Lester R. Cahn

Biopsies of normal-appearing palates of patients with known sarcoidosis: A preliminary report

Abstract In a group of patients with known sarcoidosis, palatal biopsies of clinically normal areas showed sarcoid granulomas in 38 per cent of the total. Loss of integrity and pooling of the acini of palatal mucous glands were observed in a number sufficiently large to exclude coincidence. This finding bears further investigation. It is suggested that palatal biopsy may be a useful diagnostic tool in patients with sarcoidosis, especially those for whom confirmatory evidence may be of value.

Traumatic (amputation) neuroma

Abstract A case is presented of an amputation neuroma of the mental nerve, that had caused reflex neuralgia. The pathology of the neuroma is discussed. The possibility of unsuspected neuromas following dental surgical procedures, which may be the cause of obscure pain, is considered. A technique is suggested for preventing the recurrence of a neuroma by blocking the foramen with a sterile plug of inert material.

Bone pathology as it relates to some phases of oral surgery

Abstract 1. 1. Aside from neoplasms and infections, bone lesions fall into three categories: osteomalacia, osteoporosis, and osteitis fibrosa. 2. 2. Osteomalacia is a disease due to faulty calcification of the matrix. 3. 3. Osteoporsis is a condition due to the failure of the osteoblasts to lay down matrix. 4. 4. The factors that enter into the formation of the bone matrix are: stresses and strains and steroid hormones, both of which act directly upon the osteoblasts, and protein deficiency. 5. 5. Osteitis fibrosa is not a disease entity but a histologic sign of the withdrawal of calcium salts from the bone. 6. 6. The three diseases of bone with the histologic sign of osteitis fibrosa that most often attack the jaws are: (a) Pagets disease, (b) fibrous dysplasia, and (c) hyperparathyroidism.

The Penetration of the Tissue by Vincent's Organisms A Report of a Case

The history of the following case shows that the tissues may harbor the causal agents of Vincents disease long after acute symptoms have subsided: Mr. H.; age 35. The patient complained of severe pain in the gums and of all other symptoms indicative of Vincents infection. On examination the mouth revealed a classic picture of the disease. The gums were markedly reddened and inflamed; and between the lower central incisors, and the lower right cuspid and first bicuspid, there were characteristic membranous lesions. Smears made from these areas showed Vincents spirochete and Bacillus fusiformis in profusion, almost to the exclusion of all other bacterial forms (fig. 1). Under routine treatment, which in this case was the application of sodium perborate and the home use of this drug as a mouth wash, and the local application of methylene blue, the disease was checked in forty-eight hours. Within this time almost all pain had disappeared and the patient was entirely comfortable. Four days later all soreness was gone from the gums and there were no membranous areas, although the gums in the region where the membranes had been were still injected (fig. 2). There was considerable destruction of the tissue, especially on the lingual surface between the lower incisor teeth (fig. 3). Within ten days there was no evidence that the patient had ever had the disease. So much for the case itself. I had often wondered why cases of Vincents gingivitis had acute lapses long after they had been pro-

Aphthae and herpetic gingivostomatitis

Abstract It is thus apparent from the results of various studies that the conditions called aphthous ulcer (canker sore), herpes labialis, aphthous stomatitis, herpetic stomatitis, or acute infections gingivostomatitis are infections caused by the herpes virus, since: 1. 1. The virus present in aphthous lesions, when inoculated on the scarified cornea of rabbits, produces lesions identical with those caused by the herpes simplex virus. 2. 2. Encephalitis is induced in a definite number of animals subsequent to inoculation with the virus from either herpes or aphthous lesions. 3. 3. Lipschutz intranuclear acidophilic inclusion bodies have been demonstrated in the cells of the injected cornea and the brains of animals inoculated with the virus of herpes or the virus present in aphthous stomatitis. 4. 4. Rabbits inoculated with the virus present in aphthous stomatitis are rendered immune toward the herpes virus. 5. 5. The herpetic antibody develops in the patients serum during convalescence from either herpes lesions or aphthous stomatitis. The infection by the virus usually takes place in early childhood, and the patient harbors it for the rest of his life. The virus remains dormant until some contributory factor lowers the local tissue immunity. Then the herpetic lesion occurs. In contradistinction to other virus diseases there is no permanent immunity after an initial herpes simplex virus infection. Recurrence is the rule in infections by the herpes simplex virus. The disease is self-limiting, and treatment is aimed at palliation.

Pitfalls in histologic diagnosis: A clinico-pathologic study☆

Abstract A number of oral lesions have been considered whose histologic diagnosis was not consistent with the clinical course of events. Among these lesions were pseudoepitheliomatous hyperplasia; clinical malignancy not accompanied by a significant histologic diagnosis; a hyperplastic reparative process of the mandible mistaken for fibrosarcoma; pseudotuberculosis; and chronic lymphatic leucemia.

A Case of Heterotopic Ossification in an Untreated Granuloma

The specimen was an old, lower, molar root that had remained untreated and neglected in the jaw for years. The patient from whom it was removed was 72 years old. There was some resorption of the tissues about it, and it was fairly loose. When extracted, a medium sized granuloma was found adherent. This was prepared for histological examination, because it is my practice to prepare all tissue as a matter of routine. The specimen was fixed in 10 per cent formalin, and then decalcified in 5 per cent nitric acid; washed for 24 hours in running water; dehydrated in ascending alcohols through absolute alcohol and ether; and passed through ascending percentages of celloidin, in which it was finally embedded. Sections were cut and stained with haematoxylin and eosin. Where we expected the usual picture of the granuloma, with its round-cell infiltration, fibrous capsule, and occasional epithelial cells, we found mostly fibrous tissue, with scarcely any round cells, and a small island of bone actively forming in almost the center of the granuloma. Fig. 1 is a low-power photomicrograph of the specimen. At A is the root cementum, which appears regular and even. The entire field is composed of fibrous connective tissue, with little evidence of round-cell infiltration. At B is the island of ossification. Fig. 2 is a higher enlargement of B. About the border of the ossified mass are osteoblasts staining sharply, and evidently vital and active. This is a case of bone metaplasia, or heterotopic ossification. In the course of a great many histological examinations of this lesion, this is the first time I have found bone forming in a granuloma, and it is sufficiently rare to be reported. Why it is not found more often is difficult to understand, because, from a study of the various theories of heterotopic ossification and especially that of Leriche and Policard, the granuloma should be a fertile field for the growth of bone. It 503