Bruce F. Barker

The effects of sucralfate suspension and diphenhydramine syrup plus kaolin-pectin on radiotherapy-induced mucositis.

A prospective, double-blind study compared the effectiveness of sucralfate suspension with diphenhydramine syrup plus kaolin-pectin in reducing severity and pain of radiation-induced oropharyngeal mucositis. Fourteen patients who received at least 4600 cGy to the oral cavity used one of the mouth rinses four times a day, beginning at 1600 cGy. Data were collected on daily perceived pain and helpfulness of mouth rinse, weekly mucositis grade, weight change, and interruption of therapy. Analysis of data revealed no statistically significant differences between the two groups in any parameter. A retrospective review of 15 patients who had received at least 4600 cGy radiation to the oropharynx but had not used a daily mouth-coating rinse, was compared with the study group. Comparison of the two groups suggested that consistent daily oral hygiene and use of a mouth-coating agent will result in less pain and may reduce weight loss and interruption of radiation because of severe mucositis.

The Noonan syndrome/cherubism association

Noonan syndrome is characterized by short stature, unusual facies, congenital heart disease, chest deformity, mild mental retardation, and cryptorchidism in males. It may be sporadic or inherited as an autosomal dominant trait and occurs between 1 in 1000 and 1 in 2500 live births. Cherubism is a giant cell lesion of the jaws thought to be transmitted as an autosomal dominant trait. It is usually recognized by age 7 years, follows a variable course, and is not known to be related to other genetic disorders. We herein report on four patients with Noonan syndrome, all of whom had cherubism. Two other probable cases are cited in the literature for a total of six known cases.

Herpes simplex and cytomegalovirus coinfected oral ulcers in HIV-positive patients

Four HIV-positive patients with herpes simplex virus and cytomegalovirus coinfected oral ulcers are presented. All patients had persistent oral pain associated with nonhealing mucosal ulcers. Lesions occurred on the palate, retromolar pad, tongue, and lip, and the clinical appearance of the ulcers was nonspecific. Histologic and immunohistochemical stains showed herpes simples virus alterations in keratinocyte nuclei and cytomegalovirus alterations in mesenchymal/endothelial cell nuclei and cytoplasm. Lesions in one patient responded to ganciclovir therapy. One patient improved with acyclovir, and another healed normally after excisional biopsy. Each virus alone has been described as causing oral ulcerations; their appearance together in the same lesion would suggest a synergistic relationship.

Central odontogenic fibroma of the WHO type

Two examples of central odontogenic fibroma, WHO type, are reported. The radiographic and microscopic features are discussed and illustrated. Both were treated by curettage, and neither has recurred after 10 and 9 years, respectively. We postulate an ectomesenchymal-epithelial interaction in the histogenesis of this unusual tumor.

Necrotizing sialometaplasia: Report of five additional cases

Abstract Necrotizing sialometaplasia is a benign disease which, clinically and microscopically, is often confused with malignancy. Five cases are reported to publicize the existence of this uncommon oral lesion. The clinical appearance, history, and microscopic features are discussed and illustrated.

Giant-cell hyalin angiopathy

Seven examples of an unusual hyalin degenerative change in the walls of blood vessels are discussed. We believe this is a localized phenomenon, not connected to systemic vascular disease. Inflammation is usually present, and in each case a dental procedure had previously been performed. Dental extraction was the most common procedure. Giant cells of the foreign-body type are present, but particulate foreign material was seen in only one case.

Autoimmune progesterone dermatitis and stomatitis

Autoimmune progesterone dermatitis is a rare clinical condition associated with variable cutaneous and mucosal eruptions such as urticaria, erythema multiforme, and eczema. Exacerbation is influenced by hormonal changes of the menstrual cycle. The patient described in this report had recurrent cyclic lesions on the skin, oral mucosa, and lips that appeared just before regular menstruation and persisted until a few days after. During each cycle, the eruptions appeared at the previously affected sites, mimicking the clinical feature of a fixed drug eruption. This rare phenomenon is attributed to an autoimmune reaction to female sex hormones. The condition failed to respond to therapy with prednisone, but improved with the use of an antiestrogen drug, tamoxifen. This medication suppresses ovulation and the post-ovulation rise in endogenous progesterone levels.

Restoration of mandibular continuity defects using combinations of hydroxylapatite and autogenous bone: Microscopic observations

The purpose of this investigation was to assess by light, transmission, and scanning electron microscopy the healing of mandibular continuity defects reconstructed with varying ratios of an alloplastic hydroxylapatite implant material (HA) mixed with autogenous bone (AB). This study reports the microscopic observations of implant and control sites at 6 and 18 months postsurgery. The results confirm the biocompatibility of dense HA granules. Specimens exhibited differing degrees of osseous regeneration that appeared related to the percent composition of HA. At 18 months, 86% and 91% of the HA granules were completely surrounded by bone in those specimens reconstructed with implants consisting of 25% and 50% HA, respectively. In contrast, specimens receiving implants consisting of 75% and 100% HA features osseous encapsulation of 75% and 66% of the granules, respectively. The results of this limited study indicate that dense HA granules mixed with AB in ratios ranging from 3:1 to 1:1 (AB:HA) may be successfully used as a bone extender during reconstructive surgery.

Focal osteoporotic bone marrow defects of the jaws: An analysis of 197 new cases

Abstract Osteoporotic bone marrow defects will usually present as asymptomatic radiolucencies which are located predominantly in the mandibular molar regions of middleaged women. Histologically, they are composed of either hematopoietic or, less commonly, fatty marrow. The majority of defects offer no ready explanation as to their pathogenesis; however, altered healing reactions or marrow hyperplasia may be the cause in a small number of cases. The defects often are radiographically similar to more ominous lesions, which must be ruled out.

Myospherulosis of the jaws

Two cases of myospherulosis are reported. The history, histopathology, and nature of this condition are discussed. The placement of antibiotic ointment with a petrolatum base in oral wounds may be of significance. Petrolatum may provoke an inflammatory reaction and remain in tissue for years.