Ultrastructural effects of various anticancer drugs on the primary culuture cells derived from human submandibular glands were studied. Four cases from the submandibular gland of tongue carcinoma (squamous cell carcinoma) patients who had undergone neck-dissection were obtained. The modified direct cover-glass method was employed and when the primary culture cells proliferated, they were observed by light-and electron-microscopy and in addition, morphological changes due to anti-cancer drugs influences were examined. Primary culture cells began to migrate after 3-5 days of cultivation and were epithelial-like polygonal cells of slow growth. Cell density was a little diversified according to case, in some cases small cells densely proliferated. Ultrastructually, the nucleus had a few nucleoli which consisted of the nucleolonema and in cytoplasma tonofilaments, many free ribosomes, mitochondria, lysosomes, etc., were recognized. Vacuoles were also found, but their number diversified according to case. In some cases, secretory granules, which were round, amorphous and had high density, were observed. Even though light-and electron-microscopic findings of the primary culture cells from human submandibular glands were a little diversified according to case, they seemed to be similar to ductal cells of the submandibular gland as compared with other kinds of submandibular gland cells. When the cells were affected by MMC 5 μg/ml, BLM 10 μg/ml, they had a little swelling, the lysosome membrane was broken and vacuoles increased, but these changes were not so outstanding. When the cells were affected by 5-FU 150 μg/ml, they showed remarkable swelling and some were lost. Ultrastructurally, in cytoplasma a lot of vacuoles, round colloid-like material were found and most of the organella were lost, but in the nucleus of most cells, alternation was not outstanding even though the nucleotic chromatin was dispersed in only a few cells.
Three cases of iliac reconstruction by A1508 ceramic spacers are reported. A normal contour of the iliac area after harvesting the iliac bone was recovered by using this spacer. Movement of a spacer, resorption of the iliac bone, and necrosis of covering soft tissues were not found during the follow-up period of 9 to 12 months. This method seems to be efficientf or restoring the iliac area contour, however the shape of the spacer should be improved.
Recently, vari0us surgical techniques have been developed fbr treatment of c0ngenital and acqmred malfbrmatiorB of the craniofacial bones. Especially, le Fort type I osteotomy and the mandibular sagittal split technique have had wide application apd have produced go0d results. However, we believe there is great danger when the pterygomaxillary suture is separated during le Fort type I osteotomy. Some surgeons have rep0rted complications arising fbm 1Le Fort type I oste0tomy such as nasal septum perfbration, vital tooth death, severe bleeding etc. Despite these facts, the dynamic behavior of craniofacial bones during separation of maxil lary tuberosity fmm the pterygoid plates is unknown. ln a simuladon experiment of le Fort type I osteotomy using an airdried human skull, we obtained interesting results on the measurement of the principal strain distribution at the time of separation of the pterygomaxillary suture. Four types of osteotomes were used in this simulation: straight osteotome, Obwegeser, s osteotome swan's neck osteotome and modified swan, s neck osteotome. Befbre separation of the umlateral pterygomaxillary suture, the minimum principal strain was registered by use of Obewegeser's osteotome. After separation of the unilateral pterygomaxillary suture, the minimum stmn was measured by use of swan's neck osteotome and straight soteotome (posterior to anterior about 30. to the sagittal plane).
Effects on administration of anti-tumor retinoid (Ro 10-9359, Etretinate) were studied in papilloma and squamous cell carcinoma experimentally induced from mice dorsal skin and hamster cheek pouch. Histochemical study of lectin binding and immunohistochemically detectable study of keratin, and microautoradiographic observation (3H-Etretinate, 3H-Vitamin A alcohol) were carried out. Intercellular bridges in treated tumor epithelia were decreased and intercellular space were more spread. Tumor epithelial cells were separated from each other and they showed vacuolization at the area corresponding to granular and spinous cell layers, however, no PAS positive materials were contained there. Lectin binding and keratin staining were decreased in tumor epithelial cells which are affected by Etretinate. These were slightly positive or negative to lectin and keratin reactions in intercellular space and vacuolated tumor cells. Microautoradiographic observation showed fine silver grains at the intercellular space and around the cell membrane in tumors, however, no deposits were in the cytoplasm of the tumor epithelial cells. It was concluded that vitamin A derivative Etretinate may affect the intercellular spaces and cellular membrane of tumor epithelia, possibly cause changes of the permeabilities, sugar residues of cell membranes and cytoskeletal structures, and finally break down to cytoplasm of tumor cells.
Coated tongue is important in visual diagnosis as a symptom of systemic conditions and disorders. Above all, relations between tongue coating and digestive tract disorders as an attachment factor have been discussed for a long time. However, such relations have not yet been elucidated. The authors have classified the degree of attachment of tongue coating into the four degrees; 1, 2, 3, and 4. Using the classification, the authors surveyed and reviewed the actual situation of tongue coating in patients with digestive tract disorders observed by endoscopy. The rate of tongue coating was 1.69% in healthy patients, and 53.8% in patients with digestive tract disorders. Thus, there was a remarkable difference in the rate of tongue coating between the two groups of patients, although few patients were conscious of tongue coating. By the disordered site of digestive tract, the rate of tongue coating increased in the order of gastric, duodenal and gastroduodenal disorders, while, to the contrary, the degree of tongue attachment decreased in the above order. By disorder, the rate of tongue coating in gastric and duodenal ulcers was higher than in atrophic and erosive gastritises. These results suggest that digestive tract disorders are an important factor in tongue coating.
Nuclear DNA content was detemined in 85 subjects made up of 29 patients with carcinoma of the gingiva, 26 with bordering pathological findings (23 with leukoplakia and 3 with epithelial dysplasia), 20 with non-cancerous epithelial hyperplasia (10 with epithelial hyperplasia and 10 with papilloma) and 10 subjects with normal gingival mucosa, and then compared with the histological findings to clarify relationships to cell maturation and tissue differentiation. Measurement of nuclear DNA content was performed by cytofluorometry for cells of the outer and inner layers of cancer nest in carcinomas and for cells of the basal and prickle layers of the epithelium in the other lesions. The results were as follows: In 56 subjects exclusive of patients with carcinoma, nuclear DNA content was higher in the basal layer than in the prickle layer. Particularly in normal gingivae, histograms showed 4 single peak with mode at 2C for the basal layer and under 2C for the prickle layer. The distribution of DNA content was limited within 4C. In non-cancerous epithelial hyperplasias, nuclear DNA content, particularly that of the basal layer, increased as compared with normal mucosa, and increased in papilloma but not in epithelial hyperplasia. In borderline lesions, nuclear DNA content slightly increased in Grade I and Grade II leukoplakias compared with normal mucosa, while it markedly increased at the basal layer in Grade 111 leukoplakia featuring cellular atypia and at both the basal and prickle layers in epithelial dysplasia, with the pattern of change sometimes resembling that in carcinoma. In carcinomas in situ, no appreciable variation dependent on the site of measurement was observed in the histogram pattern. In squamous cell carcinomas, nuclear DNA content was generally high but sometimes close to that in normal mucosa, and the histogram pattern showed a tendency towards diversification.Analysis of relationship between the degree of differentiationo and the nuclear DNA content in squamous cell carcinoma disclosed that nuclear DNA was higher in the outer layer of cancer nest than in its inner layer in just over 82% of well-differentiated or moderately-differentiated carcinomas. As carcinoma became less and less differentiated, the modal peak in histograms, particularly those for the outer layer of cancer nest, shifted further to the right and a more flattened pattern resulted while hyperploidy cells occurred with increased frequency, particularly in moderately-differentiated carcinomas.
The present study was performed for elucidation of the biologicalproperties of the transplantable tumor in nude mice and objective evaluation of X-irradiation effects through its cell kinetics. The experimental results are as follows: 1. An undifferentiated carcinoma arising in the palatal gland of a 69-year-old woman was inoculated into BALB/c-nu/nu nude mice, and the transplantable tumor, TS-1, has been established. 2. The histology of TS-1 tumor was almost identical to that of the original tumor through the serial passages. 3. The following cell kinetic parameters of TS-1 tumor were obtained: doubling time (TD): 33 days, time of cell cycle (Tc): 52.4 hours, DNA synthetic time (Ts): 12.8 hours, growth fraction (GF): 63.0%, and cell loss factor (CL): 89.4% 4. The growth rate of TS-1 tumor was approximately the same as that of the metastatic foci of the original tumor in the patient's lung, indicating the maintenance of original properties of the transplantable tumor. 5. The cell death caused by single dose irradiation with 1, 000rad was suggested mainly to be a “reproductive death”, whereas the death by single dose irradiation with 3, 000, 5, 000 rad, and 5 fractionated dose irradiation with 1, 000 rad was considered largely to be an “interphase death”. 6. The possibility of proliferating tumor cells to reutilize 3H-TdR liberated from the dead cells after single dose irradiation with 3, 000, 5, 000 rad and 5 fractionated dose with 1, 000 rad was speculated. 7. The GF value of the 3rd day of irradiation became lower in correlation with an increase of the irradiation doses. Single dose irradiation with 1, 000 rad prolonged Ts and Tc, while that with 3, 000 rad slightly prolonged Ts but shortened Tc. Single dose irradiation with 5, 000 rad and 5 fractionated dose irradiation with 1, 000 rad apparently shortened both the Ts and Tc values. 8. Comparing the single dose irradiation with 5, 000 rad and the 5 fractionated dose irradiation with 1, 000 rad, a dominating aspect of the fractionated method was indicated as judged by its increased effective inhibition of tumor proliferation and decreased cutaneous damage.
Metastasis of primary tongue cancer to the cervical lymph nodes was investigatedin 40 patients who had been diagnosed and treated between 1974 and 1983 in the Departmet of Oral Surgery, Kanagawa Dental College. The three-and five-year survival rates were both 553, and late metastasis was related to poor prognosis. It is considered that cervical lymph node metastasis of tongue cancer is closely related to the size of primary tumor, histological malignancy and nuclear DNA content in cancer cells and also that recurrence in the neck after radical neck dissection and its prognosis are related to the area number of lymph node metastasis and reaction patterns of the lymph nodes.
There are relatively few reports of phlebolithiasis with hemangioma in the oral region. Recently we had a case of a female patient aged 11, woth a multiple stone cavernous hemangioma in the right cheek and she showed satisfactory progress after surgical extraction. Moreover, we analyzed the omposition of the stones by using observation from the infrared spectrum, an X-ray microanalyzer and amino-acid analysis. As a result, the main components of the stone were found to be Ca and P, and from the diffraction pattern, appeared to be hydroxyapatite. The results of the amino-add analysis showed a high quantity of glycine and this indicated the presence of collagen. Through extensive reading, we can report that since 1960, 43 cases (21 male, 22 female) of this diseases rufaced in Japan. The 60.5% of the patients were 10 to 20 years old. The lesion in 25 cases (58. 1%) appeared in the cheek, and in 6 cases (14.0%), in the tongue and submandible. In 11 cases (26. 2%), the number of stones ranged 1 to 5 pieces, and the maximum number in any one case was 39 stones. From the hystopathological viewpoint, in 29 cases which were adequately described, there was 21 case preponderance (72.4%) showing cavernous hemangioma.
Case reports of giant cell epulis are rare in Japan. A case of this lesion is reported with clinical studies of epulis in our department. A 74 year old woman was admitted to our department because of a lesion in the right maxilla. The tumor was resected with alveolar bone under a clinical diagnosis of epulis. Microscopic findings: The surface of the tumor wa. covered with mucoustnembrane and connective tissue which separated the epithelium from the giant cell lesion. The central area of the tumor was occupied by short spindle cells and giant cells were seen regularly. From 1972 to 1981, 61 cases of epulis were examined histolgoically in our department. Granulomatous epulis appeard most frequently (39%) and there was 1 case (1.6%) of giant cell epulis.
A case of Frey's syndrome, where submandibular sweating during eating occurred after radical neck dissection, was reported. On the mechanism of the phenomenon in this case. it was considered that submandibular gland secretory nerve fibers were misdirected to the sweat glands of the covering skin in the course of healing after surgery.
The authors report on the method for the management of keratocysts which was first described by Voorsmitt in 1981. The method is as follows: the cyst was enucleated and the overlying oral mucosa was totally excised. The bone surface under the cyst wall was cauterized with Carnoy's solution. Three cases of keratocyst were treated by this method and no recurrence was seen during a maximum 16-month follow-up period. Case 1 was a 57-yearold female, with a multilocular cyst located in the right mandibular body. Case 2 was a 38-year-old female, with a monolocular cyst located in the left mental region. Case 3 was a 52-year-old male, with a monolocular cyst extending from the left mandibular molar region to the ascending ramus. This method seems to be beneficial for the management of keratocyst which is multilocular or located in a difficult region such as the ascending ramus. An experimental histological study on the cauterizing effect of Carnoy's solution was done on Japanese white rabbits and demonstrated that the cauterizing effect of Carnoy's solution was adequate when the application was for 3 minutes.
This report includes two cases of the nasolabila cyst at our hospital. Case 1: A 55-year-old Japanese female visited our hospital on Nov. 14, 1980. She complained of slight swelling of the right side ala of her nose for past 4 months. The area began to swell progressively with oppressive pain. Extirpation of the cyst was carried out with general anesthesia on Jan. 28, 1981. The comparatively thick cyst wall had a soft and elastic consistency. Its fluid was mucous. Microscopic examination revealed cystic lining with stratified columnar ciliated epithelium which included some goblet cells. The wall of the cyst was heavily infiltrate by plasma cells and lymphocytes. Case 2: A 44-year-old Japanese female was seen on Nov. 25, 1982. She complained of pain and swelling of the gingiva of the right first and second incisors. Apical focuses were found by X-ray, however we recognized swelling of the right side ala of her nose. Besides two apical granulomas, we removed a cyst from the right side of the apertura piriformis on the periosteum. Its fluid was mucous. Microscopic examination revealed stratified columnar epithelium with many goblet cells. The wall of the cyst was mildly infiltrated with chronic inflammatory cells. In addition to these two cases, we analyzed 74 cases in 28 years of Japanese literature (1955-1982).
A 56 year-old male patient with adenoid cystic carcinoma of the right sublingualgland origin was reported. In this case, extensive local resection of the tumor including the dissection of the parapharyngeal space along the lingual and hypoglossal nerves was carried out in combination with radical neck dissection. Surgical treatment was followed by 60 Gy of radiotherapy. He was free of disease during the follow-up period of 9 months. Adenoid cystic carcinoma arising in the sublingual gland accounted for 35 cases reported in the literature for the period of 1930-1984.
The patients at the Department of Dentistry and Oral and Maxillofacial Surgery, Kinki University Medical School Hospital during the five years (1979-1983) were analyzed statistically. 1. The total number of out-patients first seen at our clinic were 5, 159 including 2, 354 males and 2, 803 females. Patients aged 21-30 were most frequent. 2. In the classification by diagnosis of oral surgery, “Inflammatory diseases” occupied 43.6%, “Malformations and developmental abnormalities” 17.8%, “Injuries” 12.8%, “Disorders of the temporomandibular joint” 8.6%, “Cysts” 7.2%, “Tumors” 5.2%, “Neurological disorders” 3.0%, “Diseases of salivary glands except tumors” 1.9%. 3. The total number of inpatients were 208 including 134 males and 74 females. Patients aged 11-20 were most frequent. 4. In the classification by diagnosis of inpatients, “Injuries” occupied 25. 5%, “Tumors” 23.6%, “Cysts” 19. 2%, “Inflammatory diseases” 19. 2%, “Malformations” 5.8%. 5. The number of operations were 178 which involved 52 Injuries, 41 Tumors, 39 Cysts and 21 Inflammatory diseases.
1) A 31-year-old woman with adenomatoid odontogenic tumor of the frontal teeth in the maxilla was examined histochemically and electron microscopically with reference to the literature. 2) Histologically, a large cystic cavity was formed, and in a portion of the stratified squamous epithelium lining the inner surface of the cavity, a tumor mass showing typical tissue structure of adenomatoid odontogenic tumor was found. 3) Histochemically, acidophilic materials with calcification within the tumor nest showed positive amyloid staining (Congo red staining, green birefringence), and the area of cord like proliferation was alkaline-phosphatase positive. 4) Electron microscopically, solid cell layers consisted of polygonal cells similar to the inner enamel epithelium, and aggregates of fine granular fibers similar to amyloid were observed between these cells. Moreover, the stratified epithelium in the inner surface of the cyst consisted of squamous epithelium, resembling dentigerous cysts.
Ninety two patients with malignant tumors of maxillary sinus were treated at theDepartment of Oral Medicine, Otorhinolayrngology and Radiology, Ichikawa Hospital, Tokyo Dental College during 12 years from 1969 to 1981. These cases were retrospectively analysed and the following results were obtained: There were 61 males and 31 females (2: 1) and the majority were in the 6 th decade of life. Pathological classification is as follows: 64 cases (69. 6%) of squamous cell carcinoma, 6 cases (6.5%) of malignant lymphoma, 2 cases (2.2%) of undifferentiated cell carcinoma and 1 case (1.1%) of adenocarcinoma, fibrosarcoma, osteosarcoma, leoimyosarcoma, Wegener's granulomatosis and malignant ameloblastoma respectively. Squamous cell carcinomas were by far the most common malignant tumors in the maxillary sinus. There were 67 carcinomas and 9 sarcomas (7.4: 1). According to T classification proposed by JJC (1977) and NM classification by UICC (1978), 67 carcinomas were classified as 1 case (1.5%) of T1, 8 cases (11.8%) of T2 43 cases (64.2%) of T3, and 15 cases (22.5%) of T4 and they were additionally classified as 8 cases (11.9%) of Stage J, 16 cases (23.9%) of Stage if, 24 cases (35.8%) of Stage I and 19 cases (28.4%) of Stage IV. Cervical lymphnodal metastasis was found in 34 cases (50.8%) and there were 5 cases (7.5%) of distant metastasis. Almost all of carcinomas were treated by combined therapy consisting surgery, irradiation and chemotherapy. In the cases treated by combined therapy, the correlation between survival rates and Stages showed that survival rates of 3 and 5 years were both 83.3% in Stage I, 51.4% and 34.3% in Stage II respectively, 32.1% and 24.9% in Stage I respectively, and both 0% in Stage iv. The more Stage advanced, the more survival rates fell. On the other hand, 3 and 5 year survival rates of the advanced cases (Stage 111 and iv) treated by combined therapy and intraarterial infusion of anticancer drugs were both 60.0%. The author recommends combined therapy consisting of surgery, irradiation, chemotherapy and intraarterial infusion of anticancer drugs for the maxillary sinus carcinoma, especially for progressive cases.
A Leclerc operation by the temporal approach was made in a case of recurrent luxation of the temporomandibular joint. This technique can be performed under direct vision, is simple to increase only the height of the articular eminence, and can give good results without trouble. Our case was a 18-year-old male who would be a Buddhist priest, so we accomplished with modified temporal flap incision. Postoperative course is uneventful.
This paper reports the results of LeClerc's operation for prevention of recurrent dislocation of the temporomandibular joint in seven patients. There have been no recurrences of dislocation since the operation. Functional disturbances were not postoperatively observed. In comparison with other surgical procedures, LeClerc's operation seems to be able to get the best results for prevention of recurrent dislocation of the joint.
Clinico-statistical observation and follow-up survery on TMJ arthrosis in children below 15 years old were studied. The subjects were 22 patients who visited our hospital in the past 9 years and 8 months. Sixteen patients from 11 months to 7 years were followed up by recall or enquke after treatment. The results are summarized below: 1) Initial symptom of TMJ sound only was most frequent (59.1%), and none of the children showed limitation of opening mouth as the initial symptom. 2) As to present status, 9 patients (40.9%) showed isolated single symptoms (3 pain only, 4 limitation only and 2 TMJ sound only). 3) Seventeen patients (77.3%) had malocclusion containing 4 crowding of anterior teeth, 3 deep bite, 3 mandibular protrusion, 3 malposition of molar teeth, 3 posterior cross bite, and 1 maxillary protrusion. Only 5 cases had normal occlusion. 4) Radiographically, 10 ptients (62.5%) showed condylar displacement in the only affected sides (6 anterior positions, 2 posterior positions, 1 superior position, and 1 inferior position). In 4 cases (25.0%), the condylar head located almost in the center of mandibular fossae at both sides. 5) In follow-up status, 4 patients (25.0%) had no TMJ dysfunction symptoms. Most remaining patients had suffered from TMJ sound in spite of no limitation of opening mouth. 6) In 4 patients above described, 2 patients had been treated their malocclusion by orthodontists, and remaining 2 patients had been cured in our clinic by medication only or observation only.
The subject was an eighteen-year-old man with benign osteoblastoma of the mandible, and it was extremely rare tumor originating in the jaws. He had no painful swelling of the left side mandible. Findings on physical examination limited to the mandible. Examination revealed that the lesion was a walnut size, firm rigid, and raised one. X-ray examination revelaed a radiolucent lesion with a radiopaque area of the anterior part, and the lesion extended from the second premolar to the second molar. Under general anesthesia, tumor extirpation was carried out. Histological features indicated a growth of woven and/or osteoid bone tissues, abundant osteoblasts with extensive myxoid degeneration, and histological diagnosis of benign osteoblastoma. In this case, X-ray and histological findings were atypical compared with previously reported cases because of presence of comprehensive myxoid degeneration.