In this study, we examined the antitumor effect of a biological response modifier in relation to the induction of tumor necrosis factor (TNF).
Lingual carcinoma was induced in hamsters by a local application of DMBA. The animals were divided into treated and non-treated groups where in the former received an intravenous injection of LPS or OK-432 and the latter was left as controls. All animals were further classified according to the growth pattern of lingual carcinoma, either external or internal growth. The preventive rate of tumor growth for external carcinoma was examined and the survival rate of the animals with internal carcinoma was examined.
After LPS was injected into hamsters, and when a high titer of TNF was induced in the peripheral blood, lingual carcinoma was remarkably reduced. After OK-432 was injected, and when a very low titer of TNF was induced, lingual carcinoma was hardly reduced and practically remained unchanged.
The survival rate of both treated animals was significantly longer than that of the nontreated ones.
These results indicate that TNF plays an important role in reducing the tumor volume of external lingual carcinoma in hamsters. Furthermore, it was assumed that the reduction of tumor volume and prolongation of survival rate were of different action mechanisms.

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In this study, decalcified freeze-dried allografts (DFs) were transplanted into the extracted sockets in rats. New bone formation and microvascular changes during the healing process were investigated.
DFs were prepared according to the method described by Huggins et al. Bilateral upper first molars of 6-week-old rats were extracted. DFs were transplanted into the right sockets and surved as the experimental group and the left side sockets were left intact as the control group. The rats were killed at 3, 7, 10 days and 2, 3, 4 weeks postoperatively. Serial histological sections were stained with hematoxylin and eosin for light microscopy, and microvascular casts were made according to Ohta's method for scanning electron microscopic (SEM) observation.
Control group: On and after 3 days postoperatively, new bone formation initiated in the fundus of the sockets. The entire sockets were filled with a new bone up to 2 weeks and bone remodeling occurred in the fundus of sockets thereafter. In 4 weeks, a lamella-like bone structure was formed in the socket openings with a marrow observed in the fundus of the sockets. Resorption of buccal alveolar crests was observed between 7 days and 3 weeks after operation. The surface of the new bone was flat and continuous to the buccal alveolar bone.
Experimental group: New bone formation was observed at the same time as the control group. In 3 days, collagen was removed from the surface and the crevice of DF, and in 10 days, DFs were resorbed into small units. In 2 weeks, DFs were surrounded with thus formed new bone, and gradually incorporated into the new bone by 4 weeks. The incorporation of DFs into the new bone was first observed in the fundus of the sockets, and then observed in the socket openings for a long time. Resorption of buccal alveolar crests was hardly observed.
When transplanted into the extracted sockets, DFs remained for 4 weeks and were incorporated into the new bone. And the new bone recovered the original level of the alveolar ridge. This result suggests that DF is useful for preventing the residual ridge reduction after extraction of teeth and is a valuable material in the clinical dentistry.

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The purpose of this study was to evaluate the application of hydroxylapatite implants (HA) with autogenous bone grafts for mandibular reconstruction. After autogenous iliac bone grafts were transplanted into rabbit mandibles, a HA was installed in the graft immediately (IM group), or 90 days (90 D group) or 180 days (180 D group) later. The animals were sacrificed 7, 14, 30, 60, 90 and 180 days after the HA installation. The healing processes were examined by a method, newly developed by us, of combining a hematoxylin-eosin staining with contact microradiography and fluorescense labeling of the same specimen, and the rate of HA-bone bonding was examined by bone morphometry.
In the IM group, the HA-bone bonding tended to be deterred by conective tissues, and the rate of HA-bone bonding was less than that of the control group (HA installed in the mandible). However, in the 90 D and 180 D groups the bonding capacity was approximately the same as in the control group. In the 180 D group, a trabecular bone around the implant was less than in the 90 D group. Therefore, the 90 D group had better conditions for effective HA-bone bonding.
From these results, it is concluded that in the clinical application of hydroxylapatite dental implants with autogenous bone grafts, the implantation should be performed not immediately after the bone graft, but before the trabecular bone resorption by advanced bone remodeling.

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After the mental nerve of mouse was amputated and left in a denervation state for 12 weeks, neurorrhaphy was performed. Then, the ultrastructural changes in the degeneration and regeneration processes of the sensory nerve endings (encapsulated corpuscles) distributed in the lower lip mucosa were evaluated over time up to the 24th week postoperatively, using a transmission electron microscope.
1. In the encapsulated corpuscles distributed in the lower lip mucosa of normal mouse, axon terminals were found at the center, surrounded by the inner core and further by the outer core. The external shape and internal structure were similar to those of Pacini corpuscle.
2. In the degeneration process of encapsulated corpuscles after amputation of the mental nerve, axon terminals disappeared on one day after amputation, and the inner core was observed with its central portion collapsed. Thereafter, lamellar cells of the inner core showed a gradual atrophic tendency. The lamellar gap expanded, and collagen microfibrils increased. In the 12th week after amputation, only a few cytoplasms were alive near the nuclei of lamellar cells. Further, the basement membrane covering the surroundings still maintained a condition almost similar to the original state. The outer core was slower in degeneration than the inner core but the process was the same.
3. When the mental nerve was re-sutured in the 12th week after amputation, regenerated fine axons were seen along the inner surface of the basement membrane, which remained in a lamellar shape in the 4th week after re-suture. In the lamellar cells, cytoplasms extended along the inner surface of the remaining basement membrane. In the 24th week after re-suture, the axons extending toward the center of corpuscle were as thick as normal cases. Both inner and outer core were regenerated with the structure closer to that of healthy cases, whereas most axons showed no entering into the central region but intruded inside the basement membrane of inner core on the peripheral region. The axons were not thick, and the formation of inner core was also imperfect.
4. When left in a denervation state for a long period, encapsulated corpuscles were in a state different from the preoperative status in most cases even when they were regenerated through neurorrhaphy. The results of the present study suggest that morphological changes in the receptor may be one of the major causes of incomplete sensory restoration.

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An 18-year-old man with unilateral hypertrophy of the masseter muscle is reported. The patient complained of a painless swelling on the left side of the face. On palpation, there was an evident asymmetry of the masseter muscles and remarkable hypertrophy of the left masseter muscle associated with deformity, and lateral deviation of the mandible was revealed by CT scans.
The lower and inner portion of the left masseter muscle was resected and the expanded portion of the lateral cortical plate was trimmed away by an intraoral approach. There was no complication except slight paresthesia of the left cheek skin. Postoperative CT scans showed that the asymmetry of the face and the mandible was greatly improved. The patient was satisfied with the result of surgical correction.

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This questionnaire survey was performed to evaluate the course after the surgical correction of the mandibular prognathism. The objects were 47 out of 70 patients who were treated by saggital ramus split osteotomy of the mandible. Especially, temporomandibular joint symptoms after surgical correction were examined with the conclusions as follows.
1. Disturbance of the temporomandibular joint before surgery was seen in 12 out of 47 patients. 7 patients in the 12 had no temporomandibular joint symptoms after surgery.
2. An oppressive pain of the temporomandibular joint after surgery was found in 5 out of 47 cases (10.6%).
3. Six patients had an opened mouth of 2 finger width after surgery (12.8%).
4. Six patients (12.8%) answered “It doesn't move as easily as before surgery” on the lateral movement of the mandible after surgery. Two patients (4.3%) answered “It doesn't move as easily as before surgery” on the anterior movement of the mandible after surgery.
5. Temporomandibular joint symptoms after surgery were found in 11 patients (23.4%) on the opening and closing movement, 13 patients (27.7%) on the lateral movement, 5 patients (10.6%) on the anterior movement of the mandible.
6. Ten out of sites were all dull painful, indicating a temporomandibular joint pain after surgery.
7. Four out of the 16 patients had a sound which a surrounding people could recognize well, indicating a temporomandibular joint sound after surgery.

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This article describes a case of the branchiogenic carcinoma arising in the submandibular region of a 52-year-old male. The patient was referred to us with a chief complaint of the submandibular swelling. The tumor was disclosed to be malignant by fine needle biopsy. As the tumor adhered to the basis of the mandible, it was resected including its surrounding normal tissues with a segmental resection of the mandible. The patient was given a postoperative radiation therapy. Although he was followed for 4 years uneventfully, metastatic lesions then appeared in the lungs, leading to his death.
A large cystic space was seen in the surgical specimen. The tumor which developed around the cystic space was histologically revealed to be a squamous cell carcinoma. Squamous epithelium remained in some places of the cystic surface and they continued to the tumor tissues. Lymphoid tissue was noted in the stroma of the tumor. From these histological findings, the case was diagnosed as branchiogenic carcinoma.

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Forty-two patients were diagnosed sugamous cell carcinoma of the lower alveolus and gingiva in our clinic during the five years between 1981 and 1985. Twenty-five out of these 42 patients were all previously untreated cases, and received a curative operation as initial therapy. Twenty-one patients (84%) out of these 25 patients were classified into Stage III or IV. Twenty-two patients underwent a segmental resection of the mandible and 3 patients operated by hemimandibulectomy. All twenty-five patients received simultaneously neck dissection.
Recurrence or metastases after initial treatment were found in 6 patient out of 25 patients Two out of these 6 patients had a recurrence in the primary sites alone. One of the 6 patients had a recurrence in the primary sites and neck region, one in the primary sites and distant metastases, and 2 distant metastases alone. We examined the direction of tumor invasion to the adjacent tissue for classification into four patterns. Three out of 4 patients who had a recurrence in the primary sites had a tumor extended to the buccal mucosa at the first visit. On the other hand, the patients whose tumor extended to the floor of the mouth at their first visit, showed no recurrence in their primary region after surgery.
Thirteen patients (52%) had histopathologically cervical metastases, and 12 patients (48%) had no metastases in the postoperative findings. Five out of 6 patients whose primary lesion extended to the buccal mucosa, had histopathologically positive lymph nodes. Nine out of 11 patients whose mandibular bone resorption was within the limit of alveolar crest showed pathologically positive lymph nodes, six out of 7 patients whose tumor invaded the mandibular canal showed pathologically negative lymph nodes. In four out of 13 patients who showed pathologically positive lymph nodes, metastases were observed in the level 3.
We would like to suggest that a segmental resection of the mandible or hemimandiblectomyshould be performed in all cases with total neck dissection, except those with a localizedsuperficial lesion without bone resorption of the mandible.

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One hundred and twenty four patients with squamous cell carcinoma of the oral region, who were treated during the period from April 1979 to December 1988 in our clinic, were included in this study. Six cases (4.8%), one female and 5 males, of them were proved to have multiple carcinomas of the oral mucosa. The age of them ranged from 52 to 70 years, and the average age was 58.3 years. Both initial and the second carcinomas of 5 cases arised in the gingiva, but one case in the tongue and soft palate. One of these 6 cases was confirmed to have synchronous multiple carcinomas, and the others metachronous. The period between the appearance of the initial carcinoma and that of the second one in patients who were histologically diagnosed metachronous ranged from 1 year and 8 months to 16 years and 6 months. The second carcinomas of 2 cases were considered to be a radiation induced carcinoma. The second carcinomas of other 2 cases were originated from the mucosal lesion as leukoplakia and lichen planus respectively. The initial carcinomas of 2 cases recurred, but none of the 6 cases metastasized. In contrast, the second and the third carcinomas of 5 cases recurred, and 3 cases metastasized to the cervical lymph-nodes. Ultimately 2 cases died of those nodal disease. The prognosis of the second carcinomas in these cases was worse than that of the initial carcinomas. It was considered that the result had a relation to the reduced immunological activity of these cases and increased torelance of carcinoma to chemotherapy and radiotherapy.

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The patient, 67-year-old female, was found to have a cervical lymph node metastasis after 12-year radiation therapy for the tongue cancer (T2N0M0, squamous cell carcinoma). Histological grading of malignancy (Jakobsson, 1973) of the primary tumor was a moderate type with marked cellular response. Radical neck dissection was performed and examined histologically. Metastasis was observed only in one lymph node and the paracorcical area of the lymph node revealed hypertrophy.
The patient has been followed for 1 year postoperatively. She is now free of the disease. A possible factor in the patient with a long-delayed metastasis is considered to he an “abscopal effect” following radiation therapy for the primary tumor using a radium needle (76.4Gy/168 hr.).
Additionally, late development of metastases of oral squamous cell carcinoma are discussed on the basis of data from our series.

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Clinical evaluation of the mini-splint therapy for TMJ dysfunction, particularly for internal derangement, was presented.
38 patients with internal derangement of TMJ were treated with mini-splints. The appliance was built on the upper first premolar, on the side of which was indicated a dislocation of the disc, unilaterally or bilaterally. But it was also built on the upper first molar to pull down the condyle.
28 patients (84.8%) felt painless postoperatively, 15 patients (55.6%) had no sounds of TMJ. The maximal incisal opening increased from 32.3mm to 43.0mm. 17 patients with closed lock had a preoperative maximal incisal opening of 24.1mm and a postoperative one of 40.1mm.
The mini-splint therapy was a usefull technique for internal derangement of TMJ.

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One hundred and four immediate reconstructions for major orofacial defects following oral cancer surgery were performed in 103 patients using 115 various cutaneous and myocutaneous flaps during the 10-year period from 1979 to 1989. A retrospective analysis of the cases was carried out and the treatment result was presented.
Reconstructive cutaneous or myocutaneous flaps were composed of pectorals major myocutaneous flap (PMMC) in 68 cases, latissimus dorsi myocutaneous flap (LDMC) in 19 cases, free radial forearm flap (FA) in 10 cases, deltopectoral flap (DP) in 10 cases, and other miscellaneous flaps in 8 cases. Near the half of the cases had a tongue cancer followed by cancers of the lower alveolus and gingiva, floor of the mouth, buccal mucosa and so on. Ninety-nine cases had squamous cell carcinomas. Seventy-seven cases were treated as primary treatment, whereas 27 cases were secondarily treated against recurrence after previous treatmentsincluding radiotherapy and/or surgery. TNM classification was also applied to recurrent cases at the time of reconstructive surgery, and 49 cases were classified into T4, 55 cases were N1 to N3, then 58.6% of the cases were Stage IV. The mean operation time of 104 cases was 10 hours and 16 minutes, and the average total blood loss was 3, 562 grams. Complete survival of the reconstructed flaps was obtained in about 60%, and 29% of the cases showed a minor loss, however, a major loss and total necrosis of the flap were observed in 10.4% and 1.7% respectively.
Recurrence of tumor at any sites of the body was observed in 48%. The recurrence rate was 43% in Stage II, 27% in Stage III and 57% in Stage IV. Recurrence after reconstructive surgery was observed in 29% in the primary sites, 34% in the regional cervical lymph nodal areas, and 17% as distant metastases. Ten years cummulative survival rate was 42.8% in total cases, 67.2% in Stage II, 61.9% in Stage III, and 27.6% in Stage IV by Kaplan-Meier's method. The cummulative survival rates in the primary treatment group for each stage were compared with those of control groups treated without immediate reconstructive sur-gery, disclosing no difference in Stage II, slightly higher in the reconstructive group for Stage III, and 12% higher in the same group for Stage IV. However, the difference was not statistically significant.

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Sharply defined, slightly elevated grayish membranous inflammatory lesions, so called plaques opalines, are usually considered to be a typical oral manifestation of secondary syphilis.
A case of secondary syphilis in a 25-year-old woman with prominent oral manifestation is presented.
All clinicians must pay more attention to the syphilitic lesion of the oral cavity that can appear with various signs during any stages of the disease.

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A 59-years-old male patient with mandibular prognathism and anterior open bite was reported. The patient could not have meal without his overdenture during the past 40 years. He was treated by sagittal splitting osteotomy of the mandibular rumus (Obwegeser-Dal Pont method), and he was obliged to have a second operation due to infection of the right surgical wound of the mandible. He got a good occlusion without any trouble after the two operation. It was concluded that elder patients with prognathism should be treated by Obwegeser's original method instead of Obwegeser-Dal Pont method because of decrease of blood circulation in the mandible of aged persons.

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A case of calcifying odontogenic eyst associated with a complex odontoma which appeared in the mandible of a 28-year-old Japanese woman, was reported. Radiographically, this lesion showed a multilocular radiolucent area with an odontoma-like radiopaque mass and resorption of the tooth root. Histopathologic examination revealed the presence of ghost epithelial cells, calcified tissues and structures characteristic of complex odontoma. After surgical removal of the cyst, the wound healed uneventfully and the lesion is now free of symptoms 7 years after operation.

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Clinical examination was performed in 20 cases of malignant melanoma in the oralregion encountered in the First Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tokyo Medical and Dental University during the 20-year period from 1970 to 1989. The following results were obtained;
1. The incidence of malignant melanoma in the oral region was not different between sexes. The tumor was observed mostly in the maxilla and palate.
2. From the macroscopic findings the tumors were classified into 5 types as follows; 1) Black nodule type, 2) Non-pigmented nodule type, 3) Radial growth phase type, 4) Black mixed type, and 5) Non-pigmented mixed type. The clinical course of the non-pigmented nodule type was relatively bad, while that of the radial growth phase type was good.
3. The clinical course of malignant melanoma in the oral region was generally worse than those of oral squamous cell carcinoma and salivary gland carcinoma. Radiotherapy seemed to be effective in prolonging the life of these patients.

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Follicular dental cyst associated with odontoma is relatively rare. We encountered an 84-year-male with a follicular dental cyst associated with odontoma in the right mandible. The cyst included the crown of an impacted tooth (2).
The odontoma was classified as compound odontoma. The cyst and odontoma were removed under local anesthesia. The postoperative course was uneventful. In the infrared spectroanalysis, it was suggested that calcification of the odontoma was less than that of the impacted tooth.

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Atypical mycobacteriosis means the infection of nontuberuculous mycobacteria, and it is a rare disease in the head and neck regions. Since the clinical and histopathologic features of this disease are similar to those of tuberuculosis, a bacterial examination to identify the causative organism is essential. A case of atypical mycobacteriosis which appeared in the left buccal area and was diagnosed by bacterial isolation is reported.
An 8-year-old boy visited our hospital for evaluation of the left buccal and submandibular swelling. On examination, no dental caries was found in the left mandibular teeth and hematologic and radiologic examinations revealed leukocytosis and the presence of a radiolucent area at the apex of CD. The swelling was thought to be related to the abscessed mandibular molars, and extraction of CD was performed. However, there was no decrease in the swelling. One month after tooth extraction, intracutaneous reaction with PPD revealed a positive conversion, and biopsy materials were taken from the buccal and submandibular lesions. Sections of the materials showed features of a granulomatous inflammation of lymphnodes. Scattered epitheloid cells and giant cells of Langerhans type as well as lymphocytic infiltration suggestive of tuberuculosis were seen. Mycobacterium fortuitum clasified into Group IV of nontuberuculous mycobacteria was isolated from the pus obtained from the buccal lesion.
Based on these findings, a diagnosis of atypical mycobacteriosis was established. The patient was treated with antituberuculous agents including rifampicin and isoniazid. In spite of this treatment, another subcutaneous lesin appeared in the left arm and was surgically excised. Drug the rapy was continued for additional six months. The patient has remained free of disease for about two years after the second surgical treatment.

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