- Email: [email protected]
Hemophilic pseudotumors of the mandible
Quarterly
85
Dental Review
started in the lower lip, spread to the upper within 24 hours and persisted for 2 years. The mucosal surface was red, fissured and covered with scabs. The chest and gastointestinal tract were normal clinically and radiographically. A Mantoux test was inconclusive. A biopsy revealed many microabscesses. Histologically, epithelioid cells, giant cells and caseation typical of tuberculosis were seen, but no bacilli. A biopsy of the floor of the mouth for Crohn’s disease was negative. The lip lesions were regarded as tuberculids, a reaction to dead tubarcle bacilli or their products released from a non-active focus. The lips healed and returned almost to normal after antituberculosis treatment. G. R. Seward
MULKEY Hemophilic J. OralSurg.
T. F. pseudotumors of the mandible, 35 (1977) 561-568.
A haemophilic pseudo-tumour is a progressive cystic swelling produced by haemorrhage and involving muscle and bone. Case 1: An 8yearold haemophiliac had had a swelling of the right side of the mandible for 3 weeks not preceded by trauma. There was a firm, painless 6 X 4cm expansion of the angle of the mandible, with extrusion of the first molar and a septate bone cavity. After giving five bottles of factor VIII concentrate the cavity was curetted. The tissue from the cavity was a moderately cellular connective tissue containing spicules of osteoid. There were large pools of fresh blood and haemosiderin. Many fragments were lined with granulation tissue containing foreign body giant cells and chronic inflammatory cells. Postoperatively, factor VIII concentrate and EACA were administered over 10 days. Complete bony healing occurred. Case 2: A 7year-old haemophiliac had a left mandibular swelling which developed within 4 days following an attack of mumps and then persisted for a month. The mass was firm, mostly bony hard, but fluctuant anteriorly. After an infusion of factor VIII, 9 ml of blood were aspirated, but the swelling quickly recurred. Cryoprecipitate and EACA were continued after the aspiration. One year later the patient died of a head injury. Only a slight enlargement of the
mandible was to be seen on films taken at the time. Case 3: A 16-year-old boy had pain and swelling around 876/ which were impacted. After infusions of factor VIII 7/ was extracted and the gum removed over 8/. Bleeding subsequently started from a raw area at the operation site and was controlled by factor VI I I and local measures only after 4 months. During this time tissue over the bone cavity sloughed and the cavity epithelialized. An enlargement of the mandible developed which was explored, the molars extracted and the lesion curetted. Bone and tooth roots had been resorbed by a cellular connective tissue and granulation tissue which contained fresh and old clot and haemosiderin. Within 7 months the swelling had recurred and was again curetted. Encapsulated cyst-like structures filled with red cells were found. The aetiology of haemophilic pseudotumours is discussed. G. R. Seward
PARAVECCHIO
R.
Photosensitization of a patient with discoid lupus erythematosus by a dental operating light: report of a case, J. Am. Dent Assoc.
94 (1977) 907-909. About 16 hours after a 39minute dental appointment the classic pattern of discoid lupus erythematosus facial lesions erupted on a 44-year-old woman. She had not revealed her g-year-old history of the condition when answering an exhaustive health questionnaire before treatment. The lesions consist of red-purple macules with grey to yellow adherent scales. As they spread peripherally, they exhibit central atrophy and subsequent involution to a depressed scar-like area surrounded by elevated violaceous margins. When spread over the bridge of the nose a characteristic butterfly pattern is evident. The lesions persisted for 8 weeks. Treatment was the application of topical steroids and the use of sunscreens. The light emitted from the operating lamp was analysed and emission was confirmed of the 305~nm wavelength, which is within the 290-320~nm ultraviolet range. The patient knew that she was photosensitive to sunlight and had not been
85
Dental Review
started in the lower lip, spread to the upper within 24 hours and persisted for 2 years. The mucosal surface was red, fissured and covered with scabs. The chest and gastointestinal tract were normal clinically and radiographically. A Mantoux test was inconclusive. A biopsy revealed many microabscesses. Histologically, epithelioid cells, giant cells and caseation typical of tuberculosis were seen, but no bacilli. A biopsy of the floor of the mouth for Crohn’s disease was negative. The lip lesions were regarded as tuberculids, a reaction to dead tubarcle bacilli or their products released from a non-active focus. The lips healed and returned almost to normal after antituberculosis treatment. G. R. Seward
MULKEY Hemophilic J. OralSurg.
T. F. pseudotumors of the mandible, 35 (1977) 561-568.
A haemophilic pseudo-tumour is a progressive cystic swelling produced by haemorrhage and involving muscle and bone. Case 1: An 8yearold haemophiliac had had a swelling of the right side of the mandible for 3 weeks not preceded by trauma. There was a firm, painless 6 X 4cm expansion of the angle of the mandible, with extrusion of the first molar and a septate bone cavity. After giving five bottles of factor VIII concentrate the cavity was curetted. The tissue from the cavity was a moderately cellular connective tissue containing spicules of osteoid. There were large pools of fresh blood and haemosiderin. Many fragments were lined with granulation tissue containing foreign body giant cells and chronic inflammatory cells. Postoperatively, factor VIII concentrate and EACA were administered over 10 days. Complete bony healing occurred. Case 2: A 7year-old haemophiliac had a left mandibular swelling which developed within 4 days following an attack of mumps and then persisted for a month. The mass was firm, mostly bony hard, but fluctuant anteriorly. After an infusion of factor VIII, 9 ml of blood were aspirated, but the swelling quickly recurred. Cryoprecipitate and EACA were continued after the aspiration. One year later the patient died of a head injury. Only a slight enlargement of the
mandible was to be seen on films taken at the time. Case 3: A 16-year-old boy had pain and swelling around 876/ which were impacted. After infusions of factor VIII 7/ was extracted and the gum removed over 8/. Bleeding subsequently started from a raw area at the operation site and was controlled by factor VI I I and local measures only after 4 months. During this time tissue over the bone cavity sloughed and the cavity epithelialized. An enlargement of the mandible developed which was explored, the molars extracted and the lesion curetted. Bone and tooth roots had been resorbed by a cellular connective tissue and granulation tissue which contained fresh and old clot and haemosiderin. Within 7 months the swelling had recurred and was again curetted. Encapsulated cyst-like structures filled with red cells were found. The aetiology of haemophilic pseudotumours is discussed. G. R. Seward
PARAVECCHIO
R.
Photosensitization of a patient with discoid lupus erythematosus by a dental operating light: report of a case, J. Am. Dent Assoc.
94 (1977) 907-909. About 16 hours after a 39minute dental appointment the classic pattern of discoid lupus erythematosus facial lesions erupted on a 44-year-old woman. She had not revealed her g-year-old history of the condition when answering an exhaustive health questionnaire before treatment. The lesions consist of red-purple macules with grey to yellow adherent scales. As they spread peripherally, they exhibit central atrophy and subsequent involution to a depressed scar-like area surrounded by elevated violaceous margins. When spread over the bridge of the nose a characteristic butterfly pattern is evident. The lesions persisted for 8 weeks. Treatment was the application of topical steroids and the use of sunscreens. The light emitted from the operating lamp was analysed and emission was confirmed of the 305~nm wavelength, which is within the 290-320~nm ultraviolet range. The patient knew that she was photosensitive to sunlight and had not been