Characterization of tumors of jaw: Additive value of contrast enhancement and dual-energy computed tomography

BACKGROUND

Currently, the differentiation of jaw tumors is mainly based on the lesion's morphology rather than the enhancement characteristics, which are important in the differentiation of neoplasms across the body. There is a paucity of literature on the enhancement characteristics of jaw tumors. This is mainly because, even though computed tomography (CT) is used to evaluate these lesions, they are often imaged without intravenous contrast. This study hypothesised that the enhancement characteristics of the solid component of jaw tumors can aid in the differentiation of these lesions in addition to their morphology by dual-energy CT, therefore improving the ability to differentiate between various pathologies.

AIM

To evaluate the role of contrast enhancement and dual-energy quantitative parameters in CT in the differentiation of jaw tumors.

METHODS

Fifty-seven patients with jaw tumors underwent contrast-enhanced dual-energy CT. Morphological analysis of the tumor, including the enhancing solid component, was done, followed by quantitative analysis of iodine concentration (IC), water concentration (WC), HU, and normalized IC. The study population was divided into four subgroups based on histopathological analysis-central giant cell granuloma (CGCG), ameloblastoma, odontogenic keratocyst (OKC), and other jaw tumors. A one-way ANOVA test for parametric variables and the Kruskal-Wallis test for non-parametric variables were used. If significant differences were found, a series of independent t-tests or Mann-Whitney U tests were used.

RESULTS

Ameloblastoma was the most common pathology (n = 20), followed by CGCG (n = 11) and OKC. CGCG showed a higher mean concentration of all quantitative parameters than ameloblastomas (P < 0.05). An IC threshold of 31.35 × 100 μg/cm3 had the maximum sensitivity (81.8%) and specificity (65%). Between ameloblastomas and OKC, the former showed a higher mean concentration of all quantitative parameters (P < 0.001), however when comparing unilocular ameloblastomas with OKCs, the latter showed significantly higher WC. Also, ameloblastoma had a higher IC and lower WC compared to "other jaw tumors" group.

CONCLUSION

Enhancement characteristics of solid components combined with dual-energy parameters offer a more precise way to differentiate between jaw tumors.

The 'D-M-C' strategy for conventional ameloblastoma of the mandible: a retrospective study

The purpose of this multicentre study was to evaluate the efficacy of the 'dredging-marsupialization-curettage' (D-M-C) strategy in the treatment of conventional intraosseous ameloblastoma of the mandible. A total of 31 patients from three institutions, who had a pathological diagnosis of conventional ameloblastoma of the mandible, were treated with the D-M-C strategy. The surgical protocol comprised a dredging and marsupialization (D-M) step, with additional D-M steps as required. The patients then underwent curettage (C) once an obvious effect of the D-M step had been achieved during follow-up. Eight patients were followed up for ≥36 months but <60 months, while 23 were followed up for ≥60 months. Nineteen of the 23 patients followed up for ≥60 months were disease-free at the last follow-up, with no evidence of recurrence. The D-M step is effective for reducing the tumour size and preserving vital structures. The D-M-C surgical strategy may be a feasible treatment option for conventional ameloblastoma of the mandible.

Results of a Novel Technique for Increasing Bone Contact and Stability in Mandibular Reconstruction with Micro-vascularized Fibula Flap

Background

Reconstruction of large mandibular defects requires reestablishment of mandibular continuity with bone and soft tissue. The microvascularized fibula flap (MFF) has the advantage of providing both, with adequate length, low resorption rate, low infection risk and possibility of dental implant insertion. It can be adapted to mandibular defects in many different ways.

Purpose

This retrospective study will present and evaluate the results of the male-female joint technique for flap positioning and fixation.

Methods

The technique consists of designing osteotomies on the binding edge of the MFF and recipient jaw, increasing bone contact from one to five faces. Patients submitted to mandibular reconstruction through this technique were included and evaluated regarding systemic compromise, complication occurrence as well as primary and long-term stability.

Results

Ten patients underwent mandibular reconstruction with the male-female joint technique. Sixteen joints were applied, and excluding an early loss due to vascular failure, all remaining 14 joints healed uneventfully. None showed signs of early or late mobility.

Conclusion

Fitting the MFF through a male-female joint that provides greater bone contact may improve stability and reduce screw loosening and mini-plate removal rates.

NUT carcinoma of the mandible in a child: case report and systematic review

Nuclear protein of the testis (NUT) carcinoma is a rare, undifferentiated carcinoma that is characterized by NUTM1 gene rearrangements. Patients with NUT carcinoma have an overall survival of approximately 5% at 5 years despite a multimodal treatment approach. This report illustrates the management of mandibular NUT carcinoma in a pediatric patient, complemented by a systematic review of head and neck NUT carcinoma. A 5-year-old female presented with an enlarging jaw mass that was diagnosed as BRD4-NUTM1 carcinoma and was treated with hemimandibulectomy and chemoradiation. She remains disease-free 21 months after completion of therapy. A total of 63 patient cases reported in 34 articles were identified in the review. Only 26.9% (14/52) of tumors were correctly diagnosed initially as NUT carcinoma, whereas 73.1% (38/52) were incorrectly diagnosed as another malignancy; the initial diagnosis was not reported for 11 patients. The mandibular tumor subtype was among the rarest reported (n = 1; 1.6%). Combination therapy, including surgery and chemoradiation, was the most common treatment (55.2%). The patient case presented here is a novel case of pediatric mandibular NUT carcinoma. Due to the poor overall survival of patients with NUT carcinoma, aggressive upfront resection with 2-cm margins followed by adjuvant chemoradiation is advocated.

Benign osteoblastoma of the mandible: a case report

Osteoblastoma is a rare benign neoplasm formed by osteoid tissue and well-vascularized bone that occurs mainly in children and adolescents. It appears primarily in the long bones, vertebral column, and small bones of the hands and feet, and not typically in the skull and maxillary bones. The purpose of this study is to present the case of an 8-year-old girl with a diagnosis of right mandibular osteoblastoma and a review of the relevant literature. The goals of treatment were to preserve dental occlusion, masticatory function and facial symmetry while minimizing the effects on patient body image and quality of life. Osteoblastoma, although it is benign, can be aggressive, and its treatment will depend on the timing of diagnosis, size and location. Early diagnosis is essential to avoid not only radical surgery as in the case presented, but also to help minimize the risk of possible relapse and potential malignancy of a benign osteoblastoma.

A comparative study of three-dimensional airway changes after fibula flap reconstruction for benign and malignant tumours in the anterior mandible

Surgical treatment of tumours in the anterior mandible and surrounding tissues may result in defects which can be restored by a fibula free flap. The upper airway may change during this process. The purpose of this retrospective study was to evaluate upper airway changes after fibula free flap reconstruction. A total of 37 patients who underwent anterior mandibulectomy and fibula free flap reconstruction between 2012 and 2020 were recruited. Patients with benign and malignant tumours involving the anterior mandible were included. Spiral computed tomography was performed 1 week preoperatively, 1 week postoperatively, and at> 1 year (range 12-23 months) after surgery. Cross-sectional areas and volumes of the upper airway were measured. Data were analysed by two-way analysis of variance. The upper airway in the malignant tumour group showed an increasing trend, especially at the soft palate and tongue base levels (P < 0.01). In the benign tumour group, the upper airway showed no significant changes. The location of the minimum cross-sectional area moved downwards in both groups, and the area increased in the malignant tumour group during long-term follow-up. Upper airway obstruction is less likely to occur in the long term after surgical resection of anterior mandible malignancies and fibula free flap reconstruction.

Managing misdiagnosed gingival squamous cell carcinoma (GSCC) with occult symptoms: A report of two cases

Introduction

importance: Gingival squamous cell carcinoma (GSCC) is a rare neoplasm. GSCC has nonspecific features which commonly misdiagnosed with a simple toothache.

Case presentation

These are two cases; the first one describes a 62-year-old female who presented with pain in her right posterior mandibular teeth, and she was misdiagnosed with periodontal disease, but later histopathological tests confirmed gingival squamous cell carcinoma (GSCC). Consequently, the patient underwent surgery, and the gingival tumor was totally resected. Afterward, the patient was receiving chemotherapy, and the radiotherapy was postponed until the chemotherapy completion.

The second case is of a 58-year-old female who presented with pain in her mandibular incisors, and she developed a dermal fistula on her chin and therefore underwent several gingival curettages. The following histopathologic tests confirmed GSCC so she underwent surgery, after the surgery it was planned to give her chemotherapy.

Clinical discussion

GSCC is a rare neoplasm with a 6% incidence of all oral malignancies. GSCC is a very challenging cancer for a physician or a pathologist to diagnose because GSCC usually mimics the characteristics of a large variety of diseases and abnormalities. Unlike oral neoplasms, GSCC has the least association with smoking. This may lead to make mistakes in the treatment or misdiagnose it until the late-stage of GSCC.

Conclusion

Despite the rare incidence of Gingival squamous cell carcinoma (GSCC), clinicians should consider GSCC while investigating any localized lesion with nonspecific oral symptoms.

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GSCC usually presents with non-specific symptoms.

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Doctors should think of GSCC as a probable diagnosis of oral lesions with vague presentation.

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Suspicious oral lesions should be biopsied as soon as possible.

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The primary or metastatic malignancy must be surgically removed.

Evaluation of complications and flap losses in mandibular reconstruction with microvascularized fibula flap

The mandibular defects caused by mandibulectomies can involve esthetic and functional sequelae in patients. The fibula presents positive aspects and can be used as an option for mandibular reconstruction after tumor resections or extensive traumas. Furthermore, this retrospective study of the patients who have passed through a mandibular reconstruction with a microvascular fibular flap over the last 17 years describes the experience of the Oral and Maxillofacial SurgeryService at the ErastoGaertner Hospital, Curitiba/PR. The use of this flap type has a complication rate of 32.3%, which includes the fixation material exposure, flap resorptions, fistulas, pathological fractures, tumor recurrence, infections, seromas, and thrombocytopenia. Most of them are associated with patients who have received radiotherapy and/or chemotherapy. These data suggest a high frequency of complications when a reconstruction plate fixation is used. Minor complications are usual and they should not be overlooked because they can lead to devastating consequences.

Rhabdomyomatous Mesenchymal Hamartoma Presenting as a Midline Mass on a Chin

A 17-month-old boy was evaluated for a midline mass on his chin. The mass was anchored to the mentalis muscle with a stalk-like structure. The pathological diagnosis of the mass was rhabdomyomatous mesenchymal hamartoma. This is the first report of rhabdomyomatous mesenchymal hamartoma presenting as a midline chin mass in Korean pediatric patients.

Recurrent Psammomatoid Juvenile Ossifying Fibroma with Aneurysmal Bone Cyst: An Unusual Case Presentation

Juvenile ossifying fibroma (JOF) is a rare, benign, locally aggressive entity of the extragnathic craniofacial bones with a high tendency towards recurrence. Two distinctive microscopic patterns of juvenile ossifying fibroma have been described: a trabecular juvenile ossifying fibroma (TrJOF) and a psammomatoid juvenile ossifying fibroma (PJOF). Psammomatoid variant is predominantly a craniofacial lesion and occurs rarely in the jaws. The pathognomonic histopathologic feature is the presence of spherical ossicles, which are similar to psammoma bodies. Aneurysmal bone cyst exists as a secondary lesion arising from another osseous condition such as fibrous dysplasia, ossifying fibroma and giant cell granuloma. Very few cases of juvenile psammomatoid ossifying fibroma in association with the secondary aneurysmal bone cyst formation have been reported in the literature. Treatment consists of complete surgical removal; the incomplete excision has been associated with a high local recurrence rate. The authors report a case of recurrence of psammomatoid juvenile ossifying fibroma with aneurysmal bone cyst in an 8-year-old boy emphasizing the point that concomitant occurrence of these locally aggressive lesions requires adequate surgical removal and long-term follow-up.

Ameloblastoma: a clinical and therapeutic analysis on six cases

Ameloblastomas are odontogenic tumors that are locally invasive and slow-growing. Their etiology is still not well defined, but the forms of treatment have been widely discussed because of the possibility of tumor recurrence and postoperative complications. In this study, six patients who were diagnosed with ameloblastoma in the mandibular region and were treated in the Department of Orthopedics and Traumatology of Hospital das Clínicas, Federal University of Goiás, between 1958 and 1963, were evaluated. The radiological, clinical and therapeutic characteristics were evaluated. There was no predominance regarding gender in the sample studied. The symptoms most often presented by the patients were pain and tumor formation. The radiological characteristics with greatest incidence were multilocular lesions and the treatment used for all the patients was radical surgery. There was no recurrence over the minimum follow-up period of one year and six months.