We evaluated whether the degree of malignancy of tongue squamous cell carcinoma (SCC) is reflected in the distribution of proliferating cell nuclear antigen (PCNA). The PCNA labelling index (LI) was investigated in relation to the histological differentiation and the survival rate of tongue carcinoma patients.
The initial biopsy specimens of tongue SCC from 38 cases were fixed with 10% formalin, processed conventionally, sectioned and immunohistochemically stained using anti-PCNA antibody, PC 10 (DAKO, Denmark). The cells positive for immunostaining were counted under a microscope to obtain the PCNA LI.
The results were as follows. The PCNA LI was 11.8 ±6.9%(n=7) in normal epithelium of the tongue. In contrast, a high LI was noted in SCC of the tongue, being 30.2± 13.4%(n=38). With respect to histological differentiation, the PCNA LI immunostaining was high (M ± SD=35.2 ± 12.3) in moderately-poorly differentiated carcinomas (n=23), and low (M ± SD=22.5 ± 11.2) in well differentiated carcinomas (n=15). Concerning the prognosis, survival rate was high (86.8%) in cases with low PCNA LI (<30.0) and low (63.7%) in cases with high PCNA LI (≥30.0).
These results indicated that the PCNA LI is closely associated with the differentiation of carcinomas, and the prognosis of patients with SCC of the tongue. In addition, the PCNA LI was helpful in assessing the degree of malignancy of tongue carcinomas.

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In order to ascertain the effects of epidermal growth factor (EGF) on human oralsquamous cell carcinoma invasion and metastasis, we studied cell invasive and metastatic abilities by phagokinetic track assay, in vitro invasion assay, and the production of matrix-degrading enzymes by zymography of 5 human oral squamous cell carcinoma cell lines (SAS, Ca9-22, HSC-2, -3, -4). EGF (1-100ng/ml) was found to inhibit the growth of all 5 cell lines. However, phagokinetic track assay revealed that EGF enhanced the random motility of all 5 cell lines in a concentration-dependent fashion. In in vitro invasion assays, EGF increased the invasive abilities of all 5 cell lines; in particular that of SAS was significantly increased. Zymography revealed that all cell lines except for Ca9-22 produced urokinase type plasminogen activator (u-PA) and 92 kD matrix metalloproteinase (MMP-9). Exposure to EGF led to an increase in the production of u-PA and MMP-9 by the same cells. These results strongly suggest that EGF may promote human oral squamous cell carcinoma invasion and metastasis.

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The Nd YAG laser is useful in oral surgery because of its superior hemostatic and coagulating effects.
The purpose of this study is to examine the hemostatic effects of tongue wounds caused by the Nd: YAG laser and their healing process. The laser's effects on the capillary architecture and the healing process were observed using the India ink perfusion method and the injection replica scanning electron microscope method. Six-week-old male Wistar rats were used in this experiment. To study hemostatic effects, irradiation of 6, 12 and 18 watts was applied for 1.0 second, and the rats were sacrificed immediately. To study the healing process, irradiation of 6 and 12 watts was applied for 1.0 second, and the rats sacrificed on the 4th, 7th, 14th and 28th days after irradiation. The results were as follows.
The capillaries around the wound showed complete hemostasis by the Nd: YAG laser irradiation at 6, 12 and 18 watts.
Healing process of 6 watts: Epithelialization and direct proliferation of new capillaries from around the wound were observed on the 4th day. New capillaries showed continuity and capillary loops appeared at the wound margin on the 7th day. The regeneration of filiform papillae and the continued formation of capillary loops were observed on the 14th day. The wound was almost completely healed on the 28th day.
Healing process of 12 watts: Epithelialization was not observed, but the direct proliferation of new capillaries from around the wound was observed on the 4th day. Epithelialization was noted, but the capillary architecture was insufficient on the 7th day. The regeneration of filiform papillae and the formation of capillary loops were observed on the 14th day. Continued development was seen on the 28th day.
The regeneration of filiform papillae was observed as a conical elevation from the margin of the wound. The regeneration of capillay loops appeared as capillary protrusion on the 7th day after irradiation. The presence of capillary loops under the filiform papillae was necessary for the regeneration of the latter.
As to the difference between 6 and 12 watts, healing of the capillaries at 6 watts was observed earlier than at 12 watts in regard to epithelialization, the germination of new capillaries, and the stage of anastomosis. The wound almost completely healed at 6 watts, whereas healing was insufficient at 12 watts on the 28th day.

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To study the feasibility of employing cefodizime (CDZM) in the field of oral surgery, a pharmacokinetic analysis was performed for CDZM concentrations in the oral tissues after intravenous injection of 1g CDZM in 26 patients.
The following results were obtained:
1) The half-life of CDZM in serum was calculated to be 2.64 hours.
2) The peak concentrations of CDZM were 13.03 μg/g in the gum, 4.84 μg/g in the bone and 17.06 μg/g in the cyst wall. The AUC of CDZM in oral tissue to that in serum was 12.53% in the gum, 3.26% in the bone, and 8.23% in the cyst wall.

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Hyperthermia has been applied for the treatment of oral cancers, in combination with radiation and chemotherapy. However, hyperthermia apparently affects normal tissues, such as the salivary glands, which lie adjacent to tumors.
In the present study, damage to the submandibular salivary glands resulting from hyperthermal therapy was investigated in the rat. The glands were heated at 40°C (maximum temperature in glands=40.43°C ±0.31°C), 41°C (41.68°C ± 0.44°C), 42°C (42.30°C ± 0.25°C), 43°C (43.38°C ± 0.50°C), and 44°C (44.51°C ± 0.34°C), respectively. Heat was applied for 40 minutes using 13.56 MHz RF hyperthermia (NOVATHARM IH 500). Histopathology, angiography, and the uptake and excretion of ^99mTcO₄-were employed to evaluate the severity of the damage. It was found that heat below 42.30°C ± 0.25°C caused no serious damage either morphologically or functionally. At 43°C, some of the glands changed irreversibly, while others did not. All of the glands which were heated to 44°C suffered irreversible changes. The maximum tolerated temperature was, therefore, assessed as 43.38°C ±0.50°C.
To examine the process of regeneration of glands which had been damaged by heating to 44°C, BrdU was employed. Staining was positive from the 1st day until 4 weeks after heating. Coagulation necrosis was seen on the 3rd day after heating, and squamous cell metaplasia was observed on 7th day. Regenerated acinous cells that were stained by BrdU and PAS were seen 3 weeks after heating just next to the remaining normal cells. 8 weeks after heating, the borders between normal and damaged tissues had become indistinct.

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In this study, tumor blood vessels were examined during the proliferation of VX2 carcinoma, and the effects of the antifibrinolytic agent, tranexamic acid, on tumor growth and vascularization were investigated.
Materials and methods.
VX2 carcinoma cells were implanted into rabbit ears, and the rabbits were divided into two groups. Experimental group: tranexamic acid (2, 000 mg/kg) was given daily by femoral intramuscular administration for 14 days. Control group: tranexamic acid was not administered. Gross, histologic, scanning electron microscopic of microvasculature casts and ultrastructural observations were performed in each group 3, 5, 7 and 14 days after tumor implantation.
Results.
1. Grossly, tumor growth was suppressed in the experimental group compared with the control group throughout the experimental period.
2. Histologically, in the control group, tumor cells proliferated invasively with the formation of stroma and small tumor nests. In contrast, in the experimental group, tumor cells proliferated densely with little infiltration and small amounts of stroma were formed from early after tumor implantation.
3. Regarding the microvascular structure, in the control group, active angiogenesis of the tumor was found 3 days after tumor implantation. New capillaries and new sinusoidal capillaries sprouting from the vessels of the surrounding tissue extended to the tumor center after 5 days. Dense capillary networks were formed throughout the entire tumor region after a week, but capillaries were not found in the central area of tumor because of necrosis after 2 weeks.
4. In the experimental groups, tumor angiogenesis was delayed compared with the control. Angiogenesis was observed after 5 days, and new capillaries extended to the tumor center and anastomosed with each other; sparse capillary networks were formed after a week. Capillary networks were formed throughout the entire tumor region after 2 weeks, but were not as dense as the control. Ultrastructural observations by transmission electron microscopy demonstrated that some endothelial cells were immature compared with the control.

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I investigated the existence and location of cleft alveolus, teeth absence, dwarfed teeth, and supernumerary teeth in 103 patients with unilateral cleft lip and/or alveolus treated by the Second Department of Oral and Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University.
The results obtained were as follows:
1. The subjects included 54males (unilateral cleft lip without cleft alveolus 25; unilateral cleft lip with cleft alvelus 29) and 49 females (unilateral cleft lip without cleft alveolus 14; unilateral cleft lip with cleft alveolus 35).
2. The incidences of absent teeth on the cleft side and non-cleft side in the cleft lip group were 2.6% and 2.6%, respectively, whereas those on the cleft side and non-cleft side in the cleft alveolus group were 40.6% and 4.7%, respectively. The absence or presence of cleft alveolus was suggested to be a major factor.
3. The incidences of dwarfed teeth on the cleft side and non-cleft side in the cleft lip group were 15.4% and 2.6% respectively, whereas that on the cleft side in the cleft alveolus group was 4.7%. No dwarfed teeth were observed on the non-cleft side in the cleft alveolus group, which suggested the involvement of clefting. The low incidence of dwarfed teeth in cleft lip and alveolus indicated that clefting may eliminate the occurence of dwarfed teeth.
4. The incidences of supernumerary teeth were 20.5% and 5.1% on the cleft side and non-cleft side in the cleft lip group, whereas that on the cleft side in the cleft alveolus group was 4.7%. No supernumerary teeth were observed on the non-cleft side in the cleft alveolus group, which suggested the involvement of clefting. The incidence of supernumerary teeth in cleft alveolus indicated that clefting may eliminate the occurence of supernumerary teeth.
5. The location of clefting was 1∇3 (39.1%), 1∇23 (32.8%), 12∇3 (23.4%), 12∇2'3 (4.7%).
6. Studies of the location of clefting and tooth abnormalities on the cleft side confirmed that the medial nasal process and the maxillary process can give rise to the lateral incisors.

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Anthropometric analysis was carried out on the facial soft tissue of unilateral cleft lip (and palate) patients who underwent surgical operations for lip repair during 1986-1990, and the data were compared with those for cases operated during 1981-1986.
The methods of measurement and analysis were the same as described previously (J. Jpn. Cleft Palate Assoc. No.13, p47-71, 1988). Fourteen points were selected, and the patient's face was marked. The deviation of the alar base and the columellar base was estimated by using a sliding caliper directly on the patient's face before and directly after surgery, and 2 weeks, 1 month and 3 months after the operation. The subjects consisted of 25 CL (cleft lip with or without alveolar cleft) and 30 CLP (cleft lip, alveolus and palate) patients.
The results were as follows:
1. The position of the columellar base was nearer the midline than that in the previous cases 3 months after the operation.
2. In patients with narrow cleft width, both lateral nasal alae were shifted in a more symmetrical position than in previous cases.
3. The downward deviation of the alar base on the cleft side was corrected into a symmetrical position 3 months after the operation.
4. The marginal length of the naris on the cleft side was longer than that of the noncleft side 3 months after the operation. But the difference between the both sides was less than that in previous cases.

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In the field of oral surgery, titanium bone screws are used for plate fixation in the treatment of jaw fractures and maxillary degeneration, but there have been very few reports on the time course of changes during relatively short fixation. To investigate fixation changes in titanium bone screws with the passage of time, we implanted titanium bone screws with a defined screwing torque in the femoral bone of the rat, and then progressively measured the loosening torque and bone destructing torque in the period from immediately after until 8 weeks after implantation. In addition, new bone formation and calcification around the screw and in its periphery were observed macroscopically and by soft radiography; histological examination was then performed at the time exhibiting the greatest dynamic change.
The following results were obtained from this investigation. Fixation strength of titanium bone screws decreased with time, reaching a minimum 2 weeks after implantation. By 8 weeks after implantation, fixation strength was higher than that immediately after implantation. These findings indicated that the fixation strength of titanium bone screws used for anchorage in oral surgery decreases progressively until 2 weeks after implantation. This suggests the need for some form of adjuvant fixation until 3 weeks after implantation; in addition, strong occlusal force and mandibular movement that might loosen the fixed site should be avoided.

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The relationship between epithelial dysplasia and malignancy potential of oral precancerous lesions and precancerous conditions (PL & PC) was histologically examined. Histological epithelial dysplasia was investigated in 41 cases of leukoplakia and erythroplakia (L & E) 39 of lichen planus (LP), 34 of dysplastic epithelium adjacent to squamous cell carcinomas (SCC), and 8 of PL & PC which subsequently became SCC. Dysplastic score was assigned based on the dysplastic criteria of the WHO (1978). The average dysplastic scores were 2.9 ± 2.7 points in L & E, 2.2 ± 1.2 in LP 5.6 ± 2.3 in PL & PC which subsequently become SCC, and 6.3 ± 2.7 in dysplastic epithelium adjacent to SCC. Thus, the degree of dysplasia was obviously associated with the potentiality for malignant transformation. Important dysplastic characteristics were an increased nucleo-cytoplasmic ratio, dropshaped rete processes, cell crowding, pleomorphic cells and nuclei, and hyperchromatic nuclei. The methods used in this study were useful in evaluating the malignancy potential of oral lesions, and provided diagnostic suggestions.

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In the present study, we assessed whether it is possible to measure changes in the mandibular trabecular structure using orthopantomograms, which are frequently used in general clinical dentistry.
Subjects of the present study comprised 159 patients (102 males and 57 females, age range: 24 to 76 years, mean: 47. 3 years, with a history of one to eight years of dialysis) with renal osteodystrophy (ROD), a disease common in patients with compromised renal function. The subjects were divided into eight groups according to the number of years of dialysis to compare the duration of dialysis with the results of clinical laboratory tests and orthopantomograms. The following results were obtained:
1. Clinical laboratory tests showed that, compared with normal subjects, the levels of P, PTH, Al, and Mg in the patients increased, but HCO^-₃, red blood cell count, and Hb decreased with an increase in the number of years of dialysis, thus confirming systemic disorders in these patients with ROD.
2. Metacarpal index (MCI) decreased with increasing years of dialysis, showing a significant difference between the control group and patients in their 4th year of dialysis; however, the decrease was not remarkable thereafter.
3. Mandibular lower cortical thickness (MLCT) in the molar region decreased progressively with increasing years of dialysis compared with the other measured regions. The differences were significant from the 2nd year, but no change was observed after the 5th year of dialysis.
4. Mandibular trabecular width (MTW) in the molar region of patients showing changes in MLCT decreased significantly compared with control from the 3rd year of dialysis, but no change was observed after the 5th year.
5. When the subjects were subdivided into a dentulous jaw group and an edentulous jaw group, significant decreases in MLCT were noted in the dentulous jaw group from the 2nd year of dialysis and in the edentulous jaw group from the 5 th year. Comparison of these two groups by the number of years of dialysis showed no significant difference.
6. Likewise, MTW decreased significantly from the 3rd year of dialysis in both the dentulous jaw and edentulous jaw groups. Comparison of these two groups by the number of years of dialysis revealed significant differences from the 4th year of dialysis: changes in the dentulous jaw group were more remarkable.

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In a rabbit tongue cancer model, prepared by transplantation of VX2 carcinoma, the dynamics of fibronectin (FN) with the passage of times was investigated in two groups: an untreated group with active tumor proliferation a group in which tumor proliferation was suppressed by anticancer treatment. The response of FN surrounding the transplanted tumor was strongly positive reaction on day 7 after transplantation in contrast, strongly positive reaction tended to persist when tumor proliferation was suppressed. Cervical lymph node metastases were observed about the time when the FN response surrounding the transplanted tumor decreased. Furthermore, the cellular FN (cFN) response (Extra Domain A; ED-A expression) was negative reaction on day 7 after transplantation, and was thereafter expressed gradually. The expression in the group with suppressed tumor proliferation was greater than that in the group with active tumor proliferation. The FN/cFN response at metastasized lymph nodes were observed only in small case of cancer tissue wihch appeared to represent initial metastasis formation; all sites showing FN response also showed cFN response. Increased FN concentration in blood is not due to tumor bearing status, and it doesint increase until tumor proliferation is active, and it's measurement with the passage of times can therefore serve as a parameter of tumor proliferation activity. FN concentration in blood which increased during tumor proliferation was attributed to increase in either intact plasma FN (pFN) or ED-A free FN fragment by western blotting analysis of FN in plasma. For FN, there was no relation between the response surrounding the tumor and the blood concentration. The cFN response surrounding the tumor was therefore considered to be one of cancerous stroma reactions that had an inhibitory effect on the cancer. It was suggested that monitoring FN, especially cFN response surrounding the tumor, can serve as a useful parameter for evaluating treatment regimens and prognoses.

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Color and pulsed Doppler echography was used in patients with an arteriovenous malformations (AVM) of the tongue, floor of the mouth and mandible and with a hemangioma of the tongue, respectively. Color Doppler echographs of the AVM displayed a mosaic pattern with color flow signals in the nidus, whereas those of the hemangioma showed a monotonous pattern with color flow signals in the lesion. Pulsed Doppler echographs of the AVM delineated pulsatile waves of feeding arteries and drainage veins, while those of the hemangioma did not show evidence of drainage veins. Waves of feeding arteries were similar to those of drainage veins in the pulsed Doppler echographs for the AVM, which suggested the presence of an arteriovenous shunt.
The results of this investigation indicated that color and pulsed Doppler echography is useful for the differential diagnosis of vasculr disease in the oral and maxillofacial region.

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The mandibular canal is often closely related to the lower third molars. During the surgical removal of the third molar, the inferior alveolar nerve in the canal is sometimes damaged leading to impaired sensation in the lower lip. This is one of the most unpleasant postoperative complications.
The buccolingual relationship between the lower third molar and the mandibular canal cannot be diagnosed by orthopantomography although preoperative evaluation must be carried out radiologically. In present study, the relationship was determined by using CT scan.
Forty-seven lower third molars of 35 patients were evaluated preoperatively by CT scan. The mandibular canal of all cases overlapped with the third molar on orthopantomography. CT scan was taken in two ways. The first was the Tragion-Menton plane which was nearly parallel to the canal at the apex of the third molar. The second was the plane of the axis of the third molar. Axial CT scan was taken when the third molar erupted hoiizontally, and coronal CT scan was done when the molar erupted vertically.
CT scan examination exactly revealed the position of the mandibular canal in relation to the root of the third molar. The canal was located bucccally to the roots in 55 percent of cases, apicobuccally in 6 percent, apically in 23 percent, apicolingually in 6 percent, lingually in 2 percent, and between roots in 6 percent. The results of the present study were consistent with previous reports.
In 12 cases, the inferior alveolar neurovascular bundle was visible during operation. It was visible in only 2 of 22 cases when the canal was located buccally. It was visible, on the other hand, in all cases in which the canal was located apicolingually, lingually, and between roots. It also tended to be visible when the canal overlapped more strongly with the third molar on preoperative orthopantomography.

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We clinically analyzed 251 patients with sialolithiasis who were treated in the First Department of Oral and Maxillofacial Surgery, Tokyo Medical and Dental University from October 1977 to September 1991. The results were as follows:
1. The male: female ratio of the patients was 1:1.1 and a high incidence was found in the ages of 20 to 59 years.
2. Salivary calculi were most frequently found in the submandibular duct, and no right or left side preference was recognized.
3. The number of calculi ranged from 1 to 11; however, one calculi accounted for 84. 6% of cases.
4. As for the diameter of the calculi, most of them were less than 5 mm, and the largest one was 37mm.
5. The interval from the first recognition of symptoms to presentation at our clinic ranged from 1 day to 37 years. Most patients presented after more than 1 year.
6. The commonest symptom was the swelling of the submandibular gland, associated with the ingestion of food in about half of the cases.
7. In about 80% of all cases, removal of the calculus was performed.
8. In 13.1% of all cases, the following post-operative symptoms appeared: tenderness, swelling, hardening of the submaxillary region, and sensory paralysis of the hypoglossus and facialis nerves. However, symptoms improved in all cases. These results indicate that sialithiasis tends to be accompanied by swelling of the submandibular region rather than by salivary colic. Correct diagnosis is therefore difficult. Multiple calculi were found frequently; however, some of them were difficult to recognize radiologically. Therefore, care must be taken to avoid leaving stores behind and to avoid injury to the surrounding tissue.

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A giant cell granuloma suspected to be associated with cherubism in the bilateral mandibular molar regions is reported. The patient was a 12-year-old girl without a Cherubic look or familial history. However, deposits of collagenous material were noted around the capillaries by Masson trichrome stain.

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A malignant lymphoma in the floor of the mouth is reported. In, 1991, a 73-year-old man was referred to our clinic. He complained of a swelling in the floor of his mouth. Examination disclosed a diffuse swelling, measuring 50×30×20mm, with slight redness in the bilateral anterior region of the floor of the mouth. A tumor was suspected, and excision was performed under general anesthesia. The histopathologic diagnosis was diffuse pleomorphic, B-cell lymphoma. The tumor disappeared after chemotherapy. After about a year of follow-up, there has been no sign of recurrence.

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Sebaceous carcinoma of the oral region is a rare lesion arising predominantly in the parotid gland. We report a case of sebaceous carcinoma of the left buccal mucosa.
A 78-year-old man was referred to our clinic complaining of a mass in the left buccal mucosa. The mass was widely based, firm and 50×40mm in size. Under the clinical diagnosis of a malignant tumor, a biopsy specimen was taken and a histopathological diagnosis of sebaceous carcinoma was obtained. Because of unfavorable laboratory data, an advanced age of 78, and no evidence of metastasis, only wide local resection was performed. The postoperative course is favorable, however, long-term follow-up should be continued.

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Oral hairy leukoplakia (OHL) occurs mainly on the lateral border of the tongue of human immunodeficiency virus (HIV)-infected patients. Recent studies have demonstrated Epstein-Barr virus in the epithelial cell of OHL.
We described two cases of OHL which developed in HIV-infected patients with hemophilia. Light microscopic investigation revealed parakeratosis, acanthosis, koilocytosis and lack of inflammation in the subepithelial tissue. Viral particles and nucleocapsids of Epstein-Barr virus were found in the epithelial cells by electron microscopy.

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We report a case of angiosarcoma metastatic to the mandibular gingiva. A 51-year-old man was referred to our department complaining of mandibular gingival swelling. He had been admitted to our hospital with angiosarcoma of the right thigh region. Intraoral examination revealed a deep red mass at the molar region of the right mandibular gingiva. It was elastic soft on palpation. An incisional biopsy was done, and examination of the biopsy specimen revelaed a metastatic angiosarcoma to the mandibular gingiva. Though the tumor temporally responded to radiotherapy and decreased in size, the patient died of general debilitation.

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We reported eight cases of tuberculous cervical lymphadenitis encountered at our clinic during the period from 1978 to 1993. They consisted of three males and five females ranging in age from 7 to 75 years old. The clinical diagnosis was a tumor-like lesion in three cases and a strong suspicion of tuberculous cervical lympnadenitis in four cases; five of these cases were diagnosed as cervical lymphadenitis based on clinical evidence. Regarding treatment, surgery alone was used in two cases, and chemotherapy after surgery was employed in six cases. All resected specimens were histopathologically diagnosed as tuberculous lymphadenitis.
The diagnosis of tuberculous cervical lymphadenitis is difficult to make on a clinical basis. Open biopsy of the cervical lymph nodes played an important role in the diagnosis of tuberculous cervical lymphadenitis.

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A case of synovial chondromatosis of the temporomandibular joint with cranial extension is reported. A 48-year-old woman complained of dull pain at the left temporomandibular joint and limited jaw opening. The following examinations were performed: 1) sagittal tomography showed erosive resorption of the mandibular fossa; 2) magnetic resonance imaging and computed tomography revealed a tumor mass at the left temporomandibular joint extending to the middle cranial base; 3) ^99mTc bone scintigraphy showed localized higher uptake. These findings suggested synovial chondromatosis, but also led to the suspicion of a malignant tumor. Open biopsy via the trans-zygomatic approach was performed. A clinical diagnosis of synovial chondromatosis was made. Total synovectomy, diskectomy and arthroplasty were performed simultaneously. The histopathological diagnosis was synovial chondromatosis. The patients' progress has been uneventful for 21 months postoperatively.

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A case of metachronous multiple cancer in the gingiva-oropharynx and uterus of a 74-year-old female is described. Originally, the patient received treatment for squamous cell carcinoma (S.C.C.: T3N1M0) in 1968. Treatment consisted of ⁶⁰Co external beam radiation (80 Grys) to the gingiva-oropharynx including the right submandibular region. In 1980, the patient presented with cancer (S.C.C.: T4NOMO) in the same region. It was not possible to determine if the oral cancer was radiation-induced or a recurrence of the previous cancer. The gingiva-oropharynx cancer was treated with ⁶⁰Co external beam radiation (46.5 Grys), ²²⁶radium and ¹⁹⁸Au implanting (70 Grys), and it was controlled. Although hysterectomy (uterine cancer: adenosquamous cell carcinoma) was performed on March 13, 1981, the patient died due to metastasis of the uterine cancer on July 12, 1983.

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A chondrosarcoma on the mandibular condyle is described. The patient was a 58-year-old woman with left preauricular swelling. Examination disclosed a nontender, hard mass overlying the left TMJ region. The mandibular movement was limited to 26 mm of interincisal distance and the mandible deviated to the left with mouth opening. Radiographic investigation revealed a tumorous mass around the condyle showing partial resorption. The bone scintigram showed accumulation of ^99mTc into the tumor mass. The lesion, which was clinically suspected to be a chondrosarcoma, was surgically excised with the mandibular ramus, the temporal muscle and the external pterygoid muscle. Histologically, the lesion was composed of translucent cartilage and many cells with enlarged and hyperchromatic nuclei. The histopathological diagnosis was chondrosarcoma.
The patient is now being followed up, with special attention to lung metastasis.

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Oral lichen planus is considered to be a chronic inflammatory disease. However, there are a few reports of malignant transformation of lichen planus.
We report here a case of squamous cell carcinoma arising in lichen planus on the lower lip with a review of the Japanese literature.
The patient was 76 years old when lesions of the lower lip and bilateral buccal mucosa were diagnosed as lichen planus on initial examination.
We first treated the lesion with steroid ointment, but no remarkable change was noted. Then, we tried to vaporize the lesion with a CO2 laser. During the follow-up period, the lesion on the lower lip developed into squamous cell carcinoma 4 years after the diagnosis of lichen planus.

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A squamous cell carcinoma of the buccal mucosa probably arising in the minor salivary glands was reported.
About 1 month before presentation, a 65-year-old female noticed a tumor on the right buccal mucosa. It was superior to the right parotid papilla, hemospheric in form, measured 1.4 cm in diameter, and was mobile with an elastic firm consistency. The overlying mucosa was generally smooth. No abnormalities were detected by clinical examination. The tumor was removed along with the surrounding tissue. Histological examination revealed a well differentiated squamous cell carcinoma. Nodular carcinoma cell nests appeared immediately beneath the mucosa. The rests proliferated by replacing the minor salivary glands. Thickening (proliferation) of ductal epithelium was noted in the neighboring salivary glands.
Neither recurrence nor metastasis have occurred as of 4 years and 3 months after surgery.

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Chromoblastomycosis of the maxillary sinus is a very rare condition. In this report, we presented a case of chromoblastomycosis of the maxillary sinus in a 30-year-old female. Under general anesthesia, a radical sinusotomy of the left maxillary sinus was performed.
Macroscopically, the sinus contents consisted of dark-brown necrotic tissue, partly with calcification. Microscopically, the foci contained fungal elements. These organisms had a thick wall and sclerotic bodies were present.
The patient's postoperative course has been uneventful to the present date.

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A universal problem with the use of hydroxylapatite (HAP) particles has been theirtendency to migrate beyond planned boundaries. The migration of particles can result inloss of ridge form and height. As a result, various different techniques, including suturingsurgical stents, splints, and open mucosal flap procedures, have been reported.
This paper describes the author's experience using Vicryl^®-Net filled with HA particlesfor local alveolar ridge augmentation procedures in a 12-year-old boy.
It seemed efficient to use this material to prevent dispersion of HA particles in patientsrequiring ridge augmentation.

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Beckwith-Wiedemann syndrome (BWS) is a congenital disease characterized by exomphalos, macroglossia and gigantism. This paper presents a case of BWS undergoingtongue reduction at the age of six years. The patient was a three-month-old baby referredto our clinic for macroglossia from the Department of Pediatrics, Kagoshima University Hos-pital. His tongue showed hemihypertrophic macroglossia on the right side with only slightdifficulty in secretion. In our case, macroglossia induced prognathism and openbite as thepatient became older. We therefore feel that tongue reduction should be performed at theage of about one year and six months for congenital macroglossia.

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An analysis of 10 primary multiple malignant tumors of the head and neck isreported. The primary multiple tumors constituted 6.8% of 148 head and neck malignanciestreated in our department. Of 8 tumors with initial development in the head and neckregions, 3 occurred in the buccal mucosa and 5 in the maxillary gingiva, mandibulargingiva, floor of the mouth, tongue and parotid gland. The tongue and maxillary gingivawere the sites of involvement of 2 other cases in which head and neck tumors were secon-dary tumors. Sites of involvement other than the head and neck included the lungs, colon, rectum, stomach, pancreas, thyroid gland, breast, urethra and cervical lymph nodes.
Histologically, 8 of the 10 head and neck tumors were squamous cell carcinomas. Fortumors in other sites, adenocarcinoma was the diagnosis in 5 cases, followed by squamouscell carcinoma (3 cases) and malignant lymphoma (2 cases).
The results indicate that with the increasing age of patients with head and neck cancerand their improved survival rate, much more care should be directed to the potentialdevelopment of second malignancies in this patient group.

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Multiple primary carcinomas were regarded as unusual. Improvements in diagno-stic techniques and treatment as well as extension of the average life span have increasedthe incidence of multiple cancers in recent years. Reports of triple or more cancers, however, are very scarce. In this paper, a very unusual case of quintuple malignancies is reported.
The patient was a 64-year-old woman who had a squamous cell carcinoma of the buccalmucosa. During the following 9 years, breast carcinoma, squamous cell carcinoma of thegingiva of the mandible, and malignant lymphoma of the submandibular region developed. The patient died of heart failure during treatment for malignant lymphoma. Autopsyreveale the presence of adenocarcinoma of the colon.

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Benign fibrous histocytoma is a well-established soft tissue neoplasm, and the occurrence of this lesion in the oral cavity is rare. Only 3 cases of this lesion arising centrally in the mandible have been reported in the literature. In this paper, we reported a patient with benign fibrous histiocytoma of the mandible.
A 42-year-old Japanese woman was referred to our department complaining of swelling on the lingual side of the right mandibular body in November 1987. Radiographic examination demonstrated a illdefined radiolucent lesion in the right body of the mandible extending from 7 to the ramus. We performed segmental resection of the mandible in March 1988. A solid yellowish lesion was observed in the mandible body, and partial destruction of the lingual palate was found. Histopathologically, the lesion was composed of spindle-shaped figroblastic cells and histiocytic cells. The histiocytic cells showed negative staining for S-100 protein and positive staining for a-1 antitrypsin. Based on these clinical and histopathological findings, the lesion was diagnosed as benign fibrous histiocytoma. The postoperative course was good and no signs of recurrence have been seen almost 6 years and 4 months after operation.

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We report a rare case of an inverted papilloma occurring concurrently with a squamous cell carcinoma arising in the maxillary sinus.
A 46-year-old man visited our clinic complaining of swelling in left maxillary gingiva. The clinical diagnosis was a malignant tumor of left maxilla.
Exploratory biopsy resulted in a histopathological diagnosis of squamous cell carcinoma, which prompted us to perform induction chemotherapy and a left partial maxillectomy. Histopathological findings of the removed portion of the maxilla revealed a predominantly inverted papilloma and a small amount of residual carcinoma.
Microscopically, the nests of the invasive squamous cell carcinoma were clearly separated from the mass of the inverted papilloma. These findings suggested that the inverted papilloma occurred concurrently with the squamous cell carcinoma.
Radiation therapy was performed using ⁶⁰Co (total 50 Gy) after surgery.
The patient's postoperative course was uneventful and a prosthesis was inserted.

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Calcifying epithelioma is a tumor originating in hair cortex cells. It tends to occur in the head and neck region.
We reported a case of rapidly growing calcifying epithelioma. The patient, a 12-yearold girl, had a bone-like hard tumor in her parotidomasseteric region. The tumor had grown rapidly for the last three months before operation. The tumor was extirpated and histological examination revealed a calcifying epithelioma. An inflammatory stimulus apparently promoted the rapid growth of this tumor. There has been no evidence of recurrence for 8 years after operation.

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A static bone defect is detected radiologically as a radiolucent area in the vicinity of the mandibular angle. It can initially be misdiagnosed as a cyst or a benign tumor. However, most such defects are unilateral and feature partial lingual concavity of the mandible.
The case reported herein is an extremely rare occurrence of bilateral static bone defects diagnosed by submandibular gland CT-sialography and CT number. The lingual cortex of the bilateral mandibular angles appeared to have become partially concave because of the submandibular gland tissue within this concavity. Based on several examinations, the defects were diagnosed as acquired bone defects produced by pressure exerted by the peripheral tissues, particularly the submandibular glands.

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