Lesions of the taste buds are often seen in an injuried tongue, but the histopathology of these lesions are not obvious. So, the purpose of this study was to examine the microstructure of the taste buds of tongue injuried by acid chemical substances. Experimental methods: 6-week-old Wistar strain rats were used as experimental animals. In order to give a tongue injury these rats were generally anesthesized with nembutal, and 5%, 10%, and 20% diluted Hel aqueous solutions were applied to the anterior 1/3 part of the tongue dorsal center for 1 minute. After application for a given time, the injured tongues were removed, and possible lesions of the taste buds of fungiform papillae were examined by light and transmission electron microscopes. Experimental results: Despite the damage of the tongue by as low as 5% HC1 aqueous solution, the taste buds of fungiform papillae were surely injured. After application, the taste cells (1 4 type) showed an increased electron density, and light and/or dark cells could not clearly be demarcated. In addition, a degenerating tendency of these cell components and organizations was observed: namely pycnosis, swelling of mitochondria and loss of cristae, decreased endoplasmic reticulum, increased vacuoles in the nerve ending region and breaked microvilli in the taste pore, etc. With higher concentrations of HC1 aqueous solution (10% and 20%), there was a tendency of the taste buds to be damaged excessively. The cell components were degenerated and destroyed, suggesting a functional disturbance. The degree of injury by acid chemical substances in the type 3 cells and the nerve endings of the taste buds were greater then that in the surrounding epithelial cells.
We have previously reported that the 3-methylcolanthrene induced rat fibrosarcoma KMT-17 cell line and its subclone A3 shed a TAA, termed CE 7, from the cell surface and that this phenomenon might play a role in the immunological escape mechanism. We have also reported that, when tumors in rats were treated by local 30 Gy irradiation, anti-tumor immune responses of spleen cells obtained from these treated rats were augumented. Thus, we examined whether this CE 7 antigen shedding is inhibited by x-irradiation and as a result tumor immunogenicity is enhanced. When A 3 cells growing in a medium containing 10% FCS were irradiated with 60Co-γ-rays on day 2, the expression of CE 7 antigen on A 3 cells was enhanced. These CE 7 expressing cells were fixed with 1 % paraformaldehyde and used for immunization by i. d. inoculation into syngenic WKA rats. The immunogenicity of CE 7 expressing cells was increased at least 100 fold (increase of LTD50) as compared to non-irradiated cells. KMT-17 cells were transplanted into the right hind limb of syngenic WKA rats and the local tumor area was treated by irradiation with 10, 30 or 60 Gy 5 days after transplantation. CE 7 antigen positive cells were found in greater proportion within 30 Gy-irradiated tumors than in nonirradiated, 10 Gy-irradiated or 60Gy-irradiated tumors. These results suggested that irradiation enhanced the CE 7 antigen expression on A 3 and KMT-17 cells and that these CE7 antigen expressing cells can stimulate the anti-tumor immunity.
Oral hairy leukoplakia (HL) is a newly recognized virus-associated lesion of the oral mucosa that occurs in persons infected with human immunodeficiency virus (HIV). Recent studies have demonstrated Epstein-Barr virus in the epithelial cells of HL. The authors examined 69 HIV-positive patients and 4 HIV-negative patients by a negative staining method using a transmission electron microscopy (TEM). For negative staining, swab specimens were taken from the lateral border of the tongue in each patient. 146 specimens were examined with TEM after Airfuge ultracentrifugation, and 24 specimens were examined without Airfuge ultracentrifugation. Ultracentrifugation with Airfuge produced an approximately 3-fold increase in the detection of Epstein-Barr virus particles by TEM. Negative staining with Airfuge ultracentrifugation has advantages of simplicity and speediness for the clinical diagnosis of HL.
For a clinical application of Cefazolin (CEZ, Cefamezin (R) ) in the maxillofacial region, CEZ 2g was administered by intravenous drip infusion to 26 patients and a pharmacokinetic analysis was performed for CEZ concentrations in the mandibular and maxillary bones. The serum concentration of CEZ was 82.0 μg/ml after 1 hour, 46.8 μg/ml after 2 hours, 15.3 μg/ml after 4 hours and 5.0 μg/ml after 6 hours. The half life of CEZ in the serum was 1.24 hour. The concentration of CEZ in the bone was 5.7 μg/mg after 1 hour, 4.0 μg/mg after 2 hours, 2.0 μg/mg after 4 hours and 1.0 μg/mg after 6 hours. The half life of CEZ in the bone was 1.99 hour. The concentration in the bone relative to that in the serum ranged from 6 to 20%. As for the intraosseous concentration and MIC80 values of bacteria, the former exceeded the latter in most bacterial strains. The above results suggest that CEZ is useful for the treatment of various infections in the maxillofacial regions.
The purpose of this experimental study was to reveal a difference between Cortico-Cancellous Bone Block (CCBB) and Particulate Cancellous Bone and Marrow (PCBM) concerning the bone bridge formation in alveolar clefts. Artificial alveolar clefts were surgically produced in the incisive bone of 39 adult mongrel dogs. The second and third incisor teeth were removed, then bony incomrnunication and an adequate size of bony defect were created. The nasal mucosa was not incised, while the oral mucosa was divided into two at the central part and a gauze tanponade was inserted into the bony defect. Repair of the clefts was made by grafting an autogenous CCBB or PCBM obtained from the iliac crest in 30 dogs. Flaps were advanced over the grafted area and sutured to gain the primary closure. Dogs were followed radiographically for months untill they were killed. Five dogs were killed at time intervals of 1, 3, and 6 months after grafting with CCBB or PCBM. The other 9 animals were served as controls. These experimental animals were all examined histopathologically and contact microradiographically. The results were as follows: 1) These artificial alveolar clefts were useful for the bone grafting model. 2) Bone bridge formation occurred earlier in PCBM grafts than in CCBB grafts. These differences were probably ascribed to the adaptation to the clefts and the bone modelling patterns employed. 3) Poor adaptation caused a narrow bone bridge due to cortical bone resorption in CCBB grafts. In PCBM grafts, new bone formation was observed all over the transplanted zone with α well shaped bone bridge. 4) A primary closure of the transplanted area and an enough mass of bone semed to be important for making a well shaped bone bridge in PCBM grafts. 5) From these results, PCBM was considered to be a better material for bone grafts in alveolar clefts than CCBB.
Lingual osseous choristoma is a very rare lesion and was first described as osteoma of the tongue by Monsarrat in 1913. In the Japanese literatures only 13 cases were reported previously. An additional case of a 14-year-old girl is reported and discussed in this article. In most of the cases, lingual osseous choristoma arised in the posterior part of the tongue.
A clinical and histopathological report was made on 26 cases of ameloblastoma, 1 case of adenomatoid odontogenic tumor and 2 cases of odontogenic fibroma over a period of 8 years. The results were as follows; 1. As for ameloblastoma, 23 among the 26 cases were primary and the remaining 3 were recurrent. No case was malignant. The following study was made on 15 well-documented cases. 2. 12 among the 15 cases were primary and the remaining 3 recurrent. 14 cases involved the mandible and 1 case the maxilla. As for the 12 pimary cases, the age of the patients ranged from 11 to 73 years old. The average age was 35.6 years. 10 cases were male and 5 female. A wider excision than that appeared necessary from the roentgenograms was carried out in the 15 cases. No sign of recurrence has so far been found in any of them. 3. According to the WHO classification, our series could be divided into 4 histopathological types; follicular type (4 cases), prexiform type (6 cases), acanthomatous type (3 cases) and mixed type (2 cases). 4. A575 antibody (DAKO) to keratin produced a brown coloration of the parenchyma in all 15 cases. SE and NSE antibodies (Lipshaw) to keratin showed a positive reaction of the parenchyma in 13 cases. The degree of the reaction seemed to be stronger for NSE antibody than for SE antibody. These results indicate that ameloblastoma is an epithelial tumor and its epithelial components closely resemble those of simple epithelium. 5. A 33-year-old female was histopathologically diagnosed as having an adenomatoid odontogenic tumor. After extirpation, no sign of recurrence has been found. A575 antibody produced a positive coloration of the parenchyma. The reaction for EMA was slightly detectable in the parenchyma. These results indicate that adenomatoid odontogenic tumor is an epithelial tumor and its epithelial components closely resemble those of glandular epithelium. 6. A 31-year-old male (Case 1) and a female (Case 2) were histopathologically diagnosed as having odontogenic fibroma. After extirpation, no sign of recurrence has been found. A575 and NSE antibodies produced a positive reaction in Case 1, and A575, SE and NSE antibodies produced a positive reaction in Case 2. These results indicate that odontogenic fibroma is an epithelial tumor.
Recent advances in the microsurgery have enabled to reconstruct a large defect of the oral cavity by a one-stage procedure. We reconstructed two patients with a free revascularized intestinal graft immediately after radical neck dissection and resection of oral malignant tumor. As the wall of the jejunum is soft, thin and pliable, it fitted nicely to any difficult intraoral defects. Postooperative functions were better than those obtained with conventional skin flap methods in terms of deglutition and speech. Provided the patients are carefully and critically selected the described procedure appeares to be a rational substitute for other reconstructive procedures, since in terms of function and cosmetic appearance, the results are highly satisfactory.
Fibrous dysplasia is a clinical syndrome generally classified into the following three types; Albright's syndrome, polyostotic fibrous dysplasia, and monostotic fibrous dysplasia. However, its classification has diverse pathological meanings, and due to its necessity of differentiating from osteoid diseases and of selecting an appropriate surgical method a more rational classification is currently required. Thoma proposed that fibrous dysplasia occurring in the maxilla or facial bone should be standardized as facial fibrous dysplasia for discrimineting from the three types mentioned above based on its anatomical peculiarity. Recently, the authors encountered a case of facial fibrous dysplasia as noted by Thoma, the outline of which is reported after discussion of the literatures. The patient, a 17-year-old female, visited our hospital complaining of swelling in the left portion of the exterior bucca. Her case-history revealed that she had noticed the above mentioned symptoms at approximately 13 years of age which were however ignored because of absence of accompanied other subjective symptoms. Recently, she consulted a hospital dentist after the aforementioned swelling had been pointed out by her friends. On the radiogram, diffuse non-permeable images of the maxillary sinus (left side) were observed and the patient was then referred to our department. The swelling was non-symmetry and extended from the zygomatic arch on the left side to the maxillary alveolar region. Radiographic findings showed a non-permeable image with an appearance of frosted glass centering on the maxillary sinus of the left side, which involved all the roots of 3 to 7. A biopsy was performed under a clinical diagnosis of fibrous dysplasia and enucleation was then conducted under general anesthesia. The operation did not proceed with a method exclusively concentrated on the tumor because of its anatomical specificity but initial consideration was given primarily to the reappearance of maxillary sinus morphology and the measurement of the right and left facial symmetry, followed by practicable curettage and enucleation. Pathological and histologic findings revealed that the maxillary sinus was comprised of irregular bone trabecula and fibrous connective tissue, and the former was consisted of in laminar structure and osteoid regions. The postoperative prognosis was favorable, showing no abnormal findings even after a year and four months.
A review of the literatures shows that simple bone cysts of the jaw can no longer be considered rare. The clinical and radiographic appearances are mostly rather typical, but some cases have a great variation. The great majority of these lesions have been described as occurring singly in the mandible, with its bilateral occurrences being extremely rare. We reported an unusual case of simple bone cyst occurring bilaterally in the mandible of a 15-year-old girl. According to a review of the literatures 16 cases of bilateral or multiple lesions in the jaw have been reported. A discussion of the theories of origin and treatment was included.
A retrospective study on 14 patients with TMJ internal derangements who had undergone a disk plication surgery, was performed for assessing the surgical results and postoperative radiograhic changes of the mandibular condyle. Regarding the surgical results, 10 of the 14 patients were evaluated as “excellent”, 3 patients were as “better”, and the remaining 1 patient was assesed as “poor”, in an average of 40 months follow-up period. Postoperative radiographic changes were evaluated on 11 joints in a mean follow-up period of 30 months; 1 of 11 joints was disclosed as having no significant change, and each 5 joints were revealed as having mild and moderate changes respectively. There was no severe surgical complication. These results suggested that the disk plication surgery for internal derangement of the TMJ is an appropriate procedure.
Fibrous dysplasia is a localized condition seen frequently in the femur or tibia, with its relating rate occurrence in the oral cavity. In this report we introduce a case of mandibular monostotic fibrous dysplasia, and present the results of computerized tomography, infrared spectrometry, X-ray diffraction analysis, and X-ray microanalysis. The patient, a 23-year-old man, was referred to our department with a chief complaint of swelling in the right mandibular osseous body. The condition had been diagnosed at another hospital as fibrous dysplasia by X-ray and histopathological examination. There had been no further swelling or other developments since that time. The patient's face showed a slight asymmetry, and on oral examination, a painless and diffuse area of swelling was noticed in the right mandibular molar region. The lesion was surgically excised with little difficulty. Postoperative healing was uneventful and there is no evidence of recurrence after 1 year and 4 months. The CT value of the affected region was equivalent to the CaCO3 density of 660-670 mg/cm3, as compared to only 160-165 mg/cm3 for the healthy region. Infrared spectrometry revealed the chemical components to be Ca3 (PO4) 2 and CO32-. In addition, X-ray diffraction analysis resulted in the identification of hydroxyapatite-like crystals. X-ray microanalysis showed an even distribution of Ca and P, and small quantities of Mg, throughout the region.
Amyloidosis is a lesion in which an amyloid substance deposits in various organs and tissues of the body. Recently, we experienced a case of primary amyloidosis forming multiple nodules in the tongue. The patient was a 74-year-old male. Multiple nodules, 5-10mm in diameter, were observed in the tongue and the lingual frenulum. Histopatliologically, the excised nodules were diagnosed as amyloidosis. The amyloid protein was identified as protein AL by potassium permanganate treatment.
Epulis is generally classified histopathologically into several subtypes, e. g. epulis fibrosa, epulis granulomatosa, epulis fibromatosa, etc. among them epulis fibrosa and epulis granulomatosa are common in Japan, while epulis with a formation of hard tissue is relatively rare. A case of epulis fibro-osteomatosa cementoplastica is reported. The patient was a 32-year-old female who had noticed a small lump on the gingiva in the left mandibular molar region. Clinical examination revealed a mass of the thumb tip in size in the region between teeth numbered 35 and 37. Radiographic examination showed i cloudy irregular radioopacity in the mass region. The lesion was diagnosed clinically as epulis osteoplastica, and surgical operation was carried out under local anesthesia. On gross examination, the mass was mesured 19 × 13 × 11.5 mm and the/cross section showed a firm milky white mass with scattered areas of hard bony tissue. Histopathological examination was performed and the lesion was diagnosed as epulis fibro-osteomatosa cementoplastica. The postoperative course was uneventful and there is no evidence of recurrence after 6 years.
A clinical evaluation of lymphatic metastasis was carried out on previously-untreated 104 patients with squamous cell carcinoma in the oral region. Exact metastases, evaluated by microscopy, to the submandibular, middle cervical, upper cervical and submental nodes appeared in the above order of frequency. Few metastases were observed in the other parts of the cervical lymph nodes. Relatively higher frequency of metastasis to the cervical lymph nodes was detected in patients with primary lesions of the gingiva of the upper jaw, buccal mucosa, gingiva of the lower jaw, floor of the mouth and tongue. Later metastasis to the cervical lymph nodes after the primary treatment was observed at relatively low rates in patients with tumor of the maxillary sinus, gingiva of the lower jaw and oropharynx, as compared to tumors of the upper jaw, buccal mucosa, floor of the mouth and tongue. Patient's survival rate closely related to whether or not the later metastasis to the cervical lymph nodes occured while no significant correlation between the existence of metastatic lymph nodes before treatment and the patient's survical rate was detected. However, no definitive factor influencing the later metastasis could be found in the present study.
Hyperbaric oxygen (HBO) therapy is used as an adjunctive treatment for chronic osteomyelitis, but its efficacy still remains controversial. We treated 5 patients with osteomyelitis of the mandible with HBO. The type of osteomyelitis was chronic sclerosing osteomyelitis in 3 cases, chronic suppurative osteomyelitis in 1 case and acute suppurative osteomyelitis in 1 case. All cases received an antibiotic therapy and HBO (2.5 ATA) for 1 hour a day at 20 to 54 occassions in total. Three patients recovered and 2patients showed a remission of symptoms. The range of mouth opening and laboratory data, such as white cell count, erythrocyte sedimentation rate and CRP appear to be an indicator for judging efficacy of HBO therapy. The results suggest that HBO therapy is useful as an adjunctive treatment for osteomyelitis of the man-dible.
Pyogenic granuloma is a lesion with hyperplastic granulation tissue and commonly arises in the skin and the mucosa. In the oral region many causes were reported, but no definite opinion has been described. We reported 3 cases of pyogenic granuloma which arised in the tongue and the lip. All the 3 lesions were surgically removed. Postoperative courses had no problem and there is no recurrence at present. In this report, we summarized our findings in these cases.
Thyroglossal duct cysts usually arise from the remnants of the embryonic thyroglossal duct produced by the descendent of the thyroid anlage. The cysts occur mainly in the neck midline, but rarely in the oral cavity. We experienced an interesting case of thyroglossal duct cyst which was found in the sblingual area. The patient was a 6-month-old female infant. An elastic soft mass was palpable of which size was 1.5×1.0cm in the tongue. It was diagnosed clinically as a thyroglossal duct cyst based on the cystic contents and CT examination. In the treatment, we tried a radical excision of the cyst by Systrunk's procedure, which succeeded the remove the cystic mass, but failed to remove the hyoid bone. Histopathologically, the cyst was covered with columnar and stratified squamous epitheliums. Thyroid tissue was not found. The patient's postoperative course has been unremarkable for 7 months.
Rhabdomyosarcoma is an extremely rare malignant tumor but in the head and neck region, it is one of the most common malignancies of the mesenchymal tissue. A case of a 18-year-old male with embryonal rhabdomyosarcoma of the left maxillary sinus is presented. He was referred to our clinic because of the left nasal obstruction and gum swelling. A final histopathological diagnosis was established by several staining methods including H & E, PTAH, Azan-Mallory and silver stains, by immunohistochemical examination with antimyoglobin and anti-actin antibodies, and by electronmicroscopy. In the absence of cross striations this case was diagnosed to have an undifferentiated type of embryonal rhabdomyosarcoma. Whole left maxillectomy including removal of the eye ball and orbit was performed. Postoperatively, the patient recieved 55 Grays by Linac irradiation and VAC therapy (VCR, AMD, CPM) as a chemotherapy. He has been well for 18 months and there has been no evidence of local recuerrence or metastatic disease.
A 73-year-old female with basal cell carcinoma of the left labial cominissure, which invaded into the skin and cheek mucosa, was referred to our Department. The left labial comminissure defect after tumor resection was immediately reconstructed using swining rotation flap, in which the incision line was designed in the cheek, subumandible and cervicle, and rotated toward the cominnissure. One month after operation she could wear the denture. One year later she was quite satisfied with the function and esthetics of the labial comminissure without any signs of recurrence and metastasis.
A clinicopathological study was performed on 9 cases of metastasis of the oral cancer to the submental lymph node experienced in our department. As a result, it was found that the metastasis was extensive in these cases with a high incidence of recurrence in the contralateral cervical region. Compared with the submandibular lymph node, the tumor tended to develop outside the lymph node in the early stage for metastatic lesions of the submental lymph node, and the recurrence after radical neck dissection was also more frequently observed in the submental region. Therefore, the metastatic aspect in the submental lymph node apparently differed from that of the submandibular lymph node. Thus, a more elaborate treatment should be performed in such cases.
We described a case of acinic cell tumor of the right soft palate in a 79-year-old male. After the tumor was extirpated, no reccurence or metastasis has been observed for 14 months. The tumor mass was well encapusulated. Histologically and ultrastructurally, the tumor was mainly composed of large polyhedral tumor cells. They resembled serous or mucous acinar cells but could not be completely discrimihated. Other tumor cells resembled intercalated duct cells, and the size and the quantity were very small. A study on 118 cases of acinic cell tumor or carcinoma arising in the minor salivary gland yielded a recurrence rate of 11.0%, a metastatic rate of 8.5%, and a mortality rate of 1.7%.
We performed a dental treatment for a 5-year-old patient with an anamnesis of secondary methemoglobinemia at his age of 6 months. This may have been caused by PL granules. Though local anesthesia was required for the treatment, amide typed local anesthetic agents such as prilocaine and lidocaine are known to cause methemoglobinemia. During the treatment we thus checked his blood methomoglobin concentrations before and after local anesthesia (1.8ml lidocaine) to examine a possible causal relationship between lidocaine and increased blood methemoglobin levels. We used an autographic spectrum photometer (UV-265 from SHIMAZU) to determine the methemoglobin concentration in accordance with a revised Evelyn-Malloy method. As a result, we found no significant rise in the blood methemoglobin concentration at the dose level of lidocaine employed in this case.
Lesions occurring in the dorsal region of the tongue have at times been diagnosed as carcinoma. This report concerns our experience on a rare case of squamous cell carcinoma in the tongue dorsal region. The case was a 48-year-old male, who came to our clinic with a complaint of a tumor in the tongue dorsal region. Intraoral findigns showed a white circumscribed tumor of the dorsal region with palpable induration. The tumor was excised together with the induration and continuously treated with adjuvant chemotherapy (BMP therapy). Results of a 29 month postoperative follow up examination showed no recurrence of the symptom and the prognosis was satisfactory. In this report, clinical difficulties in diagnosing a lesion in the dorsal region of the tongue are discussed.
Cherubism is an uncommon disease. It is characteristic of cherbic appearance owing to expansion of the jaw and is hereditary. The lesion without familial history is virtually indistinguishable from a central giant cell granuloma of the jaw. We reported a non familial case of cherubism in a 5-year-old girl and discussed it.