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Statement of the Problem: Lining epithelium ofdontogenic keratocysts is divided into parakeratosisnd orhtokeratosis. WHO classified odontogenic kerato-yst with parakeratosis as keratocystic odontogenic tu-or (KCOT) in 2005. And odontogenic keratocyst with

rthokeratosis was not classified as odontogenic tumor,hough it is also referred to as orthokeratinized odonto-enic cyst (OOC). In order to clarify the characteristicsf each lesion, we investigated the immunohistochemi-al expression of cytokerachin (CK) in KCOT, OOC,entigerous cyst (DC) and radicular cyst (RC).Materials and Methods: We used 15 cases of

COT, 8 cases of OOC, 8 cases of DC and 8 cases ofC at Osaka Dental University Hospital. KCOT andOC were diagnosed according to the new WHOlassification in 2005.Method of Data Analysis: We studied the immu-

ohistochemical expression of CK10, 13, 17 and 19.o evaluate the immunohistochemical stain, we di-ided the lining epithelium of these lesions into threeayers (surface layer: sul, spinous layer: sl, basal layer:l), and we evaluated according to the three levels; (-):lmost or all negative cells at each layer, (�): uni-ormly positive cells at each layer, (��): stronglyositive cells at each layer.Results: 1) In KCOT, only 3 of sul were (�) for CK10.of sul and 12 of sl were (�) and 8 of sul and 12 of slere (��) for CK13. 12 of sul and sl were (�) and 3 of

ul and sl were (��) for CK17. 10 of sul were (�) andof sul were (��) and all of sl were (�) and 6 of blere (�) for CK19. 2) In OOC, 4 of sul and 3 of sl were

�) and 4 of sul and 5 of sl were (��) for CK10. Allases were (-) for CK13 and CK17. All of sul and sl were-) and 5 of bl were (�) for CK19. 3) In DC, all casesere (-) for CK10 and CK17. 2 of sul and 8 of sl were (�)

nd 6 of sul were (��) for CK13. 3 of sul and 5 of slere (�) and 5 of sul and 3 of sl were (��) and 6 of blere (�) for CK19. 4) In RC, all cases were (-) for CK10

nd CK17. 6 of sul and 5 of sl were (�) and 2 of sul were��) for CK13. 1 of sul and 2 of sl were (�) and 7 of sulnd 6 of sl were (��) and 6 of bl were (�) for CK19.Conclusion: There were deferences in the expres-

ion of CKs between the lining epithelium of KCOT,OC, DC and RC. These results suggest that dividing

nto KCOT and OOC is valid, as each disease has differ-nt characteristics of epithelium.

References

Stoll C, Stollenwerk C, et al: Cytokeratin expression patterns foristinction of odontogenic keratocysts from dentigerous and radicularysts. J Oral Pathol Med 34:558, 2005Silva, M.J.A., Sousa, S.O.M, et al.: Immunohistochemical study of the

rthokeratinized odontogenic cyst: A comparison with the odonto-enic keratocyst. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 94:

32, 2002 s

AOMS • 2009

OSTER 18ral Health Care Reduces the Risk ofostoperative Wound Infection inatients With Oral Squamous Cellarcinoma

un Sato, DDS, PhD, Sapporo, Japan (Goto J; Harahashi A;amazaki Y; Satoh A; Notani K; Kitagawa Y)

Statement of the Problem: Postoperative woundnfection (WI) is a main complication after head andeck surgery. WI may lead to significant morbidity, poorosmetic results, delayed wound healing, prolonged hos-italization, and delay postoperative cancer treatment.oor oral health is one of the risk factors for WI. Oralealth care reduces the number of microorganisms inhe oral cavity. To our knowledge, it has not been clar-fied whether oral health care would lower the risk ofostoperative WI in patients with oral squamous cellarcinoma (OSCC). This study was performed to eluci-ate the possible contribution of oral health care inreventing postoperative WI in patients with OSCC.Materials and Methods: A total of consecutive 66

npatients with OSCC were included in this study. Forty61%) of the patients were men, and 26 were women;heir averaged age was 68 years (range, 24 to 89 years).hese patients were hospitalized in the Hokkaido Uni-ersity from 2005 to 2007. The patients were dividednto 2 groups whether receiving systematic oral healthare or not. In 33 patients referred to our hospital frompril 2006 to March 2007, systematic oral health careas applied (the care group). In another 33 patients

eferred from April 2005 to March 2006, no systematicral health care was applied (the control group). Thereere no significant differences for gender, age, T-stage,-stage, or clinical stage between the two groups. In theare group, the dentists made a plan of the oral healthare for each patient and taught the patients how toare. The tooth brushing was instructed as usual. Oralucosa and tongue was cleaned using sponge brushith mouth rinse. In the control group, special care wasot applied by dentists, and only self-care was performeds usual. According to the criteria of Johnson et al, WIas defined as the presence of purulent discharge from

he intraoral incision or the presence of an orocutaneousstula.Method of Data Analysis: In the present study, 20

ariables were recorded for each patient. Those in-luded patient characteristics (gender, age, tobacco andlcohol history, diabetes mellitus, preoperative whitelood count, preoperative albumin levels in serum), dis-ase characteristics (TN-stage, clinical stage), previousreatment (preoperative chemotherapy, preoperative ra-iation, systemic oral health care, duration of the hospi-al stay before surgery), present surgical procedure (tis-

ue transplantation, tracheostomy, neck dissection,

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ength of surgery, blood loss, blood transfusion). In uni-ariate statistical analysis, we used chi-square test orann-Whitney U test. In multivariate statistical analysis,ultiple logistic regression analysis was performed. All-values less than 0.05 were considered statistically sig-ificant.Results: In all of the 66 cases, WI was observed in 14

ases (21%); in 3 cases (3/33�9%) in the care group andn 11 (11/33�33%) in the control group, representing atatistical difference (chi-square: 5.8, p�0.025). In uni-ariate statistical analysis, 12 factors correlated with WIignificantly. Those included T-stage, clinical stage, tra-heostomy, neck dissection, tissue transplantation, oralealth care, preoperative radiation, blood transfusion,uration of the hospital stay before surgery, length ofurgery, blood loss, and preoperative levels of albumin inerum. In multiple logistic regression analysis, only twoactors (tissue transplantation; p�0.014, odds ratio:1.2, 95% IC: 1.9-242.2, and lack of oral health care;�0.036, odds ratio: 6.7, 95%IC: 1.1-39.2) were signifi-ant independent risk factors for WI.Conclusion: This study suggests that systematic oral

ealth care may prevent postoperative WI in the patientsith OSCC. This is the first to describe the usefulness ofral health care for the management of OSCC.

References

Nicolas P, Daniele L, Charles F et al. Risk factors for wound infectionn head and neck cancer surgery: a prospective study. Head Neck.001;23:447-55Johnson JT, Myers EN, Thearle PB et al. Antimicrobial prophylaxis

or contaminated head and neck surgery. Laryngoscope. 1984;94:46-51

OSTER 19elationships Between Obstructive Sleeppnea/Syndrome (OSA or OSAS) andpecific Cephalometric Values, Bodyass Index (BMI), and Apnea-Hypopnea

ndex (AHI)tone Thayer, DMD, MD, Dallas, TX (Busch R; Finn R;hrockmorten G)

Statement of the Problem: To retrospectively eval-ate the relationship of specific cephalometric land-arks, body mass index (BMI), and apnea-hypopnea

ndex (AHI) in patients diagnosed with obstructive sleeppnea/ syndrome (OSA or OSAS) and treated with func-ional upper airway surgery over a 4 year period.

Materials and Methods: This retrospective reviewonsists of patients who were diagnosed by Sleep Med-cine with OSA and/ or obstructive sleep apnea syn-rome (OSAS), and referred to oral and maxillofacialurgery for functional upper airway surgery. All patientseceived a lateral cephalogram and five predetermined

pecific cephalometric parameters were analyzed: pos- I

8

erior-anterior airspace (PAS), soft plate length (SPL),yoid perpendicular to mandibular plane (H-MPA), sella-asion to mandibular plane angle (SN-MPA) and mandib-lar length (Go-Gn). These parameters were combinedith BMI and AHI in a statistical and descriptive analysis.Method of Data Analysis: One hundred five pa-

ients, over a 4 year period, met all the inclusion criteriaor study and ranged in age from 31 to 75, with anverage of 57. There were 101 males and 4 females.Results: Statistical analysis revealed significant rela-

ionships between several of the cephalometric values,MI, and AHI.Conclusion: Several of the relationships studied

rove promising as potential predictors of OSA/OSASnd may be useful in judging treatment strategies.

References

Lowe AA, Santamaria JD, Fleetham JA, Price C. Facial morphologynd obstructive sleep apnea, Am J Orthod Dentofacial Orthop. 1986;0(6):484-491Miles PG, Vig PS, Weyant RJ, Forrest TD, Rockette HE. Craniofacial

tructure and obstructive sleep apnea syndrome—a qualitative analysisnd meta-analysis of the literature. Am J Orthod Dentofacial Orthop.996;109(2):163-172

OSTER 20Cell Receptor Analysis of Lymph Nodeetastasis in Head and Neck Squamousell Carcinomaenichi Kumagai, DDS, Yokohama, Kanagawa, Japan

Hamada Y; Kobayashi H; Gotoh A; Yamada H;awaguchi K; Horie A; Suzuki R)

Statement of the Problem: Head and neck squa-ous cell carcinoma (HNSCC) is the sixth most commonalignant tumor worldwide, characterized by the lo-

oregional disease with a propensity for metastasizing tohe cervical lymph nodes. The purpose of this study waso elucidate the differences of antitumor immune re-ponse in primary tumors and regional lymph nodes.

Materials and Methods: Crude cellular RNAs fromNSCC specimens were extracted using an RNeasyMiniit (Qiagen) according to the manufacturer’s instruc-

ions. Using the adaptor ligation-mediated polymerasehain reaction and microplate hybridization assay, wexamined the characteristics of tumor infiltrating lym-hocytes (TILs) in terms of T cell receptor (TCR) reper-oires, T cell clonality, T cell phenotypes and cytokineroduction profiles within the tissue specimens ofNSCC from 17 patients. The cytokine expression pro-les and T cell phenotypes were measured by real-timeuantitative polymerase chain reaction.Method of Data Analysis: Statistical analyses were

arried out using StatView version 5.0 for Windows (SAS

nstitute, Cary, NC, USA). The nonparametric Mann–

AAOMS • 2009