To elucidate the effects of a fibroblast inhibitor (tranilast), we investigated the proliferation, invasion, and metastasis of oral squamous cell carcinoma (OSC-19) cells. The effects of tranilast on tumor growth, lymph node metastases, microvessel density, and the proliferating cell nuclear antigen (PCNA) labeling index of oral squamous cell carcinoma implanted into the tongue of nude mice were evaluated. Moreover, we investigated the invasion of OSC-19 cells into fibroblast-embedded collagen gels. Tumor growth and the incidence of cervical lymph node metastases were significantly suppressed by treatment with tranilast. The amount of fibrous tissue, microvessel density, and the PCNA labeling index of the tumors were also significantly reduced. In an invasion model, OSC-19 cells invaded collagen gels in control culture medium, but did not invade collagen gels in culture medium with tranilast. Administration of a fibroblast inhibitor may well be clinically effective for the treatment of oral squamous cell carcinoma.
This experimental study evaluated bone formation in response to hydroxyapatite-poly (D, L-lactic-coglycolic acid)(HAP-PLGA) composite scaffold in rabbits. HAP-PLGA composite scaffold was prepared by a solvent-casting particulate leaching method. A cylindrical bone defect was created in the tibia of rabbits and was filled with HAP-PLGA composite scaffold and control PLGA scaffold, respectively. Three and 6 weeks after implantion, the implantion sites were evaluated by Micro-focused X-ray computed tomography (micro-CT) and histological analysis. After 3 weeks, bone had infiltrated from the periphery of the defects in both scaffolds, although there was less identifiable bone at the center of the defects. Histological investigations revealed that cortical sites of HAP-PLGA composite scaffold were filled with bone tissue 6 weeks after implantation, whereas those of PLGA scaffold were filled with no bone tissue. Therefore, we conclude that HAP-PLGA composite scaffold enables bone tissue to grow inside. HAP-PLGA composite scaffold may be an ideal scaffold for bone regeneration and bone tissue engineering.
Bisphosphonates are used for the management of bone metastatic disease and hypercalcemia caused by malignancy, as well as the treatment of osteoporosis. Recently, a number of patients with bisphosphonate-associated osteomyelitis and osteonecrosis of the jaws have been reported in the English-language literature. This report describes patients with bisphosphonate-related osteomyelitis and osteonecrosis of the jaws in Japan. The subjects were enrolled using questionnaires sent to 239 institutions certified as training facilities by the Japanese Society of Oral and Maxillofacial Surgeons in 2006. Thirty patients (4 men and 26 women) from 18 different institutions (mean age at diagnosis, 66.9 years) were studied. As for local features, pain with or without swelling was the most common symptom and sign. The mandible was affected in 22 patients, the maxilla in 6, and both jaws in 2. Twenty patients received intravenous bisphosphonates, 8 received only oral bisphosphonates, and 1 received both types of treatment. The reasons for bisphosphonate treatment were bone metastasis from breast carcinoma (13 patients), multiple myelomas (6 patients), osteoporosis (8 patients), and hypercalcemia related to malignancy. More than 50 % of the patients underwent oral surgery including tooth extraction just before or during treatment with bisphosphonates, while 5 patients received no dental treatment. In addition to antibiotic therapy, surgery, including sequestrectomy and curettage, was performed. As for outcome, 8 of the patients were completely cured, while 17 patients remained under treatment at the time of this writing.
Oblique facial cleft is an extremely rare congenital anomaly, corresponding to No.3, 4, and 5 clefts according to Tessier's classification. Little is published about the treatment of No.5 clefts because of the rare nature of this anomaly. We report a case of bilateral oblique facial clefts, classified as a No.5 cleft on the left side and a No.4 cleft on the right side. We first saw the patient in Mexico during the charity surgical mission of the Japan International Cooperation Agency (JICA). Primary plastic surgery for the right-side cleft was performed at 8 months of age in Mexico; however, there was little aesthetic or functional inprovement. Therefore, surgical treatment was performed in Japan as a part of JICA's mission at the request of the Mexican treatment team. At 14 months of age, bilateral plastic surgery was performed, using multiple small triangular flaps for the No.4 cleft, and modified commissuroplasty for the No.5 cleft. This operation procedure, especially that for the No.5 cleft, greatly improved facial appearance and function.
Trismus is an early symptom of tetanus and commonly associated with maxillofacial injuries. A careful differential diagnosis is thus required for patients who have trismus after facial injuries. In this report, we present a case of tetanus with trismus after a facial injury. A 62-year-old man sustained facial injury on April, 200X. On May, he consulted a surgeon because the trismus had worsened since May. After debridement and the administration of tetanus antitoxin to prevent tetanus, he was referred to our hospital and admitted for nutritional management. The first clinical diagnosis was facial injuries with traumatic arthritis of TMJ; the imaging findings revealed no maxillofacial fractures or head and neck phlegmon. On the next day, tetanus was diagnosed on the basis of progressive trismus, and tetanus antitoxin was administered. On May, he was transferred to Osaka Prefectural Senri Critical Care Medical Center, and artificial ventilation was instituted under sedation. His condition improved with intravenous administration of antibiotics and by controlling tonic convulsions. On June I, he revisited our hospital for rehabilitation. Finally, he was discharged on July. It is important to consider the possibility of tetanus when examining patients with trismus, particularly after injury.
Calcifying cystic odontogenic tumors classified as a tymor by the WHO International Classification of Odontogenic Tumors and Allied Lesions in 2005, are rare. We report the case of a large calcifying cystic odontogenic tumor that arose in the maxillary sinus of a 27-yearold woman in association with odontoma and an impacted tooth. We examined the size of the lesion by dental cone beam computed tomography. It was the largest lesion to be reported in Japan, measuring 62.2×53.5×52.6mm. Dental cone beam computed tomography was very useful for accuratetly measuring the size of this tumor.
Burkitt lymphoma is one type of non-Hodgkin lymphomas that is highly malignant and dificult to cure. Atypical Burkitt lymphoma, one subtype of this tumor according to the WHO classification, is a rare disease. We describe the case of a 78-year-old man who was given a diagnosis of atypical Burkitt lymphoma. Paresthesia of the right mental region arose 4 days before presentation. Three mass lesions(in the right pterygomandibular space, the left mandibular ramus, and the duodenum)were found on clinical and radiologic examinations. Histopathologically, a sheet of predominantly medium-sized proliferating lymphoid cells with nuclear pleomorphism, a starrysky pattern, and a very high growth fraction were revealed. We therefore diagnosed atypical Burkitt lymphoma. The disease was Stage IV according to the Ann Arbor classification. He was transferred to a hematology unit and received COP therapy. Although transient improvement was noted, the patient soon showed signs of central nervous system involvement and died 2 months later.
Although varicella zoster virus (VZV) infection commonly occurs in the oral and maxillofacial region, tooth exfoliation and alveolar osteonecrosis are relatively rare complications. We describe two cases of tooth exfoliation and alveolar osteonecrosis caused by VZV infection of the trigeminal nerve and review the literature. A 66-year-old man and a 38-year-old man were referred to our hospital because of tooth exfoliation. The first patient had a history of spinocerebellar degeneration, and the second had a history of chronic myelogenous leukemia. Tooth exfoliation occurred on day 21 and day 25 after the onset of VZV infection, respectively. Clinicopathological examination in the first patient revealed actinomyces infection. Panorama x-ray films obtained previously in the second patient revealed no evidence of severe periodontal disease before VZV infection. These findings suggested that tooth exfoliation and osteonecrosis by VZV infection were not only caused by existing severe dental infectious disease, but also by various factors such as multiple oral bacteria, tissue reaction to VZV infection, and compromised status.
In the oral region, traumatic neuroma is rarely encountered in daily clinical practice. As this lesion is caused by some kinds of trauma, traumatic neuroma may develop after operations such as tooth extraction. Traumatic neuroma appears to be a tumors, however, pathologically it is not thought to be a neoplasm, but nodular hyperplasia in nerve fibers. A typical case of traumatic neuroma is presented. A 32-year-old woman with a nodule arising in the left mental foramen region was referred to us. The nodule was first noted 6 years ago and persisted without any change until treatment. Before the nodule had appeared, the patient underwent surgical removal of a mucocele from the left mental foramen at another hospital. After the operation, the same region underwent surgery twice because of recurrence. The nodule was slightly tender, covered with normal mucosa, and red-bean size at presentation. A traumatic neuroma was diagnosed clinically. The tumor was removed under local anesthesia and examined histopathologically. Numerous distinct neural bundles with densely fibrous connective tissue were observed histopathologically in the specimen. The histopathological diagnosis of traumatic neuroma was established. No signs of recurrence have occurred so far.
Reproduction of the shape of the mandible is essential for restoring or creating functional occlusion and is a very important element for the preparation of dentures and implant prostheses. Mandibular reconstruction with a titanium mesh is suitable for restoring the physiological shape of the mandible, and either a cortical bone block or particulate cancellous bone and marrow can be used. However, it is difficult and time-consuming to fit and shape the titanium mesh during reconstructive surgery. To resolve this problem, we employed the following method. A craniofacial skull model was fabricated by means of the stereo-lithography technique on the basis of CT data. Preoperatively, a titanium mesh was bent and cut to simulate the original shape of the mandible on the model with simulated resection. This procedure made it easier to fit the titanium mesh after segmental resection while maintaining the shape of the mandible and shortened the operation time. Since titanium mesh does not need to be bent more than necessary, metal fatigue can be minimized. Furthermore, preoperative surgery simulation makes it possible to estimate the necessary amount of bone graft. This method contributed significantly to preoperative planning. All patients wore implant-supported fixed prostheses, and postoperative occlusal function and esthetics have been favorable.