Neutrophils are thought to play an important role in the host defensive system against bacterial infections. In order to evaluate the oxidative metabolism of neutrophils, luminoldependent chemiluminescence of peripheral blood neutrophils and leukocytes obtained from patients with acute oral bacterial infections was investigated in this study. The results were as follows: 1. Chemiluminescence of leukocytes and neutrophils obtained from patients was activated when compared with normal volunteers 2. Chemiluminescence of neutrophils was significantly correlative with that of leukocytes. 3. Chemiluminescence measurement by using leukocytes is sufficiently useful in utilizing for clinical diagnosis.
The investigation of the shape of the temporomandibular joint (TMJ) and the condylar angulation in the transverse plane were made by using xeroradiography obtained from the submentovertical projection. Each condylar angulation was measured between the condylar long axes and the line which connected the midpoints of both ear-rods. Then, the condylar angulation of patients with so-called TMJ arthrosis were compared with those of normal volunteers. The results were as follows. 1) In 76 patients with so-called TMJ arthrosis, the condylar angulation of the left side ranged from-12.0 ° to+29.0 ° and that of the right side ranged from-7.0 ° to+33.5 °. In 20 normal volunteers, the condylar angulation of the left side ranged from +5.5 ° to +16.5 °, whereas that of the right side ranged from +4.0 ° to +22. 5 ° 2) The condylar angulation of seven patients (9.2%) showed negative angles out of 76 cases. 3) Out of patients with negative condylar angulation, six patients complained of sound, six patients of limitation and one patient of pain.
In the present study, the myosin heavy chain was extracted and purified from the chicken gizzards to obtain the specific marker of the myoepithelial cells (MEC.). The purified myosin heavy chain was injected into two rabbits for immunization, and anti-smooth-musclemyosin antibody was prepared from the antisera. Fresh frozen sections of the major salivary gland, exorbital lacrimal gland, lactating mammary gland and prostate of the rat were observed under fluorescence microscopy. Strong fluorescence was shown in these glands, and it coincided with the configuration of the MECs except for the prostate. The terminal webs of the acinar cells were also stained weakly. In addition to the MECs, all structures known to contain smooth muscle showed intense fluorescence: Fluorescence was specifically intense at all blood vessels from arteries and veins down to arterioles and venules and at the muscular stroma of the prostate. In the sublingual gland, the MECs were more developed than the MECs of the submandibular gland. It was recognized that the processes of the MEC: were rarely existed at the excretory duct of the submandibular gland. In the parotid gland, the processes of the MECs were interspersed at the basal side of the acini, and it just showed the waste-thread-like appearance. No MECs was found in the prostate. in spite of the exhaustive observation of many specimens. Moreover, major salivary glands were made to react with anti-S-100b monoclonal antibody, which was thought to be a nonspecific marker of the MECs, but they showed no fluorescence. It was considered that anti-myosin antibody was an immunohistochemical specific maker of the MECs with low grade spieces specificity and tissue specificity.
It is the purpose of this report to compare the wound healing process mechanically, biochemically, and histologically after straight type lip plasty with that after Z type lip plasty. Both sides of the upper lips of young rabbits, 4 weeks after birth and 450g in weight, were closed with the same number of 5-0 Nylon interrupted sutures. After rabbits were killed 3, 5, 7, 14 days and 1, 3, 6 months after the operation, the entire lip layer was excised. The tensile strength was measured with Instron tension meter, and the collagen content was determined spectrophotometically by Edward's method. Histological findings were obtained after staining with hematoxylin and eosin. The following conclusions were obtained. 1. The tensile strength in both groups increased more rapidly than that of previously published reports. 2. The tensiles strength after straight type lip plasty reached the tensile strength of the normal skin faster than that after Z type lip plasty. 3. The increase of tensile strength in both groups was almost parallel to the increase of collagen content during one month after the operation. 4. Histological examination showed that more post operative inflammation was found in Z type lip plasty group than in the straight type lip plasty group.
Experimental study on Aspoxicillin (ASPC, TA-058), a new parenteral penicillin was carried out and the folloing results were obtained: In vitro antibiotic activity of ASPC against 47 clinical isolates from oral infection cases were examined. The peak of the minimum inhibitory concentration was 0.39 μ g/ml and 80% inhibitory concentration was 1. 56 μ g/ml. Using SD strain rats, distribution of ASPC, ABPC and PIPC after intravenous administration in plasma and in oral tissues such as the gingiva, mandible, alveolus, submaxillary gland, tongue and masseta were assayed. Concentration after administration of ASPC in plasma and oral tissues was similar to that ABPC and superior to that of PIPC. These results suggested usefulness of Aspoxillin in the treatment of infections in the field of oral surgery.
We often encounter the cases in which periosteum with bone defects cannot be preserved because of surgical resection of tumors or injuries. Bone and periosteum transplantation are generally accepted for repair in these cases. However, there are a few reports that experimental healing process of bone defects without periosteum in the mandibular bone has been observed. This investigation was undertaken to study healing process of the amputation stump in the mandibular jaw defects of the adult dogs in such experimental situations as lack of the ability of bone formation by periosteum and bone transplantation. Thirty-nine adult dogs were used in this study. Experimenal bone defects with spacing of 10 × 15 mm were made in the mandibular bone. They were divided into two groups for comparison: A) The defect was covered with silicon sheet after preserving the inferior alveolar artery and vein. B) The defect was left uncovered after preserving the inferior alveolar artery and vein. Process of bone healing was observed for 7 months. Four different fluorochromes were administered in order to estimate activity and the source of bone formation for the period. Biopsy specimens for light microscopy and fluorescence microscopy were obtained, and radiographic examination was also performed. The results obtained were as follows: 1) The bone repair in one of A group began in 5 months. However, bone formation was found in one-half of the number of cases in A group and the outline of the mandibular bone was repaired to almost normal size in 7 months. 2) The bone formation in B group terminated in 3-5 months, but a small concavity in the normal outline of the mandibular bone could be seen after 7 months. When the inferior alveolar artery and vein are preserved, the inserted silicon sheet prevents formation of the fibrous scar tissue and pressures from the surrounding tissue. Therefore, bone formation fills up bone defects without the bone graft and/or preservation of periosteum.
The mechanism of lateral pharyngeal wall (LPW) movement was studied in postoperative cleft palate patients by ultrasonic examination. The subjects for this study were 5 adults and 20 children with nasopharyngeal insufficiency and wearing speech aids. 1. The head positioner used in this ultrasonic examination, which uses the bulb of speech aids as an index was useful to point out the LPW position in each subject and to aim the transducer at point this. 2. The ultrasonic examination of LPW was practicable without troubles in young cleft palate children (3-9 years old). 3. In the patients with nasopharyngeal insufficiency, the LPW movement during speech is obviously reduced and unstable as viewed by the real time ultrasound scan. As further examples, a peculiar movement and incongruous movement of right and left LPW were seen. 4. In several subjects, blowing is different from pronunciation in LPW mobility. During swallowing in many subjects, the medial movement is as large as in the normal subjects, but in some subjects it differed from normal subjects in movement patterns. 5. The M-mode echo curve of the LPW movement showed several patterns in speech, blowing and swallowing, and they differed from those of the normal subjects. 6. In some subjects, there was a tendency for the moved distance of the LPW for swallowing > blowing > plosive consonants >/a/ vowel /i/ vowel and nasal consonants, and in other subjects for swallowing >/a/vowel and plosive consonants >/i/ vowel and nasal consonants > blowing. 7. The starting point of the LPW movement occurs before the beginning of voice with larger time lag than that of the normal subjects, and the point of maximum movment is observed after the beginning of voice in many subjects. 8. The speed of the medial movement of the LPW was obviously less than that of the normal subjects. 9. The average time for swallowing was 1, 557 msec. 10. It was proved that 20 cleft-palate children were able to be classified into three groups by mobility of LPW as a result of the analysis of the patterns of a series of M-mode echo curves, 11. This ultrasonic method proved to be useful in assessing the nasopharyngeal function for Cleft palate patients from an early age.
For clinical application of ASPC in the oral field, a pharmacokinctic analysis was performed for ASPC concentration in the oral tissue, and the following results were obtained: 1) ASPC with a dose of 1 g was administered to 38 patients by one shot intravenous injection. Serum ASPC concentration was 46.7 μ g/ml 30 min and 12.2 μ g/ml 120 min after injection. The half life of ASPC in serum was thus estimated to be 2.2 hr. 2) Concentration of ASPC in gum and cyst wall ranged from 30 to 35% of the serum level at the highest. Peak concentration in bone was 14.9% of the serum value. 3) The AUC value and the duration time gave satisfactory results and we found that the ASPC distribution to oral tissues was good.
The form and function of the speech organ and speech function after glossectomy were studied in 13 cases that received glossectomies because of the squamous cell carcinoma of the tongue. Their speech functions were discussed from the point of speech rehabilitation and the following results were obtained: 1. The grade of articulation disorders in the group of total glossectomy (group A) was poor on palatals and velars. The age, dentition and reconstruction of the mouth strongly showed some relationship with the speech function. 2. Articulation disorders in the group of patial glossectomy (group B, C and D) had shown results parallel to those evaluated on speech organs. The speech function was good in the patients observed over three years after glossectomy. 3. The speech function in the groud of marginal glossectomy (group E) was good hardly associated with the age, dentition and period after the operation. 4. The type of articulation disorders mainly showed distortion, but one case in groups A, B, C and D showed velar sound substitution. Therefore, it was suggested that compensation of velars articulation was difficult in glossectomy cases. 5. Chief complaints after glossectomy mainly consisted of mastication and swallowing by group A and speech disorders by group B-E.
To define the mechanism involved in the transport of immunoglobulins into saliva from the minor salivary glands, the authors studied the localization of IgA, IgM, IgG, secretory component (SC) and J chain in the human lip and palatine minor salivary glands by the peroxidase-labeled antibody technique. In addition, the concentration of secretory IgA (s IgA) in non-stimulated whole saliva and serum were evaluated by a column enzyme immunoassay. At the light microscopic level, IgA, IgM, SC and J chain were pominent in the mucous acinar cells and glandular epithelial cells. However, IgG was not detected in these epithelial cells. Immunocytes containing IgA, IgG or IgM were found in the interstitium. At the electronmicroscopic level, SC was localized in the perinuclear spaces, rough endoplasmic reticula, saccules associated with Golgi complexes, cytoplasmic vesicles and secretory granules, and on the lateral and basal plasma membranes of mucous acinar cells and glandular epithelial cells. IgA, IgM and J chain, but not IgG, were also localized on the plasma membranes and in the cytoplasmic vesicles of these cells where SC is located. These findings provide the following evidence. 1) The sites of SC synthesis in the minor salivary glands are mucous acinar cells and glandular epithelial cells. 2) Polymeric IgA and IgM containing J chain are translocated through these epithelial cells as s IgA by a SC-mediated transport mechanism involving cytoplasmic vesicles. 3) Free SC is secreted into saliva through secretory granules in the mucous acinar cells, and also there is a suggestion that they are secreted through cytoplasmic vesicles in these cells. 4) IgG does not share the transepithelial cell route with IgA and IgM. 5) The slg A levels in whole saliva and serum were 180.6 ± 93 μ g/ml and 8.6 ± 3.7 μ g/ml, respectively.
Distribution of KBT-1585 was examined in oral tissue and inflamed mouth floor of mice by agar well method. After oral administration of KBT-1585 200 μ g/g in mice, the tissue concentration of mandibular bone, tongue, masseter, submandibular gland, femur and serum reached a peak in 5 minutes and that of mouth floor in 15 minutes. The tissues in order of concentration were the serum, tongue, mouth floor, masseter, mandibular bone, femur, submandibular gland. After oral administration of KBT-1585 200 μ g/g in mice of which mouth floor had been inflamed, the concentration of inflamed mouth floor reached a peak in 15 minutes. Compared with normal mouth floors, KBT-1585 was distributed rather low in inflamed mouth floors, but the concentration maintenance was good.
To clarify the characteristics of atypical pain diseases of the oral cavity, a study was conducted on 229 cases diagnosed as glossodynia in OPD at the Oralsurgical Department of the Tokyo Medical College during the period from October, 1978 to February, 1984. This study was carried out by symptom analyses using pain cards, various psychological tests, autonomic nervous function examinations, pain sense threshold and tolerance examinations with electric stimulation apparatus, pain sense abnormality examinations by laughing gas absorption, psychosomatic medical evaluations and prognoses of pain during treatment, and prognosis analyses. The following results were obtained. 1) Physical and psychosomatic investigations showed climacteric and near old-age female patients (40-60 years of age) to be prone to these diseases, whose pain was characteristically mild, persistent, superficial, localized and spontaneous, and centered in the region of the tongue tip and its lingual border. The patients frequently felt anxiety over the pain. Of the patients examined, 50.5% showed signs of worry and anxiety, 32.8% were restless, 44.5% had tendencies toward depression, and 59% showed restless autonomic nervousness. 2) The pain sense threshold and tolerance examinations using electric stimulation apparatus, showed the restless autonomic nervous patients to have significantly lower pain thresholds and tolerance values than the psychologically stable patients. 3) The administration of laughing gas at the initial medical examination resulted in the temporary alleviation of pain in numerous cases but was without effect in others. Following this, treatment of disease in the former was frequently found effective but not so in the latter. Thus, the results of disease treatment can be predicted to some extent on the basis of the results from laughing gas administration. 4) In the psychosomatic medical evaluations, correlation between disease symptoms and treatment and values obtained for various psychosomatic examinations was noted to be in direct proportion to symptom severity. This indicates that our systematic treatment was effective in bringing about a cure for the pain. 5) In 77.4% of the patients, the prognosis was found to be good. In 24.4% of the female patients, a recurrence of pain was noted but in all such cases it was less than that formerly experienced. In 60% of the patients, improvements were noted in their daily lives as well as a reduction of pain.
The technique and effect in the use of intravenous diazepam-pentazocine for inpatients receiving surgical operations under local anesthesia was described. On the 153 patients (96 male, 57 female) who had been administrated 0.2±0.05 mg/kg diazepam and 0.61±0.16 mg/kg pentazocine during operation, cardiac monitoring (heart rate, blood pressure, rate pressure product, electrocardiogram) were measured and amnesic effects were inquired the day after operation by means of a questionnaire. The results were as follows: 1) All patients were kept in good sedation and co-operation during and after the operation. 2) 85 out of 100 patients had complete or partial amnesia in the operating room. 3) 117 out of 153 patients (76.5%) did not need any analgesic agents for more than 24 hours in the postoperative course. 4) Neither severe side effects nor adverse reactions were observed in this method.
This study concerns about 103 patients with squamous cell carcinoma of the oral cavity who underwent therapeutic radical neck dissection between 1961 and 1980. Metastasis to the lymphnodes were histologically confirmed in 81 out of 103 cases (78.6%). The superior internal jugular nodes were most frequently metastasized and secondly were the submandibular nodes. The survival rate was significantly higher in the patients without metastasis compared to patients with metastasis. Three-year-survival rate was 90% in patients without metastasis and 43% with metastasis. Five-year-survival rates were 86% and 37%, respectively. Prognosis of patients with multiple metastatic nodes were worse than that of single metastatic node patients. However, the prognosis was not bad in the patients who had single metastatic location with multiple metastatic lymphnodes. The most important factor for prognosis seems to be the number of metastasis sites. Cervical metastasis after primary region treatment could be controlled by earlier detection with careful follow-up. Preventitive neck dissection seemed to be unnecessary.
109 cases with the cleft palate operated primarily by the push-back method at our institute from March, 1973 to September, 1975 were investigated for speech condition. The sufficient velopharyngeal function, slight hypernasality, and hypernasality were observed in 85 cases (78.0%), 20 cases (18.3%) and 4 cases (3.7%), respectively. In view of cleft types, sufficient velopharyngeal functions were obtained in 29 out of 32 cases (90.6%) in the isolated cleft palate group, 39 out of 45 cases (86.7%) in the unilateral cleft lip and palate group, and 17 out of 32 cases (53.1%) in the bilateral cleft lip and palate group. Then, in a case of the submucous cleft palate, hypernasality wasn't observed. Palatalized articulation accounted for 47 cases of the total 109 cases of abnormal articulation (43.1%), followed by glottal stops in 8 cases (7.3%) and nasal articulation in 4 cases (3.7%).
Sports have become very popular and, independently their of age, a great part of the population is practicing some kind of physical activity. Some of them seek to keep in shape and in good health, others have taken sports professionally. Recent reports have shown an increasein traumat ic injuries related to sports of which maxillo-facial injuries accounted for 6 %. Here we report on a survey of oral and maxillo-facial injuries suffered by rugby players in 1984. Questionnaires were sent to the 1, 570 rugby teams that constitute the West Rugby Football Union in Japan. Among the 821 teams that replied, the total number of reported injured persons was 235. Of these, 5 suffered maxillary bone fractures, 15 had mandibular bone fractures and 215 suffered teeth fractures. Teams were classified into 5 groups according to age: Group A, composed of elementary school students; Group B, junior high school students; Group C, senior high school students; Group D, college students and Group E, club teams. We were also interested in when players were more prone to injuries, that is during games or during training. The results were as follows: in Group A, 3 children suffered teeth fractures, all during training. Group B reported 12 students with teeth fractures, 4 occurred during games and 8 during training. In Group C, 3 maxillary bone fractures were reported, 2 during games and 1 during training; also, 4 mandibular bone fractures that happened during games and 5 during training. Besides, 93 cases of teeth fractures were reported, 43 during games and 50 during training. The total number of injured persons reported in this group was 105. In Group D, 2 cases of maxillary bone fractures were reported, 1 during games and 1 during training; also, 3 mandibular bone fractures that happened during games only, and 37 cases of teeth fractures of which 19 occurred during games and 18 during training. In Group E, 3 mandibular bone fractures that occurred only during games were reported; also, 70 cases of teeth fractures, 54 during games and 16 during training. From the data presented here, we concluded that a mouth guard to prevent these injuries should be adopted by rugby players during training as well as games.
258 cleft palate cases repaired in our clinic primarily during the 12 years from January 1, 1972, to December 31, 1983, were investigated clinico-statistically. The results were as follows: 1) The patients came from all over the Tohoku district in Japan. 2) The ratio of patients, classified according to cleft type, was 55.8% cleft lip and palate and 42.6% cleft palate. 3) There were more males than females with cleft lip and palate, but the reverse in patients with isolated cleft palate. 4) For the last 9 years, most patients having cleft palate repaired were around 2 years old. 5) Until 1973, cleft palate repair had been by Wardill's method, but in the past 4 years, Manchester's method was used on cleft lip and palate cases and Z-plasty method was used on isolated cleft palate cases. 6) Blood loss volume was least in Epinephrine injected cases.
Thirty-eight cases of oral and maxillofacial infections isolated Actinomyces without sulfur granules in the pus or granulation tissue were investigated clinically and bacteriologically in relation to the criteria of actinomycosis and its pathogenesis. These cases were divided into two types from clinical features and course: One was the acute type and the other was the chronic type. The former was clinically similar to the nonspecific acute pyogenic infection, and bacteriologically Streptococci were more predominantly isolated then the latter, together with Actinomyces. The latter clinically resembled actinomycosis and there were less Streptococci. It was thought that in the acute type, Streptococci were preponderant for pathogen, and Actinomyces were part of a mixed infection, while in the chronic type, Actinomyces were preponderant, although no sulfur granules were detected. As process of the infection, the acute type was thought to be in the incipient stage, and the chronic type to be in the later stage These cases were thought to be transitional cases of actinomycosis.
A case of lipoma in the floor of the mouth and the incidence of oral lipomas in comparison with benign tumors of the oral cavity dealt at the Second Department of Oral and Maxillo-facial Surgery Osaka University Dental Hospital are presented with review of the literature. Patient was a 56-year-old oriental woman complaining of painless swelling in the left floor of the mouth. The tumor was surgically removed under local anesthesia and the diagnosis was a lipoma. The incidence of oral lipomas out of benign tumors of oral cavity diagnosed in this department is 5.2%, and it is not concluded that the rate of the oral lipoma is less than that in the other sites of the body. Irritation fibromas and salivary gland tumors are excluded from the number of the benign tumors in this report. It was verified by review of the literature that lipomas in the floor of the mouth occur more often in females than males and rarely seen in the middle line of this site.
The desmoid tumor is an invasively proliferating fibrous lesion of soft tissue origin. It commonly arises in abdominal musculature and has been rarely observed in oral tissues. The present paper reports a case of desmoid tumor of the mandibular region. A fifty one year old man was admitted complaining of gingiva swelling of the left lower first molar region, which he noticed approximately 10 days prior to admission. His history comprised appendectomy 20 years previously and extraction of the left lower first molar 10 years previously. He had no history of any facial trauma. The intraoral examination revealed a 25 × 19 mm tough and rubbery mass on the gingiva of the left lower first molar area extending to the second premolar medially and the second molar distally. The radiological examination revealed a radiolucent area exteding from the alveolar ridge to the mandibular body, where a few nonradiolucent bone traveculae were observed. Some parts of border of the radiolucent area were indistinct and the other were thickened. A provisional diagnosis made from clinical findings was a malignant tumor. However, the examination of biopsy specimens taken twice from the lesion revealed the characteristic of desmoid tumor. Partial resection of the left mandible including some radiologically normal bone and gingiva was performed under general anesthesia. The postoperative course was uneventful and there was no evidence of recurrence approximately 3 years after the operation. Macroscopically the lesion was whitish-gray in cdor, tough and rubbery. The lesion border was irregular and partially indistinct without the capsule. Microscopically the lesion consisted of abundant, mature collagen fibers which ran parallelly, swirly and radiately in all directions. In fibrous stroma were spindle-shaped fibroblasts showing neither atypicality nor mitosis. Cellularity varied depending on area. The elctron microscopic findings showed that cytoplasm contained considerably developed the rough endoplasmic reticulum. Collagen fibers were dense not only around cells but also in cytoplasm. The lesion was consequently diagnosed as a desmoid tumor possibly originating from the connective tissue under the gingiva.
Pathologic calcifications are divided into two types: dystrophic calcification and metastatic calcification. The calcification of the artery is also a typical dystrophic calcification but uncommonly occurs in facial artery or carotid communis on the maxillofacial regions. Nevertheless, the calcification of the venae is very rare. This report presents a case of calcification of the venae facialis.
Although some authors reported that in some cases of subcondylar fracture of the mandible, spontaneous repositioning were shown by closed therapy and the others advocated intermaxillary elastic traction by the ipsilateral bite-block and continuous lateral percutaneous compression with the aim of active realignment of fragments. However, we could not know the detailed course of this kind of treatment. The authors experienced five cases of the condylar neck fracture with displacement but lineation, and treated by the above remedy. The observation and evaluation was made by use of the radiological examination such as Grant-Lantings projection, P-A projection and Orthopantomography. As a result, some correction of shortened ramal length was shown, but correction of inclination of the condylar fragment was not achieved by these methods. From this experience, the authors concluded that there were limits in these treatments of repositioning of the fragment, and eventually the open operation should be indicated in these cases of the fracture. In this report, some discussions were made concerning the mechanism, complication of the above treatment in the cases of condylar neck fracture displacement without dislocation.
The stress ulcer is an acute peptic ulcer of the upper digestive organ that is frequently caused by various stresses. We experienced a case of stress ulcer following pharyngeal fl ap operation on a 7-year-old girl. In our case, she was fortunately healed by conservative treatment but we suggest that it is important to manage patients, especialy children, carefully after oral surgical operations because the post operative stress ulcer can easily become a fatal complication such as perforation or massive hemorrhage.
Foreign bodies in the oral tissues are relatively rare, and such patients usually have unexpected complains. We have recently experienced 3 cases of foreign bodies in the oral region. Case 1: The patient was a 69-year-old man complaining of the neuralgic pain at the mental region. A piece of metal was buried in the soft tissue. Case 2: The patient was a 47-year-old woman complaining of the continuous pain at the mental area with small amounts of sand discharged from the vestibular mucosa. Much sand with the granulation tissue were located in the submucosal connective tissue of the vestibular mucosa. Case 3: The patient, a 23-year-old woman complained of traumatic trismus due to the traffic accident. Five small pieces of glass were impacted in the tissue between the masser and buccal skin. Clinical features of three cases of foreign bodies in oral soft tissues have been described.
Agranulocytosis is a comparatively rare condition in the outpatient clinic of oral and mxillofacial surgery. In the early stage, this lesion generally reveals no severe symptoms but if not treated adequately it may sometimes be fatal. We recently experienced one case of agranulocytosis in a 54-year old male. The patient was noted to have slight fever and ulcers on the tongue and upper lip. Examination of the blood disclosed normal red cell count and 800 white cells. Antibiotic therapy was instituted after immediate cessation of previously prescribed drugs. Consequently, the white count gradually increased to the normal range and ulcers in the oral region disappeared. He was discharged much improved on the 49th hospital day.
An intraepithelial carcinoma (carcinoma in situ) is characterized by marked cellular pleomorphism and by loss of polarity and surface stratification, with the whole thickness of the epithelium showing malignant cellular features. However, the basement membrane is intact. In this paper, 2 cases of intraepithelial carcinomas in the oral region are presented. Case 1: A 71-year-old man visited our clinic complaining of a white lesion in the floor of the mouth. The lesion was excised and thin split skin grafting was done under local anesthesia. Case 2: A 68-year-old woman visited our clinic complaining of a white lesion with erosion in the right margin of the tongue. The lesion was excised under general anesthesia. Afterwards, radiotherapy by Linac and 60Co were added. Pathologic diagnoses of the excised specimens of both patients were intraepithelial carcinomas. Postoperative course was satisfactory.
We have had the opportunity to make use of a CO2 laser apparatus and treated the surface lesions of the oral mucosa. Eighteen cases were treated and they consisted of nine cases of lichen planus and nine of leukoplakia. The lesions were vaporized at an output of 15 to 20 watts with the defocusing spot about 2mm in diameter. On leukoplakia, vaporization was done all over the lesion 1.5 to 2.0mm in depth including the marginal normal tissue. On the contrary, lichen planus was vaporized slightly in depth and at the limited area of redness and erosion. Bleeding was little at operation. Postoperatively, most of the patients complained of the contact pain. Since it was light, applying to the Anesthesin-Azulen ointment, the symptom disappeared or was reduced. Prognosis was uneventful.
The method to align and stabilize the remaining mandibular segment for the mandibulectomized patient including the mandibular condyle was reported in this article. The method used is modification of the external pin fixation. The difference between the ordinary method and the author's method is that the devices guiding the mandibular movement are attached to the ordinary external pin fixation appliance. The merits are as follows. 1. The patient can open his mouth guided by the devices attached to the ordinary external pin fixation appliance without changing the position of the remaining mandibular segment. 2. The patient can eat orally in the early postoperative period. 3. Postoperative care becomes easier because observation of the oral cavity is easy.
Two cases of parotid hemangioma in infants that involuted remarkably after treatment by compression using resin-splint and hand-maded skullcap are presented. In one case, hemangioma began reducing 2 weeks after compression therapy and involuted at one year and four months. In the other case, hemangioma enlarged temporarily, but it began to reduce just after remaking of splint and skullcap and completely involuted at eight months. In both cases there were no complications. We confirmed that compression therapy is a safe and effective modality for treating parotid hemangioma in infants.
Two aged patients, i.e., a 75-year-old patient with the well differentiated squamous cell carcinoma originating in the gingiva and an 80-year-old patient with the verrucous carcinoma, showed excellent responses to daily administration of a small dose (2.5mg) of Peplomycin. In the patient with the lower gingival carcinoma, the tumor no longer existed when the patient returned one year after discharge due to a total dose of 80mg of Peplomycin, 43, 500mg of Futraful suppository, 3, 400 rad of external 60Co irradiation, 750mg daily of Futraful suppository and 3.0g daily of Krestin over 1 year after discharge. In the other patient with the upper gingival carcinoma, administering of a total dose of 22.5mg of Peplomycin alone regressed the tumor, which was resected under local anesthesia. In both patients, the favorable general condition during the treatment including immunity was thought to be greatly contributory to the excellent responses.
Immediate reconstruction using cervical island skin flap was performed in order to resurface the defects following resection for 5 oral cancers. The flaps, which were used for repair and reconstruction of cancers at a buccal mucosa, alveolus, gingiva and tongue, survived at each transferred site, but the epidermal layer of the flaps, except the muscular one, became necrotic in the other two tongue cancers. The flap was used for repair and reconstruction of the intraoral moderate defect. Furthermore, the postsurgical palatal prosthesis was effective for rehabilitation of speech and swallowing in 3 cases of hemiglossectomy. Also an A-O plate, which secured the mandibular stumps, was useful for maintaining the mandibular movement in a case of segmental mandibulectomy during the operation.
Malignant lymphoma is a heterogenous group of neoplasms of the lymphoid system. The head and neck region is one of the favorable sites of this tumor, but intraoral presentation of lymphomas is an uncommon occurrence. Dentists and oral surgeons alike should be alert to the probability that painless swelling in the jaws and surrounding tissues may be due to the malignant lymphoma. Biopsy alone can establish the diagnosis of this disease. Radiation therapy and chemotherapy have been the treatment of choice for the majority of patients with non-Hodgkin's lymphoma. We reported here four cases of the non-Hodgkin's lymphoma in the oral and maxillofacial region. The tumors of four cases were located in the mandible, submandibular lymph node, maxillary sinus and gingiva respectively. The most significant clinical feature of these cases was painless swelling. Histologically four cases were all diffuse lymphomas. According to LSG (Lymphoma-Study-Group) classification, three cases were classified as a medium cell type, and one was a large cell type. The radiotherapy with chemotherapy was done in three cases, and one case was only treated with chemotherapy. Two of four patients have survived without recurrence, and two have died of the disease.
A pleomorphic adenoma is the most common of all salivary gland tumors. The most frequently affected gland is the parotid in major salivary glands and the palate in minor salivary glands is often observed. Incidences on the cheek, lip, floor of the mouth and tongue are comparatively rare. The writers experienced three cases of the pleomorphic adenoma originating in the cheeks and report as follows. All were females who complained of swelling of the buccal mucosa. The masses were indolent, circumscribed, well-demarcated, elastically hard and movable. In all cases, the masses were enucleated from the oral, examinated histopathologically and diagnosed as the pleomorphic adenoma. They were diverse and part calcification was seen in only one case. The prognosies were excellent.
In order to achieve closed reduction and fixation for jaw fractures, intermaxillary traction and fixation are usually performed using continuous loop wiring. However, in infantile patients or patients with unfavorable tooth and paradental condition the application of this technique is restricted. On the other hand, sufficient reduction cannot be obtained by the use of a conventional splint with methylmetacrylate resin. In order to solve this problem, we devised. reduction and fixation method using an “elastic splint” of silicon with an assist from a chin cap. With this device, not only the teeth but also the alveolar ridge and palate become the source of reduction and fixation. A deviated bone flap can be reduced by means of elasticity of the splint. Further, splints whose elasticity has been lost can be used as fixing devices, as they are, after reduction. This method was applied to 30 new cases of jaw fractures. All the cases showed improvement and normal occlusion, except for one jaw fracture accompanied by intractable infection. The period of reduction using this device was 2-14 days, 6.8 days on the average, and the period of fixation was 14-49 days, 33.7 days on the average. This device was particularly effective in cases in which no sufficient reducing or fixing source could be obtained with dentition alone (i.e., those with poor deciduous dentition, mixed dentition and poor paradental condition), in cases of missing teeth and in cases of bucco-lingual deviation.