Pain from cancer is a major problem of managing the oral cancer patients in terminal stage. Overall, pain is reported by about 50% of patients at all stages of cancer and by over 70% with advanced neoplasms. Unrelieved pain can be incapaciting and preclude a satisfying quality of life. But, pain is often poorly assessed, and many clinicians lack sufficient knowledge to optimize cancer pain treatment. There are three basic approaches to the control of pain : modifying the source of pain, altering the central perception of pain, and blocking the transmission of pain to the central nervous system. The optimal use of these approaches and an individualized plan for pain control can maximize both quality and duration of life in dying patients. Opioid analgesics are are the mainstay of pharmacologic treatment. Practical opioid therapy include selection of both drug and route, dose titration, and management of side effects. We present our experienced pharmacologic treatment protocol for cancer pain management that collaborated by Dept. of Hospice, Catholic Medical Center. It will acts as a guideline for our colleague to facilitate the translation of current knowlegde into the clinical practice.
Analgesics, Opioid ; Central Nervous System ; Clinical Protocols ; Hospices ; Humans ; Mouth Neoplasms* ; Pain Management ; Quality of Life

Nowadays, there are a lot of evidence that mutation of the p53 tumor suppressor gene is one of the most common genetic abnormalities in neoplastic progression. In this study, we analyzed 20 specimens of oral tumors (squamous cell carcinoma 14 cases, ameloblastoma 3 cases, adenoid cystic carcinoma 2 cases, malignant schwannoma 1 case) using polymerase chain reaction and direct sequencing which used an automated DNA sequencer and software for detection of mutations. Polymerase chain reactions were performed with 4 sets of primers encompassing exon 5, 6, 7, 8, and direct sequencing method was employed. The results were as followings. 1. We detected 10 piont mutations out of 20 specimens (50%). 2. The genetic alterations included 7 mis-sense mutations resulting in single amino acid subtitutions, 2 silent mutations, 1 non-sense mutations encoding a stop codon. 3. Mutations were mostly in exon 7(7 out of 10 mutations, 70%) and involved codons 225, 234, 235, 236, 238, 247. 4. Therse were 4 cases of T-->A transversion, 2 cases of C-->A transversion, A-->G transition, 1 case of C-->G, T-->G transversion respectively. 5. We could find out point mutations more conveniently using PCR-Automated Direct Sequencing method.
Ameloblastoma ; Carcinoma, Adenoid Cystic ; Codon ; Codon, Terminator ; DNA ; Exons ; Genes, p53 ; Genes, Tumor Suppressor* ; Neurilemmoma ; Point Mutation ; Polymerase Chain Reaction

Deglutition ; Fistula ; Humans ; Jaw ; Korea ; Mandible ; Mouth ; Neck Dissection ; Osteotomy ; Postoperative Complications ; Surgery, Oral ; Wounds and Injuries

To investigate epithelial cell proliferation reactivity in the odontogenic cysts, the expression of c-erbB-2 oncoprotein by epithelial lining was studied in odontogenic keratocyst(OKC, n=10), dentigerous cyst(DC, n=12), radicular cyst(RC, n=12) and normal dental follicle(n=7). The c-erbB-2 immunoreactivity was studied using a streptavidine- biotin- peroxidase method with polyclonal rabbit anti-human antibody to c-erbB-2 oncoprotein which is known to react with formalin fixed, paraffin-embedded sections and the intensity of staining was determined by manually. In all of 10(100%) OKCs, showed positive expression for c-erbB-2 oncoprotein compared with 10/12(83.3%) in DCs, 11/12(91.7%) in RCs and 5/7(71.4%) in normal dental follicles. The expression within OKC was higher than that of DC, RC and dental follicle but statistically not significant(p>0.05) and but may reflects underlying genetic defect. These results demonstrate differences in c-erbB-2 expression between the epithelial linings of the three major odontogenic cyst types, indicating differences in proliferation activity and differentiation processes within these lesions. And, in particular, these results are able to explain the peculiar aggressive growth pattern of OKC.
Dental Sac ; Epithelial Cells ; Formaldehyde ; Immunohistochemistry ; Odontogenic Cysts* ; Peroxidase

INTRODUCTION: Limited mouth opening is a representative clinical symptom of temporomandibular disorders (TMD) with anterior disc displacement without reduction (ADDWOR). Various treatment methods have been proposed for patients with ADDWOR. This study examined the clinical effectiveness of template therapy for patients with mouth opening difficulty due to the ADDWOR. MATERIALS AND METHODS: A total of 14 patients (female 12, male 2, average age: 29.1+/-14.4), who had been treated in the template clinic, Sooncheonhyang University Bucheon Hospital, from January of 2006 to December of 2008, were enrolled in this study. The subjects were selected according to the following criteria: more than 2 weeks after the onset of locking, mouth opening range < 35 mm, and confirmed ADDWOR without a synovial pathology by magnetic resonance imaging (MRI). All patients were treated with the template appliance, instructed to wear it while sleeping and exercise for at least 10 hours per day. The maximum mouth opening (MMO) range and pain recognition scores before and after template therapy were recorded and compared. A paired t-test and Wilcoxon's signed rank test were used for statistical analysis. RESULTS: After the periodical follow up, significant improvement in the opening range was observed in the template treatment group. The average MMO range before treatment was 30.2+/-3.5 mm and the average MMO after treatment and follow up was 47.1+/-4.7 mm. The mean amount of mouth opening increment was 16.9+/-5.4 mm (P<0.01) and the pain recognition scores before and after treatment was also improved.(P=0.001) CONCLUSION: The template appliance proved to be efficient for the treatment of TMD with a closed lock and painful joint due to ADDWOR.
Displacement (Psychology) ; Follow-Up Studies ; Humans ; Joints ; Magnetic Resonance Imaging ; Male ; Mouth ; Range of Motion, Articular ; Temporomandibular Joint ; Temporomandibular Joint Disorders

No abstract available.
Anesthesia* ; Anesthesia, General* ; Humans

Purpose: Dental implant-associated medication-related osteonecrosis of the jaw has been frequently reported in patients administered bisphosphonates (BPs) to prevent osteoporosis. The aim of this study was to investigate the effect of intermittent administration of parathyroid hormone (PTH) on peri-implant bone in the maxillae of ovariectomized rats systemically administered BPs. Methods: Thirty 8-week-old female Sprague-Dawley rats were randomly divided into 3 groups. The OVX-ZP group included ovariectomized rats administered 60 μg/kg of zoledronate once a week for 6 weeks and 30 μg/kg PTH after implant installation. The OVX-Z group included ovariectomized rats administered 60 μg/kg of zoledronate once a week for 6 weeks and saline after implant installation, and the control group included rats that underwent a sham operation and were then administered saline. Rats were sacrificed 4 weeks after implant placement for histomorphometric and micro-computed tomography (CT) analyses. Results: The average bone area percentage was greater in the OVX-ZP group than in the OVX-Z group (53.4%±4.0% vs. 28.9%±9.5%, P=0.01). The bone-to-implant contact ratio was 50.8%±1.4% in the OVX-ZP group and 16.9%±2.4% in the OVX-Z group (P=0.012). The average bone volume ratio as shown on micro-CT was 31.3%±19.8% in the OVX-ZP group and 19.4%±9.3% in the OVX-Z group (P=0.045). The OVX-ZP and OVX-Z groups displayed similar trabecular thickness (0.06±0.004 mm vs. 0.06±0.002 mm) (P>0.05) and trabecular separation (0.21±0.02 mm vs. 0.29±0.13 mm) (P>0.05). However, the number of trabeculae in the OVX-ZP group was significantly higher than that in the OVX-Z group (4.3±1.33/mm3 vs. 2.2±0.19/mm3) (P=0.024). Conclusions The present findings indicate that intermittently-administered PTH can promote peri-implant bone formation and suggest that PTH administration may aid in effective treatment for medication-related osteonecrosis of the jaw after dental implantation.

Basaloid squamous cell carcinoma (BSCC) is uncommon and distinct variant of squamous cell carcinoma that arises mostly in the upper aerodigestive tract and aggressive, high grade tumor with an increased tendency to be deeply invasive, multifocal, and metastatic even at the initial presentation. The typical microscopic features of carcinoma with a basaloid pattern in intimate association with a squamous component helps in diagnosis of this tumour. Since Wain's report in 1986, BSCC of oral cavity, the palate, floor of the mouth, nasopharynx, oropharynx and mastoid region have been reported. However, BSCC in the nasal cavity or in the paranasal sinuses is rare and there are few reports in the Korean literature. We had experienced a case of basaloid squamous cell carcinoma that occurred in the left maxillary sinus of 72-year-old woman and reported with review of the clinical and pathologic features from the literature.
Aged ; Carcinoma, Squamous Cell* ; Diagnosis ; Female ; Humans ; Mastoid ; Maxillary Sinus* ; Mouth ; Nasal Cavity ; Nasopharynx ; Oropharynx ; Palate ; Paranasal Sinuses

BACKGROUND AND OBJECTIVES: To determine the anatomic position of the inferior alveolar nerve (IAN) canal in patients with mandibular prognathism using the cone-beam CT (CBCT). MATERIALS AND METHODS: Fifty rami from 25 patients were evaluated. The images were taken by i-CAT and reconstructed 3-dimensionally using the Simplant 11 program. The linear distances between the IAN canal to the buccal cortex (a, a* and a**), from the IAN canal to the alveolar crest (b and b*) and the anterior margin (b**) and finally the buccal cortical thickness (c, c* and c**) were measured at three reference planes (VP, OP and HP). RESULTS: On the left side, the average distance of a, b and c were 7.12, 15.96 and 3.60 mm on the VP plane, respectively. On the OP, the distance of a*, b* and c* was 6.11, 8.83 and 2.63 mm. For the HP, the distance of a**, b** and c** was 4.84, 10.11 and 2.30 mm. On the right side, the distance of a, b and c, on the VP, was 7.10, 16.13 and 3.42 mm, respectively. On the OP, the distance of a*, b* and c* was 4.77, 8.75 and 2.68 mm. On the HP, the distance of a*, b* and c** was 4.55, 9.84 and 2.38 mm. Regarding the difference between genders, the distance in male's was longer than female's on the VP (p=0.019), and was thicker in males than females on the HP (p=0.002). CONCLUSION: The CBCT data provided accurate information about the location and course of the IAN.
Cone-Beam Computed Tomography ; Female ; Humans ; Male ; Mandibular Nerve ; Prognathism

BACKGROUND AND OBJECTIVES: To determine the anatomic position of the inferior alveolar nerve (IAN) canal in patients with mandibular prognathism using the cone-beam CT (CBCT). MATERIALS AND METHODS: Fifty rami from 25 patients were evaluated. The images were taken by i-CAT and reconstructed 3-dimensionally using the Simplant 11 program. The linear distances between the IAN canal to the buccal cortex (a, a* and a**), from the IAN canal to the alveolar crest (b and b*) and the anterior margin (b**) and finally the buccal cortical thickness (c, c* and c**) were measured at three reference planes (VP, OP and HP). RESULTS: On the left side, the average distance of a, b and c were 7.12, 15.96 and 3.60 mm on the VP plane, respectively. On the OP, the distance of a*, b* and c* was 6.11, 8.83 and 2.63 mm. For the HP, the distance of a**, b** and c** was 4.84, 10.11 and 2.30 mm. On the right side, the distance of a, b and c, on the VP, was 7.10, 16.13 and 3.42 mm, respectively. On the OP, the distance of a*, b* and c* was 4.77, 8.75 and 2.68 mm. On the HP, the distance of a*, b* and c** was 4.55, 9.84 and 2.38 mm. Regarding the difference between genders, the distance in male's was longer than female's on the VP (p=0.019), and was thicker in males than females on the HP (p=0.002). CONCLUSION: The CBCT data provided accurate information about the location and course of the IAN.
Cone-Beam Computed Tomography ; Female ; Humans ; Male ; Mandibular Nerve ; Prognathism