Assessment of the intrasinusidal volume before and after maxillary sinus augmentation using mri - a pilot study of eight patients

PURPOSE

The purpose of this study was to evaluate the suitability, accuracy, and reliability of a non-invasive 3-Tesla magnetic resonance imaging technique (3 T-MRI) for the visualization of maxillary sinus grafts in comparison to conventional, X-ray-based, established standard imaging techniques.

METHODS

A total of eight patients with alveolar bone atrophy who required surgical sinus floor augmentation in the course of dental implantation were included in this pilot study. Alongside pre-operative cone-beam computed tomography (CBCT), 3 T-MRI was performed before and 6 months after sinus floor augmentation. Two investigators measured the maxillary sinus volume preoperatively and after bone augmentation.

RESULTS

In all cases, MRI demonstrated accurately the volumes of the maxillary sinus grafts. Following surgery, the bony structures suitable for an implant placement increased at an average of 4.89 cm3, corresponding with the decrease of the intrasinusidal volumes. In general, interexaminer discrepancies were low and without statistical significance.

CONCLUSION

In this preliminary study, we could demonstrate the feasibility of MRI bone volume measurement as a radiation-free alternative with comparable accuracy to CT/CBCT before procedures like sinus floor augmentation. Nevertheless, costs and artifacts, also present in MRI, have to be taken into account. Larger studies will be necessary to justify the practicability of MRI bone volume evaluation.

Serial assessment of somatic and cardiovascular development in patients with single ventricle undergoing Fontan procedure

BACKGROUND

The palliation of patients with single ventricle (SV) undergoing Fontan procedure led to improved long-term survival but is still limited due to cardiovascular complications. The aim of this study was to describe the somatic and cardiovascular development of Fontan patients until adolescence and to identify determining factors.

METHODS

We retrospectively assessed somatic growth, vascular growth of pulmonary arteries, and cardiac growth of the SV and systemic semilunar valve from 0 to 16 years of age using transthoracic echocardiography. The Doppler inflow pattern of the atrioventricular valve was quantified by E-, A-wave and E/A ratio. All data were converted to z-scores and analyzed using linear mixed effect models to identify associations with age at Fontan procedure, gender, and ventricular morphology.

RESULTS

134 patients undergoing Fontan procedure at a median age of 2.4 (IQR 2.12 to 2.8) years were analyzed. A catch-up of somatic growth after Fontan procedure until school age was found, with lower body height and weight z-scores in male patients and patients with systemic right ventricles. An early time of Fontan procedure was favorable for somatic growth, but not for vascular growth. Cardiac development indicated a decrease of SV end-diastolic diameter z-score until adolescence. Despite a trend towards normalization, E-wave and E/A ratio z-scores were diminished over the entire period.

CONCLUSIONS

There is a catch-up growth of somatic, vascular and cardiac parameters after Fontan procedure, which in our cohort depends on the time of Fontan procedure, ventricular morphology, and gender. Beside other factors, diastolic function of the SV remains altered.

Prevalence of oral cancer and potentially malignant lesions among shammah users in Yemen

The purpose of this study was to assess the prevalence of oral precancerous lesions and squamous cell carcinoma (OSCC) in Yemeni users of shammah, a traditional smokeless tobacco habit known in the Arabian Peninsula. The study group comprised 199 male and one female shammah users who were interviewed via a standardised questionnaire and clinically examined in 48 Yemeni villages and cities. Cases with oral leukoplakia (OL) or mucosal burns (MB) were compared with users without any lesion. MB were detected in 31%, of which 46.8% were located on the tongue or floor of the mouth, and OL in 27%, of which 59.2% were located in the same region. In addition, two cases (1%) of apparent OSCC were identified. Statistically significant increased OR (95% CI) of OL were (a) 6.91 (2.66-17.95) for an average duration of the respective shammah application >5min.; (b) 4.90 (1.99-12.08) for a daily frequency of those applications >10; and (c) 4.22 (1.43-12.43) for a daily duration >6h of chewing qat, also a traditional habit in Yemen. Likewise, decreased OR were (a) 0.39 (0.18-0.85) for rinsing the mouth after the shammah application; (b) 0.36 (0.17-0.78) for successful attempts to stop the use in the past; and (c) 0.26 (0.09-0.72) for existing knowledge about the carcinogenicity of shammah that was present in only 19% overall. In conclusion, evidence was shown for a significant association between the prevalence of OL and the daily duration of shammah application in a dose-dependent manner. An appropriate public health program might help to reduce this potential OSCC burden in shammah users.

Unusual foreign metallic object (nail) in the dentition of a skull from the anthropological collection of Rudolf Virchow (Berlin)

Foreign bodies in the dentition of present day patients are frequently diagnosed. They are more rare in mediaeval and anthropological specimens. Rudolf Virchow, the doyen of pathology in Germany formed a huge collection of anthropological specimens in the 19th century. Among these specimens one skull from Tiflis (Tbilisi, Georgia) found its way into the collection of Virchow in 1881. The skull is that of a prisoner of war who died in 1877 due to dysentery. The skull is remarkable in that a metallic nail was adapted around the second right maxillary molar. Both radiological and clinical findings indicate that the nail was adapted to the tooth while the individual was still alive. In particular, erosion of the cortical bone plate in the affected area and osseous healing between the first and second maxillary molar may be taken as proof of adaptation of the nail in vivo. The reasons why the nail was applied, however, are difficult to explain. The authors assume that the nail was applied not by the individual himself. Probably, the nail was adapted as an amulet to protect the individual from injury or death.

Incidence of oral, pharyngeal, and laryngeal squamous cell carcinomas among 1515 patients after liver transplantation

The purpose of this study was to evaluate the incidence and basic characteristics of oral, pharyngeal, and laryngeal squamous cell carcinomas (OPLC) in a single-centre series of liver transplantations (LT). The medical records of 1515 LT cases with a median follow-up of 6 years were analysed retrospectively for incident cases of OPLC. Incidence rates for the oral cavity and pharynx (ICD-9: 141-149), and larynx (ICD-9: 161) were assessed separately. OPLC cases and non-cases were evaluated with regard to end-stage alcoholic liver disease (ALD) as LT indication, smoking, and immunosuppression. The cumulative incidence of 13 cases with OPLC was 0.86% in total (n=1515). For 11 cases of OPLC in 307 patients with LT for ALD, it was 3.58%. The estimates for the annual incidence of OPLC (ICD-9: 141-149) were 121.79 for females and 111.65 for males (/100.000 patient-years). For OPLC (ICD-9: 161), the estimate was 37.21 for males, respectively (no female cases). ALD (84.6%) and pre-LT smoking (92.3%) were significantly overrepresented in OPLC cases (p<0.001). Age and gender distribution were comparable to non-cases. The 5-year survival rate after OPLC was 41.5%. OPLC were demonstrated as a late-onset complication of LT with poor prognosis. The impact of pre-, post-LT smoking, and, in particular, ALD as a confounder of OPLC deserves further investigation.

Oral Candida species and betel quid-associated oral lesions in Padaung women of Northern Thailand

Purpose of the present investigation was to study the association between the betel quid chewing (BQC) habits, the oral yeast flora and oral lesions in female Padaung of northern Thailand. Oral swabs were taken from the tongue and palate of 50 Padaung women with and 50 control individuals without BQC habit. The spectrum of oral Candida species in both groups was determined microbiologically. In addition, oral mucosal lesions were registered in both groups. Mean age of BQ chewers was 35.4 years, of non-chewers was 19.2 years. Candida parapsilosis was the most common Candida spp. isolated both in BQ chewers (46%) and non-chewers (44%). Candida albicans was revealed in 24% of BQ chewers and 18% of non-chewers. There was no significant difference in carriage of Candida spp. isolated between both groups. Forty-four per cent of BQ chewers revealed betel chewers mucosa, 10% showed leukoedema. Isolated populations such as the Padaung may reveal different patterns of candidal flora, in this case a predominance of Candida parapsilosis.

[Occurrence of epithelium in the soft tissues associated with routine surgical removal of 150 mandibular third molars]

BACKGROUND

The aim of the study was to classify epithelial structures (ES) and to determine the prevalence of cysts associated with mandibular third molars (M(3)).

MATERIAL AND METHOD

Sections of HE-stained soft tissue specimens and panoramic radiographs of 150 consecutive patients undergoing surgical removal of M(3) were evaluated. ES were classified as islands and/or strands of odontogenic epithelium (OE), reduced enamel epithelium (REE), stratified cyst epithelium (SCE), oral mucosa (OM), and pocket epithelium (PE). The diagnostic criteria were defined as a pericoronal translucency >2.5 mm and SCE for dentigerous cysts (DC) and a distal translucency >2.5 mm, SCE, and inflammation for inflammatory paradental cysts (IPC).

RESULTS

Median age was 24.4 years: 23.0 years for 86 (57.3%) female patients and 25.7 years for 64 (42.7%) male patients (p=0.017). ES were found in 95.3%, classified as OE in 53.3%, REE in 34.7%, SCE in 28%, OM in 30.7%, and PE in 10.7%. Both REE and SCE were found in 6%. The total number of cases with REE and/or SCE was 56.7%. Median age of cases with SCE was 28.7 years compared to 20.7 years in cases with REE (p<0.001). Pericoronal translucencies were found in four M(3), of which three were associated with SCE. Distal translucencies were found in 47 M(3), of which 15 were associated with SCE and inflammation. The prevalence was 2% for DC and 10% for IPC.

CONCLUSIONS

A differentiated application of histological and radiological criteria enables the prevalence of cystic lesions to be more accurately determined than does the use of one criterion alone.

Hair artefacts in the head and neck region

Three cases illustrating hair artefacts in conventional and panoramic radiography are reported. Hairstyles may create a considerable range of radiopaque patterns, including simple representation of synthetic hair braid extensions or findings that seem inexplicable without thorough reconstruction of the imaging situation. It may be concluded that hair artefacts should be considered in all questionable opacities of the head and neck region.

[Detection of TP53-mutations in brush biopsies from oral leukoplakias]

OBJECTIVE

The aim of this study was to determine the prevalence of mutations of the tumour suppressor gene TP53 in oral leukoplakias.

MATERIAL AND METHOD

Brush biopsy specimens of 43 oral leukoplakias, 26 oral squamous cell carcinomas (OSCC) for reference, and the oral mucosa of 4 clinically normal volunteers were collected. DNA of the critical exons 5-8 was analysed by temperature gradient gel electrophoresis (TGGE).

RESULTS

The prevalence of mutations was 57.7% in OSCC, 39.5% in leukoplakias and 0% in controls. The highest frequency of mutations was found in exon 5 (46.2%) in OSCC and in exon 6 (23.3%) in leukoplakia. More than one mutation was detected in 26.9% of OSCC and 7% of leukoplakia specimens. At least one mutation was found in 37.5% of T1 OSCC and 100% of T4 OSCC specimens and in 37.1% of the L1 leukoplakia and 100% of L3 leukoplakia specimens.

CONCLUSIONS

TP53 mutations could be a useful prognostic indicator in precancerous oral lesions. Although the brush biopsy technique appears simple clinically, further investigations are necessary to specify the implications of genetic analysis.

Betel quid-associated oral lesions and oral Candida species in a female Cambodian cohort

BACKGROUND

Betel quid chewing (BQC) is still prevalent among elderly Cambodian women and is associated with a wide variety of oral mucosal lesions. BQC has also been associated with a reduced rate of dental caries and changes in the oral microbiological flora.

METHODS

Since no studies were available on the impact of BQC on the oral carriage of Candida species, in this study oral swabs (Fungiquick, Hain Diagnostika, Germany) were taken from the tongue and palate of 48 Cambodian women with BQC habit (study group) and 13 control subjects without BQC habit (control group) to determine the spectrum of Candida species in these two groups. In addition, we investigated lesions of the oral mucosa likely to be associated with BQC habit in both study and control groups.

RESULTS

The median duration of BQC was 10 years (range 10 months-30 years). The following oral lesions were found in the study group: betel chewer's mucosa (85.4%), oral leukoplakia (8.3%), leukoedema (37.5%) and oral lichen planus (4.2%). Oral candidiasis was seen neither in BQ-chewers nor in controls. Candida spp. were found in 70.8% of the cases (controls 69.2%). Whilst C. albicans was isolated from 27.1% of the study cohort, C. tropicalis was the second most common isolate. One control case was colonised by C. dubliniensis--the first report of this organism from a Cambodian population. There was no significant difference in the candidal carriage rate or the Candida species isolated between the study and the control group.

CONCLUSIONS

Mycological findings from the present study do not indicate that BQC has a significant effect on oral colonisation by Candida species.

Oral manifestations in 101 Cambodians with HIV and AIDS

BACKGROUND

The HIV/AIDS epidemic in Cambodia has become a major problem in the last 7-8 years, mainly because in this formerly war-stricken country the socioeconomic situation is only slowly improving. Since only very few studies have been published to date on the oral health status of Cambodian HIV/AIDS patients, it was the purpose of the present investigation to study oral manifestations in Cambodian patients with HIV disease.

METHODS

One hundred one Cambodian patients with HIV infection or AIDS were examined for the presence of oral manifestations in one medical center in Phomh Penh, Cambodia.

RESULTS

Sixty-three men and 38 women with a median age of 32 years were examined (age range 7.5-63.5 years). Of these patients, 42.6% were smokers, 46.5% of men were heavy drinkers and 90.5% of men were promiscuous compared with 5.3% of women. The most frequent AIDS-defining diseases were wasting syndrome (54.5%), Pneumocystis carinii pneumonia (PcP) (19.8%) and tuberculosis (18.8%). Puritic papular eruption, a common cutaneous manifestation in HIV-infected patients, was seen in 17.8% of patients. Candida-associated infections of the oral cavity were most common. Among the patients, 52.5% revealed pseudomembranous candidiasis and 35.6% had bilateral hairy leukoplakia. Only 10% of patients had no oral lesions. Also common were necrotising ulcerative gingivo-periodontal diseases (27.7%).

CONCLUSION

The general health status of 101 Cambodian patients with HIV infection and AIDS was poor, and they demonstrated a large number of oral manifestations. Antiretroviral therapy is presently not available and only a fraction of patients receives antimycotic treatment (25.7%). HIV infection and the AIDS epidemic in Cambodia have become a serious problem and patients urgently need adequate diagnosis and antiretroviral therapies.

Thai dental students' knowledge of the betel quid chewing habit in Thailand

385 questionnaires submitted by volunteer Thai dental students on the betel quid chewing habit in Thailand were evaluated. Questions related to the composition of the betel quid, general and oral effects as well as sociological aspects. Only 62.6% considered the habit as typical for Thailand. Knowledge about the composition of the betel quid showed that 30% of the students were poorly informed. Only 58.4% thought slaked lime to be part of the quid. Similar results were obtained for some of the questions relating to physiological and oral effects and the percentage of "do not know" answers was about 30%. It was widely accepted that betel quid chewing is more common in the provinces (83.6%) and that it is a habit of older people (92.2%); particularly women (70.7%). 71.2% of the students did not know where to buy a betel quid. The decline of the habit was monitored by the fact that 96.1% of the students' parents did not indulge in chewing the betel quid compared to 38.7% of grandparents who did. 70% of the students were convinced that the habit will totally disappear. The knowledge of the betel quid chewing habit of Thai dental students indicated a number of deficits showing that these do not come in close contact with this habit anymore in their families or societies. Since elderly people still indulge in chewing betel quid, dental education still has to focus on oral and general effects and side-effects such as oral precancer, oral cancer and oral submucous fibrosis.

[Oral leukoplakia in manifest squamous epithelial carcinoma. A clinical prospective study of 101 patients]

OBJECTIVE

The Uppsala-definition of leukoplakia has recently redefined oral leukoplakia. Based on this definition, the aim of our study was to reevaluate the prevalence of oral leukoplakia in patients with histologically proven primary oral cancer.

DESIGN

A total of 101 in-patients in four tumor centers in Berlin were interviewed and clinically examined just prior to surgery of an oral squamous cell carcinoma (OSCC).

RESULTS

The prevalence of leukoplakia immediately adjacent to the carcinoma was 15.8%. Additional leukoplakias without relation to the carcinoma were found in 4% of the patients. There were no significant differences in age- or sex-distribution, history of tobacco habits or diet between patients with or without leukoplakia. T1 carcinomas were found in 62.5% of patients with, and 24.4% of patients without associated leukoplakia, whereas a balanced distribution was found for the pre-operative staging of the tumor.

CONCLUSIONS

The prevalence of oral leukoplakia in patients with OSCC was low, compared to retrospective studies. The presence or absence of leukoplakia indicated no influence on the prognosis of the tumor, except of tumor size. The results emphasize that most OSCC develop from healthy appearing oral mucosa.

Khmer dental and medical students' knowledge about the betel quid chewing habit in Cambodia

95 of 144 questionnaires submitted by volunteer Khmer medical and dental students on the betel quid chewing habit in Cambodia were evaluated (58 medical, 37 dental). Questions related to the composition of the betel quid, the physiological and oral effects as well as traditional and sociological aspects. Statistical tests showed that there were differences between dental and medical students, particularly relating to the knowledge about oral effects. While 81.1% of dental students knew that betel quid chewing causes oral cancer, only 31.0% of the medical students were adequately informed. Similarly, 51.4% of the dental students knew about the relation between betel quid chewing and submucous fibrosis compared to 8.6% of the medical students (P < 0.001). In contrast, only 18.9% of the dental students thought that betel quid chewing strengthens the gum, while 56.9% of the medical students believed that betel quid chewing would have this effect (P < 0.001). The answers also showed that students do not indulge in the betel quid habit. The decline of the betel quid chewing habit was also indicated by the fact that while 5.3% of students had parents chewing betel quid, in contrast 40% of students reported grandparents with this habit. There are deficiencies of knowledge about the most important effects of betel quid chewing, particularly in medical students. Since both medical and dental students will in their future professional life have an enormous impact on health and health education, it seems justified that the dental and medical curricula should focus on these traditional habits. Proper health education starting in the dental and medical school is warranted in Cambodia and probably also in other South and Southeast Asian countries where the betel quid chewing habit is prevalent so as ultimately to improve public knowledge on the oral and other effects of this habit.

Betel chewer's mucosa in elderly Cambodian women

A total of 102 rural Cambodian women with a mean age of 60 +/- 8.5 years (range 39 to 80 years) who chewed betel quid were examined for oral mucosal lesions, in particular betel chewer's mucosa. The average duration of betel quid chewing was 15.5 +/- 12.8 years. The average number of daily betel quids was 5.4 +/- 2.9. Forty women (39.2%) used betel quids overnight. Thirty-eight (37.3%) did not show any oral mucosal lesion. Sixty-two (60.8%) showed betel chewer's mucosa. Homogeneous leukoplakia was found in three women (2.9%). Out of 130 sites affected by chewer's mucosa, the buccal mucosa was the most frequently involed (n = 68). In thirty-two subjects (31.4%) more than one location was affected. The presence of a lesion was significantly associated with the duration of the habit (P < 0.01) and the number of betel quids per day (P < 0.001). Betel chewing seems to be prevalent in elderly Cambodian women, while younger people do not seem to have taken up this habit. The risk for oral cancer in the Cambodian population is presently unknown.