LETTERS TO THE EDITOR
OOOO February 2014
258
1. The methyl 5-aminolevulinate cream was applied to normal mucosa to compare the absorption and distribution with that observed in mucosa that was clinically affected by oral lichen planus. The results are shown in Figure 2. 2. The question of clinical scoring of oral lichen planus is an interesting topic to discuss. Scoring is difficult because frequently more than one score may apply to each area. We agree that papular or bullous lesions could have been divided, but in this study it had no practical implication, because there were no patients with this score. 3. The criteria for this study were reductions in clinical signs. In further investigation, symptom scores, control groups, and a VAS scale as mentioned in the letter’s last sentence could be included. 4. The flare-up periods were based on patients’ reported symptoms. Further studies should also include selfreported registration of the flare-up periods. The two patients with oral lichen planus of the lip and tongue (one affected with each) were excluded for statistical reasons. Both had excellent results (i.e., total remission) after treatment. 5. In the clinical setting that was available for this study, the natural flow from the salivary glands was not a problem, but it tended to pool in the lower buccal sulcus. We did not want to use drugs to reduce the flow, and even with good suction it is difficult to avoid this pooling. The normal mucosa that was “treated” was in an area distant from the clinically affected mucosa. The lower lip was most commonly used, because both buccal mucosae were typically affected. Sigrid I. Kvaal Trond Warloe Institute of Clinical Dentistry Faculty of Dentistry University of Oslo Oslo, Norway
http://dx.doi.org/10.1016/j.oooo.2013.08.013
Keratocystic odontogenic tumor: a commentary To the Editor: We read with great interest the article titled “Can clinical and radiological features predict recurrence in solitary keratocystic odontogenic tumors?”1 by D. MacDonald, Y. Gu, L. Zhang, and C. Poh. Although systematic reviews have revealed extensive literature on keratocystic odontogenic tumor (KCOT), considerable detail regarding the features that may
indicate an increased risk of recurrence has not been explained in that literature. In this regard, the article by MacDonald et al. has been informative and provides details regarding the clinical and radiological features of those lesions that are more likely to recur. 1. According to the title and stated aim of the article, the objective of the study was to determine whether clinical and radiological features can predict the recurrence in KCOT. However, we noticed that other than age, gender, and site of the lesion, certain other symptoms associated with the cases, such as pain, swelling, and paresthesia, were not mentioned in the article. Was this because these features may not have an effect on the recurrence of the lesion? 2. From the data given in the various tables in the article, we inferred the following: a. The chance of recurrence was greater when the lesion was in the maxilla compared with the mandible. It may be concluded that the reason for this observation could be the difference in the bone pattern between the 2 jaws and also the proximity of the maxilla to more vital structures such as the orbit, nasal cavity, and maxillary sinus. b. Similarly, we observed that when the lesion was in the anterior aspect of the jaws, it had a greater chance of recurrence compared with those in the posterior aspect. We would like to confirm whether the authors also inferred the same from the results obtained in their study. 3. We would further like to ask for clarification about the difference in the method of enucleation carried out when the provisional diagnosis suggested a more aggressive lesion, as mentioned in the article. We would like to congratulate the authors in conducting this study, which has helped us to better understand various features that can help predict the risk of recurrence of a KCOT lesion. Vathsala Patil, BDS Postgraduate Student Department of Oral Medicine and Radiology Keerthilatha M. Pai, MDS Professor and Head Department of Oral Medicine and Radiology Manipal College of Dental Sciences Udupi, Karnataka, India REFERENCE 1. MacDonald D, Gu Y, Zhang L, Poh C. Can clinical and radiological features predict recurrence in solitary keratocystic odontogenic tumors? Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;115:263-271. http://dx.doi.org/10.1016/j.oooo.2013.06.042
OOOO February 2014
258
1. The methyl 5-aminolevulinate cream was applied to normal mucosa to compare the absorption and distribution with that observed in mucosa that was clinically affected by oral lichen planus. The results are shown in Figure 2. 2. The question of clinical scoring of oral lichen planus is an interesting topic to discuss. Scoring is difficult because frequently more than one score may apply to each area. We agree that papular or bullous lesions could have been divided, but in this study it had no practical implication, because there were no patients with this score. 3. The criteria for this study were reductions in clinical signs. In further investigation, symptom scores, control groups, and a VAS scale as mentioned in the letter’s last sentence could be included. 4. The flare-up periods were based on patients’ reported symptoms. Further studies should also include selfreported registration of the flare-up periods. The two patients with oral lichen planus of the lip and tongue (one affected with each) were excluded for statistical reasons. Both had excellent results (i.e., total remission) after treatment. 5. In the clinical setting that was available for this study, the natural flow from the salivary glands was not a problem, but it tended to pool in the lower buccal sulcus. We did not want to use drugs to reduce the flow, and even with good suction it is difficult to avoid this pooling. The normal mucosa that was “treated” was in an area distant from the clinically affected mucosa. The lower lip was most commonly used, because both buccal mucosae were typically affected. Sigrid I. Kvaal Trond Warloe Institute of Clinical Dentistry Faculty of Dentistry University of Oslo Oslo, Norway
http://dx.doi.org/10.1016/j.oooo.2013.08.013
Keratocystic odontogenic tumor: a commentary To the Editor: We read with great interest the article titled “Can clinical and radiological features predict recurrence in solitary keratocystic odontogenic tumors?”1 by D. MacDonald, Y. Gu, L. Zhang, and C. Poh. Although systematic reviews have revealed extensive literature on keratocystic odontogenic tumor (KCOT), considerable detail regarding the features that may
indicate an increased risk of recurrence has not been explained in that literature. In this regard, the article by MacDonald et al. has been informative and provides details regarding the clinical and radiological features of those lesions that are more likely to recur. 1. According to the title and stated aim of the article, the objective of the study was to determine whether clinical and radiological features can predict the recurrence in KCOT. However, we noticed that other than age, gender, and site of the lesion, certain other symptoms associated with the cases, such as pain, swelling, and paresthesia, were not mentioned in the article. Was this because these features may not have an effect on the recurrence of the lesion? 2. From the data given in the various tables in the article, we inferred the following: a. The chance of recurrence was greater when the lesion was in the maxilla compared with the mandible. It may be concluded that the reason for this observation could be the difference in the bone pattern between the 2 jaws and also the proximity of the maxilla to more vital structures such as the orbit, nasal cavity, and maxillary sinus. b. Similarly, we observed that when the lesion was in the anterior aspect of the jaws, it had a greater chance of recurrence compared with those in the posterior aspect. We would like to confirm whether the authors also inferred the same from the results obtained in their study. 3. We would further like to ask for clarification about the difference in the method of enucleation carried out when the provisional diagnosis suggested a more aggressive lesion, as mentioned in the article. We would like to congratulate the authors in conducting this study, which has helped us to better understand various features that can help predict the risk of recurrence of a KCOT lesion. Vathsala Patil, BDS Postgraduate Student Department of Oral Medicine and Radiology Keerthilatha M. Pai, MDS Professor and Head Department of Oral Medicine and Radiology Manipal College of Dental Sciences Udupi, Karnataka, India REFERENCE 1. MacDonald D, Gu Y, Zhang L, Poh C. Can clinical and radiological features predict recurrence in solitary keratocystic odontogenic tumors? Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;115:263-271. http://dx.doi.org/10.1016/j.oooo.2013.06.042
