Bone changes in the mandibular head and mandibular fossa in 33 patients with TMJ disorders were studied with axial computed tomography in relation to clinical findings to clarify possible factors leading to bone changes in this phenomenon. Bone changes of the mandibular head were observed in 45 (68%) of the 66 TMJs. The mandibular head was juxtaposed to the mandibular fossa in 13 (29%) of the 45 joints in centric occlusion and in 29 joints (64%) in the anterior position on CT, whereas the mandibular head with no pathological bone change was juxtaposed to the mandibular fossa in none of the 21 joints in centric occlusion and in only 1 joint (5%) in the anterior position. In the two groups of patients with and without juxtaposition of the mandibular head and mandibular fossa with bone changes, the incidence of the initial symptoms such as pain. crepitus, and difficulty in opening the mouth was increased compared with the symptoms at presentation. However, the former group had severer symptoms than the latter group. These findings suggest that bony degeneration of the TMJ is accelerated by juxtaposition of the head and fossa.
Effects of treatment with stabilization splint therapy for three months were assessed in 193 patients with unilateral temporomandibular disorders (TMD). TMD were classified according to the proposal of the Japanese Society for Temporomandibular Joint, and the following results were obtained: 1. Total pain relief according to a visual analog scale (VAS) and mouth opening were significantly improved both one and three months after placing the splint. 2. Noise in the TMJ was improved only in 23.6% of the patients. 3. Concerning specific kinds of pain, relief of occlusal pain was obtaired in 62.5% of the patients, that of pain on mouth opening in 63.8%, that of pain at rest in 88.9%, that of terderness of muscles in 74.4%, and that of terderness of the TMJ in 67.9%. The stabilization splints were effective not only for terderness of the masticatory muscles but also for that of the TMJ. 4. Total pain relief assessed by VAS was detected more frequently in type I and II patients than in type III-L, III-IL and N patients. 5. As many type III-IL patients fell into a closed-lock status, we recommend that splint therapy should not be used in this type of patient. 6. The splint was effective for many kinds of pain, but ineffective for TMJ noise in type III-C patients.
The relationship between the macroscopic condition of the root surface and clinical prognosis was studied in 11 human autotransplanted teeth. The macroscopic condition of the root surface was classified into areas with A) cementum exposure, B) attachment of Sharpy's fibers, and C) cementum injury. Histological examination of 10 healthy teeth showed that the results of macroscopic evaluation correlated well with the histologic findings of the root surface. The results of autotransplantation were evaluated clinically and radiographically in relation to the macroscopic conditions of the root surface. With the exception of case 3, in which an avulsed tooth was used for transplantation, the root surfaces of transplanted teeth showed areas with cementum exposure and attachment of Sharpy's fibers in varying proportions. Radiographically, formation of a normal periodontal space and lamina dura was confirmed 6 months postoperatively in most cases. Local replacement resorption was observed in case 3, but the patient did not complain of associated subjective symptoms. Clinically, there were no abnormalities in pocket depth, percussion sound, and mobility in any other teeth. No noteworthy difference was noted either clinically or radiographically in the postoperative course between areas with cementum exposure and those with attachment of Sharpy's fibers. The results suggest that the presence of cementum is important for regeneration of the periodontium.
A clinicostatistical study was performed in 69 motorcycle riders who had suffered maxillofacial trauma. Of the 69 patients, 50 were male and 19 were female. Age ranged from 16 to 66 years. A traffic accident with an automobile was the most common cause of maxillofacial trauma. The most common fracture site was the mandible. Of the the 51 helmeted patients, 18 (35%) used full-face-type and 33 (65%) used jet or half-type helmets. Mandibular fractures of the symphysis or parasymphysis occurred in 43% of patients who used full-face-type helmets and 18% of patients who used jet or half-type helmets. Mandibular fractures of the condylar process occurred in 7% of patients who used full-facetype helmets and 41% of patients who used jet or half-type helmets. Therefore, full-face-type helmets prevent mandibular fractures of the condylar process. Even if full-face-type helmets are used, the occurrence of mandibular fracture is considerable. To improve full-face-type helmets, a “jaw guard” should be used in the maxillofacial region and the structure of the “jaw guard” should be improved.
Most anaerobes isolated in oral infections are anaerobic gram-negative rods such as Prevotella, Porphyromonas and Fusobacterium. However, isolation of these organisms is more difficult than other anaerobes. In particular, the isolation rate of anaerobic gramnegative rods is not sufficient even though they are indigenous oral bacteria. We therefore used Brucella HK Agar w/PV (LR) with basal medium to isolate anaerobic gram-negative rods selectively and examined the usefulness of this technique. A total 132 isolates (55 aerobes and 77 anaerobes) were isolated from 48 cases of oral infections. When we used only modified GAM agar, only 17 anaerobic gram-negative rods were isolated (isolation rate: 15.6%). But when we used Brucella HK Agar w/PV (LR) with modified GAM agar, 40 anaerobic gram-negative rods were obtained (isolation rate: 30.3%). The number of isolated Prevotella and Porphyromonas was 22. Ten of them formed black-pigmented colonies. More than 95% of strains of anaerobic gram-negative rods were susceptible to CEZ, CMZ, LMOX, IPM, TC and CLDM.
Late recurrence of oral squamous cell carcinomas was investigated clinicopathologically. Recurrence of carcinomas was found in 89 (27.5%) out of 324 cases of oral carcinomas that were treated in our department from 1972 to 1986. Of these cases, 37 cases showed recurrence between 3 to 20 years after the first treatment The interval between the first and recurrent carcinoma was: 3 to 5 years in 12 cases, 5 to 10 years in 17 cases, and more than 10 years in 8 cases. Recurrence happened near the primary site in 22 cases, at a completely different site in 11 cases, and at the same site as the primary carcinoma in 4 cases. Regarding the first treatment, 26 of the 37 cases (70.3%) had radiotherapy and/or chemotherapy. Of 37 cases of recurrent carcinomas, 13 (35.1%) had a second recurrence. These results indicate that the following factors may play an important role in late recurrence: 1. Multiple occurrence of oral carcinomas. 2. Radiation-induced or related carcinomas. 3. Regrowth of the remaining cancerous cells. 4. Cancerous changes of remaining atypical epithelium near the carcinoma. 5. Completely new oral carcinoma caused by the oral environment. These findings imply that long-term follow-up observations and careful examination of the whole oral cavity are necessary. Furthermore, it is important that early treatment should be carried out as soon as mucosal alterations such as leukoplakia, erosion, etc. are noticed.
Argyrophil (AgNORs) method is a diagnostic technique for histologically grading tumor malignancy. Adenoid cystic carcinomas (n=10) classified histologically into 3 patterns [tubular (n=4), cribriform (n=6) and solid (n=3)] and pleomorphic adenomas (n=16) classified into non-recurrent (n=10) and recurrent (n=6) tumors were examined for AgNORs. Pleomorphic adenomas were histologically classified into 3 types, double layer (n=8), glandular (n=11) and non-glandular (n=7), and AgNORs in these 3 types of pleomorphic adenomas were compared with those in adenoid cystic carcinomas. The mean number of AgNORs was defined as the AgNOR number. AgNOR numbers were compared by the Wilcoxon-Mann-Whitney two-sided test, and differences associated with p<0.05 were considered to be significant. Mean±S. D. of AgNOR was significantly higher (p<0.001) in adenoid cystic carcinomas compared with pleomorphic adenomas. Comparison of AgNOR numbers in different histological types of adenoid cystic carcinomas revealed significantly higher values (p<0.05) for solid pattern tumors than for tubular and cribriform pattern tumors. No significant difference was noted between tubular and cribriform patterns. It is suggested that the AgNOR numbers in adenoid cystic carcinomas may be used to evaluate the biological grading of malignancy. There were no significant differences in the AgNOR numbers between recurrent and non-recurrent tumors in pleomorphic adenomas, or between several histological types of pleomorphic adenomas.
Adenoid cystic carcinoma (ACC) is a specific variant of adenocarcinma with a characteristic cribriform structure. ACC may arise from salivary glands and various other sites, but the origin and cellular composition of various structures in ACC is controversial. In this study immunohistochemical localization of keratin, S-100 protein, and lysozymes was evaluated for five fundamental structures (tubular, cribriform, trabecular, reticular, and solid) of 60 adenoid cystic carcinomas arising in the head and neck. Furthermore, the correlation among arising sites and the histological grading of ACC and the immunohistochemical positive classification (IPC) were investigated. IPC was classified into 3 degrees according to staining of keratin antibody. S-100 protein antibody, and lysozyme antibody, respectively. Tubular structures composed of single tumor cell rows were positive for both keratin and S-100 protein stainings. These tubular structures resembled intercalated ducts of normal salivary galnds. Tubular structures composed of two irregular tumor cell rows consisted of a mixture of keratin-positive cuboidal cells and S-100-protein-positive triangular or polygonal cells. These tubular structures may also resemble intercalated ducts. Tubular structures composed of two regular tumor cell rows consisted of keratin-positive and S-100-protein-negative luminal cells and keratin-negative and S-100-protein-negative nonluminal cells. These structures may there fore resemble interlobular ducts. In cribriform structures, cells lining cyst-like spaces showed both keratin and S-100-protein-negative staining; nonlining cells positive for both keratin and S-100 protein composed small tubules. In trabecular structures, inner tumor cells were keratin-positive and S-100-protein-negative, but the converse was true for outer tumor cells. Reticular structures may result from a reduction in tumor cells accompanied by an increase in cyst-like spaces in cribriform structures. Keratin-positive and/or S-100-protein-positive tumor cells were scattered in solid structures, but these tumor cells were not typically arranged. The IPC of keratin showed a correlation between stongly positive degree and histological Grade, but no correlation between positive degree and the arising site. The IPC of S-100 protein indicated no correlaton between positive degree and the arising site. The immunohistochemical positive rate of lysozymes was 11.7%(7/60), but only one strongly positve case was noted. In ACC there were few tumor cells which had differentiated to the point of secreting lysozymes. There was no lysozyme-positive-case in ACC originating from the nasal and antral mucosa, lacrimal gland, external auditory canal, and skin.
Open surgery for internal derangement of the temporomandibular joint was performed in 9 patients, 10 joints. Postoperative follow-up studies of 17 months or more are described. Satisfactory results were obtained in 8 cases, 9 joints according to the criteria of the American Society of Oral and Maxillofacial Surgery in 8 cases, 8 joints according to the criteria of Takahashi and Shibata. No surgical complication or postoperative severe discomfort was encountered. The surgical success rate was 88.9%.
A 68-year-old male presenting with impairment of mouth opening and pain of the right temporomandibular joint (TMJ) was clinically diagnosed as having TMJ arthrosis.Although the patient was treated with drugs and an occlusal splint, the pain increased. Stellate ganglion block was ineffective. As facial swelling and opening disturbance of the right eye appeared, he was referred to the neurosurgery department. Based on CT and neurological findings, he was diagnosed as having the cavernous sinus syndrome, especially Foix syndrome. Soon after administration of steroids and antibiotics, the ocular and TMJ condition improved. This is a rare case in which TMJ disturbance was an initial manifestation of the cavernous sinus syndrome.
We developed new ultrasonic tips for apicoectomy with retrograde gutta-percha root filling. To investigate the cutting efficency and safety of the ultrasonic tips, before clinical application we carried out an experiment on enlargment of the root canal of human extracted teeth. The results, showed that enlagement of the root canal with the ultrasonic system could be performed rapidly and accurately compared with manual enlargement using angle reamers. Our ultrasonic tips did not cause any problems for teeth during the experiment. We believe that our new ultrasonic tips are simple and convenient for clinical application.
Osteomyelitis is not commom in children. A 4 year-old boy was referred to our hospital for treatment of left mandibular swelling. Orthopantograms showed a moth-eaten appearance from D to the left mandibular ramus. The swelling was relieved by the administration of antibiotics, extraction of E and curettage. Histopathological diagnosis was osteomyelitis of the mandibule. However, after treatment swelling recurred several times over about one year. The area which showed a motheaten appearance returned to an almost normal appearance compared with the previously taken orthopantograms. However, CT revealed separated bone (sequestration) and periosteal new bone formation at the angle of the left mandibule. Megnetic resonance imaging (MRI) demonstrated decreased marrow signal intensity on T1-weighted images and increased signal intensity on T2-weighted images. Sequestrectomy and osteoplasty were performed. About two years postoperatively, clinical examination showed relatively good progress. We found that MRI was useful as a diagnostic technique and for follow up of osteomyelitis of the jaw.
Toxoplasmosis is a parasite infection caused by the obligate parasite, Toxoplasma gondii. In several types of acquired toxoplasmosis, lymph node toxoplasma is very frequent and lymphadenopathy is often the only clinical finding present. This paper describes a 31-year-old male patient who presented with swelling in the submandibular lymph nodes. He was diagnosed to have lymph node toxoplasmosis by serological investigations (IHA and IFA). The patient was treated with sulfamethoxazole 1600mg/day and trimethoprim 320mg/day for 40 days. There was a decrease in the size of the submental lymph nodes and the toxoplasma antibody titer. This infection was supposed to have been acquired from a pet cat.
This study investigated the correlation between clinical and histopathological findings in 171 cases clinically diagnosed as oral leukoplakia. Histopathological examination revealed squamous cell carcinoma in 14 cases, leukoplakia with epithelial dysplasia in 68 cases, and hyperkeratosis without epithelial dysplasia in 89 cases. According to the grade of epithelial dysplasia, the leukoplakias were classified into mild, moderate, severe epithelial dysplasia and carcinoma in situ, which included 49, 14, 3 and 2 cases, respectively. High grades of epithelial dysplasia were mainly observed on the lateral edge of the tongue or the oral floor. There was a close correlation between the clinical appearance of lesions and a high grade of dysplasia; the majority of the cases with high grades of dysplasia or with early invasive carcinoma clinically showed erosive-type lesions.
Hyperthermia (HT) combined with local vasoconstrictor injection (LVI) was used to treat a recurrent carcinoma of the mandibular gingiva, and resulted in a complete response. A 65-year-old man with a postoperative recurrent carcinoma of the mandibular gingiva received radiofrequency capacitive HT combined with i. v. injection of CDDP (10mg) and PEP (5 mg) following 60Co irradiation (3 Gy). HT combined with LVI was used for treatment. After injection of 1% lidocaine containing 0.01% epinephrine (10ml) around the tumor, HT was performed. The tumor temperature was increased to over 42°C and remained at this level for 40 minutes without pain or side effects. After treatment the tumor decreased in size and pain disappeared. On CT, a low density area was observed inside of the tumor after the completion of HT, and the tumor disappeared completely 3 months later. The results suggest that decreased blood flow causes an effective elevation of temperature and acidification of tumor tissue which in turn enhances the thermal sensitivity of the tumor.
Epithelial-myoepithelial carcinoma is a rare tumor. Previously, this tumor had been described as clear cell carcinoma. We encountered a case of epithelial-myoepithelial carcinoma which occurred in the mandible with metastasis to the regional lymph nodes. The present case was extremely rare. A 42-year-old man visited our hospital with complaints of pain and swelling of the left mandible. Panoramic radiographs showed a large radiolucent area in the left side of the mandibular body. The pathological diagnosis of the biopsy specimen of this lesion was a epithelial-myoepithelial carcinoma. Block resection of the mandibular bone and radical neck dissection were performed. More than 5 years have passed since operation, and there are no signs of metastasis or recurrence.
In this paper, two cases of calcifying epithelioma arising in the mandibular angle are presented. Case 1 is a 10-year-old boy who had a painless tumor in the right mandibular angle region. Orthopantomograms revealed a radiopaque area in the region. Case 2 is a 49-year-old woman who had a painless tumor in the same region. In some X-ray photographs, there was no radiopaque area in the region. In both cases, examination of excisional biopsy specimens showed shadow cells in the tumor. In spite of the name “calcifying epithelioma, ” calcification is not present in some cases. In case 2, calcification was evident histopathologically, but not by X-ray examination. A radiopaque appearance is apparently not essential for the diagnosis of calcifying epitheliomas.
A case of solitary neurofibroma of the tongue with Becker's nevus of the skin is reported. A 20-year old man was referred to our department with a chief complaint of swelling of the tongue. He had Becker's nevi on his shoulder and dorsum of the hand but no other signs of dermal abnormality. The clinical diagnosis was a benign tumor of the tongue. The tumor was surgically resected under local anesthesia. The histopathological diagnosis was a neurofibroma. We suspected that he had been suffering from von Recklinghausen disease, but there was no evidence of a family history or associated dermal abnormalities. In addition, Becker's nevus is considered not to be accompanied by von Recklinghausen disease. The final diagnosis of the tumor was a solitary neurofibroma of the tongue. There has been no evidence of recurrence as of 2 years 3 months after the operation.
Odontogenic fibroma derived from the mesenchymal tissue of teeth is a rare benign odontogenic tumor. This tumor usually contains inactive odontogenic epithelium and occasionally involves bone-like or cementum-like tissue. We report a 38-year-old man in whom a central odontogenic fibroma developed in the region of impacted 45. The differential histopathological diagnosis of this case was most likely a cementifying fibroma.
A case of steatocystoma simplex (SCS) near the right angle of the mouth in a 42-year-old woman is reported. A mass about 1.0×1.0cm in diameter was formed in the subcutaneous tissue. The mass was elastic soft and movable. The overlying skin and underlying oral mucosa appeared normal. No similar lesions were found in any other part of the body. The mass, suspected to be a benign tumor, was extirpated intraorally. Histopathologically, a cyst cavity lined with thinly layered squamous epithelium was observed. The epithelium did not have any stratum granulosum, but a hyalinized eosinophilic cuticle was observed at the outermost layer. Some sebaceous glands were scattered in the cyst wall, and a few glands were situated on the epithelial surface. From these findings, the lesion was diagnosed as a SCS.
We reported a case of an extravasation mucous cyst of the submandibular gland. A 25-year-old female patient complained of swelling at the right submandibular region. An elastic soft tumor, movable and measuring 32×26mm, was detected by palpation at the right submandibular region. The clinical diagnosis was a cyst of the right submandibular region. Surgical extirpation was carried out from the right submandibular triangle under general anesthesia. Histopathological examination revealed an extravasation cyst. After surgery, about four years have passed, and there is no recurrence.
Aneurysmal bone cyst is a benign cystic lesion of bone, and the incidence of this disease in the jaw is low. We reported two cases of aneurysmal bone cyst of the jaw. A 31-year-old woman presented with complaints of pain and swelling at the left side of the face. Since X-ray and CT-scan suggested a cystic lesion, cystectomy was performed. The lesion was histologically diagnosed to be an aneurysmal bone cyst. The other patient, a 40-year-old man, showed swelling at the right mandible. The patient's occlusion was impaired by the gingival swelling. X-ray findings showed the presence of a honeycomb-like lesion at the body and ramus of the mandible. CT-scan findings showed buccal and lingual expansion at the molar region. Microscopic features of the biopsy specimen were consistent with diagnosis of an aneurysmal bone cyst. We performed conservative curettage of the lesion. The postoperative courses of both of these cases were uneventful, and there has been no sign of recurrence after 7 years and 4 years, respectively.