The vascular origin diseases occurring in the oral and maxillofacial region can be divided into hemangiomas and vascular malformation. They are rare and early lesions are not easy to diagnosis, so they may be misdiagnosed as clinicians, or the method and timing of treatment may be inappropriate. For 10 years, from August 2005 to August 2015, we analyzed the clinical records, diagnosis, treatment, and prognosis of 23 patients with hemangioma or vascular malformation confirmed by clinical, histopathological or radiological examination of maxillofacial lesions at department of oral and maxillofacial surgery, Pusan National University Hospital and Pusan National University Dental Hospital. Chief complants of patients were mainly swelling, mass, and spot-like lesion on various intraoral sites. Treatments were performed with excision, embolization, sclerotherapy, depending on each lesions condition. Arteriovenous malformation cases were more frequently recurred than other lesions. Prognosis of lesions were relatively good but close observation should be needed.
Nerve injury induced protein 1 (Ninjurin1) was originally described in neuroscience in which the expression of Ninjurin1 was regulated by Schwann cells and dorsal root ganglion neuronal cells of damaged nerve tissues. After the first discovery of Ninjurin1, the widespread expression of Ninjurin1 in adult and embryonic tissues have been observed including bone marrow, peripheral blood lymphocytes, thymus, and heart. Currently, the Ninjurin1 mediated positive regulation of pre-osteoclasts fusion and osteoclast development was reported. The bone homeostasis is dynamically balanced by bone-resorbing activity of osteoclast and bone-forming activity of osteoblast. Until now, the role of Ninjurin1 was never been described in osteoblastogenesis. Therefore, in this study, we have evaluated the expression and function of Ninjurin1 in osteoblast. The ample expression of Ninjurin1 was observed in bone marrow of mouse tibia sections but it was barely expressed in osteocytes. And also the expression levels of Ninjurin1 were gradually increased during osteoblast differentiation of calvarial pre-osteoblast, C2C12, and MC3T3-E1 cells. Importantly, the expression of Ninjurin1 was increased in the absence of osteogenic stimulus, BMP2, which suggests the cell density-dependent regulation of Ninjurin1. The controlled expression of Ninjurin1 by cell-density was evidently shown in not only pre-osteogenic osteoblast lineage cells but also in non-osteogenic cancer cells such as HeLa and A549 cells. In addition, the isoform-specific knockdown of Ninjurin1 remarkably reduced the alkaline phosphatase (ALP)-positive osteoblast differentiation. Thus, our results suggest a previously unappreciated mechanism of Ninjurin1 expression and also suggest its role on osteoblastogenesis.
This study includes the clinical features of diabetic patients with fascial space infections of head and neck and those of non-diabetic patients. We retrospectively studied 62 patients who were treated for fascial space infections of the head and neck, and compared the patients’ background, the aetiology of the infection, clinical variables, laboratory values, and treatment process. Statistical analyses of the differences between groups were made with Student's t test, the chi square test, and analysis of variance, as appropriate. Diabetic patients had more spaces involved, had longer hospital stays, and developed more complications. The main microorganism of diabetic group was Klebsiella pneumonia and otherwise, Streptococcus spp. was for non-diabetic group. We conclude that diabetic patients are more likely to develop complications and it is necessary to consider about dominant microorganism when using medication for diabetes patients
Tissue engineering has been rapidly developed in oral and maxillofacial reconstruction. Biocompatible scaffold from chemically composites seeded with stem cells is essential and several growth factors for bone formation and angiogenesis are also required. To overcome limited activity of new bone formation with scaffolds, several biomechanical stimulation methods on cells have been made to grow cells in scaffold. Several bioreactors have been developed for real tissue growth in culture laboratory. In addition to biological stimulants like BMP, growth factors and exogenous drugs, biomechanical stimulation technique has also been known as an effective method in cell differentiation. We developed our own bioreactor with tensile mechanical strains. Then we tested with it for detection of suitable biomechanical effect on the cell differentiation and proliferation. And we also compared the results with the effect of low intensity pulsed ultrasound (LIPUS). Mechanical strain group showed more rapid reaction with cell differentiation and proliferation than non-mechanical strain group. Mechanical strain groups stimulated with 0.5∼0.7Hz for 6 hours and 8 hours showed more active cell differentiation than the group with 0.5∼0.7Hz for 2.5 hours tensile strain stimulation. Group of LIPUS also showed more rapid reaction in cell differentiation and proliferation. LIPUS with 3MHz showed more cell reaction than the LIPUS group with 1MHz. Our results showed the positive effect on differentiation and proliferation of cell with mechanical tensile strain, LIPUS both.
Herbal medicine has been the basis for medical treatments through much of human history, and such traditional medicine is still widely practiced today. Modern medicine makes use of many plant-derived compounds as the basis for pharmaceutical drugs. In traditionally, Achyranthes aspera, Safflower (Carthamus tinctorius) seed and Acanthopanax senticosus have been used for the treatment and prevention of bone-related diseases. In this study, we investigated the pharmacological effect of mixture of Achyranthes aspera, Safflower (Carthamus tinctorius) seed and Acanthopanax senticosus and the other herbs. Two types of enzymes were used to enhance the extraction components of amino acid, mineral content, free sugar, and flavor recovery in extracting natural herbal mixtures(NME). We evaluated regulation of osteogenic differentiation in human bone marrow mesenchymal stem cells using alkaline phosphatase staining, alizarin red S staining and RT-PCR. The CCK-8 assay indicated that NME had no cytotoxicity but increased cell survival. In addition, NME promoted the mineralization and expression of osteogenic differention marker genes in human bone marrow mesenchymal stem cells. Therefore, NME has an effect of promoting proliferation and osteogenic differentiation of human mesenchymal stem cell.
Mucinous adenocarcinoma (MAC) refers to a malignant neoplasm that belongs to a subtype of adenocarcinoma which produces mucin. The World Health Organization has classified MAC as a tumor of salivary gland origin and it is extremely rare. Therefore, its characteristics are not well-known. This study reports a case of MAC of minor salivary gland origin, which occurred in the oral commissure of an 82-year-old female patient, and a systematic review on existing cases of MAC of salivary origin. Based on the study’s findings, it is safe to assume that the occurrence of lymph node metastasis is an important factor in determining the prognosis of patients with MAC.
Benign fibro-osseous lesions are demonstrated as a group of conditions, which normal bone is replaced by a connective tissue matrix that gradually develops cemento-osseous tissue and include developmental lesion, reactive lesion, dysplasia and tumor. Cemento-osseous dysplasia is one of benign fibro-osseous lesions, which is non-neoplastic process. Histologic features of cemento-osseous dysplasia are admixtures of bone and cementoid materials in a fibrous stroma. Cemento-osseous dysplasia associated with traumatic bone cysts has infrequently been reported. Traumatic bone cyst is a pseudocyst that may befound in both the jaws and the long bones. Though blockage of interstitial fluid drainage orvenous obstruction may be the cause of traumatic bone cyst, the exact pathogenesis of traumatic bone cysts is unknown. Melrose et al. was the first to report association of cemento-osseous dysplasia and traumatic bone cystsin their series. It is assumed that different mechanism is involved in cyst formation in these cases. This report presents review of literature and describes a case of focal cemento-osseous dysplasia associated with traumatic bone cyst of the mandible and its surgical treatment.
Pseudolymphoma or benign lymphoid hyperplasia is an uncommon benign lymphoproliferative lesion that occurs very ralely in the oral mucosa, most commonly in the hard palate. It is important to differentiate between malignant lymphoma and pseudolymphoma with similar clinical and morphological symptoms. Clinically, pseudolymphoma is a firm, painless, nonulcerated, nonfluctuant, slowly growing mass or swelling on the one side of the palate. However, lymphoma at hard palate is unilateral, and some are hard, painful, or show evidence of bone destruction. The treatment of pseudolymphoma is local excision.
Basaloid squamous cell carcinoma (BSCC) is a rare and aggressive variant of squamous cell carcinoma arising in various anatomical sites. This article describes a case history of BSCC of the floor of mouth with mandibular involvement, and further discusses the appropriate management of such case with reference to the literature review. A 52-year-old male patient was referred to our clinic from another university hospital. Segmental mandibulectomy with supraomohyoid neck dissection and mandible reconstruction with left fibular free flap under general anesthesia was performed, followed by radiotherapy. Histopathological examination on the tumor lesion revealed features of squamous cell carcinoma with comedo-type necrosis. A diagnosis of BSCC was given by the oral pathology specialist. Basaloid squamous cell carcinoma (BSCC) is a biphasic variant of SCC with both basaloid and squamous cell histology. A recent report showed that there is no significant difference in the prognosis. Due to the lack of accumulated research, close follow-up and continuous research are deemed necessary. Treatment that focuses on the stage of the tumor is appropriate. A periodic follow-up observation is also very important due to the occurrence of distant metastasis to the lungs.
Juvenile xanthogranuloma (JXG) is a benign histiocytosis that occurs in the pediatric population. Cutaneous JXG is the most common form, while extracutaneous lesions, including oral JXG, is extremely rare. Cutaneous JXG can occur as multiple lesions and may have systemic visceral involvement, but this is not seen in oral JXG. In this case, we report a solitary oral JXG at the gingiva in a 3-year old male.
Lymphomatoid granulomatosis (LYG) is an uncommon Epstein-Barr virus (EBV)-associated B-cell lymphoproliferative disorder distinct from lymphoma. LYG primarily occurs in the lung with or without accompanied lesions in the skin, central nervous system, kidney, gastrointestinal tract, nose, eyes, liver and oral cavity. Solitary extrapulmonary LYG is extremely rare, and whether solitary lesions progress onto pulmonary development and dysfunction is controversial. Herein, we report a case on a solitary LYG in the maxilla gingiva with bone exposure in a patient who had been taking methotrexate for rheumatoid arthritis.
Myelolipoma is a benign tumor consists of mature adipocyte and hematopoietic elements. Mostly, this tumor locates in adrenal gland and it also can be found in extra-adrenal area. However, intraosseous myelolipoma is extremely rare. The etiology of this tumor is unclear but some hypothesis proposed that altered mesenchymal stem cell functioning and hormonal events act together in the pathogenesis of myelolipoma. With radiographic view, myelolipoma shows similar characteristics of other fat-containing tumors. The histopathologic examination is necessary for the definite diagnosis. This case report includes a patient with intraosseous myelolipoma of maxilla and mandible and literature review about the clinical, histopathologic, and radiologic features of myelolipoma.
Brain abscesses caused by odontogenic infection are a rare and life-threatening condition. When dental patients show neurological symptoms such as decreased consciousness, a brain abscess should be considered as a possible diagnosis. We reported that a 65-year-old man visited the emergency room because of left facial edema, high fever, limitation of mouth opening and decreased consciousness. CT, bone scan, and microbiologic examination revealed that the brain abscess originated from left mandibular osteomyelitis with an apical lesion in tooth #36. It was hard to diagnose the location of odontogenic infection. Because there were no evidence of submandibular abscess which is a common path of mandibular posterior infection, early diagnosis was difficult. MRI and radiographs such as facial CT and brain CT revealed procedure that inflammatory findings progressed through the coronoid process, the temporal space, into the subdural space. We compared the present case to previous cases, articles published after the year 2000 in Korea and abroad were investigated. The patient was treated successfully with extraction of causative teeth, drainage surgery, intravenous antibiotics by collaboration between the department of oral maxillofacial surgery and neurosurgery. It is difficult to diagnose brain abscess because central nervous system can be infected by various pathway. As shown in this case, patients with a brain abscess caused by a dental infection should be diagnosed and treated with a multidisciplinary approach.
Recently, a number of recent reports have reported cases of bone marrow defect (BMD) in the mandible. Among the diseases seen by BMD in radiographs, focal osteoporotic bone marrow defect(FOBMD) is asymptomatic, which is discovered incidentally and localized radiolucency. Because it varies in size, shape, trabeculae and border definition, it needs to biopsy to differential diagnose other intraosseous lesions that show radiological bone marrow defects. This cases report discusses the pre-operation considerations in patients planning to implant the mandible and suspected to have FOBMD in radiographs. The following 4 cases in Dental Hospital of Wonkwang University were taken in panoramic and Cone beam computed tomography(CBCT). In all cases, there were radiolucent lesion diagnosed with FOBMD under radiologic differential diagnosis. In three of cases the implant were placed without treatment plan change and one case changed the treatment plan with removable partial denture. BMD is anatomical state that can affect primary stability of implant fixture. During implant placement, it can lead to unexpected results that fixture is fallen into BMD and the nerve may be damaged after implant fixture removal to cause hyperesthesia. Preoperative diagnosis of these lesions by differential diagnosis with panoramic and CBCT can prevent the complications by changing the treatment plan or paying attention to the manipulation during surgery.