Mediastinitis from odontogenic infection. A case report

We report a case of mediastinitis complicating a dental infection in a 40-year-old male. Despite drainage of the localised neck abscess and the administration of systemic antibiotics, his submandibular abscess extended to involve the pericardial and pleural cavities. Drainage procedures and thoracotomies were required to treat the empyema and purulent pericarditis. Computed tomography was used to follow the progression of disease and assess the efficacy of treatment.     

Glandular odontogenic cyst. Report of two cases and review of the literature

In 1992, the World Heath Organization recognized a new type of cyst called glandular odontogenic cyst (GOC). Clinically, GOC usually presents as a painless, slow-growing swelling. The radiographic appearance is that of a large, multiloculated, well-defined radiolucency. GOC tends to affect the anterior mandible. The dental profession must be aware of the clinical significance of this lesion. The aggressive nature of the lesion has been reported and at least 25% to 55% recur following curettage. If not treated on time, extensive surgery and alteration of function may result. Two new cases are reported.     

Familial odontogenic keratocysts. Report of 3 cases and review of Japanese dental literature

Familial odontogenic keratocysts are described in this report. The Case 1 patient, who has 3 sisters, developed odontogenic keratocysts. The 2 younger sisters (Cases 2 and 3) also had odontogenic keratocysts, although the elder sister did not have any odontogenic cysts. The father of the patients had a history of removal of a jaw cyst, and the mother was found later to have malignant ameloblastoma. Besides the odontogenic keratocysts, the Case 1 patient had basal cell nevus, prominent frontal process, and ocular hypertelorism; the Case 2 patient had prominent frontal process; the Case 3 patient had prominent frontal process, ocular hypertelorism, and squint. All 3 sisters are suspected of being patients with the basal cell nevus syndrome. The Japanese dental literature concerning the basal cell nevus syndrome is reviewed.     

Mediastinitis secondary to an odontogenic infection. A case report

Infectious mediastinitis of odontogenic etiology is a rare occurrence in the United States. The mortality associated with descending necrotizing mediastinitis is estimated at 40% to 50%, even with advances made in management of such serious infections. The early diagnosis and aggressive treatment of odontogenic infections has made this entity relatively obsolete, but we have not been able to eliminate the disease process altogether. We report on a case that was managed successfully, albeit with a long, protracted course.     

Mediastinitis caused by odontogenic infection associated with adult respiratory distress syndrome.

A case of descending mediastinitis resulting from dental infection and complicated by adult respiratory distress syndrome (ARDS) is reported. The patient had a long history of heavy drinking. His condition was so serious that he died despite some successful therapies. The cause of ARDS appeared to be aspiration pneumonia. It is extremely rare for oral and maxillofacial surgeons to encounter a patient with ARDS.     

Odontodysplasia. Report of two cases and review of the literature.

Odontodysplasia is a rare developmental anomaly affecting the tooth structures in both deciduous and permanent dentitions. The enamel is thin and uneven in thickness, and the detinal tissue surrounds very large pulp chambers. Denticles are present in the pulp organ. The maxilla is involved twice as frequently as the mandible. Most of the affected teeth are in the anterior segments; however, all other teeth can be affected. The cause is unknown. Because of the tendency of the affected teeth to develop abscesses, the most common treatment is extraction. Two additional cases are reported, and the literature is reviewed.     

Central odontogenic fibroma: clinicopathologic features of 19 cases and review of the literature.

The odontogenic fibroma is a benign neoplasm infrequently reported in the literature (20 cases). Nineteen additional examples are reported. This lesion occurs most frequently in the maxilla anterior to the molars and displays a striking female predilection. On occasion, it may be associated with an unerupted mandibular third molar. Histomorphologically, it is not encapsulated. A spectrum of fibrous connective tissue stroma is present: from myxoid to densely hyalinized and from relatively acellular to cellular. Calcification may or may not be present. It is distinguished by the presence of sparse cords and islands of inactive odontogenic epithelium. Enucleation or surgical curettage is appropriate therapy and recurrence is low. As there appears to be no correlation of histologic pattern with clinical behavior, it seems unnecessary to try to separate the tumor into two variants.     

Peripheral odontogenic keratocyst: report of two cases and review of the literature

The odontogenic keratocyst is a developmental odontogenic cyst most commonly occurring in the jaws. In rare instances, however, this lesion has been reported to occur in the gingival soft tissues. Although most authors have regarded these soft tissue lesions to be peripheral odontogenic keratocysts, others have preferred to regard them as histopathologic variants of the gingival cyst of the adult. We document 2 additional cases occurring in the gingival soft tissues, and we review the existing literature concerning this unusual lesion. Given the distinct microscopic features and possible association with nevoid basal cell carcinoma syndrome, we favor the view that this lesion represents the soft tissue counterpart of the intraosseous odontogenic keratocyst.     

Pyostomatitis vegetans. Report of two cases and review of the literature

Pyostomatitis vegetans (PV) is a rare benign chronic mucocutaneous pustular disorder of unknown etiology, though it is usually associated with chronic inflammatory disease of the bowel-particularly ulcerative colitis. At the oral level PV manifests as an exophytic lesion with an erythematous perimeter and a creamy-yellow surface presenting a friable covering membrane which easily disintegrates, giving rise to the development of small ulcers or superficial erosions. The histology shows epithelial acanthosis and superficial ulceration. The underlying connective tissue exhibits neutrophil and eosinophil infiltration, with miliary abscesses in some cases. The present study describes 2 cases of PV associated with ulcerative colitis. The differential diagnosis should be established with Neumann type pemphigus vegetans, since in both cases the lesions are clinically similar and the histology reveals an important eosinophil response, acanthosis, and the formation of intraepithelial miliary microabscesses. The treatment of PV focuses on control of the disease. In the event the orofacial lesions persist, topical oral drugs such as corticoids, with additional antibiotherapy, multivitamin complexes, and nutritional supplements, can be provided.     

Adenomatoid odontogenic tumour: review of the literature and an analysis of 33 cases from South Africa

The adenomatoid odontogenic tumour (AOT) is a benign lesion of odontogenic origin. It is a slow growing tumour that results in a painless expansion of the jaws. This is a retrospective review of the demographic, clinical and radiographic features of AOTs diagnosed in a black South African population over 20 years. Of the 746 odontogenic tumours diagnosed, 4% were AOTs. The patients’ ages ranged from 9 to 37 years with a mean age of 15 years. The highest incidence was in the second decade of life (85%). The female to male ratio was 5.6:1. The maxilla was more commonly affected than the mandible in a ratio of 1.5:1. The sizes of the lesions ranged from 2 to 7 cm, with 60% involving an entire quadrant. All were of the central follicular type and appeared as well-demarcated radiolucent lesions. The canine was the most common impacted tooth. The treatment of choice was enucleation of the lesion, with no recurrences being reported.     

Peripheral odontogenic fibroma. Report of 5 cases

The peripheral odontogenic fibroma (WHO type) is a relatively rare, benign, unencapsulated, exophytic gingival mass of fibrous connective tissue. Odontogenic epithelium is found within the gingival mass, but usually appears to play a minor role when compared to the fibrous component. According to the present concept, cases reported in the literature under the terms "odontogenic gingival epithelial harmartoma" "hamartoma of the dental lamina" and "peripheral ameloblastic fibrodentinoma" are actually examples of peripheral odontogenic fibroma. Review of the literature revealed only 30 acceptable cases that fit the present concept of peripheral odontogenic fibroma. Because of the paucity of reported cases, the histomorphological spectrum and the clinical features of this lesion have not yet been fully established. This article presents five new cases of peripheral odontogenic fibroma. The connective tissue ranged from markedly cellular to relatively acellular well collagenized. Islands and strands of epithelium were present in all five cases: in four they were scanty and in one abundant. A matrix of mineralized material was present in four cases. The peripheral odontogenic fibroma must be differentiated histologically from peripheral ossifying fibroma, which is a reactive lesion, and from the peripheral ameloblastoma and the calcifying epithelial odontogenic tumour.