Orthopedically Induced Condylar Growth in a Patient with Hemifacial Microsomia

Objective

Hemifacial microsomia is a congenital abnormality that causes three-dimensional facial asymmetry, affection of the dental occlusion, and failure of growth of the midface in the growing child. This report outlines orthopedically induced condylar growth in a patient with hemifacial microsomia.

Patient

A 7-year-old girl with hemifacial microsomia, complete absence of the left mandibular condyle, and severe facial asymmetry was treated orthopedically in an early stage by means of a functional appliance. Functional therapy was instituted to stretch the deficient soft tissues to guide and promote skeletal growth and stimulate the affected areas. The treatment was completed with fixed appliances.

Results

The effect of the therapy was an excessive change in condylar growth in the affected side. Facial asymmetry was corrected and a symmetric mouth opening was established.

Conclusions

The treatment of patients with hemifacial microsomia should be initiated early enough so that the stimulus could in some degree normalize the deficient tissues and induce bone apposition, and in some cases surgical intervention could be avoided.

Increased CD14+ and decreased CD14- populations of monocytes 48 h after zolendronic acid infusion in breast cancer patients

It has been proposed that bisphosphonates cause osteonecrosis of the jaws through impairment of the monocyte population function and proliferation. Such changes have been confirmed in jaw tissues, ex vivo. In this clinical study, we report for the first time a similar pattern of changes in peripheral blood monocytes.

INTRODUCTION

The aim of this study is to examine the effect of zolendronic acid administration in the peripheral blood white cell population, seeking a plausible pathophysiological link between bisphosphonates and osteonecrosis of the jaw.

METHODS

Twenty-four breast cancer patients, under zolendronic acid treatment for bone metastasis, were included. Peripheral blood samples were obtained prior to and 48 h following zolendronic acid administration. Flow cytometry gated at leukocyte, monocyte, and the granulocyte populations for the CD4/CD8/CD3, CD3/CD16+56/CD45/CD19, CD14/CD123, and CD14/23 stainings were performed.

RESULTS

We were able to record a number of changes in the white cell populations after 48 h of zolendronic acid administration. Most importantly, in the monocyte populations, we were able to detect statistically significant increased populations of CD14+/CD23+ (p = 0.038), CD14+/CD23- (p = 0.028), CD14+/CD123+ (p = 0.070, trend), and CD14+/CD123- (p = 0.043). In contrast, statistically significant decreased populations of CD14-/CD23+ (p = 0.037) and CD14-/CD123+ (p = 0.003) were detected.

CONCLUSIONS

Our results provide evidence supporting the hypothesis that bisphosphonate administration modifies the monocyte-mediated immune response. An increase of CD14+ peripheral blood monocyte (PBMC) populations along with a decrease of CD14- PBMC populations has been recorded. The latter finding is in accordance with limited-currently existing-evidence and warrants further elucidation.

Expression of N-cadherin in salivary gland tumors

OBJECTIVE

To detect immunohistochemically the N-cadherin expression in different types of benign and malignant salivary gland tumors in an attempt to note any possible correlation to their development, stage and invasive properties.

MATERIALS AND METHODS

N-cadherin expression was examined in tissue specimens from 49 salivary gland tumors including: pleomorphic adenomas (4), Warthin's tumors (10), and myoepitheliomas (4) (benign tumors), as well as adenoid cystic carcinomas (14), mucoepidermoid carcinomas (4), polymorphous low-grade adenocarcinomas (6), and adenocarcinomas not otherwise specified (5) (malignant tumors). Twelve specimens of normal salivary glands were used as control. The perineural invasion and stage of malignant salivary gland tumors were evaluated. Immunohistochemical procedure was performed automatically using the Bond Polymer Refine Detection Kit.

RESULTS

N-cadherin expression was not found in normal salivary glands. In benign salivary gland tumors, N-cadherin along membranes of neoplastic cells as well as in centrocytes of lymphoid germinal centers was seen in 1 and 4 cases of Warthin's tumors, respectively. Varied degree of N-cadherin expression was found in 13 (45%) cases of malignant salivary gland tumors. N-cadherin expression was significantly correlated with perineural invasion (χ(2) = 11.7, p < 0.0001), but not with stage of malignant salivary gland tumors.

CONCLUSION

N-cadherin expression was observed in malignant salivary gland tumors and could be an indicator of potentially aggressive behavior. N-cadherin expression by tumor cells could be attributed to perineural invasion.

Bone-vasculature interactions in the mandible: is bone an angiogenic tissue?

Starting from early stages of craniofacial development, the leading role of vasculature, in particular endothelial progenitor cells, becomes apparent. They are probably the cells that synthesize the appropriate bone morphogenetic protein (BMP), that precedes neural crest cell migration and determines their final destination and skeletal development. During postnatal osteosynthesis in the mandible, angiogenesis similarly goes before osteosynthesis, regulates this process with the production of BMP-2 and serves as a scaffold for osteoblasts. This growth factor is involved in bone metabolism and bone injury repair. The dependence of bone from vasculature, is better understood when looking to osseous changes that result from vasculopathies and arteritides, like in diabetes mellitus and polyarteritis nodosa respectively, that affect the mandible more frequently than previously suspected. These changes are not only the result of a dysregulation of osteoblasts and osteoclasts, but of a complex network of factors that affect the vasculature, like VEGF and hypoxia. Abnormal vasculature results in qualitatively degradated bone, with an atypical architecture or even in bone necrosis. The dynamic interplay between vasculature and bone of the mandible, with the vasculature endothelium playing an initiating and regulatory role in osteosynthesis, supports the hypothesis of an angiogenic origin of bone. This hypothesis, helps in understanding of bone pathology, like avascular necrosis and of the impact of interventions and medications that affect vasculature, on bone metabolism.

Molecularly targeted drugs for the treatment of cancer: oral complications and pathophysiology

BACKGROUND

Targeted cancer therapy is a new approach for the treatment of cancer. It involves a specific molecular target, mainly a receptor that serves as a target for monoclonal antibodies or tyrosine kinase inhibitors. Side-effects of these new regimens are described to be mild, compared to those of classical chemotherapy. There is a lack in the documentation and understanding of oral complications related to molecularly targeted drugs.

METHODS

In this review, we tried to make a systematic review of the databases Pubmed and Scopus, using "targeted cancer therapy" and "oral", or "mucositis", or "stomatitis", or "bleeding", or "hemorrhage" as search terms. Specific drug name searches were not conducted. The search yielded 97 results. Only articles related to EGFR and VEGFR inhibition were selected. Finally 13 articles met the criteria. RESULTS are discussed and possible pathogenetic mechanisms for the complications of targeted cancer therapy regimens are presented.

RESULTS

It appears that the most serious side-effect is mucositis/stomatitis that may affect the whole gastrointestinal tract. It rarely results in treatment discontinuation. Reduced saliva secretion, xerostomia and dysphagia can be severe with some regimens and interfere with food uptake. Osteonecrosis, wound healing impairment, spontaneous gingival bleeding and dysgeusia were also reported.

CONCLUSIONS

Considering these data it is obvious that symptoms related to cancer treatment should be considered in the context of the holistic management of patients. Oral complications should not be ignored but recorded during physical examination, because they may significantly impair daily activities and patients' quality of life.

Distant bone metastases from carcinoma of the lip: a report of four cases

The lip is estimated to be the most frequent location for carcinoma of the oral cavity. It occurs more frequently in men, especially those with a history of exposure to sunlight. Despite the usually effective management, regional and occasionally distant metastases do occur, especially in advanced stages. In this retrospective analysis of patients with labial carcinoma presenting with distant bone metastases in 1995-2003, the extremely limited number of patients did not allow for multivariate data analysis. From a cohort of 415 patients presenting with lip lesions, 186 cases were diagnosed as carcinoma and managed accordingly. Four patients (2.14%) showed distant bone metastases, one with concurrent axillary node metastasis. Patient demographics, tumour characteristics, case management and survival were evaluated. The distant metastasis patients were of clinical stages II-IV; initial management was wide local excision with reconstruction for all cases, with one undergoing concurrent neck dissection and one adjuvant radiotherapy. Time for distant bone metastasis was 9-21 months, subsequent survival 3-14 months and overall survival 13-35 months. Distant metastases from labial carcinoma are rare, not exceeding 2%. Metastasis to bone and axillary lymph nodes is exceptionally rare and can be attributed to either inadequate initial management or aggressive tumour behaviour.

Nager syndrome (preaxial acrofacial dysostosis): a case report

The Nager syndrome is a rare condition associated with craniofacial malformations such as micrognathia, zygomatic hypoplasia, cleft palate, and preaxial limb deformities. This report features a case of the Nager syndrome occurring in a 4-year-old boy showing microdontia, thumb duplication and radioulnar synostosis, and ventricular septum defect, characteristics not usually encountered in the published cases.

Treatment of squamous cell carcinoma of the anterior faucial pillar-retromolar trigone

Cancer of the anterior faucial pillar-retromolar trigone is an uncommon head and neck tumor, which has historically been shown to be associated with poor prognosis. In this retrospective study, we reviewed our experience with primary surgery followed by postoperative radiation therapy in order to determine the impact of our treatment protocols on patients' outcome. Between January 1994 and December 1998, 31 patients with histologically proven squamous cell carcinoma (SCC) of the anterior faucial pillar-retromolar trigone were treated in our department. Surgical excision of the primary lesion and ipsilateral neck dissection were performed in all patients. Reconstruction was accomplished using masseter muscle flap or tongue flap. Postoperatively, most patients (90%) received radiation therapy (51-58 Gy) to the primary side and neck. Adjuvant chemotherapy was offered if histologic signs of aggressive behavior were identified. Four out of 31 patients were initially seen at stage I or II and 27 patients at stage III or IV of the disease. Metastatic disease was demonstrated in 78% of ipsilateral neck nodes. Occult metastases were found in 64% of clinically N0 necks. The 3-year loco-regional recurrence rates were 44.8%. SCC of retromolar trigone is considered as an aggressive and insidious tumor. The reconstruction of the deficit of the anterior faucial pillar-retromolar area with masseter muscle flap is a reliable, safe and absolutely functional method.

Shprintzen-Goldberg syndrome: case report

OBJECTIVE

The Shprintzen-Goldberg syndrome is an extremely rare syndrome with a characteristic face. This is one of a group of disorders characterized by craniosynostosis and marfanoid features. The aim of this study was to present a new sporadic case of the syndrome and describe in detail the findings at the maxillofacial region.

Double mandibular osteotomy with coronoidectomy for tumours in the parapharyngeal space

Removal of deep-lobe parotid tumours from the parapharyngeal space is often difficult because of limited surgical access and the critical vascular and neurologic structures nearby. Mandibulotomy, when necessary, is useful for improving wider visibility and control of the vascular bundle and facial nerve, but may cause damage to the inferior dental and lingual nerves. The double mandibular osteotomy with coronoidectomy gives excellent access and avoids damage to these nerves.

Early extraction of the mandibular third molar in case of eruption disturbances of the second molar

PURPOSE

General consensus has been reached on extracting mandibular third molars when they are involved in pathologic processes. However, early extraction is advisable in cases of eruption disturbances of the mandibular second molar, before or during orthodontic treatment.

METHODS

Thirty-two patients with early extraction of the mandibular third molar before or during orthodontic treatment were examined.

RESULTS

In these cases either the presence of the third molar presented an obstacle in the eruption path of the second, or third molar germ removal was considered beneficial to the course of orthodontic treatment.

CONCLUSIONS

Early extraction of the mandibular third molar facilitates the eruption of the second molar, especially in cases where evidence of crowding and lack of space in the posterior mandibular region exist. Orthodontic treatment may, in some cases, aggravate eruption disturbances of the second molar.

Submerged teeth

Submersion occurs when a previously erupted tooth becomes embedded in the oral tissues. The purpose of this paper is to examine the distribution, the degree of re-impaction, the rate of congenital absence of the successor buds and the treatment in 28 submerged teeth in 17 patients.

Testicular embryonal carcinoma metastatic to the labial mucosa of the upper lip

An unusual case of testicular embryonal carcinoma metastatic to the labial mucosa of the upper lip is reported. The clinical features and the management of the metastatic oral lesion are presented. In patients with known systemic malignancy, oral swellings may be an indication of a metastatic deposit.

Bilateral metastatic breast angiosarcoma to the mandibular gingiva: case report

Metastases to the jaws and oral soft tissues are rare. A case of breast angiosarcoma metastatic to the mandible and the gingiva, bilaterally in the premolar area is presented. The clinical, histological features and the management of the metastatic oral lesions are reported. Our case emphasises the possibility that in patients with history of breast angiosarcoma, oral inflammatory-like lesions may be an indication of a metastatic deposit.

Traumatic cervical cystic hygroma

An unusual case of traumatic cervical cystic lymphangioma in an adult man is presented.

Merkel cell carcinoma in a patient with Recklinghausen neurofibromatosis

A rare case is described of Merkel cell carcinoma of the cheek arising in a cutaneous neurofibroma in a patient with Recklinghausen neurofibromatosis. The relevant literature is reviewed.

Tympanic plate fracture following mandibular trauma

Bleeding from the external auditory canal following head trauma is not unusual. It can be caused by a posterior dislocation of the mandibular condyle associated with a fracture of the tympanic bone. Although posterior dislocation is uncommon, it is the second most frequent complication after antero-medial displacement of the condyle. We report four cases of tympanic plate fracture and present CT images demonstrating the range of injuries seen.

Hemifacial atrophy secondary to poliomyelitis

A 25-year-old woman is presented with hemifacial atrophy due to unilateral bulbar poliomyelitis infection. Although bulbar poliomyelitis is not an uncommon disease, it is rarely a cause of hemifacial asymmetry.

Agenesis of sphenoid sinus. Case report

Although the sphenoid sinuses can be identified in sections of the fetus at 4 months, at birth the sinus remains small and is little more than an evagination of the sphenoethmoid recess. After the 3rd year, invasion of the sphenoid bone is more rapid, and by the age of 7, the sinus has extended posteriorly to the level of the sella turcica. By the age of 12, the sphenoid pneumatization reaches its final form and a size equivalent to the adult, although further enlargement into the basisphenoid may occur in the adult. Agenesis of paranasal sinuses is an uncommon clinical sign and refers mainly to the frontal and secondarily to the maxillary sinuses. Agenesis of sphenoid sinuses is a very rare phenomenon in the literature. We present a 32-year-old male patient with agenesis of sphenoid sinuses that was studied by CT.

Co-existence of Dubowitz and hyper-IgE syndromes: a case report

A case of a 5-year-old girl is described whose clinical features included postnatal growth retardation, microcephaly and characteristic facial appearance. These are recognized as the main features of the Dubowitz syndrome. Apart from these features, our patient had recurrent infections of the sinopulmonary tract, high serum IgE levels, defective chemotaxis of polymorphonuclear cells and defective antibody response, findings characterizing the hyper-IgE syndrome. The co-existence of these two syndromes is rare and we suggest that this is the first such case in the literature.

CONCLUSION

Patients with the Dubowitz syndrome will Dubowitz syndrome will require long-term follow up because there is a considerable risk for the syndrome to co-exist with primary immunodeficiency or for malignancies to develop.

Delayed infantile cortical hyperostosis (Caffey's disease): case report

Late recurrence or a delayed form of Caffey's disease is an exceedingly rare condition of unknown cause. A 3 1/2-year-old boy is presented with delayed Caffey's disease showing unilateral involvement of maxilla and zygoma.

Pathogenesis of bromodeoxyuridine-induced cleft palate in mice

This study was designed to examine the pathogenesis of bromodeoxyuridine-induced (BrdU) clefts of the secondary palate in mice. Intraperitoneal injections of BrdU (500 mg/kg body weight) were given on days 11 and 12 to some pregnant mice and on days 12 and 13, and days 11, 12 and 13 to others. Evaluation of craniofacial relations and palate development in BrdU-treated mice revealed inhibition of vertical development of the palatal shelves, mandibular hypoplasia which led to failure of downward displacement of the tongue and the creation of an obstacle to reorientation of the palatal shelves. The results of this study demonstrate a strong correlation between induction of cleft palate and the presence of structural alterations in the mandible, and the mechanism of BrdU-induced cleft palate resembles the defect in the Pierre Robin anomaly.

Craniofacial manifestations of Smith-Lemli-Opitz syndrome: case report

The Smith-Lemli-Opitz syndrome is characterized by striking craniofacial features, microcephaly, mental deficiency, growth retardation, 2-3 syndactyly of the feet, and genital malformations. We present a patient and discuss dentofacial aspects of the syndrome.

Totally submerged deciduous maxillary molars. Case reports

The total reimpaction or submersion of deciduous teeth is a very uncommon phenomenon and few cases have been reported in the literature. The condition affects the mandibular second deciduous molar most often and the maxillary first deciduous molar least often. Two cases of totally reimpacted maxillary deciduous molars are reported.

A sporadic case of Lenz microphthalmia syndrome

We present a sporadic case of colobomatous microphthalmia associated with multiple congenital anomalies. Our purpose is to add a new case of Lenz microphthalmia syndrome to the literature and to draw attention to the typical pattern of facial features of this disease.

Chronic idiopathic hyperphosphatasemia. Case report

Chronic idiopathic hyperphosphatasemia, or juvenile Paget disease is a very rare syndrome that is characterized by fragile bones, bowing deformities, shortness of stature, large head, premature loss of teeth, radiographic evidence of expanded osteoporotic long bones with coarse trabeculations, and widened bones of the skull. Increased levels of serum alkaline phosphatase and increased levels of urinary total hydroxyproline are notable. We present a case of juvenile Paget disease that was associated with a history of precocious puberty. The patient had odontogenic osteomyelitis of the mandible that was treated by drainage, surgical debridement and antibiotic therapy.

Abducent nerve palsy following transverse fracture of the middle cranial fossa

Transverse sphenoidal fractures may be associated with a variety of skull base injuries and neural deficits. Among those nerve injuries, oculomotor palsies and particularly sixth cranial nerve palsy, are quite common. Blows on the side of the head in the squamous temporal region may run across the floor of the middle cranial fossa through the greater wing of the sphenoid in the transverse cranial axis. We report three cases of patients who had sustained craniofacial injury which included a transverse fracture of the middle cranial fossa through the sphenoid sinus, extending to the petrous apex and producing abducent, facial, and eighth nerve dysfunction. Spontaneous recovery from diplopia occurred in all cases within 4 months. The management of the patients and the patterns of transverse cranial base fractures and their associated clinical features are discussed.

McCune-Albright syndrome. Report of a case

The McCune Albright syndrome is seldom encountered and rarely reported in dental literature. It represents a special category of polyostic fibrous displasia associated with skin pigmentation and endocrine disturbances. We describe the case of a 9-year-old boy with the McCune Albright syndrome, who was treated for a mandibular osteolytic lesion.

Bifid mandibular condyle resulting from a sagittal fracture of the condylar head

Sagittal or vertical fractures of the mandibular condyle and chip fractures of the medial part of the condylar head are very rare entities and their identification is difficult with conventional radiographs. We report a case of a unilateral bifid mandibular condyle which resulted following a sagittal condylar fracture. This was associated with a chip fracture of the medial part of the condylar head on the contralateral side. These types of condylar fracture do not require any surgical treatment, but early mobilization is indicated.

Posterior dislocation of mandibular condyle into external auditory canal. A case report

A case is reported of a 49-year-old edentulous patient who suffered a posterior dislocation of the right fractured mandibular condyle causing a fracture of the tympanic plate. This was associated with a right transverse fracture of the petrous bone and an intact tympanic membrane. Some of the problems related to this condition are discussed.

Exomphalos, inguinal hernia, renal agenesis, skeletal dysplasia, heart disease--a "new" syndrome?

We report a growth retarded, male child with exomphalos, bilateral direct inguinal hernias, unilateral renal agenesis, congenital heart defect, costovertebral dysplasia, microcephaly, ventricular septal defect, and paroxysmal supraventricular tachycardia associated with Wolff-Parkinson-White syndrome. The natural history of that syndrome is poorly understood and provisional suggestion of a new syndrome will depend on further similar observations.