When there is a respiratory tract disorder due to swollen tonsils, mouth breathing becomes habitual because normal nasal breathing cannot be done smoothly. This influences maxillofacial development and the development and harmonization of circumoral muscles. Thus, there is a risk that various malocclusions are induced. This study was performed in order to examine the relationship between maxillofacial morphology and the form of the airway at the pharynx as well as nasal respiratory function by use of lateral cephalometric radiography and according to skeletal patterns and Hellman’s developmental stages.

The subjects were patients who visited the hospital’s department of orthodontics, part of the Iwate Medical University School of Dentistry. The subjects were judged not to have subjective symptoms of nasal obstruction regardless of nasal diseases in the examination before orthodontic treatment, and had received nasal airway patency measurement in the examination. A total of 100 subjects were selected from the patients who were diagnosed as skeletal Class I or skeletal Class n, and concerning their skeletal classes, according to Hellman’s developmental stages, they were divided into 5 stage groups ⅡC,ⅢA, ⅢB, ⅢC, and Ⅳ A, each group of which consisted of 20 patients. Lateral cephalometric radiographs and nasal airway resistance of the total 200 patients were used as references.

The results were as follows:

1. In the case of skeletal Class n,occlusion of the respiratory tract were prominently observed in the nasopharynx compared with skeletal Class I.

2. In the case of skeletal Class n,it was observed that nasal airway resistance was larger at Hellman’s developmental stages from ⅢA to ⅢC, compared with skeletal Class I. No differences were observed between the two groups thereafter.

These results show that constriction of the nasopharynx is closely related to nasal airway resistance. They also indicate that nasal airway patency is an effective index to oblectively show nasal airway resistance.

Since 1992, we have been designing the palatal plate for cleft palate neonates by the application of therrnoplastics as pre-surgical treatment since 1992. 110 neonatal patients with cleft palate have been treated with this procedure. The average duration for using the plate was the age of from 1.5 months to 12.5 months. Feeding changed from the usage of particular nipple or tube feeding, to normal feeding in all cases, except those with severe systemic disorder. The weaning period was also normal。 The cleft-width of the alveolar arch and hard palate decreased significantly. This was caused by the growth of the frontal points and the palatal process of segments, not by the mechanical constriction, itself. The total time for making each plate was 60 minutes or less. This included taking the impression and setting time. A new plate is made every 2 months to allow for growth of the alveolar arch and hard palate. Our design is an improvement because the plate is water-resistant, thinner, and semi-transparent, It consists of only one layer of materiaL There is no need for grinding the growth guide. We conclude that our pre-surgical treatment improved significantly the condition of cleft palate neonates.

Macromolecular clearance via lymphatic flow has become an important consideration in recent years due to its relation to a wide range of concerns including cancer metastasis and drug delivery. In this study, the macromolecular clearance from the tongue to regional lymph nodes through the lymphatic flow was investigated by observing the distribution and the quantity of a]bumin in the submandibular lymph nodes (SMLs) and the deep cervical lymph nodes (DCLs) of mice at various periods after the injection of albumin. The bovine serum albumin tagged with fluorescein isothiocyanate (FITC-Alb) was inlected into the right margin of the tongue. After 5,30 and 60 minutes, DCLs, SMLs and the tongue were extracted, fixed in neutral 4%paraformaldehyde, and embedded in paraffin. Serial sections were cut and the tissue was observed by fluorescence microscopy. In addition,¹⁴C-methylated bovine albumin (RI-Alb) was inlected in the same manner, and the levels of RLAlb in SMLs, DCLs and blood were quantified using a liquid scintillation counter.Five minutes after the FITC-Alb injection, FITC-Alb was observed at the apex of the tongue. At 60minutes after the FITC-Alb injection, the FITC･Alb had not diffused to the outside of the tongue. These observations suggest that the FITC-Alb had overcome the lingual septum during the initial 5minutes, but remained confined to the interior of the tongue for the rest of the experimental period.Significantly increased levels of RI-Alb were found in the SMLs on the injection side than in SMLs on the contralateral side during the experimental time. Further, FITC-Alb was observed in part of the subcapsular sinus and in the cortical area, but not in the lymph follicles (LF) lying just beneath. These results indicate that macromolecular clearance from the tongue was predominantly to the regional lymph nodes on the injection side. In addition, there was an accumulation of the injected albumin in the subcapsular sinus and cortical area but not in the LFs of a decided segment of the regional lymph nodes. The labeled albumin had also flowed into both SMLs during the initial 5 minutes. The albumin collected in the SMLs continuously until the subcapsular sinus was filled, and then the flow of albumin into SMLs ceased. The labeled albuminfrom the SMLs moved into the DCLs between 30 minutes and 60 minutes after the injection.

The lymphatic architecture of the oral region is clinically important in determining the routes of cancer metastasis and the absorption of medication. However, no reports have adequately described the distribution and circulation of lymph in the tongue. The purpose of this study is to examine the lymphatic architecture under the lingual mucosal epithelium in the golden hamster, and the route these lymphatics use to connect to three collecting lymphatic vessels in the tongue that have been described previously. Lymphatic capillaries under the dorsal mucosal epithelium and the sublingual surface of the tongue were revealed using 5’-nucleotidase staining and examined. An irregular network of lymphatic capillaries were found in the lamina propria at the lingual dorsum, and blind end lymphatic capillaries enter into the connective tissue papilla from this network. In contrast, a hexagonal network of 10μm lymphatic capillaries were observed under the flattened basal layer of the epithelium, with no blind end lymphatic capillaries from this network. In addition, thick collecting lymphatics, 50-100μm in diameter, were found over this hexagonal nymphatic network. These collecting lymphatics, do not enter into the muscle, but run in the lamina propria. Our findings suggest that these thick lymphatic vessels contribute to the mass transport of lymph, and, therefore, are responsible for the absorption on the sublingual surface.

Because oral cancer treatment has adv'anced, resulting in a higher survival rate, it is necessary to treat the preserved oral functions such as speech, mastication, and deglutition, as well as the aesthetics. Oral cancer treatment has been performed mainly by surgical therapy and radiation therapy, however, integrated treatment including chemotherapy has recently been performed. In this study, we evaluated the effectiveness and usefulness of radiation-combined intra-arterial chemotherapy for carcinomas of the tongue, which shows a high incident rate among oral cancers and has become more common recently, to establish treatment methods for preserving the function and morphology.The subjects were 63 patients who consulted our department and underwent radiation-combined intra-arterial chemotherapy. With this therapy, the case of complete response (CR) was clinically obtained in 43 patients, and the case of partial response (PR) was obtained in l7patients with a 68.3% CR rate and a 95.2% therapeutic effectiveness rate. Maintenance therapy was performed in 44 patients without performing surgical therapy of the primary lesion in the primary treatment.Twenty-nine among 44 patients showed a good clinical course without recurrence of primary lesion. Regarding T4, a good clinical course without recurrence was observed in 3 patients in which PR was obtained, and surgical therapy was added to the primary treatment, showing a 57.1%local control rate in T4.Considering these results, there is a high possibility that radiation-combined intra-arterial chemotherapy for carcinomas of the tongue can be implemented for avoiding surgical therapy of the primary lesion in the primary treatment, and it is useful for preserving the function and morphology with a high local control rate.and Maxillofacial Surgery, School of Dentistry, Iwate Medical University.

We administered general anesthesia for dental treatment of an obese patient with mental retardation. The obesity makes difficulties for respiratory management in the perioperative stage due to the raised diaphragm and fatty mediastinum. When the obese patient is mentally retarded, his manegement will be complicated ever further. Case:18 years of age male,165 cm and 115 Kg,The patient’s understanding and cooperation were so poor that the sedation technique did not take effect satisfactory. The administration of general anesthetic was planrled for his dental treatment. Anesthesia was induced with Ketalal and maintained with N₂O, O₂and sevoflurane. During the operation,the patient was kept on controlled ventilation monitoring by percutaneous SpO₂, arterial blood gas analysis, etc. without any complications. Transferred to the ward after emergence, he became delirious and manifested panic such as self-inluring and crying. We thought that the environmental changes caused these behaviors, and any respiratory trouble was not observed, then the patient was discharged、 For the obese patient with mental retardation, inability to adapt to a change of surroundings should be considered in addition to the perioperative management of respiration.

We evaluated mandibular reconstruction after rim mandibulectomy and sagittal mandibulectomy. We examined g patients: 4 patients with carcinoma of the lower gum, 2 patients with carcinoma of the mouth floor, and 3 patients with ameloblastoma of the mandible. 4 rim mandibulectomies and 2 sagittal mandibulectomies were performed on 6 patients with malignant tumors, in which X-ray finding of the bone resorption showed a pressure type on the upper portion of the mandibular canal. The 3 patients with ameloblastorna had modified rim mandibulectomy. Mandibular reconstruction after resection was performed irnmediately on 60f the patients. On the 3 with ameloblastoma, imrnediate reconstruction was carried out using a poly (L-lactide) acid (PLLA) mesh tray to hold particulate cancellous bone and marrow (PCBM). Immediate reconstruction using a Inetallic plate to fixate the remaining bone was performed on 2 0f the patients with carcinoma of the lower gum, and one of the patients with carcinoma of the mouth floor. On the 3 remaining patients, delayed reconstruction was performed using a metallic plate to fixate bone fragments after fracture, and grafting PCBM to repair bone defects.All the patients showed good clinical results and improvement of the mandibular contour after reconstruction without postoperative infection or tumor recurrence.Rim mandibulectomy and sagittal mandibulectomy were able to preserve the continuity of the mandible. The bone remaining after mandibulectomy, however, fractured easily, requiring immediate or delayed reconstruction. However, because the bone defect after rim mandibulectomy and sagittal mandibulectomy was smaller, the delayed reconstruction was comparatively easy.