Infant Odontogenic Myxoma: A specific entity

IntroductionIn children, and specifically in infants, odontogenic myxomas are extremely rare. In infants, myxoma seems to display mostly the same clinical, radiological and pathological characteristics. This paper presents a series of odontogenic myxomas in infant patients.Materials and methodsFour infant patients were included in this retrospective study. The clinical, radiological and pathological presentation was characterized and the treatment analysed.ResultsAll patients presented with a rapidly evolving paranasal swelling. CT-scan showed a maxillary homogeneous unilocular and intraosseous tumour. In all cases, pathological examination revealed a loose myxoid stroma within stellate and spindle shaped cells. All patients underwent conservative surgery through a vestibular approach.ConclusionThis patient series and a review of the literature demonstrates that odontogenic myxoma is specific in infant. We propose the name of Infant Odontogenic Myxoma for this entity.     

Myoxomas of the jaws.

A retrospective study on 15 patients with myxomas of the jaws was carried out. Follow-up information was obtained in 10 patients. Clinical, radiologic, and microscopic features were examined and the results of extensive resection versus conservative surgery were evaluated. The results seem to be in favor of the latter. Four cases are presented in detail.     

Advanced central myxoma of the jaws in Nigeria. Clinical features, treatment and pathogenesis

18 advanced cases of myxoma of the jaws are described. These had a typical age, sex and site distribution and characteristic clinical and radiographic features. Surgical treatment was radical as benefits large, poorly defined tumours, but there was no evidence that these were aggressive lesions. It is argued that the designation of myxoma as an odontogenic tumour is uncertain though not excluded. Attention is drawn to evidence that many myxomas of the jaws may be examples of myxomatous degeneration in other neoplasms.     

Odontogenic myxoma: a clinicopathological study of 33 cases

Odontogenic myxoma, a rare tumour that occurs in the jaws, has been reported to be the second commonest odontogenic tumour in many countries. Few studies, however, provide detailed clinicopathological findings of a large series of cases and no study so far has attempted to calculate the incidence of this condition. Retrospective and prospective studies were carried out in Tanzania from 1982 to 1998 (16 years) and 1999 to 2002 (4 years), respectively. A total of 33 cases of myxomas were found with a male:female ratio of 1:1.83. Most of the tumours were located in the mandible compared to the maxilla and were predominantly multilocular. Pain, diasthesia, ulceration, invasion of the soft tissues and tooth mobility were among the symptoms that patients presented with although the majority had no clinical signs or symptoms. Based on the prospective study only, an annual incidence of 0.07 per million can be ascertained. Late reporting was a common feature in this group of patients. Radical surgery with resection of the tumour with a safe margin is advocated.     

Pleomorphic adenoma of the parotid in childhood.

INTRODUCTION: Pleomorphic adenoma is a benign growth that most often appears in the parotid gland where it is the most frequent type of tumour. Its appearance in childhood is rare and there are no large series available in this age group for comparison with its presentation in adults. Surgical treatment is similar in children and in adults; whilst the prognosis is good, they may become malignant and metastasize. MATERIAL AND METHOD: In this study, we present seven parotid pleomorphic adenomas in childhood treated in our Department and a review of the literature. The following data were evaluated: sex, age, affected side, clinical symptoms and period of evolution of the symptoms, surgical technique applied and complications observed. RESULTS: The mean age at presentation was 12.4 years. All patients were males with the right side affected in five patients. The treatment was conservative superficial parotidectomy in five patients, conservative total parotidectomy in one, and an enucleation including a wide safety margin in the last case. None of the patients exhibited any permanent postoperative complication. The mean follow-up was 41.3 months (26-58 months).     

Endoscope-assisted conservative condylectomy in the treatment of condylar osteochondroma through an intraoral approach

Mandibular condylar osteochondroma (OC) can result in morphological and functional disturbances, including facial asymmetry and temporomandibular joint (TMJ) dysfunction. The aim of this study was to explore the feasibility of endoscope-assisted tumour resection and conservative condylectomy via an intraoral approach. Seven patients with condylar OC were enrolled in this study. Endoscope-assisted tumour resection and conservative condylectomy were achieved intraorally, and no conventional extraoral incision was needed. Direct vision of the magnified and illuminated operative field was realized with the assistance of an endoscope. No facial nerve injury or salivary fistula occurred in any patient. Stable occlusion was realized through postoperative orthodontic treatment. The patients showed no signs of tumour recurrence or TMJ ankylosis during follow-up (range 18–43 months). Endoscope-assisted condylar OC resection and conservative condylectomy via intraoral approach offers great advantages with no significant complications compared with conventional extraoral incisions. The endoscope provides us with a valuable treatment option for this potentially complicated procedure     

Odontogenic myxoma--a case report and clinico-radiographic study of seven tumors

The primary aim of this paper is to present clinical and radiographic aspects of odontogenic myxomas diagnosed at the Stomatology Clinic of Bauru School of Dentistry, University of S?o Paulo, Brazil and to compare them with data reported in a series published in the literature. A second objective is to report a clinical case of odontogenic myxoma in a 9-year-old patient in whom the lesion involved the anterior region of the maxilla. Dental records between 1975 and 2000 were reviewed and seven cases diagnosed as odontogenic myxoma were found in individuals aged from nine to 60 years. Of these, four occurred in women and three in men. The mandible was affected in five cases and the maxilla in two. All patients presented with asymptomatic swelling in the affected area. A mixed radiographic result was observed in five patients, while in two patients the lesion was completely radiolucent. The borders of the lesion were well-defined in six patients. In four cases there was dental displacement, although root resorption was not observed in any of these. The treatment of choice was surgical excision. Four cases did not recur during the period of follow-up, which varied from nine months to 19 years. It was concluded the clinico-radiographic study of odontogenic myxomas should be continually refined with the aim of offering the patient an appropriate treatment, since the lesion presents a high potential for recurrence.     

Juvenile ossifying fibroma. Report of four cases

The present investigation concerns 4 patients with juvenile ossifying fibroma (JOF) whose data are analyzed together with 30 cases from the literature. The tumour mainly occurs in juveniles, 79% of the patients being 15 years or younger. Radiologically as well as at surgery, the lesion is demarcated from its surroundings. Histologically, JOF is unique in showing a loose-fibroblastic stroma that contains garland-like strands of osteoid with entrapped osteoblasts, the latter feature not being observed in other fibro-osseous lesions. JOF responds very well to conservative treatment that provided permanent cure in all cases with adequate follow-up data.     

Conservative treatment of odontogenic myxoma

Odontogenic myxomas (OMs) are nonencapsulated rare benign tumors that can occur in gnathic bones. They are locally invasive and have a high recurrence rate. Radiologically, OMs show a multilocular (in the majority of cases) or unilocular radiolucency, with either distinct or poorly defined margins. Histopathologically, OMs are characterized by spindle-, wedge-, or stellate-shaped cells loosely arranged in an abundant mucoid background. Myxomas are mainly asymptomatic. Radical surgery, excision, and enucleation followed by curettage of the surrounding bony tissue have all been advocated as treatment options. This study presents a successful case of conservative treatment of OMs with a 5-year follow-up.     

Mandibular invasion by oral squamous cell carcinoma

Forty-five specimens consisting of mandibular bone and adjacent squamous cell carcinoma were histologically investigated. In 23 of them, there was no involvement of the mandibular bone: a continuous periosteal layer separated the tumour from the bone. Tumour spread through periosteal lymphatics was not observed in any of these cases and therefore there is no reason to sacrifice bone when the tumour is not fixed to the jaw. Twenty-two specimens exhibited bony involvement. In 10 of them, the bone was eroded by an advancing tumour front. None of these cases exhibited tumour invasion into cancellous spaces, dental canal or periodontal ligament space. Tumours with this type of bony involvement are amenable to mandible-sparing surgical treatment. The other 12 exhibited diffuse growth into cancellous bone, dental canal and, if present, periodontal ligament space. Cases like these are to be operated on by removing the entire thickness of the involved mandibular part. Tumours involving bone were slightly larger than those leaving bone uninvolved. The tumours eroding bone were of a smaller size than those infiltrating bone. The differences, however, are too small to have a predictive value in treatment planning. Attention is drawn to the presence of dental epithelial rests that should not be mistaken for invading tumour nests.     

Preoperative concurrent chemoradiotherapy for stages II-IV oral squamous cell carcinoma: a retrospective analysis and the future possibility of this treatment strategy

This study evaluated survival in 154 patients with stages II-IV oral squamous cell carcinoma (OSCC) treated with preoperative concurrent chemoradiotherapy and assessed the future use of this treatment strategy. 14 patients exhibited advanced stage II, 73 exhibited stage III and 67 exhibited stage IV. All patients received 40Gy irradiation and concurrent cisplatin-based chemotherapy in two courses. Radical surgery was undertaken after 2-6 weeks. The clinical tumour response, histopathologic regression grade, residual tumour grade (RGrade) in the primary tumour and the level of residual pN+ were associated with prognosis. 90% of patients with complete response and 73% of patients with good partial response in the primary tumour were RGrade 0 (no residual tumour cells) or RGrade 1 (viable tumour cells remained within central superficial portion). In patients with complete response in the neck, residual pN+ was only seen in levels IB (8%) and IIA (8%); the higher the level of residual pN+, the lower the survival rate (p<0.0001). This treatment strategy was excellent for stages II-IV OSCC. It may be possible to perform minimally invasive surgery in which the extent of resection in primary tumour and neck is reduced in patients who achieve good response following preoperative chemoradiotherapy.     

Factors that influence the method of mandibular resection in the management of oral squamous cell carcinoma

The method of conservative (rim) resection of the mandible is now well established and provides good control of disease in the primary site. There are few audits of this technique in terms of margins of resection for both rim and segmental resection of the mandible. Consecutive previously untreated patients managed with resection of the mandible as part of their treatment for oral and oropharyngeal squamous cell carcinoma were recruited for the study. The presence and extent of tumour invasion of the mandible was recorded and a retrospective analysis made to establish the incidence of unnecessary segmental resections. The invasion rate was 33% (8/35) for rims and 83% (54/65) in segmental resections of the mandible, which compares favourably with previous studies and indicates a reasonable accuracy of resection. In between 6 and 11 of the 62 cases (10-17%) a rim resection could have achieved a satisfactory resection margin and retained a functioning lower border of the mandible. The accuracy of resection in terms of margins was greater for mandibular resections (94% clear margins) than soft tissues (62% clear margins). The number of compromised margins was significantly greater in the invaded rim resection group (P=0.018). This study indicates that a more conservative mandibular resection was possible in a few cases. This is unlikely to have an adverse effect on the close or involved margin rate, which depends mainly on the accuracy of the soft tissue resection. Angling the horizontal rim resection to take into account tumour entry at the point of contact will help to ensure a clear bone margin if a conservative approach to mandibular resection is an option.     

Myxomas of the paraoral--oral soft tissues.

Fifteen cases of soft-tissue myxoma of the paraoral-oral structures have been presented. Eleven cases were garnered from an extensive review of the literature, and four previously unreported cases are described. The myxomas were slow-growing, insidious, infiltrative tumors which occurred in all age groups, with an average patient age of 38 years. Most frequent locations were the cheek, floor of the mouth, and palate. The lesions were present from 2 weeks to 6 years prior to treatment. In this series all the myxomas were treated by surgical excision, with no evidence of recurrences or metastases. The recommended therapy is surgical resection with adequate margins. Other myxomatous lesions which may mimic a myxoma are mentioned.     

Odontogenic tumours in Istanbul: 527 cases

We retrieved and analysed the records of 527 odontogenic tumours from a total of 62,565 cases in the department of tumour pathology in the Institute of Oncology, University of Istanbul, from 1971 to 2003. Of these 527 tumours, 521 were benign and 6 were malignant. The most common lesions were ameloblastomas (n=133) followed by odontomas (n=109), odontogenic myxomas (n=83) and others. There were more female patients (n=278, 53%) than male, and nearly half the patients (n=253, 48%) were between the ages of 10 and 29 years. The posterior mandible was the commonest site (n=184, 35%), followed by the premolar area of the mandible (n=98, 19%), and the anterior maxilla (n=84, 16%).     

Surgical management of bisphosphonate induced osteonecrosis of the jaws

Recent literature contains numerous articles on osteonecrosis of the jaws (ONJ) associated with bisphosphonate treatment (BPT), with most advocating a conservative approach to management. A prospective study was designed to review the surgical management of cases of ONJ that did not respond to conservative management. Forty patients, referred with ONJ that did not respond to conservative management, were treated surgically and followed up for 6 months to 4 years. Four patients were taking i.v. BPT as part of their bone cancer management and 16 were taking oral BPT for osteoporosis. The surgical management of ONJ involved antibiotic therapy, surgical debridement of all necrotic bone and tension-free primary closure. All 40 cases healed uneventfully with no wound breakdown during follow-up. Most of the literature supports the conservative management of ONJ, but the condition leaves the patient debilitated. Many cases do not respond to conservative management and the infection and bone destruction is progressive. The conservative management of ONJ is to be supported, but this prospective study has shown that those cases that do not respond may be managed surgically. It should be recognized that while the results of this paper are encouraging, some cases will be resistant to all treatments.     

Diagnostic and therapeutic problems of myxomas (myxofibromas) of the jaws.

During the period from 1969 to 1977 11 cases of myxoma or myxofibroma in the jaw region have been treated at the Maxillofacial Surgery Clinic of the University of Mainz. Various kinds of diagnostic problems are discussed. We observed, inter alia, rapid tumour growth and a imitative dynamics in the radiographs, giving rise to a suspicion of malignancy in some cases. The locally infiltrative type of growth of myxomas must be taken into account during therapy, since insufficiently radical management is liable to be followed by a recurrence.     

全面部骨折手术治疗的临床研究

目的对全面部骨折(panfacial fractures)患者临床治疗进行回顾性研究。方法我院1991-2006年全面部骨折患者60例,15例传统方法治疗即颌间结扎牵引固定;45例进行手术切开复位内固定治疗。随访1-8年,包括门诊检查及电话随访。结果所有患者外伤后均出现骨质重新愈合,无骨不连现象;保守治疗患者功能基本恢复,外形较差,手术治疗患者功能、外形均得到较好的恢复;张口度总体上看保守治疗患者恢复不如手术治疗患者。结论全面部骨折手术治疗患者获得较好的治疗效果,值得在临床上推广。     

开放复位内固定手术治疗与保守治疗髁突骨折效果对比的Meta分析

目的：采用Meta分析的方法对比开放复位内固定手术与保守治疗方法在髁突骨折的治疗效果。方法：计算机检索PubMed、Cochrane图书馆、EMbase，收集采用开放内固定技术与采用保守治疗技术治疗髁突骨折的随机对照试验，检索时间均从建库至2012年1月。按照纳入标准由2名研究者独立筛选文献并提取资料，对纳入文献的质量进行评估，采用RevMan5．0软件进行Meta分析。结果：共纳入13个研究，共859例患者，其中手术治疗409例，保守治疗450例。Meta分析结果显示：手术治疗组最大开口度优于保守治疗组OR=0．35，95％CI（0．21，0．50），P〈0．000013，两组差异有统计学意义；随诊1年，手术组错殆发生率小于保守治疗组，差异有统计学意义EOR=0．29，95％CI（0．13，0．66），P=0．0033；随诊1年，手术组与保守治疗组关节疼痛的发生率无统计学差异Eoa=0．76，95％C1（O．25，2．29），P=0．63。两组治疗方法中面部不对称的发生率EOR=I．27，95％CI（0．34，4．79），P=0．733、下颌活动受限发生率EOR=O．94，95％CI（0．43，2．07），P=0．881均无显著差异。结论：采用开放手术治疗髁突骨折与采用保守治疗相比在治疗后咬合关系恢复及术后开口度改善方面具有优势。两种治疗方法出现关节区症状的情况无显著差异。对面部发育及下颌功能的影响无明显差异。     

Long-term follow up on recurrence of 305 ameloblastoma cases

The aim of this study was to determine the appropriate treatment for ameloblastoma by considering the factors associated with recurrence, and to make a quantitative prediction of the risk factors for recurrence. Data on age and gender distribution, location of the tumour, histopathological findings, treatment method, and whether or not patients had a preoperative biopsy confirmation report were collected in 305 cases (239 patients; M: 139, F: 100) of ameloblastoma diagnosed and treated in 1985-2002. After initial statistical evaluation (chi(2)-test and Fisher's exact test), logistic regression analysis was performed to check relative significance and predict recurrence. The disease-free survival function curves of the patients with or without recurrence were obtained by the Kaplan-Meier method and compared using univariate regression analysis. The correlation between recurrence and the treatment method or histopathological type was significant. The differences between the 'conservative' and 'resection with bone margin' and between the 'conservative' and 'segmental resection or maxillectomy' groups in terms of disease-free survival were highly significant. The difference between the 'resection with bone margin' and 'segmental resection or maxillectomy' groups was not significant. A resection with safety margin is the best method to treat most proven ameloblastomas, and conservative treatment is reasonable for patients in their first decade or with unicystic or plexiform ameloblastoma.     

The outcomes of conservative and surgical treatment of stage 2 bisphosphonate-related osteonecrosis of the jaws: a case series

The purpose of the current retrospective chart review is to describe the outcomes of conservative or surgical treatment of stage 2 bisphosphonate-related osteonecrosis of the jaws (BRONJ). 14 charts (mean patient age 69.07 ± 10.37 years) describing 19 BRONJ stage 2 sites were identified. According to the treatment protocol, all patients received conservative treatment. Surgical treatment was delivered only to sites that did not respond to conservative treatment. Conservative treatment alone was delivered to 11 sites in 8 patients (mean postoperative follow-up 17.6 ± 9.4 months). Surgical treatment was delivered to 8 sites in 6 patients (mean postoperative follow-up 10.0 ± 6.1 months). Bisphosphonate exposure ranged from 1 to 8 years. In most cases, tooth extractions and wearing dentures were reported as triggers for BRONJ. At the last follow-up, BRONJ stage 0 was noted in 7 sites that received conservative treatment and 5 sites that received surgical treatment. Within the limitations of the current chart review, the results showed that although conservative treatment for BRONJ stage 2 can provide favourable outcomes, surgical treatment represents a suitable alternative in non-responsive cases.