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Human papillomavirus, type 40-associated papilloma, and concurrent Kaposi's sarcoma involving the anterior hard palate of an HIV-positive man.

A number of oral lesions have been reported in association with HIV, including lesions caused by other viruses such as the epitheliotropic human papillomavirus (HPV). More than 90 types of HPV have been identified, with the less commonly encountered strains of HPV tending to show association with immunodeficiency states. In addition, HIV-infected patients may have Kaposi's sarcoma develop, a malignancy thought to be caused by human herpes virus, type 8. Recent evidence suggests a sexual mode of transmission for this virus. We report an HIV-positive man with a large, HPV type 40-associated papilloma of the anterior palate and a previously undiagnosed focus of Kaposi's sarcoma.

AIDS-Related Opportunistic Infections↗

Incorporation of an ERA attachment for obturator framework design: a clinical report.

Swinglock framework designs have been used to retain obturators for some time. One of the problems with Swinglock designs has been loss of retention due to wear of the metal latch assembly. This clinical report describes the incorporation of an ERA attachment as the latch assembly of a Swinglock framework for an obturator. The premise behind this design was that wear would be at the expense of the nylon retention male component, which is easily interchangeable, rather than the metal component of the assembly. The life of the latch assembly, framework, and prosthesis would thereby be prolonged.

Aged↗

Oral cancer detection. The importance of routine screening for prolongation of survival.

The incidence of oral cancer has increased in the past ten years. Early diagnosis and treatment are essential to long-term survival; however, patients at highest risk visit the dentist infrequently. The reddish, velvety or erythroplakial lesion at the base of the tongue or floor of the mouth is highly suspicious in any patient and requires further evaluation. High-risk patients with less suspicious appearing lesions must be reevaluated on close recall. Prognosis improves vastly when the lesion is detected and treated early. One study demonstrated a 64% five-year survival rate for patients with oral cancer that was diagnosed before regional lymph node involvement versus a 15% five-year survival for patients whose lesions were diagnosed after regional lymph node involvement. By including an oral cancer examination in routine physical examination of patients, the physician and public health nurse can increase the likelihood of early detection of oral cancer.

Aged↗

Adenoid cystic carcinoma. A clinicopathologic study with flow cytometric analysis.

Forty-five patients with adenoid cystic carcinoma (ACC) of salivary glands were retrospectively studied to determine the prognostic use of DNA ploidy analysis compared with clinicopathologic features. Nuclear suspensions were prepared from 37 of these tumors by the Hedley technique on paraffin-embedded material. The DNA content was analyzed by flow cytometry after propidium iodide staining. Thirty-five tumors were diploid and 2 were tetraploid. Mean survival was 117 and 52 months for the diploid and tetraploid patients, respectively. The median S-phase fraction (Spf) of the 35 diploid tumors was 4.45%. Of the 17 diploid patients who died of disease, there were 11 tumors with high Spf (greater than 4.45%) and 6 tumors with a low Spf (P less than 0.05 chi-square test). The presence of more than 30% of a solid pattern in the tumor was strongly associated with poor median survival in Kaplan-Meier survival curve analysis (P less than 0.05 log rank test). Grade, stage, recurrence, and metastases were also found to be important prognostic factors. Because few tumors were nondiploid, these results suggest that S-phase fraction analysis may be a more useful prognostic indicator than ploidy classification.

Actuarial Analysis↗

Lethal cardiac toxicity after cisplatin and 5-fluorouracil chemotherapy. Report of a case with necropsy study.

This article presents a patient affected with epidermoid carcinoma of the soft palate who developed a dilated myocardiopathy with aortic embolism and fatal left cardiac failure after treatment with cisplatin (100 mg/m2, day 1) and 5-fluorouracil (1 g/m2/day i.v. days 2-6). The postmortem necropsy study showed diffuse interstitial edema and intracytoplasmic vacuolization of myocytes, without inflammatory changes. These findings were interpreted as acute toxic myocardiopathy, probably due to 5-fluorouracil treatment. Although the patient also received cisplatin, metoclopramide, allopurinol, thiethylperazine, and amitriptyline, before the onset of clinical symptoms, these drugs were not considered to play an important role in the production of this cardiopathy because of the dosage, necropsy findings, and lack of previous report.

Aortic Diseases↗

Plasmacytoma of the hard palate.

Multiple myeloma is a systemic malignant disease and is associated with a poor prognosis. It is characterized by neoplastic proliferation of plasma cells involved in the production and secretion of monoclonal immunoglobulins (M proteins). It is generally a disseminated disease involving many bones. Systemic symptoms include bone pain, pathologic fracture, renal failure, hypercalcemia, weight loss, anemia, thrombocytopenia, and neutropenia. This condition may occur as a solitary lesion (solitary plasmacytoma), which in some patients eventually progresses to plasma cell myeloma. Extramedullary plasmacytoma is defined as neoplastic proliferation of plasma cells in the soft tissue. It usually occurs in the upper respiratory tract, such as the nasal cavity or posterior oropharynx. The authors present a rare plasmacytoma case with maxilla involvement.

Diagnosis, Differential↗

MRI of mucosal malignant melanoma of the head and neck.

PURPOSE: The objective of this study was to determine the characteristic MR findings for mucosal malignant melanomas of the head and neck. METHOD: We retrospectively analyzed the MR images for six patients with this entity. T1-weighted SE images with and without gadolinium and T2-weighted fast SE images were obtained. MR images were analyzed qualitatively and quantitatively by comparing the signal intensity of the melanoma with that of muscle. RESULTS: On T1-weighted images, five melanomas were hyperintense and one was isointense. On T2-weighted images, five were of mixed intensity and one showed isointensity. The mean signal intensity ratio of the primary melanoma to muscle was 1.51 and 1.39 on T1-weighted images with and without gadolinium, respectively. These values were not statistically significant. CONCLUSION: Hyperintensity on T1-weighted images is characteristic of this entity, but not universal.

Adipose Tissue↗

Reconstruction of the soft palate by uvulopalatal flap.

Surgical removal of the soft palate in cases of neoplastic disease has a functionally detrimental effect on the patient, resulting in rhinolalia and nasal regurgitation. The authors describe their original surgical technique for repairing the lateral soft palate defect using a uvulopalatal flap. The flap is readily available and the procedure is single staged and without sequela. The aim of this reconstructive procedure is to obtain a diminished soft palate defect by primary surgery. In five patients who underwent a partial excision of the soft palate, the surgical defect was corrected at the time of initial surgery by a uvulopalatal flap. In this technique, the surface of the defect was diminished, postoperative rhinolalia and regurgitation were unremarkable, and sometimes an obturator was obviated. Using a local myomucosal flap, the procedure is simple, safe, and effective.

Adult↗

Palatal reconstruction with the palatal island flap.

OBJECTIVES/HYPOTHESIS: The management of palatal defects resulting from the extirpation of benign and malignant lesions uses a variety of methods, with the optimal techniques allowing maximal postoperative function with minimal morbidity. The palatal island flap is an effective, reliable technique for reconstructing postablative oral cavity defects. METHODS: All patients who underwent palatal resections for benign or malignant lesions at a tertiary care, referral-based head and neck cancer center since 1995 were eligible. Ten patients were identified whose surgical defects were reconstructed with palatal island flaps. The cases were reviewed for the symptomatology, tumor features, defect size, perioperative and postoperative management, complications, and impact on palatal function. RESULTS: Ten patients ranging in age from 18 to 81 years underwent palatal island mucoperiosteal flaps after resection of a variety of benign and malignant tumors, most arising from minor salivary glands. The defects ranged in size from 5 to 15 cm2, with extension into the floor of the nose in four cases and to the skull base in two. Nine patients were discharged on a regimen of oral diet, and no patient manifested permanent velopharyngeal insufficiency, speech impairment, or airway compromise. Follow-up ranged from 3 months to 6 years, with an average follow-up of 18.5 months. Delayed donor site re-epithelialization required debridement in one case, and two patients required obturation of small oronasal fistulae. CONCLUSION: The palatal island mucoperiosteal flap provides an effective means of reconstructing hard and soft palate defects with few complications and low morbidity.

Adolescent↗

Reconstruction of the oral cavity with a free flap.

Free groin flaps were used successfully within the oral cavity in 4 patients after ablative operations for cancer. Preoperative or postoperative radiation (cobalt therapy) had no apparent detrimental effect on the survival of these free flaps.

Adult↗

Reconstruction of the maxilla with a double musculoperiosteal flap in connection with a composite calvarial bone graft.

A new technique is shown for a one-stage reconstruction of the mucosa of the floors of the nose and maxillary sinus, the bone structures of the maxilla and the hard palate, as well as the mucosal layers of the hard and soft palates and vestibulum. To accomplish this coverage, a vascularized calvarial bone graft with temporal muscle from one side is combined with a vascularized temporal muscle flap from the other side to achieve a three-layer "sandwich" plasty. The advantage of this procedure is reconstruction of the complete maxillary defect with the possibility of denture rehabilitation and the avoidance of oronasal fenestration. Besides the possible complication of insufficient vascularization of the bone and muscle grafts, the donor defect in the calvarial bone and the missing muscle for mastication are to be considered.

Aged↗

Head and neck mucosal melanoma.

PURPOSE: The purpose of this article is to discuss the optimal treatment and outcomes for head and neck mucosal melanoma. METHODS: Review the pertinent literature. RESULTS: Head and neck mucosal melanoma is a rare entity comprising less than 1% for all Western melanomas. It usually arises in the nasal cavity, paranasal sinuses, and oral cavity. The optimal treatment is surgery. The likelihood of local recurrence after resection is approximately 50%. Radiotherapy (RT) reduces the likelihood of local failure but probably does not enhance survival, which is primarily impacted by advanced T stage and the presence of regional metastases. The 5-year survival rates vary from approximately 20 to 50%. Although the median time to relapse is roughly 1 year or less, late failures are common and cause-specific survival continues to decline after 5 years. CONCLUSION: The optimal treatment is surgery. Postoperative RT improves local-regional control but may not impact survival. Definitive RT may occasionally cure patients with unresectable local-regional disease or at least provide long-term palliation.

Adult↗