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Dietary-induced changes in the fatty acid composition of human cheek cell phospholipids: correlation with changes in the dietary polyunsaturated/saturated fat ratio.

Healthy normotensive volunteers aged 20 to 59 yr were randomly allocated either to a control group or to one of two experimental groups. The control group ate a low P/S ratio diet for 12 wk while the first experimental group ate a high P/S ratio diet for 6 wk followed by a low P/S ratio diet for the next 6 wk. The second experimental group ate a low P/S ratio diet in the first 6 wk followed by a high P/S ratio diet for the next 6 wk. Dietary P/S ratio, plasma linoleic acid (18:2), and cheek cell phospholipid 18:2 levels were compared in each dietary group at the end of the 1st and 2nd 6 wk. On change from a low to a high P/S ratio diet, there was a 36% increase in the proportion of 18:2 in the cheek cell phospholipids in comparison with the proportion existing before the change. This was associated with an increase in the proportion of 18:2 in the plasma lipids of this group. No reduction in the proportion of 18:2 in the cheek cell phospholipids was apparent in the control group or the group which changed from a high to a low P/S ratio diet, although in the latter group there was a reduction in the proportion of 18:2 in the plasma lipids. As the phospholipid fatty acid composition of human cheek cells reflects dietary lipid status under certain conditions, this observation may be useful in dietary and nutritional studies, particularly as human cheek cells can be obtained in a noninvasive manner.

Adult↗

Composite cervicofacial flap for reconstruction of complex cheek defects.

The authors present the reconstructive technique for complex cheek defects using the composite cervicofacial flap and study the possibilities, advantages, disadvantages, and results that can be expected. The design follows the classic outline of Mustardé's flap. The skin is undermined for 2 cm anterior to the ear, then after incision of the superficial musculoaponeurotic system (SMAS), undermining is continued below the plane of the SMAS, level with the facial nerve branches. It is continued forward to the facial vessels, which give rise to branches that ensure the blood supply of this composite flap and contribute to its high reliability. In the cervical region, undermining is done beneath the platysma, which is transected transversely in the lower cervical region to allow good upward mobility and satisfactory transposition of the flap. The flap is adapted to the defect and the medial suture line is placed as near as possible to the medial limit of the cheek aesthetic unit. The authors carried out a retrospective study of 7 patients with complex facial reconstruction after excision of malignant lesions. The defects measured from 4x4 cm to 9x7 cm. In 4 patients excision included the periosteum, and in 1 patient excision involved the entire thickness and removed the entire anterior half of the cheek. In 4 patients reconstruction involved the cheek and eyelid. In spite of the advanced age of the patients (88, 69, 91, 67, 70, 82, and 59 years), there was no distal edge necrosis. The only complication was a single case of facial paresis, which resolved spontaneously. The results were considered very good in all 7 patients. The authors conclude that the composite flap increases the possibilities of the cervicofacial flap. It is more mobile, more reliable, thicker, and more adaptable. It can be used in complex cheek defects that involve the periosteum, or even in full-thickness defects. The quality of the results obtained using this flap represents a considerable advance in facial reconstruction.

Aged↗

Cancer induction in the DMBA hamster cheek pouch: a modified technique using a promoter.

OBJECTIVE: To evaluate a modified method of carcinogenesis induction using the 9,10-dimethyl-1,2-benzanthracene (DMBA) sustained-release suture technique followed by arecaidine promotion in the hamster cheek pouch model. STUDY DESIGN: Prospective, controlled animal study. METHODS: Number 3-0 cotton sutures were impregnated with DMBA and coated with silicone elastomer. These sutures were placed in the cheek pouch of Syrian hamsters in the submucosal space to a length of approximately 1.5 cm. The suture placement was confirmed every 2 weeks and replaced if lost. After 12 weeks, the DMBA-coated sutures were removed. The cheek pouches were everted and painted with a solution of arecaidine three times weekly for up to an additional 4 weeks or until the tumor reached a size of 100 mm2. RESULTS: We placed sutures in 165 Syrian hamster cheek pouches. Of these, 133 hamsters (80.6%) produced squamous cell carcinomas that reached a size of 100 mm2 and then were randomly selected for treatment in a new drug trial. Twenty-six hamsters (15.8%) were found dead and 6 (3.6%) were killed because of severe inflammation. CONCLUSIONS: The DMBA hamster cheek pouch model is a reliable and efficient animal model for inducing squamous cell carcinoma and can be used to study upper aerodigestive tract tumors.

9,10-Dimethyl-1,2-benzanthracene↗

Donor-site morbidity in buccal mucosa urethroplasty: lower lip or inner cheek?

OBJECTIVE: To evaluate donor-site complications of buccal mucosa urethroplasty and whether there is a difference in morbidity between harvesting the mucosa graft from the inner cheek or the lower lip. PATIENTS AND METHODS: Twenty-four consecutive patients with recurrent urethral strictures were treated with buccal mucosa urethroplasty in our department between September 2002 and April 2004. In 12 patients the graft was harvested from the lower lip or cheek and lower lip (group 1), and in 12 patients from the cheek (group 2). The mean (range) age of patients was 51 (26-66) years in group 1 and 53 (32-75) years in group 2. The mean (range) graft length was 6.2 (2-16) cm in group 1 and 5.7 (2-13) cm in group 2. All patients were followed up using a mailed questionnaire that asked about pain, numbness, difficulties in mouth opening or ingestion, and satisfaction, monthly for the first 3 months and then every 6 months. The mean (range) follow-up was 12.5 (6-23) months. RESULTS: There were no bleeding complications or disturbances in wound healing. All of the patients reported numbness in the area of the mental and buccal nerves, and graft-site tenderness after surgery. In group 1, the pain lasted for a mean (range) of 5.9 (0.5-22) months, compared to 1 (0.1-7) months in group 2 (P = 0.022). Perioral numbness lasted for a mean (range) of 10.3 (0.5-23) months in group 1 and 0.85 (0.1-3) months (P = 0.0027) in group 2. There were no statistically significant differences in problems with mouth opening or food intake between the two groups, but the patients in group 1 seemed to be less satisfied (6/12 patients satisfied) than those in group 2 (11/12 patients satisfied). CONCLUSIONS: Buccal mucosa graft harvesting from the lower lip and the inner cheek are both feasible, but harvesting from the lower lip resulted in a significantly greater long-term morbidity, which resulted in a lower proportion of satisfied patients. This seems to be due to a long-lasting neuropathy of the mental nerve. We therefore have changed our technique entirely from lower lip to inner cheek graft harvesting, whenever possible.

Adult↗

Spontaneous healing of Mohs wounds of the cheek: a cosmetic assessment.

BACKGROUND: Facial defects after Mohs surgery may be closed at the time of surgery, shortly thereafter, or allowed to heal spontaneously. Selection of appropriate management options requires accurate prediction of the final cosmetic result. OBJECTIVE: To determine the relative merits of treatment options for facial defects resulting from Mohs surgery. METHODS: We prospectively and retrospectively analyzed outcomes for 132 wounds of the cheek resulting from Mohs surgery and allowed to heal spontaneously. The cheek was delineated into topographic areas and the wound location, size, and depth were recorded. Patients were observed intermittently, and a final evaluation of cosmesis was made after > or = 6 months. RESULTS: Most wounds in the nasolabial fold and preauricular areas healed with excellent results and half the wounds in the medial area of the cheek healed with good or excellent results. Central and mandibular areas of the cheek healed unpredictably, and results were unsatisfactory for most of these wounds. CONCLUSION: Final cosmetic results of Mohs surgery in the cheek area can be predicted on the basis of location, size, and depth of the wound, enabling physicians to knowledgeably select the most suitable treatment option.

Adult↗

Characterization of Na(+)-H+ antiporter activity associated with human cheek epithelial cells.

Na+ transport activity was characterized in human cheek epithelial cells obtained from normotensive adult subjects. The cells were isolated using a mouth-wash procedure and assayed for Na+ uptake using a radioactive (22Na+) rapid filtration assay. Cheek cells displayed proton-dependent Na+ uptake activity that was dependent on the magnitude of the externally directed proton gradient measured using the fluorescent probe 2',7'-bis(carboxyethyl)-5(6)-carboxyfluorescein to determine intracellular pH. Amiloride, ethylisopropylamiloride (EIPA), 5-(N,N-dimethyl)-amiloride, 5-(N-methyl-N-isobutyl)-amiloride (MIA), and 5-(N,N-hexamethylene)-amiloride (NNHA) all inhibited proton-dependent Na+ uptake, with MIA, EIPA, and NNHA being the most potent. The Michaelis constant (Km) for extracellular Na+ was 5.7 mM, while the maximum velocity for Na(+)-H+ antiporter activity was 4.3 nmol Na+.mg protein-1.30s-1. The Km for intracellular H+ was 0.17 microM, with a Hill coefficient of 0.7. Stimulation by ouabain and inhibition by bumetanide of cheek cell proton-dependent Na+ uptake indicated only relatively low activities of Na(+)-K(+)-ATPase and Na(+)-K(+)-2Cl- cotransport, respectively. These results are consistent with the presence of Na(+)-H+ antiporter activity in cheek cells. Cheek cells therefore provide a convenient, relatively noninvasive source of tissue for examining Na(+)-H+ antiporter activity in human subjects.

Acids↗

Hog barn dust extract increases macromolecular efflux from the hamster cheek pouch.

The purpose of this study was to determine whether short-term exposure to an aqueous extract of hog barn dust increases macromolecular efflux from the intact hamster cheek pouch and, if so, to begin to determine the mechanism(s) underlying this response. By using intravital microscopy, we found that suffusion of hog barn dust extract onto the intact hamster cheek pouch for 60 min elicited a significant, concentration-dependent leaky site formation and increase in clearance of FITC-labeled dextran (molecular mass, 70 kDa). This response was significantly attenuated by suffusion of catalase (60 U/ml), but not by heat-inactivated catalase, and by pretreatment with dexamethasone (10 mg/kg iv) (P < 0.05). Catalase had no significant effects on adenosine-induced increase in macromolecular efflux from the cheek pouch. Suffusion of hog barn dust extract had no significant effects on arteriolar diameter in the cheek pouch. Taken together, these data indicate that hog barn dust extract increases macromolecular efflux from the in situ hamster cheek pouch, in part, through local elaboration of reactive oxygen species that are inactivated by catalase. This response is specific and attenuated by corticosteroids. We suggest that plasma exudation plays an important role in the genesis of upper airway dysfunction evoked by short-term exposure to hog barn dust.

Adenosine↗

Heterogeneity of vascular innervation in hamster cheek pouch and retractor muscle.

The hamster cheek pouch and its retractor muscle have provided valuable insights into microvascular physiology of an epithelial tissue and striated muscle, respectively. Nevertheless, the innervation of these vascular beds has not been resolved. This study has investigated the nature of autonomic and sensory innervation of these vascular beds and has tested whether it varies within or between tissues. Multiple-labelling immunohistochemistry identified autonomic and peptide-containing sensory nerve fibres. Presumptive sympathetic vasoconstrictor axons with immunoreactivity (IR) for tyrosine hydroxylase (TH) and neuropeptide Y (NPY) innervated feed arteries and arterioles (but not veins or venules) of the retractor and anterior (muscular) cheek pouch; these axons were absent from the posterior (epithelial) region of the cheek pouch, as confirmed by catecholamine fluorescence. Presumptive autonomic vasodilator axons with IR for vasoactive intestinal peptide (VIP) consistently innervated feed arteries and proximal arterioles of the cheek pouch, but generally not those of the retractor muscle nor distal arterioles of either tissue. Sparse presumptive sensory axons with IR for calcitonin gene-related peptide (CGRP) and substance P were found near arterial and venous vessels in all regions of the cheek pouch and retractor muscle; CGRP-IR was also located in motor end plates associated with striated muscle fibres. Such regional differences in vascular innervation by autonomic and sensory neurons may selectively effect local and regional control of blood flow between and within vascular beds.

Animals↗

Responses of pulmonary allograft and cheek pouch arterioles in the hamster to alterations in extravascular pressure in different oxygen environments.

The responses to changes in transmural pressure were investigated in pulmonary allograft and cheek pouch arterioles in two oxygen environments. Neonatal hamster lung tissue was transplanted into adult hamster cheek pouches. After vascularization (8-10 days), pulmonary and cheek pouch vessels were observed by intravital microscopy in hamsters anesthetized with pentobarbital. By gassing the suffusion solution (bicarbonate-buffered Ringer's) (pH 7.4 at 35-37 degrees C) with either low oxygen (95% N2/5% CO2) or high oxygen (75% N2/5% CO2/20% O2) and after sealing the top of the chamber, extravascular pressure was altered by varying the fluid volume of the closed chamber. Changes in arteriolar diameters in response to positive and negative square-wave pressure pulses were quantified using a video micrometer and close-circuit TV system. Pulmonary arterioles showed a passive dilation or constriction in response to increases or decreases in transmural pressure (+/-20 mm Hg). These responses were not altered either by changes in PO2 or nitroprusside. In contrast, cheek pouch arterioles showed myogenic responses by constricting when transmural pressure was increased and vice versa. These responses were potentiated at high PO2 and abolished with nitroprusside. It is concluded that a myogenic response is dominant in cheek pouch arterioles but not in pulmonary arterioles under these conditions. These latter observations are consistent with results obtained from isolated, intact lung.

Animals↗

Intraoral extraction of cheek skin cyst.

BACKGROUND: When a physician encounters a benign subcutaneous cyst in the cheek, his or her decision whether to excise and how to excise the cyst takes into account the potential risk of postsurgical scarring. OBJECTIVE: To describe and show an intraoral buccal mucosal approach to excising a cyst in the inferior-anterior cheek so that skin scarring is avoided. METHOD: An incision was made intraorally in the buccal mucosa, and dissection was carried through the buccinator muscle until the cyst wall was seen. Careful separation of tissue around the cyst was done by blunt dissection, and the unruptured cyst was removed through the buccal mucosal incision. RESULT: The entire intact cyst was removed without creating any excision marks in the cheek skin. No complications were encountered, and buccal mucosal healing was excellent. CONCLUSION: A buccal mucosal intraoral approach is an alternative to a percutaneous excision to remove a cyst in the lower cheek region. The intraoral approach avoids a visible scar on the cheek skin.

Adult↗

Depressed cheek cell sodium transport in human hypertension.

Na+ transport activity was measured in cheek cells from untreated hypertensive subjects and age-matched normotensive controls identified from a blood pressure screening program. Cheek cells were isolated by a simple mouth wash procedure and Na+ transport activity was measured as the proton-dependent uptake of 22Na+ using a rapid filtration assay. The rate of Na+ uptake was about 45% lower in hypertensive subjects and this difference persisted in a follow up study 2 years later involving those subjects who remained untreated for their hypertension. The proton independent Na+ uptake was also reduced by about 46% in the hypertensive group. The increase in the rate of cheek cell Na+ transport with increasing transcellular proton gradient values was also significantly lower in hypertensive subjects. The reduced cheek cell Na+ transport observed in hypertensive subjects may indicate decreased activity of the Na+/H+ antiporter and/or changes in the ion permeability properties of the cheek cell plasma membrane in the hypertensive state. This novel assay provides a biochemically based method for discriminating between normotensive and hypertensive subjects and makes use of tissue which can be obtained in a relatively non-invasive manner.

Amiloride↗

Cheek mass as a presentation of metastatic rectal cancer.

Cheek metastasis from colorectal cancer is very unusual. We report on a 79-year-old female rectal cancer patient who underwent low anterior resection and lymph node dissection. The initial stage for this patient was T3N0M0 (by AJCC 1997). Postoperatively 49 months later, she presented with a right cheek mass that progressively enlarged within 2 weeks. Computed tomographic (CT) scan showed a well-defined 5 x 5-cm mass over the right parotid space and infratemporal fossa. The tumor was noted to be displacing the right masseter muscle laterally with obliteration of the medial border. In addition, destruction of the right mandible was also noted. Histology of this right cheek mass revealed it to be a metastatic adenocarcinoma, which was similar to that of the primary rectal adenocarcinoma. Multiple metastases including to the bone, lung, and liver were also found. The patient only underwent radiotherapy to the right cheek mass because of its rapid growth. Chemotherapy was not considered due to her advanced age. She did not complete the entire radiation therapy course because she expired. In our review, this is a very rare case presenting with cheek mass metastasis from rectal carcinoma. It was associated with widespread and aggressive disease due to rectal cancer.

Aged↗

Subciliary malar augmentation and cheek advancement: a 6-year study in 22 patients undergoing blepharoplasty.

Twenty-two patients seeking aesthetic improvement of their eyelid and orbital-cheek region underwent malar augmentation and cheek advancement in conjunction with lower eyelid blepharoplasty by means of a subciliary incision. The follow-up ranged from 12 to 78 months, with a mean follow-up of 44 months. Concomitant other aesthetic procedures were performed in 27 percent of the patients. Satisfactory goals of lower eyelid aesthetic improvement and malar augmentation with cheek advancement were achieved in 21 of 22 patients. A single patient had her implants removed within 3 weeks of her initial operation, at her request. Complications included hematoma formation in two patients, transient ectropion in two patients, and a palpable implant edge in a single patient. There were no long-term functional or aesthetic sequelae. Malar augmentation and cheek advancement have been found to be a significant adjunct to lower eyelid blepharoplasty because they improve the appearance of the cheek region and add a youthful contour to the malar area. These straightforward procedures add an effective dimension to blepharoplasty in appropriately selected patients.

Adult↗

Histological changes in the hamster cheek pouch epithelium induced by topical application of sodium lauryl sulphate.

Dentifrices, two containing sodium lauryl sulphate (SLS) and one containing stearylethoxylate as surfactant, were gently rubbed on the mucosal surface of the medial wall of cheek pouches in adult male Syrian golden hamsters. Four daily applications were performed. On the fifth day, the animals were sacrificed and cheek pouch mucosal tissue was routinely processed for light microscopy. After applications of SLS containing dentifrices, the epithelium showed consistently prominent structural changes, especially hyperkeratinization, including ortho and para-keratinization, acanthosis with widening of the intercellular spaces, and varying degrees of basal hyperplasia. Identical morphological changes were also observed after application of a paste containing only SLS as an agent. In contrast, after application of the stearylethoxylate containing dentifrice, as well as a paste containing only stearylethoxylate as an agent, the epithelium remained essentially identical to the epithelium of cheek pouches treated with sterile saline, and to the nontreated cheek pouches. From these results, we may conclude that SLS is the agent responsible for the striking changes in the epithelial structure. The specific cytological effects of SLS on the epithelial cells remain to be further studied. Interestingly, application of SLS provides a useful system for the rapid production of acanthosis and hyperkeratinization in the stratified squamous epithelium of the hamster cheek pouch.

Administration, Topical↗

Equine dental disease part 2: a long-term study of 400 cases: disorders of development and eruption and variations in position of the cheek teeth.

Of 400 referred horses with dental disorders, 349 cases suffered from primary disorders of their cheek teeth, ninety of these from disorders of development or eruption, or displacements. These included 20 cases with rostral maxillary and caudal mandibular cheek teeth overgrowths, 16 with diastemata, 15 with grossly enlarged mandibular 'eruption cysts', 4 with grossly enlarged maxillary cheek teeth 'eruption cysts', 10 cases with supernumerary cheek teeth and 23 cases with displaced cheek teeth. These displacements were believed to be developmental in 16 cases and acquired in the remaining 7 cases. Long-term response to treatments, that included removal of overgrowths and extraction of teeth with deep secondary periodontal disease was excellent for most disorders except diastemata.

Animals↗

Optical coherence tomography of malignancy in hamster cheek pouches.

Optical coherence tomography (OCT)/optical Doppler tomography (ODT) provides real-time in vivo high-resolution (10-microm) imaging of tissues and real-time spatially resolved blood flow in microvasculature. Hamster cheek pouches with induced dysplasia and malignancies were imaged with OCT/ODT to assess the potential for application to airway malignancy. In 22 Golden Syrian hamsters, 0.5% 9,10-dimethyl-1,2-benzanthracene induces carcinogenesis over 10 weeks in right side cheek pouches; the left side three served as controls. The cheek pouches are imaged in vivo prior to sacrifice, and in vitro after excision, using a prototype 1310-nm broadband superluminescent diode based OCT/ODT device. Images are compared to standard histopathology. OCT imaging offers good resolution of the hamster cheek pouches to depths of 1 to 3 mm and paralleled histologic images. The feasibility of high-resolution functional imaging is demonstrated in this hamster cheek pouch tumor model. ODT accurately detects vascular change associated with carcinogenesis.

9,10-Dimethyl-1,2-benzanthracene↗

Keratinized epithelial transport of beta-blocking agents. I. Relationship between physicochemical properties of drugs and the flux across rat skin and hamster cheek pouch.

The maximum fluxes (Jmax) of beta-blockers through keratinized membranes were determined in vitro and compared with their physiochemical parameters such as lipophilicity (log k'0) and melting point (mp). Rat abdominal skin and hamster cheek pouch mucosa were used as the model membranes. Propranolol, metoprolol, timolol, pindolol, nadolol and agenolol were used as beta-blockers with a variety of physicochemical characters. Linear relations of Jmax with either log k'0 or mp were observed both in intact rat skin and in intact hamster cheek pouch, suggesting that the lipophilicity and thermodynamic activity of a drug in the crystal state primarily affect the drug's permeation through these membranes. However, the slope, dJmax/d(log k'0), for cheek pouch mucosa was greater than that for rat skin, corresponding to the lack of appendigeal shunt pathways in cheek pouch. Penetration studies using the delipidized membranes and the isolated stratum corneum sheet of hamster cheek pouch mucosa clarified that the primary rate-limiting barrier function might exist in the lipid layer of the stratum corneum. Jmax values for the tape-stripped and delipidized skins correlated with both the solubilities of drugs in the vehicle and with the mp, suggesting the polar porous characteristics of both model membranes. However, a theoretical approach confirmed that the contribution of an intracellular or aqueous pore route in the intact membrane to the permeation of drugs with positive lipophilic indexes is negligible.

Adrenergic beta-Antagonists↗

Cross-face nerve grafting followed by free muscle transplantation in young patients with long-standing facial paralysis. Reanimation of the cheek and the angle of the mouth.

For reanimation of the cheek in 8 young patients with long-standing facial palsy a method with cross-face nerve grafting followed by free muscle transplantation has been used. The sural nerve was used as nerve graft and placed in a subcutaneous tunnel across the face. In the normal cheek 3-4 fascicles of the nerve were anastomosed to facial nerve branches innervating muscles elevating the angle of the mouth. Four to 13 months later the extensor digitorum brevis muscle to the second toe or the palmaris longus was transplanted to the paralysed cheek. It was attached between the zygomatic arch and the angle of the mouth. The end of the nerve was sutured to the muscle after taking a biopsy. The follow-up period has been 7-30 months. At 7 months 6 patients had positive EMG, either on voluntary movement or on stimulation of the contralateral facial nerve. Three of them had also a slight movement in the cheek. Two patients are as yet only 7 months postoperative. In the remaining two cases, No. 2 and 4, there were no signs of reinnervation. At 18 months 4 out of 6 patients had a synchronous natural contraction in the cheek giving increased balance to the mouth. These patients had a positive EMG. In patients No. 2 and 4 there was neither innervation nor improvement. At 30 months there was additional improvement in two cases but as previously in patients No. 2 and 4 there was neither improvement nor signs of innervation of the muscle on the EMG. The other 4 patients have not reached this postoperative stage.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗