L-CEX (long acting Cephalexin) has, a, blood effective hour about twice longer than that of CEX, so that the recommended dose of L-CEX is 500mg b. i. d as compared to 250mg, q. i. d or 500mg, t. i. d with CEX.
In the present study, the blood concentration of cephalexin was examined with time lapse for determining its optimum dose and frequency of administration. A cross over test of L-CEX and CEX was performed in 4 healthy male adults. Four groups were examined; Group I L-CEX 500mg, twice a day; Group II L- CEX 500mg, three times a day; Group III CEX 250mg, four times a day; and Group IV CEX 500mg, three times a day. The blood concentration was monitored on and after the first administration for 24 hours. The determination of blood levels was performed on serum samples by a cylinder method.
With the same dose given, L- CEX showed a lower peak serum concentration but more prolonged effective hour as compared to CEX. The serum effective hour was 11.2 hours in Group I, 18.7 hours in Group II, 10.6 hours is Group III and 13.4 hours in Group IV.
The usefulness of L-CEX was confirmed from the fact that the bactericidal effect of cephalexin shows a time-dependency. Furthermore, a dose regimen for L-CEX of 500mg, three times a day, is considered to be of most effective administration.

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Recently, peculiar changes in the epiphyseal cartilage of growing rats with osteolathyrism have drawn much attention.
In this study, the proliferation and differentiation of mandibular cartilage as well as the disturbance of endochondral bone formation in this pathology were examined.
This study was thus performed in experimentally induced osteolathyrismic rats using aminoacetonitrile (ANN).
Experimental methods:
Growing Wister male rats of 4 weeks post partum were used as experimental animals, 2% ANN in physiological saline solution was given to all rats at a dose level of 20mg per 100g body weight per day for 7 days in succession by intraperitoneal route in order to produce osteolathyrism.
Some experimental aminlas were sacrified by decapitation on 1, 3 and 6 days after ANN dosing respectively, and each sample was examined soft-radiographically, light-microscopically and electro-microscopically.
Experimental results:
The growth of rats was predominantly suppressed around 3 days after ANN administration, showing an intensive systemic distrubance.
In the craniofacial bone specimens from rats continuously received ANN for 7 days, retarded growing was seen.
Histopathologically, almost no change occurred in rats given ANN for 1 day but a suppressed proliferation of fibroblasts which normally differentiate to chondrocytes was observed in the mandibular cartilage of rats sacrified 3 days after ANN administration. In rats sacrified 7 days after ANN, decreased numberof chondroblasts and chondrocytes with thinned chondocyte zone appeared. Among these chondrocytes, deformed nuclei and invaginated nuclear membrane were observed. On the other hand, poorly developed mitochondria, rough endoplasmic reticulum and Golgi's apparatus were found is some cytoplasmic organellae, suggesting abnormal cell metabolism. In addition, the boundary between hypertrophic chondrocyte zone and bone marrow epiphysis was irregular, and decrased fine bone trabecular formation was observed.
These findings suggest that abnormal endochondral bone formation was caused by ANN.

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Plummer-Vinson syndrome is a fairly uncommon disease with triad of glossitis, dysphagia and angular erosion. Oral inflammatory lesions such as glossitis, angular stomatitis and other oral erosions are commonly observed in patients with this syndrome. However, the onset mechanism of oral lesions associated with Plummer-Vinson syndrome is still obscure. Iron deficiency is certaining important, but other factors may be also involved in the pathogenesis.
This paper describes two cases of this syndrome and the neutrophilic function in the peripheral blood was examined for the purpose of elucidating its possible role in the formation of oral lesions.
In the two patients, both females aged 67 and 47 respectively, a typical iron deficiency anemia was confirmed by routine hematology. Then tongues were markedly atrophic and are patient had spoon-shaped nails. Following the treatment with iron derivatives, they were much improved and abnormal findings almost disappeared. As for the neutrophilic functions, both phagocytizing and bactericidal power decreased prior to the Fe treatment. No change occurred in the phagocytizing power, although the bactericidal power was improved after the administration of Fe derivatives. In general, thinned or atrophied oral mucosa is said to be caused by iron deficiency in this syndrome, however, this does not necessarily contribute to the occurrence of inflammatory symptoms and other factors seen to the involved in this situation.
Our results suggest that the depressed function of nuetrophil may be, in part at least, a causative factor of oral inflammatory lesions in Plummer-Vinson syndrome.

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In this paper, two female cases of verruciform xanthoma are reported.
Case No.1 was a 22 year old female who first noticed a swelling of gingival mucosa 3 years ago. Oral examination revealed a slightly whitish, broad based lesion with granular surface 11×11mm in size on the 65 site of palatal gingiva. The clinical diagnosis was papilloma and the histological diagnosis was verruciform xanthoma of papillary type.
Case No. 2 was a 55 year old female with roughly surfaced gingival lesion which was first noticed 2 months ago. Oral examination revealed a slightly raised, whitish lesion of 10-15mm size on the 7 site of lingual alveolar mucosa. White sponge nevus was suspected clinically,
with the histological diagnosis of verruciform xanthoma of flat type.
No relapse occurred in either case after treatment.

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Pathological findings were reported in a 70-year-old female with localized amyloidosis in buccal mucosa. Clinically, she had no symptom of generalized amyloidosis. The buccal lesion consisted of amyloid deposition of minor salivary gland. The amyloid protein of this case was identified as protein AλE by potassium permanganate treatment and immunoperoxidase technique (PAP method). Although the mechanism of amyloid deposition in localized amyloidosis as in this case was not to clearly elucidated, it might be suspected that the amyloidogenic light chain of secretory-typed immunoglobulin was transformed into amyloid protein by some lysosomal enzymes.

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Angiomyoma is frequently found in the skin and subcutaneous tissues, especially in the lower extremities, but it is rarely found in the oral cavity. A case of angiomyoma of the hard palatal region is here presented.
A 42 year old housewife was referred by a dental clinic for swelling of the hard palate. She had been unconscious of this swelling until it was pointed out. Past and family histories were negative. Clinically, the tumor presented a painless well-defined, smooth, soft, compressible, submucosal swelling overlying the middle of the hard palate slightly to the left of the midline. The mucosal color was blue-purple. The clinical impression was hemangioma. In October, 14, 1982, the patient was given local anesthesia and an incision was made in the palatal mucosa along the circumference of the tumor. The tumor was easily removed en bloc with a part of the hard palatal mucosa. A surgical pac was packed into the cavity fixed by resin splint and was removed on the seventh postoperative day. She was admitted to the hospital because of bleeding that same evening. We stopped the bleeding and she was discharged the following day. Twelve months later, she is well and free of tumor. On section, the tumor measured about 9×9×5 mm and was a smooth, lobulated, white oval nodule. Microscopically there was well-delimited nodular tumor under mucosa with a delicate incomplete capsule. The tumor consisted of convoluted thick-walled vessels surrounded by benign smooth muscle with few elastic fibers. The pathological diagnosis was angiomyoma.
Angiomyoma of the hard palatal region: Report of a case

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Lipoma may occur is any part of the body where fat is existing, but is rarely found in the oral cavity. Among various lipomas, those related to the proliferation of adipose and fibrous tissues are designated as fibrolipoma.
A 76 year old man was referred to our department with a main compliant of swelling of the lower right second molar mucosa, which was first noticed about four years ago and gradually increased in size thereafter. Family and past histories showed no specific problems. Oral examination revealed that a pediculated elastic soft phyma was covered by the oral mucous membrane at 7 portion. X-ray examination showed however no anomalies and laboratory findings were all within normal ranges. The clinical diagnosis of right mandibular benigh tumor finally made (Epulis).
On January 19, 1983, the tumor was enucleated under local anesthesia, which was easily removed en bloc by incising its surrounding mucosa and performing a blunt decollement. The prognosis is favorable with no sign of relapse as of 10 months lapsed after operation. Thus removed tumor was 2.4×1.7×1.2cm in size, elastic-soft and massive in nature, of which cut surface was yellowish white. From the histological examination, the diagnosis of fibrolipoma was made based on the facts that the surface was covered by stratified squamous cells and that many matured adipose tissues were observed below the mucous membrane with porliferated fibrous connective tissue in part.

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A 44 year old hypoprothrombinemia patient with gingival swelling and pain of right upper lateral incisor region.
In order to increase prothrombin level, coagulation studies were made contrasting factor IX concentrate and fresh plasma.
Factor IX concentrate was more effective than fresh plasma was the finding.
Therefore, the surgical procedure of tooth extraction and cystectomy was performed by applying factor IX concentrate.

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Study of intra-anticular corticosteroid theraphy in temporomandibular joint arthrosis.
Intra-anticular corticosteriod therapy has secured anti-inflammatory and analgestic effects, acting rapidly in most cases. In the present study, this method was applied to 54 cases of temporomandibular joint arthrosis who had showed no response to previous conservative treatments.
The drug used was single predonisolone butyl acetate 10 mg (0.5ml) intraarticularry injected into the upper joint cavity. Generally, the effectlasted more than 2 weeks in 35 out of 53 cases (64.8%) including 4 out of 11 cases of extrinsic trauma (36.4%), 10 out of 12 cases of intrinsic trauma (83.3%) and 21 out of 31 cases of idiopathic nature. No case showed any adverse reaction during this period.

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In this paper, a case of unilateral condylar hyperplasia in which condylectomy was applied is presented.
Report of case
A 26 year old woman visited Tokyo Medical and Dental University in 1973 complaining of facial asymmetry and masticatory disturbance. 4 years later, she strongly desired to correct this condition.
There was marked facial asymmetry, the left side elongated and flattened with the chin shifted to the right. In occulusion, apertognathia was present on the left side, i. e. about 5 mm distance between upper and lower first molar tooth. She said that the condition was first recognized about 3 years before and developed gradually as was confirmed from past photographs.
Radiographic examination showed that the left condylar head was enlarged remarkably as compared with the right condyle, especially to the medio-anterior direction. The left ascending ramus was more elongated than the opposite side. 4 years after the first visit, it became about 5 mm longer.
From clinical and radiographic findings, it was diagnosed as facial asymmetry due to unilateral condylar hyperplasia.
Condylectomy was done. 5 years after the operation the symmetry of the face was continued and tooth contact was improved. Radiographically, remodelling of the bone might be seen at the edge of the resected ramus.

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Clinical findings from 6 cases of parotid calculi were reported.
1) There were 1 male and 5 female patients whose ages ranged from 13 to 62 years old at the first examination in our department.
2) The incidence of parotid calcili among all our sialolithiasis during the past 15 years was 1.8%.
3) Swelling of parotid gland was observed in all 6 cases and 2 cases among then were simultaneously suffered from pain.
4) Calculi were located in the extraglandular duct in 2 cases, in the intraglandular main duct in 1 case and in the intraglandular portion in 1 case. In the remaining 1 case, calculi multiply appeared in all portions.
5) The number of calculus was single in 4 cases of multiple in 2 cases.
6) The size of calculus varied from a grain of sand to that of rice. In addition, parotid calculus was generally smaller than submandibular calculus.
7) Sialography proved to be a valuable diagnostic and in visualizing and localizing calculi, providing an accurate amount of glandular damage.
8) Radionuclide scannings, ^99mTC-pertechnetate and ⁶⁷Ga-citrate scanning, were useful in determining the grandular function.
9) Calculi in the intraoral portion of the extraglandular duct were removed through intraoral approach, while those in the posterior portion of the extraglanduar duct or in the anterior portion of the intraglandular main duct were removed by external incision. Total parotidectomy was performed in the disseminated multiple calculi of the intraglandular duct.

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Lyophilized Porcine Skin (METASKIN) was applied to 31 cases of raw wound surface caused by surgical procedures or injuries in the oral and facial regions.
In 12 out of 31 cases it was applied to the exposed bone tissue of the maxilla or mandible, in 6 it was done to defect of oral mucous membrane, in 10 it was held over the alveolar socket after extraction of the partialy erupted mandibular third molar, in 2 to cover the donor site in plastic surgery, and in one case to cover granulating surface of the excoriation of the upper lip.
The application with the fixation and immobilization of Lyophilized Porcine Skin to the exposed soft or bone tissue successfully prevented postoperative bleeding, aided in holding sufficient clot, relieved postoperative pain originating from the exposed tissue, and prevented food debris entering into the wound, especially into the alveolar socket after tooth extraction. Thus, it was found useful in promoting healing and preventing complications in these cases.
The literature of application of Lyophilized Porcine Skin in the maxillofacial region were reviewed.

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At present, sagittal splitting osteotomy is being used widely in surgical correction of mandibular prognathism. Post-osteotomical fixation originally consisted of transosseous wiring and circumferencial wiring, but subsequently Spiessl (1976), Schmocher (1976), and Hadjianghelou (1981) suggested screw fixation. Ceramic screw fixation was introduced in Japan, in 1982. However, all post-osteotomical fixation methods have merits and demerits, and further improvements are required before a final conclusion can be reached.
We designed a new type of pin for the fixation of bone segments after sagittal splitting osteotomy and used it in 11 patients for surgical correction of the mandibular prognathism since 1977, Satisfactory results have been achieved. A follow-up study showed that the relapse rate was minimal due to the improved adaptation and compression offered by the pins, no disturbances of sensibility of the mandibular nerve were noticed apart from trivial hyposthesia in the lower lip of some patients. Tempolo-mandibular joint trouble was almost completely absent. Furthermore the fixation technique is simple and pins removal is easily accomplished.
The special features of the newly designed pin and an outline of two representative cases have been intoroduced.

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This paper presents a surgically treated case of Pierre Robin syndrome with seven dyspnea and a study on maxillofacial growth of the syndrome.
Case report: The patient was a 19 day old female infant who often choked during feeding, with mild stridor and fever. On the 7th day of life, respiratory distress had markedly appeared. Because her general condition had not improved at the obstetric hospital, she was referred to our department. Examination revealed a marked degree of micrognathia and a partial cleft palate. Efforts were made for respiration and a systemic improvement. However, one week after admission to our hospital, acute respiratory distress appeared again. Endotracheal intubation was the only way to relieve cyanosis and to keep her airway open. Because long term intubation might develop other serious problems, the surgical operation was performed by modified Randall's method under G. O. F. anesthesia on the 9 th day of hospitalization. This resulted in complete relief of symptoms. She was discharged on the 58 th postoperative day. At the age of 10 months, the tongue was detached from the lip by 2 steps in a short interval. After this, dyspnea had not appeared any more. At the age of 28 months, uranoplasty was performed. Now the patient is well grown, and her mandibular growth and phonetic problems are under observation.
Study on maxillofacial growth of Pierre Robin syndrome: Besides the above case, we experienced six cases of Pierre Robin syndrome in our department during the past 15 years. From these we selected 3 cases having similar clinical and therapeutic conditions as reported here. They were all male and averaged 12.1 years old (11.6, 11.8, and 12.8, respectively). In infancy, these 3 presented mild dyspnea and were treated only conservatively. Uranoplasty was received at the age of about 18 months. Roentgen cephalometrics were taken for this study. Measurements were carried out by Downs, Northwestern, and Sakamoto methods. In addition, Sekiguchi's method was used in order to study the influences of the uranoplasty. From the results it was suggested that the underdevelopment of the mandible continues to exist at least before adolescent growth spurt and is due not only to secondary influences of the operation such as uranoplasty but also to the nature of the syndrome itself.

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Pigmented cellular nevus is possibly the most common skin lesion. However, cellular nevi of oral tissues are considered to be uncommon, only seven cases reported in Japan.
Theories about the origin of the nevus cell are controversial. Some investigators believe that nevus cells are derived from specialized cells in the epithelium and others suggest dermal nevus as the site of origin.
The purpose of this article is to add two new cases of pigmented nevi to the literature and to illustrate and discuss their clinicopathological features. The apparent rarity of the oral nevi may be due to a failure to report because in most patients the nevi are asymptomatic and the patients were not aware of their existence.

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A case report of fibrosarcoma arising from the mandibular incisors region.
A 31 year old male noticed a swelling of gingiva of the tongue side in the mandibular incisors for about 2 months. He underwent a tooth extraction of 12, but the swelling further aggravated accompanying spontaneous pain thereafter. He was then referred to our deparment. Soybean sized mandibular lymphonode was touched, each one on both sides, and the left one was immobile with tenderness. A granuloma-like hyperplasia of walnut size was observed in the alveolus at 213 portion, extending over the tongue side. X-ray examination revealed an osteoabsorbant image with unclear borderline over the alveolus dentalis corresponding to 2|3 portion. At outopsy, the diagnosis of fibrosarcoma was made, so that a continuous amutation at 6|6 and neck dissection on both sides were performed while the remaining mandibular was maintained with A-O plate. Homotransplantation of ilium was performed 7 months after operation. As of 3 years after operation, the patient wears false teeth in part with no recurrence. Histologically, fibrous volamentum was formed in the surroundings of tumor. Each tumor cell has a large nucleus and was composed of closely proliferate cells having irregular ellipse or spindle sporophore, forming thick and short collagenous fibers in part. In the densely arranged regon, Storiform pattern on Herring bone pattern was observed.

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Lipoma may occur everywhere adipose tissue exists, but is rarely found in the oral region. In this region, the buccal mucosa tongue, oral fundus, alveolar gingiva, palate, lips and mental region are frequently affected. We recently experienced a case of lipoma arising from the submucosal region of the mucobuccal junction which corresponded to the right mandibular molars. The clinical couse is described in this paper together with the result of retrospective study on 125 lipoma so far treated in our department during the period from 1960 to 1983. Age, sex and site involved ditributions were analysed. From these analyses, it was suggested that lipomas in the oral cavity may occur more frequently in females than in males and in those more than 40 years old.

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A 46-year-old woman noticed swelling and tenderness of the subauricular region on the left side four months ago. The growth had increased in size to the point of deviating the palatoglossal arch medially.
Sialogram of the left parotid gland and CT scanning revealed the tumor mass inside the left mandibular ramus, and its contour was fairly well defined. A clinical diagnosis of a benign tumor derived from the deep lobe of the parotid gland was made.
The patient was admitted and resection of the tumor was perfomed under general anesthesia. The great auricular nerve was transplanted in place of the facial nerve. In the histologic examination, the basophilic tumor cells were arranged in acinar groups, the tumor cell nucleus was rounded and the cytoplasm was slightly granular. The granules were PAS-positive and mucicarmin-negative. Acinic cell tumor was thus diagnosed.
The postoperative course was uneventful, there has been no sign of recurrence of the tumor or metastasis to the lymph nodes or other organs since discharge.

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A newly developed heated scalpel (Shaw scalpel by Oximetric Inc.) was used in oral surgeries such as radical neck dissection and surgical excisions of oral benign and malignant tumors in order to evaluate its usefulness and critical points. This scalpel was devised to perform incision and hemostasis simultaneously. The manipulation was very excellent in the radical neck dissection and operations in the anterior half of the oral cavity but unfavorable in the narrow operative field such as the posterior half of the oral cavity. The hemostatic capacity was relatively high, showing a favorable hemostasis against veins of 1.0 mm or less and arteries of 0.5 mm or less in diameter with the scalpel heated at 140°C-190°C. The hemorrhagic volume was reduced to about half of the usual volume when the scalpel was used in the radical neck dissection. On the other hand, a large quantity of exudate was observed after the operation with Shaw scalpel, which persisted for a while. This seemed to be due to a temporal burn of the tissue surrounding the incised area from the histological findings. Based on these evidences, Shaw scalpel is considered to be useful for the surgical procedure in the oral field, although a sufficient attention must be paid not to overheat the surrounding tissues.

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A case report of multiple maglignant lymphoma in the gingiva.
We recently experienced a case of malignant lymphoma arising from the gingiva of both upper and lower jaws in a multiple fashion, with the case report described hereinafter. The patient was a 55 year old male with swelling of the gingival mucosa for 2 months. The diagnosis of advanced alveolar pyorrhoea was made in a certain dental clinic and the patient was then referred to our department. He looked pale ad hypertrophic lymph nodes were palpable in both submandibles and left neck. Extended chronic swelling of the gingiva was confirmed from the oral examination, which especially remarkable in the molar region of the left mandible. Malignant tumor was suspected based on the clinical findings, and subsequently performed radiotherapy combined with chemotherapy resulted in a disappearance of the tumor in the oral cavity and of swelling of lymph node. However, a metastasis into the right lung field was observed, for which a similar treatment was given and resulted in a disappearance of the tumor. Clinically, he was diagnosed as non-Hodqkin's malignant lymphoma is Stage II E according to the classification by Ann Arbor. Histopathologically, on the other hand, a diffuse lymphoma of large cell type was diagnosed based on LSG classification.

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A case of epulis fibro-osteoplastica. Although epulis is a phyma of relatively high incidence in the oral mucosa, less reports an epulis with bone formation in fibrous tissues have been so far available. We recently experienced a case of epulis fibro-osteoplatica and the clinical couse is described in this paper. A 45 year old female noticed a swelling of the palate of the maxillary incisors around April, 1981. Under the diagnosis of palatal tumor, an incision was given, resulted in a temporal reduction in the tumor size. However, the tumor gradually increased in size on and after October and the patient was then referred to our department.
The phyma was perdiculated having the base in the palate at 3|2 portion and the elastic hard, smooth surface without tenderness. The surrounding mucosa was normal. The tumor including its surrounding mucosa was removed and alveolar rearrangement was performed followed by a tentative suture and closure. The size of tumor thus extirpated was 25×15×12 mm, and the cut surface was grayish white, solid and elastic hard with many hard tissues.
Pathologically, irregularly shaped bone formation was noted among many proliferated fibrous tissues suggestive epulis fibro-osteoplastica. The prognosis is evenful without any tendency of relapse as of 2 years lapsed after operation.

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