Ameloblastoma in the maxilla is relatively rare even though this tumor is most frequently seen among odontogenic tumors.
We had a chance to treat a case of ameloblastoma (follicular type) in the maxilla which seemed to be clinically at first a malignant tumor and took primary culture cells from the tumor tissue.
Ultrastructural observation of the cells in vivo and in vitro were performed.
In the cells in vitro, nucleus was round and nucleolonema in the nucleoli were recognized. In the cytoplasm, many lysosomes were found and the number of rough endoplasmic reticulum was not so large as in vivo.The cells in vitro resembled columnar epithelial cells in vivo.As compared with the active cells in vivo, the cells in vitro had few organella.

View full abstract

This study intended to develop a substitute material for the hard tissue used for replacement and reconstruction of a defective tooth and bone, namely, artificial materials with mechanical and biological compatibility with the bone as well as excellent processability and manipulatability.The author developed a hydroxyapatite [HAP]-polymer composite material consisting of HAP particles, poly (2, 2, 2-trifluoroethyl methacrylate)[PTFEMA] or poly (methyl methacrylate)[PMMA], and ternary multiphase material in which metal was incorporated, as an inner core, into the composite material, and then compared these physical and mechanical properties with those of human mandibular cortical bone [MCB], HAP ceramics block and synthetic polymer.
1) The physical and mechanical properties of MCB were compressive strength 1130.0±203.0 kg/cm ², Brinell hardness number 27.0±5.2, transverse strength 1690.0±287.0 kg/cm ² and modulus of elasticity (10.5±2.3)×10⁴kg/cm ².2) Each homopolymer of PTFEMA and PMMA was generally inferior to the bone in regards to physical and mechanical properties, and its modulus of elasticity showed that the material was soft.On the other hand, while having remarkably higher values of compressive strength, modulus of elasticity and Brinell hardness number than those of the bone, the HAP ceramics block proved to be hard and brittle, with poor transverse strength.3) The HAP-polymer composite material showed physical and mechanical properties close to those of the bone at HAP 70 wt%, except for transverse strength.4) While the transverse strength and diametral tensile strength of PMMA-HAP composite material decreased as HAP content increased, those of PTFEMA-HAP composite material showed a gradual increase.5) The water absorption of PTFEMA-HAP composite material is extremely small compared with that of PMMA-HAP composite material, and changes with time was hardly seen in the physical and mechanical properties by immersion in water at 37°C.6) The transverse strength of HAP-PTFEMA-metal multiphase material in which HAP-PTFEMA composite material and core metal were used has improved rapidly, showing a strength equal to that of MCB, with the modulus of elasticity also close to that of the bone.7) The molding method for HAP-polymer composite and HAP-polymer-metal multiphase material is by heatcuring polymerization using powder and liquid, such having superior processability and manipulatability.
Thus, the usefulness for clinical application of the multiphase material in which PTFEMA and HAP 70 wt% composite materials are used with a core metal has been proved as a substitute material for hard tissue, characterize by toughness, mechanical bone compatibility, excellent stability in wet conditions and easy processability and manipulatability.

View full abstract

Regarding hydroxyapatite [HAP]-polymer-metal multiphase material developed as a substitute for the hard tissue repairing tooth and bone defects and their reconstruction, a study was made on soft-tissue and bone-tissue reactions of the HAP-polymer composite material, namely, on its facets in direct contact with the living body.For the HAP-polymer composite material, poly (2, 2, 2-trifluoroethyl methacrylate)[PTFEMA] or poly (methyl methacrylate)[PMMA] containing 70 wt% of HAP particles (mean 8 μm or 70 μm) was prepared. As controls, both homopolymer and HAP ceramics block were used.These were implanted subcutaneously in rats and in the tibiae of adult dogs for soft X-ray and histological observations and contact microradiograph for 6 months.
Subcutaneous implantation: One week after the implantation of each material, all of the test pieces showed encapsulation by the granulation tissue accompanied by mild to mediocre inflammatory cell infiltration.In 3 months and thereafter, inflammatory reaction was scarcely observed in the periphery of the materials, and the test pieces were surrounded by the fibrous capsules, showing a trend that, with polymer composite material and HAP ceramics block, inflammatory cell infiltration disappears at an early stage as compared with the homopolymer.
Intraosteous implantation: 1) It was observed that new bone formation with the homopolymer started from the endoseal bone surface away from the test piece, and presence of the fibrous tissue was seen between the test piece and the bone throughout the period. 2) Polymer-HAP 70 wt% composite material showed a bone affinity almost as high as that of the HAP ceramics block.That is, new bone formation started from the surface and periphery of the test piece, and after 3 months bone formation was seen without the presence of fibrous tissue.3) The HAP-S particular composite material group exhibited evidence that its contact with bone becomes uniform at an early stage as compared with the HAP-L particular group.No difference was observed in bone tissue reaction between the PMMA and PTFEMA composite material groups, but PTFEMA is presumed to be superior if its physical and mechanical properties and adaptability to HAP particles are taken into consideration.
Thus, it was found that the multiphase material, in which core metal is used and PTFEMA+HAP-S 70 wt% composite material are placed on the interface with the bone, is useful as a substitute material for hard tissue for its bone compatibility both biologically and mechanically.

View full abstract

Bleomycin and its analogues are widely used as antineoplastic drugs. Upon adminstration some adverse effects such as pulmonary fibrosis, stomatitis and dermatosis are often observed.There have been many reports that these adverse effects were induced by inhibition of vascularization.Some studies suggested that the disturbance of the vascularity due to Bleomycin was related to its antineoplastic effect.
Pepleomycin an analogue of Bleomycin has been shown to be equal to or more effective than Bleomycin.It has also been shown that administration of Pepleomycin results in less incidence of pulmonary fibrosis, but that stomatitis and dermatosis are frequently observed. These observations suggest that Pepleomycin has more effects on homeostasis of the circulatory system.
The present study used male rats (Sprague Dawley) that had been treated with both Bleomycin and Pepleomycin by interperitoneal injection at specified intervals.The tongue submucosa was resected.Then, changes in capillary and pericapillary tissues were observed by electron microscopy or light microscopy.
In the group treated with Bleomycin, hypertrophy was observed in the capillary endotherium. While, pericapillary tissue seemed to consistently remain unchanged.They seemed to disturbance of permeability in the capillary.In the Pepleomycin treatment group, reduction in the size of the capillary endotherium and in some cases, fenestration of the endotherium were induced.Many changes in pericapillary tissue were also observed.They seemed to accelerate permeability in the capillary.
The results of this study suggested that Bleomycin and Pepleomycin influences the local circulatory system and is related to antineoplastic effects.

View full abstract

The procedure involved in three dimensional description of diagnosis is outlined with regard to occlusion in the maxillo-facial deformities, citing examples of typical cases.
As parameters observed in occlusion, the vertical (up-and-down) postural relationship between the upper and lower dental arches was described as over bite, ‘B’ and expressed by the actual maximum (mm).In the case of the value being‘minus’, the site was additionally described by a dental formula.
The sagittal postural relationship was inscribed as over jet, ‘J’ and expressed by the actual maximum (mm).In the case of‘minus’, the site was additionally declared by a dental formula.
The horizontal (right-and-left) postural relationship between the upper and lower dental arches was inscribed as cross bite, ‘C’ and the site was further described by a dental formula. In the case of no cross bite, the relationship was inscribed as‘C₀’.
The postural relationship between the occlusal plane and a hypothetical facial median sagittal plane was described as occlusal plane, ‘O’ When these planes crossed at right angles, the relationship was inscribed as‘O₀’.When the occlusal plane was inclined toward the right or left, the postural relationships were inscribed as‘O₁’ or‘O₂’ respectively.
The thus obtained description formula for the occlusion obtained according to this procedure is:
B_a (mm)(+) J_b (mm)(+) C_xO_y
It seems that this three dimensional description can describe any occlusion and gives the standard of diagnosis among any institutions in the case of the maxillo-facial deformity.

View full abstract

Amyloidosis is a lesion which amyloid substance, fibrous protein, is deposited in all organs and tissues of the body.In the oral region, tongues are most affected. Lips, cheeks, palates and submandibular salivary glands may also be affected, but few cases were reported so far.
Clinical classification of amyloidosis is generally as follows;(1) primary amyloidosis, (2) amyloidosis with multiple myeloma, (3) secondary amyloidosis, (4) hereditary amyloidosis, (5) organ limited amyloidosis.
Recently, we have experienced a case of amyloidosis, which had occured in both cheeks of a 45-year old man.The patient complained of a tumor formations of both cheeks.These tumors were excised intraorally and amyloid fibrils were detected in them by light and electron microscopy.Furthermore, by several systemic examinations this case was diagnosed as organ limited amyloidosis.

View full abstract

A prosthetic treatment of maxillary protrusion should be indicated, when the patient is old, or anterior teeth of upper jaw cannot be preserved.For many years, removing the external labial of bone was practiced in such a case.However this method has disadvantages of lowering the alveolar ridge and sometimes causing undercuts with passing time, because the postoperative bone resorption is excessive and irregular.
We performed intraseptal alveolectomy (Dean's technique) for the prosthetic treatment in 5 cases, and satisfactory results were obtained in all cases.We consider that this technique based on biological princioles has some advantages as follows:
1) Postoperative inflamation is slight, because the labial periost and the muscle attachment are not disturbed.
2) As the periodontal membrane is preserved, healing is rapid.
3) As the labial cortical plates of bone is preserved as a vital onlay bone graft with intact blood supply, postoperative resorption is minimized, and the shape of alveolar ridge is rarely changed.
4) This technique lends itself well to immediate denture surgery, and needs no rebase for final denture.
5) We can mold the alveolr ridge into the desired contour during operation.
6) This technique is a simple dental surgery which can be done in an outpatient room under local anesthesia.

View full abstract

It is recognized that AO osteosynthesis is the better method for the fracture of the edentulous mandible.It is, however, difficult to use for mandibular fracture with severe alveolus atrophy, because of the slender mandible, that is just like a twig.Therefore, the small 1/4 rolled AO plate was selected for the advanced-age patient with such a fracture and good postoperative course was obtained without any complication.
Surgical techniques are also shown in this article.

View full abstract

Four reconstruction cases using sternocleidomastoid myocutaneous island flap following the resection of oral cavity tumors.
Osteomyocutaneous island flaps consisting of sternocleidomastoid muscle and clavicle were used in three cases in which mandiblar bone defect resulted.Small skin paddle over the clavicle was effective to prevent the grafted bone from being exposed to the oral cavity and to protect it from infection.
One flap underwent total necrosis, but others were successful.
This flap is useful for head and neck reconstructive surgery because of the application in the same operating area.

View full abstract

In 17 cases of tumors of the oral cavity, maxillofacial defects were reconstructed immediately after radical surgery using pectoralis major and/or latissimus dorsi myocutaneous flap.
The diagnosis for 16 cases were carcinomas of the oral cavity and in these cases (except one with adenocarcinoma) patients had received irradiation therapy prior to the surgery. The only case of benign tumor was buccal region hemangioma.In all of the cases, satisfactory results were obtained though partial necrosis of flap was observed in 3 cases.
Previously A-O reconstruction plate was used for a primary repair of mandibular bone defect in our hospital.Recently the authors have experienced the use of a sternum pectoralis major and a rib latissimus dorsi osteocompound flap.However, the curve of rib was opposed to a normal mandibular arch and perforation of pleura may occur during harvesting a sternum or a rib.
Myocutaneous flap for repair of wide defect that necessitates mass augmentation seems to be efficient and reliable due to permanent blood supply.On the other hand, one disadvantage is the bulky deformity of the flap which makes functional restoration of the oral cavity more difficult.
In our view, some problems which should be considered for reconstructive surgery of head and neck tumor are the following.
1) Indication and selection of a flap
2) Method for mandibular bone reconstruction
3) Muscular volume of a flap and functional restoration

View full abstract

Actinomycotic infection appears predominantly in the cervico facial area, but is seldom seen on the tongue.
A very rare case of actinomycosis of the tongue associated with leukoplakia of the dorsum of the tongue, resembling median rhomboid glossitis is herein reported and discussed.
A 63-year-old female patient visited our department complainning of a slight nodular elevation which was devoid of lingual papillae and a painless white patch in the dorsum of the tongue. Clinically, a provisional diagnosis of median rhomboid glossitis and leukoplakia of the tongue was given and primary malignancy was also suspected because of the location of the nodular lesion adjacent to the white patch and the lack of other clinical evidence to support a diagnosis of infection.Using local anesthesia, an incisional biopsy was performed and the specimen was submitted for pathological examination.
Histopathologically, the superficial layer of the epitherium was found to be hyperparakeratotic. The epitherium showed no sign of mitosis.Severe infiltration of inflammatory cells and a cystic space containning granules were noted under the acanthotic epitherium. No findings of malignancy were revealed.
With the diagnosis of median rhomboid glossitis and leukoplakia of the tongue, no special treatment, except for cessation of taking stimulants, was administered.No remarkable changes of the lesion were seen for several months. Upon further study of histopathological findings of the case, actinomycotic granules were noted because of the characteristic peripheral radiating filaments, and numerous fragments of sil-ksutures were also noticed.
Definitive diagnosis of actinomycosis associated with leukoplakia of the tongue was made and the patient was placed on a regimen of oral penicillin, 500 mg.three times a day for 2 weeks.The nodular thickened lesion which was devoid of lingual papillae disappeared and was covered with extended leukoplakia of the tongue.
Recently, the thesis that median rhomboid glossitis is not a developmental anomaly but an infectious disease caused by fungus especially candida albicans has been stressed. From that point of view, our present case may suggest the possible role of actinomycotic infection in the development of median rhomboid glossitis.

View full abstract

The treatment failures after radical neck dissection (RND) are recurrence of ipsilateral neck, metastasis of the contralateral neck and distant metastasis, all of which are difficult to treat and have poor prognosis.
Studying these failures in 76 patients of squamous cell carcinomas after RND performed in head and neck cancers, we have some results.
The primary disease controlled group (57 patients) has 89.5% survival rate.The incidence of failures is relatively few.Contralateral neck metastases are found in 12.3% of this group, but they have relatively good prognosis, showing 71.4% survival rate.
The primary disease uncontrolled group (19 patients) took unfavourable clinical course and their survival rate was 26.3%.The occurrence of failures was much greater than the primary disease controlled group.
The prognosis of both the recurrence of ipsilateral neck and the distant metastasis are fairy poor in both groups.It is no exaggeration to say that they are an ominus, mortal signs.
According to these results, the prognosis after RND directely depends upon whether the primary disease is controlled or not.
The degree of pathological invasion in involved lymph nodes relates to the recurrence rate of primary disease and seems to relate mainly to the incidence of recurrence of ipsilateral neck.

View full abstract

One of the most versatile flaps for reconstruction following moderate tissue loss in the intraoral region is cervical island skin flap.Here we report two cases in which this flap was used for immediate reconstruction of the oral lining.In one of them the procedure was as described by Farr., et al.In the other, the procedure was modified as follows;the cervical island skin flap donor site was covered with a pedicle skin flap including the platysma and subcutaneous tissue in the clavicle region.This procedure proved to relieve tension of the cervical region and offers more neck mobility.

View full abstract

A 51-year-old man with parotid gland tumor that showed a tendency to rapid exacerbation 20 years after the subjective recognition of the mass is reported with reference to the literature.The tumor parenchyma from this patient showed poorly differentiated mucoepidermoid tumors. From the widespread hyalinization and relatively;filmdom elastic fibers in the stroma, and the clinical course, it was highly possible that the patient had carcinoma in pleomorphic adenoma.The patient was treated by external irradiation and chemotherapy (5-FU, PEP), after total parotidectomy and total neck dissection.There was no recurrence or metastasis two years and two months after the combined treatment.

View full abstract

The ameloblastoma is a benign epitherial odontogenic tumor which resembles the appearance of the enamel origin.Although it usually occurs in third and forth decades of life, it may arise at any age.In 80 per cent of cases the ameloblastoma is located in the mandible. In the mandible about 70 per cent are located in the molar region, and 10 per cent in the incisor region.Recently, we experienced a case of large ameloblastoma with the right impacted canine in an 11-year-old.Radiological examination showed molar region of the mandible and tumor area is right first molar region to left second premolar region.The literature on child ameloblastoma were reviewed.Furthermore, both clinical and histopathological differences of several ameloblastoma were also discussed.

View full abstract

One hundred and twenty one patients with mandibular dysfunction complaining of maxillofacial pain were clinically observed.Since no organic change was detected at the temporomandibular joints in any, it was surmised that the dysfunction was due to functional imbalance.The dysfunction was symptomatically divided into three types: arthrogenic, myogenic and mixed.The incidence was highest in the arthrogenic type (57%) mainly comprising arthromotoralgia, followed by the myogenic type (39%) mainly comprising contraction of the masticatory muscles.Usually dental and drug combination therapies were given and favorable results were obtained.

View full abstract

A compact Nd-YAG laser (OSADA YAG LASER) was employed in surgical treatments of oral lesions in twelve cases.
The treatments were extirpations of hemangiomas (3 cases), excision of lymphangioma (1 case), extirpation of cyst (1 case), resections of oral malignancies (6 cases) and mucosal incisions in surgical orthspedics (1 case).
The equipment was small-sized and improved on the handpiece in comparison with those heretofore in use.Two types of heads (non-contact type and contact type) were provided for the handpiece.
The non-contact heads, which have a lens in the tip, showed high ability as a coagulator. It enabled perfect control of hazardous bleeding during the excision of cavernous hemangiomas.On the irradiated surface, a dense layer of heat degeneration covered by carbon deposit was observed.
The contact heads with a sharp-pointed quartz tip at the end showed high performance as a scalpel.The sense of touch resembled that of a electrosurgical unit.The cut margin was sharp and clean with minimal heat degeneration and little carbon deposit.In the partial glossectomy, it was free from uncomfortable muscle contracture or bleeding. The sutured wound of which margin cut with the contact head healed in ordinary manner.No delays of healing or rupture of the wound were observed.The microscopic finding on the cut margin also manifestatcd the characteristic difference in mode of action between the both types.
It was recognized that the compact Nd-YAG laser with two head types (contact type and non-contact type) is very useful for oral surgery.

View full abstract

The advantages are:
(1) Stabilization of osteotomized bone fragment can be sure and complete.Relapse is less than with wire osteosynthesis.
(2) In mandibular osteotomy, owing to monocortical osteosynthesis, damage to neurovascular bundle and root of teeth is rare.Miniplate can be used in maxilla that has thin layer of cortical bone.
(3) Le Fort I osteotomy, zygomatic arch suspension wiring to stabilize bone fragments is unnecessary.
(4) The period of intermaxillary fixation is shorter than wire osteosynthesis. Opening of the mouth can be possible during operation and immediate postoperation.
Since 1982, we used miniplate in 63 cases of orthognathic surgical procedure with very satisfactory results.

View full abstract