For clinical application of Ceftriaxone (CTRX) in the oral field, a pharmacokinetic analysis was performed for CTRX concentration in the oral tissues and dose of 1g CTRX was administered to 37 patients in one shot by intravenous injection. The following results were obtained. 1) The half life of CTRX in serum was thus calculated to be 7.412 hour. 2) The highest concentrations of CTRX were 39.5μg/g in the gum, 19.0μg/g in the bone and 45.7μg/g in the cyst wall. The half life of CTRX was 4.09 hours in the gum, 2.26 hours in the bone and 7.29 hours in the cyst wall. The above results suggest that CTRX had the most favorable affinity of cephem antibiotics in the oral tissues.
CBPZ was injected into rabbits at a dose of 40mg/kg body weight intravenously. The degree of shift to extraoral and intraoral tissue and serum concentration were examined. Then it was investigated for the influence which the difference in week-aged of rabbits exerted upon them. 1. Cmax of intraoral tissues in adult rabbits were high in the order of the gingiva, parotid gland, buccal mucosa, tongue, submandibular salivary gland and alveolar part of the upper jaw. In infant rabbits the level was higher in the parotid gland than in the gingiva. 2. Cmax of extraoral tissue in adult rabbits were high in the order of the kidney, liver, skin, bone marrow of the femur, spleen, muscle and cortex of the femur. In infant rabbits the level was higher in the bone marrow of femur than in skin. 3. Cmax of the gingiva in both adult and infant rabbits were similar to those of skin. Cmax of alveolar part of upper jaw were about median values of bone marrow and cortex of femur bone. The values of Cmax of the tonge were several times higher than in the femoral muscle. 4. Tmax of intraoral tissues were 5-8 minutes in adult rabbits and 4-5 minutes in infant rabbits. T 1/2 of intraoral tissue were 30-40 minutes in adult rabbits and 40 minutes in infant rabbits. 5. T 1/2 in serum were 25.4 minutes in adult rabbits and 35.1 minutes in infant rabbits. 6. Serum concentrations in infant rabbits were low compared with adult rabbits. The concentrations of intra and extraoral tissues except in the bone marrow of the femur tended to the same results.
The hemostatic effect of Nd-YAG laser on bleeding from movable mucous membranes of the oral cavity were studied. 1) Adult dogs were medicated with 500 u/kg of Heparin, after which experimental bleeding wounds were made by excising the whole epithelium layer in a diameter of 4 mm on the tongue and buccal mucous membrane of dogs. The amount of bleeding before and after a one-shot irradiation of Nd-YAG laser to the above-mentioned experimental wounds was measured. The irradiation conditions of the Nd-YAG laser were set for a spot diameter at 4, 6, and 8 mm, a power density at 50, 100, 150, and 200 W/cm2, and a one-shot irradiation time at 2 seconds. As a result, the most optimal Nd-YAG laser-irradiation condition was considered to a 6 mm for the spot diameter and 200 W/cm2 for the power density. 2) The wound healing process of Nd-YAG laser-irradiated wounds was observed, and epithelization took 2 to 3 weeks. Cases that received about 1, 000 J of total Nd-YAG laser irradiation had more severe inflammation and tissue injury. Accordingly, the irradiation conditions or combined therapy should be considered to decrease the dosage as much as possible. 3) Dogs were medicated with warfarin potassium adjusting its dosage so as to maintain the activity of thrombotest at 10-25%. With this preparation, similar experimental wounds as described above were made in two sites each of the tongue and buccal mucous membrane, and one wound was irradiated by Nd-YAG laser in spot diameter of 6 mm and a power density of 150-200 W/cm2 until it reached complete hemostasis, while the other wound was sutured with 4-0 nylon thread. The degree of bleeding after the above-mentioned treatments was observed daily, and it was found that the group that was irradiated by the Nd-YAG laser showed significantly less bleeding than the group that was sutured.
Results of surgery with chemo-and radiotherapy for 28 patients with maxillary sinus carcinoma during the past 11 years were discussed in this paper. Local recurrent tumors occurred in 8 patients (28.6%) with extended tumors of the supra-and infralateral types. These tumors appeared in the orbital and lateral sites over the sinus. Secondary metastases to the regional lymph node and recurrent tumors after neck dissection occurred in 7 patients (25.0%) with the lateral types. They tended to appear in the lymph nodes of the superior internal jugulum, parotid gland and parapharynx. Twenty eight patients in this category had a 5-year cumulative survival rate of 58.6%. Twelve deaths occurred in the following categories: distant metastases 6, lymph node metastases 3, local recurrences 2 and other 1.
Hereditary ectodermal dysplasia in the daughter and her mother indicated that they complained of partial anodontias. They showed a reduction of scalp hairs, almost complete absence of eyebrows and eyelashes. Sweating was apparent, though there was a reduction of sweat pores. Partial anodontias was present in both deciduous and permanent teeth. The authors diagnosed it as the anhidrotic (hypohidrotic) type of hereditary ectodermal dysplasia. This syndrome is inherited through an X-linked recessive gene and affected males. Females are reportedly always carriers. It is considered rare that female carriers are affected severely. The authors think it is interesting that only carriers in the family showed clinical symptoms of the anhidrotic type of hereditary ectodermal dysplasia.
Clinico-stastical observation on 91 cases of squamous cell carcinoma of oral cancer treated in the department of Oral and Maxillofacial Surgery Kurume University, during the past 10 years period from 1973 to 1982 was carried out. Primary tumors were sited on the gingiva in 38 cases, on the tongue in 35, in the buccal mucosa in 9, in the floor of the mouth in 8 and on the hard palate in 1. Of all the cases, 68 (74.7%) were referred by private dental clinics and dental clinics of city hospitals. According to TNM classification of UIC C (1978), 31 cases were classified into T4, 28 into T1, 28 into T2 and 4 into T3. Of the 91 cases, 49 (53.8%) were clinically advanced cases (stage III or TV). Most cases were treated through surgery (S) with chemotherapy (C) or through surgery in combination with irradiation and chemotherapy. Also, we made mention of screening for early detection of oral cancer.
The purpose of the present study was to evaluate the procedures recommended by WHO (World Health Organization) for examination and recording via a mass screening of oral mucosal diseases in adults. WHO procedures have defined a criteria for these diseases (A method). As a comparison to the WHO method, alternatively mass screening of oral mucosa was also conducted in a way that is characterised by the description of the detected symptoms of oral mucosa (B method). This evaluation was achieved through the analysis of the precision level of a general dental practicioner (GP) of the coincident rate, sensitivity, specificity, false positive rate and false negative rate of the diagnosis. The precision level was calculated by comparison of the results of the detection by a GP to that of an oral surgeon (SP) fully experienced in the diagnosis of oral mucosal disease. One hundredeighty five people (21 women, 164 men, mean age 33.4 ranged from 18 to 63 years) who work in manufacturing establishments were examined for oral mucosa. Out of 185 persons 113 were examined and reported on using the WHO method (A method). The remaining 72 were examined and reported on using the B method. Prior to the screening the examiners were a SP and a GP who had one day training and were calibrated according to the WHO guide (1980). The following results were obtained. 1) The coincident rate between the diagnosis by the GP and the SP was 82.3% using the WHO method (A method). and 29.2% using the B method. Sensitivity was 47.6% in A method and 27.7% in B method. was 88.3% using the A method. and 15.4% using the B method. The false positive rate was 52.4% with the A method. and 77.2% with the B method. The false negative rate was 11.7% with the A method, and 81.0% with the B method. 2) Out of 185 people 27 cases (14.6%) were detected as having oral mucosal diseases: leukoplakia (3.8%), lichen planus (0.5%), leukoedema (2.7%), leukokeratosis nicotina palatini (3.2%), and others (4.3%). These results showed that the WHO procedures clearly surpassed the B method and were useful for mass screening of oral mucosal diseases in adults. In the A method a low value of sensitivity compared to specificity suggested that the training and calibration of a GP should be taken into account and improved.
There have been advances made in hemodialysis therapy of chronic renal failure patients but in spite of this still various complications are being reported. Also oral and maxillofacial region complications are observed, one of these being xerostomia. Therefore, in order to investigate the influence of hemodialysis therapy we measured chronological saliva flow rates and the change of constituents of serum and came to the following conclusions: 1. Of 75 subjects surveyed with a questionnaire, 57 (76.0%) were found to suffer from xerostomia. 2. We set up a device measuring saliva flow rates and measured the change of flow rates of parotid saliva of patients treated with hemodialysis directly after the beginning of dialysis, during dialysis and shortly before the end of dialysis. In 10 cases among hemodialysis therapy patients, the tendency that the flow rate of the parotid saliva during rest time decreases, as the dialysis, comes near to its end was observed in most cases as results of dialysis. 3. Measurement of the irritability of the parotid saliva produced through a 10% citric acid solution showed decreasing flow rate of saliva. Further this decreasing tendency was related to clinical (severity) classification of xerostomia. 4. Comparing the case showing the increasing flow rate of saliva after dialysis with the case of exacerbated xerostomia (decreased flow rate) after dialysis, constituents of serum differences in the average values of K, blood urea nitrogen, creatinine and Pi were observed, especially in the indices of adequate dialysis, i. e. BUN, creatinine and Pi. These values before dialysis were significantly higher in the cases of exacerbated xerostomia after dialysis. From these observations it was suggested that he water content of meals be regulated before and after dialysis in order to improve xerostomia and to stabilize sustained dialysis.
Malignant solid tumors in our files (1973-85) were clinico-statistically investigated in this paper. This study comprised 201 cases; 180 carcinomas (89.5%), 16 sarcomas (8.0%) and 5 other histological tumors (All of which were melanomas, 2.5%). The maleto female ratio of incidence was 1.6 to 1. Each histological malignancy mutually showedsimilarity in sex ratio. In addition to the 201 cases in this series, 2 metastatic tumoros from other locations (lung and mamma), were also observed. Of the 180 carcinomas, squamous cell carcinomas (Sq. c. ca.) accounted for 146 of the cases (81.7%). In the occurrence of Sq. c. ca., the tongue was the most frequent site (35.6%), followed by mandibular gingiva, mouth floor, maxillary sinus, and so on inorder of incidence. Of the 201 cases, patients who had had exposure to the atomic bomb numbered 24. Out of 32 cases of malignant epithelial tumors originating in the salivary gland, however, the incidence of patiens with such exposure was higher (21.9%). The five-year cummulative survival rate of carcinoma, sarcoma and other types of tumor, was 64.5, 43.5, and 20.0%, respectively. It turned out, however, that the effects of therapy depended on where the tumors were located. For example, therapeutic results were good for tumors located at the maxillary gingiva (86.7%), mandibular gingiva (82.6%) and mouth floor (69.7%). On the other hand, rather poor results were obtained in the tongue and maxillary sinus. But there was clear prognostic difference in the survival rate of tongue cancer between its early stages (94.1%) and its advanced stages (38.7%). This reconfirmed to us that early diagnosis and early treatment are the most important factors to getting better therapeutic results.
Verruciform xanthoma, first described as a lesional entity by Shafer in 1971, is a verrucous lesion in appearance, which occurres often in oral cavity. Histopathologically the lesion shows moderate to severe parakeratin plugging and the presence of swollen “foam” cells in the connective tissue papillae between elongated epithelial rete pegs. One hundred fifty five cases of this lesion, including 4 of our own, that appear in the literature were clinicopathologically reviewed in this paper. The age of the patients ranged from 14 to 89 (mean age 50.5) years old and there was no sex predilection for occurrence. The lesion was most frequently found on the alveolar gingiva (55.5%), followed by the palate (20.0%), tongue (12.3%), buccal mucosa (4.5%) and so on. It is still fully unknown whether this lesional condition is a true neoplasm or chronic inflammatory tissue reaction, while most researchers would agree to the latter, and our cases might support the latter hypothesis. Simple surgical excision is recommended as the first choice in treatment because no recurrences have been reported except one case reported by Nowparast et al.
Necrotizing sialometaplasia is a benign, self-limiting, inflammatory, ulcerative lesion of the salivary gland. Commonly, this lesion has been reported in the minor salivary gland of the hard palate, soft palate, hard and soft palate or in the parotid gland, and a few cases of the maxillary sinus, nasopharynx, and the lower lip have also been reported. It is often confused clinically and histopathologically with malignancies, such as squamous cell carcinoma or mucoepidermoid tumors. Two cases of this lesion of the hard palate are presented in this paper. The first case is a 22-year-old Japanese female referred to us because of pain of the palate. The left hard palate was swollen with an ulcer. The histopathological report of the biopsy suspected necrotizing sialometaplasia. So the lesion was excised and histopathological examination confirmed this diagnosis. The second case is a 26-year-old Japanese female referred to us because of swelling of the palate. The left hard palate was swollen with ulcer. The histopathological findings of the biopsy revealed necrotizing sialometaplasia. No treatment was performed. In both cases, the lesions were completely healed by five or ten weeks from the time of biopsy and there was no evidence of recurrence.
Tuberculosis of the parotid gland is very rare among tuberculosis of the head and neck region. We present a case of tuberculosis of the parotid gland. The patient was a 58-year-old female. There are some methods for treatment of this disease. We treated this patient with antituberculous agents. For 9 months after treatment, no particular abnormality was observed. We discovered fibrous changes in the parotid gland by CT scanning after treatmet, but the outflow of saliva steadily of better.
Fulminant hepatitis is defined as an acute and severe hepatic failure with encephalopathy. It develops most commonly as a complication of viral hepatitis, but may also result from exposure to drugs. The prognosis for patients with fulminant hepatitis is very poor. A 50-year-old female was operated on under halothane anesthesia to reduce fractures of the mandible and zygomatic bone. On the 11 th post operative day, she abruptly complained of high fever. Her condition deteriorated gradually and was not improved with treatment including plasma exchange. The patient died 22 days after the operation. This case was diagnosed as a case of halothane-induced fulminant hepatitis.
We have clinico-stastically studied 233 cases of maxillo-facial fracture patients who had been treated during the past eight years from January, 1978 to December, 1985. From this study, we obtained the following results: Of all the patients, 185 were male and 48 were female. The male/female ratio was 4: 1. Most of the males were distributed among the ages of 10 to 19 years old (28.3%) and their twenties (26.1%). The number of patients in our department show a tendency to increase every year. The causes of fractures were mostly traffic accidents (44.1%). One hundred eighty-five cases (79.5%) were referred from public or private hospitals, and only 37 cases (15.9%) from dental clinics. Fractures of the mandible alone accounted for 69. 1%. The sites of the mandible fractures were found at the condyle (25.3%), the angle of the mandible (21.9%), and other areas (52.5%). Disturbance of mouth opening were found in 67. 8% of all cases as complications of the fracture, followed by tooth injuries (62.3%), injury of the oral mucosa (36.1%), deformity of occlusion (31.3%) and unconsciousness (24.9%).
A 4 year-old boy with the chief complaint of trismus was referred to the Department of Oral Surgery, Gunma University, on June 1, 1985. The trismus occurred during effective treatment with irradiation at the Department of Neurosurgery, after partial resection of a brain stem tumor for diagnosis on April 22, 1985. Histopathological findings revealed medulloblastoma. On the first visit he showed right side V, VI, VII cranial nerve paresis and trunkal ataxia, and the maximal jaw opening value between the interincisal spaces was only 2 mm. A jaw opening exercise with a Heister's mouth gag was prescribed for ten minutes to or more times a day. Good results were obtained using this treatment, the maximal jaw opening value increased to 24 mm on April 19, 1988. The authors propose that the trismus in this case brought on the V, VIi cranial nerve paresis and that the effect of irradiation included part of the TMJ. Cases like the above are infrequent in oral surgery.
A case of peripheral ossifying fibroma that occurred in 17-year-old girl is presented here along with the findings of a histopathological examination. Four tumors, consisting of two larger and two smaller masses, were detected in the maxillary and mandibular alveolar bones. The larger masses were diagnosed as ossifying fibromas and the smaller ones as fibromas with no apparent calcification. The presented case, having four tumors of two different histological types, hinted at the hypothesis that transformation could occur from fibroma to ossifying fibroma. Discussion was focused in this paper to the criteria for differential diagnosis between epulis osteoplastica, cemmentifying fibroma, monostotic fibrous dysplasia, and ossifying fibroma.
A 5-year-old Japanese girl with a central giant cell granuloma in the left anterior maxilla is described. Although marsupialization was performed under clinical and radiographic suspicion of a cystic lesion, tumoral growth, 1 cm in diameter, occurred in 2 weeks. Diagnosis of an aneurysmal bone cyst was made by biopsy, and total extirpation of the lesion was done under general anaesthesia. Histologically, diagnosis of the giant cell granuloma with secondary formation of aneurysmal bone cysts was made. At 11 months after surgery, however, recurrent growth was confirmed clinically and radiographically and partial maxillectomy was performed for complete removal of the lesion. Histologic appearance was similar to that of the specimen at first operation. Observation after a follow up two years and nine months later revealed no evidence of recurrence.
It is still not sufficiently known how nutritional management by tube feeding works clinically to the physical recovery in the early stage after oral surgery. In this paper, a clinical evaluation of tube feeding nutrition with elemental diet (Elental) and digestive diet (Medief) is comparatively reported on for cases of 7 and 13, respectively. This study comprised 10 malignant cases and 10 non-malignant ones. It was recomfirmed that nutritional management in the early stage after surgery showed similarly good effects in the two groups. It turned out that Elental was more useful for nutritional management and the improvement of nutritive conditions in serious malignant cases, compared with Medief. But it might necessitate careful practical applications because of possible occurrence of liver and kidney damage.
Hemangioma is a common tumor in the oral and maxillofacial regions, but cases including phlebolith are relatively rare. We encountered a case of hemangioma with a phlebolith of the upper lip. The patient was a 77-year-old man with a tumor of the upper lip. The tumor was resected. It was 6×6×5mm in size, and the phlebolith was 4×3×3mm in size. Histopathological diagnosis indicated cavernous hemangioma. We analyzed the composition of the phlebolith using a computer aided microanalyzer (CMA) and an energy dispersive spectrometer (EDS). The EDS analysis revealed that the main components of the phlebolith were Ca and P, and the Ca/P ratio was 1.76. By the CMA analysis, neither Ca nor P was detectable in the center of the nuclear-like region of the phlebolith.
A case of amyloidosis appeared in gingiva of maxilla was reported. The patient was a 81-year-old man complaining of unfitness of the dentures. In the oral cavity, the tumor was oval and elastic soft with pedicle, measuring 24×36×10mm in size, and located at the right upper molar region of the alveolar ridge. The surface of the tumor was dark-reddish, containing white flecks with keratinization at the margin of the tumor, and without spontaneous pain or tenderness. Radiographic examination showed a radiolucent region with irregular margins at the alveolar bone of the lesion. The tumor was resected under local anesthesia. Histopathologically, at the upper side of pedicle, much linear and massive hyaline substances were observed in submucosal layer. A histopathologic diagnosis of amyloidosis was made by congo red staining and electromicroscopic observation. An immunohistochemical study could not identify the types of amyloid proteins of this case.
In recent years, there has been an increase in the number of patients with maxillofacial trauma in conjunction with changes in social life, increases in the number of persons participating in sports and changes in traffic conditions. Among the patients examined at the Nippon Dental University Hospital, those with maxillofacial fractures treated in the First Department of Oral and Maxillofacial Surgery were analyzed statistically. The subjects of this study were 100 outpatients from January 1981 to December 1987, an average of 14.3 cases a year. When compared with the first year of the study, the number of cases in 1987 had increased by about 1.5-fold and the number increased every year. In an investigation of frequencies according to age and sex, the two most common age groups by far were those in their teens and twenties, accounting for 39.0% and 32.0%, respectively. Males outnumbered females by three to one. More than 70% of the patients came to the hospital within one week of receiving the injury, but there were cases of patients admitted to other hospitals for treatment of other parts of the body who did not come as outpatients until several weeks later. The most common site of the fracture was the lower jaw in 92.0%, followed by the front teeth, the region from the molars to the angle of the mandible, and the articular process. The causes of the fractures were sports related in most of the cases, accounting for 34.0%. According to figures during the 13 year period from 1955 until 1967 in this hospital the most common cause of such injuries was traffic accidents, which indicates that s change has occurred over the years.
Schwannoma develops at any site where the neural tissue exists but is a comparatively rare tumor in the oral region, and its occurrence at the lip seems to be less frequent. A summarized report is made here on our experience of 1 case, a male aged 40, with schwannoma which developed in the left lower lip. The patient visited our hospital with the chief complaint of painless swelling of the left lower lip. As status pracsens, an elastic ligament the size of a soybean and a movable and oval tumor were detected in the left lower lip. The tumor was clinically was diagnosed as a benign labial tumor. Treatment consisted of a tumorectomy peformed under local anesthesia, and no tendency for recurrence has been observed at present in the postoperative 2 years and 8 months. As a result of investigating the extirpated foci histopathologically, it was diagnosed as schwannoma (Antoni type A).