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An effort was made to determine the effectiveness of oral penicillin in the treatment. of a common dental infection. Although the number of cases treated was small, there is a strong indication that oral penicillin may be beneficial in the treatment of acute mandibular pericoronitis.

Masticatory inhibitory mechanisms were studied in 10 patients treated for diffuse sclerosing osteomyelitis of the mandible. Their masseter inhibitory reflex responses were provoked electrically by mental nerve stimulation during maximal clenching of the teeth. The masseter inhibitory reflex was normal in two patients and significantly abnormal in eight patients. The two patients with a normal masseter inhibitory reflex were free of complaints, whereas, of the eight patients with an abnormal masseter inhibitory reflex, two were free of complaints and six had moderate to severe symptoms. In three patients, spasms and involuntary bursts of electromyographic activity were found. The abnormal masseter inhibitory reflex consisted of a loss of early and late components in four patients or a loss of the late component with a normal early one in four patients. These findings seem to support the hypothesis that diffuse sclerosing osteomyelitis of the mandible is a chronic tendoperiostitis caused by muscle overuse. It is suggested that this overuse is caused by central hyperexcitability of trigeminal motoneurons.

Diffuse sclerosing osteomyelitis of the mandible has been described as a localized disease of unknown origin. We offer evidence that mandibular involvement in the recently described synovitis acne pustulosis hyperostosis osteitis syndrome exactly fits the accepted description for diffuse sclerosing osteomyelitis of the mandible. The clinical, radiologic, and pathologic findings in seven such cases are presented and discussed.

The mandible coronoid process is another site subject to various pathoses that may result in limited jaw movement. Six different pathoses that prevented the free rotation of the coronoid are presented. Differential diagnosis and treatment approach are emphasized.

Cancellous bone lesions of varying sizes were made in specimens of human mandibles and radiographed under geometrically reproducible conditions and observed by viewing of before and after radiographs and subtraction images. Of 178 lesions, traditional comparison of before and after radiographs resulted in 108 correct diagnoses. Analysis of the same lesions by subtraction radiography resulted in 162 (91%) correct diagnoses. This difference in diagnostic accuracy with the use of these two methods of radiographic analyses was significant at the p = 0.0001 level.

Dose-reducing effects of spacers with and without a Lipowitz metal plate for the purpose of decreasing osteoradionecrosis after interstitial brachytherapy for tongue cancers were examined experimentally and clinically. The thicker the sample or spacer and the thicker the metal plate, the greater was the dose reduction achieved. A more marked dose reduction was achieved with iridium than with radium because of lower gamma ray energy of iridium. Iridium has been used widely as a radioactive source for interstitial brachytherapy. It was concluded therefore that a metal plate should be used as a shield into the spacer in interstitial brachytherapy both to reduce the radiation dose to surrounding normal tissues and to help prevent osteoradionecrosis.

A rare case of multiple keratin-containing gingival cysts is presented. It is suggested that either a common dental lamina stem cell with diverging differentiation pathways or another cell of origin may be responsible for the formation of these unique cysts.

To evaluate whether gas is present in the cavity of simple bone cysts, the clinical and histologic findings of 53 patients with simple bone cysts were examined and compared with an experimental model. The model consisted of a dry mandible with the medullary bone removed and the resulting cavity injected with water. Although an air-liquid level was observed on all radiographs for the experimental model, none was observed in the clinical cases of simple bone cysts. When the experimental cavity was completely filled with water, the density in the cavity was similar to that of the surrounding water on computed tomography, but when it was filled with air, the density was lower than that of the surrounding water. In contrast, in simple bone cysts said to contain air at surgery, the cavity contents were not consistent with the density for gas on computed tomography. These results indicate that the operative finding of air in the cavity of simple bone cysts may have been in error at least in some cases.

A rare case of blood coagulation disorder, congenital factor XII deficiency, detected in a patient with mandibular osteomyelitis is presented. Routine laboratory tests showed prolonged clotting and activated partial thromboplastin time. Detailed investigations for the intrinsic and extrinsic pathways of coagulation, fibrinolytic system, kinin-kallikrein system, and complement system were performed because factor XII is known as an activator of these systems. No hemorrhagic or thromboembolic complication occurred during and after surgery. Substitution therapy with fresh frozen plasma was not necessary. Magnetic resonance imaging and electrocardiography were used to examine the possible occurrence of postoperative cerebral hemorrhage or myocardial infarction.

The aneurysmal bone cyst is an enigmatic and misnamed lesion displaying variable etiopathogenic and histologic characteristics. The aneurysmal bone cyst may appear as a primary lesion or as a secondary lesion associated with other pathologic entities. This article presents a probable self-limiting lesion that provides an opportunity to present an approach to classifying aneurysmal bone lesions.

The occurrence of eosinophilic granuloma in the mandibular condyle has been reported in only three cases. An additional case of eosinophilic granuloma of the mandibular condyle is reported. The lesion presented was treated with condylectomy and surgical curettage. There was no recurrence or soft tissue involvement on annual postoperative examination. Secondary reconstruction was planned but was not required.

Through a series of similarly produced panoramic films, a chronologic picture of a traumatic bone cyst is demonstrated. This case represents a progressive rather than static lesion. The progression of the lesion is indicative of a etiologic process other than the solitary inciting event usually associated with traumatic bone cysts.

This article reviews the clinical behavior, the histologic conditions, and the treatment of a benign osteoblastoma associated with an aneurysmal bone cyst of the mandibular condyle and ramus. A 14-year-old boy, otherwise healthy, was referred for pain and enlargement in his right temporomandibular joint-cheek region. The swelling was firm and tender, a slight facial asymmetry was present, and the mouth-opening capacity was reduced. During a 6-weeks period from the primary examination to surgery the lesion expanded extensively, anesthesia appeared in the right inferior alveolar nerve and a lateral open bite developed on the affected side. Computed tomography displayed a total destruction of the right mandibular condyle and ramus to the level of the mandibular foramen. The lesion was radiolucent without distinct borders to adjacent bone. Surgery revealed a bluish, well-vascularized predominantly cystic tumor. The lesion included the temporomandibular joint disk but without overgrowth to the temporal component. After resection of the lesion, the condyle and the mandibular ramus was reconstructed with the use of an autogenous costochondral graft. The postoperative healing was uncomplicated. At follow-up 2 years after surgery the boy was free of recurrence with normal motor and sensory nerve function.

Fifteen cases (16 concavities) of the so-called "Stafne's bone cavity" were investigated with the use of computed tomography. The sizes, bony outlines, and contents were analyzed on axial images. In all cases, computed tomography clearly demonstrated the concavities on the lingual surface of the mandible. There were no empty concavities. The bony outlines and contents were divided into three types. The concavities with a portion of submandibular gland as a content were larger than those with other contents. Four of six concavities not extending to the buccal cortical plate were filled solely with fat tissue, whereas all concavities with expansion of the buccal cortical plate contained submandibular gland.

Chronic idiopathic hyperphosphatasemia, or juvenile Paget disease is a very rare syndrome that is characterized by fragile bones, bowing deformities, shortness of stature, large head, premature loss of teeth, radiographic evidence of expanded osteoporotic long bones with coarse trabeculations, and widened bones of the skull. Increased levels of serum alkaline phosphatase and increased levels of urinary total hydroxyproline are notable. We present a case of juvenile Paget disease that was associated with a history of precocious puberty. The patient had odontogenic osteomyelitis of the mandible that was treated by drainage, surgical debridement and antibiotic therapy.

This study involved 88 cases of different types of osteomyelitis of the mandible. Sixty-nine patients had osteomyelitis after trauma, eight patients after radiotherapy, six after dental infection, and six had other causes. Thirty-three patients had septicemic infection. Multiple types of aerobic and nonaerobic microorganisms were isolated from the infection sites. Types of treatment and their results are discussed.

This report describes a case of subpontic osseous hyperplasia that occurred in the posterior mandible of a healthy 67-year-old woman. The two hard masses, which were removed from beneath a fixed partial denture that was placed 35 years ago and spanned the lower left first premolar and the first and second molars, consisted of normal viable dense cortical bone. Only 30 cases of this phenomenon defined as a slow-growing, benign osseous proliferation occurring on the crest of the alveolar ridge beneath the pontic of a fixed partial denture have been described in the literature. Possible causes, including genetic programming, functional stimulus, and mild chronic irritation are discussed, as well as rationale for treatment of this anomaly.

This study analyzed 11 patients who had small sequestra associated with ulceration of the lingual mucosa in the posterior mandibular molar area at the level of the mylohyoid ridge. The patients were adults (mean age, 45.3 years) with complaints of sensitive, occasionally painful lesions that appeared for periods that ranged from 1 week to several months. No abnormalities were evident on periapical radiographs; however, in three cases in which occlusal radiographs were available, small irregular radiopacities contiguous with the cortex were noted. Spontaneous exfoliation or surgical removal of the sequestrum resulted in resolution of the lesion. The possible etiologic factors associated with this apparent clinical-pathologic entity are discussed.

Mucormycosis (phycomycosis, zygomycosis) is an acute opportunistic infection caused by a saprophytic fungus found in soil, bread molds, and decaying fruits and vegetables. Numerous predisposing risk factors are associated with mucormycosis, although most cases have been reported in poorly controlled diabetics or in patients with hematologic malignant conditions. This report presents two cases of oral mucormycosis. One case occurred in the maxilla in a patient with well-controlled diabetes. The other involved the mandible and overlying gingiva in a patient with acute myelogenous leukemia. A review of the literature concerning oral mucormycosis is also presented.

The central giant cell granuloma is a tumor that has great potential for the displacement of teeth and the development of a facial deformity. Although its cause and behavior are still matters for discussion, its early diagnosis and treatment are a priority. We describe a patient with a large benign central giant cell granuloma of the anterior mandible. The clinical, radiographic, and histologic appearance, as well as the appropriate treatment, are discussed in light of the current literature.

This article is a review of the literature on dentigerous cysts in animals. Three different lesions have been referred to in the veterinary literature as dentigerous cysts. The first of these cysts, similar to those that occur in human beings, is extremely rare. The second lesion, an odontogenic cyst located in the anterior mandibles of mature sheep, is quite common in New Zealand and parts of Britain. The third is actually a teratoma that contains teeth and is found in the temporal region of young horses; it is also rare.

Fine-needle aspiration biopsy is a technique that is gaining great popularity in both surgical and nonsurgical specialties. Its accuracy, safety, and usefulness have been demonstrated repeatedly; however, its usefulness seems to have been overlooked by oral and maxillofacial surgeons. This technique has many advantages in the diagnosis of mass lesions, including ease of use, cost effectiveness, convenience, and accuracy. It lends itself well to oral and maxillofacial surgery.

Thirty-four patients with mandibular diffuse sclerosing osteomyelitis who had been treated by means of 61 decortications were evaluated retrospectively. Eighteen patients (53%) were free from symptoms on an average of 5.4 years after surgery. Of these, 12 had improved after their first operation. In the other six patients, decortication was performed two to four times before healing was clinically observable. Symptoms recurred in 75% of the cases within 12 months after surgery. Neither sex, location, extent, and chronicity of the disease nor the precise surgical technique used seemed to affect the outcome. The patients who exhibited improvement, however, were significantly older and more often edentulous than the patients in whom the symptoms recurred. Possible causes of failure were an insufficiently radical surgical procedure and retention of devitalized teeth in the decorticated area.

The clinical presentation of hereditary hemorrhagic telangiectasia with various manifestations has been well described as has florid osseous dysplasia. There have been no cases reported of the two pathologic entities in the same patient. We present a case with the simultaneous occurrence of hereditary hemorrhagic telangiectasia and florid osseous dysplasia with important considerations for differential diagnosis, and we discuss whether this case presents a potential syndrome.

The recurrence of a solitary bone cyst of the mandibular condyle in a costochondral bone graft is reported. A solitary bone cyst of the right condylar head and neck of a 10-year-old boy was treated by total resection and immediate reconstruction with a costochondral bone graft. Two years after the first operation, a recurrence of the solitary bone cyst within the bone graft was noted. An open treatment was performed. A review of the literature on solitary bone cysts and recurrences of solitary bone cysts shows that the case reported is unique. Possible reasons for the recurrence are discussed.

Diffuse sclerosing osteomyelitis of the mandible is a disease that is characterized by a protracted course of recurrent pain, swelling of the cheek, and trismus. The cause of the lesion has been obscure for a long period of time. Recent research, however, pointed out that this disease is likely to be caused by overuse of the jaw musculature (chronic tendoperiostitis) and can be treated accordingly. The protracted course of the disease and the difficulty of treatment with an eventual positive outcome are illustrated by a case report of a 65-year-old man with an 11-year history of diffuse sclerosing osteomyelitis (chronic tendoperiostitis) of the mandible.

Special radiologic imaging techniques were used to evaluate the results of nonvascularized bone grafts combined with rigid mandibular reconstruction plates. The radiologic findings divided 21 cases into three clearly distinct groups on the basis of resorption: slight (less than 15%), moderate (15% to 30%), and massive (more than 30%) (mean follow-up, 26 months). This division predicted the clinical results well. In contrast to earlier reports, it was shown that rigid plate bridging did not adversely influence the prognosis of the graft. Nor was early plate removal necessary to reach good ossification. Narrow-beam radiography and spiral tomography proved to be excellent tools for adequate evaluation of bone resorption and bony healing of mandibular grafts.

A case of tuberculous osteomyelitis of the mandible in a 76-year-old woman is reported. The patient sought treatment for a periostitis of the left side of the mandible. A purulent discharge was evident. Roentgenographic examination of the mandible revealed bone destruction from the midmandible to the ramus on the left side. The diagnosis was made by microscopic examination of the specimen from the involved bone. This case proved to be primary tuberculous osteomyelitis caused by the absence of the primary focus.

A cavity on the posterior buccal surface of four dry mandibles (n = 8282) is reported. The shape, size, unilaterality, and sex distribution of this phenomenon are similar to anterior and posterior idiopathic bone cavities (i.e., defects) on the lingual cortex. Posterior buccal mandibular defects differ from posterior lingual cavities in their unilateral occurrence and age distribution. The differential diagnosis for posterior buccal mandibular defects includes an anatomic variant, an aneurysmal erosion, erosion by a lymphoid nodule, and a neural neoplasm.

Recurrence was found in eight cases (18%) in a group of 44 patients (22 male) with odontogenic keratocysts treated at the Department of Oral Surgery and Oral Medicine, Odense University Hospital, from 1971 to 1983. All these recurrences were found in cysts with parakeratotic, thin, bandlike epithelium with palisade-like basal cells (Forssell group la). In 12 large cysts the use of a polyethylene drainage tube implanted at cystotomy and biopsy some months before primary cystectomy resulted in considerable reduction in the cystic lumen and also in alteration of the thin, fragile cystic epithelium into thick, solid cystic epithelium with no adhesion to the adjoining structures. No recurrence was seen in these 12 patients after an observation period of between 7 and 17 years. The decompression treatment seems to reduce the tendency to recurrence of the odontogenic keratocyst, which is far more important than the advantages to the surgeon of surgical simplicity and safety, and to the patient of less discomfort and pain.

Only five cases of osteomyelitis of the mandible as a result of sickle disease have been published. We report another case, which uniquely affected not only the osseous portion of the mandible, including the condyle, but also the adjacent musculature. Radical resection of the involved hard and soft tissue was necessary to cure the patient. Two possible etiologies are discussed. The first states that the sickle cell crisis caused a tissue anoxia in which this tissue became secondarily infected; the second states that the preexisting infection triggered or augmented the sickling phenomena.

Examination of 5366 dry mandibles at the Smithsonian Institution revealed three cases of unilateral lingual defects superior to the mandibular foramen. The differential diagnosis includes a neuroma, neurolemmoma, hemangioma, or aneurysm of the inferior alveolar artery. The clinical significance of a vascular neoplasm or aneurysm would be the likelihood of increasing the risk of injecting the anesthetic solution directly into a blood vessel.

Odontogenic keratocyst and squamous cell carcinoma commonly occur within the oral cavity; however, the juxtaposition of these lesions is rare. The light microscopic and ultrastructural features of such an event are reported. Although some morphologic similarities between the cyst and tumor were observed, definitive evidence of a common origin was not obtained.

A case of congenital dermoid fistula of the lower lip is presented. The lesion consisted of a major cystic portion, a proximal tubelike extension that opened in the lower lip as a small sinus (pit) near the left commissure, and a distal cordlike extension that entered into the left mental foramen. The cystic cavity was lined with keratinizing stratified squamous epithelium, and many sebaceous glands, sweat glands, and hair follicles were seen subcutaneously. The differential diagnosis and the pathogenesis of the lesion are also discussed.

Dysosteosclerosis is a rare bone dysplasia that has radiographic, histopathologic, and clinical similarities to osteopetrosis. This article reviews the dental findings reported in patients with dysosteosclerosis and presents the first reported case of osteomyelitis of the mandible in a patient with this disease. This is also the first report that demonstrates ankylosis of impacted teeth in dysosteosclerosis.

Lingual mandibular salivary gland defects in the posterior part of the mandible are not uncommon. Analogous defects in the anterior region, however, are rare, and the four new cases presented in this report bring the total number of reported cases up to 24. The purpose of the present study was to review and analyze the clinical, radiographic, and histologic features of the previously reported cases together with those of the present study. The majority of these defects were located in the cuspid and/or premolar area and were diagnosed in men in their fifth and sixth decades of life. Almost all defects contained normal salivary gland tissue. The differential diagnosis, treatment, and pathogenesis of these defects are discussed.

Two cases of massive osteolysis were encountered, one affecting the mandible and the other the maxilla and mandible. Only 13 cases have been reported so far in the existing literature for massive osteolysis of the mandible. It is indeed a rare disease. Our two cases were surgically treated and were clinically and histopathologically assessed.

Diffuse sclerosing osteomyelitis of the mandible is a disease of unknown etiology. The clinical and radiographic findings suggest an infectious origin, but bacteriologic and histologic findings do not support this concept. Analysis of clinical symptoms, localization of the condition, and posttreatment findings in a group of 27 patients suggest a chronic tendoperiostitis due to muscular overuse as an etiologic factor in diffuse sclerosing osteomyelitis of the mandible. This hypothesis was supported by the initial results of muscle relaxation treatment in 13 of these patients.

Visual pattern analysis of mandibular bone trabeculation of 51 patients with Down syndrome and 78 normal persons was performed by using rotational panoramic radiography with a laser scan system. The findings for patients with Down syndrome were consistent with geromorphism, one of the somatic characteristics of Down syndrome.

The etiology and pathogenesis of traumatic bone cyst are still far from being conclusively established with multiple theories, names, and forms of management being proposed and used. The rarity of these lesions in the older age groups suggests that self-healing can occur. This article presents two well-documented cases of what clinically and radiographically were consistent with so-called “traumatic bone cyst” of the mandible, which have appeared to heal without surgical intervention, thus providing additional information to our understanding of the biologic nature of this entity. Case 1 involved a 14-year-old boy with a lesion of the anterior left mandible that was monitored for 7 years and 5 months. Case 2 involved a 19-year-old female patient with a lesion of the right mandible that was monitored for 2 years and 9 months. In both cases, intraosseous biopsy or other surgical procedures were not undertaken. By the time both patients approached age 22, their lesions had resolved and the trabecular bone pattern radiographically approached normal.

Hemophilic pseudotumor of bone is a rarely encountered lesion associated with hemophilia. To date, only eight cases in the mandible have been reported in the literature. A rare case occurring in the mandible of a 2 1/2-year-old child required the fabrication of a customized wound obturator for postoperative wound care after surgical curettage. The literature is reviewed and the obturator described.

A case treated by the mandibular staple implant fastener system and prosthesis is presented. The phases of therapy, involving preprosthetic surgical preparation, construction of conventional dentures, implantation of the orthopedic appliance, preparation of an interim postsurgical prosthesis, and construction of the definitive prosthesis, are described and illustrated.

A patient with Stage I systemic sarcoid (affecting the mediastinum and cervical lymph nodes) is presented. This patient had ptosis of the eyelid and miosis (Horner's syndrome) due to involvement of the cervical-thoracic sympathetic nerves by the granulomatous process. Bony destruction simulating periodontal disease occurred in the molar-premolar region and caused pain and paresthesia. Systemic sarcoid may occur more commonly in the jaws than reported cases would indicate. Sarcoidosis should be considered in the differential diagnosis when periodontal disease appears refractory to local therapy.

The clinical and histopathologic features of forty-six cases recorded as lateral periodontal cyst are reviewed. Three distinct types of epithelial lining were noted as well as varying degrees of inflammation. The data, although inconclusive, suggest that cysts arising in the lateral periodontal area may be of either an inflammatory or developmental odontogenic origin.

An unusual case of monostotic Paget's disease (osteitis deformans) of the mandible associated with progressive resorption of the roots of some of the mandibular teeth is described.