Sports have been reported as one of the major causes of maxillofacial region injuries. We reported that in contact sports especially, many players have tooth and facial bone damage. These injuries should be prevented by the efforts of the players and medical field workers.
We are planning to develop proper protectors for mouth injuries, i.e. mouthguards. The most important point is that the mouthguard must play the physiological role consistent with facial bone dynamics.
In this report, we showed the methods to evaluate the mouthguards made in various materials and shapes. This system was conducted to determine the effccts of mouth protectors on pressure changes and bone deformation within the facial bones reacted to a known impact delivered to the inferior border of the chin.
The results show that there are sonic specific points in relation to the impacts on the facial bones with and without a mouthguard. The retromandibular regions, linguar side of the mental region and infraorbital regions are static points, but on the other hand, the inside and outside of the zygomatic arch region and nasal floor are active in the transmission of the force. According to these results, various materials were evaluated for their patterns of force transmissions, and it was possible to select a single material suitable for a mouthguard.

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Many reports of infections with Methicillin-resistant Staphylococcus aureus (MRSA) frequently appeared since the 1960's in European and U.S.A. medical journals. In Japan, however, MRSA infections were rarely reported and no attention was paid at that time.
In the 1980's, Methicillin and Cephem-resistant Staphylococcus aureus (MCRSA) occurred with increasing frequency in Japan and many cases of MCRSA infections have been reported recently.
In this report, we presented 2 cases of postoperative infections thought to be MCRSA and summarized treatment modality, especially combination administration of Fosfomycin (FOM) and Cefmetazol (CMZ).

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A case of gingival fibromatosis in a 15-year-old male is reported. This disease israre and its etiology is unknown. The symptoms of gingival fibromatosis show diffuse, extensive and hyperplastic gingiva, and not much inflammatory change. It was suspected that the causes of this case were related to the developmental anomalies and eruption stimuli. Only gingivectomy without tooth extraction was performed.

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It is well known that lower lip tumors among Japanese are rare in comparison with Europeans and Americans.
Five cases of lower lip tumors (three cases of verrucous carcinoma, one case of adenoid cystic carcinoma and one case of hemangioma) were operated on by the step form method, M shape operation method and method of sliding of one side flap. These tumors were surgically removed enblock with the healthy peripheral tissue. The defects ranged from three-fifths to two-thirds of the width of the lower lip. The patients were successfully operated on by using only the lower tissue, because the lower lip has a great capacity for defects.
Postoperative recovery of the function and shape were satisfactory. All patients are doing well and show no evidence of tumor recurrence.

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In order to evaluate the result of treatment and to ascertain the appropriate treatment form, fifty cases of squamous cell carcinoma of the floor of the mouth treated at the Department of Oral Surgery of Hokkaido University from 1970 to 1985 were reviewed. Eighteen patients were treated by surgery alone, 11 by preoperative radiation therapy, 6 by preoperative chemotherapy and 15 by radiation therapy alone.
The 5 year survival rate was 80% in the surgical group and 50% in the non-surgical group. Recurrence of the primary tumor was found in 5.7% of the former and 41.7% in the latter. Overall regional lymph node metastasis was found on 25 patients (50%). Contralateral metastasis was found on 8 cases and it was closely related to the size and site of the primary tumor. Delayed lymph node metastasis was found on 2 of the 26 irradiated necks and on 6 of the 24 non-irradiated necks. Histopathological study revealed that cortical bone was eroded or destroyed by tumor tissues in more than half of the cases in which the primary tumor had been diagnosed as having gingival invasion or mandibular adhesion. On the other hand, clinical study showed that local recurrence was found on only one case of 16 in which the primary tumor was resected by marginal resection of the mandible.

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A case of cementifying fibroma arising in the bilateral upper and lower jaws of a 41-year-old female was reported.
Roentogenograms showed various appearance of so-called cementoma in some areas and cementifying fibroma in others. But the histopathological specimen taken randomly from all areas after operation showed only the appearance of cementifying fibroma.
On the basis of the above findings, the term of classification for cementum tumors is merely a designation for a period found in the developmental process of cementum tumors.
Excision for localized lesion or curettment for extensive lesion is thought to be the first surgical choice for the treatment.

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Pleomorphic adenoma is the most common tumor of salivary glands. Most of them are seen in major salivary glands, and the minor salivary gland tumor is mainly seen at the palate. The minor salivary gland tumor is rarely found in the upper lip or the cheek.
We experienced three cases of plcomorphic adenomas in the upper lip and the cheek, and evaluated these histopathological characteristics.
In case 1, at the left side of the upper lip, the tumor histopathology showed a predominantly epithelial pattern composed of two layers of tumor cells which formed irregularly dilated lumen structures. Hyaline degeneration was extensive in the stroma. In this case, diffuse fatty tissue seeming to be fatty degeneration was seen in the stroma.
In case 2, at the right cheek, the histopathology demonstrated predominantly myoepithelial pattern composed of solid proliferation of spindle or polygonal tumor cells.
In case 3, at the left side of the upper lip was a predominatly myxoid pattern composed of wide-spread myxoid stroma, and cellular components were very few.
According to the classification based on the developmental stage of pleomorphic adenoma by Funahashi (1985), the tumor of case 1 seemed to be a metaplastic stage; of case 2, a proliferative stage; and of case 3, a degenerative stage. In case 2, the myxomatous change and the hyalinization of the stroma were partly seen, these phenomena might be a transitional stage from the proliferative to the metaplastic stages.
The fibrous capsule was thin in all cases. There were slight differences in thickness among these cases; in cases 1 and 2, the capsule was slight thicker than that of case 3. In case 1, the daughter lesions of the tumor scattered in the capsule.
We evaluated the characteristics of collagen in each case with collagen stain. The collagen fibers were mainly seen around the nest of solidly proliferating tumor cells. In the myxomatous area, there were few collagen fibers. The collagen fiber partially lost its continuity around the nest of tumor cells. The invasive or germinative growth of tumor cells to the stroma was seen in that area.
Malignant changes in pleomorphic adenoma have been occasionally reported, so careful diagnosis and long-term follow-up are necessary.

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Radical neck dissection is a common surgical technique for metastatic neck lymph nodes from the primary tumor in the head and neck.
Bilateral radical neck dissection was performed on a patient with bilateral cervical metastasis from lip cancer at an interval of 2 weeks.
In this case anastomoses was performed to provide a shunt from the unilateral internal jugular vein cut on ligation to the external jugular vein in an attempt to suppress intracranial pressure.
The patient was followed up by post-operation angiography and findings of interest suggesting the clinical significance of internal jugular vein-external jugular vein anastomoses were obtained. This communication is kt report of our results.

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Bilateral coronoid hyperplasia has a 10 to 30 year age range of onset as a rule, and rare cases are reported. The authors experienced a case of bilateral coronoid hyperplasia which might be an abortive type of Marfan syndrome, and reported the outline and studied the case about both the cause and the aspect of coronoid process growth.
The patient, a 16 years old high school student, became aware of but left his trismus as it was. Later, because his trismus became severer, he consulted our faculty and was treated by resection of bilateral coronoid process through oral cavity under general anesthesia. Thereafter the symptom was ameliorated, and ran a favorable course. The shape of coronoid process assumed the aspect which grew forward and upward by X-p findings, and coronoid process removed was not a tumor but only a hyperplasia by pathologic diagnosis. The patient showed a special feature of arachnodactyly, which was possibly an abortive type of Marfan syndrome, but was not definitely diagnosed. It was difficult to surmise the cause from its relation with Marfan syndrome and from other theories proposed to date.

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Pleomorphic adenoma frequently occurs after 30 years of age but is rarely seen in childhood. We encountered a preschool 5-year-old male with pleomorhic adenoma of the palate.
A hemispherical tumor with distinct margins (1.5×1.5-×1.5cm) was observed in the right transitional portion from the soft to hard palate.
Pathohistological examination showed a relatively distinct fibrous capsule of the tumor, and epithelial elements and interstitial tissue intermixed to various degrees. In Japan, a relatively large number of school ehildren (13) with pleomorphic adenoma have been reported.
However, the disease is rarely found in infants or preschool children, and only 4 patients including our case have been reported in Japan and Western countries. In addition, our patient is the youngest among those with pleomorphic adenoma arising in the small salivary gland, especially the palate.

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A case of lymphangiectatic fibrous polyp on the soft palate was reported. A woman aged 78 came to the clinic with complaints of a polyp on soft palate and foreign body sensation in the throat, which had been noticed for approximately 2 weeks. Visual examination revealed a reddish pedunculated mass growing from right side of the soft palate. Its surface was almost smooth and partially papillate. A clinical diagnosis was made of a tumor of the soft palate. The polyp was removed from the soft palate under general anesthesia. Histological examinaton revealed fibrous tissue and many dilated lymphatic canals in the polyp. The polyp was finally diagnosed as a lymphangiectatic fibrous polyp. The postoperative course was uneventful with no sign of recurrence.

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Seventy five carcinomas of the head and neck, which consisted of 53 oral mucous carcinomas, 9 maxillary sinus carcinomas and 13 carcinomas of the salivary gland origin were submitted to this study. In these cases, tumors derived from tli, salivary tissues were treated operatively, and squamous cell carcinomas (SCC) received chemoradiotherapy combined with surgical treatments.
Tumor remission by the preoperative therapy in SCC was almost parallel with the degree of degeneration of the tumor cells, and the histopathologic investigation by the bread loaf method (semiserial whole sections) revealed that the histopathologic safety margin (distance between the margin of the residual survival cancer cells and the cut end of the excised material) did not relate with “surgical safety margin” but correlated with the clinical, histopathologic effects. From this fact, surgical safety margin could be decided by the degree of clinical remission, and to those tumors which showed good response of more than 90% of the remission rate, reducible excision might be selected. Comparative investigation of histopathologic effects of the preoperative therapies with the degree of histologic malignancy and the mode of invasion of the tumor cells in the biopsied materials was done, however, no relation could be observed.
Immunohistologic research using Leu series monoclonal antibodies was done and it was found out that the cells infiltrated in the tumor tissues were mainly composed of T cells and HLA-DR positive cells and that among those cases of scant infiltration of Leu 2a positive cells, lymph metastasis was high. This result suggested the role of killer T cells in cancer tissues.
Regarding the control of the primary sites and metastasized lymphnodes, good results were obtained (local control=70/75, N control=20/24). Five-year cumulative survival rate was 75.5% in total and 76.5% in the oral mucous carcinoma alone. On the above results, some discussions were added including the benefit of ⁶⁰Co radiotherapy as thepreoperative treatment.

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We reviewed patients with malignant tumors in the oral and maxillofacial regions at the oral surgery clinic of the Ryukyu University Hospital during 13 years from September 1978 to August 1986. A total of 296 patients (253 primary patients) were statistically observed.
1. According to the sex of the patients, 200 were male and 96 were female patients. The ratio of male to female was 2. 1: 1. According to age distribution, the greatest numbers were in the sixth decade, and the incidence over the seventh decade was calculated to be about 30% for both.
2. In 279 cases of the carcinomas, the tumors of 261 cases (93.5%) were histologically diagnosed as squamous cell carcinoma, and 9 cases as adenoid cystic carcinoma. In 240 primary carcinomas cases, those of 226 cases (94.2%) were also diagnosed as squamous cell carcinoma.
3. According to the primary lesion and its population of 221 cases, 89 cases (74 primary cases) were in tongue, 51 cases (44 cases) in gingiva of the mandible, 45 cases (43 cases) in floor of mouth, 31 cases (30 cases) in oropharynx, and so on.
4. Histologically, the diagnosis of 15 cases was sarcoma and that of 2 cases was others. Of these 14 cases, 7 cases were non-hodgkin's lymphoma, one case malignant fibrous histiocytoma, 3 cases myogenic sarcoma and one case each of neurogenic-, osteogenic- and liposarcoma.
5. We studied the TNM-classification of 210 primary cases of oral squamous cell carcinoma involving lip and oropharynx regions. According to the category T, 78 cases (37.1%) corresponded to T 2, 56 cases (26.7%) to T 4, 49 cases (23.3%) to T 3 and 27 cases (12.9%) to T 1.
6. According to the category N, 97 cases (46.2%) corresponded to N 0, 59 cases (28.1%) to N 3, 38 cases (18.1%) to N 1 and 16 cases (7. 6%) to N 2. Of the clinical metastasis to the regional lymph node, 113 cases (53.8%) corresponded to N 1-3.
7. In stage grouping, 87 cases (41.4%) belonged to stage 1V, 51 cases (24.3%) to stage 11, 48 cases (22.9%) to stage la and 24 cases (11.4%) to stage I.

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The Hotz type orthopedic plate is widely used in the early treatment for a cleft lip and palate, to make oral feeding easier and to induce intrinsic developmental potentialities of the maxilla. This plate has been used in 4 cases of Pierre Robin Syndrome, and the early effects on respiratory, feeding, and maxillary developmental problems are discussed. As this plate held the tongue out of the palatal cleft, air way obstruction was reduced with intra-oral feeding improvement. The cleft was narrowed and changed in shape from U-type to V-type. Therefore, this plate is very effective in the early treatment of Pierre Robin Syndrome.

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Temporomandibular joint (TMJ) surgery for trauma, ankylosis, osteoarthritis, pain and dysfunction has a long history. Presently, many of the procedures described in the past and combinations of procedures are performed. But, condylectomy invariably leads to changes in TMJ function and dental occlusion. Especially, erroneous physical therapy often leads to cross bite, backward, downward, rotation of the mandibular with open-bite and masticatory problems as a result, although intensive physical therapy seems to give reasonable functional results after condylectomy.
We have reported on partial TMJ reconstruction by Proplast^® TMJ glenoid fossa prosthesis type V-K as treatment for secondary malocclusion, TMJ dysfunction and jaw deformity after condylectomy. However, a review of the literature supported the fact that permanent use of teflon and Proplast^® as glenoid fossa prosthesis in the temporomandibular joint should be followed up for a longer time.

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This report surveys the experience in 150 patients (54 male patients and 96 female patiens) who underwent sagital splitting osteotomy of mandibular ramus (Obwcgeser-Dal Pont's method) between 1972 and 1986. We divided the period into three terms (the former term group, the middle term group, the latter term group), and surveyed operation time, blood loss, operative technique, anethesic time and so forth.
The results were as follows:
1) Operation time
The average operation time of all cases was 141.0±32.7 minutes. However, the average of the former term group was 156.9±36.9 minutes, the middle was 132.0±28.6 minutes, and the latter was 137.1±28.6 minutes.
The operation time had been reduced in recent years.
2) Blood loss
The average blood loss of all case was 508.5±405.3ml. But, the average of the former was 761.0±518.9ml, the middle was 486.4±338.9 ml, the latter was 385.0±297.4ml.
We rarely needed blood transfusion in recent years as a result of the reduction of blood loss and the improvement of operating techniques.
3) Correlation between operation time and blood loss
In recent years, there was positive correlation, and we found that the reduction in operation time was related to the decrease in the blood loss.
4) The others
No postoperative vomiting and airway obstruction occurred, and none of the patients returned to the room with endotracheal intubation.

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A schwannoma that developed in the floor of the mouth of a 72-year old woman was excised surgically. The tumor was a spherical shape measuring about 5 × 4 × 5 cm and contained two large cavities. It was diagnosed as types A and B of Antoni's pathological classification.
Some case reports of neurinoma, especially occurring in the mouth floor and having cavities in it, were reviewed.

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Lymphoepithelial cyst generally occurs in the lateral cervical areas. It is characterized histopathologically as the lymphoid tissue below the lining of the stratified squamous epithelium of the cyst, but the same cyst sometimes occurs in the oral cavity. This report includes two cases of the cyst in the ventral surface of the tongue.
Case 1. A 37-year-old man visited a dental office complaining of dental caries, and was found to have a small tumor on the left side of the ventral surface of the tongue. It appeared as a round mass, approximately 4mm in diameter, and distinguished from the surrounding oral mucosa. Under local anesthesia, the lesion was totally enucleated. Histopathological findings revealed a cyst with parakeratinizing stratified squamous epithelium and lymph follicles.
Case 2. The same cyst was found on the right side of the ventral surface of the tongue in a 21-year-old woman. The tumor appeared as a round mass, approximately 4mm in diameter, white in color, and distinguished from the surrounding oral mucosa. Under local anesthesia, total enucleation was performed. Histopathologically, the inner side of the cyst was covered with a parakeratinizing stratified squamos epithelium, and the lymphoid tissue was found below the lining. In addition, we confirmed the continuance between the oral mucosa and the lining of the cyst.

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Two cases of dislocated fractured condyles in 7-year-old girl and 9-year-old boy are reported to illustrate the remodeling processes following the conservative treatment.
The degree of mouth opening, mandibular movement and occlusion were satisfactorily restored in both cases, but deformities of the condylar processes remained.

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This report describes a 78-year-old Japanese woman whose atrophic edentuous mandible had been fractured bilaterally by a bruise in violent fall in June, 1986.
Despite the attempt at surgery with Champy and A-O miniplates by intraoral approach, a non-union of the right mandibular body resulted.
On November 18 of the same year, the second surgical operation was performed. After the proximal and distal fragment of the right mandible were exposed and freshened, a bone graft and particulate cancellous bone were taken from the iliac crest of the patient's right hip. Simultaneously, a titanium mesh prosthesis was fitted to the mandible in conjunction with transosseous wires.
The postoperative course was essentially uncomplicated.

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Hereditary deficiency of Iactor XI was first reported by R.L. Rosenthal in 1953. This disease occurs mainly in people of Jewish ancestry. It is transmitted as an autosomal recessive trait and occurs with equal frequency in males and femaks.
We have experienced one case of a tooth extraction in a hereditary factor XI defiiciency patient. This case was a 52-year-old female, and the factor XI activity examined by using PTA deficient plasma (DADE) was less than 1 %. Usually the clinical symptoms are mild, and in this case recently two teeth were extracted in a private office; the first bled for 2 days and the second bled for 7 days. We transfused fresh frozen plasma before tooth extraction and clotting after surgery was normal.

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We have studied clinicostatistically 253 cases of malignant tumors of oral and maxillofacial regions from 1978 to 1986 at the First Department of Oral and Maxillofacial Surgery, Osaka University Faculty of Dentistry. Out of 253 cases, 168 cases of primary squamous cell carcinoma were analyzed for TNM classification by UICC (1978), therapy and prognosis.
From this study, we obtained the following conclusions:
1) Of 253 patients, 176 were male and 77 were female (2.3: 1). The mean age was 58.6.
2) Of all cases, 160 (63. 2%) were referred by private dental clinics and oral surgery clinics of city hospitals.
3) Histopathologically, 197 cases (77.7%) were diagnosed as squamous cell carcinoma, 24 cases (9.6%) as malignant tumors in the salivary gland, 16 cases (6.3%) as malignant lymphoma, 7 cases (2.8%) as sarcoma, 4 cases (1.6%) as metastatic tumors to oral and maxillofacial regions and 3 cases (1.2%) as malignant melanoma.
4) According to the TNM classification by UICC (1978), 168 squamous cell carcinomas of the oral cavity were classified as 21 cases (12.5%) of Tis. T1, 80 cases (47.6%) of T2, 40 cases (23.8%) of T3 and 27 cases (16.1%) of T4, and further classified as 19 cases (11.3%) of Stage I, 53 cases (31.5%) of Stage II, 53 cases (31.5%) of Stage III and 43 cases (25.7%) of Stage IV. In the NM classification, cervical lymph nodal metastasis was found in 66 cases (39.3%) and 1 case (0.4%) in T4 category had distant metastasis to the lung. The 5 year survival rate of all 141 cases treated in our clinic was as follows: Stage I: 93.3%, Stage II: 72.7%, Stage III: 53.0%, Stage IV: 36.1% and total 141 cases: 60.0%. In addition, the 5-year survival rate classified bytherapy was 48, 3% by irradial 100% by surgery, 61.2% by surgery combined with irradiation (with or without chemotherarapy) and 33.3% by chemotherapy alone.
5) According to the TNM cIassification proposed by JJC (1977), 20 squamous cell carcinomas of the maxillary sinus were classilied as 3 ases (15%) of T2, 14 cases (70%) of T3 and 3 cases (15%) of T4. The 5-year survival rate of all 19 cases treated in our clinic was 56.0%.

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Rhabdomyosarcomas are generally classified as of the following; pleomorphic, alveolar, embryonal, and hotryoid (Horn and Enterline 1958). The malignant tumors arise from striated muscle tissue or undifferentiated mesenchymal tissue, and therefore may occurthroughout the body.
Embryonal rhabdomyosarcoma is uncommon and highly malignant. It occurs mainly in children and young adults, and is found most often in the genito-urinary tract and in the nasopharynx.
In this article we report on a case of a 29 year old man with embryonal rhabdomyosarcoma of the cheek.
The patient was referred on October 19, 1979 with a complaint of left cheek swelling. He reported that he had noticed a ricegrain-sized tumor on the left cheek mucosa about 3 months before (in August, 1979) and also that it had grown gradually ever since to be big enough to be touched from the outside. Pathological examination of biopsy specimen diagnosed the tumor as embryonal rhabdomyosarcoma. On October 23, 1979 we performed leftside partial maxillectomy, tumor extirpation, and neck dissection. On post-ope 13 th day tumor recurrence was observed, and chemotherapy (cyclophosphamide, vincristin), irradiation, and LASER surgery were performed. Then he was tumor-free for approximately 3 months. However, the tumor recurred twice in his left neck, and we administrated VAC and also performed surgery. Despite of these treatments, tumor growth in neck and lung metastasis could not be controlled and the patient died May, 1982.
In this case the patient alived for 2 years and 7 months after the first examination. The combination of surgery, irradiation, and chemotherapy can be regarded to have contributed to life prolongation.

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A case of eosinophilic granuloma occuring in the mandibular bone of a 5-year-old boy was reported.
He complained of a gradually increased swelling with pain in the mandibular bone. Orthopantomography showed an irregular radiolucency in the left mandibular angle.
The diagnosis was established by needle biopsy from oral lesion. He was treated with combination chemotherapy of predonine and vinblastin and surgical extirpation.
The extirpated material was examined histopathologically and electron-microscopically.
Histopathologially, the eosinocyte infiltrate and histiocyte increased in the connective tissue, but Langerhans cell granules were not observed.
These findings were described in this paper.

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We encountered a patient with dermoid cyst the size of a hen's egg on the oral floor. Since the tongue was found to be displaced upward and phonation lacked clarity and naturalness at the initial examination, the patient was evaluated by phonetic-linguistic studies before and after the operation.
Concerning the consonants of the sounds “na” and “ni”, the preceeding consonant wave was shortened and distorted before the operation, but was made normal after it. With regard to vowels, there was a difference in the intensity of the formant frequency between before and after the operation. The site and the size of the cyst, and associated changes in the position and motility of the tongue are considered to be closely involved in the improvements in the preceeding consonants and changes in the formant frequency.

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In order to invcstigate the clinical effect of FEM-102 (each tablet contains 12.5 mg of Anethole Trithione) on dryness of mouth due to Xerostomia, Sjögren's syndrome and radiotherapy, two tablets of FEM-102 were administered orally t.i.d.(75 mg of Anethole Trithione/day) during 2-12 weeks.
The results were as follows:
1. The efficacy on dryness of mouth was evaluated on the basis of objective findings, subjective symptoms and test of saliva and salivation.The rate of effectiveness (above effective) in Xerostomia, Sjögren's syndrome and post-radiotherapy were 72.2% (26 cases/36 cases), 42.9% (3 cases/7 cases) and 33.3% (2 cases/6 cases), respectively.
2. Increase in salivation was recognized in the patients with Xerostomia and Sjögren's syndrome after administration of FEM-102.
3. As for the adverse reactions, no remarkable finding was obtained, except digestive-tract symptoms such as break wind, flatulence and sensation of abdominal distension in 11 cases.

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A clinical sudy of ofloxacin, a new synthetic antibacterial agent, for 24 patients with acute oral and maxillofacial infections was undertaken. Ofloxacin was orally given at a dose of 200mg three times a day to all patients. The results were as follows:
1. The clinical response rate was 87.5%. Side effects were not observed in any patient. The elevation of S-GOT, and S-GPT was observed after ofloxacin administration in one case in the laboratory examinations.
2.In vitro, ofloxacin showed high antibacterial activity mainly against α-streptococcus, isolated from suppurative lesions.
These rsults suggested that ofloxacin is a useful antibacterial agent against oral and maxillofacial infection.

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