Mutations in the p53 gene and human papillomavirus infection as significant prognostic factors in squamous cell carcinomas of the oral cavity.

The p53 gene has been indicated to be a tumour suppressor gene that is found in mutated form in common human cancers. Human papillomavirus (HPV) has oncogenic activity in cervical and oral squamous cell carcinomas (SCCs). The E6 protein of HPV is known to bind with p53 protein and inactive the tumor suppressor activity by promoting p53 degradation. Because of this background, we examined 38 primary, resected specimens of oral SCCs for detection of p53 mutations and HPV DNAs. Exons 5 through 8 of the p53 Mutations were observed in nine cases (24%). HPV-DNA detection and typing were performed using PCR with ¿high risk group' HPV-specified primers. HPV DNA sequences were detected in eight cases (21%). The AvaII digestion pattern of PCR-amplified HPV DNA showed that HPV-16 was present in all eight cases. Seven cases were p53 mutation-positive/HPV-negative, six cases were p53 mutation-negative/HPV-positive, and two intraosseus SCC cases were p53 mutation-positive/ HPV-positive. Thus, 15/38 (40%) cases had inactivation of the p53 protein. Interestingly, p53 mutation-negative/ HPV-negative cases had a poorer prognosis than p53 mutation positive or HPV-positive cases (P < 0.01). We conclude that (1) mutation in the p53 gene and/or HPV infection are frequent (40%) in oral SCC; (2) inactivation of p53 function by mutation and HPV infection are important genetic events in the development of 40% integral of oral SCCs; (3) p53 mutation and HPV infection are not mutually exclusive events and (4) other oncogenes or tumor suppressor genes may be crucial in the development of oral SCC if the prognosis is poor.

Identification of human papilloma virus DNA sequence in the hyperplastic epithelium of an oral denture fibroma.

The human papilloma virus (HPV) associated with hyperplastic epithelium in an oral denture fibroma was examined by southern blot hybridization. Extracted DNA was hybridized with full length linear HPV type 2a, 6b, 11, 16, 18, 31 and 33 DNAs as a mixed probe only under low stringent conditions. The hybridized bands digested with Bam HI and Eco RI were approximately 8.8 kbp and 15 kbp, respectively. Thus the lesional HPV DNA was different from HPV types used as probes and was probably integrated into host cell chromosomal DNA judging by the off-size high molecular weight bands. Considering the contaminating mesenchymal region and uninfected epithelial cells as well as the evidently limited homology with probe HPV DNAs, the virus copy number in infected cells was poorly defined. In situ antigen staining signals were widely detected in the hyperplastic epithelial layer.

Flow cytometric analysis of nuclear DNA content in tongue squamous cell carcinoma: relation to cervical lymph node metastasis.

The relationship between DNA ploidy and the incidence of cervical lymph node metastasis in 36 patients with tongue squamous cell carcinoma (SCC) was investigated. The aneuploidy rate of tongue carcinomas was 15/36 (42%), and the mean DNA index (DI) was 1.23, with a range from 0.87 to 3.54. Histologically identified cervical lymph node metastasis was observed in 11 cases, and the incidence of the cervical lymph node metastasis was significantly (P < 0.02) higher in the aneuploid cases (8/15) than in the diploid cases (3/21). Recurrence of the primary lesions was seen in nine cases 0.3-2.5 years after the initial treatment. No obvious difference in the incidence of the recurrence was noted, however, between the diploid (5/21) and the aneuploid (4/15) cases. These results indicate a significant relationship between aneuploidy and incidence of the regional lymph node metastasis, in contrast to the absence of a positive relationship between aneuploidy and recurrence of tongue SCC.

Flow cytometric analysis of cell cycle fractions in oral leukoplakia.

Flow cytometric analysis of cell cycle fractions and DNA ploidy was performed on 39 biopsy specimens of oral leukoplakia. The aneuploidy rate of these leukoplakias was 9/39 (23.1%) and the mean DNA index of the aneuploid lesions was 1.34. The aneuploidy rate was significantly higher in severely dysplastic lesions (8/17) than in mildly dysplastic (1/15, P<0.02) and nondysplastic (0/7, P<0.05) lesions. No significant differences in the percentages of each cell cycle fraction were seen between the diploid and the aneuploid leukoplakias. However, the S-phase fraction of the severely dysplastic lesions (23.0%) among the diploid leukoplakias was higher than those of the mildly dysplastic (12.4%) and nondysplastic (15.5%) lesions, and the difference between the severely dysplastic and the mildly dysplastic lesions was statistically significant (P<0.001). These results suggest that flow cytometric analysis of cell cycle fractions and DNA ploidy might offer additional information for assessing the malignant potential of oral leukoplakias.

Flow cytometric analysis of nuclear DNA content in oral leukoplakia: relation to clinicopathologic findings.

DNA ploidy of 50 biopsy specimens of oral leukoplakia was investigated by flow cytometry, and the results were compared with the clinicopathologic appearances. The aneuploidy rate of the leukoplakias was 17/50 (34%), and the mean DNA index (DI) of the aneuploid lesions was 1.22, with a range from 0.70 to 1.84. The incidence of the aneuploidy was significantly (P < 0.01) higher in nonhomogeneous leukoplakias (11/18) than in homogeneous lesions (6/32). The aneuploidy rate of the severely dysplastic leukoplakias (11/17) was significantly higher than those of the mildly dysplastic (4/22; P < 0.01) and the nondysplastic (2/11; P < 0.02) lesions. A significant (P < 0.01) difference in the aneuploidy rate was also observed between tongue (12/23) and gingival (2/18) leukoplakias.

DNA analysis of oral leukoplakia by flow cytometry.

DNA ploidy of 19 oral leukoplakias with and without epithelial dysplasia was investigated and the results were compared with 11 normal gingival biopsies, 14 oral benign tumours and 50 oral squamous cell carcinomas. The results suggest a possible relationship between DNA aneuploidy and oral leukoplakias or squamous cell carcinomas, as 32% of the oral leukoplakias and 48% of the oral squamous cell carcinomas were aneuploid although all the normal gingival biopsies and the benign oral tumours examined were diploid. No significant relationship was observed, however, between DNA ploidy and epithelial dysplasia in the leukoplakias.

Development of squamous cell carcinoma from pre-existent oral leukoplakia: with respect to treatment modality.

The present study was undertaken in order to determine whether surgical treatment of oral leukoplakia reduces the risk of the subsequent development of carcinoma. This study included 142 patients with oral leukoplakia who received or did not receive surgical treatment. All subjects were followed-up for more than 6 months with a mean follow-up period of 4 years. Malignant transformation rate was lower among patients who received surgical excision (1/75) than among those who did not receive surgical treatments (4/51). However, the malignant transformation rates were high in patients who received cryosurgery (3/12) or cryosurgery plus surgical excision (1/4). There was no obvious relation between the grade of epithelial dysplasia and the rate of malignant transformation. Our results suggest that surgical excision of oral leukoplakia may reduce the risk of the subsequent development of carcinoma.

Three-phase bone scintigraphy and viability of vascularized bone grafts for mandibular reconstruction.

Three-phase bone scintigraphy was undertaken to check the anastomotic patency and monitor the viability of vascularized bone grafts. Ten consecutive patients who underwent vascularized bone grafting of the mandible were reviewed. A successful clinical outcome was achieved in 8 patients. The graft failed in 2 patients. In this series, 3-phase bone scintigraphy of radiolabeled (99m)Tc-methylene-diphosphonate was performed at 7 days, and at 1, 3, 6, and 12 months after reconstruction. Assessments made using 3-phase bone images were compared with the clinical findings. The clinical outcome of the cases presented in our series correlated extremely well with 3-phase bone images. Three-phase bone scintigraphy is a useful method for the assessment of patency and viability of vascularized bone grafts. The use of this method can be very helpful in assessing the anastomotic patency and viability of a graft which for clinical reasons is suspected of being non-viable.

Amelanotic malignant melanomas of the oral mucosa.

Oral amelanotic melanomas are rare and the prognosis is poorer than that of pigmented melanomas because of delays in establishing the correct diagnosis and in the initiation of treatment. Amelanotic forms are also thought to be biologically more aggressive than pigmented melanomas. We have seen three cases of oral amelanotic melanomas since 1970, in two of whom the diagnosis was long delayed. Two lesions were not pigmented but one had slight pigmentation. One patient simultaneously had both an amelanotic and a pigmented melanoma in the oral cavity. Lymph node metastases and distant metastases developed in all patients, two of whom eventually died of the disease. Early diagnosis by histological examination together with immunostaining with S100 and HMB-45 are the keys to improve survival for patients with amelanotic melanoma.

Synovial chondromatosis of the temporomandibular joint accompanied by loose bodies in both the superior and inferior joint compartments: case report.

Synovial chondromatosis (SC) of the temporomandibular joint (TMJ) is a benign lesion characterized by the formation of metaplastic cartilaginous nodules. SC of the TMJ usually only affects the superior joint compartment of the TMJ. The authors report a rare case of SC of the TMJ affecting the inferior and superior joint compartments.

Complications and failures in removable partial dentures: a clinical evaluation.

The design of removable partial dentures (RPDs) is an important factor for good prognostication. The purpose of this study was to clarify the effectiveness of denture designs and to clarify the component that had high rates of failure and complications. A total of 91 RPDs, worn by 65 patients for 2-10 years, were assessed. Removable partial dentures were classified into four groups: telescopic dentures (TDs), ordinary clasp dentures (ODs), modified clasp dentures (MDs) and combination dentures (CDs). The failure rates of abutment teeth were the highest and those of retainers were the second highest. The failure rates of connectors were generally low, but they increased suddenly after 6 years. Complication and failure rates of denture bases and artificial teeth were generally low. Complication and failure rates of TDs were high at abutment teeth and low level at retainers. Complication and failure rates of ODs were high at retainers.

Stress distribution of abutments and base displacement with precision attachment- and telescopic crown-retained removable partial dentures.

Five types of removable partial dentures (two attachment dentures, two telescopic dentures and one clasp denture) were designed. The two attachment dentures were retained by the rigid-precision attachments with or without a stabilizing arm, and the two telescope dentures were retained with cone telescope crowns with or without cross-arch stabilization. The stresses acting on abutment teeth and denture bases and the movements of denture bases were investigated, and the influences of denture design were clarified. The stress acting on a terminal abutment tooth retained by a rigid-precision attachment or cone telescopic crown was larger than that acting on a terminal abutment tooth retained by a clasp. The attachment dentures tended to concentrate more stress at the terminal abutment tooth than did the telescopic dentures. The stress of denture base of an attachment denture and a telescopic denture was less than that of a clasp denture. There was no difference between the stresses of attachment and telescopic dentures. The displacement of the denture base tended to be less when the denture was designed with a rigid connection for the retainer and with cross-arch stabilization.

Relationship between the stress distribution and the shape of the alveolar residual ridge--three-dimensional behaviour of a lower complete denture.

PURPOSE: For a complete denture to function effectively, the denture must be stabilized during mastication. The alveolar ridge has various forms, and we must choose the artificial tooth arrangement that is most suitable to the form of the alveolar ridge. The purpose of this study was twofold: (i) to examine the relationship between the alveolar ridge form and the stress distribution on the mucosa, and (ii) to model the contact condition between the denture base surface and mucosa. MATERIALS AND METHODS: In this study, the three-dimensional finite element method was used for the analysis. Four types of alveolar ridge were prepared. As a loading condition, three load places were prepared: the mesial position, the central position and the distal position. We utilized the 'contact option (MARC)' to simulate the true behaviour of the denture. RESULTS: We were able to model the contact condition by using the 'contact option'. Maximum stresses were distributed on the alveolar ridge in which the absorption is severe. And, the distal load produced large compressive stresses on the inclined plane of posterior alveolar ridge in which alveolar form.

Results of surgical treatment for squamous carcinoma of the lower alveolus: segmental vs. marginal resection.

The records of 53 patients treated surgically for squamous cell carcinoma of the lower alveolar ridge were reviewed and the results of segmental and marginal resections of the mandible were compared. Analysis of these 2 treatment modalities disclosed that marginal resection was effective in controlling lower gingival cancers, with and without apparent bone involvement, if erosive bone defects that did not extend beyond the inferior alveolar canal, or invasive bone defects confined to a superficial area of the alveolar bone, were detected radiologically.

[Fourteen cases of mucosal melanomas of the oral cavity].

Fourteen cases of mucosal melanomas of the oral cavity were treated from January, 1970 to April, 1986 in our department. The patients were 10 males and 4 females and in their fifth and sixth decades with the primary sites in the upper gingiva and palates in the majority. The 3 and 5 year survival rates were 21.4% and 14.3% respectively, with unfavorable prognosis in comparison with cutaneous melanoma. The clinical stages were as follows: stage Ia (1), Ib (8), II (5), which affected the prognosis. The depth of invasion, as described by Breslow et al., were beyond 1.50 mm except in one case, which might be a significant prognostic factor in the study of mucosal melanoma of the oral cavity. Seventy one percent had neck node metastases and 35% had distant metastases. The high occurrence of metastases might be related to their poor prognosis.

Osseous choristoma of the tongue. Report of two cases.

Osseous choristoma of the tongue is a relatively rare lesion with 53 cases previously published in the literature. In this article, two additional cases are described; one in a 53-year-old woman located close to the foramen caecum, and the other in a 18-year-old woman on the left of midline and just anterior to the circumvallate papillae that was observed over a 13-year period.