Prolonged paraesthesia.
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Biomedical subjects
Publications and source records attributed to J Pedlar.
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Expression of abnormal p53 protein is a widely recognised marker of malignancy including oral squamous cell carcinoma. This is a longitudinal study of p53 expression in fixed, paraffin-embedded tissue from 3 patients with multiple, recurrent, squamous cell carcinomas of floor of mouth (n = 4, 4, 3). All carcinomas demonstrated increased expression of p53 compared to normal tissues. However, there was reduction in expression from primaries to subsequent recurrent tumours in all 3 patients. The significance of reduction of expression of p53 in sequential recurrences is unclear, but as each of these patients has now survived for at least 5 years this may be a phenomenon indicating a favourable prognosis. As this study relates to only 3 patients, a larger study is needed to confirm this initial observation.
Twenty-six patients with clicking or locking of the temporomandibular joint (TMJ) and 28 age- and sex-matched controls were assessed for generalized joint hypermobility by BEIGHTON's method. Function of the masticatory apparatus was measured with FRICTON's Craniomandibular Index. The TMJ patients had significantly higher joint mobility scores, but within the patient group there was no correlation between either the dysfunction or palpation scores and the hypermobility scores. The findings are interpreted as supporting multiple causes of TMJ internal derangement, one of which is a systemic joint factor.
Over the years there have been sporadic reports of unusual cystic lesions of the jaws, not readily classified under conventional headings but which have been variously diagnosed as median-mandibular, glandular, sialo-odontogenic or botryoid odontogenic cyst. We present five cases which do not fit into other categories of odontogenic cyst, two of which have recurred within a few years of conservative treatment. This paper aims to alert clinicians to the propensity for regrowth of these cysts, proposes the term polymorphous odontogenic cyst for these lesions, to encompass their varied histological appearances and discusses their distinction from other cyst types with mucous and papillary formations in epithelium.
The mandibular infected buccal cyst occurs on the buccal and distal aspects of the roots of the partially or newly erupted first permanent molar. It typically affects children between the ages of 6 to 10 years and the associated first permanent molar is vital. The cyst is lined with a non-keratinised squamous epithelium with inflammatory cell infiltrate in the connective tissue. Most clinical and histological features are similar to those reported for paradental cysts.
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The British Association of Oral and Maxillofacial Surgeons and the Royal Colleges have rightly responded over the years to pressures within, and outside dentistry for higher levels of training in oral and maxillofacial surgery. There has been adoption of a series of qualification as, at first desirable, then mandatory for a trainee to be considered suitable to hold the rank of consultant. Over the last 20 years there has been a concomitant change in both the title held by consultants in our field, and the range of work they have expected, and been expected to undertake. I believe that although each individual step in these processes is understandable, and seems sensible, the overall effect is not as beneficial as had been hoped. Further, as the process seems to be continuing and possibly accelerating, the time has come to reevaluate the relationship of maxillofacial surgery to dentistry and the form of training best suited to producing maxillofacial surgeons.
The concentration of cephradine in serum and mandibular bone was assayed in 22 patients undergoing third molar surgery following a single 1-g intramuscular injection. Serum and cortical bone samples taken simultaneously contained mean cephradine concentrations of 12.41 micrograms/mL and 1.25 micrograms/g, respectively. These results, when compared with those reported for other bony sites, including femoral head and knee, show a reduced bone penetration with a bone-to-serum ratio of approximately 0.10:1.
Eighteen specimens of palatal mucosa were taken from 17 human subjects. Paraffin-wax sections were stained by routine methods and with various techniques to demonstrate glycosaminoglycans (GAG). In some sections, GAG were removed by selective degradative procedures before staining. Beneath all rugae, there were myxoid areas varying in size and marginal definition. Collagen fibres were few; elastic and reticulin fibres were numerous in a minority of sections. Alcianophilia at pH 2.5, preventable by streptomyces hyaluronidase digestion, suggested the presence of hyaluronic acid beneath the rugae. Alcian-blue staining at pH 1.0 and with the critical electrolyte concentration method using 0.5 M MgCl2 did not distinguish the myxoid tissue from the surrounding connective tissue and could be prevented by digestion with testicular hyaluronidase or chondroitinase ABC. Chondroitin sulphate and, or dermatan sulphate thus may be present but were not localized to the myxoid tissue. This unusual zone of loose connective tissue may act as a physical buffer resisting the local effects of high loads by allowing reversible extrusion of the water.
Diagnosis and management of swellings of the parapharyngeal space are difficult because of the inaccessibility of the region, which contains part of the parotid gland with major vascular and neural structures that may be subject to disease. An unusual case of a spherical mass with a calcified margin within the parapharyngeal space is presented; it illustrates an approach to diagnosis and management.
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Healing was observed for 6 months following excision of full thickness normal adult human palatal mucosa (approx 12 mm X 10 mm) to measure the degree of wound contraction and determine if rugae would regenerate. Measurements of plaster models showed stretching and displacement of soft tissue not involved in the original would toward the centre of the wound from 6 weeks postoperatively. The distance between the incisive papilla and the most posterior ruga on the side of operation reduced by 2.2 mm and the first ruga on the opposite side was stretched in length by 0.9 mm. A fragment of superficial bone (approx 10 mm X 7 mm) sequestrated at 5 weeks, epithelialisation was complete by 8 weeks but the rugae did not reform at all.
Glycosaminoglycans (GAG) were extracted by digestion with papain followed by ultrafiltration and separated by cellulose-acetate electrophoresis and by chromatography of their cetyl-pyridinium complexes on cellulose microcolumns. The uronic-acid content of the tissues ranged from 0.8 to 2.4 mg/g of dry defatted tissue. Hyaluronic acid and dermatan sulphate were found in all tissues with chondroitin-4-sulphate also in skin, palatal mucosa and gingiva. There was 3-fold more hyaluronic acid in palatal mucosa than in any other tissue; it was concentrated in the antemolar rugae. A substance of presumptive salivary origin staining with alcian blue was found in cheek and floor of mouth mucosa. It migrated differently from reference GAG by electrophoresis and was not degraded by testicular hyaluronidase.
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