Hydroxylapatite (HA) is used in various clinical aids such as reconstruction of bone defect areas and augmentation of atrophic jaw bones. It has been well known that HA is nontoxic and biocompatible and has an osteoconductive character. However, it is very difficult to complete reconstruction of the lost form by using HA particles alone, because HA particles easily migrate or disperse into surrounding tissues after implantation. This study was carried out to evaluate the admixture of HA particles and autogenous bone marrow (BM), which were filled in gelatin-capsules, on bone formation in subcutaneous and subperiosteal regions of rabbits. Single layered geratin-capsules (single capsule) and double layered gelatin-capsules (double capsules) were used. Mixture of HA and BNI without gelatincapsules was implanted as control. The results were as follows: In both single and double capsule groups, no disturbance of new bone formations, which were probably induced by osteoprogenitor factor in BM, was observed. Furthermore, the degree of formation of new bone in subperiosteal region of the double capsule group was better than that in the group without capsule. These results suggest that the gelatin-capsule is useful for reconstruction of lost bone form by using either HA, BM, or both together.
The T1 and T2 relaxation times of the phantom were measured in the magnetic resonance imaging (MRI) using the headcoil and the surface coil for the temporomandibular joint (TMJ). The purpose of this study on the phantom was to investigate the feature of the surface coil for TMJ (TMJ-coil). Two spin echo (TR=2, 000 msec, TE=30 msec and TR=2, 000 msec, TE=80 msec) and one inversion recovery (TR=2, 000 msec, TI=-500 msec) pulse sequence with a 256×256 matrix and two excitations were used, and the T1 and T2 values were obtained by the ROI (region of interest) in the maps of T1 and T2. As a result of the phantom study, I acquired the knowledge that I have to set an object on the center of the TMJ-coil with a distance more than 3 cm. With the TMJ-coil, measurements of T1and T2 relaxation times of meniscus and lateral pterygoid muscle were performed on 30 normal volunteers and 30 patients who had been diagnosed internal derangement of the TMJ. The 30 patients were classified into two groups; one composed of 15 patients diagnosed meniscal displacement with reduction (goup MDWR) and the other was of 15 patients diagnosed meniscal displacement without reduction (group MDWOR). Between the volunteers and patients, there was a significant decrease in T1 and T2 relaxation times of meniscus and Ti relaxation times of lateral pterygoid muscle. There was no significant difference between group NIDWR and group MDWOR. There was no significant difference in sex or age, either. The more long-term the patients were, the more the T1 relaxation times decreased. The decrease in T1 and T2 relaxation times of meniscus probably represented water loss. The decrease in T1 and T2 relaxation times of lateral pterygoid muscle was slight compared with that of meniscus.
A method for three-dimensional analysis of dental arches using cephalograms and dental casts was developed. One piece impression of the upper and lower dental arches at occlusion with a horseshoe-shaped resin skeleton containing steel wires of 0.4mm in diameter used as radiographic markers on the labial side of the dental arches was taken using silicon base impression material. Lateral and frontal cephalograms were then taken simultaneously with mouth impression. “After dental casts with impression” were made with piaster, three points were marked at the hase of each dental cast and three-dimensional coordinate values of three points at the rips of the steel wires and the six points of the dental casts were measured. Then, “final dental casts” were removed from the impression and three-dimensional coordinate values of measurement points on teeth and tne three points at the base of each “final dental cast” wen measured. All the values measured were input in a personal omputer. The lateral and frortal ephalograms were traced and five stmdard points and the three wire points were input using the digitizer and their three dimensional coordinate values were calculated and standardized by the method described by Kobayashi, et al 7). Finally, standardized three-dimensional coordinate values of the measurement points on teeth were calculated by coordinate transformation from “final dental cast” to “dental casts with impression” and to “cephalograms”. To assess the reproducibility of this system, standardized three-dimensional coordinate values of three dental points of each dental arch on an incisor and two right and left molars were calculated twice in 10 subjects. The mean differences of coordinate values for the three axes and straight distances of the same dental points on the two measurements were in the ranges of 0.14mm to 0.43mm and 0.54mm to 0.60mm, respectively. Standard deviations of the coordinate values for the three ax s and for three-dimensional direction were between 0.13mm and 0.34mm, and 0.40mm and 0.45mm, respectively. The results of the aralysis with this method in two cases in which mandibular protrusion with lateral deviation and open bite were corrected by a combination of sagittal split osteotomy and body ostectomy, and anterior alveular osteotomics of the maxilla or the mandible, respectively, indicated that it is quite useful in analysing the movement of dental arches during and after surgery in relation to the mandibular morphology because the standardized coordinate system is set in the cranium.
This study is designed to investigate the effects of antitumor agents, peplomycin (PEP) and cisplatin (CDDP), on vascular ultrastructural changes and the permeability of endothelium, using DMBA-induced squamous cell carcinoma of the tongue in golden hamsters. PEP and CDDP were administered daily for 7 days. Horseradish peroxidase (HRP) or tannic acid solution was injected as a tracer via the heart and the vasculature was fixed by perfusion after 15 seconds. The ultrastructural changes of capillaries and venules surrounding the cancer nests were observed by transmission electron microscopy. The occurrence of plasmalemmal vesicles, fenestrae and endothelial projections was less frequent in capillariesthan in venules in the saline, PEP and CDDP groups. This suggested that the venules were substantially associated with the permeability of the tumor vascular system. HRP was taken up by almost all the plasmalemmal vesicles existing on the luminal side of cell membrane. Tannic acid mostly penetrated through the fenestrae. In the PEP group, however there were a relatively large number of fenestrae sat inhibited tannic acid penetration. The occurrence of plasmalemmal vesicles and fenestrae was more frequent in the CDDP group than the other groups. These findings suggested that the vascular permeability was markedly augmented in the CDDP group compared to the PEP group. However the leakage of tannic acid was obstructed by the tight junction of intercellular spaces in the saline, PEP and CDDP groups.
The tissues from 50 cases of oral tumor lesions, including 31 cases of squamous cell carcinomas, 3 cases of mucocpidermoid cell carcinomas, and 16 cases of benign lesions, were examined for the preserce of human papillomavirus (HPV) DNA by a dot blot hybridization kit for the detection of HPV DNA. HPV DNA were detected in 2 of 34 cases (5.9%) of the malignant oral lesions. The types of HPV detected in these two patients were HPV 6/11 and HPV 16/18, respectively. None of 16 cases of the oral benign tumors, including leukoplakia, contained HPV DNA. From the HPV 6/11 positive case, HPV containing exfoliated cells were also collected by swab. The HPV 6/11 DNA was detected in the tissue of tumor region, but totally absent in the normal region in the vicinity of the tumor. After chemotherapy and radiotherapy, the HPV DNA could not be detected from the HPV 6/11 positive case according to the disappearance of tumor. However, the HPV DNA was detected from HPV 16/18 positive case even after chemotherapy and radiotherapy, in spite of almost complete disappearance of tumor. After surgical removal of tumor, HPV DNA could not be detected. These data suggest that the HPV positive rate in oral tumors in japan is not very high and HPV infections occur in limited mucosa. Conventional therapies were also effective for the malignant oral tumor positive for HPV.
I studied the effect of estradiol on prevention of cleft lip in A/J mice using whole embryo culture system. Embryos of the 10.5th day of gestation (plug day=0) were harvested from untreated pregnant mice, pregnant mice injected subcutaneously with 25μg/kg of estradiol or the solvent of hormone on the 9. 5th day of gestation. As a control of untreated A/J mouse embryos, C 57 BL/6 mouse embryos of same developmental stage were used. These embryos were cultured for 48 hours in pure rat serum containing 2mg/ml of glucose and antibiotics with continuous supply of 95% 02 and 5% CO2 mixture gas by a rotating culture system at 25 to 10 rpm. Both A/J and C 57 BL/6 mouse embryos showed manifest growth and development in vitro. The incidence of cleft lip in vivo in A/J and C 57 BL/6 mice at the 18th day of gestation is 6.2% and 0% respectively. No cleft lip was observed in cultured C 57 BL/6 mouse embryos. Cleft lip was observed in 51.2% of untreated and 52.2% of solvent treated A/J mouse embryos in vitro. By contrast, in estradiol treated group, the incidence of cleft lip was decreased significantly to 21.3% (p<0.001). These results indicate that the effects of estradiol treatment act to the embryos before primary palate formation, and that the genetical predisposition of cleft lip in A/J mouse embryos become resistant to cleft lip.
The cystic lymphangioma is a rare tumor of the head and neck. A case of cystic lymphangioma in the cheek of a 16-year-old female was presented. The tumors were two round masses measuring 37×37mm and 20×20mm which were clinically diagnosed as an angioma. The lesion wa-s excised completely from intra-oral approach. Histologically, the excisional specimen consisted of dilated lymphatic vessels. After one year and eight months, there was no evidence of recurrence. The clinical characteristics, treatment and prognosis of 21 cases published in the literature of oral and maxillofacial surgery were analyzed and summarized.
Between 1981 and 1988, 148 total radical neck dissections (TND) were performed at the Department of Second Oral and Maxillofacial Surgery in Tokyo Medical and Dental University Hospital for initial patients with squamous cell carcinoma of the oral cavity and adjacent region. Tongue cancer patients had metastatic lymph nodes most frequently in the upper deep cervical region, lower gingiva had metastases in the submandibular region, floor of the mouth had metastases in the upper deep cervical region and in the submandibular region, and upper jaw had metastases in the upper deep cervical region and contra lateral sites. In this study of 148 determinate patients, the control rate was 65% when lymph nodes were histologically negative, 48.6% when one lymph node was positive, 43.5% when two lymph nodes were positive, 54.5% when three lymph nodes were positive, and 5.6% when four or more nodes were positive. Control rate was 65.4% for patients with lymph node involvement confined to the Level 1, 29% for patients with lymph node involvement confined to the Level 2, 33.3% for patients with spread of carcinoma to nodes in the Level 3, and 0% for patients with spread of carcinoma in the Level 4. In histopathological findings in primary region, patients with mode of invasion of 4C, 4D resulted in poor prognosis, while in metastatic cervical region patients with mode of invasion of 4D were many and showed poor prognosis. On the patterns of nodal involvement, the patients of entire node-metastatic type (Grade-D) and diffuse node-metastatic type (Grade-E) had poor prognosis. On the patterns of extranodal spread, the patients of extranodal invasion had poor prognosis. On the histological differentiation in the primary and cervical region, the patients of Grade 3 resulted in poor prognosis.
A case of Apert syndrome with cleft palate is presented. The fetures of the case were characterized by acrocephaly syndactly of hands and feet, facial abnormality, maxillary hypoplasia and cleft palate. Craniofacial pattern analyses were carried out by lateral roentogenographic cephalogram. The results slowed maxillary hypoplasia. Furthermore, the rate of area between cranial and facial space was measured with CARDIAS GP 2, 000 (Nac CO. JAPAN), ard it was showed that the cranial space of this case was smaller than the average values of normal children. With regard to the clinical findings and the craniofacial pattern, his mother showed a strong similarity. Moreover, she was given many drugs, including som, antibiotics, for hepatitis therapy early in her pregnancy. As stated above, it is assumed that hereditary and/or environmental factors were the cause or causes of the abnormalities.
Ectodermal dysplasia, a comparatively rare disease, is characterized by many kinds of hereditary dysplasia of ectodermal organs: decreased sweat glands, body hair and teeth, skin atrophy, etc. A 23-year-old woman with ectodermal dysplasia and mandibular prognathism is reported. She had 14 congenital teeth defects and paucity of scalp, eyebrow, eyelash and body hair. Further more the dysplasia of sweat glands gave rise to dry skin and uncontrolled body temperature in summer. She lost consciousness at age 22 in summer. The diagnosis arrived at in the Department of Dermatology was ectodermal dysplasia. She came to our facility with a chief complain of masticatory dysfunction and need of surgical correction of mandibular prognathism. Defects of the teeth and malocclusion induced a mandibular prognathism, and a sagittal splitting osteotomy (Hunsuck modified method) using as an intermaxillary splint and bilateral circumferential wirings was performed under gereral anesthesia. The intermaxillary wirings were removed on the 28th day. On the 44th day after surgical correction, she was satisfied and discharged.
A case of anaphylaxis to antiseptic povidone-iodine (PVP-I) is presented. When we used the PVP-I for irrigation of the operative wound after the reduction of the zygomatic arch fracture, subsequent severe edematous swelling occurred in the face and neck regions. In order to avoid anaphylactic shock, the operative wound was immediately washed with a large amount of physiological saline solution, and then hydrocortisone and predonisolone were given intravenously. As the results of these treatments, the swelling was rapidly reduced at 4 days later, and period of about 1 month was needed for complete disappearence of symptoms. Intradermal skin test with 0.1mg/ml of PVP-I showed positive reaction, but was negative in the healthy 10 volunteers used as control. Moreover, the reaction of patch testing with 100mg/ml of PVP-I was negative in this patient. From the facts stated above, we may conclude that the patient has an anaphylactic reaction of immediate type to PVP-I.
Conservative treatment for ameloblastoma frequently produces recurrence. But even after radical treatment for this lesion, recurrence may occur. Recurrence in such cases is most likely due to involvement of adjacent soft tissue structures by tumor tissue. In such cases of recurrence after conservative treatment, ameloblastoma proliferate immediately in soft tissue and gingiva. We performed segmental resection of mandible bone involving adjacent soft tissue and one-stage microsurgical reconstruction using radial forearm skin flap.
A case of herpes zoster affecting the trigeminal nerve in the left maxillary division of a 60-year-old female was presented. As a rare complication of post-zoster unusual features such as spontaneous teeth exfoliation, necrosis of the alveolar process and gingival necrosis were demonstrated. The clinical characteristics of the lesions of 23 cases with post-zoster zone necrosis documented in the literature were analyzed and summarized. The role of the herpes zoster virus in the etiology of tooth exfoliation and osteonecrosis of the jaw was discussed. Awareness of osteomyelitis associated with secondary HZ infection is important for early detection and treatment of the condition to prevent further complications, particularly in highrisk patients.
A clinicopathological study was made of the correlation between histological findings of the biopsy specimen and local cure rate of 60 cases of oral squamous cell carcinoma treated with interstitial irradiation. The following findings were obtained. 1. Local cure rate with interstitial irradiation was 82% in Ti cases, 83% in early-T2 (21-30 min) cases, 64% in advanced-T2 (31-40 mm) cases, and 25% in T4 cases. 2. Moderately or poorly defferentiated type showed lower local cure rate than well differentiated type. 3. Diffuse invading type showed lower local cure rate than clear borderline type. 4. These results suggest that the application of interstitial irradiation should be decided in view of histological findings as well as TNM classification.
We experienced a case of supposed anti-convulsant embryopathy, which is a comparatively rare disease. We would like to supply arguments for its diagnosis and also to make examination of the operative time for cleft palate associated with this case. The case is a 7-month-old male infat without siblings, whose parents' blood relative and lineages deny teratogenic diseases, His moher, who was diagnosed as epilepsy at age 9, has so far been taking anticonvulsant drugs (phenobar, sodium valporate, primidon, sultiame) without interruption during the pregnancy. The pregnant course was uneventful except for unique petit mal in gestational months 4 and 5 each but prenatal growth deficiency led to cesarean section at gestational age, 37 weeks and 3 days. The baby weighed 2, 100g (SFD) at birth, and immediately thereafter, barbiturate withdrawal syndrome appeared and multiple anomalies (wide fontanele, low-set ears, hypertelorism, ptosis of eyelids, cleft palate, contracture palmarls, short fingers, clubbed penis, small scrotum, inguinal hernias, undescended testes, etc). were noted. Thereafter, the infant needed longterm internal medical control becaue of postnatal hypognesis and psychomotor retardation. At age 3 (BW, 8, 160g), the infant received palatoplasty, intra-and post-operative courses being uneventful. Now, one year postoperatively, the infant (aged 4 years and weighing 9, 720g) still presents self-dysbasia and allopliasia in thecourse of observation.
We experienced a case of pycnodysostosis in 55-year-old woman complicated with chronic osteomyelitis in the both maxillae. Pycnodysostosis is a genetic disorder of bone characterized by osteosclerosis. In the jaws of our patient hone sclerosis was found around the remaining teeth rachographycally. We thought this increased bone density resulted from combination of the essential sclerosis with the infectious irritation. Exposure of the sequester and pus discharge were also seen at the left second premolar region of the mandible and the left first premolar region of the maxilla. Although a protracted course was encountered for the sclerosing osteomyelitis, the patient was successfully treated by antibiotic therapy and removal of sequester and pathologic bone showing abnormal sclerosis without wide resection of bone such as decortication or saucerization. We discussed the treatment of the chronic sclerosing osteomyelitis including the osteomyelitis in the patient of pycnodysostosis.
Oral hairy leukoplakia (HL) is clinically characterized as a white lesion of the lateral portion of the tongue among persons who are human immunodeficiency virus seropositive. The lesion shows a hairy or corrugated appearance.The dominant histologic features of HL are epithelial hyperparakeratosis with hairlike projection, acanthosis, vacuolated cellsresembling koilocytes and an absence of inflammation in the connective tissue. We have recently reevaluated seventy seven white lesions cases which were diagnosed as leukoplakia both clinically and histologically, and found out three white lesions cases mimicking HL.Herein is a report of a case with marked oral mucosal involvement together with an examination of Langerhans cells (LC).The clinical and histologic features of this case were very similar to HL and epithelial LC were detected in reduced numbers.
A 26 year-old woman with multiple odontogenic keratocyst complicated with mandibular ineLirable infection was admitted in our hospital. The cyst was opened under general anesthesia and the intra-arterial infusion of antibiotics was treated twice daily with on shot at a tune. Pathological diagnosis was multiple odontogenic keratocyst. After reduction of cyst cavity, it was enucleated. The postoperative course was entirely good without recurrence.
When the treatment of skeletal malocclusion is based on standardized profiles, the surgical field is expanded because of the individual morphological variations of the patients. Such an approach will not always permit functionally stable occlusion. To establish the functionally stable occlusion which we term desirable occlusion (D.O.), it is very important to set up the appropriate occlusal plane based on the fixed maxilla, and to establish the centric stop and anterior guidance. Therefore systematic treatment of the patient by a team approach is carried out with an oral surgeon, prosthodontists and orthodontists. In this paper, we report two cases of sagittal split osteotomy in which the maxillary occlusal plane was established by pre and post surgical prosthodontic treatments. In these cases it was not possible to apply orthodontic treatment for the improvement of maxillary occlusal plane because of many missing teeth. As the centric stop in the molar region were not sufficient, we utilized the resin bite splint. even after removal of intermaxillary fixation and maintained the centric stop. This stabilized the occlusion and intermaxillary relation during post surgical treatment. By applying this procedure, it is possible to maintain the centric stop throughout the post surgical treatment period and thus help in establishing desirable occlusion.
Fifty-nine cases with condylar fracture of the mandible treated at our department from April 1982 to March 1989 were reviewed and analysed. Their characteristic features were as follows. 1) Condylar fracture occured in 49. 2% of the mandibular fractures and the ratio of the male to female was 1.3 to 1. The largest group of patients were in the teen age group (30.5%). 2) The most frequent causes of condylar fracture were traffic accidents (50.8%) and most patients (86.4%) visited our department within two weeks after injury. 3) Most cases (83. 0%) were indirect fractures, and of the fifty-nine cases, forty-nine were unilateral and ten were bilateral. Tlwn thirty-seven cases (57.6%) were combined with other mandibular fractures. 4) As for the level of fracture line and the degree of malpositions, fractures with dislocation oceurred most frequently in the condylar head and superior neck region. 5) Thirty-six cases (61. 0%) were treated with conservative procedures for both condylar fractures and other fractures of the mandible. On the other hand fifteen cases (25.4%) were treated with surgical procedures for other fractures of the mandible and eight cases (13.6%) were treated with surgical procedures for condylar fractures. 6) As for prognosis, it was excellent for young people, while that for the patient with old fractures and fractures combined with other mandibular sites or with dislocation tended to be not so good. 7) Most of the conservative procedures were indicated for new fractures and fractures wills slight dislocation of the small fragment, therefore prognosis of the patients treated with conservative procedures was mostly good. On the other hand most of the surgical procedures were used for old fractures and fractures with severe dislocation, so the prognosis of the patients treated with surgical procedures tended to be not so good compared with conservative ones.
In order to compare the arthroscopic findings with pre-operative arthralgia in patients with internal derangement of the temporomandibular joint (TMJ) with closed lock, a pain questionnaire prior to arthroscopic surgery was taken in 20 patients. Quantitative pain score was calculated for each item on questionnaire, and arthroscopic findings on synovitis, degenerative change, and adhesion were evaluated by two surgeons to find correlations with the scores. Thus Spearman's correlation coefficients between pain scores and arthroscopic findings were tested. The results disclosed the positive correlations between the jaw pain on chewing and the intensity and extension of synovitis, and those between temple pain and the intensity and extension of degenerative change. These results indicated that a certain pain level in patients with closed lock is related to arthroscopic abnormal findings, consistent with synovitis, degenrative change.
A case of peripheral osteoma occurred in the mandible of a 73-year-old woman is presented. The patient had not noticed the mass in the left mandible until we pointed it out. Radiographic examination revealed a forefinger-sized, dense and radiopaque mass which protruded from the lateral surface of the left mandible. The mass was removed surgically. The removed tumor measured about 15×15×18mm and its surface was smooth and glossy like the bone. The histopathological diagnosis was a compact osteoma. Such cases are rarely reported in the literature. The patient had no evidence of recurrence at five years follow-up after operation.
We reported a rare case of malignant trichilemmoma in hair follicle tumors. The patient was a 48-year-old man. He noticed the painless tumor in his neck in 1987. He was referred to his surgeon and the tumors were surgically removed. Histopathological diagnosis was malignant trichilemmoma. But after 6 months, the patient visited our department concerning a tumor in the oral floor. After radiotherapy and chemotherapy were undertaken, we performed excision and radical neck disection. The excised tumor was characterized in electron microscopy by the presence of clear cells in the PAS stain and presence of glycogen-rich cells. As the result, histological diagnosis was recurrent malignant trichilemmoma in the oral floor.
Chronic myelomonocytic leukemia has been classified into myelodysplastic syndromes according to FAB co-operative group proposal. A 76-year-old man was diagnosed chronic myelomonocytic leukemia according to the FAB criteria. Clinical features of the patient were swelling at submandibular region and anemia, but not accompanied by spleno-hepatomegaly, swelling of the systemic lymphnodes and bleeding tendency. In hematological findings, white blood cells and monocytes increased, and myeloid precursors infiltrated the peripheral blood. Bone marrow biopsy specimens showed hypercellularity of myeloblasts and monoblast. In laboratory data, serum and urine lysozyme levels were remarkably elevated. Philadelphia chromosome was negative. The patient was treated with a small dose of VP-16 against thrombocytopenia, which was thus controled. An immunohistochemical staining of bone marrow cells was performed. Lvsozyme was strongly positive for leukemic myelomonocytic cells. arAntichymotripsin was only positive for monocyts.
The purpose of this article is to report the clinical course of a case with habitual anterior dislocation of the TIV1J treated by occlusal treatment, and to investigate the etiology of anterior dislocation of the TMJ from its arthrographic findings. The patient was 31-year-old woman who suffered from frequent opening lock symptom which began at dental treatment 7 weeks before the first visit to our hospital. The frequency became greater gradually. The clinical diagnosis was habitual anterior dislocation of the bilateral TMJ. At first visit, bilateral dislocation without self-reducing occurred every time her mouth opened more than 28 mm interincisally. There was marked tenderness of the temporal, masseter, and lateral pterygoid muscles at mouth closing which suggested disturbance of coordination between masticatory muscles. It was thought that such myalgia were due to malocclusion in which central occlusion had been unstable and vertical dimension of occlusion had decreased as a result of repeated prosthetic treatments. The arthrotomogram showed that bilateral condyles fixed at extra-fossa position located anterior to the anterior bands of the discs and that the condyles were normally under the discs at mouth closing. Video fluorographic observation revealed that the anterior bands of dislocated discs mechanically obstructed posterior translation of the condyles. This abnormal disc movement corresponding to that of incoordination of the disc suggested that the critical disc incoordination resulted in the dislocation. It seemed that the factor to separate dislocation from disc incoordination is the degree of incoordinative activity of masticatory muscles, especially between the lateral pterygoid muscle and closing muscles. Treatment was focused on elimination of the myospasm by means of a occlusal splint based on that hypothesis. After application of a splint, dislocation has disappeared completely even after prolonged maximal mouth opening up to 49 mm, and tenderness of masticatory muscles disappeared. Those clinical findings have established the concept that anterior dislocation of the TMJ is fundamentally a muscular problem: incoordination of the muscles induces incoordination of the disc resulting in dislocation. If the incoordination of the muscles is too great, the condyle is not able to be reduced into the fossa beyond the anterior band, and is resticted at an extra-fossa position. Similar to internal derangements of the TMJ, some anterior dislocation might well fall into the category of abnormal disc movement.
The results of the application of tamponade with chitin sponge coated gauze (chitin) in the operation of maxillary sinus are reported. Gauze tamponade has so far been used in radical maxillosinusectomy, but may be responsible for some infection and for bleeding and pain upon its extraction. Recently, the author was presented with tampons with chitin sponge which the Central Research Institute of Unitika has developed with a view to promoting wound healing and easy extractability. In the present study, the tampon, which has already been proved to be clinically useful as adsorbent suture and wound coating protective, was used as a substitute for the conventional gauze tampon in maxillary sinus surgery, the tampon was used in 21 patients clinically diagnosed as postoperative maxillary cyst, dental siagonantritis and the like. Good results were obtained with little pain and bleeding upon extraction, and a high concentration of lisozyme was noted in the chitin sponge following extraction, suggesting induction of lisozyme in the wound area, i.e. an action to promoote wound healing.
Applying apatite implants into apatite blocks reconstructed mandibulae was performed in dogs. Apatite implants (A.I.). 5mm in diameter and 9mm in length, and implant for bone-apatite implants (B.A.T.) 4mm in diameter and 9mm in length were used in this experiment. The sizes of block (Block) were 25mm in length and 13mm in height and the porosity rate was about 60%. After resecting bilateral alveolar parts of mandibulae, Blocks were placed into the defect areas ligated by nylon wires. At the same time implants were placed into ilia. After 3 months, implants covered with iliac bone were taken out from ilia, with A.I., placed into Blocks of the mandibulae. 3 months later, mandibulae and ilia were taken out and prepared for undecalcified specimens. The surrounding tissues of A.I. and B.A.T. were examined. A lot of neogenetic bone was formed along the macropore inside Blocks. The neogenetic bone showed different kinds of differentiation. It was higher in the mesial, distal, and bottom areas near the mandibulae and it was lower in the area toward the internal of Blocks. It was because of the distance from the mandibulae, and the placement of A.I. and B.A.T. The surrounding tissues of A.I. showed lower differentiation, as compared with B.A.I.'s. Apatite of B.A.T. was covered with grafted bone which was extensively connected with neogenetic bone inside Blocks. B.A.T. showed osseointegration between apatite and grafted bone in wide range. Grafted bone was connected the cutting surface of Blocks and neogenetic bone inside macropore, apatite was connected with the neogenetic bone formed inside Blocks through grafted bone. There was a lot of neogenetic bone found in the lingual area of B.A.I., as compared with the buccal area. Bone remodeling was shown between grafted bone and neogenetic bone. Around A.I., there was more fibrous connective tissue binding with than neogenetic bone. Fibrous connective tissue was also seen in the area where the tipper wall of mandibular canal was removed during the placement of Blocks. Fibrous connective tissue was continuous inside Blocks. From above it was implied that it was possible to apply the apatite implants into the apatite blocks reconstructed mandibulae.
Lingual mandibular bone concavities were first described by Stafne in 1942 as cystic bone cavities situated near the angle of the mandible on roentgenogram. A case of lingual mandibular bone concavity in the region of the lower right premolars is reported in this paper along with a review of the literature. The subject was a 39-year-old man. He appeared at our clinic on 5/12/'89, having been referred to us by his general dentist with X-ray findings showing radiolucent lesion of the mandible. We suspected the mandible cyst. In the operative findings, we did not recognize a cyst wall in the mandible. We picked fragments of the soft tissue at the lingual mandible. The pathological findings of these tissues were normal muscle tissue, fibrous connective tissue and fatty tissue. In consideration of the clinical, operative and pathological findings, we thought that this radiolucent lesion was a lingual mandibular bone concavity.
Three cases of poorly controlled diabetic patients who developed severe infection from odontogenic inflammation were reported. Case 1 was a 48-year-old male with uncontrolled diabetes mellitus (DM), who showed a high blood glucose level two years ago. He received an endodontic treatment and medication for acute apical periodontitis of the right lower second premolar by a general practitioner, but the abscess quickly progressed through the right submandibular region down to the neck and the supraclavicular region. Case 2 was a 49-year-old female who had undergone extraction of the left upper second molar with acute periodontitis. The inflammation promptly extended to the left pterygomandibular space, the parapharyngeal space, and the infratemporal fossa. She was diagnosed to be DM by blood examination after admission to our clinic. Case 3 was 51-year-old male who had been suffering from DM for 20 years. His DM had been treated by diet and medication. The inflammation originated from the acute periodontitis of the left lower second molar, and it extended to the left submasseteric space, the submandibular space, and the sublingual space. It was suggested that in these patients the host defence system to bacterial infection had deteriorated because of the uncontrolled DM. Anaerobic bacterias were detected from case 1 and case 3. Anaerobic bacterial infection was also suggested in case 2 in terms of abscess formation in the deep soft tissue, gas formation, and the smell of the pus, although bacterias isolated were not anaerobics. It was considered that the prompt drainage, systemic antibiotic treatment, and the control of DIM by insulin treatment were necessary in such life-threatening severe infections. The physiologic differences in the defense systems of the diabetic versus the nondiabetic patients as well as the significance of anaerobic bacteria as a cause of odontogenic infection were discussed.
Malignant lymphoma occurs rarely in the oral cavity. We experienced a case of malignant lymphoma arising from the mandibular gingiva in 69-year-old man. His chief complaint was swelling on the gingiva of the right side molar region. At first, we suspected periostitis of the mandible, so we administrated anti-biotics. We palpated fluctuation at the region and incised, but it was solid tumor and not discharged pus. Histopathological examination found chronic inflammation of gingiva. After incision, the clinical course was bad, so we performed biopsy again. Histopathological examination indicated non-Hodgkin's lymphoma, diffuse large cell type. The tumor cell demonstrated B-cell type by PAP method. The immunologic study demonstrated IgM and kappa. Patient received chemotherapy with VCR and ADM. After 3 courses of therapy, the tumor disappeared.
Metastatic tumors in the oral region are relatively rare, being only 1-2% of the overall oral malignancy spectrum. Recently we experienced a case of maxillary carcinoma metastasized from the breast. A 52-year-old woman was referred to the Department of Oral Surgery of our hospital with the chief complaint of swelling in the right submandibular region. A radical mastectomy for breast carcinoma had been performed one year previously. Intraoral examination revealed a large soft tumor extending from the right maxillary molar alveolar ridge to the hard palate. Its surface was gray, irregular and bled on slight trauma. Roentgenogram showed destruction of the right molar alveolar ridge in the maxilla. Intraoral biopsy was performed and histologic features of this specimen were identical to those of the breast carcinoma. That the maxillary tumor had metastasized from breast carcinoma was suggested. In addition, we compared the phenotype of primary breast carcinoma with metastatic maxillary tumor by immunohistochernical and histochemical methods. In the immunohistochemical study, monoclonal antibody to human epithelial membrane antigen (EMA), to human lung adenocarcinoma (KM 93), and to human stomach adenocarcinoma (KNI 231) were applied. In the histochemical study, peanut agglutinin (PNA) was adopted. In consequence, there was a marked difference in a degree of positively stained tumor cells with regard to EMA and PNA staining. The finding suggested presence of tumor cells having highly metastatic potential in the primary tumor.
The effect of treatment with bismuth subnitrate (BSN) and fosfomycin (FOM) for prevention of renal toxicity of the cisplatin (CDDP) was examined in 41 head and neck cancer patients. Patients were classified into three groups: 1) Hydration group consisted of 20 patients who were treated by CDDP with hydration and mannitol. 2) BSN group consisted of 14 patients who were treated by CDDP and BSN with hydration and mannitol. 3) BSN·FOM group, consisted of 7 patients who were treated by CDDP, BSN and FOM with hydration and mannitol. Scrum BUN, creatinine and urinary NAG were abnormally high in hydration group, but almost normal in BSN and BSN·EFOM groups. No renal toxicity was shown in BSN and BSN·EFOM groups.