Sixteen cases of adenoid cystic carcinoma of the salivary glands were studied immunohistochemically, using antibodies against erbB gene family products that were receptor type tyrosine kinase. In addition, the relationship between the expression of c-erbB gene family products in tumor tissue, and clinicopath Ological factors was also investigated. c-erb B-2 and c-erb B-3 gene products were present in all adenoid cystic carcinomas, and their overexpression was demonstrated particularly in tubular and cribriform type. From these results, the presence of c-erb B-2 and c-erb B-3 gene products was suggested to bear some relation to carcinogenesis and tumor differentiation in adenoid cystic carcinoma.
Twenty-eight tongue cancer patients, who underwent an excisional biopsy, were analyzed, focusing on the mode of cancer invasion and the clinical implications. According to the T classification, there were 19 cases of T1, 8 cases of T2, and 1 case of T3. Eighteen of these cases showed an exophytic growth pattern and 10 cases an endophytic growth pattern. Surgical margins were evaluated and found to be negative in all cases. Five cases had a recurrence at the primary site; 4 out of 5 cases had a recurrence at the superficial portion of the tongue, while the other had a recurrence in the deep portion of the tongue with cervical metastases. The mode of cancer invasion in the first resected specimens was 1 case of Grade 1, 2 cases of Grade 2, and 2 cases of Grade 3. Local control after re-excision was achieved in all cases. On the other hand, four cases, including 2 cases of Grade 4C and 2 cases of Grade 4D mode of cancer invasion, subsequently developed cervical metastases. Control above the clavicles was obtained in 3 of these 4 cases by neck dissection. Two of these 3 cases subsequently developed distant metastases to the lung, with Grade 4D mode of cancer invasion. The crude survival rate for the 28 cases was 92.9%(Ao: 25 cases, Ac: 1 case, Dc: 2 cases). If a sufficient margin is taken based on detailed observation of the tumor, then excisional biopsy for tongue cancer may be useful in the treatment of small, superficial lesions. However, patients with highly invasive tumors (Grade 4) require that careful attention is paid to secondary cervical metastasis.
Eighteen-day-old mouse embryos sequentialy treated with methyl mercury chloride (MMC) and tiopronin (TP, used to prevent cleft palate induced by MMC) on day 10 of gestation were examined for the presence of variant rugae. Nontreated mouse embryos served as controls. Variant rugae were classified into seven types (supernumerary, division, maldirection, bifurcation, shortness, cross and fusion). They were observed in MMC-treated embryos, and supernumerary was most frequent type. Division and shortness were ranked next. Variant rugae were also observed in nontreated embryos in low frequencies, although there were some differences between the control and MMC+TP treated embryos in the distribution of supernumerary rugae. The division in the MMC+TP group was characteristically found at the middle of the 2nd or 3 rd rugae. Division of the middle of the 2nd or 3 rd rugae may suggest teratogenicity.
Oro-facial-digital syndrome type I (OFD I) is a rare hereditary disease, inherited as an X-linked dominant trait with lethal effect in males. Six cases of OFD I are reportred. All were females and consanguineous. Each patient had an abnormal buccal frenula and alveolar notch, and/or congenital absence of teeth. Four cases had coarse hair, a lobulated tongue, or tongue tumors. One of these cases had an incomplete median cleft of the upper lip, a cleft of the soft palate, brachydactylia, increased nasion-sella-basion angle, and mental retardation.
We investigated perioperative episodes associated with oral surgical procedures in outpatients during the past two years. The incidence of perioperative episodes was 0.9%(44/4, 954). The most common signs and symptoms of perioperative episodes were nausea, vomiting and related symptoms, accounting for of all cases 50.0%(22/44). This was followed by cardiovascular disturbances such as hypotension (7/44), excessive bleeding (6/44), and PVC and arryhythmia (4/44). These episodes occurred during impacted tooth extraction (20/44), common tooth extraction (9/44), and puncture and arthrocentesis of the temporomandibular joint (7/44).
We performed fresh autogenous bone grafting from the symphysis mandible (chin bone grafting: CBG) in 47 patients, and obtained favorable results. Since CBG involves grafting of particulate cancellous bone and marrow, bone formed rapidly. Because the grafted bone was taken from the oral cavity, CBG was less stressful than iliac bone grafting to patients. However, as only a small quantity of bone can be taken, this method cannot be used when there is substantial bone loss. Some patients showed disturbances of the mental nerve and felt a slight upward extrusion of the mandibular anterior teeth after surgery, but these symptoms disappeared within several days or weeks.
Serological screening for nosocomial infectious diseases (syphilis, hepatitis B and C) was carried out in 270 outpatients who underwent minor oral surgery during the period from November 1993 to April 1994. Based on their past history, the patients were divided into two groups:(1) a high risk group, consisting of 43 patients who had undergone blood transfusion, or had a high risk of developing postoperative or other types of infection, and (2) a no risk group, consisting of 227 patients. The incidence of seropositive patients was 11.5%(31/270), including syphilis 1.5%(4/270), hepatitis B 1.5%(4/270) and hepatitis C 9.3%(25/270, including 2 syphilis patients). Even in the no risk group, at least 1-2 % of the patients were positive for hepatitis C virus, equivalent to the usual incidence in blood donors at the Red Cross Blood Center. In the high risk group, half of the patients were seropositive for nosocomial infectious disease, suggesting that preventative measures against nosocomial infection should be taken in high risk patients regardless of whether or not they have undergone screening.
Mollaret's meningitis is a rare form of recurrent aseptic meningitis that is characterized by repeated shortlived, spontaneously remitting episodes of fever and meningeal irritation interspaced with variable periods of good health and polymorphonuclear pleocytosis in the cerebrospinal fluid. The etiology of this syndrome has remained obscure since its initial description in 1944, and a variety of other causes should be considered in differential diagnosis. We describe a recently encountered “Mollaret's meningitis patient” with postoperative mucoepidermoid carcinoma, and present a review of the literature.
Two cases of gas gangrene in the maxillofacial region and neck that developed after odontogenic infection are reported. Case 1, a 35-year-old man, developed gas gangrene after removal of the mandibular right third molar. In case 2, a 61-year-old man, gas gangrene occurred after apical periodontitis of the mandibular right second premolar. Both cases were treated by digitally opening the site where computed tomography (CT) revealed extension of gas bubbles early after the onset of symptoms and surgical debridement with antibiotics. CT was useful in monitoring the location of gas bubbles to permit opening of the progressive large focus in multiple spaces of maxillofacial region and neck. Digital preparation of the fascia was useful for opening the focus in the early stage of the disease.
Two cases of sialodochitis fibrinosa (Kussmaul's disease) are presented. Case 1. A 52-year-old woman visited our hospital for recurrent left submandibular salivary gland swelling. Numerous eosinophils were found by histopathological examination of mucous plugs extruded from Wharton's duct. Slight eosinophilia was observed in peripheral blood samples. Case 2: A 54-year-old woman visited our hospital for recurrent swelling of the bilatelal submandibular salivary glands and the right parotid gland. Numerous eosinophils were found in mucous plugs extruded from the ducts. Kussmaul's disease was probably caused by allergic factors because an episode of Crytomeria pollenosis and elevated IgE were confirmed in the 2nd case, and eosinophilia was found in both cases.
Myxofibroma is an uncommon neoplasm of the jaws. It is most frequently diagnosed in the third and fourth decades of life and is rarely seen in patients over the age of 65 years. We encountered a case of myxofibroma in a 70-year-old woman. She was referred to our hospital for examination of dull pain and swelling in the right maxillary molar alveoli. Radiographic examination revealed a unilocular radiolucency containing irregular spotty zones of radiopacity. Examination of a biopsy specimen suggested myxofibroma. The lesion was removed including the 7-4 alveolar bone. The histologic diagnosis was myxofibroma. As of 4 years later, there has been no evidence of recurrence.
Osteopetrosis is a rare hereditary general disorder of bone, characterized by prominent radiographic features of skeletal sclerosis. Osteomyelitis of the mandible accompanied by osteopetrosis is a serious complication in the maxillofacial region. We report here a 58-year-old woman with chronic mandibular osteomyelitis accompanied by osteopetrosis caused by extraction of left first molar. The osteomyelitis caused a pathological fracture of the left side of the mandible, despite treatment by seqestrectomy and curettage. The osteomyelitis was successfully treated by mandibular continuous resection and immediate reconstruction of the mandible with a titanium plate. Three years after the operation, radiographs revealed newly formed bone in the lesion.
We recently encountered a case of pseudobulbar palsy, that was associated with symptoms occurring in temporomandibular joint (TMJ) disorder. The patient was a 61-year-old man, referred to our department for TMJ disorder. However, this diagnosis was suspected to be erroneous because the patient complained not only of symptoms of TMJ disorder but also of dysphonia and dysphagia. The patient was therefore referred to neurosurgery for further evaluation. The patient was found to have multiple cerebral infarction. The patient's symptoms were thus attributed to pseudobulbar palsy associated with the infarction. After treatment for cerebral infarction, the symptoms of TMJ disorder disappeared.
Congenital midline fistula of the upper lip is a rare anomaly, and the developmental mechanism is unclear. We reported a patient with a congenital midline fistula of the upper lip. The patient was a 53-year-old man who had suffered repeated swelling until presentation. The size of the fistula was about 0.5mm in diameter and about 20mm in depth to the anterior nasal spine. The opening was blind. The fistula tract was lined by squamous epithelium with hair follicles and sebaceous glands. This case had no other anomalies except for a short frenulum labii superioris. Postoperative healing was good without recurrence of the fistula.