原发性颌骨内癌14例临床分析

目的：探讨原发性颌骨内癌的治疗与预后。方法：对1999—2009年收治于中国医学科学院肿瘤医院的14例原发性颌骨内癌患者进行回顾性分析。采用SPSS13.0软件包对资料进行统计学分析。结果：14例患者中,12例行综合治疗,2例行单纯手术治疗。患者1、2、3年的累计生存率分别为85.1%、46.4%和23.2%,而患者1,2,3年的累计无复发生存率分别为50.0%、35.7%和17.9%。Logistic多因素回归分析显示,年龄、性别、病理分级、淋巴结转移及治疗方式均不是患者预后的独立影响因素。结论：根治性手术切除是原发性颌骨内癌的主要治疗方式,早期治疗相当重要;对于切除不彻底的患者,可考虑辅助放化疗,但疗效有待证实。     

Primary intraosseous odontogenic carcinoma arising in an odontogenic cyst or de novo: a clinicopathologic study of six new cases

The term primary intraosseous odontogenic carcinoma (PIOC) has been primarily used to describe a squamous cell carcinoma within the jaws arising either from a previous odontogenic cyst or de novo. Here, we report 6 new cases of PIOC, affecting 4 female and 2 male patients with a mean age of 56.2 years. Two cases involved the maxilla and 4 cases occurred in the mandible. The typical radiographic presentation was that of a radiolucent lesion with well or ill defined margins. Histopathologically, 4 cases were diagnosed as well differentiated keratinizing PIOC arising from previous odontogenic cysts (2 odontogenic keratocysts and 2 periapical cysts). The remaining 2 cases were poorly differentiated nonkeratinizing PIOC, which appeared to arise de novo. Treatment consisted of surgical removal, with postoperative radiotherapy in 5 cases, and to date neither recurrence nor metastasis have occurred. Knowledge of the clinical, radiographic, and histopathologic features of PIOC allows accurate diagnosis and appropriate treatment of this rare malignancy.     

原发性颌骨内鳞状细胞癌的诊断与治疗

目的:回顾性研究分析临床少见的原发性颌骨内鳞状细胞癌(PIOC)的临床病理表现,为选择合理的治疗方案提供帮助.方法:对1995-02--2007-01间收治的经病理证实的12例PIOC的临床表现、影像学特征、治疗特点等进行综合分析.结果:12例PIOC患者中以中老年多见,平均年龄45.2岁,全发生于下颌骨;临床特点以下...     

Primary intraosseous carcinoma of the mandible

The case of a 58-year-old man with a large primary intraosseous carcinoma (PIOC) of the mandible is presented. The tumour is rare, and the prognosis is usually poor. There are no specific histological characteristics of PIOC. Staining for basement membrane laminin could be a valuable aid in the differential diagnosis between PIOC and tumours of ameloblastoma origin.     

Primary intraosseous carcinoma of the mandible with probable origin from reduced enamel epithelium

This report describes a case of primary intraosseous carcinoma (PIOC) arising de novo in the mandible. The patient was a 74-year-old woman and an early PIOC was found incidentally during histopathological examination of the pericoronal tissue obtained at extraction of a deeply impacted third molar. The curetted soft tissues consisted of a microinvasive, keratinizing squamous cell carcinoma with scattered foci of carcinoma cells showing calcification; stromal osseous metaplasia was also observed. After additional treatment, the patient has remained free of disease for 2 years. Since the tumor was completely enclosed in the bone, the only identifiable source of the present PIOC is the reduced enamel epithelium. Despite its rarity, this case emphasizes the importance of careful histologic examination of all apparently innocuous dental follicles that are removed surgically.     

Risk factors and prognosis for the primary intraosseous carcinoma of the jaw

Primary intraosseous carcinoma (PIOC) is a rare but aggressive type of odontogenic tumour arising within the jawbone. Diagnosis criteria and treatment strategy remain difficult and controversial. The present study aimed to clarify the clinicopathological features and determine prognostic factors in management of PIOC. A retrospective study of 30 patients with PIOC, treated at the Hospital of Stomatology of Sun Yat-sen University between 2009 and 2017, was conducted. Clinical, histopathological and treatment modality data were collected. Follow-up data were recorded to determine prognostic factors. There were 19 males and 11 females with a mean age of 52.3 years. The most common location of the tumour was the mandible (90%). Having a history of tooth extraction or tooth mobility was the major characteristic symptom (63.3%), jaw swelling coming in second (53.3%). Half of the patients underwent surgery alone. The estimated 2-year overall survival rate (OS) and recurrence-free survival rate (RFS) were 61.3% and 40.1%, respectively. Higher histological grade was an independent risk factor for poor OS (hazard ratio (HR) 0.233 [0.059–0.915], P = 0.037), while at pN₊ stage for RFS, HR = 5.627 [1.199–26.409], P = 0.029. Because of its rarity and intrabony site, the classification, staging and treatment guidelines for PIOC should be further studied and established.     

Primary intraosseous carcinoma arising from an odontogenic cyst: a case report and review of the Japanese cases

A rare case of primary intraosseous carcinoma (PIOC) arising from an odontogenic cyst in a 58-year-old man is reported. Clinical and radiological examinations revealed an odontogenic cyst of the maxilla. Histopathologically, the lesion was composed of a cyst with a parakeratotic epithelial lining and well-differentiated squamous cell carcinoma, showing continuity between them without a connection to the oral mucosa. Twenty-eight well-documented Japanese cases of Type-1 PIOC, including the present case, were reviewed. The mean age of the 28 patients was 56.1 years, and the male to female ratio was 1.8:1.0. Compared with currently reported Japanese reviews of Type-3, foreign Type-1 and Type-3, there were no significant differences in mean patient age and sexual predominance, and no racial difference. The pathogenesis of Type-1 PIOC is also discussed.     

Primary intraosseous carcinoma associated with impacted third molar of the mandible: review of the literature and report of a new case

This study investigated the clincopathologic features of primary intraosseous carcinoma (PIOC) related to the third molar of the mandible. Six cases (5 from the literature and 1 new case; mean patient age 73 years) of PIOC associated with completely impacted lower third molar were analyzed. For comparison, 8 cases of PIOC presenting after extraction of the lower third molar were also evaluated, with a significantly lower mean patient age of 56 years. Most lesions were deceptively similar to those related to the lateral type of dentigerous cyst, and half of the impacted cases revealed an asymptomatic fracture of the mandible. In all patients except for the present case, metastasis had not been recorded. Surprisingly, no patients are known to have died of PIOC. In our experience the prognosis of PIOC associated with a completely impacted third molar is much better than commonly believed, although the number of cases involved is too small to make a general conclusion. However, delay in establishing the correct diagnosis followed by extraction without awareness of the carcinoma is know to adversely affect the prognosis.     

Primary intraosseous carcinoma of the mandible with probable origin in an odontogenic cyst

Primary intraosseous carcinoma of the jaws (PIOC) is an uncommon lesion, but may not be as rare as commonly believed. Since the putative source of the epithelium giving rise to an intraosseous carcinoma is the epithelium involved in odontogenesis, these lesions are often designated as odontogenic carcinomas. These tumors may theoretically arise (1) from the lining of odontogenic cysts, (2) from other epithelial odontogenic tumors, or (3) de novo from presumed odontogenic rests. While not included in most classifications of PIOC, it appears logical to also include intraosseous mucoepidermoid carcinomas as a fourth type of PIOC. A case of primary intraosseous squamous cell carcinoma of the mandible, with evidence of origin in an odontogenic cyst, is presented. The recent literature on carcinomas arising in jaw cysts is reviewed.     

Intraosseous carcinoma of the anterior maxilla identified as the occult primary tumour of carcinoma of unknown primary

Carcinoma of unknown primary (CUP) is defined as lymph node metastasis without a detectable origin until after the initial treatment has been performed. The most common occult primary site in the head and neck, as revealed by a review of the published literature, is the oropharynx. An occult primary site in the oral region is extremely rare. We report a rare case of head and neck CUP (HNCUP) in a 69-year-old female patient, wherein the occult primary lesion was a primary intraosseous carcinoma (PIOC) invading the anterior maxilla. During the course of the initial diagnostic workup, no primary lesion could be identified; however, cervical lymph node metastasis to left levels IB and IIA were observed in the patient. A neck dissection followed by adjuvant radiotherapy was performed. However, the PIOC of the anterior maxilla was identified 6 months after neck treatment and was confirmed as the occult primary tumour of the HNCUP. This case is quite rare and required a comprehensive workup to guide optimal treatment. Careful follow-up or active biopsy should be considered if osteolytic changes are observed in the jaw.     

Primary de novo intraosseous carcinoma of the mandible--report of a case and review of literature.

Primary intraosseous carcinoma (PIOC) is a rare malignant odontogenic neoplasm defined as squamous cell carcinoma arising within thejaws, having no initial connection with the oral mucosa and presumably developing from the residues of the odontogenic eptihelium. A 37yr old male patient reported with the complaint of pain and swelling in the right mandible and inability to open his mouth for the past six months. Examination revealed an expansile mass that involved the right mandible and extended from the 1st premolar region to the right angle of the mandible. The alveolar ridge was markedly expanded and was covered with intact, normal appearing mucosa. Radiographic examination revealed an ill-defined radiolucent area in the right body of the mandible, which extended to the lower border. Histopathologic examination revealed a well differentiated keratinizing squamous cell carcinoma. PIOC has no specific histopathologic features and can be definitively diagnosed only upon fulfillment of various criteria. These criteria were followed in our case and reported here for its rarity.     

Preoperative orthodontic treatment in children with complete cleft, yes or no?]

The authors investigated the necessity for preoperative orthodontic treatment in cases of unilateral complete clefts. For these groups of patients, they propose a pure surgical therapy instead of the preoperative orthodontic treatment.     

Assessing Patterns of Restorative and Preventive Care Among Children Enrolled in Medicaid,by Type of Dental Care Provider

BackgroundThe authors investigate the relationship of preventive dental treatment to subsequent receipt of comprehensive treatment among Medicaid-enrolled children.MethodsThe authors analyzed Medicaid dental claims data for 50,485 children residing in Wayne County, Mich. The study sample included children aged 5 through 12 years in 2002 who had been enrolled in Medicaid for at least one month and had had at least one dental visit each year from 2002 through 2005. The authors assessed dental care utilization and treatment patterns cross-sectionally for each year and longitudinally.ResultsAmong the Medicaid-enrolled children in 2002, 42 percent had had one or more dental visits during the year. At least 20 percent of the children with a dental visit in 2002 were treated by providers who billed Medicaid exclusively for diagnostic and preventive (DP) services. Children treated by DP care providers were less likely to receive restorative and/or surgical services than were children who were treated by dentists who provided a comprehensive mix of dental services. The logistic model showed that children who visited a DP-care provider were about 2.5 times less likely to receive restorative or surgical treatments than were children who visited comprehensive-care providers. Older children and African-American children were less likely to receive restorative and surgical treatments from both types of providers.ConclusionsThe study results show that the type of provider is a significant determinant of whether children received comprehensive restorative and surgical services. The results suggest that current policies that support preventive care–only programs may achieve increased access to preventive care for Medicaid-enrolled children in Wayne County, but they do not provide access to adequate comprehensive dental care.     

Haemangiomas of the parotid gland in children.

The authors present the case histories of 40 intraparotid haemangiomas, in 11 of which they achieved healing after radical surgical treatment (parotidectomy). Since 1971, the authors have adopted a conservative approach (not surgical), seeing that most of the cases involute spontaneously up to complete healing. None of the 29 cases treated conservatively has undergone exacerbations of the process, after the age of 6-9 months. No emergency surgical operations were required.     

Primary intraosseous carcinoma of the jaw: pooled analysis of world literature and report of two new cases

Primary intraosseous carcinoma (PIOC) is a rare malignant neoplasm of the jaw. These tumours are believed to arise from the odontogenic epithelium and hence are also referred to as odontogenic carcinoma. A detailed search was made for squamous cell PIOC of the jaw in English literature using Medline Cancer CD. The data obtained were transferred onto dBase software. Two detailed case reports of patients treated at Regional Cancer Centre, Trivandrum during 1996 and 1997 were also included. A pooled analysis was carried out. Survival analysis was carried out using Kaplan-Meier method and log-rank statistics were used for comparing survival. A total of 35 cases were analysed, of which 33 were from published literature. The mean age of the patients at the time of diagnosis was 52.3 years with male to female ratio being 2.5:1. Posterior mandible was the predominant site. The median follow-up time was 28 months. Overall survival at 5 years was 37.8% (95% CI; 14.8-61.0) while the corresponding disease free survival was 29.8% (95% CI; 9.2-54.1). Primary intraosseous carcinoma is a rare tumour of jawbones, characterized by progressive swelling of the jaw, pain and loosening of tooth. The tumour is locally aggressive and metastasizes to regional nodes. The overall and disease free survival is poor with almost 50% patients failing loco-regionally within the first 2 years of follow-up.     

Clinical symptoms and treatment of cervicofacial actinomycosis. Literature survey and case report

Actinomycosis is a chronic, specific inflammation which is characterized by suppuration, abscess formation, tissue fibrosis and granuloma formation. Actinomycosis has three main forms (cervicofacial, which is the most frequent, approximately 60%, pulmonary and abdominal), but other regions of the body can be involved, too (e.g. neck, ovaries, bones), that is why its differential diagnosis becomes more and more relevant. Regarding its treatment, the majority of authors recommends the combination of surgical and antibiotic treatment. The authors of this article present a typical case of cervicofacial actinomycosis, in which the authors used the combination of surgical and antibiotic treatment. As a result of the treatment the healing process was completed successfully and without complications.     

The use of calcitrin in the combined treatment of periodontitis

The authors compare the results of calcitrin therapy and surgical (flap surgery) treatment of periodontitis patients. Calcitrin was injected i. m. in a dose of 1.5 to 2 U daily for 14 days. Clinical, laboratory, and functional studies have demonstrated the efficacy of calcitrin therapy in combination with surgical treatment of periodontitis.     

The treatment of mandibular fractures, complicated by inflammations in the fracture area, by means of xenogenic cartilage]

The authors used a personal technique for the management of infected jaw fractures. If the fracture cleft was not wider than 1 cm, they performed a surgical revision (having made an incision through the mucoperiosteum of the oral vestibule) and replaced the excochleated gra-ulation tissue (including sequestrums) by lyophilized cartilage. The bone fragments were immoblized by bone sutures previously applied and also by additional plastic splints. The substitution of the cartilage by bone begun 6-8 weeks after the surgical intervention (as evidenced by radiographs); the process had terminated in about 6-10 months, the implanted cartilage being completely replaced by newly formed bone. The observation involved 16 cases. The method is also recommended for treatment on an out-patient basis.     

The importance of the surgical treatment method in cancer of the oral mucosa with the primary tumor 4 cm in size and larger]

The authors analyze the results of surgical treatment of patients with local disseminated squamous-cell carcinoma of the buccal mucosa. The data on the survival rate of patients treated with different surgical methods are presented and variants of combined operations described.