Expression of mesenchymal marker genes in carcinoma cells contributes to the progression of neoplasms. The HMGI family, consisting of HMGIC, HMGI, and HMGY, binds to transcription factors in enhanceosomes and regulates mesenchymal cell growth. Although aberrant expression of HMGIC initiates mesenchymal tumor formation, the expression of this marker gene in squamous cell carcinomas of the oral cavity has not been investigated previously. The present study was conducted to analyze expression patterns of the HMGI family in oral carcinomas. Elevated expression of HMGIC on conventional reverse transcription polymerase chain reaction (RT-PCR) was observed only in carcinoma cell lines and tissues but not in their normal counterparts. Quantitative analysis of expression levels by real-time RT-PCR demonstrated that HMGIC is up-regulated in E-cadherin-expressing cell lines. Immunohistochemical studies of carcinoma tissue sections found that HMGIC was localized in E-cadherin-positive carcinoma cells, whereas at the invasion front HMGIC was present in PCNA-positive carcinoma cells located at periphery of carcinoma cell nests and in surrounding fibroblast-like cells. The percentage of HMGIC-positive carcinoma cells decreased in poorly differentiated tumor tissue. The percentage of HMGIC-positive cases at the invasive front significantly increased in patients with cervical lymph node metastasis. These results suggest that HMGIC may have a role in the phenotypic alteration of carcinoma cells and the progression of oral carcinomas.
Odontogenic keratocyst (OKC) has a higher recurrence rate in patients with basal cell nevus syndrome (BCNS) than in those without BCNS. Relatively few studies have reported the characteristics of the epithelial lining of OKCs in patients with BCNS. We treated two patients with BCNS and examined the expression of Ki-67 antigen by immunohistochemical techniques to study the growth potential of the epithelial lining of OKCs. We also studied the characteristics of three cytokeratins (CK14, 17, 19) forming part of the structure of epithelial tissue. Ki-67-positive cells were primarily found in the basal and sub-basal layers of the epithelium. The epithelial lining of OKCs in patients with BCNS has high growth activity, and the staining patterns of CK14 and CK17 are useful in the diagnosis of OKC.
A case of spindle cell carcinoma in the maxilla is reported. The patient was an 88-year-old woman. She was referred to our department because of swelling of the maxillary gingiva. A soft mass (35×30mm) with a rough surface was present in the left upper molar region. Since the tumor was diagnosed as a spindle cell carcinoma on histological examination of biopsy specimens, surgical excision was performed with the patient under general anesthesia. Histologically, the tumor contained squamous cell carcinoma and sarcomatoid regions with spindle-shaped tumor cells. The sarcomatoid regions were closely associated with those of squamous cell carcinoma. Immunohistochemical techniques were used to distinguish between epithelial and mesenchymal properties, and keratin was found in the sarcomatoid regions. Although no cancer was evident at the surgical margins, bilateral metastases were present in the cervical lymph nodes 2 weeks after operation. Neck dissection was performed. Soon after the operation, however recurrence and metastasis developed at the surgical margin of the initial operation and the left parotid area and disease progressed rapidly. General condition deteriorated and cachexy worsened. She died 8 weeks after the second operation.
Basaloid squamous cell carcinoma, first described by Wain et al. in 1986, is a histologically distinctive variant of squamous cell carcinoma.Basaloid squamous cell carcinoma tends to have a poorer prognosis than the usual type of squamous cell carcinoma.We report a case of basaloid squamous cell carcinoma of the uvula.The patient was a 78-year-old man with a tumor of the uvula.Surgical excision was perfomed, and the outcome was good with no sign of recurrence.The pathological diagnosis was basaloid squamous cell carcinoma.
Arteriovenous malformation (AVM) of the jaw is considered a rare lesion.We report a case of AVM occurring in the jaw.A 13-year-old boy was referred to our hospital because of agressive gingival bleeding from the left lower molar region.Panoramic tomography showed a soap-bubble-like radiolucent area extending from the left first molar to the mandibular ramus. Angiography revealed an intraosseous AVM fed by the maxillary and facial arteries and a branch of the internal carotid artery. Before surgical resection of the AVM, superselective embolization of the maxillary and facial artery was done with polyvinyl alcohol. After temporary resection of the left side of the mandible from the oral cavity, the lesion was removed extraorally. The removed mandibular segment was reimplanted. The postoperative course was uneventful, and the cosmetic and functional outcomes were satisfactory.
Intraosseous lipoma is a very rare benign tumors arising in bone. Few lipomas of the jaw bones have been reported in the literature. We describe a case of intraosseous lipoma occuring in the mandible of a 35-year-old man.
We report a rare neurilemmoma arising in the center of the mandible with no neurologic symptoms near the inferior alveolar nerve. The patient was a 60-year-old man with mobility of the right mandibular molars. Orthopantomographic and computed tomographic examinations showed a well demarcated wide area of radiolucency, which included the resorbed roots of the mandibular right premolars and molars. We excised the region including the teeth; however, the lesion was not in contact with the inferior alveolar nerve or extraction socket. A microscopic examination revealed an Antoni type A neurilemmoma. No symptoms of sensory disturbance occurred postoperatively. After more than 2 years, there has been no tumor recurrence, and the prognosis remains very good.
We describe a modification of Goldstein's technique for secondary lip repair in patients with cleft lip and palate and report the outcome in 20 patients. Many patients with cleft lip have a small amount of upper lip tissue as compared with the lower lip, causing the lips to be unbalanced. Previously, we used Abbe's flap technique for such unbalanced lips; however, this method has the disadvantage of leaving scar tissue in the lower white lip area, whereas our modification of Goldstein's method does not leave scars in either the white or dry lip areas. Further more, during the 10-day period before cutting the flap, the patients experienced less stress because they were able to move their lips slightly. To perform our procedure, an approximately 7-mm-wide flap is designed inside the wet lower lip. An incision is made in the lower lip, excluding the angle of mouth, but including the labial artery. A median incision is made in the flap, and the flap is raised using the angle of the mouth as a pedicle. An incision is made in the upper wet lip, and the flap is transplanted to the upper lip. Finally, the pedicle of the flap is cut after approximately 10 days.
Single photon emission computed tomographic bone scintigraphy (bone SPECT) was performed in 16 patients with odontogenic maxillary sinusitis to compare inflammatory changes in the maxillary sinus wall including the alveolar process (bony lesions) before and after conservative therapy. Morphologic changes in bony lesions as evaluated by bone SPECT images correlated with those of the maxillary sinus mucosa (mucosal lesions) as evaluated by CT images. Morphologic changes in the bony lesions also correlated with changes in inflammatory activity in the maxillary alveolar process as functionally evaluated by bone SPECT before and after conservative therapy. Odontogenic maxillary sinusitis is considered a disease in which maxillary alveolitis causes mucosal lesions as well as bony lesions. Changes in alveolitis are associated with morphologic changes in bony lesions after conservative therapy, and these changes affect the pathophysiologic nature of odontogenic maxillary sinusitis. Bone SPECT is valuable for predicting outcome and treatment planning in patients with odontogenic maxillary sinusitis.
Many different techniques have been described for the treatment of recurrent temporomandibular joint dislocation. Surgical procedures, however, have risks in application, especially in compromised patients. Bilateral recurrent condylar dislocation in a 66-year-old man who had hemiplegia after cerebral infarction was successfully treated by autologous blood injection. Under local anesthesia, a 21-gauge needle was inserted in the superior compartment of the temporomandibular joint, and 3 cc of fresh autologous blood was injected in the compartment and 1 cc was injected in the pericapsular tissue. At follow-up 8 months after the procedure, the patient did not complain of recurrent dislocation. Autologous blood injection is an alternative treatment for recurrent temporomandibular joint dislocation, particularly in patients in whom surgical procedures should be avoided.
Intraoral vertical ramus osteotomy (IVRO) has far less adverse effects on the postoperative function of the temporomandibular joint than conventional procedures. However, after IVRO there is always a risk of dislocating proximal bony fragments on the unrotated side. This risk may be caused by movement of proximal bony fragments inferiorly and/or medially before or at the time of fixation during surgery. We describe our experience with fixation of proximal bony fragments laterally to distal bony fragments using absorbable sutures to prevent dislocation of proximal bony fragments during opening and closing movements after fixation. Our method has been found to be satisfactory for preventing dislocation of proximal bony fragments after fixation in all patients who undergo IVRO.