrence rates. The statistical analysis identified a cut-off point for LN density of 2.5%. In advanced stage disease, LN density values above 2.5% had a significant impact on the survival rate (P = 0.005), as well as the recurrence rate (P = 0.038). In conclusion, in addition to other previously known prognostic factors, LN density may serve as a strong prognostic factor for survival and recurrence in patients with advanced- and early-stage OTSCC.

C-reactive protein concentration as a prognostic factor for inflammation in the management of odontogenic infections.

Our aim was to find out if it is possible to correlate the duration of stay in hospital, the severity of infection, involvement of particular anatomical spaces, white cell count, efficacy of surgical treatment, and fever with C-reactive protein (CRP) concentrations on admission. One hundred patients met our inclusion criteria. After their notes had been examined they were subdivided according to whether the infection of the main facial space involved was less severe, moderately severe, or very severe. The relations between degree of severity and CRP concentration on admission (<100mg/L compared with 100+), age (years), sex, and duration of hospital stay (days) were examined using Poisson regression (because the distribution of characteristics, and particularly the duration of stay, were skewed). The overall model was significant (p=0.003). Pearson and deviance chi square tests did not indicate overdispersion (p=0.97 in both cases), which suggested that the assumptions about the Poisson distribution were valid. Log-rank chi square tests indicated that only severity had a significant effect (p=0.0001), and C-reactive protein concentration was not significantly associated with group on admission, age, or sex. The moderately and very severe groups had longer median (range) durations of stay than the less severe group (5 (2-8) compared with 3 (1-8) days, respectively). CRP concentration was not a prognostic factor for the extent of odontogenic infections or presumed duration of stay, but severity scoring was a significant factor in the prediction of duration of stay in hospital.

Treatment of low subcondylar fractures--a 5-year retrospective study.

The aim of the present study was to retrospectively review the treatment outcome of low subcondylar temporomandibular joint fractures. The retrospective analysis was performed on all patients treated for low subcondylar fractures (below the sigmoid notch) between 2006 and 2011. Patients were divided into two groups: the closed reduction group (maxillomandibular fixation, MMF) and the open reduction group (anteroparotid transmasseteric (APTM) approach). Out of 129 condylar fractures, a total of 37 patients met the inclusion criterion of a fracture below the sigmoid notch (low subcondylar). Ten patients (seven males and three females) were treated using the APTM approach, and 27 patients were treated conservatively by MMF. In the open reduction group, two patients (20%) had limited mouth opening that resolved following physiotherapy; the closed reduction group had a similar percentage (18.5%) of mouth opening limitation (below 35 mm). No facial nerve damage was noted. Adult patients suffering from low subcondylar fractures can be treated by open reduction and internal fixation using the APTM approach, which was found to be a safe and reproducible procedure with no facial nerve damage; however this is a surgical procedure with a shallow learning curve.

Relationship between inferior alveolar nerve imaging and neurosensory impairment following bilateral sagittal split osteotomy in skeletal Class III cases with mandibular prognathism.

Postoperative inferior alveolar nerve (IAN) neurosensory impairment was prospectively evaluated in 20 consecutive patients with mandibular prognathism who underwent bilateral sagittal split osteotomy. Routine presurgical imaging was obtained for all patients in study and control groups (10 patients each). Cone beam CT of the mandibular ramus and body was performed in 10 randomly selected patients (study group) and the precise location of the IAN was determined preoperatively and intraoperatively. Nerve sensation was evaluated by subjectively monitoring the physical feeling of the lower lip and the chin skin preoperatively and at different times postoperatively. Exact nerve location was successfully determined in all 10 cases in the study group. There were almost no significant differences between patients' sensation scores at the chin skin and lip sites. No significant differences were found between the two sides of the 20 patients. A significant increase in the score trend along the timeframes, in both groups, could be clearly seen together with a statistically significant difference (P≤0.004) between the study and the control groups. In conclusion, precisely locating the IAN using CT is a significant means for efficiently minimizing nerve damage during sagittal split osteotomy.

[Peri-implantitis or squamous cell carcinoma?]. / Péri-implantite ou carcinome épidermoïde?

INTRODUCTION: Squamous cell carcinoma developed around dental implants has seldom been described. It simulates peri-implantitis. The authors present two cases and a literature review. CASE REPORTS: A 70 year-old woman presented with an exophytic tumor developed around dental implants placed in the anterior part of the mandible. Panoramic X-rays showed major osteolysis, especially around the distal abutment implants. A 72 year-old patient, smoker, presented with chronic lichen planus; he was carrying two implants supporting an overdenture with ball-attachments, placed 15 years before. He presented with an ulcerated symphyseal tumor, bone loss around implant in position 43. The implant had been spontaneously pushed out. In both cases the diagnosis was squamous cell carcinoma. DISCUSSION: Few cases of squamous cell carcinoma developed around dental implants have been reported. They initially mimic peri-implantitis. The carcinogenic role of the implant has never been established. Another hypothesis is the migration of malignant cells, originating from a mucosal tumor, through the sulcus. Risk factors for squamous cell carcinoma (smoking or alcohol consumption, precancerous lesions) are an indication for a permanent follow-up. Biopsies will prove the diagnosis.

[Surgical management of mandibular condylar fractures in adults in France, 2005]. / Traitement chirurgical des fractures du condyle mandibulaire de l'adulte en France en 2005.

INTRODUCTION: The authors had for aim to present the latest trends in the surgical management of mandibular condylar fractures in France, in 2005. MATERIAL AND METHODS: One hundred maxillofacial surgeons were questioned on the surgical management of condylar fractures and indications. Results were presented at the 41st Congress of Stomatology and Maxillofacial surgery. RESULTS: The overall reply rate was 70%. Condylar fractures are generally managed in teaching hospitals. Open reduction and fixation was deemed appropriate in low subcondylar fractures in 76% of the cases, in 10% for diacapitular fractures. Therapeutic details and indications were a matter of huge variability. DISCUSSION: This survey highlighted the absence of any consensus as far as condylar fractures are concerned. It seems that the higher the fractures are, the lesser they are approached.

[Deep lobe parotid gland lipoma: an extremely rare entity. A case report]. / Lipome du lobe profond de la glande parotide: à propos d'un cas rarissime.

The incidence of lipoma in the parotid gland is very low, and lipomas in the deep lobe of the parotid are extremely rare and seldom considered in the differential diagnosis of deep lobe parotid gland tumours. A deep lobe parotid gland lipoma is presented and discussed.

[Dynamic distraction and early reeducation in proximal interphalangeal joint fractures: preliminary results of a 15 patients' prospective series]. / Traitement des fractures articulaires interphalangiennes proximales des doigts par distraction dynamique et rééducation précoce: résultats préliminaires d'une série prospective de 15 cas.

INTRODUCTION: The authors present early results of the treatment of interphalangeal fractures with external dynamic distractor and early reeducation. PATIENTS AND METHODS: Fifteen proximal interphalangeal fractures were treated with a "do-it-yourself" external distracter. Distraction was performed with rubber band or steel stitches. Patients sustained immediate self-mobilization and physiotherapy. Total duration of the treatment was 45 days. RESULTS: Thirteen patients had good results with normal mobility after three months and recovered 80% of their controlateral force. Algodystrophia occurred in one case with poor functional results. One late management led to severe interphalangeal rigidity. CONCLUSION: External distraction is a safe and economical treatment providing good early results with few complications. Long-term follow-up is necessary to make this procedure a standard-of-care in the management of proximal interphalangeal fractures.

[The styloid process elongation syndrome (Eagle syndrome): a case report].

Eagle syndrome is an aggregate of symptoms that includes recurrent throat pain, foreign body sensation, dysphagia, and/or facial pain as a direct result of an elongated styloid process or calcified stylohyoid ligament. The etiology is poorly understood and several theories have been proposed. The pathophysiological mechanism of symptoms is debated as well. Diagnosis is made both radiographically and by physical examination. Treatment of Eagle syndrome is either surgical or non surgical. A case report of temporomandibular joint pain that has been finally diagnosed as Eagle syndrome is presented and discussed.

[Inferior alveolar nerve repositioning in implant surgery].

Severe resorption of the posterior mandible possesses one of the most difficult restorative challenges to the implant surgery today. This resorption may prevent the placement of dental implants without the potentially damage to the inferior alveolar nerve. To create the opportunity of insertion dental implants of adequately length in those cases, the technique of nerve repositioning has been advocated. The purpose of this article is to describe two cases of nerve repositioning combined with placement of dental implants. Both cases showed appropriate postoperative healing without damage to the inferior alveolar nerve. The inferior alveolar nerve repositioning technique seems to be an acceptable alternative to augmentation procedure prior to dental implants placement in cases exhibiting atrophic posterior mandibular ridges.

[Parapharyngeal and peritonsillar infection following mandibular third molar extraction].

Numerous complications following impacted third molar extractions have been described previously. Among these are swelling, infection, subdermal hematomas, nerve injuries, injuries to adjacent teeth and mandibular fractures. The parapharyngeal space is a funnel-shaped space with its base located at the base of the skull and its apex near the hyoid bone. It is bounded medially by the superior constrictor muscle and the tonsillar fossa and laterally by the medial pterygoid muscle, the mandibular ramus, the deep lobe of the parotid gland and the posterior belly of the digastric muscle. The junction of the buccinator and superior constrictor muscles at the pterygomandibular raphe forms the anterior border. The posterior border is formed by the vertebral column and the prevertebral muscles. Infratemporal and peritonsillar space infections following third molar extractions are relatively rare because of anatomical barriers that exist in that area, but complications of such infections are considered to be highly severe and sometimes even life threatening. These complications include septic thrombophlebitis of the internal jugular vein, septic aneurysms of the internal carotid artery and mediastinitis. This article presents a parapharyngeal and peritonsillar space abscess resulting from a third molar extraction. Several articles reviewed in this paper revealed similar signs and symptoms in parapharyngeal abscesses. The main radiological finding was soft tissue swelling in the prevertebral area. Cultures have demonstrated Klebsiella pneumoniae as the dominant microorganism in these infections. Early identification and correct diagnosis of parapharyngeal and peritonsillar abscesses are necessary to avoid life-threatening complications that may accompany such infections. Airway control should receive top priority in treatment, followed by extensive surgical drainage and administration of high dose organism-specific antibiotics as well as removal of the source of infection.

Orbital infection arising from a primary tooth: a case report.

Odontogenic infections may spread to the orbit by one or more of several paths. Such extension is potentially dangerous and may lead to loss of vision. A case of infection from a primary tooth, which extended to the retrobulbar area is presented in this report. Treatment included surgical drainage of the resulting subperiosteal orbital abscess through a Caldwell-Luc approach as well as aggressive antibiotic therapy. The importance of early suspicion of this entity and its potential sequelae are discussed.

Clinical and radiographic features of eosinophilic granuloma in the jaws: review of 41 lesions treated by surgery and low-dose radiotherapy.

Eosinophilic granuloma within the jaws may radiographically mimic other benign odontogenic cysts and tumors, and different protocols have been suggested in the literature for treating eosinophilic granuloma of the jaws. Forty-one lesions of eosinophilic granuloma, diagnosed in 25 patients, were reviewed retrospectively, and data were collected regarding age, gender, ethnic origin, location, symptoms, clinical appearance, radiographic features, treatment, and recurrence. The lesions were found in youngsters (18.1 +/- 4.7 years of age), mostly in the posterior parts of the mandible, and the most common presenting symptom was pain (92%), often accompanied by swelling. Approximately one half of the lesions were radiographically well defined without ossification. All patients were treated by enucleation (with or without peripheral ostectomy) and radiotherapy; 7.3% lesions recurred during follow-up (9.3 +/- 4.6 years). In addition, the different treatments suggested in the literature for eosinophilic granuloma of the jaws were reviewed.

Burkitt's lymphoma of the oral cavity in Israel.

The clinical presentation of Burkitt's lymphoma in the maxillofacial area is variable. The objective of this study is to review and analyse all cases of Burkitt's lymphoma with oral or maxillofacial involvement diagnosed in our department. A retrospective review of patients with Burkitt's lymphoma in the facial area between the years 1978 and 1997 was undertaken. The patients, 8 male and 5 female, were from 7 to 50 years old (mean 15.3 years). Six patients were Stage I and 7 were Stage II. Five had abdominal involvement and 2 lymph node involvement besides the maxillofacial presentation. Three tumours were in the mandible, 3 in both mandible and maxilla, 2 in the palate, and 5 in the maxilla alone. In 5 patients the tumour presented as a facial swelling, in 3 as an exophytic mass, in 2 as an ulcer, 1 case presented as a hyperplastic lesion, and 2 were periapical lesions. Complaints included pain (7), swelling (5), and sensory disturbance (2). EBV titres were positive in 4 patients. Abdominal involvement was only seen in patients under 12 years old. All patients were treated with chemotherapy, while adjuvant radiotherapy was indicated in 3 cases. Follow-up of 1-20 years revealed a 2-year survival rate of 61.5%. It seems that the Israeli disease is between that of the African and American types, when considering age distribution.

Complications of miniplate osteosynthesis in the treatment of mandibular fractures.

Miniplate osteosynthesis with 2.0-mm screws is being increasingly utilized in the treatment of mandibular fractures, midface fractures, zygomatic fractures, orthognathic surgery, and in craniomaxillofacial surgery. It enables better anatomic reduction, better stability of fracture lines, quick recovery and return of function. To examine complications related to its use, data were compiled from the preoperative, immediately postoperative, and 6-months' postsurgery examinations of 143 patients with isolated mandibular fractures. Sixteen of the patients (11.2%) presented with postoperative complications that were related to the miniplate system. The authors' experience and data support the theory that the complication rate is related more to the surgical approach and technique than to the time elapsed between injury and operation.