Invasion of the mandible by lower gingival squamous cell carcinoma is an important clinical problem. A previous study suggested that bone destruction associated with carcinoma invasion was mediated by osteoclasts rather than by carcinoma cells. However, the mechanisms involved remain unclear. This study focused on the role of various cytokines in activating osteoclastic bone resorption. We microscopically examined 38 specimens of lower gingival carcinoma and classified them into an invasion group (23 cases) and noninvasion group (15 cases). The specimens were examined immunohistochemically with antibodies to parathyroid hormone-related protein (PTHrP), tumor necrosis factor (TNF)-α, interleukin (IL)-1 α, 1 β, 6, 11, 18, and TGF-β. In the invasion group, the numbers of PTHrP, TNF-α, IL- 6, and IL-11 positive cells were significantly higher than those in the noninvasion group (P<0.01). Expression of IL-1 α, 1 β, 18 and TGF-β positive cells did not differ significantly between the groups. Our results strongly suggest that invasion of the mandible by lower gingival cancer is mediated by osteoclasts. Various cancer-derived cytokines, including PTHrP, TNF-α, IL-6, and IL-11, play important roles in bone invasion by lower gingival squamous cell cancers.
In this retrospective study, the relations between changes in cell proliferation kinetics and induced apoptosis in oral squamous cell carcinoma were examined before and after preoperative chemotherapy to clarify significance of such changes. In an additional study, multivariate analysis was performed to attempt to predict changes in cell proliferation kinetics. Apoptotic index (AI) increased in all cases, although there were some differences in degree. With respect to the change in cell proliferation kinetics, left-shift-type and right-shift-type AI was clearly high before chemotherapy and increased significantly after chemotherapy as compared with the non-effective type of AI. The 5-year cumulative survival rate was 91% in patients with less than 10% of the exceeding 4 c rate of nuclear DNA content (4 cER) and 62% in patients with 10% or higher 4 cER. In patients with low 4 cER, survival rates were excellent regardless the change in cell proliferation. On the other hand, survival rate was significantly worse in the non-effective type, while survival rates were relatively good in the leftshif t type and the right-shift type: 76% for the left-shift type, 74% for the right-shift type, and 35% for the non-effective type. Thus, we attempted to predict the non-effective type. Clinical stage (UICC), Gcategory (UICC), mitotic index, 4 cER, and AI were entered into logistic regression analysis as covariates. AI and 4 cER were selected as independent variables for the prediction of non-effective type. In conclusion, left-shift-type and the right-shift-type changes in cell proliferation kinetics seemed to be favorable in terms of induced apoptosis, and had excellent survival rates. AI and 4 cER were the most powerful predictors of the change in cell proliferation kinetics.
The prognosis of patients who have oral cancer with contralateral neck lymph node metastasis (CLNM) is poor. In this study, we retrospectively evaluated the incidence of CLNM and conditions associated with the occurrence of CLNM. We reviewed the clinical records of 180 patients who had untreated squamous cell carcinoma that occurred unilaterally (except between the canines) in the oral and maxillofacial region. The patients were treated at our hospital between 1985 and 1999. A total of 29 patients had CLNM (16.1%). All of these patients had ipsilateral neck lymph node metastasis, and there was a trend toward a high prevalence of multiple node involvement. CLNM occurred in the patients with T 2-T 4 tongue cancer and with advanced (T 4) cancer in other regions. Four of the 29 patients with CLNM had simultaneous recurrence at primary sites and three of them had undergone ipsilateral radical neck dissection at initial treatment. Our results suggest that patients with T 4 tumors or T 2-T 4 tongue tumors have a high risk of CLNM. Furthermore, patients with primary tumor recurrence should be closely observed for CLNM if ipsilateral neck dissection had previously been performed.
This retrospective study was designed to clarify the incidence of postoperative delirium in patients with oral cancer. Clinical records of 129 patients were reviewed, and the prevalence, duration, clinical symptoms, and risk factors of postoperative delirium were evaluated. Postoperative delirium developed in 17 patients (13.2%) between the first day and seventh day after surgery. All patients recovered within 5 days. The symptoms of postoperative delirium included clouding of consciousness (in 17 patients) and restlessness (in 15 patients). The results of single logistic regression analysis showed that the incidence of postoperative delirium was significantly higher in men than in women and that smoking, alcohol drinking habits, and no previous operation significantly correlated with postoperative delirium. Operation time, blood loss at surgery, and reconstruction with flaps also correlated with the incidence of postoperative delirium on single logistic regression analysis. In addition, tracheotomy, many catheters, staying in a private room, and sleeplessness after operation were related to postoperative delirium (single logistic regression analysis). On multiple logistic regression analysis of these risk factors, the strongest significant correlation was found between sleeplessness and the incidence of the postoperative delirium (odds ratio: 8190.145, 95% confidence interval: 7.738 to 4672.113). Our results suggest that patients should be closely observed after operation to reduce the incidence of postoperative delirium in patients at risk for this condition.
Histologically, intramuscular lipoma is characterized by mature fat cells infiltrating into muscle fiber. The incidence of this tumor is high in the skeletal muscle of both the upper and lower extremities. However, the incidence is extremely low in the oral cavity. We describe an intramuscular lipoma occurring in the oral floor of a child. On presentation, a palpable painless fixed mass, measuring 30× 25mm was found in the right side of the oral floor. Extraoral examination revealed an elastic soft mass in the right submandibular region. Computed tomography showed a fat-like mass in the right side of the oral floor. The mass contained cord-like structures. The margin was unclear. During operation, an oval tumor was enucleated with the surrounding muscule. Microscopic examination showed that the tumor was not covered with a capsule. The stroma was composed of mature adipose cells surrounded and separated by irregular bundles of skeletal muscle fiber. There were no malignant findings, including lipoblast cells. During 7 years 6 months of following-up, neither tumor recurrence nor functional impairment has occurred.
AA case of central squamous cell carcinoma of the maxilla is presented. A 58-year-old man underwent surgery for a clinical diagnosis of radicular cyst of 2 at another hospital. However, the histologic diagnosis was squamous cell carcinoma of the maxilla, and the patient was referred to our hospital. CT examination showed that the tumor originated intraosseously. The left submandibular lymph nodes were enlarged. He underwent left neck dissection and partial maxillectomy, but recurrence occurred in the contralateral retropharyngeal space (Rouviere lymph nodes). Right neck dissection combined with parapharyngeal dissection was performed, followed by postoperative radiotherapy and chemotherapy, but he died of neck recurrence and distant metastasis 10 months after presentation.
Solitary neurofibroma of the head and neck is rare. A 72-year-old woman presented with a tumor in the mental region. The tumor had a smooth surface, elastic soft consistency, and measured approximately 8×10×10mm. The clinical diagnosis was a benign tumor of the mental region. The mass was excised under local anesthesia. Histologically, the tumor was clearly encapsulated and composed of proliferations of spindle-shape cells with wavy collagen fibers in a myxomatous stroma. Immunohistochemical examination showed some tumor cells stained positively with anti-S-100 protein and anti-neuron specific enolase antibodies. Neither cafe au lait spots nor other neurofibromas were observed on physical examination. This case was finally diagnosed as a solitary neurofibroma of the middle part of the mental region.
Myoepithelioma is a rare tumor accounting for less than 1% of all salivary gland tumors. We report a case of plasmacytoid myoepithelioma of the palate. The patient was a 65-year-old woman with a painless swelling of the palate. The tumor, measuring 18×23mm, was located at the right side of the palate.The tumor was excised under aclinical diagnosis of a pleomorphic adenoma. Histologically, the tumor was composed of plasmacytoid cells that showed positive reactions for S-100 protein, vimentin, and keratin, and a partially positive reaction for GFAP. The pathological diagnosis was plasmacytoid myoepithelioma. There has been no evidence of recurrence as of 2years postoperatively.
Angioleiomyoma is a benign tumor formed by the nodular growth of smooth muscle cells surrounding small arteries and small veins. It usually occurs in the intracutaneous or subcutaneous regions of the arms and legs and is rarely found in the oral area. We encountered a case of angioleiomyoma occurring in the palate. We describe this rare case and discuss other cases reported in the literature.
We describe a recent case of ameloblastic fibro-odontoma and review the literature with regard to the pathogenesis and clinical course to diagnosis of this tumor. The patient was a 13-year-old girl. A panoramic radiograph revealed an impacted tooth, thought to be the right mandibular 2nd molar, at the site corresponding to the right mandibular 2nd molar. A frosted, unilocular radiolucent image with a distinguishable border and a radiopaque and irregular margin were observed. The suspected diagnosis was aright mandibular tumor. Resection of the tumor and e×traction of the impacted tooth were performed. The resected specimen was a grayish white massive tumor measuring 10×5×10mm, with no internal hard tissue. The histopathological diagnosis was an ameloblastic fibro-odontoma. This type of tumor is relatively rare in Japan. Only 33 cases, including ours, have been reported. Furthermore, the presence of a radiolucent image with no distinct radiopaque regions, as seen in our patient, appears to be extremely rare because only 5 cases, including ours, could be found in the literature.
We report a very rare case of an aneurysmal bone cyst arising in the maxilla. A 12-year-old boy had bilateral swelling of the maxilla with tenderness. Radiographs revealed a radiolucent lesion, and asoap-bubbled radiolucency was recognized after close observation. A puncture of the region before biopsy aspirated blood. Angiography showed spotted shadows in the radiolucent area. A biopsy was done after transcatheter arterial embolization (TAE). The lesion had some cystic spaces with an osseous septum. Based on pathological examination of the biopsy specimen and the clinical findings, a final diagnosis of an aneurysmal bone cyst was made. Because recrudescence occurred 11 months after initial TAE, a second session of TAE was done. For the past 10 months, there has been no evidence of recrudescence.
We describe a case of odontogenic maxillary sinusitis with sulfur granules suspected to be actinomyces. An 86-year-old woman was referred to our hospital for evaluation and treatment of nasal discharge. The clinical diagnosis was odontogenic maxillary sinusitis. We extracted the right maxillary first and second molars. After extaction, the socket was opened to enter the right maxillary sinus.We obtained granulation tissue with sulfur granules from the bottom of the maxillary sinus. Histopathological examination revealed the presence of actinomyces. We irrigated the maxillary sinus with saline from the extraction socket. As of 2 months after the operation, no signs or symptoms have been observed clinically or radiographically.
Impaction commonly affects mandibular third molars. An inverted impacted mandibular premolar is rare. We describe an inverted impacted mandibular premolar, the crown of which was exposed from the lower border of the mandible. The patient was a 67-year-old man with swelling and spontaneous pain of the left submandibular area. Radiographic examination showed dental material restoration at the apex of the inverted impacted mandibular premolar. After antibiotic chemotherapy, incision, and drainage, an operation was done from an extraoral approach with the patient under general anesthesia. An incision, about 3cm in length, was made on the skin of the left submandibular region. The crown of the impacted tooth was exposed vertically from the lower border of the mandible. The tooth was removed carefully. The postoperative course was uneventful.
Molar bone fractures are often associated with mid-face fractures. Many patients present with this condition. We treated a molar complex fracture by continuous or intermittent reduction force applied with a head frame. Reduction force was produced by traction with an elastic band and compression with a screw bar. Traction and compression force were applied concurrently to three dimensionally reduce the fracture. Force was adjusted with the elastic band and screw bar. This technique could three dimensionally manipulate large fragments and restore the continuity of each buttress. It is considered one of the ideal methods to treat fractures that are difficult to reduce with rigid or semi-rigid internal fixation plates.
We report a rare case of anaphylactic shock during tooth extraction. The patient had atopic dermatitis for about 20 years. Although the serine IgE level was high, the results of drug lymphocyte stimulation tests (DLST) against all ingredients in the local anesthetics were negative. However, when we performed skin-tests against sodium metabisulfite and para-oxy benzoic acid methyl, small amounts of which were contained in the local anesthetics, sodium metabisulfite induced an allergic reaction. We conclude that this was a rare case of anaphylaxis caused by sodium metabisulfite in a patient with atopic dermatitis. We should be especially cautious when we use local anesthetics in patients with atopic dermatitis.