The arrangement of blood vessels in the cyst wall was studied in 10 radicular cysts, 10 old radicular cysts, 5 non-keratinizing primordial cysts, 5 odontogenic keratocysts, 5 dentigerous cysts and 5 nasopalatine duct cysts.
The majority of blood vessels in the cyst wall were consisted of capillaries (68.8%) and venules (25.3%) and there was no statistical difference in the distribution of constituent vessels between inflammatory cysts and developmental cysts.
The deepest layer of the cyst wall showed the highest incidence of inflammation which decreased gradually towards the outer layer in both inflammatory and developmental cysts. However this tendency was more conspicuous in inflammatory cysts and there was no section in which histological evidence of inflammation was not noted in the deepest layer of the inflammatory cysts.
In both groups of cysts, the number of capillaries increased in a similar degree in the presence of inflammation. Furthermore, there was no difference in the number of blood vessels among different layers between the two cyst types when inflammation was present. Blood vessels were distributed more densely in the inner layer of the developmental cysts in sections with no evidence of inflammatory response, but this was not the case in the inflammatory cysts.
When blood vessels in the cyst wall were divided into vertical and horizontal types by the angle made to the lining epithelium, the vertical type blood vessels increased in the presence of inflammation. The basic pattern of vascular arrangement in the inflammatory cysts was the predominance of vertical type in the deepest layer and horizontal type in the superficial layer. Despite the increase in the ratio of horizontal blood vessels, vertical type predominance was maintained even after inflammation subsided in the deepest layer. On the other hand, the cyst wall of the developmental cysts was consisted mainly of horizontal type blood vessels. In the presence of inflammation, the vertical type increased, but the horizontal type still predominanted in the deepest layer, whereas in the superficial layer the vertical type surpassed the horizontal type in most cysts.
The results indicate that analysis of vascular arrangement in the cyst wall may be of help in the differential diagnosis of inflammatory cysts and developmental cysts.

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This study was made in order to better explain the composition factors of facial beauty in surgical correction of dento-facial deformity.
For the purpose of this study, we evaluated the reactions of 290 people (by questionnaire method) when they viewed faces of three postoperative patients and one model. The model and patients were satisfied with the vertical golden division, and the size and position of their eyes were changed by photo surgery. The results obtained are as follows:
1) If each person was satisfied with the vertical golden division, the face of one patient was evaluated as the long face or the face of the other patient was the round face.
2) On the same person's face, it was evaluated that the face seemed longer if the eyes were smaller and the distance between the pupils was shorter.
3) On the same person's face, it was evaluated that the face seemed rounder if the eyes were larger and the distance between the pupils was longer.
It was suspected that the size and position of eyes influenced the facial outline image.

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In recent years several basic and clinical researches on new synthetic biomaterials, such as hydroxyapatite (HAP), have been reported. It is well known that HAP is available for bone augmentation and has osteoconductive ability. But the use of HAP is not always free of problems, because it is difficult to be handled, to be shaped and to maintain the implanted site. After implantation of granular HAP, some prognoses are poor due to infection at the implanted site and inflammation occasionally appears. The cause is tought that granular HAP easily spills from the implantation site and then is contaminated by some microorganisms. Above all, the use of HAP is limited by its physical properties. Zinc-oxide eugenol cement (ZOE), which has been used extensively in dentistry, has sedative and antimicrobial properties. HAP and ZOE were mixed (HAP-ZOE complex) in order to overcome the above faults.
The pH value and the concentrations Ca²⁺ and Zn²⁺ of HAP, ZOE and HAP-ZOE complex, which were sunk in the Ringer's solution, were examined. Their ultrastractures were observed with scanning electron microscope.
The results were summarized as follows: HAP-ZOE, complex was a paste like substance with easy handling. The pH value of HAP-ZOE complex was 9.4, that of HAP was 6.4 and that of ZOE was 7.4. The concentration of the Ca²⁺ of HAP-ZOE complex was 103. 6 ppm, that of HAP was 95.3 ppm and that of ZOE was 101.5 ppm. The concentration of the Zn²⁺ of HAP-ZOE complex was O.2 ppm, that of HAP was 0.4 ppm and that of ZOE was O.7 ppm. The ultrastracture of HAP-ZOE complex indicated that HAP as core and ZOE as matrix contacted closely, and there was an affinity between them.
In conclusion, these results suggested that HAP-ZOE complex markedly improved granular HAP's practical use and HAP-ZOE complex is thus expected as a good implantable material.

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HAP-ZOE complex was made in order to improve the handling and maintenance at the implanted site of HAP. The biological activities after implantation of HAP-ZOE complex on rat's jaw bone was observed histopathologically, compared with HAP and ZOE.
The results were summarized as follows; HAP-ZOE complex have a superiorty over HAP in handling and maintenance at the implanted site. There was a tendency of delayed bone formation in comparison with HAP. But 8 weeks after implantation, the maturity of new bone between HAP-ZOE complex and HAP showed no noticeable difference. This phenomenon indicates that HAP-ZOE complex has osteoconductive ability.
A part of ZOE implanted site was phagocyted and absorbed. The space was filled with new bone tissue including HAP.
In conclusion, these results suggested HAP-ZOE complex was biocompatible and promising as a bone cavity sealer.

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In order to improve the physical property and the handling of hydroxyapatite ceramics, we devised and produced an entity of silicon-apatite composite. Using a scanning electron microscope, we observed the shape of the surface of this composite and evaluated the cell attachment to the surface by using culture cells.
By scraping the surface of the composite, we could observe the exposed apatite particle that was coated with silicon. Although HeLa S₃ cells fully failed to attach to the surface of the silicon favorable cell attachment of these cells to the surface of the apatite could be observed. On the other hand, the cells presenting themselves in round shape were somewhat firmly attached to surface of the composite. A comparison of the cell attachment by means of colony formation on surface of the composite as an index revealed that the increased number of colonies formed on the surface was proportional to the increased ratio of apatite content. In the composite containing 70% apatite, the number of colonies was about 91% of the number of the disseminated cells, showing a favorable cell attachment to this composite.

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Ameloblastoma is considered to be a locally malignant tumor and be able to reach a large size without evidence of metastasis because of its invasiveness and tendency to recur.
Recently a massive recurrent ameloblastoma of the mandible involving the middle cranial base was experienced. The patient was a 58 year-old male, complaining of tumorous lesion of his right face The biopsied specimen indicated ameloblastoma histologically. Under general anesthesia, the tumor was extirpated including the invaded skin, combined with partial resection of the mandible, maxilla and zygoma. Though the middle cranial base was resorbed, the dura was intact and could be preserved. The wound was primarily closed and healed uneventfully. Tumor size was 28×11×10 cm and weight was 1, 750g.
There was no evidence of recurrence about 2 years after the operation.

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A case of mandibular reconstruction using a vascularized osteocutaneous scapular flap was reported.
The patient was a 52-year-old man with squamous cell carcinoma of the floor of the mouth. An osteocutaneous scapular flap of 10 × 14 cm in size was designed based on the circumflex scapular branch of the subscapular artery to reconstruct a surgically-made defect at the floor of the mouth including the tongue and gingival mnucosa.
A bone fragment of 12 cm long was cut at two points and fixed with Kirschner's wires and interosseous wiring. The donor artery and vein were anastomosed with the right superior thyroid artery and external jugular vein respectively.
Bone scan was positive at eight weeks postoperatively despite osteotomies. To enable the patient to wear his denture, flap debulking was carried out. Donor site morbidity was minimal.
We concluded that a vascularized osteocutaneous scapular flap was useful for reconstruction of composite mandibular defects in place of a vascularized osteocutaneous groin flap.

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A rare case of esophageal carcinoma metastatic to the mandible is described. Because of moderately differentiated squamous cell carcinoma of the middle esophagus, A 67-year-old man underwent intra-thoratic esophagectomy in May, 1983, at the Second Dept. of Surgery of Chiba Univ. Hospital. Four months later, pain and gingival swelling of the left first molar region developed. With no relief of symptoms he was referred to our Dept. of Oral Surgery in early November. Radiographic examination revealed a round shaped osteolytic lesion of the left posterior mandibular region. An incisional biopsy of the lesion was performed and histopathological features were similar to those seen in the primary foci of esophagus.
Tumor tissue obtained from the biopsy was cut into pieces, some fragments were transferred to culture dishes and others were transplanted in nude mice. T. T cell line was obtained directly from surgical specimens and T. Tn cell line was established from the transplanted tumor succeeded in nude mouse. Characteristics of the two cell lines were:
1) T. T. and T. Tn cells in culture were polygonal in shape and formed epithelial sheets. While T. T. cells proliferated in a multilayered structure, T. Tn cells exhibited some densitydependent inhibition of proliferation.
2) Desmosomes were prominent around the culture cells and there was no significant differences between the two cell lines ultrastructuraly.
3) Immunoperoxidase staining of T. T cells with human cytokeratin was strongly positive. However, T. Tn cells showed only a weak cellular reaction.
4) Population doubling times of the two cell lines were both 24 hours.
5) The modal chromosomal number of T. T cell line ranged from 85 to 87, while that of T. Tn line ranged 82 to 84. Results of the karyotype analysis of the two cell lines were closely similar.
6) T. T and T. Tn cells were transplantable in nude mice. Histological appearances of the tumors derived from T. T cells resembled the original one. On the other hand, T. Tn derived tumors had more poorly differentiated histological features.
Thus two cell Iines dcrived from the same tumor are valuable in analyzing various features of human tumors.

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The occurrence of multiple hamartomas is rather uncommon in the oral cavity. Only 7 cases have been published in the literature. This case report presented a case of multiple hamartomas in a 3-year-old boy. Surgical excision was performed, and no recurrence was observed for 3 years since this operation.

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The peripheral ameloblastoma is a very rare odontogenic tumor of the oral cavity, although ameloblastoma usually occurs centrally in the jaw bone. A case of peripheral ameloblastoma in the gingiva of a 49-year-old man is presented.
The clinical and histological features of peripheral ameloblastoma are also reviewed. The tumor mass was encapsulated by connective tissue.
Using local anesthesia, the lesion was excised surgically with a small amount of cortical bone, and no evidence of recurrence was seen 5 months later.

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We have clinico-statistically studied 141 cases of malignant tumors of the oral and maxillofacial regions from 1979 to 1987 at the Department of Dentistry and Oral Surgery, Kagoshima Municipal Hospital.
From this study, we obtained the following conculusions:
1) Of 141 patients, 92 were male and 49 were female and the mean age was 63.5.
2) Histopathologically, 128 cases (90.8%) were diagnosed as squamous cell carcinoma.
3) The primary tumor sites were the tongue in 54 cases, gums in 34 cases and buccal mucosa and maxillary sinus in 11 cases.
4) According to the TNM classification by UICC (1978), there were 21 cases of T1, 34 cases of T2, 38 cases of T3 and 17 cases of T4. They were further classified as Stage I in 20 cases Stage II in 24 cases Stage III in 28 cases and Stage IV in 38 cases. In the NM classification, cervical lymphnodal metastasis was found in 53 cases. There were no cases of distant metastasis.
5) 32 cases were treated by surgery (S) alone, 21 cases by surgery with chemotherapy (C), 20 cases by surgery with irradiation (R), 34cases by (R+C) and 33 cases by (R+C+S). The 5-year survial rate according to the type of therapy was 93.0% by surgery alone, 88.7% by (S+C), 63.0% by (S+R), 35.8% by (R+C) and 24.4% by (R+C+S) with the over all 5-year survival rate of 58.6%.

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Two cases with severe cervical cellulitis which originated from the odontogenic infection were reported.
Case 1 was a 48-year-old male who underwent extraction of the right lower third molar while it had acute infection. The inflammation promptly extended to the floor of the mouth, submandibular space and right cervical region.
Case 2 was a 62-year-old male who had a past history of heart infarction. Although he had been receiving an antibiotic therapy for the apical periodontitis of the left lower second molar from his dentist, it soon progressed through parapharyngeal abscess to the bilateral cervical cellulitis and finally mediastinitis.
The extended lesions of both cases could only be managed by wide ranges of curettage and drainage through extended incisions over the neck.

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Surgery combined with radio-and chemotherapy for 45 squamous cell carcinomas of maxillary sinus and maxillary alveologingiva was carried out in the First Department of Oral and Maxillofacial Surgery, Dental Clinic of the Iwate Medical University during the period from 1974 to 1987. The accumulative 5-year survival rate was superior in 54.7% of 29 maxillary sinus carcinomas compared to 49.7% of 16 maxillary alveologingival carcinomas.
Especially, most advanced patients of stage with T₄, died because of distant metastasis in the maxillary sinus carcinomas and local tumors extending to the parapharyngial space or metastasizing to the regional lymph nodes in the maxillary alveologingival carcinomas.
In the future a combined therapy should be performed taking above mentioned points into consideration.

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Forty-eight patients with oral squamous cell carcinoma (SCC) were investigated to compare the clinical type, grade of differentiation, mode of invasion, stromal reaction and immunohistochemical findings with their prognosis. The following results were obtained:
1) According to Kaplan-Meier's method, the 3-year and 5-year survival rates of 48 patiens were 62.5% and 52.1% respectively, with females surviving longer than males.
2) 43 SCC's were well differentiated, while 3 cases were moderate, and 2 cases were poor. The moderate and poor differentiated SCC's appeared erosive and ulcerative type clinically. Using Yamamoto & Kohama's classification of invasion, 12 cases were mode 2, 24 cases were mode 3 and 12 cases were mode 4 (6 cases were mode 4 C, 6 cases were mode 4D). Most cases of mode 4 demonstrated the erosive and ulcerative type or the tumor mass type clinically. The 5-year survival rates of cases categorized modes 2, 3 and 4 were 58.3%, 66.7% and 41.7% respectively.
3) The stromal reaction showed a weak lymphocytic infiltration in 12 cases, moderate in 25 cases and strong in 11 cases. Collagen fiber formation was small in 11 cases, moderate in 27 cases and abundant in 10 cases. Strong lymphocytic infiltration improved SCC prognosis. Cases with little collagen fiber formation showed a tendency to be poorly differentiated SCC and mode 4 invasion (mostly mode 4 D).
4) Carcinoembryonic antigen (CEA) and n-CEA (nonspecific cross-reacting antigen-free CEA) were detected on tumor cells of cancer pearls. n-CEA demonstrated a higher specificity than CEA.
5) The cells of cancer pearls were positively stained with keratin.
6) Cases of mode 2 and 3 were positive for CEA, n-CEA and keratin, while some cases of mode 4 were negative for these tests and showed a worse prognosis.
7) Fibrinogen was detected in the stroma bordering the tumors. Plasminogen and Antithrombin III were generally demonstrated in both the nests of the tumors and the stroma. Furthermore, α₂-Macroglobulin, C 3 and C 4 were shown within the tumor nests, the bordering stroma and on granulocytes.
8) Cases categorized poorly differentiated SCC and mode 4 were mainly of the erosive and ulcerative or tumor mass type clinically. These SCC were usually negative for CEA, n-CEA and keratin. It is suggested that immunohistochemistry should be combined with routine pathology in treatment planning and determining prognosis.

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Magnetic resonance (MR) imaging was performed in five internal derangement of temporomandibular joint (TMJ) patients, before and after intravenous administration of gadolinium-DTPA (Gd-DTPA) as a contrast agent. MR imaging was performed with a O.5 tesla unit (VISTA MR; PICKER INTERNATIONAL) using a surface coil. We obtained multiple 5 mm sagital images with open and closed jaw positions. Precontrast proton density images were obtained with a repetition time (TR) of 1, 000 msec and an echo time (TE) of 40 msec (TR/TE=1, 000/40). Gd-DTPA was administered intravenously in a dose of 0.2 ml per kilogram of body weight. After the injection, postcontrast Ti weighted images (500/20) or postcontrast proton density images (1, 000/40) were obtained.
In the postcontrast Ti weighted images, the soft tissue surrounding the articular disk was enhanced and it provided helpful information for assessing the disk position. On the other hand, there was no effect of the contrast agent in the postcontrast proton density images. None of the patients experienced allergic reactions or other side effects. Gd-DTPA appeared to be a safe and effective contrast agent for MR imaging with Ti weighted images. However, compared with our usual imaging of the TMJ, the imaging did not indicate greater MR sensitivity for detecting the articular disk by means of Gd-DTPA enhancement.

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Pycnodysostosis first described by Aoike (1954) and named by Marouteaux and Lamy (1962), is a rare skeletal bone disease. This disease is characterized by dwarfism, failure of closure of cranial sutures, obliquity of mandibular angle and defects of the terminal phalanges.
A rare case of pycnodysostosis in 42 year-old woman complicated with maxillary and mandibular osteomye-litis for a long time was reported. This patient suffered severe osteomyelitis following a tooth extraction because of extremely high bone density and abnormal dentition. We discussed the treatment of osteomyelitis associated with pycnodysostosis.

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Verrucous carcinoma, a variant form of well-differentiated squamous cell carcinoma, was first described by Ackerman in 1948. In Japan, following a case of buccal mucous membrane reported in 1967 by Kozaki et al., 50 cases were since reported.
We reported 2 cases of verrucous carcinoma of tongue and palate, and review of the literature.

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A patient with acinic cell tumor of cheek was presented, whose tumor recurred with lymph node metastasis after the initial tumor excision. In this paper, we also discussed the clinical behavior of this tumor.

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This study concerns about 11 patients with multiple primary oral carcinomas who were treated at our institution from 1967 to 1986. According to the criteria of Ueno et al.(1974), the incidence of multiple primary oral carcinoma in patients with squamous cell carcinoma of the oral cavity was 2.9%. Isochronism was confirmed in 3 cases and heterochronism in the remaining 8 cases. The average time interval between the primary carcinomas and the secondary one in patients with heterochronous carcinomas was about 3 years and the longest interval was 7 years and 5 months. In 8 out of the 11 patients, secondary lesions were detected at the contralateral site of the primary one. The secondary lesion was generally discovered at the earlier stage as compared to the primary one. Two patients with isochronous carcinomas died 11 months and 22 months after treatment respectively. Otherwise, the average life in 5 dead patients with heterochronous carcinomas was 6 years and 5 months.
These results suggest that a long-term follow up and careful examination on the whole oral cavity are necessary for sttaining successful outcome.

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In this paper, a case of osteochondroma originated in the left mandibular condyle of a 56-year-old man is reported.
Clinical examination revealed marked lower facial asymmetry and malocclusion with the mandible deviated 18 mm to the right. Radiograms revealed an oval, pedunculate, radioopaque mass attached to the anteromedial aspect of the condyle. The condyle head was displaced forward under the articular tubercle. The patient was surgically treated in a temporal approach by resecting zygomatic arch temporarily and resecting the tumor protruded into the medial side of lateral pterygoid muscle from the condyle head. The patient has been followed for three years. The symmetry of the face and occlusion was greatly improved.
Excessive unilateral growth of the mandibular condyle with occlusal disturbances and facial asymmetry has been reported in patients with hyperplasia, hyperostosis, hypertrophy, osteoma, osteochondroma, and so on. The differences between these disease entities are still obscure. Therefore, cases of these diseases in the literatures concerned have been collected and the clinical features analyzed.
As the result, these cases could be classified into hypertrophic type and nodular type. The former is characterized by morphological feature of elongation or hyperplasia of the condyle itself. In contrast, the latter shows a morphological feature of nodular protrusion from the condyle head into the lateral pterygoid muscle without elongation of the condyle itself. The onset age of the lesion and several clinical characteristics differ between the two types, therefore, different treatment methods should be considered.

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A case of multiple primary cancer affecting bladder and lips was reported. A 54-year old man was first treated for transitional cell carcinoma of the bladder (grade 2).
After eleven years of this treatment, the second tumor of the lower lip appeared. This tumor was histologically diagnosed as squamous cell carcinoma (T1NOMO), and was treated by chemotherapy (Peplomycin 35 mg) and surgery (Abbe-Estlander lip operation). At present, this patient is alive and tumor-free.

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This paper described a case of malignant melanoma of the palate with metastasis of cervical lymphnodes.
A 66-year-old woman visited our department to receive treatment for palate tumors. On the first examination, a dark brown tumor on the palate was found with similar lesions on the maxillary gingiva, buccal mucosa, ventral surface of the tongue and pharyngeal mucosa, which were all clinically suspected of malignant melanoma. On ⁶⁷Ga-citrate scintigraphic examination, abnormal accumulation of RI was observed both in the maxillary tumor and in the right middle neck lymphnode region.
Immunotherapy with OK-432 was first undertaken and chemotherapy (VBL, PEP, and CDDP) followed. Conservative radical neck dissection, cryosurgery and vaporization using CO₂ laser were carried out successively. After this treatment, chemo-imrnunotherapy (VBL, DTIC, OK-432, and BCG) was initiated.
When nodular swelling of the oral and pharyngeal mucosa were observed, additional palliative laser treatment was given.
After the treatments, neither recurrence nor metastasis were clinically observed, but the patient died of sudden heart failure without any clear relationship to the malignant melanoma.

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To overcome the operational diffficulty of TMJ arthroscopy, and to reduce injury during the examination a fine needle fiber arthroscope was developed and clinically applied. The equipment is composed of a fine needle arthroscopic probe and a television monitor system with an output for a videorecorder and camera. The characteristics of this optical system are as follows:
1) The fine needle arthroscope (0.8mm in diameter, 20 G) can be inserted into the narrow or tiny TMJ spaces, such as the lower joint compartment and also reduced iatrgenic injury to the joint tissues.
2) There is no distortion of the picture or breakage of the scope by bending. The picture is clear enough for diagnostic purpose.
3) Using this system it is possible to examine the joint both arthrographically, arthroscopically and to treat TMJ diseases, by means of pumping manipulation technique and injection of appropriate medicines. All of these manipulations are possible using only one insertion of the cannule (18 G) for each articular cavity under local anesthesia. 17 patients (19 TMJ) were examined by this system, and the results obtained are as follows:
1) Adhesions were generally seen below the articular tubercle, and they were mostly white membrane like fibrous adhesion without blood vessel, similar lesions with debris were also seen in the lower articular cavity. It was possible to perform arthroscopic detachment by using this approach.
2) Two types of disk perforation were observed, one without tissue reaction, the other with fibrous adhesion and granulation tissue.
As mentioned above, very favorable results were obtained without any complications.

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The nasolabial cyst is a non-odontogenic cyst with swelling of nasal alar region.
We experienced a case of this cyst in a woman aged 55 who had been afflicted with this lesion for 3 previous days. Approximately 8 ml of cloudy and yellowish fluid was removed, and immediately replaced by 60% urografin ^®. The roentgenograms revealed a well-defined oval cystic cavity situated in soft tissues of the face at the junction of the upper lip and lateral wall of nose.
The extirpated cyst was as large as a prigeon egg.
Microscopic examination revealed a cyst lined by a few layers of cuboidal epitherial cells. These cells appeared to be squamous but might be columnar cells containing goblet cells. Postoperative course was not eventful.

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