Retromolar Trigone Region Research Articles

Mutational analysis of BRAFV600E in a case of sialadenoma papilliferum of oral cavity

Abstract This case report presents a rare benign salivary gland tumour called sialadenoma papilliferum. It comprises 3 to 5% of head and neck tumours and about 1% of all minor salivary gland tumours. The focus is on discussing the BRAFV600E mutation analysis and exploring its clinical implications, along with delving into the histopathological differentials. We documented a 73-year-old male, who had a white patch in the left retromolar trigone region for 6 months. The tumour was excised with a clinical diagnosis of verrucous lesion. Microscopic examination revealed exophytic hyperplastic parakeratotic stratified squamous epithelium and endophytic ductal papillary proliferation. The BRAFV600E mutation was present in the patient. Subsequent regular follow-ups were conducted, revealing no recurrence of the condition. This case underscores the pivotal role of BRAFV600E analysis as an invaluable diagnostic tool when confronted with the intricacies of intraoral salivary gland neoplasms.

An unusual case of peripheral osteoma in a young patient

Osteoma is a benign osteogenic neoplasm characterized by gradual growth. Commonly, it manifests in the craniofacial region, marked by the proliferation of compact and/or cancellous bone. Despite its frequent occurrence, peripheral osteoma’s precise etiology and pathogenesis remain unknown. Post-surgical excision recurrence is rare, and malignant transformation has yet to be documented. This study aims to detail an unusual case of an 11-year-old male patient presenting with a solitary peripheral osteoma in the right retromolar trigone region, a previously unreported site. The patient was initially asymptomatic, but after one month, the lesion induced facial asymmetry and discomfort while chewing. Successful surgical intervention resulted in the lesion's removal, and after 1 year of monitoring, no signs of recurrence were observed. This paper also highlights the peripheral osteoma’s clinical, radiographic, surgical, and histopathological features, as well as its differential diagnoses.

Frequency of Cervical Lymph Node Extracapsular Spread in Oral Squamous Cell Carcinoma Patients

Aim: To estimate the frequency of cervical lymph node extracapsular spread in oral squamous cell carcinoma patients. Methodology: This prospective study was conducted in the Department of Oral and Maxillofacial Surgery, The University of Lahore from 1st December 2021 to 30th November 2022 and 50 diagnosed cases of oral squamous cell carcinoma were enrolled. Computed tomography scan was conducted for the diagnosis in addition to the histopathology of the samples. The CT scan images were used for identification of lymph node size, shape, and central necrosis. The frequency of the extracapsular extension of lymph nodes with the central necrosis was correlated with histopathology. Results: The mean age of the patients was 60.5± 11.1 years with 60% of the cases were males and 40% of the cases were females. 36% of those patients were having a history of smoking, 22% were having a history of taking pan, 14% supari & chalia, 8% alcoholics and 6% consuming gutka. The primary tumor site identified through clinical and diagnostic imaging was anterior 2/3rd of tongue in 38% followed by posterior 1/3rd of tongue in 20%, buccal mucosa 14%, mandible and lip each as 10%, maxilla 4%, floor of mouth and retromolar trigone region each as 2%. It was observed that T3 and T4 cases had more ECS than T1 and T2 with a percentage of 20% and 30% respectively. Practical implication: Knowledge of frequency and burden of this disease in Pakistan will assist in generating more efficient management and treatment protocols with early detection strategies of oral squamous cell carcinoma through association analysis and biomarker role of cervical lymph node extracapsular spread. Conclusion: Extracapsular spread is observed more in patients having advanced stage tumor or having advanced grade of oral squamous cell carcinoma. Key words: Extracapsular spread, Oral squamous cell carcinoma, Recurrence, Histopathological examination

A New Simplified Autogenous Sinus Lift Technique.

Oral maxillofacial rehabilitation of the atrophic maxilla with or without pneumatization of the maxillary sinuses routinely presents limited bone availability. This indicates the need for vertical and horizontal bone augmentation. The standard and most used technique is maxillary sinus augmentation using distinct techniques. These techniques may or may not rupture the sinus membrane. Rupture of the sinus membrane increases the risk of acute or chronic contamination of the graft, implant, and maxillary sinus. The surgical procedure for maxillary sinus autograft involves two stages: removal of the autograft and preparation of the bone site for the graft. A third stage is often added to place the osseointegrated implants. This is because it was not possible to do this at the same time as the graft surgery. A new bioactive kinetic screw (BKS) bone implant model is presented that simplifies and effectively performs autogenous grafting, sinus augmentation, and implant fixation in a single step. In the absence of a minimum vertical bone height of 4 mm in the region to be implanted, an additional surgical procedure is performed to harvest bone from the retro-molar trigone region of the mandible to provide additional bone. The feasibility and simplicity of the proposed technique were demonstrated in experimental studies in synthetic maxillary bone and sinus. A digital torque meter was used to measure MIT and MRT during implant insertion and removal. The amount of bone graft was determined by weighing the bone material collected by the new BKS implant. The technique proposed here demonstrated the benefits and limitations of the new BKS implant for maxillary sinus augmentation and installation of dental implants simultaneously.

Prevalence of retromolar foramen in nineteenth century Spanish population.

Among the non-metrical variants of the mandible that have been proven to be a key issue for dental practitioners, the retromolar foramen constitutes one of the most controversial details regarding its prevalence and associated variables. Thus, this study evaluated the prevalence of the retromolar foramen and the variables associated with its presence in a large Spanish collection of human dry mandibles from the nineteenth century. Six hundred Spanish human dry mandibles (1200 sides) belonging to an osteology collection were examined. The presence of teeth, the presence or absence of retromolar foramen, as well as its side, diameter, number, and location were evaluated. Descriptive analysis and analysis of the associations between the variables were performed. The retromolar foramen was observed in 184 mandibles (31%) and was predominantly present unilaterally (60.8%). Most mandibles (54.9%) had a single foramen. The most common location was the retromolar trigone region (84%). On analysis of the association of variables, it was observed a strong association (p < 0.001) between the presence or absence of the foramen and the presence of teeth. Moreover, a significant association was also found between sex vs. presence of teeth (p = 0.033), sex vs. presentation side of the foramen (p = 0.028), sex vs. number of foramina found (p = 0.004), and diameter vs. number of foramina found (p < 0.001). This study reveals that the retromolar foramen showed a high prevalence of 31% in nineteenth century Spaniards and was located primarily in the retromolar trigone, suggesting that dentists should be aware of and consider the relevant findings of this study.

Ewing sarcoma family of tumors of the retromolar trigone

The Ewing sarcoma family of tumors (ESFT) is the second most common primary pediatric tumor. However, ESFT of the retromolar trigone (RMT) is rare and this article reports such a case in a 10-year-old boy who presented with right-sided facial swelling. His computerized tomography (CT) scan revealed a lesion involving the right RMT region with no evidence of distant metastasis. Histopathological examination revealed a poorly differentiated malignant mass and immunohistochemistry confirmed the diagnosis of ESFT with a strong FLI1 positivity. He was started on a high-risk protocol followed by definitive radiation therapy of 54 Gy/30# by intensity-modulated radiation therapy technique. The patient showed complete response to the treatment with positron emission tomography-CT showing no evidence of active disease.

Association between the site of occurrence and pathological TNM staging in oral squamous cell carcinoma

Oral cancer is a worldwide health problem. Risk factors for oral squamous cell carcinoma (OSCC) are tobacco, alcohol, betel nuts, viral infection and dietary habit. The site of occurence of the OSCC differs substantially between different people groups mainly because of variations in the prevalence of risk factors. The prognosis varies based on the site. pTNM is also one of the most useful tools for the prediction of prognosis. Therefore, it is of interest to correlate the pTNM staging with the site of occurrence of the lesion using 36 OSCC case reports. The results revealed 36.11% of the lesion occurred in buccal mucosa. Stage III pTNM was most prevalent in buccal mucosa and tongue and Stage IV pTNM in the retromolar trigone region by significant association with p value &lt; 0.05. Thus, we report that lesions occurring in the Retromolar region, tongue and buccal mucosa need to be given special attention, as they are associated with early metastasis and poor prognosis. Early diagnosis and appropriate treatment protocol will improve the quality of life for the patients.

Double retromolar foramen during an inferior third molar extraction: a rare case report

Objetivo: O objetivo do presente estudo foi relatar a ocorrência de um forame retromolar duplo durante a exodontia de um terceiro molar inferior. Relato de Caso: Um paciente de 20 anos do sexo masculino foi encaminhado à clínica odontológica da Universidade Federal de Alagoas para realizar extração dos terceiros molares do lado esquerdo, por motivos ortodônticos. Um forame retromolar duplo foi identificado perioperativamente durante o descolamento muco-periosteal na região do trígono retromolar, distalmente ao terceiro molar inferior esquerdo, onde houve hemorragia moderada, a qual foi controlada utilizando compressão local com gaze embebida em solução de anestésico local com vasoconstritor. A ocorrência dessa variação da normalidade foi registrada por fotografias. Antes da realização do procedimento, a radiografia panorâmica do paciente sugeria a presença dessa estrutura anatômica. Conclusões: O conhecimento acerca da ocorrência de um forame retromolar duplo apresenta importância clínica para exodontia de terceiros molares inferiores e pode auxiliar o dentista na prevenção e no manejo de acidentes e complicações durante esse procedimento cirúrgico

DIFFERENTIAL DIAGNOSIS OF MANDIBULAR LESION IN PATIENTS WITH BREAST CANCER: CASE REPORT

The reported case is of a 57-year-old female patient with metastatic breast cancer in liver, pleura, and bones treated with eribulin without antiresorptives and sent for assessment of submandibular abscess after extraction of tooth 37 two months before. The examination showed increased volume in the buccal vestibule, retromolar trigone region, and left buccal mucosa without mucosal lesions, palpation hardening, or facial asymmetry. Tomography showed heterogeneous expansive lesion with peripheral enhancement and necrotic center in the left mandibular angle and branch (60 × 49 × 54 mm) with infiltration of the masticatory musculature and osteolysis of the posterior wall of the left maxillary sinus. Incisional biopsy results revealed a poorly differentiated neoplasm, confirming squamous cell carcinoma after an immunohistochemical study. The initial diagnostic hypothesis of bone metastasis was surprisingly challenged by a second primary tumor. Faced with the systemic condition, the patient progressed to palliative care evolving to death less than 2 months after diagnosis. The reported case is of a 57-year-old female patient with metastatic breast cancer in liver, pleura, and bones treated with eribulin without antiresorptives and sent for assessment of submandibular abscess after extraction of tooth 37 two months before. The examination showed increased volume in the buccal vestibule, retromolar trigone region, and left buccal mucosa without mucosal lesions, palpation hardening, or facial asymmetry. Tomography showed heterogeneous expansive lesion with peripheral enhancement and necrotic center in the left mandibular angle and branch (60 × 49 × 54 mm) with infiltration of the masticatory musculature and osteolysis of the posterior wall of the left maxillary sinus. Incisional biopsy results revealed a poorly differentiated neoplasm, confirming squamous cell carcinoma after an immunohistochemical study. The initial diagnostic hypothesis of bone metastasis was surprisingly challenged by a second primary tumor. Faced with the systemic condition, the patient progressed to palliative care evolving to death less than 2 months after diagnosis.

Role and Reliability of Pectoralis Major Myocutaneous Flap in Oro Facial Reconstruction

Background Pectoralis major myocutaneous (PMMC) flap has been used in head and neck reconstruction since its initial description. Its reliability and versatility made it the workhorse flap until the widespread rise of the microvascular surgery. The vascular supply to the pectoralis major is based on branches of the axillary artery. The skin overlying the pectoralis major receives most of its blood supply from fasciocutaneous perforators. In the literature, the flap is also associated with a high incidence of complications in addition to its large bulk. This case report shows the reliability and indication of this flap in the reconstruction of the oral defects. Case Report A 42-year-old male patient reported with the chief complaint of increasing pain and nonhealing ulcer in his left lower posterior teeth region with reducing ability to open mouth. On clinical examination, an ulceroproliferative lesion was found on the left retromolar trigone region (RMT). Biopsy was performed which demonstrated squamous cell carcinoma of left RMT. Modified radical neck dissection type II was performed with hemimandibulectomy without disarticulation with reconstruction with the PMMC flap. Conclusion It can be concluded that the flap-related complications can be minimized by proper planning with regard to the length of the PMMC flap, the defect location, and the type of mandibular osteotomy. There are some situations in which pectoralis major still appears as a valuable option even in facilities performing free flaps and for patients in good general conditions.

Radiation Induced Sarcoma of Oral Cavity-A Rare Case Report and a Short Review

Radiation - Induced Sarcomas(RIS) are rare clinical entity. They arise from the previously irradiated areas with a prolonged latency period. In this case report we present a rare case of radiation induced sarcoma with a brief review of literature. We report radiation-induced sarcoma in a 67-year-old male, involving the left Retromolar Trigone region following treatment of squamous cell carcinoma of tongue with wide excision, neck dissection and post-operative radiation. Diagnosis of radiation induced sarcoma was confirmed by history, latency period and biopsy.

Acinic cell carcinoma of the retromolar trigone region: expanding the tumor phenotype in Cowden syndrome?

Cowden syndrome (CS) is a cancer predisposition syndrome caused by germline mutations in the PTEN tumor suppressor gene. It is associated with an increased risk of thyroid, breast and endometrial cancer but many manifestations can be found in the head and neck region, some of which are pathognomonic. Here we report a 35-year-old male referred by his dentist for evaluation of a lesion located near the retromolar trigone. Comprehensive clinical examination revealed papillomatous skin lesions, macrocephaly and gingival hypertrophy. Histopathological examination of the lesion showed an acinic cell carcinoma (ACC) of minor salivary gland origin. Analysis of the PTEN gene identified a germline R130Q mutation in exon 5, confirming the diagnosis of CS, but no loss of heterozygosity was seen in DNA extracted from tumor tissue. This is to our knowledge the first case describing an association of ACC of the minor salivary gland with a PTEN-gene related disorder. It emphasizes the importance of head and neck examination in these patients.

A subcutaneous mandibulotomy approach for a salivary clear cell carcinoma of the retromolar trigone

We report a novel subcutaneous mandibulotomy approach for the excision of a rare clear cell carcinoma, not otherwise specified (NOS) of the retromolar trigone. Case reports and a review of the medical literature concerning clear cell carcinoma and subcutaneous mandibulotomy are discussed. A subcutaneous mandibulotomy approach has recently been described for large tumours of the oropharyngeal and parapharyngeal spaces in two series of patients. Clear cell carcinoma, NOS is a rare condition, with few reports in the literature. This is the first occasion a subcutaneous mandibulotomy approach for an oral tumour has been described in Great Britain and Ireland, the second reported case of clear cell carcinoma originating in the retromolar trigone region and only the fourth case of associated lymph nodal metastases.

Free composite myo‐osseous flap with serratus anterior and rib: Indications in head and neck reconstruction

Background Although the microvascular transfer of the serratus/rib myo-osseous composite flap has been previously described, the indications for its use in head and neck reconstruction have not been fully explored. Slender and easily contoured, rib bone offers reconstructive advantages over other bone sources under certain circumstances. The serratus/rib myo-osseous flap can provide vascularized muscle, bone, and cartilage; in combination with the latissimus dorsi muscle, the serratus/rib flap provides additional soft-tissue bulk on a single thoracodorsal vascular pedicle unrestricted by orientation requirements of the bone. Many orientations of bone and soft tissue are possible. Methods We describe, through three illustrative cases, the indications for this flap, which might include bony, cartilaginous, and soft-tissue requirements in the retromolar trigone region, large calvarial defects, and large composite full-thickness cheek and mandibular defects. Conclusions The serratus/rib composite myo-osseous flap reliably provides vascularized bone of relatively delicate composition which offers advantages in certain reconstructive circumstances. In addition, when combined with latissimus dorsi muscle on a single vascular pedicle, it supplies additional soft-tissue bulk which can be positioned without being constrained by the bone placement. Finally, this is a useful “backup” supply of vascularized bone when other sources cannot be used due to, for example, inability to use fibula in the face of severe peripheral vascular disease and inability to use iliac crest if this has been previously used as a donor site for nonvascularized free grafts (as in secondary reconstructions). © 1998 John Wiley & Sons, Inc. Head Neck 20: 106–112, 1998.

Major complications of radiotherapy in cancer of the oral cavity and oropharynx: A 10 year retrospective study

In an attempt to determine the late effects and associated morbidity of radiotherapy on normal tissue, patients with squamous carcinoma of the oral cavity and oropharynx were retrospectively reviewed. Between 1964 and 1975, 569 patients with cancer of the floor of the mouth, oral tongue, tonsil, and retromolar trigone region of the anterior faucial pillar had their primary lesions treated by radiotherapy alone for cure. One hundred twenty-eight of the patients were evaluable for this study. Bone and soft tissue morbidity were graded according to the late radiation scoring scheme of the radiation therapy oncology group of the European Organization on Research and Treatment of Cancer, tallying only grade 4 changes. Patients were further classified according to site of tumor, age, sex, tumor stage, histologic grade, and dental status—none of which had a positive correlation with complications. Of 31 evaluable patients with cancer of the floor of the mouth (median follow-up 136 months), 71 percent (22 of 31 patients) had at least one complication involving bone (osteonecrosis, pathologic fracture) or mucus membrane (ulcer). Sixty-one percent (25 of 41 patients) with primary cancer of the oral tongue had grade 4 sequelae (median follow-up 112 months). In 26 patients with cancer of the tonsil, 13 (50 percent) had grade 4 sequelae (median follow-up 113 months). This included 11 patients with clinical and radiographic evidence of osteonecrosis, 6 of whom required mandibulectomy. Patients with cancer of the retromolar trigone region of the anterior faucial pillar fared the best (median follow-up 122 months). Late sequelae were noted in 40 percent (12 of 30 patients). The morbidity attendant to cure by radiotherapy included at least one significant complication of bone or soft tissue in 40 to 70 percent of the patients, depending on the location of the primary tumor. There was also a positive correlation with dose of radiation received.