Adrenomedullin and tumour microenvironment

Adrenomedullin (AM) is a regulatory peptide whose involvement in tumour progression is becoming more relevant with recent studies. AM is produced and secreted by the tumour cells but also by numerous stromal cells including macrophages, mast cells, endothelial cells, and vascular smooth muscle cells. Most cancer patients present high levels of circulating AM and in some cases these higher levels correlate with a worst prognosis. In some cases it has been shown that the high AM levels return to normal following surgical removal of the tumour, thus indicating the tumour as the source of this excessive production of AM. Expression of this peptide is a good investment for the tumour cell since AM acts as an autocrine/paracrine growth factor, prevents apoptosis-mediated cell death, increases tumour cell motility and metastasis, induces angiogenesis, and blocks immunosurveillance by inhibiting the immune system. In addition, AM expression gets rapidly activated by hypoxia through a HIF-1α mediated mechanism, thus characterizing AM as a major survival factor for tumour cells. Accordingly, a number of studies have shown that inhibition of this peptide or its receptors results in a significant reduction in tumour progression. In conclusion, AM is a great target for drug development and new drugs interfering with this system are being developed

An unusual size of ameloblastic fibro-odontoma

Ameloblastic fibro-odontoma (AFO) is a quite rare, mixed odontogenic tumour generally seen in the early stages of life. Frequent signs of the tumour are asymptomatic swelling, delayed tooth eruption and mixed radiological appearance within well-defined borders. Management of the lesion includes enucleation of the tumour and long-term follow-up in order to avoid recurrence. A 9-year-old girl was referred to our clinic with swelling in her right cheek. After clinical and radiographic examination, a large lobular radiopaque mass with a radiolucent border covering the complete right maxillary sinus was observed. Under general anaesthesia, the lobules of the lesion were enucleated and the permanent right lateral incisor and canine teeth were left for eruption. Histological assessment revealed a final diagnosis of ameloblastic fibro-odontoma. Post-operative healing was uneventful and the remaining teeth erupted normally. No recurrence was observed during the 3 years' follow-up period

Tetrafid mandibular condyle: a unique case report and review of the literature

Morphological changes such as bifid and trifid mandibular condyle are rare entities. The aim of the present report is to describe a unique morphological variation of the mandibular condyle which has four separate condylar heads (tetrafid mandibular condyle) and to discuss clinical and radiological differential diagnosis of tetrafid mandibular condyle with advanced imaging techniques. Dentomaxillofacial Radiology (2011) 40, 524-530. doi: 10.1259/dmfr/6208266

An unusual case of multilocular Stafne bone cavity

Stafne bone defects (SBDs) are asymptomatic lingual bone depressions of the lower jaw that are frequently caused by soft-tissue inclusion. The common variant of SBD exists at the third molar region of the mandible below the inferior dental canal is an and ovoid-shaped homogeneous well-defined radiolucency. In this report, an unusual occurrence of SBD with multilocular appearance is presented. Asymptomatic lingual bone defects may represent various radiographic features. Detailed radiographic evaluation with CT scans should be performed to differentiate SBDs from other pathologies. Dentomaxillofacial Radiology (2012) 41, 75-78. doi:10.1259/dmfr/3473196

Anterior Stafne bone defect mimicking a residual cyst: a case report

Stafne bone defects (SBDs) are asymptomatic lingual bone depressions of the lower jaw that are frequently caused by soft tissue inclusion. The common variant of SBDs exists at the third molar region of the mandible below the inferior dental canal and has been mostly diagnosed incidentally during routine radiographic examination. The anterior variant of a SBD (ASBD) is relatively uncommon and is located in the premolar region of the mandible. Sublingual salivary glands are thought to be responsible for ASBDs. However, other structures such as lymphoid or vascular tissues might be associated with ASBDs. In the present report, an ASBD which was mimicking a residual cyst was diagnosed with the aid of a three-dimensional CT scan. ASBDs might be confused with other odontogenic or non-odontogenic pathologies because of their location and lower occurrence rate. Advanced imaging modalities, especially CT scans, are useful to assess such lesions in order to avoid unnecessary surgery. Dentomaxillofacial Radiology (2010) 39, 124-126. doi: 10.1259/dmfr/4932025

Sonoelastographic evaluation of the masseter muscle before and after mandibular setback surgery

Aims: The purpose of this study is to compare the thickness and elasticity of the masseter muscle before and after orthognathic surgery in patients with class III skeletal deformity and to investigate the relationship between the sonographic changes in the masseter muscle and the amount of mandibular setback. Subjects and Methods: The study group consisted of 14 patients with skeletal class III malocclusions who had orthognathic surgery. The control group consisted of 14 patients who had dental and skeletal class I occlusion. Muscle thickness measurements were performed with B-mode and high-frequency linear scanning probe of the ultrasound device. Elastography feature and muscle hardness ratio were obtained by applying compression and decompression on muscles at rest and during maximum contraction in the transverse plane. Patients were categorized into two groups according to the mandibular setback as = 5 mm. Results: The masseter muscle thickness after surgery was found statistically increased bilaterally in both at rest and during contraction for the study group (P 0.05). Conclusion: We believe that in the present study important findings have been emphasized for further research aiming to investigate the possible relationship between masticatory alterations and surgical outcomes after orthognathic surgery

Acute fetal distress following tooth extraction and abscess drainage in a pregnant patient with maxillofacial infection

Oral infections have been implicated in adverse pregnancy outcomes such as pre-eclampsia, premature delivery and growth retardation. A 28-year-old and 9 months pregnant otherwise healthy woman with a complaint of facial swelling and dental pain was referred to the Department of Oral and Maxillofacial Surgery. Oral examination revealed perimandibular and masticator space infection related to the left mandibular third molar tooth. Eight hours after surgical intervention, fetal distress developed. The patient was immediately taken into surgery and a male baby delivered by Caesarean section. The baby was then admitted to the intensive care unit. On the twelfth day of his admission, the baby was discharged in good health. Severe maxillofacial infection in pregnancy is a medically complicated situation which should be treated by an oral and maxillofacial surgeon in consultation with an obstetric and gynaecology service