Gilbert E. Lilly

Clinical, historic, and therapeutic features of aphthous stomatitis. Literature review and open clinical trial employing steroids.

The clinical and historic features of 50 patients with diagnosed aphthous stomatitis and treated with topical triamcinolone acetonide, 0.1% or 0.2% aqueous suspension; alone or in combination with initial burst therapy of 40 to 60 mg of prednisone, are reviewed. The mean age of our patients was 36.6 years (range 6 to 80 years). The duration of the chief complaint, usually oral pain, or more specifically, recurrent oral ulcers, was 11.1 years (range 4 weeks to 40 years). All patients showed a wide range of ulcer sizes when examined initially or at follow-up. Forty were followed up for an average of 22.9 months. Thirty-four reported prompt healing of ulcers identified at the time of initial evaluation, and no or markedly fewer ulcers subsequently if maintenance therapy of prophylactic topical triamcinolone, 0.1% or 0.2% aqueous rinse, was used. Five patients reported partial relief. No systemic side effects were noted even after long-term topical therapy. Local candidosis was a complication encountered in five patients.

Reaction of oral tissues to suture materials

Abstract The response of oral tissues to ten different suture materials was studied histologically in dogs. The monofilament suture materials (polypropylene, gut, nylon, and chromic) were associated with less severe reactions than the multifilament materials (Teflonized braided polyester, siliconized braided silk, braided polyester fiber, linen, and braided silk). These findings indicate that the oral tissue response is related to the physical nature of the suture and that Teflon or silicone treatment of the suture does not appreciably alter the comparative response. Brown and Brenn staining of the tissue sections demonstrated particles which were interpreted to be bacteria within the interstices of the multifilament suture materials. This suggests that variation in the transmission of bacteria accounts for the difference in tissue response and that silicone and Teflon treatment does not render the suture impervious to bacteria.

Clinical, historic, and therapeutic features of cicatricial pemphigoid: A literature review and open therapeutic trial with corticosteroids

Cicatricial pemphigoid is at present an incurable, autoimmune disease that involves mucosa and skin. We have documented the clinical, microscopic, and therapeutic features of 23 patients with cicatricial pemphigoid and added these to reports of past literature. The mean age at the time of diagnosis was 63 years, and women were involved twice as often as men. Eighty-three percent of patients had oral mucosal involvement, 70% had conjunctival involvement, and 22% had skin involved. Direct immunologic evaluation revealed IgG at the basement membrane in 57% of cases and C3 in 66%. We have been able to manage the disease adequately in most patients with topical or systemic corticosteroids. The most commonly encountered side effect was oral candidiasis.

Mucosal cysts of the maxillary sinus: a clinical and radiographic study.

Of 4,546 patients examined, 73 had mucosal cysts in one or both maxillary sinuses. Distribution between sinuses was approximately equal. Most cysts appeared to arise from the floor of the sinus. Almost half of those with cysts reported an allergy of some type. No significant relationship to other medical problems was found. About one half of the patients had identifiable periodontal disease, and a trend toward larger cysts with increasingly severe periodontal disease was noted. Thirty-four patients were re-examined after 2 to 38 months, and 21 still had cysts unchanged in size. A trend toward higher occurrence of cysts during certain times of the year was also noted.

Recurrent enlargement of the left maxillary alveolus

Presented is a case report of osteosarcoma of the maxilla in a patient with Pagets disease. This case is unusual because of recurrent benign soft tissue enlargements at the site of eventual malignant disease.

A computer management system for patient simulations

A series of interactive videodisc patient simulations is being used to teach clinical problem-solving skills, including diagnosis and management, to dental students. This series is called Oral Disease Simulations for Diagnosis and Management (ODSDM). A computer management system has been developed in response to the following needs. First, the sequence in which students perform simulations is critical. Second, maintaining records of completed simulations and student performance on each simulation is a time-consuming task for faculty. Third, the simulations require ongoing evaluation to ensure high quality instruction. The primary objective of the management system is to ensure that each student masters diagnosis. Mastery must be obtained at a specific level before advancing to the next level. The management system does this by individualizing the sequence of the simulations to adapt to the needs of each student. The management system generates reports which provide information about students or the simulations. Student reports contain demographic and performance information. System reports include information about individual patient simulations and act as a quality control mechanism for the simulations.

Traumatic cyst. Report of a case.

Abstract A case of traumatic bone cyst in the mandible of a 21-year-old man is reported. Microscopic findings revealed a localized deposit of cholesterol clefts within the cavity.

Case 50, Part II: Peripheral odontogenic fibroma

Following complete workup of the patient, it was decided to perform a biopsy prior to establishing a final treatment plan. Using local anesthesia supplemented by intravenous sedation, a mucoperiosteal flap was elevated from the left maxillary canine to the distal of the left maxillary second molar. On elevation of the mucoperiosteum, there was evidence of a sharply-delineated osseous mass. The lesion appeared to be confined to the alveolar aspect of the maxilla without extension to the basilar bone. The mucoperiosteal flap was thickened and felt gritty to palpation. Because of its limited extent, it was decided to do an excisional biopsy. The mass was removed with the use of osteotomes and rongeurs, and was submitted for microscopic examination. An effort was made to thin the mucoperiosteal flap, after which it was repositioned with 4/0 polyglycolic acid sutures. The patient tolerated the procedure without difficulty and has been followed on a periodic basis. She has been free of recurrence for the past 31 months.

Medical oncology in the management of head and neck cancers

General approaches and therapeutic goals of medical oncology for head and neck cancer are presented. The effectiveness of chemotherapy for the treatment of different stages of head and neck cancer in specific anatomic sites is discussed, as well as complications associated with chemotherapy, and approaches to the prevention and management of these stages. Systemic side effects that may occur with specific therapeutic agents are presented in a tabular format. Future directions and evolving approaches to head and neck cancer therapy are summarized.