Wen-Chen Wang

Tuberculosis of the head and neck: a review of 20 cases

OBJECTIVE Tuberculosis (TB) of the head and neck is currently a reemerging infectious disease and may be a diagnostic challenge for dental care providers. The aim of the present study was to retrospectively review the clinical features of patients diagnosed with TB of the head and neck during the past 16 years. MATERIALS AND METHODS Thirteen male and 7 female patients with TB of the head and neck were histologically identified following surgical biopsy in our department between 1991 and 2007. The medical charts were reviewed. RESULTS The age distribution was broad, with 11 patients (55%) older than 50 years and 4 (20%) younger than 10 years old. Thirteen patients had oral lesions and 2 had multiple lesions. The most common oral location was the buccal mucosa and/or vestibule (5 cases), followed by the alveolar mucosa (4 cases), palate (2 cases), lip (2 cases), and tongue (1 case). Seven patients had cervical TB. The predominant clinical manifestation was ulceration. Two patients were found to have coexistent metastatic squamous cell carcinoma. Four patients were identified with active pulmonary lesions and 1 patient with evidence of old pulmonary TB on the 14 chest radiographs available. CONCLUSION Tuberculosis of the head and neck may not be as rare as once thought. We emphasize the importance of early diagnosis in such lesions, especially in slow-to-heal wounds and undiagnosed neck lumps.

Sialolipoma of the Floor of the Mouth: A Case Report

Intra‐oral lipoma is a well‐known entity, but lipomatous tumors including salivary gland tissue containing clustered or peripherally located ducts and acinar cells are uncommon. They are a newly recognized entity of salivary gland lipoma, designated sialolipoma. We describe a case of sialolipoma arising in the floor of the mouth presenting with apparently normal salivary gland tissue, as demonstrated by both histologic and immunohistochemical findings, in a 67‐year‐old female. Complete surgical removal of the tumor with preservation of the sublingual gland was implemented after a careful examination confirming that the lesion did not originate from the sublingual gland.

Analysis of photostimulable phosphor plate image artifacts in an oral and maxillofacial radiology department

OBJECTIVE To analyze image artifact types and occurrence frequency when using a phosphor storage plate (PSP) digital radiographic system. STUDY DESIGN A total of 15,912 scanned digital images were evaluated by 3 observers, and image artifacts were classified into: 1) operator errors; 2) scanning errors; 3) PSP plate defects. To avoid damage to the sensor plate, a modification technique innovated by Roberts and Mol was used where needed and 2 double-sided pieces of tape were placed around the sensor plate covering. RESULTS A total of 643 image artifacts were identified. The main image artifact cause was operator error (n = 554), followed by defects of plate (n = 60) and scanning (n = 29). Scanning errors could generally be corrected by rescanning, but most other artifacts required image retaking. The use of a modified clinical technique greatly reduced artifacts caused by wearing of the sensor plate (20%). CONCLUSIONS Modified methods to decrease the occurrence of image artifacts using PSP digital radiographic system are encouraged.

VX2-induced rabbit buccal carcinoma: A potential cancer model for human buccal mucosa squamous cell carcinoma

The buccal mucosa is the site at highest risk of contracting malignancy in habitual betel-quid chewers who expose the buccal mucosa to high doses of carcinogens. Of all oral squamous cell carcinomas (SCCs), those of the buccal mucosa are most associated with the poorest prognoses. Therefore, an animal model would be helpful to evaluate new treatment modalities for buccal SCC. We evaluated whether the VX2 rabbit cancer model could be employed as a cancer model for human buccal SCC. Ten adult male, New Zealand White outbred rabbits were randomly divided into two groups A (n=2) and B (n=8). A 0.5 ml VX2 tumor cell suspension containing approximately 40 x 10(6) vital cells was injected intramuscularly into the right hind paw of the two rabbits of group A. Four weeks later, moderately to poorly differentiated hind paw SCCs were apparent in both rabbits of group A. No abdominal organ metastases, but multiple pulmonary metastases, were found in both animals. Fresh solid tumor pieces (about 5 x 5 mm) obtained from group A animals were subsequently inserted into the surgically created spaces of the left cheeks of the eight rabbits of group B. Ulcerated buccal tumors (moderately to poorly differentiated SCCs) were found in all eight animals 6 weeks later. No internal organ metastases were noted in any of the eight rabbits, but a total of 11 with an average of 2.75 cervical lymph node metastases were found in four of the eight animals. Mandibular bone and tooth pulp invasion by cancer cells was also noted in one animal. In conclusion, our findings indicated that VX2-induced rabbit buccal carcinomas could be a potential cancer model for human buccal mucosa squamous cell carcinoma.

The therapeutic effect of fractionated radiation on DMBA-induced hamster buccal pouch squamous cell carcinomas

Seventy hamsters were divided equally into experimental groups A and B and control groups C-G. After treating the pouches of groups A and B animals with DMBA (thrice a week) for 14 weeks, the heads of the animals received fractionated radiation of a total dose of 21Gy and 42Gy, respectively. The untreated pouches of groups C and D animals were similarly irradiated. The pouches of groups E and F animals were treated with DMBA or mineral oil for 14 weeks, respectively. The pouches of group G animals remained untreated throughout the experiment. Radiation response (RR) was not noted for 12 exophytic tumors of group A; the remaining 43 tumors showed partial response. For group B, no RR was noted for four exophytic lesions; the remaining 28 lesions revealed a combination of partial and complete response. No endophytic lesions of group A showed RR; a significant increase in radiation response was noted for group B compared with group A. In conclusion, the hamster pouch oral cancer model could be employed to study the effect of fractionated radiation.

Expression of inhibitors of apoptosis family protein in 7,12‐dimethylbenz[a]anthracene‐induced hamster buccal‐pouch squamous‐cell carcinogenesis is associated with mutant p53 accumulation and epigenetic changes

Fifty outbred Syrian golden hamsters were equally divided into three experimental groups and two control groups. The pouches of the experimental groups were painted bilaterally with a 0.5% 7,12‐dimethylbenz[a]anthracene (DMBA) solution thrice a week for 3, 7 and 14 weeks. One of the control groups was applied with mineral oil while another control group remained untreated throughout the experiment. Neither survivin nor cIAP2 could be detected in any of the control tissues, whereas survivin and cIAP2 were found to be significantly increased in 3‐, 7‐ and 14‐week DMBA‐treated pouches compared with the control pouches. Expression of XIAP, cIAP1 and NAIP were noted for both the control and 3‐, 7‐ and 14‐week DMBA‐treated pouches, but levels were found to be significantly elevated in the experimental groups compared with the control pouches. p53 was not detected in any control tissues, but was significantly increased in 3‐, 7‐ and 14‐week DMBA‐treated pouches. Direct sequencing revealed a point mutation (C→G) of p53 for pouch tissues treated with DMBA for 3 and 7 weeks, and there was a wide variation in the p53 sequence of the 14‐week DMBA‐treated pouch tissues, as compared with the control tissues. The control tissues had a survivin‐ and cIAP2‐methylated allele, whereas the DMBA‐treated tissues showed no evidence of survivin‐ and cIAP2‐methylation. Neither the control nor DMBA‐treated pouches showed evidence of XIAP‐, cIAP1‐ or NAIP‐methylation. Our results suggest that the expression of inhibitors of apoptosis family in DMBA‐induced hamster buccal‐pouch squamous‐cell carcinogenesis may be modulated by both genetic (mutant p53) and epigenetic mechanisms.

Clear-cell variant of calcifying epithelial odontogenic tumor (Pindborg tumor) in the mandible

We present an uncommon case (female patient aged 59 years) of the clear-cell variant of calcifying epithelial odontogenic tumor (CEOT) (also known as Pindborg tumor) in the mandible. The clinical characteristics and probable origins of the clear tumor cells of previously reported cases of clear-cell variant of intraosseous CEOT are also summarized and discussed.

Concurrent Extravasation Mucocele and Epidermoid Cyst of the Lower Lip: A Case Report

An uncommon case of concurrent extravasation mucocele and epidermoid cyst in the lower lip of a 13‐year‐old boy is described. To our knowledge, there is no other report of such a concurrence, neither at the same site nor at different locations, involving these two lesions in the oral mucosa.

Intraoral intraductal papilloma: a case report

Ductal papillomas have unique papillary features arising from the salivary gland duct system. It comprises three rare benign adenomas, namely, inverted ductal papilloma, sialadenoma papilliferum and intraductal papilloma. Here the first case of intraductal papilloma developed in the minor salivary gland of the vestibule of the oral cavity in a 71-year-old Chinese female living in a nursing home is described. This case is worthy of clinical investigation as it presents as an intraoral swelling and is mistakenly regarded as the result of a periapical pathosis. It also emphasises that a nurse or an oral hygienist who is usually the first-line oral carer of the residents of a nursing home, should be trained to perform the daily dental check and request a dentists services when necessary.

Clinical Case Report on Treatment of Generalized Aggressive Periodontitis: 5-Year Follow-up.

Generalized aggressive periodontitis (GAgP) is a distinct type of periodontal disease associated with considerably more rapid periodontal tissue destruction than chronic periodontitis. This study presents the 5-year follow-up of a patient with GAgP. A 29-year-old man reported experiencing increasing gingival recession. He was treated using cause-related therapy, provisional splints, and flap surgery combined with allograft grafting and was followed up for 5 years. This case study shows that elimination of infectious microorganisms and meticulous long-term maintenance provide an effective treatment modality for aggressive periodontitis cases. This treatment modality can restore the masticatory function and provide the GAgP patient with improved quality of life.