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In this article a new method of closing palatal defects by means of buccal fat pad flaps is reported. A double buccal fat pad flap in association with Le Fort I osteotomy approach was adopted to remove tumours of the palate and nasal fossae. The technique is described in a case of adenocarcinoma arising from the nasal septum and its indications and advantages are discussed.
PURPOSE: To report on the tumor control, adverse late normal tissue sequelae, and functional performance in patients with tonsillar fossa and/or soft palate (SP) tumors. The aim of the study is to validate the use of a more selective clinical target volume in conjunction with highly conformal radiotherapy (RT) techniques to better spare the surrounding normal tissues. METHODS AND MATERIALS: Between 1986 and 2001, T1-T3 tonsillar fossa/SP tumors were treated in the Erasmus Medical Center using external beam radiotherapy (EBRT) to 46 Gy in 2-Gy fractions to the primary tumor and neck, followed by brachytherapy (BT) to the primary. Neck dissection was performed for node-positive disease (BT group; 104 patients). If BT was not feasible, patients underwent surgery and postoperative RT (PORT) to a dose of 50-70 Gy in 2-Gy fractions (surgery group; 86 patients). Local control, regional control, disease-free survival, and overall survival were determined. Late side effects were scored using the Radiation Therapy Oncology Group criteria. Univariate and multivariate Cox regression analyses were performed for regional failure (RF), with the parameters gender, age, site, TN stage, modality, dose, and overall treatment time. Recurrences in the contralateral neck were also related to significant ipsilateral involvement of the base of tongue and/or involvement of the SP crossing the midline. To determine the performance status scale scores and degree of xerostomia, a survey was conducted among patients living with no evidence of disease and a minimum of 2 years of follow-up. For that purpose, a research nurse interviewed patients regarding eating in public, normalcy of diet, normalcy of speech, and xerostomia. RESULTS: The tumor control rates after BT vs. surgery at 5 years were 88% vs. 88% for local control; 93% vs. 85% for regional control; 57% vs. 52% for disease-free survival; 67% vs. 57% for overall survival; and 5% vs. 6% for RF. No patient had RF in the contralateral untreated N0 neck (0 of 14 vs. 0 of 15). Multivariate Cox regression analysis for RF was statistically significant for Stage T2 vs. T3 (hazard ratio 0.09) and for the dose to the neck >46 Gy (hazard ratio, 8.7; 95% confidence interval, 1.3-57.1). The significant late side effects in the BT group vs. surgery group were ulcer in 39% vs. 7% (p = 0.001) and trismus in 1% vs. 21% (p = 0.005). The performance status scale scores and response to questions regarding xerostomia for BT vs. surgery revealed no statistically significant differences for eating in public, normalcy of diet, normalcy of speech, and xerostomia. The mean visual analog score for xerostomia was 5.5 in the BT group vs. 6 in the surgery group. CONCLUSION: Excellent locoregional control was obtained in T1-T3 tonsillar fossa and/or SP tumors. The rate at 10 years was 84% (BT group) vs. 78% (surgery group). However, adverse late side effects were not negligible. In addition to modality-specific side effects (ulcer/trismus), both treatment groups were significantly affected by xerostomia. Only 6 recurrences (4%) were observed in the 149 electively treated contralateral necks, and no relapses were seen in the 29 untreated contralateral necks. We, therefore, suggest that it is not necessary to treat the contralateral neck, unless the tumor extends beyond the midline of the soft palate (uvula) or beyond the lateral one-third of the ipsilateral base of the tongue. Moreover, with the currently available CT-based neck level definitions, more conformal contours (i.e., tighter boundaries) around the clinical target volume can be designed. In this way, critical structures such as the temporomandibular joint and part of the pterygoid muscles can be avoided more easily. Also, when using highly conformal treatment techniques (e.g., intensity-modulated RT), one can further reduce the dose to the major salivary glands and oral mucosa. We believe these measures will lead to less trismus and less xerostomia.
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Benign vascular lesions-malformative, reactive, and neoplastic-are fairly common in the oral soft tissues; nevertheless, extravascular papillary endothelial hyperplasia and sinusoidal hemangioma have not been reported in this location. To our knowledge, a single case of intraoral spindle cell hemangioma has appeared in the literature. This report deals with histopathological features of these rare vascular proliferations involving the oral mucosa.
OBJECTIVE: It has been suggested that saliva exerts a protective role against the carcinogenic effect of various substances in the oral cavity. The objective of this study was to examine the ultrastructural changes of the palatal mucosa caused by the application of 4-nitroquinoline-l-oxide (4NQO) in the presence or absence of saliva. STUDY DESIGN: Wistar-Furth rats subjected and not subjected to total bilateral excision of the major salivary glands were either painted with an aqueous solution of 4NQO or with propylene glycol only (controls). Two animals of each group were humanely killed periodically. The areas of the palatal lesions were immediately sliced and processed for TEM examination. RESULTS: Ultrastructurally, the progressive changes to squamous cell carcinoma were observed in the animals painted with 4NQO. In the desalivated animals group, the ultrastructural alterations appeared earlier than in the group with salivary glands. CONCLUSIONS: Saliva appeared to delay but not hinder tumor induction by 4NQO.
Necrotizing sialometaplasia (NSM) is a self-limiting disorder affecting mainly the minor salivary glands. The significance of NSM resides in its clinical and histopathological resemblance to carcinoma. Few cases of NSM associated with eating disorders have been reported to date. We present here the clinical features and histomorphology of an additional case of bulimia-associated NSM closely mimicking an invasive carcinoma. A high index of suspicion and good communication between clinician and pathologist are essential in recognizing this entity and preventing unnecessary surgical therapy.
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A case of basal encephalocele protruding through a defect in the greater wing of the sphenoid bone is presented. The transalar type of encephalocele is uncommon and unclassified. This case, documented by computed tomography and magnetic resonance imaging, is unique in that it presented with trigeminal neuralgia and was associated with an angioma of the soft palate.
The suprazygomatic portion of the masticator space (MS) or the temporal fossa is superficial and accessible to clinical assessment. The nasopharyngeal masticator space or infratemporal fossa is deep and can only be adequately evaluated by imaging studies. Infection secondary to odontogenic abscess or malignant otitis extema commonly affects this space. Primary tumours may arise from both soft tissues and bony structures. Malignant invasion of the MS from surrounding structures may take place. The delineation of these lesions is readily achieved by both computed tomography (CT) and magnetic resonance imaging (MRI). However, perineural infiltration and intracranial extension is better seen on MRI. Accurate assessment of disease extent is necessary for drainage procedures, surgical intervention or radiotherapy planning.
A 2-month-old girl presented with a history of intermittent cyanosis and dyspnea after feeding. This was found to be due to a 2 cm long polypoid lesion attached to her soft palate. This was removed and histologic examination showed it to be choristoma. Three years later she remains well with no evidence of recurrence.
In this article a few of the more recently emphasized and pertinent conditions that may affect the hard and soft palate have been discussed. The purpose of the article is not to present in all-inclusive classification of lesions occurring the palate. Disease of the palate may be local in nature or may reflect a systemic condition. Dentists must be conscious of the palate as the site of many possible pathoses. The prosthodontist in particular must observe and carefully evaluate the palate and insure its good health before he can prescribe a prosthesis to cover it. Dentistry provides a health service which affects the entire human organism and not just the oral cavity. Therefore an understanding of the varied nature of pathosis as it relates to the oral cavity, and especially the palate, is essential. Continuous surveillance of the palatal regions insures that the dentist's obligation to detect oral abnormalities in patients is in large measure fulfilled.
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