Thomas P. Williams

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.

Oral melanoma: case reports and review of the literature.

Oral melanomas occur most often on the palate and gingiva with the maxillary arch affected 80% of the time. Melanosis may exist many years before a definitive biopsy. Long-standing lesions may ulcerate but lack rolled borders or induration, features commonly associated with squamous cell carcinoma. Melanoma that involves oral mucosa is rare with an extremely poor prognosis. Surgical management remains the preferred treatment in combination with chemotherapy. Irradiation therapy is used occasionally as a primary modality in the elderly and medically compromised patients. Lymph node dissection is not routinely practiced. The poor prognosis of oral melanomas requires that pigmented lesions of undetermined origin be routinely biopsied.

Mandibular abnormalities in neurofibromatosis: Case report and literature review

A patient with von Recklinghausens neurofibromatosis that was undiagnosed until the sixth decade of life is discussed. He came for evaluation and treatment of multiple radiolucent lesions, bilaterally distributed throughout the mandible. Histologic examination of a cutaneous nodule, as well as of the intrabony radiolucencies, confirmed the diagnosis of neurofibromatosis. Examination of the intrabony radiolucencies revealed fibrous connective tissue with an inflammatory cell infiltrate. Family history revealed marked variation in expression of the clinical features of the disease.

Pedunculated soft-tissue mass on the alveolar gingiva

A case of peripheral ameloblastoma, a rare intraoral neoplasm, has been presented. The lesion appears most commonly as a mass on the mandibular lingual gingiva of patients in their fifth and sixth decades of life. The peripheral ameloblastoma does not share the aggressive nature of the intraosseous variant. The lesion has been overtreated in the past and warrants only a local supraperiosteal excision.

Embryonal rhabdomyosarcoma of the mandible

Rhabdomyosarcoma, the malignant neoplastic analog of skeletal muscle, sometimes involves the soft tissues of the head and neck in children and adolescents. However, rhabdomyosarcoma of the mandible is extremely rare. In a review of 170 cases of rhabdomyosarcoma of the head and neck by Dito and Batsakis,’ six cases (3.5%) were found to originate in the mandible. The following is a report of a case of rhabdomyosarcoma involving the mandible in a three-year-old girl.

A team approach to the management of oral pathology

The general dentist, in the course of daily practice, encounters patients that have a myriad of pathologic conditions involving the oral and maxillofacial region. Usually, these patients are referred to the oral and maxillofacial surgeon for evaluation and treatment. However, the dentist is often involved with differential diagnosis, treatment, and follow-up care of the patient. The oral and maxillofacial region is unique in the sense that a wide variety of pathologic processes may occur in this area. This brief discussion describes the roles of the general dentist and oral and maxillofacial surgeon in the management of patients with pathologic conditions involving the oral and maxillofacial region. Pathologic processes involving the head and neck may be inflammatory, neoplastic, developmental, metabolic, or idiopathic in nature and may be localized or represent manifestations of a generalized systemic condition. When confronted with a patient with a lesion involving soft tissue, the dentist or oral and maxillofacial surgeon must determine whether to perform an incisional biopsy and establish the diagnosis before definitive surgical or medical management of the lesion or to completely excise the lesion (if a solitary mass) for submission for microscopic examination. This determination is made on the basis of the differential diagnosis and various factors such as the size, extent, and location of the lesion. For example, for a solitary mass of the lower lip that is 1 cm in diameter, bluish white in color, soft to palpation, elevated, and of short duration, which is most likely a mucous retention phenomenon secondary to escape of saliva from a ruptured minor salivary gland duct, the clinician will most likely completely excise the mass and submit the specimen for microscopic examination to confirm the diagnosis. In contrast, for an older patient having a large ulcerated

Case 50, Part II: Peripheral odontogenic fibroma

Following complete workup of the patient, it was decided to perform a biopsy prior to establishing a final treatment plan. Using local anesthesia supplemented by intravenous sedation, a mucoperiosteal flap was elevated from the left maxillary canine to the distal of the left maxillary second molar. On elevation of the mucoperiosteum, there was evidence of a sharply-delineated osseous mass. The lesion appeared to be confined to the alveolar aspect of the maxilla without extension to the basilar bone. The mucoperiosteal flap was thickened and felt gritty to palpation. Because of its limited extent, it was decided to do an excisional biopsy. The mass was removed with the use of osteotomes and rongeurs, and was submitted for microscopic examination. An effort was made to thin the mucoperiosteal flap, after which it was repositioned with 4/0 polyglycolic acid sutures. The patient tolerated the procedure without difficulty and has been followed on a periodic basis. She has been free of recurrence for the past 31 months.