In order to identify the organization of cytoskeletons in cultured oral keratinocytes and to characterize the changes of these filamentous systems in oral mucous diseases, cultures of oral keratinocytes from gingiva were investigated by immunofluoresence microscopy, using monoclonal antibodies to keratin, α-tubulin and actin.The cultures were fed with Dulbecco's modified Eagle's medium supplemented with 10% fetal calf serum, 0.4 ng/ml hydrocortisone, 10 ng/ml epidermal growth factor, 84 ng/ml cholera toxin, 100 ng/ml streptomycin and 100 unit/ml penicillin.The arrangement of keratin intermediate filaments (KIF) in these cells showed a dense meshwork around the nucleus and a radiating pattern of filament bundles to the cell periphery.Bundles of KIF ended at desmosomes.
Microtubles also showed an array similar to that of keratin but these bundles of microtubles ended freely at the cell periphery independently from those of the neighbouring cells.
The fluoresence pattern of actin showed diffuse distribution throughout the cell and filamentous structures were not observed.After treatment with cytochalasin B, KIF were rearranged into a “Lattice” structure, but no significant re-organizations were observed by colchicin treatment.
These results demonstrate that organization of cytoskeletons in oral keratinocytes is very similar to that of skin keratinocytes.

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Benign symmetrical lipomatosis (BSL) that is a subgroup of benign lipomatosis disease is rare in the oral region. We recently experienced a case of macroglossia caused by BSL. The patient, a 71 year old man, came to our department with complaints of swallowing, eating and speech disorders by macroglossia. This case was diagnosied as symmetrical macroglossia. Glossectomy was performed under general anesthesia in order to improve these function disorders.
It was diagnosised histologically because of its diffuse invasion of lipoid tissue.

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Our experience with 19 consecutive pectoralis major myocutaneous flaps was reviewd. Correlation between technical detail and long term results, especially speech function, were discussed. Also surgical complications and their causes were analyzed in some clinical cases. Conclusions are as follows;
1. Monosyllable intelligibility scores after operation decreased according to the resection area of tongue. For example, partial glossectomy: 81.9%, hemiglossectomy: 71.5% and subtotal glossectomy: 39.3%.
2. Monosyllable intelligibility scores changed according to the flap suture position. In the high suture position the score was 64.6%. And in the low suture position it was 42.3%.
3. Surgical complications after the operation were 3 cases, of orocutaneous fistura, 3 cases of partial nectosis and 2 cases of facial edema. All cases of orocutaneous fistula were low position ones.
4. Muscle atrophy of the flap was observed in all cases. Therefore in reconstructing the tongue with pectoralis major myocutaneous flap, over correction of the tongue is necessary.
5. Severe hyperkeratosis and hair regrowing from the flap were observed in 5 cases each.

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Mucoepidermoid tumorous transformation in odontgenic cysts seems to be an extremely rare phenomenon. A case of central mucoepidermoid tumor arising in the wall of an odontgenic cyst in the left premolar area of the mandible of a 37-year old woman is reported.
She, apparently in good health, was referred with gingiva bleeding. Oral examination revealed periodontal disease of the teeth. However, radiographic examinations confirmed the presence of a radiolucent area in the left premolar area of mandible. Moreover, excisinal biopsy revealed a low grade mucoepidermoid tumor. The entire tumor was located above the inferior dental canal. Furthermore, the lingual cortical plate remained intact and the submaxillary gland was not involved by the tumor. A lot of large and small cystic regions were scattered and small islands of mucous and squamoid cells were present in the connective tissue stroma. It was conceivable that our case originated from the pluripotential epithelial lining of an odontogenic cyst.

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Patients with cardiac diseases must be carefully evaluated and managed, as manycomplications may set in during or after operations. Dental surgery on 100 patients with cardiac diseases was performed in our institution from 1984 to 1987. Results: (1) 51 percent of the 100 cases were ischemic heart diseases.(2) Electrocardiographic findings before dental surgeries. 34 percent of the findings were normal. 25 percent showed atrial fibrillations, and 17. 1 percent were ST-T changes. (3) Anticoagulant therapy was maintained on 51 patients. 28 patients underwent dental surgery with interrupted anticoagulant therapy and others were performed dental surgery with non-interrupted anticoagulant therapy. (4) Complications during and after dental surgery. In 15 cases, ventricular extrasystole occurred and in 5 cases, systolic blood pressure increased from 200 to 230 mmHg. After dental surgery, we had bleeding problems in 6 cases. But there were no significant complications after careful treatment and management.

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The management of mandible and immediate reconstruction of mandibular defect following surgery for squamous cell carcinoma of the mandible were discussed in this article. The method of mandibular resection was divided into three groups: 1) marginal resection, 2) segmental resection, and 3) hemimandiblectomy. The case number of the first group was one and that of the second group was thirty four and the thrid group was two, respectively. Mesial and distal margin of the mandibular resection was determined by preoperative radiologic assessment, consisting of panoramic tomography, computed tomography and ⁹⁹Tc MDP scintigraphy.
The method of immediate reconstruction of the mandible was classified into four groups: 1) primary suture without reconstruction, 2) reconstruction of the mandibular bone alone, 3) reconstruction of the soft tissue alone, and 4) reconstruction of both bone and soft tissue. In these four groups, combined reconstruction of the mandibular bone by AO plate and soft tissue with PM-MC flap or forearm flap have produced more satisfactory results from the standpoints of facial symmetry, low local infectious probability and masticatory function by residual teeth.
In view of clinical problems such as local infection and difficulty of tissue reconstruction in a previously irradiated field, it was considered that vascularized bone and soft tissue transfer had some advantages.

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The management of mandible following surgery for carcinoma of the tongue and floor of mouth, and post operative course of the mandible were discussed in this article.
The management of the mandible was classified into four groups: 1. complete mandible conservation, 2. marginal resection, 3. segmental resection and 4. immediate reconstruction of the mandible following segmental resection.
Infection or resorption of the transplanter occurred frequently in the cases where the mandibles were reconstructed immediately by transplantation of iliac bone. It was concluded that marginal resection of the mandible made much better prognosis of conservation of the mandibular function and prevention of post operative infection. By the cases which indicated immediate reconstruction of mandibular defect, it was considered that replantation of the mandible or reconstruction using vascularized bone segment such as iliac crest or rib produced good results.

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von Recklinghausen neurofibromatosis (VRNF) is an autosomal dominant inherited syndrome defined by the presence of multiple cafe-au-lait spots and benign neurofibroma. We experienced a patient with VRNF, the outline of which we report here.
A 3-year-old female visited our clinic with the chief complaint of swelling of the right side submandibular region. The skin of the abdomen and back showed numerous light browish macula. Histopathological examination of a submandibular tumor biopsy specimen revealed benign neurofibroma plexiform type. This finding showed characteristic VRNF, but family history did not show complete autosomal dominant inheritance.

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Clinical and radiographic findings of 16 teeth (17 roots) displaced into the maxillary sinus and their treatment were studied.
Patients from 10 to 39 years of age constituted 87.5 per cent of the population with a peak in the third decade, and there was no sex prevalence. The maxillary first molars mostly affected by severe caries were involved in all cases but one with the highest incidence of displacement of the palatal root. Radiographically the floor of the maxillary sinus was located very close to the roots of the maxillary premolars and molars in 75 per cent of cases. Evidence of maxillary sinuitis was noted in 14 cases. The period from displacement to removal or spontaneous discharge was within a week in 7 cases, a week to 2 weeks in 2 cases and over 2 weeks in 6 cases. The displaced roots were removed from the tooth sockets in 7 cases and by an approach via the canine fossa in 7 cases. A root was spontaneously discharged from the socket. With the exception of 3 cases, all roots were found or thought to be present inside the sinus cavity.
In conclusion utmost care should be taken not to dislodge the root during extraction when the floor of the maxillary sinus is located in its close proximity and the earliest removal was recommended on dislodgement into the maxillary sinus to prevent the development of complications.

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An application of a palatal island flap to reconstruction of a defect following excision of a palatal tumor in two cases is reported. The first case was a 55-year-old man with a malignant tumor of salivary gland origin on the right side of the soft palate. An excision of the tumor resulted in formation of a large defect approximately 30mm in diameter with communication to the nasal cavity. The defect was closed by posterior rotation of a mucoperiosteal island flap which was elevated from the anterior portion of the ipsilateral palate, The postoperative course was uncomplicated, but slight velar dysfunction remained postoperatively due to scar contraction of the flap. In the second case, an oronasal fistula of 9× 5mm in size developed following excision of a pleomorphic adenoma in the posterior portion of the right hard palate. The fistula was successfully closed by a mucoperiosteal palatal flap elevated from the contralateral side without leaving functional disturbance.
In conclusion, the flap was found to be useful for reconstruction of palatal defects of varing sizes an locations because of good blood supply, extensive mobility, technical easiness and least aesthetic disturbance.

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Pleomorphic adenoma is the most common tumor found in the salivary glands. Its most comon site is the parotid gland in the major salivary glands, and the palate in the minor salivary glands. Among the minor salivary glands, incidence at the cheek is comparatively rate.
We recently experienced a case of pleomorphic adenoma of the cheek. The patient was a 63 year old man who complained of swelling in the buccal mucosa. The tumor was enucleated under general anesthesia. Pathological finding showed pleomorphic adenoma. Prognoses was excellent, and there is no evidence of recurrence.

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The authors treated 80 patients (85 joints) with closed-lock of the temporomandibular joint internal derangement, by mandibular manipulation technique. Among the 80 patients, 24 patients (25 joints) were treated by manipulation after pumping and hydraulic pressure to the upper joint cavity. Treatment of 61 joints (71.8%) satisfied our criteria for success: 1. More than 36 mm of interincisal opening, 2. Good anterior translation of the condyle, and 3. Complete or very significant resolution of pretreatment pain. Comparison of the success group and the treatment failure group showed that the success group was younger and had a shorter history of clicking and locking.

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Surgical treatment for internal derangement of the temporomandibular joint in 18 patients with 21 joints were done. The procedure included disk repositioning, disk plication, and diskectomy with or without arthroplasty.
Surgical skills were introduced, and a short-term follow up study of 1. 6 years or more on 12 patients with 13 joints is described.
Seven cases with eight TMJs were assesed as “excellent”, five cases with five joints were “goed” and/or “fair”, excluding one “poor” case, whereas no surgical complication or postoperative severe incomfortable episode was encounterd.

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Arthroscopic sweep with lysis and lavage of the upper joint cavity were done in treating with internal derangement of the temporomandibular joint with closed locking.
The procedure was successful. The surgical technique, indication and short-term results are discussed, and the experiences with 13 joints in 11 patients are described.

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We have used the Luhr mini compression system in the treatment of 19 mandibular fracture cases. In this report, we discuss our clinical experiences and results in these cases.
The site of mandibular fracture for which mini-plate was used was symphysis in 7 cases, mandibular angle in 7 cases, the body of the mandible in 3 cases, the condylar process in 3 cases and mental protuberance in 1 case. In the main, the plate was successfully used for the fractures with relatively larger displacement of the fractured bone. As in other mini plates, intra-oral approach is possible with the plate we used, and adequate fixation can be obtained by relatively easy procedures, with which the period of the intermaxillary fixation can be shortened. Furthermore, both the plate and the screw are made of vitallium having good tissue affinity and are highly anticorrosive, making postoperative removal unnecessary. From the above, it was concluded that this plate system is useful for mandibular fractures treatment.

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As shown in the fact that a number of patients with maxillary inflammation, oral tumor or maxillofacial fracture visit oral surgery department clinics in hospitals specifically of university via private dental clinics, the relationship between private dental clinics and the oral surgery department clinic in hospitals is very important and will become closer in the future as progress is made in dental or oral and maxillofacial surgery. However, no detailed statistical information is available on patients referred from private dental clinics to oral surgery department clinics in hospitals. Hence we performed a clinical and statistical survey on the patients referred from private dental clinics to our oral surgery department clinic during a one-year period from January to December, 1986.
1. The total number of patients referred from private dental clinics was 376 including 169 males and 207 females, which was 26.1% of all new patients appearing at the out-patient clinic during the year.
2. Patients aged 30-39 were most frequent (18.3%).
3. Of all the patients referred from private dental clinics, 304 (80.9%) were from the southern area of Okinawa Island.
4. The lesions of the referred patients were: inflammatory diseases, 127 cases (33.7%), malformations and developmental abnormalities, 40 cases (10.6%), tumors and tumorous lesions, 39 cases (10.3%), diseases of the salivary glands, 27 cases (7.1%), disorders of the temporomandibular joint, 23 cases (6.1%), injuries, 19 cases (5.5%), mucosal lesions, 13 cases (3.4%), facial pain and some cranial nerve diseases, 11 cases (2.9%), and others, 39 cases (10.3%).
5. Referred in-patients included 67 cases, which was 17.8% of the total patients referred from private dental clinics. In these cases, inflammatory diseases accounted for 16 cases (23.8%), cysts for 12 cases (17.9%) and benign tumors for 11 cases (16.4%).
6. Of all the patients referred from private dental clinics, forty-five operation (11.9%) were performed mainly under general anesthesia in the central operating room, among which were 20 tumors (44.4%) and 10 cysts (22.2%).

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The present case was a 45-year-old woman, complaining of a tumor under the left auricle. CT-sialography revealed that the tumor was extending from the deep lobe of the parotid into the parapharyngeal space; so-called dumb-bell tumor. Removal of the tumor was operatively tried under clinical diagnosis of malignant parotid tumor. However, total removal of the tumor was abandoned, because the tumor had ill defined boundaries and strongly adhered to surrounding bone. Combined radiation and chemotherapy were carried out postoperatively. Histopathological diagnosis was anaplastic adenocarcinoma. After treatment, multiple cranial nerve palsy of the diseased side appeared. She died of pulmonary insufficiency 14 months after first examination. The autopsy disclosed intracranial invasion of the parotid tumor and its metastasis to the lungs and vertebral bone.

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Verrucous carcinoma, a variant of squamous cell carcinoma, was first discribed as a distinct clinical and pathological entity by Ackerman in 1948.
In this paper, four cases of verrucous carcinoma of the oral cavity are reported. All except case No.3 could not be diagnosed verrucous carcinoma by the initial biopsies. Especially small superficial biopsies may be often interpreted as benign tumors.
Two cases were treated by surgical excision, the others by cryosurgery as the first choice treatment.
The prognosis of the two surgical excision patients was good, but the others was poor. These results suggested that complete surgical excision obtained satisfactory results in verrucous carcinoma, but this may be precluded by the medical status of the patient or the lesion extent.

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Tuberculosis is an interesting disease in immunology from the point of evolution and clinical prognosis.
A case of primary tuberculous submandibular lymphadenitis is presented. A 18-year-old woman appeared the swelling with fistel in the right submandibular region.
The operation was performed under a clinical diagnosis of submandibular sialadenitis with salivary stone.
Histopathological examination revealed tuberculous granuloma.
Chest X-ray showed nothing particular, and skin reaction to PPD was positive. Moreover the study of T lymphocytes subset in the peripheral blood by using monoclonal antibody was carried out. The decrease of the ratio of CD8⁺ T cell was observed in which the ratio of CD8⁺CD11-T cell was low level. The depression of cell-mediated immunity in the host of the patient was suggested.
The patient is well without recurrence after chemotherapy was continued for 6 months.

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We investigated the clinical effects of an OTC dental cone (^®Oxytetra Cone “Showa”)(OTC-C), by the double blind method using an inactive placebo (P) and obtained the following results.
1. OTC-C was associated with significantly better postoperative granulation from 3 days after teeth extraction.
2. OTC-C resulted in significant reductiou of redness in the surrounding gingiva from 3 days after teeth extraction.
3. Final overall evaluation showed signification superiority of OTC-C, with an effectiveness rate of 92.8%for OTC-C and 60% for P.
4. The rate of usefulness was 89.3% for OTC-C and 63.3% for P, showing significantly high usefulness of OTC-C.
5. There were no side effects in any subject.
6. The higher usefulness of OTC-C was suggested in relation to greater operative stress including extraction of teeth associated with purulent inflammation and surgical duration.
From the above findings, the superior usefulness of Oxytetra Cone “Showa” in clinical settings was confirmed. It seems necessary to take advantage of the dental cone particularly in patients with purulent inflammation or those who had systemic complications and in whom postoperative wound healing or influence on other distant organs is of concern.

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Clinical efficacy and safety of Midecamycin acetate (MOM) were compared with those of Josamycin (JM) in patients with oral and maxillofacial infections under multicentered double-blind controlled study, and the following results were obtained.
1. The overall clinical effectiveness rate was 77.4% for MOM group and 77.4% for JM group, judged by committee members with no significant difference.
2. Clinical effectiveness rate classified by diagnosis was 78.8% for MOM group and 78.0% for JM in periodontal infections but no significant difference was observed.
In pericoronitis, clinical effectiveness rate was 76.3% for MOM and 62. 5% for JM, but no significant difference was observed.
In osteitis of jaws, clinical effectiveness rate was 76.3% for MOM and 85.9% for JM, but no significant difference was observed.
3. As to improvement rate of clinical signs and symptoms, no significant difference was observed.
4. Some side effects were observed in 7 patients (3.3%) in the MOM group and 12 patients (5.6%) in the JM group with no significant intergroup difference in incidence of these side effects.
5. Some abnormal laboratory findings were observed in 4 patients (4%) in the MOM group and one patient (0.9%) in the JM group with no significant intergroup difference in incidence of these abnormal laboratory findings.
6. The clinical usefulness rate judged by doctors in charge was 72.9% for MOM group and 76.2% for JM group, with no significant difference.
From the above results, it was concluded that MOM had the same efficacy as JM for the treatment of oral and maxillofacial infections with half doses of JM.

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Clinical study of Ceftazidime (CAZ, Modacin, ^®) in various infections in the field of oral surgery were carried out. Ceftazidime was administered by intravenous injection at a daily dose of 2g (1g 2 times) to 49 patients with various infections.
Cases consisted of 31 with ostitis of the jaws, 5 phlegmon of the floor of the mouth, 3 periocoronitis, 2 odontogenic maxillary sinusitis, 1 postoperative maxillary cyst, 2 peritonsillar abcess, 2 buccal abcess, 1 temporal abcess, 1 lymphadenitis and 1 sialoadenitis submandibularis.
The following results were obtained. The clinical effects obtained in subjective judgement were excellent in 21 cases, good in 24 cases, fair in 2 and poor in O. The clinical effects obtained in judgement by point were classified as excellent in 13 cases, good in 32 and poor in 2, the effective rate of which was 95.7%, the same as the former. As for side effects, skin eruption, hypotention, nausea, and stomatic discomfort appeared.
In the laboratory examinations, elevation of s-GOT in one case was observed. The results indicated the usefullness of Ceftazidime in the treatment of various infections in the field of oral surgery.

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