Japanese Journal of Oral and Maxillofacial Surgery
Online ISSN : 2186-1579
Print ISSN : 0021-5163
ISSN-L : 0021-5163
Volume 40, Issue 3
Displaying 1-14 of 14 articles from this issue
  • Toshikage JINDE
    1994 Volume 40 Issue 3 Pages 377-395
    Published: March 20, 1994
    Released on J-STAGE: July 25, 2011
    JOURNAL FREE ACCESS
    In this experiment, five different soluble calcium phosphates ceramics were synthesized: HAP, β-TCP, α-TCP, OCP (octacalcium phosphate) and DCPD (dicalcium phosphate dehydrate). The effects of the ceramics on BMP activity were investigated in vitro and in vitro.
    Five mg of BMP was prepared along with 5 or 25 mg of ceramics. These were then combined to form complexes. These complexes were implanted epifascially in the femoral region, and their osteoinductive activities were examined at 4 weeks after implantation by means of roentogenographic and histologic observations. The amount of bone induced by the complexes was determined by a computer-supported image analysis system. For in vitro studies, a culture system which differentiated neonatal muscle into cartilage in response to BMP contained in Bone Matrix Gelatin (BMG (+)) was adopted. Calcium phosphate was applied onto the BMG, and a fetal rat muscle was placed on top, and the system was cultured. On Day 14 of culture, incorporation of [35S]-sulfate into glycosaminoglycans (GAG) was measured. Furthermore, to study the solubility of the ceramics in the culture medium, the ceramics were soaked in the same medium for 3 days, and the amounts of Ca and P and the change in pH were measured.
    HAP, β-TCP and α-TCP did not affect BMP activity when 5 mg and 25 mg ceramics/BMP complexes were implanted in the mice. OCP and DCPD did not affect BMP activity when 5 mg ceramics/BMP complexes were implanted, but inhibited BMP activity when 25 mg ceramics/BMP complexes were implanted. Only DCPD inhibited BMP activity while other ceramics did not in vitro. HAP, β-TCP and α-TCP produced no change in the Ca and P concentrations of the medium, but DCPD increased the concentrations of Ca and P and OCP decreased the concentrations of Ca and P. All the ceramics behaved similarly to the control in regard to the pH of the medium.
    It was concluded that HAP, β-TCP and α-TCP, which did not affect Ca and P concentrations in the medium, did not influence BMP activity. DCPD, which showed high solubility, inhibited BMP activity. Further investigations are necessary to determine the effect of apparent volume of OCP on BMP activity, and the effect of the phase transformation of OCP on solubility.
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  • Evaluation using electric stimulation
    Akiko KOBAYASHI, Koji KINO, Teruo AMAGASA
    1994 Volume 40 Issue 3 Pages 396-403
    Published: March 20, 1994
    Released on J-STAGE: July 25, 2011
    JOURNAL FREE ACCESS
    The recovery of sensation by the lower lip and chin after inferior alveolar nerve section performed during oral and maxillofacial surgery was examined in 11 patients. Five patients were treated with by soft tissue reconstruction, while the other 6 were not.
    Sensory testing was performed using an electric stimulator (SEM 4201). Stimulating electric current was increased gradually and the level at which the patient felt an unusual sensation was regarded as the threshold. Results from the same areas were put together to derive threshold maps of the patient's lower lip and chin. Sensory levels of the upper lip were used as control. The areas of regions with higher thresholds than control were measured. Furthermore, areas with a threshold exceeding O. 1 mA and anesthesic areas by light touchtest were also measured.
    Areas with a threshold higher than control persisted in all 11 patients at final follow-up examinations (28-81 months) after surgery. At 28 months after surgery, areas with a threshold level exceeding 1.0 mA disappeared in 3 patients. No remarkable changes were noted 12 months after surgery onwards.
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  • Akihiko FURUYA, Jun SHIMADA
    1994 Volume 40 Issue 3 Pages 404-420
    Published: March 20, 1994
    Released on J-STAGE: July 25, 2011
    JOURNAL FREE ACCESS
    As simultaneous mobilization of the maxilla and mandible has enhanced the success rates for correction of various dentofacial deformities in recent years, Le Fort I osteotomy is now routinely performed in many clinics. However, complications of life-threatening hemorrhage have been reported to be associated with Le Fort I osteotomy. It was stressed that hemorrhage is primarily related to damage of the internal maxillary artery.
    The purpose of this investigation was to elucidate which osteotome (swan's neck osteo tome, modified swan's neck osteotome, Obwegeser osteotome, Kawamoto osteotome) is the safest to use to perform disjunction between the pterygoid plate and the maxillary tuberosity, and to determine the impact force required to effect this disjunction. Using human air-dried skulls, the impact force and dynamic strain of the disjunction of the pterygomaxillary suture were measured.
    The following results were obtained:
    1) The relationship between the absolute values of the impact force and dynamic strain were linear with all osteotomes.
    2) The impact force was minimum with the Kawamoto osteotome.
    3) The rate of normal disjunction was highest when the swan's neck osteotome was employed. With the Kawamoto osteotome normal disjunction was obtained at a high frequency at the first disjunction.
    4) The disjunction lines running obliquely upwards on the pterygoid plate were observed most frequently in both the first and last disjunction series.
    5) Using the swan's neck osteotome, we found large dynamic strains on the horizontal plate of the palatine in the first disjunction series and on the central part of the medial pterygoid plate in the last disjunction series.
    6) Employing the modified swan's neck osteotome, we measured large dynamic strains on the central part of the lateral pterygoid plate and on the upper and central parts of the medial pterygoid plate.
    7) With the Obwegeser osteotome, large dynamic strains were measured on the upper and central parts of the lateral and medial pterygoid plates.
    8) With the Kawamoto osteotome, large dynamic strains were detected on the upper part of the medial pterygoid plate.
    The results suggest the swan's neck or Kawamoto osteotome to be preferable for performing disjunction ebtween the pterygoid plate and the maxillary tuberosity. However, when empolying the Kawamoto osteotome in the last disjunction, it was necessary to firmly hold the movable maxilla.
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  • Akira ARASAKI
    1994 Volume 40 Issue 3 Pages 421-437
    Published: March 20, 1994
    Released on J-STAGE: July 25, 2011
    JOURNAL FREE ACCESS
    The purpose of this study was to assess the value of induction chemotherapy based on clinicopathologic malignancy grade in systematic oral cancer treatment. Onehundred and eight patients with oral squamous cell carcinomas were surgically operated on after induction chemotherapy based on both the clinicopathologic malignancy grade and the effect of induction chemotherapy. These cases were clinicopathologically examined to determine the value of induction chemotherapy. The following results were obtained:
    The clinical response rate of induction chemotherapy was 63.0% and the histologic response rate was 54. 6%. Regarding the relationship between the histologic effect and the clinicopathologic malignancy grade, as malignancy grade became higher the histologic response tended to diminish. Regarding the relationship between the histologic response and nodal metastasis, in the good histologic response group (GradeIII/IV) there were few primary metastases and no secondary metastases. It was suggested that induction chemotherapy which showed good anticancer efficacy at t4he primary region may also have a good effect on metastatic lymph nodes. Regarding the relationship between the histologic effect of induction chemotherapy and prognosis, the better the histologic response, the better was the prognosis. There was a statistically significant difference in prognosis between the histologic responder group (Grades II B/III/IV) and the histologic nonresponder group (Grades I/II A). These facts suggested that the histologic effects of induction chemotherapy may be one of the important factors determining prognosis. For survival rate by the clinicopathologic malignancy grade, the higher the malignancy grade, the lower was the survival rate. For survival rate by the clinical stage, the more advanced the stage, the lower was the survival rate. In particular, there was a statistically significant difference in survival rate between stage El and the other stages. The total five years' cumulative survival rate was 80.8%, which was favorable. This suggested that in systematic oral cancer treatment, induction chemotherapy and surgical therapy based on the clinicopathologic malignancy grade may help to improve the prognosis of oral cancer.
    In conclusion, induction chemotherapy was less effective for advanced and high malignancy grade case. Whereas it was more effective for the other cases. The application of both induction chemotherapy based on the clinicopathologic malignancy grade and surgery based on the effects of induction chemotherapy should help to improve chances for radical cure of oral cancer.
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  • Prognostic factors
    Kousaku MATSUDA, Teiichi TESHIMA
    1994 Volume 40 Issue 3 Pages 438-453
    Published: March 20, 1994
    Released on J-STAGE: July 25, 2011
    JOURNAL FREE ACCESS
    The seventh decade of life was the age at which patients were most commonly affected and it accounted for 31.8% of the 66 cases of adenoid cystic carcinoma studied. There were 31 male and 35 female cases. In most patients (43. 2%) a mass without pain was the main complaint.
    Of the 66 tumors, 27 (40.9%) occurred in the minor salivary gland. Twenty tumors (30.3%) were found in the major salivary gland, 13 (19.7%) in the airways, and 6 (9.1%) in miscellaneous sites.
    The proliferative degree of adenoid cystic carcinomas correlated with the histologic grade and with the prognosis. Grade ill tumors tended to have a higher proliferative degree, and patients with a lower proliferative degree tended to have a better prognosis.
    Patients with tumors in the major and minor salivary gland had a good prognosis, with cumulative 10-year survival rates being 31. 6%, and 37. 3% respectively. These rates were better than that in patients with tumors in the airways, who had a cumulative survival rate of 15%,
    Recurrence rate in the 53 cases treated by surgery was 71.7%, and that in the caseswith bone invasion by the tumor was 90.0%, However, in case without bone invasion the recurrence rate was 60.6%.
    The patients treated by a combination of surgery and radiation therapy had a better prognosis than the patients treated by other therapies, but the difference was not significant.
    Comulative survival rates of the 61 patients at 3, 5, 10, and 15 years were 80.8%, 65.0%, 37.2%, and 37.2%, respectively.
    The 5-year cumulative survival rates were 81.8%, 73.6%, 25.6%, and the 10-year cumulative survival rates were 68.2%, 38.9%, and 0.0%, for histological Grades I, II, and III, respectively. A high histological grade tended to be associated with a poor prognosis.
    More than one cell in mitosis per high power field (×400) was found to be a sign of a poor prognosis.
    The presence of vascular invasion was correlated with the metastatic rate, but the presence of perineural invasion was not correlated with recurrence or metastasis.
    The clinicopathological malignant score (minimum: score 3, maximum: score 9) assessed based on three factors (clinical staging, histological grading, number of mototic cells) in this study was correlated with the prognosis of adenoid cystic carcinoma.
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  • Hideo HOSAKA, Natsuki SEGAMI, Sinsuke HORI, Yoshiyuki MORIYA, Ken-Ichi ...
    1994 Volume 40 Issue 3 Pages 454-457
    Published: March 20, 1994
    Released on J-STAGE: July 25, 2011
    JOURNAL FREE ACCESS
    Arthrocentesis which involved hydraulic distension with 200-300 ml lactated Ringer's solution following an injection of betamethasone into the superior joint compartment, was carried out in 20 closed lock cases of internal derangement of the temporomandibular joints. Prior to, immediately after, 2 weeks after, 2 months, and 6 months after the procedure, the patient's jaw opening was evaluated. The subjects rated their pain level (VAS), and filled in a questionnaire which assessed pain, jaw dysfunction, and activity limitations.
    The following results were obtained:
    1. The range of opening motion was significantly increased from 30. 7±5.9 mm to more than 40 mm (P<0.01) at immediately after, 2 weeks after, and 2 and 6 months after the procedure.
    2. VAS of pain, pain score, jaw dysfunction score, and activity limitation score also significantly decreased (P<0.01).
    3. Sixteen of the 20 cases (80%) satisfied success criteria.
    It was concluded that this procedure is not only highly effective for releasing closed lock symptoms, but also it can be carried out easily in the outpatient clinic.
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  • Emphasis on the relationship between the cysts and the mylohyoid muscles
    Katsuichi SUGIMOTO, Masashi SHIMAHARA, Haruhiko TERAI, Norihiro HASHIG ...
    1994 Volume 40 Issue 3 Pages 458-460
    Published: March 20, 1994
    Released on J-STAGE: July 25, 2011
    JOURNAL FREE ACCESS
    Recently, magnetic resonance imaging (MRI) which has a high detection rate of lesions, has erabled more detailed information to be obtained for lesions in difficult sites, even in the field of oral surgery.
    We carried out MRI in 3 patients with dermoid cysts of the oral floor, and studied the positional relationship between the cyst and the mylohyoid muscle. According to the conventional classification of Bergmann and Hagisaki based on the mylohyoid muscle, these 3 cases were sublingual and submental types. MRI showed all 3 cases to be sublingual typewith the mylohyoid muscle at the inferior site of the cyst.
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  • SUSUMU TANAKA, Takashi MIMA, Takafumi OGURA, Mitsunobu KISHINO, Tokuzo ...
    1994 Volume 40 Issue 3 Pages 461-463
    Published: March 20, 1994
    Released on J-STAGE: July 25, 2011
    JOURNAL FREE ACCESS
    A desmoplastic fibroma in the mandible of a 24-year-old female is described. This patient had complained spontaneous pain associated with a rapidly growing tumorous mass. Continuous resection of mandible, an iliac crest bone graft, and immediate reconstruction using a titanium plate were performed. The extirpated tumor measured 70×50×40 mm.
    Histopathologically, the tumor was composed of many small fibroblast-like cells and abundant collagenous fibers. Ultrastructural studies revealed an intracellular matrix, mature collagenous fibers and fibroblast-like cells. The cells had a smooth nuclear membrane and many developed rough endoplasmic reticul.
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  • Kazue YAMAGUCHI, Kenji HASHIMOTO, Yoshimasa KITAGAWA, Ichiro YAMADA, J ...
    1994 Volume 40 Issue 3 Pages 464-466
    Published: March 20, 1994
    Released on J-STAGE: July 25, 2011
    JOURNAL FREE ACCESS
    Ameloblastoma, an odontogenic tumor of ectodermal origin, in young persons is though to be a rare entity. Moreover, peripheral ameloblastoma is a relatively uncommon lesion that is histologically identical to the classical intraosseous ameloblastoma. The present study describes the clinical and histologic characteristics of a peripheral ameloblastoma occurring in the gingiva of an infant.
    A boy, aged 1 year 9 months, presented with a swelling on the lower right deciduouslateral incisor region. The swelling had been present for the previous two months with ocassional bleeding. As the deciduous teeth (c B I) were unerupted, he was followed up for 16 months. On December 3, 1991, the gingival tumor was extripated. The round mass was well demarcated. A diagnosis of peripheral ameloblastoma (follicular type) was made on the basis of clinical and histological findings and examination of the surgical specimen. The tumor cells in the follicles included central stellate cells, peripheral polyhedral cells and intermediate cells. No recurrence was observed for two years.
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  • Yoshiyasu FUKUTA, Kazumi YAMADA, Hiromi OHMURA, Keigo KUDO, Yasunori T ...
    1994 Volume 40 Issue 3 Pages 467-469
    Published: March 20, 1994
    Released on J-STAGE: July 25, 2011
    JOURNAL FREE ACCESS
    A malignant fibrous histiocytoma (MFH) arising in the irradiated maxilla is reported. The patient was a 59-year-old Japanese female who was referred to us for arelatively well defined and lobulated tumor extending from the right buccal mucosa to left hard palate. Her past medical history revealed that she had had a squamous cell carcinoma of the right buccal mucosa treated by 145 Gy of radiotherapy 3 years previously.
    Although the patient underwent a bilateral partial maxillectomy, she died due to extensive local recurrence 14 months postoperatively. Histopathologically, proliferation of atypical tumor cells of non-epithelial origin, i.e., spindle-shaped fibroblastic cells, histiocytic cells and bizarre multinucleated giant cells, were noted. Furthemore, a storiform pattern was also seen in part of the lesion.
    These features suggested that this case was a postirradiation malignant fibrous histiocytoma.
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  • Kouki TAMAYAMA, Jun-ichi MURAKAMI, Hiroto KIMURA, Toru AKITAYA, Keiich ...
    1994 Volume 40 Issue 3 Pages 470-472
    Published: March 20, 1994
    Released on J-STAGE: July 25, 2011
    JOURNAL FREE ACCESS
    Pleomorphic adenoma is the most frequent type of benign salivary gland tumors. The authors encountered a patient with a huge tumor in the parapharyngeal space, which very rarely gives rise to tumors. We report here an outline of the clinical characteristics of this case and discuss the operation method for this parapharyngeal space tumor.
    The patient was a 57-year-old man who came to our clinic complaining of a swelling on the right soft palate. The patient underwent excision of a parotid gland tumor 18 years ago. According to the CT scan and MRI findings, the tumor was the size of a hen's egg' bellshaped, and occupited the parapharyngeal space. For The surgical procedule, we chose a cervical-transpharyngeal approach with a midline mandibulotomy. The large tumor could be easily removed as a whole.
    The patient has been free of disease for two years after the operation. We could not find any problem with the mandibular osteotomy site. CT scan and MRI were suggested to be very useful either in determining the position and size of the tumor or in selecting the surgical method.
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  • With histochemical study
    Hiroshi HARADA, Ryuji NAKANO, Hiroshi MURASE, Tadamitsu KAMEYAMA
    1994 Volume 40 Issue 3 Pages 473-475
    Published: March 20, 1994
    Released on J-STAGE: September 13, 2011
    JOURNAL FREE ACCESS
    Granular cell tumors are rare, and their origin is still controversial. They arise in soft tissue, and mainly on the tongue in the oral region.
    The case reported here is a 30 year-old-female complaining of a painless nodule, which had persisted for about six months under the mucosa of the left lower lip.
    We excised the tumor along with the upper mucosa under local anesthesia.
    Pathologically, eosinophilic cells including granular capsules proliferated in the messenchymal tissue background, leading to the diagnosis of a granular cell tumor.
    Postoperatively, there has been no evidence of recurrence.
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  • Toshihiro MIZUTANI, Hideki MIZUTANI, Minoru UEDA, Toshio KANEDA
    1994 Volume 40 Issue 3 Pages 476-478
    Published: March 20, 1994
    Released on J-STAGE: July 25, 2011
    JOURNAL FREE ACCESS
    A case of an arteriovenous fistula (AVF) of the maxilla is reported. A 12-yearold boy visited our h ospital complaining of bleeding of the right maxillary gingiva. On the first visit he had a slight swelling of the right cheek and the 6 5 4 gingival region with redness and bleeding.
    Radiography showed an irregular nonradiolucency around the 5 4 apical region, and a honeycomb appearance extending from the right upper alveolar region to the right maxillary region.
    Angiography demonstrated the presence of an AVF of the right maxilla, and the feeding vessels appeared to be the right maxillary and facial arteries.
    Selective embolization of the feeders was performed via the right femoral artery by the Seldinger technique. AVITENE®(microfibrillar collagen for hemostasis) was used as the embolic material.
    After following up this patient for about 8 months, we observed a significant decrease in the lesion without recurrence. We consider this treatment to be one of the best choices for AVF of maxilla.
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  • Yumiko OHBAYASHI, Jitsuo NISHIHARA, Hitoshi SHIOTA, Akihiro TANIZAKI, ...
    1994 Volume 40 Issue 3 Pages 479-481
    Published: March 20, 1994
    Released on J-STAGE: July 25, 2011
    JOURNAL FREE ACCESS
    Subacute necrotizing lymphadenitis (SNL) was first reported by Kikuchi (1972) and Fujimoto et al.
    SNL has a characteristic clinical pattern of fever, lymphadenopathy, and leukopenia; the prognosis is usually favorable. Eighty-five percent of the cases affected by the disease are under the age of 30 years.
    SNL may be a reactiton to a viral infection, such as that caused by the Epstein-Barr virus or Toxoplasma, but the etiology of this disorder remains obscure.
    We encountered a patient who was found to have a high elevation of antibody titer to E-B virus, and a positive Paul-Bunnell reaction. A diagnosis of infectious mononucleosis (IM) was considered highly likely, but histopathological findings revealed SNL.
    This case may be associated with the E-B virus. Case reports of infectious mononucleosis which lack some of the clinical and hematological features of the disease despite a high elevation of antibody titer to E-B virus and a positive Paul-Bunnell reaction, may found to include SNL if biopsy of the lymph nodes is carried out.
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