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Objective Mantle cell lymphoma (MCL) is a rare B-cell neoplasm that has only recently been defined as a distinct entity. Because of its rarity and histologic similarities to other small cell lymphomas, the microscopic diagnosis of MCL may be challenging. This is particularly true within the oral cavity, where other lymphomas are more frequent. To date, few cases of MCL presenting within the oral cavity have been reported. Study design We present 2 new cases of MCL within the oral cavity and systematically review 7 other cases of MCL reported in the English-language literature. Historical cases were reviewed, and available data regarding morphology, special stains, demographics, clinical presentation, radiographic findings, management, and outcome were extracted. Data from our present series were then compared with the earlier published literature. Results To the best of our knowledge, this is the largest reviewed series of MCL within the oral cavity, totaling 9 cases. The features of our cases, including histology, clinical presentation, and outcome, are consistent with the 7 earlier reported cases. The majority of oral MCLs occur in an older male population, and a high proportion occur on the palate. Conclusion We conclude that MCL of the oral cavity is an uncommon diagnosis. Most oral MCLs occur in an elderly male population and have a possible predilection for the palate. The microscopic diagnosis can be challenging, given its similar appearance to other small cell lymphomas, requiring a comprehensive immunohistochemical panel for the accurate diagnosis. Like MCL occurring in other sites in the body, the prognosis and outcome of oral MCL appears to be poor.

Essentially, sialoblastoma is a disease of infancy with the oldest case presenting at 4 years of age. About one third of pediatric sialoblastoma cases will have a cribriform growth pattern. No adult cases have been reported with a specific diagnosis of sialoblastoma. If even focal cribriforming were present, such cases have undoubtedly been diagnosed as adenoid cystic carcinoma. Such was the circumstance in the 3 adult tumors presented in this report. Each case, however, has the primitive histopathology with discrete nests of basaloid tumor cells, associated bilayered ductal structures and the fibromyxoid stroma characteristic for sialoblastoma with its resemblance to fetal salivary gland or salivary gland with arrested development. One key example has 28-year follow-up. Sialoblastoma, whether in a child or adult with or without a cribriform growth pattern, appears to have a more favorable prognosis than adenoid cystic carcinoma. Aspects of the histological differential diagnosis of these 2 tumors are discussed.

Anterior midline nodule of the hard palate Soraya de Mattos Camargo Grossmann, DDS, MS, Aline Cristina Rodrigues Johann, DDS, MS, Wagner Henriques Castro, DDS, PhD, Horacio Friedman, MD, Ricardo Santiago Gomez, DDS, PhD, and Ricardo Alves Mesquita, DDS, MS, Belo Horizonte and Brasilia, Brazil UNIVERSIDADE FEDERAL DE MINAS GERAIS AND DIAGNOSE PATHOLOGY LABORATORY (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;108:808-811)

We report on a male infant with extensive, bilateral cystic and solid lung lesions who presented postnatally with respiratory distress caused by bilateral cystic lung lesions. Parenchyma-sparing resections were performed. Histology revealed the presence of neuroglial cell-lined cysts and glial nodules. In addition, a neural element containing palatinal teratoma was detected and excised. Based on previously published cases, the pathogenesis and clinical features of pulmonary neuroglial heterotopia are discussed.

This study assessed the reliability of the reverse facial-submental artery island flap for reconstructing maxillary defects. Twelve patients with cancer underwent surgical resection and sequential maxillary reconstruction using a reverse facial-submental artery island flap. There were 9 men and 3 women. The patients ranged in age from 42 to 73 years. Palate squamous cell carcinoma was present in 7 cases; and maxillary gingival squamous cell carcinoma, in 5 cases. The remaining defects were classified as class 1 in one case, class 2a in 8 cases, and class 3b in 3 cases. The sizes of the skin paddle varied from a minimum of 4 x 12 cm to a maximum of 5 x 12 cm. No flaps failed. There were no donor-site problems. The patients were followed up for 16 to 30 months; one case of tumor local recurrence was observed. The reverse facial-submental artery island flap is safe, quick, and simple to elevate. The flap can be used reliably for reconstructing maxillary defects.

Sialolipoma is a new variant of salivary gland lipoma, which was first described in 2001. We report a rare case of sialolipoma of the palate, and review another 10 cases affecting the minor salivary gland and 13 affecting the major salivary gland, together with details of the clinical and histopathological findings.

Objective Removal of tumors around the pterygoid process poses difficult challenges. Our method for removal of tumors in this area using a modification of the maxillary swing approach is reported. Methods A retrospective study of five cases was performed using the partial maxillary swing approach. Like the “maxillary swing approach”, the maxilla is swung laterally with the facial skin; however, only two-thirds of the anterior maxillary bone is swung. Results All tumors were safely removed using the partial maxillary swing approach alone, with the exception of one patient who needed an additional mandibular swing. No facial palsy, masticatory problems or necrosis of the maxilla were observed in any cases. Conclusions The partial maxillary swing approach offers a wide surgical field of the lesion around the posterior part of the maxilla and pterygoid process without severe complications and is useful for removal of tumors in these areas.

Objective The purpose of this study was to assess the treatment and prognosis of the palatomaxillary reconstruction with titanium mesh and the free radial forearm flap. Study design This is a retrospective study of 19 patients with palatomaxillary defects who underwent immediate reconstruction using titanium mesh and a radial forearm flap during the 4-year period from 2004 to 2008. Intraoperatively, the titanium mesh was fixed to the residual bones for the reconstruction of hard-tissue defect after the tumor resection; then the free radial forearm flap was harvested to repair the soft-tissue defect, serving as the intraoral lining and titanium mesh covering. Results Postoperative esthetic appearance and function were followed-up. All of the patients achieved a satisfactory facial appearance. The speech assessment was good, and the oronasal reflux did not occur in all patients. Only 3 patients had titanium mesh exposure during the follow-up period. Conclusion The free radial forearm flap with folded titanium mesh is a reliable option for reconstruction of palatomaxillary defects. It is highly effective for swallowing and speech rehabilitation as well as esthetic reconstruction.

Objective The use of myomucosal flaps harvested from the cheek area for intraoral reconstruction has been recently popularized in the literature. Several surgical techniques have been reported, and each study has described the outcomes and advantages of each method. However, the literature lacks a summary of the various surgical techniques utilizing buccinator myomucosal flaps. This paper examines the use of the 3 most important buccinator myomucosal flaps: the buccinator musculomucosal flap, the facial artery musculomucosal flap, and the buccinator musculomucosal island flap. We clarify the applications of each technique in intraoral reconstruction and discuss the indications for, and advantages and disadvantages of, each flap. Study design Forty-six patients who underwent surgical resection for malignancies of the oral cavity and reconstructions with cheek flaps were retrospectively studied. Results All flaps were harvested and transposed. Complete loss of the flap occurred in only 1 case. In 2 cases, marginal necrosis of the flap took place, with complete spontaneous healing in 2 weeks. Conclusion Buccinator musculomucosal flaps are a good option for reconstruction of moderately sized oral cavity defects. A key point in this procedure is flap selection based on not only the size and site of the defect, but also the patient's characteristics and type of surgical procedure.

Verrucous hyperplasia and carcinoma are recognized entities in the human pathology, but not documented experimentally. During application of the carcinogen 4-nitroquinoline 1-oxide to the oral cavity of rats three times a week for a maximum of 18 weeks an increasing frequency of verrucous hyperplasias and carcinomas were noted. The majority of the carcinomas were localized to the palate and 3/4 of these were verrucous carcinomas, with or without anaplastic transformation to infiltrating squamous cell carcinomas. The oral verrucous lesions have all the histological characteristics of their human counterparts. The present experimental study supports the idea that tobacco consumption may represent an important etiological factor in the development of human, oral verrucous carcinomas.

Cancer is regarded as abnormal cellular multiplication; it is not controlled by the organism, and its cells present a differentiated DNA. Initially, the disease does not show clinical signs, but it can be diagnosed by laboratory examinations. When tumors are present in the maxillofacial area, the carrier can lose structures in this area, resulting to the carrier's social environment exclusion. This article aims to show incidences and causes of malignant neoplasias in the maxillofacial area.

OBJECTIVE: Intraoral minor salivary gland carcinomas (MSGC) are rare tumors with different frequency, distribution, and prognostic factors relating to overall survival. STUDY DESIGN: From 1992 to 2006, a total of 95 patients with MSGC originating in the oral cavity were analyzed by univariate and multivariate analysis using the log-rank test and Cox-regression. RESULTS: Fifty-four percent of all patients had a low-grade disease and 46% had a high grade disease. The 2-, 5-, and 10-year overall survivals were 82%, 73%, and 58%, respectively. The T (P = .007), N category (P = .010), UICC stage (P = .021), and resection margin status (P< .0001) statistically influenced survival, whereas the M status did not (P = .16). Salvage treatment influenced the patients' overall survival significantly (P< .0001). CONCLUSION: This study confirms that in MSGC salvage surgery and tumor stage correlates well with prognosis. More studies are necessary to confirm prognostic factors and determine the true frequency of MSGC in the oral cavity.

Wider use of highly active antiretroviral treatment (HAART) for human immunodeficiency virus-1 (HIV-1)-infected patients has significantly altered the pattern of acquired immunodeficiency syndrome (AIDS)-related clinical signs and symptoms and has revolutionized the therapeutic modalities for these patients. Immune reconstitution inflammatory syndrome (IRIS) is a paradox of clinical worsening of opportunistic infections in the context of response to HAART and immunological recovery. Here we present a case of oral IRIS-related Kaposi sarcoma (KS) that appeared in an advanced HIV-1-infected patient introduced to HAART and was treated by surgical removal and antiretroviral therapy.

Purpose This study reviewed our patients who underwent maxillectomy by the lateral lip-splitting approach and evaluated postoperative outcomes. Patients and Methods Thirty-six patients with diseases in the maxilla, maxillary gingiva, and hard palate who underwent total or subtotal maxillectomy by the lateral lip-splitting approach. The marginal mandibular branch of facial nerves were dissected and preserved before and after the procedure to split the lateral lower lip in all patients. Seventeen patients were reconstructed with free vascularized flaps. Postoperative radiotherapy was administered in 26 patients. The patient's self-assessment and examiner's evaluation were included in the postoperative assessment. The patient's self-assessment included answering a questionnaire, that included evaluation of buccal scar, symmetry of cheilion, lower lip movement, oral incontinence, and lower lip sensation. The examiner's evaluation included assessment of the functions of the facial nerve. Results All tumors were removed en bloc with sufficient safety margins except 1 adenoid cystic carcinoma in maxilla. The average mouth opening was 3.81 cm. According to the results classified as good, fair, and poor by questionnaires, most of the 36 patients thought their results were good or fair. Most of the patients were high scores, according to the examiner's evaluation. The overall 5-year survival and local control rates for patients with malignant tumors were 76.7% and 85.8%, respectively. The local and regional recurrent and distant metastasis rate was 12.9%, 6.5%, and 19.4%, respectively. Conclusions The lateral lip-splitting approach is an acceptable and optional approach for maxillectomy because of wide exposure, satisfied function, inconspicuous scar, and preservation of facial nerve.

Univ Sao Paulo, Sch Med, Clin Hosp, Dept Oral & Maxillofacial Surg, BR-05403001 Sao Paulo, Brazil

Gingival melanoacanthoma is an uncommon reactive lesion, typically appearing as a solitary pigmented macule. This article reports a previously undescribed case of multifocal melanoacanthoma affecting the maxillary and mandibular gingiva and the hard palate. A literature review of melanoacanthoma of the gingiva is also provided.An otherwise healthy 60-year-old white female sought care for a periodic dental prophylaxis. The intraoral examination was remarkable for numerous painless, brown macular lesions in all four gingival quadrants and on the hard palate (eight on the gingiva and six on the palate). The lesions ranged in size from 2 to 4 mm. The patient had only been aware of one of these lesions, estimating its existence to be1-year duration. The unusual and widespread presentation of these lesions warranted biopsy.On microscopy, all surgical specimens revealed an acanthotic population of epithelium, with dendritic melanocytes distributed throughout, and numerous melanophages contained in the connective tissue. The dendritic melanocytes were immunoreactive for HMB-45 and S-100. Ultrastructural studies confirmed the presence of keratinocytes and dendritic melanocytes containing melanosomes. A 5.5-month follow-up recall disclosed six new pigmented lesions (four on the gingiva and two on the hard palate), clinically identical to the previously discerned melanoacanthomas. There has been no recurrence of any of the biopsied lesions.Gingival melanoacanthomas may present as a solitary lesion or involve multiple sites. Pigmented gingival lesions of recent origin and without etiologic factors should undergo histopathologic review. A conservative biopsy for gingival melanoacanthoma may be sufficient for lesion identity and definitive treatment.

In this article we present 2 cases of necrotizing sialometaplasia (NS) associated with angiocentric lymphoma of the midline. Immunohistochemical analysis confirmed a T-cell origin, and in situ hybridization in one case revealed its relationship to Epstein-Barr virus. These findings suggest that vascular occlusion by the neoplastic cells produces ischemia, which leads to local infarction contributing to the salivary gland lesion. To our knowledge, the association between angiocentric lymphoma and NS has been previously reported in only one instance, and we suggest that this particular type of lymphoma should be added to the list of related conditions for NS.

Summary Aim: Assessment of the efficiency of 18F-FDGPET (PET) for the detection of distant metastases and synchronous primary malignancies in patients with oral and oropharyngeal squamous cell cancer (OOSCC). Patients, methods: Retrospective evaluation of PET studies of 422 patients with histologically confirmed OOSCC. 99 patients (23.5%) demonstrated a suspect distant finding of whom 84 could be interdisciplinary evaluated and consecutively confirmed or refuted by other diagnostic modalities or biopsy. Results: In 74 of 80 evaluable cases, PET showed the primary tumour (92.5%). 26/84 suspect distant lesions (31%) showed by means of PET were confirmed to be malignancies (mean SUV 3.96; range 1.4-9.37). Main sites were the lung, the upper aerodigestive tract, and the gastrointestinal system. In the other 58 cases (69%), where the suspect lesions were confirmed as benign, mean SUV was 2.65 (range 0.7–6.5) (difference statistically significant). The SUV above which every suspect finding was proven to be of malignant condition was 6.5 (specificity 100%, sensitivity 38%, accuracy 81%). Conclusion: PET may have an important role in initial staging and the detection of distant metastases and synchronous primary malignancies. Setting a SUV threshold for determining malignancies can support interpretation. In borderline cases, however, interdisciplinary evaluation by means of other diagnostic modalities remains crucial.

Congenital teratoma is a rare malformation, and few papers have been published about it. We present a large teratoma that arose from the hard palate in a neonate. The obstructive mass caused maternal polyhydramnios and was identified prenatally by ultrasonography. The mother went into labour at 35 week's gestation at home. The child was in respiratory distress as a result of airway obstruction, and a tracheostomy was done when she was 4 hours old. She also had major cardiac abnormalities. The palatal mass was removed successfully at 4 weeks of age. The typical components of a teratoma were identified including immature neural glial tissue.

Basaloid squamous cell carcinoma (BSCC) is a histologically distinct variant of squamous cell carcinoma. It occurs in various sites of the head and neck region and is believed to carry a dismal prognosis. The palate is a very rare site of BSCC development and only three cases have been reported in the international literature. In this report, we present a case of basaloid squamous cell carcinoma of the soft palate. The therapeutic strategy and histological findings are described in detail, including immunohistochemistry with the use of involucrin, an agent used for the first time for BSCC diagnosis. In addition, a brief review of the literature is presented.

A case report of a central giant cell granuloma in the palate, which arose after orthodontic treatment, is presented with a review of relevant literature. Treatment options and clinical implications are also discussed.

This clinical report presents the treatment of an unfavorable bilateral maxillary defect with the use of an extraoral device to hold an interim obturator in place during tissue healing and maturation.

Low-grade papillary adenocarcinoma (LGPA) represents a relatively rare histological variant of polymorphous low-grade adenocarcinoma (PLGA). There has been a debate as to whether LGPA is associated with greater aggressive potential compared to PLGA; this is further obfuscated by the fact that diagnostic criteria for LGPA have not been well-defined. We believe that this is the first report of a patient with LGPA who developed metastases to the femur and scalp. We review the published evidence for classifying LGPA as distinct from PLGA. The weight of published data does support the idea that LGPA is oncologically distinct from LGPA. However, as uniform diagnostic criteria are lacking, we suggest a cut-off value of 10% or greater papillary formation as being necessary to separate LGPA from PLGA.

We report a rare case of a female patient that developed a recurrence of a clival chordoma in the pathway of surgical access following prior resection. We review the world literature regarding surgical pathway recurrences. An 18-year-old female patient presented with a 4 cm x 3 cm mass in the midline of the hard palate. She had a history of a large clival chordoma resected via a transoral transpalatal approach 2 years previously. She was diagnosed as having a recurrence of the chordoma following implantation in the surgical pathway. She was treated with a transoral radical resection of the hard palate followed by a radial free forearm flap reconstruction. Chordomas are locally aggressive, slow growing tumors with a high local recurrence rate. A rare mechanism of treatment failure is recurrence along the pathway of surgical access. Only isolated cases of this phenomenon have been reported in the world literature. We review the world literature regarding surgical pathway recurrences.

Solitary fibrous tumor (SFT) is rare mesenchymal neoplasm that has been originally and most often documented in the pleura. Recently, the ubiquitous nature of the SFT has been recognized with reports of involvement of numerous sites all over the body, i.e, upper respiratory tract, breast, somatic tissue, mediastinum, head, and neck, etc. The diagnosis of SFT still remains an enigma in our field. Furthermore, malignant SFT is extremely rare and only two cases have been reported in the oral cavity till date. Here, we present a rare case report of an aggressive solitary fibrous tumor which presented as a palatal mass and extended throughout the middle cranial fossa and exhibited features of malignancy.

Objective. The aim of this report was to examine the oral cancer incidence by sex, race/ethnicity, and anatomical subsite. Study design. Data from the California Cancer Registry (CCR) were used to calculate the age-adjusted incidence rates of invasive oral squamous cell carcinoma (OSCC) by sex, race/ethnicity, and anatomical subsite among residents in California during 1988 to 2001. Results. Although non-Hispanic (NH) black men have the highest overall incidence rate for OSCC, NH whites and NH blacks have similar incidence patterns by subsite, but the male-to-female (M:F) rate ratio is higher among NH blacks. The OSCC incidence rates for Hispanics are much lower than those for NH whites and NH blacks and similar to those of Asians. The Asian ethnic groups display dramatic variations in terms of the subsite-specific incidence rates and M:F rate ratios. Conclusion. The findings illustrate the heterogeneity and complexity of oral cancer by anatomical location and the importance of cultural habits and behavioral factors in the development of oral cancer. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:470-80)

1. Gottshalk-Sabag S, Glick T: Necrosis of parotid pleomorphic adenoma following fine needle aspiration: A case report. Acta Cytol 39:252, 1995 2. Chen YK, Lin CC, Lai S, et al: Pleomorphic adenoma with extensive necrosis: Report of two cases. Oral Dis 10:54, 2004 3. Layfield LJ, Reznicek M, Lowe M, et al: Spontaneous infarction of a parotid gland pleomorphic adenoma: Report of a case with cytologic and radiographic overlap with a primary salivary gland malignancy. Acta Cytol 36:381, 1992 4. Allen CM, Damman D, Neville B, et al: Necrosis in benign salivary gland neoplasms: Not necessarily a sign of malignant transformation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 78:455, 1994 5. Pinto RG, Couto F: Infarction after fine needle aspiration: A report of four cases. Acta Cytol 40:739, 1996 6. Li SY, Baloch ZW, Tomaszewski JE, et al: Worrisome histologic alterations following fine needle aspiration of benign parotid lesions. Arch Pathol Lab Med 124:87, 2000 7. Bayramoglu H, Duzcan E, Akbulut M, et al: Infarction after fine needle aspiration biopsy of pleomorphic adenoma of the parotid gland. Acta Cytol 45:1008, 2001 8. Pabuccuoglu HU, Lebe B, Sariglu S: Infarction of pleomorphic adenoma: A rare complication of fine needle aspiration obscuring definitive diagnosis. Diagn Cytopathol 24:301, 2001 9. Behzatoglu K, Bahadir B, Hug GE, et al: Spontaneous infarction of a pleomorphic adenoma in parotid gland: Diagnostic problems and review. Diagn Cytopathol 32:367, 2005 10. Ellis GL, Auclair PL: Necrosis of pleomorphic adenoma, in Rosai J (ed): Atlas of Tumor Pathology: Tumors of the Salivary Glands (vol 17), Third Series. Washington, DC, Armed Forces Institute of Pathology, 1996, pp 44-53

Kaposi sarcoma (KS) is the most common human immunodeficiency virus (HIV)-associated neoplasm (HIV-KS). Highly active antiretroviral therapy (HAART) results in a decrease in the incidence and prevalence of HIV-KS as well as in clinical improvement. However, in a subset of subjects who are HIV seropositive, KS may recrudesce early following the introduction of HAART as an immune reconstitution inflammatory syndrome (IRIS).The management of a patient who is HIV seropositive with rapid clinical worsening of oral KS lesions shortly after the initiation of HAART was documented. Repeated serologic testing for CD4(+) T-cell count and microscopic examination of two biopsy specimens of the oral lesion, one taken before and the other taken after cytotoxic chemotherapy, followed by surgical excision was the treatment modality used.Microscopic examination of the incisional biopsy specimen taken from the oral lesion at the time of the initial consultation confirmed the clinical diagnosis of KS. The sequential serological tests showed a progressive increase in CD4(+) T-cell counts that paralleled the rapid clinical worsening of the KS disease. This was consistent with the diagnosis of IRIS-associated HIV-KS. Subsequent cytotoxic chemotherapy brought about resolution of the IRIS and regression of the HIV-KS lesions. Microscopic examination of a biopsy specimen obtained after cytotoxic chemotherapy did not show any of the original KS. The residual palatal exophytic mass was excised.IRIS-associated HIV-KS is not a disease, but rather a temporary paradoxical immunoinflammatory reaction brought about by improvement in immune status following HAART. IRIS-associated HIV-KS can be controlled effectively by limited systemic cytotoxic chemotherapy in the setting of HAART.

MASPIN, a member of serpin superfamily, has multifaceted biological functions and an unique tumour suppressing activity. Experimental evidences showed that MASPIN suppresses tumour growth, angiogenesis, invasion and metastasis. Only a very limited number of studies considered MASPIN expression in the upper aero-digestive tract carcinomas. It was recently found that nuclear localization of MASPIN was significantly associated with lower recurrence rate and longer disease-free interval in laryngeal carcinoma. The present study investigated the biological and prognostic role of MASPIN in relation to its subcellular localization in oral carcinoma. Sub-cellular pattern of distribution of MASPIN, nuclear and cytoplasmic MASPIN expressions were immunohistochemically determined in 56 consecutive cases of oral carcinoma. Statistical analysis found a significant association between pN-stage and recurrence of disease (P = 0.032) and a significantly longer disease-free interval in pN0 patients than in pN+ ones (P = 0.038). None of the subcellular expressions of MASPIN was significantly correlated with recurrence of disease and disease-free interval in our series of oral carcinomas. Sixty-one percent of pN0 cases was strongly MASPIN-positive in the cytoplasm of primary carcinoma cells, 33% of the pN+ cases was MASPIN-positive in the cytoplasm. Statistical analysis found a significant association between MASPIN cytoplasmic expression and pN-stage (P = 0.032). Negative MASPIN immunoreactivity in carcinoma cells cytoplasm may be useful to identify patients at risk of disease disseminating to neck lymph nodes. Further investigations are necessary to understand the biological role of cytoplasmic MASPIN localization in oral carcinoma.

Radiation-induced sarcoma (RIS) or postirradiation sarcoma has been reported rarely as a long-term complication of radiation therapy (RT). We report 4 cases of oral sarcomas or sarcomatoid tumors with a rather short latency period after radiotherapy of the prior OSCC. Histopathological evaluation and immunohistochemical study were performed using a panel of markers including vimentin, cytokeratin, S-100, desmin, myoglobin, HHF-35, p53, and p16. All reported cases were positive for vimentin and negative for cytokeratin. Two cases were positive for myoglobin, desmin, or HHF-35, and were probably myogenic origin. One case was possibly a fibrosarcoma and the subclassification of the other one was not specified. Diverse expression of p53 and p16 was further observed in these 4 cases. Report of the complicated clinical processes and the analysis of genetic markers of these cases provide useful clinical and pathogenetic insights of mesenchymal malignancies associated with a status post OSCC radiation.

Aim: Description of an alternative surgical approach to the posterolateral maxillary and pterygoid region. Patients and method: Three patients with posterior maxillary/pterygoid lesions are described in whom a lower cheek flap was used to achieve optimal surgical exposure. After midline division of the soft tissues of the lower lip and chin, the incision is extended posteriorly in the inferior gingivobuccal sulcus and continued lateral from the retromolar trigone in the upward direction lateral from the maxillary tuberosity. The flap is elevated under the periosteum towards the angle of the mandible with detachment of the masseter muscle. By marginal resection of the anterior part of the ascending mandible, visualisation of the posterolateral maxillary and pterygoid region can be optimalized. Conclusion: As compared to the transoral approach, the lower cheek flap creates an optimal surgical exposure of the posterolateral maxillary sinus wall and pterygoid plates and should be considered for maxillary lesions extending into the pterygoid plate and pterygoid muscles. (c) 2007 Elsevier Ltd. All rights reserved

A 91-year-old man presented with an asymptomatic swelling in the roof of his mouth. Clinically the lesion was nontender and appeared cystic. A CT scan showed a soft tissue swelling of his palate with no bony involvement. An orthopantogram and blood tests were noncontributory. A fine-needle aspiration biopsy was suggestive of a minor salivary gland neoplasm. An excision biopsy showed papillary cystadenoma of the minor salivary gland, with numbers of psammoma bodies. A stepwise approach is demonstrated in the diagnosis of this rare minor salivary gland neoplasm. To the authors' best knowledge, this is the 12th case of this tumor seen in the palate. Furthermore, no previous case has included a fine-needle aspiration biopsy in the work-up, the cytological features of which will be described.

The desmoplastic variant of ameloblastoma is a rare, locally invasive, benign tumor of the jaws, typically found in the anterior regions of the maxilla and mandible. This ameloblastoma variant has been described as an intraosseous tumor; to our knowledge, there have been no published cases of a peripheral desmoplastic ameloblastoma. The purpose of this case report is to describe a patient with a desmoplastic ameloblastoma localized to the soft tissue of the palate with no osseous involvement.

Haemangiopericytoma is an aggressive vascular tumour with a high propensity for recurrence and metastasis. It typically occurs in the soft tissues of the extremities and trunk, and is rarely seen in the oral cavity. A case of haemangiopericytoma of the hard palate is presented. A 48-year-old woman presented with a gradually enlarging mass on the left side of her hard palate for 3 months. CT scans revealed a mass on the left side of the hard palate which extended to the nasal cavity and left maxillary sinus by causing erosion in the bones. Due to the possibility of local recurrence and occasional metastasis, a wide local excision was performed. There was no recurrence over 1 year's follow up. © 2008 The British Institute of Radiology.

Oral squamous cell carcinoma is characterised by varied clinical manifestations and is often diagnosed at an advanced stage. This article highlights a case of gingival squamous cell carcinoma which was initially diagnosed and treated as localised periodontitis.A 64-year-old Caucasian male had a 2-year history of discomfort and swelling around his upper anterior teeth. His dentist diagnosed localised periodontitis around tooth 11. The patient was treated with regular scaling but showed no improvement. Teeth 11 and 21 were subsequently extracted. He returned later with a swelling in his anterior maxilla and was referred to the Whangarei Hospital Dental Department.The histopathological report confirmed a diagnosis of squamous cell carcinoma. The patient was referred to Auckland for treatment and underwent a tracheostomy, maxillectomy, bilateral selective neck dissection and fibula free flap reconstruction. All lymph nodes retrieved and margins of the lesion were clear, and the patient did not require radiotherapy. He will be monitored over the next 5 years for recurrence.Gingival squamous cell carcinoma can be easily misdiagnosed. Suspicious lesions which are non-responsive to conventional therapy should be biopsied, even if they are not in the classic high risk anatomical areas of the oral cavity.

Background: Palatal neoplasm cases in human are very rare. More than 90% neoplasms of the palate is squamous cell type. Not only cytological pleomorphism but also nuclear anomalies are reported to be observed in oral squamous cell carcinoma (OSCC). But, site specific cytological pleomorphisms are not reported so far. Therefore, an attempt has undertaken to investigate the cytopathology of human palatal neoplasms, pattern of cervical lymph node (CLN) metastasis and to analyse the probable etiological risk factors associated with it in the present study. Methodology: In a hospital-based study, out of 136 oral cases, 9 palatal cases (6 male and 3 female) registered during May 2007 to May 2009 were included in this study. Detail case-history including the nature and types of addiction of each individual was recorded prior to the collection of samples. Two scraped exfoliated cytosmears were collected from the affected site on the pre cleaned-coded glass-slides. Collected cytosmears were immediately fixed in 1:3 aceto-alcohol (1 part of glacial acetic acid and 3 parts of ethyl alcohol). One set of smears was stained with Papanicolaou’s stain and the other was counter-stained with Giemsa’s stain for cytopathological analysis. American Joint Committee for Cancer Staging and End-Results Reporting (AJC) formulated TNM (Tumor-Node-Metastasis) System for staging of OSCC was followed. Result: Cytopathologically, a number of pleomorphic cytological atypias, such as, keratinized spindle cell (KSC), keratinized tadpole cell (KTC), keratinized strap (Antischkow) cell (KSC-A), large and small keratinized fiber cells (KFC), large and small keratinized round cells (KRC), micronucleated cell (MNC), plump keratinized squamous cell (PKSC) and non-keratinized malignant squamous cell (NMSC) were observed in such palatal neoplasms. Except NMSCs, all other cells were keratinized. Out of these, PKSC and MNC were well differentiated; KSC, KTC, KFC, KRC and KSCA were moderately differentiated and NMSC was poorly differentiated. Interestingly, in addition to the micronucleated cell (MNC), KSC-A was found to be a modal cytological atypia irrespective of age, site, sex and degree of pathogenicity which may be attributed to the addiction of tobacco in general and smoking in particular. Conclusion: Chewing and smoking of various form of tobacco and drinking of alcohol contribute a lot to the genesis of cytological pleomorphism in human palatal neoplasm. Typically atypical cells like KSC, KTC, KSC-A, KFC, KRC, PKSC, MNC and NMSCs although found less in number, modal occurrence of KSC-A along with the MNC in all the palatal neoplasm may be directly correlated with any form of tobacco smoking.

The number of harvested lymph nodes when performing sentinel lymph node (SLN) biopsy remains controversial. The aim of this study was to examine the maximum number of nodes to be harvested for histopathological analysis. We also wanted to determine if the level of radioactivity within a SLN or its size were indicators for the likelihood of nodal metastases. The SLNs from 34 neck dissection specimens from patients with T1/T2 N0 oral and oropharyngeal carcinomas were included. Altogether 76 SLNs were measured for radioactivity and lymph node dimensions and volume. Tumour was identified in 16 of 76 nodes (positive nodes), and the remaining 60 nodes were free from tumour (negative nodes). In 9 of 16 cases, metastases were in the hottest node. Two patients had more than one positive SLN: the first and fourth hottest in one and the second and fourth hottest nodes in another contained tumour. However, all patients would have been staged accurately if only the hottest three sentinel nodes had been retrieved. Lymph nodes that contained tumour had a greater maximum diameter than non-metastatic SLNs. To stage the neck accurately, only the three hottest lymph nodes required sampling.

Sialolipoma is a new variant of salivary gland lipoma first described in 2001. We present 2 cases of sialolipoma involving the soft palate and buccal mucosa of 2 female patients. A review of the English language literature revealed 16 cases of sialolipoma reported thus far. We have reviewed the clinicopathologic features of the literature cases and are adding the present 2 cases for a total of 18 cases. To the best of our knowledge, this is the first report of sialolipoma involving the buccal mucosa and the second case in the soft palate. The purpose of this publication is to increase awareness of this recently described variant of lipoma and to address the diagnostic challenges posed both clinically and histopathologically.

Hodgkin lymphoma typically presents as a nodal lesion and infrequently involves extranodal sites. The English language literature contains only 7 reports of primary Hodgkin lymphoma arising in the oral mucosa in the absence of nodal disease. We report a case of primary, extranodal Hodgkin lymphoma in the palatal mucosa of a 79-year-old white female. An incisional biopsy revealed a diffuse, mixed cellular infiltrate, consisting of benign lymphocytes, plasma cells, histiocytes, and foci rich in eosinophils. Within this background was a scattering of large, atypical cells, including Reed-Sternberg forms that exhibited immunoreactivity for CD30 and CD20 and nonreactivity for CD15 and CD45RO, supporting a diagnosis of classical Hodgkin lymphoma. Positron emission tomography exhibited a single focal area of abnormal hypermetabolic activity involving the left palate area, without involvement of any other site. The clinical stage was Ann Arbor I-A. The primary tumor and submandibular and upper neck lymph nodes were treated with a 6-MV photon beam to a total dose of 4000 cGy. There was no evidence of disease at 15-month follow-up.

Background:Oral involvement is a common manifestation of acquired immunodeficiency syndrome related Kaposi's sarcoma, and it occurs in approximately one-third of afflicted patients.Methods:We report an unusual case of Kaposi's sarcoma of the hard palate which invaded the underlying maxillary bone.Results:The patient underwent excisional biopsy and was subsequently treated with localised radiation and systemic chemotherapy including liposomal doxorubicin.Conclusions:The presentation, differential diagnosis, radiographic appearance and management of this serious complication are discussed. Our case highlights the need for a multidisciplinary approach, consisting of ENT, oncology and infectious disease consultation, to ensure appropriate management of maxillofacial, intraosseous, acquired immunodeficiency syndrome related Kaposi's sarcoma.

Neurofibromas are a clinical manifestation of neurofibromatos is type I (NF1). Management of these tumors remains a challenge for the clinician. The goal of the present study is to point out treatment guidelines for these lesions. Eighteen patients diagnosed with NF1 and presenting lesions of the craniomaxillofacial district were included in the study. On the basis of clinical evidence and patient's expectations, only six patients of this group underwent surgery. All patients that had no surgery were included in a follow-up protocol to evaluate progression of disease. Four patients who underwent surgery had good functional/aesthetic results, whereas two patients had incomplete rehabilitation.

Purpose: To quantify the trade-off between parotid gland sparing and planning target volume (PTV) underdosages for head-and-neck intensity-modulated radiotherapy. Methods and Materials: A planning study was performed for 4 patients with either soft palate or tonsil tumors treated with external radiotherapy up to 46 Gy. The trade-off between underdosages in the PTV and sparing of the parotid glands was investigated by systematically varying the optimization objectives for the inverse planning. A new way of presenting dose-volume information allows easy detection of small PTV subvolumes with underdosages that cannot be assessed in conventional cumulative dose-volume histograms. A simple radiobiological model to estimate the control probability for an electively irradiated neck level was developed. Results: The average dose to the parotid glands can decrease by >10 Gy by allowing the PTV to be underdosed in such a way that the radiobiological model predicts a decrease in subclinical disease control probability of (typically) 1% to a few percent. Conclusion: The trade-off between parotid gland sparing and underdosages in the PTV has been quantified by the use of an alternative method to present dose-volume information and by the use of a radiobiological model to predict subclinical disease control probability.

Melanocytic neuroectodermal tumor of infancy is a rare pigmented tumor generally occurring in the head and neck region in children 12 months of age or younger. The true incidence is unknown and fewer than 200 clinical case reports have been reported to date in the literature. The tumor itself is locally aggressive. It does not have a tendency to metastasize but carries a high risk of local recurrence. This report describes one patient's care, including primary palate reconstruction, and provides a review of the literature. A 7-month-old boy was found in a Haitian orphanage with a growing, very large mass originating from his right maxilla.

A case of mixed-type liposarcoma, which showed unusual dedifferentiation in the recurrence, is reported. The rapidly growing mass in the palate of a 60-year-old Japanese woman first revealed a combination of myxoid liposarcoma with features resembling storiform malignant fibrous histiocytoma. The recurrent neoplasm, showing an abrupt transition between myxoid and non-lipogenic parts, partially reverted to sclerosing well-differentiated liposarcoma. The patient died 10.1 years after the first operation.