Peter Marker

Treatment of large odontogenic keratocysts by decompression and later cystectomy: A long-term follow-up and a histologic study of 23 cases

OBJECTIVE The purpose of this study was to determine the course of healing, the frequency of recurrence, and the changes in the epithelium of keratocysts after decompression treatment. STUDY DESIGN The treatment of 23 keratocysts, which had been divided into two groups (12 and 11 patients, respectively), was carried out in two phases: (1) insertion of a polyethylene drain and removal of a biopsy specimen from the cyst wall, and (2) cystectomy and removal of the drain approximately 1 year later. Histologic examination of the biopsy material from the two phases was carried out, and the material classified according to Forssell. RESULTS Reduction in cyst volume together with bone healing occurred in all cases, although there was recurrence in two patients. Decompression resulted in substantial histologic changes in the epithelium in 19 cases (83%). CONCLUSIONS (1) Decompression results in new bone formation and thickening of the cyst wall. (2) This treatment conserves bone and anatomic structures. (3) The frequency of recurrence is low. (4) The keratocyst epithelium is modulated histologically to nonkeratocyst after decompression.

Metastases to the mouth and jaws from hepatocellular carcinomas. A case report

Hepatocellular carcinoma metastasis to the jaw and soft tissue of the oral cavity is a rare phenomenon. A case of metastatic hepatocellular carcinoma to the mandible is described. A review of the literature showed that only 19 such cases have been reported so far. As severe haemorrhage may occur during surgical removal of these metastases, it is advisable to carry out fine needle aspiration biopsy when metastasis from a hepatocellular carcinoma is suspected.

Osseointegrated implants for prosthetic rehabilitation after treatment of cancer of the oral cavity.

The treatment of oral cancer usually involves extensive resection of the mandible, excision of oro-facial soft tissue and often radiotherapy. This causes difficulty in the subsequent oral rehabilitation. The present paper reports our experience with implant treatment of this patient group. The material comprises 38 implants in 12 patients. Four patients died during follow-up, two before loading the implants. The observation time after implantation was 7 to 47 months with a median of 14 months. Six of the patients had been subjected to preoperative radiation therapy. All 38 implants osseointegrated without complications. It is concluded that healing after implantation in irradiated mandibles can be achieved without hyperbaric oxygen. Provided certain guidelines are complied with i.e. careful surgical technique, use of antibiotics and prolonged period of healing prior to loading of the implants, a radiation dosage of up to 50 Gy appears to be of little significance.

Incompletely erupted third molars in the line of mandibular fractures : a retrospective analysis of 57 cases

A retrospective investigation was carried out of 57 cases of mandibular angle fractures, where a completely or partially impacted third molar was present in the line of fracture. Closed reduction was used in all of the cases, using intermaxillary fixation over a period of 42 days. Antibiotics were given to all patients for a period of 1 week. Thirty-one patients (55%) were treated within the first 24 hours and 43 (75%) within 48 hours. Infection at the fracture site occurred in two patients (3.5%). Both of these patients had been treated within the first 24 hours. It is concluded that closed reduction with retention of the mandibular third molar within the line of a mandibular angle fracture can be carried out with less morbidity compared with cases in which rigid fixation is used and movement of the jaws permitted immediately. Because of the size of the study group, no relationship could be demonstrated between cases with infection and the time from trauma to fixation.

The Danish national guidelines for treatment of oral squamous cell carcinoma

The treatment strategy for oral squamous cell carcinoma in Denmark has traditionally varied between the different head and neck oncology centres. A study group within the Danish Society for Head and Neck Oncology (DSHHO) was formed with the aim of optimising and standardising the treatment strategy. The approach was to use single modality treatment for stage I, stage II and some stage III and combined modality treatment for stage III and IV. Surgery was the preferred treatment when it was considered possible to perform a radical excision of the tumour and possible lymph node metastases with acceptable aesthetic and functional outcome. The implementation of a recognised national guideline facilitates prospective studies on a large well-characterised cohort. This increases the possibility of obtaining valid data on parameters such as morbidity, loco-regional control and survival. In addition the establishment of a reference program facilitates national monitoring of the treatment using defined indicators and standards.

A case of benign lymphoepithelial lesion of the hard palate.

The benign lymphoepithelial lesion is a rare condition, most frequently affecting the parotid gland. A review of the literature brought to light 4 earlier cases with localization in the accessory salivary glands in the oral cavity. The present report presents a 5th case arising from the accessory salivary glands on the left side of the hard palate. Destruction of the underlying bone was demonstrated radiologically; the latter has not previously been described. The present report contains a survey of the literature, as well as a review of the pathogenesis, clinical aspects and treatment of the disease.

The ADULT-EEC spectrum: An R280C mutation with a borderline phenotype†‡

Elisa Kier-Swiatecka,* Marianne Kock, Peter Marker, Hans Eiberg, and Klaus Wilbrandt Kjaer Department of Oral and Maxillo-facial Surgery, Odense University Hospital, Odense, Denmark Institute of Orthodontics, University of Copenhagen, Copenhagen, Denmark Institute of Medical Biochemistry and Genetics, University of Copenhagen, Copenhagen, Denmark Wilhelm Johannsen Centre for Functional Genome Research, University of Copenhagen, Copenhagen, Denmark

Immediate Obturation of the Surgical Defect after Partial Maxillectomy in the Endentulous Patient

Closure of the surgical defect immediately after partial maxillectomy is the treatment of choice. The advantages are: maintaining facial contour, rapid re-establishment of speech, swallowing and mastication. A number of methods for the fixation of the immediate obturator in patients without teeth have been described. A new technique is reported where a transnasal wire holds the existing denture in position after partial maxillectomy. The method has been carried out on 7 patients with sino-nasal cancer during the period 1978-1994. The advantages of the technique are that the wire acts as an axis of rotation which together with the sponge in the cavity provide good stability of the denture. There is minimal preoperative laboratory work and simplification in replacing the surgical dressing.