We investigated the effects of tertiary amine local anesthetics (LA, procaine and lidocaine) on human neutrophil functions. For this purpose, the effects of LA on chemotaxis, phagocytosis and O2- production were estimated At concentrations of O.0125 percent or more, significant reduction of neutrophil chemotxis were observed, using zymosan treated serum as a chemoattractant. This inhibitory effect of LA was reversible and chemotactic ability was recovered after washing out of LA. Neutrophil phagocytosis and O2- production were also inhibited by LA, but 10 and 100 times concentrations of LA were required to inhibit them respectively.
It has been reported that lysozyme and lactoferrin as antibacterial factors havedefence mechanisms against oral microrganisms. The present study describes that immunohistochemical localization and origin of these substances in salivary glands, in addition their distribution patterns in salivary pleomorphic adenomas. Histogenesis of pleomorphic adenoma was also evaluated. A total 147 cases of salivary pleomorphic adenomas were examined immunohistochemically with the use of the PAP method, as well as histologically with H & E stain. 1. Lysozyme staining was expressed only in intercalated duct cells of major salivary gland, whereas it was positive in demilune and serous cells and intralobular duct cells of minor gland. Distribution of lysozymes was different in major and minor salivary glands. Lactoferrin reaction was found in serous acinor cells and ductal segments with irregular fashions. 2. Pleomorphic adenomas showed that 14%(21/147) of the cases showed positive staining for lysozyme, and lysozyme was confined to luminal tumor cells. Lactoferrin reaction in the tumor indicated 3 different distribution patterns; 1) Luminal cells positive type 51%(75/147), 2) outer cell positive 3%(4/147) and both luminal and outer cells positive 5%(7/147). Plasmacytoid cells of modified myoepithelium were occasionally positive for lactoferrin (5%). In the stromal cells, histiocytes showed positive reactions for both lysozyme and lactoferrin. 3. Modified or neoplastic myoepithelial cells were usually devoid of both the substances, however in a few instances, strong lactoferrin reactivity was found in myoepithelioma cells. 4. Histomorphological features and immunohistochemical detectable lysozyme and lactoferrin were evaluated and compared in pleomorphic adenomas and in the normal salivary glands, and histogenesis of pleomorphic adenomas was discussed in terms of immunohistochemical patterns.
Lymphatic metastasis is an important mechanism in the spread of human cancer Reports of experimental approach to lymphatic metastasis of oral cancer, however, are very scarce. In an attempt to establish an experimental model of lymphatic metastasis, the effects of incision and irradiation on regional lymph node metastasis in DMBA-induced squamous cell carcinoma of hamster tongue were studied. Squamous cell carcinomas of the tongue were induced by the method described by Fujita and coworkers in 127 hamsters. They were randomly divided into three groups. Group A (42 animals) remained untreated, group B (44 animals) received two parallel incisions in the center of the tumor once a week, group C (41 animals) received 3 Gy of 60Co once after the development of tumor. The animals were killed when in obvious discomfort or following progressive weightloss to below 70 gm. The tongue, submandibular lymph nodes, lungs and liver were removed, and histologically examined. There were no appreciable changes in the macroscopic appearance and histologic features of the induced tumors among the three groups. Metastasis to the submandibular lymph nodes was confirmed histologically in 61 (48.0%) of the 127 animals. Of a total of 365 lymph nodes, metastasis was seen histologically in 102 (27.9%). The incidence of lymph node metastasis was significantly increased (65.9%) after repeated incisions of tongue carcinomas. Three Gy whole body irradiation also increase the rate of metastasis from 31.0% to 46.3%. The process of establishing metastatic foci resemble closely that seen in human carcinomas. Metastasis to the lung or liver was found in no animal. Because of the small sample size of the tumors classified in Grade Ill, nothing definite could be said about the relationship between the rate of metastasis and the malignancy grade, but endophytic type tumors with deep and diffuse invasion showed the highest incidence of metastasis. In conclusion, the DMBA-induced tongue carcinoma with incisions can be used as an experimental model of lymphatic metastasis of human oral carcinomas.
Fibroblasts (GH1 and GH2) derived from the gingiva of two siblings with gingivalfi bromatosis were characterized. GH1 and GH2 grew slower than cells from gingiva of agematched control. The both diseased cells were capable of synthesizing much greater amounts of extracellular substances, including collagen and glycosaminoglycans, while no significant difference in quantity of synthetic protein was found between diseased and normal cells. Immunostaining study showed that GH1 and GH2 synthesized both Type I and Type III collagens and showed no difference from the normal cells. These findings suggest that the fibromatosis contains affected fibroblasts which are active in the production of great amounts of extracellular substances, compared with normal fibroblast.
Sanious pus taken from an intra-oral abscess may be composed of mixed aerobic and anaerobic microorganisms, and may require a week for bacteriologic identification of these strains. The production of volatile fatty acids occurs with primary metabolic activity of anaerobic bacteria. In the present study, volatile fatty acids of pus were analysed by gas liquid chromatography and compared with organisms isolated by commonly used cultural methods. Direct gas liquid chromatographic analysis of clinical specimens provides a rapid presumptive assessment for the presence of anaerobic microorganisms. It would be an appropriate monitoring of life-threatening infections.
The effects of benzethonium chloride; benzalconium chloride; and chlorhexidine gluconate on inactivation of human immunodeficiency virus (HIV) were investigated. A quantitative bioassay system with a HTLV-I-carrying human T cell line, MT-4 was used in this study. The chemical disinfectants were diluted with PBS and tested in final concentrations of 1.0%, O.1%, 0.01%, 0.001% in the presence or absence of 10% fetal calf serum (FCS). The following results are obtained. 1. At 0.1% concentration the three compounds were effective in inactivation of HIVeven in the presence 10% FCS. 2. At 0.01% concentration benzethonium chloride, chlorhexidine gluconate were also effective. However, in the presence of 10% FCS at this concentration these compounds were not effective. Benzalconium chloride was not effctive at this concentration. 3. These compounds showed cytotoxicity on MT-4 at more than 1. 0% concentration. These results indicate that benzethonium chloride, benzalconium chloride, and chlorhexidine gluconate are effective for inactivation of HIV infectivity above the concentration of 0.1%. Therefore, it would be useful for the control of HIV transmission to wash dental instruments with these compounds right after each dental treatment.
The relationship between serum squamous cell carcinoma related antigen (SCC-Ag) level and pathohistological view and/or stainability of tissue SCC-Ag was examined in oral squamous cell carcinoma. The specimens taken from 97 patients were stained with a monoclonal antibody against the SCC-Ag by immunoperoxidase methods. The serum SCC-Ag level was measured by a radioimmunoassay system. The well-differentiated carcinomas were stained well with this antibody, whereas the poorly-differentiated cases were stained weakly or negatively. Serum SCC-Ag levels were significantly high in the cases of invasive carcinoma, but not in the well differentiation of the tumors cases and in the well stained cases. These observations suggested that the parenchymal-stromal relationship is decisive factors in determining the serum SCC-Ag level.
H. M. G. cell strained from the tumor cell in the pleural fluid of a patient with malignant melanoma was transplanted in a nude mouse and the tumor formed was given various drugs to examine their respective effects macroscopically, light-and electron microscopically. Drugs used are MPL, DTIC, TA-077 and CDDP as alkylating agent, FT-207 as metabolic antagonist and PSK as immunological preparation. These drugs were administered singly or combinedly (MPL+TA-077, CDDP+MPL, DTIC+FT-207 and PSK+MPL). MPL, TA-077 and CDDP showed tumoristatic effect and MPL-F TA-077 and CDDP+MPL, tumor retracting effect. PSK+MPL showed greater effect compared with single administration. However, none of the other drugs had any tumoristatic effect, with no great difference from the control. In terms of the fine structure, some changes were observed in the nucleus and intracellular organelle; specific change in mitochondria and characteristic appearance of intranuclear corpuscle were seen with CDDP and with MPL+TA-077 and CDDP+MPL, respectively. Tumor cell became larger and smaller with CDDP, MPL+TA-077 and CDDP+MPL and with TA-077, PSK and PSK+ MPL, respectively. These changes proved to be related obviously to the antitumor effect.
The generation of lymphokine-activated killer (LAK) cells with recombinant interleukin 2 (rIL2) was examined in peripheral blood lymphocytes (PBL) from oral cancer patients. 4-hour 51Cr release cytotoxicity was measured on target cells, such as fresh tumor cells, fresh skin keratinocytes, K 562, Daudi and oral squamous Ca. cell lines of Ca 9-22 and NA. Fresh patient PBL usually had cytotoxicity for K 562, and was not cytotoxic for fresh autologous tumor cells, fresh autologous skin keratinocytes, Daudi cell and squamous Ca. cell lines unless induced with rIL2. Of 10 patients fresh tumor cell suspensions, 6 of squamous cell carcinoma patients were significantly lysed by autologous LAK cells (mean: 17.7 per cent, range: 0.7-54.0 per cent). Fresh tumor is more resistant to normal and patient LAK cells than cultured tumor, and is more susceptible to their LAK cells than fresh skin keratinocytes used as a normal control cell, lysed in a few cases. The ability to generate LAK activity was not influenced by the patient's age, previous therapy or tumor stage. No significant correlation between the degree of cytotoxicity and the clinical and pathological findings including tumor stage, histological grading by WHO or mononuclear cell infiltration in the tumor tissue was found. The above results demonstrate that the administration of rIL2 alone or adoptive immunotherapy with LAK cells from PBL to patients with oral squamous cell carcinoma could be appropriate as a therapeutic procedure.
Arthrographic examinations were performed for 40 joints of 39 patients with internal derangement of the temporomandibular joint (TMJ) to analyse disc movement in relation to clinical signs and symptoms in each individual. The inconsistency between the arthrographic and clinical findings was often associated with soft tissue derangements, such as perforation of the articular disc and adhesion of the capsula. Therefore arthrographic examination may be indispensable to elucidate the pathologic conditions more clearly in those cases in which soft tissue derangements of TMJ are suspected or the primary treatment proved to be unsuccessful.
20 obliterative abscesses of endodontic origin were examined bacteriologically. Bacteria were detected in 16 of 20 cases. Obligate anaerobic bacteria were isolated from 16 cases whereas facultative anaerobic bacteria were from 9 cases. The average number of isolates was 3.4 ×106 CFU/ml and 84.7% of all isolates were obligate anaerobic bacteria. Gram negative rods were predominant and Bacteroides and Fusobacterium were frequently isolated, followed by Eubacterium, and Peptostreptococci. Bacteria species isolated from periapical abscesses were similar to root canal bacteria. This indicates that these bacteria play an important role in the formation of periapical abscesses.
The effects of inralesional (il) versus intraperitoneal (ip) administration of cisplatin (12 mg/kg-24 mg/kg, single injection) were studied using transplantable squamous cell carcinoma of mice. The size of the tumor in the control and saline injected groups increased approximately 20 times and 70 times at 3 and 6 weeks, respetively, whereas tumor growth was inhibited by more than 50% in the cisplatin treated groups at 3 weeks. The inhibition was more pronounced in the il groups than in the ip groups at any stage of experiment. As compared to the ip group, relative tumor volumes in the it groups receiving 12 mg/kg and 18 mg/kg of cisplatin were less than 50% at 3 weeks. Histologically, focal necrosis of the tumor tissue was seen only in the il groups from 1 day to 1 week at the dose of 12 mg/kg. Necrosis of individual tumor nest was also observed more frequently in this group than in the ip group, but in areas of residual tumor, swelling of nucleus, disapperrance of nucleolus, nuclear vacuolization, decrease of nuclear stainability and occurrence of giant, bizarre-shaped nuclei were almost equally seen in both groups. At the dose of 18 mg/kg there was no significant difference in these changes between the two groups. Althogh necrosis of individual tumor nest was seen in all animals with ip administration, focal necrosis of the tumor tissue was not encounterd any animal, whereas focal necrosis was seen in the 3 animals in the il group. Almost complete tumor necrosis was seen in 4 animals in the il group, and 1 animal in the ip group. Mitotic index fell below O.5 in all cisplatin treated groups, but no statistical difference was noted between it and ip administration. The flowcytometoric analysis of the nuclear DNA content showed a tendency to decreases in the S and G 2 M phase cell populations in the it group and increases in the ip group. There were no differences in the weight loss and histological changes in the major organs between the two groups, but in contrast to 30% for the ip group, the rate of toxic death for the il group was 5% at 18 mg/kg. The results indicate that il administration may produce a bettter response of the tumor to cisplatin with less adverse effects than by systemic administration, possibly by maintaining higher levels of the agent in the tumor tissue.
Pemphigus vulgaris is characterized by suprabasal splitting of the epithelium and loss of intercellular attachments. In order to clarify the molecular mechanism of blister formation in oral mucosa in pemphigus vulgaris, we further analyzed the effects of pemphigus serum on the distribution of keratin intermediate filaments and also on that of desmoplakin I, II which is one of the components of desmosome, major attachment apparatus between keratinocytes. After incubation with pemphigus serum for 96 hrs at 37°C, we observed a dotted structure around the nucleus using anti-keratin monoclonal antibodies (PKK1, PKK2, PKK3 and anti-cytokeratin pan) in some of the cells from normal gingiva, and some decrease in fibrous radiating structures as we previously reported. All of anti-keratin monoclonal antibodies we used stained this dotted structure, although PKK2 stained most clearly them as well as fibrous structure among antibodies. Similar dotted staining was also observed when antidesmoplakin I, H monoclonal antibody was applied. These results suggest that the binding of pemphigus antibody to keratinocyte membrane induced the structural changes in keratin intermediate filaments, also in desmosomes, and a complex of them. We consider that these phenomena might be a characteristic feature of oral keratinocytes.
The Department of Dentistry and Oral Surgery at Yukoukai Hospital was established in April 1980. As of December 31, 1985, the total number of inpatients treated was 587 and that of outpatients 17, 975. These numbers increased year by year. We report here some clinical and statistical observations on our inpatients. The incidence of diseases was as follows: trauma: 50.0%, inflammatory diseases: 33.0%, cysts: 11.8%, tumors: 1. 1%, diseases of salivary glands: 0.6%, diseases of temporomandibular joint: 0.5%, and others: 2.9%. As can be seen, trauma and inflammatory diseases accounted for a vast majority of the diseases of inpatients. Emergency hospitalization was necessary for, 74.8% of the inpatients, 41.0% of whom were hospitalized outside regular hours (i.e., at night or on holidays).
Thyroglossal duct cysts are congenital anomalies which occur usually in the anterior midline of the neck. Most cases are found under the age of 20. We presented a case of thyroglossal duct cyst that was pointed out as cervical mass in a 60 year old female who is old for this disease. In cases like this we should examine for differential diagnosis of any mass found. When duct removal is incomplete, recurrence is inevitable. The central portion of the hyoid bone should be included in surgical excision in community with the tract extending to the base of the tongue. Sistrunk's procedure is therefore the ideal method. In this case some infection might stimulate the cyst to grow as big as noticed.
Mucoepidermoid tumor is considered to derive from the ductal epithelium of tlic salivary glands, and is composed of mucus-secreting and epidermoid cells in varying proportions. In general, this tumor is found in both major and minor salivary glands, but occurrence centrally in the jaws is very rare. We report one case of this tumor which occurred centrally in the mandible of a 25-yearold female patient, and we discussed its pathogenesis with some comments based on the literature.
An unusual case is presented of ameloblastoma arising in the submandibular region. A 50-year-old, Japanese woman. Complained of a movable, nontender mass, approximately 40 mm in diameter, in her right submandibular region. The onset of this lesion was at age 18. During the past 32 years fluid contained in this lesion occasionally was aspirated by puncture needle as treatment. Histopathology of this lesion revealed multilocular cystic tumor showing Ishikawa's Type RE ameloblastoma-like parenchyma with fibrous stroma in the lymph node. These findingssuggested that the lesion was metastatic ameloblastoma, i. e., especially malignant ameloblastoma. However, careful clinical examination failed to find the presence of the primary tumors, such as ameloblastoma of the jaw, basal cell carcinoma, squamous cell carcinoma, and craniopharyngioma. The differential diagnosis and pathogenesis of this lesion was discussed.
Various discussions have been done of surgical treatment of a subcondylar fracture. We have applied the Roger Anderson pin for cases suffering displacement and dislocation of the subcondylar fracture. This method is useful for fixation of minute segment in minor and deep surgical wounds. But surgical technique may be difficult and may cause injury of facial and auriculotemporal nerve. In these instances rigid fixation by extraoral or intraoral open reduction are indicated to resist muscle pull. Recently, Champy developed a mini plate, which is tough and pliant and intraoral open reduction was performed easily with a Champy mini plate for body fracture. We successfully treated subcondylar fracture by a intraoral reduction with Champy mini plate. Consequently we found Champy mini plate valuable for not only body fracture, but also subcondylar fracture. We will report in the following the suitability of intraoral open reduction for a subcondylar fracture.
Pleomorphic adenoma is the most common salivary gland tumor, and the histologic pattern of this tumor is one of its most characteristic features. Cyst formation in this tumor is sometimes observed, however, the etiology of which is unknown. In this paper, two cases of pleomorphic adenoma with a large cyst were examined light microscopically, and the etiology of cyst formation in the tumor was discussed. Case 1 was a 80-year-old woman with tumor in the left hard palate. The large cyst which is lined by keratinized squamous epithelia was observed in the central portion of the tumor. Case 2 was a 48-year-old man with tumor in the right parotid gland. The large cyst in which its wall was a lining of compressed fibrous connective tissue, was also observed in the tumor.
It is pointed out that minor salivary gland calculi are more common than previously supposed in the English language literature. But in Japan, reports of them are still rare and as far as we know only sixteen cases have been reported. This report contributes three additional cases of sialolithiasis in the minor salivary gland located in the upper lip of elderly persons. They were solitary, firm, freely movable, small masses. Histopathologically, all the calculi revealed similar findings that contained homogenous non mineralized organic matrix. Chronically inflamated granulation tissue surrounded the calculus in 2 cases and the dilated duct surrounded the calculus in 1 case. Chronic lobular inflamation and diffuse lobular fibrosis were common findings. The authors suggested that clinicians and pathologists tend to fail to diagnose the calculi of minor salivary gland if the calculus was small and nonmineralized, and soft tissue inflamation was prominent.
Recently, fungus infections seem to have increased with advent of therapy using antibiotics and steroid hormones. This report concerns our experience with a rare case of aspergillosis of the paranasal sinus. The case concerns a 52 year old male, who came to our clinic complaining of a swelling in the right cheek region. Extraoral examination showed that he had obvious swelling of his right cheek and trismus. While intraoral examination showed diffuse swelling and palpated fluctuation in the 17-14 mucobuccal fold to the cheek. Radiographs showed opacification of the right maxillary sinus. Since antibiotic therapy still showed opacity of the sinus, a Caldwell-Luc procedure with the clearing of the maxillary sinus was performed and irrigation with antifungal solution followed. Afterwards, histological examinations revealed aspergillosis. Results of a 29 month postoperative follow-up examination showed no recurrence of the symptoms and the prognosis was satisfactory.
This paper reports a case of papilloma occurring in the buccal mucosa treated bychemotherapy. The patient was a 81-year-old male who for about 20 years had a buccal area white lesion. Intraoral findings showed a round papillomatous tumor with a deep cleft. Although the microscopic findings in the biopsy specimen showed no malignancy, the lesion was suspected of malignant change during the clinical examination. Slight degenerative changes in the tumor resulted from systemic administration of Bleomycin totaling 100 mg and the topical application of Bleomycin ointment. However, the complete disappearance of the lesion occurred after local injection of 60 mg of Oil-Bleomycin. No recurrence of the lesion was observed after 1 year.
A series of clinical studies on squamous cell carcinoma of the lower alveolus and gingiva were performed in order to establish the method of accurate diagnosis and therapy. In this article, the results of clinical observations on primary lesion of thirty four cases which were treated surgically were discussed. On the age range of the patients, sex distinction and the part of the primary lesion, the same results as described elsewhere were obtained. In the TNN1 classification, it was considered that definition of T4 case was not always clear, concerning with mandibular destruction. In this paper, we assumed the case, which invaded in the mandible including mandibular canal, as T4. However, much more discussions have to be made for the classification of T4 case. In the relevance between T and N, the rate of clinically N positive case in each grade of T (T1-4) was 0, 60, 50, and 67 percent respectively. The grade of T was not always compatible with regional lymph node metastatic rate. Inspective type of the primary lesion was classified into two groups i. e. elevated type and ulcerated type. The former was subclassified as nodular type and cauliflower like type. The latter was subclassified as flat ulcer type, crater type and cavein type. It was suggested that roentogenographic degree of mandibular resorption by carcinoma was not always compatible with the rate of regional lymph node metastasis. In the relevance between roentogenographic type of mandibular invasion by carcinoma and rate of regional lymph node metastasis, it was suggested that N positive percentage was more frequent in motheaten type than in erosive type.
Obwegeser-Dal Pont technique for 3 facial asymmetries with prognathism and the combined correction with Le Fort I Osteotomy for 1 maxillomandibular deformity were carried out. Cephalometric measurements of the pre-and post surgical correction of both dental and chin midlines against facial midline were analyzed. Results of the values still showed that slight differences remained. The patients, however, were satisfied with the harmony between their faces and jaws and improved occlusions. Wiring for inner and outer fragments following sagittal split osteotomy was performed as to be loose because postoperative changes of the occlusal relation would make an occlusal induction and a fine regulation difficult. A certain movable space of the condyle without a disturbance of the temporomandibular joint should be remained.
Mento-Vertex (M-V), axial cephalometric projection for temporomandibular joint (TMJ) examination is not commonly utilized. We observed the condylar positions in the cases of fracture (N=43, bilateral 12 cases and unilateral 31 cases) and luxation (N=4, bilateral 3 cases and unilateral 1 case) of TMJ by this cephalogram at pre-and post-treatment. The results obtained were as follows: Anterio-medial displacement types of the condylar neck region amounted to 20 TMJ, (36. 4%), and the same types of dislocation fracture with luxation amounted to TMJ (18. 2%). In the cases, that received conservative treatment, the condylar positions did not show a great different between pre-and post-treatment. Deformed cure of the TMJ was observed in many cases. In the cases that received surgical treatment, about 73% TMJ with dislocation were reduced and fixed in the original anatomical position of the condyle. Relation between the dislocation type of the condylar fracture and prognosis was not found, but good prognosis was obtained in both cases of conservative and surgical treatment. We examined the condylar position difference between fracture with luxation and luxation only. As a result, the condylar position fracture with luxation was closer than one of luxation to the original anatomical position.
An intraoral ultrasonographic technique was developed using a small transducer which can be easily inserted into the oral cavity. The commercially available Toshiba SAL-35A ultrasonic image processor was used in these evaluations with three different configurations of transducers, each equipped with a small ultrasonic conductor to eliminate air between the transducer face and the region to be surveyed. This apparatus allows ultrasound observation of any area in the oral cavity. Thirty-five patients with oral neoplasms were examined to ascertain the efficacy of this technique. They were classified histologically as 21 cases of squamous cell carcinoma, 7 cases of pleomorphic adenoma, 3 ameloblastomas, 3 hemangiomas and 1 acinic cell tumor. Ultrasonographic findings of the tumors were evaluated with respect to the shape, as regular or irregular; the border, as smooth or rough; and the internal echo, as weak, strong or heterogeneous. The ultrasonographic findings revealed that all squamous cell carcinomas exhibited irregular shapes, and nineteen of the twenty-one had rough borders. 4 cases exhibited strong internal echoes, 9 cases exhibited weak internal echoes and 8 cases showed heterogeneous internal echoes. All cases of pleomorphic adenoma exhibited regular shapes and smooth borders. Three of seven exhibited weak internal echoes, and 4 cases showed heterogeneous internal echoes. All cases of ameloblastoma and hemangioma showed irregular shapes and homogeneous internal echoes. Comparing the ultrasonographic and histological findings, ultrasonography revealed additional details of the histological structure of the tumors. It is concluded that intraoral ultrasonography is useful in the diagnosis and treatment of oral neoplasms.
During 11 years and 9 months from March 1, 1975 to the end of December, 1987, postoperative maxillary cysts accompanied by ocular abnormalities were found in 7 patients. Close examination of their ocular abnormalities produced the following results. 1) The mean age at the time of our initial diagnosis of these 7 patients with postoperative maxillary cysts accompanied by ocular abnormalities was 49±7 years, and that of those with cysts but without ocular abnormalities was 41±10 years. The mean age was significantly higher in the former group. 2) The ocular abnormalities in the 7 patients consisted of exophthalmus in 4, impairment of the visual acuity in 2, superior excursion of the eyeballs in 6, disorder of the eye movement in 5, abnormality of the visuals field in 1, dacryorrhea in 6 and diplopia in 4. 3) The simultaneity of ocular symptom, disorder of the eye movement and diplopia was most frequent. 4) The operative findings indicated a bone defect of the size of a thumb ball on the orbital floor in all 7 patients.
On November 1, 1986, a 25-year-old woman visited our clinic with the complaint of an ulcer of the right tongue border and a right neck mass. Induration and the ulcer were present from the right tongue border to the left side. Tongue movement was severely limited. The fixed mass, which measured 40×20 mm, was palpable in the right upper neck. The histological diagnosis based on a tongue biopsy was well-differentiated squamous cell carcinoma. The clinical stage was decided to be T4N3M0. Her clinical course suggested the possibility of distant metastasis, but this was negated by 67Ga scintigraphy, bone scintigraphy and a plain chest X-ray. The metastatic cervical lymph node was large and fixed, so CT and echography were performed to determine the relationship between it and the main cervical vessels. Asadhesion or invasion to the internal carotid artery or the external carotid artery was suspected from CT and echographic findings, carotid angiography was done. Tumor vessels increased in accordance with the neck mass, but no invasive findings or adhesive findings were made by angiography. Treatment was as follows: subtotal glossectomy, right radical neck dissection, right marginal mandibulectomy and immediate reconstruction using PM-MC flap were performed after external irradiation 44 Gy, interstitial irradiation 55 Gy, hyperthermia twice, and chemotherapy (CDDP 140mg, BLM 30mg, PEP 55mg). After postoperative chemotherapy (CDDP 170mg, BLM 25mg, 5-FU 5, 000mg) was completed, she was discharged from the hospital. Now, 1 year and 8 months postoperatively, she is in good health without recurrence or metastasis. In conclusion, imaging diagnosis combined with echography, CT and angiography is helpful in the preoperative diagnosis of the relationship between metastatic lymph nodes and the carotid artery.
Long term observations were carried out on nine cases whose mandible were resected and reconstructed immediately by using AO plate singly. In five cases, the plate was stable without any problems, during the whole postoperative period ranging from 2 years 4 months to 4 years 7 months. In four cases, it was necessary to remove the plate. The reasons for removal were local reccurrence of tumor (2 cases), infection (1 case) and dyspnea due to dislocation of the plate. AO plate proved to be useful and fairly stable as a temporary implant for the immediate reconstruction of mandible in the case of oral cancer in which material and method are strictly limited.
Sebaceous carcinoma is a rare tumor originating from sebaceous glands, Meibomian glands and Zeis glands. On the other hand, ectopia of sebaceous glands is a well-known phenomenon in the head and neck, particularly in such locations as the mucocutaneous junction, the buccal mucosa and the salivary glands. A few cases of sebaceous carcinoma in the parotid glands were reported. But there were no reports of carcinomas arising from the sebaceous components in oral and paraoral sites. Generally, wide local excision has been the most common treatment. Radiotherapy efficacy has not been adequately assessed. In the paper, we present a case with sebaceous carcinoma which was thought to occur from Fordyce's condition or minor salivary gland in the buccal mucosa. A patient a 92-year-old woman, had sebaceous carcinoma of the left buccal mucosa and the left cheek and lung metastasis. We performed local excision and radiotherapy in this case. The effect of radiotherapy was satisfactory and the tumor of the cheek disappeared after irradiation. But, the patient died of advancement of metastasis without local recurrence 5 monthes after radiation.
Loxonin® is one of the non-steroidal anti-inflammatory analgesics of the phenylpropionic acid group. It is known that its side effects on digestive organs are less than those of other analgesics because of “prodrug” A clinical evaluation of Loxonin® on pain control after minor oral surgery is here reported in regard to time course of effectiveness, side effects, its availability and related points reflect, c1 in pain control. The number of test cases was 233 comprising 178 cases with single dose (120mg) only at pain onset and 55 cases with 3-divided doses (total 180mg). Of them, 23 cases were omitted because of no Loxonin® without postcperative pains. The benefit of the pain control method in the former cases reached 94.4% and the latter showed 96. 0%. The final availability was certainly more than 90% regardless of surgical treatments and inflammation degree before operation. From the results, it turned out Loxonin® was safe in the clinical use and highly effective in the pain control following minor oral surgery.