Dentofacial deformities are generally classified with the lateral cephalogram. Such classification, however, is incomplete because facial asymmetry could not be diagnosed if the evaluation of the posterior-anterior cephalometric radiogram (P-A) is not considered. Sixty adults (30 male and 30 female) who had normal occlusion were randomly selected and their P-A cephalometric radiograms were traced on acetate tracing paper. We selected 18 landmarks as follows; MHW, CG, Lo, Rof, Po, Zyg, Ms, Nf, Zm, Mx, CMo, Mo, Co, ARE, Go, U1, L1, Me. According to Sassouni's report, a line connecting left and right lateroorbitale (Lo-Lo') was used as a horizontal reference line. The median sagital plane passes through the point Cista Galli (CG) and runs perpendicularly to the (Lo-Lo') line. We measured the difference between right and left points on the coordinate and calculated the standard deviation. Then we established the statistical chart of the P-A view based on the standard diviation (SD). We chose 3 points, Mx, Go and Me as the representation. If each point shifted beyond 2 SD, we difined it as deviation. According to the chart, the dentofacial deformities were classified into following 3 groups. Group 1; The deviation only on the mandible. Group 2; The deviation not only on the mandible but on the maxilla. Group 3; The deviation only on the maxilla. Totally 239 patients were operated in our hospital for past 10 years. 67 patients among 239 (approdmately 28%) had some degree of facial asymmetry. 43 patients belonged to group 1, 24 were group 2, and there were none in the group 3.
In recent years many advances have developed in the field of temporomandibular joint (TMJ) imaging. The newest of these involves the use of magnetic resonance (MR)-CT imaging to evaluate internal derangement of the TMJ. MR-CT imaging can produce highquality tomographic images of greater soft-tissue contrast without ionizing radiation or known biological hazards. The normal TMJ was evaluated using MR-CT imaging on five volunteers (aged 20-25 years) and compared with ten patients (aged 17-65 years) who had been diagnosed internal derangement of the TMJ. MR-CT imaging was performed with the 0.5 T VISTA MR system (PICKER INTERNATIONAL) using the surface coil. We selected spin-echo sequences (TR 1, 000 msec, TE 40 msec; two averages, 256×256 matrix, scan time of 8 min 36 see). Oblique 5 mm thick images were obtained with open and closed jaw positions. Findings of MR-CT examinations were correlated with findings of conventional radiographic and clinical examinations. MR-CT provided information about meniscal position and morphology, especially in the open jaw position. MR-CT is a useful method for diagnosis of the internal derangement of the TMJ.
230 cases of primary squamous cell carcinoma of the oral and maxillofacial region were observed to determine the content of nuclear DNA by Feulgen-DNA microspectrophotometry at Department of Oral and Maxillofacial Surgry, Kobe University Hospital. The author reports here: 1) A new cell isolation technique for paraffin embedded tissue of squamous cell carcinoma 2) Relation between nuclear DNA content and clinical, histological characteristics 3) Prognostic factors by multiple regression analysis There are various techniques reported in the field of microspectrophotometry for cell isolation from paraffin embedded tissue, but none of which was found to be successful for squamous cell carcinoma. The author has, therefore, established a new cell isolation technique suitable for paraffin embedded tissue of squamous cell carcinoma. The most unique feature is to make it easy to pick up a small tissue direct from a thick paraffin specimen, and collect a large number of cells. The nuclear DNA content was analyzed in comparison with clinical, histological characteristics and statistical observation. The data on the nuclear DNA content was evaluated by histogram, classified into the following items;(1) Mode, (2) Frequency of Mode, (3) Number of cells greater than 4n, (4) Range, (5) Histogram Pattern, (6) Mean. Results indicate: -Most cases of aneuploidy cell division pattern showed poor prognosis. -Most cases of previous surgical treatment (tooth extraction, incision, puncture, etc.) at othr medical and dental units prior to this department showed polyploidy nuclear DNA content, aneuploidy cell division, and poor prognosis. -As a result of multiple regression analysis, it was found that on factors of previous surgical treatment at other medical and dental units and aneuploidy pattern of histogram adversely affected prognosis. Amongst histogram evaluation items, histogram pattern in representative of malignancy of squamous cell carcinoma. These facts indicate that nuclear DNA content of squamous cell carcinoma reflects a biological property to represent the malignancy of tumor and has significant relation to clinical and histological characteristics. And these findings suggest that the prognostic factors are of most importance for prospcctivc therapy of squamous cell carcinoma of the oral and maxillofacial region.
The blood group substances A, B and H are examples of cell surface glycolipids and glycoproteins in which the antigenic determinants are located near the carbohydrate chains of these molecules. A and B antigens are synthesized by the addition of terminal carbohydrates to a precursor substance with blood group H activity. The distribution of blood group carbohydrate chains with antigens A, B and H specificity was studied in 56 human oral squamous cell carcinomas. The cancerous lesions examined were obtained from 21 blood group A, 12 blood group B, 7 blood group AB, and 16 blood group O persons. 3 blood group antigens are evaluated in serial sections by immunohistochemical techniques with monoclonal antibodies to A, B and H antigen. In conclusion, blood A and B substances are lost and their precursor, H antigen, is accumulated in the majority of oral squamous cell carcinomas. The staining intensities of blood group substance H tend to correlate with the degree of differentiation of squamous cell carcinoma. Therefore the process of ontogenesis of a blood group carbohydrate chain occurs as step by step elongation, but such a development of carbohydrate chain is considered to be blocked in the process of oncogenesis. Investigation of blood group antigens A, B and H may be a useful marker in diagnosis of oral squamous cell carcinomas.
42 patients, suspected as having Sjögren's syndrome (88) based on sialogram of the parotid gland and were diagnosed as not having other autoimmune diseases, were evaluated in order to clarify the relationship of the sialographical appearance to immunological findings of SS. According to Fukuda's sialographical classification for SS (Class I-Class IV), tin patients were classified into three groups. 21 patients were classified as Class II, which suggests an early stage of SS. 8 patients were classified into Class III and 13 into Class IV. which suggest advanced stages for SS. Class I was not observed in this group of patients. Numbers of both peripheral blood leukocytes (leu) and lymphocytes (lym) of Class 17 patients (leu: 4, 200/mm3, lym: 1, 400/mm3) were significantly lower than those of Class II patients (leu: 5, 900/mm3, lym: 1, 900/mm3). Increase in γ-globulin, IgA, IgG and IgM in the sera of the patients was also observed as the sialographical classification advanced. Serum anti-nuclear antibody (ANA) and rheumatoid factor (RF) were observed in 43% and 38% of Class II patients, 63% and 50% of Class III patients, and 67% and 75% of Class IV patients, respectively. A high incidence of ANA and RF were observed also in Class II patients, and increases in the incidence of the above factors were seen as the sialographical classification advanced. Serum anti-SS-A antibody and anti-SS-B antibody were demonstrated in 57% and 29% of Class III patients, and 88% and 38% of Class IV patients. In contrast, the above antibodies were not observed in the sera of Class II patients.
Bone Morphogenetic Protein (BMP) was extracted from bovine corticalbone and was bound to hydroxyapatite (HAP), which was synthesized by the wet method inorder to produce fine primary particles. Precipitate of the synthesized HAP was dried at 80°C, fired at 800°C for 3 hours, pulverized then sintered at 1200°C for 8 hours with the addition of resin beads, gclatin and hydrogenperoxide to make porous powder HAP and block HAP. For the combination of BMP and HAP, two different kinds of methods were performed.(Procedure 1) BMP was suspended in distilled water, and HAP was immersed in it, then lyophilized.(Procedure 2) BMP was solubilized in 0.01 M phosphate buffer (pH 7.2) with 6 M urea, and HAP was immersed in it, then dialyzed and lyophilized. HAP-BMP complexes were implanted in the thigh muscle pouch of mice (conventional male ddy, 5 weeks) which were sacrificed 3 weeks later to investigate the osteoinductive activity and biocornpatibility of the implants. All implanted HAP-BMP complex showed better osteoinductive activity than the implantation of BMP only, especially in the group made by prccedure 2, all implants induced fairly large amounts of new bone. No inflammatory cells were observed, and HAP and induced new bone were attached directly together without any connective tissues.
Oral tumors are occassionally associated with hypercalcemia. Systemic symptoms due to hypercalcemia cause not only physical and mental troubles to patients but difficulties to physicians in choice of therapy and in prediction of prognosis since these symptoms resemble those seen at terminal stage of cancer. In the treatment of malignant hypercalcemia, simple, safe and efficient therapy that even cachectic cancer patients are able to toleate should be promptly performed. In the case reported here, a patient with tongue cancer diagnosed histologically squamous cell carcinoma, who manifested prominent hypercalcemia at a terminal stage of his clinical course was treated with synthetic eel calcitonin (Elcitonin). Administration of drug at a dosage of 160 MRCU/day intramusculary resulted in a significant decrease in serum calcium levels without notable side effects. Coadministration of glucocorticoid (Solu-Medral 250 mg/day) enhanced the effect of calcitonin. We, therefore, suggest that calcitonin with its known inhibitory action on bone resorption is one of the safest and most efficacious drugs for the treatment of hypercalcemia associated with oral cancers.
A case of osteomyelitis of the mandible with severe swelling and induration in a 63 years old man is reported. Two genera of bacteria; Streptococcus sp. and Peptococcus sp., were isolated from the disease. Subcutaneous reaction (redness, swelling and induration) were examined on rabbit abdominal skin to investigate the experimental infection of the isolated anaerobe. In the attempt, the supernatant of Peptococcus sp. after centrifugation (6500×G, 20 min), the supernatant and sediment fraction obtained by sonication treated cells were examined. As a result the inflammatory reaction was observed with sonication treated sediment fraction. These experiments suggest that severe swelling and induration on this patient was caused by the anaerobe cell wall.
Pleomorphic adenoma is the common oral region neoplasm. The glands most frequently affected by this tumor are the parotid of the major salivary glands and the palate of the minor salivary glands. However, it is said that this tumor rarely develops on the lip. We have recently experienced one case of pleomorphic adenoma on the upper lip. This patient, a 58-year-old man, was referred to our hospital with a chief complaint of a mass on the upper lip. The tumor was completely resected under local anesthesia. The removed mass measured 0.5×0.6×0.6 cm, was well encapsulated, and the cut surface was yellowish white and solid. Light microscopic findings showed that the parenchima of the tumor consisted of cuboidal or polygonal cells and that cells which conform ducts consisted of flattened monolayer cells. Electron microscopic findings showed that cells which conform ducts consisted of cells with the features of both intercalated duct cells and myoepithelial cells and that the parenchima of the tumor consists of cells similar to myoepithelial cells. Histological diagnosis was pleomorphic adenoma, suggesting that this tumor originated from epithelial tissues.
Eight patients subjected tosagittal split ostcotomy with A.O.miniplates and the results were rcported.The averagc operation time was 240.6 minutes, and the average blood loss was 290.6ml. Paresthesia of the lower lip and men tal area was observcd in patients, and the period for recovery exceeded 1 year in 15 out of 16 sides. However the range and scope of parcsthesia showed anarrowing tendency. The poriod of intcrmaxillary fixation was shorter than in wire osteos ynthesis. A. O. miniplates were removcd on 5 sides in 4 patients. The reasons were sense of incongmity, dull pain and infection. The appcarance of T. M. J. symptoms was rare. Repositioning techniques of the extemal fragments wereapplied and fbund to boeffective. Relapse and changes on latcral ccphalogmms X-ray photo, between opemtion and 1 year after operation, were minimized.
Male cases with Sjögren's syndrome are uncommon, and its detailed clinical condition is unknown. In this study, we examined clinical history, clinical symptoms, saliva secretion rate, tear fl ow rate, sialography, histological finding of the labial salivary gland and serum auto-antibodies of 12 male cases with Sjögren's syndrome. Moreover, clinical features of male and female patients of Sjögren syndrome were compared. The diagnosis and clinical classification of Sjögren's syndrome were based on the criteria established by the Ministry of Health and Welfare Sjögren's Syndrome Committee. Sialographic changes were in five stages according to the classification of Rubin & Holt. Histological changes of labial salivary gland were in five stages according to the classification of Ishikawa & Komori (1979). The results were as follows: 1) 8 patients had “definite”, and 4 patients had “probable” Sjögren's syndrome. In clinical classification of Sjögren's syndrome, 10 cases belonged to group I, 1 to group II (rheumatoid arthritis), and 1 to group III (chronic active hepatitis). Age distribution was 27-68 years and mean age was 48.7 years. 2) The incidence rate of male cases in Sjögren's syndrome was 9.0%. In male cases, the incidence rate of Sjögren's syndrome was the highest in the group I. 3) In initial symptom on male cases, the incidence rate of eye symptom was the highest, and eye symptom was observed to be more prominent in male than in female cases. 4) The incidence rate of abnormal sialography finding (stage I to IV) was 27.3% in male and 81.1% in female cases. Slighter abnormal changes of sialography were observed in male than in female cases. 5) The incidence rate of periductal focus of lymphoid cells in labial salivary gland was 30.0% in male and 76.5% in female cases. Slighter labial salivary gland changes were observed in male than in female cases. 6) The decrease of saliva was slighter in male than in female cases. 7) Decreased tear flows by Schirmer's test were severer in male than in female cases. The incidence rate of keratoconjunctivitis sicca was higher in male than in female cases. 8) The incidence rate of serum auto-antibodies was lower in male than in female cases, and especially, these auto-antibodies were not found in group I of male cases. 9) From the above, male cases with Sjögren's syndrome may be characterized by prominent eye symptoms and other poor clinical features.
Pleomorphie adenoma is the most common of all salivary gland tumors. The most frequently affected gland is the parotic, in major salivary glands and the palate in tie minor salivary glands. Minor salivary gland tumor is rarely found in t re cheek region. We recently experienced a case of pleomorphic adenoma of the cheek. The patient was a 58 rear old women who complained of swelling in the left buccal mucosa. The pleorricrphic adenoma was removc d under general anesthesia. We observed these histopathological characteristics and examined them by scanning and transmission electron microscope. Histopathological examination showed a duct-like structure and myxornatous variation. Elect. en microscope examination showed a funicular and lumenlike structure. During the 1 year observation period, prcgnosis was excellent.
Peripheral giant cell granuloma, also called giant cell epulis, is a disease characterized by the appearance of many giant cells exclusively in the oral soft tissues. This lesion has been the subject of frequent research by many authors. So far, however, the origin of giant cells has not been elucidated. A case of peripheral giant cell granuloma is reported. The patient was a 69-year-old woman who complained of tumor formation at gingiva of maxilla under a clinical diagnosis of epulis. The tumor was resected with alveolar bone under local anesthesia. By light microscopic findings, the surface of the tumor was covered with mucous menbrance and many giant cells were seen in the central area of the tumor reguly. With the electron microscope the giant cell had many mitochondoria and r-ER in cytoplasm. The mononuclear cells have high electron dense granules in cytoplasm and these cells resemble macropharges.
Fibrous histiocytoma commonly attacks the limbs, but it is relatively rare in oral lesions. The malignant type of this disease is interesting not only because of the difficulty of histological diagnosis but also because of absence of special clinical signs. We would like to show two cases of malignant fibrous histiocytoma (case 1 and 2) and a benign one (case 3). Case 1. A 55-year-old woman was referred to our department Feb. 16th, 1983 complaining of a large tumor in the right submaxillary region. The clinical examination revealed a fist-sized elastic hard mass in the right submaxillary region. She was treated with irradiation after removal of the tumor, and was irradiated again later. At present, about six years after the treatment, she has no sign of recurrence or metastasis. Case 2. A 55-year-old man was referred to our department Feb. 25th, 1984 complaining of a mass in the left upper molar region. The tumor was hen's egg-sized and elastic hard. He was treated by resection, irradiation and chemo-therapy, but the tumor could not be controlled. He died three years and three months after the treatment. Case 3. A 49-year-old man was referred to our department May 29th, 1985 complaining chiefly of a disagreeable sensation in the left mandibular ramus. There was found in the left mandibular angle region a slight swelling and a multi-locular cystic pattern was observed on X-ray films. Surgical treatment was carried out and the postoperative couse was uneventful.
A case of 51-year-old male with a large parotid tumor was presented. It took 12 years between his first notice of a little finger tip sized lump in the left parotid and removal of the lump which had grown to a huge size. Excision of the tumor was carried out with preservation of the entire facial nerve. The excised tumor was 96×76×75mm in size and weighed 240g. Histological examination revealed the typical features of a benign pleomorphic adenoma. There was no evidence of recurrence after a follow-up period of four years.
Foreign bodies found in the maxillary sinus are usually iatrogenic and include misplaced dental roots which occur during dental extraction or dental tools used during treatment. Many of the traumatic foreign bodies are broken pieces of glass or metal. However, it is a rarity in the literature for a tooth that has been misplaced in the maxillary sinus for an extended period of time in its original form to cause a traumatic problem. We have recently experienced a case of traumatic dental misplacement causing symptomatic problems 16 years after misplacement. A summary of our findings in this case is presented in this paper.
We have examined the estimated blood loss of 200 patients had a maxillary sinus radical operation in the central operating room of The Nippon Dental University, School of Dentistry at Niigata Dental Hospital from February 1979 to May 1987. The subjects included 106 males and 94 females, ranged from class 1 to class 2, according to ASA classification. Their ages ranged from 1. 5 to 73 years and the average age was 42.1±12.6 years. Their body weights ranged from 7.9 to 92.8kg and the average body weight was 56.4±10.0kg. Referring to the methods of anesthesia, nitrous oxide-oxygen-halothane was applied to 94 cases, nitrous oxide-oxygen-enflurane to 60 cases, and neurolept anesthesia to 46 cases, 181 cases in which vasoconstrictors were used during operation. A correlationship was observed between body weight and estimated blood loss. The estimted blood loss would increase with an increase in the operative time, a correlationship was observed between these factors. Cases of odontogenic maxillary sinusitis had larger estimated blood loss than those of postoperative maxillary cyst, with a statistically significant difference observed. There were no statistically significant differences observed in relation to methods of anesthesia, kinds of vasoconstrictors used, and whether or not a vasoconstrictor was used. The least estimated blood loss was shown by the group having an average systolic blood pressure (SBP) of 100 mmHg or lower, resulting in statistically significant differences from the respective groups having 101 to 120 mmHg and 121 mmHg or higher.
A pigmented nevus is defined as a harnartomatous proliferation of the melaninproducing cells (nevus cells). It is a relatively rare disease, especially in the oral mucosa. In this report, the authors present a case of a pigmented nevus of the gingiva, and review 18 cases of pigmented nevus in the region of mucous membrane or lip as previously reported in Japanese medical literature. The patient, a 63-year-old woman, was referred by her dentist complaining of denture instability due to swelling of the gingiva. About six months ago, she first noted the swelling on the left mandibular gingiva, in the area of the cuspid. The swelling gradually enlarged. At the time of oral examination, a well-defined pigmented swelling about the size of a red bean was noticed. Having been clinically diagnosed as fibroma, the lesion was surgically excised with little difficulty. A histopathological study revealed it to be an intramucosal pigmented nevus. Postoperative healing was uneventful and there has been no evidence of recurrence after a lapse of 1 year and 8 months.
Maxillary sinus mycosis is a comparatively rare disease, but its incidence has recently been elevating. Generally, many of the reports have come from the oral field and a few from the oral surgical fi eld. We would like to report here 2 cases of maxillary sinuous mycosis which we have resently experienced. Case 1 is a 50-year-old woman, who came to our hospital with swelling and tenderness in the right alar part as CC. Fungal mass detected at the first examination led us to perform Caldwell-Luc operation. Its isolated matter was fungal culture negative, but its pathohistological preparation revealed a fungal mass suggestive of Aspergillus. Case 2 is a 38-year-old woman, who came to our hospital with postnasal discharge and pain in the left buccal region at CC. CT revealed a high density shadow suggestive of fungal ball. The same Caldwell-Luc operation was performed on this patient suspected of mycosis. Its isolated matter was fungal culture negative, but its pathohistological preparation revealed a fungal mass suggestive of Aspergillus. Now, more than one year after operation, both cases are getting well without relapse.
Oral florid papillomatosis of oral muocsa is a relatively rare entity that may resemble malignant tumor (verrucous carcinoma). It should be regarded as premalignant eventuating in verrucous carcinoma. Its radical treatment is very difficult because of wide spread of lesion. We recently experienced extended oral florid papillomatosis from the right and left buccal mucosa, palate upper and lower gingiva in 74 year-old woman. BLM (total dose 75 mg) and MTX (1000mg) were mainly given as the chemotherapy. As a result, the tumor was greatly reduced and dysfunction was minimized due to operation. The case was reported with some coments based on past literature.
A 60 year-old male patient with Mikulicz's disease was reported He had a marked symmetrical painless enlargement of the bilateral lacrimal, parotid, submandibular and sublingual glands. His face showes the typical appearance from the enlargement of these glands in this disease. Laboratory examinations revealed immunological abnormality such as increased gamma globulin fraction and elevation of IgG fraction. Sialogram of his parotid and submandibular glands showed some part of shadowless pattern in the parenchyma. Histopathologically his lacrimal, parotid and submandibular glands revealed both atrophy or loss of acinar tissue with lymphoid infiltration and ductal changes including the development of epimyothelial islands. This patient is presently under control by administration of prednisolone Mikulicz's disease accounted for 16 cases reported in Japanese literature for the period of 1973-1988.
Mandibular reconstruction with condylar head is an important and indispensable surgical procedure to attain functional and cosmetical recovery after hemimandibulectomy. The widely used materials for reconstruction were autogenous, heterogenous and artificial bone, but restration by them contains many problems, especially with temporomandibular joint functions and were not always satisfactory, in mandibular movement of masticatory function. We applied the reconstruction metal plate with condylar head after hemimandibulectomy in 4 patients, and examinated post operative function. The purpose of this paper is to clarify whether or not the mandibular function after mandibular reconstruction is satisfactory. We observed 4 patients who spent 2 to 9 years after mandibular reconstruction with a condylar head. Recently, their mandibular movement and masticatory functions were studied by Saffon Mandibular Movement Anaryzer, and EMG studies were carried out on the masseter and the temporal muscles. Maximum open distance and maximum biting force were measured with a scale and biting force meter. Slight disturbances were observe when the limit of mandibular movement was exceeded. Deviation of the mandibule towards the operated side occured during full mouth opening. The obstruction of lateral movment to the operated side was slight and there was nobody who was unable to do the lateral movement at all. Decreases in EMG activity of the masticatory muscle and maximum biting force were observed at the operated side compared with the nonoperated side. Further, even at the non-operated side, there was an obvious decrease compared with normal persons described in the literatures. But, the electical discharge activities were not proportionally related with the maximum biting force. These results indicated that the mandibular reconstruction metal plate with a condylar head after hemimandibulectomy didn't give any incovenience to patient's routine life and can give approximate satisfuction in clinical evaluation in all the patients.
We have experienced one case of a large dermoid cyst in the sublingual area of a 33 years old female. By using the Magnetic Resonance Imaging technique, we reconized its availability to grasp size, internal quality and site of lesion according to differences in signal intensity between Ti and T2 values at each tissue.
Myxofibroma of the jaws does not occur with great frequency and its pathogenesis or cause is variously disputed. This report described a 26-year-old male suffering from myxofibroma of the mandible. He was referred to the clinic with chief complaint of feeling of disorder of the anterior mandible. Radiographic examination revealed unilocular and radiolucent lesion in 4-2 region. Removal of the tumor was performed surgically under general anesthesia. Pathological findings showed myxofibroma, but it was impossible to clarify that the origin was odontogenic. The patient shows no evidence of recurrence of tumor two years after surgery.
There exists many clinical and pathological classifications of the division of hemangioma. Recently, an opportunity arose to treat an unusual case of cavernous hemangioma in the masseter muscle (WHO classification). To date, only 11 such cases have been reported in Japan. Strong mastication by the patient resulted in a clear swelling of the tumor region, but without mastication no swelling was observed. These clinical characteristics identified this case as erectile hemangioma of the masseter muscle. The patient, a 15 year-old male, was admitted to our hospital in September, 1988 complaining of abnormal feeling and swelling of the left buccal region. With strong mastication, a limited hemisphere, painless, elastic soft swelling measuring 48×28mm was seen. It was necessary to identify the origin of this tumor and to find a successful operation method. There are three possible excision methods for cases of erectile hemangioma, dependent on the location of the incision which can made both extra-orally and intra-orally. The extra-oral incision can be made at the anterior auricular or at the submandible. The intra-oral method is popular for avoiding the effects of scar tissue. However, this method affords no clear view of the incision line, and can result in excessive bleeding, facial palsy and possible recurrence of the tumor. For the above mentioned reasons, and with the tumor region which was positioned centrally and near the surface of the face, it was decided to make the incision extra-orally at the submandible. The operation appears to have been successful with a good prognosis.
A case of hemangiopericytoma of the buccal mucosa in a 54-year-old woman is presented, which brings the total number of such uncommon oral cases of this tumor to 17 in Japanese literature. The tumor consisted of tightly arranged spindle-shaped cells proliferating inbetween blood capillaries showing an occasional “staghorn” configuration. The perivascular location of tumor cells was clearly revealed by the reticulin stain. Tumor cells were negative for Factor VIIIrelated antigen and devoid of conspicuous positivity for vimentin, in sharp contrast to the intense reaction of capillary endothelial cells to these antigens. The tumor cells shared ultrastructural features with normal pericytes, i.e., the presence of pinocytotic vesicles, bundles of microfilaments with dense bodies and basal lamina-like material. Thus the immunohistochemical and/or ultrastructural examination is regarded useful for differentiating hemangiopericytoma from other tumors with a pericytomatous histological pattern. This case should be followed carefully, as similar benign-appearing lesions have been reported to recur and/or metastasize occasionally after surgical enucleation.
Seborrheic keratosis are very common lesions of the skin. They occur mainly on the trunk and face, but are rarely seen in the oral region. Recently, we encountered a case of seborrheic keratosis of the upper lip The patient was a 57-years-old male who had first noted the lesion approximately 4 months before presentation. The lesion was 7×10mm in size, white, rough and slightly hard. There was no spontaneous pain or pain caused by pressure on the lesion. It was resected under local anesthesia and diagnosed histopathologically as a seborrheic keratosis of the acanthotic type. No recurrence has occurred in the two years since the operation.
Plummer-Vinson syndrome is clinically characterized by manifestations such as dysphagia, atrophic glossitis, angular cheilitis, and koilonychia. The syndrome is associated with an irondeficiency anemia. This occurs in about 7% of iron-deficient subjects. Further, this syndrome usually affects middle-aged females. In this paper, however, the case of a male patient is reported. In October, 1987, a 63 year-old man came to our hospital for consultation. He complained of sore mouth and slight difficulty in swallowing. As for his past medical history, about 30 years earlier, he had undergone a surgical operation for a duodenal ulcer. With regard to his present complaint, he had noticed the symptoms three years earlier, at which time he consulted local medical doctors, but nothing abnormal was found. Several weeks prior to his appearance at our hospital, the symptoms had increased in severity and so he sought medical advice. Clinical examination revealed brittle, spoon-shaped finger nails. Furhter, the corners of his mouth were cracked. Intraorally, the tongue was red, glossy, and smooth, owing to atrophy of the papillae. The patient was completely edentulous and uses full dentures. Laboratory tests then were conducted. A complete blood count revealed a microcytic hypochromic anemia and a further investigation including serum ferritin concentration disclosed an iron-deficiency anemia with anisocytosis and poikilocytosis. Barium contrast radiograph showed the normal esophagus and the gastrojejunostomy (the Billroth II operation) for the previous duodenal ulcer. These clinical and laboratory findings led to the diagnosis of Plummer-Vinson syndrome. He was started on a medical regimen of iron preparation to replace iron loss. He responded well to this therapy and the symptoms disappeared in five weeks. Since then his progress has been followed and he remains free of the disease.
64 cases of primary tongue cancer were studied from 1973 to 1985 in the Department of Oral and Maxillofacial Surgery at Kyoto University Hospital and the following results were obtained. 1) The 64 patients consisted of 35 males and 29 females with an age average of 53.8. Pain was the most frequent chief complaint, and 48. 4 % of them visited our clinic within 3 months after onset of the symptom. 2) 63 of 64 cases were pathologically diagnosed as squamous cell carcinoma. In stage classification, Stage I: 2 cases, Stage 11: 20 cases, Stage III: 27 cases, Stage IV: 15 cases. 3) 73% of 64 cases were treated by surgery and radiotherapy. Pull through operation was the most frequent in surgery and external radiotherapy was given in almost all the cases post operatively. Prophylactic upper neck dissection was done in 73.7% of 38 cases. 4) The accumulated 5-year survival rate was 65.6% in all cases, and 73.9 % in 47 cases of surgery + radiotherapy group. On the other hand, it was 55.6% in 6 cases of surgery group, and 35.1% in 10 cases of radiotherapy group. 5) The higher the stage and the lower the histological differentiation, the lower the accumulated 5-year survival rate tended to be.
A case of malignant lymphoma which appeared as a buccal mucosal tumor in an incipient symptom in a 56-year-old man is reported. The patient was referred to our Department of Oral and Maxillofacial Surgery, Shimane Medical University Hospital with a complaint of painless swelling of the right cheek, and CT findings confirmed that it developed from the maxillary sinus. The lesion was histologically diagnosed as malignant lymphoma, diffuse medium-sized cell type according to the Japanese Lymphoma Study Group (JLSG) classification. The immunophenotypic analysis for surface makers indicated that this malignant lymphoma was B-cell type. The clinical stage of this case was determined as stage IV from bone marrow biopsy and other examinations. He died of the disease 30 months after onset in spite of aggressive radiation therapy and chemotherapy (VEPA).
Neurilemmoma (Schwannoma) may be in all parts of the body, but it is rare in theregions of the jaw and oral cavity. In this report we presented a case of neurilemmoma located in the tongue with its electronmicroscopic and histochemical studies, and reviewed cases of neurilemmoma in the region of the tongue as reported in the Japanese literature. The patient, a 17-year-old female, appeared at our dental clinic with the chief complaint of tongue pain. She first noted the painless swelling of the tongue with no other symptoms in May 1986 But she noted the tongue pain after about one year and was introduced to our dental clinicin April, 1988. The familial and past history was unremarkable. On physical examination, there was an elastic soft and movable hemispherical mass the size of the tip of the thumb. The clinical diagnosis was a benign tumor of the tongue. The lesion was totally excised under general anesthesia in May 1988. The removed hemispherical mass measuring 30×20×20mm was encapsulated by thin film. The tumor was diagnosed histopathologically as a neurilemmoma of Antoni. A type partially with Antoni B type. In addition, an immunohistochemical study using the antibody of s-100 protein was carried out. There was no evidence of recurrence 10 months after the operation.
Ameloblastoma, dentigerous tumor originating from an epithelial element of the dental germ, is a typical oral field tumor. It is macroscopically classified into solid ameloblastoma and cystic ameloblastoma. This paper reports the case of a 36-year-old man with ameloblastoma who presented a unique tissue picture of the coexistence of solid ameloblastoma and cystic ameloblastoma separated by the compact bone of the mandibular anterior teeth.
We present a case of large complex odontoma of the mandible of an 8-year-old female that showed interesting radiographic features and remarkable radioisotope uptake. The patient visited our hospital with a complaint of delayed eruption of the left mandibular first molar. Radiographic features showed a large radioopaque lesion of the left mandibular body. The tumor was successfully removed by surgical procedure and the mandibular base of the mandible and the mandibular canal were preserved without any functional disorder. The histopathological specimens suggested that maturing process of odontogenesis was occurring. We have regarded this case as an immature odontoma or developing odontoma of early stage and discussed the considerations of the clinical diagnosis, radiographic features, histopathological findings and the relationship between the usual odontoma and the other odontogenic tumors such as ameloblastic fibroma or ameloblastic fibro-odontoma and so on.
We experienced a case of cat cry syndrome with transverse facial cleft. We reported this case with sound analysis and some considerations. The patient was a two-month-old boy. The chief complaint was a cleft from the left angular to the cheek. His face was distinctive and had a left side transverse facial cleft, micrognathia, microencephaly, saddle nose, malformation of the external ear and ocular hypertelorism were observed. His crying resembled kitten mewing, therefore we assumed this syndrome. We examinated his chromosomes and definitely diagnosed the cat cry syndrome. We analysed his crying and determined that the sound resembled kitten mewing. He had a plastic operation of transverse facial cleft under general anesthesia at his seventh month.
In the clinic of oral surgery, we find many cases of swelling of lymphnode in the submandibular or neck region, one of which is toxoplasmosis. However, there are only five cases of toxoplasmosis reported in the part of the oral surgery in Japan. We reported two cases. First case had a hen's egg sized tumor in the right submandibular region that was diagnosed as a toxoplasmosis depending on histological examination and serum anti-toxoplasma titer. The second one had some finger-tip sized lymphnodes in the right neck and was suspected as toxoplasmic lesion by titer and several other screenings.