Radiation-induced oral mucositis is an oral mucosal injury caused by radiation ionizing radiation, which often manifests as oral mucosal congestion, erosion, and ulcers. Radiation-induced oral mucositis manifesting as vascular proliferative changes in the oral mucosa has not been reported. We report a case of oral mucosal atypical vascular proliferation after radiotherapy for a malignant maxillofacial tumor. We discussed the mechanism and treatment of aty-pical vascular proliferation in the oral mucosa secondary to radiotherapy, including diagnosis, treatment, and previous literature.
Humans ; Stomatitis/therapy* ; Radiation Injuries ; Mouth Mucosa ; Neoplasms/complications* ; Cell Proliferation

BACKGROUND: Trichloroacetic acid (TCA) is an agent widely applied in dermatology for skin regeneration. To test whether TCA can offer an advantage for the regeneration of oral soft tissue defects, the cellular events following TCA application were explored in vitro and its influence on the oral soft tissue wound healing was evaluated in a canine palate model.METHODS: The cytotoxicity and growth factor gene expression in human gingival fibroblasts were tested in vitro following the application of TCA at four concentrations (0.005%, 0.05%, 0.5% and 1%) with different time intervals (0, 3, 9 and 21 h). One concentration of TCA was selected to screen the genes differentially expressed using DNA microarray and the associated pathways were explored. TCA was injected in open wound defects of the palatal mucosa from beagle dogs (n = 3) to monitor their healing and regeneration up to day 16-post-administration.RESULTS: While the 0.5–1% concentration induced the cytoxicity, a significantly higher expression of growth factor genes was observed after 3 and 9 h following the 0.5% TCA application in comparison to other groups. DNA microarray analysis in 0.5% TCA group showed 417 genes with a significant 1.5-fold differential expression, involving pathways of cell cycle, FoxO signaling, p53 signaling, ubiquitin mediated proteolysis and cAMP signaling. In vivo results showed a faster reepithelialization of TCA-treated wounds as compared to spontaneous healingCONCLUSION: TCA promoted the healing and regeneration of oral soft tissue wound defects by up-regulating the cell cycle progression, cell growth, and cell viability, particularly at a concentration of 0.5%.
Animals ; Cell Cycle ; Cell Survival ; Dermatology ; Dogs ; Fibroblasts ; Gene Expression ; Humans ; In Vitro Techniques ; Mouth Mucosa ; Mucous Membrane ; Oligonucleotide Array Sequence Analysis ; Palate ; Proteolysis ; Regeneration ; Skin ; Trichloroacetic Acid ; Ubiquitin ; Up-Regulation ; Wound Healing ; Wounds and Injuries

BACKGROUND: As harvesting techniques have improved the viability of transposed adipose tissue, autologous fat transfer is increasingly utilized for facial augmentation. Conventional techniques involve placing harvested fat deep in subcutaneous tissue through skin punctures. Trans-oral fat injections at the buccal and labial sulci and through the mucosa of the oral commissures obviate external scars. We report experience with this technique for augmentation of the cheeks, zygomatic arch, nasolabial folds, upper and lower lips, and chin in 130 patients over a 14-year period. METHODS: We report an observational case series of 147 procedures performed in 130 patients (118 women and 12 men, 19-69 years of age) in which 10 to 60 mL autologous fat supernatant harvested from the hips, buttocks, or abdomen were injected through the oral mucosa for augmentation. Single preoperative doses of antibiotic and methylprednisolone were administered in all cases. Fat frozen and banked during initial treatments was used for additional augmentation 3 to 6 months after initial treatments in 46% of cases. Outcomes were assessed clinically with physical exams and photographs. RESULTS: Mucosal puncture wounds healed uneventfully. Most patients tolerated the procedures well and recovered rapidly compared to historical experience with conventional percutaneous techniques. One patient developed a sterile seroma 3 weeks after facial augmentation that responded to needle aspiration. CONCLUSIONS: Transmucosal, intra-oral autologous fat grafting was associated with minimal visible scarring, swelling, or infection at the recipient site. This technique may be considered an alternative to percutaneous transfer for proximate peri-oral facial augmentation.
Abdomen ; Adipose Tissue ; Buttocks ; Cheek ; Chin ; Cicatrix ; Cosmetic Techniques ; Female ; Hip ; Humans ; Lip ; Male ; Methylprednisolone ; Mouth Mucosa ; Mucous Membrane ; Nasolabial Fold ; Needles ; Punctures ; Reconstructive Surgical Procedures ; Rejuvenation ; Seroma ; Skin ; Subcutaneous Fat ; Subcutaneous Tissue ; Tissue Transplantation ; Transplants ; Wounds and Injuries ; Zygoma

OBJECTIVEThe effect of Kou Yan Qing Ke Li on the prevention and treatment of radiation-induced oral mucositis was investigated in patients with nasopharyngeal carcinoma.

METHODSSixty patients with nasopharyngeal carcinoma to be treated with radiotherapy were randomized into two groups: the experimental and control groups. The experimental group (30 patients) was treated with Kou Yan Qing Ke Li during the full course of radiotherapy. The control group (30 patients) rinsed their mouths in the same way with mouth washes containing 0.9% sodium chloride injection, lidocaine, dexamethasone, vitamin B2 and B2 gargle liquid mixture, when grade 2 and above radiation-induced oral mucositis appeared in the process of radiation. Radiation-induced oral mucositis was assessed according to the radiation therapy oncology group criteria. The time of occurrence and degree of pain grade were compared between the two groups.

RESULTSThe first onset of oral mucositis in the experimental group (12.40 d ± 2.74 d) was later than that in the control group (9.46 d ± 1.39 d) (t = 5.241, P < 0.001), whereas the grade of pain and acute radiation mucositis was lower in the experimental group than that in the control group. The difference was statistically significant.

CONCLUSIONKou Yan Qing Ke Li could delay the time of occurrence of radiation-induced oral mucositis, reduce the severity of radiation stomatitis, alleviate the pain of patients, improve the clinical symptoms of patients, and effectively prevent and treat radiation-induced oral mucositis in patients with nasopharyngeal carcinoma.

Carcinoma ; Humans ; Lidocaine ; Mouth Mucosa ; Mouthwashes ; Nasopharyngeal Neoplasms ; Pain ; Radiation Injuries ; Stomatitis

Penile amputation is a rare catastrophe and a serious complication of circumcision. Reconstruction of the glans penis may be indicated following amputation. Our report discusses a novel technique for reconfiguration of an amputated glans penis 1 year after a complicated circumcision. A 2-year-old male infant presented to us with glans penis amputation that had occurred during circumcision 1 year previously. The parents complained of severe meatal stenosis with disfigurement of the penis. Penis length was 3 cm. Complete penile degloving was performed. The distal part of the remaining penis was prepared by removing fibrous tissue. A buccal mucosal graft was applied to the distal part of the penis associated with meatotomy. The use of a buccal mucosal graft is a successful and simple procedure with acceptable cosmetic and functional results for late reconfiguration of the glans penis after amputation when penile size is suitable.
Amputation, Traumatic/*surgery ; Child, Preschool ; Circumcision, Male/adverse effects ; Humans ; Male ; Mouth Mucosa/*transplantation ; Penis/*injuries/*surgery ; Reconstructive Surgical Procedures/*methods

OBJECTIVETo summarize the clinical experience for the reconstruction of upper lip defects in different degrees.

METHODSDifferent treatment methods were selected to reconstruct the upper lip defects according to the subunit, size or location of defects on the upper lip. The therapeutic results were analyzed and compared.

RESULTSFrom Jan. 1998 to Apr. 2012, 243 cases with upper lip defects were treated, including 85 cases of traumatic defects, 110 cases of defects secondary to lip cleft and 48 cases of defects after tumor resection. 48 cases were treated with direct closure, 69 cases with cross-lip flaps, 5 Cases with orbicularis oris muscle flaps, 53 cases with unilateral labial flaps, 42 cases with bilateral labial flaps, 22 cases with lower lip flaps, and 1 case with forehead flap, 1 case with forearm flap and 2 with nasolabial fold flaps. The patients were followed up for 3-18 months with satisfactory results.

CONCLUSIONSSatisfactory results could be achieved for upper lip defects with appropriate treatment methods according to the defects degree and characters.

Cleft Lip ; surgery ; Cosmetic Techniques ; Dermatologic Surgical Procedures ; methods ; Humans ; Lip ; injuries ; surgery ; Mouth Mucosa ; Surgical Flaps ; Treatment Outcome

OBJECTIVETo observe the effect of Yangyin Humo Decoction (YHD) on oral mucomembranous reaction in patients with head-neck tumor undergoing radiotherapy.

METHODSForty-Forty-two patients with head-neck tumor undergoing radiotherapy were randomized equally into two groups. The two conventional Western medical treatment was administered to all, including intravenous dripping of 2% lidocaine 20 mL, dexamethasone 5 mg, gentamycin 80,000 units, vitamin B(12) 5 mg, dissolved in saline 250 mL, and 5% sodium bicarbonate solution for gargling, but to the patients in the tested group, YHD was given additionally. The medication was started simultaneously all through the whole course of the radiotherapy. Patients were examined every day to observe and compare the degree, initiating time, and repairing time of their oral lesions; the dosage of radiation they received was recorded as well.

RESULTSThe degree of mucomembranous reaction that appeared in most patients in the test group was of grade 1-2, while in the control group, it was grade 2-3. The average time for oral lesion of 1, 2, 3 grades to be initiated in the test group was 12.0+/-1.1, 11.0+/-1.3 and 10.0+/-0.8 days, respectively, after radiation started, which was later than that in the control group (P<0.01). Moreover, the average repairing time for the lesions of grades 1, 2, and 3 in the test group was 3.0+/-0.7, 10.0+/-1.3 and 19.0+/-0.8 days, which were shorter than those in the control group respectively (P<0.01). The radiation applied on the primary tumor of patients with oral lesion of grade 1-3 in the test group was 24.2+/-2.2, 42.0+/-2.6 and 58.0+/-1.6 Gy on the average, respectively, which were higher than that applied on patients in the control group (P<0.05 or P<0.01).

CONCLUSIONThe Chinese herbal preparation YHD could alleviate oral mucomembranous reaction to radiation applied in patients with head-neck tumor.

Adult ; Aged ; Combined Modality Therapy ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Female ; Head and Neck Neoplasms ; drug therapy ; pathology ; radiotherapy ; Humans ; Lymphoma ; drug therapy ; pathology ; radiotherapy ; Male ; Middle Aged ; Mouth Mucosa ; drug effects ; pathology ; radiation effects ; Radiation Injuries ; pathology ; prevention & control ; Radiation-Protective Agents ; pharmacology ; therapeutic use ; Radiotherapy Dosage ; Time Factors ; Wound Healing ; drug effects

PURPOSE: In spite of various advantages of hyaluronic acid in wound healing, there are few research about wound healing process and period in oral and maxillofacial surgery. So, We evaluated the effects of local application of hyaluronic acid gel on wound healing of the oral mucosa using this animal model. MATERIALS AND METHODS: Young adult New Zealand White rabbits, weighting between 2.5 and 3.0kg, were used. Almost uniform round ulcerscould be created on the gingival of the rabbits by chemical injury with acetic acid. In experimental group, hyaluronic acid gel was applied daily until the wounds healed and in control group, ulcer lesion was not any treatment. The lengths of ulcers were measured the longest and shortest axes of the ulcers and calculated the areas of ulcer. For histological examination, specimens were made, and observed under a light microscope. RESULTS: The results showed that the number of fibroblasts, new blood vessels and the epithelial thickness from experimental group was higher than from control group. Hyaluronic acid promoted proliferation of the fibroblast, keratinocytes isolated from gingival tissue of rabbits in vitro. Topical application of hyaluronic acid accelerated healing of ulcers created in rabbits. CONCLUSION: The hyaluronic acid may be effective for wound healing of oral mucosal lesions.
Acetic Acid ; Blood Vessels ; Fibroblasts ; Humans ; Hyaluronic Acid* ; Keratinocytes ; Models, Animal ; Mouth Mucosa* ; Rabbits ; Surgery, Oral ; Ulcer ; Wound Healing ; Wounds and Injuries ; Young Adult

Reversible thermal injury to the esophagus as the result of drinking hot liquids has been reported to generate alternating white and red linear mucosal bands, somewhat reminiscent of a candy cane. This phenomenon is associated with chest pain, dysphagia, odynophagia, and epigastric pain. Here, we report a case of thermal injury to the esophageal and oral cavity due to the drinking of hot tea, including odynophagia and dysphagia. A 69-year-old man was referred due to a difficulty in swallowing which had begun a week prior to referral. The patient, at the time of admission, was unable to swallow even liquids. He had recently suffered from hiccups, and had consumed five cups of hot adlay tea one week prior to admission, as a folk remedy for the hiccups. Upon physical examination, the patient's oral cavity evidenced mucosal erosion, hyperemia, and mucosa covered by a whitish pseudomembrane. Nonspecific findings were detected on the laboratory and radiological exams. Upper endoscopy revealed diffuse hyperemia, and erosions with thick and whitish pseudomembraneous mucosa on the entire esophagus. The stomach and duodenum appeared normal. We diagnosed the patient with thermal esophageal injury inflicted by the hot tea. He was treated with pantoprazole, 40 mg/day, for 14 days, and evidenced significant clinical and endoscopic improvement.
Tea/*adverse effects ; Mouth Mucosa/injuries ; Male ; Humans ; Heat/adverse effects ; Esophagus/*injuries ; Deglutition Disorders/*etiology ; Chest Pain ; Burns/drug therapy/*etiology/physiopathology ; Anti-Ulcer Agents/therapeutic use ; Aged ; 2-Pyridinylmethylsulfinylbenzimidazoles/therapeutic use

OBJECTIVETo evaluate the safety and efficacy of oral endotracheal intubation in the patients with difficult laryngoscopy undergoing general anesthesia.

METHODSA total of 1 683 patients with difficult laryngoscopy, aged 1.5-67 yr, and scheduled for the elective plastic surgery were observed in this study from 1989-1997. All these patients were at American Society of Anesthesiologist physical status I. According to the preoperative predictive results for difficult laryngoscopy, we classified these patients into two groups: Group I included 1 375 patients, whose epiglottis could be viewed (laryngoscopic view grades II and III); and Group II, included 308 patients, whose epiglottis could not be viewed (laryngoscopic view grade IV). For group I, anesthesia was induced with thiopentone 4-5 mg/kg and succinylcholine 1 mg/kg; Laryngoscopy was carried out using modified Macintosh method. For Group II, anesthesia was induced with a total intravenous anesthesia or inhaled anesthesia; anesthetic depth was required to effectively inhibit laryngeal reflexes with reservation of spontaneous breathing. Tracheal intubation was performed by fiberoptic stylet laryngoscope (FOSL). During anesthesia induction and tracheal intubation procedures, electrocardiogram, arterial pressure, heart rate and pulse oxygen saturation (SpO2) were continuously monitored. Complications of intubation (arrhythmia, and so on) were observed and recorded. Immediately after laryngoscopy and successful intubation, patients were examined for any traumatic injuries at teeth, lips, tongue, and oropharyngeal tissues.

RESULTSIn group I, tracheal intubation was accomplished by the first attempt in 1 279 cases (93.0%) and the intubation time was less than 3 min in 1 304 cases (94.8%). In group II, tracheal intubation was accomplished by the first attempt in 114 patients (37.0%), and 123 patients (39.9%) had the intubation time of less than 3 min. Tracheal intubation was successful by the second or third attempt in 96 patients of group I and 156 patients of group II, respectively. Thirty-eight patients required four or more attempts, which only occurred in group II. Of all the complications of tracheal intubation, the traumatic complications were most common. The incidences of traumatic complications in the patients with laryngoscopic view grade II, III (group I ) and IV (group II) were 0.7%, 3.9% and 14.3%, respectively. Other complications such as respiratory depression were only seen in group II. A pooled incidence of the intubation complications was 6.7% (113/1 683).

CONCLUSIONAn anesthesiologist who is skillful in difficult airway management may safely manage the airway in the patients with difficult laryngoscopy under general anesthesia.

Adolescent ; Adult ; Aged ; Anesthesia, General ; Child ; Child, Preschool ; Dyspnea ; etiology ; Female ; Humans ; Infant ; Intubation, Intratracheal ; adverse effects ; methods ; Laryngoscopy ; Lip ; injuries ; Male ; Middle Aged ; Mouth Mucosa ; injuries