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Notes: Facial cellulitis caused by odontogenic bacterial infection is frequently encountered; however, facial cellulitis caused by Candida albicans infection is rarely found. A patient with oral submucous fibrosis (OSF) and unknown diabetes mellitus (DM) was treated in our out-patient dental clinic by biweekly submucosal injection of 40 mg triamcinolone acetonide into bilateral buccal mucosae plus forced mouth opening performed by the two hands of the clinician. The interincisal distance of the patient improved from 28 to 48 mm after four times of steroid injection. The symptoms and signs of OSF also improved markedly. Unfortunately, facial candidal cellulitis occurred 2 months after the last time of steroid injection treatment. The infection was cured by incision and drainage, intravenous administration of amphotericin B (100 mg once a day for a week), and an appropriate medical control of DM. No recurrence of facial cellulitis was found during the follow-up period of 18 months. To prevent the occurrence of facial cellulitis after a high-dose steroid therapy, some prophylactic procedures should be taken before the initiation of the steroid treatment.

Notes: Background:  A significant association of certain human leukocyte antigens (HLA) and haplotypic pairs with oral submucous fibrosis (OSF) has been reported. However, controversial result of no HLA association with OSF has also been reported. In this study, the phenotype and haplotype frequencies of HLA-A, -B, -C, -DRB1, and -DQB1 in 135 Taiwanese OSF patients were calculated and compared with those in 540 healthy control Taiwanese.Methods:  The analysis of HLA-A, -B, and -C antigens, and of HLA-DRB1 and -DQB1 alleles in OSF patients and healthy control subjects, was performed by serologic typing and DNA typing using polymerase chain reaction with sequence-specific primers (PCR-SSP), respectively.Results:  We found that the phenotype frequency of HLA-B76 (3.0%) in OSF patients was significantly greater than that (0%) in healthy control subjects (corrected P (Pc) = 0.000). In addition, the haplotype frequencies of HLA-B48/Cw7 (3.0%), -B51/Cw7 (6.7%), and -B62/Cw7 (8.2%) in OSF patients were significantly greater than the corresponding haplotype frequencies (0, 0.7, and 1.9%, respectively) in healthy control subjects (Pc = 0.000). The relative risk (RR) values of haplotypes B51/Cw7 (9.57) and B62/Cw7 (4.7) were greater than the RR values of phenotypes B51 (1.81), B62 (2.31), and Cw7 (1.91) in OSF patients. In addition, the etiologic fraction (EF) value of haplotype B51/Cw7 (0.63) was higher than the EF values of phenotypes B51 (0.2) and Cw7 (0.59).Conclusions:  We conclude that some Taiwanese areca quid (AQ) chewers with particular HLA phenotypes and haplotypes are prone to have OSF. In addition, some particular HLA haplotypes may play more important roles than the individual HLA phenotypes for the genetic susceptibility to OSF. However, the significantly increased HLA phenotype B76 and three of the common HLA haplotypes detected are present in only about 20% of incident cases of OSF.

Notes: Aberrant expression of the cell surface adhesion molecule CD44 and its variant forms has been shown to be associated with the invasive and metastatic potential of cancer cells, and with poor prognosis in several types of cancers. Expression of CD44 standard (CD44s) and variant (CD44v) forms in oral squamous cell carcinoma (SCC), epithelial dysplasia (ED), epithelial hyperkeratosis (EH) and normal buccal mucosa (NBM) have been examined using antibodies to CD44s, CD44v5, CD44v6 and CD44v7-8. Positive CD44s, CD44v5, CD44v6 and CD44v7-8 staining was detected in all the specimens from NBM, EH and ED. Positive staining of CD44s, CD44v5, CD44v6 or CD44v7-8 was detected in 55 (88.7%), 48 (77.4%), 59 (95.2%) and 22 (35.5%) of the 62 SCC specimens, respectively. The positive staining of CD44v7-8 in oral SCC was significantly less than that in NBM (P〈0.01). No significant correlation was found between CD44v7-8 expression and daily or total consumption of betel quids or cigarettes by the SCC patients. The 5-year survival rate for patients with CD44v7-8-positive tumours was significantly higher than that for the CD44v7-8-negative group (P〈0.03). These results indicate that loss of CD44v7-8 expression may be a valuable factor for determining prognosis in oral SCC patients.

Notes: Our recent study found that a new topical 5-aminolevulinic acid-mediated photodynamic therapy (ALA-PDT) protocol composed of multiple 3-min fractionated irradiations with a light emitting diode (LED) red light at 635 ± 5 nm for a total of 1000 s (fluence rate: 100 mW/cm2; light exposure dose: 100 J/cm2) after topical application of 20% ALA for 1.5 or 2 h can be used successfully for the treatment of oral verrucous hyperplasia. In this case report, we tested the efficacy of this new treatment protocol of ALA-PDT for an extraoral verrucous carcinoma (VC) lesion at the right mouth angle and an intraoral VC lesion at the right buccal mucosa of a 56-year-old male areca quid chewer and smoker. The extraoral tumor was cleared after six treatments of topical ALA-PDT and the intraoral tumor showed complete regression after 22 treatments of topical ALA-PDT. No recurrence of the VC lesion was found after a follow-up period of 6 months. We suggest that PDT using a topical application of 20% ALA followed by multiple 3-min fractionated irradiations with an LED red light is also an effective and successful treatment modality for VC.

Notes: Background:  Oral submucous fibrosis (OSF) is a chronic oral mucosal disease characterized by progressive deposition of collagen in the subepithelial connective tissue and epithelial atrophy. Previous studies have shown that at 330-nm excitation, the 380- and 460-nm emission peaks of the auto-fluorescence spectra for oral mucosal tissues reflect the collagen content in the subepithelial connective tissue and the nicotinamide adenine dinucleotide phosphate (NADH) content in the epithelial cells, respectively. Therefore, at 330-nm excitation OSF mucosa may have a higher 380-nm emission peak and a lower 460-nm emission peak than the normal oral mucosa (NOM).Methods:  To test the above hypothesis, we measured the in vivo auto-fluorescence spectra of 59 OSF mucosal sites and compared the measured spectra with auto-fluorescence spectra obtained from 15 NOM samples from 15 healthy volunteers, five samples of friction hyperkeratosis (histologic diagnosis, hyperkeratosis and acanthosis) on OSF buccal mucosa (FHOSF), and 29 samples of oral leukoplakia (histologic diagnosis, hyperkeratosis and acanthosis) on OSF buccal mucosa (OLOSF).Results:  We found that the spectrum of the OSF mucosa had a significantly higher 380-nm emission peak and a significantly lower 460-nm emission peak than the spectra of NOM, FHOSF, and OLOSF samples. When the mean (±SD) fluorescence intensities at 380 ± 15 nm (I380 ± 15 nm) and 460 ± 15 nm (I460 ± 15 nm) emission peaks and the mean ratio of I460 ± 15 nm/I380 ± 15 nm were compared between groups, we found that OSF group had a significantly higher mean value of I380 ± 15 nm, a significantly lower mean value of I460 ± 15 nm, and a significantly lower mean ratio of I460 ± 15 nm/I380 ± 15 nm than the NOM, FHOSF, and OLOSF groups (P 〈 0.001). However, no significant differences in the mean values of I380 ± 15 nm, I460 ± 15 nm, and ratio of I460 ± 15 nm/I380 ± 15 nm were found between NOM and FHOSF or OLOSF samples as well as between FHOSF and OLOSF samples (P 〉 0.05).Conclusion:  Because OSF mucosa has a very unique pattern of auto-fluorescence spectrum, we conclude that auto-fluorescence spectroscopy is a good method for real-time diagnosis of OSF.