[Condylar metastasis. Review of the literature and report of a case]. / Die kondyläre Metastasierung. Literaturrecherche und ein Fallbericht.

BACKGROUND: Metastases in the mandibular condyle are rare. A survey of the literature showed that only 23 of 69 selected cases qualified under the criteria of Meyer and Shklar. REPORT OF A CASE: A 48-year-old white male suffering from a previously operated lung carcinoma was referred due to pain and discomfort in the left TMJ. A solitary condylar metastasis of the mandible was revealed. Because of diffuse tumorous infiltration into periarticular tissue, irradiation treatment was performed. During the long-term follow-up growth of additional skeletal metastases occurred. DISCUSSION: The course of condylar metastases in general is similar to other metastases involving the jaw. Breast cancer as the primary tumor is most frequent, followed by lung cancer. There are no specific clinical or radiological parameters leading to diagnosis. The clinician should take a potential metastasis into account when dealing with TMJ complaints, radiological oddities, and medical history of malignant tumors. For proper treatment planning, diagnosis should be based on histology. Since the diagnosis of metastasis is usually made at an advanced stage of disease, therapy will be mainly intended as palliative.

[Solitary abscessing osteomyelitis of the mandibular condyle. A rarity]. / Die solitäre abszedierende Osteomyelitis des Kieferköpfchens. Eine Rarität.

CASE REPORT: We report on a rare case of secondary chronic osteomyelitis of the left condyle. Haemophilus aphrophilus could be isolated from the abscess material. The condyle was resected and reconstructed with an endoprosthesis in the same operation. DISCUSSION: Possible causes of the rare location of secondary chronic osteomyelitis are assembled in a review of the literature and compared with the actual case. CONCLUSION: We suggest the inoculation of microorganisms through the needle of a local anesthetic injection, bacterial contamination during the tooth extraction, or bacteremia following the dental extraction to be possible causes for the infection.

Observations on pulpal response to carbon dioxide laser drilling of dentine in healthy human third molars.

Preservation of pulpal health is the primary prerequisite for successful application of laser systems in the hard tissue management of vital teeth. The purpose of this study was to investigate the short and long-term pulpal effects to cavity preparations in healthy human teeth using carbon dioxide (CO2) laser. A total of seven, healthy, third molars that were scheduled to be removed due to space problems were used. After the laser drilling, the occlusal cavities were closed temporarily, and the teeth were extracted 7 days (n=5) and 3 months (n=2) after the operation. The specimens were fixed, decalcified, subdivided and processed for light and transmission electron microscopy. Seven days postoperatively all the five teeth that had been irradiated with the CO2 laser did not reveal any pathological changes in the pulpo-dentine complex. Three months postoperatively the two teeth that were prepared with the laser showed subtle but distinct apposition of tertiary dentine that was lined with intact odontoblasts. One of the specimens at 3 months revealed the presence of a mild, but very circumscribed, pulpal infiltration of chronic inflammatory cells subjacent to the cavity preparation. The latter is unlikely to be due to a direct effect of the laser irradiation but a possible consequence of microleakage of oral antigens and/or other tissue-irritating molecules through the temporary restoration and the remaining dentine thickness (RDT). Although these preliminary histological results suggest that the CO2 laser under investigation induced only minimal response of the dentine-pulp complex when used as a hard-tissue drilling tool, with specific energy settings, pulse duration within thermal relaxation time and emitting radiations at 9.6 microm of wavelength, larger clinical trials involving various types of teeth are necessary to reach definite conclusions for large-scale clinical application of the laser device.

Impact of whole body positron emission tomography on initial staging and therapy in patients with squamous cell carcinoma of the oral cavity.

The aim of this study is to evaluate the additional clinical information provided by whole body positron emission tomography (PET) with fluorodeoxyglucose (FDG) for initial staging of patients with squamous cell carcinoma (SCC) of the oral cavity. PET scans from the head to the pelvic floor of 34 consecutive patients (22 male, 12 female; mean age 71 years) with histologically confirmed SCC of the oral cavity were retrospectively evaluated. Clinical information including CT of the head and neck and chest X-Ray or chest CT was compared with information on nodal involvement and distant metastases or secondary tumours obtained with PET. The primary tumour was identified with PET in 33 of 34 patients (97%). In 27 Patients (81%) the clinical N-stage was confirmed with PET. In two Patients (6%) additional pathologic loco-regional lymph nodes were found. In five patients more lymph nodes were identified with CT. Distant lesions were seen with PET imaging in bone, lung, mediastinum, liver and colon. In three patients (6%) distant metastases were correctly identified. In another four patients (12%) a secondary cancer was detected. One false positive finding was described with PET. In five of 34 patients (15%) the additional findings as revealed with PET lead to a change of treatment. Whole body PET provides relevant additional information to a standard clinical staging procedure in patients with oral cavity SCC. The detection of distant metastases and secondary primary tumours can have a great impact on patient management.

Primary chronic osteomyelitis in childhood and adolescence: a retrospective analysis of 11 cases and review of the literature.

PURPOSE: Primary chronic osteomyelitis (PCO) of the jaw is a rare, nonsuppurative, chronic inflammation of an unknown cause. The disease is not age specific. So far, only case reports of this disease with an onset in childhood or adolescence have been described. PATIENTS AND METHODS: Review of the patient data of our department from the past 30 years revealed 11 patients with an early onset of PCO in childhood and during puberty. RESULTS: Demographic data, clinical course, radiologic and histologic examinations, and treatment modalities are described and compared with the literature with special emphasis on the somewhat confusing terminology used for this pathology. CONCLUSION: We present a group of 11 patients with an early onset of PCO of the mandible, which, to our knowledge, is the largest described series to date. The series shows the complexity of this disease in a young patient population, demanding a careful evaluation of each case before initiation of therapy.

Do hardware artefacts influence the performance of head and neck PET scans in patients with oral cavity squamous cell cancer?

OBJECTIVE: The purpose of this study was to evaluate the influence of (68)Ge-based and CT-based attenuation correction as well as two standard image reconstruction algorithms on the appearance of artefacts due to dental hardware. Additionally, the intensity of such artefacts was compared with (18)F-fluorodeoxyglucose (FDG) uptake in patients with known oral cavity squamous cell cancer. METHODS: Thirty-two metallic and non-metallic objects used for dentistry/dental surgery were scanned in a water-bath filled with FDG on a combined PET/CT scanner. Images were reconstructed with either CT-based or (68)Ge-based transmission data and by using iterative reconstruction or filtered backprojection. The intensity of artefacts was assessed visually using a subjective scale from 0 (no artefact visible) to 4 (very strong artefact), and by quantitative measurements. In a second study, images of 30 patients with known squamous cell cancer and dental hardware were retrospectively analysed by two observers, again using a visual assessment grading system. Wilcoxon signed rank test was used for statistical comparisons. RESULTS: Eighteen of 32 objects caused artefacts, which were visible with both attenuation correction methods. CT-based attenuation correction was visually more intense than (68)Ge-based attenuation correction (P<0.0001), and the measured (18)F concentration was also higher (P=0.0002). No difference was found between the reconstruction algorithms. In 28 of 30 patients the primary tumour was visible. FDG uptake in the primary tumour was significantly higher than measured (18)F concentration in artefacts (P<0.0001). CONCLUSION: Attenuation correction of PET images generates artefacts adjacent to dental hardware that mimic FDG uptake. In this series, the primary lesion was discriminated from artefacts.

Laser-induced temperature changes in dentine.

OBJECTIVE: The purpose of this work is to study the temperature rise and potential thermal damage caused during ablation of human dentine using a super pulsed carbon dioxide laser of 9.6-microm wavelength, equipped with a water-cooling spray and scanner system. BACKGROUND DATA: There have been no reports on thermal effects of super pulsed CO2 laser of 9.6 microm wavelength on human dentine recently. MATERIALS AND METHODS: Two different types of samples were investigated to yield data most consistent with a typical clinical situation. Human dentine slices and crown segments were studied at a drilling depth of 1.0 +/- 0.1 mm and 2.5 +/- 0.5 mm, respectively. A control group treated with a conventional hand piece was compared to four laser groups with settings varying from 2 to 8 W. RESULTS: In the laser group demonstrating the highest elevation in temperature of the four studied, dentine slices lased at 2 W for 15 sec showed a mean temperature rise of less than 1.68 degrees C at an ablation rate of 0.86 +/- 0.08 mm. Conventional drilling with a comparable ablation rate of 0.76 +/- 0.59 mm resulted in a mean rise of 2.87 degrees C. The laser groups of crown segments revealed a constant decrease in temperature. SEM observations were lacking the typical morphological changes seen in earlier studies, specifically extensive melting, charring or cracking. CONCLUSION: A maximum rise of mean temperature to 1.68 degrees C in closest vicinity to the pulpal chamber and the morphological unaltered dentine surfaces demonstrate the safe and tissue preserving character of the superpulsed 9.6 microm CO2 laser. The laser caused an even lower temperature rise than conventional drilling. Moreover, the laser showed acceptable efficacy with ablation rates that did not significantly differ from the conventional dental drill.

Temperature mapping of magnetic resonance-guided laser interstitial thermal therapy (LITT) in lymphangiomas of the head and neck.

BACKGROUND AND OBJECTIVE: Lymphangiomas of the tongue and neck are uncommon benign congenital lymphatic tumors. These vascular lesions are difficult to treat, frequently recur, and can cause patients significant morbidity. Treatment may also be complicated by adjacent vital anatomic structures. Magnetic resonance (MR)-controlled laser-induced interstitial thermotherapy (LITT) has been proven to be a noninvasive safe treatment. Real-time monitoring of tissue temperature with thermosensitive sequences allows controlled coagulation necrosis. STUDY DESIGN/MATERIALS AND METHODS: LITT was performed in a lymphangioma specimen ex vivo. In four patients (eight procedures) with lymphangiomas of the tongue and neck, MR-guided LITT was performed with a percutaneous approach in a multiapplicator technique. The laser system consisted of a titanium catheter and a protective catheter. The dome of the fiber end had a diameter of 1.4 mm with an active length of 20 mm. Temperature sensitive sequences were used in a 0.5 T open-configured MR scanner with the proton frequency shift technique to map the spatial and temporal distribution of Nd:YAG laser effects (7 Watts, 30 pulses per second, 10 minutes/location). Postoperative MR follow-up was performed at 1 week and at 3 months. In three patients, partial resection of the tumor was performed 6 months after LITT. RESULTS: In three patients, MR clearly showed a diminished tumor volume. All four patients reported subjective amelioration and in three patients former functional problems, such as speech and swallowing were improved. MR thermometry allowed accurate demarcation of changes by heat and distinction of affected tumor volume (3.0 cm +/- 0.3 cm). The histology of the patients 6 months after LITT showed laser-induced fibrosis of former lymphatic tissue. CONCLUSION: The results suggest that LITT can be performed safely with tissue preserving of vital structures and can be effective in the treatment of deep tumors, such as lymphangiomas. However, given the nature of the lesion, the potential for recurrence exists no matter what modality is chosen.

Diffuse chronic sclerosing osteomyelitis and the synovitis, acne, pustolosis, hyperostosis, osteitis (SAPHO) syndrome in two sisters.

Two sisters with diffuse chronic sclerosing osteomyelitis of the mandible and the humerus and the synovitis, acne, pustolosis, hyperostosis and osteitis syndrome (SAPHO syndrome) are presented. The diagnoses of diffuse chronic sclerosing osteomyelitis at the age of 12 years and 27 years, respectively, were based on typical medical history, clinical symptoms and radiographic, histologic and scintigraphic findings. Because skin lesions and scintigraphic enhancement of the sternoclavicular joints with hyperostosis were present, a SAPHO syndrome was diagnosed in both sisters. Microbiological cultures of biopsy specimens revealed coagulase-negative Staphylococcus aureus at the humerus and Haemophilus parainfluenzae, Streptococcus, Actinomyces and Veilonella species at the mandible. Repeated operative procedures, including decortications, resection and reconstruction, and multiple histologic and microbiologic studies were performed over a period of up to 20 years. Since HLA typing yielded identical gene loci, we suggest that hereditary and autoimmune factors may play a role in the pathogenesis of these cases.

Late sequelae after high midface trauma.

The upper midface area comprises mainly the naso-orbito-ethmoidal (NOE) region which plays a paramount role in facial expression. Fractures of this area often result in neglected bony defects in the fragile periorbital region with major secondary impairments such as traumatic telecanthus, orbital dystopia, and/or enophthalmos. Permanent cranial nerve deficits also can occur as the result of post-traumatic/post-operative sequelae. Seventy-one patients (age range 7-78 years) with severe high midface trauma, treated from January 1989 to December 1996, were reviewed with a minimum follow-up of 2 years. The patient population has been distributed according to the fracture type in three groups: Group 1 (n = 35): Isolated NOE with/without associated central midface injury; Group 2 (n = 22): NOE associated with craniofacial injury and Group 3 (n = 14): NOE associated with orbital displacement. The estimated post-surgical parameters included qualitative and quantitative data from the long-term clinical evaluation. Persistent headache and/or concentration difficulties were mainly noted in Group 1. Smell reduction or anosmia was reported mainly in Group 2. Deficits of the trigeminal and/or the facial nerve were found in Group 3. Enophthalmos and/or telecanthus were predominantly seen with injuries associated with orbital displacement.

Primary chronic osteomyelitis associated with synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO syndrome).

Diffuse sclerosing osteomyelitis may indicate the mandibular localisation of the SAPHO syndrome. Twelve patients with diffuse sclerosis of the mandible were examined for symptoms of the SAPHO syndrome. Nine patients were found to have primary chronic osteomyelitis and eight of these represented a SAPHO syndrome. Results in this series support the hypothesis of an association between primary chronic osteomyelitis and the SAPHO syndrome.

Surgical treatment of fractures of the edentulous mandible.

PURPOSE: This retrospective study presents treatment alternatives for fractures of the edentulous mandible. METHODS: A chart review of 34 patients with fractures of the edentulous mandible was performed. Patients were followed with clinical and radiographic examinations. RESULTS: Five different treatment groups were used, ranging from closed treatment to bone graft augmentation and immediate placement of dental implants. Twenty-five patients showed good bony union. Frequent complications were encountered, including pseudarthrosis, fractured plates, and persistent dysesthesia. Augmentation was more stable when implants were placed simultaneously. CONCLUSION: Treatment needs to be based on the type and location of the fracture and the degree of atrophy. Augmentation in combination with implants appears to be a good treatment for fractures of the edentulous mandible.

The pterygoid hamulus as a pain-inducing factor. A report of a case and a radiographic study.

A case is reported of a patient suffering from untraceable pain in the palate. The hyperplastic pterygoid hamulus appeared to be the cause of his discomfort. A computed tomography study on 20 adult patients revealed a wide variation in the anatomy of this region, but a fairly consistent pattern in the left-right relationship in the same patient.