Expression of the TGF-β and type I collagen genes during healing of extracted tooth sockets was studied using in situ hybridization and immunohistochemistry. 1. Histological findings A clot was formed in the extracted tooth socket 1 day after extraction. By 2days after extraction, fibrogenesis was evident in the clot. Bone trabeculae began to form from the basal wall of the tooth socket from 3days, and from the lateral walls from 3 to 5 days after extraction. The tooth sockets were filled by newly formed bone within 14 days after extraction. 2. Gene expression of TGF-β 1 At 1 day after extraction, the gene for TGF-β 1 was expressed in leukocytes near the clot, and in fibroblasts and osteoblasts in the remaining periodontal ligament after tooth extraction. The signals of osteoblasts associated with newly formed bone were increased from 3 days after extraction. Within 5 to 7 days after extraction, the most intense signals were observed in osteoblasts along the newly formed bone trabeculae and in fibroblasts. The signals in the cellular component at 7 days after extraction were stronger than those at 14 days after extraction. 3. Gene expression of type I collagen The gene for type I collagen was expressed more strongly than that of TGF-β 1. At 1 day, no signals were found in the cells of the clot, but fibroblasts and osteoblasts showed intense expression. After 2 days the distribution of signals was essentially the same as that for TGF-β 1. 4. Immunohistochemistry of TGF-β 1 At 1 day after extraction, immunolocalization of TGF-β 1 was observed in the clot, leukocytes, and in fibroblasts and osteoblasts in the remaining periodontal ligament after tooth extraction. Then, immunoreactions were observed in osteoblasts and fibroblasts. These results suggest that expression of the TGF-β gene regulates the synthesis of type I collagen by fibroblasts and osteoblasts, and plays a central role in cell proliferation and differentiation during the healing of extracted tooth sockets.
A bone-inducing substance was extracted from demineralized and defatted bovine tooth matrix by means of 6 M guanidine hydrochloride solution. The authors attempted to study the bone induction properties of this substance, the associated bone-inducing process, and to purify the substance to derive the fraction with bone induction properties. Results 1.The bone-inducing substance was extracted from demineralized and defatted bovine tooth matrix at the rate of 0.48%. 2. After implanting this bone-inducing substance to the femoral muscle of mice, typical endochondral ossification occurred. 3. After this bone-inducing substance was purified by gel-filtration, four fractions were obtained. Only the second fraction demonstrated bone-inducing activity. 4. In SDS-PAGE, the second fraction had three major bands, with molecular weights of about 28000, 20000 and 14000. 5. After these major bands were electroblotted from SDS-PAGE on to NC membrane, each band was implanted to the femoral muscle of mice. Only the band with a molecular weight of about 28000 demonstrated bone induction.
The present study investigated how elastic system fibers (ESFs) in the articular zone of guinea-pig mandibular condyle respond to aging and changes in diet by using both light microscopy and quantative analysis. The following results were obtained: 1) ESFs were observed at the fibrous zone of the mandibular condyle in all groups. 2) The number of ESFs in the fibrous zone decreased in association with aging of the mandibular joint. 3) ESFs in the fibrous zone decreased with a change in diet in the young group but increased in the adult group.
The progressive and continuous growth of malignant tumor tissue is possible only after induction of a vascular network into the tumor tissue from the surrounding tissue. Some chemical substances produced by cancer cells are known to stimulate the angiogenic process in the tumor tissue in either a paracrine or autocrine manner. The authors investigated the angiogenic process of cultured oral carcinoma cells using an in vitro experimental model. The cancer cell lines examined were KB cells and a cell line established from the metastatic lymph node of mucoepidermoid carcinoma, designated IT-2. In vitro angiogenic activities in conditioned media (CM) of KB and IT-2 were enhanced 7.3 and 6.0 times as compared with non-conditioned medium. In addition, the enhancing effect of CM was markedly diminished by pretreatment of CM with anti-b FGF or anti-VEGF Ig Gs. These results suggest that the angiogenic activities of KB and IT-2 depend on both b FGF and VEGF.
In this study, cultured epithelium was formed using serially cultivated human oral mucosal cells and transplanted onto nude mice. The morphological changes of the epithelium were observed after transplantation. The grafting procedures of the cultured epithelium was a modification of Barrandon's method. With this procedure, the cultured epithelium was transplanted without external trauma or infection. The cultured epithelium took within 1 week and gradually increased its epithelial thickness. Until 4 weeks after grafting, the grafted epithelium formed normal mucosal epithelium composed of 7-10 epithelial cell layers. However, no keratinization of the epithelium was observed. On the other hand, dermislike connective tissue was observed beneath the grafted epithelium. These results suggest that the cultured mucosal epithelium can be successfully transplanted and form a normal mucosal epithelial layer.
Cultured stratified epithelium for grafting was prepared using human keratinocytes. In the field of plastic surgery, many patients who received grafts of cultured epithelium have been reported. However, no case in the maxillofacial region has been reported. Here we report 2 cases of traumatic scars in the maxillofacial region that were treated by cultured epithelium. The patients were a 21-year-old man and a 9-year-old boy who complained of deformity due to a traumatic scar. In both cases, small skin segments, 1-2cm2, were obtained before operation, and epithelial cells were cultured by the methods of Green et al, using 3T3 cells as the feeder layer. After 3 weeks, 175-350cm2 cultured epithelium was prepared. Then, surgical debridment of the scar was carried out, and cultured epithelium was grafted onto the epithelial defects. Cultured epithelium was completely taken within 1 week. Subsequently, that the surface of the graft became smooth and pigmentation faded away.
After oral surgery, enteral nutrition of a polymeric diet (Clinimeal®) is often delivered via a nasal feeding tube (6Fr. DUO-TUBE®) to promote rapid healing. However, we are concerned about the degree of feeding tube contamination by microbes, because diarrhea is the most frequent side effect. Therefore, we examined the microbiological flora in the feeding tube just after removal of the latter. Our subjects were 44 patients who had received oral/maxillofacial surgery without general complications. Their average age was 34.7 years. The average feeding tube retention period was 11.0 days, and the average quantity of Clinimeal consumed each day was 1468 kcal (1kcal/ml). The most frequent complication was diarrhea, which occurred in 23 case (52.3%) during the tube-feeding period. The following results were obtained regarding the cases of diarrhea: 1) The feeding tube retention period was directly proportional to the diarrhea rate. 2) The types of diarrhea-causing bacteria found in the feeding tube were as follows: C.freundii in 2 cases, E.coli in 2 cases, Klebsiella in 8 cases, and Pseudomonas was found as replaced bacteria in 10 cases.
The oral function after maxillofacial reconstruction using microvascular tissue transplantation was investigated by a questionnaire survey of 335 oral and maxillofacial surgery centers in Japan. The patient's speech. mastication and deglutition were evaluated and classified as good. almost good, and poor. The number of reported cases was 220. Among these. The rates of good and almost good were 98.2% for speech. 89.1% for mastication, and 95.4% for deglutition. These results were considered to indicate satisfactory oral functions after surgery.
Our experience with 5 cases of non-Hodgkin's lymphoma treated by chemotherapy combined with G-CSF is reported. The patients consisted of 2 males and 3 females with a mean age of 72.6 years. The clinical Stage was classified as IE in 2 cases and I, II, IIIEin the 3 other cases. Two cases were treated with chemotherapy after irradiation and chemotherapy alone was performed in 2 cases. In the other case, recurrence after irradiation was treated with chemotherapy. The chemotherapy consisted of CHOP used in conjunction with G-CSF in all cases. With the excepton of one case in which G-CSF was not used after early phase chemotherapy was instituted, severe leukopenia was not encountered, and the treatment was completed as scheduled in all cases. The clinical response to chemotherapy was CR in 3 cases, and unknown in the 2 other cases without clinical evidence of tumor. In conclusion, chemotherapy combined with G-CSF, which proved to be effective in preventing leukopenia, is useful in the treatment of non-Hodgkin's lymphoma.
Head and neck cancers are frequently combined with other primary lesions in the head and neck area or in the digestive tract, especially the esophagus and stomach. Therefore, most multiple primary cancers are pathologically squamous cell carcinoma and adenocarcinoma. We report a case of carcinoma of the oral floor in a 69-year-old man with malignant reticulosis, which is one of the rare mesenchymal tumors. The primary carcinoma of oral floor was completely eradicated by chemotherapy and radiotherapy; however, the patient died from pancytopenia of unknown cause and multiple organ failure. Pathological examination at autopsy revealed squamous cell carcinoma of oral floor with malignant reticulosis involving the spleen, liver, bone mallow, lung and lymph nodes.
The hemolytic uremic syndrome (HUS) is a heterogeneous disorder characterized by hemolytic anemia, thrombocytopenia, and renal failure, occurring predominantly in infants and young children. Recently HUS in adults has been described as a complication of anti cancer chemotherapeutic agents. A 53-year-old man who was being treated for squamous cell carcinoma of the tongue developed chemotherapy-induced HUS during operation after receiving neo-adjuvant chemotherapy. Plasma exchange was carried out four times besides blood transfusion and hemodialysis therapy. His renal function was gradually improved, and he also recovered from anemia and thrombocytopenia.
We report a case of drug-induced pneumonitis caused by inhalation therapy with fibrinolytic enzyme after supraomohyoid neck dissection of a submandibular gland tumor. The patient was a 54-year-old man who had a diagnosis of carcinoma in pleomorphic adenoma. Two days before operation, inhalation therapy was started with two drugs and Elase®, containing fibrinolysin and deoxyribonuclease, to avoid postoperative respiratory complications. Three days after operation, he developed a high fever and severe cough, and the chest roentgenogram showed diffuse shadows in bilateral lung-fields. Although bacterial pneumonitis was suspected, intravenous antibiotics were not effective and no causative organism was detected in his sputum and arterial blood. However, as the administration of corticosteroids and the cessation of inhalation therapy remarkably improved clinical symptoms, we suspected drug-induced pneumonitis. The drug lymphocyte stimulation test demonstrated that Elase® was responsible for this pneumonitis. Although previous clinical reports of drug-induced pneumonitis could not be found, the possibility of side effects with any kind of drug should always be borne in mind.
Leiomyosarcoma is a malignant neoplasm of smooth muscle origin that is rare in external soft tissues of the head and neck region. We observed a subcutaneous leiomyosarcoma in the cheek of a 61-year-old man. Diagnosis was difficult since the tumor grew slowly and clinically formed a solitary painless mass. Histopathologically, the tumor consisted of spindle-shaped atypical myomatous cells, had poor proliferation, and was composed of interlacing fascicles that merged into collagenous stroma. Immunohistochemically, the spindle-shaped tumor cells were stained by vimentin and α-smooth muscle actin.
A case of osseous choristoma arising in the tongue of a 9-year-old boy is presented. The patient complained of a painless tumor on the posterior dorsum of the tongue. The lesion was a hard, pedunculated, polypoid mass, measuring 5 mm in diameter, and was covered with intact mucosa. He underwent surgical resection of the tumor under general anesthesia. Histological findings showed a well-circumscribed mass of bone beneath the normal squamous epithelium. The bone tissue showed a definite lamellar structure and its surface was lined with flattened cells. On part of the bone surface, osteoid deposition accompanied by activated osteoblasts was observed, which suggested continued remodelling of bone tissue. A definitive diagnosis of lingual osseous choristoma was made. The posteoperative course was uneventful without recurrence for about 11 months.
This paper reported a case of a branchial cyst accompanied by a scarred incomplete fistula. A 16-year-old woman visited our hospital with a complaint of swelling of the left neck. Physical examination revealed a 60×50mm elastic soft swelling with slight tenderness in the left upper cervical region, and CT examination revealed a low density oval region under the sternocleidomastoid muscle. As a result of puncture, a yellowish mustard-like fluid was obtained and cytodiagnosis of the fluid indicated class II. At removal of the cyst, a scarred incomplete fistula from the cyst adhered to the mastoid process. Histologically, the cyst wall was covered with stratified squamous epithelium and lymph follicles were observed. Two years and 10 months have passed since the operation. The patient's progress is good at present, without any signs of recurrence.
Poland syndrome is a clinical condition characterized by unilateral defects of major pectoral muscle and ipsilateral deformity of the phalanges. We report a case of submucous cleft palate with Poland syndrome. The patient was a 3-year-old girl, who was indicated to have speech disorders caused by velopharyngeal insufficiency. On oral examination, she did not have a bifid uvula. However, notching was detected in the midline posterior hard palate, and the midline soft palate muscle was separated. Under a diagnosis of submucous cleft palate, we performed palatoplasty in the patient.
A rare case of multiple sialolithiasis of the submandibular gland is reported. A patient was a 44-year-old woman. She visited our clinic with a complaint of the swelling in the right sublingual region. Occlusal roentgenograms revealed multiple stones in the right submandibular gland duct. Under local anesthesia, 10 stones were intraorally removed. One year and 3 months have passed since the operation, and there has been no problem. In the present case, a number of stones apparently moved in the saliva flow and gethered in the sublingual region. However, more cases of multiple sialolithisis should be studied to better understand the formation of multiple stones.