In the treatment of malignant tumours, estimation of the biological degree of malignancy based on the proliferation potential of tumour cells is now attracting attention. In this study, we tried to clarify the relationship between the growth potency of squamous cell carcinoma of the tongue, which was evaluated by Ki-67 antigen expression, and the histological degree of malignancy or metastasis to the regional lymph nodes: 70 cases of untreated tongue cancer and 19 cases of radical neck dissection were examined immunohistochemically using a monoclonal antibody MIB1. The Ki-67 labeling index (Ki-67 LI) in tongue cancers was significantly higher than that in the normal tongue mucosa, which indicated high cell proliferation activity in the primary lesion of tongue cancer. To study the relation between cell growth and the histological degree of malignancy, the scores of tumour differentiation, histological mode of invasion, and histological degree of malignancy were compared with the proliferative potency of tumour cells. Ki-67 LI was high in poorly differentiated tumours and tumours showing diffuse invasion. When compared with the histological degree of malignancy, Ki-67 LI was high in histologically highly malignant tumours. Among the 70 patients with untreated tongue tumours, 54 patients whose tumours could be classified by the TNM method were selected, and their TNM ranks and cell proliferation activities were compared. However, no statistically significant correlation was noted. In the 19 patients undergoing radical neck dissection, Ki-67 LI in primary lesions of tongue cancer with metastasis to the regional lymph nodes was significantly higher than that in tumours without metastasis.
In summary, immunohistological examination of Ki-67 LI in the primary lesions of tumours is a useful method for understanding the biological degree of malignancy of tumours in clinical practice, and it may be useful in selecting future treatment and evaluating the patient's prognosis.

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Alterations in the adenomatous polyposis coli (APC) gene have been considered as a cause of familial adenomatous polyposis and sporadic cancers of many digestive organs. Moreover, APC gene alterations have been recently reported in esophageal squamous cell carcinomas (SCC) as well as in gastric and colon adenocarcinomas.
To evaluate the role of APC gene alterations in the oncogenesis of tongue SCC, genomic DNAs from 14 tongue SCC tissue samples were examined by using PCR-LOH (polymerase chain reaction-loss of heterozygosity) assay, which is able to reveal LOH at exon 11 of the APC gene. Six (42.9%) of 14 samples were informative, and LOHs were detected in 4 (66.7%) of the 6 samples. Our results suggested that the LOH of the APC gene may contribute to the oncogenesis of tongue SCC.

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We carried out a multicenter double-blind clinical study to evaluate the efficacy and usefulness of CS-670, a newly-developed nonsteroidal anti-inflammatory drug, in the treatment of pain in patients undergoing extraction of a mandibular impacted wisdom tooth. The following results were obtained:
1) Three groups were compared. The CS20 group received 20 mg of CS-670, the CS40 group received 40 mg of CS-670, and LOX60 group received 60 mg of loxoprofen sodium as control.
2) Eighty-six patients in the CS20 group, 85 in the CS40 group, and 80 in the LOX60 group were included in analyses.
3) There were no significant differences in demographic factors or extraction conditions among the 3 groups.
4) Based on the patient's impression, the improvement rates of cases assessed as “very effective” or “effective” were 71.6% in the CS20 group, 91.6% in the CS40 group, and 88.5% in the LOX60 group. The differences between the CS20 group and the latter 2 groups were significant.
5) Based on the investigator's evaluation, the improvement rates of cases showing an “excellent” or “moderate” response were 67.9% in the CS20 group, 91.5% in the CS40 group, and 84.6% in the LOX60 group. The differences between the CS20 group and the latter 2 groups were significant.
6) As adverse effects, drowsiness occurred in 3 patients (3.5%) in the CS20 group and 2 (2.4%) in the CS40 group. One patient (1.3%) in the LOX60 group complained of a feeling of sickness. However, all cases were evaluated to be unrelated to the study drugs.
7) According to the criteria of the Evaluation Committee, excellent or good pain suppression was obtained in 48.1% of the CS20 group, 61.0% of the CS40 group, and 57.7% of the LOX60 group. The differences among the 3 groups were not significant. The onset of action was noted within one hour in 69.1% of the CS20 group, 82.9% of the CS40 group, and 83.3% of the LOX60 group. The difference between the CS20 group and the LOX60 group was significant. The duration of analgesic effect was more than 3 hours in 66.7% of the CS20 group, 92.6% of the CS40 group, and 82.1% of the LOX60 group. The differences between the CS20 group and the latter 2 groups were significant. The rates of excellent or good responses, evaluated based on the analgesic effect, the onset of action, and the duration of action, were 61.7% in the CS20 group, 76.5% in the CS40 group, and 80.8% in the LOX60 group. The difference between the former 2 groups was significant. Usefulness rates were 61.7% in the CS20 group, 72.3% in the CS40 group, and 80.8% in the LOX60 group. There were no significant differences among the 3 groups.
These results demonstrate that the analgesic effect of 40 mg CS-670 is equal to or better than that of 60 mg loxoprofen sodium without inducing adverse effects. Thus, CS-670 is a very useful analgesic.

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We perfomed a clinicostatistical study of 43 elderly patients with maxillofacialfractures who were over the age of 60 years and a long-term follow-up study of 27 of these cases at The First Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tokyo Medical and Dental University during the 16-year period between 1977 and 1992.
Of all maxillofacial fractures, the incidence of fractures in elderly patients was 5.1%. The ratio of men to women was 1.5:1. Falling to the ground was the most frequent cause of fracture. Fractures of the mandibule were common, and the mandibular condyle was the most frequent fracture site. Conservative therapy was usually performed and was found to be successful. The long-term follow-up study demonstrated that recovery of the occlusion was enabled by prosthetic treatment after conservative therapy.

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Cleft palate repair using Furlow double opposing Z-plasty was performed in 31 patients between 1990 and 1994. To determine the advantages and disadvantages of this technique, Furlow palatoplasty was compared with the pushback procedure. Twenty-seven patients undergoing palatal closure with the pushback technique, performed by the same surgeon during the same period, served as controls. Nineteen of the 31 patients in the Furlow group had cleft palate, nine had submucosal cleft palate, and three had cleft lip and palate. Mean age at Furlow palatoplasty was 2.4 years. In the pushback group, 17 of the 27 patients had cleft palate, three had submucosal cleft palate, and seven had cleft lip and palate. Mean age at pushback palatoplasty was 2.1 years. Operating time and blood loss in the Furlow group were 83.9±14.9 minutes and 28.3±28.8ml, respectively, while the corresponding values in the pushback group were 66.3±17.2 minutes and 39.9±38.5ml. Although operating time in the Furlow group was longer than in the pushback group, blood loss was significantly less. Intraoperative results were favorable, with acceptable operating time and blood loss. No postoperative complications occurred in the Furlow group, and adequate oral intake was achieved immediately after palatoplasty. The maximum body temperature and duration of postoperative fever in the Furlow group were 37.8±0.4°C and 37.0±21.0 hours, respectively, while the corresponding values in the pushback group were 38.3±0.5°C and 76.1±29.7 hours. The rise in body temperature in the Furlow group was significantly lower, and the postoperative course was satisfactory. Oronasal fistulas did not develop.

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Cleft palate repair by Furlow double opposing Z-plasty was performed in 31 patients between 1990 and 1994. Speech results and effects on maxillary growth following Furlow palatoplasty were investigated and compared with the pushback procedure. Twentyseven patients undergoing pushback palatoplasty, performed by the same surgeon during the same period, served as controls.
1. Twenty-two patients in the Furlow group and 15 patients in the pushback group were old enough to permit speech evaluation. Mean ages at palatoplasty in the Furlow group and the pushback group were 2.4 years and 2.1 years, respectively. There were no differences between the groups in the distribution of type of cleft or age at palatoplasty. Mean ages at speech evaluation in the Furlow group and the pushback group were 4.1 years and 4.5 years, respectively. Twenty of the 22 patients in the Furlow group had no evidence of velopharyngeal insufficiency, while one had mild and the other moderate to severe insufficiency. Twelve of the 15 patients in the pushback group had no evidence of velopharyngeal insufficiency, while one had mild and two had moderate to severe insufficiency. No significant difference was found between the two groups, and the early speech results were encouraging.
2. Effects on maxillary growth following cleft palate repair were evaluated by the presence or absence of crossbite in 18 patients in the Furlow group and nine patients in the pushback group who had completed deciduous dental eruption. Mean ages at palatoplasty in the Furlow group and the pushback group were 2.6 years and 2.0 years, respectively. There were no differences between the groups in the distribution of type of cleft or age at palatoplasty. Mean ages at growth evaluation were 4.2 years in the two groups. Only five patients in the Furlow group had anterior crossbite. In the pushback group, on the other hand, three patients had anterior crossbite, one had posterior crossbite, and three had both anterior and posterior crossbite. The difference between the presence of crossbite in the two groups was statistically significant. Furlow palatoplasty allowed adequate maxillary growth.

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The efficacy of combined treatment with amfenac sodium (150 mg/day for 14 days) and ethyl loflazepate (2 mg/day for 14 days) was clinically evaluated in 44 patients with temporomandibular disorders in comparison with 77 patients with temporomandibular disorders who were given amfenac sodium (150 mg/day for 14 days) alone.
The 121 temporomandibular disorder patients were classified into four types (I-IV) according to the criteria proposed by the Japanese Society for the Temporomandibular Joint.
The usefulness of combined treatment with amfenac sodium and ethyl loflazepate was excellent in 14 cases (31.8%), good in 14 cases (31.8%), and fair in 12 cases (27.3%).
The usefulness of amfenac sodium alone was excellent in 6 cases (7.8%), good in 34 cases (44.1%), and fair in 31 cases (40.3%).

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Kniest dysplasia is an extremely rare bone dysplasia; cleft palate is involved in 40 to 50% of the patients. Four cases of Kniest dysplasia with cleft palate are reported. The patients were three girls and one boy, from 52 days to 1 year 8 months of age at presentation to our clinic. Two of the patients were siblings, and they were related to the other patient. This suggests that hereditary factors play an important role in the onset of this disease. All patients had typical features of Kniest dysplasia on facial examination and X-ray film of the limbs. All cases underwent palatoplasty at our clinic and were treated for club foot at the department of orthopedic surgery. Including our patients, 21 cases of Kniest dysplasia have been reported in Japan, and cleft palate was present in 10 of them. This ratio agrees with the previous reports.

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This paper describes the extraction of a wisdom tooth in a patient with hemophilia A who was given recombinant human factor VIII. It has no possibility of transmitting blood borne viruses and has a good hemostatic effect. However, we believe that local hemostatic management is still important in the treatment of patients with hemophilia A.

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Complications in 90 patients (100 locations) with malar bone fractures including zygomatic arch fractures treated at our department from January 1986 through December 1991 were reviewed and analyzed in relation to the fracture patterns using the Knight & North classification. Their characteristics were as follows:
1. Limitations in mouth opening were found in 37 (53%) of 70 cases without mandibular fractures.
2. Infraorbital paresthesia was found in 40 (48%) of 81 locations.
3. Of 61 cases, diplopia was found in 5 cases (8%) and reduction of visual acuity in 4 cases (7%).
4. Of 100 locations evaluated according to the Knight & North classification, 39 locations (39%) were Group I, 19 locations (19%) Group II, 14 locations (14%) Group V, 12 locations (12%) Group III, 10 locations (10%) Group VI, and 6 locations (6%) Group IV.
5. Infraorbital paresthesia and diplopia tended to be closely related to fracture displacement but limitations in mouth opening were not related to fracture displacement.

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Desmoplastic ameloblastoma was first described by Eversole in 1984. We recently encountered a case of desmoplastic ameloblastoma in the anterior maxilla.
A 52-year-old man presented to the First Department of Oral and Maxillofacial Surgery of Meikai University. A biopsy was performed, and examination of the biopsy specimen indicated a diagnosis of odontogenic fibroma. The patient underwent tooth extraction in the affected region and tumor resection under general anesthesia.
Microscopic examination after the operation showed an extensive collagenized stroma containing small islets of tumor epithelium with a slight tendency to from cystic structures. The histological diagnosis was thesefore desmoplastic ameloblastoma.

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Ameloblastic fibroma is generally classified as an odontogenic mixed tumor and is composed of odontogenic epithelium and mesenchymal tissue, without hard tissue formation. Its occurrence is rare. Ameloblastic fibromas have been reported in only 63 patients in the Japanese literature.
We encountered an ameloblastic fibroma at the apical region of the left mandibular molar. The patient was a 24 year-old woman with a the chief complaint of a hard swelling of the left molar region. X-ray examination showed a monolocular radiolucent shadow at the apex of 6. The clinical diagnosis was a radicular cyst.
Enoculation of the tumor and tooth extraction of 6 done under general anesthesia. There has been no evidence of recurrence.

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Benign cementoblastoma is a rare odontogenic tumor that usually occurs in the mandibular molar region.
In this paper, we report a case of benign cementoblastoma occuring at the 7 root apex in a 23-year-old man. On X-ray examination, the tumor showed a circular radiopaque shadow with a clear margin, which was surrounded by a radiolucent zone of uniform width.
The clinical diagnosis was a benign odontogenic tumor. The tumor and tooth (7) were surgically removed together on January 19, 1989. The histopathological diagnosis was a benign cementoblastoma. The patient has been in good condition with no recurrence for 5 years postoperatively.

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A case of epidermoid cyst in the mandible is reported in which the cystic lining epithelium was evaluated immunohistochemically with anti-keratin antibody. The patient was a 64-year-old man who was referred to our department due to swelling of the lower labial gingiva in the median region. The swollen lesion was clinically diagnosed as a cyst of the lower jaw, and it was surgically enucleated under general anesthesia. The cyst contained serous fluid with like-scum substances, and a high level of CEA was found. The cystic epithelium was examined immunohistochemically with anti-cytokeratin antibody. Staining of PKK2 and CK10 was positive in basal cells and parakeratinizing cells, while that of CK5 and CK19 was negative.

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Odontogenic keratocyst is histologically and clinically distinct from other odontogenic cysts, especially with regard to its high recurrence rate and the remarkable growth capacity.
We report a case of a 19-year-old man with an odontogenic keratocyst of the mandible. Radiographic findings showed that a cyst measuring 50×30mm developed during 1 year 6 months, and the growth rate was about 33mm per year.
Proliferating cell nuclear antigen (PCNA) expression was also analyzed. Histopathologically, the cyst was lined by a relatively thick layer of parakeratinized epithelium, and partially deep prolongation of the epithelium was observed. A daughter cyst was not present.
Immunohistochemically, staining using monoclonal antibody to PCNA revealed that the percentage of PCNA-positive cells in the odontogenic keratocyst lining (11.2%) was about twice that in the normal gingiva (4.6%). In the odontogenic karatocyst lining, PCNApositive cells were more often found in prickle cells than in basal cells.
At present, there are no signs of recurrence as of 1 year 6 months after operation.

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We describe a mucous cyst in the submandibular region of a child that was considered to be a congenital lateral cervical cyst.
A 6-year-old boy was referred to our department on April 5, 1990 by a general dentist. His chief complaint was swelling in the left submandibular region. The patient's past medical history and family history were noncontributory. The left submandibular swelling had been noticed since November 1988. On clinical examination, a mass (50×30×30mm) was recognized in the swelling. It's border was clearly demarcated, and it did not have a wavy feeling or tenderness. Based on the clinical findings, the lesion was suspected to be a congenital lateral cervical cyst. Under general anesthesia, enucleation of the cyst was performed on July 31, 1990. The cyst wall was thick. Pathological examination revealed a mucous substance in the cyst, and the minor salivary glands were close to the cyst wall. The dibgnosis was therefore a mucous cyst. There has been no recurrence as of 3 years after operation. The cyst was suspected to be a mucous cyst that originated from an ectopic salivary gland.

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Sialolithiasis mainly occurs in the submandiblar gland and its occurrence in minor salivary glands is very rare. In this paper we report three cases of sialolithiasis occurring in the minor salivary glands of the lip. Two cases occurred in the upper lip and one in the lower lip. Histopathologically, the case in the lower lip consisted of more than six calcified masses in the minor salivary gland tissue.

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Kasabach-Merritt syndrome is a coagulation disorder associated with giant hemangioma and consumption coagulopathy.
Here we describe the procedure for hemostatic management for tooth extraction in a patient with Kasabach-Merritt syndrome.
A 22-year-old woman was referred to our clinic to have a tooth extracted.
Sixty mg/day of predonisolone p. o. and 10mg/h of nafamostat mesilate were given preoperatively, and 12ml (3V) of dried human antihemophilic factor XIII fraction was additionally administered just before extraction.
We conclude that tooth extraction in a patient with consumption coagulopathy can be performed safety by carefully correcting for any coagulation disorders.

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This report describes deciduous tooth extraction in a 10-year-old girl with congenital afibrinogenemia. The patient was referred to our clinic with complains of a toothache and tooth mobility. Several teeth were extracted after injection of 1.0g of a fibrinogen (Fbg) preparation (Fibrinogen HT-Green Cross). First, we extracted deciduous teeth (CD) without postoperative bleeding when the level of Fbg was 46mg/dl. On the next day, we attempted deciduous teeth extraction (EDC) when the level of Fbg was 41mg/dl. Later, however, bleeding occurred at the extraction site. We stopped the bleeding by injecting Fbg preparations. After discharge, swelling of the lower face was caused by local anesthesia. However, the bleeding could be controlled by injecting the same volume of the Fbg preparation.
It was suggested that the level of Fbg in patients with congenital afibrinogenemia who undergo dental treatment should be over 50mg/dl even when infiltration anesthesia is used. Furthermore, the level of Fbg should be carefully monitored.

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