Maxillary Vestibule Research Articles

Prognostic factors of oral squamous cell carcinoma: the importance of recurrence and pTNM stage

BackgroundOral squamous cell carcinoma has a poor prognosis. Therefore, prognostic factors are important to increase the survival rate. This study assessed the survival rate and the prognostic factors for survival of patients with oral squamous cell carcinoma.MethodThis study included 168 patients who underwent surgery for oral squamous cell carcinoma between January 2006 and December 2021. The survival rate was analyzed with overall survival and disease-specific survival. The patient’s age, sex, pTNM stage, primary sites (lip, tongue, mouth of floor, mandibular gingiva, maxillary gingiva, mandibular vestibule, maxillary vestibule, retromolar trigone, palate, buccal mucosa, primary intra-osseous site), smoking and alcohol drinking habits, depth of invasion, perineural and lymphovascular invasion, cell differentiation, and postoperative radiotherapy were evaluated to analyze risk factors. Kaplan–Meier methods were used to estimate the survival rates. Cox regression methods were used to investigate the main independent predictors of survival in univariable and multivariable analysis.ResultsSixty-eight patients died of oral squamous cell carcinoma during follow-up periods. Their overall survival for 5 years was 51.2%, and the disease-specific survival was 59.2%. In univariable analysis, seven factors which are neck metastasis, depth of invasion, cell differentiation, lymphovascular invasion, postoperative radiotherapy, pTNM stage, and recurrence were significantly associated with survival. In multivariable analysis, pTNM stage and recurrence were significantly associated with survival.ConclusionIn patients with oral squamous cell carcinoma, pTNM stage and recurrence were significant prognostic factors. Neck metastasis, depth of invasion, cell differentiation, lymphovascular invasion, and postoperative radiotherapy were also prognostic factors. These factors serve as markers for obtaining prognosis information in oral squamous cell carcinoma.

ORAL REHABILITATION IN A TOTAL EDENTULOUS PATIENT WITH INFLAMMATORY FIBROUS HYPERPLASIA: case report

Inflammatory fibrous hyperplasia or fissured epulis is a very common lesion in patients who use maladapted removable prostheses. It consists of a connective tissue overgrowth as a response to constant trauma in a specific area. Clinically, it is presented as an exophytic process or a well-defined elevation. It is generally, sessile-based and asymptomatic. Its consistency varies from firm to flaccid, with smooth surface or occasionally ulcerated, and its color is similar to the adjacent mucosa or erythematous. The most recommended treatment is surgical removal, however there are other methods such as cryotherapy, micro-abrasion and laser therapy. The aim of this work is to describe the stages of diagnosis and treatment, from the surgical technique for removing inflammatory fibrous hyperplasia to the patient's rehabilitation, with new prostheses. This is a case report of a 79-year-old female patient who attended the clinic at Faculdade Patos de Minas (FPM) reporting dissatisfaction with the loss of lip support and the aesthetics of her complete denture prosthetics. During the clinical examination, a nodular tissue growth was identified in the bottom region of the anterior maxillary vestibule’s sac. As a proposed treatment, an excisional biopsy was performed, confirming the diagnosis of inflammatory fibrous hyperplasia through histopathological analysis. After healing, new prostheses were produced, intending to meet the patient's requirements. The present study is expected to emphasize the importance of a thorough clinical examination, so that all changes in the patient are identified and, when necessary, perform a biopsy and histopathological analysis. In summary, it is essential to adjust or produce new prosthetic parts to prevent tissue trauma or cause negative consequences. The patient's postoperative period was uneventful, with favorable healing, and after the new prosthetic devices were put in place, function and aesthetics were restored.

Rhabdomyoma of the Oral Cavity Mimicking Reactive Lesions: A Case Report and Review of the Literature.

Extracardiac rhabdomyoma is a tumor that rarely occurs in head and neck region. Adult and fetal types of extracardiac rhabdomyoma are diagnosed only by histopathological examination. In the oral cavity, this lesion usually affects the mouth floor and tongue. Despite the low incidence, adult rhabdomyoma should be considered in the differential diagnosis of oral cavity lesions, and histopathological evaluation might be helpful for the final diagnosis. This study aims to report a rare case of rhabdomyoma mimicking reactive lesions and review the literature. A 34-year-old male was referred to the pathology department with a yellowish sessile lesion in the labial maxillary vestibule. During an excisional biopsy, a mass of unencapsulated soft tissue beneath the vestibular mucosa was observed. The yellowish color in clinical features has led to lipoma as the initial clinical diagnosis. The histological examination exhibited an encapsulated, well-circumscribed benign neoplasm composed of multiple lobules of large polygonal cells with prominent abundant granular eosinophilic cytoplasm. No cellular atypia was observed. Diagnosis of the adult type of rhabdomyoma was made by collective agreement. Rhabdomyoma can be mistaken for other reactive lesions and may resemble their appearance.

The Transoral Alar Batten Graft: A Functional Rhinoplasty Technique for the Orthognathic Jaw Surgery Patient.

Many patients seeking orthognathic jaw surgery also experience nasal obstruction. Current transoral functional rhinoplasty techniques include septoplasty and inferior turbinate reduction, which are performed through the mouth after maxillary downfracture. Although powerful, these interventions do not treat dynamic nasal sidewall collapse. The authors describe a novel transoral alar batten graft. Using the maxillary vestibular approach, septal cartilage is harvested and delivered from the maxillary vestibule into the nasal alar-sidewall junction through a small tunnel. This procedure is simple and versatile, and carries minimal morbidity, enabling the orthognathic jaw surgeon to support the nasal sidewall through a minimal-access approach and improve the patient's nasal function and airway.

DENTIGEROUS CYST IN THE MAXILLARY SINUS DERIVED FROM AN MAXILLARY THIRD MOLAR: CASE REPORT

Dentigerous cysts are considered the most common developmental odontogenic cyst. They are often asymptomatic and are discovered on control radiographs during the investigation of delayed eruption of a retained tooth. On image examination, it is possible to observe a radiolucent and circumscribed image around the crown, which can cause tooth displacement. The aim of this work is to report the clinical case of a dentigerous cyst affecting the left maxillary sinus in an 18-year-old female patient with the main complaints of headache and spontaneous drainage of purulent secretion. During extraoral examination it was possible to observe an enlargement in the left malar region associated with soft tissue expansion at the depth of the maxillary vestibule. Aspiration puncture was performed, positive for serosanguinolent secretion, and the patient underwent a surgical approach under general anesthesia. The enucleated piece was sent to anatomopathologic study and the result was conclusive for dentigerous cyst.

ECTOMESENCHYMAL CHONDROMYXOID TUMOR WITH HIGH-GRADE TRANSFORMATION

<h3>Introduction</h3> Ectomesenchymal chondromyxoid tumor (ECT) is a rare neoplasm that has traditionally been considered limited to the tongue and thought to follow a benign clinical course. Recently these tumors have been found to be characterized by a recurrent fusion gene (<i>RREB1</i>-<i>MRTFB</i>[formerly<i>MKL2]</i>). This same product has been observed in a subset of mediastinal mesenchymal tumors and a single case of a biphenotypic oropharyngeal sarcoma, raising the possibility of a shared pathogenesis. Herein we report a case of ECT, that was confirmed to harbor the <i>RREB1-MRTFB</i> fusion product, which was found to show progression to a poorly differentiated malignancy. <h3>Materials and Methods</h3> An otherwise healthy 5-year-old girl presented with an asymptomatic mass of unknown duration, which was situated in the anterior maxillary vestibule extending to the lip. Axial MRI showed a hyperintensive and heterogeneous mass with peripheral enhancement. <h3>Results</h3> An incisional biopsy was performed showing a tumor with morphologic and immunophenotypic features consistent with ECT. RNA sequencing was performed which confirmed the presence of a<i>RREB1</i>-<i>MRTFB</i>fusion product.The patient was subsequently referred for surgical resection. In addition to showing areas of conventional ECT this also revealed transition to highly cellular neoplasm characterized by sheets and nests of round-rhabdoid cells with brisk mitotic activity, bone involvement and lymphovascular invasion. Immunohistochemistry on this component was similar, suggesting high-grade progression rather than dedifferentiation. <h3>Conclusions</h3> This case adds to the recent literature expanding the anatomic distribution and morphology of ECT. More importantly, this is the first molecularly confirmed report showing progression from a conventional ECT to a high-grade neoplasm. It remains unclear whether overt dedifferentiation is likewise possible. This case suggests complete excision of ECT, to evaluate these tumors in their entity and exclude a high-grade component, is warranted. More detailed molecular studies, including management of tumors with malignant histologic attributes, are necessary.

Adenomatoid odontogenic tumor: Case report

The adenomatoid odontogenic tumor is a benign epithelial pathology that comprises 3 to 7% of odontogenic tumors. It has the characteristic of slow and progressive growth and almost no symptoms, being more frequent in women especially in the first two decades of life. Also, the anterior region of the maxilla is the anatomical location mostly affected. A white female patient, 16 years old, presented absence of the canine, first, and second maxillary premolars on the right side, prolonged retention of the right upper deciduous second molar, volumetric increase in the buccal and palatal alveolar ridge with extension to the bottom of the right maxillary vestibule, being diagnosed after the incisional biopsy as an adenomatoid odontogenic tumor. Considering the clinical and radiographic examination, it was decided to perform decompression of the lesion before performing enucleation and curettage.

Revisiting the vascularity of the keratinized gingiva in the maxillary esthetic zone

BackgroundThe active arterial-to-arterial collaterals are a significant factor in the prevention of ischemia and extensive tissue necrosis in the case of arterial blockage of various tissues. The present study investigates the mucogingival vasculature in the maxillary esthetic zone mucosa in human cadavers and functionally evaluates the area, which is supplied by the terminal arterioles, on the individual level.MethodsIn the human cadaver study, macroscopic arterial analyses of the anterior maxillary vestibule in 7 specimens were scrutinized by latex milk injection. The tracks of the mucosal branches in relation to the mucogingival junction were investigated. In the functional study, individual gingival blood flow (GBF) changes were measured by laser speckle contrast imaging (LSCI) in 31 young subjects with healthy gingiva before and during 30-s compressions. This was conducted with a ball-shaped condenser. The data was analyzed by the linear mixed model.ResultsThe vertically aligned branches of the superior labial artery (SLA) divided into small, slightly deviating sub-branches near the mucogingival junction. These arteries created collateral plexuses and supplied the attached gingiva. The compression of these branches resulted in ischemia coronally with significant individual variation. The ischemia was either apico-mesial, apico-distal, or straight apical to the compression. A significant correlation was found between the ischemic area and the magnitude of the decrease in GBF (r = 0.81, p < 0.001). In males, 77% of the subjects, and 50% of the female subjects had an ischemic response in either region. The horizontal extension of the ischemic area ranged between 0.26 mm and 8.76 mm. Males had significantly higher baseline GBF and larger ischemia than females. At the base of the papilla, significant restoration of GBF was observed during compression in males, but not in females.ConclusionThe arcade anastomoses formed by the small arteries in the keratinized gingiva of the upper esthetic zone explain the consequences of vertical incisions. The considerable individual variations in ischemic responses might be the reason for unexpected surgical outcomes in some cases. Furthermore, there is increasing evidence that men have different vascular reactivity and/or regulation of collateral circulation than women, which may affect wound healing.

LARGE SCHWANNOMA IN THE MIDDLE THIRD OF THE FACE: A CASE REPORT

The patient presented at the buccomaxillofacial surgery department, reporting that 8 months earlier he had noticed a slow growing and asymptomatic lump on the face. At the extra-oral physical examination, the increase in volume in the left zygomatic, infraorbital, and paranasal area was observed. The intra-oral examination showed hardened consistency tumor, which was painless to the touch, in the area of the hard palate and maxillary vestibule bottom, with normal-colored mucous membranes. At the tomographic exam, the presence was observed of a mixed image of approximately 8 cm in its largest diameter, with defined boundaries, located in the left middle third of the face. An incisional biopsy was carried out, in which the histopathologic analysis was schwannoma. Therefore, the proposed treatment was the aggressive excision of the lesion. The patient has been in the second postoperative year now, showing good evolution without any sign of recurrence.

Utility of decellularised urinary bladder extracellular matrix in full mucosalisation of a post-oncological maxillectomy defect.

This report highlights the utility of MatriStem Surgical Matrix Thick UBM™ (rebranded as Gentrix® ACell, Inc), a decellularised urinary bladder extracellular matrix in the reconstruction of a post-oncological maxillectomy defect. In utilising this biological construct to serve as a biological dressing, our patient underwent complete mucosalisation of his surgical site without the development of an oroantral fistula and with adequate maxillary vestibule to allow for definitive oral rehabilitation with a removable partial denture.

Vascular survey of the maxillary vestibule and gingiva\u2014clinical impact on incision and flap design in periodontal and implant surgeries

ObjectivesCurrently, empirical clinical findings on the blood supply of the maxillary vestibule are not backed up with sufficient literature. The purpose of this study was to investigate the mucosal and periosteal vascular supply in the maxillary vestibule macroscopically and radiographically to improve surgical strategies and flap designs.Materials and methodsThirty head corpses were selected (9 dentate, 11 partially edentulous, 10 edentulous). Twenty-six corpses were injected by red latex milk and embalmed with Thiel solution. Four cadavers were prepared for corrosion casting. Arterial path and anastomoses in the maxillary vestibule of dentate, partially edentulous and edentulous ridges, were analyzed macroscopically and by computed tomography (CT).ResultsTransverse periosteomucosal anastomoses were detected in the posterior and esthetic zones of the maxillary vestibule. The buccal branches penetrated the interdental septum toward the palate. In the esthetic zone, superior labial artery (SLA) supplied the mucosa and the infraorbital artery (IOA) supplied the periosteum. Corrosion casting showed anastomoses between IOA and nasal septal branches. CT analysis revealed ipsilateral and contralateral anastomoses between SLA and IOA. In dentate ridges, mucosal star-shaped terminal branches were detected.ConclusionsThe macroscopic and radiographic vascular survey analysis revealed the anatomical background behind several clinically documented phenomena related to oral and periodontal surgeries.Clinical relevanceThis study permits clinicians to design less invasive flaps when releasing incisions in the maxillary vestibule during periodontal and implant surgeries. Our observations strongly point to the significance of an undamaged periosteum to prevent compromised flap revascularization and wound healing disturbances.

EPITHELIOID RHABDOMYOSARCOMA OF THE ORAL CAVITY, NOVEL LOCATION OF A RARE ENTITY: A CASE REPORT

<h3>Background</h3> Rhabdomyosarcoma, a malignant neoplasm, is characterized by skeletal muscle differentiation. Only 33 cases of the epithelioid variant have been reported, and just 8 of them were located in the head and neck region. This aggressive entity usually presents as a fast-growing, asymptomatic infiltrative mass and presents predominantly in adults. A 53-year-old male, who was edentulous and a former smoker, presented with enlargement of 2 months' duration in the right maxillary vestibule. A clinically palpable mass was noted under the mucosa. No adenopathy or cranial nerves deficit was observed on physical examination. The initial panoramic radiograph showed a corticated radiolucent entity located on the right maxilla, with extension into the right maxillary sinus. Multidetector computed tomography (MDCT) and positron emission tomography/computed tomography (PET/CT) were performed. CT revealed an enhancing soft tissue mass of the right alveolar ridge with extension to the maxillary sinus, with erosion of the anterior and lateral walls of the sinus and the adjacent alveolar ridge. PET/CT showed a right maxillary fluorodeoxyglucose (FDG) high uptake and right neck level IIA lymph nodes with mild uptake. An incisional biopsy was performed. The histologic appearance and immunohistochemical profile supported a diagnosis of high-grade epithelioid rhabdomyosarcoma. The treatment protocol was right maxillectomy and right neck dissection with coadjuvant radiation therapy. After 1.5 years, follow-up CT was performed and did not show any signs of recurrence or metastatic disease. <h3>Discussion/Conclusions</h3> Epithelioid rhabdomyosarcoma is a rare variant of rhabdomyosarcoma. To the best of our knowledge, none has been reported in the oral cavity region; thus, this is the first case of this aggressive variant described in this location. This entity may develop without any apparent symptoms or signs of a malignant entity, thus mimicking the appearance of a benign neoplasm or inflammatory process. A comprehensive multidisciplinary approach is advised to diagnose and treat this entity accordingly.

DUDAĞIN YENIDEN KONUMLANDIRILMASI VE GINGIVEKTOMI YAPILARAK GUMMY SMILE TEDAVISI BIR OLGU SUNUMU (GUMMY SMILE)

Excessive gingival display can be managed by variety of treatment modalities, depending on specific diagnosis. This case report demonstrates the successful management of excessive gingival display with a lip-repositioning and gingivectomy. A female patient aged 26 years reported with a chief complaint of gummy smile and was treated with this technique performed under local anesthesia with the main objective to reduce gummy smile by limiting the retraction of elevator muscles (e.g., zygomaticus minor, levator anguli, orbicularis oris, and levator labii superioris). The technique is fulfilled by removing a strip of mucosa from maxillary vestibule and creating a partial thickness flap between mucogingival junction and upperlip musculature, and suturing the lip mucosa with mucogingival junction, resulting in a narrow vestibule and restricted muscle pull, thereby reducing gingival display

Management of excessive gingival display: Lip repositioning technique

The lips form the frame of a smile and define the esthetic zone. Excessive gingival display during smile is often referred to as gummy smile. A successful management of excessive gingival display with lip repositioning procedure has shown excellent results. The procedure involves removing a strip of partial thickness mucosa from maxillary vestibule, then suturing it back to the lip mucosa at the level of mucogingival junction. This technique results in restricted muscle pull and a narrow vestibule, thereby reducing the gingival display. In this case gummy smile was treated by modification of Rubinstein and Kostianovsky's surgical lip repositioning technique which resulted in a harmonious smile.

Mastication Dyspraxia: A Neurodevelopmental Disorder Reflecting Disruption of the Cerebellocerebral Network Involved in Planned Actions

This paper reports the longitudinal clinical, neurocognitive, and neuroradiological findings in an adolescent patient with nonprogressive motor and cognitive disturbances consistent with a diagnosis of developmental coordination disorder (DCD). In addition to prototypical DCD, the development of mastication was severely impaired, while no evidence of swallowing apraxia, dysphagia, sensorimotor disturbances, abnormal tone, or impaired general cognition was found. He suffered from bronchopulmonary dysplasia and was ventilated as a newborn for 1.5 months. At the age of 3 months, a ventriculoperitoneal shunt was surgically installed because of obstructive hydrocephalus secondary to perinatal intraventricular bleeding. At the age of 5 years, the patient's attempts to masticate were characterized by rough, effortful, and laborious biting movements confined to the vertical plane. Solid food particles had a tendency to get struck in his mouth and there was constant spillage. As a substitute for mastication, he moved the unground food with his fingers in a lateral direction to the mandibular and maxillary vestibule to externally manipulate and squeeze the food between cheek and teeth with the palm of his hand. Once the food was sufficiently soft, the bolus was correctly transported by the tongue in posterior direction and normal deglutition took place. Repeat magnetic resonance imaging (MRI) during follow-up disclosed mild structural abnormalities as the sequelae of the perinatal intraventricular bleeding, but this could not explain impaired mastication behavior. Quantified Tc-99m-ethylcysteinate dimer single-photon emission computed tomography (Tc-99m-ECD SPECT), however, revealed decreased perfusion in the left cerebellar hemisphere, as well as in both inferior lateral frontal regions, both motor cortices, and the right anterior and lateral temporal areas. Anatomoclinical findings in this patient with DCD not only indicate that the functional integrity of the cerebellocerebral network is crucially important in the planning and execution of skilled actions, but also seem to show for the first time that mastication deficits may be of true apraxic origin. As a result, it is hypothesized that "mastication dyspraxia" may have to be considered as a distinct nosological entity within the group of the developmental dyspraxias following a disruption of the cerebellocerebral network involved in planned actions.

Applicability of buccal fat pad grafting for oral reconstruction

This study evaluated the applicability of pedicled buccal fat pad grafting for the reconstruction of defects surgically created during oral surgery. A buccal fat pad graft was applied in 23 patients (5 males, 18 females; mean age 68.3 years) between 2003 and 2011. The graft was used to cover surgical defects of the palate, maxilla, upper gingiva, buccal mucosa, lower gingiva, oral floor, and temporomandibular joint region. Size of the surgical defects ranged from 15mm×12mm to 30mm×40mm; size of the buccal fat pad ranged from 15mm×12mm to 43mm×38mm. A pedicled buccal fat pad was prepared by incising the maxillary vestibule following primary surgery, and the surrounding connective tissue was preserved to supply nutrition to the pedicle during surgery. The buccal fat pad was placed on the raw surface of soft tissue or bone surface and sutured to the surrounding tissue of the defect. Complete epithelialization was observed within 4 weeks postoperatively. There were no complications or functional disorders during follow-up. Buccal fat pad grafting appears to be feasible for the reconstruction of surgically induced defects, and can be extended to the palate, mandible, mouth angle, and temporomandibular joint region.

Rare case of superolateral dislocation of the condyle

Dislocation of the mandibular condyle occurs most commonly in the anterior direction. When there is an intracranial displacement of the condyle, it is often associated with CSF leak. Superolateral dislocation of the condyle from the glenoid fossa is a rare condition which commonly occurs following traumatic insult to the mandible. When there is a superlolateral displacement, the condyle is often lodged in the temporal fossa. We report an unusual case of a 50-year-old male with a superolateral dislocation of the left mandibular condyle into the zygomatic arch along with a fracture of the right mandible following road traffic accident. Manual reduction of the condyle was first attempted under general anaesthesia which was futile, following which the displaced condyle was reduced by a combination of open traction and manual reduction using Keen's approach in left maxillary vestibule. After reduction of the condyle, intermaxillary fixation (IMF) was done and X plate was used to fix the mandible fracture on the right body. Postoperatively, patient was placed on IMF for a period of 2 weeks. Superolateral dislocations of the condyle can be unilateral or bilateral. These types of dislocations generally occur following traumatic injury to the mandible when the mouth is open. Early diagnosis and reduction of the condyle is required to achieve satisfactory occlusion which should be followed by physiotherapy to prevent ankylosis.

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.

Extramammary Paget’s Disease of the Floor of Mouth Associated With Minor Salivary Gland Carcinoma and Concurrent Invasive Squamous Cell Carcinoma

fibrillary acidic protein, vimentin, epithelial membrane antigen, actin, and desmin, supporting myoepithelial differentiation. Subsequently, a wide local excision was performed, and the defect was reconstructed with a bone graft and a fixed dental prosthesis. The tumor recurred after 10 years, presenting as a 1-cm mass expanding into the maxillary labial vestibule, beneath the nasal ala. A second wide local resection was performed, and the defect was reconstructed with an obturator. Eleven years after the initial presentation of the tumor, the patient is alive without evidence of disease. This tumor represents the unusual occurrence of an intraosseous salivary gland neoplasm, apparently arising from salivary tissue within the incisive canal.

Primary non-Hodgkin’s lymphoma of the mandibular gingiva with maxillary gingival recurrence

Primary (extranodal) non-Hodgkin’s lymphoma (NHL) of the oral cavity is relatively rare. We report a case of NHL involving the left anterior mandibular gingiva of a 56-year-old man. He was initially treated with antibiotics and root canal therapy of the lower lateral incisor as there was a history of trauma to this area. The adjacent lateral incisor tested non-vital. However, after 2 weeks of antibiotic therapy the swelling increased in size and an incisional biopsy was performed. A diagnosis of non-Hodgkin’s lymphoma, large-B cell type was rendered. The patient was then referred to medical oncology for staging work-up and treatment. A course of six cycles of CHOP chemotherapy (Cyclophosphamide, Hydroxydoxorubicin, Oncovin, Prednisone) and radiotherapy were scheduled. There was a complete response upon completion of the combined chemotherapy and radiotherapy. One year later, the patient developed a 2 × 2-cm, painless, firm, fixed mass of the left anterior maxillary vestibule. No additional findings were noted clinically. Magnetic resonance imaging (MRI) confirmed the clinical findings and there was no suspicion of disease elsewhere. Pathologic examination revealed non-Hodgkin’s lymphoma, B-cell type. This lesion was identical morphologically and immunophenotypically to the initial mandibular lesion. Complete radiographic staging detected no other sites of disease. The bone marrow was not involved. The lesion rapidly normalized after six cycles of Fludara, Novantrone and Mabthera chemotherapy and one cycle of Cytarabine (Ara-C). Partial remission was achieved, but the patient died of disseminated disease, 12 months after relapse. There was an associated HCV infection, which may have played a role in the fatal outcome.