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Primary hyperparathyroidism exacerbated by pregnancy
184
Journal
tongue have appeared in the submucosa as sessile or pedunculated, firm, asymptomatic masses. A 57-year-old white woman had a sessile, firm, circumscribed mass in the ventral surface of the right side of the tongue. It had been present throughout life. It enucleated easily under local anaesthesia and was composed of a iobulated mass of lamellar bone which surrounded a mass of mature, cellular cartilage. Fatty and haemopoietic marrow filled occasional spaces in the bone. The causes of abnormal calcifications within soft tissues are discussed. G. Ft. Seward KELLER E. E. and RONALD J. 6.. WEILAND L. H. Synovial chondromatosis of the temporomandibular joint, J. Oral Surg. 36 (1978) 13-19. Synovial chondromatosis is a benign cartilagenous metaplasia that affects the joints. Seven patients with the condition affecting the temporomandibular joint have been seen at the Mayo Clinic. A 48-year-old woman had pain in the jaw and ear on the right side. It was intermittent, dull, sometimes sharp and accompanied by slight pre-auricular swelling. This was soft and not fluctuant. There was slight restriction of jaw movement with deviation. The right condyle was enlarged, sclerotic and with an irregular surface. The joint was explored and numerous myomatous globules of cartilagenous material removed together with proliferative synovium and a degenerate disc. The condyle head was trimmed and a silicone implant fitted. The findings in previous cases and those in the literature are reviewed. G. R. Seward
SARANGAJIANI K. and MCCARTHY J. Multiple cystic adenoma of labial salivary glands, Br. J. Oral Surg. 15 (1977) 166-170. Cystic adenoma of minor salivary glands is rare and no previous report of multiple tumours is known. A man aged 66 presented with a cystic swelling on the inner aspect of the upper lip which had been present for 2 years and enlarging for 6 months. Many smaller
of Dentistry,
Vol. ~/NO.
2
swellings could be felt near by. All were removed under general anaesthesia. Histoconsisted of a the tumour logically, tubule-trabecular pattern of cuboidal and columnar cells which were PAS negative. Parts of the wall of the cyst were lined by a single layer of cuboidal cells. Previously these lesions have been described as basal cell adenomas but Harrison prefers the term cystic adenoma. G. R. Seward
MARTIS C. Leiomyosarcoma of the Surg. 36 (1978) 62-65.
maxilla,
J.
Oral
Leiomyoma and Leiomyosarcoma are rare in the oral cavity. A 67-year-old man had a firm non-tender mass in the right buccal sulcus of the maxilta. Clinical and radiographic examination demonstrated a tumour of the maxillary sinus extending back into the pterygoid fossa. It had invaded the pterygoid process and the sigmoid notch of the mandible. A biopsy revealed a low grade leiomyosarcoma. Through a WeberDiffenbach incision the right maxilla, zygomatic bone and arch and mandibular ramus were excised. The palatal and buccal mucosa were sutured to close the opening into the mouth. No local recurrence was seen but pulmonary metastases appeared after 33 months and 2 months later the patient
died.
A 24-year-old man presented with a 2.5cm diameter ulcer over 21/. A biopsy was reported as showing a i& grade leiomyosarcoma, and local en bloc excision was performed. There has been no recurrence over 22 months. Local recurrence or metastasis to the lungs, regional lymph nodes or generally has been mentioned frequently in previous reports. G. R. Seward PELLEGRINO S. V. Primary hyperparathyroidism exacerbated by pregnancy, J. Oral Surg. 35 (1977) 915-917. During a first pregnancy a 20-year-old woman had pain in the jaws attributed to her third molars. Later she had pain in the legs followed by a spontaneous abortion. A month later the third molars were removed, and then two lesions diagnosed as
Quarterly
185
Dental Review
benign giant cell granuloma from -54/ region. A year later the patient was pregnant again and she developed hard nodules on the mandible. Radiographs of her jaws showed multiple lesions. The serum calcium was raised to 7.2 mEq/l and the serum phosphorus was 1.4 mEq/l. The alkaline phosphatase level was 11.8 Bodansky units/ 100 ml. Classic changes of hyperparathyroidism were seen in the fingers, tibia and skull. A parathyroid adenoma was removed from the right side of the neck. A healthy boy was subsequently delivered. The differential diagnosis is discussed. G. Ft. Seward
JANUSKA J. R. and LEBUN S. G. Pulmonary metastasis to the submandibular gland, J. Oral Surg. 36 (1978) 50-51. Previously reported cases of pulmonary metastasis to the submandibular gland are reviewed. The parotid gland as a site for metastasis is more common than the submandibular gland. Berg et al. are quoted. They showed that women with carcinoma of the salivary glands had an eight times higher risk of subsequent carcinoma of the breast. A 61-year-old white man had a dry unproductive cough. Radiographs suggested a carcinoma of the right lung for which lobectomy was performed. Six weeks postoperatively the patient complained of a lump in the neck. A submandibular sialointracapsular revealed an spacegram occupying lesion. A needle biopsy was reported as anaplastic carcinoma. Palliative irradiation was given with little regression. Further metastases appeared elsewhere and the patient died. G. R. Seward
ORAL SURGERY BROWN T. W. and SOTEPEOROS G. C. for Orbital tripod osteotomy facial asymmetry, J. Oral Surg. 36 (1978) 20-24. The treatment of congenitally or traumatically displaced zygomatic bones by onlayed alloplastic materials and bone grafts is not Re-fracture of completely successful. malunited fractured bones is possible. A
tripod osteotomy is physiologically and aesthetically a sound alternative. Through a lateral eyebrow incision the periosteum is raised from the orbital and temporal aspects of the frontal process of the zygomatic bone. The orbital rim and floor are exposed through an infra-orbital incision and the two wounds joined by elevation of the periosteum laterally. The orbital floor and lateral wall are divided 4-5 mm from the rim and an inverted ‘V’ extension carried upwards in the supraorbital ridge to join the orbital and temporal aspect of the lateral cut. The cut in the temporal surface is extended downwards to the posterior aspect of the zygomaticoalveolar crest. A vertical cut in the anterior surface of the maxilla, external to the infraorbital foramen, joins the latter to the orbital rim cut. The temporal process is divided obliquely through the eyebrow incision. Through the same incision the bone is elevated into position. It is wired in place. Moderate displacement does not need grafting. A 21-year-old man sustained a zygomatic fracture which was not reduced at the time. The application of the to this case is described.
tripod
osteotomy
G. R. Seward
FORE J. E. An alternative
method
of
reducing
the
vertical height of the ramus of the mandible. Br. J. OralSurg. 15 (1977) 147-152. A woman aged 22 had enlargement of the right ramus of the mandible, a downbowing of the lower border on that side and a downwards tilt of the right side of the maxilla. A unilateral Le Fort I osteotomy was performed through an incisor to the right of the midline of the palate, a short incision between the central incisors and a horizontal incision in the sulcus between the first molar and canine. A strip of bone was removed to permit the elevation of the maxilla. Through a submandibular incision and an intra-oral one over the anterior border of the ramus, a vertical subsigmoid osteotomy was completed and the coronoid separated from the anterior fragment. Bone was removed from above the mandibular foramen upwards and from the lower end of the
Journal
tongue have appeared in the submucosa as sessile or pedunculated, firm, asymptomatic masses. A 57-year-old white woman had a sessile, firm, circumscribed mass in the ventral surface of the right side of the tongue. It had been present throughout life. It enucleated easily under local anaesthesia and was composed of a iobulated mass of lamellar bone which surrounded a mass of mature, cellular cartilage. Fatty and haemopoietic marrow filled occasional spaces in the bone. The causes of abnormal calcifications within soft tissues are discussed. G. Ft. Seward KELLER E. E. and RONALD J. 6.. WEILAND L. H. Synovial chondromatosis of the temporomandibular joint, J. Oral Surg. 36 (1978) 13-19. Synovial chondromatosis is a benign cartilagenous metaplasia that affects the joints. Seven patients with the condition affecting the temporomandibular joint have been seen at the Mayo Clinic. A 48-year-old woman had pain in the jaw and ear on the right side. It was intermittent, dull, sometimes sharp and accompanied by slight pre-auricular swelling. This was soft and not fluctuant. There was slight restriction of jaw movement with deviation. The right condyle was enlarged, sclerotic and with an irregular surface. The joint was explored and numerous myomatous globules of cartilagenous material removed together with proliferative synovium and a degenerate disc. The condyle head was trimmed and a silicone implant fitted. The findings in previous cases and those in the literature are reviewed. G. R. Seward
SARANGAJIANI K. and MCCARTHY J. Multiple cystic adenoma of labial salivary glands, Br. J. Oral Surg. 15 (1977) 166-170. Cystic adenoma of minor salivary glands is rare and no previous report of multiple tumours is known. A man aged 66 presented with a cystic swelling on the inner aspect of the upper lip which had been present for 2 years and enlarging for 6 months. Many smaller
of Dentistry,
Vol. ~/NO.
2
swellings could be felt near by. All were removed under general anaesthesia. Histoconsisted of a the tumour logically, tubule-trabecular pattern of cuboidal and columnar cells which were PAS negative. Parts of the wall of the cyst were lined by a single layer of cuboidal cells. Previously these lesions have been described as basal cell adenomas but Harrison prefers the term cystic adenoma. G. R. Seward
MARTIS C. Leiomyosarcoma of the Surg. 36 (1978) 62-65.
maxilla,
J.
Oral
Leiomyoma and Leiomyosarcoma are rare in the oral cavity. A 67-year-old man had a firm non-tender mass in the right buccal sulcus of the maxilta. Clinical and radiographic examination demonstrated a tumour of the maxillary sinus extending back into the pterygoid fossa. It had invaded the pterygoid process and the sigmoid notch of the mandible. A biopsy revealed a low grade leiomyosarcoma. Through a WeberDiffenbach incision the right maxilla, zygomatic bone and arch and mandibular ramus were excised. The palatal and buccal mucosa were sutured to close the opening into the mouth. No local recurrence was seen but pulmonary metastases appeared after 33 months and 2 months later the patient
died.
A 24-year-old man presented with a 2.5cm diameter ulcer over 21/. A biopsy was reported as showing a i& grade leiomyosarcoma, and local en bloc excision was performed. There has been no recurrence over 22 months. Local recurrence or metastasis to the lungs, regional lymph nodes or generally has been mentioned frequently in previous reports. G. R. Seward PELLEGRINO S. V. Primary hyperparathyroidism exacerbated by pregnancy, J. Oral Surg. 35 (1977) 915-917. During a first pregnancy a 20-year-old woman had pain in the jaws attributed to her third molars. Later she had pain in the legs followed by a spontaneous abortion. A month later the third molars were removed, and then two lesions diagnosed as
Quarterly
185
Dental Review
benign giant cell granuloma from -54/ region. A year later the patient was pregnant again and she developed hard nodules on the mandible. Radiographs of her jaws showed multiple lesions. The serum calcium was raised to 7.2 mEq/l and the serum phosphorus was 1.4 mEq/l. The alkaline phosphatase level was 11.8 Bodansky units/ 100 ml. Classic changes of hyperparathyroidism were seen in the fingers, tibia and skull. A parathyroid adenoma was removed from the right side of the neck. A healthy boy was subsequently delivered. The differential diagnosis is discussed. G. Ft. Seward
JANUSKA J. R. and LEBUN S. G. Pulmonary metastasis to the submandibular gland, J. Oral Surg. 36 (1978) 50-51. Previously reported cases of pulmonary metastasis to the submandibular gland are reviewed. The parotid gland as a site for metastasis is more common than the submandibular gland. Berg et al. are quoted. They showed that women with carcinoma of the salivary glands had an eight times higher risk of subsequent carcinoma of the breast. A 61-year-old white man had a dry unproductive cough. Radiographs suggested a carcinoma of the right lung for which lobectomy was performed. Six weeks postoperatively the patient complained of a lump in the neck. A submandibular sialointracapsular revealed an spacegram occupying lesion. A needle biopsy was reported as anaplastic carcinoma. Palliative irradiation was given with little regression. Further metastases appeared elsewhere and the patient died. G. R. Seward
ORAL SURGERY BROWN T. W. and SOTEPEOROS G. C. for Orbital tripod osteotomy facial asymmetry, J. Oral Surg. 36 (1978) 20-24. The treatment of congenitally or traumatically displaced zygomatic bones by onlayed alloplastic materials and bone grafts is not Re-fracture of completely successful. malunited fractured bones is possible. A
tripod osteotomy is physiologically and aesthetically a sound alternative. Through a lateral eyebrow incision the periosteum is raised from the orbital and temporal aspects of the frontal process of the zygomatic bone. The orbital rim and floor are exposed through an infra-orbital incision and the two wounds joined by elevation of the periosteum laterally. The orbital floor and lateral wall are divided 4-5 mm from the rim and an inverted ‘V’ extension carried upwards in the supraorbital ridge to join the orbital and temporal aspect of the lateral cut. The cut in the temporal surface is extended downwards to the posterior aspect of the zygomaticoalveolar crest. A vertical cut in the anterior surface of the maxilla, external to the infraorbital foramen, joins the latter to the orbital rim cut. The temporal process is divided obliquely through the eyebrow incision. Through the same incision the bone is elevated into position. It is wired in place. Moderate displacement does not need grafting. A 21-year-old man sustained a zygomatic fracture which was not reduced at the time. The application of the to this case is described.
tripod
osteotomy
G. R. Seward
FORE J. E. An alternative
method
of
reducing
the
vertical height of the ramus of the mandible. Br. J. OralSurg. 15 (1977) 147-152. A woman aged 22 had enlargement of the right ramus of the mandible, a downbowing of the lower border on that side and a downwards tilt of the right side of the maxilla. A unilateral Le Fort I osteotomy was performed through an incisor to the right of the midline of the palate, a short incision between the central incisors and a horizontal incision in the sulcus between the first molar and canine. A strip of bone was removed to permit the elevation of the maxilla. Through a submandibular incision and an intra-oral one over the anterior border of the ramus, a vertical subsigmoid osteotomy was completed and the coronoid separated from the anterior fragment. Bone was removed from above the mandibular foramen upwards and from the lower end of the