Mandibular involvement of plasmacytoma - Uncommon case report of rare entity.

Solitary plasmacytoma (SP) is an early-stage plasma cell malignancy that is in between monoclonal gammopathy of undetermined significance (MGUS) and multiple myeloma (MM) along the spectrum of plasma cell disorders. SPs can be divided into 2 groups according to location: solitary bone plasmacytoma (SBP) - these occur most commonly in the vertebrae and secondarily in long bones, and extramedullary plasmacytoma (EMP) - these encompass all nonosseus SPs. The etiology is still unknown, and they generally display a destructive course with preponderance of males. Both lesions present a risk of progression to multiple myelom. Its presence in jaws is extremely rare and when it is seen, angulus and ramus mandible are most common sites of occurrence. Histopathological examination and systemic investigation are mandatory for confirmation but support of immunohistochemistry positivity for CD138 was also done for establishing the final diagnosis.

Influence of Resonance Frequency Analysis (RFA) Measurements for Successful Osseointegration of Dental Implants During the Healing Period and Its Impact on Implant Assessed by Osstell Mentor Device.

AIM: This study aimed to investigate and assess primary and secondary dental implant stability during the osseointegration period. METHODS: A total of 77 implants were placed in 42 patients with 26 males and 16 females. The study was conducted by comparing the resonance frequency analysis (RFA) values of the implants inserted in the lower jaw. RFA was done immediately after implant insertion and after 12 weeks. Results were statistically evaluated using SPSS Statistics for Windows, Version 7.1. Level of significance was set at P < 0.05. RESULTS: Significant differences were detected between the primary and secondary stability values, respectively. Maximum RFA value of 88 and the minimum value of 52 were observed. Stability values increased during the following three months, and all implants were successfully integrated without complication. CONCLUSION: Our results indicate and suggest that there is a strong linear correlation between implant stability and ISQ values that can be directly estimated by the RFA, especially in the posterior edentulous mandible. Osstell implant device could represent a useful tool which can be used to identify the risk for implant failure.

Promotor hypermethylated genes: Prospective diagnostic biomarkers in oral cancerogenesis.

The advancements in epigenetics of oral squamous cell carcinoma (OSCC), are made in regard to DNA hypermethylation of MGMT, DAPK, ECAD (E-cadherin) and p16, as an important component of oral carcinogenesis and new potential biomarkers in molecular diagnostic strategies. The objective of the study was to evaluate the methylation status of the proposed genes and their possible role in the tumor genesis and diagnosis of OSCC. MATERIALS AND METHODS: From sixty surgically treated and molecularly analyzed patients, we obtained three groups of bioptical materials: tumor, normal contralateral and healthy tissues. Comparison of the frequencies of DNA methylation for all transcripts was utilized to validated their potential role in the cancerogenesis and detection of OSCC. RESULTS: The most often methylated genes in the tumor samples were ECAD, MGMT, DAPK followed by p16 genes (90% vs 75% vs 75% vs 52,5%), respectively. We observed frequent methylated genes in contralateral mucosa and consistently unmethylated- 0% in healthy samples. ECAD methylated genes showed the highest sensitivity for diagnosing OSCC in tumor and contralateral tissues (90% and 89,7% respectively, with a specificity of 100%). CONCLUSION: ECAD and MGMT have tumor-specific signatures and can be considered as potential noninvasive diagnostic biomarkers in OSCC.

Brown Tumour in the Mandible and Skull Osteosclerosis Associated with Primary Hyperparathyroidism - A Case Report.

BACKGROUND: The hyperparathyroidism (HPT) is a condition in which the parathyroid hormone (PTH) levels in the blood are increased. HPT is categorised into primary, secondary and tertiary. A rare entity that occurs in the lower jaw in association with HPT is the so-called brown tumour, which an osteolytic lesion is predominantly occurring in the lower jaw. It is usually a manifestation of the late stage of the disease. Osteosclerotic changes in other bones are almost always associated with renal osteodystrophy in secondary HPT and are extremely rare in primary HPT. This article reports a rare case of a brown tumour in the mandible as the first sign of a severe primary HPT, associated with osteosclerotic changes on the skull. CASE REPORT: A brown tumour in the mandible was diagnosed in 60 - year old female patient with no previous history of systemic disease. The x - rays showed radiolucent osteolytic lesion in the frontal area of the mandible affecting the lamina dura of the frontal teeth, and skull osteosclerosis in the form of salt and pepper sign. The blood analyses revealed increased values of PTH, calcitonin and ß - cross-laps, indicating a primary HPT. The scintigraphy of the parathyroid glands showed a presence of adenoma in the left lower lobe. The tumour lesion was surgically removed together with the lower frontal teeth, and this was followed by total parathyroidectomy. The follow - up of one year did not reveal any signs of recurrence. CONCLUSION: It is critical to ensure that every osteolytic lesion in the maxillofacial region is examined thoroughly. Moreover, a proper and detailed systemic investigation should be performed. Patients should undergo regular check-ups to prevent late complications of HPT.

Oncocytoma of the Deep Lobe of the Parotid Gland.

BACKGROUND: Oncocytoma or oxyphilic adenoma is uncommon salivary gland tumour, occurs predominantly in the in patients older than 60 years of age. Clinically oncocytoma resemble other salivary tumours while histology is typically consisting of oncocytes with many hyperplastic mitochondria. It usually occurs in the parotid gland. Because the features of oncocytoma are similar to those of other benign and low-grade malignant salivary tumours, clinical diagnosis is often challenging. CASE PRESENTATION: This report presents the pathologic and imaging findings of an oncocytoma arising in the deep lobe of the right parotid gland in a 74-year-old male. Oncocytoma was diagnosed on the basis of histological, magnetic resonance imaging (MRI), scintigraphic findings and fine needle aspiration cytology (FNAC). CONCLUSION: This case was unique because in the literature there are few articles about the rare presentation and deep lobe location of this type of parotid oncocytoma.

Mandibular Movement Restoration in a Child with Bilateral Coronoid Hyperplasia: A Case Report.

BACKGROUND: Coronoid process hyperplasia is an uncommon finding, characterized by an enlargement of the coronoid process, causing a mechanical obstacle by its interposing in the posterior portion of the maxilla or zygomatic arch. CASE PRESENTATION: The article presents a case report of a bilateral coronoid process hyperplasia in a 3-year-old girl demonstrated with inability to open the mouth and restricted jaw movement. Panoramic x-ray and 3-dimensional computed tomographic reconstruction showed bilateral elongation of the coronoid processes associated with deformation of the mandibular condyle with no involvement of the articular space. A coronoid resection by intraoral approach was done, followed by an aggressive physiotherapy. A considerable improvement in mouth opening of 30 mm was achieved. We strongly suggest early surgical treatment of coronoid hyperplasia to recover morphology and function consequently to reduce skeletofacial deformities in young patients. CONCLUSIONS: The article presents a clinical and surgical case of bilateral coronoidectomy in a 3-year-old girl, with retrognathic mandible. The diagnosis of bilateral coronoid process hyperplasia was confirmed, and the surgical treatment was under general anesthesia, with nasotracheal intubation guided by a nasofiber endoscope, using an intraoral approach.

Cortisol level and hemodynamic changes during tooth extraction at hypertensive and normotensive patients.

BACKGROUND: The patients that are subjects to oral-surgical interventions produce large amounts of steroids in comparison with healthy patients which are not a subject to any dental intervention. The aim of research was to determine the level of stress hormone cortisol in serum, arterial blood pressure and arterial pulse, and to compare the effectiveness of the usage of lidocaine with adrenalin in comparison with lidocaine without adrenalin during the tooth extraction. PATIENTS AND METHODS: This clinical research includes patients with indication of tooth extraction divided in hypertensive and normotensive patients. RESULTS: There is no important statistical distinction between groups, for the cortisol levels before, during and after tooth extraction regardless of the type of anesthetic used, while we registered higher values of systolic and diastolic values at hypertensive patients, regardless of the type of anesthetic. CONCLUSION: There is significant systolic and diastolic blood pressure rise in both groups of patients hypertensive and normotensive patients, (regardless of anesthetic used with or without vasoconstrictor), who underwent tooth extraction. The special emphasize is attributed to hypertensive patients where these changes are more significant. As per cortisol level and pulse rate, our results indicate no significant statistical difference in between groups.

Multiple pathohisthological parameters influencing prognosis and survival of oral cancer patients.

UNLABELLED: The aim of this study is to determine the prognostic value of available clinical and histological parameters to predict subclinical nodal metastases and survival. For that purpose we used a modification of the Jakobsson [9] grading system proposed by Richard W. Nason [12] and applied it to a series of patients with oral carcinoma. Correlation between histological parameters and cervical lymph node metastasis were made and the chi-square test showed a strong significant association between mode of invasion, depth of tumor invasion, vascular invasion and cervical metastases. Analysis of overall survival showed that overall survival strongly correlates with cervical node metastases (p=0.0004). We found that overall survival correlates with vascular invasion (p=0.005) and also overall survival correlates with tumour depth (p=0.001). There is a strong relationship between malignancy score and survival (p=0.00001) and a high malignancy score is associated with poor prognoses. PATIENTS: a total 32 with over 14 points of malignancy score, 25 (78.1%) died and 7 (21.9%) are alive. Analysis of the risk factors for subclinical cervical metastases in patients with oral cancer is important for predicting prognosis and achieving a high survival rate.