Previous studies regarding experimental carcinogenesis demonstrated that submaxillar glands (GSM) submitted to DMBA present cellular modifications of progressive gravity in different periods after eight days of the experiment (J. Dent. Res 59: 1067, 1980). This current work pursues the objective of determining, quantitatively, regions of nucleolar organizations (AgNOR) and immunomarkation of the antigen of nuclear proliferation (PCNA) for their possible link with the morphostructural findings previously described. By means of argentic impregnation, the AgNOR were identified. The histometric was performed according to the numeric parameters of AgNOR per nucleus (CABRINI et al. 1992) immersed 1000x. A triple blind reading of the five randomly chosen studies from each of the twenty cases studies with distinct experimentation stages was completed. The results were compared to the normal areas (control group). The PCNA was determined immunohistochemically (Avidina-Biotina System Dako). The average number of AgNOR was 11 after eight days; 16 after fifteen days and 12 after twenty days of the experiment (100% adenocarcinoma). In the control group, the average number of AgNOR did not exceed 6. The PCNA after eight days was negative. The reaction in the tumor area was between 20 and 30% positive. The results indicate an increase in the number of AgNOR in relation to the neoplastic proliferation, corroborated by PCNA immunodetection.
A case of a women is presented who was treated successfully with microplates for a dento-alveolar fracture of the mandible.
In a retrospective study, the authors present the results of the surgical treatment of 6 cases of orbital floor blow-out fractures with silicone implant. The diagnosis was based on history, clinical ground and coronal tomography. The surgical procedure was the same in all patients, using silicone implant. The mean follow-up time after surgery was 3 months. The mean interval time between injury and diagnosis was 34.8 days while that between injury and surgery was 55.3 days. The fractures occurred during brawls in 3 patients, car accidents in 2 patients and child's play in 1 patient. Limitation of vertical eye movements was presents in all patients, diplopia in 4 patients, enophthalmos in 3 patients and hypesthesia in the distribution of infraorbital nerve in 1 patient. Five patients hale late repairs (> 14 days) after surgery. Postoperatively, good results were obtained with regards to limitation of vertical eye movements, diplopia, enophthalmos and hypesthesia. Only one patient had a persistent and partially reduced enophthalmos. Silicone implant was well tolerated in all cases since complications such as infection, tissue reaction and extrusion were not observed. Excellent results may be obtained after late repair of orbital floor blow-out fractures. Silicone implant has the potential to be used successfully in orbital floor fractures.
Central giant cell granulomas are uncommon, locally aggressive and benign tumors of the maxillofacial skeleton. The authors report a case of tumor arising from the maxilla and present a review of essential characteristics of the lesion.
A tumor attached to the amelo-cemental junction of a third molar impacted in the maxillary tuberosity, consisted histologically of a myxomatous stroma, in which multicystic cavities lined by a columnar epithelium and mucoproducing cells, together with an aggressive squamous epithelial component were present. Although the diagnosis of polyp of the maxillary sinus cannot be excluded, this lesion most likely constitutes an unusual presentation for an odontogenic myxoma of the maxilla, in which an aggressive squamous epithelial component is present, along with a mucosecreting glandular component.
A case of a fracture of the coronoid process associated with a depressed zygomatic fracture is described. Clinical signs, radiology (3D-CT scan), treatment and follow-up are presented.
Candida species are responsible for all but exceptional examples of oral fungal infection. Oral Candida lesions are seen only in patients who are predisposed to such disease by physiological or immunological abnormalities, particularly by extremes of age and HIV infections. The infections can be acute or chronic, pseudomembranous ("thrush") or atrophic (erythemateous). In the AIDS patient, mixtures of clinical types may be seen. Diagnosis of oral Candida infection requires microscopic or culture proof of the involvement of a Candida species. Treatment depends on the type of patient and the type of infection. Topical antifungal agents, usually of the imidazole, triazole or polyene type, are commonly used, although non-specific antiseptics are recommended for denture cleansing in cases of denture-associated stomatitis.
Carcinosarcoma of the salivary gland is a rare lesion, estimated at 0.2% of malignant salivary gland tumors [1, 2]. The present article describes a case occurring in a 54-year-old man with a submandibular mass in the right neck. Histologically, this lesion was a carcinosarcoma which involves the submandibular and the sublingual glands. Its stromal component was a chondrosarcoma and the epithelial one was an undifferentiated carcinoma in the whole tumor, with areas of adenoid cystic carcinoma in the sublingual gland. To our knowledge, we have not found any previously reported carcinosarcoma involving the sublingual gland.
The right to give or withhold free an informed consent is considered in detail, historically, ethically and guidelines are suggested for the practitioner.
Degenerative troubles of the temporo-mandibular joint constitute a major pathology for the maxillo-facial surgeon. While articular replacements have long been developed and used by orthopedic surgeons, none of these seem to give satisfaction in the TMJ. After a short historical and physiological recall, a number of techniques are described, together with a short evaluation of their use. In all 597 cases are reported, whilst an attempt at classification is made in the different types of prostheses used, ie interpositional, endo-osseous, extra-cortical, and prostheses designed for extensive reconstruction.
A patient with a right latero-cervical swelling of three-months history was observed. Fine needle aspiration biopsy showed the presence of metastases of epidermoid carcinoma moderately differentiated. No signs or symptoms of head and neck neoplasm were presents. After instrumental evaluation the primary neoplasm was localised at the left lung and metastases were also localised in the right submandibular gland. Although metastases from pulmonary epidermoid carcinoma are normally bloodborne, in this case lymphatic metastases involving cervical areas were present, probably secondarily the submandibular involvement.
From 01-01-1981 to 12-31-1990 512 patients with isolated mandibular fractures, 161 patients with combined midfacial-/mandibular fractures and 15 patients with combined frontobasal-/midfacial-/mandibular fractures were treated. During that period the number of isolated mandibular fractures doubled, whereas the frequency of combined mandibular fractures was nearly constant. The male/female ratio was 3.1 to 1. The more severe the combined mandibular fractures had been, the less female patients were concerned. Most of the patients were between 16 and 30 years old followed by 31 to 45 year old patients. The main reason for isolated mandibular fractures had been assaults, followed by falls and road traffic accidents, whereas most of the combined mandibular fractures were caused by road traffic accidents. The numbers of single and double fractures of the mandible were nearly equal. Certain and uncertain signs of fractures are mostly unreliable, so that an X-ray is needed. A combined conservative and surgical treatment shows the best results and guarantees the reintegration of the patient in the every-day life as early as possible.
Swelling of the floor of the mouth is sometime difficult to diagnose clinically. Lithiasis and neoplasm are the most frequent causes of intraoral swelling. Also after plain radiology and computed tomography the diagnosis is often dubious. A case of swelling of the floor of the mouth due to an adenoid cystic carcinoma of the sublingual gland is reported.
Ki-67 is a nuclear antigen expressed in G1, S, G2 and M phase of cell cycle and absent in quiescent cells (G0). In some neoplasms, Ki-67 expression has a prognostic value. The purpose of this study was to determine the role of Ki-67 expression like prognostic factor in oral squamous cell carcinoma (OSCC). Monoclonal antibody MIB-1 that recognizes Ki-67 antigen was used. 74 OSCCs were analyzed. 49% of OSCCs did not express Ki-67 antigen. In the Ki-67 positive tumours, the expression was slight in 36.5%, moderate in 10.8% and intense in 10.8% of the cases. In all the positive OSCCs, the distribution of the marking was patchy in different zones of the tumour, moreover, in 65% of the lesions, the positive cells were located mainly in the proximity of intraoral blood vessels. A significantly more intense expression was noted on tumours that had not been differentiated (p < 0.05), with a larger nuclear pleomorphism (p < 0.05) and in lesions that invaded in the form of disassociated neoplastic cells of in small groups of neoplastic cells (p < 0.001). However, the expression of Ki-67 did not correlate with the mitosis count and it had no influence on survival.
It is also the most common primary malignant lesion of bone, excluding multiple myeloma. However it is rare: it occurs in 1 per 100,000 persons per year, and about 6% tot 7% of all osteosarcomas occur in the maxillofacial region. In this report, we discuss two cases of osteosarcoma in the maxillofacial region: one in the mandible and one in the maxilla. It is also a review of the literature. We discuss in detail the natural history of osteosarcoma in the jaw bones, the predisposing factors, the localisation, the presenting symptoms, the radiology and the methods of treatment.
A case of complete remodelling of bilateral fractures of the mandibular condyle in an 11-year-old boy is presented. Initial radiographic examination revealed fractures of the right and left condylar neck with medial and anterior dislocation of the proximal fragment. The fractures were treated conservatively, with a short-time intermaxillary fixation and early jaw function, and thirty-five months later the patient was asymptomatic. Radiographic changes observed following treatment have revealed a gradual return to normal shape and position of the condyles.
Various techniques have been described in the treatment of recurrent TMJ dislocations amongst which, joint arresters form a prominent part. We describe a new type of bio-integrable joint stop, custom made with 3D-CT help, which alleviates the two main drawbacks of the technique: lack of retention through insufficient extension, and secondary mobilization of the stop. Two cases are reported, amounting to four stops with satisfactory two years follow-up.
La recherche du ou des sites d'obstruction respiratoire qui provoquent le syndrome des apnees du sommeil est largement facilitee par la fibroscopie. les manoeuvres de Muller donnent une idee de l'importance des organes en cause. le simulacre du ronflement peut etre enregistre par variation de lumiere detectee par cellule photo-electrique et captation des vibrations acoustiques par microphone et analyse spectrale. A partir de ces donnees electriques trouvees aux differents endroits du ronflement provoque nous tachons de decouvrir les zones qui provoquent le ronflement spontane. Cette technique n'est pas encore au stade de la fiabilite. Une sonde etagee introduite dans la voie respiratoire, designe, par effet piezo-electrique le ou les sieges du ronflement. Parmi les moyens therapeutiques, l'UPP et la glossectomie partielle soit par laser sous endoscopie ou a ciel ouvert par chirurgie amenent des resultats incontestables mais inferieurs a ceux de la CPAP et de la tracheotomie. Les inconvenients ne sont pas les memes.
Blunt injury of the internal carotid artery (ICA) is a rare entity that should be considered by Maxillofacial surgeons in patients with facial fractures. Its recognition is often delayed because of the common association with other severe multi-system injuries. Early diagnosis is the key to successful management; the arteriography plays a confirmatory role on the diagnosis and determines whether surgical management of the injury is feasible. Therapeutic alternatives vary from one center to another; they include observation, conservative treatment, anticoagulation, ligation of the carotid artery with or without extracranial-intracranial bypass, and arterial reconstruction.
