Superficial oral fungal infections.

Fungal infections in humans are provoked and exacerbated by defects in the cellular immune system. Hence, the emergence of novel clinical variants of oral candidoses and rare mycoses with the pandemic spread of human immunodeficiency virus infection is not surprising. The new clinical entities of oral candidoses that have been described in the past few years have had a significant impact on the classification of these diseases. Classification of oral candidoses is an issue addressed in some detail here. Angular cheilitis is a disease commonly associated with Candida infection. In the West, it is frequently seen in the elderly, but a report from Asia indicates that the disease may be prevalent in the young age groups due to factors such as anemia, despite the similarity of the infective agents. A novel cofactor implicated in infectious states has been the host blood group secretor status, and data from three studies suggest that the latter may play an intriguing role in the pathogenesis of oral candidosis. Finally, a new mouse model has been described as a substitute for the rat model in investigating the host-parasite interactions in oral candidosis, and its pros and cons are reviewed.     

Enamel Microabrasion for Removal of Superficial Discoloration

The author reports on microabrasion for the removal of superficial enamel discoloration using a new enamel microabrasion compound and rotary application. After discussing the concept of enamel microabrasion, he describes the step-by-step procedures to follow in performing this technique.     

Superficial melanomas of oral mucous membranes.

In accordance with microscopic and clinical criteria established for superficial melanomas of the skin (superficial spreading melanoma, lentigo maligna melanoma, acral-lentiginous melanoma), three oral lesions have been evaluated. The literature on oral melanomas has also been reviewed, with special attention given to those cases that had pre-existing melanosis. One patient with a diagnosis of superficial spreading melanoma eventually died of his untreated lesion 11 years after its first appearance. Two patients had lesions diagnosed as acral-lentiginous melanoma (a group which also includes volar and subungual melanomas) that exhibited aggressive, recurrent behavior. These lesions had microsocpic features similar to lentigo maligna melanoma but did not behave in a manner consistent with that diagnosis. Electron microscopic study of one acral-lentiginous melanoma demonstrated malenosomes and premelanosomes that were like those seen in normal melanocytes and nevus cells. The superficial or radial growth phase of many oral melanomas has apparently gone unrecognized. Melanosis has been reported to be a common feature of invasive oral melanomas but has not generally been related to the natural history of these lesions. Oral lesions with a prolonged intra-epithelial or radial growth phase would be expected to have a better prognosis than nodular melanomas, but meaningful survival data are not available because of the infrequency with which oral melanomas have been subclassified.     

Superficial arteriovenous hemangioma of the oral cavity

OBJECTIVE: Superficial arteriovenous hemangioma (AH) is a benign vascular lesion that often affects the head and neck, but only 3 histologically proven intraoral lesions have been previously reported. The aim of this study was to analyze the clinical and histologic features of 36 oral AHs from 35 patients.Study Design: All vascular lesions, other than pyogenic granulomas, accessioned between 1952 and 2000 were retrieved, and clinical details were gleaned from the request forms or, when available, from the case notes. Histologic sections stained with hematoxylin-eosin were reviewed, and all selected cases were stained for smooth muscle actin and elastin. RESULTS: The age range was 12 to 90 (mean, 53 years; median, 59). Of all patients, 54% were female. All the lesions were solitary. The labial mucosa or vermilion was affected in 17 (49%) patients, the tongue in 5, the hard palate and cheek mucosa in 4 each, the gingiva or alveolar mucosa in 3, and the floor of the mouth in 1. Clinical presentation was most often a raised lesion smaller than 20 mm. Duration ranged from months to many years. Four lesions recurred. The consistent histopathologic feature was an unencapsulated mass of blood vessels located in the lamina propria, the submucosa, or both, but 3 patterns could be discerned. The most common (in 44% of cases) comprised a diffuse mixture of thick-walled and thin-walled vessels in variable proportions. The second pattern (42%) showed a lobular arrangement of smaller vessels of uniform wall thickness, sometimes associated with an arteriole. The remaining 14% showed a tortuous pattern of angular, branching, thick-walled vessels lacking inner elastic laminae; one lesion showed both this pattern and the first pattern, one showed both the lobular morphology and the third pattern. Of the patients with the lobular arrangement, 64% were female. Smooth muscle actin was a major component of the lesional vessel walls regardless of thickness, but although most contained some fibrillary elastin, none had inner elastic laminae as prominent as those seen in adjacent true arteries. All AHs contained plump endothelial cells, and mast cell numbers were increased. CONCLUSIONS: The etiology of AH is uncertain; endocrine and inflammatory stimuli may activate an underlying vascular malformation. Some lesions, especially those in younger patients, may be true hamartomas.     

Superficial parotidectomy for chronic parotid sialadenitis

Chronic sialadenitis (CS) of the parotid gland is an insidious inflammatory disorder which tends to progress and may lead to the formation of a fibrous mass. This is a review of the author's experience of superficial parotidectomy (SP) with duct ligation for non-specific CS of the parotid gland not responding to conservative management. 21 patients (11 females; 10 males) with intractable non specific CS underwent SP with duct ligation. The mean duration of symptoms was 1.93 years (SD 0.48). Fine needle aspiration cytology and magnetic resonance imaging were carried out prior to SP to rule out benign or malignant tumours. The mean duration of observation was 1.71 years (SD 0.39). Six patients (28.57%) developed temporary facial nerve palsy. Three (14.28%) patients developed Frey's syndrome. Paresthesia of the ear lobe was found in all cases. One case (4.76%) each of sialocoele and hypertrophic scar was found. There was complete resolution of symptoms in all the cases. The histopathological report confirmed three cases (14.28%) of mild CS and 18 cases (85.72%) of CS of greater degree. SP along with ligation of the duct is a safe and effective treatment for non-specific CS of the parotid gland.     

Superficial lobe parotid gland lipoma.

The author presents a case of superficial lobe of the parotid gland lipoma. The lipoma is an asymptomatic, slow growing, freely movable and relatively rare soft mass. Preoperative diagnosis is generally difficult. However certain diagnostic methods such as high resolution computed topographic scanning provides very helpful information regarding this benign parotid gland neoplasia. The treatment of choice is superficial parotidectomy that, if performed correctly excludes the possibility of any second attack.