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PubMed1991

Morsicatio buccarum et labiorum (excessive cheek and lip biting).

In some individuals habitual cheek and lip biting becomes a fixed neurosis. Pieces of oral mucosa are actually torn free from the surface, producing a distinctive clinical appearance termed morsicatio buccarum et labiorum. Sometimes it may be confused with other dermatological disorders involving the oral mucosa, and can lead to misdiagnosis. Most patients with this condition are unaware of their habit and will not aid in the diagnosis. We suggest that the histopathological features of this condition are distinctive, if not pathognomonic, and that an accurate diagnosis should be rendered if a biopsy sample is taken. Two cases are reported herein that were originally misdiagnosed as pemphigus, one of which resulted in complications of improper oral corticosteroid use.

Adult↗
PubMed1994

Pilomatrical carcinosarcoma of the cheek with subsequent pulmonary metastases. A case report.

We report a case of malignant pilomatrixoma with a pronounced biphenotypic morphology. The lesion, which was excised from the cheek of a 36-year-old man, was composed of a large pilomatrixoma lying within a spindled, sarcomatoid stroma. Fourteen months later, the tumor metastasized to the right upper lobe of the lung. We describe the tumor's pathology, histology, and immunochemistry and discuss the differential diagnosis. We also speculate on its histogenesis.

Adult↗
PubMed1998

Volatile anesthetic agents and vascular communication in the microcirculation of the hamster cheek pouch.

BACKGROUND: There is communication between tissue and the vascular network involved in regulating distribution of blood flow. Signals generated by the tissue are communicated upstream to create a coordinated network response in unison with other controllers of blood flow, such as myogenic and flow-dependent responses. METHODS: This vascular communication was modeled with the microapplication of methacholine (10(-4) M) or potassium chloride solution (KCl; 100 mM) to arterioles (40-60 microm in diameter) of the cheek pouch of anesthetized hamsters and viewed with videomicroscopy. Local and conducted (500 microm upstream) responses were measured. Halothane or isoflurane (1%, 2%, and 3%) was equilibrated with the superfusion solution and applied to the entire tissue. Responses to KCl and methacholine were then repeated in the presence of an anesthetic agent. RESULTS: Halothane and isoflurane increased the resting diameter of the arterioles. They also decreased the methacholine-initiated dilations. To test for the effects of increased resting diameter on the dilations, 0%, 5% and 10% oxygen alone was applied to the pouch to alter the tone, and the methacholine responses were repeated. The dilations decreased with oxygen-induced increases in resting diameter, but the conducted dilation decreased to a lesser extent than was seen with the volatile anesthetic agents. Neither halothane nor isoflurane decreased constrictions caused by KCl. CONCLUSIONS: Decreased methacholine-initiated conducted dilations caused by halothane and isoflurane were not due to decreases in cell-cell communication because KCl conducted responses persisted. Therefore, cell-cell vascular communication appears intact in the presence of clinical concentrations of halothane and isoflurane.

Anesthetics, Inhalation↗
PubMed1990

Full-thickness cheek and lip reconstruction with the radial forearm free flap.

The radial forearm free flap has proven versatility in head and neck reconstruction. It is superior to regional alternatives such as the pectoralis flap because it is thin, pliable, and predominantly hairless. A more recent application is the use of the folded forearm flap to replace both the skin and inner lining, simultaneously, in full-thickness cheek and lip defects. Nine such cases are presented in this report. Each patient had a recurrent lesion that had been reconstructed previously with local flaps, and all but one were treated with postoperative radiation therapy. The average size of the external defects after resection was 27 cm2, and of the intraoral defects, 18 cm2. All free flaps survived completely. The folded forearm flap solved the reconstructive problem for each patient in a single-stage procedure, providing good contour and a reasonable color match. The flap is easy to raise, has a long pedicle with large-diameter vessels, and has an acceptable donor site defect not associated with long-term morbidity.

Adult↗
PubMed2001

Primary one-stage reconstruction of cheek defect after a shotgun blast to the face: use of the latissimus dorsi musculocutaneous free flap for soft-tissue repair and facial reanimation.

The authors describe a case of a shotgun blast injury to the face in which early definitive repair of both facial soft tissues and facial reanimation was accomplished in one stage using a free flap. The trauma occurred 2 days before presentation via a hunting rifle fired at a short range. On examination, a 8 x 5-cm cheek defect was evident, involving the full thickness of the perioral facial mimetic muscles as well. A free latissimus dorsi musculocutaneous flap was transferred to the defect, with the thoracodorsal nerve coapted to an ipsilateral, severed buccal branch of the facial nerve. Postoperatively, the flap survived completely, with its skin paddle excised subsequently in two stages. Good muscle movement was obtained, providing resting symmetry and a pleasant smile. Other than soft-tissue and bony defects resulting from shotgun injuries, ablation of the facial nerve or facial mimetic muscles may be an important component of the defect that needs further consideration. The authors conclude that the current technique of one-stage, early definitive repair of soft tissues and facial reanimation in such cases of facial shotgun blast injury offers the advantages of achieving both goals with one flap and accomplishing the procedure primarily in one stage.

Adolescent↗
PubMed1993

Effects of Ruscus extract on the internal diameter of arterioles and venules of the hamster cheek pouch microcirculation.

In the present study, we investigated (a) the effects of the extract of Ruscus aculeatus, which is used to increase peripheral venous tone, on the diameter of arterioles (ID range 10-70 microns) and venules (ID range 20-135 microns) of hamster cheek pouch microvasculature in vivo and (b) the influence of temperature on the observed effects. For microcirculatory measurements, the preparations were placed under an intravital microscope and coupled to a closed-circuit TV (ccTV) system. The TV monitor display was used to obtain arteriolar and venular ID recordings (always at the same site) by an image shearing device. For systemic intravenous (i.v.) administration, the measurements were performed every 10 min, before (control) and after injection of the extract (5 mg/kg). During topical application, the extract was tested, in different concentrations, at 25 degrees, 36.5 degrees, and 40 degrees C. Systemic i.v. administration of Ruscus extract evoked venular constriction and did not affect the arteriolar diameter or mean arterial pressure (MAP). Topical application of Ruscus extract elicited concentration- and temperature-dependent responses in the vessels. At 25 degrees C, arterioles and venules dilated; at 36.5 degrees C, the arterioles remained unchanged while the venules constricted, and at 40 degrees C, the arterioles remained unchanged or constricted depending on the concentration used while the venules further constricted. The effects of Ruscus extract observed in vivo at the microcirculatory level further support the data previously reported on larger vessels and on patients with venous insufficiency.

Administration, Topical↗
PubMed1994

Possible mechanisms for the venular constriction elicited by Ruscus extract on hamster cheek pouch.

We investigated the influence of alpha-adrenoceptors blockers and calcium blockers on the effects of the venotonic agent Ruscus extract on the diameter of arterioles (ID 10-70 microns) and venules (ID 20-135 microns) of hamster cheek pouch microvasculature in vivo. For microcirculatory measurements, the preparations were placed under an intravital microscope coupled to a closed-circuit TV system. The TV monitor display was used to obtain arteriolar and venular internal diameter recordings (always at the same site) by an image shearing device. All drugs were applied topically. Ruscus extract was tested in different concentrations and in combination with prazosin (alpha 1-adrenoceptor antagonist), rauwolscine (alpha 2-adrenoceptor antagonist), or diltiazem (calcium blocker). Topical application of Ruscus extract elicited concentration-dependent responses in the studied vessels: arterioles remained unchanged in the concentration range tested, whereas venules remained unchanged or constricted depending on the concentration used. The observed venular constriction could be blocked by low concentrations (10(-9) M) of prazosin or diltiazem and by high concentrations (> 10(-6) M) of rauwolscine. Our results suggest that the venular constriction elicited by Ruscus extract in vivo, at the microcirculatory level, is mediated by calcium and by alpha-adrenoceptors and further support data previously reported on larger vessels and on patients with venous insufficiency.

Adrenergic alpha-Antagonists↗
PubMed1976

The superficial musculo-aponeurotic system (SMAS) in the parotid and cheek area.

We have investigated the superficial musculo-aponeurotic system (SMAS) in the parotid and cheek areas by anatomical dissections, by radiographs, and by histological sections. The SMAS may be helpful in corrective surgery for facial palsy and during face lifting operations if a retrofascial approach is used. This procedure, safe in the parotid area, can become dangerous in the area anterior to the parotid gland.

Cheek↗
PubMed1988

The double-door tongue flap for total cheek mucosa defects.

Lining of total cheek mucosa defects can be accomplished by opening the tongue along its lateral border and preparing two myomucosa flaps that can be swung upward and downward like a double door to be sutured into the defect. The tongue is released 3 weeks later in a second-stage operation. The operation is quick and easy compared with other methods to achieve lining for such defects. Tongue function is not impaired after healing of the second-stage operation.

Aged↗
PubMed1989

The retaining ligaments of the cheek.

The zygomatic ligaments (McGregor's patch) anchor the skin of the cheek to the inferior border of the zygoma just posterior to the origin of the zygomaticus minor muscle. The mandibular ligaments tether the overlying skin to the anterior mandible. Both these ligaments are obstacles to surgical maneuvers intended to advance the overlying skin. They also restrain the facial skin against gravitational changes, and they delineate the anterior border of the "jowl" area. The platysma-auricular ligament is a thin fascial sheet that extends from the posterosuperior border of the platysma and that is intimately attached to the periauricular skin; it serves as a surgical guide to the posterosuperior border of the platysma. The anterior platysma-cutaneous ligaments are variable fascial condensations that anchor the SMAS and platysma to the dermis. They can cause anatomic disorientation with dissection of false planes into the dermis. These four ligaments are useful as anatomic landmarks during facial dissections. The tethering effects of the zygomatic and mandibular ligaments must be interrupted if a maximum upward movement of the facial skin is desired.

Cheek↗
PubMed2001

The superiorly based nasolabial flap for simultaneous alar and cheek reconstruction.

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Understand the epidemiology of skin cancer in a patient with preexisting skin cancer. 2. Understand the indications for the use of a nasolabial flap and nonanatomic alar strut graft. 3. Describe the blood supply to the nasolabial flap. The goals of reconstructing deformities of the face acquired secondary to skin tumors include optimizing donor-site aesthetics and reconstructing the area with similar types of tissue when possible. Multiple skin-cancer defects are often seen by the plastic surgeon and complicate the reconstruction, requiring more than one flap or skin graft. A case analysis of an innovative application of the nasolabial flap for reconstruction of a simultaneous medial cheek and alar-base nasal defect is presented. Concepts in nasal reconstruction are reviewed, and the authors' approach to alar reconstruction is presented.

Aged↗
PubMed1994

Effects of NW-nitro-L-arginine and dexamethasone on early events following lipopolysaccharide injection: observations in the hamster cheek pouch microcirculation.

The effects of NW-nitro-L-arginine (L-NAG) and dexamethasone in the microcirculatory changes observed in early stages of endotoxemia was investigated in male hamsters treated with Escherichia coli lipopolysaccharide (LPS). The cheek pouch was studied in vivo by means of intravital microscopy and mean arterial and venous pressures, mean arteriolar internal diameter, spontaneous arteriolar vasomotion, microvascular blood flow, macromolecular permeability, leukocyte adhesion, and mean survival time were evaluated in animals treated with either LPS alone or the combination of LPS with L-NAG, an inhibitor of both the constitutive and inducible NO synthases (NOs). The intravenous injection of LPS (100 mg/kg) elicited a significant reduction in mean arterial blood pressure (MABP) and arteriolar blood flow. The observed arterioles dilated and the spontaneous vasomotion ceased. The combination LPS + L-NAG, both given intravenously, prevented the reduction of MABP and the vasodilation but did not help either the reduction of arteriolar blood flow or the cessation of vasomotion. In order to separate the effect of the two NOs, a group of hamsters was pretreated with dexamethasone (10 mg/kg, also intravenously) which inhibits the induction of the inducible NO synthase (iNOs). In this group, the hypotension, vasodilation, and cessation of vasomotion were prevented but the decrease in arteriolar blood flow was not affected. The mean survival time was significantly decreased by the combination of LPS + L-NAG (35 +/- 6 h) and significantly increased by the pretreatment with dexamethasone (92 +/- 5 h) compared to LPS alone (56 +/- 7 h).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2001

Effects of Ringer-acetate and Ringer-dextran solutions on the microcirculation after LPS challenge: observations in the hamster cheek pouch.

The effects of NaCl 0.9%, Ringer-acetate, and Ringer-dextran given as intravenous infusions in the microcirculatory changes observed in early stages of endotoxemia were investigated in male hamsters treated with Escherichia coli lipopolysaccharide (LPS). The cheek pouch was studied in vivo by means of intravital microscopy. Mean arterial (MAP) and venous pressures (CVP), heart rate, mean arteriolar internal diameter, spontaneous arteriolar vasomotion (AV), red blood cell velocity (RBCV) in these vessels, and long-term effects of LPS were evaluated in animals treated with either LPS alone or the combination of LPS with NaCl 0.9%, Ringer-acetate and Ringer-dextran. The intravenous injection of LPS (0.3 mg/kg) elicited a significant reduction in MAP and CVP, cessation of AV and a decrease in RBCV. In our study, the heart rate and the arteriolar diameter did not change significantly, compared with the control values obtained before the LPS injection. No improvement in the MAP could be detected with infusions of NaCl 0.9% or Ringer-acetate but the infusion of Ringer-dextran increased it significantly. All infusions tested maintained the CVP until the end of the observation period and the Ringer-dextran increased it significantly. The heart rate was maintained around 360 beats/min with a tendency to decrease 70 min after the LPS infusion in all groups studied except the group which received NaCl 0.9% where the heart rate decreased significantly. In all the four groups, the mean arteriolar diameter did not change significantly with time during the observed period. RBCV decrease with the combination LPS + NaCl 0.9% and the infusions of Ringer-acetate and Ringer-dextran maintained it until the end of the observation period. The combination of LPS + NaCl 0.9% maintained the spontaneous arteriolar vasomotion during 50 min after LPS injection and the infusion of Ringer-acetate maintained it for the 3-h observation period. The infusion of Ringer-dextran maintained the amplitude of the spontaneous arteriolar vasomotion and increased its frequency significantly. The long-term effects of LPS showed weight loss and pus on the periorbital area. Our results suggest that the best solution to maintain the microcirculatory parameters during the early stage of endotoxemia after LPS injection was the Ringer-dextran.

Animals↗
PubMed2005

Complete mobilization of the cheek zone for orbit exenteration.

Patients with malignant orbital tumors often undergo eyeball excision, orbital tissues and lids, which results in severe deformities. Our experience concerns the use of a skin fascial flap of the cheek zone, the V-Y design, in 10 patients after ocular malignant tumor resection. Seven patients had basal cell carcinomas of the lower lids with invasion of the ocular tissues. The complete tumor resection was controlled by frozen-section biopsy in all patients. The results were evaluated from an oncologic, functional, and aesthetic point of view. We noticed 2 recurrences in a minimum follow up of 2 years. The functional and aesthetic results were quite satisfactory and no serious complications were noticed in our series. The primary advantage of this interesting flap is the dominant vasculature derived from arteria transversa faciei, arteria facialis, and arteria infraorbitalis that secure good vascular contribution. It should be regarded as very useful for surface coverage problems at the orbit because it performs in a one-stage procedure with minimum morbility and good functional result.

Aged↗
PubMed1978

Quantitative histological changes during early experimental carcinogenesis in the hamster cheek pouch.

Sequential changes in the hamster cheek pouch epithelium following application of the carcinogen dimethyl benzanthracene have been assessed using stereological techniques. The most important progressive change found following cessation of carginogen painting appears to be an increase in the number and size of progenitor cells. Much of the marked increase in stratum corneum thickness seen in the early stages appeared to be related to a hyperplasiogenic rather than a neoplasiogenic action of the carcinogen.

9,10-Dimethyl-1,2-benzanthracene↗
PubMed1977

Increased cell proliferation with persistence of circadian rhythms in hamster cheek pouch neoplasms.

Squamous cell neoplasms induced by repeated topical application of 7,12-dimethyl-benz(a)anthracene in Syrian hamster cheek pouch exhibited circadian rhythms of DNA synthesis and mitotic activity. Fluctuations in the fractions of cells in mitosis and DNA synthesis observed in the tumors were approximately in phase with the circadian rhythms from normal precursor epithelium, indicating that some degree of host physiologic modulation persists during neoplastic growth. The labeling (thymidine-3H) and mitotic indices of neoplasms were considerably higher than normal throughout the 24 hr period. The duration of the neoplastic S phase--measured from the PLM curve--was 30% shorter than normal; G2 did not show detectable variation. The data demonstrated that chemically induced squamous cell neoplasms had markedly increased rates of cell production. It is postulated that applications of a carcinogen upon a cell-renewing population generate a multicompartmental cytokinetic imbalance in which: (1) a higher proportion of G0 cells is stimulated to enter the cycle; (2) the duration of the cell cycle is shortened; (3) the regulatory mechanisms fail to stimulate an accelerated rate of differentiation to compensate for the overproduction of cells; and (4) the state of proliferative hyperactivity becomes stable. An oncogenic cytokinetic mechanism based solely on a persistent decrease in cell loss (differentiation) is rule out by the present investigation, at least for squamous cell neoplasms.

Animals↗
PubMed1978

The circadian variations in the epithelial growth of the hamster cheek pouch: quantitative analysis of DNA distributions.

The pronounced diurnal rhythm in DNA distributions of the hamster cheek pouch epithelium both in the S fraction and in the (G2 + M) fraction was compared with previous studies of the changes in tritiated thymidine labelling index and mitotic activity. The DNA distributions were obtained by flow cytometry after ultrasonic disaggregation of the isolated epithelium into a suspension of single nuclei. The DNA distributions were analysed with the computer program of J. Fried (1976) and by planimetry. The S fraction was higher than the autoradiographic labelling index during the whole 24 hr period. Only the computer fitted S fraction and the labelling index had the same difference between maximal and minimal values, and maxima at the same time of day. The DNA distributions showed a diurnal release of G1 cells into S phase proceeding through (G2 + M) phase and returning to G1 phase within a 24 hr period.

Animals↗