Is it necessary to resect bone for low-grade mucoepidermoid carcinoma of the palate?

Minor intraoral tumours of the salivary glands are relatively uncommon. Most are histologically low grade and display no aggressive clinical features such as bony invasion or regional metastases. The aim of this study was to investigate retrospectively a bone-sparing approach to resection of low grade mucoepidermoid carcinoma of the hard palate in 18 patients. Only one had radiographic evidence of bony invasion and was treated by composite resection of the hard palate. Sixteen patients were treated by wide local excision with 1 cm margins of soft tissue using the periosteum of the hard palate as the deep margin. The mean (SD) follow-up time was 44 months, (range 2–140). Among patients who had only soft tissue resection the histological margins were clear in 11 patients, and 5 had close or invaded margins that were all localised to the deep margin. There were no local recurrences during the follow-up period. We suggest that a bone-sparing approach to such tumours gives adequate local control, and composite resections should be reserved for tumours that have obviously invaded the hard palate.     

Surgical management of large venous malformations of the lower face

We describe the benefits of an early surgical approach to large (more than 3 cm) venous malformations in the lower face, and discuss the advantages over conservative treatment. Fifty-eight patients with venous malformations of the lower face were treated in this hospital between 2005 and 2010 with sclerotherapy (lipidocanol), or láser, or resection, or all three. Only patients with recurrent malformations and a history of previously ineffective conservative treatment were included in the study (n = 17). Follow-up ranged from 23–65 months (mean 40). Functional and cosmetic outcomes and recurrence were recorded on a single questionnaire. Seventeen patients with a history of recurrent malformations, which had previously been treated ineffectively with conservative treatment and were more than 3 cm in diameter, benefited from early and wide resection. No recurrences were recorded during follow-up. Patients were satisfied with the postoperative cosmetic and functional results. Large malformations are both deforming and functionally disabling. These patients, who initially do not respond to conservative treatment, benefit from early definitive resection.     

Effectiveness of a new decisional algorithm in managing mandibular ameloblastomas: a 10-years experience

We present a new treatment algorithm aimed to assist surgeons to develop a rational diagnostic protocol and establish effective conservative surgical management in patients with mandibular ameloblastoma. Fifteen consecutive cases treated by conservative management were reviewed. Data collected included age, sex, symptoms and signs at diagnosis, anatomical distribution of the lesions, numbers and types of operations, number of recurrences, and duration of follow-up post-operatively. Curettage was the first operation for all patients and they were closely followed-up post-operatively. During the follow-up period (4-10 years), small recurrences were diagnosed early in 7 patients who were treated by radical surgery including marginal or "box" resection. No further recurrences were observed after the second operation. When detected early, recurrences are small and surrounded by a large amount of uninvolved normal bone so it is possible to manage them with a radical resection, so lowering the risk of further recurrence and avoiding severe cosmetic and functional problems.     

Treatment of odontogenic keratocysts: a follow-up of 255 Chinese patients

OBJECTIVE: The purpose of this study was to report our experience in the surgical treatment of 484 Chinese patients with follow-up in 255 cases. METHODS: A retrospective analysis was conducted of all odontogenic keratocysts that were surgically treated and histopathologically diagnosed between 1962 and 1998. The odontogenic keratocysts were surgically treated with enucleation, marsupialization followed by secondary enucleation, and resection with or without continuity defects. The recurrence rate was evaluated for the patients followed more than 3 years. RESULTS: Of a total of 489 odontogenic keratocysts, 327 (66.87%) were found in the mandible and 162 (33.13%) in the maxilla. Follow-up data were obtained in 255 patients. Recurrence was found in 31 cases (15.27%) in 203 patients treated with enucleation after an observation period of 3 to 29 years. Twenty-nine recurrences (17.79%) were found in 163 patients treated with enucleation alone, two recurrences (6.70%) were seen in 29 patients who received Carnoy's solution fixation of the cyst wall before enucleation, and no recurrence was found in 11 cases treated with marsupialization in combination with secondary enucleation. No recurrence was seen in 52 patients treated with resection. CONCLUSION: Odontogenic keratocysts treated with enucleation alone have a higher recurrence rate. Enucleation with adjunctive treatment can decrease recurrence rate. Radical excision has no recurrence but does have the highest morbidity rate and should be reserved for multiple recurrent cysts after conservative means.     

Surgical treatment of recurring ameloblastoma,are there options?

Our aim was to evaluate the treatment given to patients with intraosseus ameloblastomas with special emphasis on recurrence and the outcomes of primary and secondary resection. Forty-eight patients who were treated for intraosseous ameloblastoma at 8 centres across Sweden met the inclusion criteria. They showed typical distribution of age, sex, site of lesion, and characteristic presenting features. Eleven of the 48 were initially treated with radical resection and none recurred. Twenty-two of the remaining 37 who were initially treated by conservative resection presented with recurrences. Sixteen of the 22 then had conservative secondary resections, which resulted in further recurrence in 6 patients. Initial radical resection is therefore superior to conservative management as far as recurrences are concerned. We argue, however, that a conservative surgical approach is adequate for many intraosseous ameloblastomas with limited extension, because relapse can be followed by radical resection if clinically indicated in selected cases.     

Recurrent melanotic neuroectodermal tumor of infancy: a proposal for treatment protocol with surgery and adjuvant chemotherapy

The case of a 4-month-old male infant treated with combined surgery and chemotherapy for an aggressive recurrent melanotic neuroectodermal tumor of infancy (MNTI) on the top of the alveolar process of the mandible with a long-term follow-up is presented. Initial treatment comprised conservative local excision and curettage of the mandible. After several local recurrences and because radical surgical excision would give gross functional and aesthetic mutilation, finally complete, long-lasting remission was achieved with adjuvant chemotherapy, according to a neuroblastoma protocol (10-year follow-up). The reason for this protocol was because molecular genetic studies of this tumor showed loss of heterozygosity of chromosome 1p and gain of chromosome 7q analogue to neuroblastomas. A combination of surgery and chemotherapy should be the preferred treatment in case of a recurrence MNTI because optimal functional and aesthetic outcome.     

Odontogenic Keratocyst: To Decompress or Not to Decompress? A Comparative Study of Decompression and Enucleation Versus Resection/Peripheral Ostectomy

PURPOSE: We discuss the outcome of 2 well-established and widely accepted methods used for the treatment of odontogenic keratocyst (OKC), enucleation with peripheral ostectomy or resection and decompression followed by enucleation and peripheral ostectomy. PATIENTS AND METHODS: A retrospective chart review of all cases of OKC treated in the University of Maryland's Department of Oral and Maxillofacial Surgery between 1994 and 2004 was undertaken. A total of 31 patients with OKCs was identified. Three of these patients diagnosed with basal cell nevus syndrome and multiple OKCs and 6 patients who did not have adequate follow-up were excluded from this study; thus, 22 patients were evaluated. Of these 22 patients, 11 were treated with resection or enucleation with peripheral ostectomy (group I) and 11 were treated with decompression followed by enucleation when indicated (group II). RESULTS: A total of 22 patients with biopsy-proven OKC ranging in age from 18 to 90 years were separated into 2 treatment arms. Group I comprised 6 females and 5 males, age 18 to 71 years, with 6 OKCs located in the mandible and 5 in the maxilla. Group II comprised 6 females and 5 males, age 24 to 90 years, with 10 OKCs in the mandible and 1 in the maxilla. The choice of treatment approach was based on the size of the cyst, recurrence status, and radiographic evidence of cortical perforation. The last follow-up revealed no recurrences in group I and 2 recurrences in group II. Both patients with recurrence in group II had undergone enucleation of the same lesion in the past, and both cysts recurred within 2 years after initial treatment. CONCLUSIONS: Our study results concur with the literature regarding recurrence rates of OKC. The aggressive nature of some OKCs necessitates equally aggressive treatment, whereas long-term follow up even for nonsyndromic patients with single lesions is of paramount importance. Age of the patient and the site and histological characteristics of the treated lesions were not significantly associated with the incidence of recurrence.     

Ghost cell odontogenic carcinoma arising in the background of a calcifying odontogenic cyst

Ghost cell odontogenic carcinoma (GCOC) is a rare malignant neoplasm, representing 3% of all ghost cell lesions of the jaws. They can arise de novo or from a pre-existing calcifying odontogenic cyst (COC) or dentinogenic ghost cell tumour (DGCT). A systematic review of the literature reported only 12 cases of a GCOC arising from a pre-existing COC. This report highlights an additional case of a GCOC arising from a pre-existing COC after 3 years in an adolescent male. The patient initially presented with a painless swelling of the right mandibular corpus. Panoramic radiographic examination showed an expansive unilocular radiolucent lesion. After 3 years, the radiographic features appeared more aggressive with increased expansion and cortical perforation. A wide surgical resection was performed, whereby the lesion was diagnosed as a GCOC. Due to the rarity of these malignant neoplasms, limited information is available regarding their biological behaviour. One-year follow-up revealed no clinical signs of recurrence.

     

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目的探讨口腔疣状癌的病因、临床表现、鉴别诊断、组织病理学特点及治疗。方法回顾分析中国医科大学附属口腔医院1990-2012年收治的86例经组织病理确诊的口腔疣状癌患者的临床资料,总结其临床症状、病灶区影像学表现、病理学表现、治疗方案及术后随访情况。结果86例患者中44例于肿物边缘外1．0～1．5cm单纯行病灶扩大切除,21例除行病灶扩大切除外均同期行临近瓣转移修复术,11例行病灶扩大切除及功能性颈淋巴结清扫术,9例行病灶扩大切除及颌骨部分切除术,1例行病灶扩大切除＋右侧颌下腺摘除＋颌下腺导管改道术。对术后患者随访调查,单纯行手术切除的患者术后5年内复发3例（其中包括同期行临近瓣修复患者1例）,余来见复发。对复发病例再次行肿物扩大切除,未见复发。结论疣状癌的诊断需靠临床表现、镜下形态以及生物学行为判断,外科根治性手术为首选治疗方案,术后应定期复查、随访。     

口腔疣状癌86例临床及病理分析

目的 探讨口腔疣状癌的病因、临床表现、鉴别诊断、组织病理学特点及治疗。方法 回顾分析中国医科大学附属口腔医院1990—2012年收治的86例经组织病理确诊的口腔疣状癌患者的临床资料,总结其临床症状、病灶区影像学表现、病理学表现、治疗方案及术后随访情况。结果 86例患者中44例于肿物边缘外1.0～1.5 cm单纯行病灶扩大切除,21例除行病灶扩大切除外均同期行临近瓣转移修复术,11例行病灶扩大切除及功能性颈淋巴结清扫术,9例行病灶扩大切除及颌骨部分切除术,1例行病灶扩大切除+右侧颌下腺摘除+颌下腺导管改道术。对术后患者随访调查,单纯行手术切除的患者术后5年内复发3例（其中包括同期行临近瓣修复患者1例）,余未见复发。对复发病例再次行肿物扩大切除,未见复发。结论 疣状癌的诊断需靠临床表现、镜下形态以及生物学行为判断,外科根治性手术为首选治疗方案,术后应定期复查、随访。     

Keratocystic Odontogenic Tumor (KCOT/OKC)—Clinical Guidelines for Resection

Purpose

There is no clinical consensus for the treatment of Keratocystic Odontogenic Tumor (KCOT). KCOTs are regarded as benign aggressive tumors and resection is usually considered as a last option. We review the clinical indications for resection based on a case series.

Methods

This is a retrospective study of patients with KCOT treated in a single unit over 17 years. Eighty patients were identified, of which 12 (15 %) underwent resection. The remaining 68 patients were managed by enucleation and curettage, enucleation with peripheral ostectomy, or decompression with secondary enucleation. Data extracted includes gender, age, race, location, previous treatment for the lesion, surgery and outcome/follow up.

Results

Twelve patients treated by resection were identified. The location in the ten benign resected KCOTs was either the mandibular ramus or the posterior maxilla. All mandibular KCOTs exhibited perforation of the lingual plate and involvement of the pterygoid musculature. Seven of the ten cases were recurrent KCOTs and three had no prior treatment. Two had malignant changes in the KCOT and were also resected.

Conclusion

The primary reason for resection of KCOT was involvement of the pterygoid muscles. The presence of malignant change was a separate indication for resection.     

Influence of marginal and segmental mandibular resection on the survival rate in patients with squamous cell carcinoma of the inferior parts of the oral cavity.

AIM: The aim of this retrospective study was to investigate whether radical (segmental resection) or conservative (marginal) resection of mandibular bone influenced patients, survival. PATIENTS AND METHODS: A series of 136 patients selected for partial mandibular resection for the treatment of squamous cell carcinomas of the lower oral cavity was evaluated retrospectively. Fifty-four patients underwent marginal and 82 cases segmental resection of the mandible. The mean follow-up periods were 91.1+/-30.1 months and 91.5+/-26.2 months, respectively. Data was extracted from the patient records and transferred into a database for statistical evaluation. Results Mean survival was 63.0+/-35.3 months for marginal and 53.1+/-32.3 months for segmental resection. The overall survival rate was analysed according to Kaplan-Meier and the test of significance (Log Rank) which yielded no statistically significant difference in the survival rate between both groups (p=0.1119). Numbers of recurrences, second primaries, metastases and/or postoperative complications were similar in both groups, i.e. no statistically significant differences were observed (ANOVA, Post-hoc Scheffé test). Conclusion In cases with an indication for bone resection, marginal resection may achieve satisfactory control and is as effective as segmental resection.     

The multifocal nature of odontogenic keratocysts

The odontogenic keratocyst, OKC, is a very aggressive intraosseos lesion with a recurrence rate of approximately 25 percent to 60 percent.' The tendency for this lesion to "return" after surgical treatment has prompted studies to obtain more information concerning the inherent nature of the lesion. The OKC lesions are usually treated with enucleation of the soft tissue lining, curettage and ostectomy of the bony margins, or with more aggressive block resection. The purpose of this study was to characterize the multifocal aspect of the OKC and to demonstrate the presence of cystic lesions remote from the margins of the primarily diagnosed cyst itself. A retrospective chart review was conducted of seven patients who had sustained a long history of recurrent OKCs. Three types of documentation were reviewed for each patient: Orthopantomograms, cephalograms, and CT scans, which had been taken over the long-term course of the disease, Detailed operation reports of surgical procedures to treat the OKC lesions, and; Large histologic specimens from the six patients who received total resection of the involved mandibular bodies. These hemimandibulectomy slides offered a unique opportunity to observe OKC activity throughout a wide osseous area. All patients hod been operated multiple times over a period of 10 to 21 years, coming eventually to mandibular resection. The operating surgeon in all of the cases was one of the authors, Philip J. Boyne, DMD, MS, DSc. All patients exhibited the multifocal nature of OKCs with demonstrable cyst formation at distant sites in the mandible. Two patients had local recurrences at the margins of the primary lesion in addition to cyst formation at distant sites. The authors concluded that clinicians should respect the multifocal nature of OKCs. The "recurrences" observed in OKCs may not necessarily be due to the degree of skill of the surgeon or the technique used to eradicate the primary cyst, but instead are probably a reflection of the multifocal nature of the pathologic lesion itself. The OKC is a very aggressive intraosseos lesion of the jaws, which not infrequently clinicians detect in the process of routine oral examination.     

Peripheral calcifying cystic odontogenic tumour and peripheral dentinogenic ghost cell tumour: an updated systematic review of 117 cases reported in the literature

Purpose: To integrate the available data published on peripheral calcifying cystic odontogenic tumour (CCOT) and peripheral dentinogenic ghost cell tumour (DGCT) into a comprehensive analysis of its clinical and radiologic features.

Methods: An electronic search was undertaken in May, 2016. Eligibility criteria included publications reporting cases of peripheral CCOTs/DGCTs having enough clinical, radiological and histological information to confirm a definite diagnosis. Demographic data, lesion site and size, treatment approach and recurrence were analyzed.

Results: Hundred and thirty-eight lesions were found (65 publications), and 117 lesions (63 publications) with enough information were analyzed (55 CCOTs, 50 DGCTs, 12 unknown). Mean age of patients was 51.3?±?23.4 (min–max, 1–92), with higher mean age for the DGCTs variant. The lesions were more prevalent in the mandible, anterior region of the jaws, and in the second, sixth and eighth decades, with an equal sexual distribution. About 20% of all lesions showed signs of erosion of the underlying bone, with a higher rate for DGCTs. The mean lesion size was 1.3?±?0.8 (min–max, 0.4–3.0). Time of follow-up was informed for 37 lesions, with a mean?±?SD of 30.2?±?21.0 months (min–max, 6–84). Almost all lesions were treated by conservative surgery; only three recurrences were reported.

Conclusions: Peripheral CCOTs/DGCTs are rare lesions. Most of the lesions were treated by simple excision with or without curettage of the underlying bone. As the recurrence rate is very low, a conservative approach seems to be enough for the great majority of cases.     

Outcome of surgery for adenoid cystic carcinoma of head and neck region.

INTRODUCTION: Adenoid cystic carcinoma is an uncommon malignant epithelial tumour of salivary glands. The treatment of choice for these tumours is considered by some to be radical surgery, combined in many centres with postoperative radiotherapy. The goal of such treatment is local control and preservation of function. AIMS: The aim of the retrospective study was to analyse the results of surgery for patients with adenoid cystic carcinoma treated at the Institute of Oncology in Gliwice during the period of 1970-1989. MATERIAL: The analysed group includes 47 patients with adenoid cystic carcinoma. All patients underwent macro- and microscopically proven radical resection of the primary lesion located in major or minor salivary glands. RESULTS: Five- and 10-year survival rate was 85% and 47%, respectively, and 5-year disease-free survival rate was 79%. As the group of patients treated with surgery and radiotherapy was too small (nine cases), the results of combined treatment were not analysed. Local recurrence after surgery occurred in 21% of patients in different time intervals (even as long as 10 years after completion of treatment). CONCLUSION: High risk of local recurrence after surgery suggests that postoperative radiotherapy should always be given. Late development of local recurrences suggests that follow-up should be for a minimum of 10 years.     

Glandular odontogenic cyst: treatment and recurrence.

PURPOSE: To investigate the correlation between clinical characteristics, radiologic features, treatment modalities, and treatment outcome of glandular odontogenic cyst, and to suggest a treatment protocol based on these results. PATIENTS AND METHODS: The study included a total of 56 cases, 49 from the literature and 7 new cases. Demographic data, locularity and radiographic extension, cortical plate integrity, treatment modalities, follow-up, and recurrence were analyzed. RESULTS: There were 34 male and 22 female patients aged 14 to 74 years (mean, 48 years). The mandible was involved in 41 cases (73.2%) and the maxilla in 15 (26.8%), predominantly in the anterior region; 53.6% of the lesions were unilocular and 46.4% multilocular. Large lesions were found in 78.5% of cases. Cortical integrity was compromised in 53.6% (cortical perforation in 39.3% and thinning or erosion of the cortical plate in 14.3%). Recurrence occurred at a rate of 29.2%, within 0.5 to 7 years (mean, 2.9 years). Mean follow-up was also 2.9 years. Two patients had 3 recurrences each. Recurrence was associated with minor surgery such as enucleation or curettage; none of the patients treated by peripheral ostectomy, marginal resection, or partial jaw resection had a recurrence. Compared with the patients without recurrence, the recurrence group had a higher frequency of multilocularity than the nonrecurrent group (64.3% vs 41.2%) and of compromised cortical integrity (71.4% vs 47.1%). CONCLUSION: Glandular odontogenic cyst is an aggressive lesion. Treatment by enucleation or curettage alone is associated with a high recurrence rate. Small unilocular lesions can be treated by enucleation. In large uni- or multilocular lesions, an initial biopsy is recommended. Surgical treatment of large lesions should include enucleation with peripheral ostectomy for unilocular cases and marginal resection or partial jaw resection in multilocular cases. Marsupialization followed by second phase surgery is an option for lesions approaching vital structures. Follow-up should continue for at least 3 years (up to 7 years in cases with features associated with increased risk).     

Antiangiogenic therapy with interferon alpha for giant cell lesions of the jaws.

PURPOSE: Giant cell tumors are classified and treated based on their biologic behavior. We hypothesize that they are proliferative vascular lesions and would be expected to respond to antiangiogenic therapy. The purpose of this report is to present a treatment protocol consisting of enucleation, with preservation of vital structures, followed by subcutaneous interferon alpha. MATERIALS AND METHODS: Patients with a biopsy-confirmed giant cell lesion satisfying criteria for "aggressive giant cell tumor" were included. Instead of wide en bloc resection, lesions were enucleated and the patients started on interferon alpha-2 or beta (3,000,000 units/m(2)) 48 to 72 hours postoperatively. The subjects were followed by clinical examination and radiography, immediately after surgery and every 3 months until the bone cavity completely healed. Thereafter, follow-up was every 6 months. RESULTS: Eight patients (7 females), with a mean age of 18.7 +/- 11.1 years, have been enrolled. Six tumors were in the posterior mandible, and 2 were in the anterior maxilla. The mean size was 29.0 mm (range, 15 to 70 mm). All patients underwent enucleation. There were no postoperative complications, and all patients tolerated interferon. There was no evidence of tumor growth during treatment. Seven of 8 patients have completed interferon therapy, and there have been no recurrences during 1 to 6 years of follow-up. The other patient continues on treatment with no evidence of disease. CONCLUSION: Antiangiogenic therapy, in combination with curettage, is a promising strategy for treatment of aggressive giant cell tumors. Combined treatment results in a high rate of tumor control with decreased operative morbidity compared with conventional treatment.     

Sites of recurrence in oral and oropharyngeal cancers according to the treatment approach

OBJECTIVE: The purpose of this study is to evaluate the rates and the sites of tumour recurrence in patients with oral and oropharyngeal carcinomas. DESIGN: This is a retrospective study of a series of cases treated in a single institution. PATIENTS AND METHODS: A series of 2067 patients with oral and oropharyngeal squamous carcinoma, treated from 1954 to 1998 were analysed. The treatment approach was: surgery, 624 cases (30.2%); radiotherapy alone, 729 cases (35.3%); radiotherapy and surgery, 552 cases (26.7%) and radiotherapy and chemotherapy, 162 cases (7.8%). MAIN OUTCOME MEASURES: Tumour recurrence was observed in 1079 patients (52.2%): 561 cases of local recurrences (27.1%); 168 neck recurrences (8.1%); 252 locoregional recurrences (12.2%); 59, distant metastasis (2.9%) and 39 (1.9%), combination of distant metastasis with local, neck or locoregional recurrence. RESULTS: The rates of recurrence varied significantly according to the treatment performed. Oral cavity cancer patients undergoing radiotherapy alone or in combination with chemotherapy presented the highest rates of neck recurrences (22.5 and 40.0%, respectively) for clinical stage (CS) I/II and of local (41.2 and 30.1%) and locoregional (21.7 and 31.1%) recurrences for CS III/IV; yet, for CS III/IV, surgery without neck dissection was associated with the highest rates of neck recurrences (20.7%), but no differences were observed in the rates of local or locoregional recurrences for CS I/II patients. For oropharynx cancer patients with CS I/II there was no difference in the rate of locoregional failures according to the treatment. However, patients with CS III/IV undergoing radiotherapy present a highest rate of local (42.3%) and locoregional (28.8%) failures. CONCLUSION: The results suggest that surgery should be the first option for initial clinical stage oral and oropharyngeal cancers. For advanced cases independently of the site of the tumour, surgery and postoperative radiotherapy should be the standard of care because it is associated with the lowest rates of locoregional recurrence.     

Efficacy of Prolotherapy in Temporomandibular Joint Disorders: An Exploratory Study

IntroductionTemporomandibular joint (TMJ) disorders can be treated by both conservative and surgical approaches. Conservative interventions with predictable benefits can be considered as first-line treatment for such disorders. Dextrose prolotherapy is one of the most promising approaches in the management of TMDs, especially in refractory cases where other conservative management has failed.AimTo study the efficacy of prolotherapy and to establish it as an effective procedure in patients with TMJ disorders, to provide long-term solution to chronic TMJ pain and dysfunctions.Patients and MethodsWe conducted a study on 25 patients suffering from various TMJ disorders who were treated with prolotherapy, the solution consisting of 1 part of 50% dextrose (0.75 ml); 2 parts of lidocaine (1.5 ml); and 1 part of warm saline (0.75 ml). The standard programme is to repeat the injections three times, at 2-week interval, which totals four injection appointments over 6 weeks with 3-month follow-up.ResultsThere was appreciable reduction in tenderness in TMJ and masticatory muscles with significant improvement in mouth opening. The effect of the treatment in improving clicking and deviation of TMJ was found to be statistically significant (P < 0.05). There were no permanent complications.ConclusionOur study concluded that prolotherapy is an effective therapeutic modality that reduces TMJ pain, improves joint stability and range of motion in a majority of patients. It can be a first-line treatment option as it is safe, economical and an easy procedure associated with minimal morbidity.     

Juvenile intraoral pleomorphic adenoma: report of five cases and review of the literature

The aim of this study is to report on five cases of intraoral pleomorphic adenoma (PA) in patients under 18 years of age and to review the literature. Intraoral salivary gland tumours were reviewed in two Brazilian institutions and five cases of PA in patients under 18 years of age were found. Clinical data were obtained from the medical records and paraffin-embedded tissues were sectioned for proliferating cell nuclear antigen (PCNA) and p53 immunohistochemical analysis. Four patients were female and one was male; two cases affected the palate, two the upper lip and one the tongue. All five patients were treated surgically and after long follow-up periods no recurrences were observed. Tumour cells were weakly positive for PCNA and negative for p53. PA should be considered in the differential diagnosis of submucosal nodules in young patients. In youngsters, PA seems to have similar biological characteristics as in adults, with low recurrence rates after surgical resection.