Biography:

Dr Nasir Ahmad Salati is currently working as Assistant professor in Oral Pathology & Oral Medicine Department of Dr. Ziauddin Ahmad Dental College, A.M.U., Aligarh, India. He is involved In Teaching Oral Pathology, Oral Medicine, Histopathology, Oral Microbiology & Clinical Oral Pathology. His research interests include Special stains, Tissue immunohistochemistry, Oral tumors & Cryosurgery.

Abstract:

Osteopontin (OPN), a non-collagenous protein induces endothelial cell migration, acts in a subset of migratory pathways, plays a role in immune mechanisms and helps in regulatory pathways of the body. It acts as a ligand for the CD44 cell surface receptor sand stimulates chemotaxis of CD44-expressing cells. Several extracellular matrix proteins bind OPN in vitro, including fibronectin, osteocalcin and collagen types I, II, III,IV, and V, and may modulate cell-extracellular matrix interactions in vivo. As an early T lymphocyte activation protein 1 (Eta-1), it is believed to enhance Th1 but inhibit Th2 response. OPN increases invasiveness by inducing proteinases, promotes angiogenesis, increases tendency of cells towards metastasis, and acts in association with other growth factors to induce malignant properties. The purpose of present  study is a) to evaluate its expression in oral lesions b) compare intensity of expression in  these lesions,  and c) to correlate the degree of expression of OPN with prognosis.

 Study design: Purposive sampling of 120 cases of normal mucosa, mild dysplasia, severe dysplasia, OSMF and OSCCs were selected. The immune-positive reaction and score for each case was evaluated. Expression of OPN was correlated with clinical findings.

Results: In mild dysplasia & OLP, OPN expression was confined to basal cell layer with moderate intensity. The expression was strong throughout whole epithelium in severe dysplasia.OPN expression with moderate intensity in basal cell layers was observed in OSMF. The expression was very strong in OSCC.

Conclusion: Our study suggests potential role of Osteopontin in prognosis of oral lesions.

Biography:

Morhaf Sadek is a board- certified oral & maxillofacial surgeon and an adjunct associate professor in the department of Oral & Maxillofacial Surgery, University of Detroit Mercy School of Dentistry, Detroit, MI.

Abstract:

A 49-year-olf African American female was referred to the Oral and Maxillofacial Surgery Clinic at the University of Detroit Mercy, School of Dentistry for evaluation of a large, right mandibular radiolucency. Clinical examination revealed an asymptomatic slight buccal expansion of the right mandible. All teeth tested vital. Panoramic radiography revealed a large well-defined, multilocular radiolucent lesion spanning from the apex of tooth #27 to the ascending ramus distal to tooth #32. Other radiopaque lesions with radiolucent margins were noted at the apices of the mandibular incisors, left canine, first premolar and first molar. Computed tomography revealed a nonspecific expansile cystic lesion within the right mandibular body surrounding the roots of the right mandibular first through third molars as well as partially surrounding the roots of the right mandibular canine and the first and second premolars.

 Exploration of the lesion was performed under local anesthesia. Aspiration of the lesion yielded a yellowish fluid and the cavity that was surgically explored appeared hollow with a thin soft tissue lining. The H&E stain histopathology showed a mixture of loose fibrovascular connective tissue, fragments of vital bone, a mild infiltrate of chronic inflammatory cells, and extravasated erythrocytes. The histopathology, in conjunction with the surgical findings and radiography, were consistent with a diagnosis of a simple bone cyst with concomitant cemento-osseous dysplasia. Observation of the lesion will be continued until complete healing is radiographically confirmed, and outcome of the lesion will be reported in the future.

Biography:

Alan Y. Martinez completed his dental degree in Honduras and his oral and maxillofacial surgery residency in Peru. He is currently in charge of the division of oral and maxillofacial surgery at the MetroHealth System a level 1 trauma center in Cleveland, OH.  He has publish 6 articles in English and Spanish in different oral and maxillofacial surgery topics, and is a reviewer of several journals.

Alan Y. Martinez, DDS

Abstract:

Necrotizing fasciitis (NF) is a rare soft tissue infection of the subcutaneous tissue and superficial fascia that results in rapidly progressive necrosis with secondary involvement of the skin and muscle and a high mortality.  Cervicofacial NF (CNF) is an extremely rare entity, accounting for only 2.6 – 5 % of all NF (Hohlweg-Majert et al., 2006; Wong et al., 2003).  There are several different historical descriptions and references to NF dating back to  Hippocrates in 500 B.C. who described diffuse non-healing wounds.  Pouteau and Gillespie in 1783 and 1785 described malignant and gangrenous ulcers, respectively (McGurk, 2003).  In 1871 Joseph Jones, a confederate army surgeon during the U.S. civil war, was the first to accurately describe NF calling it a “hospital gangrene” (Jones, 1871).  Meleney in 1924 described 20 cases of hemolytic streptococcal gangrene (Meleney, 1924). Wilson in 1952 coined the term necrotizing fasciitis (Wilson, 1952).  Yet, there is very little information on presentation, management, and outcome of patients with NF specifically involving the head and neck.

NF is classified as one of three types based on microbiologic findings: type 1 is a polymicrobic infection with a combination of anaerobic and aerobic bacteria, type 2 is a monomicrobial infection mainly due to group A beta-hemolytic streptococci (GAS) and less commonly other streptococci, and staphylococci and type 3 is a monomicrobial infection due to marine vibrios (Low and McGeer, 1998).  The clinical manifestations of NF include: swelling, redness, pain, fever, blebs, bullae, and crepitus (Chen et al., 2001).  CNF is most commonly a sequalae of odontogenic infection. Less commonly CNF may occur as a consequence of soft tissue trauma. It may rarely occur in the absence of a known inciting factor or a known portal of entry of bacteria as was true in one of our patients (case #1). The spontaneous occurrence of necrotizing fasciitis has been reported to account for up 20 % of patients (McHenry et al., 1994).

Conclusion

Cervicofacial necrotizing fasciitis is a rare disease associated with a high morbidity and mortality. Early diagnosis and rapid aggressive radical surgical treatment are the main factors associated with reduced morbidity and mortality.