James C. Burns

Actinic cheilitis: A review of 152 cases ☆ ☆☆

OBJECTIVE The purpose of this study was to determine whether any clinical or histopathologic variables are associated with the severity of epithelial change in lesions of actinic cheilitis. STUDY DESIGN A total of 152 acceptable cases of actinic cheilitis were identified from 66,067 cases accessioned from February 1989 to June 1998. For each case, the clinical information supplied by the submitting practitioner at the time of the biopsy and 8 histopathologic variables were evaluated. RESULTS The following 5 histopathologic variables were positively correlated with an increased degree of epithelial change: acanthosis, basophilic change within the connective tissue, the presence of inflammation within the connective tissue, perivascular inflammation, and thickness of the keratin layer. None of the clinical variables was associated with an increased degree of epithelial change. CONCLUSIONS The presence of any of the aforementioned histopathologic changes should prompt a close evaluation of the lesion for the presence of either epithelial dysplasia or carcinoma.

The prevalence of oral lesions in smokeless tobacco users and an evaluation of risk factors

Background. The widespread use of smokeless tobacco (ST) has prompted concern in regard to the development of oral lesions in long‐term users.

Non-Hodgkin's lymphoma of the oral cavity associated with AIDS

A 34-year-old homosexual man had a large mass of the left side of the hard palate; alveolar bone resorption was observed in the area of the tumor. Microscopically, the lesion was interpreted as non-Hodgkins lymphoma, and immunocytochemical marker studies were consistent with a B-lymphocyte lineage.

Epithelial dysplasia of the oral cavity and lips

Between 1970 and 1986,1651 biopsy specimens from the oral cavity or lips with a diagnosis of epithelial dysplasia were accessioned by the Medical College of Virginia Oral Pathology Diagnostic Service (Richmond, VA). Of the four histologic grades of epithelial dysplasia (focal mild, mild, moderate, and severe), most of the cases were diagnosed as mild (54.1%) and the fewest (8.1%) were in the severe category. The overall mean age at time of diagnosis was 56.7 years. A predilection for occurrence in males was confirmed, but a lower than expected incidence in blacks was noted. The most common anatomic sites were the buccal mucosa, palate, and floor of mouth. The anatomic areas which were most likely to have a severe epithelial dysplasia r/ere the ventral surface of the tongue and the lip. Patients with dysplasias in more than one site had a slightly higher probability of being diagnosed as either moderate or severe. The cases associated with lichen planus usually were found on the buccal mucosa and demonstrated a shift toward a milder degree of dysplasia.

Comparison of Oral Carcinomas in Smokeless Tobacco Users and Nonusers

Biopsy reports of squamous cell carcinoma (SCC) and verrucous carcinoma (VC) were retrospectively evaluated to determine the prevalence of smokeless tobacco (ST) use and to ascertain if any clinical or histologic differences existed when comparing ST users with nonusers. Of the 874 SCC cases, 12 patients (1.4%) were ST users as compared with 7.7% (10 of 129) of the VC patients. The carcinomas in ST users, either SCC or VC, were diagnosed at a later age and were more likely to occur in the buccal mucosa/vestibule area. The SCCs in ST users were more often histologically well differentiated. Because of the anatomic site predilection, it appears probable that ST use is a causative factor in the development of some cases of oral carcinoma.

Adult smokeless tobacco use and age of onset.

To determine if an earlier age of onset is associated with greater levels of adult smokeless tobacco (SLT) use and to evaluate if this relationship differs by SLT type, 345 current adult SLT users were interviewed to obtain the age at first onset and current frequency of SLT use. The results indicated that more than twice as many SLT users began during adulthood than during preadolescence. Although preadolescent onset was associated with greater chewing tobacco use than adolescent onset, the greatest levels of both chewing tobacco and snuff use were associated with adult onset, suggesting an increased need for SLT prevention programs for young adults.

An educational program for oral cancer detection

The Virginia oral cancer screening program provides a unique educational opportunity for undergraduate dental and medical students to enhance their skills in oral diagnosis and biopsy technique. During this week-long trip to underserved areas of the state, an average of 761 patients are examined and 44 biopsies performed. Approximately 31% of all the biopsies done since 1972 have been diagnosed as either a premalignant or malignant lesion. The value of this program to both the students and the patients is discussed.

Arteriovenous malformation of the submandibular gland

1. Worthington P: Dislocation of the mandibular condyle into the temporal fossa. J Maxillofac Surg 10:24. 1982 2. Akers JO, Narang R. DeChamplain RW: Posterior dislocation of the mandibular condyle into the external ear canal. J Oral Maxillofac Surg 40:369, 1982 3. Converse JM: Reconstructive Plastic Surgery, vol 2. Philadelphia, WB Saunders, 1964 4. Goldberg MH, Aslanian R. Marco W. et al: Auditory canal hemorrhage-a sign of mandibular trauma. J Oral Surg 29~425. 1971 5, Harwood-Nash DC: Fractures of the petrous and tympanic parts of the temporal bone in children. Am J Roentgen 110598. 1970 6. Kazanzian VH. and Converse JM: The Surgical Treatment of Facial Fractures. Baltimore. Williams and Wilkins, 1959 7. Kilgore TB: Auditory canal hemorrhage with contralateral condylar fracture. Can Dent Assoc J 9:455. 1979 8. Lindeman RC: Temporal bone trauma and facial paralysis. Otolaryngol Clin North Am 12:403. 1979 9. Martis C: Bleeding from the ear in maxillofacial injuries. J Maxillofac Surg 2:126. 1974 10. Eckerdal 0. Ahlquist J, Alehagen U, et al: Length dimensions and morphologic variations of the external bony auditory canal. Dentomaxillofac Radio1 7:43. 1978 11. Eckerdal 0, Ahlquist J: External bony auditory canal and the tympanic bone. Acta Radio1 [Diagn] (Stockh) 21:425. 1980

A survey to determine the knowledge of military members about the hazards of tobacco use, and a resulting tobacco‐hazard education project

A questionnaire and an intraoral examination were administered to 340 U.S. Navy personnel in order to ascertain the use of tobacco and its effect within the oral cavity. The rate of tobacco use among these military personnel was about twice that of the general public. About 45% of the patients were not well informed of the systemic or intraoral hazard of tobacco usage. With a need for tobacco-hazard awareness documented, an educational project was designed and administered to over 4,000 military and civilian participants. This education program has now been expanded to train health care professionals so that they can perform their own tobacco-hazard education with patients and small groups.

In vivo testing of an experimental endosseous implant design

PURPOSE The purpose of this study was to test a new implant system with apically expanding, double-hinged wing stabilizers in dogs before human testing. METHODS Twenty-seven HA-coated endosseous implants were placed in five dog mandibles. The implants were placed into function for 12-weeks after a 12-week healing period. At the end of this period, the implants were evaluated clinically and radiographically. The animals then were killed, allowing for the implants to be evaluated mechanically and histologically. RESULTS After the initial healing period, 24 of 27 implants demonstrated osseointegration. Seven of eight implants restored with acrylic resin-fixed partial dentures were stable after the 12-week period of function. However, 17 of 27 implants failed to satisfactorily deploy the apical wing stabilizer system. CONCLUSION This new implant system has a number of design flaws that must be addressed before testing in humans.