Maxillofacial trauma in fatally injured victims of motor vehicle accidents

A survey of 84 victims of maxillofacial injuries sustained in road traffic accidents is presented. The material was based on the files of the Finnish National Board of Traffic Accident Investigation of the Insurance Companies, comprised the years 1972-1983 and covered the whole country. 86% of the victims were occupants of motor cars; only 24% had worn seat belts. Similarly only two of the eight motor-cyclists had worn a helmet. The majority of all victims also had other head injuries but only 24% had brain injuries; over 50% had a chest injury. In 20 cases the facial injury was thought to be the definitive fatal trauma. In the remaining cases the other injuries could have been responsible for the fatal outcome. However, aspiration of blood from the facial wounds, unconciousness and an injured thorax probably all contributed to death which in 87% was immediate. Thirty-six of the 64 victims who had not used a seat-belt or helmet could certainly, or probably, have been saved by either the belt or the helmet. The possibilities of preventing fatal maxillofacial injuries in road traffic are discussed.

Autogenous costochondral grafts in temporo-mandibular joint arthroplasty. A survey of 66 arthroplasties in 60 patients

A clinical study of 60 patients who underwent 66 costochondral arthroplasties during the period 1969-1984 is presented. In nearly half of the cases ankylosis was the main indication for operation, followed by dysplasia, tumours and osteomyelitis. The results showed that all cases in which the rib was decorticated to fit into the mandible as an inlay healed well. The mean time of IMF was 3.5 weeks. In the majority of the patients (67%) the postoperative function of the mandible was considered to be good or excellent, and nearly all patients were pain free. There were no postoperative chest infections and only one case of pneumothorax. Motor and sensory disturbances in the lower lip were each diagnosed in ten per cent of the patients.

Fatal cervical spinal injuries in road traffic accidents

The present study analyses fatal road traffic accidents involving private cars and vans in Finland during the period 1972-1982, in which an injury to the cervical spine was the main cause of death. The material consists of 289 victims; this being 10.5 per cent of all the fatalities in this category of road traffic accidents. Front seat and rear seat passengers seem to have an equal risk of sustaining a fatal cervical spinal injury. However, front seat passengers have a significantly greater chance (P less than 0.001) of having fatal cervical spinal injuries than the drivers. Of the victims 21.1 per cent had worn safety belts but there was no statistical difference between those who did and those who did not wear safety belts. Increasing age seems to increase the risk of fatal cervical spinal injuries. Patients between 16 and 25 years of age had the lowest risk and patients over the age of 60 had the highest risk of sustaining a fatal cervical spinal injury (P less than 0.001). In 48.1 per cent of the cases, the victims were multiply injured and this is similar to other main causes of death in road traffic accidents. Wearers of safety belts had significantly (P less than 0.001) more multiple injuries. Of the patients who died of cervical injury, only 8.8 per cent survived transportation to hospital and 1.4 per cent survived longer than 24 hours. A direct blow was the most common mechanism of the cervical injury (47.1 per cent) and deceleration was found in 13.1 per cent of the cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Primary intraosseous carcinoma of the mandible

The case of a 58-year-old man with a large primary intraosseous carcinoma (PIOC) of the mandible is presented. The tumour is rare, and the prognosis is usually poor. There are no specific histological characteristics of PIOC. Staining for basement membrane laminin could be a valuable aid in the differential diagnosis between PIOC and tumours of ameloblastoma origin.

Maxillofacial fractures sustained in bicycle accidents

The present report is an analysis of 93 patients (52 male; 41 female) treated in 1981-1983 for maxillofacial fractures sustained in bicycle accidents. These accidents accounted for 7.1% of all facial bone fractures treated during the same period. Most accidents were single vehicle accidents (88%) and took place during the summer months. Of the patients, 65% had mandibular fractures, 35% had midface fractures and 5% had fractures in both the middle and lower thirds of the face. Condylar fractures were by far the most common of the mandibular fractures (67%)--a result which differs from studies concerning the profile of mandibular fractures in general. The majority of the middle third fractures were zygomatic (65%). Multiple injuries were diagnosed in 38% of the cyclists and other head injuries were the most common associated injury. Mean hospitalization of the in-patients (38%) was 4.1 days and the average sick leave was 14 days. The results of the study indicate that the use of protective helmets should be strongly recommended to cyclists, although most commercially available helmets do not protect the whole facial area and especially not the chin.

Induction of concanavalin A dose-dependent T-cell growth factor production by insertion of T-cell membrane components into the AKR thymic lymphoma BW 5147

Sendai virus vesicles were used as vehicles for the insertion of various cell membranes into different cell lines. The transplantation efficiency was measured by using FITC-labelled concanavalin A (Con A) or monoclonal antibodies against the T-cell marker Lyt 2 and the major histocompatibility complex product H-2Db in a fluorescence-activated cell sorter. Results indicate that it is possible to transplant mitogen responsiveness to certain cell types. Con A stimulation of T-cell membrane transplanted BW 5147 showed that it is possible to induce a mitogen dose-dependent T-cell growth factor production. Consequently this method appears to be an attractive model for further study of the properties of the membrane structures involved in mitogen triggering of cells.

Dental bacteremia--a neglected cause of arthroplasty infections? Three hip cases

We report on three patients with late hip replacement infection. The micro-organism was microaerophilic Streptococcus viridans, an oral organism, in all patients. Dental procedures had preceded the onset of the hip infection in all cases, and severe periodontal disease was observed on subsequent admissions.

Tetracycline induced esophageal ulcers. a clinical and experimental study

Medication with oral drugs has not been considered as a cause of esophageal lesions in the general literature of esophageal disease. This study demonstrates 40 patients with complaints of sudden onset of intense retrosternal pains and odynophagia during treatment with oral tetracyclines. All patients had distinct circumferential ulcers in the esophagus. Medical history, barium swallows, esophagoscopy, biopsies and esophageal manometry revealed no other apparent etiology but a local corrosive effect of the tetracyclines. Experimental tests on the esophagus of the cat verified a severe local corrosive effect of the tetracyclines. Another tetracycline, lymecycline, not reported previously to induce esophageal lesions in man, was significantly less ulcerogenic than doxycycline and oxytetracycline. Drug induced esophageal ulcerations are likely to be more numerous than previously suspected. The experimental model used appears to be sound for investigating ulcerogenic potentials of orally administered drugs.

Occupations with low risk of lip cancer show high risk of skin cancer of the head

The standardized morbidity ratios (SMR) of lip and non-melanomatous skin cancer (basal-cell carcinoma excluded) of the head and neck in males were determined for different occupational groups in Finland. The data on all cases of these types of cancer diagnosed in Finland in the age group 35-69 years in 1971-75 were supplemented by information on occupations from the 1970 census (Central Statistical Office of Finland). The expected numbers of cases were based on the age and occupation-specific numbers of person-years computed by the Central Statistical Office, and the age-specific incidence rates of lip and skin cancers among the economically active population. The highest SMR of lip cancer among all the occupational groups was found in agriculture, forestry and fishing (1.64). In contrast, the SMR of skin cancer was not higher than expected in occupations related to agriculture and forestry. Significantly lower than expected risks of lip cancer were observed among highly educated white-collar workers, among whom the risk of contracting skin cancer was the highest (technical, scientific, humanistic and artistic work, SMR 1.78). The morbidity of both lip and skin cancers varies considerably by occupation, and the risks seem to be, at least in part, inversely related. Thus, it is probable that there are also differences in the risk factors, contrary to several earlier suggestions. The nature of these factors are discussed.

Is upper lip cancer "true" lip cancer?

A description is given of the occurrence of upper and lower lip cancers in Finland in the period 1953-1974 with the aim of reaching conclusions on the possible differences in the etiological factors involved. Substantial differences with respect to various epidemiological parameters, such as incidence rates, trends in the incidence with time, male/female ratios of the incidence rates, age-incidence curves, urban/rural ratios of the incidence rates, and geographical distribution, were demonstrated between upper and lower lip cancers. On the other hand, similarities in the occurrence of upp]er lip cancer and non-melanomatous skin cancer of the head and neck could be observed. It was concluded that in terms of etiology upper lip cancer could be regarded as a separate entity and different from "true" lip cancer of the lower lip. The role of recurrent herpetic infections of the lips is also discussed.

Second primary cancers in patients with carcinoma of the lip

The occurrence of second primary cancers in patients with lip cancer was evaluated in order to test certain etiologic hypotheses. All cases of lip cancer reported to the Finnish Cancer Registry in 1953-74 (3303 men, 320 women) were followed up for a second (or third) primary cancer through the files of the Registry either to death or to 31 December 1974 (a total of 25 510 person-years). The expected numbers of cases were calculated on the basis of the incidence rates specific for sex, age, time and residence (urban or rural) in Finland. A higher than expected risk of cancer was found among both urban and rural male lip cancer patients; among women the observed number of new primary cancers did not differ from that expected. A significant excess risk among males was noted for cancers of the lung and larynx (rural patients) and for non-melanomatous skin cancer in locations other than the head and neck (urban patients). The association of cancers of the lip, lung and larynx found earlier on a geographic level supports the hypothesis that tobacco smoking is a common risk factor in these cancers. The differences in the relative risks between urban and rural patients, however, suggest that the risk factors in lip cancer in urban areas might be partially different from those prevalent in the rural population. The results do not support the hypothesis that sunlight is an important risk factor in lip cancer.

Risk factors in lip cancer: a questionnaire survey

An analysis was made of potential risk factors of cancer of the lip in Finland. The series comprised 290 lip cancer patients, and the controls were 254 patients with squamous cell carcinoma of the skin of the head and neck, all reported to the Finnish Cancer Registry in 1972-1973. The results obtained in a questionnaire survey (response rate, 75%; 54% of the total series) indicated that the male lip cancer patients had engaged in outdoor work and smoking with significantly greater frequency than had the male controls. Together, these two risk factors posed a markedly increased risk (RR = 15.4). However, when the factors were analyzed separately, each excluding the effect of the other, no significant risk could be noted. The male lip cancer patients had recurrent herpetic infections with significantly greater frequency than did the male controls. No significant differences were apparent with respect to urban or rural residence. It is concluded that tobacco smoking and outdoor work probably act together to induce lip cancer. The mode of interaction between these factors and the etiologic role of herpesvirus are discussed.

Risk factors of lip cancer: a critical evaluation based on epidemiological comparisons

A description is given of the occurrence of lip, skin, and intraoral cancers in Finland in the period 1953-1973 with the aim of testing certain etiologic hypotheses. In addition, data on lip cancer were correlated with those of some other types of cancer. Substantial differences with respect to various epidemiologic parameters were found between lip and skin cancers. However, there were similarities between lip cancer and cancers of the upper gastrointestinal canal and respiratory organs (especially lung cancer). Negative geographic correlation was found between the age-adjusted incidence rate of lip cancer and that of cancers of the colon and prostate. In addition, the correlation was highly negative for the median income per capita (p less than 0.001). It was concluded that, in terms of cancer etiology, lip cancer is more closely related to cancer of the oral cavity than to that of the skin. Moreover, some specific socioeconomic factors associated with a low standard of living must be considered as noteworthy risk factors of lip cancer.

Epidemiological evaluation of sunlight as a risk factor of lip cancer

A total of 3,169 cases of lip cancer in males and 303 cases in females were diagnosed in Finland and reported to the Finnish Cancer Registry in 1953-73. The diagnosis was verified histologically in 95% of the cases in males and in 92% in females. The mean annual age-adjusted incidence rate was 7·3/10(5) in males and 0·5/10(5) in females. The annual incidence for males has decreased since the early 1960s. The decrease involved all age groups and was not due to a cohort effect. Only a very slight decrease in the risk was observable in females. The incidence was clearly higher in rural than in urban areas, the urban/rural ratio of the age-adjusted incidence rates being 0·6 for males. A decrease in the risk with time was observable for both urban and rural populations. The risk was highest in the northern and eastern parts of the country, for both urban and rural areas. It was concluded that the decrease in the incidence of lip cancer in Finland cannot be accounted for solely by the process of urbanization. An inverse relationship was found between the mean annual amount of solar radiation and the risk of lip cancer. The results are not in accordance with the theory of the association between exposure to actinic radiation and the risk of lip cancer. The synergistic action of some other factors related to outdoor occupation, and probably smoking, would provide a better explanation for the observations in this study.