Search

Background: Dexamethasone is widely used in the prevention of postoperative complications in oral surgery and strengthening the analgesic effect after anesthesia, but the efficacy is controversial, and the relationship between postoperative complications and pain is still unclear. The purpose of this study was to evaluate the analgesic effect of dexamethasone in the treatment of jaw cyst and to explore the relationship between postoperative complications and pain., Methods: We conducted a prospective, randomized, double-blind clinical trial. 120 patients were divided into two groups, dexamethasone group ( group D) and control group (Group C). All patients were given 0.02 mg·kg -1 of hydromorphone to relieve pain in advance at 10 min before the beginning of operation. Meanwhile, dexamethasone was injected 0.2 mg·kg -1 intravenously in group D and normal saline was injected in group C. The primary endpoint was pain intensity at 2 h, 6 h, 12 h, 24 h and 48 h after surgery. The secondary endpoints were the incidence and extent of complications after surgery, including facial swelling and trismus., Results: Compared with group C, the visual analogue scale (VAS) scores and occurrence of painful event postoperatively in group D were significantly lower both at rest (P < 0.0001 and P = 0.0014) and during mobilization (P < 0.0001 both). The degree of facial swelling and trismus in group D were significantly lower than that in group C at 24 h (P < 0.0001 and P = 0.00022) and 48 h (P < 0.0001 and P = 0.00015) after surgery, but there was no difference at 6 h and 12 h (P = 0.137 and P = 0.083) after surgery. The C-reactive protein (CRP) level at 24 h after operation in group D was lower than group C (P = 0.012), but there was no significant difference in blood glucose concentration between the two groups (P = 0.608)., Conclusion: Dexamethasone can reduce the degree of facial swelling and trismus after jaw cyst surgery by inhibiting the production of inflammation, which alleviated the postoperative pain of patients significantly. In addition, it did not increase the risk of hyperglycemia., Trial Registration: This study was registered with the Chinese Clinical Trial Registry on May 07, 2020 (URL: http://www.chictr.org.cn/showproj.aspx?proj=53344 . Registry number: ChiCTR2000032693). Registered on 07/05/2020., (© 2022. The Author(s).)

Background: Many techniques have been proposed to close an oroantral fistula (OAF), with most of them involving transoral repairs with oral soft tissue flaps. An additional Caldwell-Luc approach or endoscopic sinus surgery (ESS) is required to address coexisting maxillary sinusitis. Objectives: This study presents the endonasal closure of an OAF through modified endoscopic medial maxillectomy (MEMM) with a free nasal mucoperichondrial-osteal graft. Materials and methods: Sixteen OAF patients who underwent closure operations in our department from May 2013 to June 2018 were retrospectively reviewed. Results: The main cause of OAF was maxillary dental cysts (56.25%). The OAF size ranged from 2 × 2 to 10 × 15 mm. The first molar (62.5%) was the most frequently involved tooth. All closures were made via MEMM, using nasal mucoperichondrial-osteal grafts harvested from the septum or nasal base. All patients were followed up for at least six months. Successful closure after a single procedure was achieved in 93.75% of cases. No obvious complications or recurrences were observed. Conclusions: Endonasal repair of OAFs via MEMM with free nasal mucosal grafts is feasible and promising. The approach preserves the normal oral and nasal physiology after surgery. It could be used alone for the closure of small to medium-sized OAFs.

Two clinical observations of nasolabial cyst of uni- and bilateral localizations are reported. The comprehensive characteristic of nasolabial cysts is presented with special reference to the principal diagnostic criteria for this pathology and the potential diagnostic errors.

In this article, the case of a patient with osteocutaneous fistula at the left malar region secondary to impacted spike of a soccer cleat to the mandible is presented. Both the clinical and radiologic diagnoses failed because of an obscure anamnesis of the patient and the unavailability of viewing the spike in orthopantomogram and computed tomography. Surgical extirpation was performed to the 41-year-old man who was injured in a football match 3 months before the presentation and had a swooning history after an accidental booting. There were no early or late complications after the surgery at the end of 9 months. This study shows the importance of both obtaining a definite history of patients and sequential radiologic imaging to make a differential diagnosis between the foreign bodies and cystic or noncystic tumors and inflammatory lesions of the mandible.

The aims of this article are to introduce mandibular condylar pseudocysts to orthodontists, present 2 relevant case reports, and discuss possible differential diagnoses. Condylar pseudocyst is a radiologic variant of pterygoid fovea, which is the site of insertion of the lateral pterygoid muscle to the head of the mandibular condyle. A pathognomonic picture of a solitary well-defined radiolucency with radiopaque borders, located on the anterior aspect of the condyle in an asymptomatic orthodontic patient, is characteristic., (Copyright © 2013 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Pathological mandibular fractures are rare, accounting for fewer than 2% of all fractures of the mandible. They could be defined as fractures that occur in regions where bone has been weakened by an underlying pathological process. Pathological fractures usually may follow surgical interventions such as third molar removal or implant placement, result from regions of osteomyelitis, osteoradionecrosis, and bisphosphonate-related osteonecrosis of the jaw, occur because of idiopathic reasons or be facilitated by cystic lesions, benign, malignant, or metastatic tumors. Pathological mandibular fractures may be challenging to treat because of their different etiology and peculiar local and general conditions, often requiring a more rigid fixation. In patients with poor medical conditions, simpler and more limited options may be preferred., (© 2013 John Wiley & Sons A/S.)

Aim: The aim of this report is to introduce a rare case in which an infected keratocystic odontogenic tumor (KCOT) was initially diagnosed and treated as a dentoalveolar abscess., Background: Keratocystic odontogenic tumor (KCOT) is a benign neoplasm that can be secondarily infected. However, cervical soft tissue abscess formation as a result of an infected odontogenic cyst or tumor is a rare condition few of which have only been described in the existing literature. Also, there has been a single report regarding the coincidence of a traumatic bone cyst and a keratocytic odontogenic tumor to date., Case Report: The patient was a 29-year-old male, complaining of fever, pain and swelling in the left submandibular region. The panoramic radiography showed a well-defined and partially corticated radiolucency between the roots of the second and third left mandibular molars. In addition, a well-corticated radiolucent lesion was incidentally found on the right side of the mandible, which, following surgical exploration, was diagnosed as a traumatic bone cyst., Conclusion: In the present report, an infected KCOT manifested as a cervical abscess, coincided with a traumatic bone cyst., Clinical Significance: From the clinical point of view, it is of paramount significance to prevent misdiagnosis of similar presentations as pulp and periapical lesions, which may lead to mistreatment and thus complications.

Background: The aim of this article was to present our experience in the management of pathologic mandibular fractures., Methods: We conducted a retrospective analysis of 14 patients with pathologic mandibular fractures associated with osteoradionecrosis, bisphosphonate-related osteonecrosis of the jaw, benign/malignant lesions, osteomyelitis, idiopathic, or iatrogenic etiology. Data collected included age, sex, etiology, site, treatment, and outcome., Results: Five patients had iatrogenic fractures, 3 patients had osteomyelitis, 2 had benign cystic lesion, and the remaining 4 had primary squamous cell carcinoma, histiocytosis, multiple myeloma, and bisphosphonate-related osteonecrosis of the jaw, respectively. Eleven fractures of 14 were treated using a 2.4-mm mandibular plate., Conclusions: Pathologic mandibular fractures may be challenging to treat because of their different etiology and peculiar local and general conditions, often requiring a more rigid fixation. In patients with poor medical conditions, simpler and more limited options may be preferred.

Because of the intimate relationship between the maxillary teeth and the maxillary sinus, it is no surprise that odontogenic infections, odontogenic cysts and tumours which have their origin in the mucosa and the bone of the maxilla may extend into the maxillary sinus and, occasionally, into the nasal cavity. Diseases of the maxillary sinus can also extend into the oral cavity and can cause symptoms that mimic those of odontogenic diseases. Important diseases of the maxillary sinus are maxillary sinusitis, oroantral communications, antroliths, cysts and neoplasms.

In this retrospective study we reviewed the distribution, characteristics, and treatment of 27 cystic jaw lesions in edentulous patients, and compared these with 242 cysts in dentate patients. The mean age was 60 years (range 46-74), and the male:female ratio 4.4:1. The maxilla was more affected than the mandible, with radicular/residual cysts being the most common. Patients were treated by marsupialisation, enucleation, or enucleation with bone grafting. Edentulous men were at higher risk than women of developing cystic lesions in the maxilla. Patients who are edentulous alert us to the possibility that their general health may be compromised, and this should be kept in mind when planning treatment., (Copyright © 2010 The British Association of Oral and Maxillofacial Surgeons. All rights reserved.)

Background: Solitary bone cysts (SBC) are uncommon non-neoplastic bone lesions, which present mainly in the mandible. Their aetiology is still obscure, but it has been suggested that they may be a result of trauma in the region. Due to their asymptomatic nature, SBCs are revealed mainly accidentally during routine radiographic examination. Sometimes, patients complain of pain or delayed eruption of teeth. Treatment is recommended because, otherwise, the cyst may become symptomatic or cause a pathologic mandibular fracture., Case Report: A 7-year-old Caucasian boy presented with delayed eruption of his permanent incisors. His parents reported a history of trauma at 3 years of age. The radiographic examination revealed a bony lesion, largely displacing the permanent incisors and preventing their eruption., Treatment: Surgical exploration of the lesion was carried out and the histopathological examination result was consistent with a SBC., Follow-Up: Two years after the surgical curettage there was radiographic evidence of considerable bony regeneration. The permanent incisors erupted and were vital., Conclusion: Clinicians should be aware that SBC is associated with trauma, mainly of the mandible, and with a possible delay of eruption of the corresponding teeth.

Purpose: To investigate the incidence and the local factors of impacted permanent teeth, except for the third molar, in Chinese patients through an x-ray study., Materials and Methods: A total of 548 impacted permanent teeth from panoramic radiographs were studied and recorded according to the patients' gender and age, tooth position, and classification of impaction. The local factors contributing to impacted permanent tooth were also investigated., Results: The incidence of impacted permanent teeth in the Chinese was 6.15%. The impacted tooth showed a predilection for women and was more common in the maxilla. The impaction of the canine had the greatest occurrence, 28.10% of all impacted teeth. Vertical impaction was most common (49.09%). The chief local factor for impacted teeth was the lack of interdental space (49.64%)., Conclusions: All permanent teeth can occur with impaction in Chinese patients. Dentists should perform a thorough evaluation before planning suitable treatment., (2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

We present a case of an epidermoid cyst in contact with the inferior and lateral aspects of the left trigeminal nerve, which resulted in secondary trigeminal neuralgia of the left mandibular branch of the trigeminal nerve. The symptoms were typical of trigeminal neuralgia, with no other neurological signs and symptoms. If patients present with trigeminal neuralgia, consideration should be given to routine visualisation of the entire course of the trigeminal nerve by magnetic resonance imaging (MRI) to identify cases of secondary trigeminal neuralgia.

Background: Mucosal cysts in the maxillary antrum (MMC) are a common finding in imaging of the paranasal sinuses. Their significance remains in doubt and their prevalence in the general nonrhinitic population is unknown., Objectives: To establish the prevalence of MMCs in patients without nasal complaints and identify any association with putative causative factors. To identify any correlation between objective radiologic evidence of chronic rhinosinusitis or dental disease and the presence of cysts., Study Design: Prospective case series., Methods: Computed tomography (CT) images from 257 patients undergoing scans of the orbits for ophthalmic reasons were entered into this study. Patients responded to a questionnaire prior to scanning inquiring about nasal complaints, treatment for nasal disorders, previous nasal injury, allergy, asthma, recent upper respiratory tract infection, and dental root disease of the upper jaw., Results: Overall 35.6% of patients studied had radiologic evidence of at least one maxillary mucosal cyst. There was no association between the presence of cysts and subjective or objective evidence of sinus or dental disease. Specifically, there was no correlation between the presence of cysts and the total and ostiomeatal complex Lund-Mackay radiologic scores., Conclusions: Maxillary mucosal cysts are prevalent in nonrhinitic patients and do not reflect sinus or dental disease. Their presence should not be an indication for sinus surgery.

The Editorial Board of the Journal of Endodontics has developed a literature-based study guide of topical areas related to endodontics. This study guide is intended to give the reader a focused review of the essential endodontic literature and does not cite all possible articles related to each topic. Although citing all articles would be comprehensive, it would defeat the idea of a study guide. This section will present articles related to periradicular lesions not of endodontic origin.

Unicystic ameloblastoma (UA) is a benign epithelial odontogenic tumor of the jaws with an aggressive potential that commonly occurs in children. This cystic odontogenic neoplasm is generally asymptomatic and found during routine radiographs. The purposes of this report were to describe a case of UA involving the crown of the unerupted right mandibular second premolar in an 11-year-old girl under orthodontic treatment, and discuss its diagnosis and radiographic and microscopic findings, emphasizing its distinction from the dentigerous cyst and the inflammatory follicular cyst.

In 1942, Stafne was the first to report radiographic findings of "static bone cavities" situated near the angle of the mandible. The typical radiographic appearance of Stafne's mandibular defect is a radiolucency below the inferior alveolar canal, between the mandibular premolars and the angle of the mandible. Stafne's mandibular defect ranges from 10 mm to 30 mm in diameter. The size has been shown to be remarkably constant in diagnosed lesions followed over time. In the majority of cases, the lesion is symptomless. Routine surgical exploration is not indicated. It is suggested that the lesion is a radiographic rather than a pathological entity; therefore, consideration was given to making use of these anatomical retentive areas in a prosthetic manner. In this article, a literature review of Stafne's mandibular defect is presented and attempts to improve the retention and stability of the lower complete dentures by using this anatomical entity are described.

Multiple odontogenic keratocysts (OKCs) are principle features of nevoid basal cell carcinoma syndrome (NBCCS; Gorlin-Goltz syndrome). NBCCS is a genetic disorder transmitted by an autosomal dominant gene with variable expressivity, which is important to recognize when a patient has multiple OKCs. The cysts of the jaws are among the most common findings. Another feature is a certain appearance of the face, such as: large calvaria, high-arched eyebrows, broad nasal root, and mild hypertelorism. Before-therapy diagnosis is, therefore, as important as after-therapy diagnosis. Genetic counseling and examination may also be indicated. The purpose of this paper was to present a family case report of nevoid basal cell carcinoma syndrome with multiple odontogenic keratocysts. The features identified by these combined clinical, imaging, and histologic findings are described, along with a brief mention of the family history and a review of the literature.

Gorlin syndrome is an autosomal dominant inherited condition that exhibits high penetrance and variable expressivity. It is characterized mainly by Basal cell carcinomas, Odontogenic keratocysts and skeletal anomalies. However, medical literature documents both common and lesser known manifestations of the disorder involving the skin, central nervous system, skeletal system etc. Diagnosis of the syndrome in childhood is basically through oral abnormalities. A case of Gorlin syndrome has been reported here, with review of literature.

The typical Stafne's cavity, located on the posterior portion of the mandible, is a relatively uncommon entity. However, when the defect is located in the anterior region of the mandible, it is quite rare, having thus far been described in only 36 cases in the scientific literature. Most of these defects appear in the fifth and sixth decades of life, are localized to the area of the canines and premolars, and have a predilection for males. The inferior dental canal, one of the anatomical-radiographic landmarks that aid in the diagnosis of Stafne's cavity in the posterior region, is rarely present anterior the mental foramen. For this reason, because of its more variable radiographic appearance compared to the posterior defect, its tendency to be superimposed over the apices of the teeth, and the rarity of its localisation to the anterior mandible, it is much more difficult to establish a definitive diagnosis of a Stafne's cavity in this location. It is therefore more likely that a diagnostic error can occur, especially early on. We present a new case in a 68-year-old male in which the diagnosis was serendipitous, and we review in particular the aetiology and pathogenesis, clinical aspects, and differential diagnoses for this condition.

The fibro-osseous lesions represent a large group of disorders that have many common characteristics including clinical, radiographic and microscopic features. Although most are of unknown aetiology, some are believed to be neoplastic and others are related to metabolic imbalances. It is not unusual to see these lesions presenting with a range of radiographic appearances, causing considerable diagnostic confusion owing to their similar histology. This case report presents a histologically benign cemento-osseous lesion that is radiographically consistent with a focal cemento-osseous dysplasia, along with a concomitant simple (traumatic) bone cyst within the right mandibular alveolus, with the initial presentation as a multilocular radiolucency. Pertinent literature is reviewed.

Purpose: In this retrospective study, we analyzed immediate and late mandibular fractures after impacted lower third molar surgery., Patients and Methods: One hundred fifty oral and maxillofacial surgeons in the north of- France were questioned about their experience with intraoperative and late mandibular fracture after third molar surgery. Cases were examined clinically and radiographically., Results: Thirty-seven fractures were reported in about 750,000 extractions (incidence of 0.0049%). Only 27 cases could be precisely described: 17 intraoperative and 10 late fractures. The patients were 19 to 75 years of age, with an average age of 37 years for intraoperative fractures and 47 years for late fractures. All grades of tooth impaction were included. Only 2 patients did not have full dentition., Conclusions: The major incidence of immediate and late mandible fractures occurs in patients older than over 25 years. Men may be more likely to have late fractures (8 of 10 cases)., (Copyright 2002 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 60:163-165, 2002)

The septic condition resulting from an apical infection, a peridontal infection, an accident of dental eruption or post-extraction can be disseminated and can lead to complications. A retrospective study of 161 cases admitted at the Central Hospital of Yaounde from 1995 to 1998 was done with the aim of establishing a distribution according to sex, age, profession, infectious stage and causes of late consultation as well as the relation between the infectious stage, aetiology, age and profession. It was observed that: the age group mostly affected were: 10-19 years (25.46%) and 20-29 years (30.43%), it was at the late stage of abscess (54.03%) and of phlegmon (32.91%) that the patients came for consultation and this was primarily due to poor socio-economic conditions (55.90%), abscess was formed mostly among the students of 10-19 years and 0-9 years while phlegmon was observed mostly among the students between 20-29 years. It was for these reasons that we suggest: a better prevention of infectious dental diseases in schools and universities, a sensibilisation of parents and educators on the economic interest of early treatment of these infections.

Longitudinal record of a case of multiple impacted teeth associated with large follicular cyst in the right maxilla was presented. The patient was an 8-year-10-month-old girl whose chief complaint was delayed eruption of the right upper incisor. Clinical examination revealed a large follicular cyst in the right maxillary sinus, which greatly displaced teeth germs. Marsupialization followed by orthodontic extrusion successfully brought unerupted teeth into their positions. Greatly displaced upper right canine, which was as high as the floor of the orbit, erupted spontaneously after reduction of the lesion. During the subsequent years, the patient developed crowded dentition and reduced overbite, which needed additional orthodontic treatment with extraction of premolars. The patient was 26-years 8-months old upon completion of treatment. The surgical, orthodontic, and periodontological aspects of the case were reexamined. Marsupialization of dentigerous cysts can preserve impacted teeth, however, the outcome might be affected by several factors such as overall growth of facial bones.

Although odontogenic sinusitis is a rare entity when compared to sinus disease of rhinogenic origin, it is extremely important to identify a dental aetiology when it occurs. The offending tooth or teeth would thus require endodontic treatment or extraction, and the sinus disease carefully assessed and appropriately managed. Aetiology and presentation of oro-antral fistulae are also discussed and guidelines for the management of this complication are recommended. Certain lesions such as cysts and tumours may involve the jaws and hence the maxillary antrum; some of these, such as a radicular cyst are quite common, but the rarer ones are included for completeness. Surgical techniques are continuously evolving to optimise form and function of the jaws, and when applied to the maxilla there may be some impact on nasal and sinus function. The advent, and now proven success, of osseointegrated jaw implants have brought with them innovations and refinements of bone grafting techniques, and more recently distraction osteogenesis for augmentation. Maxillary osteotomies for surgical orthodontics, and to facilitate prosthodontic treatment are briefly mentioned, as most of these inevitably involve the antrum and/or nose. This paper discusses, in summary form, important aspects of clinical dental practice which may involve the maxillary antrum. It is thus a broad overview of certain pathologic conditions and elective surgical procedures which have relevance to both medical and dental practitioners.

Four clinical cases are presented to demonstrate the self-correcting potential of aberrant tooth germs after the elimination of eruption obstacles (in 2 cases cysts, in 2 other cases severely infraoccluded primary teeth). In the case of the submerging deciduous teeth, the tilted adjacent teeth were orthodontically uprighted after the surgical procedure. Possible causative mechanisms are discussed.

The odontogenic keratocyst has been well documented and extensively studied. It is of particular interest because of its high recurrence rate and aggressive nature. The material for this study consisted of 70 cases of odontogenic keratocysts in predominantly ethnic Chinese patients who were treated from 1981 to 1996. The cases were retrospectively studied to compare characteristics of the lesion in this population with those in previous reports. Most of the patients in this series were 21 to 30 years of age. Association with an impacted mandibular third molar was found in more than 50% of the cases. The recurrence rate was 20% for 35 patients with a follow-up period of at least 5 years. The follow-up period for the whole series ranged from 1 to 16 years. Treatment was surgical enucleation with peripheral ostectomy. There were no significant differences in characteristics with respect to presentation and prognosis between this series and those described in previous publications.

A patient presented with a large, multilocular, refractory traumatic bone cyst. The radiolucency had increased in dimension since her last recall. Over 11 years, therapy had included needle aspiration biopsies followed by simple curettage and closure, the most common therapy for traumatic bone cysts. However, all treatment had proved unsuccessful for this patient. It was decided to treat the patient with a slightly unique method. After curettage of the lesion, the traumatic bone cyst was packed with a mixture of autogenous blood, harvested autogenous bone chips, and hydroxyapatite.

A retrospective study was undertaken to analyse the etiology, site and treatment procedures of 30 pathological fractures of the mandible. Fifty percent of the fractures had an inflammatory cause. The remaining cases were associated with severe atrophy of edentulous mandibles (4), benign tumours (3), cysts (3), and primary or secondary malignancies (5). Regardless of the cause, the majority of the fractures occurred in the body of the mandible. Pathological fractures of the mandible most often have to be treated by eliminating the cause of the underlying condition while immobilizing the fragments either with osteosynthesis or archbars and intermaxillary fixation.

Clinicopathological investigations of five surgery-requiring dental diseases caused by maxillary lesions were conducted. 1) The maxillary lesions were acute maxillary sinusitis and a postoperative maxillary cyst. 2) The clinical symptom was persistent cheek pain, even though the maxillary lesions were improved and there were no lesions in the tooth crown or periodontal tissue. 3) All of the teeth with dental diseases caused by maxillary lesions had percussion pain. 4) The pathological findings of the dental diseases were ascending pulpitis and pulpal necrosis caused by maxillary lesions. 5) When patients complain of persistent cheek pain even though maxillary lesions are improved and there are no lesions of the tooth crown or periodontal tissue, we should doubt the presence of dental diseases caused by maxillary lesions (ascending pulpitis and pulpal necrosis).

The aneurysmal bone cyst is an unusual cause of a jaw mass in children. Left untreated, this relatively benign lesion can lead to deformity and destructive bone changes. We report a nine-year-old patient with a large untreated aneurysmal bone cyst, and briefly discuss the differential diagnosis of head and neck masses in children.

Nevoid basal cell carcinoma syndrome (NBCC; Gorlin syndrome), an autosomal dominant disorder linked to 9q22.3-q31, and caused by mutations in PTC, the human homologue of the Drosophila patched gene, comprises multiple basal cell carcinomas, keratocysts of the jaw, palmar/plantar pits, spine and rib anomalies and calcification of the falx cerebri. We reviewed the findings on 105 affected individuals examined at the NIH since 1985. The data included 48 males and 57 females ranging in age from 4 months to 87 years. Eighty percent of whites (71/90) and 38% (5/13) of African-Americans had at least one basal cell carcinoma (BCC), with the first tumor occurring at a mean age of 23 (median 20) years and 21 (median 20) years, respectively. Excluding individuals exposed to radiation therapy, the number of BCCs ranged from 1 to > 1,000 (median 8) and 1 to 3 (median 2), respectively, in the 2 groups. Jaw cysts occurred in 78/105 (74%) with the first tumor occurring in 80% by the age of 20 years. The number of total jaw cysts ranged from 1 to 28 (median 3). Palmar pits and plantar pits were seen in 87%. Ovarian fibromas were diagnosed by ultrasound in 9/52 (17%) at a mean age of 30 years. Medulloblastoma occurred in 4 patients at a mean age of 2.3 years. Three patients had cleft lip or palate. Physical findings include "coarse face" in 54%, relative macrocephaly in 50%, hypertelorism in 42%, frontal bossing in 27%, pectus deformity in 13%, and Sprengel deformity in 11%. Important radiological signs included calcification of the falx cerebri in 65%, of the tentorium cerebelli in 20%, bridged sella in 68%, bifid ribs in 26%, hemivertebrae in 15%, fusion of the vertebral bodies in 10%, and flame shaped lucencies of the phalanges, metacarpal, and carpal bones of the hands in 30%. Several traits previously considered components of the syndrome (including short fourth metacarpal, scoliosis, cervical ribs and spina bifida occulta) were not found to be significantly increased in the affected individuals. This study delineates the frequency of the clinical and radiological anomalies in NBCC in a large population of US patients and discusses guidelines for diagnosis and management.

We present an 8-year-old African-American boy with medulloblastoma and nevoid basal cell carcinoma syndrome (NBCCS) who exhibited the radiosensitive response of basal cell carcinoma (BCC) formation in the area irradiated for medulloblastoma. Such a response is well-documented in Caucasian NBCCS patients with medulloblastoma. The propositus was diagnosed with medulloblastoma at the age of 2 years and underwent surgery, chemotherapy, and craniospinal irradiation. At the age of 6 years, he was diagnosed with NBCCS following his presentation with a large odontogenic keratocyst of the mandible, pits of the palms and soles and numerous BCCs in the area of the back and neck that had been irradiated previously for medulloblastoma. Examination of other relatives showed that the propositus' mother also had NBCCS but was more mildly affected; in particular, she had no BCCs. This case illustrates complex gene-environment interaction, in that increased skin pigmentation in African-Americans is presumably protective against ultraviolet, but not ionizing, radiation. This case and other similar cases in the literature show the importance of considering NBCCS in the differential diagnosis of any patient who presents with a medulloblastoma, especially before the age of 5 years, and of examining other close relatives for signs of NBCCS to determine the patient's at-risk status. Finally, for individuals who are radiosensitive, protocols that utilize chemotherapy in lieu of radiotherapy should be considered.

We present a case of mucus escape reaction in which we encountered difficulty in interpreting the images acquired by plain radiography, computed tomography, and magnetic resonance imaging. The 48-year-old male Japanese patient was referred for evaluation of a gradual swelling subjacent to the inferior border of the left mandible. At the early imaging examinations, magnetic resonance imaging provided information crucial to resolving the issue of whether the lesion consisted of a central malignant disease process or a malignant disease in the submandibular space or both of these two separate disease entities. Magnetic resonance imaging demonstrated no evidence of tumorous lesion, but rather showed a fluid-containing cavity that was also confirmed by the subsequent intrasurgical inspection. On further consideration of these imaging findings, we concluded that the entity was mucus escape reaction with simultaneous occurrence of an intraconnective tissue hemorrhage adjacent to the left submandibular gland, concomitant extensive bony defect of the left mandible and lingual cortical defect, and chronic sialoadenitis of the left submandibular gland.

Acute or chronic sinusitis may be odontogenic. Bacteria involved in odontogenic sinusitis are specific organisms associated with the teeth (Streptococcus sanguis, Streptococcus salivarius, Streptococcus mutans, anaerobic germs). They are often secondary to an intrasinus foreign body following periodontitis. The treatment is both naso-sinusal and dental. Cysts of the maxilla can also invade the sinus. In particular, radiculo-dental cysts (periapical) must be surgically excised, in some cases associated with a middle meatotomy. Finally, one should look for oro-antral fistulae. The surgical technique for its closure should take into account the reversibility of the sinus lesions.

Two patients with headaches meeting the criteria of chronic paroxysmal hemicrania, as defined by the International Headache Society classification, are presented. Further investigations revealed a parasellar pituitary microadenoma in the first patient and a maxillary cyst in the second. Surgical removal of the lesions resulted in complete relief from headaches. The clinical features of this rare syndrome are discussed and suggest that a more detailed laboratory study and clinical follow-up is necessary in patients with chronic paroxysmal hemicrania.

Pathological fractures of the facial bones are relatively rare. Four pathological mandibular fractures are presented and the difficulty in diagnosing the underlying cause and the dilemma of treatment choice are discussed with a review of the literature. The authors found the incidence of pathological fractures of the facial bones in their series was 0.47%. Biopsy followed by rigid internal fixation, preferably with an AO reconstruction plate bridging the area of pathology after its removal, permits normal function and allows good and undisturbed healing which will inevitably be prolonged in such cases.

The mandibular infected buccal cyst was first described over ten years ago as a discrete pathological entity found only in children. The features of this lesion have been consistently described as a buccal location adjacent to erupting first molar teeth, a thick, hyperplastic non-keratinized epithelial lining, expansion of buccal cortex and associated infection. The paradental cyst had been described some years previously. This lesion was noted to have a similar non-specific hyperplastic non-keratinized epithelial lining but was described as being associated predominantly with third molar teeth in young adults. Recently investigators have called for the mandibular infected buccal cyst to be reclassified as a variant of the paradental cyst. In this paper, ten previously unreported cases of mandibular infected buccal cysts are presented and the evidence for their reclassification as paradental cysts is advanced.

The authors describe a new method of stimulation of regeneration of bone tissue using autografts of autologous bone marrow supplemented with autologous bone marrow stromal fibroblastoid cells (with osteogenic potential) grown in vitro and lyophilized allogenic bone. Such composite grafts have been used in the treatment of 10 patients with lesion in jaw bone. Bone healing was evaluated using clinical and radiological parameters and was compared with healing in 30 similar lesions treated using composite grafts of autologous bone marrow and allogenic lyophilized bone as well as the spontaneous healing of 45 post-cystic lesions. These data indicate, that composite grafts of autologous bone marrow supplemented with in vitro grown autologous bone marrow stromal cells and lyophilized allogenic bone have excellent capacities accelerating bone healing. In smaller lesions, composite grafts of fresh autologous bone marrow and allogenic lyophilized bone (which are easier to prepare) are also useful.

Primary intraosseous carcinoma (P1OC) of the jaws is rare. They either arise de novo or as a consequence of malignant transformation of a benign cyst or tumor. A 56-year-old patient with a P1OC of the mandible arising from an odontogenic keratocyst is described.