Adenoid cystic carcinoma (ACC) is a characteristic malignant tumor that grows very slowly but frequently metastasizes to the lung. To establish a metastasis model of ACC, we transplanted three human orthotopically ACC tissues (KOA-1: solid pattern, KOA-2: cribriform pattern, and KOA-3: solid pattern) into the tongue of nude mice, and performed histologic examinations after 3 months. The results were as following: 1) Each type of ACC was transplantable into the tongue of nude mice, with success rates from 38% to 67%. 2) Histologic patterns of the tranplanted ACC in nude mice were similar to those of specimens obtained from patients during operation. 3) Cervical lymph node metastasis was found in the KOA-1 and KOA-2 groups. 4) Lung metastasis was found in the KOA-1 and KOA-2 groups. 5) This is a new animal model for metastasis from ACC. It is expected to be useful for future studies of metastasis from ACC and its treatment.
To investigate the influence of alveolar fractures sustained during growth on the development of the mandibular bone, 29 male house musk shrews (Suncus murinus) aged 4-weeks were studied. An originally designed forceps was used to fracture the alveolar bone at the right side of the mandible of each shrew in the experimental group. Untreated shrews served as control. Immediately and 6, 10, and 15 weeks after the fracture, the healing process of the fracture was examined radiologically and histologically. The bone mineral density was measured by peripheral quantitative computed tomography (pQCT) and morphometric analysis was performed 15 weeks after the fracture, and the right and left sides of the mandible were compared. The results were as follows: 1) Small fractured segments of the alveolar bone were partially resorbed by osteoclasts 6 weeks after fracture, and new bone tissue was concurrently observed in the surrounding region. Fifteen weeks after fracture, the amount of new bone had increased, and the new bone appeared to be well-mineralized lamellar bone. The fractured segments were connected with the surrounding new bone, and the alveolar fracture had apparently healed clinically. 2) Fifteen weeks after fracture, however, the histological findings of the fractured mandibles differed from those of the control group, and the bone mineral density of the fracture site was lower than that of the opposite site of the mandible. 3) On morphometric analysis, some variables of the mandibular ramus differed significantly between the right and left sides of the mandible 15 weeks after unilateral alveolar fracture. 4) No obvious difference was observed radiologically, histologically, or morphometrically between the right and left sides of the mandible in the control group. These results suggest that a long time may be required for alveolar fractures to recover histologically, even in the case of minor fractures. When sustained during growth, such fractures may influence the development of the mandible.
We analyzed the clinical characteristics of 19 patients with squamous cell carcinoma of the upper alveolus and gingiva, who accounted for 7.5% of 254 patients with head and neck carcinoma treated between 1971 and 1996. The patients consisted of 11 males and 8 females with a mean age of 63 years. There was 1 stage I patient (5.2%), 4 stage II patients (21.1%), 3 stage III patients (15.8%), and 11 stage IV patients (57.9%). Initial treatment consisted mainly of a combination of surgery and radiotherapy in 8 cases (42.1%), surgery in 6 cases (31.6%), and radiotherapy in 5 cases (26.3%). The five-year survival rate calculated by the Kaplan-Meier method was 57.9% for the entire group of 19 patients. The outcome was not good in patients treated with radiotherapy and in those who had tumors showing diffuse invasion.
A clear visual field and hemostasis are difficult to achieve because of considerable hemorrhage during resection of maxillary carcinomas, especially in patients undergoing posterior resection. This paper describes how hemorrhage can be controlled by retrograde transcatheter arterial embolization therapy, in which a catheter is placed in the superficial temporal artery to permit continuous intraarterial infusion of chemotherapy.
Malignant peripheral nerve sheath tumor (malignant schwannoma) is a malignant neoplasm derived from Schwann cells. In the head and neck region, it is a very rare neoplasm. We encountered a case of malignant peripheral nerve sheath tumor in a 47-year-old woman. She presented in June 1995 with pain and swelling of the premolar region of the left side of the mandible. Radiographic examination showed irregular radiolucency at the left side of the mandible. Histopathologic study of the surgically removed specimen revealed malignant peripheral nerve sheath tumor. Wide resection of the mandible, including the tumor, was performed. There has been no sign of recurrence or metastasis as of 25 months after operation.
Thirteen patients with malignant lymphoma (ML) consulted our department during the 7 years from June 1990 through May 1997. The initial clinical symptoms of the patients were analyzed retrospectively. The results were as follows: 1. ML accounted for 8.7% of all malignant tumors of the oral and maxillofacial region at our department. 2. The subjects consisted of 12 males and 1 female. Their mean age was 62 years. 3. Of the 13 patients, 11 were pathologically confirmed as having non-Hodgkin's lymphoma and 2 as having Hodgkin's disease. 4. There were 3 nodal cases and 10 extranodal cases. 5. The primary site of the tumor was the cervical lymph nodes in 3 cases, the gingiva in 6, the hard and soft palate in 3, and the buccal submucosa in 1. 6. Only one case was clinically diagnosed as malignant lymphoma. The initial clinical diagnosis in the remaining 12 cases was other malignant tumors in 6 cases, osteomyelitis in 3, benign tumor in 2, and lymphoadenitis in 1.
The fungi Aspergillus species cause aspergillosis, which can be invasive and fatal in immunocompromised patients. We reported four cases of invasive oral aspergillosis in neutropenic patients with hematologic malignancies. All cases were successfully managed by early surgical debridement in combination with intensive antifungal treatment and the use of colony stimulating factors.
Keratoacanthoma (KA) is a benign lesion of epithelial hyperplasia originating from the surface epithelium. This lesion is frequently mistaken for squamous-cell carcinoma because of its similar clinical and microscopic characteristics. The lesion tends to occur in exposed areas. A case of KA arising in the lower lip of a 70-year-old man is presented. On November 22, 1995, a 70-year-old man presented with white marks and a dry feeling of his lower lip; however, there was no pain. Clinically, the lower lip appeared to have a leukoplakia-like lesion, which measured 35×15 mm and was well defined. The patient had suffered from HCV hepatitis, for which he had received treatment 5 years ago. In May 1994, he felt slight pain in his lower lip and applied Azunol ointment to it. On November 28, 1995, examination of a biopsy specimen revealed keratoacanthoma with a slightly dysplastic epithelium. The patient was followed up to May 1996; the lesion continued to grow as an exophytic mass and measured 30×15×1Omm. On May 24, 1996, as spontaneous regression appeared improbable, he was given vitamin A. Thereafter, the lesion regressed considerably, but the patient could not bear the disgusting odor of tumor necrosis. On October 17, 1996, the patient underwent resection of the lower lip tumor along with an adequate margin of normal tissue. As of the present, there has been no evidence of tumor recurrence.
Although odontoma is the most common odontogenic tumor, it seldom occurs in the maxillary sinus. We report a case of complex odontoma arising in the maxillary sinus. A 29-year-old man was referred to our department on September 20, 1994 for further evaluation of the right side of the maxilla. He had previously consulted a dental clinic for treatment in August 1994. Radiographic examination showed a radiopaque mass in the right side of the maxilla. There were no symptoms or abnormal clinical findings in either the oral cavity or the face. A computed tomographic scan displayed a high-density mass with an irregular outline in the right sinus. From these findings, the maxillary lesion was clinically diagnosed as a benign tumor (osteoma or odontoma). The lesion was enucleated under general anesthesia on February 14, 1995. The resected tumor was 40×38×30mm, grayish white, and bony hard. The histopathological diagnosis was a complex odontoma. He had no signs of recurrence sa of 2 years after surgery.
Studies of malformations in monozygotic twins are important in elucidating the roles played by genetic and environment al factors in the development of these malformations. We report on monozygotic twins with cleft submucousal palate, one of whom had ventricular septal defect. Because of differences in the severity of cleft palate, birth weight, and the heart defect, processes such as twin-twin transfusion may have played a part in the phenotypic differences.
Kabuki make-up syndrome is a rare congenital malformation characterized by long palpebral fissures, large ears, and a depressed nasal tip, associated with postnatal dwarfism and mental retardation. We report a rare case of this syndrome accompanied by unilateral complete cleft lip and palate. The cleft lip was repaired at the age of 4 months, and the cleft palate was closed by the two-step procedure, i. e., the soft palate was repaired at 22 months, and the hard palate was repaired at 6 years. Although the patient has mental retardation, her speech has advanced to almost a normal level.
This paper describes the grafting of mandibular ramus lateral cortex bone to osteotomy gaps of the anterior wall of the maxillary sinus in a patient who underwent high Le Fort I osteotomy for inferior positioning of the maxilla. The maxilla was rigidly fixed with the use of a bone plate, bone screw, and cortex bone in the thick bone of the piliform rim and the zygomatic body. Bone grafts from the lateral cortex of the mandibular ramus had several advantages. It was possible to obtain sufficient bone for maxillary lengthening.There was good incorporation of all grafts. The incision and resulting scar were hidden intraorally.