Nerve blocks for regional anesthesia of the face.

Many trauma repairs and dermatologic procedures performed on the face require anesthesia of the involved area. The specific requirements for anesthesia and vasoconstriction vary, depending on the location, size and depth of the injury or lesion. Direct infiltration of anesthetic is very uncomfortable, and adequate anesthesia may require multiple injections. In addition, direct infiltration of a volume of anesthetic sufficient to produce adequate anesthesia can cause distortion of the tissue, hindering the identification of margins. Intraoral nerve blocks routinely used by dentists can achieve safe and effective regional anesthesia in the anterior portion of the face.

Common oral conditions.

Although some oral lesions, such as torus palatinus, are normal variants, and others, such as benign migratory glossitis, are self-limited, several common oral conditions require prompt diagnosis and treatment to reduce the potential for serious complications. Treatment of dental and periodontal abscesses may include incision and drainage, antibiotic therapy, pain control and dental extraction. Treatment of sialolithiasis (blockage of the salivary gland ducts) may require application of moist heat, antibiotics and surgical removal of impacted stones. Hyperkeratosis, a white patch on the oral mucosa that does not rub off or bleed (as does the white patch of candidiasis) commonly occurs in persons who use smokeless tobacco products. The lesion may require biopsy if it still persists two to four weeks after discontinuation of the tobacco product. Squamous cell carcinoma, which accounts for 95 percent of all oral cancers and is most commonly associated with alcohol and tobacco use, is usually asymptomatic until the late stage of the disease. Suspicious lesions should be biopasied to confirm the diagnosis.

The role of oncogenes in cancer.

Researchers have accumulated evidence suggesting that most human cancers are the result of multiple events involving many genes functioning at various levels of expression over a long period of time. Recently, an important segment of cancer research has focused on oncogenes, a group of altered normal genes. The normal genes, known as proto-oncogenes, encode proteins necessary for the cell's structure, growth, and mitotic activity. Oncogenes have been found to be the activated forms of proto-oncogenes, which become activated as a result of point mutations, nucleotide deletions/insertions, or chromosomal translocations. Approximately 50 types of oncogenes have been discovered to date, and research had led us to believe that oncogenes are derived from normal genes that regulate growth and development. A general discussion of oncogenes will be presented in this review.