Differential expression of cornified cell envelope precursors in normal skin, intraorally transplanted skin and normal oral mucosa.

BACKGROUND: Skin flaps have routinely been used as substitutes for oral mucosa after extensive resection of oral tissues. However, it remains unknown how the transplanted skin flaps perform as a host defence in the new environment of the oral cavity. OBJECTIVES: To evaluate the expression of cornified cell envelope (CCE) precursors in pretransplanted (normal) skin, intraorally transplanted skin and normal oral mucosa, because CCEs are highly responsible for a protective barrier in each type of epithelium. METHODS: We used immunohistochemistry and immunoelectron microscopy to examine the expression of CCE precursors, small proline-rich protein (SPR) 2 and 3 and loricrin, in biopsy specimens of normal skin, transplanted skin and normal oral mucosa, including buccal and lingual (non-keratinized) mucosae, and palatal (keratinized) mucosa. RESULTS: Transplanted skin flaps were classified into two groups. About two-thirds of the transplanted skin flaps displayed a reddish appearance and were devoid of the stratum corneum (SC) together with a psoriasiform inflammatory tissue reaction. Others showed a native appearance, retaining the SC. While SPR2 expression was limited to the stratum granulosum (SG) in both normal and transplanted skin retaining the SC, it extended to the stratum spinosum (SS) of the transplanted skin lacking the SC and that of the normal oral mucosa. Although SPR3 expression was not found in normal skin or in the transplanted skin retaining the SC, it was strongly expressed in the SS of the transplanted skin lacking the SC and the non-keratinized oral mucosa, and in the SS and SG of the keratinized oral mucosa. Loricrin, which was expressed in the SG of normal skin, the transplanted skin retaining the SC and the keratinized oral mucosa, was not detected in the transplanted skin lacking the SC or in the non-keratinized oral mucosa. Immunoelectron microscopy confirmed the ultrastructural localization of SPR3 directly under the cytoplasmic membrane of keratinocytes of the transplanted skin lacking the SC and that of the oral mucosa. CONCLUSIONS: The altered expression of SPR2, SPR3 and loricrin reflects the possible adaptation of epidermal keratinocytes in the new environment of the oral cavity.

Comparison of reliability between the modified groin flap and the forearm flap in oral reconstruction.

OBJECTIVE: The groin flap has the advantage of minimum donor-site morbidity, while having the disadvantage of short vascular pedicle of small caliber. Modification of the groin flap has improved the former disadvantage, but the latter one remains. The purpose of this study was to compare the reliability of the modified groin flap with the forearm flap. STUDY DESIGN: Eleven modified groin flaps and 40 forearm flaps consecutively performed by a single surgeon in a hospital for patients with oral cancer were retrospectively reviewed. RESULTS: The rate of total flap loss in the modified groin flap group (8.3%) was higher than that in the forearm flap group (2.5%). The rates of partial flap loss in both flaps were similar to those of total flap loss. The failures of the modified groin flap and the forearm flap were due to arterial and venous complications, respectively. CONCLUSION: The modified groin flap appears to be a little less reliable than is forearm flap; nevertheless, it could be a good option for patients who desire less conspicuous postoperative scars.

Implantation of octacalcium phosphate combined with transforming growth factor-beta1 enhances bone repair as well as resorption of the implant in rat skull defects.

In our previous study, we reported that synthetic octacalcium phosphate (OCP) enhances bone repair if implanted in rat skull defects. We hypothesized that OCP can be used as an effective carrier for transforming growth factor-beta1 (TGF-beta1) to promote bone repair. We designed the present study to investigate histomorphometrically whether combination with recombinant human TGF-beta1 could promote bone repair caused by OCP per se (Control/OCP). A full-thickness standardized trephine defect was made in the rat parietal bone and OCP combined with recombinant human TGF-beta1 (TGF-beta1/OCP) or Control/OCP was implanted into the defect. Four rats from each group were fixed at 2, 4, and 8 weeks after implantation. Histomorphometrical analysis of the percentage of newly formed bone (n-Bone %) and remaining implants (r-Imp %) in the defect was performed. The statistical analysis showed the n-Bone % of TGF-beta1/OCP was significantly higher than that of the Control/OCP in week 4, whereas the r-Imp % of TGF-beta1/OCP was significantly lower than that of the Control/OCP. The present study demonstrated that OCP can be used as an effective carrier for TGF-beta1 and their combination enhances bone repair as well as resorption of the carrier OCP in the early stage of bone formation.

Macrophage-derived chemokine (MDC/CCL22) and CCR4 are involved in the formation of T lymphocyte-dendritic cell clusters in human inflamed skin and secondary lymphoid tissue.

Our previous study demonstrated formation of T cell-dendritic cell (DC) clusters in inflamed dermis of intraorally autotransplanted skin flaps. Such T cell-DC clusters are supposed to be important for close interactions between T cells and DCs including the specific antigen presentation. Here we show the involvement of the macrophage-derived chemokine (MDC/CCL22) and its specific receptor CC chemokine receptor 4 (CCR4) in the formation of T cell-DC clusters. Reverse transcriptase-polymerase chain reaction analysis revealed high levels of mRNA expression for MDC and CCR4 in inflamed skin and neck lymph nodes (LNs), but not in normal skin. Immunohistochemically, MDC(+) cells and CCR4(+) cells were mainly located within the T cell-DC clusters both in the dermis of inflamed skin and the T cell area of LNs. MDC(+) cells were identified to be DCs both in inflamed skin and LNs. The majority of CCR4(+) cells were CD4(+) T cells, accounting for approximately one-third of total CD4(+) T cells in the inflamed skin. Our data suggest that the MDC-CCR4 system plays an important role in the formation of T cell-DC clusters both in inflamed skin and LNs.

Immunological activation of dermal Langerhans cells in contact with lymphocytes in a model of human inflamed skin.

Langerhans cells play an important role in the skin's immune system. Little is known, however, about the antigen-presenting capacity of Langerhans cells in the context of skin inflammation. By immunohistochemistry we investigated the phenotypic characteristics of epidermal and dermal Langerhans cells and their spatial relationship with infiltrating lymphocytes. We studied skin flaps autotransplanted to the oral cavity to fill a defect after maxillofacial cancer surgery. In 15 of 21 cases sampled for the present study, the skin flaps were severely inflamed by Candida albicans infection. In contrast to the normal skin, such inflamed skin showed a marked increase in CD1a(+) dermal Langerhans cells. Double immunohistochemistry revealed that dermal Langerhans cells abundantly expressed B7-2 (CD86), a representative costimulatory molecule, and CD83, a marker of mature dendritic cells. Furthermore, these dermal Langerhans cells were in close contact with CD4(+)/CD45RO(+) lymphocytes. This cell-to-cell contact was further visualized by immunoelectron microscopy. Langerhans cells were also observed within lymphatic vessels that were identified by the expression of vascular endothelial growth factor receptor-3. Ki-67 labeling indices were 4.2% in CD4(+) T cells and 0.8% in CD8(+) T cells within the dermis. Factor XIIIa(+) dermal dendrocytes were distributed outside the clusters of lymphocytes and were not in contact with them. Our observations indicate that dermal Langerhans cells in the inflamed skin are activated to express common phenotypes to mature dendritic cells so that they could stimulate neighboring memory CD4(+) T cells.

Unique inflammatory features noted in intraorally transferred skin flaps: correlation with Candida albicans infection.

OBJECTIVE: The purpose of this study was to evaluate how well intraorally transferred skin flaps endure their new surroundings. STUDY DESIGN: Biopsy specimens were taken from 20 patients who had undergone microsurgical reconstruction and as pretransferred skin from 5 of these patients at the time of surgery. The study used immunohistochemistry for immunocompetent cells, differentiation markers for the epidermis and desmosomal proteins, and immunoelectron microscopy for desmosomal protein, in addition to routine histologic examination, including Sudan IV, periodic acid Schiff, and Grocott stains. We also measured the thickness of the epidermis and stratum corneum. Oral swabs from the skin flaps were examined for the presence of yeasts, particularly Candida albicans, by means of a culture method. RESULTS: According to the results of periodic acid-Schiff and Grocott staining, 20 cases were divided into 2 groups: fungal element-positive cases (n = 15) and fungal element-negative cases (n = 5). All swabs from the former were positive for Candida albicans. In these fungus-positive cases, histopathologic evaluation revealed marked diminution of stratum corneum and pronounced epidermal hyperplasia. Immunohistochemistry demonstrated the dermal infiltration of numerous immunocompetent cells-CD4+, CD8+, CD20+, CD68+, neutrophil elastase+, and HLA-DR+ cells-and the scarce infiltration of IgA+ and IgG+ cells. There were scattered CD1a+, CD4+, CD8+, and HLA-DR+ cells and elastase+ neutrophils in the epidermis. Expression of cytokeratin subtypes (10, 14, 16, and 19), involucrin, and tenascin showed the characteristic features of epidermal proliferation. Enumeration of Ki-67+ keratinocytes showed an increase, indicating epidermal proliferation. Expression of desmoglein 1 and desmocollin 1 in the epidermal keratinocytes was decreased in comparison with that in the pretransferred skin. Immunoelectron microscopy for desmoglein 1 confirmed the reduced immunoreactive deposits along the desmosomal plaques. In the fungus-negative cases, all such changes were a great deal milder. CONCLUSIONS: Taken together, our results demonstrate that most intraorally transferred flaps are affected by an inflammatory process that is induced by the influence of the wet oral environment. They present psoriasiform tissue reactions characterized by epidermal hyperproliferation that are mostly due to Candida albicans infection.

Reliability of internal jugular vein in oral microvascular reconstruction.

OBJECTIVE: The purpose of this study was to review the reliability of the internal jugular vein when used as a recipient vein in oral microvascular reconstruction. STUDY DESIGN: A retrospective study was done of 36 consecutive cases in which microvascular reconstruction was accomplished with a free flap using the internal jugular vein in an end-to-side fashion. The postoperative patency of 25 internal jugular veins used as recipient veins was examined by postcontrast computed tomography scanning. RESULTS: The overall flap success rate was 97%. Venous thromboses occurred in 2 cases. A common venous thrombosis occurred in one case, but the flap survived after re-anastomosis. In another case, internal jugular vein thrombosis occurred at 5 days of anastomosis, and the flap could not be salvaged by exploratory surgery. All other cases were completely uneventful. All internal jugular veins assessed on postcontrast computed tomography scans were patent at 51 to 107 days after surgery (mean, 89 days). CONCLUSION: Internal jugular vein, if available, is reliable when used as a recipient vein in oral microvascular reconstruction. However, it is not necessarily flawless.

Procollagen-positive fibroblasts predominantly express fibrogenic growth factors and their receptors in human encapsulation process against foreign body.

This paper addresses the in situ expression of transforming growth factor-beta (TGF-beta), platelet-derived growth factor (PDGF), and their receptors in the encapsulation process against a foreign body, using 20 cases of the titanium miniplate as a model of the foreign body, used clinically to fix a fractured mandible. Fibrous tissue formed during the encapsulation process was composed of scar-like and fibrogenic layers, with the former directly facing the foreign body. By immunohistochemistry using pre-fixed frozen sections, only the fibrogenic layer was characterized by expression of type I procollagen (PC-I). Spindle-shaped mesenchymal cells in the fibrogenic layer expressed TGF-beta isoforms and receptors, PDGF isoforms, and PDGF beta-receptor. In contrast, the scar-like layer had few such cells. In both layers, spindle-shaped cells did not express Ki-67 in their nuclei. Double immunofluorescence microscopy for cell identification revealed that most PC-I-positive fibroblasts expressed both isoforms and receptors of TGF-beta and PDGF in the fibrogenic layer, while in contrast, they were expressed by only a small number of CD68-positive macrophages. These results suggest that in the maintenance stage of the human encapsulation process against a foreign body, both TGF-beta and PDGF function cooperatively via their receptors in the fibrogenic layer, with such stimuli markedly diminished in the scar-like layer.

Leiomyoma of the mandible: a rapid growing case with immunohistochemical and electron microscopic observations.

A rare case of leiomyoma of the mandible is reported together with the conventional histologic, immunohistochemical, and electron microscopic findings. On immunohistochemical evaluation the tumor cells were positive for vimentin, desmin, and alpha-smooth muscle actin but negative for neurogenic antigens and markers for vascular endothelial cells. Ultrastructural examination revealed smooth muscle cell differentiation. The Ki-67 labeling index was 4.7%. The tumor showed rapid increase in size and clinical features suggestive of malignancy. However, on histopathologic evaluation it was diagnosed as a benign neoplasm, and this diagnosis was supported by the results for mitotic rate, Ki-67 labeling index, and p53 immunostaining.

Immuno-inflammatory responses in the tissue adjacent to titanium miniplates used in the treatment of mandibular fractures.

The immuno-inflammatory responses to titanium miniplates used in the treatment of mandibular fractures were studied immunohistochemically at light and electron microscope levels. Titanium miniplates were stably situated on the cortical bone surface. In the soft tissue adjacent to the surface of titanium miniplates, double layered connective tissue was observed, which consisted of dense fibrous connective tissue, and relatively loos connective tissue contained proliferated blood vessels with hypertrophied endothelial cells. These vascular endothelial cells expressed HLA-DR, CD54 and CD62P antigens. In some cases they were CD62Epositive. CD68+ and CD11c+ round or spindle-shaped macrophages had infiltrated around the small vessels. Fine titanium particles were observed in the cytoplasm of these macrophages. Both CD4+ and CD8+ T lymphocytes had also infiltrated around venules in some cases. They were CD4+ T lymphocyte-dominant. Immunoelectron microscopically, CD68+ and CD11c+ macrophages contained titanium particles in the lysosomes. Most of the macrophages showed varying degrees of degenerative change. The presence of titanium was confirmed by energy-dispersive X-ray analysis.

Full-thickness reconstruction of cheek defect involving oral commissure with forearm tendinocutaneous flap.

An 82-year-old man underwent full-thickness reconstruction of the cheek for a defect of the oral commissure resulting from a T3N1M0 squamous cell carcinoma. He had previously had both radiotherapy and chemotherapy. A tendinocutaneous flap from the forearm incorporating palmaris longus was used for static reconstruction. The vermilion was then reconstructed with rotation flaps from the contralateral vermilion. Oral function was restored, and he had no problems with drooling or speech.

Intraoral reconstruction with innervated forearm flap: a comparison of sensibility and reinnervation in innervated versus noninnervated forearm flap.

OBJECTIVE: To evaluate the cutaneous sensibility and sensory reinnervation in patients who underwent intraoral reconstruction with an innervated or noninnervated forearm flap. STUDY DESIGN: Results of the use of innervated forearm flaps in oral reconstruction was compared with the use of noninnervated flaps. The evaluation of sensibility and reinnervation comprised clinical sensibility tests and immunohistochemical investigation of postoperative biopsy specimens against S-100 and neurofilament. RESULTS: The innervated flaps (4 patients) provided earlier and qualitatively better recovery of sensation than the noninnervated flaps (9 patients). Immunohistochemical investigation revealed the existence of a larger number of regularly arranged sensory nerve fibers in the cutaneous tissue of the innervated flaps than in the noninnervated flaps. Examination with an electron microscope found the structure of these nerve fibers to be well preserved in the innervated flaps, whereas nerve fibers in the noninnervated flaps were degenerative. CONCLUSION: These findings suggest (1) that the innervated flaps are superior to the noninnervated flaps not only for the repair of defects but also for the restoration of function and (2) that the innervated flaps contribute to the improvement of the quality of life for patients.

Fixation of mandibular body fracture with combination of one-piece cast splint and miniplate.

A method for fixation of mandibular body fracture within the dental arch using a combination of a rigid one-piece cast splint and a pliable miniplate screwed at the inferior border of the mandible was developed with the highest priority placed on restoration of occlusion. This paper presents the results obtained in 36 patients treated by this method. The postoperative occlusion was analyzed using the T-scan system in 20 fully dentate patients without major caries. The data obtained in the patients were well comparable to those in normal subjects.

Symmetrical lipomatosis of the tongue presenting as macroglossia. Report of two cases.

Symmetrical lipomatosis in the oral cavity is extremely rare. Two cases of symmetrical lipomatosis presenting as macroglossia are presented. Glossectomy was performed in order to reduce the size of the tongue and for diagnosis. Because of their multiplicity, non-encapsulation and invasiveness, the lesions were diagnosed histopathologically as symmetrical lipomatosis.

Unilateral parotid swelling after general anaesthesia. A case report.

An extensive swelling in the left parotid region, extending to the buccal and cervical areas, developed in a 30-year-old man immediately after a partial nephrectomy which was performed under general anaesthesia. Radiological examination immediately after the onset revealed no abnormality, but a large swelling was detected by computed tomography in the left parotid region. Serum amylase was significantly elevated. The clinical signs had almost disappeared approximately 2 weeks after the onset, following intravenous infusion of antibiotics and transfusion. This parotid swelling was considered to be acute postoperative parotitis induced during induction of anaesthesia by luxation of the temporomandibular joint or by the positioning of the patient during operation.

Mandibular lesions in patients with adenomatosis coli.

Adenomatosis coli is a very interesting disease accompanied by a number of associated stigmata in the mandible. If left ignored, colonic lesions in patients with this disease proceed almost entirely to malignancy. Hence, detection of the stigmata is very important. The panoramic radiographs of 26 patients diagnosed as adenomatosis coli at the 2nd Department of Surgery, Hamamatsu University School of Medicine from 1978 to 1988 were compared with those of 264 controls. Osteomatous lesions were present in 62% of the patients with adenomatosis coli and 14% of the controls. Pantomographic comparison of the numbers and areas of the osteomatous lesions between the adenomatosis coli and control groups indicated that specific pathognomonic symptoms were demonstrated in panoramic radiographs of approximately 42% of the patients with adenomatosis coli.

Congenital midline sinus of the upper lip. Report of a case.

An extremely rare case of congenital midline sinus of the upper lip in a 12-year-old girl is presented. The sinus had a pit-like orifice in the midline philtral area with a duct extending 4 mm posterosuperiorly. It was excised by extraoral elliptical incision. Histopathological examination disclosed that the duct was covered by a stratified squamous epithelium with sebaceous glands. Twelve cases of this rare disease have previously been reported.