Gorham-Stout Disease of the Mandible: A Case Report

Clinical study of surgical treatments for snoring and obstructive sleep apnea

PURPOSE: Clinical study to evaluate the efficacy and the safety of various surgical treatments in snoring and obstructive sleep apnea. METHODS AND MATERIALS: We performed surgical treatments such as radiofrequency ablation, uvulopalatopharyngoplasty(UPPP) with tonsillectomy, uvulopalatopharyngoplasty with advancement genioplasty, orthognathic surgery(maxillomandibluar advancement), distraction osteogenesis device insertion. Diagnosis was performed with clinical examination, polysomnography, lateral cephalometric and computed tomography. 62(M : F = 45 :17 , mean age 41.5, mean follow-up 4 weeks) patients underwent radiofrequency ablation and 7(M : F = 5 : 2, mean age 38.9, mean follow-up 19months)patients experienced uvulopalatopharyngoplasty with tonsillectomy. Uvulopalatophayngoplasty with advancement genioplasty was performed for 3 (M : F = 2: 1, mean age 30.2 , mean follow-up 14 months)patients. The last 3(M : F = 2 : 1, mean age 21.5 , mean follow-up 24 months)patients was treated with orthognathic surgery including distraction device insertion. The results was evaluated by questionnaires, polysomnography, investigation of complications. RESULTS: Of the patients treated with radiofrequency ablation, 95% reported improvement of their symptom. 100% improvement was reported in patients treated with UPPP with tonsillectomy and UPPP with advancement genioplasty. The two of three patients who underwent orthognathic surgery showed the satisfactory of treatments. Dryness of mouth was the most common complication during short period in radiofrequency ablation and UPPP with tonsillectomy. Relapse complication was not found in any surgical treatments. CONCLUSION: Treatment for snoring and OSA is determined by severity degree of the physiologic derangements, predominant type of apnea and obstructive site. Accuracy diagnosis should be performed prior to treatment for satisfactory treatment result. This study demonstrates feasibility, safety and efficacy of surgical treatments in snoring and OSA.

Lemierre syndrome: A case report

Abscesses are common in the oral and maxillofacial area. However, secondary thrombosis of the internal jugular vein accompanying the primary abscess is rare. In 1936, Andre Lemeierre studied 20 patients who showed an initial oropharyngeal infection, septicemia, internal jugular vein thrombosis, and secondary spread of the infection, and after then this condition Lemierre syndrome. Clinically, these patients present with tonsilitis lasting several days, continuous fever, and cervical pain. In the past, ligation and excision of the internal jugular vein was often performed. Current therapeutic modality for this condition is appropriate antibiotic prescription and surgical drainage of abscess. This case report presents a patient who showed symptoms of Lemierre syndrome, initiated as an oropharyngeal infection then developed thrombosis of the internal jugular vein. This patient was admitted into Seoul National University Dental Hospital. In addition to routine antibiotic therapy, surgical incision and drainage of the infection site was performed. Without ligation or excision, the thrombosed IJV disappeared eventually. As the Lemierre syndrome is not a common disease, this case report and review of the literature would be useful regarding a treatment of patients with Lemierre syndrome.

Implant installation using vertical distraction osteogenesis at a severely atrophied edentulous mandible

Blepharoplasty by various causes

Recently, the number of facial contouring surgery such as angle reduction or malarplasty in Oral and maxillofacial surgery is increasing steadly as the demand for maxillofacial esthetic surgery of the patients is growing. Looking around international trend of oral and maxillofacial surgery, nowadays workshop or symposium about facial soft esthetic surgery such as corrective rhinoplasty, blepharoplasty, face lift are held. This means that maxillofacial esthetic surgery is new scope which oral and maxillofacial surgeons should develope. Therefore the authors present cases of blepharoplasty which got hardly used to oral and maxillofaical surgeon with literature review in order to raise the concern about maxillofacial esthetic surgery.

The relationship of p63 expression with cell proliferation and apoptosis in DMBA-induced hamster buccal pouch carcinogenesis

PURPOSE: Abnormalities in the p53 gene are regarded as the most consistent genetic abnormalities detected in head and neck squamous cell carcinogenesis. Two new members of the p53 gene family, p73 and p63 have recently been identified. They share considerable sequence homology with p53 in the transactivation, DNA binding, and oligomerization domains, indicating possible involvement in carcinogenesis. Disruption of the homeostatic balance between proliferation and apoptosis is widely believed to contribute to human oral carcinogenesis. The aim of this study was to analyze expression of p63 in squamous cell carcinogenesis and to compare with immunochemical markers representing cell proliferation and apoptosis. MATERIALS AND METHODS: Using the Syrian hamster oral cancer model, the fraction of apoptotic (apoptotic index-AI), proliferating (mitotic index-MI) and p63 expressing keratinocytes were examined at normal, dysplastic and malignant oral epithelium using the TUNEL assay, PCNA and p63 immunostaining. RESULTS: p63 significantly increased between normal and dysplastic epithelium and between dysplastic and malignant epithelium. PCNA significantly increased between normal and dysplastic epithelium and between normal and malignant epithelium. However, increase between dysplastic and malignant epithelium, though still increasing, was not statistically significant. The percentage of TUNEL positive cells increased from normal to dysplastic epithelium and returned to normal keratinocyte level in the malignant epithelium. However, differences between tissue types were not significant. The ratio of MI:AI increased significantly only in the dysplastic-malignant epithelial transition. The increase of p63 expression closely reflected the change in the MI:AI ratio during oral carcinogenesis. CONCLUSION: The p63 may be associated with the regulation of epithelial proliferation and apoptosis in DMBA-induced hamster buccal pouch squamous cell carcinogenesis. Further study is required to investigate which p63 isoforms are involved in hamster buccal pouch carcinogenesis.

Diagnosis of micrometastasis in lymph node and clinical evaluation of prognostic factor of oral SCC using RT-PCR and immunohistochemistry for cytokeratin

PURPOSE: The lymph node status assessed by conventional histological examination is the most important prognostic factor in patients undergoing surgery for oral squamous cell carcinoma. The presence of lymph node metastasis has a strong adverse impact on patient survival even after extended radical resection. Despite these findings, tumour recurrence is not rare after surgery, even when histological examination shows no lymph node metastasis. Recently, molecular- genetically and immunohistochemically demonstrated micrometastasis to the lymph nodes has been shown to have a significant adverse influence on survival in patients with squamous cell carcinoma and histologically negative nodes. The present study sought to determine the incidence and clarify the clinical significance of molecular-genetically and immunohistochemically demonstrated nodal micrometastases and to correlate these data with the stage of oral cancer. METHODS: Lymph nodes systematically removed from 71 patients who underwent curative resection between 1998 and 2003 with head and neck squamous cell carcinoma were examined molecular-genetically to detect cytokeratin 5 mRNA with RT-PCR and immunohistochemically to detect cells that stained positively for cytokeratins with the monoclonal antibody cocktail AE1/AE3. The postoperative course and survival rates were compared among patients with and without micrometastases, after numerical classification of overt metastatic nodes. RESULTS: micrometastases were detected in 43(60%) of 71 patients by RT-PCR and 26(36%) of 71 patients by immunohistochemistry. By RT-PCR analysis, patients exhibiting a positive band for CK 5 mRNA had a significantly worse prognosis than those were RT-PCR negative. By immunohistochemistry, the presence of micrometastasis did not predict patient outcome. CONCLUSION: Micrometastases detected by RT-PCR may be of clinical value in identifying patients who may be at high risk for recurrence and who are therefore likely to benefit from systemic adjuvant therapy.

the effects of insulin-like growth factor i (igf-i) on expression of vascular endothelial growth factor (vegf) mrna in mg-63 osteoblastlike cells

PURPOSE: To determine the role of Insulin-like Growth Factor-I (IGF-I) in the regulation of Vascular Endothelial Growth Factor (VEGF) expression in MG-63 cells and then to find the mechanism b which this regulation occurs. MATERIALS AND METHODS: MG-63 cells were grown to confluence in 60-mm dishes. To determine the effects of IGF-I on expression of VEGF mRNA according to time and concentration, the cells were treated with 10 nM IGF-I, following isolation of total RNA and Northern blot analysis after 1, 2, 4, 8, 12, 24 hours and after 2 hours of treatment with 0.5, 2, 10, 25, 50 nM IGF-I respectively, isolation of total RNA and Northern blot analysis were followed. To determine the mechanism of action of IGF-I, inhibitors such as hydroxyurea (76.1 microgram/ml), actinomycin D (2.5 microgra/ml), cycloheximide (10 microgram/ml) were added 1 hour after treatment of 10 nM IGF-I. RESULTS: 1. the expression of VEGF mRNA was increased with treatment of IGF-I. 2. The expression of VEGF mRNA was increased according to time- and concentration dependent manner of IGF-I. 3. The effect of IGF-I was decreased by hydroxyuera, actinomycin D, but not by cycloheximide. CONCLUSION: IGF-I regulate the expression of VEGF mRNA in the level of DNA synthesis and transcription. These results could suggest that IGF-I plays an important role in angiogenesis in the process of new bone formation and remodeling.

Development of microporous calcium phosphate coated nerve conduit for peripheral nerve repair

This study was performed to develop a useful nerve conduit which provides favorable environment for Schwann cell viability and proliferation. Milipore membrane of 0.45um pore size was selected because it permits nutritional inflow from the outside of the conduit and prevents from invading the fibrotic tissue into the conduit. The membrane was rolled and sealed to form a conduit of 2mm diameter and 20mm length. To improve the axonal regeneration and to render better environment for endogenous and exogenous Schwann cell behaviour, the microgeometry and surface of conduit was modified by coating with thin film of calcium phosphate. Cellular viability within the conduit and attachment to its wall were assessed with MTT assay and SEM study. Milipore filter conduit showed significantly higher rate of Schwann cell attachment and viability than the culture dish. However, the reverse was true in case of fibroblast. Coating with thin film of low crystalline calcium phosphate made more favorable environment for both cells with minimal change of pore size. These findings means the porous calcium phosphate coated milipore nerve conduit can provide much favorable environment for endogenous Schwann cell proliferation and exogenous ones, which are filled within the conduit for the more advanced strategy of peripheral nerve regeneration, with potential of reducing fibrotic tissue production.