Reconstructive procedures in head and neck surgery.
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We describe two cases of primary intraosseous hyalinizing clear cell carcinomas of the jaws. One tumor arose in the mandible, the other in the maxilla. Both patients were adult women. Histologically, both tumors were characterized by a population of clear, glycogen-rich cells arranged in solid nests, trabeculae, and occasional single files, surrounded by a markedly hyalinized fibrous stroma. In close admixture with the clear cells, a second component of smaller cells having eosinophilic cytoplasms was also noted. Focal areas of squamous metaplasia were seen in one of the tumors. Neither nuclear pleomorphism nor mitotic activity were conspicuous features. Mucicarmine stains were negative in both tumors. Immunohistochemically, the tumor cells expressed cytokeratins and epithelial membrane antigen. Stains for S100 protein, smooth muscle specific actin, and carcinoembryonic antigen were all negative. Both patients are alive and well 14 and 17 months respectively after the diagnosis without evidence of metastasis or recurrence. The major importance of recognizing the existence of this rare form of salivary gland-type adenocarcinoma arising as a primary lesion in the mandible or the maxilla lies in avoiding misdiagnosing it as other primary or metastatic clear cell neoplasms, including various odontogenic clear cell tumors, other primary intraosseous salivary gland tumors, and metastatic clear cell adenocarcinomas from other organs, particularly the kidney.
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This paper presents 3 atypical ameloblastomas which had a fatal outcome. One had histological features indicative of malignancy but without metastasis, another developed pulmonary metastasis and the third died of extensive infiltration of the skull base. The features of malignant ameloblastoma are discussed and reported cases of malignant ameloblastoma between 1966 and 1993 are reviewed.
OBJECTIVE: To establish the incidence of odontogenic tumours in Nigeria we present our experience during the 15-year period 1980-94. DESIGN: Retrospective review of histopathological specimens and case notes. SETTING: Teaching hospital, Nigeria. SUBJECTS: 128 Patients with histologically confirmed odontogenic tumours out of a total of 415 with tumours of the mouth and jaw. MAIN OUTCOME MEASURES: Incidence, treatment, and recurrence rate. RESULTS: Ameloblastoma (n = 21, 16%) and adenomatoid tumour (n = 16, 13%). Patients' ages ranged from 8 to 75 years (mean 33 for ameloblastoma, 31 for fibromyxoma, and 22 for adenomatoid tumour). The corresponding male:female ratios were 3:2, 2:3, and 1:1, and maxilla:mandible ratios 1:9, 1.1:1, and 2:1. The more radical the resection of ameloblastomas the less likely were they to recur. CONCLUSION: Further research is required to explain the high incidence of odontogenic tumours in Nigeria, particularly ameloblastomas.
There are three clinical types of ameloblastoma: the solid or multicystic type; the unicystic type; and the rare peripheral type. Important considerations in planning treatment include the clinical type as well as the anatomic location of the tumor and the availability of the patient for follow-up examinations. The various histologic patterns exhibited by this tumor have no bearing on its biologic behavior. In this article the treatment of the three types of ameloblastoma is discussed, with emphasis on their biologic behavior and anatomic considerations.
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One hundred four ameloblastomas, 97 in the mandible, five in the maxilla, and two in peripheral locations, were studied. A consistent correlation between the age of the patient and the radiographic or histologic type of mandibular ameloblastoma was observed. There was a tendency for ameloblastomas of the follicular type to show a multilocular or soap bubble appearance and for those of the plexiform type to show a unilocular appearance. Recurrent ameloblastomas had a predominantly multilocular appearance. Histologically, the ameloblastomas in the maxilla were of the follicular type.
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Four cases of ameloblastic fibroma appearing in the posterior maxilla and the cupsid area of the mandibula are presented. One of the lesions appeared in the wall of a cyst and another was found in connection with a cyst. The treatment is conservative but the tumor needs close follow up for possible recurrence.
The subject of this paper is the evaluation of the applicability of structural jaw and mandible radiograms in diagnosing malignant neoplastic processes infiltrating the osseous tissue. The material studied comprised 20 patients treated surgically due to neoplasms of the faciocranium. The group investigated consisted of 17 males, aged 35--65 years and three females 45--60 years old. The most numerous group of neoplasms was composed of cancers: 18 patients; the remaining two were fibrosarcomas. For structural radiographs fine grained films and folialess cassettes were used, with soft X-rays being applied for irradiating the preparations. The radiograms were prepared by means of X-ray apparatus with a small focal lamp with a diameter of 0.3 mm, and with the point-focal apparatus. On the basis of analyses covering 24 macroradiograms and 71 microradiograms, criteria for estimating the malignant infiltration of the bone were established. The possibility of practical applicability of these investigations during intraoperative evaluation of the clinically suspicious bone segments has been emphasized.
The melanotic neuroectodermal tumor of infancy (MNTI) is a rare childhood neoplasm with an alarming but classical clinical presentation. It appears as a rapidly enlarging mass in the jaws of skull of infants and unless MNTI is considered in the differential diagnosis, the lesion can easily be mistaken for a malignant neoplasm. Although possessing an aggressive growth rate and radiographic appearance, the MNTI almost always behaves in a benign fashion and can be treated with local excision. However, recent reports of malignant behavior as well as of occasional recurrences make close follow-up important. Approximately 139 cases of the MNTI have been reviewed and tabulated with respect to age at discovery, sex, tumor location, length of follow-up, and whether recurrence occurred, 2 additional cases, 1 of which was in the mandible, are presented along with theories of origin and recommended therapy.
18 advanced cases of myxoma of the jaws are described. These had a typical age, sex and site distribution and characteristic clinical and radiographic features. Surgical treatment was radical as benefits large, poorly defined tumours, but there was no evidence that these were aggressive lesions. It is argued that the designation of myxoma as an odontogenic tumour is uncertain though not excluded. Attention is drawn to evidence that many myxomas of the jaws may be examples of myxomatous degeneration in other neoplasms.
In this study, 147 cases of intrabony ameloblastoma from the files of our departments were reviewed. Clinical findings showed an average age of 31.6 years and a sex ratio of 1.1:1. The average duration of the tumour was 2.7 years. The majority of the tumours, 93.9%, occurred in the mandible with 36.1% of the cases found in the molar area. Radiographically, 62.7% of the lesions were polycystic. Histopathologically, 49.0% had a follicular pattern. There seems to be no direct correlation between the histologic patterns and the radiographic appearances of the tumors but there is a slight indication that both monocystic and polycystic types tend to have the plexiform pattern, while the soap-bubble type tends to have the follicular pattern.
Ossifying fibroma is a fibro-osseous lesion rarely occurring in the jaws, although more often than in other bones of the skeleton. It is not clear whether it represents a distinct entity or a certain stage of the fibro-osseous condition. We are presenting our experience with 16 cases of ossifying fibroma treated with local excision or resection and bone graft. Their radiographic picture varied significantly from one case to another. One case was peripheral and one recurred.
The prognostic significance of so-called organ sites was investigated in 585 cases with carcinoma of the oral cavity and lips. For the subsamples studied the numerical distribution of TNM categories, life tables and life table comparisons were computed. This produced the following results: 1. There is no demonstrable difference in prognosis between identical T catagories in the organs of the oral cavity. 2. In some cases there is a significant difference between identical N categories in organs of the oral cavity. In the No category this is, however, attributable to the substantial differences in the numerical distribution of T categories. By contrast, a logical explanation for the computationally demonstrable significant differences in the Nx category is not available. The problem is currently being investigated. 3. An assessment of identical TN combinations in the "organs" of the oral cavity proved to be impossible on account of the inadequate number of cases available. The so-called "organ localization" of primary tumours in the oral cavity need not - at least for the time being - be accorded any prognostic relevance. The findings should, however, be re-examined on the basis of greater numbers.
Seven cases of fibrosarcoma of the jaws are presented. Five cases were in the mandible and 2 involved the maxilla. There were 3 males and 4 females and ages varied from 11 to 59 years. Four patients were in their third decade. All patients died of their tumour. Reason for death was local extension (2 patients); metastatic spread (2 patients); both local extension and metastatic spread (2 patients); and post-operative complications (1 patient). Factors causing this unfavourable clinical course are discussed. Chemotherapy and irradiation were of no therapeutic benefit. Some notes on histogenesis are made with respect to an odontogenic origin of jaw fibrosarcoma. This possibility exists but contributory evidence is equivocal unless a secondary fibrosarcoma has arisen in a benign odontogenic tumour.