颌骨及口腔软组织的转移性瘤(综述)

颌骨及口腔软组织的转移性瘤近年来发现较以往为多,从而引起人们的注意。本文就其有关问题综述如下: 一、转移性瘤的发病率和发病部位: 转移性瘤可单独侵犯颌骨或口腔软组织,也可以二者同时或先后发病;临床上骨组织较软组织易于发生。恶性瘤在颌骨发生的远处转移属于骨转移的一种,Geschi-chter及Copeland估计近50%的乳癌、肾癌、前列腺癌和支气管源性癌于患者死亡前发生骨质病变,最易侵犯的骨组织依次为椎骨、骨盆、股骨、颅骨、肋骨、肱骨、偶然亦侵及颌骨。Milobsky等指出全部恶性肿瘤出现颌骨转移者约占1%,而全部口腔恶性肿瘤中有1%系转移瘤。Adler认为颌骨转移性瘤的发生,实际上远较文献     

恶性肿瘤的颌骨转移

口腔恶性肿瘤占全身恶性肿瘤的5～7%,绝大多数为原发肿瘤,继发肿瘤比较罕见,仅占口腔恶性肿瘤的1%。转移瘤可侵犯颌骨或口腔软组织,临床上骨组织较软组织易于发生。恶性肿瘤在颌骨发生的远处转移乃是骨转移的一种。有关颌骨转移瘤文献上屡有报告,且近年来发现较以往为多,应引起注意。统计资料文献中报导的颌骨转移瘤多为个案报     

颌骨中心性黏液表皮样癌的诊断与治疗--附3例报道

目的:通过分析颌骨中心性黏液表皮样癌的临床特点,为进一步提高其诊治水平提供参考。方法:对1995-2005年原发于颌骨的3例黏液表皮样癌的临床表现、治疗及预后进行回顾性分析。结果:3例颌骨中心性黏液表皮样癌临床主要表现为颌骨内渐进性增大的肿块,有感觉异常、疼痛和反复出血。2例术后局部复发,最长者在术后3a。肿瘤复发可能与切缘有关,1/2例复发患者行半侧下颌骨切除术后,未再发生局部复发和转移。结论:术前明确诊断以及定期复查,有利于颌骨中心性黏液表皮样癌的及早发现和及时治疗。而局部切除的范围依然是影响预后的主要因素之一。     

下颌骨转移癌—附5例报告

<正> 颌骨转移癌并不常见,全部恶性肿瘤约1%出现颌骨转移,颌骨的转移癌约占颌骨恶性肿瘤的1%。一旦发现,原发灶已多属晚期或转移广泛而失去根治时机,故一般预后很差。然有的肿瘤分化较好,恶性程度较低,其中一部分颌骨病变可首先被发现,且部分患者一般情况较好,经积极治疗也可获得良好效果。现将我院经治的5例报道如下,并对有关问题进行初步讨论。     

颌骨骨肉瘤3例及文献复习

目的探讨颌骨骨肉瘤的临床病理特征、诊断及鉴别诊断方法,并进行相关文献复习。 方法回顾性分析韶关市第一人民医院3例颌骨骨肉瘤临床资料,结合影像学特点,分析该病光学显微镜下的形态特征和免疫组化结果,并进行相关文献复习。 结果3例颌骨骨肉瘤,病例1发生于左上颌、病例2发生于左下颌,病例1、病例2病理诊断为颌骨普通型骨肉瘤;病例3发生于右下颌,诊断为颌骨低级别中心性骨肉瘤。颌骨骨肉瘤在临床上十分少见,与长骨骨肉瘤相比有其自身特点。 结论颌骨骨肉瘤在发病年龄,镜下特征均有所不同,临床上要注意与良性骨病相鉴别,需结合临床特征、影像学及病理镜下形态综合考虑。     

全身各部位肿瘤的头颈部转移

通过淋巴及血液系统向远处器官转移是恶性肿瘤的一个特征,而全身各部位肿瘤向头颈部转移却不常见。1902年至1953年世界文献共有176例报道,1961年又报道37例。Bhaskar指出:人体各部位的恶性肿瘤向头颈部转移只占1%。全身各部位肿瘤向颌骨转移,呈如下规律:转移至上颌骨占18%,转移至下颌骨占72%。临床表明,转移到颌骨的肿瘤可以不出现任何症状。如侵及神经则表现感觉异常或类似牙痛轻微不适,以致误诊。还可以出现带捻发音似的肿胀,如合并继发感染可出现病理性骨折。     

口腔疣状癌的临床生物学行为及治疗（附病例报道）

口腔疣状癌为临床少见的恶性肿痛，好发于颊黏膜或牙龈，发生于口唇者甚少，早期无特征性临床农现，晚期可侵犯周围组织，出现唇、颊、颌骨等组织缺损，也可出现颈部淋巴结转移，远处转移少见，生物学行为呈多样性，低度恶性，预后不确定等特点。     

上、下颌骨血管外皮瘤9例临床病理分析

目的：探讨颌骨血管外皮瘤的临床特征、治疗及预后。方法：对9例颌骨血管外皮瘤患者临床病理资料进行回顾性分析。结果：男女比为8∶1,年龄38（23～51）岁;下颌骨6例,行根治性手术及颈淋巴结清扫术;上颌骨3例,行根治性手术,未行颈淋巴结清扫术。术后2例放疗,2例化疗。术后随访49（10～101）月,1例肺转移,1例局部复发、远处转移。结论：手术是治疗颌骨血管外皮瘤主要手段,辅助放疗对改善预后可能有益。     

慢性磷性颌骨骨髓炎的临床探讨

目的 探讨慢性磷性颌骨骨髓炎的临床特点及其机理,为临床及黄磷职业病诊断提供依据。方法对6例因黄磷中毒引起颌骨骨髓炎患者的临床资料进行回顾性分析。结果 6例患者中,上颌骨4例,下颌骨2例。2例下颌骨磷性骨髓炎患者诊断为职业病。结论 磷性颌骨骨髓炎不仅发生于下颌骨,也可发生于上颌骨。上颌骨也应作为黄磷作业的健康检查及职业病诊断参考。?     

颌骨原发性骨肉瘤6例临床资料分析

颌骨原发性骨肉瘤较为少见,由于其具有生长速度快,转移早,术后易复发等特点,故预后甚差。现收集我科经病理证实的6例临床资料结合文献报告分析如下:     

Metastatic renal cell carcinoma to the condyle of the mandible

A 59-year-old woman who had left nephrectomy because of renal cell carcinoma (RCC) 3 years ago referred with trismus and a mass on her left temporomandibular joint. Computed tomography scan revealed an expanding lytic lesion on the left condyle of the mandible. Incisional biopsy was carried out. Histopathologic diagnosis was metastatic clear cell variant of RCC. Metastasis of RCC to the condyle of the mandible has not been reported yet. In this study, we presented a case of RCC metastasis to the condyle of the mandible.     

Association between the Mesiobuccal Canal Configuration,Interorifice Distance,and the Corresponding Root Length of Permanent Maxillary First Molar Tooth: A Cone-beam Computed Tomographic Study

IntroductionThe aim of this cone-beam computed tomographic study was to evaluate the association between the mesiobuccal root canal configuration (RCC), interorifice distance (IOD), and the corresponding root length of a permanent maxillary first molar tooth.MethodsOne hundred cone-beam computed tomographic scans obtained from the computerized data bank of the institute were studied. The IOD between the first mesiobuccal and second mesiobuccal canal was measured in the axial section where the second mesiobuccal canal was first visualized. The root length was measured from the cementoenamel junction to the root apex in the coronal and sagittal section. The associations of these parameters with the RCC (based on Vertucci’s classification) were evaluated.ResultsThe predominant RCC was observed to be Vertucci type II (89%). The mean root length with this configuration was 11.19 ± 1.35 mm. In type IV RCC, the mean root length was 9.13 ± 0.52 mm. A statistically significant association was established between the root length and RCC (P < .05). In roots with type II and type IV RCC, the mean IOD was 2.58 ± 0.04 mm and 2.62 ± 0.1 mm, respectively. No statistically significant relation was established between the IOD and the type of RCC (P > .05).ConclusionsThe length of the mesiobuccal root is an important anatomic parameter for predicting the type of RCC in the permanent maxillary first molar tooth.     

Metastatic renal cell carcinoma to the orbit and the ethmoid sinus

The orbit is an unusual site for metastatic renal cell carcinoma (RCC), and concurrent metastases of RCC to the ethmoid sinus and the orbit occur very rarely. The treatment goal of orbital and paranasal metastatic RCC is total exenteration. We report a rare case of metastatic RCC to the orbit and the ethmoid sinus. The patient underwent total exenteration, craniotomy, and total maxillectomy. Six years after surgery, the patient showed no sign of metastasis and had successful cosmetic result by using orbital prosthesis.     

Metastatic renal cell carcinoma presenting as a clear cell tumour in the head and neck region

Renal cell carcinoma (RCC) is the most frequent urological malignancy in adults and has a male preponderance. It accounts for approximately 3% of adult malignancies and 90–95% of neoplasms arising from the kidney. RCC usually metastasizes to lungs, bone and regional lymph nodes but very rarely to the head and neck region. The following report is based on a female patient with a previously undiagnosed RCC, which metastasized and presented as a clear cell tumour in the head and neck region. A histopathological differential diagnosis for clear cell tumours together with the contributing factors that led to the diagnosis of metastatic RCC will be discussed.     

Localization of mRNA for inflammatory cytokines in radicular cyst tissue by in situ hybridization, and induction of inflammatory cytokines by human gingival fibroblasts in response to radicular cyst contents

The expression of mRNA encoding the inflammatory cytokines interleukin-1α (IL-1α), interleukin-1β (IL-1β), interleukin-6 (IL-6), interleukin-8 (IL-8) and tumor necrosis factor α (TNF-α) have been examined in radicular cysts by in situ hybridization. Furthermore, the biological activity of the contents of radicular cysts (RCC) has been assayed by adding extracts of RCC to cultured human gingival fibroblasts (HGFs) and analyzing the culture medium for the release of inflammatory cytokines. In the epithelial layer, keratinocytes expressed all cytokine mRNAs examined at various levels. Basal layer cells expressed mRNA for each cytokine. In the subepithelial granulation tissue of the cysts, fibroblasts and macrophages expressed mRNA for IL-6, IL-8, IL-1β and TNF-α mRNA at varying levels; especially clear expression of TNF-α and IL-1β mRNA was detected on macrophages. The infiltrating lymphoid cells, largely composed of T cells and plasma cells, expressed these cytokine mRNAs, especially those encoding IL-6 and IL-8, at various levels. In vitro analysis indicated dose-dependent release of both IL-6 and IL-8 by HGFs in response to RCC. After heating to 100°C for 10 min, RCC almost completely failed to stimulate IL-6 release from HGFs. Furthermore, anti-IL-1β antibody (neutralization test) did not prevent the stimulation of IL-6 release by RCC. Significant amounts of IL-6 and IL-8 were detected in RCC in two cases, and a trace amount of IL-1β was detected in one case. This study demonstrated the wide expression of mRNA encoding inflammatory cytokines in radicular cyst tissues, and RCC itself was capable of stimulating 1L-6 and 1L-8 production from HGFs.     

不同尺寸、不同摇椅曲度不锈钢方丝在Empower自锁托槽内摩擦力的实验分析

目的 研究不同尺寸、不同摇椅曲度(rocking chair curvature,RCC)不锈钢方丝（stainless steel,SS）在Empower自锁托槽(Empower self-ligating brackets,Empower SLB)内所产生的摩擦力差异。方法 选用由标准石膏模型翻制的标准牙〖HT5”,7”SS〗牙〖KG-*3〗合模型,并于干燥条件下在其上粘结Empower SLB及颊面管,分别测量按照在电镜下确定弓丝拉拔方向的两种尺寸SS(0.46 mm×0.64 mm、0.48 mm×0.64 mm),4种不同RCC(0°、5°、10°、15°),共8种弓丝-摇椅工况组合在滑动法关闭拔牙间隙时在Empower SLB内产生的摩擦力。结果 两种尺寸弓丝分别在尖牙至第二前磨牙区加载0°、5°、10°、15°的RCC,得出以下结果：①所有工况下动摩擦力稍小于最大静摩擦力;②相同RCC下,0.46 mm×0.64 mm SS 在自锁托槽内产生的滑动摩擦力小于0.48 mm×0.64 mm SS（P＜0.05);③相同尺寸弓丝随RCC（0°、5°、10°、15°）增加,滑动摩擦力（0.46 mm×0.64 mm SS :0＜0.19 N＜0.35 N＜0.90 N;0.48 mm×0.64 mm SS:0＜0.26 N＜0.43 N＜1.00 N）逐渐增大（P＜0.05)。结论 SS在Empower SLB内的滑动摩擦力稍小于最大静摩擦力,弓丝尺寸越大、摇椅曲曲度越大,SS在自锁托槽内产生的摩擦力也越大。     

Root Canal Morphology of 116 Maxillary Second Premolars by Micro–Computed Tomography in a Mixed Swiss-German Population with Systematic Review

IntroductionThe aim of this investigation was to examine the root canal system morphology of maxillary second premolars (Mx2Ps) of a Swiss-German population by means of micro–computed tomography and provide systematic review of the root canal configuration (RCC) literature of Mx2Ps.MethodsThe RCC, main foramina as well as accessory canals and foramina frequency of 116 Mx2Ps, were investigated by means of micro–computed tomography and 3-dimensional software imaging. The RCC from the coronal to apical thirds of the root as well as the main foramina number were described by using a four-digit system code. The literature review follows the PRISMA guideline analyzing randomized controlled trials and cross-sectional, cohort, comparative, validation, and evaluation studies on RCC in Embase, grey literature, PubMed, and Scopus.ResultsMost frequently observed RCCs of Mx2Ps were 1-1-1/1 (35.3%), 1-1-1/2 (21.6%), and 2-1-1/1 (14.7%). Another 11 less frequent RCCs were observed. All Mx2Ps had 1 root. One main foramen was observed in 59.5% and two in 37.9%. Accessory foramina were observed in 46.6%. Thirty-one percent of the Mx2Ps showed accessory canals. One connecting canal between the buccal and palatal was observed in 12.1%.ConclusionsDetailed RCC information of Mx2Ps in a Swiss-German population and the results of a systematic literature review of different populations and research methods used to investigate root canal morphology and configuration of Mx2Ps are given. Within the limitations of the study, a high RCC, connecting and accessory canals variability occur in maxillary second premolars.     

Effects of polyglactin mesh combined with resorbable calcium carbonate or replamineform hydroxyapatite on periodontal repair in dogs

Abstract This study evaluates periodontal repair and biomaterial reaction following implantation of a polyglactin mesh with or without porous resorbable calcium carbonate (RCC) or porous replamineform hydroxyapatite (RHA) in conjunction with reconstructive surgery. Ligature- and surgically-induced interproximal periodontal defects of left and right mandibular premolar teeth in 7 dogs were used. Bilaterally, mesial defects of the 2nd, 3rd and 4th premolar teeth were treated with polyglactin mesh, polyglactin mesh and RHA. or polyglactin mesh and RCC. respectively. The polyglactin mesh, shaped according to the contour of the defect, was adapted to the experimental teeth: its coronal margin positioned immediately apical to the cemento-enamel junction. Gingival flap margins were adapted and sutured to cover the polyglactin mesh completely. Clinical healing was generally uneventful. The dogs were sacrificed to provide block sections for histologic evaluation at 1, 3, 6, 12, 26, 32 and 56 weeks following wound closure. Generally, cementum regeneration was observed beginning at week 6 in all groups. Bone regeneration was observed from week 3 in polyglactin mesh-treated groups, and from week 6 in polyglactin mesh + RCC or polyglactin mesh + RHA treated groups. Bone regeneration appeared enhanced in polyglactin mesh + RCC or polyglactin mesh + RHA treated defects at week 12 and 26, with little difference between the three experimental conditions at week 56. Polyglactin mesh degradation was observed at week 3 and appeared complete at week 12. The RHA did not appear to resorb, while the RCC was gradually replaced by bone from week 3. Within limitations of the study conditions, periodontal regeneration was observed following implantation of a polyglactin mesh with or without RCC or RHA in conjunction with reconstructive surgery. As a conclusion, there seems to be no significant difference in periodontal regeneration after 12 months of healing between the group treated with the membrane only, and the group treated with the membrane and the bone substitution material. Changes in connective fiber orientation over the 1st 12 weeks of healing may suggest that “fibrous encapsulation” observed in earlier studies may only represent a transient stage in periodontal regeneration.     

Association between the Root Canal Configuration,Endodontic Treatment Technical Errors,and Periapical Hypodensities in Molar Teeth: A Cone-beam Computed Tomographic Study

IntroductionThis study aimed to evaluate the association between the root canal configuration (RCC), endodontic technical errors, and periapical hypodensities in molars using cone-beam computed tomographic (CBCT) images.MethodsTwo hundred twenty-one roots were assessed from 79 patients referred for CBCT examination because of symptomatology in endodontically treated molars. Two oral and maxillofacial radiologists classified the RCC of each dental root according to Vertucci's classification. Root canals were assessed for the presence of technical errors from endodontic treatment. The presence of periapical hypodensity for each dental root and the coronal sealing condition of each tooth were also recorded.ResultsFor RCC type I, the most prevalent technical error was underfilling (17.4%). For types II and VIII, nonfilled canals were found in 54% and 100% of the cases, respectively. For type III, underfilling, nonhomogeneous filling, and nonfilled canals were equally frequent (33.3%), whereas for type IV underfilling and nonfilled canals had a prevalence of 42%. In general, there was a higher prevalence of apical hypodensities among roots with technical errors. It was also observed for type I, with an increase from 41.2%–62.9% when a technical error was present.ConclusionsThe prevalence of different endodontic technical errors varies depending on the RCC for molars. A greater complexity of RCC is related to a higher occurrence of errors and a higher prevalence of periapical hypodensity.