Juvenile ossifying fibroma of the midface.

Juvenile ossifying fibroma is an unusual maxillofacial fibro-osseous lesion characterized by cell-rich osteoid strands. A 7-year-old girl presenting with a massive juvenile ossifying fibroma of the maxilla resulting in facial deformity, orbital displacement, and extension into the anterior skull base is discussed. The importance of combining clinical, radiographic, and histopathological findings for the diagnosis and management of the tumor is discussed.

Langerhans' cell histiocytosis of the jaw bones. Report of 11 cases.

Eleven cases of Langerhans' cell histiocytosis of the jaw bones are reported. The clinical and radiographic features are described, and the role of the dentist in the diagnosis and management of this disorder is discussed.

Maxillary ameloblastoma: a retrospective study of 13 cases.

Ameloblastoma is uncommon in the maxilla, comprising about 15% of all reported ameloblastomas. Ameloblastomas are locally aggressive and, when involving the maxilla, potentially lethal. The long term outcome of 13 patients with ameloblastoma in the maxilla for whom surgery was the primary treatment between 1951-1990 was studied. Patient records from both private and public practices in Melbourne, Australia were examined as were those cases reported to the Bone Tumour Registry at the University of Bristol, England. The study showed that control of disease was achieved in all patients where the tumour was limited to the confines of the maxilla (10 cases). The mean follow-up period in this group was 7 years (range 2-20 years). In the three cases that recurred all had preoperative radiological evidence of posterior maxillary sinus wall destruction and/or pterygoid plate erosion. Two patients died of extensive local recurrence and one has persistence of the disease. Histopathological examination confirmed the diagnosis of ameloblastoma in each case with a variety of histological patterns being noted. It is concluded that notwithstanding histological type, the extent of the tumour at presentation and the adequacy of the surgical approach and removal were the main factors in successfully managing the disease.

Behavioral and tissue responses to severe phosphorus depletion in cattle.

Two-year-old Aberdeen Angus heifers were depleted of phosphorus (P) by loss of phosphate in saliva from a parotid gland fistula combined with a low-P diet. The inorganic phosphate concentrations (Pi) of plasma, parotid saliva, ruminal fluid, and feces were reduced, but cerebrospinal fluid Pi was unaltered. Plasma Pi fell to less than 1.0 mM in 12 wk, and the cows displayed an avid appetite for old bones. P-deficient cows preferred old weathered bones to fresh bones until the latter had aged for approximately 1.5 yr. They did not eat blood, peritoneal fat, or meat, fresh or aged for 2-3 yr. They did not eat Na or Ca phosphate salts or bone heated to greater than 250 degrees C. P-replete cows did not take or eat bones. The behavioral effects of P deficiency were associated with failure to gain body weight and maintain condition, significant bone changes indicated by reduced bone weight and specific gravity, osteopenia indicated by radiology, evidence of reduced bone formation indicated by plasma osteocalcin levels and histology, and abnormal estrous cycles. Prolonged P deficiency was associated with increased plasma concentrations of total Ca and 1,25-dihydroxyvitamin D and reduced plasma concentrations of parathyroid hormone.

Direct immunofluorescence of oral mucosal biopsies: a comparison of fresh-frozen tissue and formalin-fixed, paraffin-embedded tissue.

The diagnosis of some oral mucosal diseases can be facilitated by the use of direct immunofluorescence. Fresh frozen tissue is preferred when using this technique, however frequently the material received by the histopathology laboratory has been fixed in formalin. Enzyme digestion of tissue sections glued to glass slides prior to incubation with antibodies was shown in this study to give comparable results with direct immunofluorescence on fresh frozen tissue and can be used for diagnostic purposes when fresh frozen tissue is unavailable or not representative of the disease process.

Involucrin expression in some oral lichenoid lesions.

The aim of this investigation was to assess the reproducibility of a study which reported that involucrin could be used as a diagnostic marker in oral lichenoid lesions. Twenty-eight formalin-fixed, paraffin-embedded specimens were examined. They included tissue from 13 patients with lichen planus, 11 with drug-related lichenoid reactions, one with dysplasia in a lichenoid lesion and three with normal oral mucosa. In each case the biopsy site was the buccal mucosa, PAS stained smears for fungi were negative and immunofluorescence results supported the diagnosis. An immunoperoxidase technique was used to demonstrate involucrin reactivity. In all sections there was consistent positive staining for involucrin in the superficial layers of the epithelium and all the basal layers were negative. In conclusion there were no demonstrable differences in the involucrin reactivity between the different lesions.

Oral submucous fibrosis. Case report and review of the literature.

A case history and brief literature review of oral submucous fibrosis is presented. This condition is most frequently found in the Indian subcontinent and only rarely encountered elsewhere. The aetiology is considered to be related to dietary habits and customs found in the population. The condition has a known malignant potential. With increasing migration to Australia from the Indian subcontinent the condition should be known and recognized by clinicians.

Langerhans cell disease associated with pathological fracture of the mandible.

A 27-year-old male suffered a fractured mandible following extraction of a tooth. It was subsequently found that the fracture occurred in an area pathologically weakened by a localized lesion of Langerhans cell disease. Since lesions of the jaws may be seen either as the first manifestation or as a complication of widespread Langerhans cell disease, the dentist has a major role in the diagnosis and management of such cases.

Monosodium glutamate-related orofacial granulomatosis. Review and case report.

A case is reported in a 15-year-old white girl who had a swollen lower face and lips; a diagnosis of orofacial granulomatosis was made. It was suspected that her condition had an allergic basis because an increase in clinical signs and symptoms was shown to be related to the food additive monosodium glutamate. Treatment with a restricted diet resulted in resolution of the facial swelling.

Primary angiosarcoma of the oral cavity.

Primary malignant vascular tumours of the oropharynx are rare. This report is of a 69-year-old Vietnamese female with a malignant vascular lesion involving the floor of the mouth and the pharynx.

Assessment of the value of immunofluorescence microscopy in the diagnosis of oral mucosal lichen planus.

Accurate diagnosis of oral mucosal lichen planus (OMLP) is essential if appropriate management is to be instituted. Direct immunofluorescence microscopy (DIF) has facilitated the diagnosis of some dermatologic diseases with oral manifestations, but its use in the diagnosis of OMLP is less well documented. In the present study, 165 biopsies from consecutive cases for which a provisional diagnosis of OMLP was suggested clinically or on the basis of routine histopathologic, or DIF assessment were studied. In 27 cases the results of DIF were non-contributory. In 13 cases the diagnosis could only be established by DIF examination. Nine cases clinically diagnosed as OMLP were assigned to a different condition on the basis of routine histology and DIF. It was concluded that DIF was an integral step in the diagnosis of OMLP.

A clinical-pathological study of 53 intra-oral pleomorphic adenomas.

Conflict exists with respect to the type of pleomorphic adenoma (PA) most likely to recur and whether the possibility of recurrence can be determined by the histology of the lesion. In this study, specific clinical, histological features and treatment modalities were examined in 53 intra-oral PA's with respect to their relevance to the diagnosis and prognosis. No correlation was found between the duration of symptoms and the proportion of stroma in the PA's nor was there any correlation between the size and the duration. However, at the time of diagnosis, the stroma-poor tumours had attained a significantly larger size than the stroma-rich tumours. This may suggest that the cellular tumours grow at a faster rate. Hyaline cells were shown to be a distinct feature of intra-oral PA's, especially in the stroma-poor subtypes. The proportion of the stroma and the capsule integrity do not seem to influence the prognosis. Follow-up information was obtained for 51% of the patients, and despite the fact that the majority of the lesions (33/53) were treated by excisional biopsy, no recurrences were reported. The follow-up period ranged from 0.6 to 12.6 years (mean 5.3 years).

Dentinoma of the mandible.

A case of dentinoma, a rare odontogenic tumor of the mandible, is reported, with a description of the clinical and histologic findings. A brief discussion of the differential diagnosis of this entity and other odontogenic tumors with similar clinical and histologic features is provided.

Recent studies of bone appetite in cattle.

Cows depleted of phosphorus by loss of saliva from a parotid fistula and low dietary phosphate developed an avid appetite for bones. The behaviour is innate and predominantly cued by olfactory stimuli. Meat, blood or fat were not attractive and bones became more attractive after aging for 1.5-2.0 years. The appetite was also shown for guano-derived rock phosphate and bird excreta. There was no interest in inorganic calcium and phosphate salts or ashed bone. The attractant is therefore an organic constituent of aging bone and was found to be at highest concentration in the marrow fraction. Water, ether and vacuum distillation extracts of old bone or marrow, added to unattractive materials e.g., ashed bone, rendered them attractive. The residues of such extraction were of diminished interest. The attractiveness of the fractionated extracts was highest in the neutral fraction. The bone appetite was abolished by increasing the phosphate concentration in plasma but not in cerebrospinal fluid. The phosphate concentration in the blood appears, therefore, to regulate the bone appetite. The sensors could be in brain regions without a blood-brain barrier. Chronic severe phosphorus deficiency was associated with bone resorption, reduced osteoblastic and hemopoietic activities, and abnormal blood progesterone cycles.

Oral pulse granuloma: clinical and histopathological features. A review of 62 cases.

Clinical and histopathological features of 62 cases of oral pulse granuloma were reviewed and compared to the cases previously described in the literature. Oral pulse granuloma is a histopathological diagnosis for a localized lesion resulting from the implantation of food particles of plant origin. It often occurs in the posterior regions of an edentulous mandible in association with a full lower denture but it may also be found in periapical areas of grossly decayed teeth or retained roots and teeth with a history of endodontic therapy, where the root canal has been left open at some stage, associated with impacted lower third molar teeth with a history of pericoronitis, in post-extraction tissue reactions or as part of a cyst wall where there has been a communication with the oral cavity. The essential histopathological features consist of a connective tissue stroma containing variable numbers of inflammatory cells and foreign-body giant cells associated with hyaline rings and ovoid fibrillary or amorphous hyaline masses. Treatment is by local curettage or excision.

The pathogenesis of oral pulse granuloma: an animal model.

Oral pulse granuloma is one of the terms used to describe oral inflammatory lesions characterized microscopically by the presence of giant cells and hyaline rings. The various names proposed for these lesions reflect the lack of agreement regarding their pathogenesis. One theory advanced claims that the process represents a foreign-body granulomatous reaction to implanted vegetable particles, more specifically those of pulses/legumes. In this study an animal model was developed where homogenized cooked legumes were implanted into the orofacial region of rats. Animals were killed at varying intervals ranging from one day to six months and the tissues associated with the implanted material were removed and processed for light microscopy. The experimentally produced lesions had many features similar to those found in humans, the similarities becoming more pronounced with time. The results indicate that the cellulose moiety of food particles of plant origin accidentally implanted into human tissues may cause the granulomatous reaction known as oral pulse granuloma.

Direct immunofluorescence in the diagnosis of oral mucosal diseases.

Direct immunofluorescence is an important technique in establishing the diagnosis of a variety of diseases. It has become a useful adjunct to the diagnosis of oral mucosal diseases, yet many practitioners find the field confusing. This paper summarises the published findings and presents a table for ready reference for clinicians.

Intra-oral benign solid oncocytoma.

Oncocytomas are extremely uncommon in the intra-oral minor salivary glands, they are rarely reported in the literature and the histopathology and clinical details are inadequately documented. This has led to uncertainty with regard to the behaviour and prognosis of this type of lesion. A case of benign solid oncocytoma arising from intra-oral minor salivary glands is reported here with a brief review of the pertinent literature.