Biomedical subjects
Publications and source records attributed to T Loree.
During a routine dental examination, a general dentist noticed facial asymmetry in a 42-year-old man. Dental radiography suggested a pathological condition in the sinuses. The dentist referred the patient to a head and neck surgeon for further examination. Computed tomography demonstrated ectopic molars in the maxillary sinuses blocking drainage of the sinuses.
In this study of 13 patients with cystic lesions of the parotid gland, 9 patients were known to be antibody positive for the human immunodeficiency virus (HIV) and 4 were subsequently tested to be positive. All patients had computed tomographic (CT) confirmation of parotid gland cysts. Five patients had fluid aspirates showing high amylase levels. All cystic lesions had lymphoepithelial features and lymphoid histology similar to those seen in HIV infection. This study includes a review of 148 HIV patients reported in the literature, as well as our experience. Of all the reported cases, when gross pathology suggested cystic lesions, the incidence of malignancy was close to 1%. The incidence of malignancy for a solid mass, however, was close to 40%. We propose a nonsurgical management protocol which includes CT scan and needle aspiration with tissue for cytology and fluid for amylase level if possible. Watchful observation is advised for cystic pathology.
UNLABELLED: Cancer of the buccal mucosa is an uncommon and aggressive neoplasm of the oral cavity. Less than 2% of patients treated for cancer of the oral cavity at Roswell Park Cancer Institute (RPCI) from 1971 to 1997 had primary buccal cancers. Because the majority of these patients did not undergo any adjuvant treatment, this group provided us with the opportunity to assess the relationship between margin status and local recurrence for both small (T1-T2) and large (T3-T4) tumors treated with surgery alone. MATERIALS AND METHODS: The RPCI tumor registry database reported 104 patients who were treated for buccal carcinoma. A retrospective chart review identified 27 patients who met our criteria for a buccal mucosal primary tumor (epicenter of the mass in the buccal mucosa). There were 13 men and 14 women, ranging in age from 34 to 94 years (mean, 75). Data were collected regarding patient demographics, presenting symptoms, stage, treatment received, and outcome. RESULTS: All patients underwent surgical resection of their primary lesion; 21 (75%) had T1 or T2 tumors. The rate of local recurrence was 56% for the group as a whole. Patients with close or positive margins had a 66% local failure rate as compared with 52% when surgical margins were negative (greater than or equal to 5 mm from the resection margin after tissue fixation; P = ns). Among those in whom negative margins were achieved, patients with T1-T2 disease had a 40% local failure rate with surgical resection alone. CONCLUSIONS: Local excision of T1 and T2 buccal mucosa cancers with pathologically negative margins had a high rate of local recurrence in our series. Low T-stage and negative margins are not adequate predictors of local control. Even early buccal tumors may benefit from adjuvant therapy to enhance local control.
Skin overgrowth of auricular implant abutments can be a difficult and frustrating problem, leading to multiple procedures and delaying the placement of a definitive prosthesis. In the present patient, plastic rings or "washers" were employed to successfully deal with this problem. A discussion of the management of peri-implant soft tissues is presented.