We studied Cefotetan (CTT) concentration of serum and oral tissues (cortical bone, alveolar bone, gingiva, hard plate mucosa, buccal mucosa, maxillary bone, tongue, mandibular bone, cancellous bone) in 29 patients and similar experiments in 30 rats, and the following results were obtained.
(1) In rats, CTT was administered in a dose of 40 mg/kg by intravenous injection.The highest concentration was obtained in hard plate mucosa and followed in gingiva, mandibular cortical bone, tongue, submandibular gland, mandibular bone and maxillary bone at 10 minutes after administration.
(2) In humans, CTT in a dose of 2 g was administered by intravenous injection.Among gingiva, alveolar bone and cortical bone, the highest concentration was observed in gingiva. Peak concentration in gingiva was 62.6% of the corresponding serum value.In alveolar bone and cortical bone, they were 14.5% and 10.4%.
(3) In cortical bone, as from 90 minutes after administration, no detectable cases were observed in measured 6 cases, therefore, it is assumed that CTT may be rapidly excreted from cortical bone in comparison with other tissues.
(4) On the bases of these results, it was concluded that CTT is a useful antibiotic for the treatment of oral infection.

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The variations of serum SCC levels before and after chemotherapy are investigated in 28 oral squamous cell carcinomas. The mean serum SCC levels before chemotherapy and 1 week after chemotherapy are shown as follows; “No Change (NC)” cases (1.92ng/ml→1.95ng/ml, n=10) did not change; however, “Complete Response (CR)” cases (2.31ng/ml→1.26 ng/ml, n=4) and “Partial Response (PR)” cases (3.06ng/ml 2.29ng/ml, n 14) markedly decreased after chemotherapy with a significant difference. The variation rates of serum SCC levels before and after chemotherapy are-38.5% in CR cases, -23.5% in PR cases and +25.2% in NC cases. These results show that serum SCC levels correspond with the change of tumor volume in patiens.
Therefore, it suggests that the changes of serum SCC levels before and after chemotherapy would predict the effectiveness of chemotherapy in oral cancer.

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Carcinoma in pleomorphic adenoma (Ca in PA) is a rare lesion which is composed of a malignant tumor or is transformed from a benign pleomorphic adenoma. We describe immunohistochemical investigations of tumor markers in 5 cases of carcinoma in pleomorphic adenoma; keratin (polyclonal; TK: 41-65 kDa, monoclonal: KL1: 55-57 kDa; PKK1: 40, 45 and 52.5 kDa), vimentin, desmin, involucrin (Inv), S-100 protein, lysozyme (LZ), lactoferrin (LF), α₁-antitrypsin (α₁-At), α₁-antichymotrysin (α₁-Ach), carcinoembryonic antigen (polyclonal; CEA (P), NCA-absorbed polyclonal; CEA (N), monoclonal; CEA (M)), and epithelial membrane antigen (EMA).
1) Keratin which is an intermediate sized filament protein and an epithelial marker, is not a specific marker for this tumor. It showed both malignant and benign tumor cells, and did not discriminate the two lesions. Inv is lackeing in the tumor, but is detected in squamous metaplasia or keratinizing of the changed area.
2) S-100 proteins showed great variations for staining in tumor cells. Normal myoepithelial cells do not always show positive reactions.
3) LZ, LF, α₁-At, and α₁-Ach showed mostly negative in the cells of Ca in PA. They were associated with bacteriostatic mechanisms as a focal defence mechanism.
4) Polyclonal CEA reaction is not specific, and the reaction product appeared in both carcinoma and pleomorphic adenoma. True CEA reaction between cancer and pleomorhic adenoma tissues was unexpected.
5) EMA is a more useful and suspected tumor markers in correlation with histologic malignancy, grading and/or possibility.

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A 39-year-old man with squamous cancer of the left mandible, who previously had received irradiation, chemotherapy and surgery in another hospital, was seen in January 1985 complaining of severe pain due to recurrence of the cancer. He was given chemotherapy with VEMF (Vincristine, Endoxan, Methotrexate, 5-FU) and consecutively with cisplatin in our clinic. Unfortunately, they were ineffective, which resulted in marked growth and extension of the tumor. In parallel with this, he manifested the hypercalcemia (8meq/l) with no evidence of metastases to bones. Serum level of parathyroid hormone and active metabolite of vitamin D₃ were both lower, though within normal range, but nephrogenous cyclic AMP was significantly elevated. These clinical and laboratory data clearly suggested the hypercalcemia seen in this patient is so-called humoral hypercalcemia of malignancy (HHM).
We then implanted the patient's tumor into nude mice and succeeded in an establishment of tumor-bearing animals. They demonstrated the hypercalcemia similar to that of the patient in parallel with tumor growth. Endosteal surface of femurs of tumor-bearing nude mice showed an increased osteoclastic bone resorption.
These findings suggest humoral stimulator of osteoclastic bone resorption is released from the tumor. We believe these animals are a useful model for the study of HHM.

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It is generally accepted that either acute ductal obstruction or ductal filling with contrast medium during sialography increases intraluminal pressure and the substance accumulated in the luminal system is responsible for the increased intraductal pressure, but little information is available on the subseqent fate of the accumulated substance. The purpose of this study was to follow the movement of the substance accumulated intraluminally by means of retrograde injection of tracer particles.
In the present study on dogs, squid ink and ferritin particles suspended in saline solution were injectedluminally via the main duct of the submaxillary salivary gland and then traced mainly at the electron microscopic level. High intraluminal pressure was established at 80 cmH₂O, 130 cmH₂O, and 200 cmH₂O employing hydrostatic technique. Each pressure level was maintained for 5, 30, and 60 minutes.
The results showed that almost all of these foreign substances penetrated into the intercellular space of acinus and ducts by passing through the intercellular junctions. These substances finally reached the interstices of the gland across the basal lamina, but the leakage from the basal lamina increased with elevation of injection pressure.
On the other hand, there was via the coated pit uptake of a small quantity of squid ink accumulated in the intercellular space of the intercalated duct and thereafter it was found in the secondary lysosomes.
The present observation suggests that the removal route of squid ink from the lumina can be divided into two different ways. The first route appeared to be produced mechanically by the so-called back pressure and the second route was formed by the phagocytic activity of the intercalated duct cells. However, it is still unknown whether the uptake of squid ink is physiological or pathologic.

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The author performed the following examination to investigate the effect of decalcified freeze-dried homogeneous bone grafts on the irradiated rabbit mandible.
Group I: no-irradiation, bone defect only
Group II: no-irradiation, decalcified freeze-dried homogeneous bone grafts into bone defect
Gruop III: after irradiation, bone defect only
Group IV: after irradiation, decalcified freeze-dried homogeneous bone grafts into bone defect
Each defect measured 6×3×5mm was made in the inferior border of the rabbit mandible.In Group III and IV, bone defects were made 4 weeks after 36 Gy irradiation. Decalcified freeze-dried homogeneous bones were prepared in the manner described by Urist, et al. and then the crushed bone fragments were implanted into the bone defects. The rabbits were killed at 1, 2, 4, and 12 weeks postoperatively. Observation was done using H-E stain sections, labelling and microradiography.
Group I showed more rapid new bone formation in the bone defects than Group II at 1 and 2 weeks postoperatively, but at 4 and 12 weeks new cortical bones were formed and there was little difference in the healing between Group I and II. In Group III and Di, new bone formation was almost never seen at 1 and 2 weeks. Group III showed thin cortical bone formation which carved into the bone marrow side, but Group IV showed the original shape and thickness of the inferior border at 12 weeks. The author thought that these results suggested the effect of the decalcified freeze-dried homogeneous bone grafts on the irradiated bones.

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Relationship between ramifications of the facial nerve and the temporomandibular joint (TMJ) have been studied with a special reference to the surgical approach. Forty-four TMJ from 22 adult cadavers were dissected in order to observe ramifications of the facial nerve and examine the relations between them and TMJ.
It was concluded that the temporal branches of the facial nerve were preserved from surgical injury using the temporal approach for surgery of the TMJ (Al-Kayat and Bramley approach and its conservative modification).

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Clinicostatistical investigation was made about 105 patients performed neck dissection (including radical and partial neck dissection and lymph node extirpation) out of 197 oral malignant tumor patients at the Department of Oral and Maxillofacial Surgery 1st, Hiroshima University, School of Dentistry between October 1974 and September 1984.
Metastasis to the cervical lymph nodes were histologically confirmed in 45 patients. They were most frequently found at submandibular lymph nodes, but in some patients found only at lower cervical lymph nodes. Thus radical neck dissection should be proposed for the first choice of the treatment.
The comulative five year survival rates of patients performed prophylactic and therapeutic neck dissection were 60% and 62%. Although there is no significant difference between them, prophylactic neck dissection may have reduced late metastasis.
34 patients confirmed metastasis histologically were performed conservative radical neck dissection, and only 3 patients (9%) had recurrence at the cervical region. This indicates that conservative radical neck dissection is valuable provided there is no metastasis to the internal juglar vein.

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The present study was undertaken to confirm the clinical value of arthrography of the temporomandibular joint, which is currently gaining acceptance as a diagnostic tool in the field of joint pathosis. Arthrographic findings, obtained from 118 joints in 89 patients with temporomandibular joint symptoms and classified according to the criteria of Sugisaki et al., were compared with the clinical findings in each individual, with reference to the extent of maximum mouth opening, chin deviation and pain in the joint on opening and closing, together with joint noises involving reciprocal clicking and non-reciprocal clicks and crepitation. It was found that, although moderate interdependence existed between clinical symptoms and arthrographic findings, no single clinical sign or any combination of signs necessarily denoted any specific arthrographic finding. This was especially true in patients suffering from joint noises and disturbed joint movements. This result would seem to justify the need for arthrography of the temporomandibular joint to make a confirmatory diagnosis of pathological changes in the joint, since the subsequent treatment may very in accordance with the detected pathosis.

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Clinical and histopathological studies on 5 cases of benign cementoblastoma were reported.
Three male and two female patients had a mean age at first visit of 20 years.
Radiologically, the tumor appeared as a well delineated radiopaque mass which was continuous with the apex of the root.
Histologically, we found the development of the tumor started from the production of many trabecular cementums and they fused together, and finally became a large cemental mass. These sequential changes were quite different from the other types of cementoma.
The tumor was resected in toto, but recurrence occurred in one case. Accordingly, curettage of the surrounding bone seemed to be needed in any case.

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The nasoalveolar cyst is known as a cyst which develops from alveolar bone of alase nasi. Case reports of the nasoalveolar cysts are considerably rare. We experienced a case of a nasoalveolar cyst. The patient was a 62-year-old woman. She had a cyst in the left alase nasi. It was reported.

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Osler's disease is characterized by the triangular features of teleangiectatic lesions, hemorrhagic tendency and inheritance.
Recently we experienced a case of this disease. The patient was a 50 year old woman who complained of oral bleeding, and we found other 6 patients in her family. We treated her surgically and she now has a good prognosis. We detected the relationship between Osler's disease and HLA (Human Leukocyte Antigen) locus. HLA typing was carried out by microcytotoxicity test. The haplotype A2 and B5 were found in 3 of 4 patients in this family.

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This study was undertaken to determine the indication and value of marginal resection of the mandible as a method of treatment for squamous cell carcinoma of the floor of the mouth. Eighteen patients whose primary tumors were treated by utilizing marginal resection at the Department of Oral Surgery of Hokkaido University from 1977 to 1986, were studied clinically and histopathologically. Another ten patients who had undergone resection of the primary tumor by other surgical methods during the same period, were also studied histopathologically.
Local recurrence was observed in one case and the 5 year survival rate was 71. 3%. The histopathological study revealed that the cortical bone was eroded or destroyed by tumor tissues in more than half of the cases where the primary tumor had been diagnosed to have gingival invasion, mandibular adhesion or mandibular invasion. Tumor invasion into the periodontal ligament and bone marrow was also found in some cases. However, bone erosion and tumor invasion were limited within a small area, and tumor tissues did not invade beyound the extent which was anticipated before the surgery. These results suggest that some of the squamous cell carcinoma of the floor of the mouth can be removed by marginal resection of the mandible, even if the tumor invades the gingiva, the periosteum and mandible. On the other hand, in cases where the primary tumor had been diagnosed as not having gingival invasion nor mandibular adhesion, varied amounts of fibrous tissues were observed between the tumor tissues and the mandible. This suggests that squamous cell carcinoma of the floor of the mouth can be removed without resecting the mandible, if normal tissue is interposed the tumor and the mandible clinically. However, in some cases, particularly where the lesion was accompanied with infection and/or pain, it might be difficult to ascertain if the tumor had invaded the mandible or not. Therefore, it is recommended that squamous cell carcinoma of the floor of the mouth be removed by utilizing marginal resection of the mandible, if mandibular invasion is doubtful.

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Fungal infections of the paranasal sinuses were considered to be rare in occurrence. However, in recent years reports of such infection seem to have increased. In this report we presented two cases of aspergillosis of the maxillary sinus.
Case 1: A 46-year-old woman was referred to our university clinic with the chief complaint of pain in the right maxilla. Sinus x-rays showed opacification of the right maxillary sinus with calcification which resembled a foreign body. Clinical diagnosis of the right maxillary sinusitis was made and the Caldwell-Luc operation was performed revealing a sinus existed with brown caseous materials. Postoperative histopathological examination of this material revealed the presence of aspergillus.
Case 2: The patient was a 42-year-old woman. After the extraction of a maxillary molar tooth, nasal discharge continued. She was referred to our university clinic by her dentist. Sinus x-rays showed opacification of the left maxillary sinus with calcification. Clinical diagnosis of the left odontogenic maxillary sinusitis was made. Similarly to case 1, the patient underwent the Caldwell-Luc operation which revealed brown caseous materials, and postoperative microscopic examination revealed septate fungal organisms consistent with aspergillus.

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Dermoid and epidermoid cysts occur congenitally by entrapped ectodermal tissue during embryonic development, or adventitiously inflammatory and traumatic implantation of the epithelium.
In the maxillo-facial region it is found on the floor of the mouth, especially in the middle, but also occasionally occurs in the submandibular region.
We have experienced one case of a relatively large epidermoid cyst in the left submandibular region of a 51 year old woman. The lesion was clinically suspected of a benign tumor of the submandibular gland and was surgically enucleated, but later histopathologically diagnosed as an epidermoid cyst.

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The out-patients at the Department of Dentistry and Oral and Maxillofacial Surgery, Kinki University Medical School Hospital were analyzed statistically over eight years (1979-1986).
1. The total number of out-patients first seen at our clinic was 8, 668 including 4, 073 males and 4, 595 females. For the last 2 years, the number of patients seen has increased about 16% each year.
2. Recently, the number of patients over 51 years old has increased and number of patients under 50 years old has decreased.
3. Over the last 3 years, cases of “injuries” have increased 3.8%, “Cysts” 2.2%, “Disorders of the temporomandibular joint” 1.5%, “Tumors” 0.7%, cases of “inflammatory diseases” have decreased 7.3% and “Malformations and developmental abnormalities” have also decreased 2.0%.

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We encountered a 71-year-old man who had trismus and buccal skin perforation after he had treatment for adenocarcinoma of the maxilla about two years ago. He had a pair of dentures but couldn't chew many foods because of trismus, and he also complained of desiring to close his buccal perforation. Therefore, we successfully treated his trismus by removing the colonoid process and his buccal skin perforation by the hinge flap method.

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This article is a RSD case report. The patient was a 54 year old woman who had complianed of severe pain in the right mandibular region over the past 13 years. Prior to a visit to our hospital, she had undergone various medical treatments, including trigeminal nerve block, gangliongasselectomy, micro-vascular decompression operation, rhizotomy, trigeminal spinal nucleotomy, etc., on the diagnosis of trigeminal neuralgia at many medical institutes. However, none of the treatments lead to an improvement of her condition.
At the start of the treatment in our hospital, we regarded her pain as psychogenic pain, because of her abnormal personality and psychological state and the lack of evidence of remarkable organic change on a clinical and X-ray examination. After one and a half years, we at last realized that her pain was due to RSD which was brought on after the nerve block treatment for trigeminal neuralgia and the pain was modified and accentuated by psychogenic overlay.
So far, we have been performing stellate ganglion block, regimen of antidepressants and indomethacin, under a brief psycho-therapy. Although the pain still continues, the patient hasbecome remarkably settled in her mind.
We also discussed in this article the difficulty of differential diagnosis among RSD and psychogenic pain and the need for consideration of psychogenic overlay and polysurgery in this case.

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Sponge compressions and intradermal steroid injections were performed on the hypertrophic scars of the white lip which had developed after the secondary correction of a cleft lip and nose deformity in two patients. Sponge compression was not effective in both cases, but steroid therapy was moderately effective in one case where the injection was started relatively early (2 months) after the corrective operation.
Histological examination of the scar tissues which had been conspicuous preoperatively, revealed subcutaneous accumulation of abnormal collagen tissue, even in the older cases.
Accordingly, surgical removal of the subcutaneous collagen mass seemed necessary for the definitive treatment of the conspicuous scar on the white lip.

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Four cases of lipoma in the oral cavity were reported,
Case 1: A man, aged 83, presented a mass in the mucobuccal fold corresponding to 6. The tumor was extirpated and it measured 10mm by 10mm by 13mm.
Case 2: A man, aged 71, presented a mass on the right edge of the tongue. The tumor was excised and it measured 20mm by 30mm by 50mm.
Case 3: A woman, aged 61, presented swelling in the mucobuccal fold corresponding to 54. The tumor was extirpated and it measured 10mm by 10mm by 10mm.
Case 4: A man, aged 62, presented a mass in the left edge of the tongue. The tumor was excised and it measured 6mm by 6mm by 6mm.
Pathological diagnosis of the four cases was lipoma, and the prognoses of all were favorable with no sign of recurrence.

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A 7 years and 10 months old boy with tetrasomy 9 p (47 xy +i (9 p)), cleft lip and palate is reported.
Tetrasomy 9 p is a very rare chromosome abnormality and has many clinical features.
Previously, 15 cases had been reported, and our case is the 16 th case.
We can find 7 cases of tetrasomy 9 p without the extra part for the long arm chromosome 9.
We report the 8 th patient with a tetrasomy only of 9 p, who has multiple congenital malformations.
Five cases among the 15 were complicated by cleft lip and palate.
GALT enzyme activity in this case is twice the mean of the control values.

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We presented 3 cases of herpes zoster affecting the trigeminal nerve. Case 1 was a 38 year-old woman whose lesion spread over the area of the second and third branches of the right trigeminal nerve. Case 2 was a 34 year-old man whose second branch of the left trigeminal nerve was affected. Case 3 was a 40 year-old woman whose lesion merely involved oral mucosa, the right side of the palate and upper gingiva, and she had no systemic disease and no change of skin.
All three cases were treated by Vidaravine, and their prognoses were favorable without post-herpetic neuralgia.
In two cases, anti-VZV-titers in the acute phase were negative, but those in the recovery phase increased remarkably.

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Oral symptoms as observed in leukemia are varied, its clinical symptoms being also diversified. On this occasion that author has experienced a case of acute myelomonocytic leukemia presenting specific oral symptoms.
The case is a 46-year-old man, who presented left maxillary neuroparalysis and a necrotic ulcer at the palatal region. The nueroparalysis observed was localized in the left maxillary area, where pulp diagnosis confirmed dental anesthesia. It was initially regarded as due to CNS leukemia, which was, however, denied by general examination findings and other symptoms, and finally, leukemic cellular infiltration and inflammation were considered to be responsible for it. The palatal ulcer became enlarged with a decrease in neutrophils and further was complicated with a P. aeruginosa infection. Remarkable results were obtained by CFS ointment, which was prepared for P. aeruginosa in the ulcerated region and was applied directly to the affected site. CFS ointment has already been assayed for titer and has shown good results of stability.

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A case of disseminated intravascular coagulation syndrome (DIC), which was induced during surgical operation and cured by the prompt treatment, is reported. The patient was a 52-year-old female with gingival carcinoma at the mandible (T₂N₀M₀). Radiation therapy with ⁶⁰Co (total dose of 30 Gy) and chemotherapy (100 mg pepleomycin. and 60 g tegaful in total dose) were carried out preoperatively. Tumor excision with segmental mandibulectomy, immediate reconstruction of the mandible by use of A-O osteosynthetic plate and radical neck dissection were performed.
Close to the end of the surgical procedure, hemorrhagic diathesis arose. Data of laboratory examination immediately after the operation (7.7×10⁴/mm³ of platelets, 33% of prothrombin time and 43 mg/dl of fibrinogen) suggested acute DIC.
Heparin, FOY (gabexate mesilate), and FFP were immediatly administrated and then the hemorrhagic diathesis disappeared. Seven weeks were required to cure the chronic DIC completely.
At present, the patient is free from recurrence of both DIC and carcinoma.

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