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Background: Diffuse sclerosing osteomyelitis of the mandible (DSOM) and SAPHO (synovitis, acne, palmo-plantar pustulosis and psoriasis, hyperosteosis, osteitis) syndrome are not commonly associated. SAPHO has not been described to date in the stomatology and maxillo-facial surgery literature in French. Were report here a homogeneous series of 12 patients with DSOM., Material and Methods: All patients had mandibular osteitis., Results: Five patients with multifocal osteitis wre considered to present SAPHO syndrome because of the associated skin lesions. One patient with a unique focus of mandibular osteitis and palmo-plantar pustulosis probably had early-stage SAPHO syndrome. The diagnosis in the other cases was diffuse sclerosis osteitis of the mandible., Discussion: We compared our series with those reported in the literature, emphasizing diagnostic and therapeutic difficulties. Diffuse sclerosing osteomyelitis of the mandible should be distinguished from microbial osteitis. Early diagnosis is required to avoid successive and unnecessary dental avulsions. There is a possible link between DSOM and SAPHO and all patients should have a complete work-up including whole-body scintigraphy to search for other foci. A biopsy is indicated to rule out malignancy. Nonsteroidal antiinflammatory drugs can improve patient comfort in this particularly long syndrome. Although the efficacy is demonstrated, surgery and antibiotics can only delay relapse for a few months.

Objectives: To investigate the phenotype of lymphocytes and dendritic cell precursors in the peripheral blood of adult patients with histiocytosis X., Methods: Data were obtained on patients with histiocytosis X treated in La Pitié-Salpetrière Hospital. Peripheral blood mononuclear cells from 10 patients (4 with unifocal and 6 with disseminated disease) were studied by flow cytometry. A method was set up to detect circulating Langerhans cells, dendritic cells and their precursors., Results: An abnormal repartition of "memory" T lymphocyte subsets was observed, with a significant decrease of CD4CD45RO and CD8CD45RO and a reciprocal increase of CD4CD45RA "naive" cells, while CD4+ cells displaying the accessory molecule CD28 were decreased in some patients. These abnormalities disappeared in vitro after triggering of the CD3 and CD28 molecules in the absence of antigen presenting cells, hence demonstrating that there was no constitutive defect in the capacity of CD4+ and CD8+ T cells to convert from the CD45RO- to the CD45RO+ isoform. Langerhans cells were undetectable in the peripheral blood, and dendritic cells and their precursors were present in normal proportions (0.5 +/- 0.2% and 2.8 +/- 1.2%, respectively), but the latter were more numerous (4% and 6% of the PBMC) in the two patients with the more severe form of the disease., Conclusions: We found in these patients some T lymphocyte phenotype abnormalities which suggest alterations in antigen-driven activation processes. The number of dendritic precursor cells was not consistently elevated in the peripheral blood from histiocytosis X patients.

An adenomatoid odontogenic tumor located in the mandible was studied in a 28 year-old woman. The clinical, histological and ultrastructural characteristics of this rare tumor are described out and the histogenesis is discussed.

A myxoma of nerve sheaths involving the maxillary sinus was observed in a 12 year-old boy. The tumour, necrotic and calcified in this central area, was detected by a radiological opacity. In this periphery, the histological features were characteristic, showing lobules surrounded by fibrous tissue. In these lobules, spindle-shaped or stellate tumour cells were scattered in an abundant "myxomatous" matrix. The child is in good health fifteen months after surgical treatment. The histogenesis of this rare tumor is discussed in relation to this case and to those cases previously reported in the literature.

With reference to 5 personal cases involving the mandible 3 times and the lower gum twice, the authors recall the principal characteristics of calcified odontogenic cysts: very little clinical manifestation frequently limited to simple tumefaction, well bounded radiological image with low density, cyst with an epithelial border comprized of calcification and ghost cells. Calcified odontogenic cysts which have a definite morphological likeness to Malherbe's epithelioma, also have the same benigh course as the latter.

Operative difficulties when attempting to treat oral cavity angiomas suggested the use, of cryotherapy for limited lesions. The technique is simple in use non-aggressive and has few after effects. The principle of cryotherapy has been known for a long time, but it was only in the 60's that it was applied in ophthalmology, neurology, dermatology, gynecology and the treatment of hemorrhoids, as a result of the availability of new products: Freon, liquid nitrogen. Conclusions as to the value of cryotherapy are drawn from results obtained in buccal mucosa affections treated by this method over the last four years.

A patient with necrosis of the tongue was found to have Horton's disease. The other typical manifestations of this disease, though present, were overshadowed by the lingual necrosis. Recovery occurred after relatively high doses of corticoids.

A series of cases of histiocytosis X was studied by immunohistochemistry (20 cases), histoenzymology (5 cases) and electron microscopy (15 cases). The immunohistochemical methods showed in the majority of cells (histiocytes similar to Langerhans' cells), OKT6, HLA-DR ans S-100 protein antigens. Besides, Leu 4 antigen was also present on the surface of some cells. The histoenzymological analysis found acid phosphatase and specific esterases activities with a different repartition in histiocytes compared to macrophages. By electron microscopy, we detected the typical Birbeck granules. The signification of these granules and also the pathogenesis of the disease were discussed.

During the ten last years, 13 neural tumors of the tongue have been observed in the department of stomatology and maxillo-facial surgery of Salpêtrière Hospital Paris (Prof. J.M. Vaillant): 4 amputation neuromas, 5 benign schwannomas, 1 malignant schwannoma, 2 neurofibromas and 1 multiple endocrine syndrome type III. The authors analyze the clinical and histological data from these case-reports; they point out difficulties encountered in the diagnosis, and the prognostic problems brought up by such infrequent lesions.

61 cases of histiocytosis X of jaws were reported here. They occurred more often in man (72% of men) than in woman, with an average age of 27 years. The mandible was affected more frequently than the maxilla. Clinically, dental expulsion, gingival swelling, fractures or pain were the usual symptoms. Roentgenographic examination showed either central or peripheral (alveolar bone) osteolytic areas. The histologic diagnosis was easy when eosinophilic polymorphous leukocytes or histiocytes were preponderant. In the other cases, immunohistochemistry (positivity of S-100 protein) and electron microscopy (presence of Birbeck granules about paraffin embedded specimens) were of a great usefulness. The prognosis of the disease was mainly related to the diffusion of lesions to other skeletal portions or extraskeletal localizations (37% of our cases). It has been improved by combination of chemotherapy to surgery (despite of frequent recurrences), 40 upon 45 patients are well after a follow-up of 2 to 10 years after the last localization.