Search

Background: Cicatricial pemphigoid is a subepidermal disease of the mucous membranes. In some patients blisters involving the oral cavity may be the only manifestation. The purpose of this work was to detail the clinical features and biological findings, highlighting the diagnostic and therapeutic difficulties., Material and Methods: Seventeen patients, nine women (mean age 59.6 years) and eight men (mean age 67.8 years) managed between 1990 and 2000 were reviewed retrospectively., Results: Mucous membranes of the mouth were the only localization in six of the seventeen patients. Other localizations (skin, eye, nose, anus) were associated, alone or in combination, in the other eleven patients. The gingivae were involved in 15/17 patients and constituted the only localization in six. Skin lesions (sometimes involving the lower limb) were variable and found in 6/17 patients. Ocular lesions were present at diagnosis in six patients, including two with severe lesions at onset. Nasal and/or laryngeal involvement was found in 6/17 patients. These lesions were often severe with major functional impact. ENT localizations were found in patients with at least three localizations and lesions extending to mucous membranes distant from the oral cavity. A biopsy was obtained from all patients and demonstrated subepidermal detachment in eleven. Direct immunofluorescence was positive in eleven. Indirect immunofluorescence, performed in twelve patients, was negative. In two patients, both histology and immunofluorescence were negative. Electron immunomicroscopy was performed in four patients and confirmed the diagnosis. Five out of six isolated oral manifestations were treated with topical steroids alone. Multiple lesions were treated case by case using daprosone and/or systemic corticosteroids associated with topical steroids in 16/17 patients. A bolus of cyclophosphamid was given for four patients with very severe lesions which did not respond to other treatments. At last follow-up (22 +/- 17 months), none of the patients was considered cured., Discussion: Cicatricial pemphigoid is a complex chronic disease. Oral manifestations may be isolated or associated with lesions of the skin or other mucous membranes. The painful aspect of oral lesions explains why the diagnosis is often made in stomatology. Careful evaluation at diagnosis is essential and requires a multidisciplinary approach. Certain diagnosis can be provided by immunohistology, particularly electron immunomicroscopy which enables distinguishing cicatricial pemphigoid from other autoimmune diseases of the dermo-epidermal junction. Treatment depends on disease severity. Isolated oral manifestations are generally well controlled by topical corticosteroids which ocular, nasal, and laryngeal localizations often require more extensive treatment.

Oral ulcerations have very varied characteristics, the analysis of which is often sufficient for the clinician to establish a diagnosis and propose a suitable treatment. Aphthous ulcers and traumatic lesions are the most frequent, however one also sees infectious ulcerations (tuberculous, syphilitic, common germs or viruses), inflammatory diseases of the gastrointestinal tract, bullous dermatosis of autoimmune, toxic or unknown origin such as erythema multiform, and erosive lichen planus. It is thus the general context or the evolution that orientates the diagnosis, which is made more precise in certain cases by complementary investigations, in particular by the biopsy. When the ulceration is isolated it is necessary to first exclude the much-feared squamous cell carcinoma, but also other malignant ulcerated tumours, lymphomas, and tumours of the salivary glands. Thus it is imperative that the histological examination confirms the diagnosis, to formulate a prognosis and to allow the commencement of treatment.

The aim of this exploratory study was to assess the efficacy of a natural metabolite of vitamin A, retinaldehyde 0.1%, vehicled in a gel in 17 patients with oral lichen planus and in 13 patients with oral leukoplakia, twice daily for 2 months. Our investigation was clinical, histological, immunohistochemical through the expression of markers of cell terminal differentiation and biochemical by using two-dimensional gel electrophoresis of cytokeratins (CK). In addition, the activity of retinaldehyde was studied ex vivo on surviving buccal mucosa. Retinaldehyde gel 0.1% showed good clinical efficacy, resulting in 6% disappearance and 82% improvement of the lesions in lichen planus and 17% disappearance and 75% improvement in leukoplakia. This was confirmed with immunohistochemistry, which revealed down-regulation of filaggrin and CK-10 as markers of terminal differentiation in both diseases. The effects of retinaldehyde in these two diseases were further demonstrated in the ex vivo surviving mucosal model, resulting in histological disappearance of keratinization in 80% of the lichen planus fragments and 40% of the leukoplakia fragments, associated with down-regulation of filaggrin and CK-10.

Background: The efficacy of postoperative irradiation of the neck after lymph node dissection in terms of prevention of cervical node recurrence (NR) has not been demonstrated in patients with NO squamous cell carcinoma of the oral cavity., Methods: This multicenter retrospective analysis comprises 826 patients with squamous cell carcinoma of the oral cavity, all clinically NO. The primary tumor was treated by resection or brachytherapy. All patients underwent cervical dissection adapted to the site of the tumor. Fourty seven N+ patients with capsular rupture were excluded; 160 patients were N+ without capsular rupture (N+ CR-), and 619 were N-. Postoperative cervical irradiation was performed in 67 of 160 N+ CR- patients and in 49 of 619 N- patients., Results: NR developed in 78 patients, associated with local recurrence in 33 cases and isolated in 45 cases. Twenty-six of the 45 cases of isolated NR occurred in the 619 N- patients (4%), and 19 occurred in the 160 N+ CR- patients (12%, p = .001). The 26 NR observed in the N- patients occurred in nonirradiated patients. Among the 19 NR observed in the N+ CR- patients, the incidence of recurrence was not significantly different between irradiated patients (6 NR of 67.9%) and nonirradiated patients (13 NR of 93, 14%). NR rates also did not differ according to the number of lymph nodes invaded nor according to the level of the positive nodes; 14 of 45 isolated NR occurred in a nondissected suprahyoid region. Of 779 patients, 255 (33%) subsequently developed a metachronous cancer; 153 upper respiratory and digestive tract tumors, 37 lung tumors, 33 esophageal tumors, and 32 other tumors. Isolated cervical failure was responsible for 40 deaths., Conclusion: The low NR rate in NO N+ CR- patients means that postoperative irradiation can be confined to N+ CR+ patients and, as a precautionary measure, to patients with more than 3 N+ CR-. Keeping irradiation in reserve allows the treatment of metachronous cancers, which are particularly frequent in these patients, in whom the 5-year survival rate is 54% in N+ CR- and 69% in N-.

Detection and early diagnosis of oral cancers are conducted by general practitioners and dentists. Oral examination is particularly simple: it must be conducted methodically, helped with a good topographical knowledge. Oral examination allows to recognize cancers among tumorous oral lesions based on characteristic criteria. Precancerous lesions, like leucoplakias and lichen planus need a special attention; they must be treated to prevent cancers or strictly followed to catch up a possible worsening. The same physicians can help all along the treatment of oral cancers but their contribution is of major importance in prevention mostly against tobacco smoking.

Biopsy of the minor salivary glands has become a routine examination ordered by physicians working in a wide range of disciplines in order to search for or eliminate the diagnosis of Gougerot Sjögren's disease or another systemic disease. We emphasize the need to use this examinations as a part of a complete work-up of the buccal cavity and the salivary glands. We reviewed our experience with 1,500 biopsies. The glands biopsied were normal in 56% of the cases and led to the diagnosis of Gougerot Sjögren's disease in 24%, chronic sialadenitis in 10% and diverse trophic problems in 5%. The clinical stage of Gougerot Sjögren's disease is usually proposed according to the Chisholm classification which we propose to compare with the Chomette classification. Finally, we described the technique of minor salivary gland biopsy.

In earlier work, we demonstrated that 0.1 p. 100 topical tretinoin is clinically effective and well tolerated compared with placebo for the treatment of oral leukoplakia and oral keratosic or erythematous lichen planus. Here we aimed to complete this clinical protocol with histological and biochemical analyses comparing the biopsy specimens collected at inclusion and those collected after 4 months of treatment. Histological results were based on changes in keratinization observed between onset of treatment and 4 months treatment. Biochemical studies included the use of antibodies (anti-cytokeratins 10-11, anti-filaggrine) for the immunohistochemical evaluation of keratinization and 2-dimensional gel electrophoresis for measuring cytokeratins. In patients with lichen planus, histological changes during treatment showed that, in the 10 patients in the tretinoin group, keratinization disappeared in 6 and decreased significantly in 3. Immunohistochemistry revealed that cytokeratins 10-11 and filaggrin disappeared in 57 p. 100 of the patients treated with tretinoin versus 25 p. 100 in the patients given placebo. Bidimensional gel electrophoresis showed that cytokeratins 1, 2, 10 and 11 disappeared only in the tretinoin group (60 p. 100 of the cases). In patients with leukoplakia, histological changes during treatment showed that, in the tretinoin group, keratinization disappeared in 5 cases and decreased in 5 others. Immunohistochemistry revealed that cytokeratins 10-11 disappeared in 30 p. 100 of the patients treated with tretinoin versus 25 p. 100 in the placebo group. Bidimensional electrophoresis demonstrated that cytokeratins 1, 2, 10 and 11 disappeared in 43 p. 100 of the patients treated with tretinoin.