We immunohistochemically studied proliferating cell nuclear antigen (PCNA) in 25 oral squamous cell carcinomas. PCNA-positive cells were detected in all formalin fixed, paraffin embedded specimens. The results were as follows:
1. The PCNA-positive rate in the group with cervical lymph node metastasis was significantly higher than in the group with no metastasis (p<0.05).
2. The PCNA-positive rate in the group with a clinical responce of no change was significantly higher than in the group with a partial response (p<0.01).
3. The PCNA-positive rate in specimens obtained during operation was significantly lower than those obtained by biopsy (p<0.05).
These results suggests that the PCNA-positive rate may be a useful factor in selecting the most effective type of antitumor therapy.

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The immunohistochemical distributions of collagens type I, III, IV, V, VI and VII were determined using the strept-avidin-biotin (SAB) method in biopsy specimens obtained from 45 patients with squamous cell carcinoma of the oral cavity. The results are summarized as follows.
1. In squamous cell carcinomas of the oral cavity, the staining patterns for type I, III, V and VI collagens, which were distributed in the stroma of the tumor tissue, varied with the amount of connective tissue. Based on the immunohistochemical distribution patterns for these collagens at the part of the tumor showing the deepest invasion, all biopsied specimens of 45 patients could be divided into three groups: group 1: the degree of staining intensity for these collagens was strong (7/45, 15.6%), group 2: marked mononuclear cell infiltration was observed in the stroma and the degree of staining intensity for these collagens was weak (22/45, 48.8%), group 3: the degree of staining intensity for these collagens was weak and the degree of mononuclear cell infiltration was weak (16/45, 35.6%).
2. Type IV and VII collagens appeared as lines corresponding to the BM around tumor nests, though not in all cases; some showed altered staining patterns, such as interruption and attenuation, and a few cases showed no staining at all. From these observations, all biopsy specimens of the 45 patients could be divided into three groups: group A: a continuous linear pattern of positive staining for these collagens was found around the cancer nests (8/45, 17.8%), group B: alteration of BM deposition associated with mononuclear cell infiltration into the cancer nests (13/45, 28.9%), group C: BM deposition altered, without mononuclear cell infiltration into the cancer nests (24/45, 53.3%).
3. The immunohistochemical ditribution patterns of these collagen types were related to tumor size and histological malignancy.
These immunohistochemical findings may reflect biologic characteristics in individual tumors.

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We stuided the distribution of tenascin by immunohistochemical techniques using the monoclonal antibody A030 in the tissues of salivary gland tumors consisting of 10 ade-noid cystic carcinomas, 10 pleomorphic adenomas, 10 mucoepidermoid carcinomas, 10 Warthin's tumors, and 40 squamous cell carcinomas of the oral cavity. Tenascin immunoreactivity was noted in all cases studied. Tenascin was detected in the subepithelial border, periductal tissues, and the tumor nest-stromal border. The expression of tenascin showed specific staining patterns in various salivary gland tumors. The results of this study suggested that tenascin is not a stromal marker for malignancy. As the expression of tenascin was related to inflammation and tissue repair, it seemed to be implicated in these phenomena.

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A new cultured cell line, referred to as KON, was established from a metastatic tumor of the cervical lymph nodes. The primary tumor occurred in the floor of the mouth and was histopathologically diagnosed as squamous cell carcinoma. Most KON cells were polygonal and proliferated in a pavement-like arrangement. Examination with a surface electron microscope (E. M.) indicated that KON cells had numerous microvilli and intracellular bridges. Transmission E. M. examination revealed cell-to-cell attachment by desmosomes and tonofilaments in the cytoplasm. The doubling time of KON of the 28th generation was 32.5 hours and the plating efficiency in plastic dishes was 3%.
Expressions of some marker proteins were observed. The 67, 58 and 57kDa keratins were detected by Western blotting. Oncogene product ras P21, which might be closely involved in carcinogenesis, was expressed in KON by Western blotting.

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One hundred two patients (115 lesions) with oral leukoplakia were studied and followed up for an average period of 6 years 2 months. Of all cases, 38 showed an abnormal epithelium with no dysplasia and the 77 others showed some degree of epithelial dysplasia. The grade of epithelial dysplasia was thought to be related to the following changes in the WHO criteria (1978).
·loss of polarity of the basal cells.
·the presence of more than one layer of cells having a basaloid appearance.
·dro P-shaped rate processes.
·irregular epithelial stratification.
·nuclear hyperchromatism.
Epithelial dysplasia or high mean scores based on the new scoring system for dysplastic changes were found in the following types of patients: Site: tongue (lateral borders, inferior surface), floor of the mouth. Age: fourth and fifth decades of life. Clinical type: leukoplakia erosiva. Habits: drinkers or drinkers and smokers. Three patients subsequently developed squamous carcinomas in an average time of 5 years 9 months, and these patients originally had moderate to severe epithelial dysplasia.
The cumulative frequency of oral carcinoma in cases of oral leukoplakia was 0 % by 1 and 3 years, 1.2 % by 5 years, and 6.6 % by 10 years. This study suggests that certain of the characteristics of oral leukoplakia described above are associated with greater risks of malignant transformation, and thereby warrant consideration for more aggressive management.

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Fifteen patients who were treated for adenoid cystic carcinoma in our departmentduring the 22 years between July 1971 and July 1993 were studied with respect to local recurrence, lymph node and the distant metastases and factors related to these phenomena.
The results were as follows:
1. Local recurrence occurred in 53.3% of the patients. The primary site, local extension, and the presence of tumor at the surgical margin were related to local recurrence. The interval from operation to local recurrence ranged from 3 months to 9 years one month. Factors affecting to the time to local recurrence were the primary site, T category, stage grouping, local extension, histologic grade, and the presence of tumor at the surgical margin.
2. Lymph node metastasis occurred in 26.7% of the patients. Factors such as the primary site, T category and histologic grade were considered to be related to lymph no e metastasis.
3. Distant metastasis occurred in 66.7% of the patients. Metastasis developed most frequency in lung followed by bone, and uterus. The primary site was suggested to be related to distant metastasis. The time of confirming distant metastasis ranged from the first visit and to 13 years two months. Distant metastasis was related to the histologic grade. The interval from the detection of lung metastasis to death was related to local extension.

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The effects of using a speech aid appliance (SA) on speech and velopharyngeal function were studied in 9 patients in whom free flaps were used to repair defects of the soft palate and lateral wall of the oropharynx.
Improvement in speech associated with using the SA was evaluated by a standardized speech intelligibility test which consisted of 100 Japanese syllables. Velopharyngeal function was assessed synthetically by the soft blowing test, and perceptual evaluation of the consonant/b/and hypernasality of/i/. Our results are summarized below.
(1) Adequate or almost adequate velopharyngeal closure was obtained in all patients using SA. SA was effective not only for patients reconstructed with forearm flaps but also in patients reconstructcd with rectus abdominal flaps or jejunum flaps.
(2) Mean speech intelligibility improved from 39.3% without SA to 61.2% with SA. Six of 9 patients showed remarkable improvement of more than 20%.
(3) With respect to the manner of articulation, speech intelligibility in stops and affricates, which require high intraoral air pressure, showed remarkable improvement.
(4) With respect to the place of articulation, speech intelligibility in labial sound showed remarkable improvement.
(5) Shaping SA similar to a palatal augmentation prosthesis was effective in patients who showed low speech intelligibility in sounds produced using the rear portion of the tongue.
These results indicated that prosthodontic treatment using a speech aid appliance was effective in improving velopharyngeal function and speech intelligibility in patients in whom defects of the soft palate and lateral wall of the oropharynx were reconstructed with free flaps.

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Transplantation of hydroxyapatite (HAP) or boiled bone (BB) with electrically stimulated periosteum (ESP) was carried out to treat muscle and bony defects of rats and evaluate the potential for application in mandibular reconstruction.
Experiment 1. Male Wister rats, 8-10 weeks old, were used. The tibial periosteum of each rat was electrically stimulated using 15.5, μ A of direct current for 1, 3, 5, 7, 9, and 12 days. The periosteum was removed and transplanted into the abdominal muscle. Rats were then sacrificed on the 5th, 7th, 14th, 28th, and 56th days post-transplantation; soft X-rays were taken and the tissue was examined histologically.
Experiment 2. The tibial periosteum was electrically stimulated for 7 days, and HAP or BB along with the ESP was transplantaed into right mandibular bony defects. Each rat was killed at 3, 5, 7, 14, 28, and 56 days after grafting, and tissue was examined histologically.
The following results were obtained:
1. Transplantation of ESP ploduced by stimulation for 7 days was associated with differentiation into bony tissue in abdominal muscle.
2. No bone tissue was formed around HAP or BB after transplantation of only HAP or BB. Bone tissue was formed after transplantation of HAP or BB with ESP.
3. HAP with ESP or BB with ESP is expected to be a useful material for mandibular reconstruction.

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Sixty dentigerous and 10 primordial cysts were examined clinically and pathologically. Fifty-six of the dentigerous cysts had non-keratinizing epithelium and 9 of the dentigerous cysts had keratinizing epithelium. However, 5 keratinizing dentigerous cysts and 1 non-keratinizing primordial cyst were observed as exceptions.
Radiographically, the dentigerous cysts were generally of unilocular round shape with a well-defined border. However, the well-defined border was often lost due to severe infection. In contrast, the primordial cysts were more frequently shown to be of irregular and multilocular shape, and the well-defined border was well preserved even with severe infection. Thus, keratinizing epithelium was suggested to be involved in the formation of irregular and multilocular shape and to be more resistant to infection.
Pathologically, non-keratinizing epithelium often showed proliferation, a lacy appearance, and ridge elongation in association with inflammatory cell infiltration. In contrast, such changes in keratinizing epithelium were rarely observed even with heavy inflammation. Interestingly, ameloblastoma-like epithelial proliferation and calcification in the absence of inflammation were partially observed in 6 and 7 cases, respectively, independent of keratinization of epithelium. Thus, odontogenic epithelial cells were suggested to have high proliferative and differentiative activities.

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We investigated the therapeutic results obtained in 23 primary cases of squamouscell carcinoma in the buccal mucosa treated in our department. The subjects consisted of 5 cases each of stage II and III, and 13 cases of stage IV. Primary therapy was: surgery after chemoradiotherapy in 17 cases; chemoradiotherapy without surgery in 4 cases; and surgery after chemotherapy in 2 cases. Local recurrence occurred in 2 out of 19 cases after surgery for primary foci and in 2 out of 4 cases without surgery (T1 in 1 case and T4 in 3 cases). Histopathological metastasis (pN+) was confirmed as follows: T1 and T2 in 4 out of 11 cases; and T3 and T4 in 6 out of 12 cases. An endophytic growth pattern was seen in 9 out of 10 pN + cases. The 5-year cumulative survival rate was 58.3% overall. These results indicate that the positive rate of histopathological lymph node metastasis was related to the size of primary foci and an endophytic growth pattern. Surgery combined with chemotherapy and radiotherapy produced favorable therapeutic results.

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This paper describes the radiological changes during the early development of anameloblastoma in a 60-year-old man. On radiological examination, multiple cysticradiolucent features were first found between the lateral incisor root and the canine root in the left mandible.
Subsequently, a mono-cystic pattern developed. Root absorption was noted 25 months thereafter, and the patient felt discomfort. Swelling had occurred in the labial alveolar region.
The size of the lesion increased significantly at a quadratic rate.

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A rare case of vascular leiomyoma arising on the upper lip is reported with a dis-cussion of related papers.
A 77-year-old woman presented with a complaint of a painless tumor which gradually grew larger. She first noticed the lesion 2 years 8 months previously.
A small finger-tip-sized tumor was observed on the mucous membrane of the upper lip. It was movable, soft, elastic and had a smooth surface that did not deviate from the color of the normal mucosa.
Resection of the tumor was performed under local anesthesia. The suspected diagnosis was a salivary gland tumor of the lip.
The possibility of an angioma was considered during operation, because the tumor was dark red.
Macroscopically, the surgical specimen was a solid-grey tumor, suggesting either a salivary gland tumor or a vascular tumor.
Histopathologic examination indicated a diagnosis of a vascular leiomyoma, which belonged to capillary type according to Morimoto's classfication.
A review of 59 cases of oral vascular leiomyoma reported in Japan, indicated frequent disagreement between the preoperative and pathological diagnosis, which suggested difficulty in the clinical diagnosis of this tumor.

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Epithelioid sarcoma is a relatively rare soft tissue tumor of uncertain histogenesis that mainly occurs in the hands and forearms. It frequently has a benign appearance and slowly growing nodules that tend to ulcerate and recur after excision. Distant metastasis usually occurs quite late in the course. We observed an epithelioid sarcoma in the anterior mandibular gingiva that metastasized to cerebellum of a 56-year-old man. A review of the literature revealed no other reported cases of epithelioid sarcomas in this region. This report records a unique primary site for this tumor. The diagnosis was difficult because this tumor is often confused with a variety of benign and malignant conditions, owing to its clinical and histopathological presentations.

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Granular cell tumors are relatively rare. Histopathologically, the lesion is characterized by intracytoplasmic eosinophilic granules. The lesion occurs in soft tissue, mainly in the oral region and skin. The tongue is the most common site in the oral region.
Recently, we encountered a case of a granular cell tumor arising in the lower lip of a nineyear-old boy. The lesion was excised together with the surrounding tissue under local anesthesia. The patient was observed for about one year without any evidence of recurrence. Immunohistochemical study suggested a neural cell origin of the lesion.

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An odontogenic myxoma is reported. A 21-year-old man complained of painless swelling at the left lower molar region. Radiographs of the lesion showed a intra-bony mutilobular radiolucency. Examination of a biopsy specimen suggested an odontogenic myxoma. The lesion was managed by mandibulectomy under general anesthesia, immediately followed by iliac autograft and sural nerve transplantation. Histological examination revealed loosely arranged, spindle-shaped and stellate cells with fine collagen fibers. Odontogenic epithelial cell nests were found among the myxomatous cells. From these findings, the lesion was diagnosed as an odontogenic myxoma. The patient was observed a year later and no evidence of recurrence was detected.

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Nodular fasciitis is a benign pseudosarcomatous proliferative lesion of the softtissue originating from the subcutaneous fascia, most commonly in the upper extremity or trunk. Nodular fasciitis arising in the oromaxillofacial region is rare. This paper reports a case of nodular fasciitis arising in the mouth floor. The patient a 48-year-old woman who had noticed a rice-grain-sized tumor on the left side of the mouth floor 10 years previously. She was referred to our clinic because of tumor growth. At initial examination, a rather well demarcated, thumb-tip-sized tumor without pain was found at the mouth floor, and she complained of difficulty in talking. Histopathological examination showed nodular fasciitis.

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Dog-bite injury of the oral and maxillofacial region is not common. We encountered a 45-year-old woman whose lips were injured by her pet dog on June 17, 1993. Her lower lip was partially bitten off, and we reconstructed it immediately. The postoperative course was uneventful.
A review of Japanese reports on dog-bite injuries of the oral and maxillofacial region over the past 20 years revealed that: 1) 14 cases were reported (male: female=5:9); 2), There were two peaks in the age distribution, one was the first decade and the other was the sixth decade; 3) The mean age was 33.5 years old; and 4) Differences were not seen between seasons, except that fewer cases occurred in winter.

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