Le Fort I osteotomy modified by Obwegeser has become a basic technique in the treatment of jaw deformities and is used by many maxillofacial surgeons. Fixation following Le Fort I osteotomy has changed from metallic wire fixation to fixation using miniplate. Although the usefulness of miniplate is clinically recognized, dynamic evaluation of postoperative stability has been rare. The authors assessed, using SAPHON VISITRAINER II C (Sato-Iryodenshi) and Autograph S-500 (Shimazu), miniplate fixation power following Le Fort I osteotomy in various combinations of Champy's miniplate.
(1) Fixation with 6-miniplate resulted in significantly smaller displacement in three directions, compared to other fixations.
(2) On comparing displacement by 4-miniplate and 6-miniplate fixations, no significant differences were demonstrated in the sagittal and dextrosinistrol directions.
(3) Fixation with 2-miniplate produced a significantly larger displacement than that with 4 or 6 miniplates.
(4) Stability comparison of 2-miniplate fixation at the region of submalar crest with that at the margin of piriform aperture showed no significant displacement differences in the three directions.

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Implant materials which serve as substitutes for hard tissues such as teeth and mandibles must satisfy many criteria including biochemical compatibility, biomechanical compatibility, and ease of processing and handling.
The authors et al. have developed multiphase materials consisting of hydroxyapatite [HAP] particles (8μ or 7μ average diameter), poly (2, 2, 2-trifluoroethyl methacrylate)(PTFEMA) or poly (methyl methacrylate)[PMMA] around a metal core in order to obtain an implant material which easily satisfies all the proposed criteria.
The purpose of this study is to evaluate the biochemical compatibility of these multiphase materials. HAP-70 wt% polymer composite materials were placed on the interfacial layer of multiphase materials in direct contact with living tissue. In order to evaluate biochemical compatability, the HAP-polymer composite was examined using a direct contact method cell culture test which measured cytotoxity and cell adhesiveness. As controls, both homopolymers of PTFEMA and PMMA, and HAP dense ceramics were also examined.
Consequently,
(1) Neither PTFEMA nor PMMA demonstrated cytotoxity, but each tended to require more time for cell spreading and cell growth on the surface than HAP dense ceramics.
(2) HAP dense ceramics showed high degrees and rates of cell adhesiveness and growth.
(3) Both HAP-polymer composite materials, containing either PTFEMA or PMMA showed essentially the same cell adhesiveness and growth pattern as HAP dense ceramics.
These results indicate the safety and suitability of these multiphase materials for use as implant materials when hard tissue substitutes are required.

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In patients undergoing unilateral excision of the soft palate due to squamous cell carcinoma of the soft palate, a prosthesis was implanted, and the patients were studied phonetically for 18 months after operation. The following results were obtained.
1. The vowels, “a”, “e”, “i”, and “o” were pronounced perfectly by patients using the prosthesis, but the inteligibility of “u” was lowered, which tended to be mis-heard as “0” This is felt to arise because the resonance chamber was deformed by the mounting of the prosthesis. However it was possible to compensate for this by using the tongue.
2. Among the consonants, almost all sounds except for plosives and nasals, were improved by the prosthesis. Trouble with plosives was caused by imperfect elevation of the internal pressure of the oral cavity, and its improvement was inadequate even 18 months after operation. This seems to be a limitation of prosthetic therapy at the present.

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An intermaxillary fixation conventionally used in reconstruction of the fractured mandible imposes an enormous amount of inconvenience lasting for 6-7 weeks on patients.
Reconstruction of mandibular fracture without the use of an intermaxillary fixation has been developed. Of various methods so far developed, a method proposed by Champy has gained most widespread applications.
In practical application, however, the Champy's method, which is regarded at present as most advantageous, must be performed within 6 hours after fracture and is thus restricted by time.
In Japan, patients with mandibular fracture are rarely referred to oral surgeons within 6 hours after injury but almost always a day or two later at the earliest.
This paper presents a new method developed for reconstruction of the fractured mandible without recourse to an intermaxillary fixation. The method can be applied to patients within 2 weeks after injury. A reconstructed mandibular model by simulation surgery is prepared and a metal cast arch bar is prefabricated using the above model. This arch bar is first fitted to the non-dislocated side of the dental arch. The dislocated side of the dental arch is then inserted into the arch bar. Finally Champy's miniplates are screwed to the lower margin of the mandibular body.
Photoelastic stress analysis after fixation by this method disclosed normal distribution of stress such as seen in unfractured mandible.

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Four pulverized bone substitutes for practical use; Alumina (Al), Hydroxyapatite (HAP), Titanium (Ti) and Silica (Si) were studied from the viewpoint of phagocytic activity and cytotoxityin vitroby utilizing rat peritoneal macrophages. In addition to the activation of lysosomal enzyme, the activity of acid phosphatase released from macrophages in the incubation medium were measured after incubating in the presence of those four powderin vitro. We made an attempt to evaluate the biocompatibility of the materials objectively in this study. The results obtained were as follows;
1. In Al and Ti group, the rates of adhesion and viability of macrophages, exhibited the same time courses of changes as the control. In Si group, the rates were the lowest at 120 minutes after incubation. HAP group showed moderate rates between Al, Ti group and Si group.
2. Scanning electron microscopy revealed that some cytoplasmic vacuoles appeared in macrophage of Si and HAP group. Any significant morphological changes were not observed in Al and Ti group.
3. Si group showed the highest value of acid phosphatase activity in four groups. In HAP group the activity was lower than those in Al and Ti groups. Based on the above findings, it was clarified that the effect of such bone substitute on cellular injury increased gradually in order of Al, Ti, HAP and Si. It might be considered that our test can be a promising can didate as a screening test of bone substitutes.

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Odontogenic keratocyst has been reported by many authors as a specific entity of odontogenic cysts since first described by Philipsen.
Histopathologically, keratinization of the epithelial lining and formation of micro cyst; clinically, higher incidence of recurrence are characterized. Three hundred and sixty odontogenic cysts operated in the Department of Oral Surgery from 1966 to 1984 were studied. A representative histopathologic section from each cyst was screened, using the criteria for odontogenic keratocysts as stated by Pindborg.
Of the 360 cases, 24 fullfilled the histologic criteria for odontogenic keratocysts, for a 6.7 per cent incidence. Of the twenty-four patients, one was diagnosed as basal-cell nervous syndrome, and had five cysts. Of the 24 patients, six had cyst recurrence for a rate of 32 per cent. One patient each had recurrence after one year five months, after three years, after three years four months, after three years five months, after four years six months and one four years ten months after the primary operation. Recently, some investigators have pointed out that odontogenic keratocyst may be benign cystic epithelial neoplasia. In our study, this opinion has been taken into account in view of the higher incidence of recurrence, but no histologically precise feature was obtained.

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We reported a rare case of malignant fibrous histiocytoma (MFH) of the left maxilla in a 76-year-old woman. The tumor destroyed the alveolar bone of the left maxilla. Moreover, it not only filled the left maxillary sinus but also invaded its surrounding walls. The tumor was diagnosed histologically as MFH. After surgical removal of the tumor, it recurred in seven weeks. The patient died about a year after her first examination.

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Alumina ceramics have excellent biocompatibility and have been used as a bone substitute. We used alumina ceramics as artificial jaws for reconstruction of the mandible or as supplements to improve mandibular asmmetry since 1982. The results in 7 patients were satisfactory, but in one patient the alumina ceramic artificial jaw was fractured by stress at operation. We used stainless steel wire for fixation in this case, however, the artificial jaw had to be removed because of loosening of the wire. In two other cases the surgical wound ruptured. The wounds healed after irrigation, administration of antibiotics and surgical treatment. We concluded that stainless steel wire is inappropriate for fixation because of its different properties and alumina ceramic is not subject to infection. In an alumina ceramic prosthesis is chosen after due consideration, a good postoperative course can be expected.

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Up to now, most clinical and statistical analyses of Maxillofacial fractures have been done on the population as a whole. No detailed information on maxillofacial fractures specifically of high school students could be found despite the fact of high frequency of occurrence among this group. We conducted an investigation into the cases of maxillofacial fractures of high school students treated at the oral surgery department clinic of the Ryukyu University Hospital during the five year period from January, 1980 to December, 1984.
We noted that 44 cases or 15. 4% of all patients with maxillofacial fracture were high school students. Males were found to be more prone to maxillofacial fracture than females (4.2: 1). First year students proved to be more prone to such fractures than second and third year students. Of the total cases, 19 (43%) were in-patients and 25 (57%) were out-patients.
The causes of fractures were mostly traffic accidents (63%) especially two-wheeled vehicle accidents (50%), followed by fist blows and sports accidents (14%, respectively).
Of all fractures, 29 cases (65%) were found in the mandible, 8 (18%) in the maxilla (including the middle third facial region), and 7 (17%) in the mandible and maxilla. In the mandible, the most frequent fractures were found in the region of the molar and angle, and the second most frequent were in the incisal area.
Among the 44 cases, a total of 140 complications were observed; among those complications, 33 were found in the oral mucosa, 24 in the teeth, 27 in the facial skin. Twenty-one cases experienced unconsciousness and there were 6 cases with fractures other than facial.
Only 4 cases (10%) were referred to us from private dental clinics. Thirty-two cases (73%) were referred from public and private hospitals, and the remaining cases from various other sources.

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It is occasionally difficult to treat a medial or lateral rotated zygomatic fracture by the closed method. Open reduction leads the better stability of fragments after operation. The relapse of the zygomatic corpus is, however, liable to occure, when only wire ligature on fronto-zygomatic suture and maxillo-zygomatic suture are employed.
The reason for this is that masseteric muscle adheres from zygomatic corpus to arch. In our clinic, the use of mini plate has given good results to such cases. The mini plate is fitted to the infra-orbital region for the medial rotated fragment and to the fronto-zygomatic suture region for the lateral rotated fragment. This method shows rigid fixation, stability and resistance against relapse after surgery. Four representative cases given in this paper.

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Clinical experience of two cases with arteriovenous fistula of mandible
Arteriovenous fistula is a vascular lesion showing communication between artery and venos without passing through capillary vessels. It often presents serious problems to the patients and clinicians because of high risk of severe hemorrhage occurring either spontaneously or as d result of unsuitable surgical procedures. This paper described the treatment of two patients who suffered from arteriovenous shunt of mandible.
Case 1: A 25 year old man complaining of swelling left, cheek visited our hospital on January 12, 1971. He had been under the care of several surgeons in the past, the previous treatment had induced surgical excision of buccal tissue and ligature of left facial artery. The lesion had spread from the left cheek to the left submandiblar region. It was diagnosed by carotid angiography as arteriovenous malformation. By the first treatment at our clinic in 1971, surgical excision was performed to check region but before long, recurrence was observed at that region. As the succeeding treatments, therefore, cryosurgery and continuous infusion of 5 FU was performed. Scarcely getting good results by those treatments, we did a radical operation including hemimandiblectomy. Consequently no recurrence has been observed till now.
Case 2: 55 year old female, complaining of intraoral bleeding, visited our clinic on April 23, 1981. A few weeks before visiting our clinic, she had a sudden attack of intraoral bleeding at night. The next day she visited the clinic and was diagnosed as ameloblastoma of mandible. Examination showed the lack of mucous membrane about 5 mm in size on the left lower alveolar ridge. Pulsation was palpable and a bruit was audible in the region of the left mandibular angle. The lesion was diagnosed as A-V fistula being concerned in artery of mandible, facial artery and vertibral artery by carotid angiography. Radical operation was performed, and over 6 years no signs of recurrence have been found till now.

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Thyroglossal duct cyst, a comparatively uncommon disease, arises from epitherial rests in the remnants of the thyroglossal duct produced by the descendant of the thyroid anlage. There have been 11 cases of thyroglossal duct cysts treated at the Kyushu University Dental Hospital from 1976 to 1984 and the authors did clinical and histopathological studies of them.
Results were as follows:
1. Clinically, in 11 cases-7 males and 4 females-the thyroglossal duct cyst appeared between the age of birth and the age of 68 years, but many cases showed the onset within ten years old, and in 9 cases, the cyst appeared at or below the level of the hyoid bone. The cysts vary in contents and measure from 8 mm to 50 mm in diameter.
2. Histopathologically, the entire specimens were lined with the prural epitherium. The epitherium lining of the cysts were stratified aquamous epitherium in 11 cases, ciliated columner in 7, and cuboidal or columner epitherium in 8. There are many adexa, such as thyroid tissue (4 cases), mucus glands (5 cases), and goblet cell (5 cases), but the frequency of their appearance are in the location of the cysts.

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Schwannoma is an endodermal tumor originating from schwann's cell of myelinated nerves. There are few cases of schwannoma in the oral region, especially in the jaw. We have experienced a case of central schwannoma of the mandible. The patient, a 53-year-old woman, was pointed out a radiolucent area in the right lower part of the jaw by a dentist, and she visited our hospital. Based on the clinical diagnosis of radicular cyst, the lesion was enucleated under local anesthesia November 4, 1986. Histopathologically, the section demonstrated a dense proliferation of slender cells with spindle-shaped nuclei in a whorl or palisading arrangement. It was diagnosed as schwannoma, Antoni type A. It is reported that schwannoma infrequently recurs and the patient has a favorable postoperative course without any recurrence for a year.

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DIC (Disseminated intravascular coagulation) in a patient with undifferenciated adenocarcinoma of the submandibular gland was reported.
The patient was a 74-year-old man referred to our hospital because of swelling at the right submandibular region.
DIC was found hematologically eight days after radiation. The platelet count decreased to 65×10³/μl, fibrinogen decreased to 164 mg/ml and fibrin and fibrinogen degradation produsts (FDP) increased to 40μg/ml.
At first treatment was daily performed with continuous heparin-drip (12, 000 U/day), and then gabexate mesilate (1, 200 mg/day) was administrated during 29 days. As a result of this treatment, hemostatic improvement was obtained.
Discussion was also made concerning the diagnosis, treatment and cause of DIC and in addition the reports of DIC in oral and maxillofacial surgery were reviewed.

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Long-standing dislocation of the temporomandibular joint is a comparatively rare occurrence, although dislocation of the temporomandibular joint itself is not infrequent. Most patients with TMJ dislocation are early diagnosed and treated by manipulation technique because symptoms are rather characteristic.
This paper described a long-standing TMJ dislocation casc from the asp, t of diagnosis and treatment that occurred in a 17 year-old female with cerebral palsy, epilepsy, micrognathia, and pneumonia. At the same time several problems about the difficulty of the treatment modality were discussed.

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Rubella, usually a mild disease, is a common viral infection in children. However maternal rubella infection can cause severe congenital defects-for example cataract, deafness, heart disease etc., -and it is called congenital rubella syndrome.
We recently experienced a case of cleft lip and palate which was suspected to be congenital rubella syndrome.
The patient was a six-month old baby boy with unesthetic appearance and difficulty of sucking with cleft lip and cleft palate on the right side.
He also had several congenital defects (cataract, deafness and foot deformity) besides cleft lip and cleft palate.
Thus we suspected that he had been suffering congenital rubella syndrome.

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Dermoid and epidermoid cysts are congenital cysts caused by the impaction of embryonal ectoderm, or are acquired cysts caused by inflammatic and traumatic implantation of the epithelium.
Epidermoid cysts are known to occur usually within the oral cavity, and rarely in the jaw bone. The cyst is lined by a comparatively thick even layer of hyperkeratinizing stratified squamous epithelium and its cavity is filled with keratin, but without skin appendages.
The authors have recently experienced one case of epidermoid cyst in the right mandibular molar region of a 32 year old female, and reported the outline of this case with some comments based on the literature of Japan.
This lesion was pathologicallly diagnosed as epidermoid cyst. In the treatment, the cyst was surgically enucleated under general anesthesia with Enflurane Dec. 24, 1986. The patient has shown recuperation after six months following surgery and we will continue to make careful observation of the patient's prognosis.

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We have experienced a case of analyzing hemangioma with multiple phlebolite on the right tip of the tongue. The phlebolite were observed with Scanning electron microscopy (SEM) and Contact microradiography (CMR). The stone components were also analyzed by chemical method and X-ray microanalyzer.
The observation of SEM and CMR showed that stratiform calcification took place and their internal structures were slightly different depending upon the sizes of stones. The constitution of stones was 8% water, 7% organic matter and 85% mineral. Preponderance of minerals were calcium and phosphorus. Ca/P ratios calculated by the chemical analysis and X-ray elemental analysis were similar to that of hydroxyapatite.

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Trigeminal neuralgia is one of the diseases which we encounter frequently in oral surgery. The treatments for this disease are mainly symptomatic therapies such as pharmaceutical treatment and nerve blocking treatment, but the existing circumstances are that none of these methods has a decisive effect, and is unable to produce a favorable result in many cases.
The authors have experienced 2 refractory cases which were clinically diagnosed as idiopathic trigeminal neuralgia. The patients repeatedly developed pain, though pharmaceutical treatment or various other treatments such as alcohol blocking were made. Therefore, various studies have been made for the treatments, and an attempt has been made to perform alcohol blocking orthoptically by exposing the nerve operatively. As a result, favorable progress has been observed without recurrence so far, which we report here with some of our consideration added.

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A tendency noticed in recent years that patients with temporomandibular joint arthrosis are increasing. Difficulties are usually encountered for selecting countermeasures because the etiology and pathological behavior varies so much with individual patients. In our clinic a special section is made for treatment of outpatients with temporomandibular joint arthrosis but many patients fail to continue visiting our clinic during the course of the treatments.
We have therefore conducted a clinical statistical study on 348 patients who visited our clinic with temporomandibular joint arthrosis complaints in the past 3 years. Questionnaires were also given to 138 of them who failed to complete the therapy, in order to find their reasons for suspending their visits to our clinic.
The results revealed the following findings;
1. As in the conventional reports, female patients in their 20s with chief complaints of pain had the largest share of the total number of patients. Those whose terms of visits to our clinic for less than one month were of the largest percentage.
2. Those who could be judged as successfully cured amounted to 197 out of 348 cases (56.6%).
3. Those who suspended their visits to our clinic were mainly males. Those with a chief complaint of awkward sounds in the temporomandibular joint were of the largest percentage. They stopped coming before their fifth visit.
4. Those who failed to continue their visits to our clinic were of the largest percentage among those who made their first visits to our clinic after more than 2 years had passed since the onset of their disease.
5. Those who failed to continue their visits to our clinic due to relieved symptoms were of the largest percentage of the total number of patients.
6. In the majority of the patients who failed to continue their visits to our clinic, more or less symptoms of temporomandibular joint remained even at the present time.
7. Approx. 10% of the patients suspended the treatment, despite unrelieved symptions.
On the basis of the above results, the difficulties in the therapeutic treatment of temporomandibular joint arthrosis were realized. It was therefore conceived as necessary to strive for establishing accurate therapy against it and for better recognition of patients against temporomandibular joint arthrosis so as to have their better cooperation to the therapeutic treatments.

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The efficacy of Amfenac Sodium (Fenazox^®), nonsteroid anti-inflammatory agent on temporomandibular joint pain was clinically evaluated in 28 temporomandibular arthrosis patients. Amfenac Sodium dosage of 200 mg was given orally in 4 times daily for two weeks.
The results were as follows:
1) Temporomandibular joint pain and limitation of mouth opening because of pain improved remarkedly.
2) Effectiveness of Amfenac Sodium was “Excellent” in 5 cases (17.9%), “Good” in 12 cases (42.9%) and “Fair” in 10 cases (35.7%).
3) Side effects were observed in 8 of the 28 cases. Most of those 3 cases had slight gastrointestinal disorders and only two cases were dropped.
4) The usefulness of Amfenac Sodium was in 3 cases (10.7%) “Excellent”, 13 cases (46.4%) “Good” and 10 cases (35.7%) “Fair”.
It is suggested that Amfenac Sodium is useful for relief from temporomandibular joint pain in temporomandibular arthrosis patients.

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