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Vascular Malformations
Symposia 89th ANNUAL MEETING, SCIENTIFIC SESSIONS AND EXHIBITION October 8-13, 2007, Honolulu, Hawaii
SYMPOSIUM ON PEDIATRIC OMS PATHOLOGY Wednesday, October 10, 2007, 7:00 am–9:00 am
Vascular Malformations Bernard J. Costello DMD, MD, Pittsburgh, PA Much has been learned about congenital vascular malformations in the craniofacial region over the last few decades, but they remain challenging to diagnose and treat effectively. While these are benign entities, they occasionally are life threatening due to exsanguinations. After resection, they can also be incredibly deforming and may present unique reconstructive challenges. The advents of improved imaging modalities and interventional radiology techniques have transformed our abilities to diagnose these patients and provide effective and safe therapy. Diagnosis and management of vascular lesions will be discussed from fetus through adulthood with an emphasis on the latest outcome data and published experience. References Mulliken JB, Glowacki J: Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics. PRS 1982, 69: 412-420 Kademani D, Costello B, Ditty D, and Quinn P: An alternative approach to maxillofacial arteriovenous malformations with transosseous direct puncture embolization. Perrott DH, Schmidt B, Dowd CF, and Kaban LB: Treatment of a high-flow arteriovenous malformation by direct puncture and coil embolization. J Oral Maxillofac Surg 52 (1994), pp 1083–1086
Pediatric Maligniancies Eric J. Dierks, DDS, MD, Portland, OR If one groups all the malignant tumors of the head and neck occurring in children, roughly one quarter would be comprised of Hodgkin’s disease, another quarter of non-Hodgkin’s lymphoma, another quarter would include the various sarcomas and the last quarter would encompass all the rest. This presentation will address two areas of particular interest to oral and maxillofacial surgeons; the evaluation and treatment of the various pediatric sarcomas, using rhabdomyosarcoma and Ewing’s sarcoma as examples and the evaluation and management of the pediatric neck mass. References Tracy, TF, Muratore, CS, Management of common head and neck masses, Semin in Pediatr Surg 16:3-13, 2007
AAOMS • 2007
Al-Khateeb T, Bataineh AB Rhabdomyosarcoma of the oral and maxillofacial region in Jordanians: A retrospective analysis, Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology 93:580 2002
Odontogenic Cysts and Tumors Eric R. Carlson, DMD, MD, Knoxville, TN Odontogenic cysts and tumors are common pathologic entities of interest to oral and maxillofacial surgeons. While these lesions are commonly reported in adults, their incidence in the pediatric population is compelling and warrants review. Odontogenic cysts have been subclassified as developmental and inflammatory, with the cysts of interest including the odontogenic keratocyst, calcifying odontogenic cyst and the glandular odontogenic cyst as part of the former subclassification. Odontogenic tumors have been subclassified as those of odontogenic epithelium; those of odontogenic epithelium with odontogenic ectomesenchyme ⫹/⫺ dental hard tissue formation; and those of odontogenic ectomesenchyme ⫹/⫺ included odontogenic epithelium. This subclassification is of significance from the standpoint of histogenesis rather than from the standpoint of treatment or age at diagnosis. For example, each subclassification of the odontogenic tumors contains entities that occur in adult and pediatric patients, and entities that may be cured with enucleation and curettage surgeries as well as those that require resection for surgical cure. This notwithstanding, many individual odontogenic tumors have subtle differences regarding their presence in pediatric patients, and this represents the focus of this presentation. The odontogenic keratocyst is the most interesting odontogenic cyst in the adult and pediatric populations. While treatment is the same in both populations, the presence of Nevoid Basal Cell Carcinoma Syndrome is important to diagnose in an expedient fashion. Besides the presence of multiple odontogenic keratocysts in 50% or greater frequency in this syndrome, the odontogenic keratocysts associated with this syndrome peak about one decade earlier compared to sporadic cysts which are more commonly noted in the adult population. As such, diagnosis of these cysts in the pediatric age group may permit an early diagnosis of this syndrome. Perhaps the most controversial odontogenic tumor is 1
SYMPOSIUM ON PEDIATRIC OMS PATHOLOGY Wednesday, October 10, 2007, 7:00 am–9:00 am
Vascular Malformations Bernard J. Costello DMD, MD, Pittsburgh, PA Much has been learned about congenital vascular malformations in the craniofacial region over the last few decades, but they remain challenging to diagnose and treat effectively. While these are benign entities, they occasionally are life threatening due to exsanguinations. After resection, they can also be incredibly deforming and may present unique reconstructive challenges. The advents of improved imaging modalities and interventional radiology techniques have transformed our abilities to diagnose these patients and provide effective and safe therapy. Diagnosis and management of vascular lesions will be discussed from fetus through adulthood with an emphasis on the latest outcome data and published experience. References Mulliken JB, Glowacki J: Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics. PRS 1982, 69: 412-420 Kademani D, Costello B, Ditty D, and Quinn P: An alternative approach to maxillofacial arteriovenous malformations with transosseous direct puncture embolization. Perrott DH, Schmidt B, Dowd CF, and Kaban LB: Treatment of a high-flow arteriovenous malformation by direct puncture and coil embolization. J Oral Maxillofac Surg 52 (1994), pp 1083–1086
Pediatric Maligniancies Eric J. Dierks, DDS, MD, Portland, OR If one groups all the malignant tumors of the head and neck occurring in children, roughly one quarter would be comprised of Hodgkin’s disease, another quarter of non-Hodgkin’s lymphoma, another quarter would include the various sarcomas and the last quarter would encompass all the rest. This presentation will address two areas of particular interest to oral and maxillofacial surgeons; the evaluation and treatment of the various pediatric sarcomas, using rhabdomyosarcoma and Ewing’s sarcoma as examples and the evaluation and management of the pediatric neck mass. References Tracy, TF, Muratore, CS, Management of common head and neck masses, Semin in Pediatr Surg 16:3-13, 2007
AAOMS • 2007
Al-Khateeb T, Bataineh AB Rhabdomyosarcoma of the oral and maxillofacial region in Jordanians: A retrospective analysis, Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology 93:580 2002
Odontogenic Cysts and Tumors Eric R. Carlson, DMD, MD, Knoxville, TN Odontogenic cysts and tumors are common pathologic entities of interest to oral and maxillofacial surgeons. While these lesions are commonly reported in adults, their incidence in the pediatric population is compelling and warrants review. Odontogenic cysts have been subclassified as developmental and inflammatory, with the cysts of interest including the odontogenic keratocyst, calcifying odontogenic cyst and the glandular odontogenic cyst as part of the former subclassification. Odontogenic tumors have been subclassified as those of odontogenic epithelium; those of odontogenic epithelium with odontogenic ectomesenchyme ⫹/⫺ dental hard tissue formation; and those of odontogenic ectomesenchyme ⫹/⫺ included odontogenic epithelium. This subclassification is of significance from the standpoint of histogenesis rather than from the standpoint of treatment or age at diagnosis. For example, each subclassification of the odontogenic tumors contains entities that occur in adult and pediatric patients, and entities that may be cured with enucleation and curettage surgeries as well as those that require resection for surgical cure. This notwithstanding, many individual odontogenic tumors have subtle differences regarding their presence in pediatric patients, and this represents the focus of this presentation. The odontogenic keratocyst is the most interesting odontogenic cyst in the adult and pediatric populations. While treatment is the same in both populations, the presence of Nevoid Basal Cell Carcinoma Syndrome is important to diagnose in an expedient fashion. Besides the presence of multiple odontogenic keratocysts in 50% or greater frequency in this syndrome, the odontogenic keratocysts associated with this syndrome peak about one decade earlier compared to sporadic cysts which are more commonly noted in the adult population. As such, diagnosis of these cysts in the pediatric age group may permit an early diagnosis of this syndrome. Perhaps the most controversial odontogenic tumor is 1