Female anterior wall onlay urethroplasty with lower lip buccal mucosal graft: Importance of the laterally extended incision

Objective:To describe the outcome of female anterior wall(pubic side)onlay urethroplasty with buccal mucosal graft using laterally extended surgical dissection in patients with previously failed minimally invasive techniques.Methods:From January 2016 to April 2018,17 symptomatic patients with previously failed minimally invasive procedures were enrolled in the study.The diagnosis of urethral stricture was confirmed based on a combination of patients’symptoms,post-void residual urine,video-urodynamics,and cystoscopy.Urethroplasty with lower lip mucosal graft was performed using the modified laterally extended dissection.Patients were evaluated pre-operatively and 12-month post-operatively with the American Urological Association symptom score,post-void residual urine,and maximum flow rate.Results:Despite the previously failed minimally invasive procedures,urethroplasty with lower lip buccal graft and laterally extended dissection resulted in favorable outcomes(success rateZ94%).The mean
standard deviation of American urological association symptom score improved from pre-operative levels at the 12-month post-operative follow-up(25.82
3.97 to 10.88
5.57);so did postvoid residual urine(71.12
74.98 mL to 15.00
28.30 mL),and maximum flow rate(7.88
1.72 mL/s to 25.82
5.59 mL/s)with all statistically significant(p<0.05).Conclusion:The current study showed that female urethroplasty with buccal graft could be highly successful in experienced hands.An anterior approach could be superior to the posterior one due to higher mechanical support and lower sacculation rate.A laterally extended incision may improve visualization and better graft placement by providing wider working space.The results should be evaluated in the future studies with larger sample size.

Tunica albuginea versus buccal mucosa graft urethroplasty for anterior urethral stricture: A prospective randomised pilot study

Objective:The objective of the study was to compare the outcome of tunica albuginea urethroplasty(TAU)and buccal mucosa graft(BMG)urethroplasty for anterior urethral stricture.Methods:Thirty patients who met the inclusion criteria were randomised into two groups:TAU(Group A)and BMG urethroplasty(Group B).Surgical outcome was evaluated with pre-and post-operative work-up involving retrograde urethrogram,voiding cystourethrogram,uroflowmetry,and urethroscopy.Patients were followed up till 1 year.Results:Mean duration of surgery was statistically significant between two groups(p=0.0005).Maximum urine flow rate was comparable when compared between two groups(p=0.22)but statistically significant when compared pre-and post-operatively(p<0.001).At follow-up of 1 year,the successful outcomes were 80% in Group A and 87%in Group B.A total of five patients who had unsuccessful results required redo urethroplasty.Complications were minimal in both the groups.Conclusion:TAU provides outcomes equivalent to those of BMG urethroplasty.TAU has less operative time,easy to perform,and beneficial in patients with poor oral hygiene.

Single stage dorsal inlay buccal mucosal graft with tubularized incised urethral plate technique for hypospadias reoperations

Aim： To report the experience with single stage dorsal inlay buccal mucosal grafts using the Snodgrass technique for complex redo cases. Methods： From May 2004 to December 2005, a total of 53 patients aged from 3 to 34 years old （average 11.62 ± 7.18 years） with failed previous hypospadias surgery were included in the present study. Indications included urethral strictures and repair breakdown. The unhealthy urethra was unroofed from the meatus in the ventral midline, a buccal mucosal graft was inlayed between the incised urethral plate and fixed to the corpora cavernosa. The neourethra was tubularized, and covered with subcutaneous （dartos） tissue and penile skin. Glanuloplasty was also performed in all cases. Outcome analysis included clinical follow-up, and endoscopy in 2 selected cases. Results： The buccal mucosal graft was 3.0-7.5 cm in length and 0.7-2.0 cm in width. All patients required glanuloplasty, with buccal mucosal grafts extended to the tip of the glans. After a follow-up of 14-30 months （mean 22.6 months）, the total complication rate was 15.1%, with five cases of fistula and three cases of stricture. Conclusion： Inlaying dorsal buccal mucosal grafts applying the Snodgrass technique is a reliable method for creating a substitute urethral plate for tubularization. The recurrent rate of urethral stricture and fistula is at an acceptable level for redo cases. This approach represents an effective, simple and safe option for reoperations.

Role of the Chinese Herbal Medicine Xianhuayin on the Reversal of Premalignant Mucosal Lesions in the Golden Hamster Buccal Pouch

Aim To investigate the role of the Chinese herbal medicine Xianhuayin on the reversal of 7,12-dimethylbenz[a]anthracene （DMBA）-induced premalignant mucosal lesions in the oral buccal pouch of golden hamsters. Methodology The animals were randomly divided into a non-diseased control group （n=5） and an experimental group including 50 animals in which the buccal mucosa had been painted with DMBA （0.5% in acetone） to generate an oral mucosa premalignant lesion. Animals in the experi- mental group were further divided into Xianhuayin-treated group （n=30）, untreated prem＇alignant lesion group （n=10） and normal saline （NS）-treated group （n=10）. The cheek （buccal） pouch mucosa of the golden hamsters in each group was observed with light and electron microscopy eight weeks after intragastric administration with NS or Xianhuayin. Results In the non-diseased control group, the buccal mucosa was keratinized and stratified squamous epithelium under a light microscope. In the untreated premalignant lesion group, variable degrees of epithelial dysplasia was observed. The irregular epithelial mucosa gradually became distinct in the Xianhuayin-treated group. Scanning electronic microscopic （SEM） analysis showed that surface of the cells exhibited honeycomb structures in the hamster of untreated- group. The cells were morphologically irregular, overlapped and loosened in the untreated premalignant lesion group. Most of the cell surface exhibited honeycomb structure in the Xianhuayin-treated group. Transmission electronic micro- scopic （TEM） analysis showed that buccal mucosal epithelial cells were morphologically regular in the non-diseased control group. Desmosomes and tonofibrils were reduced and the nucleus was morphologically irregular in the untreated premalignant lesion group. In the Xianhuayin-treated group, the widening intercellular gap was gradually reduced, desmosomes and the cells becoming morphologically regular. No significant difference was observed between the hamsters in NS-treated group and those in the untreated premalignant lesion group. Significant therapeutic efficacy was observed in the group receiving Xianhuayin. Conclusion Xianhuayin is effective in the reversal of DMBA-induced premalignant lesions in the buccal pouch of golden hamsters.

Formulation of unidirectional release buccal patches of carbamazepine and study of permeation through porcine buccal mucosa

Objective:To achieve transbuccal release of carbamazepine by loading in unidirectional release mucoadhesive buccal patches.Methods:Buccal patches of carbamazepine with unidirectional drug release were prepared using hydroxypropyl methyl cellulose,polyvinyl alcohol,polyvinyl pyrrolidone and ethyl cellulose by solvent casting method.Water impermeable backing layer(Pidilite?Biaxially-oriented polypropylene film)of patches provided unidirectional drug release.They were evaluated for thickness,mass uniformity,surface pH and folding endurance.Six formulations FA2,FA8,FA10,FBI,FB14 and FB16(folding endurance above 250)were evaluated further for swelling studies,ex vivo mucoadhesive strength,ex vivo mucoadhesion time,in vitro drug release,ex vivo permeation,accelerated stability studies and FTIR and XRD spectral studies.Results:The ex vivo mucoadhesion time of patches ranged between 109 min(FA10)to 126 min(FB14).The ex vivo mucoadhesive force was in the range of 0.278 lo 0.479 kg/m/s.The in vitro drug release studies revealed that formulation FA8 released 84%and FB16 released 99.01%of drug in140 min.Conclusions:The prepared unidirectional buccal patches of carbamazepine provided a maximum drug release within specified mucoadhesion period and it indicates a potential alternative drug delivery system for systemic denvery of carbamazepine.

Buccal administration of mucoadhesive blend films saturated with propranolol loaded nanoparticles

The aims of this study were to prepare and characterize hydroxypropyl methylcellulose(HPMC)/polycarbophil(PC) mucoadhesive blend films saturated with propranolol hydrochloride(PNL)-loaded nanoparticles to improve permeability of drugs that undergo firstpass metabolism. An ionic cross-linking method and film casting technique was used to prepare nanoparticles and mucoadhesive blend films, respectively. Increasing concentrations of PNL(70, 80, 90 mg/film) in HPMC/PC blend films containing PNL-loaded nanoparticles(PN-films) and HPMC/PC blend films containing PNL(80 mg/film) without nanoparticles(PPfilms) were prepared to test swelling, mucoadhesiveness, release, permeation and physicochemical properties. Scanning electron microscope(SEM) images showed a partially smooth surface with a wrinkled occurrence and spherically shaped, well-dispersed nanoparticles on the surface of PN-films containing PNL 80 mg/film(PN-films-80). The size of the nanoparticles on the surface of PN-films-80 was around 100 nm, which was similar to the nanoparticle size observed using light scattering technique. The swelling index(SI)of all PN-films and PP-films increased greatly in the first period time(10–20 min) and reached swelling equilibrium at 20 min and 30 min, respectively. For the PN-films, the concentration of PNL influenced the mucoadhesive properties and tended to be higher when the amount of PNL increased. Immediate release of all blend film formulations was found in early time points(10–30 min). After 120 min, the release of PN-films-70 was lower than the other PNfilms. Permeation studies using porcine buccal mucosa showed that inclusion of nanoparticles in the films increased the permeability of PNL compared to PP-films. Therefore, buccal administration of mucoadhesive blend films containing PNL-loaded nanoparticles could be a promising approach for drugs that undergo first-pass metabolism.

A clinical perspective on mucoadhesive buccal drug delivery systems

Mucoadhesion can be defined as a state in which two components, of which one is of biological origin, are held together for extended periods of time by the help of interfacial forces. Among the various transmucosal routes, buccal mucosa has excellent accessibility and relatively immobile mucosa, hence suitable for administration of retentive dosage form. The objective of this paper is to review the works done so far in the field of mucoadhe- sire buccal drug delivery systems （MBDDS）, with a clinical perspective. Starting with a brief introduction of the mucoadhesive drug delivery systems, oral mucosa, and the theories of mucoadhesion, this article then proceeds to cover the works done so far in the field of MBDDS, categorizing them on the basis of ailments they are meant to cure. Additionally, we focus on the various patents, recent advancements, and challenges as well as the future prospects for mucoadhesive buccal drug delivery systems.

A Two-Stage Buccal Mucosal Graft (BMG) for Managing Recurrent Proximal Penile Hypospadias in Pediatric &Adolescent Populations

Introduction: The presence of a recurrent proximal penile hypospadius represents a surgical challenge to the urologist due to the presence of excessive scarring and fibrosis of the tissues. This problem is more pronounced in circumcised patients, in whom there is no enough skin for one stage procedures. Buccal mucosal grafts represent a good surgical option. The aim of this study was to evaluate the results of two stages buccal mucosal urethroplasty in pediatric & adolescent patients, presenting with recurrent proximal penile hypospadias who are circumcised. Methods: Thirty seven pediatric & adolescent patients underwent two stages buccal mucosal urethroplasty for recurrent proximal penile hypospadius. In all cases the buccal graft was placed dorsally followed by the second stage closure after 6 months. Results: The mean age was 17.7 (14-20) years. With a mean follow-up of 28.3 months, 33 patients (89.2%) had a final successful outcome. Of the 4 cases that were considered as failure, 3 patients (8.1%) developed urethra-cutaneous fistula that required closure after 3 months. The remaining patient developed meatal stenosis. Conclusion: Although buccal mucosal urethroplasty is a two staged procedure, it is feasible option for pediatric & adolescent patients presenting with recurrent proximal penile hypospadius, who had no skin available for penile flaps, with a success rate approaching 89.2%.

Orthognathic Surgery Combined with Partial Lipectomy of the Buccal Fat Pad： Case Report on Optimization of Esthetic Outcome

Orthognathic surgery involves correction of functional and often esthetic disharmonies. The purpose of this case report is topresent the case of a 22 years-old female with class III dentofacial deformity that required orthognathic surgery to treat hermalocclusion and buccal fat pad excision for optimizing soft-tissue facial contour. Treatment planning involved a counterclockwiserotation of the maxilomandibular complex with genioplasty based on digital 3D surgical planning using the Dolphin Imaging 11.7 3DPremium software. Prototyping splints allowed surgical procedures （bilateral sagital mandibular osteotomy associated to a Le fort Iosteotomy） that corrected position of the gnathic bones. In the same surgical procedure, the buccal fat pad was partially removed for asharp cheek contour giving a slimmer appearance to her face. After 5 months, the patient was reassessed and reported no complaintsregarding esthetics or function. This case illustrates that a combination oforthognathic surgery and an esthetic procedure can result in astable and harmonious facial as well as occlusal outcomes.

Morphological study of the asymmetrical buccal cavity of the flatfish common solea(Solea solea) and its relation to the type of feeding

Objective:To investigate the surface architecture of the asymmetrical buccal cavity of Solea solea which are considered one of the most important predators in benthic communities.Methods:Adult Solea solea were obtained from Mediterranean Sea near Damielta.The heads were removed and processed for scanning electron microscopy.Its buccal cavity is asymmetrical and divided into roof and floor and the tongue for histological studies.Results:The buccal cavity roof is formed from upper jaw,velum and the palate.The upper jaw has several wing like processes with teeth arranged in several rows which may help in cutting and pushing the food to the entrance of the digestive canal while the floor is formed from the lower jaw and the tongue.The tongue is divided into apex,body and root.There is a gradual decrease of goblet cells in the tongue from anterior to posterior.These goblet cells function in protection of the epithelium.CoDctusions:Teeth in the floor of the buccal cavity and taste buds can be considered adaptive changes of the oral cavity related to the feeding habits and was a source to identify new and better methods of nutrition in aquaculture of Solea solea.

Effect of the parasitic isopod,Catoessa boscii(Isopoda,Cymothoidae),a buccal cavity parasite of the marine fish,Carangoides malabaricus

Objective:To examine the effect of isopod parasite Catoessa boscii(C.boscii)on Carangoides malabaricus(C.malabaricus).Methods:The host fish C.malabaricus infested by C.boscii were collected directly from the trawlers landed at Parangipettai coast during December 2008 to November2009.Data regarding the total length,width,weight and sex of the host fish were recorded.Effect of infestation on C.malabaricus,the length and weight data were analysed and host specificity of isopods was also examined.Results:During the sampling period,585 C.malabaricus were examined.Among them,218 specimens were found to carry 243 parasites.Three pairs of isopods(one male with one female)were recorded from the host fish and each pair was attached to the tongue in the buccal cavity of the host.Another pair was also found where the male and male,female and female isopod had settled on the tongue in the buccal cavity.Gross lesions observed in the buccal cavity of infested fish showed small pin-holes in the tongue region,through which dactyls of pereopod's penetrating claws dig into the host tissues.The maximum weight loss was reported in females(5.43%)than in males(3.75%)of C.malabaricus.Due to infestation of different isopod parasites in both male and female fish,the effects on the length-weight relationship of C.malabaricus were compared.The rate of increased growth in weight in uninfested female fish was found to be higher than that of the infested.The weight gain is faster in uninfested fish than in the infested fish.Conclusions:From the above mentioned observations,it is clear that the worst of fish on account of the infestation of isopods are the C.malabaricus succumbed to the attack of isopod parasites.Although,the infestation did not cause immediate death,it had affected the normal growth of the host fish.

Bioadhesiveness of thiolated pectin for buccal delivery of carbenoxolone sodium

Pectin is a biopolymer that has numerous useful purposes in food and beverage industry, cosmetic products and pharmaceutical fields. One of the important properties of pectin is its bioadhesive properties. Native pectin provides fair bioadhesive properties that can be improved by modification of pectin structure. The immobilization of thiol groups on polymer can significantly improve the bioadhesive properties due to in situ cross-linking between thiol groups of polymer and mucin [1].

Case of primary extracranial meningioma of the maxillary sinus presenting as buccal swelling associated with headache:A case report

BACKGROUND Meningiomas are benign tumors that originate from the meningothelial arachnoid cells,but they rarely develop extracranially.There is no specific surgical guideline for resecting them in the maxillary sinus,and little is known about their biological behavior and operative management.CASE SUMMARY We present a 54-year-old female patient referred to our department with a primary extracranial meningioma that presented as buccal swelling associated with headache.On clinical examination the mass was non-tender,fixed,sessile and non-pulsatile situating in the right maxillary sinus.Computed tomography scan showed a well-defined mass of 7 cm×6 cm×6 cm compressing the surrounding structures.Magnetic resonance imaging revealed a well circumscribed heterogenous lesion with necrotic center and relatively hypointense on T2-weighted imaging.Imaging studies revealed no evidence of intracranial extension and metastatic nests.Biopsy showed grade I primary extracranial with low mitotic activity.Total maxillectomy with excision of tumor and adjacent paranasal structures following reconstruction of the orbit and maxilla with tissue patch was done by the maxillofacial surgeon.The biopsy reported fibrous meningioma based on the hematoxylin and eosin section.On immunohistochemistry the tumor cells were positive for vimentin,focally positive for epithelial membrane antigen and CD99 and negative for signal transducer and activator of transcription 6.The mass was removed surgically with reconstruction,and the pathological studies confirmed the diagnosis to be an extracranial meningioma.The present study briefly reviews the current knowledge concerning the diagnosis and treatment of extracranial meningiomas in the head and neck area and offers suggestions for managing extracranial meningiomas in the paranasal sinuses.CONCLUSION To conclude,extracranial meningiomas in the paranasal sinuses may be successfully managed by surgical treatment without evident post-surgery complications.

Mandibular Buccal Bifurcation Cyst:Report of Two Cases

Mandibular buccal bifurcation cyst is a rare inflammatory odontogenic cyst.We reported two cases who complained of painful swelling of extraoral soft tissue.Intraoral examination revealed the partially erupted mandibular first molar.Cone beam computed tomography showed a well-defined cystic lesion surrounding the first molar.Histopathologic images showed the cyst wall was infiltrated by a large number of plasma cells,neutrophils and eosinophils,and lined with a thin layer of non-keratinized stratified squamous epithelium.Finally,the two patients were diagnosed as mandibular buccal bifurcation cyst and treated with cyst enucleation and curettage.

The Buccal Lid Approach for Removal of Impacted Mandibular Molars—When, How and Why?

Background: The surgical removal of impacted mandibular molars represents one of the most prevalent procedures carried out by the oral and maxillofacial surgeon. Despite its prevalence, unusual impaction location of mandibular molars necessitates alternative extraction approaches. One of the methods described for extraction of deeply impacted molars is the bony lid approach which was first presented for surgical endodontic treatment of mandibular molars. The aim of this study was to evaluate the outcome of the bony lid approach in extracting mandibular molars. In addition, critical clinical key points, new aspects while performing this procedure, indications and contraindications are discussed. Materials and Methods: 9 patients were treated with the bony lid technique. A retrospective analysis of medical charts was conducted to evaluate the results of surgery. Results: The operative technique described in the article was successfully carried out in 12 cases of impacted mandibular molars. No incidence of permanent sensory deficit was recorded. In one patient, an infection mandated the removal of the bony lids. In all other cases the healing process was uneventful. Conclusion: The bony lid technique has many advantages over alternative extraction methods and should be considered as a treatment option in cases of critical proximity between an impacted tooth and the inferior alveolar nerve.

Vascular Malformation with Multiple Organized Thromboses in Buccal Region

Vascular malformations occur most frequently in the maxillofacial and oral regions. Although many cases of vascular malformations with phlebolithiasis have been reported, only few reports have documented cases of thrombosis formation. We report a rare case of a vascular malformation with multiple thromboses in the left buccal region. A 28-year-old woman had a painless swelling in the left cheek when she consulted our hospital. T1-weighted magnetic resonance imaging revealed a low-signal lesion, having the same intensity as the muscle, in the left buccal region, and T2-weighted imaging revealed a high-signal lesion. Additionally, three tuberous tumours were noted in this lesion showing both a light high signal on T1-weighted imaging and a low signal on T2-weighted imaging. Based on these imaging findings, as well as clinical and pathological findings, the patient was diagnosed with multiple vascular malformations in the left midfacial region. The three tuberous tumours showed necrotic tissue in the central area, which was formed by calcified and concentric fibrous tissue, and vascularization. Because tumorous lesion and typical vascular structure by the Elastica Van Gieson staining were not observed, these tumours were seemed that fibrin thrombus in this lesion formed the organized tissue.

Tobacco Exposed Buccal Mucosa Graft—A Potential Carcinogen for Scrotal Cancer

Squamous cell carcinoma of scrotum is not common. It was the first cancer directly associated with a specific occupation i.e. chimney sweeps. We report a case of squamous cell carcinoma of scrotum developed in a patient of stricture urethra with multiple perineal urinary fistulas treated with lay open urethra with buccal mucosal graft. Tobacco exposed buccal mucosa graft can act as a carcinogen for scrotal cancer in patients with multiple fistula and poor hygiene.

Diverticulum of the buccal mucosa: A case report

BACKGROUND A diverticulum is the medical or biological term for outpouching of a hollow structure in the body.It particularly occurs in the digestive system,but rarely occurs in the oral mucosa.CASE SUMMARY This report describes a rare case of diverticulum presenting in the buccal mucosa in a 44-year-old woman that was initially diagnosed in Stomatology Hospital,Wuhan University.We made our diagnosis under the guidance of imaging data,and the patient underwent surgical resection.CONCLUSION This report is the first confirmed case of buccal mucosal diverticulum.in addition,we elucidated that in general,idiopathic developmental abnormalities caused by succinate muscle defects are responsible for diverticulum development.

Effects of 4-(3-Chloro-Benzyl)-6,7-Dimethoxy-Quinazoline on Kinetics of P120-Catenin and Periplakin in Human Buccal Mucosa Squamous Carcinoma Cell Line

In order to detect molecular markers for the epidermal growth factor inhibitor 4-(3-chloro-benzyl)- 6,7-dimethoxy-quinazoline (tyrphostin), we investigated the kinetics of p120-catenin and periplakin in the human buccal mucosa squamous cancer cell line BICR 10 treated with 3 nM tyrphostin. Growth of BICR 10 cells was inhibited by treatment with tyrphostin. Although changes were not observed in the expression of EGFR and p120-catenin, expression of Akt, Src and periplakin in BICR 10 treated with 3 nM tyrphostin tended to decrease. In addition, phosphorylation of EGFR, Akt and Src was inhibited by treatment with tyrphostin. On immunocytochemical staining, immunoreactions with phosphorylated EGFR, phosphorylated Akt and phosphorylated p120-catenin were weak in BICR 10 treated with tyrphostin. There was a slight immunocy to chemical reaction to periplakin in BICR 10 cells induced by tyrphostin. In conclusion, the decrease in phosphorylation in EGFR and p120-catenin by tyrphostin, following the decrease in Src or Akt phosphorylation, may inhibit expression of several growth factors associated with the proliferation and migration of cancer cells.

Pre-formulation Study for Preparation of Mucoadhesive Buccal Tablets Containing Nystatin and Cashew Gum by Direct Compression

Cashew gum is a branched chain heteropolysaccharide extracted from the cashew tree (Anacardium occidentale L.).Purified cashew gum (PCG) is free of plant contaminants and is highly soluble.Several studies have indicated this polymer can be relevant in the pharmaceutical industry for production of tablets.Recently,our research group reported that PCG can be used as a diluent for tablets produced by direct compression.Nystatin (Nys) is the drug of first choice for treatment of oral candidiasis,in the form of a suspension.The treatment consists of up to six daily doses of a suspension of nys at 500,000 IU,causing low therapeutic adhesion by patients.The objective of this study was to investigate the behavior of PCG together with nys and other excipients (flavoring agents and lubricating agent) for future manufacture of mucoadhesive buccal tablets by direct compression.For that purpose,we performed pre-formulation tests (FTIR,TGA,XRD,solubility,pH,granulometry,swelling degree and powder flow) with physical mixtures of the drug and excipients.The results were excellent,demonstrating that PCG is a polymer with potential for this type of application.