Lipa Bodner

Growth potential of peripheral giant cell granuloma

PURPOSE The purpose of this study was to investigate the association of selected demographic, systemic health, and oral health characteristics of patients with large (> 2 cm) peripheral giant cell granuloma and to assess its growth potential and the possible underlying causes. METHODS A series of 79 cases including 15 subjects with lesions 2 to 5 cm in the largest diameter is presented. Age, sex, site, size, systemic health, oral hygiene, and report of oral dryness of subjects with large lesions were compared with those of subjects with small lesions (< 2 cm). RESULTS No differences were found in mean age between the small lesion group (mean age = 31 +/- 6 years) and the large lesion group (mean age 53 +/- 24.2 years). Female predilection (male/female ratio 1:1.5, 1:2.75.) was more significant in patients with large lesions. No statistically significant differences were found in systemic health score (mean American Society of Anesthesiology score 1.39, 1.53). Oral hygiene score (percent calculus 78% +/- 3.1%, 95% +/- 2.7%, percent gingival bleeding 58% +/- 3.6%, 73% +/- 5.4%, percent deep pocket 30% +/- 2.8%, 42% +/- 3.1) was better among the patients with small lesions. The percentage of patients with a report of oral dryness was significantly higher (3.1%, 27%) among patients with large lesions. CONCLUSIONS Findings from this study suggest that patients with large (> 2 cm) peripheral giant cell granuloma lesions are more likely to be women with lower oral hygiene scores and xerostomia. Further studies are required to measure the relative risk of these factors.

Clinical characteristics and treatment of patients with oral lichen planus in Israel

Oral lichen planus (OLP) has a multiple-site involvement, with the buccal mucosa being the most prevalent. A possible relationship between OLP and the risk of malignancies in the involved site is documented. The characteristics of OLP have been studied in different populations; however, no similar studies have been conducted in any Jewish population. The purpose of this study was to evaluate the natural history of OLP in Israeli Jewish patients. Data were collected from 157 charts of patients with histologically confirmed OLP. No evidence suggesting a connection between OLP and diabetes, cardiovascular disease, smoking, alcohol use, or positive Candida culture was found. Skin involvement of lichen planus was found in one fifth of the patients. Symptomatic OLP was noted in half of the patients, mainly in those with the erosive form. In 65% of the patients with symptoms, improvement by more than 50% was shown within 2 weeks of steroid use. The transformation rate of 1.3% of OLP into malignancy was observed in the entire group. A constant follow-up for contributing symptoms and for early diagnosis of suspected transformed lesions is of utmost importance.

Efficacy of fibrin sealant in patients on various levels of oral anticoagulant undergoing oral surgery.

OBJECTIVE The purpose of this study was to investigate the efficacy of fibrin sealant in patients on oral anticoagulant therapy undergoing oral surgery with varying degrees of surgical trauma and various intensities of anticoagulation. STUDY DESIGN A consecutive series of 69 subjects on oral anticoagulant therapy undergoing oral surgery without changing anticoagulation intensity is presented. For each subject, indication for anticoagulation, international normalized ratio on day of treatment (low, 1.0-2.0; medium, 2.1-3.0; high, 3.1-5.0), degree of surgical trauma (on a scale of 1-12), and complications were recorded and correlated. RESULTS There were 32 (46.4%) patients with prosthetic valves, 23 (33.3%) with atrial fibrillation and rheumatic or ischemic heart disease, and 14 (20.3%) with previous thromboembolism. Twenty (29%) patients were on low-intensity anticoagulation (international normalized ratio, 1.0-2.0), 26 (37.7%) were on medium-intensity anticoagulation (international normalized ratio, 2.1-3.0), and 23 (33.3%) were on high-intensity anticoagulation (international normalized ratio, 3.1-5.0). Each of 39 (56.5%) patients was in surgical trauma category 1, 2, or 3; the remaining 30 (43.5%) patients were in surgical trauma categories 4 through 12. Complications occurred in 3 (4.3%) patients and took the form of minor postoperative bleeding. No correlation was found between complications and international normalized ratio or degree of surgical trauma. CONCLUSIONS The use of fibrin sealant in oral surgery for patients on oral anticoagulant therapy is safe, and it can be provided in an international normalized ratio range of 1.0 through 5.0 and in a surgical trauma scale range of 1 through 12.

Experimental tongue cancer in desalivated rats

A group of 39 rats underwent excision of the submandibular and sublingual glands and ligation of the parotid ducts through the midventral incision of the neck, while the control group (41 rats) underwent a sham operation. All rats were administered 4NQO in a final concentration of 0.001% in drinking water. At 7, 14, 22 and 28 weeks after administering 4NQO, both groups of rats were killed and their tongues dissected, inspected and then fixed in 10% buffered formalin for histopathological examination. Clinical examination during the first 14 weeks revealed that rats in both groups looked healthy and no differences in body weight were noticed. Afterwards, the average weight gain of the desalivated rats was lower than in the control group (P < 0.01). The number of macroscopic oral lesions increased with time in both groups. However, in the desalivated rats, the first identifiable lesions were seen as early as week 7, whereas in the control group macroscopic lesions were seen only after 22 weeks. Histological examination revealed more affected rats in the desalivated group in the first 14 weeks after administering the carcinogen; lesions showed more severe pathological changes including two cases with evidence of squamous cell carcinoma. The differences between the desalivated groups and control decreased after 22 weeks with almost no differences at the end of the experiment.

Primary intraosseous squamous cell carcinoma arising in an odontogenic cyst - a clinicopathologic analysis of 116 reported cases

PURPOSE To review the literature on primary intraosseous squamous cell carcinoma (PIOSCC) associated with odontogenic cyst. METHODS All well-documented cases of PIOSCC published between 1938 and 2010 were collected. Only cases of PIOSCC arising from the lining of an odontogenic cyst, including the keratocystic odontogenic tumor, were selected. Age, sex, signs and symptoms, affected jaw, cyst type, treatment, histopathology, and outcome were recorded. RESULTS The mean age was 60.2 years (range 1.3-90). There were 80 (69%) men and 36 (31%) women. Mass and pain were the most common presenting symptoms. The mandible was affected in 92 (79%) patients and the maxilla in 24 (21%). It was a residual/radicular cyst in 70 (60%) patients and a dentigerous cyst or a keratocystic odontogenic tumor in the remaining 40%. The histopathology was well-differentiated SCC in 53 (46%) patients and moderately differentiated SCC in 47 (40%) patients. Fifty-three (46%) patients were treated with surgery alone and 44 (38%) with surgery and radiotherapy. Fifty-eight (62%) patients survived 2 years and 36 (38%) survived 5 years. CONCLUSION PIOSCC has a predilection for men (M/F ratio of 2.22:1), affects mainly adults in their 6-8th decades, occurs most frequently (79%) in the mandible, and is associated mainly with a residual/radicular cyst. Histologically, the well-to-moderately differentiated SCC was the most common. Surgery alone or combined therapy of surgery and radiation was the most common approach. The prognosis is 62% surviving 2 years and 38% 5 years.

Oral lipoma: analysis of 58 new cases and review of the literature

Lipomas are common soft-tissue tumors but occur infrequently in the oral region. Here, we present 58 new cases of oral lipoma (OL), their clinical features, diagnostic workup, and management. The records of 58 patients with OL were reviewed. Demographic data, presenting symptoms, primary tumor site, histopathology, and clinical management were analyzed. Extraoral and intraosseous lesions were excluded. The patients were 29 men and 29 women with mean age of 59.7 years, range, 11 to 98 years. Tumor sites included the buccal mucosa (n = 31), tongue (n = 10), lip (n = 6), floor of the mouth (n = 6), and vestibule (n = 5). The mean tumor size was 2.1 cm (range, 0.3-5.0 cm). The mean tumor duration before excision was 2.6 years (31.2 months), ranging from 2 months to 12 years. Most common presenting symptom was an asymptomatic, circumscribed mass. Histologically, the tumors were classified as classic lipoma (n = 28), fibrolipoma (n = 19), intramuscular lipoma (n = 4), minor salivary gland lipoma (n = 2), angiolipoma (n = 2), and spindle cell lipoma (n = 3). A case of spindle cell lipoma affecting the lower lip that has not been described previously is presented. The provided treatment was surgical excision. Although uncommon, OL are most common in adults and very uncommon in children. No sex predilection was found. The buccal mucosa region is the most common site followed by the tongue. Classic lipomas are most common in the oral region and comprise 48% of the tumors. A case of spindle cell lipoma of the lower lip is reported. Its clinical, histologic, and cytogenetic workup is the first well-documented case. Further cytogenetic studies should be undertaken to learn more about the pathogenesis and tumorigenesis of OL.

Cystic lesions of the jaws in children.

Sixty nine pediatric patients with cystic lesions of the jaws were successfully diagnosed and treated. Thirty one (45%) were dentigerous cysts (D.C.), 15 (22%) were eruption cysts (E.C.), 12 (17.3%) were traumatic bone cysts (T.B.C.), nine (13.3%) were radicular cysts (R.C.), one (1.5%) was primordial cyst (P.C.) and one (1.5%) globulomaxillary cyst (G.M.C.). The mean age for E.C., R.C., D.C., T.B.C. was 4.7, 9.2, 11.5, and 13.3 years, respectively. The mean age of E.C. is significantly (P<0.05) younger than D.C. and T.B.C. but not from R.C. No significant age differences were found between R.C., D.C. and T.B.C. The differences in mean cyst diameter were not significant. Male to female ratio was 1. The treatment modalities were: marsupialization, enucleation or enucleation with bone grafting. The findings demonstrate that the distribution and characteristics of jaw cysts in children is unique and is different from the distribution in adults. The relatively high rate of developmental cyst and the fact that they occur in an area with rapid developmental changes, suggest the need for more conservative surgical management in this selected patient population.

Teeth in the maxillary sinus--imaging and management.

PURPOSE To evaluate the images obtained by CT in diagnosis and treatment plan of teeth in the maxillary sinus. METHODS Twelve patients with teeth in the maxillary sinus were studied by plain film radiography (PFR) and by CT with a dental software programme, which displays multiple panoramic and cross-sectional views of the mandible and maxilla. The three-dimensional morphology of the tooth, its inclination, proximity to the sinus wall, surgical planning and prediction of prognosis and complications were estimated on both PFR and on CT scans and scored. RESULTS The radiographical features interpreted from PFR were fair or poorly diagnosed whereas CT provided excellent features. The surgical approach of choice was based on CT interpretation. CONCLUSION CT is useful for diagnosis and treatment planning of teeth in the maxillary antrum.

Parotid and submandibular calculi in children

Twelve pediatric patients with parotid or submandibular salivary gland calculi were successfully diagnosed following appropriately aimed imaging methods. The treatment modalities were: secretory stimulation of the gland to induce spontaneous passage, sialolithotomy or sialadenectomy. The treatment of choice was dependent on the size and location of the calculi, as well as on the affected gland and its functional secretory state.

Effect of decalcified freeze-dried bone allograft on the healing of jaw defects after cyst enucleation

PURPOSE This study radiographically evaluated the changes that occur in jaw defects after enucleation of cysts and either grafting with demineralized freeze-dried bone allograft (DFDBA) or packing with absorbable gelatine sponge (Gelfoam). PATIENTS AND METHODS Thirty-two patients (14 males, 18 females) with cystic lesions of the jaws were divided into two groups. Group A underwent enucleation and bone grafting with DFDBA. Group B underwent enucleation and packing with Gelfoam. Both groups were evaluated radiographically before surgery, immediately postoperatively, and 6, 12, 24, and 36 months postoperatively. The density of the area was measured with a digital densitometer. RESULTS The density in group A was significantly (P < .05 to .01) greater than in group B at 6 and 12 months postoperatively. The difference at 24 months was not significant. Group A reached density levels at 6 months that were reached by group B at 12 months. CONCLUSION The findings demonstrate that decalcified freeze-dried bone allograft enhances bone healing in jaw defects after cyst removal.