Expansile mandibular lesion in a child.
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Biomedical subjects
Publications and source records attributed to S V Pellegrino.
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A week after dental treatment, a dentoalveolar abscess developed in a 14-year-old boy. Surgical intervention was needed to evacuate pus and remove the cause of infection. It is suggested that initially establishing drainage after dental treatment would have prevented the sequela that ensued.
Salivary obstruction may result from growth of a malignant tumor in the vicinity of the salivary gland, as well as result from sialolithiasis. Lymphomas of all types, including Hodgkin disease, lymphosarcoma, and reticulum cell sarcoma frequently are diagnosed in the region of the head and neck. The biopsy of a suspected tumor should be done by multiple needle biopsies. Open biopsies should be avoided to prevent seeding and spreading. When the diagnosis of malignant lymphoma is made, the tumor must be classified histologically and the extent of disease must be determined and staged for proper treatment. Treatment should consist of radiation and chemotherapy. Surgery is of little value. Malignant lymphomas usually are disseminated widely and end fatally.
Glossopyrosis and glossodynia may occur from local or systemic factors or from any irritation along the course of the lingual nerve. Although cylindroma is relatively rare, it must be considered along with other malignant lesions when neurologic symptoms of burning and pain of the tongue persist. Examination of the lesion is best carried out as multiple needle biopsies rather than as open biopsy, in order to avoid seeding of the skin and lymphatics of the neck. Recurrences are frequent and, because of the slow growth, there must be a long follow-up period. Metastases to the lung and brain, although late, occur in large numbers of patients. Best results are obtained by a combination of radiation therapy and operation because the infiltration is so extensive that operation alone may not eliminate the tumor completely.
Primary hyperparathyroidism may remain subclinical as long as there is adequate calcium in the diet. If the demand for calcium increases, as in pregnancy, the symptoms become evident. Any giant cell growths should alert the oral surgeon to the possibility of hyperparathyroidism. Untreated, hyperparathyroidism ultimately leads to fractures, irreversible kidney damage, and death by renal failure. Tetany must be guarded against after parathyroid surgery. Finally, the brown tumors of hyperparathyroidism need not be removed surgically since bone will regenerate if the disease is correctly treated by removal of the parathyroid adenoma.
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