Sándor Bogdán

Differentiation of Primary Human Submandibular Gland Cells Cultured on Basement Membrane Extract

There is no effective treatment for the loss of functional salivary tissue after irradiation for head and neck cancer or the autoimmune disease Sjögrens syndrome. One possible approach is the regeneration of salivary glands from stem cells. The present study aimed to investigate whether small pieces of human submandiblar gland tissue contain elements necessary for the reconstruction of salivary rudiments in vitro via acinar and ductal cell differentiation. Primary submandibular gland (primary total human salivary gland; PTHSG) cells were isolated from human tissue and cultured in vitro using a new method in which single cells form an expanding epithelial monolayer on plastic substrates. Differentiation, morphology, number, and organization of these cells were then followed on basement membrane extract (BME) using RNA quantitation (amylase, claudin-1 (CLN1), CLN3, kallikrein, vimentin), immunohistochemistry (amylase and occludin), viability assay, and videomicroscopy. On the surface of BME, PTHSG cells formed acinotubular structures within 24 h, did not proliferate, and stained for amylase. In cultures derived from half of the donors, the acinar markers amylase and CLN3 were upregulated. The PTHSG culture model suggests that human salivary gland may be capable of regeneration via reorganization and differentiation and that basement membrane components play a crucial role in the morphological and functional differentiation of salivary cells.

Atypical courses of the mandibular canal: Comparative examination of dry mandibles and x-rays

Knowledge of the course of the mandibular canal and its anatomic variations is of great importance in oral surgery, especially in preprosthetic operations and the insertion of endosteal implants and during the planning of removable dentures prepared in cases involving extensively atrophied mandibles. We review the literature on duplicated mandibular canals, which is based exclusively on radiologic findings. Then, we compare this with an examination of dry mandibles and further radiologic studies. The incidence of duplicated mandibular canals observed in macroscopic examinations of mandibles was substantially higher than that revealed by radiographs. One case involving a novel variation, a triple mandibular canal, is reported.

False diagnosis caused by Warthin tumor of the parotid gland combined with actinomycosis.

A case is reported in which a unilateral parotid gland cystadenolymphoma was combined with actinomycosis. A 48-year-old woman presented with a mass in the left parotid region and paresis of the lower left palpebra. The computed tomography, echography, and parotid radiographic findings did not exclude a neoplasm of the left parotid gland. The ramus of the mandible was involved in the process. Intraoperative freezing histology, total parotidectomy, and partial mandibulectomy were performed, with sacrifice of the facial nerve followed by nerve reconstruction. The final histological evaluation was Warthin tumor with actinomycosis. Four years after treatment, the patient is free of disease. No similar cases seem to have been reported thus far.

Comparison of postoperative complications following bone harvesting from two different donor sites for autologous bone replacement (hipbone and proximal epiphysis of the tibia)

Whereas autologous bone replacement was earlier applied in maxillofacial surgery virtually only for the restoration of mandibular defects and for the osteoplasty of patients with cleft alveolar process, the free transplantation of autologous bone (spongiosa or cortical bone or both) is nowadays primarily used for implantation purposes. Autologous bone is still the gold standard for bone replacement. This is the case even though a wide selection of bone substitutes is currently available, with which new bone equivalent to autologous bone can be produced in certain cases. Autologous bone is often obtained from intraoral sources, but if a larger quantity of spongiosa is required, these sites (the chin, the retromolar area of the mandible, the muscular process, etc.) are not suitable. Of the extraoral donor sites, the most frequently used site is the iliac crest, but the proximal epiphysis of the tibia is also appropriate for this purpose since we have recently performed bone transplantations on appreciable numbers of patients, we decided to compare the morbidity data relating to the two donor sites. In the 9 months between March and November 2007, sinus elevations were carried out on 14 patients with bone taken from the tibia, while in 38 patients bone was taken from the iliac crest for osteoplasty on clefted alveolar process. The comparison was based on postoperative clinical examinations, the complaints of the patients and objective study of the morbidity relating to the two donor sites. Clinically the patients tolerated both interventions well. Mobilization took place on the day of intervention. There were no major complications; one minor haematoma was observed after each type of surgery. The postoperative complaints of the patients did not reveal any essential difference. Following bone harvesting from the iliac crest, the gait of the patients slightly hampered for up to 10 to 14 days. In the tibia cases, the patients experienced no pain on walking by the second day. As regards donor site morbidity, protracted (1-2 weeks) oedema was observed after hip surgery, with paraesthesia of the area of innervation of the n. cutaneous femoris lateralis in 1 case, while there was a minor seroma following tibia surgery in 1 case. Our clinical experience suggests that, if 10-15 cm(3) spongiosa is required for augmentation purposes and there is no need for cortical bone, the patient is exposed to less stress when bone is taken from the proximal epiphysis of the tibia.

Overall survival of oropharyngeal cancer patients treated with different treatment modalities.

Therapeutic modalities of use in tumor therapy can be applied in various combinations to treat malignant lesions of the mesopharynx. A study was made of the overall survival of patients with mesopharyngeal carcinoma treated with different modalities in our institution in the period 1995-2000. In this retrospective study, a total of 66 patients were divided into 4 groups: Patients who took part in 1) intra-arterial chemotherapy and subsequent irradiation; 2) intra-arterial chemotherapy and surgical care; 3) only surgical care; or 4) only irradiation or palliative treatment. In each group, the five-year survival rate was examined, as a function of the age of the patient, the initial tumor size, the lymph node status and the clinical stage. The five-year overall survival rate in group 1 was 28.57%, in both group 2 and group 3 was 66.66%, and in group 4 was 20%. For all of the 66 patients, it was 43.93%. For groups 2 and 3, the Kendall rank correction test did not reveal a significant effect of the lymph node state or the clinical stage on the survival, whereas the effects of the age and the initial tumor size did prove to be significant. The Cox regression test showed the latter of these two effects to be the stronger. As 64 of the 66 patients examined were treated for tumors in clinical stages III or IV, the five-year survival rate of 43.93% may be said to be good. The comparison of groups 2 and 3 revealed that (in spite of the poorer initial prognosis in group 2) the survival rates were the same, i.e. the neoadjuvant intra-arterial chemotherapy improved the prognosis.

Carbon/carbon implants in the oral and maxillofacial surgery – Part 1

UNLABELLED Over the past 20-30 years various carbon implant materials have become more interesting, because they are well accepted by the biological environment. The traditional carbon-based polymers give rise to many complications. The polymer complication may be eliminated through carbon fibres bound by pyrocarbon (carbon/carbon). AIM The aim of this study is to present the long-term results of carbon/carbon implants. METHODS Mandibular reconstruction was performed with pure (99.99%) carbon implants in 16 patients. Predominantly tumorous cases were included (10 malignant tumors, 4 large cystic lesions and 2 augmentative processes). RESULTS Because the interventions had been performed 6-8 years before the last follow-up visit, the authors report long-term results. Of the 16 patients, the implants had to be removed earlier in 5 patients because of the defect that arose on the oral mucosa above the carbon plates. The most probable cause of this complication was the strain in the oral mucosa and disturbances in its blood supply (previous surgery, irradiated tissue, etc.). During the long-term follow-up, plate fracture, loosening of screws, infection or inflammation around the carbon/carbon implants were not observed. After 8 years one carbon implant was substituted with an autogenous bone. CONCLUSIONS The clinical conclusion is that if the soft part cover is appropriate, the carbon implants are cosmetically and functionally more suitable than titanium plates. The structural and chemical investigation of the removed implant will be published in the near future.

Modified procedure for secondary facial rehabilitation following total bilateral irreversible peripheral facial palsy.

We present the case of a middle-aged gentleman who developed total bilateral irreversible peripheral facial palsy over a period of 10 years, starting with palsy of the marginal mandibular and buccal branches of the facial nerve and progressing to the zygomatic and temporal branches. The patient did not develop any other neurological symptoms, and all neurological and other tests have remained negative over the last 10 years. Dripping of saliva and inability to close the mouth necessitated reanimation of the perioral region with the help of a fascia lata graft fixed to the fascia of the masseter muscles. The increasing lagophthalmos and associated eye problems were alleviated with a temporal muscle transposition combined with a lengthening procedure using the temporal fascia, passed through the upper and lower eyelids and hooked around the medial canthal ligament. The fascia strips were sutured not to the canthal ligament itself, but to each other, thereby placing equal self-adjusted tension on the upper and lower eyelids. Both operations were successful and improved eating and eye closure functions, allowing resolution of the eye symptoms.

Report of a rare case of tongue cancer in childhood

The occurrence of tongue cancer is fairly rare in childhood, thus, clinicians may not include this possibility in differential diagnosis while observing a tongue lesion in this age. For this reason, adequate therapy and surgical removal can be performed only with great delay and it can lead to worse prognosis and outcome. The authors present a case of tongue cancer in a 15 year old child, with a review of the literature to alert the clinician to this entity and the importance of its diagnosis.

Reply to letter to the editor commenting on the article “Intraosseous venous malformation of the zygomatico-orbital complex. Case report and literature review with focus on confusions in vascular lesion terms”

Sir, This is in response to the Letter to the Editor regarding our paper intitulated BIntraosseous venous malformation of the zygomatico-orbital complex. Case report and literature review with focus on confusions in vascular lesion terms.^ Wewould like to thank Dr. Colletti for the appreciation and interest in our paper, as well as the insightful comments and concerns. The following points should be noted: As highlighted in our paper, the preoperative diagnosis of the lesion was confusing, the results of the biopsies were contradictory, and our latest was reported as AVM. Although US did not confirm a high-flow lesion, this result conducted us to order an angiography, during which the radiologist identified with success and decided to obliterate the nourishing vessels. The attached angiographic images show how effective this obliteration was (see Fig. 1 and 2). The final specimen, however, was reported to be an Bintraosseous cavernous hemangioma^. We raised the awareness of the pathologist to the ISSVA classification and asked to reconsider the diagnosis. The diagnosis was changed to intraosseous VM. These issues regarding the pathological examination gave us the motivation to publish this case report and to review the literature for confusions in terminology. It was even more shocking during the research for the review that there were numerous articles dealing with these confusions (just to name the author of the letter, Colletti orMulliken et al. as valuable contributors), with so little effect on the clinical community. Regarding the use of sclerosing agent in intraosseous vascular lesions, we used the sclerotization with success in the soft tissue vascular lesions as well as in some of the bony lesions, e.g., aneurysmal cysts. We appreciate and thank again Dr. Colletti for sharing his valuable experience and shading light on the controversy in using sclerosing agents in intraosseous venous malformations; we will keep in mind and spread his constructive remarks.

Intraosseous venous malformation of the zygomatico-orbital complex. Case report and literature review with focus on confusions in vascular lesion terms

Intraosseous vascular malformations (VascM) of the facial skeleton are rare entities, raising difficulties even today in their treatment. We present a case for zygomatic intraosseous venous malformation of traumatic etiology with growth dynamics presentation and a multidisciplinary treatment approach, with intravascular embolization surgical ablation and primary reconstructruction using a titanium patient-specific implant (PSI), and a review of the literature for intraosseous vascular lesions of the facial skeleton focusing on the diagnostic syntagms used by the involved medical personnel, to shed light on the confusions over these terms.