This study investigated the relation between the expression and clinicopathlogic significance of VEGF, PD-ECGF, and VEGF-C in oral squamous cell carcinoma (OSCC). The expression of these angiogenic factors in OSCC specimens from 62 patients was examined by immunohistochemistry. VEGF expression significantly correlated with lymph node metastasis, histologic differentiation, and mode of invasion (p<0.05), but not with age, sex, tumor size, or vessel invasion. PD-ECGF expression significantly correlated with age and mode of invasion (p<0.05), but not with sex, tumor size, lymph node metastasis, histologic differentiation, or vessel invasion. VEGF-C expression strongly correlated with the lymph node metastasis (p<0.01), but not with the other factors. Logistic regression analysis of lymph node metastasis was performed. Univariate analysis showed that lymph node metastasis correlated with mode of invasion, VEGF-C, VEGF, and vessel invasion (p<0.05). Multivariate analysis of these four factors revealed that mode of invasion and VEGF-C were exclusive independent factors influencing lymph node metastasis (p<0.05). Angiogenic factor-positive cases showed higher microvessel density (MVD) than negative cases, and only PDECGF expression statistically correlated with MVD. Univariate analysis of overall survival showed that VEGF, lymph node metastasis, tumor differentiation, and mode of invasion were significant prognostic factors. Moreover, multivariate analysis of these four factors with Cox's proportional hazards model revealed that VEGF and lymph node metastasis were independent predictors of outcome. The 5-year cumulative survival rate by the Kaplan-Meier method was 54.9 % for the VEGF-positive group and 90.5 % for the VEGF-negative group. The VEGF-positive group showed a significantly lower survival rate than the VEGF-negative group (p<0.01). These results indicate that VEGF and VEGF-C may be a reliable predictors of outcome and regional lymph node metastasis, respectively. Moreover, VEGF and VEGF-C may be important factors for developing new diagnostic systems for prognosis and metastasis in OSCC, respectively.
Incidental detection of cervical lymph node metastasis from thyroid carcinoma during neck dissection for oral cancer is uncommon clinically. There is no consensus regarding the treatment of primary thyroid lesions associated with metastasis. Cervical lymph node metastasis from papillary thyroid carcinoma (PTC) was detected incidentally in 3 of 325 patients who underwent radical neck dissection for metastasis of oral squamous cell carcinoma (SCC) between 1978 and 2002. The patients were one man and two women 44 to 56 years of age. All three patients had SCC of the tongue. Physical examination and radiologic evaluation showed no intrathyriodal lesions. PTC had metastasized to the cervical lymph nodes at levels II to IV. The patients did not receive additional treatment for their thyroid lesions and were followed-up by computed tomographic and echographic examinations. PTC did not show any growth or metastasis during the follow-up period (2 years 11 months - 8 years 7 months), although one of the patients died of recurrence of SCC 2 years later. PTC is usually indolent and associated with low mortality. We suggest that incidental PTC should be followed by imaging studies when the thyroid gland shows no clinical or radiologic evidence of lesions.
To define the optimal timing for secondary bone grafting to the alveolar clefts, we studied the effects of early secondary bone grafting on maxillary growth. The subjects were 13 patients with unilateral cleft lip/palate (UCLP) who had undergone bone grafting at 5 or 6 years of age (range: 5 years 10 months-6 years 10 months, mean: 6.2years) from December 1993 through February 1998. As control 6 other patients with UCLP who did not undergo bone grafting until 10 years of age were studied. Maxillary growth was compared between the two groups by means of maxillary plaster casts taken at selected intervals from 6 to 10 years of age. The results of analyses showed that the width of the tuber maxillary regions and molar regions and the alveolar arch length of the maxilla grew significantly from 6 to 10 years of age, regardless if bone grafting was done or not. Although the width of the canine regions significantly increased in patients who had not undergone bone grafting until 10 years old, the growth of the canine regions seemed to be inhibited when the patients underwent bone grafting at 5 or 6 years of age. Several studies have reported that the width of the canine regions reaches the peak value when the permanent incisors start to erupt, with minimal growth after the eruption of the incisors is completed. From these, it was suggested that bone grafting should be avoided in patient with 5 or 6 years of age, before the permanent incisors have started to erupt.
The purpose of secondary alveolar cleft bone grafting is to reconstruct the dental arch. This study examines postoperative ambulatory recovery after secondary iliac particulate marrow and cancelous bone grafting. A total of 33 patients with cleft lip, alveolus, and/or palate underwent bone grafting between February 1998 and December 2000. These patients comprised 20 males (23 operations) and 13 females (13 operations) with a median age of 11 years at operation and an age range of 7 to 24 years. Four to eight grams (median 5 g) of autogenous particulate marrow was harvested from iliac bone. The median recovery time until the patients could move about with the use of a wheelchair was 1 day. They could walk with and without aid on the 3rd and 5th postoperative days, respectively. The patients were discharged when they could walk up and down stairs, and the median discharge day was the 14th postoprative day.
Primary carcinoma arising in the dorsum of the tongue is very rare and may be erroneously diagnosed as a benign lesion. We present a case of squamous cell carcinoma of the dorsum of the tongue in a 49-year-old man. Intraoral examination revealed a tumor measuring 41×30×7 mm in the midline of the dorsum of the tongue. A biopsy was performed, and the diagnosis was squamous cell carcinoma. After preoperative chemotherapy, total resection of the tumor was performed. During about 1 year of follow-up, there has been no sign of recurrence or metastasis.
A case of mandibular metastasis from malignant hemangioendothelioma of the chest wall is reported. On October 5, 2000, a 65-year-old man, who had been admitted for malignant hemangioendothelioma of the chest wall, came to our department for bleeding after extraction of the lower left second molar. The bleeding was associated with granulation-like tissue in the extraction fossa. Panoramic radiography showed osteolytic lesions in the left body of the mandible and both heads of the mandible. Bleeding was stopped by vascular embolization of the left maxillary artery. Biopsy was performed, and histological examination revealed mandibular metastasis of a malignant hemangioendothelioma of the chest wall. The patient later underwent radiotherapy because of severe pain. Although the mandibular tumor grew, bleeding and pain were controlled, and his quality of life improved. He died of respiratory failure 1 month after our first medical examination.
Cervical lymph node metastasis from oral carcinoma is usually treated surgically because of its relatively low response to radiochemotherapy. We report the case of a 75-year-old woman with large metastatic lymph nodes and local recurrence of lower gingival carcinoma, which were treated successfully by nedaplatin (CDGP) plus 5-fluorouracil with radiation therapy.
We report a rare case of bilateral carcinomas of the maxillary sinuses. In 1987, the patient received irradiation therapy (60Co 50.4Gy) and partial maxillectomy for left maxillary squamous cell carcinoma (SCC, T3NOMO). Because of tumor recurrence in the left cheek 2 months after operation, he received excision of the tumor and had been free from tumor for 16 years thereafter. In 2003, he was referred to our clinic because of diffuse swelling, hypoesthesia of the right cheek, and the induration of the right upper gingiva and buccal mucous membrane. A biopsy specimen was histologically diagnosed as mucoepidermoid carcinoma, and he received chemoradiation (40Gy/20fr and TXT 18mg×3, CDDP 7.2mg×10), followed by subtotal maxillectomy and microvascular reconstruction with a free rectus abdominis muscle flap. To our knowledge, this is the second case of bilateral maxillary cancers (SCC and mucoepidermoid carcinoma) to be reported in Japan.
Hereditary angioedema (HAE) is a rare hereditary disease caused by a functional disorder of Cl inhibitor or low Cl-inhibitor protein. Dental treatment and oral surgery in patients with HAE can trigger lifethreatening laryngeal edema. However, such episodes of edema can be prevented by appropriate drug therapy. A 46-year-old man with HAE was referred to our hospital because of facial swelling and abdominal pain. The patient ws admitted and given tranexamic acid. After symptoms improved, he received tooth extraction and cystectomy under local anesthesia. Because we performed minimally invasive surgery and administered tranexamic acid and Cl inhibitor concentration perioperatively, no edema occurred. The patient did not require intubation or tracheotomy.
Hypoglossal nerve palsy (HNP) with fasciculation of the tongue is unusual, but occasionally occurs as the initial or solitary sign of an intracranial lesion. We report a case of HNP caused by a vertebral artery aneurysm which was found due to fasciculation of the tongue. A 40-year-old man was referred to Iizuka Hospital because of lingual deviation and slight dysarthria. Intraoral examination showed hemiatrophy in the right side of the tongue with fasciculation and deviation towards the right side on protrusion. There were no other clinically significant neurological findings. Magnetic resonance imaging and an angiographic examination revealed a vertebral artery aneurysm, which was treated by proximal arterial occlusion of the vertebral artery to prevent rupture and subsequent subarachnoid hemorrhage. The postoperative course was favorable, without any serious sequelae. This case demonstrates the importance of investigating the possibility of intracranial lesions in patients who have HNP with fasciculation of the tongue.
This paper describes the clinical course of a patient who underwent zygoma implant therapy. An 81-year-old man was referred to our hospital because of an unstable upper complete denture. His severely absorbed maxilla had a large bone defect in the anterior region. At first, we performed autogenous iliac bone grafting for conventional dental implants, but the results were unfavorable. The patient desired restoration of masticatory function and selected zygoma implant therapy. We placed four implants, 40 or 45mm in length, from the molar region to the zygomatic bone through the lateral wall of the maxilla. He obtained good masticatory and speech functions after placement of an implant-based overdenture. Neither peri-implantitis nor sinusitis occurred for more than 3 years. These results suggested that zygoma implant therapy could be a salvage procedure for patients with an unfavorable outcome of bone augmentation.