Sporadic oral angiomyolipoma : Case report

Angiomyolipoma (AML) is a rare, benign tumour composed of a variable proportion of lipocytes, smooth muscle and thick-walled blood vessels. AML is part of a family of tumours arising from perivascular epithelioid cells (PEComas), and many cases are associated with tuberous sclerosis, with the kidney being the most frequent site involved. We report a case of sporadic AML in the hard palate of a 52-year-old male, an extremely unusual location for this tumour. Differentiation from other benign and malignant oral mesenchymal lesions depends on recognition of the three histologic components, and immunohistochemical techniques may be helpful. AML occurring in the head and neck do not express HMB-45, an antibody that identifies immature melanosomes, conversely to the usual immunopositivity shown in AMLs from kidney and liver, suggesting that there are differences among them. A wide surgical excision is considered curative, as this tumour usually behaves in a benign fashion

Tumor pardo en la sínfisis mandibular como primera manifestación clínica de hiperparatiroidismo: diagnóstico y tratamiento

El tumor pardo es una de las lesiones óseas que pueden encontrarse en pacientes con hiperparatiroidismo. Pueden localizarse en cualquier hueso, afectando ocasionalmente al territorio craneo- maxilofacial. Si bien en la mayoría de los casos el diagnóstico de tumor pardo se realiza en pacientes en los que se ha diagnosticado previamente el hiperparatiroidismo, en ocasiones éste puede ser el primer signo de la enfermedad. Presentamos un caso de tumor pardo localizado en la sínfisis mandibular que fue el primer signo clínico de hiperaparatiroidismo secundario a un adenoma paratiroideo hiperfuncionante. Se revisan el diagnóstico diferencial de este tipo de lesiones y sus posibles tratamientos.Brown tumor is one of the lesions that develop in patients with hyperparathyroidism. Any of the squeletal bones can be affected including the cranio-maxillofacial ones. Most of the times the brown tumor appears after a final diagnosis of hyperparathyroidism is made. However brown tumor can be the first clinical sign of the disease. A clinical case in which a brown tumor located in the anterior part of the mandible appears as the first sign of primary hyperparathyroidism is presented. The possible differential clinical diagnosis and the recommended treatments are revised

Surgical treatment of benign parapharyngeal space tumours : presentation of two clinical cases and revision of the literature

Parapharyngeal space (PPS) tumours, most of them benign, account for some 0.5% of tumours of the head and neck. The importance of these tumours lies mainly in two aspects: on the one hand, the difficulty of early diagnosis, due to the lack of symptoms in the initial stages and, on the other, the extreme complications of performing surgery in the parapharyngeal region. This article discusses two clinical cases of parapharyngeal space tumours: a 45 year old man and a 60 year old woman. We revise the scientific literature and analyse the diagnostic and therapeutic procedures used, placing special emphasis on describing the different surgical approaches to the parapharyngeal space: transcervical, transcervical-transparotid, transpalatal or transoral, transmandibular and orbitozygomatic, all of which, used alone or combined with others, allow for complete resection of these tumours with minimum morbidity

Treatment of bilateral hyperplasia of the coronoid process of the mandible : Presentation of a case and review of the literature

Bilateral hyperplasia of the coronoid process is infrequent. It consists of an elongation of the coronoid process of the mandible and is, accordingly, a mechanical problem, limiting mouth opening. This article looks at the case of a 28 year-old male with significant limitation on opening his mouth, secondary to bilateral hyperplasia of the coronoid process. We reviewed the literature and analysed the diagnostic and therapeutic procedures used, paying special attention to the surgical approaches to the coronoid process and emphasising the importance of early post-operative rehabilitation, describing our experience with the TheraBite® (Atos Medical AB, PO Box 183, 242 22 Hörby, Sweden). The satisfactory result of the procedure is marked by the stable recovery of the mouth opening, achieved by a good combination of surgical and physiotherapeutic techniques

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

Assessment of time intervals in the pathway to oral cancer diagnosis in north-westerm Spain. Relative contribution of patient interval

Despite continuous advances in diagnosis and therapy, oral cancers are mostly diagnosed at advanced stages with minor survival improvements in the last two decades. Both phenomena have been attributed to delays in the diagnosis. This study aims at quantifying the time elapsed until definitive diagnosis in these patients and the patient interval?s contribution. A hospital-based, ambispective, observational study was undertaken on incident cases with a pathological diagnosis of oral squamous cell carcinoma recruited during 2015 at the Oral and Maxillofacial Surgery services of CHUAC (A Coruña) and POVISA (Vigo) hospitals. 74 consecutive oral cancer patients (59.5% males; median age: 65.0 years (IQ:57-74)) were studied. Most cases (52.7%; n=39) were at advanced stages (TNM III-IV) at diagnosis. The period since first sign/symptom until the patient seeks health care was the longest interval in the pathway to diagnosis and treatment (median: 31.5 days; IQR= 7.0 ? 61.0) and represents >60% of the interval since symptom onset until referral to specialised care (pre-referral interval). The average interval assigned to the patient resulted to be relatively larger than the time elapsed since the patient is seen at primary care until a definitive diagnosis is reached (diagnostic interval). Median of the referral interval for primary care professionals: 6.5 days (IQR= 0.0 ? 49.2) and accounts for 35% (19% - 51%) of the diagnostic interval. The patient interval is the main component of the pathway to treatment since the detection of a bodily change until the definitive diagnosis. Therefore, strategies focused on risk groups to shorten this interval should be implemented in order to ease an early diagnosis of symptomatic oral cancer

Tratamiento quirúrgico del granuloma central de células gigantes: estudio y seguimiento de 10 casos. Revisión de la literatura

ResumenObjetivosEl granuloma central de células gigantes (GCCG) es una lesión benigna, no odontogénica, de origen incierto y con unas características epidemiológicas, clínicas y radiológicas bien conocidas. El objetivo de nuestro estudio es recoger, describir y evaluar nuestra experiencia en el tratamiento quirúrgico de este tipo de lesiones y su seguimiento, haciendo especial hincapié en los datos clínicos y radiológicos así como en las complicaciones y recidivas tras el mismo. Se realiza, además, una revisión de la literatura científica.Material y métodosSe trata de un estudio retrospectivo de 10 casos intervenidos en nuestro centro entre los años 1998 y 2008. La edad media fue de 35 años. Se describen las características clínicas y radiológicas de cada caso, así como la mejor opción de tratamiento quirúrgico, evaluación del mismo, complicaciones y recidivas.ResultadosSe realiza tratamiento quirúrgico en los 10 casos, de los cuales 4 presentan características clínicas y radiológicas de agresividad. El tratamiento de elección es la escisión y curetaje hasta hueso sano en el 60%, y en el resto resección amplia con márgenes. El periodo de seguimiento medio es de 6,7 años, con una tasa de recidiva del 1%.ConclusiónEn nuestra experiencia coincidimos con la mayoría de los autores al considerar el tratamiento quirúrgico de elección en el momento actual, señalando la importancia de realizar un adecuado diagnóstico y una clara diferenciación entre lesiones agresivas y no agresivas para determinar la radicalidad de la intervención.AbstractObjectivesCentral giant-cell granuloma (CGCG) is a benign, non-odontogenic lesion of uncertain origin and well-known epidemiologic, clinical and radiologic characteristics. The aim of this study was to compile, describe and evaluate the authors’ experience with the surgical treatment of CGCG and its follow-up, with special emphasis on clinical and radiologic data, complications and recurrences. The scientific literature was reviewed.Material and methodsA retrospective study was made of 10 cases treated surgically at our center between 1998 and 2008. The mean age of patients was 35 years. The clinical and radiological characteristics of each case were described, as well as the best surgical option and the evaluation, complications, and recurrences.ResultsAll 10 cases, 4 of which exhibited aggressive clinical and radiologic behavior, were treated surgically. The treatment of choice was excision and curettage to healthy bone in 60% and resection with a surgical margin in the rest. Mean follow-up was 6.7 years and the recurrence rate was 1%.ConclusionThe authors share the opinion of other authors that surgery is currently the treatment of choice. Adequate diagnosis and clear differentiation between aggressive and non-aggressive lesions is important in deciding how radical the intervention should be