Antral Lesions Research Articles

Clinicopathological characteristics of patients with pain after endoscopic submucosal dissection for gastric epithelial neoplasm.

Endoscopic submucosal dissection (ESD) is widely used for large superficial gastrointestinal tumors. Epigastric pain is a frequent complication of ESD. However, little is known about its incidence and associated factors. This study evaluated pain incidence and characteristics of patients with pain after gastric ESD. We retrospectively analyzed a prospectively collected registry of clinical, endoscopic, and pathologic results of patients who underwent ESD for gastric adenoma or cancer from January 2010 to December 2015. A Visual Analogue Scale (VAS) was used to assess pain immediately after, and 2, 12, and 24h after ESD. The primary outcome was the use of painkillers (VAS score > 4). Analyzed data included age, sex, pathology, specimen and tumor size, procedure time, and tumor location. Of 1226 patients, 461 (36.4%) needed a painkiller at least once after ESD (pain group). Compared with the no pain group, the pain group had more females, less alcohol consumption, larger tumor and specimen size, and more antral lesions. In multivariate analysis, female sex (OR 1.559, 95% CI 1.217-1.996, p < 0.001), antral tumor location (OR 1.780, 95% CI 1.398-2.265, p < 0.001), and procedure time over 30min (OR 1.443, 95% CI 1.130-1.842, p = 0.003) were predictive factors for pain. This study showed that a considerable number of patients needed one or more painkiller doses after gastric ESD. The factors affecting pain included sex, procedure time, and lesion location. Endoscopists should use preemptive or aggressive pain management in high-risk patients after ESD.

High-density mapping and ablation of concealed low-voltage activity within pulmonary vein antra results in improved freedom from atrial fibrillation compared to pulmonary vein isolation alone

Despite advancements, the goal of durable pulmonary vein isolation (PVI) in all patients undergoing ablation for atrial fibrillation (AF) remains elusive. New high-density mapping (HDM) allows detection of concealed low-voltage signals (CLVSs) that persist after PVI and may represent vulnerabilities in the lesion set. The purpose of this study was to determine the incidence of CLVSs after PVI and the effect of CLVS ablation on outcomes. We conducted a case control study comparing 150 patients undergoing HDM-guided PVI and subsequent CLVS mapping and ablation (39 redo, 111 de novo) against 452 historical controls undergoing traditional PVI alone. PVI was similarly performed and confirmed in both groups. Baseline characteristics were similar, except left atrial size was larger in the HDM-guided group. Acute PVI was achieved in nearly all patients in both groups. In the HDM group, 31 of 150 patients exhibited CLVS after luminal PVI, and all were subsequently eliminated. During mean follow-up of 320 days, after controlling for baseline characteristics, the HDM-guided group exhibited a hazard ratio of 0.19 in freedom from AF (P <.001). De novo patients exhibited a hazard ratio of 0.44 relative to redo patients in the HDM-guided group. Both subgroups exhibited significantly lower event rates compared to controls in log-rank analysis (P <.001). CLVSs are commonly identified with HDM after PVI, likely representing vulnerabilities in antral lesion sets. Ablation of these targets seems to significantly improve freedom from AF compared to PVI alone.

What Is the Acute Antral Lesion Size After Pulmonary Vein Isolation Using Different Balloon Ablation Technologies?

Clinical outcome after pulmonary vein isolation (PVI) may be linked to both durability of PVI and the antral lesion size. Data on balloon-guided technologies are scarce. We investigated the size of the isolated surface area (ISA) acutely after PVI achieved by cryoballoon (CB) or laser balloon (LB), both using voltage mapping.Methods and Results:In 40 patients (73% male, mean age 66±9 years), a bipolar voltage map before and after PVI in sinus rhythm was acquired to delineate the isolated antral surface area (IASA, contiguous area of low voltage <0.5 mV) and the ISA (relative size of the low-voltage area in relation to the whole antral surface area including the posterior wall). IASA (CB: 57±14 cm2vs. LB: 42±15 cm2; P=0.002) as well as ISA (65±8% vs. 54±10%; P=0.001) were significantly larger in the CB than in the LB group. No periprocedural complications occurred. During a mean follow-up of 326±142 days, 4/20 and 5/20 patients experienced an AF/AT recurrence in the CB and LB groups, respectively. No differences in clinical outcome were observed between patients with a large (≥55%) or small (<55%) ISA. Balloon-guided PVI is associated with antral lesion formation. CB-guided PVI is associated with the largest ISA as compared with LB procedures. ISA size did not correlate with clinical outcome after a single procedure in the present study population.

A Case of Advanced Gastric Cancer with Para-Aortic Lymph Node Metastasis from Co-Occurring Prostate Cancer.

An 84-year-old man was diagnosed with two synchronous adenocarcinomas, a Borrmann type IV advanced gastric adenocarcinoma in his antrum and a well-differentiated Borrmann type I carcinoma on the anterior wall of the higher body of his stomach. Pre-operatively, computed tomography of the abdomen revealed the presence of advanced gastric cancer with peri-gastric and para-aortic lymph node (LN) metastasis. He planned for palliative total gastrectomy owing to the risk of obstruction by the antral lesion. We performed a frozen biopsy of a para-aortic LN during surgery and found that the origin of the para-aortic LN metastasis was from undiagnosed prostate cancer. Thus, we performed radical total gastrectomy and D2 LN dissection. Post-operatively, his total prostate-specific antigen levels were high (227 ng/mL) and he was discharged 8 days after surgery without any complications.

Application of an individualized operative strategy for wedge resection of gastric gastrointestinal stromal tumors: Effectiveness for tumors in difficult locations

There is some concern that wedge resection of gastric gastrointestinal stromal tumors is not feasible in certain anatomic locations, such as the cardia or antrum. We sought to review our experience with treatment of gastric gastrointestinal stromal tumors with a particular focus on nonanatomic wedge resections in these challenging locations. Patients undergoing resection of gastrointestinal stromal tumors from 2000-2014 at the Montreal General Hospital were identified from a prospectively collected database, and outcomes were tabulated. An individualized operative strategy was used to guide resection based on tumor location, size, and characteristics. Disease-free survival and overall survival analyzed using the Kaplan-Meier method. Data are presented as median (range). We identified 59 patients who underwent operative resection for gastric gastrointestinal stromal tumors. Tumor location was fundus/body/greater curvature in 35 (59%) patients, lesser curvature in 8(14%) patients, antrum in 8 (14%) patients, and cardia in 8 (14%) patients. Median tumor size was 4.5cm (1.4-25cm). The majority of cardia and antral lesions were removed with wedge resections (14/16, 87%). For cardial and antral tumors, on-table gastroscopy was used to guide the operative approach and prevent narrowing of the Gastroesophageal junction or pylorus in all patients undergoing wedge resection. Negative pathologic margins were achieved in all patients. The 5-year disease-free survival was 91% and 5-year overall survival was 95%. When selected appropriately, and under the guidance of on-table gastroscopy, laparoscopic nonanatomic wedge resection can be performed successfully in the majority of cases, even for gastrointestinal stromal tumors near the GEJ or pylorus, with excellent oncologic outcomes.

Clinical relevance of aberrant polypoid nodule scar after endoscopic submucosal dissection.

To describe a series of patients with aberrant polypoid nodule scar developed after gastric endoscopic submucosal dissection (ESD), and to discuss its pathogenesis and clinical management. We reviewed retrospectively the endoscopic database of two academic institutions located in Brazil and Japan and searched for all patients that underwent ESD to manage gastric neoplasms from 2003 to 2015. The criteria for admission in the study were: (1) successful en bloc ESD procedure with R0 and curative resection confirmed histologically; (2) postoperative endoscopic examination with identification of a polypoid nodule scar (PNS) at ESD scar; (3) biopsies of the PNS with hyperplastic or regenerative tissue, reviewed by two independent experienced gastrointestinal pathologists, one from each Institution. Data were examined for patient demographics, Helicobacter pylori status, precise neoplastic lesion location in the stomach, tumor size, histopathological assessment of the ESD specimen, and postoperative information including medical management, endoscopic and histological findings, and clinical outcome. A total of 14 patients (10 men/4 women) fulfilled the inclusion criteria and were enrolled in this study. One center contributed with 8 cases out of 60 patients (13.3%) from 2008 to 2015. The second center contributed with 6 cases (1.7%) out of 343 patients from 2003 to 2015. Postoperative endoscopic follow-up revealed similar findings in all patients: A protruded polypoid appearing nodule situated in the center of the ESD scar surrounded by convergence of folds. Biopsies samples were taken from PNS, and histological assessment revealed in all cases regenerative and hyperplastic tissue, without recurrent tumor or dysplasia. Primary neoplastic lesions were located in the antrum in 13 patients and in the angle in one patient. PNS did not develop in any patient after ESD undertaken for tumors located in the corpus, fundus or cardia. All patients have been followed systematically on an annual basis and no malignant recurrence in the ESD scar has been identified (mean follow-up period: 45 mo). PNS may occur after ESD for antral lesions and endoscopically look concerning, especially for the patient or the family doctor. However, as long as curative R0 resection was successfully achieved and histology demonstrates only regenerative and hyperplastic tissue, PNS should be viewed as a benign alteration that does not require any type of intervention, other than endoscopic surveillance.

Pulmonary Vein Isolation With Incomplete Antral Ablation Lines: Is More Ablation Necessary? Results of a Randomized Trial.

A full circumferential set of antral lesions is not always required for bidirectional pulmonary vein conduction block. It is unknown whether a partial lesion set that isolates the veins will have clinical success rates similar to a full circumferential lesion set, and if procedural times or procedural risk will be affected. We performed a prospective, randomized clinical trial to test the hypothesis that a partial lesion set that isolates the pulmonary veins has comparable clinical success rate and shorter procedure times compared to a strategy of completing the circumferential lesion set once the veins are isolated. A total of 119 patients were enrolled, 59 randomized to circumferential ablation, and 60 to segmental. Mean age was 58.3 ± 10.1, 77% male. Mean procedure time was 221.0 ± 46.9 minutes in circumferential and 224.7 ± 51.3 in segmental (P = 0.68). Twelve-month freedom from AF recurrence was 61.3% overall, 64.4% in circumferential, and 58.3% in segmental (P = 0.50). Among 25 segmental patients with AF recurrence, 23 underwent second ablation. Among 33 areas of conduction recovery, 23 (70%) occurred in segments ablated at first procedure and 10 (30%) in segments not previously ablated, suggesting reversible conduction block from edema. No difference in AF recurrence or procedure time is detectable in a sample of 119 patients randomized to segmental or circumferential antral ablation to achieve pulmonary vein isolation. Second ablation procedures confirmed that some antral sites do not require ablation. A segmental approach results in unacceptably high rates of untargeted or recovered antral sites to make this approach feasible.

A Novel Microwave Catheter Can Perform Noncontact Circumferential Endocardial Ablation in a Model of Pulmonary Vein Isolation.

Pulmonary vein isolation is an effective treatment for atrial fibrillation. Current endocardial ablation techniques require catheter contact for lesion formation. Inadequate or inconsistent catheter contact results in difficulty with achieving acute and long-term isolation and consequent atrial arrhythmia recurrence. Microwave energy produces radiant heating and therefore can be used for noncontact catheter ablation. We hypothesized that it is possible to design a microwave catheter to produce a circumferential transmural thermal lesion in an in vitro model of a pulmonary vein antrum. A monopole microwave catheter with a sideways firing axially symmetrical heating pattern was designed. Noncontact ablations were performed in a perfused pulmonary vein model constructed from microwave myocardial phantom embedded with a sheet of thermochromic liquid crystal to permit visualization and measurement of thermal lesions from color changes. 1200 J ablations were performed at 150 W for 80 seconds and 120 W for 100 seconds at high (0.8 L/min) and low (0.06 L/min) flow through the modeled pulmonary vein. Myocardial tissue was substituted for the phantom material and ablations repeated at 150 W for 180 seconds and stained with nitro-blue tetrazolium. The catheter was able to induce deep circumferential antral lesions in myocardial phantom and myocardial tissue. Higher power and shorter ablations delivering the same amount of microwave energy resulted in larger lesions with less surface sparing. A microwave catheter can be designed to produce a circumferential thermal lesion on noncontact ablation and may have possible applications for pulmonary vein isolation.

Aggravation by Clopidogrel, An Antiplatelet Drug, of Antral Damage Induced by NSAID in Rats: A Prophylactic Effect of Antiulcer Drugs

Recent studies suggested a risk of gastric adverse reaction on the concomitant use of antithrombotic drugs with NSAIDs. We investigated whether clopidogrel, a P2Y12 receptor antagonist, aggravates antral damage induced in rats by indomethacin and examined the effects of several antiulcer drugs on these lesions. Male SD rats fasted for 24 h were refed for 1 h, and then administered indomethacin (30 mg/kg) s.c. 1 h after refeeding, and the stomachs were examined for lesions 6 h thereafter. Clopidogrel (3‐30 mg/kg) was given p.o. 3 times, 48, 24 h and 30 min before indomethacin. Famotidine or teprenone was given p.o. 1 h before indomethacin. Indomethacin alone produced damages, mostly nonhemorrhagic lesions, in the antrum of refed rats. Clopidogrel dose‐dependently worsened these lesions with convertion of nonhemorrhagic damages into hemorrhagic ones. The ulcerogenic response to indomethacin plus clopidogrel (30 mg/kg) was significantly suppressed by pretreatment with famotidine with a decrease in hemorrhagic lesions. The aggravating effect of clopidogrel was also attenuated by teprenone, though the effect was less pronounced than that of famotidine. These results suggest that 1) clopidogrel aggravates NSAID‐induced antral lesions, converting from nonhemorrhagic into hemorrhagic damage, and 2) these lesions are effectively prevented by both antisecretory and mucosal protective drugs.

Orbitomaxillary mass after repair of the orbital floor

A 48-year-old man presented with an orbitomaxillary mass 31 years after repair of the orbital floor. He gave a history of progressive diplopia and paraesthesiae of the right infraorbital nerve. He also noted improvement in his long-standing post-traumatic enophthalmos. Imaging showed a large orbitomaxillary cystic mass, which was thought to be secondary to a silicone implant. The implant and the cystic mass were removed, and the orbital floor was reconstructed with titanium mesh. Histological examination confirmed an inclusion cyst. Maxillary antral lesions can present with symptoms such as sinusitis, paraesthesiae, diplopia, and orofacial pain, and they may arise from the lining of the sinus, or from surrounding structures such as the orbit, nose, or maxilla. This was a late complication of silicone elastomeric implants, and there are alternative treatments for defects of the orbital floor.

Evaluating the Diagnoses of Gastric Antral Lesions Using Magnifying Endoscopy with Narrow-Band Imaging in a Chinese Population

To evaluate the accuracy of diagnosing gastric antral lesions in routine clinical practice using magnifying endoscopy with narrow-band imaging (M-NBI) as a real-time diagnosing technique. Consecutive patients undergoing upper endoscopy were selected for the study. In each patient, the mucosa of the gastric antrum was observed by M-NBI, and the gastric microstructure was categorized into five types (A-E). Based on these patterns, histological types were predicted in a real-time manner. The accuracy of these predictions was evaluated based on histological findings. Inter-observer agreement was also assessed. A total of 207 sites in 90 patients were examined by M-NBI. Compared with type A gastric microstructure, types B and C gastric microstructure showed a significantly higher degree of inflammation (P < 0.001). The sensitivity, specificity and accuracy of types B + C microstructure as a predictor of gastric inflammation were 85.4, 81.7 and 83.1 %, respectively. Similarly, the sensitivity, specificity and accuracy of type D microstructure as a predictor of gastric intestinal metaplasia were 71.8, 95.2 and 90.8 %, respectively, and those of type E microstructure as a predictor of early gastric cancer were 80.0, 98.9 and 97.6 %, respectively. The sensitivity and specificity of type B alone, type C alone and types B + C combined for the detection of Helicobacter pylori infection were 52.2 and 87.0 %, 22.8 and 92.2 %, 75.0 and 79.1 %, respectively. The kappa value for the inter-observer agreement was 0.715 (95 % confidence interval 0.655-0.895). In conclusion, M-NBI can significantly improve the accuracy of the prediction of histopathology of gastric antral lesions in vivo, implying the possibility of using M-NBI as an effective diagnosis technique.

Maxillary antral lesions: An analysis of 108 cases seen in a Tertiary Hospital in Benin City, Nigeria

Aim: This article aims to determine the clinicodemographic pattern and histopathological types of the maxillary antral lesions in a Nigerian population. Materials and Methods: Eleven years retrospective review of case records of patients with histologically diagnosed maxillary antral lesions seen at the Otorhinolaryngological and Oral Pathology/Medicine Departments, University of Benin Teaching Hospital, Benin City, Nigeria was performed. Result: A total of 108 patients with maxillary lesions were seen during the period under review, comprising of 57 (52.8%) males and 51 (47.2%) females, giving a ratio of 1.1:1. The patients' mean age was 41 years (±1.9 standard deviation) and the peak age group was the third decade of life (n = 22, 20.4%). The most frequent clinical features were painless maxillary swelling (n = 91, 84.3%), nasal discharge (n = 41, 38.0%), nasal obstruction (n = 34, 31.5%) and toothache (n = 30, 28.0%). Most patients (n = 31, 28.7%) presented for treatment within a year of onset of the lesion (n = 69, 63.9%) and the left maxillary antrum was the most commonly affected site (n = 64, 59.3%). The antral lesions were mostly malignant lesions (n = 56, 51.9%), with squamous cell carcinoma accounting for 37 (34.3%) of the cases; followed by benign lesions (n = 23, 21.3%), inflammatory/infective lesions (n = 13, 12.0%), cystic lesions (n = 9, 8.3%), and reactive lesions (n = 8, 7.4%). Conclusion: A high prevalence of neoplastic maxillary antral lesions, consisting mostly of malignant lesion was observed in this study. Routine histopathological examination of recurrent or persistent maxillary antral lesions is recommended for early detection of malignant lesions or malignant transformations among reactive or benign antral lesions.

Evaluation of bowel wall thickening by computed tomography to differentiate benign from malignant lesions.

Computed tomography(CT) is an excellent non-invasive modality to evaluate bowel wall thickening.The aim of our study was to evaluate CT appearance of bowel wall thickening due to various benign and malignant conditions taking into consideration pattern of attenuation, bowel wall thickness, extent of lesion, symmetry of lesion and other associated CT findings. The prospective study was carried out on 50 patients who underwent computed tomographic evaluation of abdomen for suspicion of bowel pathology based on ultrasonography, barium studies and/or clinical grounds. The studies were conducted on Siemens ART and GE High speed CT scanners. The examination was performed as is done routinely for an abdominal scan with imaging done from diaphragm to pubic symphysis in supine position with the right lateral decubitus scans in selected cases for better characterization of gastric antral and duodenal lesions. Oral, rectal and intravenous (IV) contrast agents were administered. The diagnosis was confirmed by cytology or histopathology of any biopsy or surgical specimen. However, in cases where surgery was not done, diagnosis was confirmed by clinical response to medical treatment. Based on the various CT characteristics of abnormal bowel wall thickening, sensitivity and specificity of classifying a lesion as benign or malignant were calculated. Majority of the malignant bowel lesions were showing the following characteristics i.e. heterogeneous pattern of enhancement, marked bowel wall thickening, asymmetry of the lesion and focal/segmental bowel involvement. Overall, CT showed a sensitivity of 97% and specificity of 93% in differentiating between benign and malignant etiology of abnormal bowel wall thickening. Due to its high sensitivity and specificity, CT is an ideal imaging modality for differentiating between benign and malignant etiology of abnormal bowel wall thickening. Radiologists should be aware of the usefulness of specific CT criteria of bowel wall thickening to better differentiate benign lesions from malignant or potentially malignant lesions that warrant further diagnostic evaluation.

The presence of metastases in regional lymph nodes is associated with tumor size and depth of invasion in sporadic gastric adenocarcinoma

BackgroundGastric adenocarcinoma is more often found in men over 50 years in the form of an antral lesion. The tumor has heterogeneous histopathologic features and a poor prognosis (median survival of 15% in five years).AimTo estimate the relationship between the presence of nodal metastasis and other prognostic factors in sporadic gastric adenocarcinoma.MethodWere evaluated 164 consecutive cases of gastric adenocarcinoma previously undergone gastrectomy (partial or total), without clinical evidence of distant metastasis, and determined the following variables: topography of the lesion, tumor size, Borrmann macroscopic configuration, histological grade, early or advanced lesions, Lauren histological subtype, presence of signet ring cell, degree of invasion, perigastric lymph node status, angiolymphatic/perineural invasion, and staging.ResultsWere found 21 early lesions (12.8%) and 143 advanced lesions (87.2%), with a predominance of lesions classified as T3 (n=99/60, 4%) and N1 (n=62/37, 8%). The nodal status was associated with depth of invasion (p<0.001) and tumor size (p<0.001). The staging was related to age (p=0.048), histological grade (p=0.003), and presence of signet ring cells (p = 0.007), angiolymphatic invasion (p = 0.001), and perineural invasion (p=0.003).ConclusionIn gastric cancer, lymph node involvement, tumor size and depth of invasion are histopathological data associated with the pattern of growth/tumor spread, suggesting that a wide dissection of perigastric lymph nodes is a fundamental step in the surgical treatment of these patients.

Maxillary Sinusitis Caused by Mucormycosis

A 60-year-old male complained of headache, nasal discharge, and diplopia for over one month with a history of left upper molar extraction, and he had recently experienced severe discharge of purulent exudate from his left antrum. Under the diagnosis of maxillary sinusitis, the Caldwell-Luc operation was performed, and several fragments of amorphous white mucoroid materials were removed. In the histological observation, sinus mucosa was relatively well preserved, but showed diffuse infiltration with eosinophilic polymorphonuclears. Huge molds of mucormycosis were associated with the surface of mucosa. He was treated with amphotericin-B deoxycholate, resulting in the uneventful healing of the antral lesion. The current case of antral mucormycosis was very rare but effectively treated by surgical removal of antral mucosa and the following antibiotic therapy for the strong inhabitants of fungal molds. We also presumed that the patient was superinfected with commensal fungus of mucormycosis during broad spectrum antibiotic therapy for the previous dental infection.

Helicobacter pylori infection does not promote hepatocellular cancer in a transgenic mouse model of hepatitis C virus pathogenesis

Helicobacter pylori (H. pylori) and hepatitis C virus (HCV) infect millions of people and can induce cancer. We investigated if H. pylori infection promoted HCV-associated liver cancer. Helicobacter-free C3B6F1 wild-type (WT) and C3B6F1-Tg(Alb1-HCVN)35Sml (HT) male and female mice were orally inoculated with H. pylori SS1 or sterile media. Mice were euthanized at ~12 mo postinoculation and samples were collected for analyses. There were no significant differences in hepatocellular tumor promotion between WT and HT mice; however, HT female mice developed significantly larger livers with more hepatic steatosis than WT female mice. H. pylori did not colonize the liver nor promote hepatocellular tumors in WT or HT mice. In the stomach, H. pylori induced more corpus lesions in WT and HT female mice than in WT and HT male mice, respectively. The increased corpus pathology in WT and HT female mice was associated with decreased gastric H. pylori colonization, increased gastric and hepatic interferon gamma expression, and increased serum Th1 immune responses against H. pylori. HT male mice appeared to be protected from H. pylori-induced corpus lesions. Furthermore, during gastric H. pylori infection, HT male mice were protected from gastric antral lesions and hepatic steatosis relative to WT male mice and these effects were associated with increased serum TNF-α. Our findings indicate that H. pylori is a gastric pathogen that does not promote hepatocellular cancer and suggest that the HCV transgene is associated with amelioration of specific liver and gastric lesions observed during concurrent H. pylori infection in mice.

Lipoma gástrico gigante sintomático tratado con gastrectomía subtotal laparoscópica: caso clínico

Gastric lipoma is a rare benign gastric tumor. We report a 62-year-old man, who presented with abdominal pain, vomiting and weight loss. An upper gastrointestinal endoscopy showed a gastric antral, submucosal tumor. Abdominal ultrasound and computed tomography revealed a large antral lesion with content of high echogenicity and fat density, measuring 11 x 6 cm. The patient was treated with a laparoscopic distal subtotal gastrectomy, and a Roux-en-Y reconstruction. The patient had no postoperative morbidity, was started on a liquid diet on the third postoperative day and was discharged on the third postoperative day. The pathological study revealed a gastric lipoma with clear margins. This laparoscopic procedure represents a good alternative in the treatment of this benign gastric tumor.

Sa1608 Comparative Study of Argon Plasma Coagulation and Radiofrequency Ablation Using Halo90 Device for Treatment of Gastric Antral Vascular Ectasia Lesions

Sa1608 Comparative Study of Argon Plasma Coagulation and Radiofrequency Ablation Using Halo90 Device for Treatment of Gastric Antral Vascular Ectasia Lesions

Evaluation of the histopathology of orofacial lesions in a North-East Nigerian tertiary centre

The aim of this study was to evaluate the relative frequencies, types and site distribution of oro-facial lesions in a North-Eastern Nigerian tertiary centre. The records of the Departments of Oral-Dental Surgery and Pathology of a tertiary hospital in Nigeria were reviewed and analyzed for patients with oro-facial lesions during a seven year period (January, 2001 - December, 2007). The main outcome measures were patients' age and sex, histology assessment, tissue type and location. A total of 102 (51.3%) benign lesions, 59 (29.6%) malignant lesions and 38 (19.1%) inflammatory/reactive lesions were seen. The common benign neoplasms were ameloblastoma (23.5%), fibrous dysplasia (15.7%) and pleomorphic adenoma (13.7%). The malignant lesions were mainly well differentiated squamous cell carcinomas (28.8%) and terminal duct carcinoma (11.9%). Inflammatory lesions comprised mainly of chronic osteomyelitis (15.8%) and non-specific chronic inflammatory lesions; giant cell granulomas, granulation tissues which constituted 10.5% each. [corrected] There were 104 (52.3%) males and 95 (47.7%) females giving a male: female ratio of 1.1:1. The mean age of the patients was 36.1(SD ± 18.9) years with a range of 1 to 85 years. Most tissue specimens were soft tissues (61.3%), while bone specimen accounted for 15.6% of all specimens analysed. There were 62 (31.2%) mandibular lesions, 24 (12.1%) palatal lesions and 15 (7.5%) parotid lesions, while maxillary antral lesions were the least, constituting only 0.5% of all lesions studied. [corrected]. The range of diagnosed lesions from our study was diverse, though our results do not represent the actual prevalence of orofacial lesions within the general population, but simply reflect the frequency of histologically diagnosed lesions at a health center in North-East Nigeria. This survey has shown that most oro-facial lesions studied were benign neoplasms and that most of these neoplasms were from the mandible.

Evaluation of a Maxillary Sinus Floor Augmentation in the Presence of a Large Antral Pseudocyst

Sinus floor augmentation has been established as a predictable technique to overcome maxillary bone loss. Antral cystic lesions may lead to intrasurgical complications and should be accurately diagnosed. However, antral pseudocysts have recently been described not to be contraindicated for sinus-grafting procedures. The current article sought to report clinical, cone beam computed tomographic, and histologic results of a maxillary sinus floor augmentation, performed with piezoelectric surgery, in the presence of a large antral pseudocyst. Success of graft maturation was confirmed with histologic analysis, which also indicated the absence of inflammatory infiltration in the tissue evaluated. On the basis of our findings, it is possible to perform a predictable treatment based on sinus floor augmentation in the presence of antral pseudocysts. Graft maturation can also be achieved 6 months after sinus-lifting surgeries.