The subjects were 29 patients under 20 years old (6 males and 23 females: T-group) of TMJ arthrosis who visited the Department of Oral Surgery at Nagoya University Hospital, the Department of Dent-Oral Surgery at Nagoya University Branch Hospital and the Lion Foundation for Dental Health.They were classified on the relation of the first molars occlusion with their plaster models of dentition. And so, on their cephalograms, 16 angular, 11 linear measurements and 6 ratio of two lines were analized and compared with those of 117 females under 20 years who did not have TMJ arthrosis (N-group). The following results were obtained: 1. The result of classification of their occulusion showed no existence of normal occulusion and Angle class I: 7 (male O, female 7·T-I), calss II: 15 (m. 4, f. 11: T-II), class III: 7 (m. 2, f. 5: T-III) 2. On T-I group, frontal growth of the maxilla and the ramus height of the mandible were apparently inferior to those of N group, the mandibular plane angle was larger, and the mandible showed clockwise rotation. 3. On T-II group, low frontal growth of the maxilla, more uprighting of the upper central incisor, and low growth of the ramus height and the mandibular body length, and clockwise rotation and retrusion of the mandible were observed. 4. On T-III group low frontal growth of the maxilla was observed. From the results, it was guessed that TMJ arthrosis in young people of these patterns of the growth of maxilla and mandible were closely related to discordance with Mm.masticatorii or the lack of resting occulusion.
The study of measuring perioral muscle pressure has a long history with many investigations.The measurement methods of perioral muscle pressure varied greatly, however, most studies were concerned with the measuring instruments.Because of the complexity of oral function, it is difficult to catch the functional forces of perioral muscle exactly. So, the measuring instruments have been improved repeatedly. We also developed a new cantilever type pressure transducer utilizing a strain gauge.This transducer has box appearance 8×4×1.6mm in size.The 2-active gauge method was employed to provide compensation for temperature change.In the functional test, the result confirmed that this transducer was useful for clinical analysis.
Tumor blood vessels (TBV) play an important role in the growth of tumors and in cancer therapy.There has been much literature on the vasculature of TBV, but little work on TBV in the human oral region.So the purpose of this study was to clarify the ultrastructure of TBV in human oral squamous cell carcinoma.Conclusions are drawn as follows: I.Normal blood vessels in oral mucous membrane partially showed endothelial fenestrations with diaphragm (F. D.), but endothelium without F. D.was dominant.The numerical ratio of the former to the latter was about one to four.On the other hand only endothelium without F. D.existed in the blood vessels of tongue muscle. 2.In TBV in the untreated cases there were some morphological characteristics. 1) The ratio of the number of endothelium with F. D.to ones without F. D.increased twofold, and discontinuous endothelium (gap) appeared.The gap and F. D.always showed coexistence in the same vessels. 2) Irregular surface, especially numerous luminal processes, characterized the configuration of endothelial cells. 3) Markedly elongated tortuous and dilated junctions were frequent. 4) Two special cell components were observed: Weibel-Palade granules and tubuloreticular inclusions. The above-described findings, seen mainly in TBV with a diameter of about 20μ, suggested that the permeability of TBV increased considerably. 3.On the other hand, tumor capillaries with a diameter of less than about 8μin the untreated cases were composed of plump endothelial cells with low electric density due to sparcity of cell organelles.A number of mesenchymal cells, which surrounded these capillaries, may be related to angiogenesis. 4.After exposure to X-ray with combinations of bleomycin TBV changed ultrastructurally. In the earlier period, lysosomes and microfilaments in the cytoplasm of the endothelium and irregularity of the nucleus appeared.During the period in which the treatment was completed, the number of lysosomes and microfilaments increased frequently.Furthermore, thrombosis, necrosis of endothelium and destruction of vessels was observed. Namely exposure to X-ray with combinations of bleomycin was presumed to have damaged the endothelium of TBV.
Concerning 23 patients diagnosed as having head and neck region malignant tumor, we studied PPD, PHA, Su-PS skin reaction, and the change of blood lymphocytes subpopulation using the OK series monoclonal antibody. Skin reactions showed tendencies of decrease in the following order: good prognostic cases, cancerous cases, and death cases. In regard to OKT-3+, OKT-4+, OKT-4+/OKT-8+, they showed tendencies of decrease in the following order;good prognostic cases, cancerous cases, and death cases. We didn't get a significant correlation coefficient from OKT-8+, OKIal+. The OKT-4+/OKT-8+decreased in the case of operation, and irradiation therapy.
An improved assay method for interleukin 1 (IL-1) using murine (C3H/He) thymocytes has been developed.First, the responder cells to IL-1 among the thymocytes were characterized using the fractionated cells by peanut agglutinin (PNA), PNA-agglutinable (PNA+) and PNA-nonagglutinable (PNA-).PNA-cells, which were of Thyl+TL-TdT-matured medullary type, demonstrated substantial levels of proliferation after stimulation by human recombinant IL-1β(rIL-1β) in the absence of mitogens.Cells with a low density, which were isolated by Percoll-discontinuous density gradient and enriched of PNA-cells, also demonstrated a mitogenic response to rIL-1β in the absence of any other stimulants.This mitogenic response of PNA-thymocytes to rIL-1β was completely abrogated by removal of adherent cells from the PNA-cells or addition of monoclonal antibody against haplotype specific Ia antigen (Iak) in the cells, suggesting that the IL-1-induced proliferation of PNA-thymocytes may be dependent upon Ia antigens on the adherent cells.This IL-1 assay method using Iadependent response of PNA-thymocytes to IL-1 was found to be much more reproducible and reliable than the conventional concanavalin A co-stimulator assay method.Using the method, IL-1 activities either in the culture fluids of macrophages/granulocytes stimulated by inducers or those inside the cells could be easily determined.This PNA-thymocyte assay could also effectively be used for the suppressive effect of anti-inflammatory or anti-rheumatic drugs on macrophage IL-1 production.Thus, the method should be valuable for experimental and clinical studies of IL-1 production in healthy or diseased animals and people.
Serum TA-4 was examined in patients with oral diseases and the following results were obtained. 1) TA-4 was peculiar to oral squamous cell carcinoma. 2) TA-4 was useful to diagnose patients in progressive stages, though it was not helpful with patients in early stages. 3) TA-4 was more sensitive than other tumor markers. 4) Serum TA-4 levels reflected the conditions of patients quickly, so TA-4 may be useful for evaluating regression or progression and detecting recurrence in oral squamous cell carcinoma.
We have experienced using the Nd-YAG laser on oral regions. Five leukoplakia, five lichen planus, three hemangioma and one case of hyperplasia of gingiva cases were given Nd-YAG laser beam treatment, and we had good results;so this report is presented. Laser therapy for oral region diseases is considered to be available, used under the proper irradiated condition according to the ocurrence, nature of the objective region.
We encountered a 48-year-old man who had masticationary dysfunction since be had his 67 teeth set in a cast crown about four years ago. There was also a mass located in the left cheek. This mass was diagnosed as benign hypertrophy of the masseter muscle, and the masticationary dysfunction was treated with jointguard, resin temporary crown, permanent crown and bridge. One year and two months after treatment the masticationary dysfunction almost disappeared and the hypertrophy of the left masseter muscle showed shrinking tendency.
Cat scratch disease developed on submental region of a 17-year-old girl was reported. The patient visited our clinic with complaints of swollen submental region and slight tenderness.Chemotherapy of antibiotics or steroid hormone against this lymphadenopathy were not effective.Examination of enucleated lymphonodes by a pathologist resulted in a diagnosis of cat scratch disease that marked growth of epithelioid cells and multiple small abscess.Further, about two months previously, she had been scratched submental region by a cat.
Two cases of salivary calculus in parotid gland duct were reported.Morphological observation on salivary calculi was carried out on the scanning electron microscope (SEM) and X-ray microanalyzer in case No.2. These results of SEM findings were consistent with those of many investigators.The Xray microanalysis showed the salivary calculi contained chemical elements such as Ca and Pions. The results of the present study were discussed together with the literature.
Eight cases of erythema exudativum multiforme (EEM) with involvement of the oral mucosa are reported. The diagnosis was made on the basis of the total clinical picture, including differential diagnosis from herpetic gingivo-stomatitis, recurrent aphtha, pemphigus and pemphigoid. Five cases of moderate to severe EEM were treated with systemic corticosteroid; an initial dose of 1.0 to 3.0 mg/day of bethamethasone was administered for several days and then gradually reduced. Corticosteroid was given for 7 to 17 days (mean 11.6 days). This treatment appeared to be helpful in shortening the healing time of this self-limited disease (EEM). Other mild cases (3 cases) were treated with topical use of a steroid ointment and soothing mouthwashes. Seven cases had history of taking drugs such as cold medicine prior to onset. But the etiology of EEM is not yet obvious.
We report on five of thirty-seven cases which were treated by applying the system of Champy osteosynthesis. The flexible and easy bending plate of this system can make good adaptation to the bone surface. Moreover this surgical technique is systematic and simple, so can be used in many types of maxillofacial fractures, mandibular reconstruction, and surgical treatment of jaw deformities, etc. We are convinced that this system is very advantageous for maxillofacial osteosynthesis.
Clinical and histological characteristics of 19 cysts that occurred symmetrically in the anterior portion of the midline maxilla were studied. Radicular cysts in the incisal region were excluded because they did not fit to the above category. Twelve were non-dentigerous developmental cysts and palatal swelling was found more often than in the other group of cysts with an unerupted supernumerary tooth, and the bony defect of the palate was noted in 11 cases.Radiographically, nasopalatine duct cyst was suspected in 8 cases, but the other 4 cysts presented the features consistent with those of median palatine cyst and in one the normal structure of the incisal canal was clearly recognized in the cystic radiolucency, although the relationship was confirmed at operation. Pseudostratified ciliated columnar epithelium was the main lining element in 8 cases.Mucous cells and Goblet cells were frequently seen. Neurovascular bundles were found in 8 cases and the subepithelial blood vessels were arranged parallel to the epithelial layer.Diagnosis of nasopalatine duct cyst was suspected in all cases. The other 7 cysts were dentigerous cysts with a swelling on the labial aspect of the anterior maxilla.The lining epithelium was stratified squamous epithelium and mucous cells and neurovascular bundles were noted in 2 cases, but differential diagnosis was easy because of the presence of the crown of an unerupted tooth in the cystic cavity. The results indicate that the cyst occurring symmetrically in the anterior portion of the midline maxilla is either nasopalatine duct cyst or dentigerous cyst and the possibility of median palatine cyst or radicular cyst is comparatively low.
Surgical resection of the mandibular bone or surrounding tissues is followed by immediate or secondary reconstruction. Of vital importance are accurate, aesthetic reconstruction of original facial features and restoration of function. Precise dimensional measurement of the surgical area before, during and after operations in individual patients is indispensable. However, a precision gauge suited exclusively for use in mandibular reconstruction has not been develpped so far. Consequently reconstruction has depended on unreliable techniques, usually visual judgements. This occasionally resulted in unexpected depression of the mandibular angle, or facial asymmetry or deformity due to a delicate difference in the thicknesses of surrounding soft tissues. To solve this problem, a precision gauge was newly devised and clinically applied. This instrument facilitated satisfactory and aesthetic reconstruction of the mandible. This instrument is of stainless steel and has a maximum length of 45.5 cm and width of 12cm. The center shaft is mobile. The chin rest at the lower end of the shaft is applied to the anterior center of the chin. This rest is gently curved so to fit the curvature of the chin. The straight shaft is hooked at the lower end to erect vertically upward in the median line of the face. This straight shaft thus passes through the philtrum and nasal apex to the glabella. The 2 clawed arms of the semicircular protractor are adjusted so that the calws will fit bilaterally to the surfaces of the mandibular angles. The arms arc widened or narrowed by sliding the central bar which is stopped by a screw. Preoperative values of the position of the center shaft and the angle of the protractor are recorded and referenced during and after the operation. By obtaining the same values during the operation, the preoperatively bilateral asymmetry can be easily ensured. Many clinical applications produced satisfactory results in the reconstruction of the mandible including the angle. This instrument may be considered to have a significant value.
Facial paralysis in children is very rare in comparison with adults. This time we had the case of a facial paralysis in a six year old boy who came to our department with left cheek swelling as his main complaint. After giving antibiotics and steroid, the paralysis disappeared with the decrease of the left maxilla infection symptom.
A case of organized aneurysm derived from the branch of the external carotid artery was reported with brief reference concerning with the etiology and differential problems of the disease. A 54-year-old man complained of painless, persistent swelling of the left side submandibular and the upper neck region was refered for treatment. By bimanual palpation on both the skin and the oral mucosa an elastic, firm, smooth and relatively movable egg size mass was revealed. The overlaying soft tissues were normal and the salivary gland was not affected. The clinical findings and his history suggested the lesion to be benign tumor, and removal was done. During surgery, connection of the lesion with the facial artery at its origin was found. The excised tumor was microscopically examined using H. E. and Van Gieson's st, tiis. The lesion was composed of two layers and a number of cystic cavities in the central rct-zitia in which hemosiderin was included and thrombus was formed. The outer layer wa yellowish by picric acid and inner thickened layer in reddish brown by acid fuchsin. Histopathololigcally, the tumor-like lesions was thought to be aneurysm with advanced org, nization of the thickened tunica intima, and the diagnosis agreed with the surgery finding.
Two cases of the thyroglossal duct cyst are reported. The first case had two cystic cavities which reached to the underportion of the hyoid bone. The second case showed a fistular type which ended just in front of the hyoid bone. The median part of the hyoid bone was resected enblock with the cyst in the first case. In the second case, resection of the bone was not made. Necessity of hyoid bone resection at cystectomy is briefly discussed.
Two cases of long-standing bilateral forward dislocation of the mandible are presented. Both patients were successfully operated on by eminectomy after Myrhaug's description. Case 1: A 62-year-old woman visited our clinic, complaining of both forward displacement of her chin and difficulty in closing her mouth for 37 days. Manual reposition was tried without success. Open reduction according to the Myrhaug's epinectomy was performed under general anesthesia. Case 2: A 74-year-old woman visited our clinic, complaining of masticatory disturbance for 57 days. After unsuccessful manual reposition, open reduction according theMyrhaug's procedure was done under general anesthesia. Postoperative courses of both patients were satisfactory. The reason why luxation was not immediately reduced but left untreated andthusbecame long-lasting cases was that dislocation of the temporomandibular joint was not noticed by surgeon, physician or otolaryngologist whom both patients visited.
43 cases of primary carcinoma of the bilateral maxillary antrums had been reported in Japanese literature between 1937 and 1978.However, in the field of oral surgery there has been no report on this type of the maxillary carcinoma. This paper described a case of the synchronous carcinoma of the bilateral maxillary antrums in a 72-year-old female who was asymptomatic subjectively and objectively at the first visit to our clinic with complaint of unstability of the upper denture. However, radiographic and C. T. scanning examinations revealed destructive and absorptive changes in the bilateral maxilla and the zygoma. The histopathological examinations of the specimens taken from the bilateral antrums revealed undifferentiated squamous cell carcinoma. Based on careful analysis of the past history, clinical findings and histopathological evidences, we concluded that this tumor had developed independently in each sinus and was a synchronous primary double cancer.
Hemangioma is a dysontogenic malformation which appears as a tumor-like lesion predisposing head and neck areas. This report represents the detailed description of a case of cavernous hemangioma with phleboliths adjacent to the right submandibular gland. A 16 year-old Japanese girl was referred to the clinic with a chief complaint of a submandibular swelling which enlarged during and after meals.The salivary flow from the right submandibular gland was rather lower than that of the opposite side. Roentogenograms showed several radiopaque masses at the right submandibular area suggestive of sialoliths. However, sialograms indicated that these masses were not construed as submandibular gland. Moreover the swelling was fluctuant and blood could be aspirated by puncturing. Under the diagnosis of hemangioma, the tumor was extirpated, which was about 4 cm in diameter and histologically diagnosed as a cavernous hemangioma with several phleboliths. Phleboliths mostly consisted of hydroxyapatite by X-ray diffraction analysis. The clinical symptoms disappeared and there is no recurrent.
We have reported a case of 65 year-old woman in which a large neurilemmoma occurred in the infratemporal fossa and presented clinically as a swelling in the cheek. It contained a cystic degeneration cavity and inner fluid. The tumor was removed en block by intraoral surgical approach. Histopathological findings were neurilemmoma (Antoni A and B type). Biochemical analysis of the inner fluid revealed declination of protein involvement compared to serum.
We had a case of foreign bodies in the right temporal by traffic accident. June 12, 1985, a 22-year-old female was referred to our hospital with a complaint of traumatic trismus.22 days previously she had been transferred to a surgical hospital after the right side of her face hit the windshield in the traffic accident May 20, 1985.She was hospitalised for 21 days.A computed tomographic (CT) scan and radiographic appearance showed foreign bodies in the infra temporal region.We removed the foreign bodies consisting of 38 pieces of glass and 70 hairs under general anesthesia.The patient freed of trisumus after operation and is quite satisfied.
Basal cell adenoma, which belongs to other types of monomorphic adenoma by WHO classification, is a very rare salivary gland tumor. A case of parotid tumor we experienced was a 73 year old female. It was diagnosed adenolymphoma in the first inspection because of its softness and variation in hardness but it also seemed probably to be a mixed tumor during follow-up. Finally it was confirmed as basal cell adenoma.The report of its finding in computed tomography and scintigraphy was presented.
A new intensive methotrexate-5-fluorouracil regimen (MF therapy) prior to surgery and posterior to the treatment of advanced squamous cell carcinoma of the head and neck is presented, employing twice-weekly parenteral low doses of methotrexate, once-weekly parenteral low doses of 5-fluorouracil and parenteral doses of leucovorin 24 hours following methotrexate. Toxicity and therapeutic results in patients treated with this regimen compare favorably with results of weekly administration of high-dose methotrexate. Partial response (PR) was observed in five of seven cases (71%) treated on the intensive low dose schedule. Two cases showed minor responses (MR). All patients are alive and have no recurrence. This initial chemotherapy is highly effective in the treatment of this group.
Neurilemmoma (Schwannoma) is a relatively rare tumor and rises from Schwann cell of the peripheral nerve sheath. A case of neurilemmoma of the hard palate is presented. A 12 year-old boy was referred to our clinic complaining of a tumor of the palate, for which he received extraction of the left upper second deciduous molar and incision.The tumor was removed under local anesthesia. The histological findings revealed the neurilemmoma and peroxidase anti-peroxidase (PAP) method of this tumor showed positive immunoreaction for S-100 protein. The neurilemmoma of the hard palate is not common and the clinical features are discussed with review of literature.
Pleomorphic adenoma is the most common of all salivary gland tumors, This tumor frequently affects major salivary glands, but sometime occurs in minor salivary glands. It is relatively rare that this tumor occurs in the cheek. We experienced a case of pleomorphic adenoma of the cheek with recurrences in a 62-year-old female. The patient had the removal of pleomorphic adenoma of the cheek twice in the past, but it recurred each time. The present tumor was surgically removed under general anesthesia. The tumor was pathlogically diagnosed as pleomorphic adenoma. Fifteen months after surgery, the patient showed no evidence of tumor recurrence.
Verruciform Xanthoma with histopathological characteristics of verruciform growth and the proliferation of xanthoma cell in the lamina propria was first described in 1971 by Shafer as Histiocytosis-Y. Though occasionally reported later in occidental countries, this disease is relatively rare. Especially in Japan this disease is rarely documented. The gingiva is a common site of occurrence. Those occurring in the tongue or buccal mucosa are very rare. Recently we encountered a 64-year-old woman with this disease in the left lateral margin of the tongue.
Two cases of reconstruction of postoperative defects of the mandible, mouth floor and tongue with the free radial forearm flap are presented. The patients were 63-and 61-yearold females.Both cases had advanced squamous cell carcinoma of the gum extending to the mouth floor and tongue (T4N1M0). Their postoperative courses were uneventful and the only postoperative complication was paresthesia around the anatomical snuffbox of the hand. The free radial forearm flap is thin and pliable, therefore postoperative recovery of function and shape are satisfactory. This flap seems to offer great versatility and wide possibilities of application. The long and large vessel pedicles make anastomosis simple and reliable. Consequently we consider the free radial forearm flap to be excellent for intra-oral reconstruction.
Multiple primary cancer was first recorded by Billroth in 1889, since then the number of cases reported has increased every year. Opportunities for the discovery of synchrous or metachronous multiple primary cancer have accompanied the development of therapy and diagnosis techniques for malignant tumors. In the 9 years from 1976 to 1985, our oral surgery division detected 12 cases of multiple primary cancer out of the 128 cases of oral cancer treated. We analyzed the occurrence and the different combination of organs in which multiple primary cancer occurs.5 of the 12 cases located within the same oral region were found to be multiple primary cancer (41.7%). There were 2 cases where the occurrence of epidermoid carcinoma was detected in the previously affected area, occurring long after the radiation therapy treatment of tongue cancer ended. In regard to the periodic examinations which follow oral cancer treatment, special consideration should be given to the detection of multiple primary cancer, as well as the regeneration and spread of primary cancer. Periodic examinations are an important part of the follow-up process, and continue to play an important role long after radiotherapy treatment has ended.