Gingival exophytic lesions as first oral manifestation of primary lung adenocarcinomas: Systematic review.

Metastases from malignant tumors in the oral cavity are rare and comprise approximately 1% of all oral neoplasms, being more frequent in the jaws than in the soft tissues. The presentation of a gingival metastasis as the first manifestation of a primary tumor in the oral cavity is extremely rare. The objective of this review is to update the diagnosis and management of oral metastasis being the first clinical manifestation of the tumor and review all the cases published to date, providing a new original clinical case with very specific histopathological characteristics. We systematically reviewed the literature in order to find all the cases of primary lung tumors that appeared with a gingival metastasis as the first manifestation. The search process involved a total of 1916 articles. After reading the latter, 15 (one of them with two different cases) met the inclusion criteria. Of the 15 articles, 6 were rated as medium quality (40%) and 9 as high quality (60%). We present a lung adenocarcinoma that first manifested as a metastasis in the gum, simulating a benign lesion. The unusually high growth rate of this lesion should conduct to have other diagnostic possibilities, and histopathological confirmation is essential.

Clinicopathological features of 214 maxillary sinus pathologies. A ten-year single-centre retrospective clinical study.

BACKGROUND: Diagnosis of maxillary sinus pathology must include the clinical radiological study (CRS) and histopathological analysis. The aim of this study is 1) to describe the clinicopathological features of maxillary sinus lesions, obtained successively in a single medical centre over the last 10 years and 2) to determine the sensitivity and specificity for the diagnosis of malignant lesions based exclusively on the CRS. METHODS: It is a single-centre observational retrospective clinical study on patients who attended the University Hospital Complex of Santiago de Compostela (CHUS) with sinus pathologies during the period of 2009-2019. RESULTS: The sample consisted of 133 men (62.1%) and 81 women (37.9%), with an average age of 46.9 years (SD = 18.8). In terms of frequency, the most frequent pathology was the unspecified sinusitis (44.4%), followed by polyps (18.2%), malignant tumours (9.8%), inverting papilloma (7.5%), fungal sinusitis (4.7%), cysts (3.7%), benign tumours (2.3%), mucocele (2.3%) and other lesions (1.9%). Cysts and benign tumours were diagnosed earliest Vs malignant tumours (65.2 years (SD = 16.1)) were diagnosed the latest (p < 0.001). Based only on the CRS for malignancies, diagnostic indexes were 71.4% sensitivity and 97.9% specificity, with a Kappa value of 0.68 with (p < 0.001). CONCLUSION: Maxillary sinus pathology is very varied with therapeutic and prognostic repercussions. CRS is sometimes insufficient and histopathological confirmation is essential.

Clinical study comparing alveolar distraction using the lead system and MODUS MDO 1.5/2.0.

This article compares 2 different alveolar distractors: Lead System (LS) and MODUS MDO 1.5/2.0 (M-MDO). This is a clinical retrospective study; 32 distractions were performed. We used the LS distractor (intraosseous) on 24 patients and the M-MDO (extraosseous) on the other 8. The variables included bone alveolar ridge height, alterations of the oral mucosa, number of distractors, implant survival, and complications. We also developed descriptive and univariate statistical analysis. The mean increase of bone height after performing the alveolar distraction was 6.15 mm, 5.74 mm with LS, and 8.36 mm with M-MDO (P < 0.0001). The survival rates of the implants in the intraosseous and extraosseous groups reached 100%. However, the use of M-MDO resulted in a significant defect in the alveolar mucosa during implant insertion (100%), an event that did not occur when using LS (P < 0.001). The most common complication in the intraosseous group was the tilting of the segment (25%), whereas, in the extraosseous group, the main difficulty was the rod interference with the opposing arch (75%). Bone defects after alveolar distraction appeared both in the intraosseous group (66.7%) and in the extraosseous group (50%). Both the LS and the M-MDO distractors are effective for alveolar bone distraction. The choice of one distractor over another depends on the clinical characteristics of each case, such as the size and shape of the defect, the patient's tolerance, the distance to the opposing arch, and the surgeon's experience.

Palatal approach for maxillary alveolar distraction.

PURPOSE: The purpose of this report was to describe a surgical technique for performing alveolar distraction in the upper jaw via a palatal approach. PATIENTS AND METHODS: To illustrate this technique we report 2 clinical cases in which palatal-approach alveolar distraction was used to rectify insufficient alveolar rim height. The first case involves a 50-year-old man with atrophy of the alveolar rim in the posterior upper jaw. From the palatal side, a transport segment pedicled to the vestibular mucosa was cut, and 2 Lead System distractors (Leibinger, Kalamazoo, MI) were placed. The second case involves a 23-year-old woman with a bone defect in the alveolar rim in the premaxillary sector of the upper jaw. Again, from the palatal side, a transport segment pedicled to the vestibular mucosa was cut, and a single Lead System distractor was placed. RESULTS: In both cases the height of the alveolar rim was successfully increased by 8 mm, allowing placement of three 12-mm implants in case 1, and two 12-mm implants in case 2. CONCLUSIONS: We recommend a palatal approach and intraosseous distractors for alveolar distraction in the upper jaw.

Minor complications arising in alveolar distraction osteogenesis.

PURPOSE: This study evaluates complications that arise during mandibular alveolar distraction osteogenesis and suggests treatments. METHODS: We monitored complications that arose during alveolar distraction osteogenesis in 5 patients who underwent a total of 7 distractions, in all cases using an intraosseous distractor (Lead System, Leibinger, Germany). We report our responses to each type of complication. RESULTS: All 7 distractions were followed by the placement of 2 implants. The restoration was ideal in 4 of the 7 cases and functional but not ideal in the remaining 3. In all 7 distractions, we observed complications, although many were minor complications readily avoided by the use of appropriate technique. The complications were, first, intraoperative complications, namely 1) fracture of the transport segment (1 of 7 cases; RESPONSE: appropriate preventative measures), 2) difficulties in finishing the osteotomy on the lingual side (7 of 7 cases; RESPONSE: use of fine chisels made from cement spatulas), and 3) excessive length of the threaded rod (1 of 7 cases; RESPONSE: cut the rod). Second, complications arose during distraction: 1) incorrect direction of distraction (2 of 7 cases; no corrective measures necessary in the present cases), 2) perforation of the mucosa by the transport segment (2 of 7 cases; response: smooth the crest of the segment with a bone rongeur), and 3) suture dehiscence (1 of 7 cases; no significant implications). Third, there were postdistraction complications, namely bone formation defects (4 of 7 cases; response: guided bone regeneration). CONCLUSIONS: A number of complications may arise during alveolar distraction osteogenesis. Most of these complications can be considered minor and are readily avoided or resolved by the use of appropriate procedures.