Mandibular Tumor Research Articles

Pregnancy epulis associated with life threatening haemorrhage in a Nigerian woman

Pregnancy tumour is a clinical term used to identify a pyogenic granuloma that occurs in pregnant women. Pregnancy tumour is not uncommon, but severe bleeding associated with the lesion necessitating blood transfusion is rare. We report a rare case of mandibular gingival pregnancy tumour with a life-threatening haemorrhage in a 25-year-old Nigerian woman. The patient had lost an estimated 2 litres of blood before presentation. Her packed cell volume was 8% at presentation. The patient was managed by infusion of fluid, transfusion of 4 units of blood and ligation of the facial artery; and excision of the lesion. Following an uneventful healing, she was discharged 10 days later with a PCV of 40.5%. Following subsequent review there was a recurrence 2 months later that regress after 1 month. She was subsequently lost to further follow up.

Multiple keratocystic odontogenic tumors associated with nevoid basal cell carcinoma syndrome having distinct PTCH1 mutations: a case report

Nevoid basal cell carcinoma syndrome (NBCCS) is a rare autosomal dominant disorder characterized by developmental abnormalities and a predisposition to cancers. Although multiple jaw tumors, such as keratocystic odontogenic tumors (KCOTs), are one of the most frequent complications in NBCCS, the molecular mechanism for how KCOTs develop in NBCCS is poorly understood. A 15-year-old girl with 2 jaw tumors was diagnosed as NBCCS according to the clinical criteria. The pathologic findings indicated that the 2 tumors were consistent with KCOTs. A PTCH1 mutation, c.1472delT, was detected in her peripheral blood as well as in the 2 tumors. Interestingly, an additional PTCH1 mutation, c.264_265insAATA, that was not present in the peripheral blood, was found in the maxillary tumor but not the mandibular tumor. The Ki-67 labeling index was significantly higher in the maxillary KCOT (17.7%) than in the mandibular KCOT (14.3%). These findings indicate distinct molecular mechanisms of tumorigenesis in these KCOTs.

Gingival carcinoma: retrospective analysis of 72 patients and indications for elective neck dissection

Gingival squamous cell carcinoma (SCC) is relatively uncommon, and little is known about its metastatic pattern. We retrospectively reviewed 864 consecutive patients with oral SCC who were seen at the University of Maryland Department of Oral and Maxillofacial Surgery (1991–2005), and identified 111 cases of gingival SCC. Inclusion criteria were fulfilled in 72 patients (mean duration of follow up 49 (1–153) months). Mean (range) age was 72 (45–93) years; 41 patients were women and 31 men. Distribution was almost equal: mandible 35 and maxilla 37. Forty (56%) were in the early stages (pI/II) and 32 (44%) in the later stages (pIII/IV). Twenty-nine patients had primary neck dissections, of whom 7/21 had clear, and 6/8 invaded, cervical nodes. The total number of occult nodal metastases was 9/29 (31%) in the mandible and 14/35 in the maxilla (one patient with initially clear nodes had both invaded nodes at neck dissection and a recurrence in the neck). The number of early compared with late stage occult metastases was 4 of 20 patients (20% T1/T2) and 5 of 9 patients (55% T3/T4) in the mandible and 2 of 22 patients (9% T1/T2) and 2 of 13 patients (15% T3/T4) in the maxilla. Two of 9 patients developed occult nodes within T2 maxillary gingival SCC. Bony invasion was identified in 17 patients (24%) occurring in 8 of 19 patients (42%) with invaded nodes compared with 9 of 53 patients (17%) with clear nodes. Overall survival at 2 and 5 years was 53 of 72 patients (74%) and 27 of 72 patients (38%) respectively. Elective neck dissection is indicated for all stages of mandibular gingival tumours and T3/T4 carcinomas of the maxillary gingiva. T2 maxillary SCC should be considered for elective neck dissection. Overall disease-free survival was worse among those with cervical metastases ( p = 0.004) and those who had had marginal resections ( p = 0.04).

Mandibular Melanotic Neuroectodermal Tumor of Infancy Treated Conservatively With Enucleation

Melanotic neuroectodermal tumor of infancy (MNTI) is an uncommon, rapidly growing neoplasm of neural crest origin that primarily develops in the maxilla of infants during their first year of life. Mandibular lesions are rare and account for about 6% of all cases. Radical surgical excision is usually curative, but patients should be followed up closely because recurrence may occur in approximately 10% to 20% of cases. In this study, we report a case of mandibular MNTI in a 4-month-old male patient that was conservatively treated with enucleation and curettage and has shown no recurrence 11 years after surgery. Review of the English-language literature revealed that of more than 350 cases of MNTI reported so far, only 23, including the present one, have been encountered in the mandible. Most patients (91.3%) were younger than 1 year, whereas the male-to-female ratio was 1.3:1. Most lesions were treated with wide surgical excision, with only 2 cases being conservatively treated with enucleation. Recurrence was noted in 36.8% of cases at less than 3 months postoperatively. In conclusion, MNTI lesions in the mandible, albeit rare, show high recurrence rate. However, small-size mandibular MNTI lesions may be successfully treated with conservative enucleation. Close follow-up is highly recommended, in particular during the first 6 postoperative months.

Juvenile ossifying fibroma of the mandible: a case report.

ABSTRACTBackgroundFibro-osseous lesions of the jaws, including juvenile ossifying fibroma, pose diagnostic and therapeutic difficulties due to their clinical, radiological and histological variability. The aim of this study was to report the outcome of a 9 years old girl with diagnosed juvenile ossifying fibroma treatment.MethodsA 9 years old girl presented with a 6 x 8 cm sized hard fixed tumour on right ramus and corpus of the mandible. On the radiological examination tumour showed an irregular but well bordered, unilocular and expansive lesion on the right corpus and ramus of the mandible. There was no teeth displacement or teeth root resorbtion. Microscopically, the tumour had trabeculae, fibrillary osteoid and woven bone. After the clinical, radiological (panoramic radiography, computed tomography and magnetic resonance imaging) and histologic analysis it was diagnosed juvenile ossifying fibroma. In the history of the patient there has been an acute lymphocytic leukaemia in the remission for 3 years.ResultsBecause of large size of mandibular tumour, resultant expansion and destruction of mandibular cortex, the patient underwent right hemimandibulectomy using transmandibular approach. There was no recurrence or complications for two years follow-up.ConclusionsAlthough juvenile ossifying fibroma is an uncommon clinical entity, its aggressive local behaviour and high recurrence rate means that it is important to make an early diagnosis, apply the appropriate treatment and, especially, follow-up the patient over the long-term.

Intraoral Perineurioma, Soft Tissue Type: Report of Five Cases, Including 3 Intraosseous Examples, and Review of the Literature

Soft tissue type perineuriomas (STP) are uncommon tumors, oral examples being very rare. They have been described in the mandible, gingiva, lips, retrotonsillar mucosa and maxillary vestibule. Herein, we report the clinicopathologic features of five STP, two affecting the buccal mucosa and three the mandible. Three patients were women and two men. All tumors were characterized by a proliferation of cytologically bland, mitotically inactive spindled cells with round, ovoid or spindled nuclei, embedded in a variably collagenous and myxoid matrix. Interestingly, two mandibular tumors featured psammoma bodies and one, in addition, contained irregular calcifications. Tumor cells showed the immunohistochemical profile of perineurial cells including epithelial membrane antigen, Glut-1, claudin-1 and collagen type IV. S100 and neurofilament proteins were not expressed by the tumor cells. A few minute, peripherally situated, entrapped nerves were identified. All tumors were reported gross-totally excised and no recurrences have taken place. The clinical characteristics of STP are summarized and its differential diagnosis relative to other spindle cells tumors and meningioma is discussed.

Mandibular Rim Excision in Seven Dogs

To describe a surgical technique for excision of minimally invasive mandibular tumors at the level of the premolar and molar teeth, and report outcome in 7 dogs that had mandibular rim excision. Case series. Dogs (n=7) with a mandibular tumor at the level of the premolar and molar teeth. Using an intraoral approach to the mandible, buccal, and lingual mucosal incisions are made to obtain a 10 mm clean margin beyond neoplastic tissue. After subperiosteal soft tissue elevation, a curvilinear rim mandibulectomy is performed, leaving the mandibular canal and ventral cortex intact, followed by osteoplasty. The remaining attached gingiva and alveolar mucosa are sutured over the bony defect. Seven dogs were treated (1997-2008) for odontogenic and early malignant neoplasms involving the mandible by mandibular rim excision. All dogs had healed, healthy gingival covering over the surgical defect, very good postoperative function, and good quality of life. Mandibular rim excision, with preservation of the ventral cortex and mandibular canal content, can be a good option for treatment of early odontogenic and malignant lesions of the mandible in medium to large breed dogs. In medium to large dogs with minimally invasive mandibular neoplasia, mandibular rim excision should be considered as a viable surgical option.

Acute Myeloid Leukaemia Diagnosed by Intra-Oral Myeloid Sarcoma. A Case Report

Myeloid sarcoma (MS) is a rare extramedullary malignant tumor composed of immature myeloid cells. It is strongly associated with a well known or covert acute myeloid leukaemia, chronic myeloproliferative diseases or myelodysplastic syndromes. Intraoral MS scarcely occurs. An unusual case of acute myeloid leukaemia, which was diagnosed by mandibular MS that was developed in the alveolar socket after a dental extraction, is reported. The histological examination (including immunohistochemical analysis) of a subsequent biopsy showed infiltration of the oral mucosa by neoplastic cells. This lesion was therefore classified as acute myeloid leukaemia. The patient was referred to oncologists that confirmed the initial diagnosis. The patient underwent chemotherapy and the mandibular tumor disappeared. Forty days later, a relapse of the disease, which appeared as a great-ulcerated lesion, was developed in the hard palate. Thirty days after the second chemotherapy had finished, a new intraoral tumor was developed in the vestibular maxillary gingiva. Review of the literature shows no report of intraoral relapse and particularly multiple relapse of a MS that involves the oral cavity. Even though MS is encountered infrequently in the oral cavity, it should be considered in the differential diagnosis of conditions (especially tumors) with a similar clinical appearance.

“An exophytic mandibular brown tumor”: an unusual presentation of primary hyperparathyroidism

A case of 35-year-old male patient with previously undiagnosed primary hyperparathyroidism who presented with an atypical exophytic mandibular swelling is reported. The aim is to alert the clinicians to include this entity although extremely rare, in the differential diagnosis of swellings in the maxillofacial region and to highlight another remarkable aspect in the multitude of presentations associated with primary hyperparathyroidism especially in the setting of normocalcemia.

Primary Hyperparathyroidism Presenting as a Palatal and Mandibular Brown Tumor

Primary hyperparathyroidism is a fairly frequent pathologic diagnosis characterized by hypersecretion of parathyroid hormone, which results from adenomas in 80% to 85% of all cases. At clinical onset, the most common symptoms are hypercalcemia-related and some of them are pain due to kidney stones, polyuria, gastrointestinal, and neurologic disorders, whereas rarer symptoms are due to brown tumors and expansive lesions often found in fibrocystic osteitis. Brown tumors represent the terminal stage of the remodeling processes caused by an increased osteoclastic activity and fibroblastic proliferation during primary or secondary, albeit more seldom, hyperparathyroidism. The manifestation of primary hyperparathyroidism as skeletal disease has nearly disappeared in the last 2 decades. Cases are now most often diagnosed by the coincidental finding of asymptomatic hypercalcemia. Advanced screening techniques have made clinical evidence of bone disease rare. This article contains a case of brown tumor on the maxilla, palate, and mandible in addition to nephrectomy and proximal femur fracture, which are probably associated with primary hyperparathyroidism although less common nowadays. The diagnosis was suggested by the clinical history and confirmed by biochemical, radiologic, and histopathologic evidence. Excision of a parathyroid adenoma normalization of the metabolic status was then realized.

Mandibular Virtual Reconstruction Surgery Guided by Mimics

Aiming at a clinical case of a 52-year-old male patient, the patient’s mandible will be 3 Dimensional (3D) reconstructed and the surgery will be planed. This patient who suffered from mandibular tumor needed to undergo surgery. This study used a Toshiba 64-row Spiral CT to scan patient’s maxilla and mandible. 368 layers consecutive maxillary and mandibular CT images which scanning slice thickness is 1mm were obtained. The original images which format were DICOM were import to Mimics. After decided the bone threshold value the contour lines of every layers were extracted. Every image was passed the processing steps of edge division, selective editing, filling holes, wiping off redundant data and 3D reconstruction. After these steps the 3D geometric model of maxilla and mandible was obtained. The dimension of mandibular tumor and accurate location of the removal part were determined. These steps provide accurate original data for the manufacture of mandibular Rapid Prototyping (RP) model.

Poster 24: Inferior Alveolar Nerve Preservation During Mandibular Benign Tumors Treatment—A Neurosensory Disturbance Evaluation

Statement of the Problem: The inferior alveolar nerve (IAN) is commonly resected during the surgical treatment of mandibular benign tumors. The current study evaluated the neurosensory disturbance in 6 patients who underwent mandibular resection with IAN preservation.

Endoscopically-assisted removal of large mandibular keratocystic odontogenic tumour: minimally invasive approach

Endoscopically-assisted removal of large mandibular keratocystic odontogenic tumour: minimally invasive approach

Epstein-Barr Virus–Associated Lymphoepithelioma-like Carcinoma of Mandible

We describe the first case of an lymphoepithelioma-like carcinoma (LEC) of the mandible with a view to discuss probable histogenesis from salivary gland inclusions in the mandible, effective therapy, the unusual pattern of nodal metastases, and association with the Epstein-Barr virus. An 11-year-old boy presented with a lytic lesion in the left mandible and bilateral neck node enlargement. Histologically, the biopsied metastatic neck nodes showed sinusoids distended with histiocytes and single large atypical cells that mimicked Hodgkin lymphoma. The mandibular tumor on biopsy showed morphology similar to an undifferentiated carcinoma or LEC of nasopharynx with nuclear Epstein-Barr virus-associated in situ hybridization signals. The patient received ifosfamide, cisplatin, and etoposide chemotherapy followed by a hemimandibulectomy, which did not reveal any residual tumor. Postoperative radiotherapy was completed, and 3 years later the patient is alive and free of disease.

Mandibular reconstruction after resection of benign tumours using non‐vascularised methods in a series of patients that did not undergo radiotherapy

AbstractAim: A case series analysis of 52 consequent subjects of immediate mandibular reconstruction after tumour resection using non‐vascularised methods, undertaken at U.P. King George's University of Dental Sciences and King George's Medical University, is being reported. To assess the success of reconstruction on subjective and objective evaluation based upon Mandibular Reconstruction Assessment Scale (MRAS) questionnaire.Methods: Patients with benign mandibular tumours irrespective of age, sex, site and socio‐economic status were included. Primary reconstruction was carried out after resection in two surgical units on surgeon's choice using stainless steel wire (6/52; 12%), stainless steel reconstruction plate (10/52; 19%) or titanium reconstruction plate (36/52; 69%) without bone graft (23/52; 44%) or with bone graft (29/52; 56%). Bone grafts were harvested from iliac crest (21/52; 40%), rib (2/52; 4%) and an additional pectoralis major myocutaneous flap with iliac crest bone graft (6/52; 12%) to provide cover to the reconstruction plate was also used.Results: The primary outcome measurements were wound healing, mouth opening, chewing efficiency, jaw movements, cosmetic achievement and speech on a five‐point scale, all of which improved significantly after surgery. The overall complication rate was 17%. Three patients (6%) had loosening of the screw, two (4%) showed dehiscence of the plate, two (4%) showed tumour recurrence and one (2%) had infection of the graft that was subsequently removed.Conclusion: Titanium reconstruction plates with iliac crest graft provided good result in the absence of microvascular reconstruction because of unavailable long operating time and lack of expertise. Long‐term satisfactory rehabilitation can be achieved using removable dentures or prosthesis on dental implants on the contraption provided by the non‐vascularised tissue despite non‐calcified bone visible on the skiagram.

Crescentic osteotomy for resection of oral tumours in four do

Rim resection of mandibular tumours and a simplified technique using a biradial osteotomy blade for maxillary tumours in dogs has not previously been described. The medical records and radiographs of dogs with mandibular (n = 3) or maxillary (n = 1) tumours resected using crescentic osteotomies were reviewed. The owners of two of the dogs reported excellent outcomes without any long-term complications or tumour recurrence. The goal of this study was to describe the surgical technique for performing a crescentic osteotomy for resection of maxillary and mandibular tumours. This technique for resection of mandibular and maxillary tumours is clinically applicable in carefully selected cases.

Hiperparatiroidismo primario en el adolescente: Caso clínico

We report a 13 year-old mate with a history of multiple fractures and kidney stones. The laboratory showed a hypercalcemia of 11.5 mg/dl, a PTH of 112.6 pg/ml and 24 hour urinary calcium of 571 mg. Bone densitometry showed spine and femur Z scores of -2.9 and -1.6, respectively, kidney ultrasound showed nephrocalcinosis and a MIBI-SPECT scintigram showed a higher uptake in the right lower parathyroid gland. The diagnosis of primary hyperparathyroidism was made and the patient was operated, excising the right lower parathyroid gland. After surgery, serum calcium and PTH levels returned to normal values. In children, the proportion of cases with parathyroid hyperplasia is higher than in adults. Therefore, during surgery all four parathyroid glands must be explored. There is also a higher frequency of ectopic adenomas. Family history must be explored to discard the presence of a multiple endocrine neoplasia (MEN I or II), a familial hyperparathyroidism or a syndrome of primary hyperparathyroidism associated to mandibular tumor.

Long‐term results of mandibular reconstruction with autogenous bone grafts and oral implants after tumor resection

(a) To evaluate retrospectively the clinical outcome of non-vascularized bone grafts used for the reconstruction of mandibular defects following tumor resection; (b) to evaluate the clinical outcome of implants and implant-supported prostheses placed in the reconstructed areas; and (c) to evaluate patients' satisfaction regarding function and esthetics after oral rehabilitation. In a 9-year period (1995-2003), 29 patients affected by mandibular tumors involving to tooth bearing areas were treated by means of tumor resection and immediate or delayed reconstruction with autogenous non-revascularized calvarial or iliac bone grafts. Among these patients, 16 patients were selected for dental rehabilitation of the lost dentition with implant-supported 3fixed prosthese333s. For to 7 months later, the patients received 60 oral implants for the prosthetic rehabilitation of the reconstructed edentulous areas. No total failure of the graft was observed, while partial loss of the graft was observed in one patient. The mean follow-up of patients after the start of prosthetic loading of implants treated was 94 months (range: 36-132 months). Two patients dropped out of the follow-up after 3 and 4 years of observation, respectively. Two implants were removed due to loss of osseointegration, while two implants, although still integrated, presented peri-implant bone resorption values higher than those proposed by Albrektsson et al. for successful implants. Cumulative survival and success rates of implants were 96.7% and 93.3%, respectively. Results from this study demonstrated that bone defects following resection of mandibular tumors can be predictably reconstructed with autogenous bone grafts taken from the calvarium or the anterior iliac crest. It has also been shown that the long-term survival and success rates of implants placed in the reconstructed areas (96.7% and 93.3%, respectively) may guarantee an excellent prognosis of implant-supported prostheses.

The minority report—our experience with paediatric jaw tumours

The aim of this paper is to investigate the distribution of paediatric odontogenic and non-odontogenic tumours involving the jaws as per to age, sex, biological behaviour, histopathological spectrum and site, as well as to evaluate treatment modalities and long-term follow-up outcomes. Our study was performed with a retrospective analysis of 66 patients aged 15 years and below with maxillary and mandibular tumours treated in the Department of Oral and Maxillofacial surgery, Nair Hospital & Dental College, Mumbai from 1996 to 2007. Tumoural formations were grouped under three main headings: odontogenic, benign non-odontogenic and malignant non-odontogenic. Distributions according to age and sex, as well as histopathologic spectrum and location, were determined for each lesion. Mean age at diagnosis was calculated. Incidence of a particular lesion in the pediatric group was compared to that in adults. Finally, the treatment modalities and long-term follow-up outcomes were assessed. We found that paediatric jaw tumours were mostly observed in the 11–15 age group and more commonly affected the mandible. Mixed tumours were the most common type of the odontogenic tumours and mesenchymal tumours were the most common non-odontogenic tumours. Overall, benign non-odontogenic tumours were most frequently observed.

Repeated distraction osteogenesis for excessive vertical alveolar augmentation: a case report

In this article, a procedure involving 2-stage alveolar distraction osteogenesis using eccentric distraction devices for the augmentation of resorbed transplanted iliac bone following mandibular tumor resection is presented. A 6-month consolidation period was allowed between the first and second distractions, and endosseous implants were placed 4 months after the second distraction. Computerized tomographic images obtained before the implantation revealed that, 10 months after the first distraction, the bone generated still showed lower density compared with the basal bone, but the bone from both distractions showed enough maturity for implantation. It may be concluded that 2-stage alveolar distraction osteogenesis can be a useful and safe procedure for excessive alveolar lengthening if a sufficiently long consolidation period is allowed.