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Objective To clarify the relationship between oral lichen planus (OLP) and systemic oxidative stress, we examined serum antioxidant and urinary oxidative stress marker levels in patients with OLP. Methods Fifteen female patients with clinical and histopathological diagnoses of OLP were enrolled in this study. The mean patient age was 67.6 years (range, 56–81 years). Ten age- and sex-matched volunteers without oral mucosal lesions were selected as a control group. Serum levels of the antioxidants vitamin A, vitamin C, vitamin E, folate, zinc, uric acid, and superoxide dismutase activity were evaluated. Urinary levels of the oxidative stress marker 8-hydroxy2’-deoxyguanosine (8-OHdG) were measured by enzyme immunoassays. All values were compared between the two groups. Results The mean value of serum vitamin C was lower in the OLP group (5.73 ± 2.34μg/mL) than in the control group (9.22 ± 3.65 μg/mL; P = 0.0125). Serum levels of vitamin A, vitamin E, folate, zinc, uric acid, and superoxide dismutase activity did not significantly differ between the two groups. The mean values of creatinine adjusted urinary 8-OHdG were 10.1 ± 7.34 ng/mg creatinine in the OLP group and 13.7 ± 12.7 ng/mg creatinine in the control group; these values did not significantly differ between the two groups (P = 0.5189). Conclusion Our results suggested that serum levels of vitamin C are low in patients with OLP. However, oxidative stress (determined by measurement of urinary 8-OHdG level) was not significantly higher in patients with OLP. Thus, the relationship between OLP and systemic oxidative stress was not fully elucidated in this study.

Increased histamine production and the overexpression of receptors (H1R∼H4R) has been reported in several tumors. The effects of TGFβ1 and epigallocatechin gallate (EGCG) on histamine synthesizing enzymes (HDCs), and the histamine transporter systems and receptors were investigated in this study.Four oral cancer cell lines (HSC2, HSC3, HSC4, and SAS) were treated with or without TGFβ1 or EGCG for 24 h. The expression levels of HDC, SLC22A3, H1R∼H4R, and TAS2R14 were investigated by Western blotting. Histamine concentrations were determined using the enzyme immune assay. Bitter taste receptor (TAS2R14 and TAS2R39) mRNAs were investigated by RT-PCR.Varying expression levels of HDC, SLC22A3, H1R∼H4R, and TAS2R14 were observed in the four cell lines, where histamine concentrations were found to be ∼500 fmol/ml in cell culture media and induced 2-2.5 times higher amounts of histamine following EGCG treatment. TGFβ1 increased HDC expression in three cell lines, SLC22A3 expression in three cell lines, H1R expression in two cell lines, H2R expression in three cell lines, H3R expression in three cell lines, and H4R expression in three cell lines. EGCG decreased HDC expression in all four cell lines, SLC22A3 expression in three expression, H1R expression in all four cell lines, H2R expression in two cell lines, H3R expression in three cell lines, and H4R expression in two cell lines.EGCG upregulated histamine production and decreased the expression level of H1R in the oral cancer cell lines. It might prove useful for cancer therapy during histamine regulation.

Although the efficacy of docetaxel, cisplatin, and 5-Fluorouracil (TPF) as induction chemotherapy has been confirmed, the therapeutic outcome and prognostic factors of concurrent chemoradiotherapy (CCRT) should be investigated.Laboratory data of patients who underwent CCRT for advanced squamous cell carcinoma (SCC) of the head and neck were investigated to clarify the grade of side effects. Survival rates and prognostic scores were also calculated. Multivariate analysis was performed to examine the prognostic factors of the patients.Although there were significantly more advanced cases in the TPF group (n=72) than those in the cisplatin group (n=50), there were no significant differences in patient survival rates. In the TPF group, the lymphocyte count, albumin level, and C-reactive protein level of the patients before treatment were significantly correlated with patient outcomes.CCRT using the TPF regimen had remarkable treatment effects in advanced head and neck cancer.

We report a case in which it was difficult to distinguish cervical lymph node involvement from Hodgkin’s lymphoma vs cervical lymph node metastasis from tongue cancer. Additionally, we report the histopathology for a postoperative follow-up biopsy of an enlarged lymph node in this patient with Hodgkin’s lymphoma in remission.

We report a rare case of squamous cell carcinoma (SCC) of the buccal mucosa with multiple distant metastases developing 6 months after resection. Because of its rarity and the multitude of organs involved by metastases, the treatment strategy was challenging and could not be standardized. A 61-year-old woman was referred to our institution in November 2016 for the diagnosis and treatment of a left buccal lesion. Biopsy revealed SCC. On the basis of the clinical diagnosis of buccal mucosal cancer (cT3N2bM0), intraoral tumor resection with neck dissection was performed. The postoperative course was uneventful. However, 6 months later, regional recurrence in the left nasopharyngeal mucosa occurred. Positron emission tomography/computed tomography revealed abnormal accumulations of fluorodeoxyglucose in the left lung, hilar lymph nodes, liver, adrenal glands, retroperitoneal lymph nodes, left clavicle, left scapula, ribs, thoracolumbar spine, sacrum, ilia, and femurs. Biopsy of the left ilium revealed SCC. These findings were compatible with multiple distant metastases from the oral SCC. To suppress the growth of distant metastases, platinum-fluorouracil chemotherapy plus cetuximab were administered, with responses in the nasopharynx and soft tissues only. Nivolumab was added to suppress the bone metastases; however, 7 days after administration, the patient died of acute respiratory distress syndrome. Evaluation of the expression of epithelial–mesenchymal transition markers including E-cadherin in the invasion front of oral SCC revealed normal results.

Computer-assisted surgery (CAS) is used in various clinical settings. The introduction of CAS has improved accuracy and safety by reducing the duration of surgery. An 86-year-old man was referred to our hospital for treatment of a mandibular fracture. Considering his advanced age, it was desirable that the surgery duration should be as short as possible. Virtual surgical planning was performed with computer software based on the preoperative computed tomography (CT) data. Mandibular segments were reconstructed as an ideal configuration of the patient’s mandible. Finally, a 3-dimensional (3-D) life-size model of the patient’s mandible was constructed with a 3-D printer based on the simulation data using a rapid prototyping method. A titanium reconstruction plate was bent to adapt to the simulated mandibular model preoperatively. During surgery, the prepared plate was fitted to the mandible with minor adaptations. The surgery was completed uneventfully. CAS was effective in forming the ideal configuration of the mandible with reduced operating time and less blood loss. Therefore, this method is useful for the treatment of fractures of the atrophic mandible.

This study aimed to clarify the advantages and disadvantages of conventional visual inspection (CVI), endoscopic white light imaging (WLI), and narrow-band imaging (NBI) and to examine the diagnostic accuracy of intraepithelial papillary capillary loops (IPCL) for the detection of oral squamous cell carcinoma (OSCC). This cross-sectional study included 60 participants with oral mucosal diseases suspected of having oral potentially malignant disorders (OPMDs) or OSCC. The patients underwent CVI, WLI, NBI, and incisional biopsy. Images were evaluated to assess the lesion size, color, texture, and IPCL. Oral lichen planus (OLP) and oral leukoplakia lesions were observed in larger areas with NBI than with WLI; 75.0% were associated with low-grade (Type 0–II) IPCL. Various types of oral leukoplakia were seen; however, all OSCC cases showed high-grade (Type III–IV) IPCL. The diagnostic accuracy of high-grade IPCL for OSCC showed a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 100%, 80.9%, 59.1%, 100%, and 85.0%, respectively. A non-homogeneous lesion with high-grade IPCL strongly suggested malignancy. Overall, our results indicate that WLI and NBI are powerful tools for detecting precancerous and cancerous lesions using IPCL. However, NBI is influenced by mucosal thickness; therefore, image interpretation is important for accurate diagnosis.

Pseudogout is a disease characterized by calcium pyrophosphate crystal deposition. Involvement of the temporomandibular joint (TMJ) is rare. We herein report a case of tophaceous pseudogout of the TMJ with cranial extension. An 83-year-old woman was referred to our institution for treatment of right TMJ pain. The patient’s medical and family histories were unremarkable. Magnetic resonance imaging showed a mass of about 35 mm in diameter compressing the bottom of the right temporal lobe of the brain. Based on a clinical diagnosis of a right TMJ tumour, biopsy was performed under general anaesthesia. The histopathological diagnosis was pseudogout. Considering the risk of surgically induced brain damage, the patient’s advanced age and her relatively good quality of life, the treatment plan simply involved the observation of the lesion. Fourteen months after biopsy, the patient’s activities of daily living remained unchanged and she had no TMJ pain.

Radiation therapy (RT) plays a significant role in the management of head and neck malignancies. This study aimed to review the clinical symptoms and various imaging findings of osteoradionecrosis (ORN) and provide a clinical perspective on the development of ORN. The retrospective cohort was composed of 57 sites in 54 patients who had a history of RT and suspected ORN and 48 sites in 45 patients who were confirmed to have ORN. Image analyses included computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET)/CT, bone scintigraphy, and single-photon emission CT (SPECT). The irradiated tissue was damaged by RT, and the extent of damage was correlated with clinical symptoms. The bone marrow showed sclerotic changes and the devitalized bone showed bone resorption after invasive stimulation. Chronic trismus and pathological fracture are considered severe conditions, typically occurring in the last stage of ORN. Furthermore, neurological symptoms were an important sign of tumor recurrence, since diagnostic imaging was difficult. The possible treatment options vary depending on the stage of ORN. We speculate that bone sclerosis reactions and bone resorption are sequential reactions that seem to be protective measures of the bone to radiation injury.

Ameloblastoma is a benign tumor that develops in the jawbone. Occasionally, however, it may become malignant and metastasize to other tissues. Although it has been suggested that various cytokines and several adhesion factors may play a role in its malignant transformation, the details have not been elucidated. In this context, it has been reported that butyric acid produced by periodontopathic bacteria causes progression of malignant tumors occurring in the mouth via podoplanin. However, the influence of butyric acid on ameloblastoma has not been clarified. In the present study, therefore, the expression of various cytokines and adhesion factors in ameloblastoma upon stimulation with butyric acid or cytokines was investigated using real-time reverse-transcription polymerase chain reaction. Three cell lines (HAM1, HAM2 and HAM3) established from the same ameloblastoma were used in the experiments. It was found that the expression of mRNAs for epidermal growth factor (EGF) and transforming growth factor beta 1 (TGFβ1) was increased in HAM2 and HAM3, respectively, upon stimulation with butyric acid. In addition, stimulation with EGF and TGFβ1 led to an increase in the expression of laminin β-3 mRNA in the respective cell lines. These results suggest that butyric acid may be involved in ameloblastoma exacerbation through the expression of laminin 332 (LM332) via EGF and TGFβ1 produced by ameloblastoma itself.

Background Angiosarcoma occurs very rarely in the oral cavity, and the epithelioid type is even rarer. Here, we report a rare case involving an elderly man with a primary epithelioid angiosarcoma that originated from the mandibular gingiva and resembled a dentigerous cyst on radiographs. Case presentation A 66-year-old Japanese man visited our hospital with a chief complaint of gingival swelling in right mandibular third molar region. A panoramic radiograph showed bone resorption around the crown of right mandibular third molar, which was impacted. Incisional biopsy confirmed a diagnosis of epithelioid angiosarcoma. The lesion exhibited aggressive proliferation after biopsy resulting in uncontrolled bleeding and difficulty in closing the mouth. Mandibular segmental resection including the tumor was performed without reconstruction. Because of the aggressive preoperative course of the tumor, the patient received adjuvant chemotherapy. There were no signs of recurrence during a 2-year follow-up period. Conclusions A review of the literature yielded only four reported cases of epithelioid angiosarcoma in the jaw region, with the lesions occurring in the maxilla in three cases. To our knowledge, this is the second case of primary epithelioid angiosarcoma in the mandible.

Background The symptoms of hypopituitarism are not usually discussed in the clinical setting of oral surgery. Case presentation We herein report a case of hypopituitarism that became evident after biopsy and extraction of several teeth in a 68-year-old man with tongue cancer. Three days after biopsy, the patient developed nausea and vomiting, and his serum sodium had fallen to 124 mEq/L. His serum cortisol concentration was low. Although the plasma concentration of adrenocorticotropic hormone (ACTH) was within the normal range, ACTH stimulation testing showed a lack of cortisol response. Given these findings, we suspected secondary adrenal insufficiency. To investigate the cause of secondary adrenal insufficiency, MRI of the head was performed, which revealed pituitary gland atrophy. The results of pituitary anterior lobe hormone-stimulation tests were compatible with hypopituitarism. Thirty days after biopsy, partial tongue resection was successfully performed under general anesthesia with perioperative hydrocortisone supplementation. Conclusions We must be aware of various signs of hypopituitarism when we perform invasive dental treatment.

Objective to re-examine measures to prevent oral mucositis caused by drugs in head and neck cancer patients during cancer treatment by measuring salivary excretion of 5-fluorouracil. Saliva, blood, and urine were simultaneously collected from oral cancer patients and breast cancer patient at the point in time of before, during, and after the administration of 5-FU, then the 5-FU levels of the samples were quantitatively analysed using LC-MS/MS. In all patients, the 5-FU levels in saliva and serum peaked at 30 min to 3 h after the start of 5-FU treatment, and high levels were maintained throughout the administration of the drug. With regard to urinary 5-FU levels, they remained high from 3 to 120 h after the start of 5-FU treatment. After the completion of 5-FU treatment, even though it not appeared in the patients’ serum and urine promptly, 5-FU was detected in saliva at 12 h after the completion of 5-FU treatment in one oral cancer patient and at 48 h after the completion of 5-FU treatment in the breast cancer patient. It was suggested that the level of hydration after the completion of chemotherapy may be involved in the differences in 5-FU excretion.

Oral diverticulum is rarely encountered, and the histopathological findings are unclear. We herein report a case of an oral diverticulum and describe its histopathological findings. A buccal mucosal outpouching was observed in a 66-year-old man. Food debris was seen within the outpouching. Under the clinical diagnosis of a diverticulum-like lesion, excision of the outpouching was performed through an intraoral incision to stop food impaction. Histopathological examination revealed that the excised lesion was a true diverticular structure composed of a keratinising, squamous epithelial lining with a surrounding fibrous connective tissue wall, with inflammatory cell infiltration and haemorrhage. The histopathological diagnosis was a diverticular pouch of the buccal region. Clinicians should be aware of this lesion to ensure correct diagnosis and treatment.

We encountered a patient with a huge osteoma extending over half of the mandible, which was incidentally discovered on a head-and-neck computed tomography (CT) by an otolaryngological examination for vertigo. A tumorous lesion of the right mandible was noted, and the patient was referred to our department. The tumor extended from the median mandible over the right anterior margin of the ramus of the mandible. To improve the abnormal intraoral morphology, tumor resection and orthopedic surgery were performed. The histopathological diagnosis was a cancellous osteoma. Dentures were attached after surgery, and the postoperative course has been favorable with no tumor re-enlargement.

Primordial odontogenic tumor (POT) is a benign mixed epithelial and mesenchymal odontogenic tumor included into the current World Health Organization (WHO) classification of Head and Neck tumours in 2017. As far as the authors have confirmed, only eight cases of this tumor have been reported so far. This paper reports a case of POT that occurred in the right mandible of a 5-year-old patient. Panoramic radiograph showed a well-defined homogeneous radiolucency displacing the unerupted second deciduous molar to the deep part of the mandible. Histopathologically, the tumor was composed of cell-rich mesenchymal tissue with myxoid areas, surrounded by columnar epithelium and non-keratinized cuboidal epithelium in the outer layers. The histopathological diagnosis was POT. The expression patterns of cytokeratins (CK) 14, 18, 19, vimentin and CD34 suggested that the grade of differentiation of the POT was approximately equivalent to that of normal primary tooth germ tissues in cap stage to late bell stage.

骨欠損に対して再生医学的アプローチをする上で,骨再生組織への新生血管による血液の供給や循環は,安定した骨の形成や感染防御の面において重要であると考えられる.本研究は,bFGF徐放システムによる骨再生モデルを用いて,マイクロフォーカスCTにより同一個体の経時的な骨再生の経過を観察し,連続組織標本を作製することで,骨再生と血管新生の関係を明らかにすることを目的とした.実験方法は,10週齢のWistar系ラットの頭頂骨に直径7mmの骨欠損を形成し,実験群にはbFGF 10μg含有酸性ゼラチンディスクを埋入した.また,対照群には同ディスクに生理食塩液を含浸させたものを埋入した.埋入後2日,1週,2週,4週に同一ラットをマイクロフォーカスCTにて撮影し,三次元画像解析ソフトにて三次元的に骨再生の経過を観察した.また,埋入後1週と4週に連続組織標本をFilm-transfer法にて作製し,H-E染色を行った後,冷却3CCDカメラ装着光学顕微鏡にて二次元コンピューター画像に入力し,再生骨と新生血管の同定を行った.実験の結果,マイクロフォーカスCT所見では,実験群は埋入後2日で再生現象を確認することができなかったが,埋入後1週,2週になると軽度の骨再生が認められ,4週まで継続していた.骨体積計測の結果,埋入後2日,1週,2週では実験群と対照群との間に有意差は認められなかったが,4週には対照群に対し実験群では有意に体積が増加していた(P, In devising regenerative medical approaches to bone defects, the blood supply to, and perfusion of, regenerated bone tissue by angiogenesis is considered important to ensure stable bone formation and the prevention of infection. This study was conducted to clarify the relationship between bone regeneration and the angiogenesis bFGF sustained release system by serially observing the process of bone regeneration in the same rats, employing microfocus X-ray CT and preparing serial tissue sections. A bone defect of 7mm in diameter was prepared in the parietal region of 10-week-old Wistar rats, and an acidity gelatin disc (AGD) containing 10μg of bFGF was embedded in the study group. In the control group, the same disc saturated with physiologic saline was embedded. The rats were scanned by microfocus X-ray CT 2 days, 1 week, 2 weeks, and 4 weeks after disc embedding, and the process of bone regeneration was three-dimensionally observed using 3D visualization software. Also, 1 and 4 weeks after disc embedding, serial tissue sections were prepared using the film-transfer method, H-E staining was performed, their 2-dimensional images were input into a computer via an optical microscope with a color-chilled 3CCD camera, and regenerated bone and newly-formed vessels were identified. By microfocus X-ray CT, bone regeneration could not be confirmed 2 days after disc embedding in the study group, but slight bone regeneration was noted 1 and 2 weeks after disc embedding, and bone regeneration continued until after 4 weeks. As a result of measurement of the bone volume, no significant difference was noted between the study and control groups 2 days, 1 week, or 2 weeks after disc embedding, but the bone volume had increased in the study group compared with the control group after 4 weeks (p