Twenty patients with multiple oral leukoplakia were clinicopathologically studied. The relations among recurrence, malignant transformation and site, clinical appearance, epithelial dysplasia, and method of treatment were assessed. The numbers of men and women were similar. The age of the patients ranged from 43 to 82 years. The most common type of multiple oral leukoplakia was characterized by white spots on the gingiva. Epithelial dysplasia was associated with all types of clinical appearance. As for the treatment procedure, 39 of 51 cases (76.5%) underwent vaporization by laser surgery. The rate of recurrence was 31.3%. The most frequent site and clinical appearance n patients with multiple oral leukoplakia were the palatal mucosa and erythroleukoplakia type, respectively. Recurrence of multiple oral leukoplakia was suggested to be related to clinical appearance and the treatment procedure, although there was no relation between recurrence and epithelial dysplasia. Patients treated by cryosurgery had the highest rate of recurrence. Malignant transformation occurred in 2 of the 51 patients (3.9%), and the average time until relapse was 7 years 5 months. The clinical appearance was white-spotted type in both patients, and the site was the buccal mucosa and the gingiva, respectively. Mild and moderate dysplasia were pathologically confirmed in these patients.
To clarify the relation between matrix metalloproteinase (MMP) activity in synovial fluid (SF) of the temporomandibular joint (TMJ) and arthroscopic findings of intracapsular lesions, MMP-2, 3, 9 activity in the SF of patients undergoing arthroscopic examination and in the SF of volunteers was determined. SF was obtained from 16 patients (16 joints) with TMJ closed lock and 4 volunteers (6 joints) without TMJ disorders. MMP-2, 3, 9 activity in SF was detected by MMP activity assay with specific substrates for each enzyme. There was no significant correlation between MMP-2, 3 activity and arthroscopic findings, such as synovitis, cartilage changes, and adhesion. However, MMP-9 activity in SF isolated from joints with severe synovitis, cartilage changes, and adhesion was higher than that in SF obtained from the volunteers. These results indicate that increased MMP-9 activity is related to the presence of severe synovitis, cartilage changes, and adhesion.
Epithelial-myoepithelial carcinoma (EMC) comprises less than 1% of all salivary gland neoplasms and is essentially a tumor confined to the major glands, particularly the parotid (80%). A case of epithelial-myoepithelial carcinoma of the submandibular gland is reported. An 85-year-old man had a painless mass in the left submandibular region for 4 years. The mass was removed with the left submandibular gland. Histologically, the tumor consisted of a proliferation of double-layered duct-like structures with two distinctive cell types. On immunohistochemical analysis, reaction products for keratin and EMA were predominantly found in the inner epithelial cells, while those for smooth muscle actin and S-100 protein were observed in the outer epithelial cells. The patient showed no recurrence or metastasis for 2 years 2 months after surgical resection of the tumor tissue.
Benign lymphoepithelial lesions (BLEL) are an uncommon autoimmune disease. Clinically, BLEL show painless tumor formation in the major salivary glands. Pathologically, BLEL are associated with infiltration of lymphocytes into the salivary glands, followed by the formation of lymphoid follicles and myoepithelial islands. In this report, we describe two cases of BLEL. Case 1: A 48-year-old woman with a history of Sjogren's syndrome presented with a tumor at the left border of the tongue. BLEL arising in the lingual minor salivary glands is very rare. Case 2: A 50-year-old woman presented with bilateral BLEL in the submandibular glands.
Necrotizing fasciitis is a severe bacterial infection of the soft tissues that is characterized by rapid extension along fascial planes and soft tissue necrosis. We present a case of cervical necrotizing fasciitis resulting from pericoronitis of the mandibular third molar. A 72-year-old man was admitted to our hospital because of increasing swelling and pain in the left mandibular region. Local examination revealed a large swelling with redness and tenderness, extending from the left side of the mandible to the neck. There was a malodorous necrotic ulcer at the site of the left mandibular third molar. Cultures revealedPeptostreptococcus sp., Bacteroides sp., Prevotella intermedia, α-Streptococcus, andEubacterium lentum. Fasciitis and skin necrosis spread from the left mandible to the upper arm. We made an incision and drained and debrided the obviously nonviable tissue. The patient was ischarged after 104 days. The key to successful management of such an infection is aggressive surgical intervention.
We started to use Hotz plates in 1995 and have noticed that some patients cannot continue to use the plate until 1 year old. The purpose of this study was to survey the usage of Hotz plates in patients with cleft lip, alveolus, and palate. The subjects consisted of 48 patients with unilateral cleft lip, alveolus, and palate. They were classified into a usage group (39 subjects) or a discontinued group (9 subjects) depending on whether they continued to use the plate until 1 year old. The results were as follows: There were no statistically significant differences between the groups in age at initial usage of the plate, the width of the alveolar cleft at the time of initial usage, the width of the palatal cleft at the time of initial usage and at 1 year old, and the number of erupted teeth at 1 year old. There was a statistically significant difference between the groups in the width of alveolar cleft at 1 year old. The proportion of subjects having a 0 mm width of the alveolar cleft at 1 year old was significantly greater in the discontinued group than in the usage group. We conclude that patients who cannot continue to use the plate have a narrow alveolar cleft.