No abstract

We studied corresponding structures on the oral and basal surfaces of the oral epithelial layer, focusing on the microanatomy of gustatory papillae. Specimens for scanning electron microscopy were obtained from the rat soft palates and fixed with a mixture of 2% paraformaldehyde and 1% glutaraldehyde. They were first prepared without postfixation and conductive-staining to study the oral surface. After examination, the epithelium was reinforced by additional sputter coating and treated with 6 N NaOH at 60°C to exfoliate the basal epithelial surfaces without any significant artifacts. The papillae, showing circular, elliptical or fusiform protuberances on the oral surface, were classified into two types: types I and II. The type I and type II papillae contained one and two taste pores, respectively. On the basal epithelial surface, the basal portions of the taste buds were associated with concentrically arranged nerve fibers and Schwann cells. Another characteristic finding on the basal epithelial surface was the presence of excretory ducts of minor salivary glands in a close spatial relationship to taste buds. It is suggested that saliva coming out through the duct is mixed with food, thus enabling intimate contact with the taste pores of the papillae.

The three-dimensional architectures of the perigemmal cells and their keratin bundles in the rat circumvallate papillae were studied by transmission and scanning electron microscopy. The perigemmal cells were classified into three layers: basal, middle and upper. The basal layer consisted of polygonal cells located close to the basal lamina, the middle layer comprised longitudinally elongated cells fitting the lateral convexity of the taste bud, and the upper layer was imbricating flat cells along the upper portion of the taste bud. When fresh specimens were jointly treated with Triton X-100 and sonication, the taste buds were often detached and the cytoplasmic matrices of the perigemmal cells were effectively removed. Consequently, we were able to demonstrate an extensive network of the subplasmalemmal keratin bundles of the perigemmal cells. The framework appeared either as a thin lacework, a thick fence-like structure, or a lattice work in the basal, middle, and upper layers, respectively. The thin lacework in the basal layer was considered to be a developing process of the framework. The thick fence-like structure in the middle layer probably plays a primary role in supporting the taste bud. The latticework in the upper layer is believed to reflect a remodeling in reducing the keratin framework.

Reports of abnormalities in hemostasis after minor surgery, especially after the extraction of teeth in patients with disseminated intravascular coagulation (DIC), are rare. This report presents a case of chronic DIC associated with an aneurysm, leading to hemorrhage after the extraction of a tooth. The patient was an 81-year-old man with a history of hepatitis C, atrial fibrillation, and aneurysms. We performed local hemostatic treatment , but intermittent hemorrhage continued. On investigating the cause of the persistent hemorrhage, we found a distinct rise in fibrinogenolysis markers and an increase in a thoracic aortic aneurysm. Chronic DIC of fibrinogenolysis predominant type was therefore diagnosed. As for treatment, hemostatis was successfully achieved by an improvement in advanced fibrinogenolysis. DIC, associated with a variety of basal disorders and varying conditions , requires immediate corrective action under an appropriate diagnosis.

We describe two cases of tetanus. Both patients referred to our hospital because of difficulty in mouth opening. Physical examination revealed severe trismus, dysarthria, and dysphagia in both patients. Patients had no noticeable history of trauma. The patients were given a diagnosis of tetanus on the basis of clinical course and symptoms such as rapidly progressive trismus, dysarthria, and dysphagia. The patients were admitted to our hospital immediately. One patient was given antitetanic human immunoglobulin, tetanus antitoxin, antibiotics, and dantrolen sodium. He recovered without tracheotomy or tracheal intubation, and was discharged on the 25th hospital day. The other patient was given antitetanic human immunoglobulin, tetanus antitoxin, antibiotics, vecuronium bromide, propofol, and magnesol. A tracheotomy was performed in the latter patient because of dyspnea. He discharged on the 26th hospital day. Both patients had no functional sequelae. Tetanus often leads to death when early diagnosis and early treatment are not appropriately performed. Oral surgeons should consider the possibility of tetanus in patients with trismus and examine them carefully.