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目的探讨腮腺多形性腺瘤的治疗方法。方法通过对1992—2009年江苏省徐州市第六人民医院口腔科收治的148例腮腺多形性腺瘤患者的临床资料进行总结,比较分析腮腺浅叶切除术(88例患者)与腮腺区域性切除术(60例患者)两种术式治疗腮腺多形性腺瘤的效果。结果采用腮腺区域性切除术治疗的病例,术后瘢痕、局部凹陷畸形、暂时性面瘫、涎瘘、Frey综合征及腮腺功能等方面明显优于采用腮腺浅叶切除术的病例。两种术式的术后复发率差异无统计学意义。结论应根据肿瘤的部位及大小选择不同的术式,对界限清楚、体积较小的腮腺浅叶多形性腺瘤应尽量采用腮腺区域性切除术,预防面部凹陷畸形,减少并发症;对过大或边界不清的肿瘤仍宜采用传统腮腺浅叶切除术,以减少复发。     

Interdisciplinary combined treatment of craniofacial osteosarcoma with neoadjuvant and adjuvant chemotherapy and excision of the tumour: a retrospective study

Osteosarcomas are highly malignant tumours of bone, and are rare in the craniofacial area. They account for only 1% of all head and neck malignancies. In this study we describe the treatment of 12 patients who were diagnosed with osteosarcoma of the mandible or maxilla between 1990 and 2004. These patients were given interdisciplinary treatments, either with a combination of neoadjuvant and adjuvant high-dose chemotherapy following the protocol of the cooperative osteosarcoma study group (COSS) with radical excision of the tumour (n=7), with a combination of radiation and radical excision (n=2), or with radical excision alone of the tumour (n=3). The 5-year survival of the group treated only by excision was 1 of 3, whereas that of the group treated by combination of chemotherapy and surgical removal was 7 of 7. The two patients treated with radiation and excision also lived 5 years after the end of the treatment, but had side-effects of radiation, whereas those treated with chemotherapy had no serious side-effects. We therefore conclude that combined interdisciplinary treatment of radical resection of the tumour with high-dose chemotherapy according to standard protocols is the most effective treatment for craniofacial osteosarcomas.     

Large facial lymphatic malformation treatment using sclerosing agent followed by surgical resection: clinical and pathology report

Lymphatic malformations are rare slow-flow vascular malformations, with high tendency to appear in the head and neck region. The treatment of these lesions ranges from follow-up to sclerosing agent injection to surgical excision. The authors present a case of a new born with large extensive lingual and submandibular lymphatic malformation, for which the patient underwent tracheostomy and gastrostomy insertion. He was then treated successfully with sclerosing agent injections followed by surgical excision, with 7 years follow-up. The second case presented is a two and a half baby with large lingual lymphatic malformation, treated successfully with doxycycline injections followed by intraoral excision of the lesion. Pathology of the excised lesion is then demonstrated, which shows for the first time the different layers affected by the sclerosing agent.     

Buccal hemangioma with phleboliths. Report of two cases

Two cases of buccal hemangioma with phleboliths were reported. Angiography, angioxerography, and computerized tomography were carried out before the procedures were planned. One patient was treated by means of surgical excision of the tumor after ligation of the left external carotid artery. The second patient was treated by means of surgical excision alone. Histologic examinations suggested that the thrombi in the blood vessels of hemangiomas might become the core of the phleboliths. Analysis of the phleboliths by means of x-ray diffraction and infrared spectrometry confirmed calcium phosphate and calcium carbonate as the main components of the phleboliths.     

舌下腺囊肿145例临床病例分析

目的:对舌下腺囊肿临床病理资料进行回顾性分析,评价手术方式与疗效的关系。方法:术前行穿刺、超声等检查,在全麻或局麻下经口内进路、颌下进路或口内联合颌下进路行舌下腺及囊肿摘除术,术后标本进行组织病理观察。结果:87例穿刺液淀粉酶检查阳性76例,88例单纯型舌下腺囊肿经口内行舌下腺及囊肿摘除术均无复发;18例哑铃型舌下腺囊肿经口内或颌下联合口内进路行舌下腺及囊肿摘除术,术后无复发;32例口外型舌下腺囊肿分别经口内、颌下进路及颌下联合口内进路行舌下腺及囊肿摘除术,其复发率分别为0、50%、0。病理切片镜下观察,143例中82例(57.3%)囊肿有纤维囊壁,但只有4例有部分上皮衬里。结论:舌下腺囊肿的囊壁无上皮衬里,完整摘除舌下腺是治愈的关键。     

Regional lymph node metastasis created by partial excision of carcinomas induced in hamster cheek pouch with 9,10-dimethyl-1,2-benzanthracene

The feasibility of using the hamster cheek pouch/dimethyl-benzanthracene (DMBA) system as an experimental model of lymphatic metastasis was investigated. Forty male Syrian golden hamsters treated with DMBA were divided into two equal groups--one with surgical excision of their tumors and a control group without tumor excision. In the excision group, the animals received three applications/week to the left cheek pouch of 0.3% DMBA in acetone for 14 weeks. Following a three-week observation period, the tumors in the pouch were excised at their base, and the animals were killed after four weeks of further observation. In the control group, the animals were treated for 14 weeks in a manner similar to that used for the excision group, left for seven weeks without treatment, and then killed. Cheek pouches with tumors and cervical lymph nodes were processed for histological examination. All of the animals, both with and without metastasis, had borne squamous cell carcinomas (SCC) in their treated cheek pouches. Histologically, seven out of 16 animals in the excision group showed metastatic deposits of SCC confined to the left cervical lymph nodes, while in the control group, metastasis was not found in any of the 19 animals with SCC in their cheek pouches. The results demonstrate that surgical excision of the hamster cheek pouch carcinoma is efficient in producing unequivocal lymph node metastasis.     

Calcifying epithelioma of Malherbe (pilomatrixoma) of the cheek

A case of a large calcifying epithelioma of Malherbe in a 15-year-old Nigerian girl is presented. The tumor was treated by excision and the wound was skin-grafted.     

Osseous choristoma of buccal mucosa: report of a case

A rare case of osseous choristoma is presented. The lesion, in a 12-year-old girl, involved cheek mucosa and was successfully treated by local excision.     

Leiomyosarcoma of the maxilla: report of two cases.

Two cases of leiomyosarcoma of the maxilla have been reported. These lesions occurred in 67- and 24-year-old men. One was treated by hemimaxillectomy, and the other by radical local excision.     

Primary malignant melanoma arising in the dorsum of the tongue

We present the case of a 53-year-old White man with primary malignant melanoma of the dorsum of the tongue that arose in an area of widespread diffuse pigmentation. He was treated by wide excision and insertion of iridium pins (65Gy over 5 days). Ten months later he developed metastases that were treated by palliative irradiation.     

Malignant melanoma of a parotid lymph gland. An unusual case

A case of malignant melanoma in an intra-parotid lymph gland treated by excision is reported. The patient remains disease-free 9 years after surgical treatment, and no primary lesion has been found.     

Diode laser versus sclerotherapy: bloodless approaches in the treatment of oral pyogenic granuloma (randomised controlled clinical trial)

Odontology - Oral pyogenic granuloma (PG) is traditionally treated by surgical excision which is associated with bleeding, pain and a high rate of recurrence. Our research aimed to clinically...     

区域性切除术在腮腺多形性腺瘤中的临床应用

目的 探讨区域性切除术在腮腺多形性腺瘤治疗中的应用价值。方法 对62例位于腮腺浅叶直径小于2 cm的多形性腺瘤行区域性切除术。在距肿瘤0.5～1.0 cm的正常腺体组织中切除肿瘤。结果 58例经2—7年的随访未见复发,患侧腮腺导管唾液分泌流畅,术区无凹陷畸形。结论 区域性切除术在治疗体积较小的多形性腺瘤中能够保证手术的安全切缘,保存腺体功能,预防面部凹陷畸形,降低各种并发症的发生率。     

Osteochondroma of the mandibular condyle: surgical excision followed by occlusal stabilization

Osteochondroma of the mandibular condyle in adults can be treated by surgical excision, condylectomy followed by costochondral graft or orthognathic surgery. Such complex treatment plan may not be appropriate for patients with old age, affected with chronic osteochondroma of the condyle. In this clinical report, we present a patient with osteochondroma of the condyle treated by surgical excision. The patient's postoperative occlusion was a contraindication for orthognathic surgery because of the severe abrasion of the teeth and the chronic compensation of the dentition to the deviated mandible. Surgical excision of the lesion was carried out under general anesthesia, and the remaining condylar head was salvaged as much as possible. No graft materials or posthodontic condyle reconstruction was carried out. Because there was no occlusal stop to secure the mandible in a centric relation position of the condyle, a stabilization splint was delivered to position the condyle in a relatively stable position. The stability of the condyle position was evaluated by follow-up cone beam computed tomographic scans of the pathologic and the contralateral condyle, along with clinical factors such as occlusal contact points and mandible movements assayed by ARCUSdigma (KaVo). After significant condylar position was achieved, full prosthodontic reconstruction was performed to both the patient's and the dentist's satisfaction.     

On the inability of root debridement and periodontal surgery to eliminate Actinobacillus actinomycetemcomitans from periodontal pockets

In a previous study, we observed that root debridement was inefficient in eliminating Actinobacillus actinomycetemcomitans from adult periodontitis lesions. The present report describes the effects on A. actinomycetemcomitans of subsequent treatments of 6 patients that had at least 2 separate sites still harboring A. actinomycetemcomitans 6 months following debridement. 1 site or more in each individual was treated with renewed root debridement and at least 1 other site was treated by surgical excision of the gingival tissue. The results indicated that retreatment with either repeated root debridement or with surgical excision of the gingival tissue was not more effective in eliminating A. actinomycetemcomitans than initial debridement. The possible reasons for this limited therapeutic effect on the subgingival presence of A. actinomycetemcomitans are discussed.     

Pleomorphic adenoma of the nasal septum.

A brief review of the world literature on pleomorphic adenoma of the nasal septum is presented. One further case is reported, treated by surgical excision via lateral rhinotomy. Alternative surgical approaches are considered.     

Management of oral carcinoma: benefits of early precancerous intervention

Management of oral precancerous lesions remains polarised between interventional surgery and conservative treatment. We have previously shown the efficacy of carbon dioxide laser excision for both diagnosis and treatment of oral precancerous lesions. The aim of this study was to review the clinicopathological details of a group of patients in whom pre-existing but occult invasive carcinoma was diagnosed histopathologically in specimens excised by laser. We retrospectively reviewed 169 patients who attended the Maxillofacial Dysplasia Clinic at Newcastle General Hospital with single, new oral premalignant lesions over a 5-year period (2004-2008). They were all treated by laser excision of lesions that were confirmed to be dysplastic from examination of preoperative incisional biopsy specimens. There was a significant correlation between the results of diagnostic incisional, and laser excision, biopsy specimens (p < 0.01), but 15 patients had signs of occult invasive carcinoma in the excision specimens (9%). In all cases the carcinomas were completely excised by the laser. Carbon dioxide laser excision is not only an effective treatment of precancerous lesions, but also facilitates early diagnosis and management of oral carcinoma at a stage when it is otherwise clinically undetectable.     

The efficacy of three different surgical techniques in the management of drug-induced gingival overgrowth

OBJECTIVES: The aim of the present study was to evaluate the efficacy of three different surgical techniques in both the management and effect upon rate of overgrowth recurrence of drug-induced gingival overgrowth (DIGO). MATERIALS AND METHODS: Two cohorts of patients who required surgical correction of their DIGO participated in the study. After baseline periodontal measures (plaque index, gingival inflammation and probing pocket depths), the patients underwent surgery. A split-mouth, crossover design was used to compare conventional gingivectomy with flap surgery (n=27), and conventional gingivectomy with laser excision (n=23). The main outcome variable was the rate of recurrence of DIGO following surgery. RESULTS: At 6 months, there was significantly less recurrence (p=0.05) in patients treated with laser excision, compared with those treated by conventional gingivectomy. The differences in rate of recurrence of DIGO were also reflected in changes in several periodontal parameters. Flap surgery offered no advantage over conventional gingivectomy with respect to the rate of recurrence. CONCLUSIONS: DIGO can be managed by a variety of techniques. Laser excision results in a reduced rate of recurrence.     

Pseudoxanthoma elasticum

We report a case of pseudoxanthoma elasticum in a 44-year-old Afro-Caribbean woman who presented with excessive wrinkling and loosening of the skin of the neck. She was treated by platysmoplasty and bilateral neck lift followed by latent excision of nuchal skin folds.     

Osteosarcoma in irradiated fibrous dysplasia

A case is described of osteosarcoma arising in a pre-existing fibrous dysplasia fifty years after radiotherapy for facial hirsutism. The patient was treated by surgical excision and chemotherapy and is alive and free of disease five years later.