Accessory parotid gland tumours: 24 years of clinical experience

The accessory parotid gland (APG) is salivary tissue anterior to and anatomically separate from the parotid gland. APG is a common anatomical variation, but APG tumours are extremely rare. The authors report 6 patients with APG tumours emphasizing the diagnosis, clinical features, indications and rationales for different treatment approaches. Patients with primary tumours of the parotid gland or APG tumours who underwent surgical treatment were included. APG tumours comprised 1.23% of overall parotid tumours (6/488) and had a malignancy rate of 33.3% (2/6). There were three male and three female patients with a mean age of 39 years (range 14–70 years). 5 of 6 parotidectomies entailed superficial lobectomy, while one was a total parotidectomy with composite resection of masseter muscle. Concomitant selective lymphadenectomy was carried out in 3 of 6 patients. At 5 years disease-free survival was 83.3%. Mean follow-up was 161 months (range 14–253 months). Although nonsalivary diagnoses frequently occur in the buccal area, APG tumours should be considered in every differential diagnosis in patients presenting with a mid-cheek mass. From oncosurgical, cosmetic and functional standpoints, treatment by facelift parotidectomy or ‘S-incision’ with concomitant superficial lobectomy is the recommended surgical approach; high-grade malignancies require total parotidectomy with regional lymphadenectomy.     

Long-term outcomes of implant-based dental rehabilitation in head and neck cancer patients after reconstruction with the free vascularized fibula flap

The study aimed at evaluating, comprehensively, implant-based dental rehabilitation in head and neck cancer patients after maxillofacial reconstruction with a vascularized free fibula flap (FFF).Data were obtained by retrospectively reviewing the medical records of patients treated in Amsterdam UMC-VU Medical Center. Dental implant survival and implant success according to the Albrektsson criteria were analyzed. Additionally, prosthetic-related outcomes were studied, with a focus on functional dental rehabilitation.In total, 161 implants were placed in FFFs, with a mean follow-up of 4.9 years (range 0.2–23.4). Implant survival was 55.3% in irradiated FFFs and 96% in non-irradiated FFFs. Significant predictors for implant failure were tobacco use and irradiation of the FFF. Implant success was 40.4% in irradiated FFFs and 61.4% in non-irradiated FFFs, mainly due to implant failure and non-functional implants. Implant-based dental rehabilitation was started 45 times in 42 patients, out of 161 FFF reconstructions (27.9%). Thirty-seven patients completed the dental rehabilitation, 29 of whom achieved functional rehabilitation. Irradiation of the FFF negatively influenced attainment of functional rehabilitation. For patients with functional rehabilitation, the body mass index varied at different timepoints: FFF reconstruction, 24.6; dental implantation 23.5; and after placing dental prosthesis, 23.9.Functional implant-based dental rehabilitation, if started, can be achieved in the majority of head and neck cancer patients after FFF reconstruction. Actively smoking patients with an irradiated FFF should be clearly informed about the increased risk for implant and prosthetic treatment failure.     

Primary malignant neoplasms of orofacial origin: a retrospective review of 256 cases in a Nigerian tertiary hospital

A retrospective review of cases histologically diagnosed as malignant lesions of the orofacial region in 1992-2003 from the records of the Department of Oral Pathology and Biology, Lagos University Teaching Hospital, Nigeria was carried out. All cases were subjected to analysis of age, gender, site distribution and histologic types. Malignant tumours constituted 18% of all the biopsies of orofacial lesions seen within the period. The mean age of patients was 42.2+/-21.5 years (range: 2.5-85). There were 177 (69%) epithelial tumours of which squamous cell carcinoma was predominant, 47 (18%) sarcomas and 32 (13%) lymphomas. Squamous cell carcinoma (44%) was the most common malignant orofacial tumour. Osteosarcoma (32%) and Burkitt's lymphoma (56%) was the predominant sarcoma and lymphoma, respectively. Patients with a histologic diagnosis of carcinoma were older than those with sarcomas and lymphomas (P<0.01), and those with a histologic diagnosis of malignant lymphoma were significantly younger than those with sarcomas (P<0.01). Almost 25% of patients with carcinomas were below the age of 40 years. Malignant orofacial tumours are not uncommon in the studied environment, with a sizable proportion of carcinomas occurring before the age of 40 years.     

Pilot prospective study of prosthesis needs at the prosthesis service of the CCTOS of Abidjan]

Studies on the dental health in Ivory Coast showed that the specific needs in prosthesis are numerous. Are there covered? What are the rates of the prosthetic consumption? It is to this question that the authors of the present work wanted brought a beginning of answer through a pilot prospective survey on the prosthetic demand to the service of prosthesis of the CCTOS of Abidjan. This survey was about 150 patients of all sex and all age come specifically for prosthetic rehabilitation, during the active period of February to April 1994. It takes out again of this survey this following results: from a general epidemiological point of view, the women are more numerous than the men, with an access frequency of 56%. Most topics are young, with an age between 20 and 30 years. The "social" rates that convenient the CCTOS attract the patients whose economic income is little important gladly or that are deprived of a health insurance. The prosthetic antecedents show that more than 65% of the topics never carried mainly a prosthesis for lack information or for lace money. Among the topics that already underwent a prosthetic treatment, prosthesis associate partial resin is the more frequently recovered in spite of an interesting rate of fixed prosthesis (37% of carriers). The clinical data reveal that aesthetic remains the main motive of the consultation, with 58% of demands and the prosthesis associate resin is in more of 70% of the cases the chosen therapeutic option.     

Multiple primary tumours of the parotid gland

The authors reviewed the clinical and histopathological records of 69 cases of multiple primary tumours (MPT) of the parotid gland treated at Peking University School of Stomatology. It accounted for 3.4% of all parotid tumours (2055 patients). Fifty-nine patients were male and 10 were female. The median age was 58 (range 24-80) years. The average time interval between the diagnosis of bilateral parotid tumours was 5 years (range 5 months-15 years). Three clinical types were classified as bilateral parotid tumours (31 cases), unilateral multifocal parotid tumours (29 cases), and the combination of bilateral parotid tumours with unilateral multifocal parotid tumours (9 cases). Histologically, Warthin's tumour was the most common type (60 patients), followed by pleomorphic adenoma (8 cases). Three cases were malignant including adenoid cystic carcinoma, squamous cell carcinoma and mucoepidermoid carcinoma. The histopathologies of tumours were of the same type in 63 patients, and distinctly different in six patients. The tumours were found and diagnosed synchronously in 48 patients, and metachronously in 21 patients. Since some parotid tumours are MPTs, careful preoperative diagnosis is necessary. B-mode ultrasound is the technique of choice for the screening of MPT. Meticulous intraoperative inspection and palpation of the glandular tissues and periglandular lymph nodes are necessary.     

Extraoral maxillofacial prosthetic rehabilitation at the M. D. Anderson Cancer Center: a survey of patient attitudes and opinions

STATEMENT OF PROBLEM: Measures of satisfaction after extraoral maxillofacial prosthetic rehabilitation have been sparsely reported. PURPOSE: This article reviews the care-related opinions of patients who were provided extraoral prostheses at the M. D. Anderson Cancer Center over the course of 10 years. MATERIAL AND METHODS: A questionnaire was delivered to 263 extraoral prosthetic patients to elucidate their degree of satisfaction with several parameters, including prosthetic use, care, quality, durability, longevity, and cost. In addition, issues relating to self-image, socialization frequency, and income-earning ability before and after rehabilitation were surveyed. RESULTS: The views of 76 respondents demonstrated a general satisfaction with their prostheses. A majority believed that their prostheses fit comfortably, and most were satisfied with cosmesis. In addition, a preponderance of respondents reported no substantial alteration in social activity after rehabilitation. Although the number of respondents relying on their own employment fell by more than 50% after rehabilitation, nearly all reported a relatively static income before and after rehabilitation. CONCLUSION: The survey revealed a high degree of patient satisfaction with extraoral maxillofacial prostheses. Nevertheless, areas of potential improvement were not lost on the survey's population. The patients desired prostheses that last longer and have improved color stability. An interest in improved retentive mechanisms was mentioned by several patients, and only about half of the respondents perceived prosthetic cost to be completely reasonable.     

Functional rehabilitation using orthognathic surgery, bone transplants and implants after irradiation of malignancy in early childhood

Functional rehabilitation has been carried out in four young patients by use of orthognathic surgery, bone grafting and implants. All four patients had been successfully treated for malignant tumours in the midface during early childhood by use of full dose irradiation. Retarded growth of the maxilla together with missing root formation of permanent teeth prevented the alveolar process to develop. Bimaxillary osteotomies with inlay bone graft have been made in two cases and maxillary osteotomy le Fort I with interpositional and inlay grafting in two individuals. Implants surgery has been made in a second stage surgery. A total of eighteen implants has been inserted and during five years follow-up two implants have been lost (survival rate 90%). All patients have been successfully rehabilitated with fixed bridge prosthesis.     

无牙牙合患者修复前后双侧颞下颌关节盘-髁关系的初步分析

目的:观察无颞下颌关节症状和体征的无牙颌患者修复前后双侧颞下颌关节(TMJ)盘-髁关系、关节腔积液及髁突骨质异常的变化。方法:通过8例无牙颌患者全口义齿修复前后双侧颞下颌关节的磁共振成像(MRI)检查,比较其修复前后双侧颞下颌关节MRI影像表现的差异。结果:修复前,8例无牙颌患者的16个关节中,10个关节盘移位(62.5%),包括7个关节盘内侧移位(43.8%),2个关节盘外侧移位(12.5%),1个关节盘前移位(6.25%);关节腔积液7个关节(43.8%);髁突骨质异常4个关节(25.0%)。修复后,8例无牙颌患者的16个关节中,10个关节盘移位(62.5%),包括7个关节盘内侧移位(43.8%)、2个关节盘外侧移位(其中1个关节盘外侧移位好转)和1个关节盘前移位(6.25%);关节腔积液7个关节(43.8%);髁突骨质异常4个关节(25.0%)。除1个关节的积液增加外,其余关节积液无变化。结论:长期缺牙可能引起无牙颌患者颞下颌关节的结构紊乱。无牙颌患者全口义齿修复后近期,关节盘移位、关节腔积液及髁突骨质异常无明显改变。     

Salivary duct carcinoma: clinicopathological and immunohistochemical studies

Nine cases of salivary duct carcinoma were reviewed clinically, histologically and immunohistochemically, with special evaluation of biomarkers with prognostic significance (p53, Ki67, c-erbB-2 and DNA content). Eight tumours occurred in the parotid gland and one in the submandibular gland. The average age of the patients (8 males and 1 female) was 62.8 years (range = 47 − 74 years). Tumour size ranged from 1 to 6 cm (mean = 3.46 cm). Recurrences were found in 33.3% (3 patients), regional metastases in 44.4% (4 patients) and systemic metastases in 33.3% (3 patients). Three patients died of their disease (median survival = 12.3 months), one is alive with the disease (follow-up of 222 months) and 5 are alive without evidence of disease (mean follow-up of 75 months). p53 protein nuclear immunostaining was positive in 66.6% and c-erbB-2 overexpression was observed in 100% of the tumours. Ki 67 positivity ranged from 6.75% to 47.5% of tumour cells (mean = 21.3%). DNA aneuploidy was found in 4 tumours (44.4%) and DNA diploidy in 5 (55.5%). Our results seem to indicate that Ki67 immunostaining can be useful in the evaluation of the biological behaviour of these tumours, as well as the presence of a high proliferative index of aneuploid cells and the presence of distant metastases.     

Autotransplantation of teeth (I). Indications for transplantation with a follow-up of 51 cases

The indications for autotransplantation of teeth in 45 patients have been analysed together with a follow-up of the success rate of surgery. Most of the transplants were mature teeth, 37 out of 51, with closed apex. The majority of transplantations were carried out in order to replace single tooth losses (40) but in 11 cases, the teeth were used as an abutment in prosthetic rehabilitation. In 14 cases, an impacted tooth was transplanted to its normal position. The follow-up ranged from 3 months up to 10 years. No progressive root resorption has been observed so far; only 6 cases with slight surface resorption. Clinical signs of anchylosis were noticed in 4 teeth and shallow bone defects in 6 patients. Small- or medium-sized periapical destructions were observed in 4 cases. Mature transplanted teeth were always subjected to endodontic therapy within a month; the immobilisation varied between 2-4 weeks, while trying to keep it as short as possible with maintained stability. The experiences so far achieved do encourage a more comprehensive use of the method to solve problems associated with oral rehabilitation, from both prosthodontic and orthodontic points of view.     

Diagnosis and treatment of epithelial salivary gland tumours in children and adolescents

In a series of 2,871 epithelial salivary gland neoplasms managed in the Peking University School of Stomatology between 1974 and 1999, 86 arose in children <16 years of age (52 parotid, 12 submandibular gland, 2 sublingual gland, and 20 minor salivary gland). Considerable delay was encountered in diagnosis (benign 24 months and malignant 16 months). In this group of children, 46 tumours (53%) proved to be malignant, with an incidence in the parotid, submandibular, sublingual, and minor salivary glands of 31/52 (60%), 2/12, 0/2, and 13/20 (65%), respectively. Sixty-six of 86 neoplasms (77%) occurred in children between 10 and 16 years of age. Only six neoplasms were encountered in children of 5 years or younger, four of which were high-grade malignant tumours. Benign tumours were successfully treated by local excision with only one recurrence. Of 46 malignant neoplasms, 8 were treated palliatively; of the remainder 8 were lost to follow-up and 2 patients died of their disease.     

Outcomes of oral squamous cell carcinoma arising from oral epithelial dysplasia: rationale for monitoring premalignant oral lesions in a multidisciplinary clinic

Surveillance of oral epithelial dysplasia results in a number of newly diagnosed cases of oral squamous cell carcinoma (SCC). The clinical stage of oral SCC at diagnosis influences the magnitude of treatment required and the prognosis. We aimed to document the stage, treatment, and outcome of oral SCC that arose in patients who were being monitored for oral epithelial dysplasia in a dedicated multidisciplinary clinic. Those with histologically diagnosed lesions were enrolled on an ethically approved protocol and molecular biomarker study. Details of clinical and pathological TNM, operation, radiotherapy, recurrence, second primary tumour, and prognosis, were recorded in patients whose lesions underwent malignant transformation. Of the 91 patients reviewed (median follow-up 48 months, IQR 18-96), 23 (25%) had malignant transformation. All were presented to the multidisciplinary team with stage 1 disease (cT1N0M0). Of these, 21 were initially treated by wide local excision, 2 required resection of tumour and reconstruction, and 2 required adjuvant radiotherapy. At follow-up 3 had local recurrence, one had regional recurrence, one had metachronous lung cancer, and 5 had second primary oral SCC. There were further diagnoses of oral dysplasia in 5 during follow-up, and it is estimated that 76% of patients will have one or other event in 5 years. Disease-specific survival was 100% and overall survival was 96% (22/23). Median follow-up after diagnosis of oral SCC was 24 months (IQR 11-58). Specialist monitoring of oral epithelial dysplasia by a multidisciplinary team allows oral SCC to be detected at an early stage, and enables largely curative treatment with simple and usually minor surgical intervention. The high incidence of second primary oral SCC in high-risk patients with oral epithelial dysplasia further supports intensive targeted surveillance in this group.     

Prospective clinical evaluation of 1920 Morse taper connection implants: results after 4 years of functional loading

Purpose: This study evaluated the survival rate and the clinical, radiographic and prosthetic success of 1920 Morse taper connection implants.
Material and methods: One thousand nine hundred and twenty Morse taper connection implants were inserted in 689 consecutive patients, from January 2003 until December 2006. Implants were clinically and radiographically evaluated at 12, 24, 36 and 48 months after insertion (mean follow-up per implant: 25.42 months). Modified plaque index (mPI), modified sulcus bleeding index, probing depth (PD) and the distance between implant shoulder and first crestal bone–implant contact (DIB) were measured in mm. Success criteria included the absence of suppuration and clinically detectable implant mobility, PD<5 mm, DIB<1.5 mm after 12 months of functional loading and not exceeding 0.2 mm for each following year, the absence of recurrent prosthetic complications at the implant–abutment interface. Prosthetic restorations were fixed partial prostheses (364 units), single crowns (SCs: 307 units), fixed full-arch prostheses (53 units) and overdentures (67 units).
Results: The overall cumulative implant survival rate was 97.56% (96.12% in the maxilla and 98.91% in the mandible). The cumulative implant success rate was 96.61% (95.25% in the maxilla and 98.64% in the mandible). Only a few prosthetic complications were reported (0.65% of loosening at implant–abutment interface in SCs).
Conclusion: The use of Morse taper connection implants represents a successful procedure for the rehabilitation of partially and completely edentulous arches. The absence of an implant–abutment interface (microgap) is associated with minimal crestal bone loss. The high mechanical stability significantly reduces prosthetic complications.     

Flapless CAD/CAM-guided surgery for staged transition from failing dentition to complete arch implant rehabilitation: a 3-year clinical report

The transition of patients from failing dentition to complete arch implant rehabilitation often requires that the patient be rendered edentulous and has to wear a complete removable dental prosthesis for varying periods of time. This is objectionable to many patients. A staged treatment approach allows a fixed interim restoration, patient comfort, and prosthodontic control throughout the rehabilitation process. CAD/CAM-guided flapless implant surgery has the advantage of prosthetically driven implant placement and minimal postoperative sequelae. A patient with a failing dentition was treated with this combined protocol and was followed up for 3 years after loading. Implant and prosthesis survival rates were 100%, with no technical complications encountered up to the last recall. The purpose of this clinical report is to describe a combination of CAD/CAM-guided flapless surgery and a staged treatment approach, thereby giving the patient a tooth-supported or implant-supported fixed interim prosthesis during the entire rehabilitation process. The various surgical, laboratory, and prosthetic stages are illustrated for the complete arch prosthetic rehabilitation, and the 3-year follow-up outcome is reported.     

P53 and bcl-2 immunoexpression in patients with oral lichen planus and oral squamous cell carcinoma

Objective: The aim of this study was to determine by immunohistochemistry the presence and significance of p53 and bcl-2 proteins in oral lichen planus (OLP) and oral squamous cell carcinoma (OSCC). Study Design: We used 21 cases diagnosed as OLP 16 diagnosed as OSCC and four normal gingival biopsies taken from healthy patients were used as controls. Slides were processed for immunohistochemistry using anti-p53 and anti-bcl-2 monoclonal antibodies. Results: We found p53 immunoexpression in 71.4% OLP cases and 68.7% OSCC cases, with no immunoexpression in control cases. Bcl-2 was negative for all OLP and OSCC cases, and mild positivity was observed in normal tissue. We found significant correlation among p53 expression and OSCC malignancy. Conclusions: Our results suggest that TP53 system mainly promotes a hyperproliferative state by cell cycle arrest of the OLP epithelial cells for repairing damaged DNA nor apoptosis and that anti-apoptotic action of bcl-2 is not important in this disease.     

Management of locally aggressive mandibular tumours using a gas combination cryosurgery

This study evaluated the results of curettage followed by cryosurgery using a combination of propane, butane, and isobutane gas for several benign but locally aggressive bone tumours on the mandible. Twenty-nine patients (16 men and 13 women) participated in the study. Patient ages ranged from 6 to 87 years (mean, 23.72 years). Before enucleation and cryosurgery, some patients received prior treatment consisting of marsupialisation to decrease tumour size. Twenty-seven of the 29 patients (93.10%) showed no evidence of clinical or radiographic recurrence after treatment through enucleation and cryosurgery. Wound dehiscence, which was observed in all cases, healed by second intention. The average follow-up period was 70.55 months (range, 53–120 months). These results suggest that enucleation followed by cryosurgery is an effective therapy for managing locally aggressive mandible tumours. In addition, this treatment is a less expensive intervention than more radical procedures.     

A clinical-pathological study of 53 intra-oral pleomorphic adenomas

Conflict exists with respect to the type of pleomorphic adenoma (PA) most likely to recur and whether the possibility of recurrence can be determined by the histology of the lesion. In this study, specific clinical, histological features and treatment modalities were examined in 53 intra-oral PA's with respect to their relevance to the diagnosis and prognosis. No correlation was found between the duration of symptoms and the proportion of stroma in the PA's nor was there any correlation between the size and the duration. However, at the time of diagnosis, the stroma-poor tumours had attained a significantly larger size than the stroma-rich tumours. This may suggest that the cellular tumours grow at a faster rate. Hyaline cells were shown to be a distinct feature of intra-oral PA's, especially in the stroma-poor subtypes. The proportion of the stroma and the capsule integrity do not seem to influence the prognosis. Follow-up information was obtained for 51% of the patients, and despite the fact that the majority of the lesions (33/53) were treated by excisional biopsy, no recurrences were reported. The follow-up period ranged from 0.6 to 12.6 years (mean 5.3 years).     

Salivary gland tumours treated in the stomatological clinics in Bratislava.

During the period of 1951-1996 a group of 1021 patients (484 men and 537 women, mean age 53 years, range 2-87 years) with salivary gland tumours were analysed retrospectively. The mean follow-up period was 8 years (range 10 months-25 years). The frequency of benign tumours was 74% (n = 755) and malignant tumours 26% (n = 266). Lesions were sited in the parotid gland 83% (n = 847), in the submandibular gland 10.8% (n = 110), in the sublingual gland 3.2% (n = 33) and in the minor salivary glands 3% (n = 31). The most common benign tumours were pleomorphic adenoma in 53.9% (n = 550) and Warthin's tumour 9.7% (n = 99). Of the malignancies, the adenoid cystic carcinoma was most common (6.4% of cases, n = 65) and mucoepidermoid carcinoma occurred in 5.2% (n = 53). The predominant therapy was surgery alone or in combination with postoperative radiotherapy in 93.7% (957 cases), radiotherapy alone after fine needle aspiration biopsy for 4.7%, and 19 patients remained untreated.     

Post-cure response in periodontal practice in Belgium

The recall response of patients with prosthetic rehabilitation on implants (n = 530) and patients treated for periodontal disease (n = 2364) in a periodontal private practice was evaluated. The recall response over 7 years following treatment showed that (1) with time the response to treatment diminished for all patient groups, (2) (post) juvenile periodontitis patients responded poorly to follow-up, (3) patients with rapidly progressing periodontitis were most eager to regularly visit the periodontist, (4) implant patients with complete rehabilitation responded better than those with partial restorations who in turn responded better than those with a single crown on an implant.     

Odontogenic tumours in children and adolescents: a collaborative study of 431 cases

This study describes the oral and maxillofacial pathological characteristics of a series of odontogenic tumours in children and adolescents from three Brazilian reference centres. The records were reviewed for all odontogenic tumours in patients up to 18 years old based on criteria proposed by the World Health Organization (WHO) in 2005. Data concerning sex, age, skin colour and tumour location were collected and plotted. Four hundred and thirty one odontogenic tumours in children and adolescents were found, accounting for 37.5% of the total number of odontogenic tumours diagnosed. Benign tumours were predominant (99.8% of the cases), and odontoma was the most frequent type (41.4%), followed by keratocystic odontogenic tumours (25.5%) and ameloblastoma (14.6%). Odontogenic tumours were rarely detected in early childhood, and their prevalence increased with age. An almost equal distribution was observed with respect to sex and the site of the lesions. This study is the largest reported retrospective analysis describing odontogenic tumours in children and adolescents to date. The authors detected some variation in the relative frequency of odontogenic tumours compared with similar reports. Additional studies should be conducted based on the new WHO classification and predetermined age parameters to enable comparative analysis among different worldwide populations.