Philip Worthington

Osseointegrated implant rehabilitation of the previously irradiated mandible: Results of a limited trial at 3 to 7 years☆

The use of osseointegrated dental implants in patients with defects of the head and neck acquired as a result of ablative surgery for malignancy is an accepted and valuable extension of the well-documented use of these implants for the treatment of edentulism. In patients who have received ionizing radiation as part of tumor therapy, the use of dental implants is poorly documented. A limited trial of 21 Brånemark implants placed in the previously irradiated mandibles of four patients is reported here. The implants have been in place and functioning for periods of 3 to 7 years. No implants have been lost. Patient selection, treatment, and complications encountered are discussed. Guidelines for further use of osseointegrated implants in patients with previously irradiated mandibles are suggested.

Dislocation of the mandibular condyle into the temporal fossa

Summary A case of traumatic anterosuperior dislocation of the mandibular condyle into the temporal fossa is described. This form of dislocation does not seem to have been previously reported. The causative mechanism, diagnostic features and the clinical management are discussed.

Oral histoplasmosis as a presenting disease in acquired immunodeficiency syndrome.

A 43-year-old homosexual man visited his dentist with painful, nodular, ulcerated lesions on the soft palate, right buccal mucosa, and right posterior maxillary gingiva. Serologic studies for exposure to human immunodeficiency virus, performed before biopsy, were positive. Biopsy of the maxillary gingiva demonstrated sheets of histiocytes containing small intracellular yeasts, which on culture were identified as Histoplasma capsulatum. Bilateral leukoplakic lesions with some vertical furrowing involving the lateral borders of the tongue were also noted. Histologically, hyperkeratosis and fungal hyphae were identified. The patient was treated for histoplasmosis with amphotericin B, which resulted in significant improvement of the oral lesions. He was subsequently hospitalized for fatigue and dyspnea and was found to have Pneumocystis carinii pneumonia. Pulmonary status deteriorated within a 3-week period, and the patient died. Autopsy findings were negative for histoplasmosis but positive for necrotizing and cavitary P. carinii pneumonia, pulmonary and hepatic herpes simplex infections, and pulmonary and intestinal cytomegalovirus infection.

The surgical approach to the pterygoid region

Abstract Four suggested approaches to the pterygoid region are briefly reviewed and their advantages and disadvantages mentioned. One of these methods is illustrated by a case report.

Juvenile xanthogranuloma of the tongue.

Oral juvenile xanthogranuloma is a rare condition, with only 10 histologically proven cases previously described. A histologically unusual variant is reported here, diagnosis of which was aided by the use of immunohistochemical stains. Previously reported cases are reviewed, and their characteristics are tabulated and discussed.

Melanoma metastatic to the mandible: Report of a case

Metastasis of a tumor to the jaws can simulate an infection, but the presence of paraesthesia and loose teeth or inadequate response to treatment should alert the clinician to a more serious cause. A malignant melanoma metastatic to the jaws illustrates these points.

Firm mass of the tongue

A 35year-old white man was referred to the University of Washington oral and maxillofacial surgery service with a firm, painless nodule on the left dorsum of the tongue (Fig 1). The patient had been aware of the lesion for 8 to 10 years during which time the area was completely asymptomatic. There was no history of previous trauma. Examination revealed a 1.0 x O.&m firm, grey-white, sessile nodule in the anterior two thirds of the left dorsum of the tongue, adjacent to the midline. The lesion was hard to palpation and noncompressible.

The management of the palatal pleomorphic adenoma

Abstract Certain clinical and histopathological features of the palatal pleomorphic adenoma are reviewed and the conclusion is reached that wide local excision of the soft tissues is to be recommended. A technique of surgical repair of the resulting full thickness fenestration of the soft palate is suggested using a rotated, unlined island flap based on the contralateral greater palatine vessels.This has proved a short, reliable and uncomplicated procedure in an initial series of six patients.

Bilateral low condylectomy of the mandible

The operation of low condylectomy of the mandible is seldom performed bilaterally. The indications and consequences are reviewed, and a case is reported in which the adverse sequelae commonly attributed to this procedure were avoided over an 11-year follow-up period.

The benign lymphoepithelial lesion of the salivary glands: A case report*

The literature on the so-called benign lymphoepithelial lesion of the salivary glands is reviewed. A case is reported demonstrating progression to malignant lymphoma (lympho-sarcoma) over two years. Other examples of autoimmune disorders developing malignant lymphoma are recalled.