Evalution of tumor growth is essential when assessing the malignancy of cancer. It is difficult to evaluate tumor growth in oral cancer by measuring tumor size on the basis of imaging studies, such as computed tomography and magnetic resonance imaging because oral cancer often invades complex structures consisting of bone, muscle, and salivary glands. Some authors reported that it is useful to evaluate tumor proliferation by immunohistchemical methods using proliferating cell nuclear antigen (PCNA) and Ki67. In this study, we surgically transplanted oral squamous cell carcinomas resected from patients and the established cell lines in nude mice. When the transplanted tumor grew, we evaluated the correlation between tumor growth by measuring tumor size and cell growth activity, evaluated by cell proliferation markers (PCNA, Ki67) using immunohistochemical methods. We obtained good signals on PCNA and Ki 67 immunostaining. It was easy to calculate the labeling indices with an image analyzer. Both PCNA labeling index and Ki67 labeling index correlated with transplanted tumor growth, evaluated by measuring tumor size, in the nude mice. Ki67 labeling index reflected tumor growth better than PCNA labeling index.
We investigated the usefulness of an enteric nutritional supplement, Sanet-1.5TM, which was prescribed after surgery for jaw deformities. Sanet-1.5TM was prescribed at 1, 443 kcal on the first postoperative day, 1, 786 kcal on the second postoperative day, 2, 064 kcal on the thirdpostoperative day, and 2, 100 kcal from the fourth to the 14th postoperative day. The nutritional supplement was given through a 8 Fr. naso-gastric tube. Nutritional status was assessed on the basis of pre-albumin, retinol binding protein, transferrin, and body weight. Liver function was evaluated by glutamic oxaloacetic transaminase and glutamic pyruvic transaminase, and renal function was evaluated by blood urea nitrogen and creatinine. Clinical symptoms such as diarrhea were also observed. Moreover, Sanet-1.5TM was compared with Sanet-V TM which has been already been confirmed to be useful in terms of nutritional development and safety. Conclusions: 1) Good nutritional status with rapid turnover protein was obtained in 85.7% of patients treated. 2) There was no appreciable problem in liver or renal function. 3) As for side effects, gastrointestinal symptoms such as diarrhea occurred in 28.6% of patients treated. 4) In all patients, the usefulness of Sanet-1.5TM was confirmed. 5) Improvement in nutritional status and the safety and usefulness of Sanet-1.5TM were equivalent to those of Sanet-VTM
Impression material has been used to take facial impressions to make maxillofacial prostheses. The design of a prosthesis has depended considerably on the experience and esthetic sense of the person making it. We describe a non-contact three-dimensional measurement system that can be used instead of impression taking. Facial wax-models are then made by a milling machine. This process led to a satisfactory maxillofacial prosthesis. This system was applied to an epithesis in a patient who had a large defect of the left mid-facial area following surgery for a maxillary tumor. A laser surface scanner did not deform the patient's face or cause stress. Scanning the face digitally facilitates the preservation or transmission of date, if necessary. A mirror-image could easily be made by modifying the data, which allowed the epithesis to be designed objectively.
Ameloblastoma is an epithelial odontogenic tumor that occurs most frequently in the jaws. However, it can occur rarely in soft tissue, and such cases are commonly referred to as peripheral ameloblastoma. We encountered a case of peripheral ameloblastoma that arose in the lingual gingiva of a mandibular molar in a 48-year-old man. An initial medical examination revealed a papilloma-like lesion, which was diagnosed pathologically as papilloma on examination of a biopsy specimen. We completely excised this tumor for histological study, and the final diagnosis was peripheral ameloblastoma. This papilloma-like lesion was confirmed to have arisen from the odontogenic epithelium by immunohistochemical studies with anti-cytokeratin antibody. Here we describe this case of peripheral ameloblastoma.
Surgery to correct a mandibular fracture in a patient with congenital antithrombin (AT) deficiency is described. The patient was a 20-year-old man with a medical history of cerebral infarction. He was receiving warfarin (4 mg/day). Laboratory studies revealed prolongation of prothrombin time and decreased thrombo test values and AT activity. Six days before operation, infusion of AT concentrate was started after stopping warfarin therapy. The initial dose was 4000 units. The dose was then gradually decreased every 24 hours. Under general anesthesia, open reduction and rigid internal fixation for the mandibular fracture was performed after infusion of 3000 units of AT concentrate. During the first 13 postoperative days, AT concentrate was infused every day, and the level of AT activity was maintained above 100%. On the 14th postoperative day, warfarin (4 mg/day) was restarted. The postoperative course was uneventful, and to date, thromboembolism has not occurred.
We describe a case of necrotizing fasciitis, involving the oral floor, neck, and superior mediastinum, that was secondary to pericoronitis of a wisdom tooth. It was accompanied by sepsis, candidiasis, and disseminated intravascular coagulation. The patient, a 70-year-old man, visited our hospital for trismus and swallowing pain, and was immediately hospitalized because of marked swelling of the neck. A CT scan revealed gas fluid from the oral floor to the mediastinum. He required a skin graft and training in mouth opening and neck expansion as well as drainage and administration of antibiotics for treatment. Five months later he was discharged.
A case of parapharyngeal abscess associated with odontogenic infection and septicemia is reported. The patient was 27-year-old man with no underlying disease. His chief complaints were a swelling of the left submandibular region, severe trismus, swallowing pain, a high fever, and general fatigue. He was suspected to have peritonsillitis or a parapharyngeal space abscess caused by acute suppurative apical periodontitis of the left mandibular third molar. He was given intravenous antibiotics, but symptoms worsened. Three days after admission, the level of consciousness decreased, and hematological tests revealedan increase in the white blood cell count (29400/μl) and CRP (40.71mg/μl). Septicemia was diagnosed, and the patient immediately received surgical drainage and panipenem/betamipron (0.5g×4/day), clindamycin (0.6g×4/day), and γ-globulin. The postoperative course was uneventful, and no recurrencewas observed. Streptococcus constellatus was isolated from the pus and Serratia marcescens wasisolated from the blood.
Acute mediastinitis is undoubtly one of the most serious infectionsinvolving the mediastinal tissue and thoracic organs. Rarely, infective mediastinitis occurs as acomplication of odontogenic infection and is referred to as descending necrotizing mediastinitis (DNM).Early diagnosis and aggressive medical and surgical therapy are the most effective ways to decrease themorbidity and mortality. We describe a case of DNM due to an odontogenic infection in 53-year-old man and briefly review the literature.
Holoprosencephalies are a group of disorders characterized by failure of differentiation and cleavage of the prosencephalon. Embryologically, the central part of the face and the prosencephalon are closely connected in early development. We report a case of holoprocencephaly with unilateral cleft lip and palate. The cleft lip was repaired at the age of 2 months. The result was good esthetically and had a good psycological effect on the patient's parents.