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Nodular fasciitis is a benign, fibrohistiocytic tumor most commonly arising on the trunk. Histopathologically it can be misdiagnosed as fibrosarcoma. We present a case report and review of the literature. Local excision to completely remove the tumor proved curative at 1 year of follow-up. We concluded that nodular fasciitis can be encountered on the cheek and should be regarded as a benign tumor.
The mucosa of the cheek-pouch of five golden Syrian Hamsters was irradiated with the beam of an argonionlaser (diameter 0.5 mm and 200 mW). The effect on the micro- and macro-vessels and the bloodstream, especially of the microcirculation, is studied intravitalmicroscopically. In the microcirculation and also in the small and large venous and arterial vessels a restriction of bloodstream, praestasis, pendulumstream, stream reversal and some white microthrombi, -- emboli and agglutination of erythrocytes are visible. The bloodless welding of the vessels takes place even before the evaporation and coagulation necrosis of the surrounding epithelium of the mucosa as a result of the relatively selective effect of the Argon Laser on the reddish vessel-system by a continuous narrowing of the vessels-walls to the complete loss of their lumen rather than by a thrombosis. Firstly the capillaries, the venoles and the arterioles are obliterated, then those of middle size and at last the large venae and arteries in which case large vessels function for a moment as smaller ones. A continuously growing imbibition with increasing duration of the laser irradiation can be observed. Three clinically important phenomenon, depending on the laserdose can be observed: 1. a partial, 2. a subtotal and total obliteration of the network of the vessels, and 3. a total destruction of the blood-vessels and also of the tissue. Therefore clinically a subtotal or total network obliteration of the blood-vessels of strongly vascularised tissues, haemangiomas, teleangiectasias in case of morbus Rendu-Weber-Osler and livid enlarged nasal conchae might be obtained. Further a total tissue-destruction with a break in the continuity of the tissue for example with strongly vascularised carcinoma or its metastases might be effected.
We studied 35 patients with facial palsy after stroke, admitted to a rehabilitation hospital. We examined the patients on admission and after one, two and six months with 1) clinical evaluation of the facial function using a modified House-Brackmann scale, 2) photographs of patients with six different facial expressions; these photos were evaluated by "blinded" observers using the modified House-Brackmann scale, 3) questionnaire about patients emotional reactions to the facial paralysis and 4) facial sensation. No differences were found between a control group of 12 and a group of patients (23) training facial function 2-3 times a week, each session of 15 minutes, with EMG-biofeedback and cheek taped between training sessions. A significant improvement in facial function occurred spontaneously after one month in rehabilitation unit in the total group. After six months 2/3 of the patients had normal facial function or mild dysfunction. Patients with right-sided facial palsy showed a significantly better improvement at six months as compared to patients with left-sided facial palsy. The questionnaire showed that only half of the patients were aware of the asymmetric face. We cannot recommend training with EMG-biofeedback to patients with facial paralysis after stroke. Spontaneous remission is to be expected.
Myofibromas are benign mesenchymal tumors that are commonly found in the dermis and subcutaneous tissues of the head and neck. Although most lesions are recognized during infancy and early childhood, several cases have been reported in older children and adults. We describe the case of a 9-year-old girl who presented with a solitary nodule in the left cheek and a history of minor trauma. Preoperative imaging detected the presence of a subcutaneous soft-tissue mass consistent with a soft-tissue neoplasm rather than a hematoma. Analysis of fine-needle aspiration material was nondiagnostic. Incisional biopsy revealed that the lesion was a myofibroma.
A case of a 3-year-old girl, with lesions of the cheek skin, treated with a series of topically applied steroid ointments was described. There were treatment complications, including atrophy, erythematous macules and hirsutism.
Merkel cell carcinoma (MCC) is a rare tumor of neuroendocrine origin. It is a highly invasive and aggressive neoplasia, that frequently presents regional and distant metatases. Therefore, there is high mortality associated with it. This report presents two male patients, one sixty three years and the other eighty eight years of age, with MCC of the cheek and invasive metastatic lesions to the head and neck areas. One of the patients died of associated distant metastatic disease and the other patient died of comorbid conditions present at time of tumor excision.
The volumes of the cell nuclei of the spinous layer of the human oral mucosa show considerable variations in dependence upon both the process of aging and the cellular metabolism. The differences in the mean volumes of cell nuclei are fairly large for the bony palate as well as the cheek, and statistical evidence has been obtained for these. Stomatologically, this investigation may be regarded as having broken new ground and will add to our understanding of the aging of human organs of mastication.
A four-year-old boy had fallen from a tree in nursery school and had minor symptoms immediately after the trauma. He was admitted to the local casualty clinic the same night, but no signs of local injury were detected. The next morning he was admitted to the department of oto-rhino-laryngology at the local hospital due to increasing local swelling and pain in the cheek. A computed tomography examination demonstrated an extensive preauricular soft tissue swelling and a long central hypodensity from the left ear to the oropharynx. The presence of a penetrating foreign body was suspected and the boy was admitted to our hospital. An examination in general anaesthesia revealed a small skin lesion medial to the tragus in the left external auditory meatus and a wooden stick was seen crossing the oropharynx. The eight and a half centimetre long wooden stick had penetrated from the cartilaginous part of the left external auditory meatus to the right palatal tonsil. It was removed through a pre-auricular incision. No complications were observed and the boy could leave the hospital after four days of observation with antibiotic therapy and tetanus prophylaxis.
OBJECTIVE: To study the methods and results of a combination of forehead skin flap and sternocleidomastoid island myocutaneous flap in the reconstruction of large through-and-through defect of check. Methods One case of check cancer received ampliative resection and functional neck dissection. The defect area of the skin side was 9 cm x 7 cm, of the mucosa side 4.5 cm x 3.0 cm. The defect of the mucosa side was repaired with sternocleidomastoid island myocutaneous flap which blood supply was from thyroidea superior artery, occipitalis artery and carotis extra vein; of the skin side with forehead skin flap which blood supply was from temporalis superficialis artery and vein. The size of the sternocleidomastoid island myocutaneous flap was 5 cm x 3 cm, of the forehead skin flap 10 cm x 6 cm. RESULTS: Two flaps and the split survived after operation. One-stage healing was achieved. The patient was discharged from hospital 2 weeks after operation. The color and the quality were good. The tumor did not recur during follow-up of one year. The patient could take care of herself, and she lived normally in talk and diet. CONCLUSION: A combination of forehead skin flap and sternocleidomastoid island myocutaneous flap is a useful method to repair large through-and-through defect of cheek after cancer dissection. It is easy-to-operate and economical.
This is a report of a case of retinoblastoma that mimicked Burkitt's lymphoma by presenting with a left proptosis and a right cheek mass. With the aid of fine-needle aspiration cytology, the diagnosis was established as retinoblasstoma and a left modified exenteration was performed. The patient had adjuvant chemotherapy and radiotherapy to the left orbit and the right maxilla with regression. At 12 months postoperatively, there was no evidence of recurrence, and the patient was still hale and hearty. In conclusion, this patient had left retinoblastoma with metastasis to the contralateral jaw. It is important to note that orbital Burkitt's lymphoma can be a differential diagnosis of retinoblastoma.
A 55-years-old man visited his family doctor because of a one-day existing, not painful, right-sided swelling of the cheek. It appeared to be a subcutaneous emphysema, caused at an attempt to remove mandibular third molar roots, using a water- and air-cooled air rotor. Rare potential seũelae resulting from subcutaneous emphysema are venous air embolism, airway obstruction because of neck swelling, pneumomediastinum, and mediastinitis. Using air-cooled instruments in surgical orofacial treatments should be avoided because of the possible atrogenic life-threatening complications.
The effects of histamine alone and in the presence of AVP or DDAVP on microvascular permeability to macromolecules was evaluated in the superfused hamster cheek pouch. FITC-Dextran (MW 70,000) was employed as a macromolecular tracer to quantitate the increase in macromolecular permeability produced by the topical application of histamine. Intra-vital light microscopy was utilized to quantitate and localize FITC-D extravasation sites along the vascular tree, and fluorimetric measurement of the FITC-D concentration in the suffusate (S) and plasma (P) was used to calculate the FITC-D S/P ratio to quantitate the increase in macromolecular permeability. The infusion of histamine for 5 minutes at a rate which produced a suffusate histamine concentration of 1 X 10(-5) M produced a marked increase in the number of venular FITC-D leakage sites, the [FITC-D]s, and the FITC-D S/P ratio. These effects of histamine were prevented by treatment with either AVP or DDAVP which was infused at a rate sufficient to produce a suffusate concentration of 1 X 10(-8) M. AVP produced profound vasoconstriction whereas DDAVP prevented the histamine-induced increase in the formation of venular FITC-D leakage sites, the [FITC-D]s, and FITC-D S/P ratio without producing vasoconstriction. These data suggest that the antagonism of the histamine-induced increase in macromolecular permeability by AVP and DDAVP is not dependent on vasoconstriction per se, but rather is attributable to the stimulation of a vasopressin receptor on the venular endothelial cell which is identical to or similar to the vasopressin receptor mediating the anti-diuretic effects of these agents.
In the hamster cheek pouch, microvascular effects of iloprost at a nonhypotensive dose include vasodilatation at the level of arterioles and venules without changes in microvascular permeability, increased number of perfused capillaries/cm2, prevention of microvascular spasm and capillary ischemia as caused by LTD4, and inhibition of histamine- and 5-HT-induced venular leakage of FITC-dextrane. As regards the effects on basal vessel tone, capillary density, and prevention of LTD4 effects, PGE1 had similar effects as also shown by others in the human cutaneous microcirculation. However, PGE1 did not prevent the microvascular leakage caused by histamine. The Ca2+-antagonist nifedipine, apart from arteriolar vasodilatation, neither increased venular diameter and capillary perfusion nor prevented the effects of LTD4 and histamine. The microvascular actions of iloprost by improvement of tissue perfusion and prevention of mediator-induced tissue edema and vasospasm could contribute to the beneficial effects observed in ischemic diseases.
Changes in vascular permeability to FITC-dextran 150 associated with topical application of platelet activating factor (PAF) in the hamster cheek pouch preparation were calculated using a mathematical model (Baxter et al., Microvasc. Res. 34:336, 1987). Least square estimates of apparent permeability-surface area product (PS) and interstitial diffusion coefficient (D) were calculated from the data and the mathematical model using a Marquart optimization algorithm. Calculated PS products varied with applied PAF concentration while the best-fit estimate of apparent D remained constant at 10.5 X 10(-10) cm2/s. Average baseline PS was 16.5 X 10(-8) ml/s. PS increased to 45.2 X 10(-8) ml/s and 52.3 X 10(-8) ml/s with application of 10(-8)M and 10(-7)M PAF, respectively. A further increase in PAF concentration to 10(-6)M decreased the calculated PS product to 30.5 X 10(-8) ml/s. PAF is a potential modulator of macromolecular permeability in the microcirculation. This is the first study which quantitates the changes in PS of FITC-dextran 150 as a function of PAF concentration.
Three patients operated for labial commissure cancer with cheek flap reconstruction are presented. In two cases general anaesthesia and in one local analgesia was used. There was no local recurrence, dehiscence, contracture or interference with function. This could be a method of choice for reconstruction of small lesions on labial commissure. The site of the incision lines fully comply with the aesthetic demands as they simulate the natural lines of the face.
An in vivo study of the hamster cheek pouch epithelium using the stathmokinetic technique (Colcemid) demonstrated a circadian variation in mitotic influx. Based on measurements of all nucleated epithelial cells the diurnal mean was estimated in two separate experiments as 0.34%/h +/- 0.02 (SE) and 0.27%/h +/- 0.02 (SE) respectively. 3HTdR was injected in the latter study (a double labelling experiment). The significant difference between the two experiments is, however, probably due to biological variations. The maximal values for the mitotic rate were found during the light (resting) period, as were the maximal values for the mitotic index. The mean mitotic influx for the 'light period' was estimated as 0.5-0.4%/h, and for the 'dark period' as 0.2%/h. Independent analyses demonstrated the necessity of a circadian-dependent correction of the 1 and 4 h values of accumulated metaphases. The 1 h value was significantly too high during the light as well as the dark period. The 4 h value was found to be too low, but only significantly so during the dark period. Basing the estimation of mitotic rate on the 3 h accumulation value produced only very similar results to those found by using all four accumulation periods. The use of overlapping experiments proved that only cells entering mitosis after Colcemid application were arrested, so that when arrested metaphases were counted the accumulation line was correctly drawn through the origin. In the latter study (the double labelling experiment) both S- (Møller and Keiding 1982) and mitotic influx were estimated, the estimates being 0.55%/h +/- 0.03 (SE) and 0.27%/h +/- 0.02 (SE) respectively. Even considering possible methodological problems, the discrepancy between the S efflux and the mitotic influx indicates cell death and/or differentiation from G2.
The paper reports on a case of recurrent hemangiopericytoma of the cheek, discusses the results of hyperthermia combined with intra-arterial chemotherapy after the postoperative recurrence and draws significant conclusions about the therapeutic approach to this type of tumour.
Histochemical distribution of lactate, isocitrate and succinate dehydrogenases in normal oral epithelium and in well differentiated squamous cell carcinoma of cheek region was studied. Lactate dehydrogenase, isocitrate dehydrogenase, and succinate dehydrogenase activity was found to be more in the malignant cells. Succinate and lactate dehydrogenase presented a conspicuous pattern in which the cells located at the periphery of the malignant sheets in well differentiated squamous cell carcinoma showed moderate to intense activity as compared to cells in the central portion. The results are discussed and it is suggested that the enhanced glycolysis and subdued function of the tricarboxylic acid cycle is not a universal criterion during malignancy as reported in the previous investigations.