Biomedical subjects
Publications and source records attributed to W R Tyldesley.
The clinical presentation or recurrent aphthous ulceration in children is described together with current views on the aetiology and pathogenesis of the disease. Factors that predispose to this type of oral ulceration are discussed and a rational approach to the management of recurrent aphthous ulceration in children is proposed.
A patient with intra-oral squamous cell carcinoma arising in an area of cyclosporin-induced gingival hyperplasia associated with a renal transplant is presented. This appears to be the first reported case of its kind. Subsequently, the patient developed a carcinoma of the lateral margin of the tongue, with metastasis to the deep cervical lymph nodes. The incidence and types of malignancy following conventional immunosuppressive and cyclosporin therapy are briefly reviewed. Long-term frequent follow-up of cyclosporin-treated patients is recommended to facilitate early diagnosis of such lesions.
Mixed connective tissue disease (MCTD) is a multisystem disorder with overlapping features of systemic lupus erythematosus, scleroderma and polymyositis and is differentiated from them by a high titre of antibody to ribonucleoprotein. Orofacial manifestations of MCTD include trigeminal neuralgia-like pain, neuropathy, features suggestive of Sjögren's syndrome and lymphadenopathy. The recent experience of two patients presenting with trigeminal neuropathy as an early manifestation of this disease is described. One of these patients presented with 'lichenoid' oral mucosal lesions as a further early manifestation of MCTD. This appears to be the first case with this presenting feature to be described in the literature.
The clinical presentation of seven patients with oral lesions of Crohn's disease, but with no evidence of other gastrointestinal involvement was described by Tyldesley in 1979. The clinical progress of five of these patients available for review is reported after a minimum period of 10 years. The gross oedema of the lips and painful buccal lesions present in all five patients have shown gradual resolution from the time of initial diagnosis. The nomenclature for oral Crohn's disease and related conditions is discussed with specific reference to the term 'orofacial granulomatosis'.
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Forty-six patients were seen over a four-year period because of oral blistering. Of these 26 were thought to have pemphigoid affecting the oral mucosa. The clinical features in these patients are compared with the commonly accepted descriptions and some differences noted. The nomenclature is reviewed and the term 'intermittent mucosal pemphigoid' is suggested to describe a clinical variant in which lesions are few and widely separated in time and which heal without scar formation. The relationship between oral pemphigoid and oral 'blood blisters' is discussed.
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A full haematology screen was carried out on 398 patients under investigation for recurrent oral ulceration or stomatitis. Thirty-three patients were found to have lowered serum folate and/or red cell folate levels without iron deficiency. Of these only six were found to have a mean corpuscular volume (MCV) outside normal limits or to have recognisable erythrocyte abnormalities. No correlation was found between serum or red cell folate levels and the MCV. Eighteen patients were found to have lowered serum B12 levels without iron deficiency, of these seven were found to have a MCV outside normal limits. A significant negative correlation was found between serum B12 levels and the MCV. It is concluded that haematological screening in these cases should include estimations of serum folate, red cell folate and serum B12 levels even in the face of an apparently normal peripheral blood film.
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