Robert B. Brannon

Problems in Mass-Disaster Dental Identification: A Retrospective Review

A wide variety of problems may prevent or hinder a dental-identification (ID) team in its efforts to identify mass casualties. Since these problems have been infrequently reported in a comprehensive manner, the authors identified and summarized these problems to increase the awareness of dental-ID team members and to prepare them for future mass-disaster missions. The authors analyzed 50 mass disasters--ten in which the authors as members of military dental ID teams played a major role and 40 from the literature--and summarized problems that they confronted.

Glandular Odontogenic Cyst: Analysis of 46 Cases with Special Emphasis on Microscopic Criteria for Diagnosis

The glandular odontogenic cyst (GOC) is now a relatively well-known entity with recent reviews indicating over 100 cases reported in the English literature. The GOC’s importance relates to the fact that it exhibits a propensity for recurrence similar to the odontogenic keratocyst, and that it may be confused microscopically with central mucoepidermoid carcinoma (CMEC). Numerous histopathologic features for the GOC have been described, but the exact microscopic criteria necessary for diagnosis have not been universally accepted. Furthermore, some of the microscopic features of GOC may also be found in dentigerous, botryoid, radicular, and surgical ciliated cysts. The purpose of this multicenter retrospective study is to further define the clinical, radiographic, and microscopic features of GOC, to determine which microscopic features may be helpful for diagnosis in problematic cases, to determine the most appropriate treatment, and to determine if GOC and CMEC share a histopathologic spectrum. In our series of 46 cases, the mean age at diagnosis was 51xa0years with 71% of cases in the 5th–7th decades. No gender predilection was noted. 80% of cases occurred in the mandible, and 60% of the lesions involved the anterior regions of the jaws. Swelling/expansion was the most common presenting complaint, although some cases were asymptomatic. Radiographically, most cases presented as a well-defined unilocular or multilocular radiolucency involving the periapical area of multiple teeth. Some lesions displayed a scalloped border. Cases also presented in dentigerous, lateral periodontal, and “globulomaxillary” relationships. The canine area was a common location for maxillary cases. All cases were treated conservatively (enucleation, curettage, cystectomy, excision). Follow-up on 18 cases revealed a recurrence rate of 50% (9/18), with 6 cases recurring more than once (range of follow-up: 2xa0months to 20xa0years; average length of follow-up: 8.75xa0years). The mean interval from initial treatment to first recurrence was 8xa0years, and from first recurrence to second recurrence was 5.8xa0years. Two cases recurred three times and the interval from second to third recurrence was 7xa0years (exact interval only documented in one case). All cases exhibited eosinophilic cuboidal (hobnail) cells, a feature not specific for GOC, but necessary for diagnosis, in our opinion. Univariate analysis indicated several features that are most helpful in distinguishing GOC from GOC mimickers in problematic cases, including: (1) the presence of microcysts (Pxa0<xa00.0001); (2) epithelial spheres (Pxa0<xa00.0001); (3) clear cells (Pxa0=xa00.0002); (4) variable thickness of the epithelial cyst lining (Pxa0=xa00.0002); and (5) multiple compartments (Pxa0=xa00.006). Stratified analysis indicated that when microcysts are present, epithelial spheres and multiple compartments are still significant, and clear cells are marginally significant in distinguishing GOCs from GOC mimickers. The presence of microcysts (Pxa0=xa00.001), clear cells (Pxa0=xa00.032), and epithelial spheres (Pxa0=xa00.042) appeared to be most helpful in distinguishing GOC associated with an unerupted tooth from dentigerous cyst with metaplastic changes. There were no statistically significant differences microscopically between GOCs that recurred and those that did not. The presence of 7 or more microscopic parameters was highly predictive of a diagnosis of GOC in our series (Pxa0<xa00.0001), while the presence of 5 or less microscopic parameters was highly predictive of a non-GOC diagnosis (Pxa0<xa00.0001). Islands resembling mucoepidermoid carcinoma (MEC-like islands) were identified in the cyst wall of three cases, only one of which had follow-up (no evidence of disease at 74 mo.); therefore, at this time insufficient information is available to determine whether GOC and CMEC share a histopathologic spectrum or whether MEC-like islands in GOCs are associated with more aggressive or malignant behavior.

Ameloblastic carcinoma of the mandible

Ameloblastic carcinoma is a rare, aggressive odontogenic neoplasm of the jaws in which the epithelial cells exhibit cytologic features of recognizable ameloblastoma and malignancy. Cases with metastasis have been infrequently reported.

Oncocytic mucoepidermoid carcinoma of parotid gland origin.

This article reports 3 cases of oncocytic mucoepidermoid carcinoma of the parotid gland and compares them with 9 cases from the literature with emphasis on clinical behavior, treatment, and recurrence rate. The tumor occurs most often in the middle-aged to elderly, with a decided predilection for the parotid gland. All three oncocytic mucoepidermoid carcinomas from the Armed Forces Institute of Pathology series were low grade with extensive oncocytic change. Treatment modalities consisted of superficial parotidectomy, total parotidectomy, or total parotidectomy. The mean follow-up interval was 5.5 years. Only one case from the literature, a high-grade mucoepidermoid carcinoma, recurred. Results of this study indicate that the parotid gland oncocytic mucoepidermoid carcinoma behaves in a fashion similar to typical mucoepidermoid carcinoma, with prognosis dependent on clinical stage, histopathologic grade, and adequacy of treatment. Recognizing the spectrum of oncocytic differentiation in salivary gland tumors will serve to establish appropriate diagnoses and treatment.

Minor salivary gland mucoepidermoid carcinoma in children and adolescents: a case series and review of the literature.

IntroductionBecause well-documented cases of mucoepidermoid carcinomas that are of minor salivary gland origin and occur in children and adolescents have rarely been reported, little information regarding their clinical features and biologic behavior is available. This case report represents a retrospective clinical analysis of five minor salivary gland mucoepidermoid carcinomas accessioned from a 35-year period at the Louisiana State University School of Dentistry and combines the data with 15 well-documented cases from the English language literature.Case presentationThe five mucoepidermoid carcinomas in patients from birth to 19u2009years of age accounted for 1.3% of the accessioned minor salivary gland neoplasms. There were an additional 15 well-documented cases in the literature. Combining the data for the 20 mucoepidermoid carcinomas resulted in a mean age of 13.5u2009years and a 2.3:1 female-to-male ratio. Collectively, the hard palate, soft palate, and hard palate/soft palate junction accounted for 85% of the cases. Thirty-five percent of the cases presented as a fluctuant submucosal swelling with surface color alterations. The average duration was five months, and bone involvement occurred in seven cases. A histologic grade of low to intermediate predominated (95%). Surgical removal was the treatment in all cases. Thirteen cases had adequate follow-up of three years or more, and recurrence was documented in only one case. There were no cases of death or metastasis in this series.ConclusionsIn children and adolescents, mucoepidermoid carcinomas have a female predilection and occur most commonly on the hard or soft palate or both. A fluctuant submucosal lump with a bluish color is a helpful diagnostic clue. The histologic grades of most mucoepidermoid carcinomas in the first and second decades of life are low and, to a lesser degree, intermediate. Complete surgical excision is the treatment of choice and results in a recurrence rate of less than 10%.

Jonestown tragedy revisited: the role of dentistry.

The authors record the contribution of dentistry to the identification of victims of one of the most significant tragedies of the 20th century--the mass suicide of members of a religious cult, which initially resulted in 913 deaths and ultimately in 923. Though forensic dentistry played a significant part in identifying victims, the only report by members of the United States identification team did not examine dentistrys valuable role. Furthermore, the dental-investigation aspects have been mentioned merely in passing by the news media despite an infinite number of stories on the tragedy ranging from factual to expose. The dental teams organization, methodology, and significant contributions to forensic dentistry and a variety of remarkable problems that the team encountered and the lessons learned from them are documented in this paper.

Tenerife revisited: the critical role of dentistry.

The authors record the contribution of dentistry to the identification of victims of one of the most significant disasters in the history of aviation-the March 1977 collision of two Boeing 747 jumbo jets in the Canary Islands, which resulted in 583 fatalities. Dental identification was the primary method of victim identification because a high percentage of the bodies were severely burned. Virtually all aspects of the U.S. identification efforts have been reported with the exception of the valuable role of dentistry. The dental teams organization, methodology, and significant contributions to forensic dentistry and a variety of remarkable problems that the team encountered are documented.

The role of the dental hygienist in mass disasters.

The authors examine the specialty of dental hygiene and address its role in the identification of mass-disaster fatalities. Very little exists in the literature on what dental hygienists can often and what they have contributed as members of dental-identification teams. To encourage forensic dentists to seek out the valuable assistance of these highly trained professionals, the authors illustrate how their services can be used in mass disasters.

The crash of LOT flight 007: dental identification.

The authors record the contribution of dentistry to the identification of American victims of one of the most significant aircraft tragedies involving American athletes-the March 1980 crash of a Soviet-made Ilyushin 62 Polish jetliner and the deaths of 31 Americans including a 22-member U.S. amateur boxing team with several U.S. Olympic team candidates. Preparedness was a factor in the dental teams ability to resolve many notable and unexpected problems. Jurisdictional restraints that Polish authorities imposed on the U.S. investigative team hindered its efforts to identify American passengers. The team used dental and fingerprint methods of identification whenever possible and obtained further evidence from anthropologic methods, visual recognition, and personal effects. Dental readiness, organization, methodology, and lessons learned are documented in this paper.

Transient lingual papillitis: a papulokeratotic variant.

Transient lingual papillitis is an inflammatory disease involving the fungiform papillae of the tongue and is typically localized, accompanied by pain or tenderness, and of short duration. The unusual clinical and pathologic findings regarding a condition we identify as a recurring papulokeratotic variant of transient lingual papillitis are described. In the child whose case we present, this condition was nonpainful and florid in distribution. The etiology, clinical features, and histopathology of this heretofore-undescribed variant are discussed and compared with the findings in previously reported cases of transient lingual papillitis.