In humans over 120 human papillomavirus (HPV) types have been completely described. HPVs have also been classified as low and high risk HPV types based on the clinical behavior of the HPV infected tissues. HPV proteins, especially the oncoproteins E6 and E7 of the oncogenic HPVs, interact with different degrees of affinity, with host cell proteins to disturb the normal epithelial differentiation and apoptosis by stimulating cellular proliferation, DNA synthesis and inhibition of cell cycle regulators. The best characterized interactions so far are the interactions between E7 and pRb and E6 and p53. Continued and aberrant expression of the E6 and E7 genes of the high risk HPVs will lead to genomic instability which finally after accumulation of mutational events can result in malignant transformation. Persistent infection with high risk HPV increase the risk of squamous cell carcinoma, while the low risk HPV may be associated with benign lesions. Also, HPV infections can be detected in the oral cavity and HPVs have been described as being associated with malignant lesions, such as oral squamous cell carcinoma and with benign lesions such as leukoplakia and oral papilloma. It is suggested that oral mucosa might serve as a reservoir of HPVs. Now, an inoculation of vaccine preventing HPV infection is performed, and the result begins to appear for the prevention of the cervical cancer. In addition, an improvement in the state of oral hygiene decreases the rate of HPV infection, and indicated that oral care may be an effective way to prevent HPV infections. The present conditions and the future prospects of the prevention and the treatment of HPV infections in the oral region are reported.
Many patients with oral cancer have double cancers, especially in the upper gastrointestinal tract. We studied synchronous double cancers in 138 patients with oral cancer who underwent gastrointestinal endscopy and 161 who underwent positron emission tomography (PET) preoperatively. Fifteen patients (10.9 %) had cancer or precancerous lesions in the upper gastrointestinal tract on gastrointestinal endoscopy: 10 in the esophagus and 5 in the stomach. The histopathological diagnosis was severe epithelial dysplasia in 6 patients, carcinoma in situ in 4, and carcinoma in 5. These 15 lesions were asymptomatic and detected by gastrointestinal endscopy for the first time. Patients with severe epithelial dysplasia were observed, and those with carcinoma or carcinoma in situ underwent radical therapy. All of these gastrointestinal lesions were treated successfully, without any recurrence or metastasis. Double cancers were detected by PET in 3 patients (1.9 %) : lung and esophageal cancer, gastric cancer, and ovarian cancer in one patient each. These 3 cases also were detected by PET for the first time and were free of clinical symptoms. Radical therapy was performed in 2 patients. The other patient had advanced disease and received only palliative therapy. Although PET could not detect most cancers or precancerous lesions in the upper gastrointestinal tract that could be detected by gastrointestinal endscopy, it was useful for detecting malignant lesions in sites other than the upper gastrointestinal tract. Our results suggest that preoperative gastrointestinal endscopy and PET examinations can detect double cancer in the early stage and contribute to better outcomes in patients with oral cancer.
We report a case of epidermoid cyst arising in the floor of the mouth, which developed gradually over the course of 7 years and caused delirium, dyspnea, oral disorder, dysphagia, and insomnia. A 63-year-old woman had noticed swelling in the submental region 7 years ago, but did not seek treatment. She visited the Department of Neurosurgery of our hospital with her family because of unstable behavior. Computed tomographic examination showed no evidence of neurosurgical disease, and she was referred to our department because of an enlarged tongue. At presentation, a large, elastic soft tumor mass was found in the floor of the mouth. The covering mucosa was normal, but the tongue was pushed posterosuperiorly and could not be observed directly. A elastic soft tumor mass covered by normal skin was noted in the submental region. Magnetic resonance imaging showed a poorly demarcated, cyst-like structure from the subglossal space to the submental region. T2-weighted imaging revealed a 115 × 75 × 55 mm cystic lesion containing homogenous high signal intensity. A diagnostic puncture was carried out, and 200 mL of brownish-yellow muddy fluid was collected. Thereafter, the volume of the cyst decreased, and dyspnea was alleviated. The clinical diagnosis was an epidermoid cyst. The cyst was intraorally resected with the patient under general anesthesia. The pathological diagnosis was an epidermoid cyst. At present, functional impairment has improved, and the patient is under observation.
A dismasking flap is a skin incision technique in which a circumpalpebral incision is combined with a conventional coronal incision to establish a large surgical field on the face. We describe a patient in whom an osteochondroma arising in the mandibular condyle was resected using a dismasking flap. A 42-year-old woman with a left temporomandibular joint tumor was undergoing treatment at our hospital's Department of Otolaryngology when she was referred to our department because of trismus. Trismus and pain exacerbated during jaw movement. The maximum mouth opening was only 20 mm. The patient gave informed consent for the temporomandibular joint tumor to be resected under general anesthesia. Surgery was performed in collaboration with the Department of Neurosurgery and of Plastic Surgery. Dismasking flap procedures were performed, and the zygomatic arch was transiently dissected to expose the tumor. The tumor was excised with the mandibular condyle. The site of mandibular condyle resection was immediately reconstructed using an artificial condyle. The histopathological diagnosis of the excised tumor was osteochondroma. As of 1 year 8 months after surgery, the patient's range of mouth opening is 35 mm, and there has been no recurrence of the tumor.
We report the rare case of oral bleeding in a patient with 5p-syndrome and hemophilia A. A 6-year-old girl with 5p-syndrome and hemophilia A had three episodes of oral bleeding. Hemostasis was performed, with an uneventful course. The first and second episodes were caused by self-inflicted injuries to the gingiva of the maxillary anterior teeth. To control the bleeding episodes, 500 mg/day of tranexamic acid was administered intravenously, and the bleeding site of the cervical gingiva was packed with Surgicel. A hemostatic splint was placed for wound protection and hemostasis, resulting in an uneventful recovery and discharge. The third episode bleeding involved the tongue and was treated by administering tranexamic acid at a dose of 500 mg/day for 7 days from the first hospital day. However, since hemostasis was difficult to achieve, 1,000 units of factor VIII concentrate was administered. The level of factor VIII activity rose from 5.0 % immediately after admission to 120 % 1 hour after administration, and the lingual bleeding stopped. Subsequently, the hemostatic and wound healing status remained favorable and stable, and the patient was discharged on the 15th hospital day.