Fibrodysplasia ossificans circumscripta of the masseter muscle.

Fibrodysplasia ossificans circumscripta (FOC) is a lesion characterized by localized calcification of the investing fascia of skeletal muscle. It is often related to repeated trauma and was formerly known as traumatic myositis ossificans. Surgical procedures involving muscles are also believed to be a factor in the origin of the lesion. When FOC develops in the muscles of mastication it can lead to severe trismus. A case is reported of FOC in the left masseter muscle of a 44-year-old man who presented with marked limitation of opening. It was believed that previous fractures of the left maxilla and mandible and/or the subsequent surgical treatments were responsible for the onset of FOC. The radiographic and microscopic features of FOC are discussed in relation to recent theories on the etiology, pathogenesis, and treatment of the lesion.

Toxic exposure sign: Desert Shield/Desert Storm.

As part of the Desert Shield/Desert Storm Registry at the VA Medical Center, Allen Park, Michigan, we have evaluated more than 600 patients since 1992. More recently, we have taken notice of patients appearing with common oral findings that were repetitive and similar in appearance. Their cause is currently unknown. We present our findings. Continuous evaluations will be performed and likewise reported.

Sarcoidosis. Report of two cases with oral involvement.

Sarcoidosis is a multisystem granulomatous disease in which pulmonary involvement is the most characteristic feature. Even though extrapulmonary manifestations occur infrequently in the area of the head and neck an occasional patient will have oral involvement. As we will demonstrate in these case reports, sarcoidosis should be included in the differential diagnosis of oral and perioral papular lesions noted on examinations of the head and neck.

Thoracic malignant fibrous histiocytoma metastatic to the tongue and skin of the face.

A 60-year-old white man was found to to have metastatic malignant fibrous histocytoma in the tongue and facial skin 15 months after diagnosis of the primary lesion in the thorax. This is believed to be only the fourth reported case of this tumor metastatic to the oral cavity and the first lingual metastasis from outside the jaws.

Condyloma acuminatum in the oral cavity: four cases and a review.

The number of reported cases of condyloma acuminatum has increased rapidly in recent years. While the viral etiology of these lesions has been established, differentiation from other papular growths is often difficult. Reports of condyloma acuminatum lesions in the oral cavity are appearing more frequently, although they still are sparse. Four cases of oral condyloma are described, and the English-language literature on other such cases is reviewed. Presumably, as the incidence of this type of infection continues to increase, oral condylomata will become a commoner diagnosis. Physicians and dentists should be aware of the necessity of recognizing wart-like eruptions in and around the oral cavity.

Dental treatment and late prosthetic joint infections.

Hospital and dental charts of 2,693 patients in whom total prosthetic joints had been placed at the Veterans Administration Hospitals of Ann Arbor and Allen Park, Michigan, as well as at The University of Michigan Hospital, were analyzed. Of the thirty (1.1%) late prosthetic joint infections (greater than 6 months after placement), only one (0.04%) could be temporally associated with dental treatment. A Fisher's exact test of the data reflected that dental treatment in this population did not increase the incidence of late prosthetic joint infections (p value is 0.0005). Nine of the thirty late infections occurred in insulin-dependent diabetic patients and patients on long-term immunosuppressive therapy. An analysis of the organisms isolated from the late infections shows that 54% where Staphylococcus epidermidis and Staphylococcus aureus. These data do not support the practice of prescribing prophylactic antibiotic coverage of prosthetic hip and knee joints prior to all dental therapy. Rather, use of antibiotics during dental treatment appears warranted only if a chronic bacteremia is anticipated or where a predisposing systemic condition may exist.

Cowden's disease (multiple hamartoma syndrome).

A case report of Cowden's disease has been presented along with a discussion of its multiple system involvement. Its association with thyroid and breast malignancy make its differentiation from other or similar disease entities vital.

Evaluation of osteogenesis following immediate and delayed reimplantation of frozen autogenous mandibular bone.

A follow-up study of the feasibility of delayed reimplantation of frozen autogenous mandibles after ablative surgery for oral carcinomas with mandibular involvement was performed. Fifteen young adult mongrel dogs were used and evaluated clinically, bacteriologically, radiographically, histologically, and by radionuclide imaging. The animals were divided into two groups according to whether they underwent immediate or delayed reimplantation. These were subdivided into those who received grafts with and without autogenous marrow augmentation. The results were positive and suggested clinical evaluation. Twelve patients had undergone delayed reimplantation along with marrow augmentation over the past 3 years. Again, the results are most promising and we believe that, with further refinement, this technique will offer a new and acceptable modality for facial reconstruction in the cancer patient.

Frozen autogenous mandible as an immediate replacement graft.

A study in animals was designed to examine the feasibility of grafting autogenous frozen mandible. Two groups of animals were used. In the first group, periosteum was elevated from the bone before resection. In the second group, the periosteum was removed with the resected specimen. Osteogenesis was shown by clinical, radiographic, fluorescence, and histologic studies in both groups of animals. The same technique was performed in nine humans with carcinomas that involved the mandible. The results were encouraging. We believe that immediate or delayed reconstruction with autogenous frozen mandible in a patient undergoing ablative surgery of the head and neck with involvement of the bone may offer the patient, as well as the surgeon, another acceptable treatment modality.

Oral squamous-cell carcinoma within a white-sponge nevus.

A 59-year-old woman had thick plaques of leukoplakia on the tongue bilaterally. The condition was initially diagnosed by biopsy as a white-sponge nevus. A second biopsy of a suspicious area on the right side showed squamous-cell carcinoma two years later. It is speculated that prednisone therapy for steroid-dependent intrinsic asthma may have caused a loss of "immunologic surveillance," which permitted development of malignancy in a previously benign condition.

Myositis ossificans traumatica of the masseter muscle. Report of a case.

A case of myositis ossificans traumatica has been reported. Clinical, histopathologic, and roentgenographic entities have been referred to. An up-to-date review of the literature on this disorder has been presented.