Methods for three-dimensional analysis of mandibular morphology and its postoperative change in which three-dimensional coordinate values of the landmarks on the mandible were measured and standardized by a personal computer using simultaneously taken frontal and lateral cephalograms were described and the efficacy of their clinical application was evaluated.
The deviations of standardized three-dimensional coordinate values of six small steel balls placed on the skull which were calculated from eight cephalograms taken in different positions as well as the differences in the distance of these balls calculated from cephalograms and direct measurements were found to be small enough for clinical use. With the exception of 0.7mm in the mean difference of mandibular outline on the ZY-plane, standard deviations of all values evaluated were within 0.5mm in the analysis of U1, L1 and outer shapes of the mandible in 25 patients whose cephalograms were taken preoperatively on two separate occasions within a period of 4 months.
The prediction of postoperative position of the mandible consisted of measuring the amount and direction of the movement of defined points on a dental model and displaying the movement of other bony points in the cephalometric tracings by coordinate transformation. The accuracy of the prediction was studied by comparing the predicted and postoperative positions of the mandible in three-dimensions in 44 patients in whom mandibular prognathism was corrected by the sagittal split osteotomy. The mean differences of coordinate values at L1 were within 0.84mm and the mean differences of mandibular outlines on the XY-, ZY-and ZX-planes were 0.76, 1.09 and 1.58mm, respectively.
Thus, the methods described here proved to be quite useful for the diagnosis, treatment planning and the assessment of postoperative changes in patients with skeletal deformity of the mandible.

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Various studies of oral malignant tumors were reported, but the relationship between their ultrastructure and microscopic and clinical findings is rarely examined. It is said that the attachment of malignant tumor cells is looser than that of normal epithelial cells and that inter-cellular spaces of malignant tumors are wider than those of normal tissue. In this study we examined the ultrastructure of oral squamous cell carcinoma, especially the cell attachment which was taken in Erlangen University (West Germany).
All cases used for this study were clinically advanced. Electronmicroscopically the nucleus was irregular and the nuclear cytoplasm ratio was high. In the cytoplasm tonofilaments were well developed and the other organellas were not outstanding. Between the cells, desmosomes and microvilli were seen. In the high cell atypical cases numerous microvilli and few desmosomes were observed and foliate membrane bound cytoplasmic extensions were observed in the intercellular spaces. It was difficult to confirm the relationship between the ultrastructure of the cancer cells and the degree of differentiation.

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The cellular proteins of 12 specimens of maxilla and oral squamous cell carcinoma were analyzed by two dimensional isoelectric focusing-sodium dodecyl sulfate gel electro-phoresis. The number of polypeptide spots detectable in individual gels was about 110 per 200μg of proteins with pIs from 4.5 to 8.5 and MWs from 22, 000 to 72, 000. Many of the polypeptides were common to these lesions. However, there were nine main polypeptides which showed differences between normal tongue mucosa and squamous cell carcinoma. In the carcinoma, two polypeptides (7.0/45 K, 7.2/47 K, pI/MW) were decreased and four polypeptides (4.8/33 K, 6.9/49 K, 7.1/38 K, 7.4/59 K) were increased in an amount but only polypeptide, 7.9/38 K was varied in an amount by differentiation of carcinoma. This polypeptide was increased in moderately and lower differentiation and decreased in well differentiation. The remaining two polypeptides (4.8/38 K, 4.9/37 K) that were not normally present appeared in carcinoma, but these two new polypeptides were not specific to carcinoma because they were also present in dysplastic lesion. These results suggest that two dimensional electrophoresis may be useful in biochemical diagnosis of maxilla and oral squamous cell carcinoma.

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Ofloxacin (OFLX) a new pyridonecarboxylic acid derivative for oral use was investigated with regard to tissue transfer in the oral cavity.
Ofloxacin was administered to 10 patients at a single dose of 200mg and the serum and tissue concentrations 2 hours after administration were determined.
Ofloxacin was observed at a level of 2.81±1.83μg/ml in the serum, while tissue levels were determined to be 5.60±3.20μg/g in the gum, 4.75±3.43μg/g in the bone and in other tissue 1.28±5.45μg/g indicating a greater degree of transfer in the tissue as opposed to serum.

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Recently, arthrographic technique has been very significant on diagnosis for internal derangement of temporomandibular joint (TMJ). These techniques include a dynamic examination with the lower or both joint space arthrography under fluoroscopy, and single or double contrast arthrotomography with the lower or both joint spaces.
Purpose of this study is to compare the findings and methods of these techniques and to discuss the best technique for examination of the soft tissue of the TMJ. The materials were 148 joints of 126 patients with TMJ dysfunction in total of 178 joints who received arthrographic examination during a recent period of about 2years. As a result, in the diagnostic rate of disk position, the single contrast of the lower joint space arthrography was 78.1%, the single contrast of both joint spaces arthrography was 85.1% the single contrast of both joint spaces arthrotomography was 96.7%, and the double contrast of both joint spaces arthrotomography was 96.2%, in the diagnostic rate of configuration, it was 0.0%, 0.0%, 82.1%, and 94.2% respectively.
The single contrast arthrography of the lower joint space made it possible to easily and simply detect approximate position and dynamics of the joint disk, and that double contrast arthrotomography of both joint spaces was found to be useful for detailed examinations of disk configuration.
Additionally it was an encouraging method to carry out double contrast of both joint spaces arthrotomography after single contrast arthrography of the lower joint space under fluoroscopic examination.

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The object of this study is to observe structural changes of the jaw bone after sagittal split osteotomy. The osteotomy was on mandibles of adult dogs. Time tracing was performed by using two hard tissue labelling agents (tetracycline and calcein) during the experiment.
Microradiograms and labelling findings obtained from horizontally incised large ground sections ranging from the mandibular first molar to the ramus were compared. We obtained the following results:
1. About 15 days after the osteotomy, a new bone formation was observed, extending over a wide range between the interradicular septa of the mandibular first molar and the ramus. However, no new bone formation was found by the buccal surface of the incised extremity. At approximately the same time, a new bone formation began even on the internal surface of the compact bone around the mandibular canal.
2. Starting from the 29 th day after the osteotomy, a new bone formation became inactive in the external wall of compact bone and the interior of the compact bone facing the mandibular canal. Secondly, a new bone formation on the external wall of compact bone disappeared after 90 days through an active resorption. In comparison with this disappearance, a relatively thick bone trabeculae has continued to run apart from the internal wall of compact bone the mandibular canal even after 180 days passed.
3. A new bone formation on the internal wall of compact bone and spongy bone remained to a small degree about 15 days later, and became active after 29 days. After 50 days, the extent of both the incised extremity parts were almost filled with new bone. However, the remodeling began in the new bone after 28 days. As a result, the bone trabeculae consisted of a mixture of compact bone and porous bone. The bone near the alveolar crest showed a compact alignment and the lower part of bone became porous about 180 days later.
4. It was also observed that the remodeling was active in the internal compact bone after 15 days and progressed not only around the incised parts but also to a wide extent in other parts. As a result, the buccal surface of the compact bone near the incised edge was concave. In these procedures, however, the remodeling advanced also in the compact bone.

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Recently the simple bone cyst of the mandible is no longer considered rare as a result of the advent of panoramic radiology. But recurrence of the simple bone cyst is still very rare. To date, there have been 8 cases of recurrence after surgical intervention that we could research.
We reported a case of recurrence of simple bone cyst in a 11-year-old boy which we observed 7 years after surgical intervention. A follow-up radiograph, taken 1 year after surgical intervention revealed almost complete resolution of the defect. But panoramic radiograph taken after 7 years showed a recurrence in the same region in the right mandible.
We reviewed 8 cases of recurrence and discussed treatment for such lesions.

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Dislocation of the mandibular condyle into the cranial fossa is a rare injury, and survey of literature reveals only 24 cases up to 1988.
We treated this case of a 21 year old man who had been injured in a traffic accident, and reported his condition and treatment. We found that CT scan and tomography of TMJ were reliable for making the diagnosis of condyle dislocation into the cranial fossa.
The treatment was carried out by neurological surgeons who removed the epidural hematoma from the cranial fossa. After bematoma removal we discovered the condyle had been dislocated and we then performed manual reduction.Then we repositioned the jaws and placed them into intermaxillary fixation. One month post opcratively the intermaxillary fixation was removed. The prognosis was mostly good.

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Wemade clinical examinations of 21 sialolithiasis cases from 1986 to 1988. At the same time, we analyzed the components of sialoliths by infrared-spectro analysis and studied the relation between the components and the position of sialoliths.
The following results were obtained.
1. Man to woman ratio was 1 to 0.75.
2. High frequency occurrence of sialoliths were in the salivary duct exit and from 20th age group to 50th age group.
3. Sialoliths showed a tendency to be big in the salivary gland and in an old-age group.
4. The components of sialoliths showed a tendency to be rich in protein at the exit of salivary duct and inorganic matter at the salivary gland.
5. The components of sialoliths in a younger age group showed a tendency to be almost equal between protein and inorganic matter.
6. Sialoliths less than 5 millimeters in diameter showed a tendency to be rich in protein and those more than 5 millimeters in diameter showed a tendency to be rich in inorganic matter.

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A tumor consisting of clear cells such as in the case of clear cell carcinoma of the kidney is often seen in nearly any organ. However this occurs quite rarely in the salivary gland. We examined the histochemical and immunohistochemical distribution of clear cell tumor in the oral floor of a 74 year-old female. The tumor consisted of clear cells with heterogeneity and showing a mixture of bimorphic patterns with glandular elements containing an inner layer having eosinophilic large cells, an outer layer of clear cells and monotonous proliferation of clear cells in some portions. These clear cells contained cytoplasmic glycogen as PAS positive granules. Positive results were obtained for keratin, EMA, vimentin, S-100 protein, actin and myosin by immunohistochemical examination of the tumor cells. This tumor thus originated from multipotential cells capable of differentiating into both glandular epithelial and myoepithelial cells. This tumor appeared biologically to be at least a low-grade malignancy. After a follow-up of 2 years and months following extirpation of the tumor, the patient showed no symptoms.

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Myelodysplastic syndrome is a blood disorder characterized by anemia, neutropenia, thrombocytopenia, and morphological abnormalities of blood cells. And the bone marrow is normo-or hypercellular.
A 54-year-old male with this syndrome was referred to our clinic, complaining of oral bleeding. All wound sealings were successfully performed using the fibrin adhesion system (Beriplas^® P) for local hemostasis. Excellent results were obtained in the present case.

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Necrotizing sialometaplasia is an ulcerating, self-limiting inflammatory lesion of the salivary gland. The most common site of occurrence is reported to be the minor salivary glands of the hard palate. It is often misdiagnosed clinically and histopathologically, as malignant lesions such as a squamous cell carcinoma or a mucoepidermoid carcinoma. A case of this disease, occurred after an intra-oral anesthesia, was reported.
A 29-year-old Japanese man noted a painless ulcer and swelling of his hard palate after an infiltrating anesthesia for pulpectomy of the left maxillary second premolar. An excisional biopsy of the lesion revealed a picture of necrotizing sialometaplasia. The lesion healed completely 6 weeks after the biopsy and no evidence of recurrence was noted.

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The malignant fibrous histiocytoma (MFH) is the most common soft tissue sarcoma and may arise at almost any age. Maxillo-facial region MFH reports are relatively rare, but two cases of MFH of the maxilla are reported as follows.
Case 1. A 46-year-old man was referred to our department in March 1986 for slight pain of 156 alveolar buccal parts. Radiographic findings showed destruction of the lateral bony wall of left maxillary antrum. He received serial treatments of arterial infusion chemotherapy and segmental resection of left maxilla. Five months later, a local recurrence developed and additional treatments of chemotherapy, radiotherapy (40 Gy, ), and surgical operations were performed. But these therapies were ineffective on the tumor growth. Two years and three months following first examination, the patient died of lumber metastasis. Histopathologically, the tumor consisted of fibroblastic spindle shape cells and pleomorphic giant cells. Occasionally storiform pattern with mitotic figures of tumor cells were seen.
Case 2. A 45-year-old woman visited us in March 1987 complaining of swelling and hypesthesia of right cheek. Radiographic examination revealed extensive bone resorption of right maxilla. Tumor scan with 67Ga showed a strong uptake of radionuclide in the region. After treatments of infusion chemotherapy, partial resection of right maxilla was performed. The lesion recurred locally four months following the surgical operation. The patient received total resection of right maxilla with orbital exenteration. At present, two years postoperatively, there is no evidence of recurrence or distant metastasis. Histological studies of the resected specimen revealed a malignant fibrous histiocytoma with storiform pattern predominance. Immunohistochemical stainings of arantichymotrypsin and lysozyme were positive in the tumor cells. Including these two cases, clinical features of MFH in oral and maxillo-facial regions were reviewed in the Japanese literature.

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A total of 166 odontogenic tumors were examined clinicostatistically.
The tumors were classified as odontoma (36.8%), ameloblastoma (31.8%) and cementoma (21.7%). The remaining 10% contained seven rare tumors. No malignant tumors were found.
They were divided into three groups histogenetically, such as ectodermal, mesodermal and mixed tumors.
Each group has its own characteristic distributions of age, sex and location.
With regard to symptoms, expansions of the jaws were found in most cases. Impacted teeth were found in mixed tumors frequently, but rarely in mesodermal tumors.

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Kawasaki disease has rarely been reported in the dental literatures despite the presence of characteristic oral clinical features. A case, which was suspected of dental infection, was reported herein.
A 5-year-old boy was referred to our clinic with a chief complaint of swelling of the right submandibular region and elevated fever. On physical examination, the patient showed sicca of the lips, bilateral congesting of the conjunctivae, idurative edema of hands and feet, and polymorphous exanthema of the body. The lymphadenopathy of the right submandibular region was also presented. Intra oral examination, revealed strawberry tongue, erythema of the oral and pharyngeal mucosa, but no evidence of dental infectious disease. These clinical features suggested that the patient was suffering from Kawasaki disease. With pediatrician consultation, the patient was diagnosed Kawasaki disease, and received aspirin therapy.
The patient was discharged 10 days after admission, at which time no signs or symptoms of the disease remained.

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Peripheral giant cell granuloma (giant cell epulis) is a rare giant cell lesion in Japan. The purpose of the present paper is to report a case of peripheral giant cell granuloma that ocurred in an 8-year-old boy whose chief complaint was swelling of the gingiva of maxillary left moral oral region. The lesion was a sessile nodule covered by normal mucosa. There was no abnormal finding of underlying bone and laboratory examinations were in normal rates. Histologically the lesion consisted of granulation tissue containing numerous multinucleated giant cells. These cells were more prominent in the central area of the lesion. No resorption of the underlying alveoral bone was seen at the surgical resection of the esion. Postoperative course was uneventful.

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We encountered a patient with palatal perforation due to acquired atage 3 syphilis that has been very rarely observed in recent years.
A 58-year-old male had dysphonia due to a perforation in the median line of the hard palate. After its closure with a palatal obturator, marked improvements were acoustically observed in pronunciation. Examination of voice and speech revealed improvements in speech articulation: from 67 to 89% for monosyllables and from 36 to 72% for meaningless threesyllables. Hydrodynamic examination, leak ago of expired air into the nasal cavity, which was observed before the application of the palatal obturator improved. Nasopharyngeal fiberscopy showed no disturbances in nasopharyngeal closure function before or after the application.

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Adoptive immunotherapy is a treatment approach in which lymphokine-activated killer (LAK) cells with antitumor reactivity and interleukin-2 (IL-2) are administrated to a tumor-bearing host. It has been shown that the incubation of human peripheral blood lymphocytes with IL-2 generates LAK cells that can lyse natural killer (NK) cell resistant, or fresh, autologous tumor cells but not normal cells. Adoptive immunotherapy has therapeutic benefit for advanced or metastatic cancer patients whose treatments are difficult. Two patients with adenoid cystic carcinomas of maxillary sinus and another two with squamous cell carcinomas of upper alveolus and gingiva were treated by local adoptive immunotherapy using intra-arterial infusion in combination with radiotherapy. In this study, the therapeutic effect of this combined therapy and changes of patient's immunoparameters are reported.
Patients were treated by radiotherapy (⁶⁰Co: 2 Gy per day) for five days. Thereafter, each patient received recombinant IL-2 (rIL-2; 5×10⁵ units per day) as constant infusion and intermittent administration of LAK cells (5×10⁶ to 10⁷ cells: 1 to 2 times per week) using intra-arterial infusion into superficial temporal artery. LAK cells were generated by in vitro incubation of patient's peripheral blood mononuculear cells in presence of 1, 000 units per ml of IL-2 for 3 to 4 days. The total amounts of IL-2 and LAK cells were 2.1 to 2.7×10⁷ units and 1.8 to 4.5×10⁶ cells, respectively. The total doses of irradiation ranged from 40 to 80 Gy.
As a result of this treatment, complete responses were observed in all treated patients. There was no side effect due to this treatment.
In the study of the surface markers of the peripheral blood lymphocytes, it was found that the percentage of Leull positive cells markedly incresed during and after the treatment as compared with that determined before the therapy. A significant increase of the percentage of OKM1 or Leu 7 positive cells after the treatment was also observed, sugesting that NK cells containing OKM1, Leu 7 or Leull may be induced by this therapy, whereas NK or LAK activity of peripheral blood lymphocytes did not show a significant increase.
In conclusion, the treatment with local adoptive immunotherapy in combination with radiotherapy was effective therapy for head and neck cancer patients.

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One hundred and sixty cases of salivary gland tumors histologically diagnosed at the Department of Oral Surgery, Faculty of Dentistry, Kyusyu University during the period from 1966 to 1987 were reviewed and clinically analysed. The results are:
1. They were composed of 70.0% of benign tumors and 30.0% of malignant tumors.
2. Pleomorphic adenoma were most common, which comprised 66.3% of all tumors and 94.6% of benign tumors.
3. Adenoid cystic carcinoma and mucoepidermoid tumor were equally common in malignant tumors. They comprised about 20% of all tumors and more than two thirds of malignant tumors.
4. Benign tumors occurred more frequently in women (66.1%) than men (33.9%) and malignant tumors occurred more frequently in men (54.2%) than women (45.8%).
5. The average age of the patients affected by malignant tumors was higher than that of benign tumors (malignant tumors 53.0 years old, benign tumors 44.9 years old), and benign tumors were distributed evenly in all generation, but most malignant tumors occurred in middle or high generation.
6. They occurred almost equally in major salivary glands (50.6%) and minor salivary glands (49.4%).
7. Palatal gland tumors were most common, and comprised 36.3% of all tumors.
8. The incidence of malignant tumors in minor salivary glands was higher than that of major salivary glands.

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Psoriasis vulgaris is known as a systemic cutaneous disease. Baker et al. reported 4 cases of arthritis of the TMJ complicated with psoriasis in 53 cases. It is said that clinical signs of psoriatic arthritis are similar to that of rheumatoid arthritis. Some cases have deviation of the mandibular movement and disturbanee of the mouth opening due to destruction of the condylar head. Others have pain and tenderness of the TMJ region due to erosion and flattening of the condylar head. However, there have been few reports of psoriatic arthritis of the TMJ in Japan.

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This paper reports a case of median mandibular cyst. The patient was a 16-yearold girl with a swelling of the midline of the mandible. Radiographical examination showed an almond-like radiolucent lesion, which mere histologically lined by a thin layer of cuboidal epithelial cells. Such clinical and histological findings suggested that the present cyst was a fissural origin. Careful consideration is needed for diagnosis of such cystic lesions because some problems still remain in previously discussed diagnostic criteria.

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Peripheral calcifying epithelial odontogenic tumor (PCEOT) is rare benign tumor.
A 67-year-old man was referred to our department with a chief complaint of “gingival swelling” of the right upper canine-premolar region. Clinically the “swelling” was a painless hemi-spherical hard mass with normal overlying mucous membrane. Radiographically, no abnormal finding was noted in the region. Under local anesthesia an enucleation of the tumor was carried out. The tumor was well encapsulated and well defined from the underlying bone. The enucleated tumor was 10×9×8mm in size. Histological examination revealed the typical features of a CEOT. There was no evidence of recurrence after a follow-up period of seven years.

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This paper described a case of Plummer-Vinson syndrome and developmental changes of 4 primary taste qualities; sweet, sour, bitter and salty.
In the patient, a male aged 78, a typical iron-deficiency anemia state was comfirmed by routine hematology. The tongue was very smooth because of atrophy of the filiform papillae and he had spoon-shaped nails. Slight difficulty of swallowing was also complained. Taste threshold values and difference threshold values of 4 taste qualities increased with this patient, especially sweet, sour and salty. Bitter was the only taste usually recognized.
Following treatment with iron derivatives, there was much improvement and abnormal findings almost disappeared. The taste threshold values and difference threshold values for 4 taste qualities gradually decreased with improvement of iron-deficiency anemia. Therefore the taste abnormality of this patient was caused by atrophy of the papillae of tongue from irondeficiency anemia.

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The par ticlated cancellous bones from ilium are commonly used for the reconstruction of alveolar cleft. Recently, we attempted to make use of fibrin tissue adhesive system (Tisseel) combined with bone grafting in 20 cases, and the results obtained were compared with the previous 11 cases without this adhesive system.
In the operation, this adhesive system revealed several technical merits; local hemostatic effect, positioning of particulated cancellous bones, formation of alveolar ridge and adhesion of mucoperiosteal flap to the grafted bones. The grafted bones in 20 cases with this system survived completely except for 1 case, whereas in the previous 11 cases, 3 cases were unsatisfactory. Neither complications nor side effects were observed.

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Five cases reported as neurilemmoma of the oral cavity in the Second Department of Oral Surgery, Kyushu Dental College Hospital, during the period from 1974 to 1986, were clinically analyzed.
1. Five cases of neurilemmoma had been reported. Its incidence was seen in 1.8% of the 247 patients who had undergone incisional biopsy in our clinic.
2. Of the five cases, one was located on the lingual dorsum, one in the parapharyngeal space, two on the gingiva near the mental foramen, and the other on the lower lip.
3. As to shape of the tumors, all were oval or spherical, and size was between red bean and thumb tip.
4. All of five cases occurred in females.
5. Histopathologically, all cases were found to be Antoni type A.
6. Treatment was performed in all cases by total enucleation and no recurrence was observed up to now.

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Twenty-nine previously untreated patients with carcinoma of the oral cavity, maxillary sinus and oropharynx were treated in a nonrandomized study utilizing combination of cisplatin and radiotherapy.
15 of 29 (51.7%) patients underwent cisplatin induction chemotherapy followed by radiation, the remaining 14 (48.3%) patients received simultaneous administration of cisplatin with radiation.
Treatment and survival results are reported and compared to results obtained in treating 43 historic controls with radiotherapy (RT) alone. All patients in the control group were previously untreated.
The overall major response rate was 82.8% in combined modality group, and 72.1% in RT-alone group. There was no significant difference in response rate between these 2 treatment modalities.
In stage I·II patients, the overall response rate and acutarial 3-years survival was 88.9%, 83.3% in combined modality group, and 96.2%, 82.0% in RT-alone group. There was no statistically significant difference for overall response rate and survival rate between combined modality group and RT-alone group.
In stage III·IV patients, the overall response rate and actuarial 4-years sruvival was 80.0%, 51.9% in combined modality group, and 35.3%, 17.7% in RT-alone group. Combined modality produced a significantly increased response rate and survival in stage II·IV patients compared to patients who received RT-alone.
In the combined modality group, the incidence of secondary regional lymph nodes metastases after completion of the initial treatment was decreased compared to those seen in RTalone group. Our results suggests that the use of cisplatin induction chemotherapy prior to radiation improves the complete response rate compared to that seen in simultaneous administration of cisplatin with radiation.
Most significant toxicity was the gastrointestinal toxicity, nausea, vomiting and mucositis. In general, toxicity was tolerable and reversible.
In conclusion, the combination of cisplatin and radiotherapy appears to be associated with a higher response rate and prolonged survival compared to radiotherapy alone.

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Schwannoma occurs in all parts of the body, but occurrence in the oral and maxillofacial regions is relatively rare.
Recently we experienced a case of Schwannoma located in the tongue. The patient, a 30-year-old man, visited our hospital with a chief complaint of mass formation in the left side of the tongue. After excision of the tumor under local anesthesia, it was found to be multinodule. Under light microscopy, it showed the picture of Antoni type A. In addition, by an immunohistochemical study using the antibody of S-100 protein, the reactivity in the tumor cell was positive. From electron microscopic findings the tumor consisted of Schwann cells.
There was no evidence of recurrence for 7 months after the operation.

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