A survey of consultant members of the British Association of Oral and Maxillofacial Surgeons regarding bisphosphonate-induced osteonecrosis of the jaws

The aims of this survey of consultants in the British Association of Oral and Maxillofacial Surgeons were threefold. Firstly, to estimate the number of patients screened for oral health before starting intravenous bisphosphonate medication, secondly, to indicate the use of antibiotics in patients on bisphosphonates who need routine extraction of a lower first molar tooth, and finally to estimate the number of new and currently managed cases of bisphosphonate-induced osteonecrosis of the jaw (BONJ) in the last year, and approximately how many of those currently being managed had healed.     

Oral lesions in patients participating in an oral examination screening week at an urban dental school

BACKGROUND: Dental education must emphasize early diagnosis and management of oral mucosal disease, including early detection of oral premalignant lesions and cancer. The authors evaluated clinical findings of oral screening examinations of dental patients during a one-week period in an urban dental school clinic. METHODS: Third- and fourth-year dental students conducted clinical screening examinations for all dental patients of record seen during the Yul Brynner Foundation's Oral, Head and Neck Cancer Awareness Week in April 2006. RESULTS: Of 262 patients, 100 (38.2 percent) reported that they had used tobacco for a mean of 8.1 years. Most patients reported having denture or tooth and gingival problems. The dental students reported abnormal findings in 55 patients (21 percent). Two patients had suspected premalignant lesions that were diagnosed as lichen planus and traumatic keratosis. CONCLUSIONS AND CLINICAL IMPLICATIONS: The one-week screening provided an educational opportunity for the dental students, and the results demonstrate the value of having a focused week to reinforce the importance of head and neck and oral soft-tissue examination. The finding of mucosal lesions in 21 percent of patients of record reflects the fact that lesions were present but undetected. In addition, there are important implications for teaching and patient care. The screening week provided an opportunity for students to be active in a national campaign for cancer detection, and it represents an opportunity for visible community participation in the recognition of oral mucosal diseases in dental training programs and broadly for the profession.     

British Association of Oral and Maxillofacial Surgeons first national audit in support of revalidation

This is the first national audit of Fellows of the British Association of Oral and Maxillofacial Surgeon with the specific purpose of supporting consultant revalidation. The audit was performed online. There were 127 responses from 275 email invitations. The audit reflects the range of activity by consultants with over 90% being involved in dento-alveolar, trauma and oral medicine. 78% of consultants performing head and neck oncology had a database and 75% of cleft lip and palate surgeons. Contributions to audits in the last 3 years were least common in oral medicine (7%), skull base (7%), aesthetic surgery (8%), and paediatric maxillofacial surgery (12%). There were many different audits reflected in consultants responses and there is merit in focusing on specific audits suitable for national comparison and benchmarking.     

口腔黏膜癌前病变及鳞癌中Fas/FasL的表达研究

目的 :研究凋亡相关基因Fas/FasL在口腔正常粘膜、上皮单纯增生、上皮异常增生和鳞癌中的表达及意义。方法 :采用SABC免疫组织化学方法检测正常口腔粘膜 ( 10例 ) ,上皮单纯增生 ( 8例 ) ,上皮异常增生 ( 2 0例 ) ,鳞癌 ( 32例 )中Fas/FasL的表达。结果 :在正常口腔粘膜中Fas表达于棘层和粒层细胞的胞膜 ;FasL局限于基底层细胞的胞膜和胞浆。上皮异常增生中随异常增生程度的增高 ,Fas表达降低 ;FasL表达增强 ,甚至遍布上皮全层。鳞癌组中Fas表达明显低于正常组 (P <0 .0 5 ) ,且与组织学分级呈正相关 ;FasL表达明显高于正常组 (P <0 .0 5 ) ,且与组织学分级呈负相关。结论 :Fas在调节鳞状上皮细胞自我更新中具有重要作用。Fas表达水平下调 ,FasL上调 ,可能是口腔上皮癌变过程中的一个早期事件。Fas/FasL是肿瘤细胞逃逸肿瘤反应T细胞攻击而获得免疫赦免的重要机制之一。     

The efficacy of oral lumenoscopy™ (ViziLite®) in visualizing oral mucosal lesions

Early diagnosis of oral mucosal lesions has been advocated as a means of improving outcomes of cancer therapy. Improved visualization of mucosal lesion* may aid in diagnosis by guiding tinue sampling or referral. This multi‐center study reports the effect of chemiluminescent light (ViziLite) upon visualization of mucosal lesions. The cftemiluminescent light did not appear to improve visualization of red lesions, but white lesions and lesions that were both red and white showed enhanced brightness and sharpness.     

A comparison of the management of potentially malignant oral mucosal lesions by oral medicine practitioners and oral & maxillofacial surgeons in the UK

This study describes the results of a survey undertaken to assess the management of potentially malignant oral mucosal lesions by oral medicine practitioners and compares their approach with that of oral & maxillofacial surgeons that we have previously described. Significant differences were noted between the two groups in the use of photography to document the lesions and in the use of certain special investigations, which included measurement of serum iron, serum ferritin, serum Vit B12, red cell folate and candidal isolation. The groups also varied in the perceived importance of the age of the patient and anatomical site of the lesion when deciding on the need for further biopsy. There was also significant variation in the use of certain treatment modalities, including excising non-dysplastic and severely dysplastic/carcinoma in-situ lesions and eliminating trauma when treating mild/moderately dysplastic and severely dysplastic/carcinoma in-situ lesions. Significant differences in the frequency and duration of follow-up were noted for non-dysplastic lesions. Finally, the two groups differed significantly when asked to rank the perceived importance of certain factors (the histopathology of the most recent biopsy and the anatomical site of the lesion) when deciding the need to follow-up. Possible reasons for the variation are discussed.     

Assessment of online visibility of the British Association of Oral and Maxillofacial Surgeons (BAOMS): A strategic study

The Internet is a powerful method of acquiring and sharing information. In marketing and business, online visibility is vital for publicity and the reputation of an organisation. To our knowledge, the importance of such visibility in medicine in general, and in Oral and Maxillofacial Surgery (OMFS) services in the UK, has not previously been investigated. We aimed to provide a better understanding of the way that patients use the Internet by asking 450 patients to complete a questionnaire when they attended outpatient OMFS departments at 2 centres. We also assessed the online visibility of the British Association of Oral and Maxillofacial Surgeons (BAOMS) and investigated the correlation between the strength of online visibility and professional reputation. Results from the self-administered, anonymous, validated questionnaires showed that 82% of patients agreed that the Internet was a powerful source of information, and two-thirds associated online visibility with a good reputation. However, the perceived online visibility of the BAOMS was poor (2%). This study mirrors findings in business publications, and confirms the link between online visibility and professional reputation. It also shows that there is a gap between patients’ perceptions and the level of uptake of professional resources. We propose various strategies to bridge this gap and to promote the online visibility and professional reputation of the BAOMS and of OMFS services in the UK.     

口腔颌面外科住院患儿使用抗生素的现状调查

目的:了解口腔颌面外科住院患儿抗生素的使用情况,为临床合理用药提供参考。方法:随机抽查上海交通大学医学院附属第九人民医院2005-2006年口腔颌面外科患儿住院病历102份,年龄为3个月～18岁。填写"抗生素使用情况调查表",调查内容包括患者性别、年龄、疾病诊断、用药情况、实验室检查、细菌培养及药物敏感试验等;分别统计每位住院患者的用药种类、用药时间、联合用药、住院全程更换抗生素种类、给药途径。分析小儿口腔颌面外科抗生素使用是否合理。结果:抗生素使用率为94.12%,其中单独用药、二联用药使用率分别为74.51%、19.61%,主要采用静脉给药,口服用药54例,无肌注给药;住院全程更换抗生素种类2种37例(36.27%),3种24例(23.53%),4种10例(9.80%);细菌培养2例(1.96%);使用抗生素时间≤3d25例(24.50%),3～7d49例(48.04%),>7d22例(21.57%)。使用频率高的是头孢菌素、林可酰胺与青霉素类。结论:抗生素合理使用是主流,但仍存在未掌握手术预防用药原则、临床标本采集送检率较低、药物使用方法不合理、抗生素更换频繁与用药起点太高等不合理现象。应采取病区合理化布局、术前加强儿童保健、合理使用抗生素等对策。     

口腔黏膜癌前病变及鳞状细胞癌中VEGF的表达及意义

目的 :探讨VEGF在口腔扁平苔藓、口腔白斑、口腔鳞状细胞癌中的表达及其在口腔鳞癌发生、发展过程中的意义。方法 :应用VEGF多克隆抗体对 10例正常黏膜、2 7例口腔扁平苔藓、2 4例口腔白斑及 30例口腔鳞状细胞癌分别进行免疫组化检测。结果 :VEGF在口腔鳞状细胞癌组织中高表达 ,与口腔扁平苔藓、口腔白斑、正常口腔黏膜组织存在着显著性差异 (P <0 .0 5 ) ;在口腔扁平苔藓和口腔白斑中VEGF有一定的表达 ,且表达强度强于正常口腔黏膜组 (P <0 .0 5 )。结论 :VEGF的过表达与口腔鳞癌的发生、发展有关 ,可以将其作为预测口腔黏膜恶变潜能的重要标志物。     

Concomitant Association of Oral Submucous Fibrosis and Oral Squamous Cell Carcinoma and Incidence of Malignant Transformation of Oral Submucous Fibrosis in a Population of Central India: A Retrospective Study

Aim

To evaluate the incidence of oral squamous cell carcinoma concomitant with oral sub mucous fibrosis in central India and to correlate precipitating factors associated with oral submucous fibrosis and oral squamous cell carcinoma. This paper also aims to study the incidence of oral squamous cell carcinoma arising secondary to untreated oral submucous fibrosis.

Materials and Methods

Two hundred and twenty five cases of oral squamous cell carcinoma and one hundred and nineteen cases of oral submucous fibrosis of various regions in oral cavity were included in the study. All the included cases were clinically and histopathologically diagnosed and retrospective data was retrieved.

Result

In the present study of 119 patients of oral submucous fibrosis, 97.4 % were found to have betel nut chewing habit. Incidence of malignant transformation to oral squamous cell carcinoma in patients of untreated oral submucous fibrosis was found to be 4.2 % in the present study. The incidence of oral cancer concomitant with oral submucous fibrosis was found to be 25.77 %, which is statistically significant.

Conclusion

From the present study, it is evident that the malignant potential of OSF is underestimated. However, considering the small sample size and the fact that the study was carried out in a small geographical area, further study with a larger sample size and longer duration of follow up on a multicentric basis may be required to reveal the actual malignant potential of the disease.     

口腔粘膜上皮异常增生和鳞癌组织中凋亡蛋白Bax的表达研究

目的 研究凋亡相关蛋白Ｂａｘ在口腔正常粘膜、上皮异常增生和鳞癌组织中表达及意义。方法 采用免疫组化方法检测１０例正常粘膜、１０例单纯性增生上皮、３２例异常增生上皮１９例高分化鳞癌、９例低分化鳞癌石蜡包理样本中Ｂａｘ的表达。结果 正常粘膜中见Ｂａｘ弱表达局限于角化层。上皮单纯增生时Ｂａｘ表达较正常组增强,轻度异常增生时反面较单纯增生下降,随异常增生程度加重,Ｂａｘ明显增加。癌变时Ｂａｘ表达较正常组增     

Oral cavity squamous cell carcinoma survival by biopsy type: a cancer registry study

Background: Biopsy of a suspected oral squamous cell carcinoma (SCC) is important for diagnosis. Concerns have been raised about the potential for tumour spread by incisional biopsy techniques. This study aimed to investigate the five‐year survival and recurrence of oral SCC after incisional and excisional biopsy in total population data available from the Western Australian Cancer Registry (WACR). Methods: Total population data from the WACR, comprising all primary oral SCC cases diagnosed between 1990 and 1999, were examined. Information extracted included date of birth, gender, biopsy date, biopsy type, disease stage (TNM classification), disease site, date of recurrence and date of death. Records were excluded if the diagnosis was fine needle aspiration based, was not that of oral SCC and if a history was noted of another malignant neoplasm. Incisional and excisional biopsy cases were compared for five‐year survival, adjusting for disease stage. Results: No association was found between biopsy type and five‐year survival or recurrence amongst individuals with Stage I or II disease. Conclusions: In this study, biopsy type was not associated with survival of oral SCC patients with Stage I or II disease, adding to the evidence that incisional biopsy of oral SCC can be a safe procedure.     

口腔黏膜癌前病变和口腔鳞癌组织Fas/FasL的表达及其意义

目的：研究调亡相关基因Fas／FasL在正常口腔黏膜、上皮异常增生和口腔鳞癌组织中的表达及意义。方法：应用免疫组织化学方法检测10例正常口腔黏膜、26例上皮异常增生、38例口腔鳞癌组织及肿瘤浸润淋巴细胞（TIL）中Fas／FasL的表达。结果：Fas在正常口腔黏膜中广泛表达;上皮异常增生和鳞癌组织表达明显下调（P〈0．05）;Fas表达与口腔鳞癌分化程度有关;FasL在正常口腔黏膜不表达;上皮异常增生和鳞癌组织表达明显上调（P〈0．05）;FasL表达与口腔鳞癌分化程度无关（P〉0．05）;TIL细胞Fas、FasL阳性表达率为81．6％和84．2％。结论：Fas表达与口腔黏膜上皮细胞的自然分化成熟、衰老及口腔鳞癌的形成和肿瘤的恶性度有关;FasL的表达上调可能是口腔鳞癌组织免疫反攻击的体现;Fas、FasL可作为监测口腔上皮癌变的标记物。     

口腔粘膜癌前病变及鳞癌中RASSF1A基因甲基化与表达的研究

目的 研究RASSF1A基因甲基化状态及其基因表达异常与口腔癌前病变及鳞癌发生发展的关系。方法 采用甲基化特异性PCR（MSPCR）技术检测了10例正常口腔粘膜、8例上皮单纯增生、20例上皮异常增生、32例鳞癌组织中RASSF1A基因甲基化状况；运用逆转录-聚合酶链反应（RT-PCR）研究口腔粘膜癌前病变及鳞癌组织中RASSF1A基因mRNA的表达水平。结果 10例正常口腔粘膜无甲基化。且RASSF1A基因mRNA呈100％表达；8例上皮单纯增生中，有1例甲基化，1例RASSF1A mRNA表达下降；20例上皮异常增生中，有3例甲基化，5例RASSF1A mRNA表达下降；32例鳞癌组织中，有13例甲基化，占40．63％，15例RASSF1A mRNA表达下降或无表达。占46．88％。结论 RASSF1A基因甲基化是口腔癌癌变的早期事件，与口腔鳞癌的发生发展有关。RASSF1A基因甲基化与RASSSF1A基因转录抑制高度相关。