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Double mandibular osteotomy technique with inferior alveolar neurovascular bundle preservation for improved access to tumors of the parapharyngeal space
1174 Abstracts The greatest width as well as thickness of the tumor was found in patients with the highest expression of p53 protein (score 4). It was found a statistically significant effect of p53 protein expression on tumor length and also there was a trend of larger values of all tumor sizes (width, length and thickness) in patients with expression of p53 protein more than 10%. Prognostic significance of p53 overexpression for the OSCC recurrence and/or metastatic disease has not been determined. The study of the molecular pathogenesis of OSCC could help in prediction of the clinical behavior of the tumor and therapeutic modality of treatment. Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.499
237 Misdiagnosis of polymorphous low-grade adenocarcinoma in salivary glands Q. Zhang 1,2,∗ , L. Li 2 , Y. Zhang 1 Department of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital, Nanchang University, Nanchang, China 2 Department of Head and Neck Surgery, West China College of Stomatology, Sichuan University, Chengdu, China
1
Objective: To investigate the clinicopathological character of polymorphous low-grade adenocarcinoma (PLGA) and reasons of its misdiagnosis. Methods: Nine cases ultimately diagnosed as PLGA in recent years were retrieved from the files of the Affiliated Stomatological Hospital of Nanchang University. Clinical and pathological features were reviewed. Results: Seven cases occurred on palate glands and two cases on parotid glands; of the nine cases, only one was diagnosed as PLGA preoperatically, while others were misdiagnosed preoperatically and during operation (fine needle aspiration cytology or frozen section). Three cases were diagnosed as pleomorphic adenoma, three as mucoepidermoid carcinoma, one as cystic adenoid carcinoma, one as Warthin’s tumor. Ultimate diagnosis was based on immunohistochemistry examination which showed that CK, SMA, UEA and histaminase D were positively expressed in the tumor. Conclusion: PLGA arises often in the palate minor salivary glands or tail part of parotid glands. Differential diagnosis should be made because it is easily be misdiagnosed as other tumors.
Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.500
238 Calcifying epithelial odontogenic tumor of the maxilla treated by conservative surgery: report of a case G. Yildirim 1 , E. Najafov 1 , A. Selcuk 1,∗ , D. Dolanmaz 1 , O. Gunhan 2 1 Oral and Maxillofacial Surgery, Selcuk University Faculty of Dentistry, Konya, Turkey 2 Pathology, Gulhane Military Medical Academy, Ankara, Turkey
Introduction: The calcifying epithelial odontogenic tumor (CEOT), also known as “Pindborg tumor”, is a benign odontogenic neoplasm that can be locally aggressive in nature and accounts for 0.4–3% of all odontogenic tumors. The mandible is affected twice as often as the maxilla, with a marked predilection for the premolarmolar-ramus region. CEOT is frequently associated with unerupted teeth, in particular mandibular molars. More than two thirds of tumors occur between the third and fifth decades of life and there is no gender predilection. A typical patient appears with a diffuse, slow-growing, painless mass in the jaw and rarely experiences any reportable symptoms such as pain or swelling. Radiologically, the lesions may show different features depending on the age of the lesion. Treatment options range from simple enucleation or curettage to radical and extensive resections. Recurrence rates between 14% and 22% have been reported. If the clinical, radiologic, and histologic profiles of the CEOT is now well defined, other questions such as treatment strategy or incidence of recurrence are still debatable, mostly because of the small number of lesions reported in the literature and lack of long-term followup. Treatment should be individualized for each lesion because of variations in the clinical and histologic features. Aim: In this presentation a calcifying epithelial odontogenic tumor in a 32-yearold patient at the right maxillary posterior region which is seen very rarely and its conservative treatment will be presented. Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.501
239 Double mandibular osteotomy technique with inferior alveolar neurovascular bundle preservation for improved access to tumors of the parapharyngeal space C.M.S.d.A. Pinto 1,∗ , P.M. Araújo 2 , F.N. Lima 1 , F.M. de Castro Júnior 3 , L.A.A. Ferreira 3 , R.L.M. Nogueira 2 1 Cirurgia e Traumatologia Buco-Maxilo-Faciais, Hospital Batista Memorial, Brazil 2 Cirurgia e Traumatologia Buco-Maxilo-Faciais, Universidade Federal do Ceará, Brazil 3 Cirurgia de Cabe¸ca e Pesco¸co, Universidade Federal do Ceará - Hospital Universitário Walter Cantídio, Fortaleza, Brazil
The parapharyngeal space harbors 0.5% of all head and neck neoplasms. The surgical approach is the primary difficulty during these tumors resection once superiorly the access becomes more restricted by the progressive encroachment of the mastoid process and the angle of the mandible. Different types of mandibulotomy performed to improve the access to the parapharyngeal space are described in the literature. The aim of this work is to describe the technique used during parapharyngeal space neoplasms resection when a wider access is necessary. The technique is a pre-mental foramen mandibulotomy combined with a ramus osteotomy, which allows the mandibular body segment to be rotated completely out of the operative field. After the tumor resection the mandibular segment is reduced and its fixation is made with 2.0 and 2.4 plates and screws systems. The double mandibulotomy not only provides a wider field but also protects the inferior alveolar neurovascular bundle, which remains completely contained into the osteotomized mandibular segment. This technique dispenses the use of the intermaxillary fixation and provides to the patient postoperative early mandibular function and inferior alveolar neurovascular bundle vitality, with no hypoesthesia of this nerve in the postoperative. Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.502
237 Misdiagnosis of polymorphous low-grade adenocarcinoma in salivary glands Q. Zhang 1,2,∗ , L. Li 2 , Y. Zhang 1 Department of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital, Nanchang University, Nanchang, China 2 Department of Head and Neck Surgery, West China College of Stomatology, Sichuan University, Chengdu, China
1
Objective: To investigate the clinicopathological character of polymorphous low-grade adenocarcinoma (PLGA) and reasons of its misdiagnosis. Methods: Nine cases ultimately diagnosed as PLGA in recent years were retrieved from the files of the Affiliated Stomatological Hospital of Nanchang University. Clinical and pathological features were reviewed. Results: Seven cases occurred on palate glands and two cases on parotid glands; of the nine cases, only one was diagnosed as PLGA preoperatically, while others were misdiagnosed preoperatically and during operation (fine needle aspiration cytology or frozen section). Three cases were diagnosed as pleomorphic adenoma, three as mucoepidermoid carcinoma, one as cystic adenoid carcinoma, one as Warthin’s tumor. Ultimate diagnosis was based on immunohistochemistry examination which showed that CK, SMA, UEA and histaminase D were positively expressed in the tumor. Conclusion: PLGA arises often in the palate minor salivary glands or tail part of parotid glands. Differential diagnosis should be made because it is easily be misdiagnosed as other tumors.
Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.500
238 Calcifying epithelial odontogenic tumor of the maxilla treated by conservative surgery: report of a case G. Yildirim 1 , E. Najafov 1 , A. Selcuk 1,∗ , D. Dolanmaz 1 , O. Gunhan 2 1 Oral and Maxillofacial Surgery, Selcuk University Faculty of Dentistry, Konya, Turkey 2 Pathology, Gulhane Military Medical Academy, Ankara, Turkey
Introduction: The calcifying epithelial odontogenic tumor (CEOT), also known as “Pindborg tumor”, is a benign odontogenic neoplasm that can be locally aggressive in nature and accounts for 0.4–3% of all odontogenic tumors. The mandible is affected twice as often as the maxilla, with a marked predilection for the premolarmolar-ramus region. CEOT is frequently associated with unerupted teeth, in particular mandibular molars. More than two thirds of tumors occur between the third and fifth decades of life and there is no gender predilection. A typical patient appears with a diffuse, slow-growing, painless mass in the jaw and rarely experiences any reportable symptoms such as pain or swelling. Radiologically, the lesions may show different features depending on the age of the lesion. Treatment options range from simple enucleation or curettage to radical and extensive resections. Recurrence rates between 14% and 22% have been reported. If the clinical, radiologic, and histologic profiles of the CEOT is now well defined, other questions such as treatment strategy or incidence of recurrence are still debatable, mostly because of the small number of lesions reported in the literature and lack of long-term followup. Treatment should be individualized for each lesion because of variations in the clinical and histologic features. Aim: In this presentation a calcifying epithelial odontogenic tumor in a 32-yearold patient at the right maxillary posterior region which is seen very rarely and its conservative treatment will be presented. Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.501
239 Double mandibular osteotomy technique with inferior alveolar neurovascular bundle preservation for improved access to tumors of the parapharyngeal space C.M.S.d.A. Pinto 1,∗ , P.M. Araújo 2 , F.N. Lima 1 , F.M. de Castro Júnior 3 , L.A.A. Ferreira 3 , R.L.M. Nogueira 2 1 Cirurgia e Traumatologia Buco-Maxilo-Faciais, Hospital Batista Memorial, Brazil 2 Cirurgia e Traumatologia Buco-Maxilo-Faciais, Universidade Federal do Ceará, Brazil 3 Cirurgia de Cabe¸ca e Pesco¸co, Universidade Federal do Ceará - Hospital Universitário Walter Cantídio, Fortaleza, Brazil
The parapharyngeal space harbors 0.5% of all head and neck neoplasms. The surgical approach is the primary difficulty during these tumors resection once superiorly the access becomes more restricted by the progressive encroachment of the mastoid process and the angle of the mandible. Different types of mandibulotomy performed to improve the access to the parapharyngeal space are described in the literature. The aim of this work is to describe the technique used during parapharyngeal space neoplasms resection when a wider access is necessary. The technique is a pre-mental foramen mandibulotomy combined with a ramus osteotomy, which allows the mandibular body segment to be rotated completely out of the operative field. After the tumor resection the mandibular segment is reduced and its fixation is made with 2.0 and 2.4 plates and screws systems. The double mandibulotomy not only provides a wider field but also protects the inferior alveolar neurovascular bundle, which remains completely contained into the osteotomized mandibular segment. This technique dispenses the use of the intermaxillary fixation and provides to the patient postoperative early mandibular function and inferior alveolar neurovascular bundle vitality, with no hypoesthesia of this nerve in the postoperative. Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.502