1251
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Moscoso JF, Urken ML. The iliac crest composite flap for oromandibular reconstruction. Otolaryngol Clin North Am 1994; 27:1097-117. [PMID: 7885693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Reconstruction of oromandibular defects following tumor ablation remains a complex endeavor. Its outcome greatly influences a cancer patient's quality of life and ability to become re-integrated into society. The number and variety of reconstructive options attest to the complexity of the problem and to the failure of any one method to demonstrate its superiority. We have favored the iliac crest-internal oblique free flap because of the quality of the bone and flexibility of the soft tissues. These qualities make this flap the ideal option for reconstruction of through-and-through defects of the oral cavity. Our experience reveals that this flap is highly successful in restoring functional mastication in most patients and is associated with minimal donor site morbidity. It is important to recognize, however, that it represents one of many available techniques for the reconstruction of composite oral mandibular defects.
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1252
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Abstract
A case of reconstruction of a large mandibular defect is presented, in which a 17 cm free vascularised fibular bone graft was first anastomosed to a radial fasciocutaneous flap in situ in the forearm, and then the combined flap was transferred and revascularised in the neck.
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1253
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Abstract
Surgical necessity or the ravages of disease frequently result in the loss of mandibular continuity with consequent disruption of function and form. The role of the maxillofacial surgeon is central to the restoration as far as possible of maximum cosmesis and oral function. The suggestion in the recent consultative document on future organisation of cancer services lends weight to this role where it states 'In future the surgical management of cancer should be carried out by surgeons who specialise in a particular anatomical area'.
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1254
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Bortot G, Campolongo F, Bauer M, Della Sala SW, Togni R. [A giant-cell tumor of the mandibular condyle. A report of a clinical case]. MINERVA STOMATOLOGICA 1994; 43:611-4. [PMID: 7739498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The authors present a case of a giant cell tumor of the mandibular condyle, which is a very rare condition. Problems relating to diagnosis and treatment are examined. Specifically non neoplastic and neoplastic lesions in which giant cells are identified have been evaluated.
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1255
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O'Leary MJ, Martin PJ, Hayden RE. The neurocutaneous free fibula flap in mandibular reconstruction. Otolaryngol Clin North Am 1994; 27:1081-96. [PMID: 7885692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Despite the delayed application of the free fibula flap to mandibular reconstruction, its recognition as a reliable, sensate skin paddle combined with enough bone to repair any mandibular defect and offer bicortical fixation of osseointegrated implants has proved the free fibula flap to be a "workhorse" in the repair of composite mandibular defects. The low donor site morbidity slightly eases the wait for the molecular reconstructive "cocktails" from the shelf of the next millennium.
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1256
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Chung TS, Yousem DM, Seigerman HM, Schlakman BN, Weinstein GS, Hayden RE. MR of mandibular invasion in patients with oral and oropharyngeal malignant neoplasms. AJNR Am J Neuroradiol 1994; 15:1949-55. [PMID: 7863948 PMCID: PMC8334282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE To investigate whether MR imaging is an accurate means of assessing mandibular invasion in patients with carcinoma. METHODS We retrospectively studied the MR scans of 22 patients with pathologic or surgical confirmation of mandibular invasion from oral and oropharyngeal cancers. The MR images were blindly analyzed using primary criteria of: (a) cortical breakdown, (b) replacement of bone marrow fat, or (c) gadopentetate dimeglumine enhancement of a mass at the bone marrow defect. Secondary criteria of: (a) contiguous soft-tissue mass, and (b) mass on both sides of the mandibular cortex were also examined. Mandibular invasion was graded as periosteal/cortical, medullary, or no invasion. RESULTS Primary positive findings of cortical breakdown and abnormal bone marrow signal were highly sensitive (100%) for periosteal/cortical invasion and medullary involvement, respectively. However, a high rate of false-positive studies hampered the MR accuracy, which fell into the 73% to 77% range. A negative MR study was highly predictive, but a positive study was less valuable. Gadolinium enhancement added little to the MR study's accuracy. False-positive studies mainly occurred in the setting of prior irradiation, osteoradionecrosis, and odontogenic infections. CONCLUSIONS MR imaging is a sensitive method for detecting mandibular invasion but has a low positive predictive value. A negative study virtually excludes cortical/periosteal or bone marrow invasion.
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1257
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Spijkervet FK, de Bont LG, Boering G. Management of pseudoankylosis of the temporomandibular joint: report of cases. J Oral Maxillofac Surg 1994; 52:1211-7. [PMID: 7965321 DOI: 10.1016/0278-2391(94)90550-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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1258
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Haughey BH, Fredrickson JM, Lerrick AJ, Sclaroff A, Gay WD. Fibular and iliac crest osteomuscular free flap reconstruction of the oral cavity. Laryngoscope 1994; 104:1305-13. [PMID: 7968158 DOI: 10.1288/00005537-199411000-00001] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A method for reconstruction of oral cavity soft tissues using segmentally or axially supplied free muscle flaps harvested as a unit with their bone components is presented. Both fibular/soleus and iliac crest/internal oblique free flaps are documented, and the pros and cons of each donor site are presented. Twenty-one patients, 17 with cancer or osteoradionecrosis and 4 with benign or congenital conditions of the mandible, have undergone this operation. Ten bone grafts were simultaneously embedded with osseointegrated implants. All free flaps except one survived and resulted in a smoothly mucosalized oral lining. Six patients have had their implants successfully uncovered, all of whom are wearing prostheses. Four other patients are using tissue-borne prostheses. Transfer of free, nonbulky muscle flaps for mucosalized oral soft-tissue reconstruction is feasible in selected patients using first the fibular and, second, the iliac donor site; this soft-tissue technique also contributes to prosthetic dental rehabilitation.
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1259
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Pellissier S, Duvoisin B, Fontolliet C, Monnier P. [Magnetic resonance imaging and x-ray computed tomography in advanced cancer of the oral cavity. A comparative clinical, radiological and morphological study]. JOURNAL DE RADIOLOGIE 1994; 75:577-83. [PMID: 7844775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The objective of this prospective study is to assess the impact of magnetic resonance imaging (MRI) and computed tomography (CT) as compared to physical examination in the choice of type of surgery for advanced intraoral cancers (with or without resection of the mandibula). From 1990 to 1993, we operated on 21 intraoral malignant tumors with segmental resection of the mandibula followed by a histological examination. The preoperative evaluation consisted of an MRI (n = 8), a CT (n = 8) or both (n = 5). MRI suspected an infiltration of the bone in 9 cases, CT in 4 and physical examination in 16. This was histologically confirmed in 6 of the 21 patients only. MRI and CT both have a high sensitivity, as does physical examination, but neither have a good specificity (physical examination: 5 true positive, 4 true negative, 11 false positive, 1 false negative; MRI: 4 true positive, 4 true negative, 5 false positive, 0 false negative; CT: 3 true positive, 7 true negative, 3 false positive, 0 false negative). In conclusion, the decision of a mandibular resection can only be taken after a careful physical examination, including palpation under general anesthesia in a fully relaxed patient. This is best accomplished during the pretherapy bronchoesophagoscopy, routinely performed for the detection of synchronous second primary tumors using toluidin blue as a vital staining method. If this initial evaluation gives a suspicion of a massive infiltration of the mandible, an MRI, rather than a CT, should be performed to determine the extent of the resection because of a high rate of artefacts with CT.
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1260
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Bonawitz S, Gosain AK, Matloub HS, Larson DL. Revascularization of free mandibular reconstruction after early emergency arterial ligation. Ann Plast Surg 1994; 33:552-6. [PMID: 7857052 DOI: 10.1097/00000637-199411000-00015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A 70-year-old man with a squamous cell carcinoma involving the anterior arch and body of the mandible underwent resection and reconstruction with a 10-cm free vascularized iliac crest bone graft, preserving periosteum and minimal adjacent soft tissue. On postoperative day 12, he experienced bleeding from an orocutaneous fistula, requiring emergency ligation of the arterial pedicle to control hemorrhage. After ligation, continued bleeding was noted from the margin of the graft, with active filling of the venous pedicle. The 10-cm mandibular bone graft survived without appreciable resorption during a period of follow-up of 5 years. We believe that bone graft survival in the present case was due to early vascular communication between the periosteum and adjacent soft tissues of the graft with the recipient bed. This mechanism may serve to maintain bone graft viability after early arterial disruption, when repeat arterial anastomosis is believed to be contraindicated.
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1261
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Smeele LE, van der Wal JE, van Diest PJ, van der Waal I, Snow GB. Radical surgical treatment in craniofacial osteosarcoma gives excellent survival. A retrospective cohort study of 14 patients. EUROPEAN JOURNAL OF CANCER. PART B, ORAL ONCOLOGY 1994; 30B:374-6. [PMID: 7719220 DOI: 10.1016/0964-1955(94)90014-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
14 patients with an osteosarcoma of the craniofacial bones were evaluated retrospectively. 10 patients were males and 4 were females, ages varied from 10 to 74 years with a mean of 37 years. Ten tumours were located in the maxilla and four in the mandible. All patients underwent surgical resection of the tumour. One patient was irradiated postoperatively with 67.5 Gy and another patient received adjuvant chemotherapy with melphelan. Follow-up ranged from 6 months to 10 years with a mean of 4 years 2 months. Of 14 patients, 5 have died of local disease of whom 1 also had distant metastasis. Disease-free survival was 82.5% after 2 years and 68.8% after 5 years. Overall survival was 79.1% after 5 years. Univariate statistical analysis was carried out, revealing age < 35 years (P = 0.033) and radical surgery (P = 0.007) as statistically significant factors in disease-free survival. It is concluded that radical surgery in young patients with a craniofacial osteosarcoma gives long-term disease-free survival.
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1262
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DelBalso AM, Banyas JB, Wild LM. Hemangioma of the mandibular condyle and ramus. AJNR Am J Neuroradiol 1994; 15:1703-5. [PMID: 7847217 PMCID: PMC8333727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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1263
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Arcuri MR, Tabor M, Fergason H. Treatment of odontogenic myxoma of the mandible with bone graft and dental implant supported fixed partial denture: a clinical report. J Prosthet Dent 1994; 72:230-2. [PMID: 7965894 DOI: 10.1016/0022-3913(94)90334-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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1264
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Raghuveer HP. Solitary, central neurofibroma of the mandible: a case report. JOURNAL OF PIERRE FAUCHARD ACADEMY (PIERRE FAUCHARD ACADEMY. INDIA SECTION) 1994; 8:107-9. [PMID: 9791251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
A case of Solitary Central Neurofibroma in a 53 years old female is reported. This is an apparently single primary lesion, in which physical and Radiological examination failed to reveal other bony lesions or the stigmata of multiple neurofribomatosis.
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1265
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Singh Gómez C. [Myxoma of the jaw]. REVISTA MEDICA DE PANAMA 1994; 19:193-7. [PMID: 7746904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The author describes the clinical, radiographic and histological characteristics of three tumors diagnosed as maxillary myxomas at the National Oncological Institute. In the first two patients the tumor was completely excised and 74 and 67 months after surgery, respectively, both patients are well. The third patient underwent curettage of the lesion and, at the time of this report, 3 months after surgery, he has had no recurrence of the tumor and is also well.
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1266
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Mounsey RA, Boyd JB. Mandibular reconstruction with osseointegrated implants into the free vascularized radius. Plast Reconstr Surg 1994; 94:457-64. [PMID: 8047597 DOI: 10.1097/00006534-199409000-00006] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Complete oral rehabilitation after oromandibular resection is a goal that is frequently difficult to attain. Poor speech, inability to eat a solid diet, and cosmetic deformity are all potential problems. The introduction of osseointegrated implants and free vascularized bone grafting are two techniques that have permitted improved results of oromandibular reconstruction. When used together they provide the best possibility for providing oral continence, a stable denture, and minimal cosmetic deformity. The free vascularized iliac crest has been used widely to reconstruct mandibular defects with the placement of enosseus implants. However, the radius provides a good alternative to reconstruct the mandible. We report four cases of mandibular reconstruction with the use of the free vascularized radius with subsequent placement of osseointegrated implants. The results of these cases suggest that enosseus implants can be used successfully in the radius. The radius is ideal to reconstruct small to moderate-sized defects of the lateral mandible with loss of oral mucosa.
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1267
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Keller EE. Skeletal-dental reconstruction of the compromised mandible with composite bone grafts. Atlas Oral Maxillofac Surg Clin North Am 1994; 2:21-30. [PMID: 11905361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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1268
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Misiek DJ. Vascularized free bone grafts for maxillary and mandibular reconstruction. Atlas Oral Maxillofac Surg Clin North Am 1994; 2:123-40. [PMID: 11905360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Vascularized osteocutaneous free grafts have been successfully applied to maxillofacial reconstruction. Careful planning allows for implant prosthesis fabrication in these cases. The scapula, fibula, and ilium are the donor sites that result in the most favorable application of implant prosthetics. Intraoral soft tissues, although compromised, are manageable with meticulous home oral hygiene practices and frequent recall examinations with professional cleaning. Many patients severely impaired by trauma, neoplasm, or congenital deformity can have restoration of form and function with the amalgamation of microsurgical and osteointegration techniques.
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1269
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Bardot J, Jallut Y, Zanaret M, Legré R, Magalon G. [Mandibular reconstruction using an iliac crest free flap vascularized by the deep circumflex iliac vessels. A clinical study apropos of 30 cases]. ANN CHIR PLAST ESTH 1994; 39:442-7. [PMID: 7755325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Thirty cases of mandibular defects were reconstructed with a free iliac flap vascularised by the deep circumflex iliac vessels. Twenty five of these cases involved soft tissue damage with a defect of the mandible. The surgical procedure described by I. Taylor was used. Three anatomical variations of the pedicle were found. The features of the iliac bone are particularly suitable for mandibular reconstruction. The natural shape of the iliac bone does not require complex osteotomies and its healing capacity allows simple osteosynthesis. The thickness of the muscular pedicle, and thus the flap, is determined by the position of the lower edge of the skin components with respect to the iliac crest. This type of flap currently remains very useful in reconstruction of major mandibular and adjacent soft tissue destruction because of the very low incidence of failure (2 cases) and complications.
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1270
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García García A, Suarez Quintanilla D, Diz Dios P. Total mandibular replacement with a titanium plate after mandibulectomy for osteosarcoma. J Oral Maxillofac Surg 1994; 52:863-7. [PMID: 8040742 DOI: 10.1016/0278-2391(94)90239-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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1271
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Johnson CD, Hill I, Vela J. Squamous cell carcinoma of the floor of the mouth with invasion of the mandible. THE JOURNAL OF THE GREATER HOUSTON DENTAL SOCIETY 1994; 66:13-4. [PMID: 9584743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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1272
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Dabbs DJ, Schweitzer RJ, Schweitzer LE, Mantz F. Squamous cell carcinoma arising in recurrent odontogenic keratocyst: case report and literature review. Head Neck 1994; 16:375-8. [PMID: 8056584 DOI: 10.1002/hed.2880160413] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Keratinizing odontogenic cysts of the mandible commonly have an aggressive clinical course, marked by multiple recurrences. Primary intraosseus carcinoma (PIOC) of the mandible is rare, and when it occurs it is often found to be arising in or closely associated with some type of cystic structure. METHODS A patient with squamous cell carcinoma arising from an odontogenic keratocyst is studied clinically, radiographically, and pathologically. RESULTS The patient who was documented to have an odontogenic keratocyst, 1 year later had a squamous carcinoma removed from the recurrent cyst. CONCLUSION We report the occurrence of squamous cell carcinoma arising from a recurrent odontogenic keratocyst, which has not previously been documented in the literature. The literature on this subject is reviewed.
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1273
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Yoo GH, Eisele DW, Askin FB, Driben JS, Johns ME. Warthin's tumor: a 40-year experience at The Johns Hopkins Hospital. Laryngoscope 1994; 104:799-803. [PMID: 8022240 DOI: 10.1288/00005537-199407000-00004] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Warthin's tumor previously has been thought to occur much more commonly in men than in women and rarely in African Americans. One hundred thirty-two cases of Warthin's tumor treated at The Johns Hopkins Hospital from 1952 to 1992 were retrospectively reviewed. There were 90 (68%) men and 42 (32%) women, with an overall man-to-woman ratio of 2.2:1. The number and percentage of women with Warthin's tumor increased over each consecutive decade: 1952 to 1962, 5 (21%); 1963 to 1972, 6 (29%); 1973 to 1982, 11 (31%); and 1983 to 1992, 20 (39%). A positive smoking history was found in 88% of the men and in 89% of the women with a Warthin's tumor. Eleven (8%) African Americans and 1 (0.75%) Asian American were diagnosed to have a Warthin's tumor. Also, the incidence of African Americans with a Warthin's tumor increased over each decade: 0 (0%), 1 (4.8%), 2 (5.5%), and 8 (16%). This study's results indicate a progressive increase in the occurrence of this tumor in women and in African Americans and a higher overall incidence in African Americans than previously reported.
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1274
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Rosol TJ, Nagode LA, Robertson JT, Leeth BD, Steinmeyer CL, Allen CM. Humoral hypercalcemia of malignancy associated with ameloblastoma in a horse. J Am Vet Med Assoc 1994; 204:1930-3. [PMID: 8077139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Humoral hypercalcemia of malignancy was evident in a horse that had a locally invasive ameloblastoma of the left hemimandible. Surgical removal of the neoplasm resulted in prompt return of serum calcium and parathyroid hormone concentrations to within reference limits. The tumor contained parathyroid hormone-related protein, as demonstrated by immunohistochemistry and western blot analysis. It is likely that production of this protein by the neoplasm was important in the pathogenesis of the hypercalcemia. The case represented a sporadic form of humoral hypercalcemia of malignancy attributable to an uncommon epithelial neoplasm, and indicated that humoral hypercalcemia of malignancy can develop with neoplasms in horses.
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1275
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Kawai T, Murakami S, Hiranuma H. Radiologic appraisal of healing after iliac crest bone grafts. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1994; 77:678-83. [PMID: 8065738 DOI: 10.1016/0030-4220(94)90334-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Radiographic changes were observed in 45 patients who had undergone iliac bone grafting with either metal or wire fixation after resection of the mandible. Changes were generally not observed during the first month after surgery. Bony resorption was seen during the second or third month. Osteogenesis commenced at any stage, but was usually radiographically evident by 3 to 6 months. Union was not radiographically evident in most cases until more than 6 months had elapsed after surgery. For follow up, plain film radiographs 4 to 6 months after surgery are recommended in patients who receive bone grafts.
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