Comparison of robotic and coblation tongue base resection for obstructive sleep apnoea.

OBJECTIVES: To compare the efficacy and safety of transoral robotic surgery (TORS) with endoscope-guided coblation tongue base resection. DESIGN: Retrospective case-control study. SETTING: University-based tertiary care medical center. PARTICIPANTS: Patients with obstructive sleep apnoea (OSA) who underwent endoscope-guided tongue base coblation resection or transoral robotic surgery (TORS) in combination with lateral pharyngoplasty at a single institution in South Korea between April 2013 and December 2016 were investigated. Forty-five patients who had moderate-to-severe OSA with tongue base collapse and a minimum follow-up period of 6 months with postoperative polysomnography (PSG) were enrolled in this study. MAIN OUTCOME MEASURES: All patients underwent pre- and postoperative (at least 4 months after surgery) overnight PSG. Available information on results of the PSG, Epworth sleepiness scale and complications of the TORS and coblation groups were compared. RESULTS: Postoperative PSG studies showed improved sleep quality for most patients. The mean postoperative apnoea-hypopnea index (AHI) was reduced significantly from 45.0 to 17.0 events/h (P < .0001) in the TORS group and from 45.6 to 16.2 events/h (P < .0001) in the coblation group. The mean rates of improvement (AHI reduction > 50%) were 75.0% in TORS patients and 62.1% in coblation patients and the difference was not significant. Less frequent postoperative morbidity, including bleeding, taste dysfunction and foreign body sensation, was recorded in TORS patients. CONCLUSIONS: Both the coblation and TORS groups showed similar surgical outcomes, TORS achieved PSG results non-inferior to and complication rates comparable to coblation.

Mucous cell differentiation in a unicystic ameloblastoma.

The authors report a case of unicystic ameloblastoma with mucous cell differentiation in the right mandible of a 24-year-old Korean male who suffered from painful swelling for 2 months. A radiograph showed a well-circumscribed radiolucent lesion between the root of the right first premolar and the first molar tooth. Microscopic examination revealed the cystic lesion was lined with ameloblastic epithelium and goblet cells in the epithelium. The mucous cells reacted positively to mucicarmine stain. The possible pathogenic mechanism of this case reflects the pluripotential character of the odontogenic epithelium. The prognosis is probably that expected for conventional unicystic ameloblastoma.

Metastatic tumours to the jaws and oral soft tissues: a retrospective analysis of 41 Korean patients.

This article describes a pooled analysis of 41 Korean patients with metastatic oral tumours. The data reviewed are from Korean dental and medical case reports published between 1983 and 2004. The mean age was 55.2 years, and the male-to-female ratio was 1.9:1. There were more metastases in the jawbone than in oral soft tissues. The lung was the most common primary site for jawbone metastases, whereas the liver was for those of oral soft tissues. In contrast to reports in Western literature of the breast being the most common primary site, the liver was the most common primary site, followed by the lung and thyroid. These differences may be caused by a relatively high incidence rate of hepatocellular carcinoma in Korea.

The effect of phytic acid on in vitro rate of starch digestibility and blood glucose response.

The effect of phytic acid on starch digestibility was studied in vitro and related to the blood glucose response (glycemic index) in healthy volunteers. The glycemic index was found to correlate negatively with the phytic acid content of the food tested. In vitro digestion studies involving human saliva at physiological pH and temperature showed that in the presence of sodium phytate (equivalent to 2% phytic acid based on the starch portion), the rate of digestion of raw wheat starch was reduced significantly by 50%. This was reversed by the addition of calcium which is known to complex phytic acid. Similarly, when sodium phytate was added to unleavened bread, its digestibility was also decreased and in feeding trials high phytate bread produced a flattened blood glucose response.

Malignant lymphoma of the maxillary sinus manifesting as a persistent toothache.

Many teeth have been mistakenly extracted or endodontically treated because of an incorrect diagnosis of orofacial pain, including toothache. A case of persistent toothache originating from a malignant lymphoma of the left maxillary sinus is presented. Root canal therapy and extraction of the upper left quadrant teeth from the canine to the second molar did not resolve the chief complaint. The patient was referred to a neurologist and received a diagnosis of a malignant lymphoma, a rare lesion of the maxillary sinus. This case stresses the importance of considering malignant neoplasm of the maxillary sinus as a potential etiologic factor in the differential diagnosis of orofacial pain.

Selective gene expression in hepatic tumor with trans-arterial delivery of DNA/liposome/transferrin complex.

Since hepatocellular carcinoma (HCC) is frequently presented at an advanced stage, only a small portion of patients with HCC can be treated with local modalities. Gene therapy is, therefore, one of the more promising approaches for patients with advanced HCC. To develop a new strategy for targeting gene delivery to the hepatic tumor, the efficiency of the transarterial delivery of liposome-DNA complex was evaluated in VX2 carcinoma implanted into the liver of rabbits. A mixture of pSV-beta galactosidase plasmid (40 micrograms), lipofectin (80 microliters), and transferrin (852 micrograms), the optimal proportion of which determined in vitro, was infused via the hepatic artery of a rabbit with VX2 hepatic tumors. The efficiency of trans-arterial gene delivery was compared to that of intra-tumoral injection. Rabbits (5 in each group) were sacrificed 48 hours after gene delivery and hepatic tissues were examined using X-gal staining. beta-galactosidase staining was observed exclusively within the tumor following the trans-arterial gene transfer. In contrast, adjacent peritumoral cells in addition to hepatic tumor cells were transfected by the intra-tumoral injection of transgene. These data indicate that enhanced gene expression in hepatic tumors is possible using trans-arterial delivery of the liposome-DNA complex.

Simultaneous occurrence of an odontogenic keratocyst and giant cell granuloma-like lesion in the mandible.

An odontogenic keratocyst (OKC) and a giant cell granuloma (GCG) in the jaws are well-known entities, which have been reviewed extensively. However, there is no report in the literature of the simultaneous occurrence of these two lesions. A case of OKC in the mandible displaying foci of a GCG-like lesion is described. It is unclear whether the two lesions were just coincidental or were actually related to each other.

Solitary plasmacytoma of the mandible in a renal transplant recipient.

A solitary plasmacytoma occurring in the mandible of a 15-year-old Korean male 6 years after renal transplantation is reported. The tumour presented as a hyperplastic gingival overgrowth in the right madibular molar area. Histology and immunohistochemistry revealed plasmacytoma and monoclonality of the kappa chain and IgG. In situ hybridization for Epstein-Barr virus encoded RNA (EBER) showed positive signals in the tumour cells. The tumour regressed after reducing the immunosuppressive agents with concurrent radiotherapy. The patient remains in a stable condition with normal renal functions after 7 years without recurrence. This case confirms that Epstein-Barr virus associated B-lymphoproliferative disorders are still a major complication of immunosuppression.

Nevoid basal cell carcinoma syndrome: a retrospective analysis of 33 affected Korean individuals.

This article describes a pooled analysis of Korean individuals with nevoid basal cell carcinoma syndrome (NBCCS). The data upon which this review is based has been retrieved from published case reports in Korean dental and medical literature between the years 1981 to 2002. We found 33 subjects who met the diagnostic criteria for NBCCS. Relative frequencies of associated complications are presented and compared with those of the English literature. Odontogenic keratocyst (OKC) and palmar and/or plantar pits, and hypertelorism were the most frequently observed anomalies. OKCs are often the first signs of NBCCS and can be detected in patients younger than 20 years of age. However, the incidence and clinical manifestations of NBCCS in Korean individuals were found to be rather different from those of other countries. The relatively low frequency of basal cell carcinomas and falx calcification among the major criteria were two major differences. The frequencies of the minor criteria concur in general with the ranges given by some others. It is concluded that these differences may be attributed to genetic and geographic differences.

Odontogenic ghost cell carcinoma: a case report with reference to the relation between apoptosis and ghost cells.

The neoplastic variant of calcifying odontogenic cyst has various designations, and its malignant counterpart has been reported as aggressive epithelial odontogenic ghost cell tumor or odontogenic ghost cell carcinoma. We present a case of odontogenic ghost cell carcinoma with reference to the relation between the ghost cells and apoptosis. A 33-year-old man complained of a mandibular mass. The mass occupied the entire right side of the mandible with destruction of both buccal and lingual bone. The mass also infiltrated into submandibular and sublingual spaces. Histologically, the mass was composed of a solid proliferation of hyperchromatic and pleomorphic epithelial cells with abnormal mitoses. Islands of ghost cells were frequently admixed with nucleated cells, and there were foci of ameloblastic differentiation. Immunohistochemical stains for cytokeratins, involucrin, and apoptosis-related proteins such as Bcl-2, Bcl-X(L), and Bax were done. Terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick-end labeling (TUNEL) assay was also performed. The nucleated cells adjacent to the ghost cells expressed cytokeratins and involucrin, but the ghost cells had no reaction. Bcl-2 was negative. Both Bcl-X(L) and Bax were demonstrated in the nucleated cells adjacent to the ghost cells. The ghost cells exhibited Bax protein. Some nucleated cells adjacent to the ghost cells were positive with TUNEL assay. The above results indicate that ghost cells undergo abnormal terminal differentiation as an apoptotic process.

Calcifications in a clear cell mucoepidermoid carcinoma of the hard palate.

Although calcification is a common finding in inflammatory salivary gland disorders, salivary gland tumour rarely shows calcifications. A case of clear cell mucoepidermoid carcinoma (MEC) of the hard palate with extensive intratumoural calcifications visible on computed tomography (CT) scans and histologic sections is described. The calcification in the salivary gland tumour of the palate recognized by a CT scan should be considered in the differential diagnosis of a MEC. The mechanism of the intratumoural calcification in our case is speculated to be a result of a secretory function of the tumour cells.

Temporalis muscle as a disc replacement in the temporomandibular joint of sheep.

Temporalis muscle flaps were evaluated in sheep. Flaps placed following discectomy were examined at 2, 4, 12, and 24 weeks. Histologic evaluation showed avascular necrosis and subsequent displacement and loss of tissue from the joint resulting in close contact between the condyle and fossa. Muscle flaps placed lateral to the joint in operative controls were examined at 4, 12, and 24 weeks. This muscle remained viable while undergoing fibrous replacement. Although the surface layers of the condyle and fossa were initially lost, the tissues were reformed with time. This experiment showed that in the sheep, temporalis muscle does not withstand functional loading within the joint. However, despite the lack of interpositional material, the condyle and fossa can remodel.

Preferential expression of L-type amino acid transporter 1 in ameloblasts during rat tooth development.

Certain amino acid transport systems play an important role in supplying organic nutrients to each cell and for cell proliferation during tooth development. However, the mechanisms responsible for such actions are unclear. This study demonstrated for the first time that LAT1 and 4F2hc are expressed during tooth development in prenatal and postnatal rats, and that the transporters show cell-specific expression in ameloblasts, which are the epithelium-derived dental cells. LAT1 and 4F2hc expression was not observed in other dental cells of the developing teeth such as odontoblasts and cementoblasts. Overall, these results suggest that LAT1 and 4F2hc might play an important role in enamel formation.

Occlusion of large atrial septal defects with a centering buttoned device: early clinical experience.

A feasibility clinical study was conducted for the transcatheter occlusion of large ostium secundum atrial septal defects with the centering buttoned device. The centering buttoned device is a modification of the regular buttoned device in which a centering counter-occluder is sutured at the central 40% portion of the occluder. During centering it is stretched, forming a parachute-shaped structure and pulling the occluder over the center of the defect. During buttoning, the counter-occluder forms a double figure eight, opposing the right atrial side of the atrial septum. Occlusion was performed in 12 patients aged 6 to 56 years. All had been rejected for transcatheter occlusion by the regular buttoned device, because of either their defect size or the lack of adequate septal rim. The defect size varied between 23 and 31 mm, and the device size varied between 45 and 60 mm. Nine had immediate effective occlusions of their defects and three residual shunts. One patient with unbuttoning had hemolysis at 2 weeks and underwent surgery. Early results of the transcatheter occlusion of large atrial septal defects are promising, and larger clinical trials are justified.