Intraosseous oral leiomyoma: systematic review and report of one case

OBJECTIVES

The objectives of this study were to report one case of intraosseous oral leiomyoma and to systematically review the English literature.

METHODS

The clinical and radiographic findings of a patient who presented with intraosseous oral leiomyoma were recorded. In addition, 11 references from the English literature that reported 12 patients were reviewed.

RESULTS

Thirteen patients (age range 8 months to 71 years; mean 36 years, median 25 years) were reported to present with intraosseous oral leiomyoma. After excluding one patient whose sex was not reported, there were five female patients (42%) and seven males (58%). The majority of patients presented with either no symptoms or with an asymptomatic swelling. Eleven of 13 lesions occurred in the mandible; the most common site was the posterior of the jaw. Radiographically, intraosseous oral leiomyoma was found to present as either a unilocular or multilocular radiolucency with either well defined or ill defined borders and frequent cortical involvement.

CONCLUSIONS

Intraosseous oral leiomyoma was found to occur in the mandibular posterior region of relatively young patients, with cortical involvement and a slight male gender preference. Surgical excision was the treatment of choice and no recurrence has been encountered.

Amlexanox oral paste: a novel treatment that accelerates the healing of aphthous ulcers

Five percent Amlexanox oral paste is a novel treatment for aphthous ulcers. In 3 controlled clinical studies that evaluated 1,124 immunocompetent patients with mild to moderate aphthous ulcers, 5% Amlexanox oral paste (Aphthasol) was shown to accelerate healing of these ulcers. Treatment with Aphthasol reduced the median time to ulcer healing and to complete pain resolution in a statistically significant manner. This was true both when treatment with 5% Amlexanox oral paste was compared to treatment with a vehicle and when treatment with the Amlexanox paste was compared to no treatment. Study results after 3 days comparing treatment with the paste and no treatment indicated complete healing of ulcers for 21% and 8% of patients, respectively. Complete resolution of pain after 3 days was reported for 44% and 20% of patients, respectively.

Recurrent aphthous stomatitis

Recurrent aphthous stomatitis (RAS) is the most common oral mucosal disease in North America. In some instances, RAS represents the central feature of the multisystem disease complex Behcet's syndrome. This article reviews the clinical features, contributing etiologic factors, and etiopathogenesis of RAS and Behcet's syndrome and describes therapeutic considerations and strategies essential to management of patients suffering from recurrent mouth ulcers.

Mucous membrane pemphigoid. Treatment experience at two institutions

The initial oral findings and treatment in 50 cases of mucous membrane pemphigoid are presented. Histologic and immunologic studies were undertaken in each case to confirm the clinical diagnosis. The treatments prescribed are summarized and illustrate that topical steroids are effective, but in some cases systemic steroid therapy with or without other immunologically active drugs is required. A significant number of patients had extraoral manifestations of the disorder.

Oral presentation of pemphigus vulgaris and its response to systemic steroid therapy

This article reviews our experience during a 20-year period with patients with oral lesions of pemphigus vulgaris. Of the 30 patients, 20 were women and 10 were men, with an age range of 24 to 68 years. The soft palate was involved in 80% of cases at initial presentation. Direct immunofluorescence studies were positive for IgG in the intercellular region in all cases where lesional tissue was histologically studied. Systemic steroid therapy alone controlled the disease in 24 patients, one patient was given no treatment, and the remaining five required additional treatment with either azathioprine, cyclophosphamide, or gold. Steroid therapy was continued in the long-term at a reduced dose, but side effects such as diabetes mellitus, hypertension, and duodenal ulcers were observed. Long-term steroid therapy is therefore the treatment of choice for the oral lesions of pemphigus vulgaris, but in some cases alternative treatment options may be required.

Oral lesions in patients with psoriasis: a controlled study

Stomatitis areata migrans was found in 5.4 percent of patients with psoriasis compared to 1 percent of control patients, while benign migratory glossitis was identified in 10.3 percent of patients with psoriasis and 2.5 percent of control patients. The association of these disorders with psoriasis indicates that they may be manifestations of psoriasis of the oral mucosa.

Sensitivity reaction to the cinnamonaldehyde component of toothpaste

Sixteen patients developed a variety of oral lesions following a change in the toothpaste they used. Mucosal biopsy demonstrated features consistent with application of a topical medicament and patch testing, towards the constituents of the toothpastes, indicated the flavouring agent cinnamonaldehyde as being the likely responsible agent. Avoidance of the implicated toothpastes resulted in a considerable improvement in clinical signs and symptoms, whereas rechallenge in ten patients resulted in recurrence of symptoms in eight patients. It is concluded that sensitivity to the cinnamonaldehyde constituent of certain toothpastes, although uncommon, should be considered as a possible aetiological factor in patients presenting with non-specific oral changes.

The effect of citrus limonoids on hamster buccal pouch carcinogenesis

Two citrus limonoids, limonin and nomilin, were tested for their effects on the development of 7,12-dimethylbenz[a]anthracene (DMBA)-induced buccal pouch epidermoid carcinomas. Forty-five female Syrian hamsters were divided into three equal groups. The left buccal pouches of the animals in each group were pretreated topically with two applications of dimethylsulfoxide (DMSO) (group I), a 2.5% solution of limonin dissolved in DMSO (group II) or a 2.5% solution of nomilin dissolved in DMSO (group III). After this initial treatment, 11 hamsters from each group were selected. The left buccal pouches of these animals were painted 2 or 3 times weekly with a 0.5% solution of DMBA in mineral oil. On alternate days the pouches were painted with DMSO (I), the 2.5% solution of limonin (II) or the 2.5% solution of nomilin (III). The 12 remaining hamsters were used as controls and were painted with mineral oil and DMSO (I), mineral oil and the 2.5% solution of limonin (II), or mineral oil and the 2.5% solution of nomilin (III). After 15 weeks the hamsters were killed, the pouches were excised and the tumors were counted and measured. Tumors of variable size were common in the animals treated with DMBA. However, the animals receiving topical applications of limonin exhibited a 60% reduction in tumor burden. Further comparisons between groups I and II showed that this reduction in tumor burden was due to a 20% decrease in tumor number and a 50% decrease in tumor mass. The results for group III showed that nomilin was considerably less effective as an inhibitor of DMBA-induced neoplasia.

Epidemiological and diagnostic aspects of oral squamous cell carcinoma

Available data in United States on morbidity, mortality and survival is reviewed and trends discussed. Oral squamous cell carcinoma is a small problem in numerical terms, but is a highly lethal disease. The diagnosis is not difficult for the competent pathologist but problems arise in the diagnosis and prognosis of potentially malignant conditions. Our understanding of the behavior of dysplastic lesions is limited and any attempts to determine individuals "at risk" should be encouraged.

Recent advances in oral mucosal research

Major progress in investigation of the normal structure and function of the oral mucosa has been made within the last ten years and has come principally from the application of various techniques developed in basic science disciplines to specific mucosal problems. However, it is apparent that many gaps still exist in our knowledge of the oral mucosa and, although it is to be expected that different workers will have distinct views on which of these are the most significant, some basic areas for further investigation can clearly be identified. For example, little is known about epithelial control systems and their disturbance by epithelial disease processes, about the nature of the interactions occurring during development and maintenance of the oral mucosal epithelia, or about the epithelial cell surface and its role in normal function. The specific properties and behavior of the cell populations of the subepithelial connective tissues appears to be poorly understood and the existence and significance of functional changes in mucosa with age and malnutrition are uncertain. It is increasingly apparent that successful progress in such investigations involves approaches using diverse methodologies. For example, epithelial-mesenchymal interactions are likely to involve multiple mesenchymal factors acting in concert to establish and maintain epithelial form and, because of this complexity, the nature of the inductive influences is not likely to be elucidated in model systems unless individual variables can be rigidly controlled. Defining the cellular and acellular elements in mesenchyme and reconstructing a functional mesenchyme from purified components may not be a simple task, but with current methods for cultivating mucosal keratinocytes and fibroblasts, as well as for purifying various components of the ground substance, it should be possible to initiate such a program of study. Some of the most dramatic advances made over the past 5-6 years in epidermal research have come about through the utilization of newly developed biochemical investigative techniques, examples of which include the use of gene cloning to study the organization of the keratin gene family, and the use of immuno-fluorescence with monoclonal antibodies to discern when various keratin proteins appear during differentiation.(ABSTRACT TRUNCATED AT 400 WORDS)

Etiology of oral squamous cell carcinoma

The traditional list of etiological factors related to oral squamous cell carcinoma namely, tobacco, alcohol, syphilis, and oral sepsis has been expanded to include iron deficiency, chronic candidosis, and herpes simplex virus. The development of current concepts in these areas is discussed. In evaluating the need for future research, special emphasis is given to the concepts of multifactorial etiology and the role of mutagens. Suggestions for future research are discussed.

Intraoral melanoacanthoma

Two cases of melanoacanthoma occurring on oral mucous membranes are presented. Melanoacanthoma is considered to be a benign mixed tumor of keratinoacytes admixed with pigment-laden dendritic melanocytes. All intraoral melanoacanthomas reported thus far have been pigmented lesions of the buccal mucosa and have occurred in young to middle-aged black females. These tumors may grow rapidly and therefore they often mimic the radial growth phase of an intraoral melanoma. Because melanocanthomas have no distinguishing clinical features, biopsy is mandatory.

Applications of xeroradiography in dentistry-a review

Xeroradiography is the technique in which electrostatically charged plates sensitive to X-rays are used in diagnostic radiology in place of conventional film. There has however been anxiety that radiation dosage for xeroradiography may be at unacceptably high levels. James et al., however, in 1973 showed that by increasing the kilovoltage to at least 120 the exposure could be reduced by 60 per cent. Using higher kV lateral oblique jaw and lateral and anteroposterior skull xeroradiographs have been produced with lower radiation exposure than conventional film. Bony detail is much more sharply delineated on xeroradiographs and soft tissues are visible on the same picture without use of a grid or wedge filter. These features are of obvious advantage in cephalometrics and orthognathic surgery. Panoramic techniques are potentially the most useful way of applying xeroradiography. The combination of full jaw coverage with the sharp definition only possible at present with intra-oral radiographs would provide more information for the dentist, save time for the radiographer and reduce the dose to the patient. Excellent results have been obtained with autopsy specimens on machines which develop 90kVp, but optimal exposure for a normal adult requires a panoramic X-ray machine development 120 kVp. Xeroradiography has the advantage, therefore, of providing more detail of diagnostic value with lower radiation exposure to the patient. The process requires no silver, which is in increasingly short supply.

The advantages of xeroradiography for panoramic examination of the jaws and teeth

Xeroradiography is an electrostatic imaging method which was significant advantages over conventional radiographic techniques. This article introduces the use of xeroradiography for panoramic examination of the jaws. The resultant images not only contain superior local contrast and detail when compared to conventional panoramic radiographs but also correlate well with histopathologic changes. The investigation indicates that xeroradiography is an important new diagnostic tool for detection of disease of the jaws and teeth.

Induced calcification in the subdermal tissues of the rat

Subdermal implants of calcium hydroxide, magnesium hydroxide, plaster of Paris, and a control material were made in rats. A tetracycline and a chloro-s-triazine dye were given at various intervals to some rats. Histochemical and fluorescence studies showed an amorphous, lamellar, noncellular, mineralized tissue in the capsules surrounding the inorganic implants.

A histological study of the periapical tissues of incompletely formed pulpless teeth filled with calcium hydroxide

Treatment of incompletely formed teeth in dogs revealed that a paste made of calcium hydroxide and water is superior to two widely used root canal filling materials. Success was based on the absence of an inflammatory response in the periapical tissues and continued root formation.