We sometimes perform the operation of the palate on the diabetic patients. The present study, therefore, investigates the wound healing of the palate in mice with diabetes and with diabetes injected with insulin. Methods and Results: Experiment I (Palatal mucoperiostium of the mice was removed): In normal mice, there were no remarkable changes at Days 1 and 2, but the epithelium started to cover the connective tissue of the wound edge at Day 4, and the wound was completely covered by the epithelium from Days 14 to 21. In diabetic mice, the epithelium started to cover the connective tissue of the wound edge at Day 7, but the wound was not completely covered by the epithelium at Day 28. In diabetic mice injected with insulin, findings of the wound healing were similar to those of normal mice. Experiment II (Palatal inucoperiosteal flap was raised and replaced immediately to the same position): In normal mice, the epithelium of the wound between the mucoperiosteal flaps was completely fused at Day 4, but in diabetic mice the healing was delayed until Day 14. In diabetic mice injected with insulin, healing of the wound was similar to that in normal mice. Results: The present study suggests that wound healing of the palate in diabetic mice injected with insulin is improved compared to non-diabetic mice and in diabetic patients, wound healing is dependent on the control of the hyperglycemia and the extent of the surgical interventions.
In order to examine the feasibility of adoptive immunotherapy by IL-2 activated killer cells (LAK cells) and rIL-2 in oral cancer patients, the induction of LAK cells in serum-free medium instead of human serum contained medium was studied. The following results were obtained. 1. The LAK cells induced in serum-free medium (LAK-SF cells) had as high cytotoxic activity against Raji and K562 cells as the LAK cells in human serum contained medium (LAK-S cells) 2. As the result of flow cytometric analysis, both LAK-SF and LAK-S cells expressed similar cell surface markers. 3. It was shown that transferrin was a significant factor and insulin worked as a suppressive factor to induce the LAK cells in serum-free medium. 4. It was revealed that cytotoxic activity of LAK-SF cells was higher than that of LAK-S cells against head and neck carcinoma cell lines. As a result of the foregoing studies, the LAK cells induced in serum-free medium could be applied to adoptive immunotherapy in oral cancer patients.
Histology and brief clinical data in 500 oral tumor cases were reviewed and compared to those reported from Japanese and western institutes: they were admitted to the Department of Oral and Maxillofacial Surgery, Nara Medical University during 1981-1990. The lesions were divided into 3 groups: non-odontogenic tumors (450 cases, 90%), odontogenic tumors (24 cases, 4.8%), and major salivary gland tumors (11 cases. 2.2%). Four hundred and fifty cases of non-odontogenic tumors were classified as non-neoplasia (46%), malignant (28%) and benign (14%) neoplasias, and dysplastic epithelium (11%). Male to female ratio and mean age in cases with non-neoplastic lesions, benign tumors, dysplastic epithelium, and malignant tumors was 1: 1.9 and 49 years, 1: 1.5 and 39 years, 1.1 and 61 years, and 1.8: 1 and 63 years, respectively. Tongue was the most frequent site for cancers (32% of all cases) followed by floor of the mouth (15.4%), gingiva (14.5%), and maxillary sinus (12. 8%). Sites of epithelial dysplasia were tongue (65%), cheek mucosa (18%, ), gingiva (8%) and so on. The results of present study at Nara review of literature suggested that no remarkable differences were present in sex ratio, age, site of lesions, and histologic types among oral tumor cases in Japan and Western countries.
The authors wish to report on two clinical cases of Kabuki make-up syndrome, together with some bibliographical comments. The clinical features of these cases were characterized by maldevelopment, stunted skeletal development, peculiar face, fingertip pads and cleft palate. Case No.2 was infected with cytomegalo-virus two months after birth. At the same time his mother also showed positive reaction of IgM antibody of cytomegalo-virus. Therefore, it was doubtful that congenital infection by cytomegalo-virus are present in case No.2. It is assumed that the infection of cytomegalo-virus exerted any influence on the possibility of cause of Kabuki make-up syndrome in case 2.
The malignant progression of oral leukoplakia has been sometimes reported. In this report, a man with leukoplakia on his buccal mucosa, which was treated with, cryotherapy but later showed a transformed squamous cell carcioma on the same region, was presented. A 55-year-old man visited our clinic with an extended white lesion on his right buccal mucosa. From the biopsied specimen this lesion was diagnosed as leukoplakia. At first cryotherpy was given but a small lesion remained. Nine years after therapy, an oral squamous cell carcinoma was proven from the biopsy of this lesion. Cryotherapy was inure frequently used from 1970 to 1980s. This case suggested that cryotherapy for oral leukoplakia must be applied more carefully, especially when the lesion is large, and needs a long term follow up.
The relationship between initial radiographic features and prognosis in 38 patients with squamous cell carcinoma of the lower gingiva treated at the Department of Oral and Maxillofacial Surgery at Kyoto University Hospital during the period from 1973 to 1986 was investigated. Radiographs were first divided into two groups with or without bone resorption. Those showing resorptions were classified according to the mode of resorption as erosive type or invasive type and these were further divided, according to the range of resorption, into those in which the tumor did not extend into the mandibular canal (A range) and those in which it did (13 range). Kaplan-Meier 5-year survival rates were calculated in each group. 26 (68.4%) of the cases showed bone resorption radiographically, of which 16 (61.5%) were of invasive type and 10 (38.5%) were of erosive type. 18 cases (69.2%) were A range and 8 (30.8%) wereB range. Of the 18 A range radiographs, the number of invasive type was almost equal to that of erosive type, but in B range, the invasive type showed a preponderance. The 5-year survival rate of patients whose initial radiographs showed no bone resorption was 66.7%, while it was 29.8% where radiographs revealed hone resorption. There was a significant difference (P<0.01) in the 5-year survival rate between patients of invasive type (0%) and those of erosive type (67.5%). These results suggested that there was a significant relationship between the mode of bone resorption and the clinical course in patients with a squamous cell carcinoma of the lower gingiva.
We analyzed chnicostatistically 307 cases (3.9%) which were diagnosed as having a salivary gland lesion at our department during 6 year and 2 month period from the establishment of our department in October 1986 to the end of 1987. New patients totaled 7, 782 during that period. Results: Malformation numbered 4 cases and distured salivary secretion was seen in 42, of which 37 cases complained of dry mouth, and 5 others, of hypersecretion. Sialosis numbered 8 cases, while trauma was only one. Retention cyst numbered 130 cases, 42.4% of the total patients. Mucous cyst numbered 90 cases and renula 40. Sialolithiasis numbered 47 including only one case of parotid sialolithiasis. There were 32 patients with sialoadenitis, of which 27 were parotitis. There were 20 patients with lympho-epithelial lewsion, of which 18 had Sjögren's disease. Salivary gland tUlnOrti MIMbrI-CCI 23 cases, of which 17 were benign tumors and 6 were malignant tumors. By site 10 cases were in the parotid gland, 7 in the palate and others. Histopathologically, pleornorphic adenoma numbered 12 cases, monomorphic adenoma 2 and others. On the other hand, as for malignant tumors, pleomorphic adenoma was found in 2 cases and others in 4.
A 19-year-old man was successfully treated by total glosscctomy for squamous cell carcinoma on the right margin of the tongue. A pectoralis major musculocutancous flap and deltopectoral flap were used to cover that oral cavity and the orophynx reconstructed area. Right radical neck dissection and left supraomohyoid neck dissection were performed, which histologically revealed no lymphnode metastasis. The primary lesion was treated by surgery and was well controlled, but a cervical lymphnode metastasis was found one year later (left side). CT-scan, echography and angiography showed that the metastatic cervical tumor surrounded the internal jugular vein and invaded into the wall of the internal jugular vein. Angiography especially showed a decreased blood flow. The histological diagnosis was made by fine needle aspiration. The reconstructive surgery was performed by transplanting the great saphenous vein after removal of the metastatic tumor and the internal jugular vein. Angiography especially showed a decreased blood flow. The histological diagnosis was made by fine needle aspiration. The reconstructive surgery was performed by transplanting the great saphenous vein after removal of the metastatic tumor and the internal jugular vein.
A papillary adenocarcinoma with metastasis occurred in a 68-year old man. The neoplasma arose on the left apex of the tongue and metastasized to both neck lymph nodes. A partial glossectomy, marginal resection of the mandible and total neck dissection of both sides of the neck were performed. Histopathologic examination showed that the tumor was papillary adenocarcinoma, which invaded into deep muscle tissues and adjacent minor salivary glands but not in to the sublingual gland. In addition, metastatic papillary adenocarcinoma of 10 lymph nodes in the remaining 26 left cervical lymph nodes and 1 lymp node in the remaining 16 right cervical lymph nodes were observed. To clarify whether papillary adenocarcinoma of the tongue originated in the minor salivary gland or cc topic thyroid gland the immunohistochemical method was applied with the result that amylase (salivary type) was positive but thyroglobulin was negative. TI use results including clinical manifestation indicated that tumor originated in the minor salivary gland.
We reported a 72-year-old man developed a malignant clear cell hidradenoma of the cheek. One year ago, the tumor was rice grainsized, but in a few months the tumor grew rapidly. It was treated by resection but recurred soon thereafter. The lesion distended capillary and red-dish colored with ulceration in the center part. The tumor invaded from the skin into the subcutaneous tissue, showing big and small tubular as well as cystic stractures. The tumor was consisted mainly of clear cells. Therefore, the diagnosis of clear cell hidradenoma was made. We report a case of malignant clear cell hidradenoma and a review of the literatureconcerned.
A 24-year old male complaining of teeth mobility without pain was admitted. Dental radiography showed obvious irregular roots resorption and disappearance of lamina dura. His early, history radiography findings and blood examination showed that the cause was renal osteodystrophy. This was the first report of renal osteodystrophy with teeth roots resorption in the world.
Pleomorphic adenoma is the most common salivary gland tumor. This tumor is most frequently seen in the parotid gland. Two cases of recurrent pleomorphic adenoma in the parotid gland, which occurred in sisters, are reported. Ramsay-Hunt syndrome was complicated with the tumor in one case. Case 1: A 75-year-old female patient, complained of the right facial palsy with herpes zoster in the oral cavity and auricle, and a recurrent tumor in the right parotid gland. The mass was well-demarcated and movable. After many investigations, the clinical diagnosis was a recurrent tumor of the parotid gland with Ramsay-Hunt syndrome. She was treated with intravenous administration of adenine arabinoside and stellate ganglion block. Under general anesthesia, the tumor was resected by superficial parotidectomy, and the exposed facial nerve was covered with a sternomastoid muscular flap to prevent Frey syndrome which often occurs after this kind of operation. Case 2: A 61-year-old female patient, a sister of case 1, complained of a recurrent tumor in the left parotid gland. The mass was multiple and adhered to the covered skin. After many investigations, the clinical diagnosis was a recurrent tumor of the parotid gland. Under general anesthesia, the tumor was resected by superficial parotidectomy together with removal of the covered skin, and the exposed facial nerve was covered with a sternomastoid muscular flap. The skin defect was treated with a splint thickness skin graft. After surgery, the patients showed no facial palsy and no evidence of tumor recurrence. We usually classify pleomorphic adenoma into four subclasses. One case presented in this article was of myxomatous type, and the other of intermediate type. Recurrent pleomorphic adenoma of the parotid gland which occurred in the same family has not been reported to our knowledge. No case of primary or recurrent pleomorphic adenoma complicated with Ramsay-Hunt syndrome has also been reported.
This paper reported a very rare case of malignant schwannoma which probably arose from small branch of the inferior alveolar nerve. The 73-year-old woman patient had felt occasional spontaneous pain in the mandible right side for 4 years. Bony swelling with oppressive pain was observed in mandible right premolar and molar regions. Roentgenogram revealed a larger than hen egg-sized radiolucent lesion with reticular radiopaque appearance in mandible right side which was suspected myxoma. The patient was treated by segmental resection of the mandible. Postoperative pathological diagnosis was malignant schwannoma because part of the tumor cells showed atypism, mitosis and infiltration out of cortical bone. Tumor cells were immunohistochemically positive for S-100 protein. There was no evidence of recurrence and metastasis in the patient 5 years and 4 monthsafter operation. It was suggested that the tumor had low grade malignancy in this case.
The wall of radicular cysts is usually composed of non-keratinized squamous epithelium derived from an inflammatory event in the periapical region. The incidence of ciliated epithelium in radicular cysts is extremely rare and the origin of cyst epithelium is still obscure. We have experienced a case (45-year-old male patient) of mandibular radicular cyst lined with ciliated epithelium including mucous cells and a keratin immunohistochemistry using monoclonal antibodies, PKK1, KL1, K8. 12 and K4. 62, was performed in order to analyze the etiology and the origin of cyst epithelium. The cyst wall was divided into 3 categories histopathologically, Type 1; cyst epithelium with mucous cells, Type 2; desquamated cyst epithelium and Type 3; ciliated cyst epithelium. Three monoclonal antibodies, PKK1, KL1 and K4. 62, revealed a negative reaction in the basal cell layer of all cyst walls but K8. 12 showed a weak reaction. In addition, K8. 12 and K4. 62 reacted strongly with intermeditaed cell and superficial cell layers in all types. PKK1 and KL1 gave a negative or very weak staining in the same region. There are strong reactions of KL1 and K8. 12 and weak of PKK1 and K4. 62 in desquamated cells of type 2. A characteristic staining pattern of ciliated cells in type 3 implicated that KL1 and PKK1 reacted positively and K8. 12 and K4. 62 negatively. It is suggested that the cyst lining epithelium is derived from glandular metaplasia based on the results of keratin staining and a high proportion of type 1 among all cyst walls. However, we could not deny that the cyst epithelium of dental origin differentiated into three different cell types including desquamated cell with a strong tendency of stratification.
In arthroscopic procedure, there are several methods to approach into the superior joint cavity of TMJ. However, it is difficult to obtain total vision of the superior joint cavity by a single approach. Here, we present a supero-mid-lateral approach by which almost all of the supeior joint cavity can be visualized. In this technique the point of insersion of trocar is perpendicular to the skin and at the highest point of lateral aspect of mandibular fossa. Arthroscope can be moved along the transverse axis of both the anterior and posterior synovial pouch, and longitudinally along the lateral discal groove in the superior joint cavity. This approach was applied in 24 joints of 15 closed-lock cases. Anterior displacement of the disk was observed in all 24 joints. Among these there were antero-medial disk rotation in 19 joints and antero-lateral in one joint. Disk adhesions were observed in 24 joints at lateral area, 23 joints at anterior synovial pouch, 11 joints at medial area and 4 joints at posterior synovial pouch. Nineteen perforations were observed in 18 joints of 11 cases. Sixteen of these perforations were in the lateral aspect of the disk and the remaining three were in posterior and medial aspects. The results of the presented cases suggest that the supero-mid-lateral approach is highly effective in tempromandibular joint arthroscopy.
Four hundred and eight patients with arthrosis of the TM J, who visited our clinic from January, 1987 to December, 1989 were classified into 5 types based on a newclassification proposal advocated by the Japanese Society of Temporomandibular Joint in 1986. The patients consisted of 93 males and 315 females in the ratio of 1: 3. 4. Fifty-eight cases (14.2%) were classified into type I, 21 (5.1%) in type II, 263 (64.5%) in type III. 53 (13.0%) in type IV, 5 (1.2%) in others type and 8 (2.0%) were unclassified. In type III, 136 (33.4%) cases had an anterior disc displacement with reduction 103 (25.2%) had an anterior disc displacement without reduction, and 24 (5.9%) had an intermittent closed lock. The sex ratio by type was 1: 3.5 in type I, 4.3: 1 in type II, 1: 4.0 in type III, and 1: 6.6 in type IV The average age was 38.1 years old in type I, 41.7 in type II, 32.0 in type 11, and 54.6 in type IV. The average age was the lowest in patients with intermittent closed lock and the highest in type IV. Even the cases of types II, III, IV frequently accompanied a pain at the masticatory muscies. The patients diagnosed as type II showed male predominance and a relatively acute course in their histories. According to arthrographic examinations performed on patients who complained of painful masticatory muscles alone and whose maximal interincisal distance was more than 40mm, it was revealed that these patients belonged to anterior disc displacement without reduction. The differentiation from type I was sometimes difficult only by clinical findings in such cases. The cases of which bone changes of the TMJ are not so rcmarkable and the discs are displaced, could not be clearly determined as either type III or type IV. The judgment of type II was most difficult because of its pain characters being the sole determinant. The 4 cases classified into others type showed morphologic changes in the disc, such as perforation or adhesion, although disc displacement was not identified. Although it is not easy to classify all of the cases only by their clinical symptoms, it is thought that the new classification proposal fundamentally has an advantage of simplifying the complicated etiology of arthrosis of the TMJ.
There are very few papers showing clear dental findings in progressive facial hemiatrophy. A case of progressive facial hemiatrophy of the right side with a number of dental abnormalities in a 10-year-old girl is reported. There were no systemic abnormalities. Atrophy was noted only on the right side of the face including skin, subcutaneous tissue, muscles and bones. The tip of the nose and the philtrum were deviated to the right. The mouth angle of the suffering side was lifted. The lower jaw was shifted to the right. The dental arch was asymmetric and the palate in the suffering side was deeper than in the opposite side. The right side of the occlusal plane was inclined and the right premolars were out of occlusion. 87 were missing congenitally, the eruption of 7 was delayed and its roots was curved. All crowns and roots of the teeth in the right side were smaller than in the opposite side. The amount of salivary flow from the right submandibular gland was one fourth of the left gland although the sialographical examination did not show any atrophy of the salivary gland.
The CT findings of 42 patients with surgically verified benign lesions of the maxillary sinus were evaluated to demonstrate the value of Cl. Comparison with conventional radiologial methods was made. 1. The opacification of the maxillary sinus lumen in Waters view shows the relationship in proportion to the soft tissue that occupies the sinus in CT finding. 2. The thickening in the posterior wall of the maxillary antra may cause the opacification in Waters view. 3. The Waters view can depict rnore significantly the maxillary soft tissue in CT finding than the Caldwell view and panoramic view. 4. CT is of value in demonstration of fluid level, mucosal swelling, mucosal thickening and the thickening of the bony walls.
Although treatment progress has substantially decreased incidence of tetanus, once aperson develops this disease, fatality is very frequent owing to diagnostic difficulty. Reported herein is a case of tetanus with the chief complaint of trismus that our department encountered. Patient was a 43-year-old male. On December 30, 1989 in Ichihara City, Chiba Prefecture he had a severe fall. He was brought to the surgical department of a hospital because of left ear contusion and received emergency treatment. Speech disturbance appeared around January 9, 1990 and tnismus the next day. Patient recognized general malaise around January 16. He went to the neurosurgery and internal medicine departments of near by hospitals during this period, but case etiology remained unknowl. On January 17, he came to the department of neurosurgery of this university. Hey diagnosed facial palsy and sent him to our department for examinaton. Clinical manifestations on the first physical examination were definite trismus, cervical and back pains, left auricle contusion, and tetanica face (i.e., risus sardonicus). According to his history of trauma and clinical progression, we diagnosed tetanus. We ran a germiculture examination with the effusion obtained from the contused part of his left ear and applied a topical treatment.(Clostridium butyricum was later detected). After his admission to this department, we began treating him with tetanus immune human globulin, antibiotics, anticonvulsants, relaxants, neuroleptics and the like. Because of the possibility of respiratory muscle palsy, on the third clay after hospitalization, he was transferred to anesthesiology's department intensive care unit (ICU) and the department of neurology and was successfully treated. Tetanus is a disease with a high fatality rate. Thus, correct diagnosis and treatment in the early stage is necessary. Tetanus patients show trismus symptoms in the course of disease progress and sometimes seek treatment at dentistry and oral surgery departments. Therefore familiarity with the clinical symptoms of these cases and cooperative treatment with related departments are essential to effective treatment.