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Buccal Patches are the type of drug formulation that has normally a different course of administration through the buccal mucosa for drug delivery. The product is placed between upper gingiva (gums) and cheek to treat local and systemic conditions. Buccal patch have good accessibility to the membranes that line the oral cavity. These patches tend to help drug enter directly into the systemic circulation escaping hepatic first pass metabolism. This type of drug delivery method is considered useful for elevating the bioavailability of drugs. This review is a thorough study to apprehend the procedures involved in assessment of buccal patches and the modern approach towards this type of drug delivery. This article intends to analyze the overall profile of Buccal Patches and scope of future advances.

Congenital epulis is a benign tumor of upper gingiva. Larger lesions interfere with mouth closing and normal feeding and may obstruct airways. We present a neonate with a large epulis. Case Report:...

Oral macule and mucosal melanoma are often difficult to differentiate from each other, and a conclusive diagnosis of mucosal melanoma is difficult to make, either clinically or pathologically, in younger adults. We report the case of a 26-year-old female who presented with a black pigmented lesion of the left upper gingiva. The lesion was finally diagnosed as a mucosal melanoma 10 months after the patient’s first visit to a hospital. She received partial left maxillectomy. She has been alive without active disease for 3 years after first operation. Considering that in general, subepithelial invasion is seen even from the early phase in cases of mucosal melanoma, prompt and precise pathological diagnosis is necessary to ensure appropriate therapy.

Introduction: Ligneous conjunctivitis is rare form of conjunctivitis characterized by woody fibrinous membranes. Plasminogen deficiency has been introduced as the most common cause and formation of membrane is the result of impaired wound healing process. Case Report: We present a 4-month-old male infant with chronic membranous conjunctivitis. Multiple scrapping of membranes were performed with no improvement. Fibrinous membranes were also seen on nasal cavity and upper gingiva. After his blood revealed plasminogen blood levels of 11.9% (normal: 75-135%), diagnosis of ligneous conjunctivitis due to plasminogen deficiency was obtained. Treatment was then changed to topical fresh frozen plasma and heparin. Dramatic resolution of membranes was observed after 15 months therapy combined with membranes scraping. Conclusion: Ligneous conjunctivitis is rare manifestation of plasminogen deficiency that occurs sporadically where local infection and multiple surgeries might act as trigger to induce fibrinous membranes. Topical heparin and FFP could treat the disease successfully.

Ameloblastic fibrodentinoma (AFD) is a rare benign tumor usually interpreted as a neoplasm similar to ameloblastic fibroma (AF), characterized by formation of dysplastic dentin on histopathological diagnosis. Peripheral –type ameloblastic fibro-dentinoma (PAFD) is exceedingly rare, with all previously reported cases involving young patients. We here report a case of PAFD occurring in upper gingiva of an 11-year old male child, which was surgically incised.

The clinical presentation of oral lichen planus and oral lichenoid lesions is diverse. A special category of patients presents with lichenoid lesions affecting only the mucosa of their upper lip and the anterior upper gingiva. This is a concise review summarizing the specific characteristics of these patients.

Amelobasltoma is a benign neoplasm of the jaw bones that originate from the odontogenic epithelium. They are more common on the mandible than the maxilla. Rarely such tumours arise outside these bones, when they are termed extraosseous or peripheral ameloblastoma. We report a case of extraosseous ameloblastoma in a 30 year old woman, who presented with a painless lesion on the upper gingiva. The lesion was excised completely and the histopathology was suggestive of extraosseous ameloblastoma.

Basal cell adenocarcinoma arising from the minor salivary gland is extremely rare. We report a 76-year-old Japanese man with basal cell adenocarcinoma originating in the upper gingiva. He underwent subtotal maxillectomy combined with resection of the coronoid process, and reconstruction was performed using a rectus abdominis microvascular flap. The patient has been followed for 40 months after operation without any evidence of disease.

Metastatic tumors of the oral region are rare and comprise approximately 1% of all malignant oral tumors. To our knowledge, only one case of metastatic eccrine porocarcinoma of the oral cavity has been described previously. We report an extremely rare case of eccrine porocarcinoma that metastasized to the upper gingiva. A 69-year-old man who had underwent an operation for eccrine porocarcinoma of the back was referred to our department because of an upper gingival tumor on the right side. At presentation, he already had systemic skin metastases from eccrine porocarcinoma, including the facial skin.Intraoral examination revealed a 30mm×20mm hard submucosal mass. The tumor was excised and showed histological features similar to that of the back tumor. Therefore, the tumor was diagnosed to be a metastatic eccrine porocarcinoma of the upper gingiva. Finally, 8 months after the operation at our department, the patient died of multiple organ failure due to systemic metastases.

われわれの施設では, 2002年から2004年にかけて上顎歯肉扁平上皮癌進行例の3例に外側咽頭後リンパ節 (LRPN) 転移がみられた。断層画像では, 原発腫瘍は大臼歯部歯肉から硬口蓋へ浸潤し, また患側の後咽頭間隙内に各々, 10×10mm, 11×8mm, 9×5mmの大きさの転移性リンパ節が認められた。これら3症例と本邦における論文で報告されている, LRPN転移を生じた他の上顎歯肉癌7例を, 原因となったリンパ路と臨床的特徴に重点を置いて分析した。LRPN転移は, 2例では切歯管・鼻腔底―上咽頭側壁路あるいは5例で硬口蓋―口蓋帆挙筋内側路として輸入リンパ管に由来した可能性がある。他の3例では, 頸部郭清術や多発性頸部転移によって生じた通常はみられない逆行性リンパ流に, このような稀な転移が由来した可能性がある。頸部転移のあった8例中7例でLRPN転移が同側にみられた。これらの7例中4例で, 顎下部または上頸部リンパ節転移が同時にみられた。2例では初診時の断層画像でLRPN転移がみられ, 3例は初回治療終了直後にみられたが, これらの各々が進行癌: (r) T3-4であった。一方, (r) T1-2の4例ではLRPN転移は後発転移であった。よって, 上顎歯肉癌が生じた場合では常に, 外側咽頭後リンパ節は断層画像において関心を寄せるべきである。

We report a rare case of bilateral carcinomas of the maxillary sinuses. In 1987, the patient received irradiation therapy (60Co 50.4Gy) and partial maxillectomy for left maxillary squamous cell carcinoma (SCC, T3NOMO). Because of tumor recurrence in the left cheek 2 months after operation, he received excision of the tumor and had been free from tumor for 16 years thereafter. In 2003, he was referred to our clinic because of diffuse swelling, hypoesthesia of the right cheek, and the induration of the right upper gingiva and buccal mucous membrane. A biopsy specimen was histologically diagnosed as mucoepidermoid carcinoma, and he received chemoradiation (40Gy/20fr and TXT 18mg×3, CDDP 7.2mg×10), followed by subtotal maxillectomy and microvascular reconstruction with a free rectus abdominis muscle flap. To our knowledge, this is the second case of bilateral maxillary cancers (SCC and mucoepidermoid carcinoma) to be reported in Japan.

1985年から1999年までに当科で根治治療を行った上歯肉，硬口蓋原発扁平上皮癌51例を対象として原発巣制御の治療成績を検討した。この時期における全体の原発巣制御率は70.6%であったが，治療法別では，手術のみ73.3%，根治照射71.4%，術前照射＋手術68%，T分類別ではT1：85.7%，T2：60%，T3：77.8%，T4：80%，術式別では上顎部切69.2%，上顎全摘80%であった。腫瘍の存在部位と原発巣制御の関係をみてみると，口腔前方に腫瘍が存在する場合，制御は良好であったが，後側方や正中に存在する場合で制御が不良であり，再発部位として側頭下窩深部や翼口蓋窩への再発が比較的多く認められた。このような例では救済手術が不可能で，直接的な死因となることが多いため，手術手技上，後方側方への深い浸潤がある例では，できるだけ良好な視野が得られるようなアプローチを充分計画することが大切と思われた。

Concool F®is a chemical mouthwash containing chlorhexidine gluconate that is used for the treatment of periodontal disease and halitosis. We report a case of gingival necrosis caused by incorrect use of Concool F®A 52-year-old woman was referred to our hospital because of gingival necrosis. One week before presentation, she went to sleep after putting a cotton roll soaked in a large amount of Concool F®solution (0.36 % chlorhexidine gluconate) on the upper gingiva to reduce bad breath. She noticed bleeding and a painful ulcer in the upper gum from the maxillary right lateral incisor to the left second premolar.Whenever a mouthwash agent containing chlorhexidine gluconate is used, we must be cautious about its usage and dosage and instruct the patients on proper use.

Objectives: To evaluate the significance of maxillary bone invasion by gingival carcinoma as an indicator of cervical metastasis. Methods: Twenty-one patients with squamous cell carcinoma of the upper gingiva were included in the study. The extent of bone invasion was assessed by dental CT. Six patients had cervical metastases at the initial examination and eight more developed them during the 2-year follow-up period. The relationship of cervical metastases with age and gender of these patients, as well as with the size of the lesion and extent of bone invasion, was examined by logistic multivariate regression analysis. Results: There was a significant relationship between the presence of bone invasion and the presence of cervical metastasis (P

We analyzed clinicopathologically patients with upper gingival carcinoma, especially those with cervical lymph node metastasis. This study included 35 patients who had undergone treatment for upper gingival carcinoma from 1975 to 2001. Clinically suspected node positive (N(+)) cases were appeared in 7 of the cases (20.0%). The TNM classification (UICC) was T4N1 and T4N2 in 3 each patients, with all patients classified as M0. Histopathologically confirmed node positive (pN(+)) cases appeared in 4 of 7 N(+) cases and 4 cases of secondary metastasis, for a total of 8 cases. A high prevalence of pN(+) cases were found among the endophytic, and 4C types. Regarding treatment modality, preoperative chemotherapy was administered to 30 of the cases. Chemotherapy was administered intra-venously in 8 cases and intra-arterially in 13 cases. Among patients treated intra-venously, there were no cases demonstrating neck metastasis ; however, among those treated intra-arterially, there was secondary metastasis in 3 cases. The 5-year cumulative survival rate was 81.3% overall and 62.5% among the pN(+) cases. Uncontrolled sites in pN(+) cases consisted of cervical lymph node metastasis in one case, and distant metastasis in another case.

今回われわれは診断後, 約3か月の臨床経過中に完全に自然消失した上顎歯肉原発悪性リンパ腫の1例を纖したので, その概要を報告する。症例は80歳女性で, 右側上顎臼歯部の腫脹を主訴に来院した。初診時の口腔内所見では右側上顎臼歯部に30×45mmの一部潰瘍を伴うび慢性の腫脹を認め, X線写真, CT所見においても右側上顎臼歯部を中心に骨の破壊像が認められた。頸部リンパ節には, 異常は認められなかった。生検を施行し, 悪性リンパ腫 (び慢性, 大細胞型, B細胞) (WHO分類) の病理診断が得られた。しかし, 無治療にもかかわらず約3か月の短期間に病変は自然消失した。以降, 経過観察を行っているが初診日より約1年6か月経過した現在, 再燃は認められない。

Iatrogenic arteriovenous fistula (AVF) is rarely seen in the oral cavity, especially located on the distal greater palatine artery, which has not ever been reported before. We present a case of a 13-year-old girl who had received one simple suture over the left upper gingiva in a dental clinic which 4 days later resulted in an iatrogenic AVF with life-threatening bleeding, but was successfully treated by exploratory surgery. This case report describes our experience in managing such a complication, which was caused by a simple procedure.

Introduction Localized amyloidosis in the head and neck is a rare and generally benign condition. In the oral cavity, amyloidosis usually involves the tongue or buccal mucosa. We present the second case of oral amyloidosis arising in the gingiva ever reported, to the best of our knowledge. Case presentation A 73-year-old White Spanish man presented a persistent nodular mass involving his upper gingiva. The lesion was surgically resected and the histological examination revealed a subepithelial, multinodular amorphous and fibrillar accumulation. Staining of the specimen for Congo red proved positive, exhibiting a reddish colour under light microscopy and apple-green birefringence under polarized light. With immunohistochemical tests, pentagonal amyloid component was demonstrated. An extensive study excluded any systemic involvement; a diagnosis of localized primary amyloidosis was made. After 2 years of follow-up, no clinical progression to systemic amyloidosis or local recurrence was observed. Conclusions Localized amyloidosis of the gingiva is an extremely rare condition that seems to show no clinically distinct feature. Histologic examination is the first step towards diagnosis, followed by immunohistochemical tests. The diagnosis of localized amyloidosis should always be integrated with blood tests, a bone marrow biopsy, echocardiography and digestive endoscopy to intercept systemic involvement.

Oral metastasis of breast cancer is less common than metastasis to other sites like the lung and liver. Breast cancer can metastasize to the oral cavity, with presentation like a benign oral lesion. We present an interesting case of breast cancer involving the gingiva with sparing of the underlying bone.

Twenty cases of upper gingival carcinoma and 13 cases of hard palate carcinoma were evaluated clinicopathologically. In addition, the relationship between surgical intervention and outcome was also studied.All upper gingival carcinomas were identified as squamous cell carcinoma histologically. In the hard palate, there were various kinds of carcinomas arising mainly from the salivary glands (10/13 cases). Furthermore, almost all cases in the hard palate were welldifferentiated mucoepidermoid carcinomas, classified into the early stages of T 1 or T 2.The 5-year cumulative survival rate of the patients with hard palate carcinoma was 100%. In contrast, the 5-year cumulative survival rate of patients with upper gingival carcinoma was 50.2% among all cases, 66.7% among 9 stage II+III cases, and 32.3% among 11 stage IV cases.Surgical intervention involving tooth extraction in the tumorous area had been done in eight patients with upper gingival carcinoma before their first visit to our institute. Of these patients, seven (87.5%) were classified as T 4, and cervical lymph node metastases were confirmed histologically in five (62.5%). Careful follow-up in thus necessary in such patients.

A case of peripheral cemento-ossifying fibroma of the edentulous upper gingiva in a 55-year-old woman is reported.

To clarify the diagnostic utility of CT in the evaluation of carcinoma of the maxillary gingiva and hard palate.The CT scans of 27 patients with squamous cell carcinoma of the upper gingiva and hard palate were reviewed. Tumor extent and bone destruction were compared with the surgical and histopathological findings to estimate the sensitivity, specificity and accuracy of CT.The primary tumor was detected by CT in 89% of patients. The grade of bone destruction determined by CT correlated well with that verified at surgery or by histopathological examination. The sensitivity, specificity, and accuracy of CT for invasion to the buccal mucosa were 64%, 89% and 75% respectively. For maxillary sinus invasion, CT showed low specificity but high sensitivity. The accuracy was 86% when the criterion for sinus invasion was the presence of an enhanced mass continuous with the primary tumor.CT is helpful for the evaluation of tumor extent in the upper gingiva and hard palate carcinoma. However, invasion of the maxillary sinus should be considered carefully, because CT findings suggestive of destruction of the floor of the maxillary sinus are not always consistent with sinus invasion.

Multiple primary malignancies (MPMs) were found in 55 (9.3%) out of 591 patients with oral cancer treated between 1972 and 1994 at Chiba Cancer Center Hospital. There were 43 men and 12 women. The mean age of the patients with MPM was 63.4 years, with a range of 42 to 87 years. MPMs occurred frequently in patients with cancers of the upper gingiva (15.4%) and floor of the mouth (14.9%). Additional malignancies developed in the digestive tract (59.3%) and respiratory system (23.7%). Thirty malignant tumors arose before oral cancer and 29 after oral cancer, and 18 MPMs developed synchronously (within 1 year). Among 29 malignancies diagnosed during follow-up of oral cancer, 11 were asymptomatic, 16 symptomatic, and 2 unknown whether they were asymptomatic or symptomatic. In a few patients, oral malignancies were treated palliatively due to other MPMs. The prognosis of patients with MPMs was poor: 9 died of oral cancer, and 12 died of other subsequent cancers. During both treatment and follow-up of oral cancer, synchronous and subsequent primary malignancies should be borne in mind to facilitate early detection.

Since the establishment of our department in April 1979, 190 patients with newly diagnosed oral squamous cell carcinomas were treated and observed for over one year as of March 1994. Survival rate during this 15-year period was as follows. All cases: 5 years-66.7%, 10 years-64.8%. Upper gingiva: 5 and 10 years-74.9%. Tongue: 5 years-73.1%, 10 years-69.1%. Oral floor: 5 and 10 years-67.3%. Buccal mucosa: 5 and 10 years-62.2%. Lower gingiva: 5 and 10 years-50.3%. T 1 cases: 5 and 10 years-87.6%. T 2 cases: 5 and 10 years-73.5%. T 3 cases: 5 years-54.8%, 10 years-47.0%. T 4 cases: 5 and 10 years-35.8%. N 0 cases: 5 and 10 years-79.6%. N 1 cases: 5 years-41.7%, 10 years-27.8%. N 2 a cases: 5 and 10 years-50.0%. N 2 b cases: 5 and 10 years-36.4%. N 2 c cases: 5 and 10 years-28.6%. N 3 case (only one case): 0%. Stage I cases: 5 and 10 years-86.1%. Stage II cases: 5 and 10 years-83.6%. Stage III cases: 5 years-57.1%, 10 years-50.0%. Stage IV cases: 5 and 10 years-37.8%.

A case of oral multicentric carcinoma is reported. The patient was a 51-year-old man who presented with a tumorous nodule at the molar region of the left upper gingiva. The tumor was excised and diagnosed histologically to be verrucous carcinoma. Other tumorous lesions successively arose from the upper anterior gingiva, left buccal mucosa, lip mucosa, right upper gingiva, and right buccal mucosa during the next 15 years. Histopathological examination showed these tumors to be squamous cell carcinomas. They were all treated by local exision, and there has been no further reccurrence. Carcinogenesis caused by “field cancerization” or “field origin of tumors” of the oral mucosa was suggested in this patient.

Most carcinomas of upper gingiva and hard palate are classified as T4 stage on the basis of the UICC criteria, since they easily invade the underlying bone tissue. We classified 43 patients with squamous cell carcinoma of the upper gingiva in terms of three criteria: (1) the original T-classification by UICC, (2) the classification by the Japan Society for Head and Neck Cancer (JSHNC), and (3) a new classification in which the maxillary sinus or nasal floor is used as the defining borderline for T4 (MSF classification). Our study demonstrated that the new classification was superior with regard to distribution of patients by T stage, correlation with prognosis and choice of treatment method.

Presence of elevated fluoride concentration in saliva is important for the prevention of caries. In the present study, we developed an intra-oral bioadhesive tablet aimed at delivering F(-) in the mouth over a prolonged period of time. Various tablet formulations were tested in vivo for their tolerance and adhesiveness. Two formulations were selected for further studies on salivary fluoride clearance. For comparison, mouthrinses with increasing F(-) concentrations were also examined. Results indicate that a bioadhesive tablet located on the upper gingiva is able to sustain salivary F(-) concentrations for about 10h without major side effects. Mouthrinses with high F(-) concentration were able to prolong salivary fluoride retention for more than 6h.

We presented 3 cases of herpes zoster affecting the trigeminal nerve. Case 1 was a 38 year-old woman whose lesion spread over the area of the second and third branches of the right trigeminal nerve. Case 2 was a 34 year-old man whose second branch of the left trigeminal nerve was affected. Case 3 was a 40 year-old woman whose lesion merely involved oral mucosa, the right side of the palate and upper gingiva, and she had no systemic disease and no change of skin.All three cases were treated by Vidaravine, and their prognoses were favorable without post-herpetic neuralgia.In two cases, anti-VZV-titers in the acute phase were negative, but those in the recovery phase increased remarkably.

Experiments were carried out on 8 adult subjects to measure the influence of transient, intra-oral electrical stimulation upon jaw displacement and chewing rhythm during natural, unilateral chewing in man. Jaw movements throughout continuous gum-chewing sequences were monitored with a non-invasive transducer designed to record incisor point displacement in 3 dimensions. The displacement signals were sampled by a computer which delivered non-noxious, and in some subjects noxious, stimuli in a pseudo-random sequence to the upper gingiva of the ipsilateral side at fixed points in the chewing cycle. Statistical comparison of paired test and control cycles revealed that the disruptive effects of the stimuli became more common and greater as the stimulus strength increased. Marked changes were observed in the duration of the masticatory cycle, especially with painful stimulation. Whereas stimuli delivered during jaw opening usually evoked either lengthening or shortening of subsequent phases in the cycle that were consistent (although different) for individuals, those delivered during closure consistently produced a lengthening of that part of the cycle at or near the intercuspal position of the teeth. Stimulation during the jaw-closing phase did not prevent the teeth from achieving the control intercuspal position, whereas strong stimuli during jaw opening often altered the coordinates of the maximum jaw-opening position. Thus the response to such stimulation during chewing depends upon the phase of the cycle at which the stimulus is delivered, the most predictable result being a lengthening of the cycle by stimulation just before the onset of intercuspation.

Oral Malignant lymphomas are rare. Prognosis of extra-nodal malignant lymphoma is good, but that of oral malignant lymphoma is poor.Three cases of oral malignant lymphoma experienced in our oral surgery are reported. Case I (Maxilla, Stage IE) was treated by surgical excision and chemotherapy. Case II (Mandible, Stage IIE) and case III (Upper Gingiva Stage IE) were treated by radiation therapy. Case I and case II had no recurrence for more than 11 years, and case III for more than 6 years.

A primary plasmacytoma of the upper gingiva is reported, and histologic criteria for distinguishing it from plasma cell granuloma are described.