Apical lesions have been considered to be caused by the bacteria in the root canal. However, many reports have insisted that no bacteria were found in apical lesions. Furthermore, the relationship between these bacteria and inflammatory cells in the lesions remains still unknown.
For this reason the author prepared 99 apical lesion cases and observed for the presence or absence of bacteria with various stainings light-microscopically. They were observed in 56 cases (56.6%) of the lesions consisting of 60 colonies of gram-positive and 13 of gram-negative bacteria. Several kinds of cocci were found most frequently followed by mycetes, small and large rods. These bacteria were often observed in the part of fibrous tissues with relatively little infiltrating cells such as lymphocytes or plasma cells.
Immunohistochemical staining revealed the helper/suppressor T cell ratio was higher in the bacteria positive lesions. In all cases, B cells were observed as much as T cells, and the average of T/B cell ratio was 1.93.
No correlation was recognized between the clinical state and the existence of bacteria.

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There are few systemic examinations of salivary gland tissue in human lymph node (heterotopic salivary gland), so the significance of these tissue retrains obscure.
In this study, we examined the appearance and histological pattern of these tissues in extraparotid lymph nodes obtained from 156 cases of radical neck dissection and intraparotid lymph node obtained from 31 cases of parotidectomy (parotid gland with salivary gland tumor) of various ages. We discussed the possible mode of development and significance of these tissues and the relation between these tissues and salivary gland tumors.
The results are summarized as follows.
1) In 19 of 156 cases of radical neck dissection, 27 extraparotid lymph nodes that included salivary gland tissue were found.
2) In 21 of 31 cases of parotidectomy, 39 intraparotid lymph nodes that included salivary gland tissue were found.
3) 3 types of invasive mode of salivary gland tissue into lymph node, a course through the hilus, a course through the capsule, a course through both the hilus and capsule, were found.
4) These salivary gland tissues were composed of mature acini, small ducts resembling intralobular duct of adult parotid gland and striated ducts, immature acini and immature small ducts resembling fetal parotid gland tissue.
5) Various appearances, cyst formation of duct system (16. 7%), oncocytic change of the duct epithelium (10.6%), adenomatous hyperplasia consisting of the oncocyte with minor cyst formation (10.6%), and proliferative appearance of duct epithelium (22.7%), were recognized in the salivary gland tissue in lymph nodes.
6) In intraparotid gland lymph node, various changes, atrophy, inflammation, fat infiltration, of parotid gland did not influence the salivary gland tissue in lymph nodes.
7) We believed that the salivary gland tissue in lymph nodes are of immature gland type and have active potentiality for cytodifferentiation. We thought that some salivary gland tumors, especially adenolymphoma, arose from salivary gland tissues in lymph nodes.
8) We thought that further studies on salivary gland tissue in lymph nodes are significant for the elucidation of the development of salivary gland tumors.

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Tumor infiltrating lymphocytes (TIL) interact most closely with tumor cells and accurately reflect the tumor host relationship. Many reports have indicated that grade of TIL is concerned with clinical prognoses. On other hand, it is suggested that TIL are immunosuppressed and unable to provide antitumor activity.
In this study, we have attemptted preoperative intratumoral injections of OK-432 in oral cancer patients to reverse immune paralysis and induce antitumor activity. OK-432 is used widely as biological response modifiers in Japan. Analysis of TIL is performed by indirect immunohistologic technique with monoclonal antibody. It is suggested that OK-432 injection auguments the grade of TIL, in which Leu 3a⁺ cell, Leu 11a+ cell and LeuM1+ cell are significantry expanded and but Leu2a⁺ cell are not.

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It is widely accepted that acceleration of coagulation and inhibition of fibrinolysis have been found in malignant tumors. By breaking down the fibrin barrier surrounding the tumor mass, fibrinolytic enzymes (Urokinase and Dextran Sulfate) are able to elevate the concentration of antitumor agents reaching tumor tissue. This in turn, results in labilization and acceleration of lysosome release from tumor cells.
In the present study, the effects of tissue-Plasminogen Activator (t-PA) and Peplomycin (PEP) singly or in combination, on cellular lysosome of experimentally induced hamster lingual carcinoma were assessed with acid phosphatase (ACPase) ultracytochemically.
1. In control group, the ACPase was demonstrated mainly in cellular lysosome and occasionally in golgi apparatus.
2. In the experimental group treated with t-PA 100×10³ IU/kg alone, no significant ultrastructural change was noted.
3. In the experimental group treated with PEP 10 mg/kg alone, lysosome of tumor cells increased in number without obvious ultrastructural changes.
4. In the experimental group treated with t-PA and PEP in combination, cellular lysosome appeared enlarged and labilized with lysosomal enzymes released in the areas of cytoplasmic degeneration and necrosis.
The present investigation suggested that t-PA, when treated in combination, was capable of elevating of the localized concentration of PEP reaching tumor tissue. Such findings implied that t-PA was able to increas the tumorcidal effect of PEP.

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Evaluation of tongue movements is often hampered by the morphological complexityof the tongue. We analyzed tongue movements wtih an optical sensing system developed by the Department of Electrical Engineering and Computer Science, Faculty of Engineering, Kumamoto University, in which micro photo-transistors were incorporated.
The distance between the palate and the surface of the tongue was measured by photometry of the reflex light. The palatal plate employed for the measurement had a phototransistor and a sensor consisting of two LED's placed asymmetrically relative to the phototransistor and driven at a 90° phase shift. The sensor-tongue distance was determined as a function of the phase angle of reflex light signals, which provided distance-sensing characteristics less susceptible to the effects of the reflection factor than the methods based on the amplitude. The available output range was to 30 mm toward the lower surface of the tongue from the sensor placed on the hard palate. From these results, the apparatus was considered to be useful for evaluation of tongue movements.

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A case of odontogenic myxoma of the mandible is reported. A 52-year-old woman was referred with painless swelling in the anterior portion of the mandible. The swelling had been present for 15 years and enlarged gradually. On examination, there was firm swelling in the anterior tooth region and both labial and lingual expansion of the lower alveolus were noted. X-ray films showed a well-defined intra-bony multilobular radiolucency. The biopsy suggested odontogenic myxoma. Under endotracheal anesthesia, partial resection of the mandibule was performed by an intra-oral approach. The tumor was a solid yellow white mass and showed myxomatous appearance. The bone defect was immediately reconstructed with HAP particules (Actceram K^®), HAP-TCP block and autogenous iliac cancelous bone. In histological examination the specimen showed loosely arranged, spindlesaped and stellate cells with fine collagen fibers. There were odontogenic epitherial cell nests and a small number of calcified materials like cementicle. From these findings, the lesion was diagnosed as odontogenic myxoma. The patient was observed two years later and there was no evidence of recurrence.

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The so-called gummy smile is a smile with an excessive gingival exposure of the labial maxillary region.
The newly devised method described by Miskinyar was applied in the case of a girl aged 12. This method is a myectomy and partial resection of the levators labii superioris. It seems that the cause of gummy smile was the hyperactivity of the levators labii superioris in this case. 1 year and 5 months after the operation, her smile was very attractive and pleasing to her and the surgeon.
We concluded that the method described by Miskinyar was useful and safe.

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A case of a large amount of calcification in the right submandibular and cervical lymph nodes is presented. A 32-year-old man was referred to our department by his dentist for evaluation of multiple calcifications in the right submandibular and cervical regions. The right side of the panoramic radiograph demonstrated multiple well-circumscribed, irregular radiopaque masses consistent with calcifications of the anterior auricular, parotid, upper superficial and deep cervical, and submandibular lymph nodes.
Physical examination revealed multiple, well-circumscribed, firm, movable, and nontender masses in the preauricular, retromandibular, and submandibular regions. Pathological diagnosis was calcification of the lymph nodes. A possible mode of calcification in the lymph nodes was discussed.

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A case is presented of peripheral osteoma occurring at the inferior border of the mandible. Such cases are rarely presented in Japan. The procedure of the diagnosis and treatment is described. This male patient was aware of the bony lump at age 4 and first visited our Hospital with complaints at age 22. Its histopathologic diagnosis was an osteoma durum, although roentogenographs showed resemblances in appearance to osteoid osteoma of the similar region in already reported cases.
From the points of anatomical oncogenic properties and literature considerations on osteoma, a possible pathogenic mechanism of the osteoma was discussed. It was suggested that a kind of muscular and/or periosteal participation might be a causative factor, though there was not yet obvious evidence in EMG tests of the neighboring masseter muscle.

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Cleidocranial dysplasia is a form of congenital systemic bone dysplasia, that has such clinical characteristics as aplastic or hypoplastic clavicle bilaterally, delayed ossification of the skull, delayed deciduous dentition and jaw bone development. In Japan, many cases have been reported but relatively few in siblings or structural findings on teeth. We recently experienced cleidocranial dysostosis in an 18-year-old girl and her 16-year-old brother. We detected signs of intraoral abnormality and recorded histological findings related to extracted teeth.
Both cases showed hypoplastic development of the skull, upper jaw, clavicle, pelvis, and bones of the hand. The sister had 19 impacted teeth including 7 supernumerary teeth in her jaws. An impacted tooth extracted from the median upper jaw showed hypoplasia, namely enamellike tissues could be seen in the dentine, and there was very little cementum. Her brother had prolonged retention of the deciduous teeth and 28 impacted teeth including 10 supernumerary teeth. These impacted teeth were mainly seen in anterior teeth and premolars.
In examination of the family, their father was thought to have had similar physical features. Therefore it is assumed that a prepotent factor was transmitted to his children.

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Bifid tongue is a rare congenital deformity. Most of the cases were complicated with other defcrmities. Only several cases were solely bifid tongue. We had a chance to treat a 21-day-old girl who had a bifid tongue without other deformities. Bifurcation was located about 25mm behind the tongue tip. One third of it was completely divided and two thirds of the rest was separated by membrane like connective tissues and a papillary like process. Tongue plasty was completed at the age of five months. The girl was followed up for two years and 3 months, and she had no speech or eating problems.

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A necropsy case suggested that only sarcomatous element was metastasized in the upper gingival region, also spread in other systemic organs, from mammary carcinosarcoma is clinically and histopathologically discussed and presented.
Summarized conclusions were as follows:
1. Characteristic features of this gingival tumor were a polypoid and pedenculated growth in clinical and constructed by sarcomatous structures with spindle shaped or multangular cells, fibrous tissues combined with osteoid formation slightly in microscopic.
In particular, this metastatic tumor was quite similar to the sarcomatous part of primary carcinosarcoma in mammary gland histopathologically.
2. The patient was dead due to serious rapid systemic metastases, then necropsy was performed.
3. Remarkable common histological findings in each examined metastatic tumors were a nodular and polypoid in shape, osteoid formation with cartilaginous metaplasia in part, spindle or multangular cells as well as oral tumor and osteoclast like multinucleated giant cells as a result of a stromal reaction.
4. Based on these findings, gingival tumors were considerred as one of the systemic metastasized sarcomas from mammary carcinosarcoma.
Entity and metastatic pathway of this tumor may attribute to the cancer genesis and requires more investigation to identify this entity.

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Neurilemmoma is a benign neoplasm believed to arise from the Schwann's sheath. Neurilemmoma of the oral region is an uncommon disease and especially that of the cheek is very rare.
We reported a case of large neurilemmoma occurring in the area from the cheek to the pterygopalatine fossa in a 75-year-old woman, complaining a swelling of the cheek. The tumor was removed en bloc by intraoral approach. It was spherical in shape, measuring about 35×25×15mm and included a large cyst. Histopathological findings showed features of neurilemmoma (type A and B of Antoni's pathological classification).
We reviewed Japanese literature of neurilemmoma occurring in the region from the cheek to the infratemporal fossa reproted from 1970 to 1988 and 13 cases were found.

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The patient was a 15-year old girl. About eight months previously she noticed gingival swelling in 8 region, and pain in 7.
She was referred to our hospital by a dentist on Sep. 18, 1987.
A ramus of the mandible showed absorption of bone.
Tumorectomy was done on Oct. 21, and after that histopathological diagnosis of benign fibrous histiocytoma was made.

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Verruciform xanthoma is a painless verrucous and parakeratinized lesion that appears in the oral cavity. The lesion of our case was located in the lower gingiva of a 55-year-old man.Clinically, the lesion may be confused with papilloma, leukoplakia and verrucous carcinoma. Although we suspected leukoplakia, a malignant disease could not been excluded. Therefore, we measured DNA content of this lesion using flow cytometry. DNA histogram showed a ploidy pattern suggesting nonmalignant lesion. We present a case of verruciform xanthoma with a review of literature, and a clinical use of flow cytometry as a rapid diagnosis in this paper.

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Oncocytoma is usually a benign tumor composed solely of oncocytes. This tumor generally arises from the salivary gland, thyroid, nasal gland, bronchia, pancreas and mammary gland, and most preferably originates in the parotid gland, however, its incidence is extremely low.
We presented the case of a 54-year old female who had an oncocytoma of the superficialis parotid gland. Her chief complaint was swelling in the right parotid gland region. CT scanning showed a limited slightly high density mass in the right parotid gland and MR-CT scanning revealed a high intensity mass with pulse sequence of short Spin Echo.
Accumulated sodium pertechnatate Tc 99m of the right parotid gland was lower than in the left one, and the time activity curve showed no functional difference in either side.
We suspected a cyst from the scanning, and attempted a puncture aspiration. About 2ml of light yellow fluid was aspirated from the swollen site.
In histological examination of this fluid, leukocytes, histiocytes, squamous cells and transitional epithelial cells were found.
The swelling disappeared but a soybean sized mass could be felt in this region. Therefore we operated to remove a clear border soybean sized mass with semi parotid tissues in the superficial region.
The his tiological diagnosis was oncocytoma. The patient is in good condition with no recurrence as of 2 years postoperatively.

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Surgical procedures to remove tumors of the mandible lead to various functional disturbances. To prevent those disturbances, bone grafts or various artifical materials had been used for immediate reconstruction of the mandible. We applied alumina ceramics and autogenous bone graft at the time of immediate reconstruction for bone defects caused by the treatment of mandibular lesion. As results, the fixation of residual and artificial bone was reinforced, and autogenous bone played a part of alveolar ridge so satisfactorily, allowing easy wearing of partial denture with new bone formation in the resected region.

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Schwannoma is relatively rare in the oral region. We reported 2 cases of schwannoma of the tongue.
Case 1: A 12-year-old girl complaining of a tumor of the tongue visited our hospital.
Examination revealed a red bean-sized tumor in the left dorsal surface of her tongue. After excision under local anesthesia, the histopathologic findings indicated schwannoma.
Case 2: The patient was a 16-year-old girl having a thumb tip-sized tumor in the left apex surface of the tongue. The tumor was excised under local anesthesia and histopathologically diagnosed as schwannoma.
The postoperative courses of both cases have been satisfactory without recurrence.

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A rare case of pleomorphic adenoma arising in the maxillary sinus is reported.
A 58-year-old man complained of pus discharge from the oroantral fistula following the extraction of the right second molar.
CT scan revealed a mass of 30 HU unit suggesting a formation of post operative maxillary cyst. Surgical excision of the lesion was carred out by Caldwell-Luc i method, and the oroantral fistula was closed. The pathological diagnosis was pleomorphic adenoma. The patient showed no evidence of recurrence of the tumor for two years postoperativelly.

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The sagittal spliting operation for mandibular ramus is widely applied in orthognathic surgery as a common surgical technique for mandibular osteotomy.
The sagittal spliting bone fragments in this procedure are generally fixed by circumferential wiring. In addition, there are fixing methods by bone screw, bone pin, . etc.
Recently, we have developed a new method to fix saggital spliting bone fragments without passing through buccal skin, using pure titanium U-type staples from the incised region of the oral mucosa. This new fixation method has been applied since March, 1988 in 5 cases. All these cases exhibited satisfactory results, showing no relapse 10-14 months after the operation. The fixation staples were removed between 3-14 months after the operation, and the removal was performed under local anesthesia for outpatients in 4 cases. We believe that this fixation method is very useful as a bone fragment fixation procedure in the sagittal spliting operation for mandibular ramus.

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Pleomorphic adenomas derive from major or minor salivary glands. It appears most preferably in the parotid gland and relatively rare in the submandibular gland. Cyst formation and extensive haemorrhage in the tumors are not common.
Recently, we found pleomorphic adenoma with a large cystic lesion in the left submandibular gland of an 81-year-old woman. An enlargement of the left submandibular lesion had been growing for five years. The tumor showed a firm, nodular, non-tender mass protruding from the submandibular region without palpable cervical or submandibular lymph-nodes. The tumor was excised locally with submandibular gland and adjacent normal tissue under enflurane anesthesia with endotracheal intubation. The removed mass measured 7×3×2cm in size and had a thickened capsule including completely separated two large cysts. Histologically the tumor was diagnosed as pleomorphic adenoma with a large cyst and a haemorrhagic lesion.
Subsequently the patient has been free of recurrence during three years after operation.

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Osteopetrosis (marble bone disease) is a rare hereditary bone disorder of which prominent radiologic feature is skeletal sclerosis. The dense bone with its minimal bone marrow spaces and limited blood supply often leads to the development of osteomyelitis. We experienced a case of chronic osteomyelitis of the mandible in a 19-year-old man with osteopetrosis.
Treatment consisted of sequestrectomy, extensive surgical debridement, and closed continuous irrigation method with a detergent-antibiotic solution. The postoperative course during the past 24 months was uneventful without complications, such as wound dehiscence or pus discharge. Radiographs revealed bone regeneration of the operated site.

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Major salivary glands are the predilection site of sialolithiasis. Sialolithiasis occurring via minor salivary glands is very rare.
This paper presents a case of sialolithiasis that occurred in the left upper lip and seemed to have developed via minor salivary glands.
The patient was a 47-year-old man who presented at our Department with a swelling in the left upper lip. Plain X-ray revearled a calcification-like radiopaque spot of adzuki bean size in this area. It was managed by surgical removal of the calcified lesion under local anesthesia.
By X-ray diffraction analysis of the resected specimen, it had a low-crystalline amorphous structure. Qualitative analysis using on X-ray microanalyzer disclosed the Ca, P, S, Mg, Na, K and Cl contents in the specimen.

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A 27 year-old male who suffered from severe maxillary retrusion and mandibular protrusion with several tooth caries and impactions, lingually tipped teeth and alveolar bone and collapsed arches was presented. In order to accomplish a completely reasonable leveling of the dental arches and decompensation of the incisor area in both arches, anterior and posterior alveolar osteotomies and corticotomy were done during preoperative orthodontic treatment. Finally, two jaw surgerie (quadangular Le Fort-II osteotomy and sagittal split ramus osteotomy) were chosen to correct the abnormal relationship of the dento-facial complex with severe infraorbital hypoplasia and mandibular prognathism. Desirable functional occlusion and preferable skeletal and soft tissue esthetics were obtained.

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Among 150 cases with malar bone fractures treated for the past 7 years in the Department of Oral Maxillofacial Surgery, Nara Medical University Hospital, thirty-four patients were treated with Gillies temporal approach method.
According to the classification by Knight & North in 34 patients, the number of patients in group II. was 24, and the number of patients wity zygomatic body fractures was 10. Follow-up study was performed in all 34 patients.
Types of zygomatic arch fractures and length of the time from injury to treatment were reviewed in each case. Types of zygomatic arch fractures were classified into 10 groups. As for the prognosis after treatment, good results were obtained in V-shaped depression type and in case treated within two weeks after injury, but generally unfavorable in rotated body fractures.
These results indicated that the prognosis depends on an accurate diagnosis of malar bone fractures and immediate therapy.

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Two cases of rare true median cleft of upper lip are reported. The first case was a 4-year-old girl with median cleft of upper lip and median cleft of alveolus and palate. This type of median cleft was found only in 3 cases in our literature review in Japan.
The second case was a 6-year-old boy with median cleft of upper lip and club-shaped skin masses in the left nostril and median alveolus, which was similar to those reported by Sharma (1978) and Nakamura, et al. (1985). Both skin masses were pathologically hamartomas. We examined histologically the upper lip removed at cheiloplasty and found that the specimen showed hypogenesis of the skin accessories and hypogenesis and derangement of the muscle tissue (orbicularis oris). It was considered that our findings support the mesodermal penetration theory of Stark, et al.

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