Thirty-three cases of oral squamous cell carcinoma (S. C. C.) were studied immunohistochemically, using an antibody against vascular endothelium (JC70A). The relationship between the distribution of microvessels and clinicopathological factors was also investigated. In healthy epithelium, crosssections and the course of microvessels had a regular appearance. However, in S. C. C., microvessels appeared to be irregular and their density was increased. In highly differentiated S. C. C., microvessels were localized around the cancer nests, but in poorly differentiated S. C. C., microvessels were scattered. The density of microvessels in highly-differentiated S. C. C. was higher than that in poorly differentiated S. C. C. However, no correlation between the density of tumor vessels and tumor proliferation. indicated by T classification and PCNA labelling Index, could be demonstrated. The relationship between tumor vessel density and the histological grade of the mode of invasion was determined. At the invasive edge of the tumor, tumor vessel density was higher in grades 4C and 4D than in other grades. The vessel density was also higher in tumors with lymphnode metastasis, than in those without lymph node metastasis. These results suggested that tumor invasion and metastasis may be related to the distribution of tumor vessels.
This study was designed to identify differences in the masticatory muscles between patients with mandibular prognathism and normal subjects. Electromyograms during maximum centric occlusion and in the occlusion adjusted to 5 kg by the use of a jaw force meter (NIHON KOHDEN Co.) were recorded at the masticatory muscles (masseter, anterior and posterior temporal muscles) by means of surface electrodes. The occlusal force and total contact area during maximum occlusion were recorded and calculated using an Occlusal Prescale System (Fuji Film Co.). Thirteen patients with mandibular prognathism and 20 subjects without craniomandibular dysfunction were studied in terms of their electromyographic signals and occlusal force before and after orthognatic surgery. Histochemical analysis of the masseter muscles was carried out in 9 patients and 4 normal subjects. The results were as follows: 1) The masseter muscles are the main muscles during masticatory movement in subjects without biting malfunction. The anterior temporal and posterior temporal muscles change their activity according to the working side and the balancing side. 2) It was found that patients had higher electromyographic activity than subjects without malfunction in a closed-jaw position before surgery. The total-contact-area and occlusal force were significantly lower in patients compared with the normal group. There was no difference in average biting pressure. 3) After orthognathic surgery, total-contact-area of centric occlusion and occlusal force were increased. There were no significant differences between patients and subjects without malfunction. There were also no significant differences in average biting pressure between the two groups both before and after surgery. 4) There was a period of electric-overdischarge among the patients for 2 or 3 months after operation. Concurrently, a change in load ratio among the muscles was noted. 5) A so-called “type 1 fiber predominance” masseter in which type 1 fibers accounted for over 55% of muscle fibers was found frequently in the patients. In some cases, electric-myographic volume was still high even after operation. This was found particularly among patients with a high-Type 1 fiber-ratio.
Standards for stored autologous blood transfusion were established recently based on the clinical experience and research data for 140 autologous blood transfusions, which have been carried out in orthognathic surgery patients between 1985 and 1992 at the First Department of Oral and Maxillofacial Surgery, Kagoshima University Dental Hospital, Japan. Regarding standards designed to avoid anemia after phlebotomy, one time collection volume was decided using the following formula: predicted Hb level after collection=(circulating blood volume-one time collection volume) ÷circulating blood volume×Hb level before collection ≥10 g/dl. Fifteen female patients with mandibular prognathism were studied hematologically following a 400 ml autologous blood collection and a transfusion to evaluate the efficiency of this new standard. Two units of whole blood were collected 15 days before each patient's operation. All units of collected blood were transfused without homologous blood transfusion. RBCs, Hb and Hct, which were reduced after the phlebotomy, normalized the day before operation. The rate of reticulocytes was tended to increase during the period of blood storage and for one week after operation. The iron level in the serum was minimum on the day following operation, suggesting the need for postoperative iron supplementation. Increased serum erythropoietin levels, similar to reticulocytes, showed high erythropoietic activity from the first day following the phlebotomy to the postoperative period. There were no differences between the actual minimum Hb level and the predicted Hb level after blood collection of 400 ml. The Hb level on the first day after operation was significantly higher than the calculated Hb level on the same day without blood transfusion (p<0.01). These results suggested the usefulness of our standards.
This study reviewed 9 patients (2.8%) with multiple primary oral cancer in the maxillofacial region who were treated at the Department of Oral and Maxillofacial Surgery of Kanagawa Dental College from 1970 to 1992. The patients ranged from 36 to 73 years of age (mean 56 years). There were 3 males and 6 females. Primary cancers (all squamous cell carcinoma) were found in the mandibular and maxillary gingiva in 3 cases, right and left buccal mucosa in 1 case, right and left maxillary sinus in 1 case, tongue and buccal mucosa in 1 case, maxillary gingiva and buccal mucosa in 1 case, mandibular gingiva and buccal mucosa in 1 case, and in the mandibular gingiva and maxillary sinus in 1 case. Background factors included Plummer-Vinson syndrome in 1 case, and multiple leukoplakia in 3 cases. The interval between the appearance of primary and secondary carcinomas ranged from 6 months to 8 years and 5 months ; the average interval was 3 years and 11 months. TNM classification of the primary cancer was T1 in 1 case, T2 in 5 cases, T3 in 3 cases, NO in 4 cases, Ni in 5 cases, and MO in every case. TNM classification of the secondary cancer was T1 in 3 cases, T2 in 3 cases, T3 in 3 cases, NO in 6 cases, N1 in 3 cases, and MO in every cases. TNM classification of the tertiary cancer was T1NOMO in 2 cases. In primary carcinomas, 5 cases were treated with chemotherapy, radiation and surgery, 2 cases with chemotherapy and radiation, and 2 cases with surgery alone. In secondary lesions, 3 cases were treated with chemotherapy, radiation and surgery, 2 cases with radiation and surgery, 3 cases with surgery alone, and 1 case with chemotherapy and radiation. In tertiary lesions, 2 cases were treated with surgery alone. During an observation period ranging from 2 to 14 years. 5 patients are still alive and 4 have died of cancer.
The present study was conducted to evaluate the clinical usefulness of Sai-boku-to (Kanpo medicine) for the treatment of glossodynia. Oral administration of 7.5 g Sai-boku-to per day for one to two months was performed to treat glossodynia. Clinical examinations were carried out in order to evaluate subjective symptoms such as pain, heat sensation and unpleasent feelings. The success rate was 60% after one month and 82.4% after two months' administration. Mild side effects, recorded in 3 cases, disappeared without any treatment, and did not preclude the long-term use of Sai-boku-to. These results demonstrate that Sai-boku-to is a clinicaly useful drug for the treatment of glossodynia.
A 78-year-old female was referred to our clinic for evaluation of pigmentation on the soft palate. Oral examination revealed three separate dark pigmented spots on the soft palate which were unassociated with bleeding, pain, or ulceration, and brown discoloration extending to the bilateral and posterior pharyngeal walls. A diagnosis of malignant melanoma was made by biopsy of one spot. After 104×106 IU of interferon, 30 Gy irradiation, and 2 courses of chemotherapy, one of the three lesions in the soft palate exfoliated and discoloration of the lateral and posterior pharyngeal walls disappeared, while the other two lesions persisted. She subsequently underwent a wide resection, including the entire soft palate and the posterior area of the hard palate, to treat the residual lesions. Histologic examination of the resected specimen did not reveal any remaining melanoma cells. Fifteen months after treatment she has not shown any evidence of local recurrence or regional lymph node or distant metastasis.
The present paper reports a case of Hodgkin's disease of the submandibular lymph nodes. The patient was a 71-year-old male who presented with submandibular lymph node swelling (6×4cm) associated with a slight increase in the ratio of monocytes (9%) and slightly low serum protein (6.1g/dl). Ultrasound imaging of the lymph node revealed a relatively homogenous internal hypoechoic density with a bottom echo and acoustic enhancement. Pathological examination revealed many eosinophilic Hodgkin's cells and Reed-Sternberg cells which reacted with LN-2 antibody. The patient was determined to be in Clinical Stage IA. He was treated by radiation (total dose 30Gy) and MOPP (2 cycles), inducing a CR state.
We have encountered a rare case of a true median cleft of the upper lip. The patient was a 4-month-old female baby with a median cleft of the upper lip and the lower attached labial frenulum. Surgery was performed when she was 1 year old. The postoperative course was good and the results were satisfactory esthetically.