Charles A. Waldron

Fibro-osseous lesions of the jaws

In the first volume of the Journal of Oral Surgery, Dr G. Victor Boyko presented a case of osteofibroma of the mandible associated with leontiasis ossea of the skull (Boyko GV: J Oral Surg 1:100, 1943). The patient was a 32-year-old white woman who had complaints of right mandibular enlargement and a prominence of the right frontal and temporal areas of uncertain duration in August 1939. Mandibular radiographs showed an area of reduced radiodensity. Skull films showed a marked increase in density of the inferior part of the right temporal region and of the frontal bone, with evidence of both bone destruction and proliferation in the inferior frontal and orbital regions. A mandibular biopsy was reported as osteofibroma. The patient was kept under observation for 8 months after the biopsy, with little change in her condition. A course of deep x-ray therapy was then delivered to the mandibular lesion. She subsequently developed a pathologic fracture that was treated by maxillomandibular fixation. The fracture stabilized and at the last clinical examination, in June 1942, the patient had a union with good functional occlusion and was reported to be in good mental and physical condition.

Leukoplakia revisited. A clinicopathologic study 3256 oral leukoplakias

During a 13‐year period, 3256 specimens clinically diagnosed as leukoplakia “keratosis,” “white patch”) were submitted to the oral pathology laboratories of Indiana University School of Dentistry and Emory University School of Dentistry. These comprised 6.2% of the tissue specimens processed by these laboratories. The cases were analyzed as to age of occurrence, site of involvement, and pathologic findings. It was found that: leukoplakia occurs chiefly in the 5th, 6th, and 7th decades; about half of the lesions involved the mandibular mucosa, mandibular sulcus, and buccal mucosa; leukoplakia was slightly more common in men (54.2%). Microscopic study showed that 80.1% of the leukoplakias were varying combinations of hyperorthokeratosis, hyperparakeratosis, and acanthosis without evidence of epithelial dysplasia. Mild to moderate epithelial dysplasia was noted in 12.2% of specimens, and severe epithelial dysplasia or carcinoma in situ was found in 4.5%. Infiltrating squamous cell carcinoma was diagnosed in 3.1% of specimens submitted with a clinical diagnosis of leukoplakia. The risk of epithelial dysplasia, carcinoma in situ, or carcinoma varied between the anatomical locations of leukoplakia. The incidence of epithelial alteration, ranging from dysplasia to carcinoma, was 42.9% for lesions of the floor of the mouth, 24.2% for tongue lesions, and 24.0% for lip leukoplakias. The incidence of similar epithelial alterations in other sites varied from 18.8% for palatal lesions to 11.7% for leukoplakias of the retromolar area. The data suggest that there are regional differences in the incidence and character of leukoplakia in the United States. The Emory material, obtained almost exclusively from patients residing in the Southeastern United States, showed a proportionately higher total incidence, a lower male/female ratio, and a greater frequency of epithelial dysplasia, particularly in females, than the Indiana material, which came almost entirely from residents in the Northcentral United States.

Central giant cell lesions of the jaws: A clinical, radiologic, and histopathologic study

The histology, radiographs, and follow-up information for 142 cases of central giant cell lesions of the jaws were reviewed in an effort to determine which, if any, microscopic features could be correlated with clinical behavior. The majority of these lesions were asymptomatic and relatively innocuous. However, some displayed a more aggressive clinical course characterized by root resorption, pain or paresthesia, and cortical perforation. The over-all recurrence rate in the 142 cases was 16%. Adequate follow-up information (mean, 48 months) was only obtained for 47 patients, and 23 (46%) of these experienced one or more recurrences. Statistically significant histologic differences in distribution of giant cells and frequency of osteoid within the lesions were found in lesions that recurred as opposed to those that did not. The concept that giant cell lesions of the jaws are not totally different entities from giant cell tumors is discussed.

Sclerotic cemental masses of the jaws (so-called chronic sclerosing osteomyelitis, sclerosing osteitis, multiple enostosis, and gigantiform cementoma)

A series of thirty-eight cases of densely sclerotic lesions of the jaws was studied. The lesions were all at least 1.5 cm, in diameter. Pain, drainage, or localized expansion of the jaw was present in two thirds of the patients. Thirty-four of the thirty-eight patients were women, and twenty-five were negros. In fourteen instances, a radiographic survey of the entire jaws was available. Thirteen of these fourteen patients had multiple lesions which were usually symmetrically distributed throughout the jaws. In twenty-four patients radiographs of the lesional area only were available for review. In thirty-four of the thirty-eight cases (89 per cent), the sclerotic masses were interpreted as cementum. Although this condition has previously been described as chronic sclerosing osteomyelitis, sclerosing osteitis, multiple enostosis, or gigantiform cementoma, it appears more appropriate to consider these lesions as part of the spectrum of the benign fibro-osseous lesions of periodontal ligament origin. Four of the sclerotic lesions, which were radiographically indistinguishable from the cemental lesions, consisted only of bone. Two of these appeared to be examples of true chronic sclerosing osteomyelitis, and two may be appropriately designated as enostosis or osteomas.

Odontogenic adenomatoid tumor (adenoameloblastoma): Survey of 111 cases

Abstract As other studies have suggested, the odontogenic adenomatoid tumor is predominately a tumor of young persons under the age of 20 years. There is a marked female preference (7:4), as well as a marked maxillary preference (4.5:2.5). Fully 76 per cent of these lesions occur in the anterior regions of the jaws, and 74 per cent are associated with an unerupted tooth—most commonly a cuspid (68 per cent). It has been shown that the odontogenic adenomatoid tumor has, on occasion, an inductive effect upon the connective tissue and cannot continue to be considered a pure epithelial tumor. A significant number of cases with long-term follow-up has been presented which, in our opinion, offers sufficient support for the widely held concept that the odontogenic adenomatoid tumor is a benign lesion that does not recur after conservative removal.

Benign fibro-osseous lesions of the jaws: A clinical-radiologic-histologic review of sixty-five cases: Part I. Fibrous dysplasia of the jaws

Abstract A clinical-radiologic-histologic review of twenty-two cases of fibrous dysplasia involving the jaws is presented. The lesions showed a 13:9 predilection for the maxilla and frequently involved the maxillary sinus, orbital floor, and zygoma. The discase tends to appear early in life. Ten of the twenty-two cases were diagnosed in the first or second decades. In three additional patients the probable onset of the lesions was in the first or second decade. None of the patients in this study had apparent extracranial lesions of fibrous dysplasia. Clinically, a painless asymmetry was the only significant finding. Histologically, about one half of the cases showed the “classic” features of metaplastic woven bone in a fibrous stroma. The remaining cases showed variable amounts of lamellar bone. The presence of lamellar bone is not considered incompatible with a diagnosis of fibrous dysplasia of the jaws. The relation of fibrous dysplasia to fibrous osteoma of the jaws is discussed. Most of the so-called “fibrous osteomas” of the jaws should be considered as examples of fibrous dysplasia.Abstract A clinical-radiologic-histologic review of twenty-two cases of fibrous dysplasia involving the jaws is presented. The lesions showed a 13:9 predilection for the maxilla and frequently involved the maxillary sinus, orbital floor, and zygoma. The discase tends to appear early in life. Ten of the twenty-two cases were diagnosed in the first or second decades. In three additional patients the probable onset of the lesions was in the first or second decade. None of the patients in this study had apparent extracranial lesions of fibrous dysplasia. Clinically, a painless asymmetry was the only significant finding. Histologically, about one half of the cases showed the “classic” features of metaplastic woven bone in a fibrous stroma. The remaining cases showed variable amounts of lamellar bone. The presence of lamellar bone is not considered incompatible with a diagnosis of fibrous dysplasia of the jaws. The relation of fibrous dysplasia to fibrous osteoma of the jaws is discussed. Most of the so-called “fibrous osteomas” of the jaws should be considered as examples of fibrous dysplasia.

Unusual multilocular cysts of the jaws (botryoid odontogenic cysts).

Abstract Two cases of an unusual multilocular cyst of the jaws are described, both clinically and histologically. Although the etiology is unknown, the lesion is probably of odontogenic origin. This appears to be a distinct entity which has not been previously reported.

Verrucous carcinoma of the oral cavity: A review of forty-nine cases

Verrucous carcinoma is a distinctive, extremely well-differentiated, slow-growing variant of the squamous cell carcinoma. Forty-nine cases of this neoplasm were gathered from the Oral Pathology Service at the Emory University School of Dentistry from 1965 to 1979. The most common site of occurrence was the buccal mucosa, followed by the mandibular alveolar ridge and gingiva. The majority of our patients were between the ages of 50 and 80 years, and most of them were Caucasians. Although most other series of oral verrucous carcinoma show a male predominance, almost 60 percent of our cases occurred in females. The role of radiation therapy in treatment of oral verrucous carcinoma is controversial, and adequate surgical excision appears to be the treatment of choice.

Primary intraosseous squamous carcinoma. Report of two cases

Two cases of primary intraosseous squamous carcinoma (PIOSC) are reported. One PIOSC is in the mandible of a 24-year-old man and appears to be a keratinizing PIOSC arising de novo. The other PIOSC presented in the edentulous maxilla of a 56-year-old man and was diagnosed as a PIOSC arising from an odontogenic cyst. The 2nd tumor subsequently metastasized to a cervical lymph node. Previous reports have noted a favorable prognosis for PIOC arising in odontogenic cysts, and only 3 other instances of metastases of a PIOSC in an odontogenic cyst have been documented.

Granular-cell ameloblastic fibroma: Report of two cases

Abstract Two cases of an unusual odontogenic tumor have been presented. Both lesions were considered to be ameloblastic fibromas with extensive granular-cell change in the mesodermal component. The patients were considerably older than the typical patient with ameloblastic fibroma. We suggest that the granular-cell alteration in the mesodermal component represents an aging or degenerative response in the lesion. These lesions possibly are related to the granular-cell congenital epulis. The granular-cell ameloblastic fibroma appears to be a quite benign lesion, and curettage is probably sufficient for cure.