It has been said that chronicity of odontogenic maxillary sinusitis induces changes in the maxillary sinus mucosa due to causative organism and develops attributively to retention caused by decreased excretion of inflammatory products. It has been considered that not only the pathogenicity of the microorganism but also disturbed ciliary function of the sinus mucosa are largely responsible for the above fact.
The authors investigated micro-structures in the surface of the sinus mucosa by centering on the morphological changes of the ciliated structure in the samples obtained by a radical operation for odontogenic maxillary sinusitis, and obtained some findings.
Observation methods: The samples for observation were first washed enough with a phsiological saline solution as soon as possible after collection and divided into two, scanning electron microscopic samples and light microcopic ones. The formers were fixed in 2.5% glutaraldehyde for 6 hours followed by fixation with O₈O₄ for further 3 hours, while the latters were fixed in a 10% neutral formalin solution. Subsequently, for the scanning electron microscope using evaporated with platinum according to the usual method. On the other hand, the light microscopic samples were embedded in paraffin, prepared to thin section, stained with H-E and examined light microscopically.
Results of observation: A pathological change, such as so called infiltrative type, fibrous type or mixed type, were noted in the mucosa of the chronic maxillary sinusitis. Even though the surface appears to be macroscopically smooth, the microstructural surface had lot of unevenness, and lesions differed depending on areas of the same region. Of the areas, those with relatively slight lesion exhibited images similar to the normal structural surface of sinus mucosa, and the ciliated cells were clearly seen. Non-ciliated cells were noted dispersedly among the ciliated cells. However, in the areas severe lesion inflammatory by-products appeared frequently; the ciliated cells decreased in number; short cilia, disturbance of directinity and erectness of cilia, and some mutual ciliary fusion was noted. In addition to increase of non-ciliated cells and atypical cells were seen.
An interpretation was that such morpathological abnormalities in ciliated structure suggest a disturbed ciliary function for the chronic maxillary sinusitis.

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We have already reported that the effectiveness of radiosensitization and nitro-group radiosensitizer misonidazole (MISO) and dinitroimidazole-ethanol (DNIE).
These radiosensitizers have some side effects on human and mice.
5-methoxy carbonyl-2-methyl sulfinyl-1-methyl imidazole (KIH-3) is a non nitro-group radiosensitizers of hypoxic tumor cells.
Then, the purpose of our studies to compare the sensitizers emhancement of MISO, DNIE and KIH-3.
On in vitro, KIH-3 had effected 5 times of MISO in V 79 cell culture, so we have examined to give 100/mouse but all mice died (nude 5, ddY 5, cony. 5).
The safe maximum dosage of KIH-3 was 40mg/mouse.
Methods and evaluation: Battelle Columbus Laboratories Protocol.
Radiation: ⁶⁰Co 15 Gy local radiation. These radiosensitizers were administrated into the mice's abdomen prior to 30 minutes of local irradiation.
Tumor: Ehrlich solid carcinoma. On the first day of the experiment, 2-3 pieces of a 1-3 mm tumor block in Eagle's MEM medium were transplanted to subcutaneous of the right thight of each mouse.
Animals: Male nude ICR mice, ddY mice and conventionl ICR mice (10 weeks, 20-25g).
Results: On Ehrlich solid carcinoma of nude mice and cony. ICR mice, KIH-3+⁶⁰Co 15 Gy therapies were more effective than the control group, but the carcinoma increased on ddY mice.
There were no significant difference in the tumore growth of nude, ddY and cony. ICR mice between KIH-3 combination therapy group and ⁶⁰Co 15 Gy single dose therapy group.

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Sixty patients operated upon for surgical correction of prognathism between 1975 and 1982 were requested to complete the Cornell Medical Index-Health Questionnaire (abbrev. to CMI) and a questionnaire to evaluate their psychology.
CMI is d questionnaire that examines physical and mental symptoms of a patient and the patient's neurotic tendencies. Physical symptoms are classified into 12 and mental ones into 6 sections. According to this questionnaire, patient's neurotic tendencies were classified into 4 areas: Area I (diagnosed to be normal, 26 patients), Area II (provisionally diagnosed to be normal, 23 patients), Area III (provisionally diagnosed to be neurotic, 8 patients), and Area IV (diagnosed to be neurotic, 3 patients).
The results obtained are summarized as follows:
1. Changes in the physical and mental symptoms of the patient before and after operation.
With regard to the digestive tract, the respiratory system and the nervous system, the number of physical symptoms was found to be significantly decreased and the number of mental symptoms regarding inadequacy, depression, anxiety and anger was significantly found to be decreased after operation.
2. Relation between the patient's neurotic tendencies before the operation and the response to the questionnaire after the operation.
Although the patients of Areas I to III had tendencies to respond favorably to the questionnaire, the patients of Area IV did not.
Therefore those of the Area IV are considered patients who are maladjustive to plastic surgery.

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The term “giant cell reparative granuloma” was introduced by Jaffe in contrast to the giant-cell tumor of bone. Recently we experienced a case of giant cell reparative granuloma occuring in the left maxilla of a 10-year-old male. Clinical examination revealed slight swelling of the left cheek due to mass in the left maxilla and the delayed eruption of 3. The mass was removed by extraction of 234 and the curettage of surrounding tissue was carried out. We kept the patient under observation for 2 years to ascertain that there was no recurrence.
Clinical treatment of this case was presented and the literature on giant-cell tumors was reviewed.

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Although mumps virus (MV) infection that induces bilaterally inflammatory reaction such as swelling and tenderness in parotid salivary glands is easily diagnosed, virological and serological investigations are needed for a final diagnosis of an atypical case that suggests MV infection accompanying solitary swelling of certain major salivary glands. In general, it can be serologically diagnosed as MV infection if the serum level of antibody raised against MV at the convalescence of the disease is increased by 4 times in comparison to that at the acute phase. It is considered a major drawback of this diawgnostic method that the final decision is not obtained until recovery from the disease. In the present communication, we describe two atypical cases of MV infection that was diagnosed by MV isolation from the saliva of patients in the initial phase of the disease.
Two adult patients, complaining of an unilateral swelling of parotid salivary gland, were examined in our clinic. Since we suspected virus infection, the saliva from these patients was inoculated into green monkey kidnkey Vero cells. Several days later, cytopathic change that seemed to be induced by virus infection, appeared in the inoculated monolayers. Examination of the cells with the indirect immunofluorescent antibody staining technique and transmission electron microscopy revealed that MV replicated in the inoculated Vero cells. Thus, these cases could be diagnosed as MV infection early, at the first visit to our clinic.

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Three rare cases of calcifying odontogenic cyst are reported here: in addition to the radiological and histopathological studies.
Case 1. In the mandibul of a 9-year-old girl.(E-E)
Case 2. In the maxilla of a 19-year-old male.(7-2)
Case 3. In the maxilla of a 35-year-old female.(123)
Radiologically, all cases showed a few radiopaque structures inside the cystic radiolucent areas. Case 1 and 2 had impacted teeth.
Histopathologically, odontoid or tooth germ structures were adjacent to the epithelium of cyst in case 1.

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The granular cell tumor which is characterized by acidophilic granules in the cytoplasm is a rare tumor. The lesion is often found in the oral cavity and skin. In the oral cavity, the lesion commonly occurs in the tongue and rarely in the buccal mucosa and lips. Thus far, the granular cell tumor was reported 34 times in the oral cavity in Japan, 25 cases in the tongue, 4 in the gingiva, 1 in the buccal mucosa and 2 in the palate.
We reported 4 cases of this lesion which was found in the tongue (2 cases), lower lip (1 case) and buccal mucosa (1 case). Every case examined was seen female and the lesion was excised under local anesthesia. All lesions were benign tumor and were not found to be recurring.

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The median mandibular developmental cyst is an extremely rare lesion. It has a disputed orgin.
Recently, we experienced a case of a so-called median mandibular cyst which was doubted, and was diagnosed as a non odontogenic cyst based on the results of the clinical and histopathological evaluation. It was reported.
The patient was a 45-year-old man who was reffered to us for evaluation of his X-ray radiolucency of the mandibular symphysis.
The history of traumas to the lower jaw was not obtained from the patient.
Upon routine examination, a slightly bulging, nontender nonfluctuant, hardmass was noticed on the labial surface in the lower anterior region of the mandible.
Electric pulp testing revealed that the right central incisor was nonvital and other incisors were vital.
Radiographs revealed a spheral-shaped radiolucency, 2 cm in diameter, at the midline of the mandible and separated the roots of the central incisor teeth. The clinical diagnosis was a developmcntal cyst.
Under local anesthesia, the cyst was enucleated in toto. In surgical findings, the cyst wall had no connection with the roots of the teeth.
Histopathological examination of the cyst wall showed it was lined by a stratified cilliated epithelium and fibrous connective tissue.
One area of the cyst revealed the squamous metaplasia in the field of inflammation.

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this study extended over a three-year period, from 1981 to 1983.
Serum of 1, 013 patients who visited our hospital were checked for the presence of HBs Ag by R-PHA.
And, findings are as follows:
1. Of the all participants, fifty-four (5.3%) were HBs Ag positive.
2. The difference between the male and female, regarding the seropositivity, was the male (7.6%) was higher than the female (3.0%).
3. Sixteen cases (10.3%) were found in the thirties age group, 13 cases (8.9%) in the fifties, and 6 cases (6.6%) in the sixties. High frequency was found among people of a comparatively advanced age.
4. Normal value rates of GOT (AST) and GPT (ALT) was approximately 70%.
5. The positive percentage of HBs Ag was 5.2% on the main island in OKINAWA and was 7.7% on other islands in okinawa.

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The one hundred and six cases of radical neck dossection (RND) procedures were studied which were performed from Jan. 1975 to Dec. 1982.
Of the 89 patients, 65 were males and 24 were females. The greatest percentage of patients were seen during the fifth and sixth decades of their lives. Sites of primary lesions were mandible (containing lower gum 22). tongue (20), floor of mouth (19), maxillary sinus (7), submandibular gland (6), upper gum (5), buccal mucosa (3) and others (7). TNM classifications were as follows: T 1 (5), T 2 (26), T 3 (14), T 4 (30), Tx (10), sarcoma (4); N 0 (44), N 1 (40), N 2 (4), N 3 (1); M 0 (89), M 1 (0). Eighty five percent of all cases were squamous cell carcinoma pathologically.
Of the 106 cases of RND, 25 were performed prophylactically, and 81 therapeutically.
All cases, contained 21 cases of upper neck dissection.
The metastasized cases were pathologically found in 58% of all cases and in 71.6% of the cases which were done therapeutically.
The accuracy of clinical diagnosis on cervical metastases was shown because of the high ratio of true positive and true negative, and of a low ratio of false positive and false negative (17.8%, 1.0% respectively).
However, the false ratio of mandible (37. 5%) was the highest among other primary lesions. According to results, clinical diagnosis on cervical metastases of the mandible was more difficult than other primary lesions.
The pathological positive ratio in the cervical nodes was shown as follows: maxillary sinus, upper gum, buccal mucosa; 100% respectively, floor of mouth; 44.4%, mandible; 36.4%, tongue; 59.1%, submandibular gland; 66.7%.As to the distribution of involved nodes, the majority of them were recognized in submandibular nodes and jugulo-digastric nodes. But there were no involved nodes at all in spinal accessory nodes. In the case of the tongue, they were distributed from the submandibular nodes to the jugulo-omohyoid nodes.
In the case of the floor of mouth, buccal mucosa and submandibular gland, they were distributed from the submandibular node to the jugulo-digastic nodes. In both cases of upper gum and the maxillary sinus, they were distributed from the submandibular nodes to the jugulo-carotid nodes.
A tendency was found that the prognosis was poorer as the numbers of involved nodes and lower level of cervical nodes increased. The multiple involved nodes always contained either submandibular nodes or jugulo-digastric nodes.
In the cases except squamous cell carcinoma, it was clearly recognized that there were more numbers of involved nodes and they were distributed over wide levels and the prognosis was very poor compared with the squamous cell carcinoma cases.

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In the surgical management of parotid gland tumors, it is very important to know the relationships beteen tumors and facial nerves preoperatively. However, it is not always easy to understand the relations precisely.
In this study, the relationships in 10 patients with benign parotid tumors were evaluated by a myomonitor. The result was that the relationships evaluated by the myomonitor were precicely same as the surgical findings in all cases.
This method is simple and useful to predict the relationships between benign parotid tumors and facial nerves preoperatively.

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Hemangioma is common in the region of the head and neck, especially in the tongue, lip and buccal mucosa. But the hemangioma which includes the phlebolith is relatively rare. The authors reported two such cases.
Case 1 was a 17-year-old man who visited our clinic complaining of a swelling of the left cheek. The swelling had been there since his birth, and it had gradually increased in size with general bodily growth. He was diagnosed as a buccal hemangioma with phleboliths.
The tumor occupied the entire left cheek. Subtotal extirpation was performed and a multiple ligature suture was done to the residual tumor. The postoperative histological diagnosis was cavernous hemangioma with phleboliths. Scanning electron microscopic findings of the phlebolith revealed a concentrical lamellar structure. Analyses of the phleboliths by means of infrared spectrometry and X-ray diffraction identified calcium phosphate as the component of the phleboliths, and suggested the existence of calcium carbonate.
Case 2 was a 37-year-old woman who had noticed the tumor on her left cheek 16 years before and it was excised at that time. But it recurred one month later and grew slowly.
Total resection of the tumor was performed in our clinic. The resected tumor was walnutsized and well-capusulated one. The postoperative histological diagnosis was cavernous hemangioma. Thrombi and phleboliths were also observed within the tumor.

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A case of the blue rubber-bleb nevus syndrome which occurred in the oral cavity in a 61-year-old female was reported with a review of literature. Histological investigation disclosed that this lesion had the characteristics of carvernous hemangioma which had no apparent difference in comparison with another carvernous hemangioma in the oral cavity. For differential diagnosis, the authors recommended that blood examination should be done to detect anemia which frequently accompanys this syndrome.

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Two cases of lipoma developed in the region of mandibular angle were studied, and the following results were obtained.
1. Both of the patients were males in their forties.
2. Both of the lipomas were subcutaneous tumors located at the mandibular angle. They were soft tumors with a clear boundary.
3. Ultrasonic examination of the lipomas showed a heterogeneous solid pattern with an unclear boundary.
4. The isolated lipomas were lobulated yellowish tumors covered with a thin capsule.
5. Histopathologically, the lipomas consisted of mature fat tissues, and they had a lobulated structure due to the boundaries caused by blood vessels and peripheral connective tissue.

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The authors report the case of a 39-year-old woman with acromegaly due to putuitary adenoma, who had been treated at our hospital's Department of Neurosurgery. The patient was referred to our clinic for evaluation of dentofacial abnormalities. She was 167cm tall and weighed 72kg, the soft tissue of the extremities was thick and the skin was rough surfaced. Extraoral examination revealed remarkable mandibular prognathism and protrusion of the superciliary arch specific to this disease. Intraorally, there was macroglossia and no occlusion was seen except for the right molar region. Over-jet was-3mm. Cephalometric analysis revealed the following findings: decrease of SNA due to the protrusion of the point N, almost normal mandibular plane angle due to overclosure, and a relatively small gonial angle in comparison with other types of skeletal mandibular prognathism. As the abnormalities were beyond surgical correction, occlusion was corrected prosthetically by an over-lay full denture of the maxilla and a partial denture of the mandible.

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Oral infections caused by anaerobes are now more frequent because of improved culturing techniques. Some cases of difficult treatment caused by oral anaerobes are occasionally encountered. Recently, we experienced a case of inveterate oral anaerobic infection.
The patient, 25-year-old woman, was admitted to our hospital with the complaining of swelling in the left cheek. The lesions were diagnosed as a submasseteric abscess and an abscess of pterigomandibular space caused by the pericoronitis of the lower third molar. Three oral indigenous anaerobes, Propionibacterium acnes, Bacteroides melaninogenicus, and heparinase-producing Bacteroides, were isolated by bacteriologic examinations. The closed continuous irrigation method has been used for the management of this inveterate infection with chemotherapy. The post-operative course was uneventful and no recurrence was observed.
The correct selection of antibiotics and properly timed surgical intervention are recognized as cornerstones in the treatment of infection. The closed continuous irrigation method is recommended for these cases.

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A case of unilateral enlargement of the coronoid process of the mandible was presented. The patient was a 37-year-old female and she complained of restricted mandibular movement and swelling of the left zygomatic region. A routine X-ray examination revealed a bony mass at the tip of the left coronoid process. A coronoidectomy was performed intraorally so that the restricted mandibular movement was improved. Computed tomography was extremely useful not only in the diagnosis of this condition but also in deciding the surgical procedure. Histologically, the specimen showed a proliferation of cartilage cells existed in a disordinary arrangement, in general, and enchondral ossification was markedly disturbed, but there was not any degree of cellular pleomorphism or atypia. The histological diagnosis of osteochondroma of the coronoid process was obtained.
The nature of this condition has been obscure. Although the majority of reported cases lack the histological evidence of the neoplastic nature, some show a proliferation of the cartilage, cellular pleomorphism or slight atypia of the cartilage cells. Our case suggests this condition has a basically neoplastic nature.

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Herpes zoster is a dermatomucous disease caused by varicella-zoster virus and manifested with varicella in regions controlled by specific peripheral nerves. In particular, this is relatively frequent in the region controlled by the trigeminal nerve. This paper reports a patient with herpes zoster which occurred, after dental extraction, in the region innervated by the first and second rami of the trigeminal nerve and was accompanied by ophthalmoplegia externa. The incidence of such ophthalmoplegia externa associated with herpes zoster ophthalmicus in this region is relatively low. However, in cases of herpes zoster ophthalmicus, ophthalmic symptoms are said to be more prolonged with a greater variety of patterns than dermal lesions. Therefore, examinations from the aspect of ophthalmology as well as internal medicine are very important in treating patients with this condition.
In our patient, this disease occurred after dental extraction. As the prodrome of herpes zoster, neurological symptoms procede with a probability of about 60%. In this patient, toothache prior to the manifestation of rash was diagnosed as a dental and periodontal disease, and dental extraction was carried out. It seems, however, more appropriate to regard the toothache as a prodromal neurological symptom preceding rash. Dental treatment, if too hastily performed for CI, patient complaining of toothache, may aggravate the underlying disease or induce complications.

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A case of submandibular lymphadenitis accompanied by heterotopic bone formation is reported herewith and discussed in terms of the mechanism of bone formation. To the best of our knowledge, no such report of intralymph nodal bone formation could be seen.
The patient was a 43-year-old woman who had noticed the swelling with slight oppressive pain in the left submandibular region about 10 years ago. The swelling was left untreated, however, due to the slight degree of the oppressive pain even though it recurred and then diminished again dozens of times. But when the swelling and the oppressive pain became stronger than before, the patient came to our hospital. Radiographic examination revealed many radio-opaque round images roughly the size of millet or rice seed in the left side of the submandibular region. Histopathological examination revealed matured bony tissue with formed bone marrow in the lymph node.
In the past, many case reports and various experimental studies on heterotopic bone formation have been presented. The authors, however, have merely discribed their own views concerning its onset mechanism, and no established theory has yet resulted.

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This paper describes a rare case of double cancer of the spindle-cell carcinoma and squamous cell carcinoma. This patient was 48-year-old. He had primary cancer of the spindlecell carcinoma in the right side of mandibular. The lesion was resected. After a year we found secondary cancer of the squamous cell carcinoma on the left side of his tongue and resected it. There has been no evidence of recurrence and metastasis, but observation will continue.

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We conducted a clinical and statistical analysis on 421 cases of maxillo-facial fractures at the clinic of the Oral Surgery Department of Ryukyus University Hospital during the ten years period from October 1973 to September 1983.
1) Out of the 421 cases annalyzed, 201 cases (47.7%) were inpatients and 220 cases (52.3%) were outpatients.
2) One hundred and twenty-three cases (29.3%) were found in the twenties age group, 122 cases (29.0%) in the teen age group, 328 cases were male patients and 93 cases were female patients. The ratio of the male to the female was 3.5 to 1.
3) There were 159 cases (37.3%) caused by traffic accidents, 100 cases (23.8%) by fist blows, and 47 cases (11.2%) by overturning.
4) Ninety-nine cases (23.5%) of all patients visited our hospital within 24 hours, 152 cases (36.1%) within three days, and so on. The fresh fractures injuried within two weeks were 373 cases (88.6%). The remaining cases were old fractures.
5) One hundred and eighteen cases (28. 0%) were refered to us from private dental clinics, 97 cases (23.8%) from prefectual hospital, and so on.
6) Of all the facial fractures, 291 cases (69. 1%) were found in mandible, 94 cases (22.3%) in maxilla (including the middle third facial region), 63 cases (8.5%) in the combined mandible and maxilla. The fractures of the bodies of the mandible, the maxilla and the middle third facial region were 325 cases (77.1%). The fracture of the alveolar process of the mandible and maxilla were 96 cases (22.3%). Regarding the fractures of the bodies, 249 cases were found in the mandible, 52 cases in the maxilla (including the middle third facial region), 26 cases in the combined mandible and maxilla.
7) In the region of the mandible, most frequent fractures were found in the region of the molar and the angle, second were in the incisal region and third were in the region of the condylar process. According to the Le-Fort classification (including unilateral fractures) there were 21 cases of Le-Fort III, 9 cases of Le-Fort II. Unilateral fracture of the zygoma was seen in 38 cases.
8) One hundred and eighty cases (65. 5%) of the mandibular fractures were result of direct force, and most of the fractures of the maxilla from direct force.
9) The complications of 1, 148 cases were observed in our cases in the area of associated injuries, 294 cases were found in the oral mucosa, 217 cases in the teeth, 266 cases in the facial skin, and so on. There were 169 cases of unconciousness, and 65 cases with fractures other than facial.

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A case of bilateral submandibular sialolithiasis was reported. A 62-year-old woman was referred to us because of painless swelling in the left submandibular gland.
Roentgenographic examination showed a presence of salivary stones in the bilateral submandibular ducts.
Two salivary stones were removed from the left submandibular duct and one from the right submandibular duct intraorally.
The stones were examined with the scanning electron microscope equipped with an electron probe X-ray microanalyzer.
The cut surface of the salivary stones showed a structure consisted of concentric layers surrounding one central core. Calcium, phosphorus, and sulphur were detected in every stone as the main elementary compositions.

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Malignant fibrous histiocytoma of the oral region is rare. Clinical course, histopathological observations and biochemical analysis of malignant fibrous histiocytoma of the mandible in an 18-year-old male is reported.
The clinical findings revealed rapid enlargement of two nodular tumors 5 cm and 3cm diameter, in the molar region of the right mandible and tender regional lymph nodes. Radiographically, separation of the wisdom tooth and the second molar tooth and an irregular radiolucent area reaching to the mandibular canal were shown. Segmentary resection of the mandible and radical neck dissection were carried out. Postoperative course of the patient was uneventful and no recurrence or metastasis was found after 2 years.
Histopathologically, most of the tumor consisted of a highly myxoid tissue. In the myxoid area widely spaced spindle cells, pleomorphic cells and giant cells were arranged in a matrix.
In electron microscopic examination, fibroblast-like cells, histiocyte-like cells and polynuclear giant cells were observed.
By the biochemical methods, type I, III and V collagen were detected by the SDS-PAGE method. Dihydroxylysinonorleucine was found to be the major reducible cross-link in this collagen and its ratio to hydroxylysinonorleucine is 2.4. This suggested that the collagen is similar to the hard tissue collagen or at the young and growing stage. Pyridinoline and histidinoalanine were found to be the noreducible cross-link in this collagen.

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