J. Philip Sapp

Extracondylar osteochondromas of the jaws

A review of the literature and the addition of two new cases have revealed that according to a histologic criterion there are presently twenty reported cases of osteochondroma of the jaws located outside the condyles. Although most of the extracondylar lesions have occurred on the coronoid process, cases are now reported on the maxilla and the body of the mandible. The clinical features of these lesions are compared with those located in the condyle, and the radiographic and surgical approaches of the extracondylar lesions are discussed.

Treatment of oral Kaposi's sarcoma with a sclerosing agent in AIDS patients. A preliminary study.

Presently oral Kaposis sarcoma is primarily treated with systemic and intralesional chemotherapy, immunotherapy, radiation, and occasionally lasers. Each of these modalities achieves varying degrees of success. In patients with acquired immunodeficiency syndrome, the traditional treatments are frequently accompanied by local and generalized side effects that are detrimental to an already compromised immune system. Experience using sclerosing agents to treat other oral vascular lesions in healthy patients is known to produce excellent results. To evaluate the use of this treatment method in patients with acquired immunodeficiency syndrome, 15 oral lesions in 12 patients were injected with 3% sodium tetradecyl sulfate (Sotradecol). Thirteen lesions were located on hard palate; nine were nodular, three papular, and three macular. One week after treatment, some degree of ulceration occurred in all lesions with healing beginning by the middle of the second week. Six lesions required a second treatment to completely resolve. In one patient, healing was delayed, and the patient encountered a period of discomfort as a result of superficial bone sequestration. All other lesions healed uneventfully without the major side effects encountered with the other commonly used methods. Patients were followed for recurrence until they died or moved away. No recurrences were noted, with many followed for 18 months or longer. It is suggested that for lesions 2.6 cm or less in size, a sclerosing agent may be a better treatment modality than those now commonly used for oral Kaposis sarcoma.

Absence of radiometric differentiation between periapical cysts and granulomas.

A recent study reported that the mean density of periapical cysts was greater than that of periapical granulomas. This study, which used a larger sample size and a robust method for standardization of density and contrast between images, found no difference between the radiographic density of cysts and granulomas classified by microscopic evaluation. Cysts tend to be larger than granulomas, but there was wide variation in size of both types of lesions. There was no significant correlation between the density of a lesion and its size.

c-myc Oncoprotein expression in oral precancerous and early cancerous lesions

Squamous cell carcinoma of the oral cavity is often preceded by clinically evident precancerous lesions. These lesions exhibit progressive cytomorphologic changes connoting cellular transformation to malignant neoplasia. Molecular events underlie the microscopically identifiable cytological changes that herald transformation. Various proto-oncogenes are activated, overexpressed or mutated in the process of transformation. This investigation was designed to determine whether the nuclear binding c-myc oncoprotein, an activator of cell division, parallels or precedes cytomorphological changes at various histologically defined stages in oral precancerous lesions. Employing immunohistological methods, it was determined that c-myc nuclear labelling paralleled the progressive histological changes among various stages of transformation. It was also noted that some, yet not all, instances of benign keratoses which lacked any cytologic evidence of atypia harboured c-myc oncoprotein positive nuclei. It is concluded that c-myc expression is correlated with progressive cell transformation in oral cancerous lesions.

A clinical comparison of xeroradiography and conventional film for the interpretation of periapical structures

Xeroradiography and D-speed and E-speed film radiography were evaluated for the radiographic interpretation of periapical disease. Fifty-six consenting dental patients, either with or without periapical disease, were studied. Each patient received two radiographic examinations, one using xeroradiography and the other using either D-speed or E-speed film. Each tooth in the study population was evaluated independently relative to its history, clinical appearance, and clinical test results. Diseased teeth were endodontically treated. Teeth judged to be normal were followed for 1.5 yr to verify a clinically asymptomatic state. In both cases clinical assessments determined the true presence or absence of disease. Ten dentists scored the radiographic images for the presence of periapical disease and changes of various anatomical structures. Receiver-operating-characteristic (ROC) analysis of the three imaging techniques demonstrated no statistical difference in the diagnostic utility of xeroradiography (0.842 receiver-operating characteristic value) versus conventional radiography (0.843 receiver-operating characteristic value). In terms of radiation dose, xeroradiographic and E-speed film images required about one half the patient radiation exposure of D-speed film radiography. Therefore, xeroradiography or E-speed film techniques are preferred over conventional D-speed film radiography for the interpretation of periapical structures.

Serum antibody responses to indigenous oral mucosal antigens and selected laboratory-maintained bacteria in recurrent aphthous ulceration☆

Sera from subjects with recurrent aphthous ulceration (RAU) and control subjects were tested for relative levels of IgM, IgG, and IgA antibodies against eight selected laboratory-maintained bacteria, including Streptococcus sanguis which has been implicated in the etiopathogenesis of RAU. There were no differences in relative serum antibody levels for any isotype against any bacteria between control and RAU groups. RAU subjects with active lesions were then paired with control subjects, and each serum was tested against sedimentable material derived from the oral mucosa of each pair member. The analysis of data indicated that RAU and control subjects had similar levels of serum antibodies to indigenous mucosal antigens, but RAU subjects had significantly less antigenic material than control subjects.

Osteomyelitis of the mandible as a complicating factor in paget's disease of bone

A case of osteomyelitis of the mandible in a patient with extensive Pagets disease of bone is presented. The changes in the bone with Pagets disease makes the diagnosis, clinical assessment and management of the osteomyelitis in such patients a difficult task.

The distribution and morphologic variation of hyaline deposits in odontogenic lesions

The deposits of homogeneous hyaline substances present in epithelium-containing odontogenic lesions were evaluated in 201 tumors. The material was evaluated to establish the types of odontogenic lesions capable of producing the substance, its frequency of occurrence, its microscopic variation, and the different morphologic relationships of the substance to the odontogenic epithelium present in the lesions. The deposits were found in 40.3 percent of the 201 odontogenic tumors and frequently in several other nonneoplastic odontogenic lesions. It was most consistent in odontomas but was found to some extent in all types of epithelium-containing odontogenic tumors. It was present either in a basement membrane location or as a diffuse deposit in the connective tissue. In the latter location, the deposits commonly contained enclaved islands of odontogenic epithelium and had a distinct tendency to calcify. The study also suggests that since some odontogenic tumors may contain large amounts of the hyaline deposits, multiple sections through different parts of the tumor may be required to find the epithelial elements necessary for the correct diagnosis.

Salivary Gland Disorders

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Surgical suction damage: a common tissue artifact.

The vacuum effect of a surgical suction tip can induce significant artifactual alterations in the connective tissue of specimens removed for diagnostic or therapeutic purposes. The alterations described in this article consist of a surgical suction artifact characterized by the formation of numerous, pleomorphic vacuoles that, on casual microscopic examination, resemble the morphology of traumatized adipose tissue. This artifact occurs when a vacuum draws air into connective tissue and mobilizes connective tissue mucins (acid mucopolysaccharides) that localize within the vacuoles that are formed.