Cervical necrotizing fasciitis—Review and case series

Poster I / O r a l Pathology submucosal mass with an intact overlying mucosa. Muscle infiltration may occur. Clinical differential diagnosis include: fibroma, salivary gland lesions (neoplasms and mucoceles), and benign nerve sheath tumour. Herniated buccal fat pad must also be included at the top of the differential list of oral lipomas, as well as fibroepithelial polyps. The diagnosis of spindle-cell lipoma is based on histopathologic features that assist to rule out other soft tissue tumours (eg: schwannoma, myxoid neurofibroma, leiomyoma, nodular fasciitis, myxolipoma, fibrolipoma, malignnt fibrous histocytoma and myxoid solitary fibrous tumour) and, most importantly, more aggressive entities (eg: liposarcoma and fibrosarcoma) which may require a more radical approach with a more wider margin of excision. Spindle cell lipoma is a benign entity with no sex predilection. Distinction between this entity and a sarcoma must be highlighted. Oral spindle cell lipomas respond well to local excision under local anaesthesia, with so far no recurrences have been reported at follow-up.

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CERVICAL NECROTIZING FASCIITIS - REVIEW AND CASE SERIES

B. Nierzwicki, C. Meyer. Department of Oral and Maxillofacial Surgery

University of Missouri, Kansas City Truman Medical Center USA Kansas City, Missouri, USA Cervical necrotizing fasciitis (NF) is a rapidly spreading soft tissue infection of polymicrobial origin characterized by necrosis of the subcutaneous tissues and fascia. NF, if left unchecked, invariably leads to systemic toxicity, multi-system organ failure, and eventual death. The purpose of this poster presentation is to review the microbiology, pathogenesis and management of cervical necrotizing fasciitis, based on case series. We are presenting 3 patients of varying ages who presented with similar rapidly progressing symptoms consistent with necrotizing fasciitis. On both ends of the spectrum are: a 15-year-old otherwise healthy boy, who underwent elective pre-orthodontic extractions of paritally impacted wisdom teeth, and a 53-year-old female with multiple co-morbidities who presented with sudden-onset progressive cervical swelling. All patients underwent initial incision and drainage with subsequent serial debridements of necrotic tissues with Puls-a-vac irrigations. Endotracheal intubation followed by a tracheostomy, prolonged mechanical ventilation in surgical ICU and parenteral antimicrobials with nasogastric feedings were employed. All patients recovered well, however extensive defects due to serial debridements required split-thickness soft tissue grafts after resolution of the infection. Early recognition of this life-threatening disease is critical for successful treatment. The initial signs are frequently not distinctive from acute cellulitis or an abscess. However, some findings should make one suspicious of NE These features include (1) odontogenic infections that spread to the lower neck or anterior chest; (2) abnormal accumulation of gas in the tissues; (3) very rapid progression of the infection; and (4) a peau d' orange appearance of the involved skin, which may change to a dusky discoloration as the disease progresses. Shock and multiorgan failure are relatively common, so resuscitation and general supportive measures are critical in all cases.

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HETEROTOPIC ORAL GASTROINTESTINAL CYST

Y. Aguilar-Lizarralde, J.l. Y~Sez-Vilas, A. Valiente-Alvarez. Regional

Universitary Hospital Carlos Haya, Malaga, Spain The heterotopic oral gastrointestinal cyst is a rare pathology. The ethiology is unknown, although there are several theories. The most frequent localization is the mobile tongue. It is usually asympthomatic but can produces difficulties in speech, swallow and respiration. Patient 20 months old with a cystic mass in the posterior aspect of the left border of the tongue. It was resected under general anesthesia. During surgery we observed a clear fluid like saliva from inside the cyst. After seven years, the patient presents a new cystic mass in the posterior aspect of the lingual dorsum, that was resected with a security margin. The pathology study described a cyst lined in a great part by stratified squamous epithelium with areas of fundal gastric tissue. There also areas lined by pancreatic tissue and salivary glands. The CT scan differential diagnosis was lymphangioma, rabdomyosarcoma. The heterotopic oral gastrointestinal cyst is a unfrequent entity that we must have in mind when we have a patient with a cystic mass in the oral cavity. It is more important in pedriatic population. The treatment is surgical resection and long term follow up, because of the posibility of recurrence several years after surgery.

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~ T H E PREVALENCE AND VARIATIONS OF ORAL MUCOSAL LESIONS IN A TURKISH POPULATION C). 0£ok, T. C)zen, N. Dorian, K. Orhan, K. Karakurumer. Department of

Oral Diagnosis and Radiology, GMMA, Ankara; Department of Oral and Maxillofacial Surgery, GMMA, Ankara; Department of Oral Diagnosis and Radiology, University of Ankara, Ankara, Turkey The aim of this study was to investigate the epidemiology of oral mucosal lesions in a Turkish population to obtain data for using in planning an oral health data for the country. Besides this aim, the study is also important to know the state of health and the needs of treatment in a developing country with restrictions in the governmental health service budget. A random sample by age, gender, and socioeconomic status was obtained, comprising a total of 1000 individuals (661 women, 339 men, 1 1 4 2 years). Only patients of Turkish nationality were selected. Individuals were interviewed and examined in GQIhane Military Medical Academy, Centre of Dental Sciences, Department of Oral Diagnosis and Radiology, according to the World Health Organization guidelines by an oral diagnosis and radiology consultant. Information on smoking habits, alcohol, dental hygiene, brushing habits, halitosis, fixed and removable prosthesis was collected by the residents of oral diagnosis and radiology. The consultant examined clinically the oral mucosal lesions and initial diagnoses were made for these lesions. In order to confirm the initial diagnoses and to obtain final diagnoses, biopsy were taken from all mucosal lesions and sent to Department of Pathology. The final diagnoses of the oral mucosal lesions certified following both clinical and histopathologic examinations. To determine the relationship between the age, sex, smoking, alcohol to oral mucosal lesions in the 1,000 patients examined. Chi-square analyses were used for statistical differences (P<0.05). The subjects were divided to seven age groups: 11 to years, 20 to 29 years, 30 to 39 years, 40-49 years, 50-59 years, 60 to 69 years and older than 70 years. Of the 1 000 subjects examined, 661 were female, 339 were male. 313 subjects were smoking while only 19 subjects were alcoholic. 42 subjects were not brushing teeth while 400 subjects were only brushing one time daily. 416 subjects were brushing two times, while 142 subjects were brushing ideal three times in a day. In total 437 oral mucosal lesions were recorded (%43.7). The determined oral mucosal lesions were as follows: Tongue lesions; ankyloglossy was found in 0.3%, macroglossy was found in 1.3%, median ramboid glossitis was found in 0.5%, fissural tongue was found in 8.6%, geographic tongue was found in 3.0%, hairy tongue was found in 5.3%, black hairy tongue was found in 3.7%. verrucous papilloma was found in 0.6%, oral Lichen planus which was localized on tongue was found in 0.2%. (Truncated)

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THERE A NEED FOR A LONG TERM EMS THERAPY IN OSAS?

A. Ludwig. Department of Cranio-Maxillofacial Surgery, University of

Goettingen, Germany Muscle stimulation techniques have became alternatives for therapy of OSAS. In this study it was of interest for how long the electromyostimulation therapy has to be applied by the patient. In two groups of OSAS patients an individually shaped mouth floor electrode (IME) had been used for electromyostimulation therapy. The enoral-cutaneous EMS was carried out with the low frequency stimulation apparatus I-pulse two times daily for thirty minutes during daytime hours, only. For achievement of an efficient recruitment of the muscles, patients were instructed to choose treatment with maximum intensity. In group I only over a period of eight weeks the EMS was applied and than stopped. In group II the patients used EMS therapy for half a year continuously. Before stimulation and 4, 8, 12 and 26 weeks after starting stimulation 3Dvolumetric sonographical measurement of the geniohyoid muscle was carried out by B-scan sonography in combination with a 3D-workstation. All patients (n =12, average age 50.1 years) totally applied the EMStherapy. After four weeks EMS-therapy a volume increase in both groups was registered: in group I in median of 19.0% (minimum 9.2%, maximum 27.6%) and after eight weeks of 27.0%; group I1: 19.6% and 28.2% (8 weeks). Additionally also in both groups a shortening (contraction) of the muscle in length of 4.7% / 4.9% in median was measurable. In group I after the end of the stimulation period a decrease of the muscle volume developed in all cases. After 26 weeks the volume was next to the baseline before stimulation (+ 4.3%). In the second group, the increase of volume persisted (+ 29.4%) over the observation period of 12 to 26 weeks. No decrease could be found. Despite the weakness of the muscle in the first group snoring and apnea occur only in 50%