Spindle cell lipoma of the floor of mouth.

The patient was a man in his 60s with the gradually increasing mass in his mouth. A well-defined, elastic soft mass with a major diameter of 60 mm was found on the right floor of mouth. The magnetic resonance imaging findings showed a well-defined mass with high signal on both T1 and T2-weighted image in the right sublingual space. The mass was slightly heterogeneous inside and had a septum-like appearance. The tumor was resected with care not to damage the capsule. Histopathological findings showed mature adipocytes, spindle-shaped cells, and collagenous components. Spindle cells were CD34-positive. The tumor was diagnosed as spindle cell lipoma. The patient was followed up for 6 months with no recurrence. Spindle cell lipoma is a rare entity and this is the largest case in the oral cavity. Because there are wide variety of adipocytic tumors, the careful examination of their imaging and histopathological findings is essential.

Extracellular calcium stimulates osteogenic differentiation of human adipose-derived stem cells by enhancing bone morphogenetic protein-2 expression.

Bone morphogenetic protein-2 (BMP-2) promotes the differentiation of non-osteogenic mesenchymal cells to osteogenic cells. In this study, we isolated human adipose-derived stem cells (hASCs) and investigated the effects of recombinant human BMP-2 (rhBMP-2) and extracellular Ca2+ concentration ([Ca2+]out) on the osteogenic differentiation of hASCs. rhBMP-2 promoted calcium deposition in hASCs and stimulated the mRNA expressions of six proteins known to be involved in the osteogenic differentiation of hASCs: Runx2, osterix, alkaline phosphatase, osteonectin, bone sialoprotein and osteocalcin. Elevation of [Ca2+]out enhanced the level of alkaline phosphatase enzyme, increased the mRNA expressions of Runx2 and osteocalcin and induced the expressions of BMP-2 mRNA and protein in hASCs. Elevation of [Ca2+]out transiently increased the intracellular Ca2+ concentration ([Ca2+]in) due to activation of the calcium-sensing receptor (CaSR). The Ca2+-induced expressions of BMP-2 mRNA and protein were inhibited by the calmodulin antagonist, W-7. Furthermore, elevation of [Ca2+]out decreased the cytoplasmic level of phosphorylated nuclear factor of activated T-cell-2 (NFAT-2) and increased the nuclear level of dephosphorylated NFAT2. Taken together, these results suggest that rhBMP-2 promotes the osteogenic differentiation of hASCs. Furthermore, an increase in [Ca2+]out enhances the expression of BMP-2 via activation of the CaSR, elevation of [Ca2+]in and stimulation of Ca2+/calmodulin-dependent NFAT-signaling pathways.

Can occlusal evaluation of children with unilateral cleft lip and palate help determine future maxillofacial morphology?

Objective : To investigate the change in occlusal evaluations from the 5-year-olds' index to the Goslon Yardstick and to compare the relationship between the evaluations and maxillofacial growth in patients with complete unilateral cleft lip and palate (UCLP). Design : A prospective longitudinal study. Subjects : The sample consisted of 85 patients with complete UCLP who underwent surgery from 1969 to 1994 and were treated at the Kyushu University Hospital in Fukuoka, Japan. Subjects had two serial dental casts performed at the ages of 5 and 10 years. Furthermore, each patient had lateral cephalographs taken at the age of 5 years, 76 of 85 subjects had films taken at the age of 10 years, and 54 subjects also had lateral cephalograms taken after the age of 15 years. Methods : Every dental cast was evaluated by the 5-year-olds' index and the Goslon Yardstick, respectively. The lateral cephalographs were traced and digitized, and angular dimensions were calculated. Outcomes were compared using Spearman's rank-order correlation analysis and the Kruskal-Wallis analysis. Results and Conclusion : Dental arch relationships were evaluated and rated as 2.96 in the 5-year-olds' index and 2.85 in the Goslon Yardstick, respectively. Both groupings showed a significant relationship, and they showed no change in 36 out of 85 subjects (42.3%), significant improvement in 30 (35.3%), and deterioration in 19 (22.3%). Two occlusal groupings and maxillofacial morphology on the cephalographs indicated that the grouping reflected the anteroposterior position of the mandible. Moreover, both groupings showed some relation to previous maxillofacial growth, but they did not show any relationship with future growth. The Goslon Yardstick may not predict maxillofacial morphology in adulthood.

Effects of the patient's age and the size of the primary lesion on the speed of shrinkage after marsupialisation of keratocystic odontogenic tumours, dentigerous cysts, and radicular cysts.

Marsupialisation, by which a surgical window is created in the cavity of a cystic lesion, has been recommended to avoid the formation of a bony defect in the jaw and a reduction in a patient's quality of life. However, information about the factors that affect the reduction in the size of a cyst after marsupialisation is limited. We have studied the effects of the patient's age and the size of the primary lesion on the speed of shrinkage after marsupialisation of keratocystic odontogenic tumours (KCOTs), dentigerous cysts, and radicular cysts. The speed of shrinkage (mm(2)/month) was evaluated by measuring the radiolucent area on panoramic radiographs taken before and after marsupialisation for KCOT (n=28), dentigerous cysts (n=26), and radicular cysts (n=18) in the mandibular molar regions. The mean duration of marsupialisation for each type of cyst was 11 (5), 8 (5), and 5 (2) months, respectively. The radiolucent area decreased linearly in the 3 types depending on the time after marsupialisation: r=-0.86 (p<0.01), r=-0.73 (p<0.01), and r=-0.72 (p<0.01), respectively. The relative speed of shrinkage did not correlate with the age of the patients, though it did correlate with the size of the radiolucent area before marsupialisation in KCOT (r=0.69, p<0.01) and radicular cysts (r=0.73, p<0.01). These results suggest that the size of a cyst before marsupialisation may affect the speed of shrinkage in KCOT and radicular cysts, while the age of the patient does not.

Multiple schwannomas in the oral floor: case report.

We present a case of multiple schwannomas of the oral floor in a 62-year-old man, which met the diagnostic criteria of schwannomatosis.

Eruption prediction of mandibular premolars associated with dentigerous cysts.

OBJECTIVE: A tooth with a dentigerous cyst (DC) does not always erupt by marsupialization. The eruption duration and conditions of DC-associated premolars were examined to predict such eruption following marsupialization. STUDY DESIGN: The eruption and conditions including depth, root formation, inclination, and eruption space were examined retrospectively in 21 DC-associated mandibular premolars using dental and panoramic radiograms. RESULTS: Fifteen of 21 premolars erupted half within 3 months and all 15 erupted completely within 10 months after marsupialization, without orthodontic traction. The age of the patients, tooth depth, and inclination were significantly different between the erupted and non-erupted groups, whereas there was no significant difference in the root formation or the eruption space between the 2 groups. CONCLUSIONS: The successful eruption of a DC-associated premolar can be predicted within 3 months after marsupialization. Furthermore, the eruption may be affected by the patient's age, tooth depth, and tooth inclination.

Immunohistochemical analysis of interleukin-1 alpha, its type I receptor and antagonist in keratocystic odontogenic tumors.

BACKGROUND: Interleukin-1 alpha (IL-1 alpha) is thought to play a crucial role in the growth of keratocystic odontogenic tumors (KCOTs) in the jaw. The function of IL-1 alpha is regulated by the local levels of IL-1 alpha, its receptor and receptor antagonist (IL-1Ra) in tissues. In this study, the expression of these proteins was investigated both before and after marsupialization in KCOTs. METHODS: The expression of IL-1 alpha, IL-1 receptor type I (IL-1RI) and IL-1Ra was detected immunohistochemically in 10 specimens of KCOTs. RESULTS: IL-1 alpha was intensively expressed throughout the epithelium in all cases, while mild expression of IL-1 alpha was detected in the subepithelial layer endothelial cells and fibroblasts. Mild or intensive immunoreactivity for IL-1RI was also observed in the epithelial cells in all cases, and in the endothelial cells and fibroblasts in five cases respectively. The expression of IL-1Ra was detected in the epithelial cells in five cases, and in the endothelial cells and fibroblasts in three cases. After marsupialization, the immunoreactivity for IL-1 alpha and IL-1RI in the epithelial cells decreased, while the immunoreactivity for IL-1Ra in the epithelial cells increased. However, the immunoreactivity for IL-1RI and IL-1Ra in endothelial cells and fibroblasts did not change significantly. CONCLUSION: The effects of IL-1 alpha on the epithelial cells might be downregulated after marsupialization by changing the expression levels of IL-1 alpha, IL-1RI and IL-1Ra in the epithelium of KCOTs.

Ca2+ stimulates COX-2 expression through calcium-sensing receptor in fibroblasts.

Fibroblasts isolated from jaw cysts expressed calcium-sensing receptor (CasR). In the fibroblasts elevated extracellular Ca(2+) ([Ca(2+)](o)) increased fluo-3 fluorescence intensity, and the production of inositol(1,4,5)trisphosphate and active protein kinase C. Phospholipase C inhibitor U-73122 attenuated the Ca(2+)-induced increase in fluo-3 fluorescence intensity. Elevated [Ca(2+)](o) enhanced the expression of cyclooxygenase-2 (COX-2) mRNA and protein, and the secretion of prostaglandin E(2) in the fibroblasts. CasR activator neomycin also increased the expression of COX-2 mRNA, and U-73122 attenuated the Ca(2+)-induced expression of COX-2 mRNA. Elevated [Ca(2+)](o)-induced phosphorylation of extracellular signal-regulated protein kinase-1/2 (ERK1/2), p38 mitogen-activated protein kinase (MAPK), and c-Jun N-terminal kinase (JNK), and U-73122 inhibited the Ca(2+)-induced phosphorylation. The inhibitors for each kinase, PD98059, SB203580, and SP600125, attenuated the Ca(2+)-induced expression of COX-2 mRNA. These results suggest that in jaw cyst fibroblasts elevated extracellular Ca(2+) may enhance COX-2 expression via the activation of ERK1/2, p38 MAPK, and JNK through CasR.

The use of free-periosteum for secondary bone grafting to the maxillary alveolar clefts.

Some modification on the surgical technique for bone grafting to the alveolar clefts has been required. Secondary bone grafting was performed with and without free-periosteum on 34 (mean age, 9.8 +/- 1.1 years) and 44 (mean age, 10.7 +/- 1.2 years) alveolar clefts, respectively. Vertical bone formation which scored 3 or 4 was obtained in 97.1% of free-periosteum grafted clefts, while it was obtained in 79.5% of the control group. The rate of postoperative wound dehiscence in free-periosteum grafted clefts (20.6%) was not significantly different from the control group (11.4%). In the wound dehiscence cases, however, the grafted periosteum covered the grafted bone and prevented bone exposure. The score of bone formation in the free-periosteum grafted clefts (3.57 +/- 0.79) was significantly higher than that of the control group (2.60 +/- 1.34). Thus, free-periosteum grafting in secondary bone grafting is useful for bone formation in alveolar clefts.

Marsupialization inhibits interleukin-1alpha expression and epithelial cell proliferation in odontogenic keratocysts.

BACKGROUND: Marsupialization results in the reduction of odontogenic cyst size. Interleukin-1alpha (IL-1alpha) is thought to play a crucial role for the expansion of odontogenic keratocysts. The aim of this study was to investigate the effects of marsupialization on the expression of IL-1alpha and on the proliferating activity of a lining epithelium in odontogenic keratocysts. METHODS: The concentrations of IL-1alpha, interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) in the intracystic fluids of odontogenic keratocysts were measured by the enzyme-linked immunosorbent assay (ELISA). The expression of IL-1alpha mRNA in odontogenic keratocysts was measured before and after marsupialization by in situ hybridization. The expression of IL-1alpha and epithelial cell-proliferating activities in odontogenic keratocysts were also measured by immunohistochemistry using antibodies for human IL-1alpha and Ki-67 antigen, respectively. RESULTS: The intracystic fluid levels of IL-1alpha were significantly higher than those of IL-6 and TNF-alpha in odontogenic keratocysts. In situ hybridization and immunohistochemistry showed that strong expression of IL-1alpha mRNA and protein was mainly detected in the epithelial cells of odontogenic keratocysts. After marsupialization, the signal intensities for IL-1alpha mRNA and protein were significantly decreased. In addition, the Ki-67 labeling index of the epithelial cells was decreased proportionally with the grade of IL-1alpha mRNA expression after the marsupialization. CONCLUSION: Our findings suggest that marsupialization may reduce the size of odontogenic keratocyst by inhibiting IL-1alpha expression and the epithelial cell proliferation.