Epithelialization in oral mucous wound healing in terms of energy metabolism.

PURPOSE: The purpose of this study was to clarify the "healing capacity" of wounds of the oral mucosa in comparison to those of the skin, and to evaluate the wound healing mechanism of oral mucosa using a cytobiological approach from the aspect of energy metabolism in oral keratinocytes. MATERIALS AND METHODS: Samples of epidermal and oral keratinocytes collected at surgery and of cultured oral keratinocytes were used to analyze (1) by gas chromatography the composition of fatty acids (16:0, 18:2, 20:4) in the cell membranes of keratinocytes, (2) by immunohistochemical staining of GLUT-1 antibody and specific PAS staining the localization of glucose metabolism, and (3) by RT-PCR and Western blotting the expression of GLUT-1 mRNA and of protein in the keratinocytes of the basal and parabasal layers of each epithelial tissue. RESULTS: 1. The % composition of palmitic acid (16:0) was significantly higher in buccal mucosal keratinocytes (27.18+/-3.74%) and in the gingiva (23.00+/-1.40%) than in the epidermis (17.54+/-0.37%). 2. Immunohistochemical staining showed GLUT-1 protein in the skin to be expressed only in the bulge region of hair follicles and in the epidermal basal layer, and observed nearly throughout all epithelial cell layers in the oral mucosa. 3. PAS-positive cells were observed among differentiation-enhanced cells in the upper prickle layer in the oral mucosa. 4. The same results were obtained from RT-PCR and a Western blotting analysis. CONCLUSION: The present study demonstrated definite cytobiological evidence that the oral mucosa surpasses the skin in regard to its wound healing capacity.

Two cases of masticator space abscess initially diagnosed as temporomandibular joint disorder.

Diseases causing trismus or pain of the temporomandibular joint (TMJ) include temporomandibular joint disorders (TMJD), trauma, tumors and an inflammation. This report describes two cases of masticator space abscesses causing trismus and TMJ pain, which were initially diagnosed as TMJD. The first case was a 62-year-old female suffering from trismus and right-TMJ pain without swelling or redness, which was diagnosed as TMJD with MRI (TMJ region) findings of bilateral anterior disc displacement without reduction. However, five days later the right-TMJ pain became more severe and MRI (maxillofacial region) revealed a right masticator space abscess. She was treated with antibiotics and underwent an intraoral incision following hospitalization. She recovered well and was discharged from the hospital on the 15th day. The second case was a 68-year-old female having trismus and left-TMJ pain, which was diagnosed as TMJD at another hospital. She received instructions for jaw opening training, but visited our hospital because her symptoms were not improved. At the first visit, the mouth opening range was 18 mm and an anterior dislocation of the left condylar process was found by X-ray imaging. CT-scan revealed an abscess in the left masticator space. Therefore an intraoral incision was performed under general anesthesia and antibiotics were administered. She recovered well and was discharged from hospital on the 12th day. When we treat TMJD, we must keep in mind the possibility of the inapparent presence of some unseen inflammation, especially an abscess formation in the masticator space.