Anthony P. Barrett

A long-term prospective clinical study of oral complications during conventional chemotherapy for acute leukemia.

Oral complications were detected during 89% of hospital admissions for treatment of acute leukemia in adults. Changes that reflected the underlying myelosuppression and general immunosuppression predominated. Hemorrhagic phenomena (77%), neutropenic ulceration (49%), and herpes simplex virus infections (39%) were the most common.

Evaluation of nystatin in prevention and elimination of oropharyngealCandida in immunosuppressed patients

Thirty-three patients with acute leukemia or lymphoma received an ongoing topical treatment with an oral suspension of nystatin during prolonged periods of intensive chemotherapy and severe granulocytopenia. The preparation proved ineffective in eliminating colonized Candida species from the oropharynx in ten of eleven patients at the time of admission and was of questionable value in preventing later colonization in others. The difficulties surrounding the identification of systemic candidiasis, its significance in the immunosuppressed patient, and the role of topical antifungal prophylaxis are discussed.

Zoster sine herpete of the trigeminal nerve

Zoster sine herpete infection that involves the trigeminal nerve is rarely reported. The present case details a case of varicella zoster virus infection of the mandibular division of the left trigeminal nerve without evidence of a vesicular eruption. The diagnosis was established on clinical findings and was supported by the demonstration of an IgG antibody titer of > 1:640 during the acute phase of the disease.

A long-term prospective clinical study of orofacial herpes simplex virus infection in acute leukemia.

Orofacial mucocutaneous infections resulting from herpes simplex virus (HSV) were detected in 40% of patients with acute leukemia. Of the 34 separate episodes, oral mucosal sites were involved in 22 cases. Evidence to support dissemination of HSV was found in 3 patients on 4 separate occasions. The relationship of neutrophil levels to the onset and resolution of lesions is examined. The value of acyclovir for treatment of these HSV-induced lesions is reported, and the question of administering this agent for routine prophylaxis against HSV in these patients is addressed.

A critical evaluation of panoramic radiography as a screening procedure in dental practice

One thousand consecutive panoramic radiographs were assessed to determine the risk/benefit relationship involved when this technique is used to screen patients for previously undiagnosed pathologic processes. The results of the investigation do not support the use of this technique as a routine procedure in general dental patient assessment.

The value of exfoliative cytology in the diagnosis of oral herpes simplex infection in immunosuppressed patients

Conventional exfoliative cytology was effective in confirming a clinical suspicion of oral mucosal infection by herpes simplex virus in nineteen out of twenty (95%) immunosuppressed patients who were studied.

Clinical characteristics and mechanisms involved in chemotherapy-induced oral ulceration

The clinical characteristics of chemotherapy-induced oral mucosal ulceration in a group of patients with acute leukemia were examined in detail in a long-term prospective clinical study. Differences in regional susceptibility within the mouth to the effects of chemotherapy were apparent. A reconstruction of the probable mechanisms involved is presented.

Selective anesthesias of peripheral branches of the trigeminal nerve due to odontogenic infection

Infection of dental origin may induce anesthesias of peripheral branches of the trigeminal nerve and should be considered in the differential diagnosis of such neuropathies. This article presents two cases in which focal odontogenic infection caused sensory disruption at peripheral points along the maxillary and mandibular divisions of the trigeminal nerve. In both cases resolution of symptoms followed extraction of teeth responsible for the infection.

Perineural spread of squamous cell carcinoma involving trigeminal and facial nerves

Perineural spread of squamous cell carcinomas in the orofacial region predominantly involves the trigeminal and facial nerves. Central spread, particularly along the trigeminal nerve, produces sensory impairment and involvement of other divisions through invasion of the gasserian ganglion, as illustrated in these case reports. Early diagnosis and medical referral is important because central invasion has a poor prognosis.

Chronic indolent orofacial herpes simplex virus infection in chronic leukemia: a report of three cases.

Orofacial mucocutaneous infections caused by herpes simplex virus (HSV) may exhibit a distinct chronic indolent pattern of behavior in some immunosuppressed patients as opposed to the more familiar aggressive patterns. Three patients with chronic leukemia who illustrate this chronic indolent pattern are presented. These cases should alert the clinician to the variable clinical appearance that HSV may adopt in the immunosuppressed patient.