Plasma levels of factor Xifi and its substrates [plasma fibronectin (PFN) and α2-plasmin inhibitor (α2-PI)] were measured in leukemia patients with intractable oral mucosal ulcers to study the implications of these parameters in ulcer formation and healing. The findings were as follows: 1. Oral mucosal ulcers appeared predominantly on the buccal surface of the gingiva at the lower molars and at the margin of the tongue. 2. Regarding the relationship between oral mucosal ulceration and chemotherapy agents, the incidence of ulcers was higher when Ara-C, ADM, DNR, VCR or PSL were administered. 3. There was no significant difference in the plasma factor XIII level between healthy individuals and leukemia patients without ulcers, while PFN and α2-PI levels were slightly higher in the latter. 4. Factor XIV PFN and α2-PI levels were significantly lower at the time of oral mucosal ulcer formation than in the absence of an ulcer. 5. The platelet count was significantly lower in the presence of an oral mucosal ulcer than in its absence. 6. There was no significant difference between the time of oral mucosal ulcer formation and absence of ulcer in terms of plasma fibrinogen (Fib) level, WBC count or neutrophil count. 7. The CRP level was significantly higher at the time of oral mucosal ulcer formation than in the absence of such an ulcer, while the T-P level showed no significant difference between the presence and absence of oral mucosal ulcer. 8. The incidence of ulcer formation was higher in patients with a WBC of <1, 000/mm3 and a neutrophil count of <500/mm3. 9. No correlation was noted between the factor XIII level, the α2-PI level, the PFN level and the platelet count at the time of oral mucosal ulcer formation. 10. A positive correlation was shown between factor XIII and PFN levels, between the α2-PI and Fib. levels, between the factor XIII level and platelet count, and between the factor XIII and T-P levels in the absence of an oral mucosal ulcer. Various blood parameters were thus measured in leukemia patients in the presence and absence of ulcerous lesions of the oral mucosa and the results suggested that factor Xifi and related factors forming its substrate may play a role in the development and healing of ulcers.
One-hundred and twenty-six cases of mandibular ameloblastoma, consisting of 111 primary and 15 secondary cases, were analyzed. The correlation among tumor characteristics, treatment and prognosis was discussed. 1. In the anterior group, patients were relativery old. Most tumors were radiographically demonstrated to be of honeycomb or multilocular type, and the majority histologically revealed follicular pattern showing Ishikawa Type I or II. 2. In the molar/retromolar group, patients ranged in age from the second to fourth decades. Over half of the tumors were of unilocular type radiographically and revealed plexiform pattern showing Type III. Honeycomb or mixed type were rare in this region. 3. The majority of the cases involving impacted teech were seen in the second or third decades and the site was consistently confined to the molar/retromolar region. Cases involving impacted tooth were not seen in the anterior region. These findings suggest that the tumor occurs in the molar/retromolar region at an earlier age than in the anterior region and that the distinct radiographic findings in each of these regions are caused by different structures of bone trabeculae. 4. In regard to capsule invasion of the tumor, the overwhelming majority of unilocularplexiform-type and unilocular-Type III lesions were of shallow invasive type. Growth was characterized by expansion. However, extracapsular invasion should be considered in other combinations of types because tumor invasion tended to be deep. 5. Regardless of histologic type, bone marrow invasion was seen in all cases of honeycomb and mixed type. Even in the cases of uni-or multi-locular type, bone marrow invasion should be considered when the tumor is follicular type showing Type II. 6. Recurrence rates in cases followed up for more than 3 years were 0/14 for patients undergoing mandibular resection, 0/13 for partial resection, 8/55 for enucleation followed by curettage, and 1/18 for cryosurgery. 7. Enucleation followed by curettage is used in uni-or multi-locular type, and in mixed or honeycomb type in combination with partial resection. 8. The indications for cryosurgery are the same as for enucleation followed by curettage. 9. Partial resection is used to treat relatively confined honeycomb type. 10. Fenestration is used to treat cystic tumors when the inferior border of the mandible is extensively affected. 11. Mandibular resection is employed in cases where the tumor causes extensive destruc-tion of the inferior border of the mandible, except in unilocular type. 12. Thirteen cases regarded to be unicystic ameloblastoma occurred in the second or third decades. All cases involved impacted teeth and revealed plexiform type showing Type III. Enucleation followed by curettage or cryosurgery was employed as treatment and no signs of recurrence were noted.
The diagnostic accuracy of temporomandibular joint arthroscopy was evaluated at autopsy. Arthroscopy was performed in the upper compartment of 36 temporomandibular joints in 18 fresh cadavers to investigate the accuracy of arthroscopic diagnosis of disc perforation and two types of adhesion (band adhesion and pseudowall). Punctures were made by inferolateral, anterolateral, and endaural approaches. Subsequent dissection revealed that eight of nine disc perforations had been accurately diagnosed arthroscopically and that all band adhesions had been diagnosed arthroscopically. Six of seven pseudowalls had been diagnosed, but four pseudowalls had been overdiagnosed arthroscopically. Therefore, the diagnostic accuracy of disc perforation was 97%, that of band adhesion was 100%, and that of pseudowall was 86%. It was concluded that arthroscopic diagnosis of disc perforation or band adhesion was reliable, whereas arthroscopic diagnosis of pseudowall was not reliable. Double-puncture penetrating from two different directions, either an inferolateral-anterolateral approach or an inferolateral-endaural approach, was considered to be significantly more effective for diagnosing disc perforation within the lateral third of the joint.
We examined 13 cases of primary oral aspergillosis in adult leukemia patients. Although the patients received systemic and local antifungal treatment in laminar air-flow rooms, primary oral aspergillosis generally developed in about 20 days in association with adrop in leukocyte count to under 1, 000/mm3 after chemotherapy. The initially involved area was the marginal gingiva which was associated with necrosis and severe pain. At the same time, spiking fever of about 39°C was observed. Necrotic changes of the gingiva progressed rapidly and invasively extended from the mucosa to muscle and bone. Local aspergillosis basically disappeared when the hematologic status of the patients returned to normal levels under antifungal treatment. The prognosis of primary oral aspergillosis was relatively good. However, damaged oral tissues were easily reinfected with aspergillus during chemotherapy. These findings suggest that oral hygiene plays an important role in the development of oral aspergillosis in adult leukemia patients.
The frequency of lymph node and distant metastases and the metastatic patterns of salivary gland carcinomas were studied clinically and pathologically. Forty-nine salivary gland carcinomas (9 from the parotid gland, 7 from the submandibular gland, 6 from the sublingual gland, 14 from the palatal gland, 5 from the retromolar gland, 4 from the buccal gland and 4 from other glands) were reviewed. Five-year survival was estimated at 91.6% for 25 cases without metastases, and 58.5%for 24 cases with metastases. The frequency of lymph node and distant metastases varied depending on the anatomical site of origin. In carcinomas of the parotid, submandibular and retromolar glands, lymph node metastasis was more frequent than distant metastasis, whereas in carcinomas of the sublingual and palatal glands, distant metastasis was only observed. Different histological carcinomas showed different patterns of metastasis. In adenoid cystic carcinoma, distant metastasis was more frequent than lymph node metastasis. However in mucoepidermoid carcinoma and adenocarcinoma, lymph node metastasis was more frequent than distant metastasis. In mucoepidermoid carcinoma, metastasis tended to developed early in the course of the disease. In adenoid cystic carcinoma, metastasis developed up to 18 years after treatment. The histological pattern of adenoid cystic carcinoma and the histological grade of mucoepidermoid carcinoma were related to the appearance of metastasis. Adenoid cystic carcinoma of solid and trabecular types and mucoepidermoid carcinoma of epidermoid cell type metastasized frequently.
This report describes rare postoperative complications occurring after left radical neck dissection in three patients with advanced head and neck cancer. A chylous fistula occurred in the first patient, chylothorax in the second, and both in the third. The high triglyceride content of the drainage demonstrated the presence of chyle in the three patients. Chylous fistulas occurr due to injury and incomplete ligation of the thoracic duct and lymphatics in the left lower neck. Chylothorax is caused by the breakdown of intrathoracic ducts associated with increased internal pressure arising from ligation of the thoracic duct. The first patient was reoperated on and ligated because of high fistula output. The other patients were conservatively managed with closed-wound drainage, low fat nutritional support and/or thoracocentesis. Treatment was successful. Generally, the treatment of chylous fistulas is conservative, including techniques such as local compression, drainage, nutritional management and/or IVH. Reoperation and ligation of the thoracic duct and lymphatics are required when the output is continuous or high. Chylothorax following left radical neck dissection is recommended to be treatedly conservatively.
Thirty-eight previously untreated patients with carcinoma of the oral cavity were analyzed in regard to the relationship between induction chemotherapy, primarily employing CDDP, and nutritional status. The prognostic nutritional index (PNI) proposed by Onodera was used to quantify nutritional status. The PNI value was calculated by the following formula: PNI=10 × serum albumin valued-0.005 × lymphocyte count. The PNI value before chemotherapy was 47.2 ± 6.7 in patients showing a sufficient response to chemotherapy and 48.1 ± 4.9 in nonresponders. These results were comparable. Regarding the change in PNI after chemotherapy, a rise in PNI was more frequently noted in responders than in nonresponders (52.9% vs.9.5%, P<0.05). These results were attributed to the reduction in pain associated with mastication or swallowing in patients showing tumor regression in response to anticancer therapy, resulting in increased appetite in this group.
We investigated arachidonic acid (AA) metabolites in synovial fluid of 18 patients with temporomandibular joint (TMJ) arthrosis. AA metabolites were separated and quantified by high performance liquid chromatography (HPLC). Among 18 patients, 15 were treated by injections of sodium hyaluronate (SH) into the superior joint compartment of the TMJ. We assessed the effect of treatment clinical symptoms and the generation of AA metabolites. In addition, we measured the leukotrienes (LTs) produced by polymorphonuclear leukocytes (PMNs) obtained from peripheral blood and studied the effect of SH. The following results were obtained: 1. Clinical symptoms of TMJ arthrosis improved after intra-articular injections of SH. 2. As clinical symptoms improved, AA metabolites decreased. 3. SH tended to inhibit the generation of LTs produced by stimulated PMNs. 4. This study suggests that TMJ arthrosis is associated with inflammation.
Small cell carcinomas usually occur in the lung, and they often metastasize to the brain. We encountered a case of small cell lung cancer (SCLC) which apparently metastasized to the oral region. The patient was a 50-year-old man with a tumor in the mandibular gingiva which was suspected to be the primary lesion. Pathologically, it was diagnosed to be a small cell carcinoma, because round or short spindleshaped cells were observed using hematoxylin-eosin stain, and the NSE (neuron specific enolase) immunohistochemical staining method was positive. Chest X-ray examination, CT scan and scintigraphy indicated the presence of in the right upper pulmonary lobe. As SCLC rarely occurs in the oral region, the oral lesion was considered to have originated in the lung. However, the diagnosis could not be confirmed because biopsy of the lung tumor was impossible. The patient died due to septicemia 3 months after admission.
We report a relatively rare case of oral symptoms associated with leukemia. A 63-year-old man who had undergone chemotherapy for chronic lymphatic leukemia was referred to our clinic for severe periodontitis, particularly prominent in the maxilla. Symptoms became worse over 2 years, and sequestration finally occurred in most of the alveolar bone of the maxilla. Only conservative treatment was performed due to leukemia.
We report on the autotransplantation of mature permanent teeth. The recipient beds were made by splitting alveolar process osteotomy. In general, tooth transplantation is difficult in patients with slender alveolar processes. However, it is possible to make a recipient bed by means of splitting alveolar process osteotomy. If necessary, we used particulate bone obtained by extraction of impacted teeth or splitting alveolar process osteotomy to repair the bone defect. Good results were obtained. The indication range for tooth transplantation was able to be expanded by these procedures.
A case of synovial osteochondromatosis of the temporomandibular joint is presented. A 32-year-old female visited our department complaining of disturbances in mouth opening. On examination, the interincisal opening was 28 mm with pain in the left TMJ. There was no joint noise in the affected joint or preauricular swelling. Conventional radiographic examination showed a normal appearance in the left joint. Arthrography of the left TMJ revealed anterior displacement of the disk without reduction. Arthroscopy of the superior compartment of the left TMJ revealed small nodules on the synovium of the mandibular fossa and a loose body in the anterior recess. The nodules and loose body were removed arthroscopically. Histopathologically, the diagnosis was synovial osteochondromatosis. Arthroscopy was extremely useful in the diagnosis and treatment of this condition.
Lymphoepithelial cysts generally occur at the lateral aspect of the neck. They are rarely found in the oral cavity. We recently encountered a patient with a lymphoepithelial cyst on the ventral surface of the tongue. The patient was a 55-year-old woman who complained of a small mass at the base of the tongue. Clinically, the mass was localized at the right ventral surface of the tongue. The mass was 7 × 4 mm, elliptical, localized, and presented with a pink color and smooth surface. Its consistency was elastic hard and it was mobile by palpation. The clinical diagnosis was a benign tumor of tongue. The lesion was totally excised under local anesthesia. Pathologically, the mass had a cyst cavity and the wall consisted of stratified squamous epithelium and lymphoid tissue. The pathological diagnosis was lymphoepithelial cyst. Now, 3 months after the operation, there is no evidence of recurrence in the patient.
Sialolithiasis is a generally considered to be a relatively rare disease in children. I lowever, we recently diagnosed sialolithiasis in the left submandibular duct of an aged 3 years and 2 months. Although routine microscopic examination of the enucleated specimen revealed sialolithiatic components similar to those described by other authors, transmission electron microscopy showed needle-like crystalline substances of high electron density in bacteroid corpuscles suggesting the possible involvement of endobacillary calcification in the development of sialolithiasis.
A rare case of a papillary cystadenoma extending from the lower lip to the buccal mucosa of a 79-year-old female is presented. The tumor consisted of a single cyst with multiple papillary projections into its cystic space. It appeared to have potentially malignant characteristics because the cellular atypia of this tumor had apparently increased histologically in surgical specimens obtained two times from the same patient. When encountered, papillary cystadenoma should be treated by radical removal, and the patient should be carefully followed up similar to other patients with malignant tumors.
A case of von Recklinghausen disease with a palatal tumor occurring in a 48-year-old man is presented. The patient had many cafe-au-lait spots and elastic-like soft cutaneous tumors extending all over the body. At the center of the hard palate mucosa, a small fingertip-sized tumor was observed. This lesion was excised under local anesthesia and submitted for microscopic examination. The histopathological diagnosis was neurofibroma. The patient's postoperative course was uneventful and stabilized dentures were inserted.