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Penetrating injury of the cheek requiring skull base exploration.

We report a case of a very unusual penetrating injury of the middle third of the face. The patient was involved in a road traffic accident, and the indicator control lever became impaled in his right cheek. There was contralateral orbital damage resulting in loss of sight. The cribriform plate was breached and a pneumoencephalocele ensued. We discuss the modern management of such injuries including injury assessment. We emphasize the importance of crash scene information gathering and analysis of injury mechanisms. Facial injury zonal classification and imaging are reviewed in the context of the case. We discuss the reasons that led us to treat this patient via the subcranial approach.

Accidents, Traffic↗

Intraoral cheek fistulae: a refined technique.

Taste reactivity testing (TRT), which entails infusing a solution into the oral cavity of subjects, is used across a wide range of studies. For laboratories inexperienced in the conventional technique of implanting cheek fistulae, the surgery can be problematic for both the subjects and the experimenter. We have proposed a refined method for fistulae implantation that is less invasive, thereby reducing the pain and distress of the animals. Using this refined technique, we were able to replicate the findings of previous TRT studies, namely that a high dose of lithium chloride produces an increase in aversive and a decrease in ingestive orofacial and somatic responses. Using indices of health, we demonstrate that unlike animals with the conventional method of fistulae implantation, subjects that receive the refined technique regain their pre-surgery body weights rapidly and show no physical signs of discomfort. Additional advantages of the refined technique are discussed.

Animals↗

Metallic foreign body embedded in the cheek for 20 years.

The unique tissue response to a knife blade embedded for more than 20 years in the cheek of a patient is discussed. Chronic proliferative inflammation resulted in iron corrosion products that were phagocytized by inflammatory cells.

Cheek↗

The hamster cheek pouch: an immunologically privileged site suitable to the study of granulomatous infections.

The hamster cheek pouch is an invagination of oral mucosa, characterized histologically as skin-like. In this paper we describe anatomical, histological and embriological features of the pouch and comment on the pouch as an immunologically privileged site since it lacks lymphatic drainage and has few Langerhans cells. We present the review from literature and our observations after inoculation in the pouch of mycobacteriae (BCG, Mycobacterium tuberculosis and Mycobacterium leprae) and a fungus (Paracoccidioides brasiliensis). Lesions in the pouch were granulomatous but smaller and long lasting; even granulomatous, the reaction was inefficient to control the proliferation of agents compared with inoculation in other sites, except for BCG. Appearance of immunity was also delayed or absent and, when it was detected, a sharp decrease in number of agents in pouch lesions was observed. These observations make the pouch an interesting site for the study of the role of immune system in infectious diseases and in granuloma formation.

Animals↗

A light and electron microscopic study of lamellated nerve endings found in the rat cheek mucosa.

Lamellated nerve endings in the cheek mucosa of fifteen adult Sprague-Dawley rats were studied with light and electron microscopes. Serial sections revealed that the terminal axon of the lamellated nerve endings is in the central portion, and that the inner core is made up of two stacks of lamellae. These are characterized by many corpuscles located within a single papilla, which shows structural specializations at several levels. Electron microscopy showed that the corpuscles are circular in shape and that the lamellar sheets possess a rich rough endoplasmic reticulum, mitochondria and numerous glycogen-like granules. Numerous bundles of collagen fibers and an amorphous substance are located in the interlamellar spaces. The axon terminal is characterized by the presence of neurofilaments, neurotubules and mitochondria. The capsule consists of several laminae formed by cytoplasmic extensions of perineural cells presenting many caveolae, mitochondria, rough endoplasmic reticulum profiles and microfilaments.

Animals↗

Comparative light, scanning, and transmission electron microscopic study of chemically induced premalignant lesions in hamster's cheek pouch.

The early chemically induced epithelial dysplastic changes in the hamster's cheek pouch were studied using light, scanning, and transmission electron microscopy. Epithelial dysplasia was noticed on the light microscopic level by the sixth week of the experiment and became marked by the eighth week. At the scanning electron microscopic level, surface alterations with features previously reported in early epithelial dysplasis in human and oral mucosa were seen by the second week of the experiment and progressed over time. These early changes were also confirmed at the ultrastructural level. The usefulness of scanning and transmission microscopy in detecting early oral epithelial dysplastic changes in this animal model is discussed.

9,10-Dimethyl-1,2-benzanthracene↗

Vascular reactions during electrical stimulation. Vital microscopy of the hamster cheek pouch and the rabbit tibia.

Vital microscopy during electrical stimulation was performed in the hamster cheek pouch and the rabbit tibia. Stimulation with DC of 5,20 or 50 microA or AC of 20 microA was demonstrated to cause macromolecular capillary leakage as evidenced by FITC-dextran fluorescence and histological demonstration of extravasated white blood cells. It was further demonstrated that the vascular leakage was blocked by administration of indomethacin. Pulsed electromagnetical fields did not visibly affect the vascular permeability within 3 h. As the same DC electrical stimulator has been demonstrated to increase the osteogenic capacity in similar titanium implants in the rabbit tibia, it is suggested that the observation of macromolecular leakage may predict a positive osteogenic response.

Animals↗

[Microcirculatory changes in the cheek pouch mucosa of hamsters in the dynamics of experimental traumatic shock].

Acute experiments conducted on hamsters demonstrated significant disturbances of the microcirculation in the mucosa of the cheek pouch during a severe traumatic shock after a standardized mechanical injury of the hip. All the animals died in the course of the first 24 hours after this trauma. If the animals died not earlier than in one hour after the trauma the microcirculation changes were distinctly phasic in character; particularly there was seen a phase of temporary relative adaptation and stabilization of the peripheral circulation, invariably followed by the phase of decompensation, the terminal phase and death. In cases with a rapid lethal issue in the course of one hour no distinct phasic character of the microcirculation changes was observed, but there was a more or less rapid aggravation of all he indices. In difference from the majority of other investigators, no marked intravascular erythrocyte aggregation was seen by the authors in the experiments described.

Animals↗

Lipsarcoma of the cheek.

A case of liposarcoma of the cheek in a 39-year-old man has been presented. This tumor, which is one of the most common malignant tumors of soft tissues in the body generally, is extremely rare in the oral regions. Initial surgical excision in this case was followed closely by a second more extensive local dissection in view of the pronounced tendency of the liposarcoma to infiltrate locally beyond the apparent limits of ite pseudocapsule. Early and adequate surgical intervention is most important in the long-term control of this tumor. Accurate histopathological diagnosis provides important information relative to the prognosis and preferred treatment.

Adult↗

[Problems posed by loss of cheek tissue on a tumorous terrain].

The authors describe the case of a patient with right retrocommissural lesion treated by iridiumtherapy and an enormous orostoma which appeared three years later. Radiography showing a metallic opacity caused hesitation for some time between diagnosis of radionecrosis and a recurrence. Treatment called for extensive excision of the cheek. Satisfactory cover was obtained by means of a broad lingual flap for the deeper layers and by a cervical flap for the superficial layers.

Cheek↗

Complications of an unrecognized cheek biting habit following a dental visit.

Cheek biting is a chronic, usually innocuous, self-inflicted injury that is occasionally seen in children. This case report describes the characteristic features of this entity in an 8 year-old girl, including an unfortunate complication following an inferior alveolar mandibular block for restorative dental care.

Anesthesia, Dental↗

[Nonprogressive, late-onset atrophy of the cheek].

Lipodystrophies are rare conditions in which the most remarkable feature is an atrophy of the subcutaneous tissues. Until two decades ago, they were all considered under the name of "lipoatrophic diabetes", and only recently they have been properly classified. Currently four syndromes are recognized: congenital total lipodystrophy, late onset or acquired lipodystrophy, cephalothoracic or partial progressive lipodystrophy and partial face-sparing lipodystrophy. We report the case of a 73-year-old patient, long distance bus driver, who presented to our clinic for the correction of a malar atrophy located on the left side of his face. Until he was 48 years old his appearance was normal, but at the time he reports the slow onset of a facial atrophy which was confined to the cheek. The atrophy was very slowly progressing, so that at this moment at 73 years of age he presented to our observation for the correction of the asymmetry. Clinical examination and history oriented us towards a variation of Parry-Romberg's syndrome characterized by a non progressive late onset hemifacial atrophy. No muscle or bony involvement is present. No other important abnormalities, excluding a moderate hyperglycemia have been observed. A biopsy of the region shows a marked elastosis and a complete atrophy of the subcutaneous fat. Correction of the deformity was achieved with autologous fat injection and was still satisfactory after one year.

Adipose Tissue↗

Cheek reconstruction with laterally based flaps.

Laterally based cervicofacial advancement flaps that follow the borders of facial aesthetic subunits provide a more aesthetic solution to the reconstruction of anterior cheek defects than do standard cervicofacial flaps or skin grafts. The circulation in these laterally and inferiorly based flaps is improved, because the transverse facial artery is spared. These flaps also provide better contour and possess more aesthetic scar placement than do anteriorly and inferiorly based flaps.

Cheek↗

Mandibular cheek tooth development and its relationship to age in young Friesian cattle.

The oral and intra-osseous development of each of the six manidibular cheek teeth found in the permanent dentition of cattle was studied. The animals used were all British Friesians, of varying sex, and slaughtered at different weights at ages between 13 and 22 months. The various stages of development observed in each tooth together with the mean age and age range at which they were seen are recorded. Significant differences were found between the ages at which several of the developmental stages were seen in most of the teeth and indicated that tooth formation in the Friesian cattle studied tended to fall within well defined age limits.

Age Determination by Teeth↗

Microvascular response to local application of dequalinium chloride. A vital microscopical study of hamster's cheek pouch and a microangiographic study of rabbit's ear.

Dequalinium chloride is a topical antiseptic, whose use may be attended by skin necrosis. Since microcirculatory changes are an early and distinct manifestation of tissue injury, the tissue damaging effect of dequalinium chloride on the microcirculation was examined. The immediate vascular reactions were studied by vital microscopy, of the hamster cheek pouch and the late effects were visualized by microangiography of the rabbit ear. An aqueous solution of dequalinium chloride in concentrations well below those used in clinical practice induced severe microcirculatory disturbances.

Animals↗

Vascularization of premalignant lesions in carcinogen-treated hamster cheek pouch.

Of 27 lesions induced in Syrian golden hamsters by 12 applications of 0.5% 7,12-dimethylbenz[a]anthracene in liquid paraffin, 14 showed a static phase of at least 28 days' duration in their life history. Ten static lesions resumed growth, and this was accompanied by clinically obvious vascularization in 8 cases, 7 of which culminated in carcinomas by the end of the study. Because the wall of the normal hamster cheek pouch possesses small nodules whose histologic structure closely resembles that of hyperplastic epithelium, they could be misinterpreted as a product of carcinogenesis.

9,10-Dimethyl-1,2-benzanthracene↗

Fructose diet and VEGF-induced plasma extravasation in hamster cheek pouch.

AIM: To determine in the hamster cheek pouch whether or not the changes in plasma extravasation induced by vascular endothelial growth factor (VEGF) could be affected by fructose diet. METHODS: Hamsters were subjected to control drinking water or to water containing fructose (10 %) for 18 weeks. RESULTS: The fructose diet induced a small but significant increase in glycemia (0.80+/-0.11 and 1.09+/-0.15, n=8 and 9 for control and fructose- treated animals, respectively, P<0.05). Bradykinin-induced plasma extravasation was not affected by the fructose diet while the effects of VEGF were markedly increased (maximal number of leakage sites: 76+/-20 and 126+/-55, n = 8 and 9 for control and fructose-treated animals, respectively, P<0.01). CONCLUSION: Even moderate changes in glycemic levels can produce profound alteration in the VEGF response.

Animals↗