Cefoperazone distribution in oral tissue and inflamed mouth floor of mice was examined by agar well method.
After abdominal administration of Cefoperazone 200μg/g in mice, tissue concentration reached a peak in 10 minutes. The tissues in order of concentration were serum, mouth floor, submandibular gland, femur, tongue, masseter, and mandibular bone.
After abdominal administration of Cefoperazone 200μg/g in mice of which mouth floor had been inflamed, the concentration of inflamed mouth floor reached a peak in 10 minutes. Compared with normal mouth floors, Cefoperazone was distributed rather low in inflamed mouth floors, but concentration maintenance was good.

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Two hundred and two routine orthopantomographic observations were made on the location of mental foramen, and the course of mandibular canal in accordance with our criteria. The locations of the mental foramens were classified in both horizontal and vertical planes.
1. In the horizontal plane, 52.2% of the mental foramina were found in the apical area of the second premolar, and 26.5% were between the two premolars.
2. In the vertical plane, 86.2% of the mental foramina were found below the level of the apices of the premolars.
3. Single high mandibular canals, either touching or within 2mm of apices of second molars, were about 12 to 13%.
4. Most mandibular canals were in the intermediate zone, relatively high in the second molar region and low in the first molar region.
5. Single low mandibular canals, either touching or within 2 mm of the cortical plate of lower border of the mandible, were 2 to 4%.

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This paper reports the changes in total collagen content and relative quantities of type III and type V collagen to type I during the tooth extraction wound healing in rabbits.
The collagen content was fairly low on days 1 and 2, but increased continuously from day 5 to day 17. The ratio of type III to type I collagen was high in the early stage of wound healing by both interrupted gel electrophoresis of pepsin-soluble fraction and gel electrophoresis of CNBr-soluble fraction. Type V collagen was found in pepsin-soluble fraction of tooth extraction wound tissues. The ratio of type V to type I collagen was also high in the initial stage of wound healing.

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The purpose of the serial studies were to develop a three-dimensional reproduction for diagnosis and surgical therapy planning.
In the present study, the author devised the methd of making models reproduced through applying high resolutional computed tomography (GE CT/T).
Preliminary examinations were carried out on the CT numbers and on the measurement of CT film images for three-dimensional reproduction.
The results are summarized below:
1) There were few hourly changes of CT numbers.
2) At the interspace of the phantom teflon rod and water, CT numbers changed gradually because of the partial volume effect and the edge response. Although the true boundaries of the materials could be indentified with the median CT number of the two substances.
3) Setting up to 1, 000 on the window level and 1, 200 on the window width, the measurement value of the views of the phantom teflon rod which had been magnified 1.8 power coincided with the true size.
4) Supplementary examinations were carried out on the same methods using a pig mandible, and the results were affirmed.
The models were made of acrilic boards which the images of CT films were traced. Those boards were waxed up and trimmed in the boxies for three-dimensional reproduction by using cephalograms.
The reproducible accuracy of the completed models was satisfactory for use in the field of the maxillofacial surgery.

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In the maxillofacial region, relatively many cases of hemangioma have been reported. However few were of the central hemangioma of the mandible and histologically the cases of Masson's vegetant intravascular hemangioendothelioma are very rare. No cases of this tumor have been reported in our country.
Recently we experienced a case of this tumor. The patient was a 27-year-old male and his panoramic radiograph taken before dental carious treatment at a dental office showed a soap-bubble-like radiolucent area in the right molar region of the mandible. So he was referied to the Department of Oral Surgery of the University of Higasi-Nippon-Gakuen.
In this case we selected surgical extirpation of the tumor and this procedure proved the final diagnosis of this lesion. The patient has no sign of recurrence 4 years after the operation. We present our case briefly including a review of literature.

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Two cases of congenital epulises of the new born were reported.
Case 1: A seven-day-old female baby was found to have a smooth, round, red mass with a pedicle, measuring 10×15×7mm in size, arising from the E D region of the alveolar ridge. Though it was reduced in size 80 days later, the mass was excised under general anesthesia. Histologically, the lesion showed the characteristic features of a congenital epulis. It consisted of large polyhedral cells with abundant granular eosinophilic cytoplasms which were positive in PAS staining.
Case 2: A four-day-old female baby was found to have a smooth, round, red mass with a broad base, about 5×10×5mm in size, arising from the C region of the alveolar ridge. Under local anesthesia the mass was excised 47 days after the first inspection. Microscopic examination revealed many granular cells with PAS positive granules. The cells were similar to those seen in case 1.

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The CO₂ laser was used for the vaporization in seven cases of tongue lesions.
The result was very successful without excess bleeding under operation and no postoperative deformity of the tissue.
Though the postoperative pain associated with this procedure using laser was generally known to be slight, most patients in our reseach complained of not slight but moderate pain. Even severe neuralgic pain was manifested in one case.
Secondary tumor formation was also observed in one case.

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Though there have been several reports of tooth eruption in the maxillary sinus, eruption in the superior wall of the maxillary sinus is very rare. In most cases, the inverted tooth is situated in the floor of the maxillary sinus.
We encountered a rare case of a wisdom tooth erupting in the superior wall of the right maxillary sinus. The patient, a 21-year-old female, was referred with mobilization of the upper right first and second molars and a purulent dischage in the same gingival margin. Roentgenographic and computed tomographic examination revealed lower radiolucency in the right maxillary sinus than in the left, and a tooth-like structure in the posterior and inner regions of the superior wall of the same maxillary sinus. Clinical diagnosis was odontogenic maxillary sinusitis due to an infection of the erupted tooth in right maxillary sinus.
Under general anesthesia, the erupted tooth was extracted and radical operation was performed according to Caldwell-Luc method, the removed tooth appeared to be the upper right wisdom tooth, based on the morphological findings and absence of an upper right wisdom tooth in the oral cavity.
Postoperative recovery was without complication. There were no signs of recurrence 2 years after the operation.

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Clinical, radiographic and histologic features of 6 recurrent odontogenic keratocysts that developed in 5 patients were described.
The rate of recurrence in 28 cases with a minimum of one year follow-up was 21.4% that corresponded well to the average rate reported in other studies. The recurrence was noted 9 months to 5 years after treatment. The results indicated the necessity of regular and long-term follow-up because of the absence of symptoms associated with recurrence in most cases. The mean age of the patients was 16.6 years which was significantly lower than that of patients wthout recurrence.
Radiographically, the lesions were unilocular in 4 cases with smooth or scalloping borders and multilocular in other cases. Three cases manifested themselves as huge radiolucent lesions extending from the molar area to the mandibular notch. The initial lesions were also extending over 5 teeth in 2 of 3 cases that developed in the tooth bearing area, but the huge size was not the findings characteristic of the recurrent cases. The cysts were associated with impacted teeth in 5 cases, but the condition could not be regarded as the cause of recurrence. In terms of location, there was no predilecton in the site of recurrence.
Five of the 6 cysts had been treated by marsupialization followed by enucleation and primary closure, whereas recurrence was found in no case in which marsupialization, marsupialization followed by enucleation and packing open, enucleation and packing open or block resection were performed. Thus, treatment modality was the most important prognostic factor. Because of the various advantages of marsupialization, we are still in favor of the procedure in the treatment of the cyst occurring in young patients. When enucleation should be considered after marsupialization, however, the utmost care should be taken to remove the cyst en bloc with a margin of safety to include the soft tissue over the areas of bony defect and a layer of the surrounding bone to which it may be adhered and leave the wound to heal secondarily.
The presence of epithelial islands or daughter cysts in the cystic wall could not be correlated the recurrence.

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Many reports have been made in the past on the procedures and their improvements of lip reconstruction by plastic surgery. In such procedures, it is important not only to completely resect the neoplasm but also to restore the lip provided with necessary functions and cosmetic beauty. This paper presents “Gillies' fan flap” for the reconstruction of the lip. Our procedure yields satisfactory esthetic and functional results without fear of circulation disturbance in the region after the reconstruction by the flap.

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A case of partial radionecrosis of sphenoid and temporal bone was reported. The patient had received combined therapy of surgery, radiotherapy and chemotherapy for his left maxillary sinus carcinoma.
After the combined therapy, a painful inflammation appeared due to necrosis of the affected bone and soft tissues. Resection of the left ascending ramus of the mandible was also performed because of persistent tumor mass at the left infratemporal fossa. Epithelization of the exposed bone following left temporal region surgery did not occur but progressiveosteonecrosis with infection led to breakdown of the outer tissues, and his left zygomatic arch and a part of the sphenotemporal suture were exposed.
The possibility of the occurrence of intracranial complication was also considered, andresection of the nectrotic bone and reconstruction using sternocleidomastoid myocutaneous flap were performed.

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Reestablishment of mandibular continuity following radical surgery for oral cancer has been a challenging task to the head and neck surgeon. Treated autografts such as autofrozen or irradiated bone have been used for primary reconstruction of the mandible.
The first 14 consecutive cases in which a mandibular defect was immediately reconstructed with a boiled autogenous mandible are reviewed. The defect consisted of horizontal ramus alone in 5 cases and symphysis with one or both rami in 9. The resected segment of mandibular bone was dissected free of the gross cancer, shaved and boiled in water for fifteen minutes. The treated bone was replanted with internal fixation, then intraoral and surrounding soft tissue defects were reconstructed with pectoralis major or latissimus dorsi myocutaneous flap. It is essential to the success of this procedure that the boiled autograft is enveoped with the muscle of the myocutaneous flap and all dead space is eliminated. The follow-up period ranged from 2 months to 1 year and 7 months, with a 65% success rate. There has been no tumor recurrence originating in the boiled bone. Radiographic examination of reimplanted bone revealed a gradual absorption process, but in some cases showed evidence of neo-osteogenesis at the contiguous area.
Primary reconstruction of mandible with reimplantation of the boiled autogenous bone is distinguished by its ease and is a reasonable alternative in cosmetic and functional restoration.

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Two cases of speech disorders caused by soft palate injuries lead to the following conclusions on speech assessment before and after pharyngeal flap operation and wearing a speech aid.
1. After the primary operation, complete nasopharyngeal closure was not obtained in two cases.
2. A patient who wore a speech aid at the age of fourteen and thirteen years after injury showed a better effect of wearing a speech aid.
3. Only a slight effect of wearing a speech aid was observed in a 54-year-old patient who had relatively good (+) mobility of the soft palate and pharyngeal lateral wall, but had incomplete nasopharyngeal closure continuously for as long as forty-one years.
4. In case 1 which exhibited a remarkable effect after pharyngeal flap operation, mobility of the soft palate and pharyngeal lateral wall was remarkably good (++). Further it was considered important that the patient wore a speech aid prior to the above-mentioned operation when he was 14 years old and his speech function was completely improved.
5. The speech condition of a patient suffering from acquired imcomplete nasopharyngeal closure after the age of learning speech mainly consisted of nasality and no severe articulation disorders were observed.
6. It was emphasized that treatments on acquired incompete nasopharyngeal closure due to soft palate injury should be given as early as possible from the standpoint of improving the nasopharyngeal closure function in the same way as the treatment of congenital cleft palate patients.

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Many studies were reported as epidemiological investigations in population, for the purpose of recognizing the evoking mechanism of temporomandibular joint pain dysfunction. Frequency of certain symptoms such as joint sounds, difficulty of opening mouth wide and masticatory pain was sometimes observed in high rates of more than 50%.
In this report, as a result of a questionnaire survey, the rate of each cardinal symptom in an approximate 4000 adult population showed that TMJ sound were noted in about 6%, mouth opening difficulty in about 2% and pain in about 1.5%. These subjective symptoms were observed equally in both sexes and of little significacnce when judging the need for treatment. Comparing the maximal mouth opening, the symptomatic group showed a lower value than the sex-age-matched control group.
Occlusion has been discussed as a main factor of TMJ dysfunction. However, the etiology is evaluated to be probably multifactorial and complex in general. In this investigation, the individual mean DMF (decay, missing, filling) teeth index showed a significant high rate in the symptomatic group. Although there seems to be a relationship between dental condition and masticatory symptoms, these facts must be considered as an only one of various etiologicfactors. It can be stressed that at least dental treatment for some decayed and missing teeth should be done as early as possible after relief from masticatory pain and trismus.

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The number of injuries caused by pets has been increasing recently. Although there are various types of wounds, most can be roughly classified into bite and scratch wounds.
There are a lot of reports on bite wounds on the face, especially on the lip, eyelid, nose, and ear. These wounds must be reconstructed from the functional and aesthetic points of view.
We treated a case of dog bite avulsion on the lower lip involving the mucocutaneous junction, skin and muscle by applying double Z-plasty and a muscular pedicle island flap.
The result was satisfactory.

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Case of fibroma which had developed in the tongue of a 39-year-old man was reported.
In addition to clinical finding, light and electron microscopic observation, the tumor was examined by X-ray qualitative spot analysis.
By light microscopy, the tumor was covered with keratinized squamous epithelium, the lamina propria mucosa was characterized by a remarkable increase in fibrous connective tissue, dilation of capillary endothelia and infiltration of inflammatory cells.
By scanning electron microscopy, the lamina propria mucosa was remarkably characteristic of increased mature collagen fibers which appeared as radial reliculation and bundle types.
Under transmission electron microscopy, the development of tumor cell's organelles was remarkable, mature collagen fibers which showed a periodic rhabdoid structure of 640 Å were observed in stroma.
As a result of X-ray qualitative spot analysis, the constituent elements of the tumor consisted of P, S, Cl, K and Ca.
There has been no recurrence of the lesion as of 8 months after the operation.

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We performed immediate reconstruction of the mandible in a patient with ameloblastoma by forming a fresh selfiliac bone segment into the ramus mandibulae after hemimandibulectomy.
The patient was a 27-year-old woman with slight swelling in the region of the right angle of the mandible. As oral findings, redness and slight pressure pain were found in the region from the buccal gingiva corresponding to 8-4 to the transitional zone to the bucca, and parchment crackling was palpable. X-ray examination revealed a polyvacuolar radiotransparent picutre with clear margins in the area from 4 to the mandibular notch and an impacted tooth in the region of the mandibular notch.
The operative procedue was as follows: After hemimandibulectomy according to Manchester's method, the form of the mandible extirpated was reconstructed with a lead plate, and a bone graft segment having the form of the ramus mandibulae was obtained by applying the lead plate to the iliac bone on the same side. Extension bone grafting was performed by making the part corresponding to the caput mandibulae compatible with the mandibular fossa of the temporal bone.
There was no complication due to postoperative infection. Almost no deviation of the jaws at the time of mouth opening was observed 50 days after the operation, when the intermaxillary fixation was removed. The results of a 3-year follow-up was favorable from both cosmetic and functional standpoints.

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Two patients with cementifying fibroma occurring centrally in the mandible were reported. The first case was a 64-year-old man with a walnut-sized, radiopaque lesion with sharp demarcation of the site in the mandible 5-7, and resection of the tumor was performed. The second case was a 29-year-old woman with an oval semiradiopaque lesion with sharp demarcation of the site in the mandible ranging from the 7 mesial root to the sigmoid notch, and partial resection was performed. Histologically, various amounts of cementum were formed in fibrous tissues in both patients, but there were some differences in the amounts of cellular components and hard tissues present. Tumors were found to consist of fibroblastic cells, cementoblastic cells and undifferentiated mesenchymal cells electron microscopically. The cementum-like, hard tissues were formed irregularly along the collagen fibers, but signs of early calcification were observed in the form of irregular aggregations of small bristle-like, osmophilic crystals. A small number of matrix vesicle-like structures were also present around the aggregation. The first and second cases show favorable courses without relapse at present, three years and three months and three years and one month, respectively, after resection.

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Thermographic evaluation was made on three patients with Abbe flap. They had recieved primary repairs in infancy or childhood. The Abbe flap was inserted into the middle of the upper lip, and the vascular pedicle was separated on the 14th postoperative day in all patients.
Thermographically the flap was cold for 3 postoperative days and became cold again for 2 days after the flap was separated. The temperature of the distal or proximal portion of the flap fell 1.1 to 2.0°C during four or five postoperative days compared with those of the surrounding normal skin. After the flap was separated, the temperatures of the flap againfell 1.0-3.7°C for 2 days at the middle and distal portion.
Since cyanosis and edema were clinically noticed in the flap when there was a fall in temperature, thermography was considered to be useful not only for judgment of flap survival but also for objective and quantitafive analyses of the wound healing process.

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We succeeded in devising a new method for the surgical removal of mucoceles. This method is different from previous removal methods which use various impression materials for injection. An α-cyanoacrylate monomer adhesive is injected into the cystic cavity to coagulate (not to replace) its contents and cyst walls and remove them en bloc quite easily. Our surgical method is as follows:
An 18-gauge needle on a 2.5-cc syringe is inserted into the cyst, and some of the fluid within the cyst is aspirated. The syringe is then replaced with the one containing the α-cyanoacrylate monomer adhesive, and the adhesive is injected into the cyst. After the adhesive coagulates, the mass is easily removed as in the case of enucleation of a substantial benign tumor. Finally the wound is sutured.

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Pedicle skin flaps, the same as other reconstructive materials, are effectively used in maxillofacial surgery. Surgeons are interested in flap survival because the most serious complication is epithelial necrosis. Flaps of excessive length cannot obtain as good results as those of proper length. It is easy to recognize that the key point in flap survival is flap revascularization, although the details are not clearly understood at recent. Arterial blood flow in flap segments in the rat dorsal skin was measured chronologically by the radioactive microsphere distribution method. The most ischemic segment of the flap immediately after operation indicated the highest arterial blood distribution on 14th postoperative day.

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The analgesic effect and safety of a single dose of Indoprofen (IND) 200mg was compared with that of Aspirin (ASP) 750mg and Inactive placebo (PL) In a double blind trial in patients with postexodontic impacted wisdom teeth pain. The numbers of patients analyzed were 68 for the IND group, 65 for the ASP group and 81 for the PL group. The following results were obtained.
1. In pain improvement rating, moderate or better improvement was obtained in 52 patients (83.9%) of the IND group, 23 (41.8%) of the ASP group and 23 (29.9%) of the PL group. There was a significant superiority for IND over the other two agents (P<0.001).
2. The onset of analgesic effect of IND was 30 min., and efficacy was maintained for 6 hours. At all evaluation times, pain in the IND group was significantly less than in the other two groups (P<0.001 or P<0.01).
3. Side effects were observed in 5 patients (7.4%) of the IND group, 6 (9.2%) of the ASP group and 4 (4.9%) of the PL group with no significant difference.
4. Overall usefulness was rated as “markedly useful” in 24 patients (38.7%) of the IND group, 3 (5.5%) of the ASP group and 3 (3.9%) of the PL group. There was a significant difference among the three groups (P<0.001).

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The effect of a new non-steroidal anti-inflammatory agent, ONO-3144, with an action mechanism different from those of known agents on postoperative inflammation following minor oral surgery was evaluated by a double-blind controlled clinical trial using mefenamic acid and inactive placebo. The results we as follows:
1) Among the total 320 cases in the present study, the following were subjected to analysis: 304 cases for analgesic effect and oveall safety rating (excluding 16 exclusion cases), 282 cases for anti-inflammatory effect (excluding 22 drop-out and 16 exclusion cases) and 289 cases for utility rating (including 7 drop-out cases where drug administration was discontinued due to side effects or insufficient effect). There was good inter-group equivalency in terms of patient background and adequate random allocation was confirmed.
2) In the 0-H group (ONO-3144, high dose), 44% efficacy in analgesic effect, 71% efficacy in anti-inflammatory effect and 65% utility taking into accout of side effects were observed, providing significantly better efficacy and utility than in any of the 0-L group (ONO-3144, low dose), M group (mefenamic acid 600mg/day) and P group (inactive placebo).
3) Incidence of side effects was 13% in the O-H group, 10% in O-L group, 3% in M group and 9% in P group, without any significant intergroup difference. Gastrointestinal symptoms were the mainside effects of ONO-3144, but none were severe.
4) Based on the foregoing results, it is concluded that ONO-3144 is worthy of use as a postoperative, anti-inflammatory agent following oral surgerys.

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