Ten cases of malignant lymphoma examined clinically, histopathologically and immunophenotypically are reported. 1) This study comprised of 8 males and 2 females patients; the majority advanced in age. Half were nodal lymphomas and half were extranodal. 2) According to Ann Arbor staging classification, 3 cases were seen in each of Stages I, II and U. One case was excluded because it was a relapse. Histologically, all were non-Hodgkin's lymphomas comprising of small lymphocytic (1), mixed small and large cell (1), diffuse large cell (2), large cell, immunoblastic (4) and small non-cleaved cell (2), according to the Working Formulation. Six were of high grade malignancy. 3) The immunophenotypic analysis for surface markers examined in 8 cases revealed that seven had characters of B-cells and only one had those of T-cells. 4) Cases of Stage I or II were usually treated with irradiation in the past. But chemotherapy combined with radiotherapy has recently been put into practice even for most cases in these Stages. 5) Only one patient is now surviving. The results clearly show that the prognosis of malignant lymphoma, especially in high grade, is extremely poor.
Concentration and term of chemical carcinogens must be the most important variants for their effectiveness. A two-phase carcinogenesis experiment induced by a chemical carcinogen (DMBA) was conducted. The purpose of this experiment was set on the verification of the most suitable concentration and term for the two-phase carcinogenesis that is induced by identical on hamster's buccal pouches. A 10-week application of 0.1% DMBA acted as an initiator and a 6-week application of 0.5% DMBA did as a promoter. The reverse order of those two did not induce tumors.A 6-week interval (intermission) between those two was the most suitable for this carcinogenesis model. Those results were unexpectedly similar to Odukoya and Shklar's work (1982). Only a 10-week application of 0.1% DMBA or a 6-week application of 0.5% DMBA caused no tumors at all. The effect of the 10-week application of 0.1% DMBA for an initiator was not reversible for at least 8 weeks. Although the method of this experiment is not along with that of Berenblum's two-phase carcinogenesis, this experiment shows clearly that there are two or more phases in the process of the DMBA induced carcinogenesis.
Using the 2-D data provided by CT-Tomography and MRI-tomography of oral and maxillofacial diseases (cyst, benign tumor, primary tumor and regional lymphnodes of malignant tumor), 3-D images were reconstructed and spatial analysis was attempted. We report the general concepts. The hardware used consisted of the Hewlett-Packard HP-9000/300, which utilizes a 16-bit CPU. A digitizer was used to construct 3-D images from serial CT-tomography and MRItomography images. Output was displayed on a color monitor and photographs. The 3 cases on which we usedthis technique included a 19-year-old male with plunging ranula, a 50-year-old male with maxillary pleomorphic adenoma, and a 58-year-old male with squamous cell carcinoma of the maxillary sinus (T3N3M0). As 3-D reconstruction can be done in any arbitrary direction or cross section, it is possible to spatially determine the position of the disease inside the body, its progression, and its relationship with adjacent organs. Through image analysis, it is possible to better understand the volume and surface area of the disease. 3-D image reconstruction is an effective tool in the determination of diagnosis, therapeutic guidelines, and surgical indications, as well as effectiveness of treatment.
We studied in-vitro antibiotic activity against isolates from oral infections and also distribution to oral tissues after administration of Ceftazidime (CAZ, Modacin®), and following results were obtained. An 80% MIC level of Ceftazidime was measured against a total of 181 strains isolated from 39 clinical cases with oral infections. The peak MIC level was 1.56 μg/ml. Concentration of Ceftazidime on human oral tissues after 1 g administration in the gum and cyst wall ranged from 10 to 50% of the serum level at highest. The peak concentration in bone was about 14.3% of the serum level, which was relatively lower than that in the gum and cyst wall. The half life of serum concentration was about 99 minutes. The above results suggest that ceftazidime was useful in chemotherapy of oral infections diseases.
The experiment on the three-dimensional movement of specimens of small-, medium-, and large-typed mandible was made, and the following results were obtained. 1. The positional changes of the lower first incisor, point B, Pogonion, and Menton on the lateral head films were to be within only 1 mm, even if the occlusal plane of the specimens were given the rotary movement less than 6 degrees in the frontal plane or less than 9 degrees in the horizontal plane in two dimensions. 2. It was considered under an additional clinical study that the rotary movement of the mandibular occlusal plane in the frontal plane and horizontal plane, individually in the two dimensions or in the more complex three dimensions, had little effect upon the positional changes of the lower first incisor, point B, Pogonion, and Menton on the lateral head films on general cases which were indicative of sagittal splitting osteotomy of the mandibular ramus.
In order to investigate the real condition of tongue cancer in Japan, a statistical survey was made on autopsied cases of tongue cancer, listed during 5 years (1982-1986) in the Annual of the Pathological Autopsy Cases in Japan. The following results were obtained: 1. A total number of 545 cases (Male 409, Female 133, Unknown 3) of tongue cancer were revealed. The average age at death was 59.2 ± 13.2 years in male, and 64.8 ± 14.1 years in female. 2. The autopsy rate of the cases with tongue cancer in Japan was 18.4 percent. 3. Tongue cancer was found most frequently in the 50-59 year age group (144 cases), followed by 60-69 year age group (142 cases) and 70-79 year age group (123 cases). These age groups totaled 75.0 percent of all cases of tongue cancer. 4. As to tongue cancer location, the lateral border was the most frequently affected site, and root of the tongue (30.5%) followed. The average age of cases dying from tongue cancer, originating from the lateral borders, was 61.8 ± 15.0 years; that from the tongue root was 62.2 ± 11.6 years, and that of the anterior site of the tongue was a comparatively advanced age (67.1 ± 11.6). 5. Histologically, 98.1 percent of the tongue cancer was squamous cell carcinoma. 6. In 43.4 percent of the cases with tongue cancer there was metastases both in the organ and lymph nodes; 33.8 percent of the cases had metastasis only to the organs, and 3.0 percent had metastasis only to the lymph nodes. Concerning the organs, the lung was the most common site (46.7%), followed by cervical soft tissue (22.0%), thyroid (14.6%), pharynx (14.6%), liver (13.8%), pleura (13.8%) and kidney (12.1%). The cervical lymph nodes were most frequently invaded (28.1%), followed by pulmonary hilur (13.3%), paratracheal (8.1%), supraclavicular (6.4%) and mediastinal (4.9%). 7. Of all tongue cancers, 117 cases of multiple primary cancers affected both the tongue and other organs were found (double cancer: 96, triplem cancer: 20, quintuple cancer: 1). Common organs with cancer which were combined with tongue cancer were stomach, esophagus, lung, colon, bone marrow, lymphatic tissue, and liver. 8. The causes of death not associated with tongue cancer were pneumonia, rupture of vessel, ulcer (perforation) and hemmorrhage in the digestive tract, hemmorrhage by tumor and fungal infection etc.
Renal osteodystrophy (ROD) was first reported by Virchow in 1855 and Lucas in 1883, but in the field of the oral and maxillofacial regions were reported for the first time in 1945 by Weinmann. ROD is one of the pathologic bone resorption' as in inflammatory bone resorption and tumor bone resorption. This study is carried out for purpose of finding a method by which bone lesions shown on mandibular roentgenogram can be evaluated objectively. There are very few methods that permit quantitative evaluation of the lesions. Therefore, this study is performed for objective and quantitative evaluation by correlating changes on the dental/mandibular roentgenogram with the duration of haemodialysis and clinical laboratory tests. Subjects consisted of 80 patients (54 male and 26 female patients) on haemodialysis 3 times weekly but without bone lesions in the measured region. Their age ranged between 24 and 65 years (average 45, 5 years). The patients were assigned to subgroups according to haemodialysis duration. Abnormal findings obtained in the study are summarized below. 1) In clinical laboratory tests, abnormal levels of P, PTH, Al, Mg and HCO-3 weredetected, showing the condition in which ROD could occur. 2) According to the interpretation of radiogram, lesions tend to increase in lamina dura, trabecula, mandibular canal and maxillary sinus floor line with the increase in duration of haemodialysis. 3) Significant difference in metacarpal index (MCI) were observed from 4 years after initiation of haemodialysis. As compared with control group, mandibular lower cortical thickness (MLCT) value of molar region decreased significantly from 2 years after initiation of haemodialysis, indicating that MLCT values can reveal ROD induced bone lesions earlier than MCI. 4) As compared with control group, mandibular trabecular width (MTW) values in the patients became more significant from 1 year after initiation of haemodialysis, showing that trabecular structure is affected earlier than cortical bone. It was thus suggested that the changes in trabecular structure occur at 2 year intervals after initiation of haemodial-ysis.
Actinomycosis, which is a granulomatous inflammation and difficult to heal, has become reatively rare due to antibiotics. We encountered one case of actinomycosis of the mandible which was suspected to be a parotid gland tumor, because of swelling at the parotid gland region, trismus, and multiple radiolucenies of the mandible. The granulation tissue was removed almost “en bloc” and curreted thoroughly at the resorbed region of the mandible. Pathologically the actinomycetic mass was found in the granulation tissue. For antibiotics, LMOX was given nine days post-operatively, and after diagnosed pathologically, AB-PC was given for twenty-eight days. Now, four years after the operation the patient has satisfactory ossification at his mandible without recurrence.
In oral surgery, an intraoral approach is naturally the most frequent route of access to the operation site. Compared to an extraoral approach, however, an intraoral approach is more liable to result in the development of postoperative swelling in the jaw due to hematoma or edema, often accompanying severe symptoms. Such swelling has so far been controlled by topical or systemic administration of steroid hormones, continuous suction drainage and compression of the facial soft tissue using conventional elastic bandage. However, the conventional elastic bandage has in most cases proved inadequate to achieve effective compression on the wound with evenly-distributive compressive force, because it has tended to exert excessive compression due to convergence of compressive force or to lose compressive force due to displacement of the bandage. Since 1985, we have used surgical garments chin-neck bandage POLLI® manufactured by Caromed International Inc., U. S. A., for the control of postoperative swelling. We have recognized a number of advantages demonstrated by these garments, This paper describes the favorable results obtained by use of these garments.
Discoid lupus erythematosus (DLE) is a chronic disease localized in the skin or mucosa, and systemic symptoms as usually seen in SLE are rerely noted. It is said that lesions are seen also in the oral mucosa in about 20 percent of DLE patients with dermal lesions, but little has been reported in Japan about the oral lesion of DLE so far. It may be caused by the difficulty of differential diagnosis. Because, the oral DLE is free from pathognomonic findings, its clinical findings are varied, it is similar to lichen planus, leukoplakia and other diseases, and it is particularly similar to the lichen planus histopathologically. We recently experienced a case of oral discoid lupus erythematosus in a 26 year-old female patient with lesions in the buccal mucosa and gingiva, and its outline is reported together with reference literature, mainly relating to distinction from lichen planus.
A case of multiple primary cancers was reported in this paper. One lesion arised in left mandibular molar gingiva to oral floor and another one subsequently in rectum, in a 58-year old woman with branchial cyst on her left neck. The patient came to our University Hospital with complaint of painless mass of left upper neck and the delay in healing of extracted wound on left lower molar region. The oral lesion was histologically proved to be squamous cell carcinoma by biopsy and servical lesion was considered to be branchial cyst by clinical symptoms. Both were treated by surgical operation. Oral cancer was treated by antitumor agent and radiation. Six months later, adenocarcinoma of rectum was found and was treated at the surgical department by surgical method and antitumor agent. Up to now, there is no evidence of recurence in either foci.
In order to obtain an effective closure of the anterior residual fistula following cleft palate surgery in case undergoing orthodontic treatment with brackets and arch wire, a new type of obturator seeking for its maintenance support to the remaining deciduous canine was invented. Its supporting system is constructed of a full cast metal crown for the palatally displaced deciduous canine as an abutment and the special clasp generating retaining force in cooperation with the metal crown. A case presented in this article showed an effective obturation and marked improvement in voice quality with this system. The high points of the system are summarized as follows; 1) the remaining deciduous canine as an abutment for the obturator is available. 2) the system does not interfere with simultaneous orthodontic therapeutic procedures. 3) the patient can obtain a smooth and comfort environment for speech, since the supporting system between the abutment canine and the obturator can be designed to be small enough.
Asymmetry of the lower third of the face, almost accompanying the deformity of maxilla or malocclusion, is ordinarily treated with repositioning osteotomy of maxilla or sagittal splitting ramus osteotomy for the purpose of the correction of occlusion. However, facial asymmetry is not completely corrected with such procedure in some cases, having laterognathism, condylar hyperplasia or temporomandibular joint ankylosis, resulting in a poor esthetic condition. In such cases, straightening genioplasty is indicated commonly. However, a case with significant asymmetry affecting the lateral aspect of the mandibular body cannot achieve straightening with this procedure. Consequently, onlay bone graft or alloplastic material implant is indicated to correct the remaining mandibular asymmetry. Recently, we introduced a Proplast® chin implant in a case of severe mandibular asymmetry. This is a report of our experience concerning treatment. A nineteen-year-old woman with a chief complaint of mandibular asymmetry resulting from a unilateral condylar hyperplasia was referred to our department. Primarily, the treatment was done to decrease the degree of asymmetry of mandible with the procedure of sagittal splitting ramus osteotomy and the ostectomy of lower portion of excessive mandibular body. However, the deficit of the right mental region was still remaining. We implanted a Proplast® chin implant to correct this asymmetry and obtained good esthetic result without any clinical problems.
Solitary neurofibroma of the tongue is very rare. A 60-year-old woman was referred to our clinic with the chief complaint of a tumorous lesion at the midline of her tongue. Under the clinical diagnosis of a fibroma, excisional biopsy was performed. The pathologic findings revealed a picture of a neurofibroma. The tumor cells were positive for S-100 protein and within the tumor were several nerve fibers positive for myelin basic protein by the immunohistochemical method. Neither caf é au lait spots nor other neurofibroma of the skin were noted. It was diagnosed as a solitary neurofibroma of the tongue, and this is the third case reported in Japanese literature.
In 1942, Stafne reported bone cavity of radiolucent lesion below the mandibular canal in the region between the foward part of the mandibular angle and the third molar. The cavity appears either round or oval, and the walls of the cavity are generally dense and thick. Other cases of this type of cavity or defect have been reported by many author after Stafne's article. Considering the etiology, it has been suggested that the cavity or defect may be caused by embryonic abnormality, anomalies of developmental, pulsation of the artery and pressure of hypertrophied submandibular gland. Because of the uncertain etiology, various terms have been proposed to designate the condition, such as Stafne's bone cavity, latent bone cyst, static bone cabity or defect, mandibular embryonic defect, idiopathic bone cavity, developmental bone defect. Although many cases have been reported, the course of the developmental of bone defect is not yet recorded. We examined the developmental process of this kind of defect. A case was soon in a 43-year-old male patient. His dentist found lower right first molar cementoma in a radiograph and referred him to us for treatment. On this occasion, nothing remarkable was found except first molar from the panoramic investigation. Three years later, a new radiograph revealed that a small area of bone rarefaction (radiolucent 20 × 15 mm) had appeared in the region of mandibular canal between trigonum retromolare and distal root of the third molar. 10 months later, the radiolucent area moved downward to the inferior border of the mandibular canal. It was turned into an oval shape and outlined by a radiopaque border. After another 6 months, the oval area showed a definite shape that was surround by a compact bone. The latest radiographic examination was performed after another year and no change was detected (10 × 5 mm). On microscopic examination, the lesion consisted of fibrous connective tissue with neurovascular structure. The arteries revealed thrombosis with recanalization of the thrombus and bursting hemorrhage. The wall of the defect consisted of compact bone without osteoblast or osteoclast. We considered that the defect was a bone destruction caused by hemorrhage by rhexis of the thrombosed small arteries in the mandibular canal and that the typical defect of cortex outline could be a result from failure of bone repair owing to the persistent existence of the soft tissue in the bone defect.
Chondrosarcoma of the maxilla is a rare tumor. A 85-year-old woman called on our clinic complaining of a painless swelling of the left cheek. Histopathological examination revealed chondrosarcoma of the maxilla, and she was the oldest among such case in the Japanese literature. Left total maxillectomy was performed. The postoperative course was uneventful until 3 months after surgery when local recurrence occurred. At 1 month after local recurrence, multiple lung metastases were found by chest roentogenogram. Recurrent tumor invaded the mandible, lung metastases increased, and she died 10 months after onset.
We have experienced a case of mandibular prognathism with submucosal cleft palate and mandibular five incisors. Both of these conditions arc competitively rare. The case was 21 year-old male suffering from malocclusion. Under hospitalization of the patient, we found submucosal cleft palate and mandibular five incisors. These conditions frequently escape diagnosis because they often have few clinical symptoms. We performed an osteotomy (bilateral Obwegeser-Dal Pont technique) under general anesthesia after about 1 year preoperative orthodontic treatment. We did routine observation for more than 1 year since the operation and observed nothing particular and that occlusion has been stabilized.
Recent advances in microsurgery have enabled one-stage reconstruction of free skin flap. Forearm flaps were developed by Yang et al. in 1978 and have been widely used in oral surgery. Patient was a 60 year old male who suffered from carcinoma invading from right cheek to commissure (T4N1M0). We reconstructed immediately with free forearm flap following right upper neck dissection and resection of the tumor. His postopertive course was uneventful without any complications. The free radial forearm flap was thin and pliable, therefore postoperative recovery of the function and shape was very satisfactory.
Speech was evaluated for a patient whose palate was reconstructed by an island palatal mucoperiostal flap after resection of carcinoma at the junction of the hard and soft palates. Mobility of the palate was less in the reconstructed side than the healthy side. Nasal escape of air was not observed in blowing, articulation of/P/ but appeared slightly in vowels articulation. Speech findings showed fairly good results and slight nasality without weak consonant.
Clinical evaluations of Sulbactam Cefoperazone (SBT/CPZ, Sulpemzome®) in various infections in the field of oral surgery were carried out.Sulbactam/Ceforperazone was administered to 51 patients with various infections. Sulbactam/Cefoperazone wasadministered by intravenous injection at a daily dose of 2 g (1 g × 2 times). Cases consistedof31 with maxillary ostitis, 3 phlegmone of the floor of the mouth, 4 pericoronitis, 2odontgenic maxillary sinuitis, 4 buccal abscess, 3 infection of post operative maxillary cyst, 1parotitis, 1 submaxillary limphadenitis and 2 peritonsillitis. The clinical effects obtained insubjective judgement were exellent in 25 cases, good in 22, fair in 4 and poor in none. The clinical effects obtained in judgement by point were excellent in 14 cases, good in 33 and poor in 4.The effective rate of which was 92.2%, the same as the former. As for side effects, stomatic discomfort appeared in one case. In the laboratory examination, elevation of s-GOT was observed in A patient, andelevation of BUN was observed in another patient. The results indicated theusefullness of Sulbactam/Cefoperazone in the treatment of various infections in the field of oralsurgery.