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Abstracts from Mund-, Kiefer- and Gesichtschirurgie (volume 1 number 3 1997)
British Journulo/ Ol-u/ ondht~~rll~)/~lac~alSurger~~(1997) 35. 293-294 d 1991 The British Aasocmion of Oral and Maxdlofaclal Surgeons
Abstracts from Mund-, Kiefer- und Gesichtschirurgie (Volume 1 Number 3
Expression of the proliferation markers PCNA and MIB 1 in verruCOW carcinomas of the oral cavity. D. Theegurten, A. BurfuJ, N.C. Gel/rich, S. Philippou. (Mund Kiefer GesichtsChir 1997; 1: 133-136).
of the corresponding regions are necessary. The aim of these studies is to find out the prognostic value of the HPV infection for this facultative premalignant disease. Correspondence: Dr Dr M. Vesper, Universitstskrankenhaus Eppendorf, Mund-, Keiferund Gesichtschirurgie, Martinistrafle 52, D-20251 Hamburg, Germany.
Expression of proliferation markers PCNA and MIB 1 was evaluated in 17 verrucous carcinomas and in five cases of normal squamous epithelium of the oral cavity. lmmunohistochemistry revealed no significant differences in the proliferative activities. Highest expression was seen in the basal zones. Proliferative activity in more than 26% of cells is no longer compatible with verrucous carcinoma, but favours the diagnosis of squamous cell carcinoma. Correspondence: Dr D. Theegarten, Abteilung fiir Pathologie, Ruhr-Universitxt, Bochum. Universit&sstraOe 150, D-44780 Bochum, Germany.
Highly malignant-cell lymphoma presenting the clinical appearance of osteomyelitis of the mandible. T Pluth, K. Herrog. I. Anagnosfopoulos. (Mund Kiefer GesichtsChir 1997; 1: 150-153). A case of precursor B-cell lymphoma of unusual location in the mandible is presented. Clinical features as well as technical examinations led to the misdiagnosis of chronic ostemyelitis. Only immunohistological examination of intraoperatively taken biopsies was able to reveal the true diagnosis. High-dose chemotherapy was started and full remission could be achieved. Correspondence: Dr Dr Th. Plath, Klinik fiir Kieferchirurgie und plastische Gesichtschirurgie, Klinikum Benjamin Franklin, Freie Universitat Berlin. Hindenburgdamm 30, D-12200 Berlin. Germany.
Basaloid-squamous carcinoma of the oral mucosa. K. A. Grfitz, H. D. Kufner, M. Mif:e. T. Reichert, w CVcrgner. (Mund Kiefer GesichtsChir 1997; I: 137-145). The basaloid&quamous carcinoma (BSC) that was first described in 1986 by Wain et al for the head and neck region is a rare distinct variant of squamous cell carcinoma (SCC). The cardial histopathologic feature is a biphasic cellular pattern of basaloid and squamous components. BSC has been confused with solid adenoid cystic carcinoma (ACC). Although the number of reported cases is small, BSC appears biologically virulent, with a propensity to aggressive local behaviour, early regional and distant metastasis, and subsequent poor survival. We report the clinicopathological characteristics of 4 new cases and compare their immunohistochemical features with those of solid ACC and conventional SCC. Our results show that BSC, ACC and SCC react to CK S/6. SCC is CK lo- and CK 13-positive, while BSC and ACC are negative for these markers. BSC and ACC react to CK 8. but in ACC only the luminal cells are CK 8 positive: therefore ACC has a glandular pattern. Our findings indicate that the immunohistochemical differences between BSC and ACC can facilitate their differential diagnosis. Because the biologic behaviour of BSC differs from ACC and SCC, distinction among these tumor types is warranted. Correspondence: Dr Dr K. A. Griitz, Universittits-Klinik fiir Mund-, Kieferund Gesichtschirurgie. Augustusplatz 2. D-55121 Mainz. Germany.
Non-invasive acoustic airway monitoring of tracheal tubes: a contribution to quality assurance? A4. Kunkel. U. Wahlmann, .W Wagner. (Mund Kiefer GesichtsChir 1997; 1: 154158). Non-invasive acoustic airway monitoring was evaluated in an experimental study. Recording amplitude and travel time of acoustic pulse response, an area-distance function of the cross sectional dimensions of the endotracheal tube and the adjacent airway was calculated to obtain an acoustic pattern of the airway. Measurements on models and excised human cadaver lungs were performed to discover whether displacement or obstruction of the artificial airway can be detected in the acoustic equivalent. Regression analysis revealed a close correlation between displacement of tracheostomy tubes and the shifting of the acoustic areadistance function (corr. coeff. 0.97-I ). Dispersion analysis confirmed reasonable reliability (coeff. of variation 0.6&21. I’%,). Location and amount of obstructions could likewise be identified. Thus acoustic mapping provides an adequate approximation of the true geometry of tracheostomy and endotracheal tubes. We conclude that acoustic monitoring may provide a powerful tool to achieve primary prevention of airway disturbances in intubated and mechanically ventilated patients, as geometrical changes of airway configuration can be detected even before they cause substantial effects on respiratory metabolism. Correspondence: Dr Dr M. Kunkel. Klinik fiir Mund-, Kieferund Gesichtschirurgie, Augustusplatz 2, D-55101 Mainz, Germany.
Demonstration of human papilloma virus DNA in oral lichen planus. M. Vesprr. S. Riethdorf E. Christoph, A. Ruthkr. R. Schmrtle, T. LGrzing. (Mund Kiefer GesichtsChir 1997; 1: 14&149). Human papilloma viruses (HPV) can be detected in different epithelia with the help of the polymerase chain reaction (PCR). The role of HPV in the development of anogenital cancers has been intensively studied, and current evidence shows that most cervical cancers are associated with so-called high risk HPV types (e.g. HPV 16 and 18). HPV infections can also be demonstrated in oral premalignant lesions and squamous cell carcinomas. Depending on the sensitivity of the detection method, 40-67X of leukoplakias, 2.5-76% of squamous cell carcinomas and O-87% of cases of lichen planus were described as being infected with HPV 16 or 18. Whether lichen planus can be considered as a premalignant lesion is still controversial. By the use of PCR and hybridization we found infections with the high risk HPV types 16, 18 and 31 in 42% (3/7) of the patients with lichen planus. Further investigations with a higher number of cases in combination with the analysis of the viral gene expression as well as the clinical and histological control
Median facial dysplasia in patients with cleft lip and palate: characteristics and problems in interdisciplinary treatment. Ch. Opit:. D. Suhklrw, D. K. Sherty. R. Lrhmann. (Mund Kiefer GesichtsChir 1997; 1: 159-164). The diagnosis of median facial dysplasia is made in cases of a typical deficiency of the median facial structures without concomitant abnormalities of the brain, and presence of unilateral or bilateral cleft lip and palate. The identification and description of this type of cleft lip and palate are important because such patients have severe growth disturbances and tissue deficiencies. These make surgical reconstruction and orthodontic treatment difficult. This is demonstrated in two examples. The clinical and roentgenological 293
294
British
Journal
of Oral
and Maxillofacial
Surgery
findings in the mother of one of the demonstrated patients point to a discrete form of the same anomaly. Correspondence: Prof. Dr Charlotte Opitz, Universit%tsklinikum CharitC, Medizinische FakultBt, Humboldt-Universitst, Berlin. Zentrum ftir Zahmedizin, Abteilung fiir Kieferorthopadie und Orthodontie, SchumannstralJe 20-21, D-10098 Berlin, Germany.
Correspondence: Prof. Dr Dr H.-P. Howaldt, Klinik ftir Mund-, Kiefer- und Gesichtschirurgie, Justus Liebig-Universitst GieBen, KlinikstraBe 29, D-35385 GieBen, Germany.
Scanning electron microscopic study of primary fracture healing. H.-A. Merten, M Rieger, H. G. Luhr. (Mund Kiefer GesichtsChir 1997; 1: 165-168).
Ameloblastic fibromas are rare benign odontogenic tumors, which appear preferentially in adolescents and young adults. They are most often found in the mandible. The present case report describes a 40-year-old patient with an ameloblastic fibroma in the upper jaw, an extremely rare site. The diagnosis, differential diagnosis, histology and therapeutic procedure are described. Correspondence: Priv.-Doz. Dr J. Piesold, Klinik fiir Mund-KieferGesichtschirurgie, Klinikum Erfurt GmbH, Nordhtiuser StraBe 74, DO99089 Erfurt, Germany.
J. Wiltfang,
Scanning electron microscopy was used to study primary bone healing. This technique, essential for a three-dimensional description, has provided excellent visualization and revealed new aspects of the micromorphology of primary bone healing. Calcifying collagen bundles were responsible for the first mechanical stability. Bone healing took place later in fracture vaults generated by compressed fracture fragments which were partially nonvital. A direct bridging of the fracture fragments by sprouting osteons was not observed. Correspondence: Dr Dr J. Wiltfang, Abteilung ftir Mund-, Kieferund Gesichtschirurgie, Universitgt Ghttingen, Robert-KochStrasse 40, D37070 GBttingen, Germany. Lateral orbitectomy for correction of endocrine ophthalmopathy. H. P. Howaldt, C. Klein, A. Dederichs. (Mund Kiefer GesichtsChir 1997; 1: 169-173). Grave’s disease is often associated with various symptoms summarized as endocrine orbitopathy. A surgical procedure is presented which reduces the exophthahnos by approximately 4.5 mm by resecting the caudal and lateral orbital wall through a subciliar incision. The surgical intervention regularly leads to an amelioration of the functional symptoms of endocrine orbitopathy, such as diplopia, cornea1 exposure and lid irregularities. In one case an acute reduction of vision on both eyes significantly ameliorated immediately after surgery. The operation described also improves the aesthetic appearance of the patients, who often suffer psychologic impairments associated with Grave’s disease.
Ameloblastic fibroma in the upper jaw. J. Piesold, (Mund Kiefer GesichtsChir 1997; 1: 174-178).
Aggressive St. Freidl,
hemangiopericytoma N.-C.
Gellrich,
of
M. Zerfowski,
W. Meerbach.
the maxillofacial region. (Mund Kiefer
S. Philippou.
GesichtsChir 1997; 1: 179-181). Hemangiopericytoma is a rare tumor that originates from the pericytes. Only histology permits a reliable diagnosis. There are no known parameters to predict the biological behavior of the tumor, so every hemangiopericytoma has to be treated as potentially malignant. No age or gender prevalence of this tumor in the region of the head or neck has yet been observed. Hemangiopericytoma should be treated by radical surgery: chemotherapy or radiation should be reserved for incompletely removed or metastatic tumors. Metastasis and recurrences have been described even decades after first tumor treatment, so that all patients should undergo life-long follow-up. As an example for a fulminant course of a malignant hemangiopericytoma (G3) we present the case of a 24-year-old female patient who initially presented nonspecific symptoms, was diagnosed late, and eventually died of her tumor despite chemotherapy and surgical treatment. Correspondence: Dr Dr St. Friedl, Klinik fiir Mund-, Kiefer- und Gesichtschirurgie, Ruhr-UniversitBt Bochum, In der Schornau 23-25, D-44892 Bochum, Germany.
Abstracts from Mund-, Kiefer- und Gesichtschirurgie (Volume 1 Number 3
Expression of the proliferation markers PCNA and MIB 1 in verruCOW carcinomas of the oral cavity. D. Theegurten, A. BurfuJ, N.C. Gel/rich, S. Philippou. (Mund Kiefer GesichtsChir 1997; 1: 133-136).
of the corresponding regions are necessary. The aim of these studies is to find out the prognostic value of the HPV infection for this facultative premalignant disease. Correspondence: Dr Dr M. Vesper, Universitstskrankenhaus Eppendorf, Mund-, Keiferund Gesichtschirurgie, Martinistrafle 52, D-20251 Hamburg, Germany.
Expression of proliferation markers PCNA and MIB 1 was evaluated in 17 verrucous carcinomas and in five cases of normal squamous epithelium of the oral cavity. lmmunohistochemistry revealed no significant differences in the proliferative activities. Highest expression was seen in the basal zones. Proliferative activity in more than 26% of cells is no longer compatible with verrucous carcinoma, but favours the diagnosis of squamous cell carcinoma. Correspondence: Dr D. Theegarten, Abteilung fiir Pathologie, Ruhr-Universitxt, Bochum. Universit&sstraOe 150, D-44780 Bochum, Germany.
Highly malignant-cell lymphoma presenting the clinical appearance of osteomyelitis of the mandible. T Pluth, K. Herrog. I. Anagnosfopoulos. (Mund Kiefer GesichtsChir 1997; 1: 150-153). A case of precursor B-cell lymphoma of unusual location in the mandible is presented. Clinical features as well as technical examinations led to the misdiagnosis of chronic ostemyelitis. Only immunohistological examination of intraoperatively taken biopsies was able to reveal the true diagnosis. High-dose chemotherapy was started and full remission could be achieved. Correspondence: Dr Dr Th. Plath, Klinik fiir Kieferchirurgie und plastische Gesichtschirurgie, Klinikum Benjamin Franklin, Freie Universitat Berlin. Hindenburgdamm 30, D-12200 Berlin. Germany.
Basaloid-squamous carcinoma of the oral mucosa. K. A. Grfitz, H. D. Kufner, M. Mif:e. T. Reichert, w CVcrgner. (Mund Kiefer GesichtsChir 1997; I: 137-145). The basaloid&quamous carcinoma (BSC) that was first described in 1986 by Wain et al for the head and neck region is a rare distinct variant of squamous cell carcinoma (SCC). The cardial histopathologic feature is a biphasic cellular pattern of basaloid and squamous components. BSC has been confused with solid adenoid cystic carcinoma (ACC). Although the number of reported cases is small, BSC appears biologically virulent, with a propensity to aggressive local behaviour, early regional and distant metastasis, and subsequent poor survival. We report the clinicopathological characteristics of 4 new cases and compare their immunohistochemical features with those of solid ACC and conventional SCC. Our results show that BSC, ACC and SCC react to CK S/6. SCC is CK lo- and CK 13-positive, while BSC and ACC are negative for these markers. BSC and ACC react to CK 8. but in ACC only the luminal cells are CK 8 positive: therefore ACC has a glandular pattern. Our findings indicate that the immunohistochemical differences between BSC and ACC can facilitate their differential diagnosis. Because the biologic behaviour of BSC differs from ACC and SCC, distinction among these tumor types is warranted. Correspondence: Dr Dr K. A. Griitz, Universittits-Klinik fiir Mund-, Kieferund Gesichtschirurgie. Augustusplatz 2. D-55121 Mainz. Germany.
Non-invasive acoustic airway monitoring of tracheal tubes: a contribution to quality assurance? A4. Kunkel. U. Wahlmann, .W Wagner. (Mund Kiefer GesichtsChir 1997; 1: 154158). Non-invasive acoustic airway monitoring was evaluated in an experimental study. Recording amplitude and travel time of acoustic pulse response, an area-distance function of the cross sectional dimensions of the endotracheal tube and the adjacent airway was calculated to obtain an acoustic pattern of the airway. Measurements on models and excised human cadaver lungs were performed to discover whether displacement or obstruction of the artificial airway can be detected in the acoustic equivalent. Regression analysis revealed a close correlation between displacement of tracheostomy tubes and the shifting of the acoustic areadistance function (corr. coeff. 0.97-I ). Dispersion analysis confirmed reasonable reliability (coeff. of variation 0.6&21. I’%,). Location and amount of obstructions could likewise be identified. Thus acoustic mapping provides an adequate approximation of the true geometry of tracheostomy and endotracheal tubes. We conclude that acoustic monitoring may provide a powerful tool to achieve primary prevention of airway disturbances in intubated and mechanically ventilated patients, as geometrical changes of airway configuration can be detected even before they cause substantial effects on respiratory metabolism. Correspondence: Dr Dr M. Kunkel. Klinik fiir Mund-, Kieferund Gesichtschirurgie, Augustusplatz 2, D-55101 Mainz, Germany.
Demonstration of human papilloma virus DNA in oral lichen planus. M. Vesprr. S. Riethdorf E. Christoph, A. Ruthkr. R. Schmrtle, T. LGrzing. (Mund Kiefer GesichtsChir 1997; 1: 14&149). Human papilloma viruses (HPV) can be detected in different epithelia with the help of the polymerase chain reaction (PCR). The role of HPV in the development of anogenital cancers has been intensively studied, and current evidence shows that most cervical cancers are associated with so-called high risk HPV types (e.g. HPV 16 and 18). HPV infections can also be demonstrated in oral premalignant lesions and squamous cell carcinomas. Depending on the sensitivity of the detection method, 40-67X of leukoplakias, 2.5-76% of squamous cell carcinomas and O-87% of cases of lichen planus were described as being infected with HPV 16 or 18. Whether lichen planus can be considered as a premalignant lesion is still controversial. By the use of PCR and hybridization we found infections with the high risk HPV types 16, 18 and 31 in 42% (3/7) of the patients with lichen planus. Further investigations with a higher number of cases in combination with the analysis of the viral gene expression as well as the clinical and histological control
Median facial dysplasia in patients with cleft lip and palate: characteristics and problems in interdisciplinary treatment. Ch. Opit:. D. Suhklrw, D. K. Sherty. R. Lrhmann. (Mund Kiefer GesichtsChir 1997; 1: 159-164). The diagnosis of median facial dysplasia is made in cases of a typical deficiency of the median facial structures without concomitant abnormalities of the brain, and presence of unilateral or bilateral cleft lip and palate. The identification and description of this type of cleft lip and palate are important because such patients have severe growth disturbances and tissue deficiencies. These make surgical reconstruction and orthodontic treatment difficult. This is demonstrated in two examples. The clinical and roentgenological 293
294
British
Journal
of Oral
and Maxillofacial
Surgery
findings in the mother of one of the demonstrated patients point to a discrete form of the same anomaly. Correspondence: Prof. Dr Charlotte Opitz, Universit%tsklinikum CharitC, Medizinische FakultBt, Humboldt-Universitst, Berlin. Zentrum ftir Zahmedizin, Abteilung fiir Kieferorthopadie und Orthodontie, SchumannstralJe 20-21, D-10098 Berlin, Germany.
Correspondence: Prof. Dr Dr H.-P. Howaldt, Klinik ftir Mund-, Kiefer- und Gesichtschirurgie, Justus Liebig-Universitst GieBen, KlinikstraBe 29, D-35385 GieBen, Germany.
Scanning electron microscopic study of primary fracture healing. H.-A. Merten, M Rieger, H. G. Luhr. (Mund Kiefer GesichtsChir 1997; 1: 165-168).
Ameloblastic fibromas are rare benign odontogenic tumors, which appear preferentially in adolescents and young adults. They are most often found in the mandible. The present case report describes a 40-year-old patient with an ameloblastic fibroma in the upper jaw, an extremely rare site. The diagnosis, differential diagnosis, histology and therapeutic procedure are described. Correspondence: Priv.-Doz. Dr J. Piesold, Klinik fiir Mund-KieferGesichtschirurgie, Klinikum Erfurt GmbH, Nordhtiuser StraBe 74, DO99089 Erfurt, Germany.
J. Wiltfang,
Scanning electron microscopy was used to study primary bone healing. This technique, essential for a three-dimensional description, has provided excellent visualization and revealed new aspects of the micromorphology of primary bone healing. Calcifying collagen bundles were responsible for the first mechanical stability. Bone healing took place later in fracture vaults generated by compressed fracture fragments which were partially nonvital. A direct bridging of the fracture fragments by sprouting osteons was not observed. Correspondence: Dr Dr J. Wiltfang, Abteilung ftir Mund-, Kieferund Gesichtschirurgie, Universitgt Ghttingen, Robert-KochStrasse 40, D37070 GBttingen, Germany. Lateral orbitectomy for correction of endocrine ophthalmopathy. H. P. Howaldt, C. Klein, A. Dederichs. (Mund Kiefer GesichtsChir 1997; 1: 169-173). Grave’s disease is often associated with various symptoms summarized as endocrine orbitopathy. A surgical procedure is presented which reduces the exophthahnos by approximately 4.5 mm by resecting the caudal and lateral orbital wall through a subciliar incision. The surgical intervention regularly leads to an amelioration of the functional symptoms of endocrine orbitopathy, such as diplopia, cornea1 exposure and lid irregularities. In one case an acute reduction of vision on both eyes significantly ameliorated immediately after surgery. The operation described also improves the aesthetic appearance of the patients, who often suffer psychologic impairments associated with Grave’s disease.
Ameloblastic fibroma in the upper jaw. J. Piesold, (Mund Kiefer GesichtsChir 1997; 1: 174-178).
Aggressive St. Freidl,
hemangiopericytoma N.-C.
Gellrich,
of
M. Zerfowski,
W. Meerbach.
the maxillofacial region. (Mund Kiefer
S. Philippou.
GesichtsChir 1997; 1: 179-181). Hemangiopericytoma is a rare tumor that originates from the pericytes. Only histology permits a reliable diagnosis. There are no known parameters to predict the biological behavior of the tumor, so every hemangiopericytoma has to be treated as potentially malignant. No age or gender prevalence of this tumor in the region of the head or neck has yet been observed. Hemangiopericytoma should be treated by radical surgery: chemotherapy or radiation should be reserved for incompletely removed or metastatic tumors. Metastasis and recurrences have been described even decades after first tumor treatment, so that all patients should undergo life-long follow-up. As an example for a fulminant course of a malignant hemangiopericytoma (G3) we present the case of a 24-year-old female patient who initially presented nonspecific symptoms, was diagnosed late, and eventually died of her tumor despite chemotherapy and surgical treatment. Correspondence: Dr Dr St. Friedl, Klinik fiir Mund-, Kiefer- und Gesichtschirurgie, Ruhr-UniversitBt Bochum, In der Schornau 23-25, D-44892 Bochum, Germany.