The expression of the cytokeratin (CK) 19 gene was investigated by reverse transcription-polymerase chain reaction (RT-PCR) and Northern blotting in two cases of erythroplakia, arising in the floor of the mouth of a 61-year-old man and the tongue of a 54-year-old man. Normal gingival tissue and squamous cell carcinomas were used as control. The results were as follows: 1. Expression of CK19 mRNA on RT-PCR analysis. CK19 mRNA was moderately expressed in erythroplakia, slightly expressed in normal gingiva, and strongly expressed in squamous cell carcinomas. 2. Expression of CK19 mRNA on Northern blotting analysis. CK19 mRNA was moderately expressed in erythroplakia and strongly expressed in squamous cell carcinomas. CK19 mRNA was slightly expressed in normal gingiva. These results indicate that epithelial dysplasia and carcinoma are abnormal processes of epithelial cell differentiation.
We retrospectively analyzed 73 patients with tongue carcinoma who were treated at the Department of Oral and Maxillofacial Surgery, Tokyo Women's Medical College between January 1980 and December 1993. The lesions in the 73 patients, consisting of 45 males and 28 females, were staged according to the TNM system. Five cases were classified as stage 0, 13 cases as stage I, 33 cases as stage II, 11 cases as stage III, and 11 cases as stage IV. Treatment for the primary site was as follows: 37 patients received interstitial implants alone, 11 patients received external-beam radiotherapy plus an interstitial implant, 15 patients underwent surgery alone, 5 patients underwent surgery after chemotherapy, and 2 patients received combined therapy with radiotherapy, chemotherapy, and surgery. Three advanced cases did not receive curative treatment. The five-year cumulative rate of survival was 82.2% for stage I patients, 79.9% for stage II patients, 62.3% for stage III patients, and 45.5% for stage IV patients. The local control rate was 79% for radiotherapy and 86% for surgery. Cervical metastases occurred after treatment of the primary site in 15 of 36 cases (42%) treated by irradiation and 3 of 16 cases (19%) treated by surgery.
Papillary cystadenocarcinoma frequently occurs in the ovary or bile duct, but rarely arises in the maxillofacial region. Papillary cystadenocarcinoma was firstly classified in 1991 in “Histological Typing of Salivary Gland Tumors, ” published by the WHO. Here we describe a case of papillary cystadenocarcinoma occurring in the parotid gland. The patient was 65-year-old man who consulted the department of surgery of the medical school because of a painless swelling at the angle of the mandibular region. Adenocarcinoma of the parotid gland with metastasis to the regional lymph nodes was suspected on examination at the department of surgery, and partial resection of the parotid gland with radical neck dissection were performed at our hospital. Histopathological examination revealed a papillary cystadenocarcinoma. Radiation therapy was administered after the operation. There have been no signs of recurrence or metastasis as of 1 year and 6 months after treatment.
Granular cell ameloblastoma is a variant form of ameloblastoma characterized by extensive granular cell changes of tumor cells histologically. The incidence of this tumor is relatively low. Case 1: A 69-year-old woman presented with swelling of the right side of the mandible, which had persisted for 3 years. On radiography, a honeycomb radiolucent lesion with an ill-defined margin was noted from the canine to the second molar on the right side of the mandible. We performed segmental resection of the mandible and reconstruction with an iliac bone graft. The parenchyma showed a plexiform and follicular pattern, with large tumor nests in some areas. Bone marrow invasion was noted. Case 2: A 57-year-old woman presented with swelling and pain in the molar region at the right side of the mandible. Symptoms had persisted for 10 years. On radiography, a cystic radiolucent lesion with a well defined margin, extending from first molar to the ascending ramus on the right side of the mandible was observed. We enucleated the tumor along with the surrounding bone. A plexiform pattern was noted adjacent to the cystic cavity along with a thick connective tissue capsule.
Adenomatoid odontogenic tumors are rare in the molar region and occur most commonly in the anterior jaw. This report describes the clinical and histological findings of an adenomatoid odontogenic tumor associated with the lower first molar. A healthy 21-yearold woman was referred to our department for a painless bony swelling on the right side of the mandible. Radiographic examination showed a well-circumscribed cystic lesion surrounding the crown of a molar like impacted tooth and an irregular intralesional radiopacity. Under general anesthesia the cystic tumor was enucleated along with the impacted tooth. The extracted tooth was morphologically identified as the lower right first molar by the presence of five cusps and three roots and by the fact that a tooth had not erupted at the site of the lower first molar. Histological examination revealed advanced calcification and proliferation of spindle-shaped and polygonal tumor cells containing eosinophilic and PASpositive droplets between the intercellular spaces. Despite the lack of duct-like structures, the overall histological features confirmed the diagnosis of an adenomatoid odontogenic tumor. Four years four months after the operation there have been no signs of recurrence.
Leiomyoma most frequently arises in the uterus or alimentary tract and rarely occurs in the head and neck region. We report a case of leiomyoma in the mandible. The patient was a 45-year-old man with swelling of the right mandible. Radiographic examination showed a relatively clearly demarcated area of bone resorption in right lower molar region. A malignant tumor was suspected on the basis of clinical findings. The tumor was resected along with the cortical bone of the mandible. The histopathological diagnosis was leiomyoma.
Soft tissue myxoma is a very rare neoplasm in the oral cavity and only 13 Japanese patients have been described in the literature between 1941 and 1995. This paper presents a case of soft tissue myxoma arising in the soft palate of a 51-year-old man. The lesion was treated by surgical excision under general anesthesia, and there have been no signs of recurrence as of about 10 years after the operation.
Osteoblastoma arises primarily in the vertebral column, limbs, and other long tubular bones. It rarely occurs in the jaws. This report describes a 22-year-old woman who visited our department because of swelling and pain at 3 2. Intraoral examination revealed marked pain on percussion at 3 2 with turgescence on the lingual side. Radiographic examination showed sequestrum-like findings with the presence of both radiopaque and radiolucent areas. Under local anestesia, 3 2 were extracted and the tumor was extirpated en bloc. Pathological examination suggested that the lesion was an osteoblastoma. The patient's postoperative course is favorable as of 41 months after the operation.
We recently encountered a rare case of desmoplastic fibroma occurring in the right side of the maxilla with osseous lesions of the left shoulder, left forehand, and neck. A 47-year-old woman was referred to us for painless swelling of the right side of the maxilla. On intraoral examination, the swelling was firm, nontender, and had a sessile base and a smooth surface. Computed tomography revealed a soft tissue mass at the right side of the maxilla, measuring 28×35×40mm, which showed poorly defined radiolucency and a welldemarcated margin. The tumor had elevated the right sinus floor, and spread into the right pterygomaxillary fissure, with oppressive erosion to the right ramus of mandible. At the neck region, right shoulder, and right forearm, there was radiographic evidence of cottonlike and solid osteopetrosis. Wide resection of the maxilla, including the surrounding tissues, was performed under general anesthesia. At the present, the patient's progress is good.
We described our experience with a recurrent case of buccal cancer in which reconstruction was performed with a skin-grafted rectus abdominis flap. The patient was a 61-year-old woman. She had been undergone tumor excision and reconstruction with a D-P flap at 54 years of age (histopathological diagnosis, acinic cell carcinoma). Recurrence occurred 7 years later. We planned to excise the tumor and perform reconstruction with a rectus abdominis flap. A rectus abdominis flap was prepared before tumor excision, at the same time, free skin was grafted to the raw surface of the flap. Three weeks later, the tumor was excised, and reconstruction was performed. The rectus abdominis flap covered with skin was positioned so that the skin side of the flap formed the cheek and the graft side formed the oral wall. Fat reduction of the flap was performed 18 days later. The flap was successfully transplanted without any necrosis. The outcome was excellent because the flap resembled the natural curve of the cheek. This method is useful for secondary reconstruction and for reconstruction after excision of benign tumors or slowly progressing cancers, such as salivary grand carcinomas.
A technique for the correction of secondary cleft lip and nose deformity, which employs a bone graft to the alveolar cleft and a cartilage graft to the alar region, is described in this paper. The technique is summarized below. First, iliac cancellous bone is grafted to the alveolar cleft to provide a bony base for support of the nostril floor and the alar base of the nose. Second, the hypoplastic and displaced alar cartilage is elevated and suspended using the open rhinoplasty method. Third, the cartilage harvested from the nasal septum or ear is trimmed and grafted to the hypoplastic alar cartilage, the lower lateral cartilage, or both. The use of bone and cartilage grafts compensates not only for scar contraction but also for congenitally missing and hypoplastic bone and cartilage that support the lip and nose. We believe that this technique provides the best chance of producing an excellent long-term cosmetic outcome.
Arthroscopy of the temporomandibular joint (TMJ) was developed by Onishi in 1975, and arthroscopic surgery for internal derangement was subsequently developed by Sanders (1986) and Murakami (1988). Arthroscopic surgery is an atraumatic procedure; however, double or triple punctures with metal instruments are associated with increased morbidity. We developed a new method for arthroscopic lysis by atraumatic balloon pumping with the use of a Swan-Ganz catheter or wedge pressure catheter. We performed this procedure in seven patients with internal derangement of the TMJ. This new method successfully increased mouth opening and decreased TMJ pain. No postoperative complications occurred.
A 48-year-old Japanese woman presented with symptoms of swelling and pain at the right side of the oral floor. Radiographic and computed tomographic examinations revealed extremely elongated and thickened bilateral styloid processes. Both processes were shortened surgically via an intraoral approach using a chisel. The excised right bony rod was 55mm long with a maximum thickness of 8.5mm, while the left bony rod was 60mm long and up to 10mm thick. Histopathological examination of the specimens revealed hyaline cartilage and lamellar bone at the base of the excised bony rods and fibrocartilage at the tip of the rods.