Resident: Tyler Roberts
Article: Traumatic herniation of the buccal fat pad
Author: Horie. et al
Journal: Pediatric Dentistry
Volume # 23:3, pages: 249 - 251
Year: 2001
Major topic: Traumatic herniation of the buccal fat pad
Type of article: case review
Purpose: To diagnose and treat this rare truamatic lesion found most commonly in children
Kep pts/findings
The buccal fat pad consist of 4 segments: the ptergoid, buccal, superficial and deep temporal areas. It lies wedged between the masseter and the buccinator. It extends on one end from the anterior region of the masseter through to the retromolar region of the mandible. Up until the year 2000, only 31 cases of traumatic herniation of the buccal fat pad has ever been reported.
Case 1
A 10 month old reportedly fell down while holding chopsticks in his mouth. The chopsticks did not break and minimal bleeding was noted at the time of injury. On examination a laceration was found present on his right buccal mucosa, inferior and distal to the parotid papilla. From the laceration a reddish-yellow soft pedunculated mass measuring 1.0 x .5 x.5 cm was protruding. The working diagnoses was given. The treatment included irrigating and reapproximating the margins and placing 4-0 nylong sutures while under local anesthesia. An antibiotic was given for four days and in two weeks the lesion had completely healed.
Case 2
A 1 year 9 month old had fallen while holding her toothbrush in the mouth. The tooth brush was not broken and minimal bleeding was present. The following morning a large mass extended from the right buccal mucosa into the oral cavity. The pedunculated mass appeared to be reddish brown in color with the dimension of 1.5 x 1.0 x 1.0 cm. and located just inferior to the parotic papilla. The working diagnosis was given. Three days later the mass was excised at the hospital under general anesthesia. The patient recieved. 4-0 nylon sutures and was placed on antibiotics for 5 days. One month later everything appeared to be healed with no cosmetic defects.
summary of conclusions:
Almost all cases of buccal herniation of the fat pad have been due to a traumatic injury. It most frequently occurs in infants and small children under the age of 4. The site of the lesion is almost always along the oclussal table near the parotid papilla. Histologically this lesion is not capsulated and composed of mature adipose tissue. Treatment includes excision or reaprroximation of the pad depending on size. No history of recurrence has been reported after treatment.
Showing posts with label 07/24/09. Show all posts
Showing posts with label 07/24/09. Show all posts
Wednesday, July 22, 2009
Dentigerous Cysts in Primary Dentition: Report of 2 cases
Resident: Tyler Roberts
Author: Delbem et al
Journal: Pediatric Dentistry
Volume # 28:3, pages 269-271
Year: 2006
Major topic: Dentigerous cyst in children/adolescents
Type of article: case review
Kep pts/findings:
Dentigerous cyst are benign odontogenic cysts associated with the crowns of unerupted permanent teeth. They are usually single in occurrence and located in the mandible. They are the second most common type of odontogenic cyst, accounting for 49% of all cystic lesions. They are most common in male patients and frequently occur during the second or third decade of life. These lesions are usually asymptomatic and discovered at the time of routine radiographic examination. If the cyst is greater than 2cm in diameter swelling, mild sensitivity, tooth mobility and displacement may be observed. Radiographically these lesions are symmetric, well-defined, unilocular surrounding the crown of the unerupted tooth. Possible complications include: permanent bone deformation or fracture, expansive bone destruction, loss of permanent teeth, development of squamous cell carcinoma
Case 1
A 10 year old presented with swelling on the left side of his jaw. An intraoral examination revealed bulging along the cortical bone that extended from his mandibular left first bicuspid to the distal of the permanent mandibular left first molar and a radiographic lesion that appeared unilocular, radiolucent and was associated with the dental crown of the bud of the mandibular left second molar. A differential diagnosis suggested a dentigerous cyst. Marsupialization was chosen as treatment. The primary mandibular left second molar was extracted, the lesion was decompressed and a space maintenance appliance was inserted. The parents were told to irrigate the lesion with listerine solution and clean the appliance daily. A histopathologic examination revealed that the lesion was indeed a dentigerous cyst.
Case 2
An 8 year old boy, was found to have a volumetric increase of the lingual cortical plate in the region of the primary mandibular right lataeral incisor which showed prolonged retention. Radiographically a well-defined, unilocular, radiolucent lesion was present surrounding the bud of the permanant mandibular right lateral incisor. The lesion appeared to be causing root resportion of the primary lateral incisor and canine. The working diagnosis was a dentigerous cyst. Treatment included extraction of the primary mandibular right lateral incisor and primary canine as well as total enucleation of the cyst due to the small size. Stitches were placed and removed seven days later and seven months later eruptive movements of the permanent right lateral incisor was present along with new bone neoformation was visible in the area.
Summary of conclusions: Dentigerous cysts are benign and asymptomatic. Because they are common among cyst they should not be overlooked at the time of routine radiographic examination. Small cyst are most likely to undergo complete enucleation while larger cyst may require decompression for healing to take place.
Author: Delbem et al
Journal: Pediatric Dentistry
Volume # 28:3, pages 269-271
Year: 2006
Major topic: Dentigerous cyst in children/adolescents
Type of article: case review
Kep pts/findings:
Dentigerous cyst are benign odontogenic cysts associated with the crowns of unerupted permanent teeth. They are usually single in occurrence and located in the mandible. They are the second most common type of odontogenic cyst, accounting for 49% of all cystic lesions. They are most common in male patients and frequently occur during the second or third decade of life. These lesions are usually asymptomatic and discovered at the time of routine radiographic examination. If the cyst is greater than 2cm in diameter swelling, mild sensitivity, tooth mobility and displacement may be observed. Radiographically these lesions are symmetric, well-defined, unilocular surrounding the crown of the unerupted tooth. Possible complications include: permanent bone deformation or fracture, expansive bone destruction, loss of permanent teeth, development of squamous cell carcinoma
Case 1
A 10 year old presented with swelling on the left side of his jaw. An intraoral examination revealed bulging along the cortical bone that extended from his mandibular left first bicuspid to the distal of the permanent mandibular left first molar and a radiographic lesion that appeared unilocular, radiolucent and was associated with the dental crown of the bud of the mandibular left second molar. A differential diagnosis suggested a dentigerous cyst. Marsupialization was chosen as treatment. The primary mandibular left second molar was extracted, the lesion was decompressed and a space maintenance appliance was inserted. The parents were told to irrigate the lesion with listerine solution and clean the appliance daily. A histopathologic examination revealed that the lesion was indeed a dentigerous cyst.
Case 2
An 8 year old boy, was found to have a volumetric increase of the lingual cortical plate in the region of the primary mandibular right lataeral incisor which showed prolonged retention. Radiographically a well-defined, unilocular, radiolucent lesion was present surrounding the bud of the permanant mandibular right lateral incisor. The lesion appeared to be causing root resportion of the primary lateral incisor and canine. The working diagnosis was a dentigerous cyst. Treatment included extraction of the primary mandibular right lateral incisor and primary canine as well as total enucleation of the cyst due to the small size. Stitches were placed and removed seven days later and seven months later eruptive movements of the permanent right lateral incisor was present along with new bone neoformation was visible in the area.
Summary of conclusions: Dentigerous cysts are benign and asymptomatic. Because they are common among cyst they should not be overlooked at the time of routine radiographic examination. Small cyst are most likely to undergo complete enucleation while larger cyst may require decompression for healing to take place.
Monday, July 20, 2009
A clinicopathologic and immunohistochemical analysis of melanotic neuroectodermal tumor of infancy
Resident’s Name: Brian Schmid DMD
Author(s): A.W. Barrett et al.
Journal: Oral Surg Oral Med Oral Path
Month, Year: 2002
Major topic: A small retrospective, histological study of melanotic neuroectodermal tumors in infants (MNTI)
Type of Article: Retrospective
Findings: MNTI’s are quite rare and usually considered benign with only 250 reported cases, typically as a single or paired lesion but also in clusters of 5 or more. The membrane can be intact or ulcerated, blue, brown or red and can even resemble an eruption cyst. There is no sex predilection and presentation is typically less than 1y.o. The treatement of choice is surgical removal with a conservative lymph node dissection to rule out metastasis. Radiotherapy and chemotherapy are ineffective and would be contraindicated in such young patients anyhow.
Searching through pathology department archives, 8 cases of melanotic neuroectodermal tumors were found; 7 in males and 7 affected the maxilla. The cases ranged from 1963-1999. The age of presentation was 2.5-14 months and all were treated with excision. Three of the cases “involved the whole maxilla” and 2 crossed the midline but only 1 case required a radical bilateral maxillectomy. Radiographically the lesions could present a radiopaque or radiolucent state and moth single and multilocularity. Histologically the lesions present as small melanocyte-like cells mixed with smaller neuroblast-like cells. There is good evidence that these lesions are of neural crest origin. The purpose of this study as to elucidate a histological/immunological assay that could be performed to successfully predict aggression and malignancy of a given tumor. NB84 is a reliable marker for childhood neuroblastoma but was negative on all account in this study. While the most aggressive case was the only one positive for CD99 and Ki67, this is inconsistent with many previous findings. There is a small chance of recurrence which can be monitored with regular intra-oral exams.
Key points/Summary: While this study did not specify any immunohistological markers which could help identify the more malignant episodes of this tumor, further study is necessary and in the meantime it is in the best interest of the patient to perform proper soft tissue exams at regular intervals in all patients. Erythroplakic and pigmented lesions are of particular importance to note, monitor and treat.
Assessment of article: Chock full of biochemistry goodness but with some valuable clinical peppering. They included no photos of the study patients, which may not have been available, or even stock photos of an MNTI.
Author(s): A.W. Barrett et al.
Journal: Oral Surg Oral Med Oral Path
Month, Year: 2002
Major topic: A small retrospective, histological study of melanotic neuroectodermal tumors in infants (MNTI)
Type of Article: Retrospective
Findings: MNTI’s are quite rare and usually considered benign with only 250 reported cases, typically as a single or paired lesion but also in clusters of 5 or more. The membrane can be intact or ulcerated, blue, brown or red and can even resemble an eruption cyst. There is no sex predilection and presentation is typically less than 1y.o. The treatement of choice is surgical removal with a conservative lymph node dissection to rule out metastasis. Radiotherapy and chemotherapy are ineffective and would be contraindicated in such young patients anyhow.
Searching through pathology department archives, 8 cases of melanotic neuroectodermal tumors were found; 7 in males and 7 affected the maxilla. The cases ranged from 1963-1999. The age of presentation was 2.5-14 months and all were treated with excision. Three of the cases “involved the whole maxilla” and 2 crossed the midline but only 1 case required a radical bilateral maxillectomy. Radiographically the lesions could present a radiopaque or radiolucent state and moth single and multilocularity. Histologically the lesions present as small melanocyte-like cells mixed with smaller neuroblast-like cells. There is good evidence that these lesions are of neural crest origin. The purpose of this study as to elucidate a histological/immunological assay that could be performed to successfully predict aggression and malignancy of a given tumor. NB84 is a reliable marker for childhood neuroblastoma but was negative on all account in this study. While the most aggressive case was the only one positive for CD99 and Ki67, this is inconsistent with many previous findings. There is a small chance of recurrence which can be monitored with regular intra-oral exams.
Key points/Summary: While this study did not specify any immunohistological markers which could help identify the more malignant episodes of this tumor, further study is necessary and in the meantime it is in the best interest of the patient to perform proper soft tissue exams at regular intervals in all patients. Erythroplakic and pigmented lesions are of particular importance to note, monitor and treat.
Assessment of article: Chock full of biochemistry goodness but with some valuable clinical peppering. They included no photos of the study patients, which may not have been available, or even stock photos of an MNTI.
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