Receptor-binding cancer antigen expressed on SiSo cells (RCAS1) is a type II membrane protein isolatedas a human tumor-associated antigen against a human uterine adenocarcinoma cell line, SiSo. RCAS1 acts asa ligand for a putative receptor present on immune cells such as T, B, and NK cells and inhibits the growth ofreceptor-expressing cells, further inducing apoptotic cell death. These observations suggest a role of RCAS1 in theimmune escape of tumor cells. Although a variety of cancer tissues have been screened and found to be positivefor RCAS1 expression, whether RCAS1 is expressed in head and neck cancer remains unclear. This study examinedwhether RCAS1 is expressed in adenoid cystic carcinoma (ACC) tissues or various cell lines (HSG, AZA1, AZA3, and HSY) derived from human salivary glands and whether tumor cells that express RCAS1 induce apoptosisof its receptor-positive cells, peripheral blood lymphocytes (PBLs). RCAS1 transcripts and proteins weredetected in 4 cell lines. Immunohistochemical examinations revealed that RCAS1 was slightly to moderately positivein 11 of 13 cases (84.6 %) of ACC. Confocal laser microscopy showed that PBLs stimulated with interleukin (IL)-2 undergo apoptosis by co-culturing with HSG or HSY cells. Our results of TUNEL showed that apoptotictumor-infiltrating lymphocytes were distinctly observed around RCAS1-positive tumor cells in ACC tissues. Theseresults suggest that RCAS1 expression might be associated with the progression of salivary gland tumors and apossible mechanism for oral cancer immune escape.
A retrospective study of 17 cases of nasopalatine cysts was performed. The investigation comprisedclinical and histological observations, including assessment of CT images. The mean age of the patients at diagnosis was 51.9 years, ranging from 25 to 83 years. Fourteen of the subjectswere men, and only 3 were women. Clinical symptoms were present in 16 (94%) patients, and one case wasfound incidentally on X-ray examination. The most common symptom was swelling of the anterior part of thepalate. Occlusal X-ray and CT examinations were performed in all patients. The diameters of the cysts were estimatedby CT imaging, and the mean values were 24 mm transversely, 19mm anteroposteriorly, and 19mm inheight. The cysts were typically round or ovoid on both CT scans and occlusal radiographs. Only two casesshowed heart-shaped radiolucency on occlusal films, whereas CT scans showed no such features in these cases. As for the surgical procedure, all cysts were enucleated, and the wound was closed primarily, without marsupialization.Eleven cysts were approached from the labial side, and six from the palatal side. Histologically, the cystwall consisted of various types of epithelium, and squamous epithelium was seen in all cases.
One of the major issues in patients who undergo reconstructive surgery after ablation of oral malignanttumors is the decline in the quality of life due to disorders of deglutition. Rehabilitation in such patients should beperformed on the basis of the functional assessment of deglutition. Methods are available for the assessment ofdeglutition; however, there is no standardized quantitative system for evaluating the oral stage of deglutition. Indeglutition, tongue movement, which transports food into the pharynx, is important, and dysfunction of the oralstage causes food to remain in the mouth as well as early transport into the pharynx. Several methods for assessing oral function with the use of food samples have been developed. In the presentstudy, our goals were to choose the best food property for assessing the oral function of patients with deglutitiondisorders due to dysfunction of tongue mobility after ablation of tumors of the tongue, mouth floor, and lower gingivafollowed by reconstruction, and to prepare a standardized method for assessing oral function. Food properties were assessed by sensory evaluation, which was a subjective assessment. First, we establishedsix criteria defining oral sensation on transport of food from the mouth to the pharynx. Thirty volunteers who hadnormal oral function ate 13 standardized foods. The volunteers assessed the properties of each standardized foodaccording to the six criteria, scored from-2 to 2. Then, we analyzed the data by principal components analysis.The results showed that two factors were associated with eating difficulty in the oral stage of deglutition; onefactor was plotted on the X-axis, and the second factor was plotted on the Y-axis to construct food-property maps.Thus, the food properties were visualized, and the food samples were divided into four groups. Twenty patients who had undergone partial glossectomy to total glossectomy, ate one food from each of thefour groups on the map, and we assessed the amount of food remaining in the mouth. In the test, a banana fromGroup I, jelly from Group II, meat flakes from Group M, and protein puree from Group IV were used. The Group IV foods showed the broadest dispersion in the amount of food remaining in the mouth. In contrast, Group II foods showed the narrowest distribution in the amount of food remaining. Group I, II, and IV foodsdid not cause misdeglutition; however, Group IlI foods caused aspiration in 3 of the 20 patients. Our results suggest that Group IV foods may be able to distinguish slight differences in the ability to swallowamong patients who have undergone ablation of tongue tumors. In conclusion, swallowing tests using Group IV foods such as protein puree can be used to assess the site and amount of food remaining in the mouth, and thereby provide indices of the recovery of the oral stage of deglutition.
Several studies have examined the eruption of ectopically impacted teeth with regard to the position ofthe tooth germ, aberration of the course of eruption, and defects in the eruption site. Tooth impaction is oftencaused by a tumor or a cyst. We describe our experience with a rare case involving projection of an ectopicimpacted tooth into the mandibular notch in a patient receiving treatment for osteomyelitis. A 59-year-old man wasreferred to the Department of Oral and Maxillofacial Surgery, Kameda General Hospital on January 25, 2001because of dental problems. Panoramic radiography showed apical periodontitis and slight radiopacity in the rightlower second molar region. Projection of an ectopically impacted tooth was also identified in the mandibularnotch, which was asymptomatic. We discuss the findings and review the literature on erupting ectopically impactedteeth in the mandible.
We report a rare case of subdural abscess secondary to odontogenic infection. A 62-year-old womanwas referred to our hospital because of severe trismus with a painful swelling in the left temporal region, whichoccurred after extraction of the left maxillary molars owing to severe periodontitis. A CT scan revealed an abscessextending from the pterygopalatine fossa to the deep temporal space. Immediately after hospitalization, theabscess was surgically treated by drainage via an intraoral incision and a temporal skin incision. In addition, antibioticswere administered intravenously. The postoperative course was uneventful, and clinical symptoms improvedrapidly. However, sudden aphasia occurred on the 18th postoperative day. Brain CT scanning revealed multiplesubdural abscesses extending from the left temporal lobe to the parietal lobe. Although conservative anti-inflammatorytreatments were given, hemiparesis developed. Thus, craniotomy was performed to remove the abscess. The postoperative recovery was excellent, with no sequela.
A case of syphilitic lymphadenitis of the neck, without syphilis of other regions, is presented. Thepatient was a 41-year-old man. A medical examination revealed a 35×35mm mass and swelling of several lymphnodes in the left side of the neck. The mass was thought to be a malignant lymphoma. However, serological examinationrevealed elevated values of the RPR test (titer, 1: 64) and TPHA test (1: 2560). Light microscopicexamination of the mass also showed lymphadenitis associated with follicular hyperplasia with extension into themedulla and proliferation of plasmacytes and epithelial-like cells within the follicles. Conseqently, the mass wasdiagnosed as syphilitic lymphadenitis. An intravenous drip injection of ABPC was administered at 2.0g/day for4days postoperatively, and oral ABPC 1.5g/day was given for 2 months. Cervical lymph node swelling disappearedcompletely. Interview of the patient suggested that syphilis was acquired 2 months befor the onset of symptoms, and the syphilitic lymphadenitis was apparently caused by oral infection.
We describe a case of acute suppurative arthritis of the temporomandibular joint that gradually progressedto degenerative bony changes of the condyle over a period of 3 years 3months safter treatment. However, the patient remained clinically asymptomatic. The patient, a 51-year-old man, presented with trismus and severe TMJ pain. On initial examination, themandible was found to have shifted to the contralateral side, with malocculusion. The range of motion was limitedto 24mm. CT scans revealed massive swelling of the lateral pterygoid muscle. The right mandibular condylarhead was displaced anteriorly. The patient was admitted to the hospital and underwent surgical drainage from the joint space. The right maxillarymolar stumps were removed. The symptoms completely resolved within 2 weeks. The occlusion returned towithin normal limits. Maximum opening increased to 44mm. However, CT scans revealed worm-hole-like boneresorption in the right TMJ condyle. The patient was discharged from the hospital on 17th day. Follow-up was uneventful, and maximum opening increased to 52mm. CT scans disclosed extensive resorptionof the lateral condyle and proliferative bony changes of the articular surfaces. However, the patient was asymptomaticwithout further disturbance of daily activities, maintaining a range of motion of 48mm.
We describe our experience with a case of osteochondroma of the left mandibular condyle. A 38-yearoldman presented with a 16-year history of slowly developing facial asymmetry and occlusal dysfunction. Preoperative computed tomography (CT) and magnetic resonance imaging (MRI) revealed a well-definedtumor arising from the left mandibular condyle. A huge tumor was located in the infratemporal fossa. Osteochondroma of the mandibular condyle was diagnosed. Preoperative analysis of a gnathostatic model andpaper surgery indicated that facial asymmetry and occlusal dysfunction would be improved by immediate reconstructionof the jaw with an artificial mandibular condyle after resection of the tumor. The lesion was surgicallytreated via a temporal-preauricular approach, Al-Kayt-Bramley's method, by resecting the zygomatic arch temporarily.The tumor was removed by means of condylectomy, and the defect was repaired with artifical material.The postoperative course was uneventful. The use of an artificial mandibular condyle with an adjustable connectorcontributed to the postoperative TMJ function and occlusal restoration.
We report on a 66-year-old man with adenolipoma of the hard palate. The patient consulted our hospitalfor detailed examination of a palatal mass. Magnetic resonance imaging showed a well-delineated tumor in thepalate. Since CT scanning indicated no bone resorption, the tumor was resected en bloc, with the patient undergeneral anesthesia. Histopathological examination suggested adenolipoma. During 4 years 6 months of postoperativefollow-up, the patient's course has been good, without relapse.
Adenosquamous carcinoma is a malignant tumor with histological findings of both squamous cell carcinomaand adenocarcinoma. It often arises in the nasal and sinus mucosa of the maxillofacial region. Thirty-sixcases of adenosquamous carcinoma developing from oral mucosa have been reported. However, none of themwere found on the buccal mucosa. We report a case of adenosquamous carcinoma of the buccal mucosa. The patient was a 64-year-old man; he visited our hospital because of an ulcer of the right side of the buccalmucosa in April 2000. On initial examination, there was a 12×12mm ulcer which bled easily and was tender and surrounded byinduration (20×20mm). There was no lymphadenopathy in the neck and no radiological abnormality that suggestedbone resorption in the right side of the maxilla or mandible. The tumor was diagnosed as squamous cellcarcinoma on initial biopsy. After preoperative chemotherapy with peplomycin, we resected the tumor. The finalhistopathological diagnosis was adenosquamous carcinoma. Four years have passed since the operation, with noevidence of recurrence or metastasis.
Malignant tumors rarely metastasize to the oromaxillary region. We report a case of esophageal carcinomathat metastasized to the tongue. A 63-year-old man who was given a diagnosis of esophageal carcinoma onendoscopy was referred to our department for further evaluation of a swelling in the tongue. A hard mass was palpatedon the right margin of the tongue. The mass was covered with normal mucosa and adhered to the surroundingtissue. Histopathological examination revealed a poorly differentiated squamous cell carcinoma, infiltrating into themuscular layer of the tongue. There was no continuity between the tumor and covering epithelium.Histopathologically, the tumor of the tongue was similar to that of the esophagus. Finally, 81 days after the operation, the patient died of multiple organ failure.
Three cases of trigeminal neuralgia-like pain caused by an intracranial tumor are reported. All patients were women 58 to 65 years of age. Their main complaints of these cases were paroxysmal pain affectingthe left side of the face, the right side of the mandibular gingiva, and the left side of the apex and the border ofthe tongue, respectively. In all patients, an intracranial tumor was found, either on CT or MM. These tumors werelocated at the cerebellopontine angle. Radiation therapy with a gamma knife was selected for two cases and surgicalresection was introduced in one case. When trigeminal neuralgia is suspected, it is important to ascertain thepresence of intracranial tumors by means of CT or MRI.
Transcatheter arterial embolization (TAE) is an effective and minimally invasive treatment againstuncontrolled arterial bleeding. We report a traumatic aneurysm that occurred after tooth extraction and was treatedby TAE. A 48-year-old woman was referred to our hospital because of uncontrolled intraoral arterial bleeding 4days after third molar extraction. In her medical history, she had been treated for liver cirrhosis and hepatocellularcarcinoma. A pseudoaneurysm of the inferior alveolar artery was found on selective carotid angiography. Massive arterial bleeding from the aneurysm was successfully treated by TAE. TAE and selective carotid angiographywere useful for the management of hemorrhage probably caused by a traumatic aneurysm after toothextraction.