Wilms' tumor metastiatic to mandible and oral mucosa. Report of a case.
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Epithelial islands in association with nerve fibers in the jaw bones have been reported previously. We describe two such cases and present evidence that the epithelial structures as observed in this study are odontogenic rests and not neuroepithelial organs. Regardless of origin, it should be recognized that these epithelial islands do not represent neural invasion by carcinoma.
An instance of anesthesia of the lower lip caused by a compound odontoma in the mental foramen region is described. Removal of the odontoma was followed by a full recovery of the sensation.
The results of immediate stabilization for surgical defects of the mandible in 18 patients are presented. Fourteen patients with malignant lesions underwent immediate stabilization without bone grafting, but with associated myocutaneous flap soft tissue reconstruction. Four patients with benign lesions were treated with immediate stabilization and bone graft reconstruction, but without myocutaneous flap soft tissue reconstruction. Results at from 4 to 34 months reveal two bone plates lost to massive intraoral exposure. The remaining plates remain in place with excellent functional and cosmetic results.
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This study constitutes a follow-up of a study completed in March 1988, involving 18 patients receiving bone plate stabilization for the repair of surgical defects after mandibular resection. An additional 11 cases are presented with follow-up periods of 3 to 23 months. Of the original study of 18 patients, follow-up was available for 13. Of these 13, five patients died, three as a result of their tumors. One patient was previously reported to have had recurrent disease and loss of the stabilization plate. One patient lost the plate in an area of recurrent tumor just before succumbing to his malignancy. The remaining three died with their stabilization plates in place and functioning. The eight remaining patients with long-term follow-up and 11 additional patients with shorter-term results are now described.
Two cases of metastatic renal clear cell carcinomas of the mandible are presented in which the jaw symptoms preceded the discovery of the primary lesions. Their presentation mimicked vascular abnormalities both clinically and on special investigations and both required biopsy, one of which was a major excision, for diagnosis. The histological differential diagnosis of metastatic renal clear cell carcinoma from other clear cell tumours arising in the orofacial tissues can also be difficult, often requiring specialised knowledge and techniques. These points illustrate that the differential diagnosis of a pulsatile soft tissue jaw tumour developing below intact mucosa and eroding bone, should include metastatic tumour as well as vascular anomaly, vasoformative tumour, extra nodal lymphoma and primary bone tumour.
A case of a malignant ameloblastoma in a 49-year old Sri Lankan woman with widespread pulmonary metastases is presented, the diagnosis confirmed by needle biopsy. The current histological classification of odontogenic carcinomas and the management of metastatic pulmonary deposits are discussed.
Clinical results obtained with hollow titanium screws and reconstruction plates in the bridging of mandibular bone defects of 17 patients are described. Following implantation the newly forming bone establishes direct contact with the sprayed titanium surface of the screw and the underside of the plate and permeates the screw. The stability of anchorage therefore increases with the duration of implantation. The reconstruction system also allows salvaging of small fragments such as the condyloid process. The adjustable, individually shaped, mandibular condylar prosthesis permits precise restoration of articular guidance on the reconstructed side while preventing incorrect loading of the opposite joint. The clinical results confirm the recently published findings from animal studies.
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A case is presented where secondary mandibular reconstruction with an aluminum oxide ceramic prosthesis was performed for a patient who had had an earlier hemimandibulectomy and primary bone graft for management of an ameloblastoma. Various factors that were considered in the construction of the prosthesis and problems encountered during operation are discussed. Although the prosthesis was found to be quite useful for the restoration of facial contour, the results of a long-term follow-up are needed to obtain a final evaluation of the reconstruction.
The functional and cosmetic outcome of 11 patients who had anterior arch mandibulectomy for stage II-IV oral cavity carcinoma and were reconstructed with AO stainless-steel or titanium plates was retrospectively analyzed. Although the complication rate was high, plate removal was uncommon. Patients were afforded good function and cosmesis. Severity of postoperative infection corresponded to a low preoperative absolute lymphocyte count, which suggests that increased preoperative diet supplementation may decrease the incidence of early infections. Improved mandibular function and esthetics may allow future patients to be offered early reconstruction routinely.
Forty-one cases (37 patients) of mandibular reconstruction using AO plates were reviewed. The patients' ages ranged from 27 to 83 years (mean, 52.3 +/- 18.1 years) and their cases were followed for 6 to 42 months (mean, 12.7 +/- 8.3 months). Cases were grouped by the location of reconstruction: anterior mandible crossing midline as group A (12 cases), body segment of the mandible as group B (16 cases), condyle and ramus of the mandible as group C (13 cases). The incidence of revision as a measure of outcome was calculated by actuarial methods accounting for loss to follow-up or death. Revision or plate removal occurred in 22.2% (9 of 41 cases), with an incidence of 52.2% (6 of 12 cases) in group A, 12.5% (2 of 16 cases) in group B, and 7.7% (1 of 13 cases) in group C. Combined use of an AO plate and bone graft had a revision rate of 33.3% (4 of 12 cases), whereas the reconstructions with only a plate had a revision rate of 17.2% (5 of 29 cases). The difference between the immediate reconstructions (19.2%; 5 of 26 cases) and delayed reconstructions (26.7%; 4 of 15 cases) was not significant, but delayed reconstruction of the anterior mandible resulted in the highest failure rate (57.1%; 4 of 7 cases). The revision incidence was significantly higher when the area had been radiated (33.3% of 24 radiated cases and 5.7% of nonradiated cases required revision). In particular, the radiated group A had a remarkably higher failure rate (63.2% of 10 cases).(ABSTRACT TRUNCATED AT 250 WORDS)
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