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Volume 117, Number 5 Abstracts e379

reports should aid in the establishment of such a guideline toheighten the security and prediction of ideal outcomes.

CR0226 RARE STONES Sonita Koshal, Department of OralSurgery, Eastman Dental Hospital, University College Lon-don Hospitals, London, United Kingdom

Background: Sialolithiasis is a common disease of thesalivary glands. However, sialoliths in the minor salivary glandsare considered very rare. The clinical features are not alwaystypical, so clinical misdiagnosis is common. We report 2 rarecases of stones found in the minor salivary glands.

Summary: In case 1, a 21-year-old man attended with a 6-month history of a lower right lip 1 cm swelling. He found itvaried in size, was not painful, and never burst. He had a historyof liths removed from his right submandibular gland 5 yearsearlier and from a lacrimal duct 3 years earlier. The differentialdiagnosis was a mucocele. The mucocele was excised, but therewas an unexpected finding of two 4-mm sialoliths at the base ofthe cavity. The lower lip salivary glands are an unusual site for asialolith to occur, and even more so for multiple liths. A multi-organ disease was considered, but no underlying systemic causewas found. In case 2, a 26-year-old man attended the clinic with a2-year history of a hard swelling within his right anterior tongue.The patient felt it had increased in size and was not painful. Therewas a normal appearance of overlying tongue dorsum and ventralmucosa. Clinically, a 1-cm, hard, smooth, and discrete swellingwas palpated. The differential diagnoses were a cystic lesion orneoplasm. The swelling was excised, and a 5-mm sialolith wasremoved from within the musculature of the anterior right tongue.The stone appeared to have originated from the anterior lingualsalivary glands, also known as glands of Blandin and Nuhn.

Conclusions: These 2 interesting cases and the literaturesuggest that sialoliths of the minor salivary glands may occurmore frequently than previously thought and should therefore beincluded in the clinical differential diagnoses. However, atypicalsigns and symptoms can make this a challenge.

CR0285 THREE CASES OF CANDIDAL CHEILITISMichiko Ozawa, Yoshinori Jinbu, Emi Inoue, HiromiHayashi, Hiroto Itoh, Tadahide Noguchi, Mikio Kusama,Jichi Medical University, Shimotsuke, Japan

Background: Oral candidiasis is an opportunistic infection byCandida species, often associated with hyposalivation, anticancerdrugs or radiation for head and neck cancers, denture use, steroidtherapy, or long-term treatment with antibiotics. The main symptomsof candidiasis are pain in the oral mucosa, burning sensation, anddysgeusia. However, candidiasis affecting the lips is relatively rare. Inaddition to the causes mentioned, candidiasis involving the lips maypotentially involve topical steroids for dermatitis.

Summary: We describe the cases of a 74-year-old woman(case 1), a 54-year-old woman (case 2), and a 71-year-old woman(case 3) with swelling and redness of the lips. Case 1 was diag-nosed as candidal cheilitis by biopsy. Case 2 was diagnosed ascandidal cheilitis by fungal culture. Initially, metal allergy wassuspected in case 3, but it was diagnosed as candidal cheilitis byclinical symptoms. The boundary between the skin and vermilionzone was slightly clearer a week after starting topical antifungaluse, with improved swelling and redness of the upper and lowerlips. After a month of use, redness had almost disappeared, andthe boundary between skin and vermilion zone was clear.Swelling, redness, and pain disappeared with antifungal treat-ment, and progress has been good, with no recurrence.

Conclusions: The development of oral candidiasis is oftenattributable to reduced capacity for saliva secretion and weak-ening of the immune system, whereas development of candidiasisaffecting the lips may also involve use of topical steroids, similarto dermatitis of the vermilion zone. Because the use of steroidsand oral antibiotics may be conducive to candidal infection, thepossibility of candidal cheilitis should also be considered in caseswhere cheilitis does not improve with steroid ointments, or incheilitis with inflammation.

CR0408 MUCOEPIDERMOID CARCINOMA OF THEMAXILLARY SINUS IN A YOUNG PATIENT ThaísGimenez Miniello, Celso Augusto Lemos Junior, ThiagoCelestino Chulam, Juliane Pirágine Araújo, Victor Piana deAndrade, Fabio Abreu Alves, Department of Stomatology,A.C. Camargo Cancer Center, São Paulo, Brazil

Background: Salivary gland tumors account for about 1%of tumors of the head and neck region. Sinonasal mucoepi-dermoid carcinoma may be confused with odontogenic tumors.

Summary: An 18-year-old boy presented a swelling, whichinvolved both the palate and vestibular region of the right maxilla.The panoramic radiograph found a large osteolytic lesion affectingthe maxilla. Our diagnosis hypotheses were ameloblastoma andkeratocystic odontogenic tumor. An incisional biopsy was per-formed, and the result was low-grade mucoepidermoid carcinoma.To better evaluate the tumor, computed tomography was per-formed, which found a lesion with soft tissue density arising in themaxillary sinus and involving the right side portion of the hardpalate and maxilla. In addition, some areas of bone erosion wereobserved. The treatment consisted of tumor resection withmicrosurgical free flap reconstruction. After 3 months, a dentalprosthesis was made, and the patient is asymptomatic.

Conclusions: The present case showed a very rare case ofmucoepidermoid carcinoma that arose in maxillary sinus. Owingto its clinical and radiographic features, this tumor can be mis-diagnosed as an odontogenic tumor.

CR0415 A CASE OF COMPLEX CONNECTIVE TISSUEDISEASE WITH A DIAGNOSTIC DILEMMA Daniela Ion,Priya Thakrara, Penelope Shirlaw, Department of OralMedicine, Guy’s and St Thomas’ NHS Foundation Trust,London, United Kingdom

Background: A 52-year-old woman was referred by rheu-matology for investigations of a dry mouth.

Summary: The patient presented with a decade of mixed-pattern connective tissue disease under the joint care of rheu-matology and dermatology. Six years earlier, the patient beganto notice having dry eyes and mouth, with increasing severityover time. Serial investigations failed to arrive at a satisfactoryexplanation or diagnosis. Her connective tissue disease manifes-tations have now been attributed to an Ehlers-Danlos type 3,probable poikilodermatomyositis and possible photosensitivelupus. She is currently maintained on weekly methotrexate andfolic acid rescue, with no other medications likely to cause drymouth as a side effect. There are no signs to suggest a nodalosteoarthritis portraying the sialadenitis, nodal osteoarthritis, andxerostomia (SNOX) syndrome diagnosis as an alternative. Cur-rent investigations to establish whether or not the patient hasSjögren syndrome have so far found a low whole salivary flow(< 0.1 mL/min), normal stimulated parotid flow (0.75 mL/min),borderline lacrimal flow in the left eye and normal flow in theright eye. Serology has persistently found negative status for

ORAL MEDICINE OOOO

e380 Abstracts May 2014

extractable nuclear antigens, antinuclear antibodies, doublestranded DNA, and rheumatoid factor autoantibodies. Recentsalivary gland ultrasonography has confirmed a normal echo-texture of the major salivary glands. A labial gland biopsy isplanned as so far the diagnosis of Sjögren is unlikely.

Conclusions: This case highlights the diagnostic dilemmawhen assessing patients with xerostomia as 1 component of acomplex connective tissue disease presentation. By the ModifiedAmerican European Diagnostic criteria, the Sjögren diagnosiscannot be sustained, even with a positive lip gland biopsy.However, following the newly proposed SICCA Collaborationcriteria, the diagnosis is still doubtful without the lip biopsycontribution, unless ultrasonography is permitted as an alterna-tive. The results of further investigations will be presented in thecontext of the diagnostic criteria for Sjögren syndrome, high-lighting the current controversies in its diagnosis.

CR0421 TWO SURGICAL TREATMENTS FOR THEMANAGEMENT OF KERATOCYSTIC ODONTOGENICTUMORS Rebeca Vasconcelos, E.L. Queiroz, S. Corby-Nunes, P.M. Corby, B.L. Schmidt, Bluestone Center forClinical Research, NYU College of Dentistry, New York, NY,USA

Background: The keratocystic odontogenic tumor (KCOT)is a benign odontogenic neoplasm that has destructive and infil-trative behavior and a high recurrence rate. The KCOT can occuras part of nevoid basal cell carcinoma syndrome (NBCCS) withhigh prevalence or as a sporadic case. A wide spectrum of sur-gical treatment has been reported for the KCOT, with no optimaloutcomes. The treatment modalities include enucleation alone orwith peripheral osteotomy, resection, treatment with adjuvantsubstances (Carnoy solution or cryotherapy), marsupialization,and decompression.

Summary: In this poster we report 2 different surgicaltreatments for KCOT: (1) a modified decompression techniqueand (2) enucleation with cryosurgery and a simultaneous bonegraft.

Conclusions: The techniques presented in these case reportshave been reported to be associated with a lower recurrence rate.However, given the clinical behavior of KCOTs and the well-documented high recurrence rate, long-term follow-up withclinical examination and plain radiographs is required.

CR0432 ORAL MANIFESTATIONS OF ARECA NUTHABITS: SELECTED CASES Nirav H. Parekh, Sonal Shah,Dharti Patel, Alexander Ross Kerr, Department of OralMaxillofacial Pathology and Radiology, New York UniversityCollege of Dentistry, New York, NY, USA

Background: Areca nut chewing with or without tobacco iswidespread in people of South Asian countries. Areca nut alka-loids are addictive, and habitual use of areca nut can adverselyaffect oral health. There is a growing immigrant population fromcountries like India, Pakistan, and Bangladesh, and these immi-grants bring these habits to the United States. Currently, there arefew restrictions on the sale and distribution of areca nut products.To help educate oral health care providers, we will present aseries of clinical cases from South Asian immigrants in New YorkCity to show the different habits and oral manifestations of arecanut use.

Summary: The cases compare and contrast 2 differenthabits, namely the chewing of paan or betel quid (where the userrolls up the ingredients in a betel leaf) and guthka (where the user

opens a single-use industrially manufactured sachet containingthe ingredients). The oral manifestations include severe dentalattrition, extrinsic staining, betel chewer’s mucosa lichenoid re-actions, and potentially malignant oral disorders including oralsubmucous fibrosis epithelial dysplasia and oral squamous cellcarcinoma.

Conclusions: An understanding of these habits and theiroral manifestations can facilitate better patient care managementof such patients, including the early detection of potentially ma-lignant oral disorders.

OI0269 TREATMENT OF ORAL LICHEN PLANUS WITH0.1% TACROLIMUS IN ORAGARD-B Siddharth Gupta,Nitasha Gupta, Department of Oral Medicine and Radi-ology, I.T.S. Dental College, Hospital and Research Centre,Greater Noida, India

Objectives: The purpose of the study is to investigate theefficacy and safety of 0.1% tacrolimus powder in Oragard-B forthe treatment of patients with symptomatic oral lichen planus(OLP).

Methods: A nonrandomized, unblinded study was con-ducted in 20 patients with symptomatic oral lichen planus. Pa-tients were provided with 20 g containers of study medication,and instructed to apply 3 times daily until the resolution of thelesions. Clinical assessment was performed every 15 days. Tissuechanges from pretreatment values and posttreatment values werecompared using Wilcoxon signed rank test; a value of P < .001indicated a significant change.

Results: The patients responded well to topical tacrolimus.Eleven patients had complete resolution of lesions, and all 20patients had significant improvement in their symptoms. Therewere significant improvements comparing pretreatment statuswith posttreatment changes (P < .001).

Conclusions: Topical tacrolimus in Oragard-B is effectivein the treatment of patients with symptomatic oral lichen planus.

OI0442 LOW-COST ORAL SPLINT IN THE BRAZILIANPUBLIC HEALTH SERVICE Paulo Pimentel, Jr., LairaMachado de Braganca Soares, Department of Dentistry,Niterói, Rio de Janeiro, Brazil

Objectives: The mechanisms of action of oral splints arestill controversial. Nevertheless, their use in the managementof temporomandibular disorders (TMDs) is known to helprelieve pain and to protect tooth wear associated with bruxism.The use of articulators, the need for occlusal adjustments,and the laboratory steps to fabricate acrylic splints are asso-ciated with costs that are too high for splints to be used inthe Public Health Service (PHS). The aim of this study was toevaluate the use of acetate oral splints in patients referred tothe PHS Orofacial Pain and TMD Center in Rio de Janeiro,Brazil.

Methods: The patients referred to the OFP/TMD Centerwere assessed according to the American Academy of Orofa-cial Pain criteria. They were educated to recognize and avoidoral parafunctional habits, to understand sleep hygiene andmethods for reducing anxiety, and to perform therapeutic ex-ercises and were provided directions on the use of analgesicsand adjunctive drugs. When needed, the oral splints were madeof acetate. Casts of the lower or upper arches were made, thesplint was pressed in a vacuum press device using an acetateplate, and it was then fitted to the patient. Additional occlusalbuild-up with self-curing acrylic was performed only when