Fourty-nine patients with secondary hyperparathyroidism (2°HPT) were studied on the panoramic radiograph index (PRI) in comparison with two indexes judged by dental films and other data before parathyroidectomy.Intensity of 99mTc-MDP accumulation was represented by using a quantitative method of bone-to-soft tissue uptake ratio (B/St ratio) on calvaria, mandible and L3.Twenty-three patients of these patients were evaluated using bonescintigraphy as well. PRI was correlative with two roentgenographic indexes of dental film, roentgenographic changes of hand, serum alkaline phosphatase (Al-P) and intact PTH, but not with c-PTH and m-PTH. B/St ratio on mandible, calvaria and L3 were respectively correlative with PRI, Al-P, index of hand and intact PTH. These results indicate that renal osteodystrophy (ROD) relatively causes the changes of not only lamina dura but also maxilla and mandible on X-ray, and PRI and B/St ratio of mandible are useful for evaluation of ROD, in patients with 2°HPT.
Four cases of pituitary hormone deficiency with cleft defects of the lip and palate were reported. In all cases, we noticed the small premaxilla, but there was no cerebral anomaly such as holoprosencephaly.The present report suggests the small premaxilla is a sign of the pituitary hormone deficiency in cleft lip and palate children.This clinical feature would be useful for diagnosis of the pituitary hormone deficiency.
Measurement of DNA content has been one of the most useful aids for the diagnosis of nuclear atypia or malignancy in carcinoma.In order to improve the cytologic diagnosis of oral cancer, the DNA distribution study was added to the DNA content study with autoscanning microphotometric measurement.The exfoliated cells from normal oral epithelium (NOR: normal) of 40 cases, leukoplakia (PRE: precancerous lesion) of 7 cases, and squamous cell carcinoma in oral cavity (MAL: malignant) of 54 cases were dyed with Feulgen staining and examined.The DNA distribution was analyzed with digital image processing.The new parameter “Density Score” was defined from the computing contour lines of DNA density with the computer program that originated in this study. The following results were obtained. 1.The DNA content, the maximum DNA density, the mean DNA density, the total measured points of a nuclear region and the nuclear diameter (short and long) were the highest in MAL. 2.Density scores were the highest in MAL, and had a tendency to be higher in PRE than in NOR. 3.The increase of density scores in MAL corresponded to DNA ploidy (diploid, hyperdiploid, and aneuploid) of DNA histogram pattern. Owing to the meausrements of both distribution and content of nuclear DNA, this study proved that the cytologic diagnosis of oral cancer would be improved, and then the rate of misdiagnosis would be reduced.
Evaluation of the osteoinductive potential has been mainly performed by the bone morphometric method or contact microradiogram.However, these methods are much coninlicated and require a long time to prepare the samples.Then, to evaluated the osteoinductive potential of demineralized bone matrix the author used dual energy X-ray absorptiometry which was possible to analyze in situ mineral contents. The pellets about 2 mm thick and 5 mm in diameter of demineralized bone matrix were prepared by collecting tibial diaphyses from 4 and 5 week-old rabbits, and followed by treating them with 0.5N HCl.Two bone defects were made in the center of the tibia of rabbits weighting 3.5 to 4 kg under intravenous anesthesia.Mesial defects were filled with demineralized bone matrix pellets (DB group), and the others were only bone defects (BC group). The bone density of the block including the bone defects was measured at 1, 2, 3, and 4 weeks nostoperatively.Using a Hologic QDR 1000, the amount of bone mineral density (BMD, g/cm2) was measured by scanning in four equal parts about 30mm in length, 10mm mesially from the distal end of the tibia, utilizing the program for the lumber spine.A cornnarison was made with the adjacent site to the bone defect as a control. Tn the first week, BMD showed low values in both DB and BC groups.In the 2nd week, BMD was higher in both groups than that of the first week, but the increase in the DB group was significant when compared with that in the BC group.In the 4th week, BMD in the DB group was similar to that of the control site.From the results of bone density measurements, dual energy X-ray absorptiometry is thought to be usetul in the evaluation of bone induction experiments.
This paper describes a method for determining the displacement of bone segments under application of a static load to evaluate the stability of the fractured mandible fixed with titanium miniplates. 1.In single miniplate fixation of linear-shaped acrylic resin models, fixation with a4-hole lona miniplate at either the upper or lower 1/3 area gave better resistance to displacement than fixation with a 4-hole regular miniplate. 2.In single miniplate fixation of linear-shaped acrylic resin models, fixation with a 4-hole regular miniplate at either the upper or lower 1/3 area had no affect on the displacement. 3.In single miniplate fixation of linear-shaped acrylic resin models, fixation with a 4-hole long miniplate at either the upper or lower 1/3 area also had no affect on the displacement. 4.Fixation with two miniplates yielded more resistance to displacement than fixation with one miniplate in both the linear-shaped and U-shaped acrylic resin models. 5.In simulatory osteosynthesis in the body region with one miniplate, the largest displacement was recorded by fixation at the upper 1/3 area with a 4-hole regular miniplate. However, large displacement was recorded by the other modes of single miniplate fixation. 6.In simulatory osteosynthesis at the median region with one miniplate, the displacement was smallest by fixation at the lower 1/3 area with a 4-hole regular miniplate.However, large displacement was recorded by the other modes of single miniplate fixation. 7.In simulatory osteosynthesis with two miniplates at either the body or the median region, the displacement was small and showed no difference by any mode of fixation.The displacement was smallest especially by fixation with two 4-hole regular miniplates. 8.In simulatory osteosynthesis at either the body or the median region, fixation with two miniplates resulted in smaller displacement, compared to fixation with one miniplate.
Although many investigations for pathogenesis of temporomandibular joint (TMJ) disorders have been made by biochemical and histochemical methods, it has not been elucidated completely. In the present study, a preliminary examination was made concerning localization on some of proteoglycans (PGs), glycosaminoglycans (GAGs) and tenascin a glycoprotein in the articular disc of human adult TMJ immunohistochemically.The fresh materials of the normal articular discs were obtained from 3 adult cadavers within 48 hours of mortality.The 9A2, 3B3, 1B5, CS56, 6B6, 2B1, 5D4 and anti-tenascin antibody were utilized as primary antibodies by the indirect immunohistochemical method. As a result, we found the following three points. Firstly, chondroitin 6-sulfate and keratin sulfate were localized intensively in the articular disc, whereas, chondroitin 4-sulfate could not be detected in the disc. Secondly, small DS-PGI were recognized intensively not only in the articular disc but also in the retrodiscal fat pad, which were stronger than small DS-PG II. Thirdly, large PG could not be observed except on the vessel wall of capillaries in the retrodiscal fat pad.tenascin was identified at perineurium and some parts of synovial membran on the inferior cavity of TMJ. We concluded that the toughness and flexibility of the articular disc against loading might be attributable to the above-mentioned structure of the reasonably composed extracellular matrix (ECM).
Localization of involucrin and epithelial membrane antigen (EMA) in the lining epithelium of 32 jaw cysts (13 radicular cysts, 2 dentigerous cysts, 3 nasopalatine duct cysts, 6 odontogenic keratocysts and 8 inflammatory cysts of unknown origin) was studied with the aid of immunohistochemistry. In radicular cysts and inflammatory cysts, EMA gave a suprabasal staining and involucrin stained only in acanthomatous area where EMA stained negatively.In contrast, the epithelial lining of odontogenic keratocysts reacted with involucrin, but did not react with EMA. The staining pattern of odontogenic keratocysts for involucrin remained unchanged even in the presence of secondary inflammation, indicating that the involucrin staining would be a useful marker for the diagnosis of odontogenic keratocysts.Nasopalatine duct cysts and dentigerous cysts were negative for both stainings unless infected.Positive staining for EMA may be correlated with inflammation.The origin of inflammatory cysts could not be identified by the staining pattern of involucrin or EMA.
To ascertain influences of cancer treatments on cellular immunity and also to study whether cellular immunoreactivity has a relation with lymph node metastasis or T stage, parameters such as lymphocyte subset proportions, T cell blastogenesis and nonspecific cytotoxicities were investigated on peripheral blood from 70 patients with head and neck carcinoma. Originally, blastogenesis and LAK activity were inferior compared to those in the healthy controls, however other parameters were within each normal range.T stage and lymph node metastasis did not bring any difference except for lowered blastogenesis in T3 and T4. After treatments, CD4+Leu8+ cells decreased, and proportions of CD8+Leu8+, CD16+CD57- and CD16-CD57+ cells contrarily increased.Further, blastogenesis in all T stages and LAK activity in advanced T stages were significantly suppressed by treatments while NK activity was scarcely suppressed. The above changes were stronger in advanced tumor (T3 and T4) cases who received more induction therapies than early stage (Ti and T2) cases.These results indicate that lymph node metastasis does not bring any visible change of the usual immunologic parameters, and that T cells especially CD4+Leu8+ cells are very sensitive, and LAK activity is suppressed in the pathologic condition, however NK cells are resistant to cancer treatments.Moreover, bothCD16-CD57+andCD4+Leu8+ cell populations seem to be useful markers in detection of cellular immunosuppression associated with cancer treatments because the former increased having a correlation with tumor death and the latter decreased exhibiting a reverse correlation with the increase of the former.
By using a silver staining technique, nucleolar organizer regions associated protein (Ag-NORs) ha ve been studied in paraffin sections of oral squamous cell carcinomas, benign lesions, such as leukoplakia and papilloma, and normal oral mucosa.The mean numbers of Ag-NORs were: squamous cell carcinoma (n=19), 6.18±1.84;papilloma (n=9), 2.70±0.50; leukoplakia (n=10), 2.92±0.69;normal oral mucosa (n=4), 2.48±0.13.There was a significant difference in the mean number of Ag-NORs between squamous cell carcinoma and the other two groups (P>0.05).The number of Ag-NORs seemed to have relations to the cellular atypism of squamous cell carcinoma and the grade of epithelial dysplasia of leukoplakia.These findings suggest that quantification of Ag-NORs may be used for differential diagnosis of malignant and benign oral tumors, and estimation of proliferative activity of oral preneoplastic and neoplastic lesions.
Innervation of carcinomas induced by application of 9, 10-dimethy1-1, 2-benzanthracene (DMBA) was investigated in the hamster tongue by using immunohistochemistry concerning neurofilament protein (NFP) and glia specific S-100 protein. The tumor induced by application of DMBA was a well-differentiated squamous cell carcinoma having cord-like invasion of the underlying fibrcus tissue and muscle layer. The characteristic feature of the innervation was the extreme scarcity of NFP-and S-100 pro tein-immunopositive neural elements recognized in the stroma and around blood vessels of the carcinomas. A few NFP-positive neural elements which were observed in the carcinoma invading zone were very fine and also found not to bear any relation to blood vesseles nor tumor nests. Unlike calcitonin gene-related peptide-positive nerves, a dense distribution of S-100 protein-positive neural elements characteristic of arterioles in the surrounding muscle layer was also not seen around arterioles abundant in the carcinoma invading zone. The results indicate a high pain threshold and the absence of autoregulatory mechanism in the blood vessels of the carcinoma tissue.
Accessory parotid tumors comprising about 1% of all primary parotid neoplasms. This disease is usually present with asymptomic buccal mass.The age at diagnosis varied from 8 to 73.The spectrum of tumors arising in accessory parotid gland is similar to that of tumors arising in the main parotid gland.Although more than half of the accessory parotid tumors are malignant. Masses arising in accessory parotid glands usually occur along the central third of the alar region, parallel to Stenon's duct.Sialography and CT scanning are occasionaly required for diagnosis. A 56-year-old female complained of an asymptomatic mass in her right preauricular region. After many investigations, clinical diagnosis was a benign tumor arising in the accessory parotid gland.Under general anesthesia, the facial nerve was exposed by elevating the temporal-pre-auricular-cervical flap and the tumor was resected.Pathological examination in the operation revealed a picture of adenoid cystic carcinoma.Local wide resection was done and the facial nerve branch near the tumor was resected.The resected nerve was reconstructed by nerve transplantation with the greater auricular nerve.After the operation, radiotherapy was done.We found no evidence of reccurence or metastasis.
Surgical and non-surgical, these two treatments of condylar neck fracture have long been a matter of controversy.The purpose of this paper is to evaluate the prognosis of the condylar neck fractures which were treated by each way.We recalled the patients of the condylar neck fracture to our clinics from a starting period of 6 months after initial treat-ment.Out of 187 cases we recalled, 142 cases were unilateral and 45 cases were bilateral. We evaluated unilateral cases.Out of 142, 89 were treated non-surgically and 53 surgically. We classified the fracture levels and conditions by the radiograms and compared those with the clinical prognosis and morphological results. The results were as follows. 1. Regarding morphological results on the condition of dislocated or disarticulated fracture of TMJ, the surgical group was better than the non-surgical group. 2. The case with better morphological results showed less deviation and pain on TMJ. 3. In the surgical group, Kirschner-wire pinning showed the best morphological result.
In the past 7 years from September 1984 to September 1991, reconstruction using OHARA® titanium plate system for mandibular defects, was carried out on 15 patients. Patients, 8 male and 7 female, ranged between 10 to 73 years of age. They were histopathologically classified as 5 malignant tumor, 4 benign tumor, 3 osteomyelitis and 3 others cases. Operations were performed in 8 cases of segmental resection of the mandible, 7 cases of hemimandibulectomy of the mandible, which were performed in 14 cases of immediate reconstruction for defects and 1 case of secondary reconstruction for defects.Kinds of used titanium-nitride plate were 7 cases of condyle type, 2 cases of angle type, 4 cases of body type, and 2 cases of straight type, which were used only titanium-nitride reconstruction plate in 10 patients, titanium-nitride plate with bone graft in 5 patients and titanium-nitride plate with the subcutaneous flap in 2 patients. In the clinical course after reconstruction, there were 7 years as the longest and 2 years as the shortest.Recently, it has not been noticed that it is necessary to eliminate the titanium-nitride plate in 13 patients except for 2 patients who died due to another disease. On the other hand, patients are wearing partial dentures in 8 cases and full dentures in 7 cases by prosthetic treatment.
Ten cases which were suspected of tumor in the major salivary area were assesed comparing the results of pre-operative diagnostic examinations (present history, physical examination, sialography, Technetium-99 and Gallium-67 imagings, ultrasonography and computed tomography) with surgically and pathologically confirmed diagnosis. The aim of this study is to obtain information concerning differential diagnosis between salivary tumor and inflammatory lesion, and between benign and malignant salivary tumors. It seems that differential diagnosis between tumor and inflammatory lesion seems to be possible with pre-operative examinations, however discrimination between benign and malignant tumors is difficult.It is very important to make a provisional diagnosis of the lesion in major salivary gland area putting all kinds of information from individual examinations together. In the case of suspicious malignant tumor, we must establish a total cure system including an open biopsy and following therapies.
The simple diagnostic arthroscopy in the out-patient clinic was developed and applicated to 28 patients (30 joints) with closed lock of the temporomandibular joint. The equipments were the needle arthroscope of 0.9 mm in diameter, its cannula, and the mandlin. The technique was consisted of superior compartment puncture by a 20 gage needle, local anesthesia by a pumping action, insertion of the mandlin through the needle, switching the needle to the cannula as a guide for the mandlin, and diagnostic arthroscopy under the circulation of saline.On all of 30 joints, the technique was completed successfully and safely, without any severe complications. This technique will expand via its diagnostic arthroscopy indication, similar to another diagnostic imaging.
Preoperative evaluation of the jaw bone is one of the important factors for dental implant therapy.However, there is no conclusive indicator to assess the quality of the jaw bone.We had a trial to measure the bone density of the mandible with the Digital Image Processing method (DIP method) which had been developed for the bone measurement of osteoporosis. Occlusal radiograms of edentulous mandibles in 10 healthy subjects (male: 3, female: 7, Age: 59-84 years old) were taken with an aluminum wedge on the same films.And the bone mineral content and three dimensional patterns of the bone density were obtained by the DIP method. The 3-D patterns of the edentulous mandibles depended upon individuals and showed a wide variety.These could be classed into 5 groups. These facts suggest that it is necessary to assess the bone quality of the recipient site itself, and the DIP method for the mandible is useful to preoperative evaluation for dental implant therapy.
Reported was a case of oral verrucous carcinoma with special reference to numerical aberration of chromosome 17 which was determined by means of fluorescence in situ hybridization.The tumor consisted of heterogenous cell populations with a different chromosomal copy number: 37% of cells had two copies, 27% had 3 copies, 6% had 4 copies and 8% had 5 copies.Surgical resection following irradiation was performed and the patients are now well.
Simple bone cyst is no longer considered rare today.However, the etiology and growth process of the disease are still unknown. In this report of 2 cases, the authors present 3 cysts in the mandible.All of their records since the first examination could be traced back in 7-year and 9-year previous orthopanoramic radiography. Case 1: An 18-year old boy.The cyst of the right mandible had developed from the right molar region near the mental foramen and the left ascending ramus along the mandibular canal for 9 years. Case 2: A 16-year old boy.The lesion originated in the area under the apex of the left canine near the mental foramen and had developed for 7 years. We supposed the origin of these two cases may have been in contact with mandibular canal.
We made a retrospective study on the usefulness of autologous blood transfusion conducted by using stored autologous blood with or without blood dilution in orthognathic surgery. Ninety-six patients had received autotransfusion in our department from 1985 through 1991. Their mean age was 19.8 years.Females predominated over males in the ratio of about three to one.The main disorder of the patients was prognathism (90cases);the major method of operation was a sagittal splitting ramus osteotomy.The average volume of autologous blood donation was 525.1ml, and 72% of blood loss was covered by autologous blood transfusion.Hematologically postoperative anemia of the patients was recovered with autotransfusion, and serum erythropoietin levels in autologous donors increased significantly (P<0.05).No complications were observed and clinical courses of all cases were satisfactory. The above results indicate that autologous blood transfusion is quite safe and can be recommended for use in orthognathic surgery.
Sixty cases of osteoradionecrosis of the mandible were retrospectively studied. The primary sites of those were 37 tongue, 12 mouth floor, and 11 oropharynx.The majority of tongues were treated by combined 137Cs implant with 60Co external irradiation. Most mouth floors and all oropharynxes were irradiated by 60Co external irradiation. The average doses of irradiation were 89.5 Gy in the tongue, 61.1 Gy in the mouth floor, and 81.3 Gy in the oropharynx. The degree of disease in osteoradionecrosis was classified as follows, severe which had a skin fistula or a pathological fracture, mild which formed a sequester bone, slight which temporarily exposed bone.Of all cases, the most were severe and only one slight case. The mild cases of the tongue were as many as the severe cases but the severe cases in both mouth floor and oropharynx were much more than the mild cases.The severe cases were mostly found in external irradiation and few in intestinal irradiation.It seems that the severity is related to the dose of external irradiation.There was the tendency for severe cases of the the tongue with combined radiotherapy to be mostly found by dose more than 40Gy of the external irradiation regardless of dose of intestinal irradiation.The severe and progressive cases were mostly recognized in external irradiated cases.
MRI studies were performed on 29 patients with tongue tumors.26 cases were fresh, others were recurrent.Signal intensity of tongue tumor was not characteristic and specific, and it was a low-iso signal on T1 weighted image (WI), heterogeneously iso-high signal intensity on T2 WI, heterogeneous enhancement on gadolinium-DTPA enhanced image compared to muscle signal intensity. In 3 of 29 patients, the tongue tumor invaded to the mandible.With regard to the grasping tumor invasion to the mandible, the STIR method was superior to T1, T2 WI of the spin echo method.Dynamic enhanced MR images were performed in 6 of 29 patients. Dynamic.change of signal intensity after gadolinium-DTPA administeration were assessed with fast low angle shot imaging. On dynamic study at about 20 seconds after gadolinium-DTPA injection, the first signal intensity in the periphery of the tumor gradually began to increase.Maximum signal intensity of the tumor showed at about 70 seconds after gadolinium-DTPA injection. In search from 0 to 5 minutes, after the tongue tumor showed maximum signal intensity, its signal maintain the maximum.Necroic and peritumorous edema showed a significantly lower and more gradual increase in signal intensity than adjacent neoplastic tissue on dynamic enhanced MRI.
A case of adenoameloblastic odontoma in the maxillary anterior region was reported. The patient, a 19 year-old woman, complained of occlusal pain at 2. In the first medical examination, swelling was admitted at 1-3 labial and palatal gingiva region.Radiograph showed a clearly demarcated radiolucent lesion at 2 In pulp test, 2 was non-vital, and 13 were vital. We performed enucleation and apicoectomy of 23.The tumor had a well defined fibrous capsule, so we easily removed the tumor.The tumor, presented globulary, was measured in a region of about 16 mm which included hard tissues. Microscopically, this tumor was encapsulated with thin fibrous tissues.The calcified tissues and odontogenic epithelia could be observed in the tumor.The calcified tissues were analogous to odontoma which contained regular and irregular dentinal tubules. The odontogenic epithelia revealed various patterns, i.e.sheet-like, adenomatoid and follicular struc tures.The adenomatoid structures were composed of cuboid cells, and the pscudoluminal region was occupied by fine fibrous materials.The present case was pathologically diagnosed as adenoameloblastic odontoma.6 months have passed, and there have been no symptoms of recurrence.
Polymorphous low-grade adenocarcinoma (PLGA) is a minor salivary gland neoplasm usually arising intraorally, primarily in the palate.It is characterized by morphologic variability, cytologic uniformity, and an infiltrating growth pattern.Recently, PLGA is listed in the existing WHO classification (1990) as a subclassification of adenocarcinomas. We present an unusual case of PLGA involving the upper lip of a 50-year-old male. The histopathologic findings are, in contrast to weaker atypism of tumor cells, considerable histologic variety.The spectrum of growth patterns included solid, clear-cell, adenoid cystic, and fascicular areas.Tumor cells were isomorphic with a lightly eosinophilic cytoplasm and uniformed round nuclei with a few mitoses. Immunohistochemically, tumor cells were stained with S-100 protein, carcinoembryonic antigen (CEA), cytokeratin (KL-1), vimentin, epithelial membrane antigen (EMA), and glial fibrillary acidic protein (GFAP).