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Purpose: Postoperative wound infection (WI) is a main complication after head and neck surgery. Poor oral health may be a risk factor for WI. We therefore assessed the contribution of oral health care in preventing postoperative WI in patients with oral squamous cell carcinoma (OSCC).Methods: A total of 66 consecutive inpatients with OSCC (mean age, 68 years) was divided into two groups that did or did not receive oral health care. There were no significant between group differences in gender, age, or T-, N-, or clinical stage. Patients in the care group were given oral health care plans by doctors of oral medicine, whereas patients in the control group were not. Twenty-three variables were recorded for each patient.Results: WI was observed in 14/66 patients (21%), three (3/33 = 9%) in the care group and 11 (11/33 = 33%) in the control group (p < 0.025). Univariate statistical analysis showed that 11 factors correlated with WI significantly: T-stage, clinical stage, wearing of dentures, tracheostomy, neck dissection, tissue transplantation, oral health care, preoperative radiation, blood transfusion, operation time, and blood loss. In multiple logistic regression analysis, only two factors were significant independent risk factors for WI: tissue transplantation (p = 0.01; odds ratio, 24.5) and lack of oral health care (p = 0.04; odds ratio, 6.0).Conclusion: Oral health care may reduce the risk of postoperative WI in patients with OSCC. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the diagnostic accuracy of fluorodeoxyglucose positron emission tomography (FDG-PET) relative to computed tomography (CT) for detecting metastatic cervical lymph nodes in patients with squamous cell carcinoma of the head and neck (HNSCC), and to ascertain the factors that affect this accuracy. Methods: A total of 1076 lymph nodes obtained from 35 neck dissections in 26 HNSCC patients who preoperatively underwent both FDG-PET and CT were retrospectively analyzed. For pathological metastatic lymph nodes, the lymph node size (short-axis diameter), the ratio of intranodal tumor deposits, and the size of intranodal tumor deposits (maximum diameter of metastatic foci in each lymph node) were histologically recorded. Results: Forty-six lymph nodes from 23 neck sides were pathologically diagnosed metastases. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of FDG-PET evaluated individually per neck side were 74%, 92%, 80%, 94%, and 65%, respectively, whereas those of CT were 78%, 58%, 71%, 78%, and 58%, respectively. FDG-PET detected 100% of metastatic lymph nodes > or =10 mm, intranodal tumor deposits > or =9 mm, and intranodal tumor deposits with a ratio >75%, whereas no nodes or tumor deposits smaller than 5 mm were detected. The spatial resolution limitations of FDG-PET were responsible for 16 of 20 (80%) false-negative PET results in lymph nodes. Conclusions: FDG-PET is a useful tool for preoperative evaluation of the neck because it accurately detects metastatic lymph nodes > or =10 mm and has fewer false-positive cases than CT. The high specificity of FDG-PET for lymph node metastases may play an important role in avoiding unnecessary neck dissection. [ABSTRACT FROM AUTHOR]

Studies have shown that exercise can enhance learning and memory. Conditioned taste aversion (CTA) is an avoidance behavior induced by associative memory of the taste sensation for something pleasant or neutral with a negative visceral reaction caused by the coincident action of a toxic substance that is tasteless or administered systemically. We sought to measure the effects of treadmill exercise on CTA in rats by investigating the effects of exercise on acquisition, extinction and spontaneous recovery of CTA. We made two groups of rats: an exercise group that ran on a treadmill, and a control group that did not have structured exercise periods. To condition rats to disfavor a sweet taste, consumption of a 0.1% saccharin solution in place of drinking water was paired with 0.15M LiCl (2% body weight, i.p.) to induce visceral discomfort. We measured changes of saccharin consumption during acquisition and extinction of CTA. The exercise and no-exercise groups both acquired CTA to similar levels and showed maximum extinction of CTA around 6 days after acquisition. This result indicates that exercise affects neither acquisition nor extinction of CTA. However, in testing for preservation of CTA after much longer extinction periods that included exercise or not during the intervening period, exercising animals showed a significantly lower saccharin intake, irrespective of having exercised or not during the conditioning phase of the trial. This result suggests that exercise may help to preserve aversive memory (taste aversion in this example) as evidence by the significant spontaneous recovery of aversion in exercising animals., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objective: This study aimed to elucidate the association between masticatory ability and physical performance in community-dwelling edentulous older adults wearing complete dentures., Background: Physical performance parameters are significant predictors of decreased activities of daily living. Previous studies have shown the relationships between oral conditions and these parameters. Here, we focused on complete denture wearers., Methods: Two hundred and ten edentulous adults aged ≥65 years and wearing complete dentures were enrolled. The following oral conditions were examined: masticatory ability measured by colour-changing chewing gum, number of foods considered chewable, pain when using dentures and denture base fit. Handgrip strength (HG) and one-leg standing time with eyes open (OLST) were used to evaluate muscle strength and static balance. Spearman's rank correlation coefficients were calculated to examine the correlations between oral conditions and physical performance. Forward stepwise linear regression models were applied with each physical performance parameters as the dependent variable and oral conditions as the independent variable., Results: The women did not show significant correlations between oral conditions and the physical performance. In men, significant and positive correlations were found between the number of chewable foods and HG, and between the colour scores and OLST. The significant correlation between the colour scores and OLST was still noted in the stepwise liner regression analysis after adjusting for demographic, social and medical conditions, and other oral conditions., Conclusion: In Japanese elderly edentulous men wearing complete dentures, masticatory ability evaluated as the mixing ability may be associated with static balance., (© 2012 The Gerodontology Society and John Wiley & Sons A/S.)

Objective: The aim of this study was to assess relationships among perceived chewing ability, dentition status, muscle strength and balance in community-dwelling older adults using analysis of moment structures (Amos)., Background: Physical performance parameters such as muscle strength and balance can predict the future onset of disabilities in activities of daily living among older adults. In this context, elucidation of the relationships among oral conditions and physical performance parameters is necessary., Materials and Methods: Data on occlusal contact patterns of natural teeth (OPNT), self-assessed masticatory ability (mastication), body mass index (BMI), handgrip strength (HG) and one-leg standing time with eyes open (OLST) were collected from 501 independently living adults aged 65-74 years. The relationships among these parameters were analysed using Spearman's rank correlation coefficients and Amos., Results: Subjects of both genders showed significant correlations among OPNT, mastication, HG and OLST, evaluated using Spearman's rank correlation coefficients. For each Amos model, the goodness-of-fit statistic indicated a good level of fit. In both men and women, OPNT was significantly related to mastication, and mastication was related to HG but not to OLST. OPNT was related to neither HG nor OLST in women and was related to OLST but not HG in men., Conclusion: The findings observed in this study present a possible importance of dental status and perceived chewing ability for the onset of disability by influencing physical performance in community-dwelling older adults., (© 2012 The Gerodontology Society and John Wiley & Sons A/S.)

Background: We have demonstrated that salivary interleukin-6 (IL-6) concentrations change during the treatment in patients with oral squamous cell carcinoma (OSCC). We sought to elucidate the correlations between salivary IL-6 concentration and early locoregional recurrence in OSCC., Methods: Stimulated saliva was collected before and after surgery from 27 consecutive patients with OSCC. Recurrence-free survival (RFS) curves were plotted using the Kaplan-Meier method., Results: Of the 27 patients, 11 (41%) were diagnosed with locoregional recurrence within 24 months postsurgery. The median concentrations of IL-6 presurgery and postsurgery were 2.8 pg/mL and 2.1 pg/mL, respectively. The median postsurgery concentration of IL-6 was significantly higher in patients with than without locoregional recurrence (p = .02). Multivariate analysis revealed that postsurgery salivary IL-6 concentration was an independent risk factor for locoregional recurrence (p = .03; risk ratio, 0.14)., Conclusions: Posttreatment concentration of salivary IL-6 may predict early locoregional recurrence in OSCC., (Copyright © 2012 Wiley Periodicals, Inc.)

Objectives: The increasing medical expenses of elderly persons in Japan's rapidly ageing society have become a major concern. It is therefore important to elucidate the factors associated with such escalation. Here, we focused on the relationship between subjective self-assessment of oral health, as an index of general health, and medical expenses (excluding dental repair) under the hypothesis that oral health contributes to general medical expenses. Several studies have shown that oral health status is correlated with general health status among elderly persons. We speculated that oral health status might show a relation with medical costs among elderly persons. However, few studies have investigated this relationship to date., Materials and Methods: Participants were 259 elderly subjects (range: 65-84 years; 120 men, 139 women) residing independently. Subjective assessment of oral health was evaluated by their responses ('Good', 'Not good' and 'Not at all good') on a survey questionnaire. The correlation between subjective assessment of oral health and medical expenditure was analysed using Spearman's rank method, the Mann-Whitney U-test and the Kruskal-Wallis test. Medical expenses were used as the dependent variable in multinomial logistic regression analysis with background and intraoral factors as independent variables., Results: A slight yet statistically significant correlation was observed between subjective assessment of oral health and outpatient treatment fees., Conclusion: The findings revealed that subjective assessment of oral health is significantly and independently related to the medical expenses of community-dwelling elderly persons after adjusting for social background, living environment and physical factors., (© 2011 The Gerodontology Society and John Wiley & Sons A/S.)

Objective: We have previously reported that the histologic mode of invasion of oral squamous cell carcinoma (OSCC) is a significant risk factor for pain. Here we sought to determine whether pain is a risk factor for poor prognosis in patients with OSCC., Study Design: We evaluated the relationships between overall survival rates and clinicopathologic variables, including gender, age, T- and N-stages, pathologic findings, and pain in 109 consecutive patients with untreated OSCC., Results: Of these 109 patients, 40 (37%) reported spontaneous pain. Univariate analysis showed that the overall survival rates of patients with spontaneous pain was significantly lower than those of patients without pain (P = .002). Multivariate analysis revealed that spontaneous pain and N-stage were significant independent predictors of overall survival rates., Conclusions: This is the first report showing that spontaneous pain before treatment may be associated with poor prognosis in patients with OSCC., (Copyright © 2011 Mosby, Inc. All rights reserved.)

Purpose: Deciding on treatment carcinoma of the tongue when the tumor has a thickness of 1.5 cm or more is difficult. Surgery often requires wide resection and re-construction, leading to considerable functional impairment. A cesium implant is an attractive option, but according to the Manchester System, a two plane implant is needed., Materials and Methods: According to the textbook, a tumor is sandwiched between the needles, which are implanted at the edge of the tumor. This may cause an unnecessarily high dose to the outer surface of the tongue, which sometimes leads to a persistent ulcer. To avoid this complication, we invented a modified implantation method, and applied the method to five consecutive patients., Results: With a minimum follow-up of 2 years, all primary tumors in 5 consecutive patients have been controlled. No complications occurred in soft tissue of the tongue or in the mandible., Conclusion: Our modified Manchester System was feasible and effective for tumors that has a thickness of 1.5 cm or more.

The origins and mechanisms of pain arising from oral cancer are important. Oral cancer pain impairs a patient's quality of life. This study was undertaken to elucidate significant risk factors associated with spontaneous pain in patients with untreated oral squamous cell carcinoma (OSCC) before treatment. A total of 113 patients (82 men, 31 women; median age, 64 years) with untreated OSCC were examined. Correlations between spontaneous pain in the primary site and sex, age, primary site, TN stage, clinical stage, and clinical growth type of cancer (exophytic or endophytic), as well as the degree of histological differentiation and the histological mode of invasion were evaluated. At the initial examination, 42 (37%) of patients had spontaneous pain. In univariate statistical analyses, reported pain correlated significantly with patient age and the clinical growth type of the cancer, as well as with the degree of histological differentiation and the histological mode of invasion. Multiple logistic regression analysis showed significant correlations between reported spontaneous pain and the clinical growth type of the cancer (P = 0.0003; odds ratio, 9.5; 95% confidence interval, 2.8-32.3), as well as reported spontaneous pain and the histological mode of invasion (P = 0.0026; odds ratio, 4.7; 95% confidence interval, 1.7-12.7). Clinical and histological endophytic growth patterns of OSCC might be significant risk factors for the presence of spontaneous pain before treatment.

Objectives: To show relationships between oral conditions and physical performance in the elderly living independently., Methods: A total of 821 persons participated. Data on background factors and self-assessed masticatory ability were collected by means of questionnaires. An intraoral examination was performed to examine the pattern of occluding pairs of natural teeth. Handgrip strength and one-leg standing time with eyes open were measured. Step-wise linear regression models were conducted with muscle strength or one-leg standing time as the dependent variables; the pattern of occluding pairs and self-assessed masticatory ability as the principal independent variables., Results: The self-assessed masticatory ability was retained in the final model of the step-wise regression for the handgrip strength, and significant relationships were established in the participants aged 65-74, but the pattern of occluding pairs was not retained. The pattern of occluding pairs, and the self-assessed masticatory ability were retained in the final models for the one-leg standing time, and significant relationships were shown here., Conclusion: The self-assessed masticatory ability may be significantly related to muscle strength and static balance function, and the pattern of occluding pairs may be significantly related to the static balance function, particularly in the elderly aged 65-74.

The purpose of the present study was to investigate the clinical usefulness of the detection of serum p53 antibodies (p53 Abs) in patients with oral squamous cell carcinoma (SCC). Preoperative values of p53 Abs were measured by enzyme-linked immunosorbent assay in 113 patients with primary oral SCC and seropositive patients were reevaluated postoperatively. The positivity rate of p53 Abs was 16%, and the 5-year survival rate of patients positive for p53 Abs was significantly lower than that of patients negative for p53 Abs (56.2% vs. 80.7%; P = 0.018). The preoperative presence of p53 Abs was found to be an independent prognostic factor in a multivariate analysis (P = 0.028, hazards ratio = 3.34), and its positivity was significantly related to secondary cervical lymph node metastases (P = 0.029). Six of nine patients who remained seropositive for p53 Abs through the disease course and the one with seropositive reversion from temporary negative status developed treatment failure. Therefore, the detection of p53 Abs in the serum of patients with SCC may be a useful prognostic marker.

We report a juvenile case of diffuse sclerosing osteomyelitis of the mandible that showed a favorable response to pamidronate, a bisphosphonate derivative. Although conventional treatments had been ineffective for 5 years, pamidronate administration brought about conspicuous improvement both clinically and radiographically. Severe adverse reaction was not found except for low-grade fever and lassitude on the day following administration. During the course of the treatment, however, nonsuppurative osteomyelitis of the right humerus also occurred, leading to the established diagnosis of chronic recurrent multifocal osteomyelitis. Pamidronate therapy was again performed successfully with near disappearance of clinical symptoms. Both bone-specific alkaline phosphatase (bone formation marker) and pyridinoline cross-linked carboxyterminal telopeptide of type I collagen (bone resorption marker) showed a marked decrease with pamidronate therapy, suggesting that pamidronate is useful for the treatment of chronic recurrent multifocal osteomyelitis with inhibitory effect on bone turnover.

The patient is a 65-year-old man, who underwent curative resection for maxillary sinus carcinoma after chemoradiation. Lung metastases were observed two months following resection, and were treated with S-1 at a dose of 120 mg/day. One course of the S-1 administration regimen consisted of 2 weeks and a 1-week interval. The patient achieved long survival for 527 days with no adverse reaction. Therefore, this treatment on an outpatient basis greatly contributed to his quality of life. We consider S-1 as a first-line anti-cancer drug for tumor dormancy therapy.

Background: The purpose of this study was to investigate the incidence and clinical significance of genetically diagnosed lymph node micrometastasis for patients with oral squamous cell carcinoma (SCC)., Methods: A total of 495 lymph nodes obtained from 21 patients with primary oral SCCs that had p53 mutations were examined for corresponding p53 mutations in lymph nodes using mutant allele-specific amplification (MASA)., Results: Among 476 histologically negative nodes, 44 were scored as positive for metastasis by MASA. All 19 histologically positive lymph nodes were genetically positive. Four of the 10 pN0 cases and nine of the 11 pN-positive cases had genetically positive micrometastases. Four patients who had five or more genetically positive lymph nodes located in three or more levels, three with disease staged as pN0 or pN1, died of cancer., Conclusions: These results indicate that a high rate of micrometastasis in cervical lymph nodes of oral SCCs and patients with multiple or lower neck spread of micrometastases have a poor prognosis; they should be treated with postoperative adjuvant therapy., (Copyright 2005 Wiley Periodicals, Inc.)

The cys-cys (C-C) chemokine ligand 21 is a member of the C-C chemokines that constitute a group of heparin-binding cytokines with a pattern of four or six conserved cysteines. The CCL21 is known to be expressed in secondary lymphoid tissues, however it has rarely been reported for the expression on peripheral lymphatic vessels in somatic tissue. Here we investigated the expression of CCL21 on lymphatic vessels identified by anti-desmoplakin in uninflamed and inflamed human gingiva. In uninflamed tissue the expression of CCL21 was detected on lymphatic vessels in gingiva. In uninflamed gingiva the expression of CCL21 was detected on all lymphatic capillaries of the mucosal connective tissue papillae. There were two types of collecting lymphatic vessels in the lamina propria mucosae expressing CCL21 strongly or very weakly. In inflamed gingiva no expression of CCL21 was detected on lymphatic vessels. In all tissue sections no blood vessels expressing CCL21 were observed. These results may suggest that the expression of CCL21 is predominantly induced in the peripheral lymphatic endothelium of the uninflamed mucosal microcirculation, and that under inflamed conditions a reduction of CCL21 occurs in lymphatic endothelium.

There have been reports on the migration of teeth or implants into the maxillary sinus, but we know of no report on the migration of a gutta-percha point that had been used to fill a root canal into the ethmoid sinus. We report such a case which presumably migrated through the maxillary sinus.

Objective: To investigate the relationship between the efficacy of carbamazepine (CBZ) and the presence of the trigger zone for diagnosis of trigeminal neuralgia (TN). Study design CBZ was administered to 61 patients with suspected TN. All patients underwent intracranial examination by magnetic resonance imaging or computed tomography. The final diagnosis was established by oral and maxillofacial surgeon and neurosurgeon., Results: Of the 61 patients, 50 were finally diagnosed as having TN and 6 as having atypical facial pain. CBZ was effective for pain relief in 45 of the 50 TN patients (90%), and in 5 of the 11 patients (45%) with other diseases (P <.005). However, CBZ also relieved pain in some patients other than TN. Thirty of the 31 patients (97%) with a distinct trigger zone and 20 of the 30 (67%) without a trigger zone were diagnosed as having TN (P<0.005)., Conclusion: The efficacy of CBZ is an auxiliary indicator of TN and the presence of a distinct trigger zone is a strong indicator of TN.

The Toll-like receptor (TLR) is a part of the innate immune system sensing pathogen-associated molecular patterns (PAMPs). Recently, TLRs 2 and 4 have been demonstrated for the ligand engagements, which result in the induction of cytokines. Here we investigated the expression of TLRs 2 and 4 on lymphatic vessels producing cys-cys chemokine ligand 21 (CCL21) in the human small intestine. The specificity of antibodies to TLRs was tested on a human monocyte leukemia cell line, umbilical vein endothelial cells (HUVEC), and periodontal ligament fibroblasts (PDLF) with the examination for the TLR gene expression by the reverse transcription-polymerase chain reaction (RT-PCR), and lymphatic vessels were identified by antibodies for platelet-endothelial cell adhesion molecule-1 (PECAM-1) and desmoplakin. The expression of CCL21 was not clearly detected on collecting lymphatic vessels in the submucosa while it was generally observed on the central lacteals of villi and lymphatic capillaries in the lamina propria mucosae. The reaction of antibodies to TLRs 2 and 4 was also not clearly detected on collecting lymphatic vessels in the submucosa and central lacteals of villi, but generally observed on lymphatic capillaries expressing CCL21 in the lamina propria mucosae of tissue where the expression of CCL21 and TLRs was not clearly observed in blood vessels. These may suggest that the expression of CCL21, and TLRs 2 and 4 is predominantly induced in the peripheral lymphatic endothelium of the small intestinal microcirculation. The lymphatic endothelium may contribute to allow dendritic cells to home into secondary lymphoid tissue through the expression of TLRs, the ligand engagements of which result in the induction of chemokines.

Reliable variables to predict the radiosensitivity of each tumor have not been identified. Recent studies have demonstrated that specific regions of mutations within the core domain of p53 protein correlate with responses to chemotherapy and radiotherapy in some tumor types. In this study, we evaluated the relationship between specific p53 mutations and radiosensitivity in 49 patients with oral squamous cell carcinomas (SCCs) who underwent preoperative radiotherapy. Exons 5 through 8 of the p53 gene were examined by polymerase chain reaction-single-strand conformation polymorphism and direct sequencing. We detected p53 mutations in 27 (55.1%) cases. DNA contact mutations were detected in 11 (40.7%) of these 27 cases in L3 loop, loop-sheet-helix motif, and zinc-binding residues. Tumors containing p53 DNA contact mutations had significantly poorer responses to radiation than the other tumors, although no statistically significant difference between tumors with and without p53 mutations was found. These data indicate that DNA contact mutation of p53 could be a useful marker to predict the radioresistance of oral SCCs.

Purpose: : To demonstrate appropriate treatment methods for mandibular osteoradionecrosis (ORN) by evaluating previous results., Methods: : The relationship between the time interval after radiation therapy (RT) and the severity of ORN was examined. Eighty-seven patients were classified according to the extent of the lesion (grades), and the cure rates were calculated according to the RT modality, the grade, and the treatment method for ORN., Results: : The later ORN developed and the higher the dose of irradiation, particularly among the patients who received external RT, the more it progressed. The initial cure rates for conservative management, marginal, and segmental mandibulectomy were 39.7%, 50%, and 86.7%, respectively., Conclusions: : Conservative management should be limited to early-onset ORN after brachytherapy with or without a low dose of external irradiation. Marginal mandibulectomy is appropriate for the late-onset ORN after brachytherapy with or without low-dose external irradiation. Segmental mandibulectomy is required for late-onset ORN after a high dose of external irradiation., (Copyright 2003 Wiley Periodicals, Inc. Head Neck 25: 181-186, 2003)

In this study, we focused on p53 mutations in specific regions, including DNA-binding surface regions, to clarify the correlation between mutations within the specific regions of p53 and clinical outcomes of patients with oral cancers. We analyzed p53 mutations in 121 fresh primary oral squamous cell carcinomas (SCCs) by polymerase chain reaction-single-strand conformation polymorphism or a yeast functional assay. p53 mutations were detected in 51/121 (42%) cases. Mutation of p53 was not associated with any clinicopathological parameters; however, tumors containing specific p53 mutations, e.g. DNA-binding surface regions (L2, L3 and the LSH motif) and conserved regions (II-V), had significantly poorer prognoses than tumors with mutations outside of those regions. Moreover, locoregional failure, lymph node metastasis and the occurrence of subsequent distant metastasis were also significantly associated with mutations within DNA-binding surface regions. These data indicate that specific mutations of p53 could be important prognostic factors in oral SCCs., (Copyright 2002 Elsevier Science Ltd.)

Mucinous adenocarcinoma is characterized by large pools of extracellular mucin. The tumor has been reported in the nasal cavity, paranasal sinus, breast, colon, stomach, prostate, skin, and lung. Mucinous adenocarcinoma also arises as a primary tumor of the major salivary glands. However, its occurrence is exceedingly rare and has only recently been recognized. Only 9 cases in the major salivary glands have been reported. We present an additional case of MAC in the maxilla that was considered to have developed from a palatal minor salivary gland.

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 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.

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.

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.

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.

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.

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.