Traumatic bone cyst of the mandible of possible iatrogenic origin: a case report and brief review of the literature

The traumatic bone cyst (TBC) is an uncommon nonepithelial lined cavity of the jaws. The lesion is mainly diagnosed in young patients most frequently during the second decade of life. The majority of TBCs are located in the mandibular body between the canine and the third molar. Clinically, the lesion is asymptomatic in the majority of cases and is often accidentally discovered on routine radiological examination usually as an unilocular radiolucent area with a "scalloping effect". The definite diagnosis of traumatic cyst is invariably achieved at surgery. Since material for histologic examination may be scant or non-existent, it is very often difficult for a definite histologic diagnosis to be achieved. We present a well documented radiographically and histopathologically atypical case of TBC involving the ramus of the mandible, which is also of possible iatrogenic origin. The literature is briefly reviewed

[Non-Hodgkin lymphoma of the mandible--a case report with differential diagnostic considerations]

Approximately 5% of all malignant lesions are diagnosed as malignant lymphomas, of which 2-3% are localized in the head and neck region. After the squamous cell carcinoma and neoplasms of the salivary glands, malignant lymphomas represent the third most frequent malignant lesion in that region. Malignant lymphomas can be grouped into Hodgkin- and non- Hodgkin lymphomas (NHL) and subdivided into nodal (lymph nodes) and extranodal lymphomas. We present the case of an extranodal non-Hodgkin lymphoma in the left mandible of a 47-year-old woman, who was referred to our department with an unclear swelling, which was supposed to be infectious. After clinical and radiological examination, a biopsy was taken and a CD20 and BCL-6 protein positive non-Hodgkin lymphoma of the large B-cell type (DLBCL) was diagnosed. The patient was treated primarily with immunochemotherapy (R-CHOP protocol) and refused to undergo a subsequent radiotherapy. The 18 months follow-up showed a complete remission of the lymphoma. In this paper, the NHL in the oral and maxillofacial region is presented as a cause of unclear swelling. Important differential diagnostic conditions are discussed

[Periapical osseous dysplasia of the anterior maxilla--a case presentation]

Osseous dysplasias (formerly cemento-osseous dysplasias/ CODs) represent a specific clinico-pathologic spectrum of related, non-neoplastic benign fibro-osseous lesions. The most recent WHO classification (2005) defines them as bone-related lesions (9262/0). The controversial presence of cementum was solved by complete removal of the term "cemento" in the revised classification of tumors. Normal bone architecture is replaced by fibroblasts and collagen fibers containing variable amounts of mineralized material. Osseous dysplasias are often identified as an incidental finding on standard dental radiographs of adults. They usually cause no specific symptoms or obvious clinical findings. Four different types of ODs can be distinguished: the periapical osseous dysplasia (POD), the focal osseous dysplasia (FocOD), the florid osseous dysplasia (FOD) and the familial gigantiform cementoma. This case report presents an unusual localization of a periapical osseous dysplasia (POD) in the anterior maxillary bone in a 33-year old female patient of Caucasian origin. Radiological, clinical and histopathological characteristics of the POD and similar benign lesions are defined and discussed

Computer-guided CO2-laser osteotomy of the sheep tibia: technical prerequisites and first results

OBJECTIVE: The purpose of this study was to examine for the first time the feasibility of performing complete osteotomy of sheep tibia using a computer-guided CO2-laser osteotome, and to examine bone healing under functional loading. BACKGROUND DATA: Bone cutting without aggravating thermal side effects has been demonstrated with scanning CO2-laser osteotomy. Further research is necessary to develop a clinically usable laser osteotome, which may allow new types of bone surgical procedures. MATERIALS AND METHODS: The scanning parameters for performing tibial osteotomies were determined in preliminary ex vivo trials. Osteotomies were performed in the mid-diaphysis of sheep tibia using either the prototype laser osteotome (osteoLAS, study group; n = 12), or an oscillating saw (control group; n = 12). Both groups were divided into two subgroups each (n = 6), and the two groups were sacrificed after 4 and 12 wk. Radiographs were taken postoperatively and after 4, 8, and 12 wk to compare the course of bone healing. RESULTS: Laser osteotomies of sheep tibia up to a depth of 20 mm were possible without visible thermal damage to the bone. A sequential PC-controlled cut geometry with artificial widening of the osteotomy gap was required for a complete osteotomy. Both clinically and radiologically, the laser and control groups showed undisturbed primary gap healing. Bone healing was similar and undelayed after both laser osteotomy and osteotomy done by mechanical saw. CONCLUSIONS: Osteotomy of multi-layered bones with a scanning CO2-laser demonstrates clinical and radiological healing patterns comparable to those seen with osteotomy done by standard mechanical instruments. It is, however, a technically demanding procedure, and complete laser osteotomies of long bones are only reasonable in bones with a diameter <20 mm, which will likely restrict the use of this technique to bones 7-10 mm thick. Through the use of computer guidance, extremely precise osteotomies and sophisticated cut geometries are possible using this technique. For practical applications, precise control of the depth of laser cutting and easier manipulation of the osteotome are require

Performance of orthopantomography, planar scintigraphy, CT alone and SPECT/CT in patients with suspected osteomyelitis of the jaw

PURPOSE: The aim of this study was to evaluate the performance of a novel flat-panel single photon emission computed tomography (SPECT)/CT in patients with suspicion of osteomyelitis (OM) of the jaw in comparison with conventional orthopantomography (OPT), planar bone scintigraphy (PS) and CT alone. METHODS: Forty-two patients (21 female, 21 male, mean age 52, range 10-84 years) with suspected OM (n = 38) or exacerbation of a known OM (n = 4) were investigated with OPT, CT alone, PS and combined SPECT/CT. Images were separately reviewed by a nuclear physician/radiologist and jaw surgeon regarding presence of OM. Additionally, the different methods were rated regarding their usefulness for diagnosis (5-point scale: from 1 = diagnostic to 5 = useless). Biopsy served as the standard of reference in 30 patients and clinical/imaging follow-up of at least 6 months in 12 patients. RESULTS: In 35 of 42 patients the final diagnosis of OM was established according to the reference standard. Sensitivity, specificity and accuracy for OPT was 59, 100 and 66 %, for CT alone 77, 86 and 79 %, for PS 100, 71 and 95 % and for SPECT/CT 100, 86 and 98 %. SPECT/CT was significantly more accurate compared with CT alone (p = 0.0078) and OPT (p = 0.001). SPECT/CT was rated as the most useful imaging modality (mean value 1.2) compared with PS (2.2), CT (2.5) and OPT (3.2). CONCLUSION: SPECT/CT is an accurate method to assess the presence of OM of the jaw and superior to CT alone and OPT. SPECT/CT slightly improved the specificity of PS. However, SPECT/CT in this study was not significantly more accurate compared with PS and whether the advantages to the patient of a one-stop study as opposed to doing separate CT and PS justifies its routine use in terms of cost requires further study