: Conservative management should be limited to early-onset ORN after brachytherapy with or without a low dose of external irradiation. Marginal mandibulectomy is appropriate for the late-onset ORN after brachytherapy with or without low-dose external irradiation. Segmental mandibulectomy is required for late-onset ORN after a high dose of external irradiation.

Twenty-three cases of accidental ingestion during dental procedures, which occurred at the Center for Dental Clinics of Hokkaido University Hospital between 2006 and 2010, were analyzed retrospectively. We examined not only the objects ingested, but also details of the circumstances (treated teeth, types of treatment, professional experience of the practitioners). Except for two cases (an unidentified endodontic file and the tip of an ultrasonic scaler, which were recovered by vacuuming), the other 21 accidentally ingested objects were all found in the digestive tract, and none in the respiratory tract, by radiographic examination of the chest and abdomen. The ingested objects were mostly metal restorations (inlays or onlays) or prostheses (crowns or cores). Ingestion occurred more frequently during treatment of lower molars, and when procedures were being conducted by practitioners with less than 5 years of experience. No adverse events related to ingestion were reported. The present study found no cases of aspiration or complications related to the ingested objects. However, considering the risk of life-threatening emergencies related to accidental aspiration and ingestion, dentists must take meticulous precautions and be ready to deal with this kind of emergency during dental procedures.

Examination of contrast-enhanced CT images and MR images revealed that the contents of SBCs were not aberrations of the submandibular gland, as has generally been thought, but fatty tissue, blood vessels and soft tissue.

Hepatocyte growth factor (HGF) is thought to play a role in cell motility and invasion. Matrix metalloproteinases (MMPs) have been implicated in invasion and metastasis of tumor cells. We have previously reported that the Ets-oncogene family transcription factor E1AF positively regulates transcription of MMP genes in transient expression assays and that overexpression of the E1AF gene confers an invasive phenotype on breast cancer cells. Here we examined the effect of HGF on E1AF and MMP gene expression in terms of the invasive potential of the oral squamous cell carcinoma cell line HSC3. HGF stimulated expression of the E1AF gene. The levels of MMP-1, -3 and -9 mRNAs increased in cells treated with HGF and correlated with E1AF upregulation. In contrast, no obvious upregulation of MMP-1 and -9 mRNA was observed in ASE1AFHSC3 cells transfected with the antisense E1AF expression vector into parental HSC3 cells. The wild-type MMP-9 gene promoter was activated by endogenous E1AF in HSC3 cells, and chloramphenicol acetyltransferase (CAT) activities increased when HGF was added to transfected cells. On the other hand, CAT activity was reduced to almost two-thirds of the wild-type activity when HSC3 cells were transfected with a CAT reporter plasmid driven by a mutant MMP-9 promoter lacking the Ets-binding site, and induction of CAT activity was not observed upon addition of HGF. Analysis of organotypic raft cultures revealed that HSC3 cells invaded and degraded collagen gel actively upon addition of HGF. These results suggest that HGF induces expression of the Ets-related E1AF transcription factor gene whose product in turn activates MMP genes and leads to oral cancer cell invasion.

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