Temporomandibular juxtaarticular chondroma : case report

Chondromas are benign tumours composed of mature hyaline cartilage. We present here the first case in the English language medical literature of juxtaarticular chondroma of the temporomandibular joint in the parotid region. Within the rarity of cartilage disorders of the temporo-mandibular joint (TMJ), this particular condition is a diagnostic curiosity. The patient, a 54 year old woman, presented a right preauricular tumour of 3.5 cm. which had been developing for 4 years. It was not painful but there was a recent symptomology of TMJ dysfunction, with pain and clicks. The diagnostic possibilities of a parotid pleomorphic adenoma and of a cartilage tumour of the TMJ suggested a difficult preoperative differential diagnosis, which influenced our approach regarding therapy. The tumour was excised, preserving the parotid gland. This enabled us to confirm the histological diagnosis of chondroma, composed solely of chondroide tissue. We have described the clinical characteristics of our case, and carried out a review of the relevant literature, emphasising the differential diagnoses

Cyclooxygenase-2 (COX-2) and epidermal growth factor (EGF) in oral premalignant epithelial lesions

[Resumen] Las lesiones premalignas orales incluyen eritroplasias (manchas rojas) y leucoplasias (manchas blancas), las cuales se desarrollan a lo largo de superficies epiteliales. Estas lesiones son considerados marcadores en la “car- cinogénesis de campo” ya que pacientes con lesiones premalignas orales pue- den desarrollar carcinoma de células escamosas (CCS) en el sitio de las lesio- nes, así como en otros lugares de tracto aerodigestivo superior. Se está hacien- do un gran esfuerzo para identificar nuevos biomarcadores SEBs (surrogate endpoint biomarkers) para el carcinoma de células escamosas de cabeza y cue- llo. Los SEBs candidatos para el carcinoma de células escamosas invasivo en el trato aerodigestivo superior deben ser detectables con los cambios molecu- lares celulares y tisulares que tienen lugar durante la formación del tumor. Entre los diferentes marcadores que se han propuesto hasta la actualidad, la ciclo- oxigenasa-2 (COX-2) y el receptor del factor de crecimiento epidérmico (EGFR) parecen ser los más prometedores. COX-2 se sobre expresa durante el pro- ceso tumoral, desde hiperplasia temprana a enfermedad metastásica. EGFR también está anormalmente activado en tumores epiteliales, pues las células de casi todas estas neoplasias expresan altos niveles de este receptor, una carac- terística asociada con un peor pronóstico clínico. En este sentido el tracto aero- digestivo superior proporciona un sistema o modelo único para el estudio de CCS y para la investigación de nuevos candidatos SEBs[Abstract] Oral premalignant lesions include leukoplakia (white patch) and erythroplakia (red patch), which develop on epithelial surfaces. These lesions are markers for field cancerization because patients with oral premalignancy can develop squamous cell carcinoma at the site of the lesion(s) and at other sites in the upper aerodigestive tract. An effort is being made to identify surrogate endpoint biomarkers (SEBs) for head and neck squamous cell carcinoma (HNSCC). Candidate SEBs for invasive squamous cell carcinoma (SCC) of the upper aerodigestive tract are detectable molecular, cellular, and tissue changes that take place during tumorigenesis. Among the markers that have been proposed to date, cyclooxygenase-2 (COX-2) and the epidermal growth factor receptor (EGFR) seem to be the most promising. COX-2 is overexpressed during tumor transformation from early hyperplasia to metastasic disease. EGFR is also abnormally activated in epithelial tumors, since cells of almost all these kinds of neoplasm express high levels of this receptor, a characteristic associated with poor clinical outcome. The upper aerodigestive tract provides a unique model for studying the development of squamous cell carcinoma and for investigating candidate SEBs

Temporomandibular disorders: the habitual chewing side syndrome

Background:Temporomandibular disorders are the most common cause of chronic orofacial pain, but, except where theyoccur subsequent to trauma, their cause remains unknown. This cross-sectional study assessed chewing function (habitualchewing side) and the differences of the chewing side and condylar path and lateral anterior guidance angles in participantswith chronic unilateral temporomandibular disorder. This is the preliminary report of a randomized trial that aimed to testthe effect of a new occlusal adjustment therapy.Methods:The masticatory function of 21 randomly selected completely dentate participants with chronic temporoman-dibular disorders (all but one with unilateral symptoms) was assessed by observing them eat almonds, inspecting the lateralhorizontal movement of the jaw, with kinesiography, and by means of interview. The condylar path in the sagittal plane andthe lateral anterior guidance angles with respect to the Frankfort horizontal plane in the frontal plane were measured onboth sides in each individual.Results:Sixteen of 20 participants with unilateral symptoms chewed on the affected side; the concordance (Fisher’s exacttest, P = .003) and the concordance-symmetry level (Kappa coefficientk= 0.689; 95% confidence interval [CI], 0.38 to 0.99;P = .002) were significant. The mean condylar path angle was steeper (53.47(10.88) degrees versus 46.16(7.25) degrees;P = .001), and the mean lateral anterior guidance angle was flatter (41.63(13.35) degrees versus 48.32(9.53) degrees P = .036)on the symptomatic side.Discussion:The results of this study support the use of a new term based on etiology, ‘‘habitual chewing side syndrome’’,instead of the nonspecific symptom-based ‘‘temporomandibular joint disorders’’; this denomination is characterized inadults by a steeper condylar path, flatter lateral anterior guidance, and habitual chewing on the symptomatic sideThis study was financed with a grant PI11/02507 from the Institute of Health Carlos III of the Ministry of Science and Innovation of the Government of Spain. It was completed with the equipment granted by the General Directorate of Universities and Research; Department of Education and University. Xunta de Galicia. Official Journal No. 143 Galicia, July 22, 1996. And the Department of Innovation, Industry and Commerce. Xunta de Galicia, April 30, 2004S

Cell-Free microRNAs as potential oral cancer biomarkers: from diagnosis to therapy

Oral cavity cancer is the most frequent malignancy of the head and neck. Unfortunately, despite educational interventions for prevention and early diagnosis, oral cancer patients are often diagnosed in advanced stages associated with poor prognosis and life expectancy. Therefore, there is an urgent need to find noninvasive biomarkers to improve early detection of this tumor. Liquid biopsy has emerged as a valuable tool in medical oncology which provides new horizons for improving clinical decision making. Notably, cell-free microRNAs (miRNAs), a class of short non-coding RNAs, are emerging as novel noninvasive cancer biomarkers. Here, we provide an overview of the potential clinical application of cell-free miRNAs as diagnostic, prognostic, and therapeutic biomarkers in oral cancerS

Aplasia of the lacrimal and major salivary glands (ALSG). First case report in spanish population and review of the literature

Aplasia of the lacrimal and the major salivary glands (ALSG) is a rare disorder with scarce cases described in the recent literature. The pattern of genetic inheritance is autosomal dominant with variable expressivity. A 40 years male patient was referred to the Oral and Maxillofacial Service at the Hospital Universitario de A Coruña diagnosed with complete agenesis of all salivary glands. Our case it is the first of ALSG syndrome in the Spanish literature. Imaging tests are necessary to confirm the lack of formation of salivary glands and alteration of lacrimal system. A mutation of FGF10 has been proposed as the responsible of the syndrome. The management of the lacrimal alteration depends of the clinical findings. Clinical suspicion remains the principal tool to diagnose the syndrome

Evaluation of COX-2, EGFR, and p53 as biomarkers of non-dysplastic oral leukoplakias

[Abstract] Objective. Identify candidate SEBs (surrogate endpoint biomarkers) for premalignant trends in head and neck mucosa. Study design. Study, by qPCR (quantitative real-time polymerase chain reaction), the expression of COX-2, EGFR and p53 in 24 biopsies of non-dysplastic oral leukoplakia and contra-lateral normal-appearing mucosa. Results. COX-2 was up-regulated in leukoplakia (79.2%); whereas EGFR and p53 were up-regulated (p > 0.05) in oral contra-lateral normal-appearing mucosa (60% and 46% respectively). Also, p53 expression was correlated with tobacco smoke habits and Spearman's rank correlation coefficient showed a positive linear correlation between p53 and EGFR mRNA expression levels. Conclusions. COX-2 would serve as SEB of oral leukoplakia. The results suggest that p53 appears to be one of the molecular targets of tobacco-related carcinogens in leukoplakia and that the co-expression of p53 and EGFR may play a role in this kind of oral pre-cancerous lesion. More detailed studies of EGFR and p53 should be continued in the future

Neurofibroma plexiforme en mucosa yugal: presentación de un caso clínico

Presentamos un caso clínico de neurofibroma plexiforme localizado en región geniana, a nivel submucoso. Su interés radica en que, a pesar de ser el tumor de origen neurógeno más frecuente, es una entidad poco habitual y que rara vez se localiza a nivel intraoral. Por otra parte, la variedad plexiforme es todavía menos frecuente. Desde el punto de vista clínico, se manifiestan como lesiones anodinas, con escasa sintomatología, que cuando aparece es derivada de la compresión nerviosa. En nuestro caso el tumor era asintomático salvo por el tamaño. Radiológicamente no existe una imagen definitiva. Tiene relación con determinados síndromes poliglandulares y facomatosis. El tratamiento es básicamente quirúrgico aunque existen dudas de la idoneidad del mismo y se están buscando nuevas vías de tratamiento. Aprovechando la descripción del caso se realiza una revisión bibliográfica incidiendo en la epidemiología, comportamiento clínico, métodos diagnósticos, así como en el tratamiento de este tipo de tumores benignos.The case reported deals with a solitary plexiform neurofibroma affecting the cheek submucosa. Neurofibroma is an uncommon tumor which rarely appears in oral cavity but it represents the most common neurogenic tumor. Furthermore, plexiform variety is less frequent. Clinically, oral neurofibromas usually apperars as anodyne and asintomatic lesions. Sometimes, they produce nervous compression. In this case, tumor is big but asintomatic. There is no definitive radiologic image. It has association with poliglandular syndroms and phacomatosis. The treatment of choice is excision. There are doubts of the surgical results so that some authors are looking for new non-surgical treatments. The clinical characteristics, epidemiology, diagnosis and treatment are described as soon as a bibliographic revision

Efficacy and safety comparison of two amoxicillin administration schedules after third molar removal. A randomized, double-blind and controlled clinical trial

Objective: The aim of this comparative double-blind, prospective, randomized, clinical trial was to evaluate two amoxicillin administration patterns. The first was a short prophylactic therapy and the second a long postoperative regimen. Study Design: The study population consisted of 160 patients who underwent mandibular third molar extraction. Patients were randomized into two equal groups. In group 1, 2 grams of amoxicillin were administered 1 hour before the procedure and 1 gram 6 hours after surgery. In group 2, patients received 1 gram of amoxicillin 6 hours after surgery followed by 1 gram every 8 hour for 4 days. All patients received the same number of tablets thanks to the use of placebo pills. A total of 25 variables were evaluated, such as alveolitis, surgical infection, number of analgesic needed, subjective pain scale, post-surgical inflammation, consistency of the diet, axillary temperature and millimetres of mouth opening loss after the surgery. Results: No statistically significant post-operative differences were found within the recorded parameters between the groups. Conclusions: Postoperative 4-days amoxicillin therapy is not justified

Oral leiomyoma in retromolar trigone : a case report

Leiomyomas are bening tumours originated on smooth muscle. The most frequent site of appearance are uterine myometrium, gastrointestinal tract and skin. The highest incidence ocurs between 40 and 49 years of age. Its presentation is unusual in children or in older patients. Leiomyomas are unfrequent in the oral cavity, but in this location are usually localized on tongue, lips and palate. Leiomyomas use to appear as well-defined masses, with slow growth and totally asymptomatic. Pain is present just in rare cases. The treatment is surgical escision. Recurrences are extremely unfrequent. The diagnosis is mainly determined by histological studies due to its unspecific clinical appearance. Histopathologicaly proliferation of smooth muscle cells is observad without necrotic areas. A low number of mitotic figures can be seen. We present the case report of a 25-year old male patient, with a leiomioma on his right retromolar trigone.The low incidence of this pathology, the age of the patient and the inusual location, make the report of the case worthy

Oral bisphosphonate-related osteonecrosis of the jaws : clinical characteristics of a series of 20 cases in Spain

Objective: The objective of this study was to define the clinical characteristics of osteonecrosis of the jaws (ONJ) induced by oral bisphosphonates in a series of patients from a circumscribed area in northwest Spain. Study Design: A retrospective multicentre study was undertaken in 3 hospitals in an area with a radius less than 100 km in the Autonomous Community of Galicia (Spain). The medical records were reviewed and an oral examination was performed of patients diagnosed with oral bisphosphonate-related ONJ in the previous 3 years. Results: We detected 20 cases of ONJ (24 lesions) related to oral bisphosphonates (alendronate [16 patients] and ibandronate [4 patients]), which were mainly administered as treatment for osteoporosis (17 patients). The mean interval between initiation of treatment and confirmation of a diagnosis of ONJ was 66±43 months (range, 6-132 months); in 7 patients (35%) the interval was less than 36 months. The past history revealed hypertension in 13 cases (65%) and diabetes in 4 (20%); 7 patients (35%) were on corticosteroid treatment. Oral surgery had been previously performed in 13 patients (65%) and the remaining 7 patients (35%) had removable dental prostheses. The lesions most frequently affected the posterior mandible (62.5%). The majority of the lesions (75%) were classified as stage 2, although lesions were identified in all established clinical stages (including 2 stage 0 lesions). Conclusion: In conclusion, in the present series, ONJ induced by oral bisphosphonates typically develops in women around 70 years of age, taking alendronate, that underwent oral surgery. Most lesions are located in the posterior mandible and are classified as stage 2 at diagnosis. Some patients presented no known risk factors, suggesting that there may be risk factors still to be identified. There are well-defined patterns of clinical presentation that can facilitate early diagnosis of ONJ