The anatomical morphology of the lip and nose is very important for cleft lip surgery. The purpose of this study was to analyze the morphology around the nose and mouth in normal babies. We took photographs of 410 normal Japanese 3-to 5-month-old babies' faces from the same distance using a head fixation and photo apparatus to examine the difference in sex and both side as well as possible correlation among various determined. items. The results obtained are as follows. 1. Standard values were obtained for normal Japanese 3-to 5-month-old babies' faces. 2. Males had larger values than females in almost all items examined. 3. Determined values in transvers direction left side were larger than those for the right side. 4. No correlation was observed in this study.
An anti-cancer drug sensitivity test was performed using a transplantable human osteosarcoma originated in the mandible (HOSIVIN-1). The drugs tested in this study were Adriamycin (ADM), Cis-platinum (CDDP), and Methotrexate (MTX)(high and low-dose). The effect of the drugs were judged according to the Battelle Columbus Laboratories Protocol (BCLP), and the following results were obtained. 1) Growth inhibition was seen with all drugs. 2) With respect to the duration of effect and the maximum rate of tumor inhibition, the most effective drug was losv-dose MTX followed by CDDP, high-dose MTX and ADM in that order. 3) In the substantial weight change, only low-dose MTX group showed no weight loss. Refering to its low incidence of side effect as well, it was suggested that low-dose MIX was most useful in this experiment.
Fibronectin (FN), one of the glycoproteins existing in plasma and extracellular matrix, is found in the connective tissue stroma and basement membrane of cancer. It is also reported that fibrinogen (Fbg) cross-links to FN deposited in the tumor stroma and shows a high serum level in cancer patients. The purpose of this study was to examine the tissue localization and distribution of FN and Fbg with time lapse in experimentally induced carcinoma (VX2 carcinoma implanted in tongue) and its metastatic lesions in rabbits and to compare with those observed in wound healing process of normal oral mucosa in rabbits. Distribution of FN and Fbg was examined with direct imrnunoperoxidase technique. The plasma FN and Fbg levels in rabbits bearing VX2 carcinoma and foreign body granuloma were also quantitatively measured by a single radial immunodiffusion method. The results obtained were as follows: 1) The tumor enlarged aggresively, and metastasized to cervical lymph nodes and lungs on 10 days after implantation. 2) FN deposits were found in the tumor stroma on 7 days after implantation and in a capsulelike connective tissue around the tumor nest on 14 days after. 3) Fbg was present as a fibrin nets surrounding the tumor nest on 7 days after implantation and it disappeared after 10-14 days. 4) In the metastatic tissues (cervical lymph nodes' and lungs), FN and Fbg showed no marked deposits except around the tumor cells in the early stage of metastasis. 5) In the experimentally induced wound of oral mucosa, FN and Fbg deposits were consistent with the distribution of fibroblast, collagen fiber, and histiocyte in immature granulation tissue. This reaction was similar to that observed in stroma of early VX2 carcinoma. 6) The plasma FN level in rabbits bearing VX2 carcinoma increased gradually in 26% on 21 days after implantation comparing with the control value. The plasma Fbg also showed increased levels in 68% on 28 days after implantation comparing with the control value. The results suggested that the stromal fibroid production in malignant tumors might be one of the vital defense reactions against tumor growth similar to the case of wound healing reactions. It is also suggested that the tissue distribution of FN and Fbg as well as plasma FN and Fbg levels would be a good biological marker of tumor growth and metastatic process in oral cancers.
Dysplasia is commonly seen in the speckled and erosive type of leukoplakia. A comparative study on the ultrastructure of dysplasia with carcinoma would be instructive when erosive type leukoplakia of is differentiated from the carcinoma. We studied the organelles of cells leukoplakia of simple, verrucous and erosive type and both early and invasive carcinoma in relation to the changes of the basment membrane underlying these lesions. 21 cases of leukoplakia, 14 cases of early and invasive carcinoma and 4 cases of normal mucosa were examined with ligh and electron microscopes (HITACHI H-600). The specimens were carefully selected to investigate the ultrastructure of basal cells and adjacent basement mebrane. Leukoplakia of erosive type showed a close similarity in the ultrastructure to early and invasive carcinomas in the following points: 1) Increased nuclear to cytoplasmic ratio, indentation of nuclear membrane, enlarged nucleolus and increased chromatin content near the nuclear membrane. 2) Increased size of basal cells at the basement membrane.They have pleomorphic mitochondria with distinct crista and well-developed rough endplastic reticulam and Golgi apparatus. 3) Loosing of the intercellular space due to underdevelopment of cell junctions such as tonofilament, desmosome and hemidesmosorne. 4) Increased cytoplasmic processes with finely villous and branched structures. They penetrate the basement membrane and protrude into the stroma. 5) The varied morphology of the basement membrane including disruption, thickening, disappearance, stratification, branching and doubling. The ultrastructural study on the basal cells and basement membrane of erosive leukoplakia showed a close similarity to those of early and invasive carcinomas.
The purpose of the present study was to examine three types of Expanded-Polytetrafluoroethylene (Gore-Tex® EPTFE Patch), namely Soft Tissue Patch, Cardiovascular Patch and Surgical Membrane as for whether they could be used as suitable synthetic materials for restoration of bone cavities. Twenty dogs were used in this experiment. Bone cavities were covered with materials subperiosteally and later examined histologically. The results were as follows; 1) Soft Tissue Patch Healing of bone cavity wound was uneventful macroscopically throughout the study. In week 6 the bone cavity was filled with a new bone tissue, and the penetration of new bone tissue into porous structures of the material was also seen. Furthermore, maturation of the new bone tissue was found in week 8. In addition, microradiographic and von Kossa stain findings showed that penetration of the new bone tissue extended into structures along the material surface. 2) Cardiovascular Patch Bone cavity wound was filled with a new bone tissue similar to the case of Soft Tissue Patch, however. penetration of the new bone tissue into porous structures of Cardiovascular Patch was seen more internally than that in Soft Tissue Patch group. The material from the bone cavity wound was seen on occasion. Moreover, fibrous connective tissue was also seen between the material and new bone tissue. The infiltration of cells into the microporous structure was not found throughout the study period. The result of the present study suggested that Soft Tissue Patch and Cardiovascular Patch had excellent biocompatibilities to bone tissue and were considered as useful synthetic materials for restoration of bone defect.
Hamster MFH cells induced by DMBA heterotransplanted in nude mice were frozen and kept at -80°C. Morphologic changes of the cells after frozen preservation were investigated and the distribution of organizing elements of undifferentiated cells overlapping the cellular ultrastructure was analysed as a fundamental study. The results obtained were as follows: 1. Light microscopic findings: After frozen preservation, the opulation of fibroblast-like cells decreased and the tumor was composed mainly of undifferentiated, multinucleated, giant cells. 2. Electron microscopic findings: After frozen preservation, fibroblast-like cell changed rough endoplasmic reticulum frozen dilated cisternae to narrow. Multinucleated giant cells in histiocyte-like cell type increased. 3. A large amount of sodium, phosphorus, sulfur and potassium in erythrocytes, marginal heterochromatin, and nucleoli in undifferentiated mesenchymal cells were found by X-ray microanalysis. But there was a difference in weight percent of these elements between the three tissues.
Objective measurement of nasality is important for clinical estimation of speech competence in patients with repaired cleft palate. Since nasality is caused by intermixing of phonic energies in the nasal and oral channels, it is considered to as a best direct method for estimating the nasality objectively to separate the sound energy from the mouth and that from the nose by a shield plate and measure them individually. The grade of nasality (hyper nasality, slight hyper-nasality and no nasality) could be measured reliably by comparing voice judgments with oral and nasal sound pressure levels by this shield plate method. The vowels /a/, /e/and /o/, which all require a low tongue position, showed a good correlation between the rank-ordered listner's judgment on the nasality and the value of “oral sound pressure n-onus nasal sound pressure”. The vowels /i/and /u/, which require a high tongue position, could not be classified distinctly but was useful to determine the presence of nasality. Because of its simplicity, this method is believed to be a potentially valuable clinical tool.
Peripheral ameloblastoma is a rare tumor of the oral cavity. A case of peripheral ameloblastoma appeared in the lower right mandibular gingiva of a 71-year-old male was presented. The tumor was a semi-spherical mass measuring 25×15×12mm which was clinically diagnosised as a fibroma or an epulis. Histologic examination of the lesion revealed an ameloblastoma of plexiform type. The tumor was excised with a rim of normal tissue. After 18 months, there was no evidence of recurrence. The clinical and histopathologic characteristics, surgical treatment and prognosis of the lesion of 63 cases documented in the literatures concerned were also analysed and summerized.
This study was undertaken to investigate postoperative maxillary cyst from the clinical aspect such as patient's sex, affected side, patient's ages at the first examination, at the primary radical operation of sinus maxillaris and at the onset of postoperative maxillary cyst, duration between the first medical examination and onset of the symptoms, chief complaints, clinical symptoms, location and nature of the cyst, possible relationship between root of the tooth and the cyst, bleeding during operation, postoperative complaints, and so forth. These findings were compared with those already reported in the papers and similar results were obtained. Interesting findings among them were as follows. (1) Axial CT examination showed closure of the nasal meatus in 86.8%. (2) Bone absorption was observed in all cases, and multilocular cyst were found in more than 70 percent of the 38 cases examined. (3) Penetration of the tooth root into the maxillary cyst or the sinus was found in 10 out of 37 cases, of which first or second premolar protruded most frequently into the cavity. (4) The average blood loss was less estimated during operation under local anesthesia than under general anesthesia. (5) The frequency of postoperative complaints concerning nasal and paranasal cavities was lower in patients treated with secondary closure than in those with primary closure when the medical examination was carried out in 23 patients elapsed more than one year after operation.
Lipoma may occur in any parts of the body where adipose tissue is present, but is rarely found in the oral cavity. It is designated as a fibrolipoma when the fibrous connective tissue forms a more significant part of the tumor. Recently, we encountered three cases of fibrolipoma: the first case occurred in the left buccal mucosa, the second case occurred at the right margin of the tongue, and the third case at the right hard palate. Clinically, these tumors were diagnosed as fibromas and were excised under local anesthesia. Pathologically, the specimens revealed a picture of fibrolipoma.
Hemangioma occurs frequently in the head and neck region. Most hemangiomas are not true tumors but represent a vascular malformation. A case of erectile hemangioma of the masseter muscle with two phleboliths is presented. This case was 38 year-old woman who complained of painless swelling in the left mandibular angle following contraction of the masseter muscle. However this swelling become smaller than 3-4 seconds in spite of continuous contraction. Surface skin color is normal. One oval radiopaque shadow was found in this region by X-ray examination. The external angiogram showed no pooling of contrast medium and hypervascularization. Surgical dissection was performed with an extra-oral method under general anesthesia. The postoperative histopathological diagnosis was cavernous hemangioma. This tumor had two phleboliths. These were analyzed with an infrared spectrometry and observed scanning electron-microscopically after acid etching (0.2 N HCl 20 sec). 17 months after surgery, there was no indication of new tumor growth in this region.
Benign cementoblastoma (BC) is considered as an odontogenic tumor of mesenchymal origin characterized by proliferation of cellular cementum, and is also called “true cementoma” by many workers. BC has been considered to be a rare odontogenic tumor, but the number of report on BC is now increasing, and 64 tumors were reported in Japan since 1953. Clinically, BC develops frequently in the lower molar region of comparatively younger generation and usually presents a distinct lesion with characteristic radiographic and pathohistologic appearances. Generally, surgical prognosis of BC is well, though 5 cases with postoperative recurrence have been documented in Japan. The present paper reports a case of BC with postoperative recurrence. The patient was a 20-year-old man who had a thum's tip-sized tumor in his lower left premolar region of the mandible. Clinical and radiographic examination revealed a well circumscribed lesion in the mandible. This tumor was pathologically diagnosed as BC. Twenty four months later, recurrent BC was found. In addition to the above mentioned case, BC cases with or without recurrence were reviewed in the Japanese literatures concerned.
A case report of a 56-year-old male with malignant fibrous histiocytoma (MFH) of the maxillary sinus is presented. The patient rejected to receive a radical surgery. Radiation therapy and multiple courses of chemotherapy were thus carried out but not effective. Careful pathologic study is necessary to differentiate MFH from fibrous histiocytoma.
A metastasis was recognized in the contralateral lymph node after radiation therapy and surgical operation including ipsilateral radical neck disection and primary tumor excision for gingival squamous cell carcinoma (T3N2bM0). Intramuscular injection of pepleomycin was initially carried out with no tumor regression. In addition to the above chemotherapy, therefore, we treated this patient with intratumoral injection of OK-432, resulting in marked reduction in size of the metastatic lesion. It is thus suggested that intratumoral administration of OK-432 with or without chemotherapy maybe effective for such a recurrent case of oral cancer.
Cysts of the minor salivary glands are common, but that of the parotid glands are rate. A case of cyst of the parotid gland in a 13-year-old girl was present. The patient was referred to our clinic by her doctor because of massive painless swelling in the right side of the parotid area. Mechanical trauma, laceration, chronic obstruction due to stricture, and the presence of a sialolith and chronic sialoadenitis can account for the formation of parotid retention cysts in same cases. In this case, no obvious etiologic factor (s) could be determined, but calculus of Stensen's duct was suspected. The mass was removed surgically, and the histopathological diagnosis was a retention cyst of the parotid gland. No evidence of recurrence was observed up to date.
We have recently experiencd a case of large ameloblastoma with severe hypoproteinemia. The patient was a 34-year-old man, who was pointed out the existence of ameloblastoma in the left molar region of the mandible 13 years ago in our hospital, but refused to receive a therapy for ameloblastoma. After 13 years, he came to our hospital with a complaint of airway obstruction. He had a difficulty in eating, so his general condition was very bad. Especially, he had severe hypoproteinemia as total protein in his blood was 3.0g/dl. We tried to recover his general condition but failed to normalize his hypoproteinemia because of a leak of serum through a fistula opening in the oral cavity. Before the treatment for restoration sudden bleeding from the tumor compelled us to perform an operation, but we could not resect all of the tumor because of massive bleeding. After that, we used a sclerosing agent. Though it was locally effective, his general condition became worsened and he ultimately died of lung edema. We report a case of advanced ameloblastoma with severe hypoproteinemia.
Mucoepidermoid carcinoma is one of the tumors originating from the salivary glands and classified as a malignant tumor by many authors. This tumor usually occurs in the parotid gland and the hard palate but rarely in the buccal region. A case of this tumor in the buccal mucosa was reported. A 30-year-old female complained of a mass in her left buccal region. The mass was resected under local anesthesia. Histopathological examination revealed a picture of mucoepidermoid carcinoma. The lesion was then reconstructed with extended resection and D-P Rap.
Clinical results in 76 cases of sialolithiasis of the submandibular gland and a case report of multiple parotid sialoliths are presented. Sialolithiasis of the submandibular gland occurred most frequently in the fourth decade of life. There was no sex prevalence. The submandibular duct was the most common site of involvement (67.2%) and sialoliths were found in two or more of the duct, gland and transitional portion in 9. 2% of the cases. As compared to 24. 9 months in patients with sialoliths in the duct, the period from the onset of symptoms to the initial visit in patients with intraglandular sialoliths was longer (96.7 months). The most common chief complaint was a swelling and/or pain of the submandibular region. In patients with intraductal sialoliths, the main symptoms included swelling and/or pain of the submandibular region or of the mouth floor and they often manifested themselves on eating, whereas sialoliths in the gland and transitional portion were associated less frequently with symptoms of the mouth floor and eating episodes. Sialoliths could not be demonstrated in 9 patients with plain radiographs. Sialoliths were removed by intraoral sialolithotomy in 43 of 51 patients with intraductal sialoliths and 7 of 9 patients with sialoliths in the transitional portion, whereas sialoliths were removed by sialoadenectomy of the submandibulr gland in 8 of 9 patients with intraglandular sialoliths and in 2 patients with sialoliths in the transitional portion. A combination of the two procedures was employed in 5 of 7 patients with sialoliths at more than 2 different sites. Six sialoliths evacuated spontaneously and sialolithotomy was not done in 5 patients because of poor systemic condition, or reluctance to receive a treatment probably due to the absence or disappearance of acute symptoms. Two sialoliths were found in the duct and the gland of parotid with CT.
It is reported that stabilization of hydroxyapatite (HA) particles is one of the most important matters to obtain a good result in the ridge augmentation with HA. A surgical splint is usually used for stabilizing HA particles, however, it does not always work effectively. In this paper, a case of mandibular augmentation is reported in which an excellent result was obtained by use of an urethral catheter for stabilizing HA particles and preventing displacement of them. It seems that this method is effective but scme technical improvements are needed.
Autotransplantation of an impacted tooth accompanied with dentigerous cyst has rarely been reported. The patient was a 17-year-old girl. Her oral manifestation indicated a loss of the upper right second premolar, and the region had no space for tooth growth. Findings of panoramic radiograph and CT scan revealed an impacted tooth with a cyst in the right maxillary sinus. Clinical diagnosis was dentigerous cyst. Under general anaesthesia, the impacted second premolar and the dentigerous cyst were removed from the right maxillary sinus, and the tooth was autotransplanted to the prepared recipient site where the upper left second premolar had already been lost. The cystic cavity was filled with green-yellowish pus. It was considered that the infection was caused by apical periodontitis of the right upper first premolar. Microscopically, the cystic wall revealed edema, marked inflammation and partial lining of the squamous epithelium. The histopathological diagnosis was dentigerous cyst. On the 3 rd day after transplantation, the transplant was pulpectomied, and on the 8 th day, root canal filling of the transplant was done. On the 39 th day after transplantation, the fixation of the transplant was removed. Six months after transplantation, a metal crown was set to the transplant as a bridge from lateral inciser to the transplant of the left maxilla. About two years after transplantation, there was no particular change related to the transplant, and the periodontal tissues were fairly good. Three years after transplantation, however, the radiographic examination revealed a slight root resorption of the transplant and pus discharged from the periodontal pocket of the transplant. It was suggested that the root resorption of the transplant was caused by the long extraalveolar period (90 minutes) and extended inflammation into the periodontium of the transplant. It was thus considered that the pus-discharge was resulted from local marginal periodontitis. The autotransplantation in this case was tried under unfavorable condition, but it seemed that the postoperative course was comparatively good.
Cystic lymphangioma is usually seen in the submandibular or cervical region of infants. A case of a 15-year-old man with cystic lymphangioma in the parotid region encountered in our oral surgery is reported. CT scan and MRI were the most effective methods that allowed us to estimate the qualities and lesions of cystic lymphangioma. Though it seems better to remove it completly in one operation, it is difficult to do so. Thus there is a potential risk of recurrence after surgery. A small cystic lymphangioma sometimes tends to be cured completely. In addition, bleomycin injection and radiation therapy are frequently effective when we can't remove it completely in one operation. Fortunately, the operation in this case succeeded and no recurrence was observed for 9 months after operation.
A clinical study on 62 cases of odontoma is reported. The study included 33 cases of compound type, 21 cases of complex type and 8 cases of undefined type histologically. Patient's ages at the first visit ranged from 7 to 74 years and the mean was 26 years. The compound type was found mostly in the upper anterior area, and the complex type was seen in the lower molar area prevalently. The chief complaints were disturbance of tooth eruption or dislocation of teeth commonly in the compound type and an inflammation in the complex type. Impacted teeth neighbouring the odontoma were seen in 74.2% of all cases. A large odontoma was obsei ved in 2 cases, each one in the maxillary sinus (33 g) and in the mandibular ramus (66g).
One large hemangioma of the lower lip was resected by Nd-YAG laser of noncontact type in combination with intratumoral ligation. The operative procedure was safely performed at one time and the tumor disappeared completely in a short time. After 4 months follow-up period, the wound was completely healed and resulted in less scar formation and post-operative deformity and dysfunction. This patient is now in a good condition and shows no evidence of tumor recurrence.
It is well known that Thorotrast, a kind of oily contrast medium, remains in the liver for a long time. Here we report a case of foreign body in the oral floor, which was at last revealed to be on oily contrast medium. The patient, a 44-year-old woman, came to our department because of uncomfortable feeling in the oral floor. As a past history, she had received an operation on sialoadenoectomy 10 years ago. Roentgenographically, some radioopaque substances were observed in the oral floor. It was revealed that these substances consisted of protein and triolein. Therefore, we diagnosed this foregin body as an oily contrast medium which had been used in the previous clinic.
A case of metastatic adenocarcinoma of the mandible from the pancreas was reported and 70 cases of metastatic tumors in the mouth and jaws as for reported in the Japanese lietrature were analysed. The mean age of the patients was 51 years with a range of 1 to 76 years. The lung was the site of primary organ with the highest incidence, and it was followed in order of frequency by the uterus, kidney and stomach. Bone metastasis occurred more often in the mandible than in the maxilla, and the site of predilection was the molar region of the mandible. The most common symptoms were swelling, pain, bleeding, loosening of teeth and paresthesia. Paresthesia was noted in 36.7% of the patients with mandibular metastasis. In 23.4% of the cases, the oral metastasis was found prior to the recognition of primary lesions. Histologically, adenocarcinoma was a most frequently encountered tumor. The metastatic lesions were treated by surgery, chemotherapy or irradiation in 52 cases while no treatment was carried out in 12 cases. The prognosis of these metastatic tumors was very poor because the treatment was done for palliation in most cases.
Adenosquamous carcinoma (ASC) of the head and neck is extremely rare. We experienced ASC of the mandibular gingiva in a 64 year-old man having a history of lobectomy for pulmonary adenocarcinoma. The patient visited our clinic complaining of painless swelling on the mandibular gingiva in the central, lingual region. Soft, relatively smooth tumor measured 2.5×1.5cm in diameter was found on the gingiva. The overlying mucosa was deeply hyperemic and erosive in parts. One of the left submandibular lymphnodes solidly swelled to the size of the thumb-tip. Biopsied specimens exhibited both natures of squamous and adenomatous carcinoma microscopically, and the tumor was extirpated with no induction therapy. Histopathologic findings of the extirpated lesion were those of tumor nests consisted of proliferated peripheral basaloid cells and central squamous cells with necrotic spaces which gave a pseudoglandular picture. In some areas, mucous substance was observed in the ductlike structure, and mucous cells could be identified though being only few in number. Immunohistochemically, it was found that Total-Keratin was positive in the whole tumor cells, but RGE-53 Keratin existed only in basaloid cells. Metastatic lymphnode exhibited almost the same appearance as the primary lesion. From the above findings, the gingival tumor was considered as ASC but not a metastatic lesion from lung adenocarcinoma.
A lateral cervical cyst occurred in a 30-year-old man with hemophilia A was reported. The cyst was located in the anterior portion of the sternocleidmastoid muscle, and was adjacent to the parotid gland. Amylase, GOT, GPT, γ-GTP and LDH activities of cyst contents were higher than those in patient's serum samples. Especially the amylase activity was extremely high. Histopathologically, the lining of the cyst wall was consisted of columnar or cuboidal cells. In addition serous gland and lymphocyte accumulation without germinal center were observed in some places of the connective tissue. The electron microscopic view had a strong resemblance to that of Varthin tumor. It is strongly suggested that our case was a parotid retention cyst.
Dermoid and epidermoid cysts are either congenital cysts caused by impaction of embryonal ectoderm or acquired cysts caused by inflammation or traumatic implantation of epithelium. In the oral region, the majority of cysts usually occur on the floor of the mouth, and occurrence in the tongue is extremely rare. We encountered a case of epidermoid cyst on the inferior surface of the tongue, and simultaneously reviewed 9 cases of dermoid and epidermoid cysts of the tongue reported in the Japanese literatures during the past 68 years. The patient was a 23-year-old male. Under the clinical diagnosis of benign tumor, the lesion was enucleated. Later, it was histopathologically diagnosed as an epidermoid cyst.
A case of inverted supernumerary tooth in the right nasal cavity in a 4-year-3-month-old girl during the deciduous dental stage was presented. Previous reports and etiology were reviewed. It was possible to extract the tooth through the nostril and it seemed to be a deciduous supernumerary tooth from the morphological structure and the patient's age at the onset of disease. The etiology of intranasal tooth is unclear. We speculate that the supermumerary tooth in this case was caused by extrusion of a deciduous tooth germ into the nasal cavity at the formation of primary palate.
A case of simple bone cyst in a 11 year old girl is presented. Radiographically, there was a well defined multiocular radiolucency, which was extended from TI apical region to the mesial region of 8 1 toothgerm. Really, the lesion had multiocular structure accompanying multiple lesions. Although the etiology of simple bone cyst is unknown, bleeding from the surroundings of A. alveolaris inferior at infancy was suggested as a cause of this disease.
The relationship between clinical and histological factors and prognosis was investigated retrospectively in 60 patients with squamous cell carcinoma of the oral cavity encountered in our clinic during the post 6 years from 1983 to 1988. The subjects were classified into three groups, no metastatic group;metastasis was not recognized within a year after primary treatment, primary metastatic group; metastasis was recognized at first examination, secondary metastatic group;metastasis was recognized after the primary treatment. We performed a comparative study in these three groups especially on the clinical and histological factors.Clinically, we evaluated the tumor size according to the TNM classification of UICC (1987). Histologically, we evaluated the tumor cell population factors (differentiation, nuclear polymorphism and mitosis) according to the classification of WHO and Hanazawa and investigated the histological factors (tumor-host relationship), mode of invasion, stage of invasion and cellular response according to the classification of Yamamoto and Willen. The following results were obtained: 1) The relationship between the size of primary lesion and cervical lymph node metastasis was suggested. 2) The relationship between the mode of invasion and cervical lymph node metastasis was suggested. 3) The relationship between cellular response (cellular reaction against tumor) and cervical lymph node metastasis was suggested. 4) The relationship between the stage of invasion and cervical lymph node metastasis was suggested. 5) The primary tumor with cervical lymph node metastasis mostly distributed in the cases of M or more for the mode of invasion and T2 or more for the tumor size of primary lesion. 6) No distinct relationship was observed between cellular malignancy and cervical lymph node metastasis. 7) The primary tumor with cervical lymph node metastasis was mainly distributed in the cases with total histological malignancy score of 9 or more. 8) These findings suggest that histological malignancy of the tumor and host cellular reaction against the tumor are more important factors than cellular malignancy of the tumor its, lf when cervical lymph node metastasis is evaluated.
A case of acinic cell tumor of the left retromolar minor salivary gland in 83-yearold man was reported, and review of literature was briefly carried out. The tumor first appeared as a mass of 20×19 mm in size, which was histologically diagnosed as an acinic cell tumor of the minor salivary gland. Mandibulectomy was performed from to the middle part the ascending ramus, including the tumor mass, but recurrence occurred after 1 year and 10 months. It was resected again successfully. Despite of careful follow up he died of raputured aneurysm of the abdominal aorta without any evidence of local recurrence. We simultaneously studied 24 cases of acinic cell tumor of the minor salivary gland in the Japanese literature during the period from 1969 to 1988.
A case of maxillary metastasis from abdominal hepatocellular carcinoma, occurred in a 59-year-old male, is reported in this paper with literature review. In this case, a maxillary gingival mass with occasional bleeding was his chief complaint at reference from his dentist. Biopsy was carried out and the histology revealed maxillary metastasis of the hepatocellular carcinoma. Later, sarcomatous change of the tumor was detected in the specimens taken from the primary site and the metastatic lesions in other parts of the body.
We recently experienced three cases of benign cementoblastoma occuring in the mandible. Case 1 was a 37-year-old female with the lesion involving the apex of the right lower first molar. Case 2 was a 31-year-old female with the lesion involving the apex of the left lower impacted wisdom tooth. Case 3 was a 46-year-old female with the lesion involving the apex of the right lower first molar. Under the clinical diagnosis of cernentoma, tumor excision and tooth extraction were performed in all cases. On histopathological examination, the excised section showed a mass of cementum-like structure or was composed of mature cementum. Also, the calcified mass was surrounded by cementoblast cells and the postoperative courses in the three cases were uneventful without any sign of recurrence.
A case report on a 26-year-old male with odontogenic myxofibroma of the left side mandible was presented. The patient was referred to our department with chief complaints of slight pain and swelling of the left side mandible. Radiographs revealed a large unilocular and radiolucent lesion in the left side mandible. An incisional biopsy examination was performed and a diagnosis of myxofibroma was then made. The tumor was well circumscribed showing apparent encapsulation. Microscopic sections disclosed an odontogenic epithelium composed mainly of large myxomatous tissue. The final diagnosis was myxofibroma of the odontogenic tissue in origin.
A closing method of the anterior wall in the maxillary sinus radical operation is reported. The operation follows Coldewell-Luc method, but the window is closed by musclepedicle-bone replantation consisted of Musculus levator anguli oris and anterior wall bone. This method can defends the invasion of scar tissue into the maxillary sinus and prevents some complications. We report the detail of this surgical technique and the meaning of closing the anterior opening of the maxillary sinus using this method.
Clinical cases of osseointegrated implants (Brånemark System) in the Department of Oral Surgery, Nagoya University Hospital were reported in this paper. Especially the changes of masticatory efficiency after the treatment was discussed. Results obtained were as follows: 1) Five patients who had an extreme difficulty in wearing conventional removable dentures were included in the present study. The subjects consisted of 2 males and 3 females, and their ages ranged from 50 to 66 years. 2) The lesion was an edentulous mandible in 3 cases and partially edentulous maxilla in 2 cases. One of the maxillary cases had no anteior teeth, and the other had no posterior teeth bilaterally. 3) Six fixtures were installed in each mandibular case. The anterior maxillary case received 4 fixtures, and the posterior maxillary case received 5 fixtures. A total of 27 fixtures were thus installed in the 5 cases. One fixture in the mandible failed to osseointegrate, giving the fixture survival rate of 96.3%. 4) Postoperatively, we observed transient paralysis of the mental nerve in one mandibular edentulous case and transient TMJ symptoms in another edentulous case after insertion of the superstructure. 5) The comparison was made between pre-operative and post-operative masticatory efficiencies. All of the cases showed remarkable improvement, the mean score being 38 preoperatively and 96 postoperatively. Results from the present study indicate that osseointegrated implant therapy is a useful method for occlusal reconstruction if the case is discreetly selected and the team approach ispursued by well-trained oral surgeons and prosthodontists.
Fibrous dysplasia is more common in children and young adults than in older persons, and the children affected with this disease may have a facial deformity. The treatment of the lesion generally includes a surgical intervention, but the majority of the lesions are too large to excise surgically without leaving a severe facial deformity. We recently experienced two cases of fibrous dysplasia in the cranio-facial region of a 10-year-old girl and a 12-year-old boy. In this paper, we reported them and discussed about the operation time and the method of treatment, reviewing the previous literatures.
We recently experienced a patient under prolonged dialysis in whom remarkable distension of the upper and lower jaws and palate occurred, causing dyslalia, dysphagia and change in complexion. Swelling of the parathyroid was observed at diagnostic imaging and diagnosed as renal osteodystrophy due to hyperparathyroidism, for which a surgical treatment was given and some tolerable results were obtained. However, it was considered, as an issue for the future, that none of the therapies now available constitutes a radical treatment without relying on parathyroidectomy and renal transplantation.
A model of severely atrophic mandible is modified with wax to a desired postoperative ridge form. An extended surgical splint is produced from clear acrylic resin. After completion of the subperiosteal tunnel dissection, the surgical splint is fixed to the mandible with circummandibular ligatures. Hydroxyapatite particles are injected into the tunnel. This method can prevent migration of hydroxyapatite particles and reduce extension of the alveolar ridge.
We report a case of granulomatous lesion in the upper lip which was histopathologically diagnosed as lupus miliaris disseminatus faciei (LMDF). A 59-year-old woman had two small nodes with pain in the upper lip for 2 months. The pathological finding demonstrated that many granulomatous lesions composed of epitheloid cells and Langhans-type multinucleated giant cells were formed in the dermis. In some lesions, central necrosis was also observed. Other investigations, including chest X-ray examination and cultures of bronchial secretions, showed no evidence of tuberculosis (T. b.). Angiotensin I converting enzyme in the serum, which is widely used to diagnose sarcoidosis, was within normal range. Tuberculin test (PPD 0.05 μg/0.1 ml) was positive. Since there was no obvious evidence of T. b. or sarcoidosis, she was finally diagnosed as LMDF mainly from the histopathologic features. She is well and shows no sign of recurrence 7 months after surgical treatment.
The results of treatment in a 19-year-old female patient who had received palatoplasty 14 years ago was evaluated by Y-G psychological test after pharyngoplasty, speech therapy and Kosteêka operation for treating psychological problems and speech disorders due to cleft palate. The patient at first visit made a communication with other people except her family only by writing or her sister's speeking for her. At least, the patient could establish her economical, social life by speech therapy with counselling, articulatory therapy and surgical orthodontic therapies. The course of treatments was summarized as follows: 1. Treatment for glottal stop as an articulation disorder was insufficient because of incomplete nasopharyngeal closure. 2. Modified Perkos method of pharyngoplasty was performed for improvement of incomplete nasopharyngeal closure, then a surgical improvement of skeletal deformities and antagonistic occlusion was attempted by Kosteêka's method. Although the former operation alone was insufficient, the combination with the later sufficiently improved her esthetics and speech. 3. In the speech therapy with counselling and articulatory therapy, her psychological problems were improved, that is, she became able to communicate by speaking through being insufficient. Finally, the patient could establish her economical, social life. 4. Y-G psychological test revealed type AC before treatment and type D after treatment. Comparison of Co, A, S levels between before and after the treatment, showed a striking difference. The results of Y-G psychological tests coincided with therapeutic results in this patient.
Temporomandibular arthrosis is caused by various etiologic factors, including muscular dysfunction, disorder of articulardisk, bony changes of the temporomandibular joint and other psycological factors. It is difficult to diagnose and treat this arthrosis without classifying these etiologic types. Recently, clinical classification of the temporomandibular arthrosis was established. So, we attempted to classify our patients with temporomandibular arthrosis by this classification, and studied the effect of a muscle relaxant (eperisone hydrochloride: Myonal®) in these classified patient groups. It was revealed that Myonal was effective for patients with type I arthrosis with a significant improvement rate.