This study was carried out to investigate the histological characteristics of the soft palate in three patients with congenital velopharyngeal incompetence. These patients were diagnosed as type Ia congenital velopharyngeal incompetence classified by cephalometric radiography with contrast media. The tissues examined consisted of the medial zone of the soft palate excised from the three patients and seven normal cadavers. These specimens were sectioned successively at two-or three-millimeter intervals on the frontal direction. The medial zone of the soft palate in all patients were noted macroscopically to be thinner than those of the control group. Histologically, fewer muscle fibers, more fibrosis of the interstitum and misdirection of fibers were found to varying degrees in the three patients compared with the normal cadavers.
We investigated the psychosocial aspects of 67 mandibular prognathism patients, 24 males and 43 females, by interview prior to surgical procedure based upon our protocol. The conclusions are as follows: 1) Many of the subjects, both male and female patients, desired the operation because they wished to improve their appearence. 2) On the average, they started to suffer from jaw deformity since adolescence. 3) 75% of the subjects showed chewing difficulty and 69% speaking difficulty. However, the difficulties were not so severe as to intefere with daily life. 59% of the subjects pointed out adverse effects of jaw deformity on their life and behavior, especially on their mind. 4) Through evaluation by means of sliding scales, it was revealed that the subjects inclined to regard their deformity as larger, to suffer from their deformity more severely, and to be more self-conscious than we suspected. It was also shown that the degree of the suffering and the self-consciousness did not bear a relation to the real degree of their deformity, but to the deformity imagined in their mind. 5) We did not find behavioral problems in their social relationships. 6) Half of the subjects forecasted the change in their face after surgial correction. The forecast was generally vague. Some of the subjects expected their personality to become more lively as a result of their operation.
In cases of mandibular fracture, there are many variations in the condylar position in glenoid fossa. However, most show practically no functional disturbances in jaw movements. So the authors studied the relation between the radiological condylar position and clinical features. The objects were 87 patients seen at the Department of Oral Surgery, Kyushu University Dental Hospital, between 1978 and 1983, and had taken in pre-. and post-treatment temporomandibular joint radiographs by modified Schaller's projection. The results were as follows: The condylar position in pre-. and post-treatment showed many variations, but we couldn't find a characteristic change in the condylar position at mouth close after treatment. The relation between functional disturbances and the condylar position were still not clarified. In our estimation after treatment, the jaw function seemed to be good in most cases because the condyles were situated at the anterior to the articular tubercle in the opening position. These results showed that the functional adaptation of the TMJ came about post operatively.
The changes in latency and amplitude of the cranial evoked potentials (EP) generated by mechanically stimulating the whiskers were measured in adult rats, in which the unilateral infraorbital nerve innervating the whiskers was crushed. 1. In normal rats with intact infraorbital nerves, disphasic EPs were recorded subcutaneously from the contra and ipsilateral hemisphere. Latency of the contralateral waves was always shorter than that of the ipsilateral ones. 2. Immediately after crushing the unilateral infraorbital nerve, latency of the contralateral EPs evoked by stimulating the crushed side whiskers was prolonged with a significant correlation between the positive and negative component of the EPs. Latency of the EPs simulataneously recorded from the ipsilateral side showed no significant changes. As a result, in some cases latency of the ipsilateral EPs became shorter than that of the contralateral ones. Most of these changes were restored within 3 weeks. 3. The contralateral positive and negative EPs evoked by stimulating the crushed side whiskers showed immediate amplitude reduction. Positive EPs recorded from the hemisphere ipsilateral to the stimulation was consistently reduced in amplitude, while in the negative component, increases and decreases in amplitude were found to occur at roughly the same frequency. In the ipsilateral evoked positive component, the amount of amplitude reduction tended to show a positive correlation with the length of time needed to recover control value. 4. The ratio of the latency after crushed side stimulation to that after intact side stimulation (C/I ratio) was increased significantly for one week after the nerve crush. The ratio of amplitude of the negative component to the positive component of individual EPs (N/P ratio) was found to be smaller for one week in the EPs evoked on the contralaterral hemisphere by stimulating the crushed side whiskers. The N/P ratio of the EPs on the ipsilateral hemisphere by stimulating the crushed side whiskers was increased at the 1st week after the crushing. These changes returned to normal at the 2nd week. These results indicated that reliable parameters to predict recovery time course of the tactile function after infraorbital nerve crushing would be (1) the N/P ratio of amplitude of the EPs evoked simultaneously on both sides of the head following stimulation of the crushed side whiskers, and (2) the C/I ratio of latency of the EPs evoked through the crossed pathway on the contralateral hemisphere by stimulating the crushed or intact side whiskers.
The purpose of this paper is to investigate the mechanism of scar formation on the palate which can inhibit maxillary development after cleft palate surgery. After 4 types of operations (elevation of the mucoperiosteum, excision of the mucosa, excision of the periosteum, and excision of the mucoperiosteum) were carried out on rabbit palates, the healing processs was studied histologically and biochemically by measuring lysyl oxidase activity which is necessary for collagen cross-linking. The results were as follows. The lysyl oxidase activity increased sharply and peaked at 4 days after elevation of the mucoperiosteum or excision of the mucosa when fibroblast had histologically appeared in the wound. On the other hand, the activity increased gradually up to 14 days after periosteum excision, or excision of the mucoperiosteum, showing histologically remodeling of the underlying bone. The results suggest that it is very important to avoid periosteum injury and to decrease the wound area exposing the bone without the mucoperiosteum as much as possible for growth of the maxilla after cleft palate surgery.
To achieve a complete under-standing of the biomechanical aspects involved when maxillofacial bones are stricken by external forces, it is necessary to study them as one body. Experiments carried out following this concept are reported here. Different weights were applied to the mandible at the center of the mental region and the distribution of principal strains of bone were analyzed. It was found that force is transmitted through the mandibular bone along the bone radial structure. On the maxillofacial bone, the zygomatic arch received most of the stresses and suffered frequent damage.
Recently, osteomyelitis which develops subacutely or chronically from the start, and subacute or chronic osteomyelitis which follows an acute attack treated with antibiotics, have been increasing, although typical acute or chronic osteomyelitis have decreased. We would like to present a case with severe reumatic arthrosis which had Brodie's abscess and subacute osteomyelitis on bilateral mandible and was treated successfully with antibiotics and some surgical procedures like trepanation. The patient, a 75-year-old man, visited our clinic January 18 th of 1983 complaining of pus discharge from right side of the mandible. He had been suffering from severe rheumatic arthrosis and had been treated with steroids for the past several years. Six months before his first visit to us, he got acute osteomyelitis on the right side of the mandible after extraction of the right lower first molar. He was admitted to another clinic and was treated for 3 months, but did not recover from the osteomyelitis. At the first visit to us the clinical examination revealed low grade fever, pus discharge from fistulae on the right lower molar gum and the anterior area of the right ear, and a cystic lesion similar to Brodie's abscess at the right side of the mandible were observed on X-rays. He was admitted and treated with antibiotics and trepanation. After treatment the pus discharge stopped. Two years later, simular subacute localized osteomyelitis occurred on the left side and frontal portion of the mandible and was treated in the same way. About 2 years after the second treatment, he died of renal disease without the recurrence of osteomyelitis on either mandible side.
Tumor resections through mandibular preservation as far as possible were carried out for 6 benign tumors composed of 3 ameloblastomas, 2 myxomas and 1 cementifying fibroma. Grafts of 1 particulate cancellous bone and marrow (PCBM), 4 bone chips and 1 block bone taken from the iliac bone without the crest were used for repair or reconstruction of the various types of the defects. All patients were in good clinical courses without postoperative infection. In this paper the results of above bone grafts for mandibular defects which clinically were observed during the past 3 to 6 years were discussed.
Transport of LMOX administered by intravenous drip infusion (1g/30 minutes) to the bone and soft tissues as well as the pus in the upper and lower jaws was examined in 77 oral surgery cases. The serum concentration of the agent was 102.2μg/ml after 30 minutes, 43.9μg/ml after 1 hour, and 13.1μg/ml after 4 hours. The maximum tissue concentrations were 17.6μg/g in the upper jaw bone, 9.8μg/g in the lower jaw bone, 37.4μg/g in the upper jaw soft tissue, 20.1μg/g in the lower jaw soft tissue, and 40.2μg/g in the pus. These concentrations relative to the serum concentration ranged from 20-50% despite a considerable variation among sites. As for the intraosseous concentration and MIC 80 values of bacteria, which are the most important indexes, the former exceeded the latter in most bacterial strains examined except P. aeruginosa. These results indicate that LMOX is a useful drug in oral surgery.
Only a few cases of xanthogranuloma have been reported in oral and maxillofacial fields. In this paper, we present a case of xanthogranuloma associated with sialolithiasis. A 44-year-old male visited our hospital because of left submandibular region swelling. Salivary stone was found radiographically, in left submandibular salivary gland and duct. Salivary gland extirpation was performed under general anesthesia. During the operation, it was very difficult to distinguish salivary gland from circumference. Pathological examination of salivary gland and mass, which seems to be lymphanode, revealed that these were xanthogranulomatous sialodenitis and xanthogranuloma respectively. Xanthomatosis, including xanthogranuloma, sometime is accompanied with hypercholesterolemia. However, serum cholestorol in this case was within normal limits. We reported a case of xanthogranuloma in submandibular region with a review of literature.
The plunging ranula is thc rare mucocele that extends to the submandibular region. A case of plunging ranula is presented. Thc patient is a 2-year-old male. Though there are many treatment procedures for this disease, we extraded both the eyst wall and sublingual gland. Two years after the operation, no special abnormality was recognized. We considercd that the analysis of amylase activity in the eyst fluid is valuable for diagnosis, becausc it is higher than that of the serum.
The chief complaints of multiple myeloma are commonly described as weakness, skeletal pain, and arthralgia. Oral manifestations of multiple myeloma are rare in Japan. In our Department of Oral Surgery, Sapporo Medical College, from 1976 to 1986, multipul myeloma was seen in only one of 325 oral malignant tumor patients. This study reports on this particular case. A 51-year-old man having a mass formation in his posterior mandible of the right side is described. He had biphasic IgD-λ type M-proteins in serum and Bence-Jones protein of λ type in urine, and he also had OKT 4 epitope deficiency.
In the operation of lip carcinoma, although it is important to completely remove the tumor in this region, it is equally important for immediate reconstruction for patient's prompt social return. In the present, many study reports of lip carcinoma recommend immediate reconstruction. There are four reconstructive classified methods: Abbe-Estlander method, mental flap method, buccal flap method, and distal flap method. In this report, we performed immediate reconstructive operation in two cases according to Fries method. This method is a modification of the Bernard method which belongs to buccal flap method. In consequence, satisfactory results were obtained from functional and aesthtic standpoints.
Neurilemmoma is known to be a relatively rare disease, especially in the regions of the jaw and oral cavity. The majority of such tumors reported have been in the tongue, but occurrence in the floor of the mouth is rare. In this report we presented a case of neurilemmoma in the floor of the mouth together with its electronmicroscopic and histochemical studies, and reviewed 14 cases of neurilemmoma in the region of the floor of the mouth as reported in the Japanese literature. The patient, a 72-year-old man, was referred by his dentist with a chief complaint of swelling in the right floor of the mouth. He first noted the painless swelling in the right floor of the mouth with no other symptoms about 2 years ago. On physical examination, there was a well-defined nodular mass which was the size of the tip of the thumb. On palpation, 4, part of the mass revealed fluctuation but an attempted aspiration with an 18 gauge needle yielded nothing. Under the clinical diagnosis of benign salivary gland tumor, the lesion was surgically enucleated with little difficulty. The removed spherical mass was encapsulated by thin film, and composed of several multilobulated nodules, measuring 2.7×2.1×1.7cm, 5g in weight. The cut surface revealed the formation of several microcysts 2 to 3mm in diameter. Histopathological study revealed it to be a neurilemmoma of type A and B. In addition, an immunohistochemical study using the antibody of S-100 protein was carried out and revealed the reactivity in parenchymal cell. Postoperative healing was uneventful and there is no evidence of recurrence after 2 years and 3 months.
The clinical investigations on the malar bone fractures treated in the past 5 years are reported with a proposal of the direct operative method for the arch fractures. Out of 31 malar fracture instances, 25 arches were involved. Persisting jaw trismus, however, was sometimes noticed immediately after the injury was observed in only a few cases. In 15 cases of the arch fractures complicated with the clear deformity, persistant jaw trismus or other fractures, the direct approach method was applied without sequence of facial nerve. Some merits of this surgical technique such as operative easiness, exact reduction and no requirement of the fixing equipment are advocated in view of the good results of the experience.
Malignant melanoma of the skin is now classified into four major types: 1) lentigo maligna melanoma (LMM), 2) superficial spreading melanoma (SSM), 3) nodular melanoma (NM), 4) acral lentiginous melanoma (ALM). However, classification of melanoma of the oral mucous membrane has not yet been well-documented. We discussed clinico-pathologically our nine oral melanoma cases and the following findings were obtained. 1. Eight of nine cases showed three lesion phases clinically; a nodular lesion (A-phase), a plaque lesion (B-phase), and a macular lesion (C-phase). 2. Histological examination revealed spindle or epithelioid tumor cells in A-phase, pre-invading tumor cell nests resembling pagetoid tumor nests in B-phase, proliferation of dendritic melanocytes or simple hyperpigmentation along the basal cell layer in C-phase. 3. According to the above findings, eight cases were interpreted as ALM, while one case lacking for B-and C-phase was considered as NM.
Today so many antibiotics are available to clinicians, so treatment of infections is easy. However it, is still difficult if patient's defenses are compromised, for instance, DM. We experienced a case of temporal phlegmon. The patient was a 46 year old man having DM. for 9 years. He was admitted to our clinic and was given IVD infusion and incisions. Then phlegmon seemed to be cured, but he had a relapse. We found that IV antibiotics infusion was not effective, so the patient was placed on a regime of 250 mg intraarterial CER infusion via suprathyroid artery 3 times a day for 6 days. The patient then had an uncomplicated course.
Two cases of cervical tuberculous lymphadenitis are presented. The first was a 63-year-old woman, complaining of tumors in the lateral neck region. Both tumors were clearly separated and elastic hard. One tumor was movable in the submandibular region, but another tumor in the neck region was not well in mobility. Clinically, neoplasm was suspected and extirpation of the tumors were carried out. Histopathological examination of the enucleated materials revealed central caseous necrosis with Langhans' giant cells and proliferation of epitheloid cells. The two tumors were diagnosed as tuberculous lymphadenitis after considering positive reaction of tuberculin skin test, acceleration of ESR and histopathological findings. The second case was a 64-year-old man, complaining of tumor in the submental region. At first examination the tumor was found to be thumb finger size, clearly separated and elastic hard. This tumor increased in walnut size with reduction mobility of in a week. Malignant neoplasm was suspected and extirpation of the tumor was carried out. Histopathological examination of the enucleated material revealed central caseous necrosis with proliferation of epitheloid cells. The tumor was diagnosed as tuberclous lymphadenitis after considering positive reaction of tuberculin skin test, acceleration of ESR and histopathological findings. In both cases, tubercle bacilli were not observed and the chest X-ray films showed no pulmonary tuberculosis. Because clinical symptoms of cervical tuberculous lymphadenitis resemble that of malignant neoplasm, care should be taken at diagnosis.
Type I dentinal dysplasia is a rare hereditary disturbance in dentin formation and is mainly characterized by teeth with short blunt roots and partial or complete lack of pulp chambers. This report describes the clinical and radiographic features of type I dentinal dysplasia in a 26-year-old man, with a review of literature.
Vascular lesion of the jaws are rare but special consideration should be paid because of the potential for fatality. A case of arteriovenous fistula of the mandible was reported with its course and treatment. A ten year-old girl was admitted to our hospital as an emergency with a bleeding of the left gingiva of the mandible. Orthopantomography showed an irregular radiolucency extending from left canine region to mandibular ramus. Angiography proved arteriovenous fistula of the mandible, and the main vessels to the lesion appeared to be the left external carotid artery and the abnormal extension of right inferior alveolar artery. Operation was postponed because the patient was young and her lesion was very large, so brisk bleeding and danger to her life was predicted during operation. Her course was closely watched for about four years. During this early period, she came several times by ambulance because of gingival bleeding, but during the middle period no gingiva bleeding or radiographically decrease of the lesion were noticed. Although in the latter period, frequent gingival bleeding and lesion enlargement were observed again. She was operated on at age fifteen. The left external carotid artery, afferent and efferent vessels to the lesion were ligated and marginal resection of the left mandible and enucleation of the tumor were carried out. The postoperative course was entirely good and without com
A 68 year-old-female with keratotic basal cell carcinoma in the upper lip was referred to Iwate Medical University Dental Clinic. Two-thirds defect following surgery of the tumor was immediately reconstructed using Webster's technique due to the modified Abbe flap, in which the incisions to relieve tension in the bilateral peri-alar and labiogingival sulcus were added. One year later the patient was quite satisfied with the esthetic and functional results of insertion of upper and lower partial dentures.
We recently experienced two cases of hemangiomas with phlebolithiasis. The first case was a 67-year-old woman who complained of tumor of the tongue. The tumor contained 4 calculi. The second case was a 12-year-old girl with chief complaint of painless swelling at the right submental region. The tumor was located in the anterior belly of digastric muscle and contained 2 calculi. Both tumors were extirpated with ligation and histologically diagnosed as cavernous hemangiomas with phleboliths. In the tumor tissues, several thrombs with various degrees of organization, fibrosis, hyalinization and calcification were observed. From such histopathological findings, it was indicated that phleboliths should be completely or remarkably calcified thrombs. We also discussed 45 cases of such diseases of head and neck regions reported from 1982 to 1986 in Japan.
Warthin's tumor is comparatively rare epitherial benign tumor of the salivary gland. Embryologically, the tumor is believed to be derived from ductal tissue that became trapped in a lymphnode, although there is also some feeling that this tumor may be multicentric in origin. A case of multicentric unilateral Warthin's tumor was experienced in a 61-year-old man who had a pigeon egg sized mass in the left parotid region. As pre-operating diagnosis was parotid gland tumor, we did a superficial parotidectomy. Microscopically, evidence of multicentric foci was sought in normal parotid gland. As a consequence the histopathologic diagnosis was multicentric Warthin's tumor. There was no sign of facial nerve paralysis or recurrence at about 6 months after the operation.
The hamartoma is a relatively rare tumor in the mouth. It has been reported in various organs, including the liver, spleen, kidney and lung. We recently experienced a case of hamartoma arising from the tongue. A fifteen year old boy complained of the tumor of the tongue which had been present since two months after birth. The tumor was removed under general anesthesia, which was histopathologically leiomyomatous hamartoma of the tongue. Neither recurrence nor metastasis was seen after the operation.
Xerostomia is dryness of the oral mucosa caused by reduced salivary secretion. The condition may be due to diseases of the salivary glands, secretory nerve disorders, and systemic diseases, but there is currently no effective treatment. We administered the herbal preparation Syousaikotou consisting of Saiko mixed with glycyrrhiza and ginger which have long been used in Chinese medicine to improve taste and smell, in patients with xerostomia. The subjects were 19 patients with oral xerosis admitted to, or regularly visiting, the Department of Oral and Maxillofacial Surgery, Shiga University of Medical Science, Department of Dentistry and Oral Surgery, Otsu Municipal Hospital, Department of Dentistry, Kyoto City Hospital. These patients consisted of 12 with uncomplicated oral xerosis, 5 with Sjögren's syndrome, and 2 with radiation-induced oral xerosis. This preparation (granular extract, Tsumura) was administered 5. 0 daily for 2 weeks to 6 months. Subjective, objective symptoms and salivation was evaluated before and after the administration period. The outcome of treatment was expressed in five stages as markedly improved, improved, slightly improved no change and got worth. An increase in salivation was observed in 16 patients. Subjectively, the condition was markedly improved in 2 and improved in 3; objectively, it was markedly improved in 3 and improved in 5 patients. The preparation was considered to deserve further evalution as a treatment of xerostomiasis.
Postoperative management of nutritional aspects is one of the major problems in dentistry, especially in oral and maxillofacial surgery. In this report, clinical results of Besvion® as enteral nutrition are presented based on 40 patiens in oral and maxillofacial surgery. The results were as follows. 1) Thirty seven patients could take Besvion® orally. 2) Thirty five patients were evaluated as effective according to the criteria determined by the body weight change ratio. 3) Side effect most often seen was diarrhea, but it was transient and posed no problem for long term use of Besvion®. 4) It was concluded that Besvion® was useful nutrient in oral and maxillofacial surgery.