Yeast flora of the mouth and skin during and after irradiation for oral and laryngeal cancer.

The quantitative and qualitative changes occurring the fungal flora of 22 patients with oral and 9 with laryngeal carcinoma were studied during and after radiation therapy. Each patient received 6000 rad of externally applied radiation in divided doses for 5 weeks. The fungal flora was isolated from the patients' oral cavity and irradiated skin sites during irradiation and 2 weeks and 4-6 months afterwards. The number and types of fungi increased in both groups of patients after the start of irradiation and persisted at high levels for at least 4-6 months after treatment. Candida albicans and C. tropicalis were the principal yeasts isolated throughout the period studied but seven other species were also identified. All the yeast isolates were sensitive in vitro to miconazole, ketoconazole, amphotericin B and nystatin. Any of these antifungal agents should be appropriate for therapy.

Oral cancer and precancer: establishing a diagnosis.

In this article in the Oral Cancer series, consideration is given to the various factors that should be taken into account in deciding upon, and carrying out, a biopsy of potentially malignant lesions of the oral mucosa. The ways in which a biopsy specimen may be spoiled by incorrect handling are described, and advice is provided on the procedures to be followed when submitting such material to a pathology laboratory. Other methods of sampling tissues for diagnostic purposes are briefly reviewed, followed by an account of the main pathological features of oral cancer and precancer.

Lingual nerve damage associated with the removal of lower third molars.

In a study of 1117 consecutive surgical procedures by a variety of operators to remove a lower third molar, the incidence of lingual nerve damage was determined to be 11%. Slightly more than half the cases made a full recovery within 6 weeks. All who would recover fully did so within 36 weeks. Six cases (0.5%) in the series failed to make a full recovery. Most strongly implicated in the temporary dysaesthesias was the raising and retraction of the lingual mucoperiosteal flap, especially in the case of unerupted teeth, when general anaesthesia was used. A variable incidence was found between individual operators. Cases of permanent damage arose when distal bone was removed with a bur, despite the use of a lingual flap retractor. The high incidence of lingual nerve damage in this series suggests that dental surgeons should be much more alert to the danger of this complication, and also that a warning of its possible occurrence should be given as part of the process of obtaining informed consent to operation.

A pilot study of the clinical effects of irradiation on the oral tissues.

The clinical effects of irradiation on the oral mucous membrane of 22 patients with oral or circumoral carcinomas (oral group) were compared with nine patients with laryngeal carcinomas (laryngeal group). Each of the patients received 6000 rads of radiation in divided doses five days each week for five weeks, alternately left and right sides. After one week of irradiation, patients in the oral group had diminished salivary flow, some erythema and orally-derived pain. After three weeks, severe clinical changes were present and these changes increased throughout the treatment period. Four to six months after treatment, the majority of the clinical changes had resolved in the oral group but salivary flow from parotid and submandibular/sublingual glands was still diminished. The laryngeal group had few clinically detectable oral changes at any time, with the exception of diminished salivary flow which recovered four to six months later in the case of the parotid glands but not in the submandibular and sublingual glands. The fungal flora changes in these two groups of patients are fully described elsewhere. Both oral and laryngeal groups had similar sharp rises of fungal colony counts with little diminuation even at six months after treatment, despite the abatement of signs and symptoms. It is suggested that direct radiation damage is the primary cause of oral symptoms with the role, if any, of fungi being that of opportunist pathogens on compromised tissues.

A preliminary study of the dynamics of resolution of experimental haematomas: radioisotope studies in animals.

A preliminary investigation was carried out in order to establish a method for the study of experimental haematomas. For this purpose haematomas were produced in rabbits by subcutaneous injection of rabbits' own blood after labelling the various blood components with appropriate radioisotopes. In addition, radioisotope labelled human serum albumin and fibrinogen were studied. The results show that there is considerable variation in the rate and pattern of dissipation of the various components of the experimentally produced haematoma. The significance of these findings is discussed.