The purpose of this study was to investigate whether a combination of fibrin glue, biodegradable scaffold (β-tricalcium phosphate;β-TCP), and mesenchymal stem cells (MSCs) would promote new bone formation and provide three-dimensional templates for bone growth at heterotopic sites in rats with plasticity. Growing MSCs and developing matrices, explanted from the rat femur, were minced and mixed with fibrin glue in a syringe. The MSCs/fibrin glue-β-TCP complex was injected into the subcutaneous space of the back of the rat. Eight weeks after implantation, macroscopic examination revealed a pearly opalescence that was firm on palpation. Histologic investigations showed newly formed bone structures in all rats treated with the MSCs/fibrin glue-β-TCP complex. No bone structures were found in the fibrin glue or β-TCP control groups. Our results demonstrate that injectable MSCs/fibrin glue-β-TCP complex can provide a three-dimensional scaffold for the successful transplantation and engraftment of osteoblasts. This technique holds promise of becoming a minimally invasive means of delivering autogenous bone to correct or repair bone defects such as those associated with osteoprotic fractures, paradontosis, and tumor resection.
Florid cemento-osseous dysplasia (FCOD) was newly added to the World Health Organization classification of odontogenic tumors in 1992. We reviewed 7 cases of FCOD treated between 1994 and 2001. All patients were women. The mean age was 69.4 years, with a range of 60 to 89 years. FCOD lesions often occurred in the posterior part of the mandible. The lesions were removed under general anesthesia. Histopathological examination of the surgical specimens showed that FCOD consisted of many lobulated masses resembling cementum. FCOD lesions were often surrounded by loose, fibrous connective tissue containing many small cementicle-like masses. Computed tomography and 99mTc-MDP scintigraphy were useful for both diagnosis and management of FCOD.
We investigated the relation of oral and maxillofacial cancer to upper gastrointestinal fiberscopic findings and evaluated the value and reliability of gastrointestinal fiberscopy (GIF). Sixty-two patients with oral and maxillofacial squamous cell carcinoma were examined by GIF in consultation with an internist. The results were as follows: 1. The incidence of upper gastrointestinal lesions in patients with oral and maxillofacial cancer was higher than that in the general population. 2. There was no relation between the region or the stage of squamous cell carcinoma and the incidence of upper gastrointestinal lesions. 3. There were 6 cases (9.7%) of double cancer. There were also many precancerous lesions, such as esophageal dysplasia (3 cases, 4.8%), Barret's mucosa (3 cases, 4.8%), atrophic gastritis (26 cases, 41.9%), and intestinal metaplasia (9 cases, 14.5%). Four cases of active peptic ulcer (6.5%) were also found. 4. The incidence of esophageal lesions in patients with smoking and drinking habits was significantly higher than that in patients without smoking habits, drinking habits, or both. In conclusion, it is important to examine the upper gastrointestinal tract of patients with oral and maxillofacial cancer by GIF not only to screen for double cancers but also to detect precancerous lesions and active peptic ulcers.
A case of MALT lymphoma in the parotid gland is reported, along with a brief discussion. An 81-year-old woman was referred to our department on November 11, 2000 because of a swelling in the left parotid gland. A benign lymphoepithelial lesion in the left parotid gland had been diagnosed in 1984, and rheumatoid arthritis was diagnosed in 1993. A tentative diagnosis of a recurrent parotid tumor was made, and superficial parotidectomy was performed with the patient under general anesthesia. A histopathological diagnosis of MALT lymphoma was made. Secondary Sjogren's syndrome was diagnosed on detailed examination. In this patient, the MALT lymphoma was considered to have arisen from the benign lymphoepithelial lesion and was suspected to be associated with Sjogren's syndrome. There was no evidence of recurrence 2 years after the operation.
Spindle cell carcinoma (SpCC) is a biphasic tumor consisting of a squamous cell carcinoma component and a sarcomatoid component of spindle cells. Without immunohistochemical or ultrastructural study, it is difficult to differentiate the sarcomatoid component of SpCC from sarcoma. We describe a case of spindle cell carcinoma arising as a polypoid mass in the tongue of a 74-year-old woman. The mass was successfully differentially diagnosed on immunohistochemical analysis. Pathological analysis of the tumor revealed three components of squamous cells, histiocyte-like cells, and spindle cells. Immunohistochemical characterization of tumor cells was done with antibodies to keratin, vimentin, smooth muscle actin, desmin, and 5-100 protein to differentiate SpCC from melanoma and leiomyosarcoma. The histiocyte-like cells and spindle cells were positive for keratin and vimentin, and negative for smooth muscle actin, desmin, and 5-100 protein. Given these findings, we diagnosed SpCC. In the 7 months following surgery, there has been no local recurrence or metastasis.
Improved therapy for cancer has resulted in many long-term survivors. Some of them may have a second cancer during long-term follow-up. The prevalence of multiple primary cancers has therefore increased, and many cases have been reported. However, cervical lymph node metastasis from both double cancers is rare. We describe a rare case of cervical lymph node metastasis suspected to have arisen from double primary cancers: an upper gingival cancer (squamous cell carcinoma: SCC) and a cancer of uterine body (adenocarcinoma: AC). Histopathological examination after radical neck dissection revealed SCC at levels I to III and AC at levels IV and V. AC in the neck resembled to the cancer of uterine body histopathologically. On the basis of these findings, the SCC at levels I to III was considered to be metastasis from the upper gingival cancer, whereas the AC at levels N and V was consistent with metastasis from the cancer of uterine body.
We report a rare case of congenital epulis with tooth-like hard tissue. The epulis was found on the palatal gingiva of a 1-year 5-month-old boy. It was a smooth, round mass with a pedicle that may have been connected to tooth-like hard tissue. The tumor was excised with the patient under general anesthesia. It consisted of fibrous connective tissue with rich vascularity. The histopathological diagnosis was fibrous epulis.
Dialysis-related amyloidosis (DRA) is a serious complication occuring most often in patients undergoing long-term hemodialysis (LHD) and in patients receiving renal replacement therapy. The deposition of amyloid, which consists of beta 2 -microgloblin that is not removed by normal hemodialysis, is a major contributing factor to DRA. We describe a case of bilateral amyloidosis of the temporomandibular joint (TMJ) that developed after LHD therapy. A 68-year-old man was referred by the transplant surgery department of our hospital to our outpatient clinic for detailed examination of a left preauricular swelling. The first examination showed swelling of the left preauricular soft tissue. The swelling was about 3cm in a diameter and 1cm in height, nontender, and firmer than other intact areas of facial skin. In the right preauricular soft tissue, we palpated a nontender, round subcutaneous lesion about 2.5cm in diameter. Magnetic resonance imaging suggested amyloidosis. An excisional biopsy of the left TMJ was performed, revealing DRA of the TMJ. DRA of the tongue, lip, and buccal mucosa have been often reported, but DRA of the TMJ has not been previously reported in Japan or abroad in the oral and maxillofacial field. There is no treatment available for this condition. The patient is being followed up periodically, and there has been no change in his condition.
A statistical analysis was performed to determine factors that influence the clinical outcome of unilateral condylar fractures of the mandible. In this study, the fracture location was limited to the condylar neck and base of the condylar process. Twenty-eight patients, 18 males and 10 females, were treated at our clinic between January 1997 and December 2001. The age range was 7 to 79 years, and the average age was 32.6 years. Seventeen cases involved fractures of the condylar neck and 11 cases involved fractures of the base of the condylar process. Fifteen cases were treated conservatively by intermaxillary fixation, and 13 were treated surgically by using a titanium mini-plate or lag screw osteosynthesis system. The clinical outcome was determined according to the classification described by Kamiya 6 months after injury. The outcome was good in 21 cases, whereas 7 cases had restricted mouth-opening or joint sounds during jaw movements. This study revealed that two factors can negatively influence the clinical outcome of unilateral mandibular condylar fractures: one is the type of fracture in all cases and the other is the age of the patient at injury in cases treated conservatively.
Angioneurotic edema is subcutaneous or mucosal swelling resulting from increased vascular permeability, which can be produced by a variety of conditions. There are two forms of angioneurotic edema: hereditary and non-hereditary. Deficiency of C 1 esterase inhibitor (C 1 INH) function is known to be associated with hereditary angioneurotic edema. Non-hereditary angioneurotic edema associated with deficiency of C 1 INH function is rare. We report a case of non-hereditary angioneurotic edema with facial edema triggered by odontogenic inflammation. The patient was a 58-year-old woman who was referred to our clinic because of facial swelling after pulpectomy of the right lower incisors. Marked edema was present in her face, lips, cheeks, and soft palate. Laboratory examination revealed a deficiency of C 1 INH. Because no member of her family had episodes of facial swelling or deficiency of C 1 INH, the diagnosis was non-hereditary angioneurotic edema with deficiency of C 1 INH. We describe the clinical course of the patient and the mechanism of angioneurotic edema.
Osteopetrosis shows scleotic changes of the skeletal bone caused by decreased numbers or functional abnormalities of osteoclasts. Patients with osteopetrosis are susceptible to jaw osteomyelitis associated with odontogenic infection. The osteomyelitis in patients with osteopetrosis is usually intractable. Osteomyelitis of the jaw was caused by infection after tooth extraction in all four cases reported here. Three of the four cases involved only the maxilla. The lesion recurred after only curettage, sequestrectomy, or both in all cases. Segmental mandibulectomy is recommended to radically cure osteopetrosis.