Search

Five cases of central squamous cell carcinoma of the mandible were investigated with the use of computed tomography. Bucco-lingual extent and spread along the mandibular division of the trigeminal nerve were evaluated. Three patients with trismus showed involvement of the masseter or medial pterygoid muscle on computed tomography. Involvement of more than two landmarks along the trigeminal nerve were observed in cases with both paresthesia of the lower lip and severe pain that resembled neuralgia. Perineural invasion was confirmed histologically in four cases, and all of these patients had both severe pain and mandibular canal involvement that could be demonstrated with computed tomography. When localized soft tissue changes are evident along the course of the trigeminal nerve in the region between the mandibular foramen and foramen ovale, ascending perineural spread should be suspected. Computed tomography findings correlated well with clinical symptoms but added information about the spread of the lesion within the surrounding soft tissue.

The aneurysmal bone cyst is an enigmatic and misnamed lesion displaying variable etiopathogenic and histologic characteristics. The aneurysmal bone cyst may appear as a primary lesion or as a secondary lesion associated with other pathologic entities. This article presents a probable self-limiting lesion that provides an opportunity to present an approach to classifying aneurysmal bone lesions.

Two cases of rare metastases from malignant neoplasms to the posterior mandible in young adults are reported. Multiple imaging modalities were necessary to identify the many metastases and, in one case, the suspected primary site. Many of the radiographic images are presented for that case.

A primary Ewing's tumor in the mandible is reported, and the diagnostic imaging features of this lesion are discussed. Modalities used included panoramic and plain films, computed tomography, and 99mTc-MDP scintigraphy.

Familial adenomatosis coli is known to be associated with tooth impactions, odontomas, and osteomas. Three cases were examined by panoramic radiography and computed tomography. Computed tomography was especially useful for detecting osteomas in the maxilla and also revealed a wavy cortical thickening in the mandible in one instance. The latter finding has been reported for other bones in the body but not previously for the mandible.

Metastatic tumors to the jaw are a rare occurrence. The incidence of metastatic Ewing's sarcoma to the jaw has been reported to be less than 2% of all cases of Ewing's sarcoma. Early detection of such lesions is difficult because the signs and symptoms do not appear until the lesion has progressed considerably. The treatment options are therefore limited to palliative care of the patient rather than cure. This article reports a case of Ewing's sarcoma that had metastasized to the mandible and reviews the literature.

The clinical experience of a patient with a large exostosis who had a chief complaint of difficulty in opening the mouth is reported. Radiographic examinations, especially tomography and a CT scan, were useful in the diagnosis. Surgical removal is the treatment of choice. The lesion is usually approached by a combination of intraoral and buccal routes; we also employed such an approach in this particular case.

Previous reports have focused on the fact that laminar periosteal new bone is a common radiologic sign of Ewing's sarcoma of the jaws. Critical analysis of the literature does not lead to this conclusion. A case is reported and radiologic appearances described. A review of the literature shows striking clinical and radiologic similarities to osteogenic sarcoma of the jaws. A differential radiologic interpretation of Ewing's sarcoma of the jaws is offered.

A 52-year-old man developed intermittent swelling, pain, and paresthesia during a one-year period prior to the histologic diagnosis of reticulum-cell sarcoma. The clinical profile and radiographic examination suggested either chronic osteomyelitis or malignancy. Treatment was confirmed to radiation therapy with resolution of the malignancy but a guarded prognosis. Twenty-two previously reported cases of primary reticulum-cell sarcoma of the mandible are reviewed.

Sixty-four instances of histologically documented ossifying and/or cementifying fibromas were evaluated. Adequate radiographs were available in 43 of the cases. Most of these benign fibro-osseous neoplasms occurred in women, with a predilection for the third and fourth decades. Six distinct radiographic patterns could be identified: (1) radiolucent, superimposed over teeth or residing in edentulous regions (28%); (2) radiolucent with opaque foci, lying in edentulous areas or superimposed over teeth (42%); (3) radiolucent, interposed between contiguous teeth (5%); (4) radiolucent with opaque foci, interposed between contiguous teeth (9%); (5) multilocular expansile (7%); and (6) aggressively expansile with opacification (9%). All lesions exhibited well-defined margins. Root resorption was a feature in 11% of the sample, and root divergence occurred in 17% of the cases.

Benign cementoblastoma is a rare benign odontogenic tumor of mesenchymal origin. As only a few documented cases have been reported in the literature, the clinical and histologic criteria for identifying this type of tumor are still uncertain. Thus, problems of differential diagnosis warrant the present report of a case of benign cementoblastoma in the mandible of a 27-year-old man.

Radiographic patterns encountered in mandibular cystogenic ameloblastoma, a variant encountered among teen-agers and young adults, are described and correlated with age and recurrence after surgery. More than 75% of the cases are located in the posterior mandibular ramus area, and 50% are associated with an impacted third molar. The predominant radiographic patterns include unilocular and scalloped or macromultilocular pericoronal , interradicular , or periapical expansile radiolucencies.

The eighth case of a benign osteoblastoma of the jawbones is presented. The tumor showed early recurrence after imcomplete curettage. The tumor-bearing part of the mandible was resected and reconstructed with an autologous bone graft. The histologic features of the entire specimen proved its benighn character. The patient is doing well 2 years after surgical treatment.

The case of a patient with an extensive squamous-cell carcinoma of the floor of the mouth with erosion of the mandibular bone is presented. The history and initial clinical picture were consistent with either carcinoma with superimposed infection or chronic osteomyelitis with an acute exacerbation. A discussion of diagnosis and treatment of carcinoma of the floor of the mouth follows this case report.

Oral manifestations of neurofibromatosis have been reported in only 4% to 7% of affected persons. All oral tissues, hard and soft, have been reported to be affected with tumors, but the tongue has been the most common site. We report on the oral and radiographic findings in twenty-two patients with neurofibromatosis. The prevalence of oral and radiographic findings in our sample was 72%, which is much higher than previously reported. The five most common findings are oral neurofibromas, enlarged fungiform papillae, intrabony lesions, wide inferior alveolar canals, and enlarged mandibular foramina.

In a series of 31 patients with NHL presenting in the oral region, nine lesions were in the maxilla and 5 were in the mandible, for a total of 14 (45%) lesions that arose in bone. The most common locations were the posterior regions of the maxilla (7 cases) and mandible (4 cases). Diffuse subtypes clearly predominated, 13 out of 14 cases demonstrating this pattern. Six of the cases were in children, and 4 of these qualified as Burkitt's lymphoma. In general, it was found that the statistics relating to survival of patients with jawbone lymphoma correspond closely to the findings reported for skeletal lymphomas. Despite the high incidence of diffuse patterns, 6 of these 14 patients with NHL in bone were alive with no evidence of disease 3 years or longer.

The case of a 33-year-old woman with Burkitt's lymphoma is presented. This is the third case that has been reported from India. The primary involvement was in the mandible. Endoxan was administered without response. Radiotherapy was resorted to as the second choice of treatment, but metastases developed rapidly in other organs. The patient survived for only 3 months after a diagnostic biopsy.

A radiographic study was conducted to determine the prevalence of benign fibro-osseous lesions of periodontal ligament origin (BFOLPDLO) in black women. Of 491 black women with both a panoramic radiograph and a full or partial periapical series, thirty-eight or 7.7% (age-adjusted rate = 7.7%) exhibited BFOLPDLO. Of these thirty-eight patients, twenty-nine had what is clinically recognized as periapical cemental dysplasia, for a prevalence of 5.9% (age-adjusted rate = 5.5%). The combination of a panoramic radiograph and a full or partial periapical series appeared more sensitive in the detection of BFOLPDLO than a panoramic radiograph or full series alone.

A case of adenomatoid odontogenic tumor in which trauma was apparently a significant causative factor is presented. Consultation with an oral pathologist prevented unnecessary radical surgery.

Two cases of simple bone cyst are presented. The first is unusual because of its radiologic appearance simulating ameloblastoma and its prolonged healing time, requiring surgical intervention on several occasions. The second is presented because of the occurrence of bilateral cysts, of which there are only eight other reported cases. It is postulated that the first case might represent a single large simple bone cyst that had several chambers with tenuous connections or that it might be an example of multiple simple bone cysts in close proximity.

A case of osteogenic sarcoma of the mandible is presented. The most striking radiologic finding in this case was irregular widening of the mandibular canal, with areas of narrowing and loss of fine parallel cortical margins of the walls of the canal. These changes were accompanied by widening of the periodontal membrane of the adjoining teeth, an early sign of osteogenic sarcoma described by Garrington and colleagues, and loss of lamina dura of the same teeth and one additional adjacent tooth.

The odontogenic myxoma is an uncommon neoplasm of the jaws that is believed to arise from the primitive, mesenchymal portion of the tooth germ. This study surveys nine cases of odontogenic myxoma of the jaws. Analysis of the clinical material revealed that the myxoma occurred most frequently in the posterior regions of the mandible and will recur if initial therapy is too conservative. The average age of the patients in this series was 26.5 years. Five cases involved females and four involved males. Electron microscope findings revealed that the tumor cells are probably responsible for the secretion of the myxomatous intercellular material of the neoplasm.

This report describes the case of a 64-year-old woman with painful symptoms of the mandible produced by a lesion diagnosed as Bence Jones myeloma (kappa type). A bone survey revealed osteolytic lesions in the mandible, cranial bones, and humerus. Urinalysis showed no abnormality regarding the presence of monoclonal immunoglobulin fragments. Serum analysis by electrophoresis and immunoelectrophoresis did not demonstrate the presence of monoclonal immunoglobulin. However, the latter procedure disclosed a precipitation line formed by concentrated urine against anti-kappa serum. Microscopic examination of a mandibular specimen revealed numerous atypical plasma cells. Immunoperoxidase studies demonstrated kappa-chains localized within the rough endoplasmic reticulum, perinuclear region, and Golgi apparatus of the myeloma cells. The pathogenetic mechanism of the condition in this case, as well as its relation to Bence Jones myeloma and nonsecretory myeloma, is discussed.

Metastasis of osteogenic sarcoma to the mandible is extremely rare. A case of mandibular metastasis of an osteogenic sarcoma of the left fibula is presented. The patient, a 17-year-old Japanese girl, was suffering from a metastatic gingival tumor, 3 by 5 cm. in size, with ulceration. Eventually, there were multiple metastases not only to the mandible but also to the thoracic vertebrae, lumbar vertebrae, sacrum, zygomatic bone, clavicle, sternum, humerus, rib, femur, tibia, lung, and meninges.

Thirty-eight patients with neurofibromatosis were examined clinically and radiographically for manifestations of the disease in the head and neck region. Ninety-two percent of the sample had at least one intraoral or radiographic sign of the disease. This suggests that the incidence of jaw and skull involvement in neurofibromatosis may be greater than previously reported in the literature.