Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology - Articles in Press

Corrected Proof

Wolfgang Zemann — 2012-05-17

Synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome affecting the mandible is rare. Primarily for this reason, there is still no generally accepted treatment strategy. Deng et al. reported an interesting case of a patient suffering from SAPHO syndrome involving the mandible. They presented the results of a single case treated with roxithromycin and concluded that this conservative approach seemed to be effective. This is consistent with other reports in which the usefulness of antibiotic treatment (roxithromycin, tetracycline, clindamycin, macrolides) has been described. Deng et al. considered that medical treatment should be attempted before considering surgical intervention because of the potentially severe complications, including paresthesia of the lower lip, facial asymmetry, mandibular dysfunction, and reconstruction-related complications after surgery.

Comparison of spatial and contrast resolution for cone-beam computed tomography scanners - Corrected Proof

2012-05-16

Objective: The purpose was to evaluate the perceived spatial and contrast resolution for a wide range of cone-beam computed tomography (CBCT) devices. Study Design: A customized polymethyl methacrylate (PMMA) phantom was developed. Inserts containing a line-pair and rod pattern were used. The phantom was scanned with 13 CBCT devices and 1 multislice CT (MSCT) device using a variety of scanning protocols. The images were presented to 4 observers for scoring. Results: The observer scores showed excellent agreement. A wide range was seen in image quality between CBCT exposure protocols. Compared with the average CBCT scores, the MSCT protocols scored lower for the line-pair insert but higher for the rod insert. Conclusions: CBCT devices are generally suitable for the visualization of high-contrast structures. Certain exposure protocols can be used for depicting low-contrast structures or fine details. The user should be able to select appropriate exposure protocols according to varying diagnostic requirements.

A comparative evaluation of the systemic and local alendronate treatment in synthetic bone graft: a histologic and histomorphometric study in a rat calvarial defect model - Corrected Proof

Hulya Toker, Hakan Ozdemir, Hatice Ozer, Kaya Eren — 2012-05-14

Objective: The purpose of this study was to compare the relative efficacy of systemic and local alendronate treatment of synthetic bone graft in a rat calvarial defect model. Study Design: Forty Wistar rats were divided into 4 groups: experimental animals received alendronate systemically or locally combined with micro-macroporous biphasic calcium phosphate (MBCP) graft material. In the control group, the defect was left empty. On each animal, a 5-mm standardized bone defect was created with a standard trephine bur in calvarium. All animals were killed after 8 weeks. The number of osteoclasts, osteoclast morphology, resorption lacunae, osteoblastic activity, and lamellar bone formation were histopathologically evaluated and the newly formed bone area was analyzed histomorphometrically. Results: Eight weeks after surgery, the number of osteoclasts and the resorption lacunae in the MBCP group using systemic alendronate therapy was significantly higher than those of the other groups (P < .05). Osteoblast number in the MBCP group using systemic alendronate treatment was significantly increased (P < .05). No significant difference was found among all MBCP groups using local or systemic alendronate treatments with regard to new bone formation (P > .05). Conclusions: Within the limits of the study, alendronate, when administered systemically or locally, did not increase bone regeneration with MBCP graft in the rat calvarial defect model.

Gorham-Stout syndrome of the facial bones: a review of pathogenesis and treatment modalities and report of a case with a rare cutaneous manifestations - Corrected Proof

2012-05-14

Gorham disease is a very rare condition associated with spontaneous destruction and resorption of 1 or more bones anywhere in the body. Many authors have suggested and/or implicated trauma as the initiating factor in the majority of the reported cases. It can affect almost all bones, and a combination of bones has been reported. In the maxillofacial skeleton, the first facial case was reported by Romer in 1928. Until now, only a few cases of Gorham disease affecting the maxillofacial bones, including this case report, have been reported. We present a brief review of the pathogenesis and treatment modalities of the disease and report a very rare clinical picture of the disease affecting a young and otherwise healthy patient with massive osteolysis of the mandibular bone and extensive involvement of the mouth floor and skin of the chin, which to our knowledge, is the only case report with skin manifestation affecting the maxillofacial region. Such skin manifestations play an important role for the diagnosis and add a clue for management of such condition.

The clinical and radiographic characteristics of condylar osteochondroma - Corrected Proof

Qinggong Meng, Si Chen, Xing Long, Yong Cheng, Mohong Deng, Hengxing Cai — 2012-05-14

Osteochondroma is one of the most common benign bone tumors, but it is rare in the mandibular condyle. The purpose of this study was to increase the clinical and radiographic cognition of osteochondroma in the mandibular condyle. Thirty-four patients with radiographic and pathologic features of unilateral condylar osteochondroma were included in this retrospective study. All cases received clinical and radiographic examinations before tumor resection. Common manifestations included facial asymmetry, hypomobility, malocclusion, joint dysfunctions, and even external auditory canal stenosis. Osteochondroma might arise on the different condylar areas, such as the medial aspects (55.9%), anterior-superior (11.8%), posterior-superior (11.8%), lateral (8.8%), and generally enlarged (11.8%). The tumor formed a pseudojoint under the anterior eminence in 55.9%; the affected mandible presented normal shape in 58.8%; and horizontal mandibular deviation was caused by the tumor or elongated ramus in 70.6%. The condylar osteochondroma may locate in different positions encircling the condyle, which increases recognition and diagnosis of these lesions.

Mandibular lateral shift induces the increased expression of TGF-β, VEGF, and Col-II in the condyle of rat temporomandibular joints - Corrected Proof

Mengjie Wu, Xinping Lin, Zhiyuan Gu, Ting Xu, Li Liu, Yiqun Zhou — 2012-05-14

Objective: The present study evaluates histologic changes to and expression of angiogenic factors in rats with mandibular functional shift (MFS). Study Design: After 1, 2, and 4 weeks of MFS, rats in the experimental and control groups were killed. Histologic micrographs of the ipsilateral condyle cartilage were obtained. The localization and expression of vascular endothelial growth factor (VEGF), transforming growth factor beta (TGF-β), and type-II collagen (Col-II) in temporomandibular joints (TMJs) were evaluated through immunohistochemical staining. Results: The results showed that structural changes in the condyle cartilage could be observed 2 weeks after MFS. TGF-β expression reached its peak 2 weeks post-MFS, whereas VEGF and Col-II reached their peaks 4 weeks posttreatment. Conclusions: Compressive forces applied to the TMJ could enhance the expressions of VEGF, TGF-β, and Col-II, and activate angiogenesis. The proteins appear to play important roles in the remodeling of the TMJ.

Nonsebaceous lymphadenoma of salivary gland: report of a case with immunohistochemistry and review of the literature - Corrected Proof

Francesca Angiero, Angelita Ferri, Gabriella MariaValente, Giorgio Cattoretti — 2012-05-14

Objective: Nonsebaceous lymphadenomas are rare benign neoplasms. We emphasize the role of immunohistochemistry and attempt to elucidate the pathogenesis by investigating the distribution of 2 transcription factors, MYC and BLIMP1. Study Design: A 70-year-old man was evaluated for a 3-cm left parotid mass. Ultrasound-guided fine-needle aspiration biopsy findings were suggestive of a diagnosis of pleomorphic adenoma. A left superficial parotidectomy was performed, and based on histopathology a diagnosis of lymphadenoma, nonsebaceous type, was rendered. Results: The tumor was positive for AE1/3, CKA, BclII, P63, CD79a, CD3, and MYC; focally positive for CK7 and epithelial membrane antigen; and negative for CD10, calponin, CD117, and BLIMP1. Conclusions: The rarity of nonsebaceous lymphadenoma and its superficial resemblance to commoner salivary gland tumors may present a diagnostic challenge for pathologists. The expression of MYC in the ductal component and the differentiation-related expression of PRDM1 in the superficial keratinizing layers point to a potential role for these 2 transcription factors in the pathogenesis of this neoplasm.

Recurrent unilateral submandibular swelling - Corrected Proof

Ibrahim O. Bello, Ahmed Qannam, Ahmed Sulaiman — 2012-05-14

A 27-year-old female patient from the Republic of Yemen presented to the Oral and Maxillofacial Surgery Department, College of Dentistry, King Saud University, with a 2-year history of a recurrent, painful submandibular swelling. She described the pain as an intermittent, dull ache in the right lower jaw region that becomes worse after meals. The pain was relieved with over-the-counter analgesics, such as nonsteroidal anti-inflammatory drugs. Her past history was significant for asthma and anxiety. Clinical examination revealed a somewhat enlarged, nontender, soft right submandibular gland. The gland was milked for saliva. Normal saliva was driven out of the gland with no signs of purulence or decreased flow. No hardened masses or calculi were felt on palpation of the Wharton duct or the gland itself. The overlying mucosa was normal. The overlying skin was nonpulsatile, and of normal color and temperature. A requested orthopantomogram (OPG) showed no radiographic abnormality within the submandibular region. This was followed by an ultrasound examination, which showed an essentially normal-appearing gland apart from dilatation of some of the ducts.

1,25Dihydroxy vitamin D3 improves titanium implant osseointegration in osteoporotic rats - Corrected Proof

Chenchen Zhou, Yunfeng Li, Xuemei Wang, Xueping Shui, Jing Hu — 2012-05-14

Objective: This study aimed to investigate the effects of 1,25(OH)2D3 on implant osseointegration in osteoporotic rats. Study Design: Twelve weeks after bilateral ovariectomy, each rat had 2 titanium screws implanted in the proximal tibiae. All animals were then randomly divided into 2 groups: control (10 rats) and 1,25(OH)2D3 (10 rats). 1,25(OH)2D3 was administered through oral gavage at 0.1 μg/kg/d, and control animals were given vehicle. Eight weeks later, tibiae with screws were harvested for μCT, histologic, and biomechanical analysis. Results: Compared with control, 1,25(OH)2D3 increased percent bone volume by 96.0%, percent osseointegration by 94.4%, mean trabecular number by 112.5%, mean trabecular thickness by 51.8%, trabecular connective density by 38.0%, and decreased trabecular separation by 39.3% in μCT analysis. The 1,25(OH)2D3 increased bone area density by 1.2-fold and bone-to-implant contact by 1.5-fold in histomorphometry, and increased the maximal push-out force by 2.0-fold in biomechanical test. Conclusions: The 1,25(OH)2D3 improves implant osseointegration in osteoporotic rats.

Enormous aneurysmal bone cyst of the mandible: case report and radiologic-pathologic correlation - Corrected Proof

Galal Omami, Reji Mathew, Dennis Gianoli, Alan Lurie — 2012-05-14

A 33-year-old patient with a huge aneurysmal bone cyst (ABC) was imaged using cone-beam CT, MRI, and angiography. ABC is an uncommon non-neoplastic, expansile lesion of bone. Although common in the appendicular skeleton and spine, only 2% of the lesions occur in the craniofacial skeleton. The plain radiographic features of gnathic ABC may show an omni-expansile unilocular or multilocular radiolucency. Fluid-fluid levels have been reported in cystic compartments of ABCs; however, this feature is not diagnostically specific for ABC. In this article, we present a case of a rapidly growing, extraordinarily large ABC of the posterior mandible, with emphasis on comparative imaging features of this lesion in cone-beam CT, MRI, and carotid angiography.

Dosimetric distribution to the tooth-bearing regions of the mandible following intensity-modulated radiation therapy for base of tongue cancer - Corrected Proof

2012-05-14

Objectives: Osteoradionecrosis is a significant complication following head and neck radiotherapy. The purpose of this study was to determine the intensity-modulated radiation therapy (IMRT) dosages delivered to the tooth-bearing regions of the mandible. Study Design: A total of 28 patients with base of tongue cancer with the following stages: T1-2/N2-3 (n = 10), T3-4/N2-3 (n = 10), and T1-4/N0 (n = 8), treated with IMRT, were included. Average mean and maximum doses were calculated for the anterior, premolar, and molar regions. Results: Lower doses were seen in anterior bone with smaller tumors. Large tumors, regardless of laterality, resulted in high doses to the entire mandible, with anterior bone receiving more than 6000 cGy. Conclusions: Tumor size is important in preradiation dental treatment planning. This information is important in planning pre- and postradiation dental extractions. Dosimetric analyses correlating mean and maximum point dose with clinical presentation and outcomes are needed to determine the best predictor of osteoradionecrosis risk.

Bizarre parosteal osteochondromatous proliferation of the maxilla: a case report - Corrected Proof

2012-05-14

Bizarre parosteal osteochondromatous proliferation (BPOP) is a rare benign lesion of bone, known as Nora's lesion. The lesion often behaves like a malignant tumor, clinically and microscopically. BPOP usually occurs in the small tubular bones of the hands and feet, and a lesion arising in the oral and maxillofacial region is extremely rare. In this report, we present a case of BPOP arising in the maxilla of an adult woman, in the absence of trauma. After the initial lesion was excised, the patient began orthodontic treatment. The lesion recurred twice, both times appearing in almost the same location. Finally, the lesion was excised via marginal resection of the maxilla. In this case, it is suspected that the orthodontic treatment may have affected the recurrence of BPOP, because there was no history of trauma.

Alveolar ridge augmentation for implant fixation: status review - Corrected Proof

Ibrahim E. Zakhary, Hatem A. El-Mekkawi, Mohammed E. Elsalanty — 2012-05-14

This literature review was performed to illustrate and compare different alveolar ridge augmentation procedures before dental implant placement. The review was based on clinical and research studies listed in Pubmed. There is not enough evidence to support any single method as gold standard for any given condition, and choice seemed to be based on personal preferences. There is a lack of long-term survival data or success rates of grafting materials regarding donor and recipient sites. Although ridge splitting and distraction osteogenesis techniques eliminate donor site morbidity, circumvent the use of grafting materials, and reduce the operation time, some disadvantages and limitations should be considered. More studies are needed to compare the fate and characteristics of new bone obtained by these different procedures, as well as subsequent implant survival rates.

Metachronous clear cell carcinoma of the tongue and kidney: a diagnostically challenging coincidence - Corrected Proof

2012-05-14

Clear cell carcinomas (CCCs) account for 1% of carcinomas of the salivary glands. A 63-year-old woman presented with a painless, nonulcerated, nodular mass on the right side of the tongue, without palpable neck nodes. After excision and cryotherapy of the mass, the histologic evaluation revealed CCC. At the age of 55, she had undergone radical nephrectomy for CCC of the kidney which extended into the renal vein (pT3aN0). Although she had remained metastasis-free during the follow-up, the clear cell morphology raised the possibility of late lingual metastasis of the renal CCC. A clinical search for metastases, and a series of immunostainings and analysis of the von Hippel–Lindau gene were therefore performed on paraffin-embedded blocks of both tumors: Primary metachronous CCC of the tongue was diagnosed. This case illustrates the diagnostic challenge posed by CCC of the tongue if there is a history of CCC of the kidney.

Unusual large tongue ulcer - Corrected Proof

Soulafa A. Almazrooa, John Ouano, Sook-Bin Woo — 2012-05-14

A 67-year-old woman was seen by an oral and maxillofacial surgeon for a 4-week history of right tongue soreness and numbness. She was aware of the lesion as she was recovering from gastrointestinal surgery after which she had been intubated in the intensive care unit for 7 days. This lesion had been present continuously since then. Her medical history was significant for breast cancer treated with lumpectomy, gastric ulcer, gastroesophageal reflux disease, pneumonia, and osteomyelitis of the foot. At the time of presentation, she was on pantoprazole, fluticasone, and salmeterol. For her current complaint, she was using a mixture of viscous lidocaine, diphenhydramine, aluminum hydroxide, and magnesium hydroxide, and 0.12% chlorhexidine oral rinse. She had a history of allergy to penicillin which caused a rash. She had smoked half a pack of cigarettes per day for 20 years and had quit less than a year prior. She drank 7 alcoholic drinks per day and worked as an administrative assistant. The patient was well appearing, alert, and oriented. She appeared to be well nourished, although her speech was thick. The patient reported mostly numbness of the tongue, with occasional soreness. There was no facial asymmetry, swelling, or lymphadenopathy. Intraoral examination revealed a tender ulcerated defect on the right lateral and dorsal tongue measuring 3.0 × 2.5 cm. The area was slightly indurated, but the wound did not appear to be infected (). Several days later, when she returned for a biopsy and management of the lesion, she reported that a piece of tissue had “fallen out” from her tongue ().

Treatment of mucous membrane pemphigoid with the combination of mycophenolate mofetil, dapsone, and prednisolone: a case series - Corrected Proof

Konrad Staines, Philip J. Hampton — 2012-05-14

Mucous membrane pemphigoid (MMP) is an autoimmune blistering disorder characterized by inflammation, blistering, and scarring and predominantly occurring at mucous membranes. Successful treatment can be challenging, and uncontrolled disease may result in significant morbidity with scarring of the conjunctiva and oropharynx leading to blindness and dysphagia, respectively. We report safe successful treatment of 6 patients with significant MMP-related oral inflammation with the use of a previously unreported combination of mycophenolate mofetil, dapsone, and prednisolone given at relatively low doses. We propose that this combination of treatments should be investigated further.

A novel c.1255G>T (p.D419Y) mutation in SH3BP2 gene causes cherubism in a Turkish family - Corrected Proof

Nuriye Dinckan, Yeliz Guven, Hulya Kayserili, Oya Aktoren, Oya Zehra Uyguner — 2012-05-14

Cherubism (MIM no. 118400) is a rare autosomal dominant disorder characterized by bilateral multilocular lesions of the upper and lower jaws. The lesions usually manifest clinically during early childhood, progress until puberty, and regress in adulthood. SH3BP2 is the only gene currently known to be associated with cherubism. This study began with an 8-year-old boy who was referred owing to overgrowth of mandible. A panoramic radiograph revealed multilocular radiolucent lesions of the upper/lower jaws, suggestive of cherubism. Sequence analysis of SH3BP2 revealed a novel c.G1255T change in exon 9 of the gene where 80% of the disease-causing mutations were observed. We report here the clinical and molecular findings of a family with 3 affected members in two generations showing variable clinical expressivity with the regression of symptoms with advancing age and the lack of penetrance.

Keratocystic odontogenic tumor: a recurrence analysis of clinical and radiographic parameters - Corrected Proof

Fadi Titinchi, Christoffel J. Nortje — 2012-05-14

Objective: The aim of this study was to analyze the clinical and radiologic features of keratocystic odontogenic tumors (KCOT) and their recurrence patterns. Study Design: The authors undertook a retrospective analysis of 145 histopathologically proven KCOT. Recurrence was analyzed for age, sex, site, size, radiographic appearance, treatment, and association with nevoid basal cell carcinoma syndrome (NBCCS). Results: The mean age at presentation was 34.5 years, with a male predilection. Most KCOT (75.2%) were located in the mandible, with the posterior regions being most commonly affected. Radiographically, the majority of KCOT were unilocular (71.0%) in appearance, and 16.5% had scalloped margins. There was no significant association of recurrence rate with sex, site, size, radiographic appearance, and treatment. However, KCOT had significantly higher recurrence associated with age (P < .01) and NBCCS (P = .001). Conclusions: Most clinical and radiologic features of KCOT were similar to earlier reports. Recurrence was significantly associated with second and eighth decades of life and NBCCS.

Endoscopic-assisted resection of peripheral osteoma using piezosurgery - Corrected Proof

2012-05-11

Endoscopic-assisted surgery has gained widespread popularity as a minimally invasive procedure, particularly in the field of maxillofacial surgery. Because the surgical field around the mandibular angle is extremely narrow, the surrounding tissues may get caught in sharp rotary cutting instruments. In piezosurgery, bone tissues are selectively cut. This technique has various applications because minimal damage is caused by the rotary cutting instruments when they briefly come in contact with soft tissues. We report the case of a 33-year-old man who underwent resection of an osteoma in the region of the mandibular angle region via an intraoral approach. During surgery, the complete surgical field was within the view of the endoscope, thereby enabling the surgeon to easily resection the osteoma with the piezosurgery device. Considering that piezosurgery limits the extent of surgical invasion, this is an excellent low-risk technique that can be used in the field of maxillofacial surgery.

Deep venous thrombosis: report of 2 cases - Corrected Proof

Sanjog O. Chandak, Prashant K. Pandilwar — 2012-05-10

Postsurgical deep venous thrombosis (DVT) is an established complication with rare incidence in maxillofacial surgery. We report 2 cases of postsurgical proximal DVT after hemimandibulectomy from 2000 to 2009 along with pathogenesis, clinical findings, and management of DVT.

Xerostomia and salivary hypofunction in vulnerable elders: prevalence and etiology - Corrected Proof

Bing Liu, Michael R. Dion, M. Marianne Jurasic, Gretchen Gibson, Judith A. Jones — 2012-05-07

Objective: The goal of this article is to review existing research on the prevalence and etiology of dry mouth in the vulnerable elders and identify knowledge gaps. Study Design: Vulnerable elders (VE) are persons aged >65 years who have any or all of the following: limited mobility, limited resources, or complex health status. A systematic search was conducted of PubMed sources from 1989 to May 2010. Evidence was evaluated on the prevalence and etiology of xerostomia and salivary gland hypofunction (SGH) in VE. Results: The search identified 1,422 publications. The inclusion/exclusion criteria yielded 348 articles, 80 of which are cited herein. Conclusions: Research has showed a high prevalence of xerostomia and SGH in VE. Common etiologies include medications, poor general health, female gender, and age. Gaps still exist in the evaluation of dry mouth in VE. Nonetheless, oral dryness will remain an important health issue as life expectancy increases.

A comparative evaluation of pain and anxiety levels in 2 different anesthesia techniques: locoregional anesthesia using conventional syringe versus intraosseous anesthesia using a computer-controlled system (Quicksleeper) - Corrected Proof

Senem Özer, Mehmet Yaltirik, Irem Kirli, Ilhan Yargic — 2012-05-07

Objective: The aim of this study was to compare anxiety and pain levels during anesthesia and efficacy of Quicksleeper intraosseous (IO) injection system, which delivers computer-controlled IO anesthesia and conventional inferior alveolar nerve block (IANB) in impacted mandibular third molars. Study Design: Forty subjects with bilateral impacted mandibular third molars randomly received IO injection or conventional IANB at 2 successive appointments. The subjects received 1.8 mL 2% articaine. Results: IO injection has many advantages, such as enabling painless anesthesia with less soft tissue numbness and quick onset of anesthesia as well as lingual and palatal anesthesia with single needle penetration. Conclusions: Although IO injection is a useful technique commonly used during various treatments in dentistry, the duration of injection takes longer than conventional techniques, there is a possibility of obstruction at the needle tip, and, the duration of the anesthetic effect is inadequate for prolonged surgical procedures.

Characterization of the osseointegration of Algipore and Algipore modified with mineralized collagen type I - Corrected Proof

2012-05-07

Objective: Algipore is a clinically established bone substitute. The present study evaluated the osseoconductive and resorptive characteristics of Algipore modified with collagen type I (ACI). Study Design: Three defects of 10 × 3 mm were set in the frontal bone of 10 adult female minipigs. One cavity was filled with commercially available Algipore, and the second with ACI. The third cavity was left unfilled and served as reference. After 4 months of healing, the animals were humanely killed. Bone formation and resorption characteristics of the substitutes were evaluated histomorphologically and histomorphometrically using Donath's sawing and grinding technique. Results: Neither material caused inflammatory reactions. Compared with controls, both substitutes showed significantly higher fractions of trabecular bone (control: 42.2%; Algipore: 58.7%, [P < .001]; ACI: 53.6%, [P = .013]). After 4 months, the remaining fraction of Algipore was 42.2% and the fraction of ACI was 47.9% (P = .016). Conclusions: The present study demonstrates that the modification of Algipore with collagen I does not show any benefits compared with pure Algipore in small calvarial bone defects in minipigs.

Postprocedural inflammatory inferior alveolar neuropathy: An important differential diagnosis - Corrected Proof

Benjamin I. Silbert, Stefan Kolm, Peter L. Silbert — 2012-05-07

Lingual or inferior alveolar nerve (IAN) injury after dental procedures may result from direct trauma or local anesthetic agent and presents with immediate onset of typically nonprogressive symptoms, including pain and sensory changes. We report a case of delayed-onset pain and progressive sensory symptoms after IAN block for amalgam restoration. A 54-year-old man presented with progressive right-sided facial pain 48 hours after IAN block for amalgam restoration, followed 1 week later by hypoesthesia and allodynia in IAN distribution. The presentation is more consistent with inflammatory neuropathy, as is well recognized in brachial plexopathy. Imaging was used to exclude local and central causes, following which the clinical diagnosis was made. Inflammatory neuropathies may be distinguished from iatrogenic causes on the basis of delayed symptom onset, early severe pain, and progressive sensory symptoms. Awareness of this condition is important, because early steroid therapy followed by medications for neuropathic pain may provide benefit.

Slowly growing swelling on body of the mandible with paresthesia on lower lip - Corrected Proof

2012-04-30

A 23-year-old female patient reported with the chief complaint of swelling on the lower left posterior teeth region of the jaw and paresthesia of left lower lip of 6 months of duration. On the basis of clinical findings and conventional radiographic features, odontogenic tumor or cyst was suspected. Advanced imaging i.e. CT scan, Denta Scan, MRI further provided the exact nature, extent and location of the lesion and later on by histopathological examination, it was diagnosed as an intraosseous schwannoma of the mandible. In this clinicopathologic conference section, elaborate differential diagnosis and radiological features of this rare case is presented.

A rapidly enlarging mandibular swelling - Corrected Proof

Karen A. Eley, Cyril Fisher, Stephen Gould, Stephen R. Watt-Smith — 2012-04-30

A 12-year-old boy presented to the Department of Oral and Maxillofacial Surgery with a 2-week history of a mass in the lower right molar region. Over that period it had rapidly enlarged, but was not associated with any discomfort. The first molar tooth had been extracted 18 months before presentation for unrestorable dental decay. There was no history of trauma or further dental symptomatology. His past medical history was unremarkable, he was systemically well, and there was no family history of note. Intraorally, there was a 4 × 2-cm nontender ulcerated mass centered at the first molar socket (). The upper teeth occluded with the mass, and, extraorally, there was mild fullness in the region, but no erythema. There was no palpable lymphadenopathy, and systemic examination was normal. A full blood count, urea, electrolytes, liver function tests, and calcium were all within the normal range. Panoramic radiography (OPG) demonstrated developing dentition with absence of the lower right first molar tooth. There was evidence of a soft tissue mass arising from this region, with an apparent underlying lucency of the mandibular bone. A computed tomography (CT) scan of the region confirmed destruction of the lingual cortex of the mandible with some periosteal new bone formation. The soft tissue mass was poorly delineated, with evidence of calcification (, A and B, ). A 6-mm right submandibular lymph node and several small submental nodes were evident.

Solid variant of keratocystic odontogenic tumor with ameloblastomatous transformation: a case report and review of the literature - Corrected Proof

Ning Geng, Di Lv, Qian-ming Chen, Zhi-Yu Zhu, Rui-Qing Wu, Zhi-Xiu He, Yu Chen — 2012-04-30

The solid variant of keratocystic odontogenic tumor is an extremely rare tumor. Its clinical and pathologic features remain poorly defined, even in the 2005 World Health Organization odontogenic tumor classification. We report an unusual lesion in a 38-year-old female Chinese patient. The lesion demonstrated the solid or multiple cystic architecture of a keratocystic odontogenic tumor, but also exhibited ameloblastomalike lining epithelium in some areas. The complex histopathology made a pathologic diagnosis difficult. Finally, the lesion was diagnosed as solid variant of keratocystic odontogenic tumor with ameloblastomatous transformation. We present the clinical and pathologic details of the case, and review the relevant literature.

Letter to the Editor - Corrected Proof

Yoko Hasegawa — 2012-04-30

We thank Dr. Sujir for his kind comments regarding our most recent article published in Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics. We also thank him for his observations and for sharing his experience.

Gingival ulceration and exposed bone - Corrected Proof

2012-04-27

A 53-year-old woman presented to our Department of Oral and Maxillofacial Surgery with a complaint of continuous painful ulcerations for the preceding month on the attached oral mucosa, especially covering the hard palate and mandibular anterior. The lesions were becoming progressively larger. She did not report general symptoms, such as fever or night sweats, but had a weight loss of 4 kg within the preceding 6 months. She denied regular alcohol and tobacco consumption.

Morphologic variations of sesamoid cartilages of the nose in Iranian cadavers - Corrected Proof

Ali Ebrahimi, Mohammad Hosein Kalantar Motamedi, Nasrin Nejadsarvari — 2012-04-27

Background: Accessory cartilages are small nasal cartilages between the lateral crus and piriform aperture of the nose bilaterally. These cartilages are among the supporting structures of the nasal tip. Study Design: This prospective cross-sectional study was conducted on Iranian fresh cadavers for evaluation of ethnic differences. Seventy-two sesamoid cartilages in 41 cadavers (mean age 42 years) were dissected to evaluate anatomy and anthropometry of the sesamoid cartilages. Elevation of the dorsal nasal flap after a collumellar incision was done. After the separation of the lower lateral cartilages and sesamoid cartilages on each side, the anatomy and anthropometry of the cartilages were assessed. Results: In 12% (5) of the cadavers there were no sesamoid cartilages, and in 88% (36) of the cadavers there was 1 sesamoid on each side. The shape of the sesamoid cartilages was rectangular in 66% (27) and triangular in 22% (9). The mean length, width, and thickness were 3 mm, 2 mm, and 0.75 mm, respectively. Conclusions: This cartilage was single on each side of the nose and its shape was an irregular rectangle or triangle and has an important role in preserving nasal alar contour and tip projection. These findings confirm ethnic variations in the sesamoid nasal cartilages when this Iranian population is compared with other populations assessed in earlier reports.

Multidisciplinary approach for the aesthetic treatment of maxillary lateral incisors agenesis: thinking about implants? - Corrected Proof

2012-04-27

Missing maxillary lateral incisors create an esthetic problem with specific orthodontic and prosthetic considerations. Implants are commonly used to replace congenitally missing lateral incisors in adolescent orthodontic patients. However, an interdisciplinary approach should be observed during the diagnosis, prognosis, and treatment plan to provide a result with good predictability and meet the esthetic and functional expectations of the patient. The present study describes a case of a young patient with tooth agenesis of maxillary lateral incisors, which was conducted with an integrated planning. After 5-year follow-up of 2 fixed implant-supported prostheses, clinical and radiographic examination showed the treatment to be successful.

Distracted mandible does not reach the same strength as normal mandible in rabbits - Corrected Proof

2012-04-27

Objective: The aim of this study was to determine the resistance and fracture strength values of the bone with the use of biomechanical tests in different consolidation periods of mandibular distraction osteogenesis. Study Design: In this study, 21 mature male New Zeland rabbits were used. After distraction, rabbits were separated into 3 groups to experience 4, 8, and 12 weeks' consolidation periods. Nonoperated hemimandibles of 6 rabbits were used as a control group. After 5 days' latency period, 0.5-mm distraction was applied twice a day, i.e., 1 mm/d lengthening. After the 5-mm lengthening application, we left the animals for 1, 2, or 3 months of consolidation period. Bending stress and strength values of the bone at fracture point were measured with the use of a 3-point bending test. Results: There were significant differences between the control and 3 study groups regarding bending stress and strength values. In addition, each study group was significantly different from each other. Conclusions: Bending stress and fracture strength of the bone may not reach that of normal bone after completion of 3 months' consolidation. It should be considered to keep in place extraoral appliances or comfortable intraoral distractors for a long period.

Surgical removal of a third molar at risk for mandibular pathologic fracture: case report and clinical considerations - Corrected Proof

Paolo Boffano, Fabrizio Ferretti, Giuseppe Giunta, Cesare Gallesio — 2012-04-27

Surgical removal of mandibular deeply impacted third molars may be challenging and could be associated with several possible risks. Intra- or postoperative mandibular fracture during or after third molar extraction is a major though rare complication. Before starting the surgical removal of a mandibular deeply impacted third molar, various predisposing factors of mandibular fracture should be considered and kept in mind: adult age, male sex, deep inclusion, tooth ankylosis, and associated bony pathology. The aim of this article is to report and discuss the surgical management of a mandibular deeply impacted third molar associated with a follicular cyst.

Closed reduction of mandibular condyle fractures using C-arm fluoroscopy: a technical note - Corrected Proof

Tomoaki Imai, Masahiro Michizawa, Naofumi Yamamoto, Tatsuro Kai — 2012-04-27

We describe a C-arm technique for mandibular condylar fractures in an anatomic study using a model skull and show its feasibility in a clinical case. The C-arm allowed posterior-anterior visualization of the condylar process. The X-ray axis was canted ∼15 degrees cranially to the Frankfort horizontal line. The skull's sagittal plane was rotated ∼15 degrees ipsilaterally to the X-ray axis. This technique facilitates clear visualization of the condylar neck with easy, flexible, and timely adjustments. In selected cases, this method would convert the clinical settings of the condylar fracture pattern to that which would not be amenable to an open approach, making possible minimally invasive surgical procedures.

Stimulating neuronal processes that benefit patients and our profession - Corrected Proof

Craig S. Miller — 2012-04-26

Oral medicine needs a process for continual development of new therapeutic strategies to manage the growing population with poor oral health. The need arises from current therapeutic approaches that in many cases are unable to manage various aspects of painful, neurological, mucosal, bony, and salivary disorders, leaving some patients dissatisfied with the level of relief, frequency of dosing required, side effects that can develop, and risk for disease progression. An additional factor driving this need is the increasing complexity of medical care that often requires practitioners to make drug and dosage adjustments or additional referrals to manage other aspects of the complaint or comorbidities. Thus, our patients suffer from an incomplete armamentarium that is unable to yield 100% success, and we as practitioners suffer from inadequately powered studies to determine what are the best choices for complicated situations. In the meanwhile, we rely on incremental advances as they are achieved to offer new hope.

MRI evaluation of movement of the mandibular condyle and articular disk on application of an occlusal splint - Corrected Proof

Nanditha Sujir, Keerthilatha M. Pai — 2012-04-23

We took great pleasure in reading the article “Movement of the mandibular condyle and articular disc on placement of an occlusal splint” by Hasegawa et al. Even though occlusal splints are widely used for the management of temporomandibular joint (TMJ) disorders, their exact mechanism of action still remains a controversy. In this regard, the article by Hasegawa et al. has been very informative and provides quantitative data regarding the effects of stabilization splints on the TMJ.

Stereolithographic cutting guide in mandible reconstruction - Corrected Proof

Guang-sen Zheng, Yu-xiong Su, Gui-qing Liao — 2012-04-23

We were honored to read the letter of Dr. Pedro Infante-Cossio. The application of image-guided techniques is growing in oral and maxillofacial surgery, especially in mandibular reconstructive surgery. At the beginning, it simply provides a mandible stereomodel that allows the surgeon to bend the reconstruction plate before surgery. Then the surgeon can do surgical simulation on the computer to optimize the surgical protocol. Recently, many surgeons are focusing on how to convert the simulation to the real surgery accurately. As mentioned in the letter of Dr. Pedro Infante-Cossio, we agree that a customized template for osteoctomy is very helpful. Actually, we have also developed triple templates defining mandibulectomy, fibula osteoctomy, and transfer for accurately implementing surgical simulation, and we have tested the accuracy via cadaveric study. Also, we have finished several cases of mandibular and maxillary reconstructive surgery with this technique. We found it to be effective especially in implementing some complicated cases.

Intramuscular hemangioma presenting with multiple phleboliths: A case report - Corrected Proof

A. Zeynep Zengin, Peruze Celenk, A. Pinar Sumer — 2012-04-23

A rare case of intramuscular hemangioma of the masseter muscle with multiple phleboliths is described, including features evident in plain radiography, ultrasound, and magnetic resonance imaging (MRI). A 21-year-old woman presented with a complaint of swelling on the right masseter muscle. A plain radiograph from the soft tissue of the right cheek showed a large number of round, target-like radiopacities that varied in size. Ultrasound revealed a lobulated cystic lesion in the right masseter muscle with increased echogenicity. MRI showed a space-occupying lesion in the right masseter muscle, which was isointense on T1-weighted image close to the muscle tissue and hyperintense on T2-weighted image, containing fields with no signal septations. A plain soft tissue X-ray image can demonstrate phleboliths and aid in the diagnosis of an intramuscular hemangioma. In addition, nonionized techniques such as ultrasound and MRI can provide useful information to clinicians regarding the location of calcifications and the structure of masses.

Angina presenting as orofacial pain: A case report - Corrected Proof

Mark J.A. Turner, Kevin G. McMillan, Andrew J. Gibbons — 2012-04-16

This paper highlights a case of exertional angina that presented as orofacial pain with no other cardiac symptoms or history. Clinicians should be aware of this as a possible diagnosis in cases where facial pain has no apparent cause

A giant radiopaque mass in the masticatory space - Corrected Proof

Young-Ah Cho, Hye-Jung Yoon, Seong-Doo Hong, Jae-Il Lee, Sam-Pyo Hong — 2012-04-12

A 2-year-old boy presented with a giant mass in the masticatory space. The mass exhibited a lobulating ossification, with no attachment to the adjacent normal bone. An enucleation was performed under the tentative diagnosis of extra-articular synovial chondromatosis, benign ossifying neoplasm, non-neoplastic heterotopic ossification, or low-grade malignancy. Upon microscopic examination, the excised mass was composed of multiple osteocartilaginous areas. We hereby present detailed clinicopathological findings.

Hard and soft tissue changes of osteomyelitis of the jaws on CT images - Corrected Proof

2012-04-12

Objectives: This study aimed to assess the hard and soft tissue changes in osteomyelitis (OM) of the jaws using CT images. Study Design: The CT images of 153 patients (59 males and 94 females) with OM of the jaws were retrospectively reviewed. The relationships between each space involvement, between space and muscle involvements, between cortical bone defect and space involvement, and between cortical bone defect and muscle involvement were evaluated. Results: The cortical bone defect was more common on the buccal side in the maxilla and on the lingual side in the mandible. The most commonly involved muscle was the buccinator muscle in the maxilla and the masseter muscle in the mandible and the most frequently involved space was the buccal space followed by the masticator space. Conclusions: CT is a useful tool in evaluating both hard and soft tissue changes of OM of the jaws.

Angioleiomyoma of the hard palate: report of a case and review of the literature and magnetic resonance imaging findings of this rare entity - Corrected Proof

2012-04-12

Angioleiomyomas are benign solitary smooth muscle tumors originating in the tunica media of vessels. They are rarely encountered within the oral cavity, and the number of reported cases specifically involving the hard palate remains small. A 39-year-old man presented with a 2-cm painless swelling on the left anterior hard palate. The mass had been present for ∼5 years before presentation, during which time it had slowly enlarged. Magnetic resonance imaging (MRI) showed a uniform signal pattern with T1 signal intensity slightly higher than surrounding soft tissues and marked hyperintensity on T2-weighted sequences. Although the MRI characteristics of angioleiomyomas affecting the extremities have previously been reported, this is the first reported case describing the MRI features of an oral-cavity angioleiomyoma. In view of the inability to differentiate angioleiomyoma from other pathologies with similar MRI features, simple local excision for definitive histopathologic diagnosis remains recommended.

The use of bovine screws to promote bone formation using a tibia model in dogs - Corrected Proof

2012-04-12

The objective of this study was to evaluate the use of a unique resorbable bovine bone screw to stimulate bone formation. Bovine bone screws were inserted in the tibia of beagle dogs. Each animal received 8 screws, divided into groups A (screws + no membranes), B (screws + titanium reinforced membranes), and C (bone defects treated with autogenous bone grafts). Animals were killed at 2, 4, and 6 months. New bone was measured with a periodontal probe and reported an average of 7.4 mm in vertical bone gain for group B, 3.6 mm for group A, and 1.7 mm for group C. Submission to Kruskal-Wallis test showed statistical differences among groups (P < .05). Histologic examination revealed an intimate contact between the newly formed bone and the resorbing bone screws. We conclude that bovine bone screws provide an environment for new bone formation and thus may provide an alternative therapy for enhancing bone formation vertically, including for regenerative procedures as well as before implant therapy.

Stereolithographic cutting guide for fibula osteotomy - Corrected Proof

2012-04-12

We read with great interest the article titled “Mandible reconstruction assisted by preoperative virtual surgical simulation” by Zheng et al. in OOOO. The authors are to be congratulated on adding imaging techniques to oral-maxillofacial reconstructive techniques. In that study, 9 patients were indicated for mandible resection and reconstruction. Surgery was carried out with the help of the reconstructed mandible stereomodel, prebent titanium reconstruction plate, and positioning template. We would like to comment on the surgery simulation point, which is relevant to our own experience.

Measurement accuracy of temporomandibular joint space in Promax 3-dimensional cone-beam computerized tomography images - Corrected Proof

Zhi-ling Zhang, Jun-ge Cheng, Gang Li, Ji-zong Zhang, Zu-yan Zhang, Xu-Chen Ma — 2012-04-09

Objective: The aim of this study was to evaluate and compare the measurement accuracy of the temporomandibular joint (TMJ) space in the Promax 3D cone-beam computerized tomography (CBCT) images scanned with 2 different dental protocols. Study Design: TMJ space impression models were made according to the occlusion. Forty joints were scanned with the standard and the large view protocol of the Promax 3D CBCT scanner. Two observers measured the joint spaces 3 times on both radiographs and the photocopies of the impression models. Results: A total of 120 CBCT images were measured. There were no significant differences among the actual joint spaces and the CBCT measurements performed with the 2 scanning protocols (P = .305). The inter- and intraobserver variabilities were not significant. Conclusions: The 2 scanning protocols provided by the Promax 3D CBCT scanner were reliable and similar for recording the TMJ space.

Antifungal activity of coronarin D against Candida albicans - Corrected Proof

2012-04-09

Objective: The objective of this study was to investigate the antifungal activity of coronarin D on Candida albicans and its activity was compared with clotrimazole and nystatin. Methods: Coronarin D was extracted by liquid chromatography and used in antifungal testing. The inhibitory effect of coronarin D on C. albicans was determined by cultures and an applied broth dilution test. The rate of fungicidal activity was evaluated by time-kill curves. Morphologic alterations of fungal cells were investigated using scanning electron microscopy. Results: Coronarin D was effective against C. albicans; the minimum inhibitory concentration (MIC) and the minimum fungicidal concentration (MFC) were 2 and 4 mg/mL, respectively. The C. albicans killing activity of coronarin D was higher than clotrimazole and nystatin at 2×MFC and 4×MFC, respectively. Morphologic alterations of fungal cells consistent with cell membrane damage were observed in the coronarin D–treated cells. Conclusions: Coronarin D showed promising antifungal activity against C. albicans in vitro.

Skeletal maturity assessment with the use of cone-beam computerized tomography - Corrected Proof

2012-04-05

Objective: The aim of the study was to compare cervical vertebrae maturity assessed with the use of cone-beam computerized tomography (CBCT) with the hand-wrist maturation method and cervical vertebrae maturation assessed with the use of lateral cephalography for the assessment of skeletal maturity. Study design: Assessment of skeletal maturation was done using skeletal maturity indicators (SMI) from hand-wrist radiography, cervical vertebrae maturity index (CVMI) from CBCT and lateral cephalography (cephalo-CVMI). The Spearman correlation coefficient was used for statistical analysis. Results: We observed a significant relationship between CBCT-CVMI and cephalo-CVMI as well as between CBCT-CVMI and SMI stages. The Spearman correlation coefficient value between CBCT-CVMI and cephalo-CVMI was 0.975 (P < .0001) and between CBCT-CVMI and SMI was 0.961(P < .0001). Conclusions: Cervical vertebrae maturity assessment with CBCT provided a reliable assessment of pubertal growth spurt, and therefore CBCT can be used to assess skeletal maturity.

Use of the Beers criteria to identify potentially inappropriate drug use by community-dwelling older dental patients - Corrected Proof

Daniel D. Skaar, Heidi L. O'Connor — 2012-04-05

Objective: Recognizing drugs with serious adverse experience (AE) potential in an aging population would assist practitioners in preventing drug safety issues. This study identifies drugs with potential for causing serious AEs, describes the AEs, and estimates prevalent use among older adults visiting the dentist. Study Design: Drugs with serious AE risk for older adults were identified with the use of the Beers criteria. Analyses of older adults visiting the dentist using the Medicare Current Beneficiary Survey tested associations between demographic and health-related variables and use of these drugs. Potentially serious drug-related AEs are described. Results: More than 3 in 10 older adults visiting the dentist were prescribed a Beers-criteria drug. Commonly prescribed Beers-criteria drugs used in dentistry include benzodiazepines and long-acting nonsteroidal antiinflammatory analgesics. Conclusions: Awareness of potentially harmful drug-related AEs, their clinical consequences, and prescribing frequency for older adults will assist dentists in clinically managing patients and avoiding inappropriate prescribing.

A large painless swelling of the posterior mandible - Corrected Proof

2012-04-05

A 60-year-old man presented with primary complaint of a large painless swelling of the left side of the mandible. On examination, an obvious swelling was present on the left side of the body of the mandible, extending anteriorly from the left mandibular first premolar to the angle of the mandible posteriorly; involving the lower border of the mandible, causing its expansion and thinning and also showing buccolingual cortical expansion. The patient's medical history was noncontributory, and physical examination revealed no other abnormality. The lesion was covered by normal-appearing mucosa. A panoramic radiograph revealed the presence of an ill-defined, multilocular radiolucent lesion in the body of mandible ().

Nodular fasciitis over the anterior wall of the maxillary sinus: a case report and review of the literature - Corrected Proof

Nemaly Chaithanyaa, Pradeep Somannavar, Nemaly Aishwarya Annajal — 2012-04-05

Nodular fasciitis (NF) is a benign tumor that grows extending from the muscular fascia to the subcutaneous tissue and, less frequently, into the underlying muscle. The cause of such proliferation is unknown, although trauma is believed to be important because of the location of these lesions over bony prominences. NF can often be confused with myofibromatosis or a sarcoma owing to its rapid rate of growth, rich cellularity, and mitotic activity. It is important, therefore, to distinguish the lesion from a more aggressive condition. NF that occurs in otherwise healthy individuals usually presents with a history of rapid growth, and is commonly found in the upper extremities and on the chest and trunk. We present a case of NF in a 39-year-old female patient occurring over the anterior wall of the maxillary sinus, along with a review of the literature.