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Pyogenic granuloma (PG) is a well-known localised granulation tissue overgrowth. It remains an aetiopathological enigma, with trauma, inflammatory and infectious agents being the suspected causative factors. It is a relatively common benign mucocutaneous lesion occurring intraorally or extraorally and is more common in women in the second decade of their lives than in men. Although it is a common lesion it may present with varying clinical features that sometimes may mimic more serious lesions such as malignancies. The clinical diagnosis of such lesion can be quite challenging. This case report drives attention towards the uncommon location of PG of lobular capillary haemangioma type occurring on anterior palate. Surgical excision of the lesion was planned because of the discomfort attributed to large size of the lesion and hindrance in mastication.

A teratoma is a true neoplasm composed of multiple tissues foreign to the sites from which they originate. The estimated incidence of mature congenital teratomas at all sites is 1 in 4000 live births, of which at least 2% are oropharyngeal. An epignathus tumor is a congenital malformation classified as a mature teratoma. The incidence of epignathus is much rarer, estimated from 1:35,000 to 1:200,000 live births and has a female predominance. Teratomas, by definition, are neoplasms that consist of all 3 germ cell layers, and in the case of epignathus teratomas, the germ cell layers are mature differentiated tissue. A 1-day-old infant presented to us with giant epignathus that arose from the palate and extended to the lateral oropharynx and to the tongue. The tumor did not cause immediate respiratory obstruction, but there was difficulty with feeding. At the fifth day of the baby's life, the tumor was excised completely under general anesthesia through an endotracheal intubation.

Background Recently, some patients have been found to have superficial squamous cell carcinoma (SCC) of the head and neck region during GI endoscopy; however, endoscopic biopsy from a lesion in the head and neck region is troublesome. An endocytoscopy system has been reported to enable optical biopsy of an esophageal lesion. Objective To evaluate the feasibility of in vivo cellular imaging with an integrated endocytoscopy system for patients with superficial SCC of the head and neck. Design Experimental pilot study. Setting University hospital. Patients This study involved 12 patients who were found to have superficial SCC of the head and neck during GI endoscopy. Intervention Endocytoscopic images were taken of each lesion and of the surrounding mucosa. The images were later reviewed by 1 pathologist and 2 endoscopists who were unaware of any other findings. Main Outcome Measurements Correlation between endocytoscopy diagnosis and histologic diagnosis. Results Adequate endocytoscopic images could be obtained in 11 of the 12 patients (15 of 16 lesions). For endocytoscopic images of 15 lesions and 12 areas of surrounding mucosa, the overall accuracy of endocytoscopic diagnosis in differentiating between nonmalignant and malignant histopathology by the pathologist, endoscopist 1, and endoscopist 2 were 96%, 96%, and 96%, respectively. The kappa value for interobserver agreement was 0.77. Limitations Single-center experience, small number of patients. Conclusion An endocytoscopy system has the potential to be used as an optical biopsy for superficial head and neck lesions.

Uvular enlargement may occur acutely as a result of infection, allergy, or trauma. Squamous cell carcinoma may present as a progressively enlarging uvular mass. Primary MALT (mucosa-associated lymphoid tissue) lymphoma of the uvula and a neuroendocrine tumor of the parapharyngeal space presenting as a uvular mass have each been previously described in the literature. Here we present a case of low-grade B-cell lymphoma presenting as a uvular mass in a 55-year-old patient with progressive throat swelling and dysphagia.

Objective To understand the role of angiogenesis and hypoxia in cancer progression of primary oral melanoma (POM). Materials and Methods Sixteen malignant primary melanomas were immunostained with markers CD34, VEGF and HIF-1α. Stained cells were counted in the invasive front and inside the tumour, and the differences were compared and correlated with histological parameters and disease-specific survival of the patients. Results Tumour invasive front showed increased MVD and increased vessel VEGF and HIF-1α expression compared with the intratumoural compartment. No such differences were seen in tumoural melanocytes of the two compartments. Positive correlations were observed between CD34 and VEGF, CD34 and HIF-1α and VEGF and HIF-1α expression in invasive front vessels. CD34 expression was statistically correlated with the level of infiltration. A significant trend to worse disease-free survival was also determined with increased invasive front vessel expression of CD34, VEGF and HIF-1α. Conclusions Our data highlight the importance of the invasive margin in POM biology. The high angiogenic activity and endothelial VEGF and HIF-1α expression in invasive front vessels have a significant impact on patient survival and future agents targeted against VEGF pathway may represent a novel and effective therapeutic opportunity. Larger studies are needed to further address our findings.

Minor salivary gland tumors of the palate are rare and may pose a diagnostic and therapeutic dilemma for the head and neck surgeon. The authors reviewed their 46 years of experience with minor salivary gland tumors of the palate to determine the factors that influence outcome and their implications for treatment. Malignant tumors were seen in 116 patients (78%) and benign tumors were found in 33 patients (22%). Adenoid cystic carcinoma was the most common malignant tumor, occurring in 43 patients, and pleomorphic adenoma was the most common benign tumor, occurring in 30 patients. Univariate analysis on the malignant lesions showed that grade 3 tumor histology (P < .001), tumor size greater than 3 cm (P < .001), perineural invasion (P = .031), bone invasion (P = .012), positive surgical margins (P < .001), and positive initial but negative final margins (P = .004) were all associated with decreased survival. With multivariate analysis, tumor size, margin status, and grade were shown to be independently associated with decreased survival (P < .05). The recurrence rate at the primary site was significantly higher for adenoid cystic carcinoma than for other histologies (P = .0059). The 2-, 5-, and 10-year disease-specific survival rates for patients with malignant disease were 96%, 87%, and 80%, respectively. Wide surgical excision with adequate margins is essential for a favorable outcome in patients with malignant minor salivary gland tumors. Postoperative radiotherapy is reserved for patients with grade 3 tumor histology, large primary lesions, perineural invasion, bone invasion, cervical lymph node metastasis, and positive margins, although a clear-cut survival advantage has not been proven. Recurrence, especially regional and distant metastasis, portends an extremely poor prognosis.

We have analysed both the nuclear-cytoplasmic (N/C) ratio and nuclear volume densities (VVN) in defined strata from human hard palate lesions with and without malignant potential to determine the prognostic reliability and/or validity of this parameter. Measurements of cellular and nuclear areas of basal and spinous cells from normal (N) and pathological palatal epithelium were made on histological sections using an image analyser. The lesions comprised fibrous hyperplasia (FH), traumatic inflammation (INF), benign hyperkeratosis (HK), squamous cell papilloma (PP), dysplastic epithelium adjacent to invasive carcinoma (CE) and islands of invasive squamous cell carcinoma (CI). In basal cells, no significant differences were detected in comparisons of N/C and VVN between all pathological groups and the N control group. The mean value for CE was lower than that obtained for N. In spinous cells, the only statistically significant comparison was between IF and FH for both N/C and VVN. Both parameters were lower in CE than in N. Of all groups analysed except CI, the CE group is the only one likely to possess an increased malignant potential. The N/C ratio therefore seems to be of no value as a predictor of malignancy in palatal epithelial lesions.

12 cases of acinic cell carcinoma diagnosed in Northern Ireland from 1942 to 1982 on which there was at least 10 years' follow-up were reviewed, by pooling cases from all regional pathology laboratories. Clinical findings at presentation were established from case notes, together with details of eventual clinical outcome. Sections were examined to determine tumour size, morphological pattern and cytological constitution, the presence or absence of cytological atypia, mitotic activity, lymphocytic and desmoplastic responses, and to assess for infiltrative margins and adequacy of excision. The tumours arose in 8 females and 4 males, aged 22 to 86 years at presentation. Eleven tumours were in the parotid, one in the soft palate. Two patients suffered local recurrence, both more than 7 years after diagnosis. Five patients had regional lymph node metastasis, four at presentation. No patient suffered haematogenous metastasis or died of tumour. Of the features examined, incomplete excision increased the risk of local recurrence. While numbers are small, the acinic cell carcinoma in Northern Ireland is an unpredictable low-grade malignant tumour which is capable of recurrence and metastasis. Adequate excision at presentation appears to be the most appropriate therapy.

Epstein-Barr virus (EBV) type B, a less potent transformer of B lymphocytes than type A, has rarely been detected in EBV-associated neoplasms except in AIDS-related lymphomas, in which about 50% of the cases contained this sub-type. In this study we analyzed the association of EBV and the distribution of virus sub-types in Asian non-Hodgkin's lymphoma (NHL) of the upper aerodigestive tract. We studied archival material of 29 NHL cases from Malaysia. B- and T-cell associated antigens were demonstrated by immunohistochemistry, and EBV early RNA EBER-1 was demonstrated using the RNA in situ hybridization technique. EBV was detected in the majority of tumour cells in 11/13 T-NHL but in only 1/16 B-NHL. EBV was sub-typed by single-step polymerase chain reaction of the EBNA-2 gene. This was successful in 9/10 cases of EBER-I-positive tumours and all contained type-A virus only. Our results showed a preponderance of T-cell lymphoma of the upper aerodigestive tract in the ethnic Chinese group of Malaysian patients, and EBV was strongly associated with T-NHL but not with B-NHL. Our results suggest that type-A EBV is the prevalent sub-type in Asian NHL of the upper aerodigestive tract, similarly to findings in Asian nasopharyngeal carcinoma. © 1995 Wiley-Liss, Inc.

Objective Prosthetic treatment for speech disorders attributable to surgically acquired soft palate defects are introduced. Case A patient who underwent soft palate resection for cancer is presented. The resected portion of the soft palate was confined to the posterior segments. A prosthesis with a speech bulb was adapted to the patient. Conclusion Excellent restoration of speech and improvement of velopharyngeal function was achieved following placement of the special prosthesis.

Epignathus is an unusual, benign, congenital teratoma of the hard palate. Most of these teratomas are unidirectional and protrude through the mouth. Hence, the prognosis depends on the size of the tumor and degree of face distortion and airway obstruction. Occasionally, intracranial extension of the tumor is present, involving and destroying the brain tissue, resulting in a poor prognosis. The authors describe 2 cases of bidirectional epignathus, showing the different findings on ultrasonography and magnetic resonance imaging.

We report a case of hemangiopericytoma of the soft palate of 60-year-old patient, who noticed a mass of the soft palate and experienced difficulty in speaking. We found a pediculate, hard, elastic mass measuring 38 mm (cross-sectional diameter). Computed tomography (CT) scans and dynamic magnetic resonance imaging (MRI) confirmed irregularly shaped mass and revealed a heterogeneous internal composition, consistent with vascular tumors. We excised the tumor under general anesthesia. Histopathological diagnosis was based on positive immunoreactivity of CD99 and vimentin and weak, positive staining of CD34. Three and half years following tumor excision, there is no recurrence or metastasis.

Epithelial-myoepithelial carcinoma (EMC) arising from the minor salivary gland of the hard palate is very rare. A 34-year-old lady presented with a nodular swelling in the hard palate. Histopathologically, a diagnosis of clear cell predominant EMC was suggested. Immunohistochemistry demonstrated the biphasic nature of the tumor and confirmed the diagnosis of EMC.

The color of the human oral mucosa is not uniform. Chromatic variations can occur, depending on the degree of keratinization, melanogenic activity, number of melanocytes, vascularization, and type of submucosal tissue. If a pathological pigmentation is suspected, its benign or malignant nature will guide the treatment plan. This article presents a rare case of malignant melanoma of the anterior maxilla with asymptomatic palatal pigmentation and regional lymph node metastasis. Flow charts for the diagnosis and treatment of pigmented lesions (with special emphasis on treatment of primary and metastatic melanoma) are included.

The purpose of this study was to investigate the incidence of cervical metastasis in squamous cell carcinoma (SCC) of hard palate and maxillary alveolus and to define its impact factors.We conducted a retrospective study of patients surgically treated for SCC of hard palate and maxillary alveolus from 2002 to 2011. In situ hybridization was performed to detect high-risk human papillomavirus (HPV) infection.The incidences of cervical metastasis and occult metastasis were 17.2% (11/64) and 9.8% (5/51), respectively. The pT classification and vascular invasion were correlated with cervical metastasis. Occult metastatic risk was significantly higher among patients with pT4. Presence of positive nodes impaired prognosis significantly.SCC of hard palate and maxillary alveolus has nonnegligible incidences of both overall and occult metastasis, which were highly associated with pT classification. We recommend routine, synchronous elective neck dissection for T4 lesions, whereas observation is an alternative for T1 to T3 lesions.

The objective was to examine the role of tobacco smoking and alcohol drinking in the incidence of oral cavity cancer by subsite in France, a high-incidence area. We analysed detailed data on lifelong tobacco smoking and alcohol drinking from 772 oral cavity cancer cases and 3555 controls included in a population-based case-control study, the ICARE study. Tobacco smoking increased the risk of oral cavity cancer even for the smaller quantities and durations, whereas alcohol drinking increased this risk only in heavy drinkers who were also ever smokers. The combined effect of smoking and drinking was greater than multiplicative. The floor of the mouth was the subsite that was the most affected by the harmful effects of tobacco and alcohol, whereas the gums were less susceptible. The risk associated with tobacco and alcohol consumption did not differ between intraoral cavity and subsites usually included in the oropharynx (soft palate and base of the tongue). Population-attributable risks for oral cavity cancer were 78.6% for tobacco smoking, 7.3% for alcohol drinking and 80.7% for tobacco and/or alcohol consumption. These results indicate that regular oral check-ups should be targeted at smokers and heavy drinkers, and that prevention efforts should be focused on smoking cessation.

The superiority of volumetric staging (VS) over TNM/TNM-grouping system was previously prospectively tested in our head neck cancer population treated with intensity-modulated radiotherapy (IMRT); gross tumor volume (GTV) was the strongest predictor for disease control. Aim of this work was to specifically assess the prognostic value of VS in oropharyngeal cancer (OC).Between 04/2002 and 12/2011, 277 consecutive OC patients underwent definitive IMRT. Mean/median follow-up was 33/27 months (3-113). Three volumetric cut-offs were used (resulting in 4 GTV subgroups: 1-15 cc (14%), 16-70 cc (62%), 71-130 cc (20%),130 cc (4%)).Outcome in the OC subgroup was prospectively assessed with VS and compared with that resulting from TNM and AJCC staging.Primary GTV was most reliably predicting local control (p0.0001), all other outcome parameters were predicted best by the total GTV (p0.0001).This is -to our knowledge- the first volumetric staging system for OC, and was found to be most reliable in predicting outcome in OC patients treated with IMRT.

A 72-year-old man was referred from the surgery department for rehabilitation following surgical resection of Basaloid carcinoma. The first surgical intervention involved the anterior palatal region and was restored with a simple obturator. Two years later further surgery was undertaken to excise a recurrent tumor in the nose and part of the cheek. This resulted in an exposed nasal cavity and maxillary sinus. In addition, there was a small oral aperture composed of thin tissue that stretched to its maximum due to scar formation. The defect was restored with a full thickness skin flap but it subsequently broke down leaving the midface exposed with limited mouth opening due to tissue contraction and scar formation after the flap operation. The defect was rehabilitated with Co-Cr obturator intraorally and a silicone nose retained to the naso-palatal extension of the obturator by a magnet extraorally. This resulted in practically good retention, placement, and adaptation of the two parts of the prosthesis.

Purpose An analysis was performed of the clinical and epidemiologic characteristics of a group of patients diagnosed with oral metastases of distant primary tumors or unknown primary malignancies. Material and Methods The study series consisted of 16 patients with oral metastatic lesions seen in the Department of Stomatology and Maxillofacial Surgery, Valencia University General Hospital (Valencia, Spain) that had been diagnosed in the previous 15 years. A retrospective analysis was made of patient age and gender, clinical characteristics of metastatic lesions, location of the primary tumor, and time elapsed from diagnosis to the death of a patient. Results There were 13 male and 3 female patients (mean age, 58.8 years). Ten patients had been diagnosed previously and were being treated for a primary tumor; 2 patients were diagnosed with a primary malignancy in the department; and 4 patients presented with an unidentified primary tumor (metastatic disease diagnosed from biopsy study). The predominant clinical presentation was mixed soft tissue and bone metastases followed by solely soft tissue lesions and solely bone lesions. Some patients showed no apparent oral lesions. Primary malignancies originated mainly from the lung followed by the prostate, gastrointestinal tract, thyroid gland, breast, and liver. Mean survival from diagnosis of oral metastases was 8.25 months. Conclusion Oral metastatic lesions are infrequent, can affect male and female patients equally, can manifest at any age, and may constitute the first manifestation of a still unidentified primary malignancy. According to the literature, bone metastases are more common than soft tissue metastases. Nevertheless, in the present series, there was a clear male predominance, and the oral metastases showed a predominance of mixed presentations followed by solely soft tissue lesions and solely bone metastases.

Free fibula flap is widely used in head and neck reconstruction. Imaging studies of the donor site can reveal vascular abnormalities and therefore prevent acute leg ischemia.Evaluation of the role of donor site vascular imaging studies for free fibula flap planing.Out of 35 free flap reconstructions performed in Otolaryngology Head and Neck Surgery Department in Medical University in Lublin in 2011-2012, there were 10 fibula flaps. Each patient had preoperative lower leg subtraction angiography performed.Lower leg angiography revealed vascular abnormalities in two out of 10 patients scheduled for free fibula flap transfer. One had dominant peroneal artery and second occlusion of anterior tibial artery. In both cases fibula was harvested from the other leg.Imaging studies reveal lower leg vascular abnormalities in 20% of cases thus facilitate surgical plans alternations and prevent serious complications in free fibula flap patients.

To determine the role of cigarette filter on the incidence risk of oral squamous cell cancer among male smokers in a Chinese population.A multicentric hospital-based case-control study was applied. Three hundred and nineteen male cases and 428 male controls matching for age ( ± 3 years) were identified from January 2008 to December 2010. Detailed smoking histories were obtained by interviews. Logistic regression model was used to compare the influence of filter and non-filter cigarettes on oral cancer risk.The adjusted odd ratios (ORs) for oral cancer were 1.30 (95% CI 1.15, 1.48) of filter cigarette smokers, 2.06 (95% CI 1.17, 3.62) of non-filter cigarette smokers, and 1.73 (95% CI 1.33, 2.25) of mixed smokers, as compared with non-smokers. When classified current smokers according to smoking pack year, the ORs of mixed smokers were 2.27 (95% CI 1.06, 4.85) in20 pack year, 0.81 (95% CI 0.57, 1.14) in 20-39 pack year, and 0.86 (95% CI 0.57, 1.29) in ≥ 40 pack year, as compared to filter cigarette smokers.The protective effect against oral cancer of cigarette filter was limited, restricted to smokers of small amount of smoking accumulation. For most smokers, the difference was non-significant between filter and non-filter cigarettes on the risk of developing oral cancer.

Schwannomas, also known as neurilemmomas, are uncommon neoplasms, derived from schwann cells. These neoplasms, although rare, should be considered in the differential diagnosis of slow growing tumour masses of the oral cavity. The growth of these tumours sometimes causes displacement and compression of the nerve of origin, giving rise to clinical signs and symptoms. It can develop at any age and there is no sex predilection. Intraorally, the tongue is the most common site followed by the palate, floor of the mouth, buccal mucosa, lips and jaws. Surgical excision is the treatment of choice for schwannomas, with few reports of recurrence or malignant transformation. In this paper, the authors report two cases of patients with intraoral schwannoma, where the preoperative clinical diagnosis was inconclusive and final diagnosis was established based on radiographic and histopathological examination.

Desmoplastic melanoma (DM) arising in the oral cavity is a rare neoplasm that may be confused with a variety of non-melanocytic benign or malignant lesions.To present a case of DM in the oral mucosa mimicking fibrous inflammatory hyperplasia, discusses the difficulties involved in the diagnosis and offers a literature review on the clinicopathologic and immunohistochemincal aspects of this neoplasm.A 62-year-old white male, smoker, was referred with a chief complaint of pain and swelling in the palate. The oral examination revealed multiple brown-to-black patches and a non-pigmented sessile nodule located on the mucosa of the hard palate. The clinical diagnosis of the pigmented lesions was either oral melanosis or melanoma. The nodular lesion was clinically diagnosed as fibrous inflammatory hyperplasia. Incisional biopsy was performed on the pigmented lesion and the microscopic sections revealed a melanotic macule. The nodular lesions histologically revealed an amelanotic desmoplastic melanoma.Reactive lesions close to a pigmented area should be investigated with great care.

Malignant melanoma is the least common but most deadly of all primary skin cancers. Oral malignant melanoma is a rare aggressive neoplasm usually seen in middle aged persons. This malignancy is more frequently seen on the hard palate and gingiva. Oral melanomas are associated with very poor prognosis because of the tendency to metastasise or invade tissues locally more readily than other malignant tumours of the oral cavity especially in the case of a geriatric patient. The surgical approach, combined with the chemotherapy, is the first choice treatment. This report highlights a case report of 71-year-old female patient diagnosed and treated surgically for an oral malignant melanoma of the pedunculated variety affecting the hard palate and gingiva with review of literature.

Currently, transoral robotic surgery (TORS) with the daVinci robot is mainly used for squamous cell carcinoma of the oropharynx and supraglottic larynx. The safety, efficacy, and functional outcomes regarding this approach have previously been described. In addition to transoral resection of squamous cell carcinoma, we have found use for this technique in removing selected tumors of the parapharyngeal space. Three patients with benign or malignant tumors of the parapharyngeal space who underwent successful transoral resection using the daVinci robot were included in the study. In all three cases, complete tumor excision was achieved without any complication. None required conversion to an open procedure. Mean TORS operative time and intraoperative blood loss were 16.3 min and 4.7 mL, respectively. Inadequate oral exposure, involvement of the internal carotid artery, limited cervical spine mobility and large tumor size are the main limitations of this approach. Result indicates that magnified view, 3D visualization with the combination of the transoral robotic experience, allow en bloc resection of selected parapharyngeal space tumors located medial to the carotid sheath.

The coexistence of different types of malignancy in cervical lymph nodes has been reported previously. We report the first case, to the best of our knowledge, of concurrent metastatic adenoid cystic carcinoma and squamous cell carcinoma (SCC) in cervical lymph nodes. A primary SCC developed three decades after treatment for adenoid cystic carcinoma of the palate, and the synchronous metastases became clinically apparent the following year. The aetiology of the SCC may have been related to radiotherapy or smoking. Whether the adenoid cystic carcinoma would have remained dormant, or was reactivated after perturbation of host defence mechanisms, is not known.

Non-Hodgkin's lymphoma usually involves lymph nodes, but can involve extranodal sites. Oral lymphomas are relatively rare and often difficult to diagnose in a clinical setting. A case of non-Hodgkin's lymphoma of the hard palate who had undergone external beam radiation therapy and was found to be well one year following treatment is reported.

Nevus of Ota, a benign melanocytic pigmentary disorder with rare malignant transformation potential, affects 0.014-0.034% of the Asian and Black population and has a strong predilection for females. It occurs in the area innervated by the first and second division of the trigeminal nerve. Oral manifestation is rarely noted with only 14 cases reported till date. This report documents a case of Nevus of Ota with the infrequently noted oral involvement, in an Indian lady. Since oral manifestation is not acknowledged in Tanino′s classification, the authors propose a modification to the same.

The objective of this report is to present an unusual case of a gigantiform cementoma manifesting with gross expansion of the maxilla in a 6-year-old black female. No history of similar lesions in the family of the patient was obtained. Radiographic examination revealed a well-circumscribed lobular radio-opaque mass surrounded by a radiolucent margin. The macroscopic specimen showed lobular mineralized masses with a ″ginger root″-like appearance. Microscopic examination showed a lobular calcified mass with a peripheral zone of fibropsammomatous tissue corresponding with the radiolucent margin. The differential diagnoses, which include osteoma, ossifying fibroma and cementoblastoma, are discussed.

Prosthetic rehabilitation with an obturator for a total or subtotal maxillectomy patient is a challenging task, as there are little or no residual maxillary structures to depend on for support, retention, and stability of the prosthesis. This clinical report describes the prosthodontic management of a patient operated on for a bilateral subtotal maxillectomy secondary to ameloblastoma of the palate with a closed hollow obturator. The processing technique described in this article to fabricate the hollow obturator is a variation of other well-known techniques. The variation comprises the use of a wax bolus to maintain a predictable internal dimension for a hollow obturator. This technique allows fabrication of a complete hollow obturator prosthesis as a single unit in heat-polymerized acrylic resin using a single-step flasking procedure.

Carcinoid (neuroendocrine) tumors of the head and neck rarely occur outside the larynx and, until now, none has been reported in the oral cavity. We describe what we believe is the first reported case of an atypical carcinoid tumor, or any other type of neuroendocrine carcinoma, of the uvula.

For patients undergoing radical head and neck surgery, the deformity or physical defect adds to the agony. Rehabilitation of patients with such deformities is a challenge for the maxillofacial prosthodontist to enhance the esthetics and give psychological strength to the patient. This clinical report describes the rehabilitation, using a silicone prosthesis, of a large facial and orbital defect due to mucoepidermoid carcinoma.

This study evaluated the applicability of pedicled buccal fat pad grafting for the reconstruction of defects surgically created during oral surgery. A buccal fat pad graft was applied in 23 patients (5 males, 18 females; mean age 68.3 years) between 2003 and 2011. The graft was used to cover surgical defects of the palate, maxilla, upper gingiva, buccal mucosa, lower gingiva, oral floor, and temporomandibular joint region. Size of the surgical defects ranged from 15mm×12mm to 30mm×40mm; size of the buccal fat pad ranged from 15mm×12mm to 43mm×38mm. A pedicled buccal fat pad was prepared by incising the maxillary vestibule following primary surgery, and the surrounding connective tissue was preserved to supply nutrition to the pedicle during surgery. The buccal fat pad was placed on the raw surface of soft tissue or bone surface and sutured to the surrounding tissue of the defect. Complete epithelialization was observed within 4 weeks postoperatively. There were no complications or functional disorders during follow-up. Buccal fat pad grafting appears to be feasible for the reconstruction of surgically induced defects, and can be extended to the palate, mandible, mouth angle, and temporomandibular joint region.

Objectives To explore changes in distribution of stage at diagnosis among individuals with oral and pharyngeal cancers over the past two decades and whether the changes differ by race. Methods We obtained 1991–2008 cancer incidence data for nine anatomic sites of the oral and pharyngeal structure from the Florida Cancer Data System. These cancers were grouped into oral squamous cell carcinoma (SCC), pharyngeal SCC, and other head and neck cancers. Annual percent change was calculated for each group to characterize trends in age-adjusted cancer incidence over time by race and stage at diagnosis. Results During 1991–2008, the overall age-adjusted oral SCC incidence was decreasing for both races, with a greater decline observed among Blacks. There was a large drop in incidence of regional-stage diagnoses among Blacks. For pharyngeal SCC, the age-adjusted incidence of localized- and regional-stage diagnoses was increasing for Whites during 1991–2008, with the largest increase in the incidence of regional-stage diagnoses. The percentage of localized-stage diagnoses was increasing for both races for oral SCC. A slight increase in percentage of localized-stage diagnoses was observed for Blacks for pharyngeal SCC, whereas no obvious change was observed among Whites. Conclusions Blacks continued to have lower percentages of localized-stage diagnoses than Whites for nearly all sites, but an increasing percentage of localized-stage diagnoses was observed for oral SCC among Blacks. For pharyngeal SCC, the increase in incidence among Whites was accompanied by an increasing percentage of late-stage diagnoses. Coordinated public health approaches with a special emphasis on screening underserved populations are needed.

Aim The purpose of the present article is to discuss four different case reports of the so-called calcifying odontogenic cyst and highlight the histopathological diversity of the same. Background Calcifying odontogenic cyst was first described by Gorlin et al in 1962. Ever since, its identification as a specific odontogenic lesion, controversies and confusions have existed regarding the relationship between cystic lesions and solid tumor masses that share cellular and histomorphologic features. Although several classifications were proposed, dilemma still persists regarding the nature of these lesions as cysts, neoplasms and even malignancies. Conclusion and clinical significance The classifications discussed for the so-called calcifying odontogenic cyst by various authors have only added to further confusion rather than enlightening. Though many authors state that classifications remain only an academic exercise, it definitely has significance in treatment planning. Emphasis should, therefore, be laid on a universally accepted classification. How to cite this article Sonawane K, Singaraju M, Gupta I, Singaraju S. Histopathologic Diversity of Gorlin's Cyst: A Study of Four Cases and Review of Literature. J Contemp Dent Pract 2011;12(5):392-397.

To evaluate the diagnostic value of dynamic contrast-enhanced MRI (DCE-MRI) for differentiating between benign and malignant tumors in the palate.26 patients with submucosal palatal tumors were preoperatively examined using DCE-MRI. Their maximum contrast index (CImax), time of CImax (Tmax), and washout ratios (WR300 and WR600) were determined from contrast index curves. The submucosal palatal tumors were divided into two groups according to their Tmax values: the early enhancement group (Tmax300 s) consisted of 9 malignant tumors and 6 benign tumors, while the late enhancement group (Tmax≥300 s) included one malignant tumor and 10 benign tumors. We compared the following DCE-MRI parameters between the benign and malignant tumors: CImax and Tmax in all cases and CImax, Tmax, and the washout ratios in the early enhancement group. In addition, we performed a regression analysis of the relationships between tumor size and DCE-MRI parameters; i.e., CImax, Tmax, and washout ratios, among the malignant salivary gland tumors and pleomorphic adenomas.In all cases and the early enhancement group, significant differences in Tmax were detected between the benign and malignant tumors (P0.001 and P0.05, respectively), and the optimal Tmax cutoff value for differentiating between them was found to be 165 s. None of the other parameters displayed significant differences between the benign and malignant tumors. Only the WR600 of the pleomorphic adenomas was significantly correlated with tumor size (R2=0.92, P0.001).Tmax is a useful parameter for distinguishing between benign and malignant submucosal palatal tumors.

INTRODUCTION: The aim of this study was to determine the types, frequency, distribution, and demographic characteristics of salivary gland tumours in a large representative sample. ----- PATIENTS AND METHODS: We retrospectively analysed the medical records of 779 patients with tumours of the salivary glands surgically treated from 1985 to 2009 at a single institution. ----- RESULTS: There were 500 benign and 279 malignant tumours. The average age of patients with benign tumours was 50 years and of malignant salivary gland tumours 56 years. No differences in age and incidence of tumours existed between males and females. The majority of the tumours occurred in the parotid gland (509), followed by the minor salivary glands (212), the submandibular gland (51) and lastly, the sublingual gland (7). Minor salivary gland tumours occurred most frequently on the palate, the pleomorphic adenoma being the most frequent benign tumour type and the adenoid cystic carcinoma being the commonest malignant tumour. Tumours of the sublingual gland were rare, but all were malignant. Malignant tumours were more common in the minor salivary glands and the submandibular gland. ----- CONCLUSION: This large study of salivary gland tumours in Croatia could improve our understanding of the significant differences in the global distribution of salivary gland tumours which have been reported.

WOS: 000309547200011, PubMed ID: 22976682, Canalicular adenomas are uncommon, benign epithelial neoplasm of the salivary glands that usually involve the upper lip and the buccal mucosa of elderly people. Differential diagnosis of the canalicular adenoma versus adenocarcinoma is important because it may result in unjustified radiotherapy or extensive and aggressive surgery. Despite the benign nature of canalicular adenomas, complete surgical removal and a regular clinical follow-up are recommended. The current study describes the diagnostic procedures, surgical management, and follow-up of a canalicular adenoma involving the palate of a 79-year-old man.

The transferrin receptor (TfR) appears in vigorously proliferating cells. We did an immunohistochemical study of TfR in oral tissues and a quantitative analysis by flow cytometry of TfR in a cancer cell line after an anticancer drug treatment. TfR was found in the parabasal and basal layers of the normal epithelium, but rarely in benign tumors. Generally, in the malignant tumors, the poor prognostic cases showed strong staining regardless of the differentiation of the tumor. In the flow cytometric analysis, the amount of TfR decreased according to the reduction of the proliferative ability of cancer cells. These results suggest that TfR expression may be useful as a prognostic marker.

Background. A murine model of oral cavity carcinogenesis is needed to study the molecular aspects of malignant transformation. 4-Nitroquinoline-1-oxide (4NQO), a water-soluble carcinogen, produces squamous cell carcinoma in rodents. Protocols were designed to investigate the temporal aspects of neoplastic transformation. Methods. 4NQO was applied topically to mouse palates for up to 16 weeks. Mice were observed and killed from 24 to 49 weeks. Results. A spectrum of lesions ranging from atypia to moderately differentiated invasive squamous cell carcinoma (SCC) was produced. The severity of the lesions corresponded to the duration of treatment and the length of observation. There was no gross or microscopic evidence of an inflammatory reaction to 4NQO. The lesions were focal and normal mucosa predominated in the treated mice. Conclusion. 4NQO reliably produced preneoplastic and malignant oral cavity lesions, which morphologically and histologically mimic human head and neck cancer. Lesions develop long after 4NQO exposure and without an inflammatory response. Thus, the model should be useful for molecular analysis of neoplastic transformation. © 1994 John Wiley & Sons, Inc.

Purpose: To investigate the relationship between clinicopathologic features and bone invasion in adenoid cystic carcinoma. Patients and Methods: Thirty-two patients with adenoid cystic carcinoma were included. Of 17 patients with suspected bone invasion based on clinical and/or radiographic findings, 13 also underwent histologic evaluation. Results: Bone invasion was detected in nine patients. Bone involvement was radiographically classified as erosive, diffuse invasive, or minimal change. No tumor infiltration into the surrounding bone marrow spaces was observed in the erosive-type tumors. However, tumor invasion through the resorbed cortex was observed with the diffuse invasive tumors and through the bone defects in the minimal change tumors. Conclusion: Histologically, diffuse invasive radiographic change was observed with solid lesions. However, minimal bone resorption was observed on radiographs of the glandular lesions, even when the tumor cells had infiltrated extensively into the bone marrow spaces. In the tumors of the tubular type, all three radiographic types were observed.

Clinical examination was performed on 20 cases of malignant melanoma in the oral region encountered at the First Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tokyo Medical and Dental University, during the 22-year period from 1970 to 1991. In addition, we reviewed 140 cases reported in the Japanese literature since the last major review in 1974. The results of our study revealed that the clinical course of malignant melanoma in the oral region is worse than oral squamous cell carcinoma and that treatment by radiotherapy is effective in prolonging the life of these patients. Clinically, the tumors were classified into five types: (1) pigmented nodular type; (2) nonpigmented nodular type; (3) pigmented macular type; (4) pigmented mixed type; and (5) nonpigmented mixed type. We suggest that oral malignant melanoma might be different from cutaneous malignant melanoma and that new criteria for diagnosis and therapy for oral disease should be considered.