Mucosal malignant melanomas in head and neck surgery: a retrospective study of six patients and review of the literature

Introduction

Of all malignant processes of the oral mucosa, 0.5% are malignant melanomas. Because of late diagnosis, pattern of growth, close proximity to the bone (particularly in palatinal localizations), and the correlated infiltration, malignant melanomas have a bad prognosis.

Patients and methods

In this retrospective study, six cases of patients with oral mucosal malignant melanoma are evaluated, and a critical review of the literature is presented. The female to male proportion was 1:1 with an average age of 60.2 years; all patients were treated between January 1999 and July 2007. A neck dissection was performed on two patients because of clinically positive lymph nodes; one patient received interleukin 2 therapy, and three patients received postoperative radiotherapy. Two male patients died.

Conclusions

We recommend biopsy on every growing lesion, pigmented or nonpigmented, for the required diagnosis and, in cases of malignant melanoma, wide excision as a second step. Neck dissections should be performed in patients with clinically positive lymph nodes. Concerning interleukin 2 therapy, further studies should be performed in order to evaluate a routine application.     

Stafne bone cavities: systematic algorithm for diagnosis derived from retrospective data over a 5-year period

Stafne bone cavities are usually found in men 50–70 years old. Typically they appear as lingual, open, ovoid lesions of the molar region of the lower jaw, and most contain parts of the submandibular gland. We have retrospectively examined panoramic radiographs acquired over a 5-year period. All lesions suspected of being Stafne bone cavities were included and analysed further to retrieve statistical information and derive a systematic diagnostic algorithm. We identified 21 Stafne bone cavities among 2928 patients (0.7%). Four of these were confirmed on cone-beam computed tomography (CT). One patient had magnetic resonance imaging (MRI) to confirm the diagnosis. The M:F ratio was 14:7 and the mean age 53 years (range 22–82). All cavities were located in the posterior mandible, 9 on the right and 12 on the left. The mean length was 10.9 (range 4.5–23) mm and height 5.7 (range 3.3–17.3) mm. All cavities were located in the posterior mandible. Sixteen panoramic radiographs (0.6%) were classified as possibly having a Stafne bone cavity but did not fulfil enough criteria to confirm the diagnosis. These 16 were not further analysed. It is rare to diagnose a Stafne bone cavity on a panoramic radiograph. Thorough investigation is essential to exclude differential diagnoses such as keratocystic odontogenic tumour, ameloblastoma, or a metastasis.     

Surgical Treatment of Bone Marrow Lesion Associated with Recurrent Plantar Fasciitis: A Case Report Describing an Innovative Technique Using Subchondroplasty®

Plantar fasciitis is one of the most common chief complaints seen in the foot and ankle clinic. With a relatively benign course, most cases are self-limiting or amendable to conservative therapy; ~90% of all plantar fasciitis cases will respond to these methods. When conservative treatment and time fail, surgical intervention can be necessary to improve outcomes. We present a novel method using Subchondroplasty^® (SCP^®; Zimmer Holdings, Inc.; Warsaw, IN) and revision fasciotomy in a case in which initial fasciotomy had failed. After the patient had failed to improve, a worsening underlying bone marrow lesion was identified at the origin of the plantar fascia; thus, SCP^® was used with repeat fasciotomy. SCP^® involves injecting calcium phosphate into bone marrow lesions to stimulate long-term bone repair. At 10 months after SCP^®, the patient remained pain free and had returned to running at the final follow-up examination. This surgical treatment should be considered as an adjunctive procedure for those patients with plantar fasciitis, identifiable bone marrow lesions on magnetic resonance imaging, and continued pain when other treatment modalities have failed.