Cytokeratins are intermediate filaments forming part of the cytoskelton of both normal epithelia and their malignant counterparts. The fragment of cytokeratin subunit 19 (Cyfra) has been reported to be a new marker of non-small cell carcinoma of the lung. However, the usefulness of Cyfra for diagnosis, prognosis, treatment monitoring, and combination assay in oral squamous cell carcinoma (O-SCC) has not been reported. Cyfra in the serum of 50 patients with O-SCC, 20 patients with oral benign diseases, and 10 healthy controls was determined by a solid-phase immunoradiometric assay based on the two-sandwich method. The results were as follows: 1. The mean serum concentration in patients with O-SCC (2.24±2.55 ng/ml) was significantly higher than that in 20 patients with oral benign diseases (1.38±0.77 ng/ml) and that in 10 healthy controls (1.17±0.41 ng/ml). 2. The mean serum concentration of Cyfra was significantly lower in the good-prognosis group (1.76±1.25 ng/ml) than in the poor-prognosis group (3.08±3.83 ng/ml). When good cancer control was obtained, the serum level of Cyfra returned to normal. When local recurrence or metastasis was clinically detected, the serum level of Cyfra fell to normal or nearnormal levels, but it remained higher than in the good-prognosis group; all but one of these patients had a normal level. 3. Cyfra evaluation in O-SCC is valuable as a tumor marker for diagnosis, prognosis, and treatment monitoring.
Since neo-adjuvant therapy with intra-arterial infusion of CDDP/CBDCA and irradiation was introduced in our clinic, the cure rate of squamous cell carcinoma of the head and neck has improved greatly. However, not all patients have a good prognosis. We believe that one of the most important factors influencing patients' prognoses is the histological response to neo-adjuvant therapy. Seventy-five patients were divided into responders (47 patients) and nonresponders (28 patients) according to the histological findings of the resected materials. The former had a score of II B or more, and the latter II A or less according to Shimosato's classification. Though there was no significant difference between two groups with respect to T, N and stage classifications or tumor cell differentiation. The cumulative survival rate, calculated by the method of Kaplan-Meier was significantly higher in the responder group than in the nonresponder group (p<0.05, logrank test). The histological grading of malignancy before treatment was significantly lower in the responder group. The difference in the tumor-host relationship score between the groups was particularly large.
Serial lateral roentgenocephalograms of 32 infants with isolated cleft palate were taken at the time of palatoplasty and at four years of age at Kyushu University Dental Hospital. Six dimensions and six angles were measured on each cephalogram. By cluster analysis of craniofacial characteristics at four years of age, thirty-two subjects were classified into three groups: A, B and C. The measurements were evaluated by ANOVA and Student's t-test to identify the craniofacial characteristics of each group. The craniofacial characteristics in each group at the time of palatoplasty were also analyzed and compared with those at four years of age. The relation between the classification and the patients' sex, methods of operation, and the operator were studied by χ2 test. The results were as follows: 1. The thirty-two subjects were classified into three subgroups by cluster analysis: group A, 20 subjects; group B, 6 subjects; and group C, 6 subjects. In group A, the cranial base length, the anterior mid-facial height, and the maxillary length were small, and the size of the mandible was medium. The relation between the upper and lower jaws was characterized by an anteriorly positioned mandible. In group B, the cranial base length, the anterior mid-facial height and the maxillary length were medium or large, and the size of the mandible was large. The relation between the upper and lower jaws was normal. In group C, the cranial base length, the anterior mid-facial height, and the maxillary length were medium, and the cranial base angle was the largest. The size of the mandible was the smallest, and the mandibular angle was the largest. The relation between the upper and lower jaws tended toward opisthogenia. 2. The craniofacial characteristics at four years of age were similar to those at the time of palatoplasty. 3. By the χ2 test, there were no relation between the classification of craniofacial characteristics and sex, operative method, or operator. In conclusion, the congenital craniofacial characteristics have an important effect on the postoperative craniofacial characteristics.
We studied 13 male cases of Sjögren's syndrome (SS). The incidence of periductal lymphocytic infiltration of the labial glands, parotid glands, or both in the male cases was 18%(2/11), which was significantly (P<0.01) lower than that in female cases (133/195: 68%). The rate of patients with keratoconjunctivitis sicca (KCS) was higher in males than in females, although the difference was not statistically significant. There were no marked differences in the incidence of SS-related sialographic findings or the rate of patients with any other autoimmune diseases between the male and female patients.
Between 1971 and 1995, 96 patients with squamous cell carcinoma of the tongue were treated at our department. This study compared recently treated patients with formerly treated patients. The patients were classified into group A (1971-1984) and group B (1985-1995). We studied the primary therapy used and the outcome of treatment. Early stage carcinomas (Stage I and II) have increased recently. As for treatment, surgery has increased for both early and advanced carcinomas (Stage III and IV). Local control rates at 2 years were 68.5% in group A and 63.4% in group B. Five-year absolute survival rates were 73.3% and 82.4%, respectively. Patients in group B with advanced disease had a slightly poorer outcome of treatment. Recently, in our department we usually perform surgery in patients with advance cancer. However, the outcome of treatment is poorer than formerly. This point requires further examination.
A 76-year-old man with synchronous multiple primary cancers consisting of squamous cell carcinoma in the maxillary sinus and adenocarcinoma in the nasal cavity is described. Radiographs showed destruction of the medial bony wall of the maxillary sinus and invasion of the nasal cavity by the tumor in the maxillary sinus. After chemotherapy and radiotherapy, a partial maxillectomy and tumor resection were performed. The tumor in the maxillary sinus showed necrosis and had shrunk remarkably. However, the tumor in the nasal cavity was found to be a polyp independent from the antral lesion. Histopathologically, the former was a squamous cell carcinoma and the latter was an adenocarcinoma.
Liposarcoma is one of the most commom malignant mesenchymal tumors in adulthood. Although any region of the body may be involved, the most frequent sites are the thigh, pygal region, and retroperitoneum. Occurence in the head and neck region, paticular in the oral cavity, is rare. A case of liposarcoma in the cheek region is described. A 60-yearold woman presented with a slowly enlarging mass of the right cheek. Extirpation was performed through a transoral approach, and microscopic examination of the mass revealed lymphadenitis. After 9 months, small masses recurred in the same region, and biopsy was performed. The microscopic diagnosis was myxoid liposarcoma according to the classification of the Armed Forces Institute of Pathology (AFIP). Under general anesthesia, a radical wide excision of the mass from the skin to mucosa and immediate reconstruction of the soft tissue defect using a platysma myocutaneous flap were performed. As of 2 year and 7 months after the operation, the patient has been free of recurrence and metastasis.
A radiographic examination of a 6 -year-old girl revealed a monolocular radiolucent area involving the dental germ of lower first molar. The lesion was about the size of a hen's egg and was located at the right side of the mandible. After histological examination of bits of tissues removed from the region, the case was diagnosed as ameloblastoma. Enucleation with an open wound was performed repeatedly. The radiolucency disappeared, and the lower first molar erupted when the patient was 8 years old. At the age of 10 years and 10 months, the lower second molar and the premolar also erupted. However, at 16 and 20 years of age, she had recurrences of the tumor. Eventually, the patient underwent extraction of the lower second molar and extirpation of the tumor. The patient, now 21 years old, is doing well, with no symptoms of clinical disturbances.
A case of peripheral osteoma in the mandible of a 56-year-old man is described. He noticed a hard mass of the mandible while he was in junior high school. The mass grew gradually, but there were no other symptoms, and he did not consult a doctor for 43 years. Radiographic examination revealed a hen-egg-sized ovoid, radiopaque mass in the floor of the mouth. The mass was removed surgically, and the histopathological diagnosis was osteoma spongiosum characterized by delicate cancellous bone with yellow bone marrow.
The patient was a 20-year-old woman with micrognathia due to Hallermann-Streiff Syndrome. Extension of the mandible by sagittal splitting and genioplasty using a hydroxyapatite porous block were performed. Titanium implants were used to correct malocculusion due to a congenitally missing tooth. The patient's clinical course has been satisfactory, with no functional or cosmetic abnormalities as of 8 years after the operation. We concluded that a hydroxyapatite porous block is a biomaterial with sufficient bio compatibility to serve as a filling material for genioplasty.
Bernard-Soulier syndrome (BSS) is a rare hereditary autosomal disorder characterized by a low platelet count, the appearance of giant platelets, prolonged bleeding time, and loss of glycoprotein I b. The patient was a 28-year-old woman referred to our hospital for tooth extraction. Under hemostatic control by the infusion of HLA-class I antigen matched platelet concentrates, 8E/8/8 were extracted. After infusion of the platelets, there was shortening of bleeding time, an increased number of platelets, and a slight increase in platelet adhesiveness. No abnormal bleeding occurred during the operation. However, ristocetin-induced platelet aggregation was unchanged. Clinically, although there was slight bleeding for several days from the wound at 8/8, it was stopped with the use of a splint and surgical pack.
A 3 -year-old boy plesented with a pronunciation disturbance. Noonan's syndrome had been diagnosed at another hospital and he had short stature, a shield-like chest, cryptorchism, a webbed neck, cubitus valgus, a high arched palate, and heart disease. On initial diagnosis cleft palate was not suspected, and he started speech therapy. After 3 years, there was no improvement in his speech disturbance. He came to our department, and velopharyngeal incompetence, was diagnosed. Pharyngoplasty was performed.
Sturge-Weber syndrome is characterized by various symptoms, including facial port-wine nevi, epilepsy, mental retardation, hemiparesis, and glaucoma. A 8 -year-old-girl was referred to our clinic for gingival proliferation at the right side of maxilla. She also had a facial port-wine nevus, epilepsy, and mental retardation. Gingival proliferation was treated by gingivectomy, and the facial port-wine nevus was covered with makeup. This case is described.
A total of 179 patients with jaw cysts who had been treated at our department during the past five years were classified according to the WHO criteria (1992) and their clinicopathological characteristics were studied. The results are summarized below: 1) The study group consisted of 74 cases of radicular cysts (including 7 cases of residual cysts), 71 cases of dentigenious cysts (including 8 cases of keratocysts and 63 cases of nonkeratocysts), 33 cases of primordial cysts (including 12 cases of keratocysts and 21 cases of non-keratocysts) and 1 case of paradental cyst. 2) The incidence of mandibular cysts (121 cases) was approximately twice that of maxillary cysts (58 cases). 3) Twelve karatocysts in the primordial cyst group showed parakeratosis. The dentigenous cyst group included three cases of orthokeratosis and five cases of parakeratosis. These findings suggest a relation between keratocyst patterns and the origin of these jaw cysts.
We encountered a case of congenital mucous cyst of the lower lip. At birth, the patient was found to have a slightly protruding mass with a pinhead-sized surface on the mucosa of the right lower lip. We diagnosed a congenital mucous cyst. The patient was a 4 -month-old girl who presented with a mass on the right lower lip. No tooth eruption was observed in the oral cavity. A globular pedunculated mass, approximately 5 mm in diameter, was detected on the mucosa of the right lower lip, and the cyst was excised. Her postoperative progress has been good, with no signs of recurrence. Histopathological examination revealed a cyst lined with the stratified squamous epithelial cells that formed the surface layer. The cyst wall was clearly observed. The wall was not composed of epithelial tissues, but of histiocytes, fibloblasts, capillaries, and fibrous connective tissue. These findings suggested that the mucous cyst wall.
Static bone cavity is usually an asymptomatic lesion caused by localized bone defects of the lingual cortical bone in the posterior region of the mandible. It rarely occurs in the anterior part of the mandible. Case report: A 24-year-old man was referred to us for examination of a cystic radiolucency in the anterior region of the mandible. The lesion was accidentally detected on a radiogram for dental examination. The radiogram revealed a well-defined unilocular radiolucency extending from the right canine to the left premolar region of the mandible. No resorption or divergency of the roots was observed. The teeth adjacent to the lesion were positive on electric pulp testing. An excisional biopsy was performed under a clinical diagnosis of a cyst or tumor in the mandible. We found salivary gland tissues in the mandible and a defect of the lingual cortical bone. The specimen was found to be normal sublingual salivary gland tissue on histological examination.
Eighteen patients with sleep apnea syndrome (SAS) were treated with mandibular advancement splints (MAS). SAS was diagnosed on the basis of clinical symptoms and Apnomonitor examination. The body mass index was between 19.5 and 30.5. The results of a questionnaire administered to the patients and their families indicated that snoring decreased or disappeared completely in 17 of 18 patients (94%) by mandibular advancement splint (MAS) therapy. However, muscle fatigue of the jaw and temporomandibular joint (TMJ) pain was reported by some patients. Muscle fatigue of the jaw and TMJ pain decreased gradually as the patients became accustomed to MAS. The questionnaire was useful in understanding the effects and the problems of MAS therapy. In 13 of 14 patients (92%) who were assessed by Apnomonitor examination, the apnea index (AI) was dramatically improved by MAS insertion, i. e., it decreased from 58.8 to 0.3. No effect was found in one patient with enlarged lingual tonsils. MAS therapy was also useful in some patients without obesity or retrognathia. The results suggest that MAS not only enlarge pharyngeal space but also may strain the pharyngeal or lingual muscles. We concluded that MAS therapy was effective in the management of SAS.
There has been no report describing a deficiency of trace elements in oral and maxillofacial surgery because few patients receive long-term enteral nutrition. In this report we describe a 52-year-old man who required long-term enteral nutrition because of cerebral infarction after an operation for a malignant tumor. After receiving enteral nutrition for 11 years, selenium deficiency occurred. As for clinical symptoms, pale fingernails and low concentrations of selenium in serum were noted. There was no evidence of cardiac disease, but there was a risk of severe cardiomyopathy. Therefore, an oral preparation of 100μg per day of selenious acid was given prophylactically, and his serum selenium concentration and clinical symptoms became normal. Glutathione peroxidase, in which selenium is an important active element, plays a part in cell structure and homeostasis. Some studies have shown that this enzyme is involved in immunity and the inhibition of cancer. In the future, an increased prevalence of trace element deficiency is expected as more patients receive long-term enteral nutrition. We should be aware of the potential deficiency of trace elements such as selenium in such patients.