The role of oncogenes in tumorigenesis has been observed by molecular biology and cell biology. A variety of human cancer cells from carcinomas of the bladder, breast, colon, kidney, liver, lung, ovary, pancreas, and stomach and from hematopoietic tumors and from tumors of mesenchymal origin contains mutant ras genes that are capable of transforming NIH 3 T 3 cells. In the present study five oral squamous cell cartinoma cell lines were screened for the presence of activated oncogenes by NIH 3 T 3 transfection assay coupled with the in vitro neomycin selection method. Activated c-H-ras-1 was detected in cellular DNAs from two cell lines, ZA and HOC-313, both obtained in our Department from human oral cancer tissues. HOC-313 DNA was found to lose the Msp I recognition sequence within the 11th and 12th codon of the ras protein, suggesting that HOC-313 had activation at the 12th codon, while ZA was sensitive to the enzyme digestion. To know the nature of the activation in ZA, the nucleotide sequences of exon I and exon II of c-H-ras-1 in one of the primary transfectant were determined by dideoxynucleotide chain-termination method. ZA was found to have two point mutations at the 13th and 27th codons within the first coding exon. The former change was associated with amino acid substitution from glycine to arginine but the latter was a silent mutation. The former point mutation was expected to generate a new Bgl I recognition site (GCCNNNNNGGC), which was comfirmed by the restriction analysis of ZA DNA. It is, thus, suggested that the point mutation in codon 13 of ZA c-H-ras-1 was responsible for the activation. DNAs from 33 human oral tumor tissues and from 9 human oral squamous cell carcinoma cell lines were analyzed for the loss of Msp I recognition site at the 12th codon of c-H-ras-1 using Southern blot hybridization No activation at the 12th codon was observed exceptfor HOC-313. DNAs from 19 human oral tumor tissues and from 8 human oral squamous cell carcinoma cell lines were also analyzed for the restriction fragment length polymorphism (RFLP) of the L-myc gene. Patients with only the L band (10 kb Eco RI fragment) had poor prognosis compared with those with either the S band (6 kb Eco RI fragment) or the S and L bands.
The running and distribution density of blood vessels developing along with structural changes in the implantation bed, surrounding alveolar bone and distant mandible were observed after a bone defect was made in the lower fourth premolar of the adult dog and was filled with a hydroxyapatite block or a portion of the iliac crest used as a control. In this experiment, angiography was used in the lower jaw at the time of sacrifice. Then a large ground section from the lower canine to first molar was prepared to observe vascular features. 1. Blood vessels branching from the inferior alveolar vessels entered into various parts of the transplanted iliac bone from the surrounding alveolar bone and formed an irregular capillary network by the 8th day after operation. 2. The vascular network within the transplanted iliac bone disappeared by the 14th day as the bone was absorbed. 3. Small blood vessels around the transplantation bed proliferated, and then entered into a new bone by the 14th day. 4. Small blood vessels around the transplantation and implantation bed formed a distinct vascular network by the 40th day. 5. Capillaries began to enter into hydroxyapatite pores until 40 days after operation and were arranged reticulated after 180 days. 6. A dense vascular network was formed around the iliac transplantation bed as a result of active bone absorption until about 60 days after operation, while a slightly rough reticulated vascular network was formed within the transplantation bed as a result of active bone formation. 7. The density of vascular distribution surrounding transplanted bone and hydroxyapatite decreased after 90 days. 8. Blood vessels in the iliac transplantation bed (after 90 days) and in the hydroxyapatite implantation bed (after about 180 days) were arranged along with the arrangement of bone structure; namely, they showed lamellar running in the vicinity of the top and irregular running in the base.
1. We experienced a basal cell nevus syndrome with huge multiple jaw cyst as major symptom and reported the case with other 4 experienced cases in our department. 2. Ocular hyperterorism, broadened nasal root, frontal and biparietal bossing, jaw cyst, bridging of sella turcica and family appearance were observed at all cases. 3. Basal cell nevi and pits were observed in cases 1, 2 and 5, but were unknown in cases 3 and 4. 4. Keratocyst was the histological diagnosis of all jaw cysts. 5. Treatment methods with jaw cysts were: Encleation after murspalization in case 1, presently murspalization and in the future enucleation in case 2, encleation alone in cases 3 and 4, and murspalization alone in case 5. Yet, cases 2 and 5 were recurrence by murspalization alone, therefor it was thought necessary to do complete enucleation including the surrounding healthy bone tissues. 6. As jaw cysts were keratocyst, they were apt to recur, and the importance of long term progress observation is important.
The purpose of this report is to describe the size and shape changes of mandible after operation in patient with ankylosis of the temporomandibular joint. A condylectomy of congenital ankylosis was treated at age 6. The cephalomatic radiographic results of the follow-up study 7 years after operation show that the gonial angle size and curvature of the lower border of mandible (antegonial notch) of affected side have increased. These results suggested that the growth of the ramus of the mandible of the affected side is more disturbed than the growth of contralateral unaffected side of that patient. Therefore, it would be very important for the growth of the ramus after the operation that continuous mechanical stimulation to bone such as a jaw exerciser was constructed usually on the affected side of mandible. Other problems for treatment of the temporomandibular joint of children, such as opportunity and methods for condylectomy are discussed.
We present here some views obtained through clinical research and pathologic histological research on 84 cases diagnosed as mucocele at the department of dentistry and oral surgery, Nagoya National Hospital during 10 years and 9 months from April, 1978 to December, 1988. The mucocele we investigated were 63 cases of the mucocele which was derived from the minor salivary gland, 16 ranula cases, and 5 cases of Blandin-Nuhn gland cyst (total 84 cases). With regard to the manifestation frequency by age group, the mucocele derived from the minor salivary gland occurred numerously in those under 30 years old, and it occurred particularly numerously in those from 0 to 9 years old totaling as many as 15 cases. The ranula numerously occurred also in those under 30 years old, and the Blandin-Nuhn gland cyst in large numbers in those under 10 years old. With regard to the manifestation frequency by sex distinction, the ratio of the mucocele, derived from the minor salivary gland, of male to female was 1: 1.3, indicating higher femaletendency. With regard to size, most were under 6 to 10mm, accounting for 41 cases (48. 8%), followed by 26 cases (31. 6%) of under 5mm, and 5 cases (6. 0%) of over 21mm in the order mentioned. As a trend, those in the regions of labia, forelingual gland, and buccal mucosa were small, and those in the oral floor region (sublingual type) were large. With regard to the number of clays from recognizing symptoms to visiting our hospital, the majority was from 1 to under 3 months in 34 cases (40. 5%), followed by from 3 to under 6 months in 15 cases (17. 9%) in the order mentioned. The shortest period was one day, and the longest was 20 years. There were 7 cases of frequent manifestation (8. 3%). The ratio of male to female was 1: 2. 5, indicating it occurred more in female, and further there were 18 cases of anamonesis (21. 4%) such as trauma or pernicious habit.
Epidermoid or dermoid cyst occurs throughout aberranted ectodermal tissue during embryonic development, or inflammatric and traumatic aberration of the epithelium. These cysts occur rarely in oral cavity. It occurs in the oral cavity mostly on the oral floor and rarely on the cheek. The authors have experienced two cases of epidermoid cysts on the left cheek. Case 1: 24 years old man. The cyst was well-demarcated and had movability on the left cheek, and could be easily extracted from extra-oral under local anesthesia. The authors supposed that this cyst had a posterior origin, because the patient had an external injury over 2 years ago. Case 2: 24 years old man. The cyst was well-demarcated and had movability on the left cheek, and could be easily extracted from intra-oral under local anesthesia. The authors supposed that this cyst had an inborn origin, because the patient had not an posterior origin. Two cases was epidermoid cyst for histopathological diagnosis.
A case of malignant lymphoma of the mandibular bone is reported. The patient was a 3-year-old male and visited our hospital with a complaint of painless swelling of lower gingiva. The radiographic examination showed severe absorption of the mandibular bone and 67Ga seintigram revealed abnormal 67Ga accumulation in the mandible and para-aortic lymph nodes. In histological examination a typical “starry-sky pattern” was demonstrated and the diagnosis of Burkitt's tumor was made.
The combined effects of UFT and irradiation on Ehrlich ascites tumor and malignant tumor lines derived from oral and maxillofacial region transplanted into nude mice were observed. As for the results, a significant elongation of mean survival time of mice bearing Ehrlich ascites tumor was observed when high-dose irradiation (8 Gy, 10 Gy) was combined with 5-FU or UFT. But significant enhancement of antitumor effect was observed in the combination with UFT and low-dose irradiation (2 Gy, 4 Gy). With regard to the malignant tumor lines, no remarkable enhancement of antitumor effect were observed in three squamous cell carcinoma lines. 011 the other hand, synergistic inhibitions of tumor growth were observed when combined with UFT 30 tog/kg and 4 Gy in three adenocarcinoma lines derived from salivary glands. There was inconsiderable decrease in body weights in treated nude mice. Therefore, it is considered that the combination therapy UFT and irradiation is useful for the treatment of oral carcinomas, especially salivary gland carcinomas which are thought to be resistant against radiotherapy or chemotherapy.
To elucidate the relationship between lesion titer of herpes simplex virus (HSV) and clinical states, virus isolation and infectivity titration were carried out in 200 samples collected from clinically suspected lesions of 178 patients in the Department of Oral Surgery, Yokohama City University Hospital. The virus isolation rate in patients diagnosed to have a primary HSV infection were 68%, 52% in those with a recurrent infection, and 56% in total. In patients with a primary infection, the isolation rate exceeded 90% up to five days after onset, then decreased markedly. Average virus titer remained unchanged until seven days of disease (3.3-3.8 log10 TCID50/2ml/sample). In patients with a recurrent infection, the isolation rate was relatively high in the early phase (77% on day 0 and 1), then showed a tendency to decrease. Average virus titer was highest in the samples obtained in the early phase (5.8 log10 TClD50/2ml/sample). Virus isolation rate was higher in primary cases than in those of recurrence. Average virus titer in lesions, however, was significantly lower in the primary infection, which was a finding of interest. Regarding the change of virus infectivity, titer in the early phase of the recurrent cases was remarkably high at first, then tended to decrease more quickly as time elapsed compared with those of primary infection. Morbid states were roughly classified into three categories: 1) “redness”, 2) “vesicle etc.” (vesicle and pustule), and 3) “ulcer etc.” (erosion, ulcer and crust). Their involvements were examined according to the number of days after the onset of the disease. In the primary infection, “ulcer etc.” occupied more than half of the lesions throughout the period. In the recurrent infections, “vesicle etc.” was the majority in an early phase but after 4 days this decreased markedly and, instead “ulcer etc.” occupied more than 2/3 of the lesions. Changes in morbid states, virus titers, and isolation rates in the course of HSV infection and their relationship were discussed.
Glomus tumor is a rare neoplasm arising from a specialized vascular structure, an arterio-venous anastomosis called the glomus apparatus. Glomus apparatus is composed of epithelioid glomus cells which function is thought to be a regulator of circulation and blood pressure. Glomus tumor is characterized by a proliferation of glomus cells and frequently observed in the fingernails, but it is very rare in the oral cavity. In this paper, a case of glomus tumor arising in the mandibular gingiva is reported with the review of the literature.
Sixty cases of oral leukoplakia treated at our Department from 1975 to 1987 and accompanied by long-term follow-up observation were reviewed, and the relation between oral leukoplakia and it's malignant transformation was clinicopathologically analyzed. A total of 60 oral leukoplakia cases had been followed up for an average of 6 years 5 months and the histological diagnosis of each case was confirmed on biopsy. The 38 male and 22 female patients ranged in age from 20 to 81 years. The number of cases classifid according to treatment was: surgical therapy 32 cases, cryosurgery 16 cases, chemotherapy 3 cases, and follow-up 9 cases. During the follow-up period, malignant transformation was found in 2 cases (36 year old male and 74 year old female). The lesions which transformed to squamous cell carcinoma originated in the lateral tongue. Dysplasia was identified in 2 cases, all mild in degree. Squamous cell carcinoma developed in 1 out of these 2 dysplasia cases.
The palatal island flap technique (the vascular pedicled mucoperiosteal island flap) has been reported to be useful for the reconstruction of the defect in the oral region. The purpose of this study is to investigate the procedure and the wound healing of the donor site, and the postoperative sensorial recuperation of donor and recipient sites. 10 cases reconstructed with palatal island flap were examined. The largest defect was 40×40 mm and the smallest one was 5×10 mm. To donor sites, skin graft, fibrinoplastic agents, lyophilized porcine skin, or atelocollagen were applied, and reepithelizing terms were measured. Postoperative sensorial recuperation of donor and recipient sites appeared perfectly in two years. In conclusion, this technique was found to be useful for the reconstruction of oral mucosa, because of technical ease and least disturbance.
The tumor extension of T4 cases of upper gum carcinoma (UG-Ca) is clinically similar to T2 cases of maxillary sinus carcinoma (NIS-Ca). However, the prognosis of the former is remarkably unfavorable compared with the latter. A comparative study between 16 cases of UG-Ca (T4) and 14 cases of MS-Ca (T2) was undertaken in order to assess the difference in their prognosis. The 5 year accumulative survival rate of UG-Ca (T4) was 36.5% and MS-Ca (T2) was 92.3%. While the control rate of the primary lesion after initial therapy, the former was 50% and the latter was 78.6%. As for the rat of cervical metastases noted clinically, it was 75% and 35.7% respectively. Bilateral cervical metastases was noted in 6 cases of UG-Ca (T4) and none in MS-Ca (T2). With respect to the 5 year accumulative survival rate of the cases with pathologically confirmed nodal involvement, it was 0% for UG-Ca (T4) but MS-Ca (T2) was 66.7%. The unfavorable prognosis for UG-Ca (T4) cases was attributed to failure to control primary and cervical metastases. Therefore, it is necessary to reexamine the margin of the primary resection and the timing for carrying out RND.
The relationship between subjective and objective evaluation of facial asymmetry of mandibular prognathism patients shown by photographs, was investigated. Seven parts of measuring distances and angles representing facial asymmetry were selected in the first experiment and six for the second experiment. The parts of the face include: the distance from the median line of the face to point A, B, Ch and Al of right and left sides, angle ABC of right and left sides, angle OBC of right and left sides, and the right and left sides of the chin (Me) as shown in the diagram of a mandibular prognathism patient. The two results are as follow: 1) The evaluation by the oral surgeons in our department, using multiple regression analysis, showed that the more the asymmetry in the region of the mandibular angle was severe, the more the facial asymmetry was felt to be severe. On the other hand, the result obtained from a questionnaire, distributed at the same time to the same subjects showed the chin to be most important for realizing facial symmetry. Therefore oral surgeons are inclined to pay too much attention to asymmetry of the chin region. 2) Multiple regression analysis shows, for oral surgeons and the public, that the postoperative improvement of facial asymmetry is most closely related to the improvement of the symmetry of the mandibular angle region. However, 57.5% of oral surgeons, on the questionnaire, regarded the asymmetry of the chin region as most important in evaluating the asymmetry of the face. The percentage indicating the mandibular angle was only 20%. This was remarkably different from the 60% of the public. Together the multiple regression analysis and questionnaire results coincide, and they suggest that the mandibular angle is the most important part in judging the asymmetry of the face.
The authors recently experienced a plastic surgery (Bernard's method) for extensive defect of lower lip due to self-mutilation. The patient is a 7-year-old girl suspected Lesch-Nyhan syndrome. The prognosis is now good with no recurrence and no problems. The authors will discuss the treatment after operation and countermeasure of self-mutilation in this paper.
The thyroglossal tract cyst is an uncommon developmental cyst which may form anywhere along the embryonic thyroglossal tract. This article presents a case of thyroglossal cyst. The 31-year-old male patient complained of a tumor in the midline of the anterior neck for about one month. Ultrasonography showed an echo-free cystic pattern with a comparatively defined and irregular border. Computed tomography also revealed a cystic lesion with inflammation. An exploratory puncture aspirated yellow-colored mucoid fluid. Microorganisms were not isolated from fluid, and the cytology revealed basal cells, foam cells, macrophages, lymphocytes, keratin, and numerous neutrophils with no evidence of malignancy. The cyst was excised under clinical diagnosis of thyroglossal cyst. A cord-like structure was seen to the level of the hyoid bone during the surgery, that followed Sistrunk's principles.
Hypertrophy of the masseter muscle is a relatively uncommon condition which may occur unilaterally or bilaterally. The etiology is unclear in most cases. A case of unilateral masseteric hypertrophy in a 17-year-old girl was described. Histochemical study was performed and features of the masseter muscle were compatible with a myopathic disorder, uniform type 1 fiber and gross hypertrophy of type 1 fibers. This disorder was termed branchial hypertrophic myopathy or hypertrophic masseter myopathy because it was confined to the masseter muscle.
Fifty-three closed lock cases of internal derangement of the temporomandibular joint (TMJ) were studied on the correlation between disk configuration at MR imaging and nine clinical parameters composed of opening degree, age, clicking and locking duration, visual analogue scale of pain (VAS), pain score, jaw dysfunction score, life activity limited score, and TMJ X-ray photo findings. Disk configuration and degree of anterior disk displacement were assessed on MR imaging in closed mouth position: the antero-posterior length of disk and the distance from condyle to anterior and posterior portion of disk were measured, respectively. Results were obtained as follows; 1. Duration of clicking and locking were not correlated with MR index except that there was a strong correlation between clicking duration and the distance from condyle to anterior portion of the disk at MR imaging. 2. Opening degree was related to the disk deformity and the access of posterior portion of the disk to condyle. 3. Disk configuration and degree of antrior disk displacemnt were not correlatd with TMJ pain, but jaw dysfunction was related to the disk deformity and the distance from posterior portion of the disk to condyle. 4. TMJ X-ray photo findings were not correlated with clicking duration (below 3 years), locking duration (below 30 weeks), opening degree and disk configuration at MR imging. 5. In evaluation of factors related to opening degree in 53 patients with closed lock by means of multiple regression analysis, age, locking and clicking duration, TMJ pain, life activiy limited score were more strongly correlated to opening degree than the others.
Since 1986 we used three dimensional CT for patients who possibly sustained fractures of the middle third of the facial skeleton. For the cases accompanied with brain injury, we usually first obtain a 5 rnm thick slice brain area CT, and then the middle third of the facial skeleton area CT with slice thickness of 1. 5mm. Until now only skilled surgeon could correctly visualize the fracture of the middle third of the facial skeleton which was composed of complicated thin bones, but with the 3D-CT image, every surgeon can visualize the fracture easily. Especially, the cut view method permits correct detection of the fracture of the skull base. Thus we could visualize fractures of the middle third of the facial skeleton preoperatively and could make the operative plan correctly and get good results. 3D-CT imaging program was very useful for treating the middle third of the facial skeleton.
The patient was a 47-year-old male suffering from mucosal lesion of the upper lip and a submaxillary region swelling. The painless mucosal ulcer was seen with a slightly raised margin and induration in the left side of the upper lip, and a semifist-sized indurated lymphonode with a slight pain was observed in the left submaxillary region. Serological examination revealed the elevation of TPHA-T at a titer of 1: 1, 280 and RPR-T 1: 4. Further, by using Warthin-Starry method, Treponema pallidum could be stained in the biopsy specimen taken from the labial lesion. This rare case presented a typical syphilitic primary complex that had a hard chancre on the lip and hard buboses of submaxillary lymphonodes. The patient was treated per us with ANIPC-CVA for six weeks, which was enough to eliminate the syphilic lesions. The blood serological data entered the normal range two months after administration.
Pyogenic granuloma occurs in the skin and the mucous membranes. The most characteristic features of the lesion are endothelial proliferation and formation of numerous vascular spaces. However criteria to differenciate the lesion from capillary hemangioma or epulis hemangiomatosa has never been established. We examined the histopathological, histochemical and immunohistochemical features in 5 cases of pyogenic granuloma, 6 cases of epulis hemangiomatosa and 2 cases of capillary hemangioma. 1) Histopathological study by hematoxylin-eosin staining: In every cases of pyogenic granuoma and 2 out of 6 cases of epulis hemangiomatosa, ulcer formation and superficial inflammation were seen. Every cases of pyogenic granuloma and epulis hemangiomatosa revealed small lobules of proliferated endothelial cells with many vascular spaces in deeper portion of the tumor. These lobules were quite simillar to that of ordinary capillary hemangioma. 2) Histochemical study by Ulex europaeus agglutinin I (UEA-I) lectin: UEA-I lectin has been known as the marker for endothelial cell of blood vessel. Endothelial cells in small lobules showed specific and strongly positive reaction to UEA-I lectin. 3) Immunohistochemical study by Factor Via related antigen (F VI-RAG): Endothelial cells of lobules revealed no specific reaction to F Via-RAG. In conclusion, it is suggested that pyogenic granuloma and epulis hemangiomatosa are capillary hemangioma with granulation tissue induced by irritations such as repeated trauma or infection.
Optimal dose of N-22 (Mofezolac), a new non-steroidal anti-inflammatory agent, was evaluated in a double-blind comparative study on post-exodontic pain, at 3 single dosing levels of 100 mg, 150 mg and 200 mg, respectively. The results are summarized as follows. 1) A total of 197 cases subjected for analysis are broken down into a group of 68 cases with a 100mg dose, that of 64 eases with a 150mg dose and that of 65 cases with a 200mg dose, respectively. No significant deviation in clinical background factors of all cases was recognized. 2) A total of 189 cases (67 cases-100mg, 60-150mg arid 62-200mg) were subjected for analysis of its efficacy. Analysis by U-test proved both 150 mg and 200mg groups to be significantly superior (P<0.05 and PK<0.01) to 100 mg group. The improvement rates (“Improved or more”) were 61.2%(41/67) with 100mg, 73. 3%(44/60) with 150mg and 78.8%(47/62) with 200mg, respectively. 3) Side effects were observed in 3 cases; an iching sensation in one of 100 mg group and drowsiness/headache in two of 200mg group, all of which was transient, with no clinical sign of being serious. 4) A total of 189 cases were subjected for analysis of its clinical usefulness (67 cases-100mg, 60-150mg and 62-200mg). U-test proved both 150mg and 200mg to be significantly superior (P<-0.05 and P<0.001) to 100mg. On the basis of the foregoing results, the optimal dose at clinical sign of post-exoclontic pain is estimated to be a single dose regimen of 150mg.
Clinical usefulness of N-22 (Mofezolac; N), a new non-steroidal antiinflammatory agent, on post-exodontic pain was evaluated at a single dose level of 150mg/time, in a double-blind comparative study, in comparison with Mefenamic acid; M also at a single dose level of 500 mg/time; results are summarized as follows. Of a total of 228 cases, 33 with no onset of post-exodontic pain took neither of the agents and were therefore removed, meaning that 195 cases were subjected for analysis, in comparison with M put under previously well controlled studies. No significant difference in patient background factors between N and M groups was found. Based on the protocol, either N or M was administered alone for evaluation at a single dose level/time. Double dummy method was used in allotment for administration of 4 kinds of test agents-N, NI, N's placebo and M's placebo. Of a total of 193 efficacy evaluable cases (N-96 & M-97), 25.0% of N group and 11.3% of M were rated “Remarkably improved” in final global improvement rate, with N group found significantly superior (P<0.05). Of a total of 194 safety evaluable cases, such adverse reactions as headache/nausea and drowsiness each in one case of N (2 in all); drowsiness/irritability, diarrhea, abdominal pain and drowsiness/languor each in one case of M (4 in all) occurred, none of which was found clinically serious, with no significant difference between the two groups. From the foregoing study, N-22 is found clinically useful, with little difference between a single dose of N 150 mg and that of M 500mg.