Biologic responses implant materials; almina ceramic, hydroxyapatite, carbon ceramic and titanium, inserted in the mandible from 8 dogs and in the femur from 36 rabbits were examined with the use of routine histology, scanning electric microscope (SEM), X-ray microanalyzer (EMX) and micro X-ray diffraction. The materials from the 1, 2, 4, 8 and 20 weeks in the rabbits femur and from the 1 and 4 weeks in dogs mandible were tested to evaluate bone reactions which contacted the implant materials in the femur as well as tissue reaction in attached gingival epithelium of the mandible. Histologically, new bone formation, which was in contact with both the implant materials almina ceramic and hydroxyapatite, was more prominent in comparison to titanium and carbon ceramic. Gingival tissues attached to the ceramics materials showed no foreign-body reaction without epithelial proliferation. Gingival reaction to inserted titanium reveals epithelial downgrowth with slight pocket formation. Implanted carbon ceramic materials into bone tissue show absorption from their surface and their adjacent bone structure showed no foreign-body reaction. Histological reactions to the ceramics into bone structures usually showed no marked inflammatory reaction and no reactive proliferation of connective tissue fibers. Concentrations of Ca and P-ions in the bone tissue which attached to the materials were higher than that in the normal bone with the X-ray microanalysis technique. From the present study, almina ceramic and hydroxyapatite, as implanted materials, showed an excellent histologic reaction to bone and soft tissues.
The essential metal metabolism of the neoplastic disease has been investigated on its serum level and isoenzyme. There are few reports on the essential elements analysis of the neoplastic tissue, muscle and lymphonodes. The VX2 carcinoma, transplanted into the maxillary sinus of the domestic rabbits, was prepared for the research of the findings of the microscope, scanning electron microscope and X-ray microanalyzer (XMA). The movement of phosphate and karium had little change and showed the reverse peak between the controled muscle and the tumor. The local lymphonode of the rabbit, bearing the tumor at the maxillary sinus, indicated almost the same pattern in each lymphonode on the XMA findings. The karium in the lymphonode showed the highest peak at the inner layer of the vessel.
Effects of the occlusal alteration on the rat masseter muscle have been studied ultrastructurally, furthermore Mg2+-ATPase activities were observed cytochemically to suppose cellular metabolism. Unilateral upper molars of 7-week-old rats were extracted to make the occlusal alteration. At intervals of 3 and 5 days, 1, 3, 6, 12 and 16 weeks, following surgical procedure, the masseter muscle on the extraction side was sampled. Morphological changes and localization of Mg2+-ATPase activities were examined by means of an electron microscope. At 3 days to 1 week after occlusal alteration, it was observed that architectural changes of myofibrils included partially abnormal running of myofibrils and fragmentation of the Z-band. Sarcoplasmic reticulum and the T-system underwent a swelling-like transformation, 3 weeks after experimental procedure. Moreover, some of the myofibrils became narrow with the reduction of myofilamerits. These changes became conspicuous after 16 weeks. The ATPase activities in normal masseter muscle was localized in the sarcolerruna, caveolae, terminal cisternac of the sarcoplasmic reticulum and matrix of mitochondoria. At 16 weeks after extraction, the ATPase activities decreased as compared with the control muscle. These findings suggest that occlusal alteration may lead to abnormal conditions of muscular tissue of masseter resembled disuse atrophy or denervation atrophy.
Serum sialic acid in patients with acute oral bacterial infections and healthy parsons was measured by enzymatic method. Significant raised levels of serum sialic acid were found in patients with acute infections as compared with healthy persons. Serum levels of sialic acid corresponded with the clinical condition of infections diseases and recovered normally with clinical improvement. Serum concentrations of sialic acid were well correlated with those of C-reactive protein and numbers of white blood cells. In addition, serum sialic acid significantly increased postoperatively. As human serum does not contain free sialic acid and sialic acid almost binds to glycoprotein such as C-reactive protein, acid glycoprotein, and so on, these results suggest that raised levels of serum sialic acid may be caused by the increase of acute phase proteins. Therefore, measurement of serum sialic acid is thought to be useful as a marker which reflects the clinical condition of infections diseases rather than infections themselves.
Preservation of medical images by converting them to digitize, which is among the recent advances in medical electronics equipment, is useful in preventing deterioration of the images and in storing, retrieving and transmitting the images. In addition, alteration of the expression of the digitalized images, e. g., by coloration, canbles more accurate recognition of a part which is difficult to distinguish in former images. At present, monochrome images obtained by Roentogcnography etc., are extensively used in the medical field, as an aid for diagnosis and research. In the present study, images of dental X-ray films and microradiograms were read optically, converted to digital signals, and subjected to coloration, in order to evaluate the usefulness of digitization of medical images. The above procedure resulted in more objective confirmation of parts which are difficult to distinguish macroscopically, demonstrating that it is useful in clinical practice and research in combination with the use of current monochrome images. This method is characterized by the facts that high precision of the image is maintained because of the use of linear scan with a drum scanner, and that information from a monochrome image is digitized and stored preliminarily. These features allow repetition of reproductive display, coloration, change in shade, and pattern classification of the image, with the same information and in a short period of time.
This study is based on an analysis of biopsy specimens that were diagnosed histopathologically in Department of Oral Pathology, Tokushima University School of Dentistry from 1979 to 1983. 1. The total number of the specimens during this five years were 1, 624 and it corresponded to 1, 248 cases (patients). 2. About 66.4% of all the specimens in this series were represented by the 20 different types of common lesions. About 17.5% of the 1, 624 specimens were squamous cell carcinoma, 10.0% were radicular cysts and 6.3% were mucous cysts. 3. The most common cases of the 1, 248 patiens were radicular cysts which showed about 12.4% of all the cases, followed by 7.5% of mucous cysts and 6.8% of squamous cell carcinoma. 4. Therefore, a number of the specimens per each case were many in the malignant tumors. 5. The cystic lesions revealed the largest group in this series, and composed 467 cases (37.5%) of all 1, 248 cases. The tumorous lesions followed with 198 cases (15.9%) of all the cases.
A total of 1, 262 patients of temporomandibular arthrosis who visited the Department of Dental and Oral Surgery at Nagoya University Hospital over a period of 13 years from January 1971 until December 1983 were clinically and statistically observed. The following results were obtained. 1. The number of patients suffering from this disease tends to increase every year, and the percentage of these patiens, out of all new patients, was 1.7% in 1971 and has stayed above 6% since 1978, reaching 7.3% in 1983. 2. By sex, the ratio of male to female patients was 1: 2.66, and the predominance of female patients was significant. 3. By age group, 33.9% of the patients were in the twenties, 18.4% in the teens, 18.3% in the thirties, followed by those in the forties, fifties, over sixties, and under 10. Then distributon was a single-peak curve. 4. The illness manifested on one side in 89.0% and on both sides in 11.0%. In the onesided cases, the left side was more affected than the right side, but there was no significant difference. 5. As the symptom at the initial onset of disease, temporomandibular joint pain was experienced in 39.0% of the cases and temporomandibular joint noise in 30.8%, the sum of which amounts to nearly 70%, and 89.2% of the initial symptoms were single symptoms. 6. As the chief complaint, 70.3% were related to pain, followed by difficulty in opening the mouth, and noise. 7. By cause, 64.9% of the cases were caused by an intrinsic trauma, 22.2% by a spontaneous episode, and 12.0% by an exoteric trauma. 8. The number of visits to our department and the remedies were as follows. Those visiting five times or less were 56.4%, and the average number of visits per patient was 7.2. The remedies were classified into medical treatment, physical treatment, dental treatment, joint cavity injection and muscular training, or others. Two mehod were applied in 36.2% and three methods in 31.3% of the cases. Above all, the medical treatment was applied to 84.3% of all patiens, and the dental treatment to 53.7%.
Clinico-statistical observation on TMJ arthrosis in young people under 20 years old was studied. The subjects were 238 patients who visited Department of Oral Surgery, School of Medicine, Nagoya University Hospital during the 13 years (1971-1984). 1. The proportion of young people to hole TMJ arthrosis patients by each year had been increased gradually. 2. On sexual difference, female is 2.4 times more than male. On damaged side, the left side is a little more than the right side. 3. On incidental classification, internal injury is the most usual case (76.1%), the second is external injury (13.0%), and the third is ideopathic (10.9%). In primary clinical symptoms, the sound of TMJ is the most usual one. As mentioned above, we considered that in young cases of TMJ arthrosis, the sound of TMJ has been generated by dislocation of the disc because of disharmony of TMJ components by internal injury.
Adenoid cystic carcinoma (ACC) is an uncommon tumor in the region of head and neck, and its clinical feature is characterized by sluggish growth and frequent recurrences due to its invasive evolution and extension along the perineural lymphatics. A case of ACC, a 73-year-old woman, is presented here. In 1964, she had undergone the excision of a tumor from her left cheek, and for the past 20 years she was free of the tumor until she came to our department complaining of a asymptomatic, round-tumor about 5 cm in diameter, in a similar location. As a biopsy specimen showed ACC, the excision of the tumor and post-operative irradiation of 30 Gy was carried out. Pathological, and various clinical examinations, indicated that the tumor which had arisen in a minor salivary gland of her left cheek, and had been excised, recurred 20 years later.
The purpose of this study is to clarify the usefullness of the CO2 laser in the treatment of hemangioma in oral and maxillofacial regions. The CO2 laser surgery was performed on ten patients at the Oral Surgery Department of the Hokkaido University Dental Hospital between 1981 and 1985: seven with labial hemangioma, and one case each of lingual, buccal and mandibular hemangioma. The results are as follows: The CO2 laser surgery appeared to be extremely effective in the treatment of hemangioma because of its hemostatic ability, thus the increased visualization of the operative field reduced the excision of surrounding tissues of the lesion to a minimum degree, which resulted in less post-operative deformity and dysfunction.
Four patients suffering tongue cancers were discussed, concerning their clinical course after irradiation, using radium needling. Local control for primaly tumors remained during the time from 8 months to 9 years. Recurrent tumors appeared in the opposite side of the tongue at the 4 th year and in a buccal mucosa through mandibular ramus at 8 th months, which were in distant portions from the primary tumors. Therapeutic neck dissection for the cervical lymph metastases was carried out on two patients without prophylactic ones. It was very difficult to differentiate the recurrent tumor from the radiation necrosis or the ulcer, because of the symptoms associated with induration and pain. Resection and reconstruction for 2 recurrent tumors and 2 radiation ulcers had successful results. However, the repeated biopsies for radiation necrosis which may develop into ulceration, should not be taken.
3 cases of double-headed condyle of the mandible in patients with TMJ arthrosis are reported. These double-headed condyles were found mainly in the radiographs taken from transorbito-condylar projection. In one case, complete duplication of the condylar head was seen, but in the other cases, the duplication was incomplete and only a notch was seen. We considered that these double-headed condyles were caused by some congenital reason. In our patients, the symptoms of TMJ arthrosis did not always appear at the same side of doubleheaded condyle. Therefore, it was suggested that double-headed condyle had no direct influence on the clinical feature of TMJ arthrosis.
Ameloblastoma is the most common tumor among odontogenic tumors. Statistical reports show that this tumor is frequently seen in the mandible, but is relatively rare in the maxilla. This report deals with the detailed description of a case of the ameloblastoma in the maxilla. The patient, an 82-year-old male, was referred to our clinic with complaining of swelling of the palate. Excision was done under general anesthesia. The tumor was a grayish mass, and its size was about 42×31×20 mm. Histopathological diagnosis was ameloblastoma of the maxilla. There was no sign of recurrence at about 2.5 years after the operation.
Malignant fibrous histiocytoma (MFH) is defined as a neoplasm that is composed of histiocytic and fibroblastic cells. This tumor is the most common soft tissue sarcoma of late adult life with poor prognosis. The majority of tumors occur on extremities, abdomen and the retroperitoneum but uncommonly in the maxillofacial region. A case of MFH arising in the right maxilla was described. The patient, a 60-year-old female, who had swelling of the 76| alveolar part, was referred to our department by a dentist. In the first operation, A multinodular, white and grayish, tumor developing in the right maxillary sinus was noted. Up to date of writing the local recurrence was repeated, so total maxillectomie and orbital exenteration were performed. Radiotherrapy and chemotherapy as adjunctive treatment were added, the former showed good effect but the latter was ineffective. Histological findings showed histiocytic and fibroblastic cells with more pronounced nuclear atypia with a little part of storiform area. The pleomorphic giant cell and mitosis were also seen. Histochemically, the cells were positive for both acid phosphatase and naphtol AS-D acetate esterase. Histological classification of this case was the pleomorphic subtype according to Enjoji et al. The metastatic lesion at the left lung was recongnized but it was controled by radiotherapy. Primary lesion showed no sign of recurrence and this patient is being seen in the outpatient clinic wearing maxillofacial prosthetics. Although MFH of the maxillofacial region is being reported with increasing frequence, the diagnosis and treatment of this tumor must be done carefully.
A case of malignant fibrous histiocytoma was encountered which developed a tumor (5.0×4.5×4.0 cm) extending from the right maxillary region to the maxillary sinus region of a 60-year-old woman. By electron-microscopic observation, this tumor was composed of fibrouslike cells, histiocyte-like cells and multi-nuclear giant cells in varying propotions according to the excised regions, some parts of which were bleeding. In this tumor, xanthoma-like cells, which have been observed by many research workers, were not evident, as far as we could see. But it is noteworthy that unknown multi nuclear giant cells with many granules and vacuoles were recognized.
This paper describes a case of bilateral Warthin's tumors of the parotid glands associated with amelanotic malignant melanoma of the maxillary gums in a 66-year-old man. The patient twice underwent neck dissection for his malignant melanoma. Although these Warthin's tumors were clinically asymptomatic, histological examination revealed them in the parotid regions of the dissected tissue. Clinical features and incidentally detected cases of Warthin's tumor are discussed.
Plasmacytoma, which is also called “myeloma”, is a tumor composed of plasmacytelike cells, displaying varied phases of differentiation. It is rare that it solitarily occurs in the maxilla. Below is outlined our case of plasmacytoma. The patient was a female, aged 52. In January 1983, she visited our Department complaining of a small chicken egg-sized swelling extending from the left buccal region to left upper molrs site. The present illness and the X-ray film made us suspect the ameloblastoma. From the results of twice attempted biopsies, the authors obtained findings of an amyloid tumor displaying infiltration by lymphocytes and plasmacytes. The amyloid tumor generally develops as a partial symptom of systemic amyloidosis. But the general physical examination performed by the Internal Medicine of our University, in accordance with our request, resulted in strong suspicions of a solitary plasmacytoma. In June 1983, under general anesthesia, the tumor was extirpated. It was composed of plasmacyte cells, and exmination for immunoglobulin, by the PAP method, detected monoclonal production of a IgG, λ chain, and the diagnosis of plasmacytoma was established. A large amount of amyloid, which wrapped the external side of the plasmacytoma, was produced by the tumor itself. The sedimentation of this substance, in a large amount, made bioptic diagnosis difficult. Two months after the tumor relapsed, irradiation in total dose of 5, 600 rad, and re-extirpation of the assumedly remaining tumorous tissue were performed. The postoperative course was satisfactory up to date, after an operation 2 years and 5 months previously. The present case is characterized by the facts that the formation of a large amount of amyloid around the plasmacytoma made the diagnosis difficult, and that it was rarely visible solitarytype plasmacytoma which developed in the maxilla with IgG.λ chain being monoclonally observed in the cytoplasm by immunohistochemical methods.
Supernumerary teeth are seen frequently, but the multiple, and generalized ones, are relatively rare. A 13-year-old male consulted us because he had no eruption of permanent teeth except for lower incisor teeth and an upper first molar. At the age of nine, his systemic disease of cleidocranial dysplasia was diagnosed by his school doctor. Radiographically by us, a surprisingly excessive number of teeth were impacted in the both jaws: 28 permanent teeth and 18 supernumerary teeth. The latter were seen in the regions of the front teeth and the premolar, and each tooth was paired to permanent ones and resembled them in shape and size. It is our opinion that these supernumerary teeth might be developed from the third dental laminas.
Schwannoma (neurilemmoma, neurinoma) is a benign tumor originating from the Schwann cell of neurilenuna, which had been reported to occur rarely in the oral cavity. Recently, we experienced one large Schwannoma which occurred in the right palatal region of a 12-year-old boy. The tumor was extirpated completely, together with portions of the alveolar and palatal bones. The oral defect, resulting from the extirpation, was reconstructed with a palatal prothesis. The prognosis has been quite good.
A case of granuloma, suspected as parasitic disease, which appeared in the submandibular region, is presented. A 59-year-old woman came to our clinic with a chief complaint of swelling of the left part in the submandibular region. Resection of the phyma was performed under general anesthesia. The 40×35×20 mm phyma was oval in shape, yellowish white, hard and elastic and was greywhite in the divided surface. The histopathological features of the resected specimen showed eosino cell infiltration with innumerable crystals (Charcotp-Leyden crystal) in the necrotic focus. The disease was diagnosed as parasitic granuloma, of which it was especially thought to be of gnathostoma.
In sagittal split osteotomy of the mandibular ramus using ceramic screw fixation, contact with or insertion of screws into the mandibular canal is regarded to cause for functional disturbance of the inferior alveolar nerve. In order to reduce the incidence of this disadvantage, the authors have devised a three dimensional supposition method to locate the mandibular canal after movement of the distal fragment. The authors remodeled a upper member of the articulator into a supposition instrument. This instrument consisted of a mounting frame for a upper dental plaster cast and a metal bar that the condyle region of the mandibular ramus model was fixed to. After mounting the upper dental cast to this instrument, the lower dental cast was fitted, and immobilized, to it. The mandibular ramus model composed of two plates, the outer one was made of clear plastic plate was fixed to the metal bar of the supposition instrument and the inner one was bonded to the lower dental cast. After the two ramus plates were separated, the lower dental cast was moved to the planned position and the safety zone for screw fixation was indicated by the mandibular canal drawn across the inner plate. This supposition method has been used in 26 cases of ceramic screw fixation in sagittal split osteotomy. The success rate of avoiding contact with the mandibular canal was 82.7%(43 of 52 rami). This method achieved a more favorable result than cases in which this method was not used (61.2%).
Various methods are available for autogenous iliac graft. We have already reported the method by which particulate cancellous bone and marrow are collected with a curette through a window prepared in the compact bone of the anterior iliac crest and transplanted. This method has the advantage of less surgical invasion to bone donor sites, transplantation of more active osteoblasts of the endosteum, and undifferentiated mesenchymal cells of the bone marrow over the conventional bone chip graft. Using this method, however, operation for the primary disease at the recipient side must be conducted under general anesthesia even when it can be done under local anesthesia, because the compact bone of the anterior iliac crest is windowed with a chisel. For this reason, we have devised a new method by which PCBM is collected, with an iliac drill newly developed, instead of the chisel in order to further reduce the surgical invasion during PCBM collection. This method can be conducted under local anesthesia, because the size of incision is small and its influence on patients is extremely limited. The range of its application is wide, and satisfactory results have been obtained. This paper is a report on the surgical technique of this method and the iliac drill and curette newly developed.
We came across a case of adenoid cystic carcinoma in the left palate. The patient, a 47 year-old woman, was treated by surgical resection. The tumor invaded insidiously to deep structures (mucous of right nasal cavity floor and highest part of nasal septum). The frozen section was very useful and important for complete resection of this tumor. We re newed understanding of insidious growth of adenoid cystic carcinoma, and the difficulty of complete resection of this tumor. Postoperatively, the patient was given tegaful (750mg/day) to the present and, after 11 months, was free from local recurrence and distant metastasis.
We presented the modified Skoog's method, in which two vertical flaps from the prolabium, based superiorly on both sides of the columella, are transposed into an incision region. And we analized the standard photographs of these patients. We came to conclusion that this method gives better results than other methods.
A twenty two year-old male with osteogenic sarcoma of the left temporomandibular joint, was received high dose methotrexate (MTX) therapy (200mg/kg-315mg/kg) after the recurrence of tumor. To clarify the safety administration technique for high dose MTX therapy, serum and urine concentration of MTX were measured by means of enzyme assay method. The results obtained were as follows: 1) The peak serum concentration of MTX reached more than 1.0×10-4 M and two phases of serum disappearance were seen after the infusion. 2) The serum concentration at 24, 48, 72 hours after the infusion were within the safety range, respectively. 3) For several hours after the infusion, the urine concentration of MTX showed high level. On the contrary, the urine pH showed low level with concomitant decrease of its volume. 4) The urine excretion of MTX almost finished within 18 hours after the infusion. 5) The clinical side effect was limited to nausea and vomitting. From these results, it was suggested that the monitoring of the serum concentration, urine pH and urine volume was important for the safety administration of high doses MTX therapy.
Methotrexate (MTX) concentrations in serum and urine of a patient with osteogenic sarcoma were determined after four infusions of high-dose MTX, (200, 250, 300, 315 mg/kg) with a citrovorum factor rescue. The peak serum MTX levels were attained during the 6-hour-period of infusion. After the infusion, serum levels showed the biphasic decline with the flection at 24-46 hours; their half-lives were 1.48-2.79 hours and 9.13-18.61 hours, respectively. Cumulative amounts of MTX excreted in urine during 82 hours were 50-60% of each dose. For each dose from 200 to 315mg/kg, the plots of urinary excretion rate were similar to the biphasic curve of the serum level. A good correlation was seen between the urinary excretion rate and the serum level, and its coefficient was 0.976 (n=38, P<0.005). These results suggest that the data of the urinary excretion rate of MTX may be useful for prediction of the serum MTX level.