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Recurrent sinus of the cheek due to a retained foreign body: report of an unusual case.

Pathological sinuses in the maxillofacial region are frequently encountered in clinical practice. These sinuses may be a sequelae of periapical and periodontal pathologies or infections like osteomyelitis, actinomycosis etc. Classical clinical symptoms and radiographic features accompany all these infections. Rarely, sinuses in the oro-facial region can be sequelae of retained occult foreign bodies like wood in the soft tissues. We report a case of recurrent sinus of the cheek caused by an occult wooden splinter and discuss its diagnosis and clinical management.

Adult↗

Cheek pressure and head posture.

Maxillary cheek pressures are measured in the molar area, at the teeth and high in the buccal sulcus, in both natural and extended head positions, with teeth at rest and in function. Highest pressures are found on the alveolar process, with some increases with the head extended and the jaw at dental rest position.

Adult↗

Alveolar soft-part sarcoma of the cheek.

Alveolar soft-part sarcoma is a rare malignant tumour of uncertain histogenesis, the two main sites of which are the lower extremities in adults and the head and neck in children. We know of only three case reports of intraoral locations without tongue involvement. Here, we describe the first case of an alveolar soft-part sarcoma of the cheek which presented in a patient over 30 years old and had an extremely rapid and eventually fatal evolution. We have also reviewed hypotheses about its aetiology.

Biopsy↗

Nasolabial fasciocutaneous free flap for cheek defects.

The nasolabial fasciocutaneous free flap provides another option for the reconstruction of cheek defects. The flap can offer excellent skin texture and color match, precise donor and recipient vessel size match, and the potential for a superior donor-site scar.

Carcinoma, Squamous Cell↗

[Provocable tumor of the cheek as a manifestation of so-called "infiltrating lipoma" of the masseter muscle].

We report on a 29-year-old male patient, who presented at our outpatient clinic with a 6-year history of progressive swelling of the right cheek. Contraction of the masseter muscle increased the swelling. MR-Imaging revealed a tumor measuring 2 x 3 cm, which was located within the masseter muscle. The histological diagnosis was infiltrating lipoma, which to our knowledge has not been described in this area before. This particular type of lipoma is extremely rare in the head and neck. The diagnostic and therapeutic management of infiltrating lipoma is discussed, and guidelines for adequate follow-up suggested. In addition, the authors review other sites of this tumor and describe its histological characteristics and differential diagnosis.

Adult↗

Pemphigus vulgaris localized to the nose and cheeks.

Pemphigus vulgaris is an autoimmune blistering disease characterized by disseminated bullae and erosions of the mucosal surfaces and skin. Cases of pemphigus vulgaris with localized lesions on glabrous skin have been reported, and most of them have been attributed to the Koebner phenomenon. Lesions limited to the nose have mostly been described in pemphigus foliaceus, but the nose has also been the initial site of pemphigus vulgaris in a few patients. We report 4 cases of localized pemphigus vulgaris: one case with lesions limited to the nose and cheeks and 3 cases with isolated lesions on the nose. Recurrent episodes in these patients also occurred on the nose. None of them showed mucosal involvement or dissemination during a follow-up period of 2 to 9 years. Three patients had autoantibodies against desmoglein-3 as detected by immunoblot. In the other patient, antibodies against desmoglein-3 were detected by enzyme-linked immunosorbent assay. These localized lesions may represent a subgroup of pemphigus vulgaris or a period of limited activity during this chronic disease.

Adult↗

Congenital aplasia of the parotid gland with omolateral cheek angioma: case report and review of the literature.

Congenital agenesis of the parotid gland is a rare entity whose etiopathogenesis is still unclear. It is usually bilateral and is sometimes associated with other developmental anomalies of the head and neck region. A case is presented in which aplasia of the right parotid gland was associated with an omolateral angioma of the cheek. The radiological diagnostic approach and a review of the literature on agenesis of the salivary glands are presented.

Cheek↗

Cutaneous embryonal rhabdomyosarcoma presenting as a nodule on cheek; a case report and review of literature.

We report a case of primary cutaneous rhabdomyosarcoma, solid embryonal type, presenting as a rapidly enlarging nodule on the right cheek of a 7-year-old boy. This lesion had begun as a pea-sized nodule 8 months previously, and, with suspected abscess, had been incised. It recurred 2 months later; at that time, incisional biopsy was consistent with malignant round cell tumor. Wide local excision of the tumor was then completed. Subsequent immunohistochemical staining with desmin and myoglobin confirmed embryonal rhabdomyosarcoma. The patient underwent radiation therapy followed by chemotherapy and continues to be disease free at 14 months after his wide local excision. Rhabdomyosarcoma presenting as a dermal nodule is rare. It usually presents as an asymptomatic papule without distinctive clinical features and therefore may result in delayed diagnosis unless a biopsy is performed.

Cheek↗

Protective effects of S-allylcysteine on hepatic glutathione and glutathione-dependent enzymes during hamster cheek pouch carcinogenesis.

The effects of S-allylcysteine (SAC) on hepatic lipid peroxidation and antioxidant status during 7,12-dimethylbenz[a]anthracene (DMBA)-induced hamster buccal pouch carcinogenesis (HBP) were investigated in male Syrian hamsters. Enhanced lipid peroxidation in the liver of tumour-bearing animals was accompanied by significant decreases in the activities of glutathione peroxidase (GPx) and glutathione S-transferase (GST) and a reduction in reduced glutathione (GSH) levels. Administration of SAC significantly decreased the formation of lipid peroxides and enhanced the levels of antioxidants and detoxifying enzymes. We suggest that the elevation of hepatic GSH and GSH-dependent enzymes by SAC may play a key role in preventing cancer development in the hamster cheek pouch.

9,10-Dimethyl-1,2-benzanthracene↗

Contribution of active membrane processes to conducted hyperpolarization in arterioles of hamster cheek pouch.

OBJECTIVE: Conduction of vasodilation triggered by acetylcholine (ACh) in arteriolar networks reflects hyperpolarization and its spread from cell to cell along the vessel wall. The amplitude and distance of the vasomotor response appear greater than can be explained by simple passive decay of the electrical signal. The authors tested the hypothesis that the conduction of hyperpolarization involves active membrane processes as the signal travels along the arteriolar wall. METHODS: Intracellular recordings of membrane potential were made from either the smooth muscle or endothelial cell layer of arterioles of the hamster cheek pouch in vivo. Acetylcholine was delivered onto an arteriole using microiontophoresis at defined distances from the recording site, and transient hyperpolarizations were recorded. The area enclosed by the transients (voltage x time integral below baseline) was measured and compared to the area expected if the hyperpolarization was spreading passively. RESULTS: In 11 of 15 recordings from smooth muscle and 5 of 7 from endothelium, areas of the transients were larger than expected for purely passive spread of the electrical signal. CONCLUSIONS: Conduction of hyperpolarization is enhanced by active membrane processes as the signal travels along the arteriolar wall. Signal augmentation will promote blood flow to tissue regions from which hyperpolarization of arterioles originates.

Acetylcholine↗

The lymphatic status of hamster cheek pouch tissue in relation to its properties as a graft and as a graft site.

Hamster cheek pouch skin, transplanted to the side of an isogenic host's chest wall, retains its immunologically privileged status as evidenced by the prolonged survival of inlaid homografts of ordinary skin. Various findings sustain the premise that exemption from rejection by otherwise susceptible homografts in both intact pouch tissue and in established pouch skin isografts is due to an impediment in the afferent pathway of the immunologic reflex, i.e., to deficient lymphatic drainage. Although lymphatics were not apparent when dye was injected into pouch skin grafts or into grafts of ordinary skin sustained by them, lymph vessels were readily and consistently revealed by dye injected into intact trunk skin or established isografts of trunk skin. When suspensions of viable lymph node cells from specifically sensitized parental strain donors were injected superficially into either the intact skin or established grafts of normal skin on F(1) hybrid hamsters, a striking hypertrophy of the regional lymph nodes occurred, due to graft-versus-host reactivity. However, similar cell suspensions inoculated into intact pouch tissue or into pouch skin grafts on F(1) hamsters incited no regional lymphadenopathy, indicating the lack of appropriate pathways to the nodes. When skin homografts were inlaid eccentrically into pouch skin isografts, so that they were in contact with host skin at one edge, rejection occurred. Furthermore, rejection of long-established intrapouch skin homografts resulted if the hosts received: (a) small homografts of ordinary skin transplanted to conventional beds; (b) suspensions of donor strain pouch skin epidermal cells, injected intracutaneously; (c) lymph node cells from specifically sensitized donors of the same strain, i.e. adoptive immunization; or, (d) if a portion of the target homograft's perimeter was surgically approximated to body skin. Treatment of normal hamsters with two closely spaced pulses of ALS, although only marginally effective in prolonging the lives of homografts of trunk skin, enabled pouch skin homografts to survive for very long periods. The influence of this brief treatment with immunosuppressant was still demonstrable if challenge of hosts with the weakly immunogenic pouch skin homografts was delayed for 100 days.

Animals↗

Experimental Staphylococcus infection in the hamster cheek pouch: the process of localization.

Small amounts of staphylococcus suspensions were injected into the cheek pouches of hamsters. Within 5 hours, the organisms were recovered from all outlying areas of the pouches, and in the following hours the entire structures showed vasodilation, edema, petechiae, and accumulation of leukocytes in the venules. Leukocytosis also occurred at this time. Between 24 and 48 hours, well defined abscesses developed at the sites of injection, and there was a sharp decrease in the bacteria in all other areas. From the 3rd day onward, organisms were only occasionally recovered from tissue outside the abscesses. At this period of localization, the generalized edema and petechiae also subsided, as did the leukocytosis. Localization of infection was not due to a walling off process, since the bacteria were disseminated through the entire pouches in the 1st few hours, but these organisms diminished rapidly, while those at the original injection sites continued to grow and reproduce for several days. Localization of infection appeared to be due to the inability of the bacteria carried away from the site of injection to reproduce. This in turn may have been due to dilution, to lack of sufficient toxin to produce a necrotic substrate, or to greater accessibility of these organisms to phagocytes.

Animals↗

Mint prevents shamma-induced carcinogenesis in hamster cheek pouch.

Shamma, a complex mixture of powdered tobacco, slaked lime, ash, oils, spices and other additives, has been linked to oral cancer in Saudi Arabia. Shamma varies in colour and odour due to the nature of the additives which characterize different brands. Using the Ames Salmonella assay, a chloroform extract of a brand named 'white shamma' (WSH) was found to be mutagenic, while that of a brand called 'brown shamma' (BSH), which is known to contain mint as a flavouring agent, was found to be non-mutagenic. Using HPLC, a mutagenic and a non-mutagenic fraction were isolated from the extract of BSH. The non-mutagenic fraction of BSH was found to neutralize the genotoxic effect of the mutagenic fraction when the two were recombined. A chloroform extract of mint showing no mutagenic activity in the Ames assay effectively inhibited the mutagenicity of carcinogens/mutagens like benzo[a]-pyrene, aflatoxin B1, methylmethane sulfonate and extract of WSH. A carcinogenicity assay designed to test the effects of WSH and BSH in the hamster cheek pouch model showed that the former was tumorigenic, while the latter was not. However, when crushed leaves of mint were mixed with powdered WSH (in 1:1 proportion), the tumorigenic effect of the latter was abolished. These data strongly suggested that mint has a chemopreventive effect against shamma-induced carcinogenesis, which could be due to its antimutagenic properties.

Animals↗

Cheek and lip pressure against maxillary dental arch during dummy sucking.

The sucking pattern and intra-oral negative air pressure were studied simultaneously with the cheek/lip pressure in 12 children when sucking a dummy. The cheek/lip pressure was measured at the canine and at the second primary molar on the right side of the upper dental arch. The cheek/lip pressure peaks followed the intra-oral negative air sucking pressure peaks continuously. In the canine region the mean value of maximum cheek/lip pressure was 54 g/cm2. The corresponding value at the second primary molar was 21 g/cm2. During dummy sucking the mean cheek/lip pressure was 3.4 times higher against the canine compared to the second molar (P less than 0.001). The intra-oral negative air pressure was approximately the same whether the cheek/lip pressure was measured at the canine or at the second primary molar. The results indicated that the circumoral muscles were especially active during dummy sucking, in addition to the cheek pressure in the canine region.

Cheek↗

Vascularization induced in the cheek pouch of the Syrian hamster by tumor and nontumor substances.

We tested fresh amelanotic and dry amelanotic melanoma tissue, gelatin, embryo and adult connective tissue, fresh and dry liver, fibrinogen, fibrin, pouch membrane, starch, dry hamster embryo and placental tissue, and glycogen in the transparent cheek pouch chamber of the Syrian hamster to explore the specificity of tumor angiogenesis and the mechanism that may selectively inhibit proliferation of blood vessels in the pouch membrane. Differences between the proliferations induced by tumor and normal tissues, various proteins, and polysaccharides were qualitative as well as quantitative. The glucocorticoid 6 alpha-methylprednisolone (MPS) decreased and sometimes totally inhibited the vascularization phenomenon. Dry tumor tissue induced capillary proliferation in seven of eight chambers 3 days after surgery; two of seven chambers of MPS-treated animals showed a reaction 10 days after the operation. MPS suppressed (in some cases only partially) capillary proliferation in chambers with implants of adult connective tissue, fresh liver, starch, or glycogen.

Animals↗

7,12-Dimethylbenz[a]anthracene adduct formation with Syrian hamster cheek pouch epithelial DNA: in vitro studies in organ explant culture.

Studies examined the binding of radiolabeled 7,12-dimethylbenz[a]anthracene (DMBA) to epithelial DNA of hamster cheek pouch (HCP) maintained in organ explant culture. Adduct formation was studied as functions of [3H]DMBA dose, of the time after single [3H]DMBA applications, and of the route by which the DMBA was administered--either topically or in the culture media. Total DMBA-DNA adduct formation [total binding index (TBI)] was determined by DNA-bound 3H activity, and qualitative binding characteristics were further studied by high-pressure liquid chromatography. [3H]DMBA was applied either in the culture media at concentrations of 0.005-0.5 micrograms/ml or topically in mineral oil or ethanol in doses of 0.005-0.5 micrograms to each tissue fragment. Histopathologic changes in DMBA-treated HCP fragments included substantial aberrations in maturation of cornified and keratin layers and focal squamatization and dysplasia of the basal epithelium--considerable tissue necrosis was encountered in the high-DMBA-dose groups. Dose-response data were qualitatively similar among treatment types, with the greatest TBIs in topical ethanol groups and the lowest TBIs in culture medium groups. Kinetics of adduct formation and removal showed a rapid increase in TBIs to peak values at 24-72 hours followed by a biphasic decrease in TBIs, which leveled off at 7%-20% of peak values at 120-240 hours. Chromatographic analyses of selected samples at various times from all treatment groups showed three major peaks that are likely to be the same 1,2,3,4-tetrahydro-3,4-dihydroxy-1, 2-oxide-deoxyribonucleoside adducts observed in other rodent in vivo and cell culture systems. These results are consistent with those of other laboratories studying DMBA-DNA interactions and suggest that in vitro studies of DMBA-treated HCP explants are useful in studying the molecular nature of DMBA-DNA interactions in oral mucosal carcinogenesis.

9,10-Dimethyl-1,2-benzanthracene↗

Effect of high-voltage pulsed current and alternating current on macromolecular leakage in hamster cheek pouch microcirculation.

BACKGROUND AND PURPOSE: Electrical stimulation (ES) is supposed to affect edema formation by inhibiting macromolecular leakage from microvessels. The purpose of the study was to determine the effects of various forms of ES on macromolecular leakage from microvessels. SUBJECTS: Fifty-three hamsters were randomly assigned to one of seven groups: a control group (histamine only); groups that received histamine with cathodal high-voltage pulsed current (HVPC) at intensities of 90%, 50%, and 10% of visible motor threshold (VMT); groups that received anodal HVPC at intensities of 90% and 50% of VMT; and a group that received alternating current (AC) at 90% of VMT. METHODS: Anesthetized animals were injected with fluorescein-labeled dextran. Macromolecular leakage was determined by computer analysis of fluorescence microscopy images for 5 minutes after treatment. RESULTS: When compared with controls, leakage was less in groups treated with cathodal HVPC at 90% and 50% of VMT and anodal HVPC at 90% of VMT. CONCLUSION AND DISCUSSION: Cathodal and anodal HVPC, but not AC, curb macromolecular leakage from the microvessels of histamine-treated hamsters. [Taylor K, Mendel FC, Fish DR, et al. Effect of high-voltage pulsed current and alternating current on macromolecular leakage in hamster cheek pouch microcirculation.

Animals↗