Steven D. Vincent

Oral lichen planus: The clinical, historical, and therapeutic features of 100 cases

Lichen planus is a chronic inflammatory epidermal and mucosal disease, the cause of which is poorly understood. We reviewed the clinical and historic features of 100 patients referred to our clinic for diagnosis and management of lichen planus. The age, gender, chief complaint, duration of the chief complaint, medical history, medications, and clinical findings were recorded. Past therapeutic modalities were reviewed. Of therapeutic significance, 25 patients with oral lichen planus had a secondary oral candidiasis. Management of symptomatic lichen planus with topical and systemic steroid is discussed. The pharmacology of topical and systemic steroid usage and the rationale for treatment are discussed.

Clinical, historic, and therapeutic features of aphthous stomatitis. Literature review and open clinical trial employing steroids.

The clinical and historic features of 50 patients with diagnosed aphthous stomatitis and treated with topical triamcinolone acetonide, 0.1% or 0.2% aqueous suspension; alone or in combination with initial burst therapy of 40 to 60 mg of prednisone, are reviewed. The mean age of our patients was 36.6 years (range 6 to 80 years). The duration of the chief complaint, usually oral pain, or more specifically, recurrent oral ulcers, was 11.1 years (range 4 weeks to 40 years). All patients showed a wide range of ulcer sizes when examined initially or at follow-up. Forty were followed up for an average of 22.9 months. Thirty-four reported prompt healing of ulcers identified at the time of initial evaluation, and no or markedly fewer ulcers subsequently if maintenance therapy of prophylactic topical triamcinolone, 0.1% or 0.2% aqueous rinse, was used. Five patients reported partial relief. No systemic side effects were noted even after long-term topical therapy. Local candidosis was a complication encountered in five patients.

Clinical and therapeutic features of polymorphous low-grade adenocarcinoma

Polymorphous low-grade adenocarcinoma, also known as terminal duct or lobular carcinoma, was first described in two clinical case series in 1983. Before that time most of these neoplasms were diagnosed as benign salivary gland neoplasms including pleomorphic adenomas, variants of monomorphic adenomas, or salivary malignant conditions including malignant pleomorphic adenomas, adenoid cystic carcinomas, and adenocarcinoma not otherwise stated. This neoplasm with few exceptions originates in minor salivary gland tissue of the posterior hard and soft palates or buccal mucosa. It is characteristically slow to enlarge; clinical reports show the neoplasm present for many years before diagnosis. We have evaluated the clinical and microscopic features of 15 cases from the archives of The University of Iowa Surgical Oral Pathology Laboratory and added these to published case reports. A total of 204 cases were evaluated with a female/male ratio of almost 2/1. Forty-nine percent originated in palatal mucosa. Polymorphous low-grade adenocarcinomas arising from pleomorphic adenomas or de novo have been reported within major salivary glands and outside the oral cavity. A 17% recurrence rate was found with a regional metastasis rate of 9%. Five cases had multiple recurrences, and 13 recurrences were at or beyond 5 years after the initial diagnosis. Regional node metastases were identified at the time of initial treatment or at the time of recurrence in 9% of cases in which follow-up data were specified.

Clinical, historic, and therapeutic features of cicatricial pemphigoid: A literature review and open therapeutic trial with corticosteroids

Cicatricial pemphigoid is at present an incurable, autoimmune disease that involves mucosa and skin. We have documented the clinical, microscopic, and therapeutic features of 23 patients with cicatricial pemphigoid and added these to reports of past literature. The mean age at the time of diagnosis was 63 years, and women were involved twice as often as men. Eighty-three percent of patients had oral mucosal involvement, 70% had conjunctival involvement, and 22% had skin involved. Direct immunologic evaluation revealed IgG at the basement membrane in 57% of cases and C3 in 66%. We have been able to manage the disease adequately in most patients with topical or systemic corticosteroids. The most commonly encountered side effect was oral candidiasis.

Oral candidosis: Clinical, historical, and therapeutic features of 100 cases

Oral candidosis is an increasingly important disease that affects a significant percentage of the population. Traditionally known as an opportunistic pathogen, the broader clinical scope of oropharyngeal candidal infections is now being recognized. The clinical and historical features of 100 patients referred for diagnosis and management of candidosis have been reviewed. The age, gender, chief complaint, medical history, medications, and clinical findings have been noted. A wide range of clinical signs and symptoms, and the rationale behind the topical and systemic antifungal therapies provided to this patient population, are discussed.

Central granular cell odontogenic fibroma

First described in 1962, the so-called granular cell ameloblastic fibroma has been a rarely reported benign odontogenic tumor. On reviewing the literature, we have identified eight previously reported cases. All cases involved well-circumscribed radiolucencies in women who ranged in age from 53 to 65 years. Seven lesions occurred in the posterior body of the mandible, and one occurred in the premolar region of the maxilla. All lesions were treated with surgical excision, and no recurrences were identified during follow-up periods of 6 to 144 months. Two additional cases also appear to represent instances of this neoplasm, which bring the total number identified to ten. We describe the clinical, radiographic, and histopathologic features of two additional cases and suggest reasons the tumor should be referred to as central odontogenic fibroma, granular cell variant.

Magnetic resonance imaging used to assess patients with trigeminal neuralgia.

To assess the value of magnetic resonance imaging in the evaluation of trigeminal neuralgia, 51 patients were studied by magnetic resonance imaging after a trigeminal protocol. Clinical and magnetic resonance imaging results were correlated. Seventeen (33%) nonvascular abnormalities and 27 (53%) vascular contacts or compressions of the trigeminal nerve were demonstrated. Of the patients younger than of 29 and 39 years of age, 100% and 45%, respectively, had a tumor or multiple sclerosis compared with 20% and 18% of those older than 40 and 60 years of age, respectively. One third of the patients with pain in more than one branch of the trigeminal nerve had tumors. On the basis of this study, magnetic resonance imaging may be useful in discovering underlying pathoses associated with trigeminal neuralgia if patients have failed to respond to an initial conservative treatment. The patients most likely to exhibit significant magnetic imaging resonance findings are young and with pain in more than one trigeminal branch.

Incidental Findings on Cone Beam Computed Tomography Images

Background. Cone beam computed tomography (CBCT) has gained widespread acceptance in dentistry for a variety of applications. Most dentists who are not radiologists/trained in radiology are generally not familiar with interpretation of anatomical structures and/or pathosis outside their area of primary interest, as often this was not within the scope of their training. Objectives. To assess that the number of incidental findings on a CBCT scan is high both within and outside of the primary area of interest, thereby emphasizing the importance of interpretation of all areas visualized on the scan. Materials and Methods. An oral and maxillofacial radiologist reviewed 1000 CBCT scans (382 males and 618 females) for findings both in- and outside the area of interest. Results. Of the 1000 subjects that were reviewed, 943 scans showed findings in the primary regions of interest and/or outside the regions of interest, and 76 different conditions were visualized in these scans both in and outside the areas of interest. Conclusion. From the wide scope of findings noted on these scans, it can be concluded that it is essential that a person trained in advanced interpretation techniques in radiology interprets cone beam computed tomography scans.

Acquired tufted angioma: a unique vascular lesion not previously reported in the oral mucosa

We describe two patients with acquired tufted angioma, a unique vascular lesion not previously reported in the oral mucosa. In one patient, the lesion manifested as a purple–red papule and, in the other, as a blue submucosal swelling. Both lesions were non‐painful and neither was associated with a history of trauma. The histopathological features consisted of scattered, irregularly shaped tufts, primarily composed of poorly formed capillary spaces and slit‐like vascular channels. Capillary spaces were often closely packed, producing solid areas which stained for smooth muscle actin. Staining for factor VIII‐related antigen was positive only within endothelial cells lining well‐formed vascular channels. Both lesions were treated by excision; short‐term follow‐up of one patient revealed no evidence of recurrence. Similarities between this and other vascular processes may have resulted in misdiagnosis of this lesion in the past. The clinical significance of acquired tufted angioma in the oral mucosa is not known.

Diagnosing And Managing Oral Lichen Planus

Lichen planus is a chronic and recurrent inflammatory disease characterized by unpredictable exacerbations and remissions. It affects the skin and/or mucous membrane in nearly 2 percent of the adult population. The symptoms are transient, but clinical evidence of oral disease is more persistent.