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Peripheral odontogenic fibroma. Case report and review of the literature
P o s t e r II / Others [-P'-2--~ PERIPHERAL ODONTOGENIC FIBROMA. CASE REPORT AND REVIEW OF THE LITERATURE G. Laissle, C. Montini, A. Basili, L. Castell6n, R. FariSa. Departament of
Oral Surgery, School of Dentistry, Mayor University, Santiago, Chile The peripheral odontogenic fibroma (WHO type) is a relatively rare, benign, unencapsulated gingival mass of fibrous connective tissue. It is considered to be the extraosseous counterpart of the central odontogenic fibroma. Usually it has not radiographic features. The purpose of this article is to report a case of this uncommon lesion and a review of the literature. A 24-year-old, male patient, who presented a lingually swelling of the gingival tissue in relationship to 3.4 and 3.5 teeth. The removement with an extense cuterage of the lesion was made and the posteriorly biopsy was taken. A four month's clinical and radiographic fellow was done. The biopsy indicated the diagnosis of peripheral odontogenic fibroma, WHO type, a rare odontogenic benign tumor, in an uncommon location. The fellowship showed no evidence of recidiva. However this pathologic entity is rare and uncommon, it should to be considerated on the differential diagnosis of soft tissue tumors. It is extremely necessary to made a fellow of this type of lesions to establish its rate of recidiva.
167 styloideus to lower margin of the thyroid, the surrounding soft tissues were infiltrated. Enlarged lymph nodes were present in supraclavicular fossa, intrathoracically and intraabdominally. Surgical treatment revealed polycystic abstsess. Chest x-rays: without pathological findings. Langhans cells were found in the histological specimens, which is indicative of specific inflammation. Bacterioscopy of pus was negative. The culture showed Mycobacterium tuberculosis growth of. Further treatment was continued in the Lung Clinic according to the guidelines of treatment of tuberculosis. Susceptibility to isoniazid, rifampicin, pyrazinamide, ethambutol, strepthomycin was established. Tuberculous lymphadenitis usally presents as painless swelling of one or more lymph nodes. The most commonly involved nodes are those of the posterior or anterior cervix or those of supraclavicular fossa. Frequently the process is bilateral. Tuberculous lymphadenitis involving the axillary or the inguinal nodes is rare. The diagnosis is made exchesively by culture identification of the microbe. Other valuable components of the diagnostic process include epidemiological features, chest x-ray, needle biopsy or surgical resection of the node and skin testing. The diagnosis of tuberculous lymphadenitis is easily confused with other inflammatory conditions such as lymphoma or sarcoidosis.
[•9• [-P'2--~ NEW METHOD OF MINIMAL INVASIVE REMOVEMENT OF MEGASTYLOIDS USING INTRAOPERATIVE NAVIGATION IN A CT SUPPORTED OPERATION ROOM (THE MULTIFUNCTIONAL IMAGE-GUIDED THERAPY SUITE (MIGTS)
K. Schwenzer-Zimmerer*, R. Sader*, S. Zimmerer, J. Wirt, A.L. Jakob, H.F. Zeilhofer*. Clinic for reconstructive surgery, department of cranioand maxillofacial surgery, Switzerland The megastyloid syndrom or Eagle syndrom is a rare painful disease with dysphagia, pain while talking and disturbances of mouth opening caused by hyperthrophic styloids. With the conventional therapy the resection of the styloids via an submandibular or retromandibular outher approach is the gold standard, but causes extended outher scares. The aim in this case was to find a minimal invasive way to remove the styloids. A 37 years old female patient with hypertrophic styloids (right 47mm, left 52 mm, length of the ramus ascendens mandibulae 60 mm) with the typical symptoms. After clinical suspicion and conventional x-rays an axial spiraI-CT was performed using the thin-layer technique with subsequent 3D reconstruction and casting of a rapid prototyping model in order to find a tool to remove the styloids via reduced size approaches supported by navigation and intraoperativ CT controll (polarisnavigation device, CARCAS, MIGTS). A 5 mm in diameter hollow shaft was placed by navigation over the styloids through each with a 1 cm incision submandibular on top of the navigated drill with inner water cooling system. After CT controll concerning the correct placement of the hollow shafts the styloids were removed by drilling over this devise. Both styloids could be removed completely. The styloid caused pain was fully regressive. On the left side a slight palsy of the facial nerve occured, which was fast decresing. The wounfhealing was not disturbed. Only 2 small inconspiceous scares submandibular were clinical detectable. For the styloid syndrom the navigated minimal invasive procedure is an adequte alternative in the surgical approach. Nevertheless the navigation tools, which are originally used for othopedic surgery, should adapted concerning size and weight on the more delicate fine structures in this area. *Equal collaborators.
•2•]
LYLMPH NODE TUBERCULOSIS LOCALIZED IN THE NECK: A CASE REPORT
O. Jagur, 0. Pintson. Department of Maxillofacial Surgery University
Hospital Tartu, Tartu, Estonia The aim of this study was to assess the diagnosis and treatment of lymph node tuberculosis. A 66 year old male presented with a tumor-like formation in the region of the right sternocleidomastoideus muscle, with a diameter of 10 cm, which had developed during 6 months. The presenting symptoms and signs were fever, night sweating and weakness. Blood analysis showed a decrease in hemoglobin. Diagnostics involved of detailed clinical examination, chest x-rays, CT scan and histopathological and microbiological examination. CT scan showed a polycystic formation located on the right side of the neck, extending from processus
CORRELATION BETWEEN ULTRASONOGRAPHIC AND HISTOPATHOLOGICAL DIAGNOSIS OF CERVICOFACIAL SOFT TISSUE SWELLINGS
V.I. Ugboko, B.O. Akinbami, EJ. Owotade, A.E. Obiechina. Department
of Oral and Maxillofacial Surgery, Faculty of Dentistry, Obafemi Awolowo University, Ile-lfe, Nigeria To determine the correlation between sonographic and histopathological diagnosis of 57 soft tissue swellings of the cervico-facial region. Fifty-seven consecutive patients with cervico-facial soft tissue swellings that presented at the Maxillofacial Unit of Obafemi Awolowo University Teaching Hospital, Ile-lfe, Nigeria from August 2002 to November 2003 constituted the study population. Based on a questionnaire format, the patients' demographics and relevant clinical information were obtained. Ultrasonographic evaluation was done using the B-mode transcutaneous ultrasonic imaging device with a transducer frequency of 5MHz. All the lesions were subjected to histopathological examination. There were 32 males and 25 females whose ages ranged from 2 weeks to 70 years (mean 24.6 +S.D.20.7) Histopathological investigations showed that tumours constituted 27(47.4%) cases, followed by cysts 20(35.1%) and hamartomas 10(17.5'%). Positive correlation was observed in the sonographic and histological diagnosis of 22(81.5%) tumours, 8(80%) hamartomas and 20(100%) cysts. Hence there was a significant positive correlation of ultrasound and histological diagnosis in all classes of swellings. Though ultrasound was accurate and sensitive in the diagnosis of majority of the swellings, it was however not specific. Ultrasound is useful and reliable in the diagnosis of most cervicofacial soft tissue swellings. However, its accuracy, specificity and sensitivity in our locality can be improved upon with the availability of higher frequency probes.
[-~--~
OPG/RANKL/M-CSF CYTOKINE EXPRESSION DURING CYST HEALING -PRELIMINARY REPORT
A. Cieslik-Bielecka 1 , T. Bielecki 2, T.S. Gazdzik 2, T. Cieslik 1. 1/ Department and Clinic of Maxillofacial Surgery, Silesian Medical University, Zabrze, Poland; 2Department and Clinic of Orthopaedics, Silesian Medical University, Sosnowiec, Poland The aim of these experiments is observation bone defects healing with using biochemical markers of bone metabolism. Between November 2003 and November 2004 in Clinic of Maxillofacial Surgery 12 patients in age 15-81 (the average 52 years old) were treated using platelet gel method. Platelet rich plasma (PRP) is a blood plates concentrate, which we can obtain by spining in centrifuge and isolation full autogenous blood (GPS system, Biomet-Merck). Condensation of the blood plates causes concentration growth of the TGF-b, PDGF, VEGF, IGF, EGF, integrins and others adhesive molecules in PRP, which among others activate osteoclasts and osteoblasts. After adding calcium and thrombin origins galatinous mass - platelet gel is formed. In all 18 cases indication to perform operation was cyst presence in mandible. Bone healing is estimated in before and and in 3, 5, 8, 12, 18, 24 and 32 week after operation performing X-ray films and dual X-ray absorptiometry. In experimental periods blood is taken into laboratory estimation. Levels of osteoprotegerin, ligand RANKL, M-CSF, IL-1 and IL-6 by ELISA method
Oral Surgery, School of Dentistry, Mayor University, Santiago, Chile The peripheral odontogenic fibroma (WHO type) is a relatively rare, benign, unencapsulated gingival mass of fibrous connective tissue. It is considered to be the extraosseous counterpart of the central odontogenic fibroma. Usually it has not radiographic features. The purpose of this article is to report a case of this uncommon lesion and a review of the literature. A 24-year-old, male patient, who presented a lingually swelling of the gingival tissue in relationship to 3.4 and 3.5 teeth. The removement with an extense cuterage of the lesion was made and the posteriorly biopsy was taken. A four month's clinical and radiographic fellow was done. The biopsy indicated the diagnosis of peripheral odontogenic fibroma, WHO type, a rare odontogenic benign tumor, in an uncommon location. The fellowship showed no evidence of recidiva. However this pathologic entity is rare and uncommon, it should to be considerated on the differential diagnosis of soft tissue tumors. It is extremely necessary to made a fellow of this type of lesions to establish its rate of recidiva.
167 styloideus to lower margin of the thyroid, the surrounding soft tissues were infiltrated. Enlarged lymph nodes were present in supraclavicular fossa, intrathoracically and intraabdominally. Surgical treatment revealed polycystic abstsess. Chest x-rays: without pathological findings. Langhans cells were found in the histological specimens, which is indicative of specific inflammation. Bacterioscopy of pus was negative. The culture showed Mycobacterium tuberculosis growth of. Further treatment was continued in the Lung Clinic according to the guidelines of treatment of tuberculosis. Susceptibility to isoniazid, rifampicin, pyrazinamide, ethambutol, strepthomycin was established. Tuberculous lymphadenitis usally presents as painless swelling of one or more lymph nodes. The most commonly involved nodes are those of the posterior or anterior cervix or those of supraclavicular fossa. Frequently the process is bilateral. Tuberculous lymphadenitis involving the axillary or the inguinal nodes is rare. The diagnosis is made exchesively by culture identification of the microbe. Other valuable components of the diagnostic process include epidemiological features, chest x-ray, needle biopsy or surgical resection of the node and skin testing. The diagnosis of tuberculous lymphadenitis is easily confused with other inflammatory conditions such as lymphoma or sarcoidosis.
[•9• [-P'2--~ NEW METHOD OF MINIMAL INVASIVE REMOVEMENT OF MEGASTYLOIDS USING INTRAOPERATIVE NAVIGATION IN A CT SUPPORTED OPERATION ROOM (THE MULTIFUNCTIONAL IMAGE-GUIDED THERAPY SUITE (MIGTS)
K. Schwenzer-Zimmerer*, R. Sader*, S. Zimmerer, J. Wirt, A.L. Jakob, H.F. Zeilhofer*. Clinic for reconstructive surgery, department of cranioand maxillofacial surgery, Switzerland The megastyloid syndrom or Eagle syndrom is a rare painful disease with dysphagia, pain while talking and disturbances of mouth opening caused by hyperthrophic styloids. With the conventional therapy the resection of the styloids via an submandibular or retromandibular outher approach is the gold standard, but causes extended outher scares. The aim in this case was to find a minimal invasive way to remove the styloids. A 37 years old female patient with hypertrophic styloids (right 47mm, left 52 mm, length of the ramus ascendens mandibulae 60 mm) with the typical symptoms. After clinical suspicion and conventional x-rays an axial spiraI-CT was performed using the thin-layer technique with subsequent 3D reconstruction and casting of a rapid prototyping model in order to find a tool to remove the styloids via reduced size approaches supported by navigation and intraoperativ CT controll (polarisnavigation device, CARCAS, MIGTS). A 5 mm in diameter hollow shaft was placed by navigation over the styloids through each with a 1 cm incision submandibular on top of the navigated drill with inner water cooling system. After CT controll concerning the correct placement of the hollow shafts the styloids were removed by drilling over this devise. Both styloids could be removed completely. The styloid caused pain was fully regressive. On the left side a slight palsy of the facial nerve occured, which was fast decresing. The wounfhealing was not disturbed. Only 2 small inconspiceous scares submandibular were clinical detectable. For the styloid syndrom the navigated minimal invasive procedure is an adequte alternative in the surgical approach. Nevertheless the navigation tools, which are originally used for othopedic surgery, should adapted concerning size and weight on the more delicate fine structures in this area. *Equal collaborators.
•2•]
LYLMPH NODE TUBERCULOSIS LOCALIZED IN THE NECK: A CASE REPORT
O. Jagur, 0. Pintson. Department of Maxillofacial Surgery University
Hospital Tartu, Tartu, Estonia The aim of this study was to assess the diagnosis and treatment of lymph node tuberculosis. A 66 year old male presented with a tumor-like formation in the region of the right sternocleidomastoideus muscle, with a diameter of 10 cm, which had developed during 6 months. The presenting symptoms and signs were fever, night sweating and weakness. Blood analysis showed a decrease in hemoglobin. Diagnostics involved of detailed clinical examination, chest x-rays, CT scan and histopathological and microbiological examination. CT scan showed a polycystic formation located on the right side of the neck, extending from processus
CORRELATION BETWEEN ULTRASONOGRAPHIC AND HISTOPATHOLOGICAL DIAGNOSIS OF CERVICOFACIAL SOFT TISSUE SWELLINGS
V.I. Ugboko, B.O. Akinbami, EJ. Owotade, A.E. Obiechina. Department
of Oral and Maxillofacial Surgery, Faculty of Dentistry, Obafemi Awolowo University, Ile-lfe, Nigeria To determine the correlation between sonographic and histopathological diagnosis of 57 soft tissue swellings of the cervico-facial region. Fifty-seven consecutive patients with cervico-facial soft tissue swellings that presented at the Maxillofacial Unit of Obafemi Awolowo University Teaching Hospital, Ile-lfe, Nigeria from August 2002 to November 2003 constituted the study population. Based on a questionnaire format, the patients' demographics and relevant clinical information were obtained. Ultrasonographic evaluation was done using the B-mode transcutaneous ultrasonic imaging device with a transducer frequency of 5MHz. All the lesions were subjected to histopathological examination. There were 32 males and 25 females whose ages ranged from 2 weeks to 70 years (mean 24.6 +S.D.20.7) Histopathological investigations showed that tumours constituted 27(47.4%) cases, followed by cysts 20(35.1%) and hamartomas 10(17.5'%). Positive correlation was observed in the sonographic and histological diagnosis of 22(81.5%) tumours, 8(80%) hamartomas and 20(100%) cysts. Hence there was a significant positive correlation of ultrasound and histological diagnosis in all classes of swellings. Though ultrasound was accurate and sensitive in the diagnosis of majority of the swellings, it was however not specific. Ultrasound is useful and reliable in the diagnosis of most cervicofacial soft tissue swellings. However, its accuracy, specificity and sensitivity in our locality can be improved upon with the availability of higher frequency probes.
[-~--~
OPG/RANKL/M-CSF CYTOKINE EXPRESSION DURING CYST HEALING -PRELIMINARY REPORT
A. Cieslik-Bielecka 1 , T. Bielecki 2, T.S. Gazdzik 2, T. Cieslik 1. 1/ Department and Clinic of Maxillofacial Surgery, Silesian Medical University, Zabrze, Poland; 2Department and Clinic of Orthopaedics, Silesian Medical University, Sosnowiec, Poland The aim of these experiments is observation bone defects healing with using biochemical markers of bone metabolism. Between November 2003 and November 2004 in Clinic of Maxillofacial Surgery 12 patients in age 15-81 (the average 52 years old) were treated using platelet gel method. Platelet rich plasma (PRP) is a blood plates concentrate, which we can obtain by spining in centrifuge and isolation full autogenous blood (GPS system, Biomet-Merck). Condensation of the blood plates causes concentration growth of the TGF-b, PDGF, VEGF, IGF, EGF, integrins and others adhesive molecules in PRP, which among others activate osteoclasts and osteoblasts. After adding calcium and thrombin origins galatinous mass - platelet gel is formed. In all 18 cases indication to perform operation was cyst presence in mandible. Bone healing is estimated in before and and in 3, 5, 8, 12, 18, 24 and 32 week after operation performing X-ray films and dual X-ray absorptiometry. In experimental periods blood is taken into laboratory estimation. Levels of osteoprotegerin, ligand RANKL, M-CSF, IL-1 and IL-6 by ELISA method