We investigated clinically and virologically 108 patients with oral papilloma at Second Department of Oral and Maxillofacial Surgery, Osaka Dental University during the fifteen years from 1981 through 1995. The patients consisted of 64 males and 44 females. Their ages ranged from 8 to 82 years (average age, 46.5), but the majority (80%) of them were in the fifth decade of life or older. Oral papilloma occurred most frequently in the palate (42 cases), followed by the gingiva (26 cases) and tongue (25 cases). In 84 of the 108 cases, the greatest diameter of the tumor was 10mm or less. We examined human papillomavirus (HPV)-DNA with the use of molecular biological methods in 25 oral papillomas randomly selected from among the 108 cases. HPV-DNA of low risk type was detected in all 25 cases (HPV-6, 11), and there was no case of high-risktype HPV-DNA (HPV-16, 18, 31, 33, 52, 58). The results indicate that the occurrence of oral papilloma is associated with HPV-6 or HPV-11 infection.
An intramedullar pin inserted from the base of the mandible is used for open reduction of fractures of the mandibular condylar process. However, as this procedure requires that the pin or screw is inserted into the mandibular ramus, there is a risk of injuring the mandibular canal during insertion. In this study, we evaluated the possibility of mandibular canal injury during insertion of an intramedullar pin in Japanese dry skulls. The results were as follows. 1. Between 10.8% and 29.7% of the skulls had the risk of mandibular canal injury during pin insertion, and the risk of injury was higher (16.7% to 58.3%) in the presence of an edentulous mandible. 2. When the morphologic characteristics of mandibles with the risk of mandibular canal injury were compared with those of mandibles without such a risk, there were significant differences in the angle of the condylar neck, the angle of the posterior border of the condylar neck, or the angle of the posterior border of the mandibular ramus to the mandibular plane. 3. The shorter the distance between the mandibular canal and the posterior border of mandible or the mandibular angle, the higher was the risk of the mandibular canal injury. The larger the angle between the mandibular condylar neck and the mandibular plane or between the posterior border of the mandible and the mandibular plane, the higher was the risk of mandibular canal injury.
Eighty-six cases of obstructed abscesses in the oral and maxillofacial region were studied bacteriologic ally. Isolated anaerobic organisms were identified in detail and assessed with regard to antimicrobial susceptibility to several agents. Anaerobes were isolated from approximately 95% of cases that had isolated organisms. Gram-positive cocci, including Peptostreptococcus and Gemella, and gram-negative rods, including Prevotella, Porphyromonas, and Fusobacterium, were isolated frequently. As for antimicrobial susceptibility, some strains of Prevotella were resistant to β-lactam agents. In particular, many strains of Fusobacterium were resistant to erythromycin. Clindamycin and levofloxacin were highly active against anaerobes isolated from infections in the oral and maxillofacial region. Our results suggest that anaerobes as well as Streptococcus should be considered when treating infections in the oral and maxillofacial region.
We studied procedures for freeze-drying and changes in mechanical properties of extracted human ribs. To establish the basis for clinical application, we freeze-dried human extracted ribs. We measured residual moisture and tested the mechanical properties of the ribs and obtained the following results. 1. When the ribs were freeze-dried, the residual moisture of the ribs tended to gradually decrease. This phenomenon was observed after a prolonged duration of freeze-drying following equalization of the inside temperature of the ribs and the chamber temperature.(This decrease in moisture is generally seen on completion of the drying procedure.) Freeze-drying decreased the residual moisture content to below 5%. 2. We found no distinct difference in the three-point bending strength and the compression strength of male ribs, even when the freeze-drying time was prolonged. The results show that freeze-drying treatment does not diminish rib strength. 3. The fracture toughness value of human ribs (male) processed by freeze-drying was 1.29±0.68MPa√m on average.
Nedaplatin (CDGP) is a new anticancer platinum complex, developed in Japan. We studied the toxicities of three compounds, CDGP (n=9), cisplatin (CDDP, n=17), and carboplatin (CBDCA, n=12), when used for FC therapy. Toxicity, including hematotoxicity, gastrointestinal toxicity, and renal toxicity, was evaluated according to the World Health Organization criteria after chemotherapy. In some patients, urinary excretion of N-acetylbeta-D-glucosaminidase (NAG) was also measured. The CDGP group had hematotoxicity, including thrombocytopenia (22%), leukopenia, (56%) and anemia (67%), gastrointestinal toxicity, including nausea and vomiting (67%), and abnormal changes in renal function variables (11%). Gastrointestinal toxicity and nephrotoxicity were mild in the CDGP group. Grade 3 or 4 thrombocytopenia and leukopenia were found in 11% of patients in the CDGP group. Hematotoxicity in the CDGP group was similar to that in the CDDP group and milder than that in the CBDCA group. Gastrointestinal toxicity and nephrotoxicity were similar in the three groups. The maximum NAG index in the CDGP group was similar to that in the CDDP group and higher than that in the CBDCA group. Our results suggest that myelosuppression could be a dose limiting factor in patients receiving combination therapy with 5-Fu and CDGP. Repeated administration of CDGP has an increased risk of nephrotoxicity.
Calcifying epithelial odontogenic tumor (CEOT) is rare benign tumor occurring most commonly in the mandible. Here we describe a 27-year-old woman with CEOT in the left side of the maxilla. Radiographic examination revealed inpaction of 13 5. A well-defined cystic lesion with a granular-shaped radiopaque appearance surrounded 13. Under general anesthesia, the tumor was enucleated, and 1 3 5 was removed. Histopathologically, tumor cells were polygonal and some had intercellular bridges. Tumor cells were arranged like pavement, surrounding a concentric area of calcification. In addition, eosinophilic amyloid-like substances with a homogenous appearance were seen in the parenchyma. The diagnosis was CEOT.
A very rare case of a peripheral cemento-ossifying fibroma in the mandibular incisal region of an 11-month-old girl is reported. The patient was referred to our department for evaluation of swelling in the mandibular incisal region. The clinical diagnosis was epulis, and extirpation of the tumor was performed under local anesthesia. Histological examination showed a basophilic calcified mass and a stroma consisting of cellular fibrous tissue, without a capsule. The histopathological diagnosis was cementoossifying fibroma. The patient has been observed for four years, with no evidence of recurrence.
Arteriovenous hemangioma is apparently caused by some abnormality occurring in the course of development of arteries and veins. It is manifested as an arteriovenous fistula or an arteriovenous aneurysm. Acquired arteriovenous hemangioma is caused by trauma or incomplete excision of a hemangioma. In the oral region, arteriovenous hemangioma usually arises in the jaw bone, and reports of cases arising in soft tissue are rare. Recently, we treated an arteriovenous hemangioma that had developed in the lower lip and extended to the right buccal region of a 30-year-old woman. Purpura of the mental region had been present since birth. The lesion was excised when the patient was 5 years old, and she subsequently had received surgical therapy four times. Accordingly, angiography showed no characteristic findings of arteriovenous hemangioma, and the lesion was surgically removed. Histologically, the walls of the arteries and veins consisted of well-developed layers of muscle, and the vascular lumen was dilated. Based on these findings, arteriovenous hemangioma was diagnosed.
Palatal push-back operations are the most popular technique for palatoplasty. However, mucoperiosteal defects of the hard palate after palatoplasty can cause scar contraction, which leads to poor growth of the maxilla. Therefore, various artificial and biological materials have been used to cover mucoperiosteal defects. The authors report on five patients who received grafts of cultured oral mucosal epithelium for mucoperiosteal defects. Clefts of the soft and hard palate were present in three patients, and a cleft of the soft palate was present in two patients. The average age of the patients was 1 year 4 months. Palatoplasty was done by push-back operation. Oral mucosalepithelial cells were obtained from patients who underwent extraction of their wisdom teeth or installation osseointegrated implants and were cultured by the methods of Green et al. and Hata et al. using 3T3 cells as the feeder layer. After 3 weeks, cultured oral mucosal epithelium was prepared. The, cultured oral mucosal epithelium was grafted on a raw surface after palatoplasty, with a chitin sheet as a carrier. In all patients, the grafted areas underwent re-epithelialization after about 1 week.
Eight patients with unilateral condylar fractures of the mandible who were treated at our clinic by Martin-Eckelt lag screw osteosynthesis are described. The patients were aged 14 to 78 years. There were 4 males and 4 females. Four patients had fractures of the base of the condylar process, and four had fractures of the condylar neck. Two patients had no dislocation, four had dislocation, and two had luxation. Clinical examinations 6 months after primary operation showed that mouth opening was not less than 40mm in any patient. Radiographic examinations revealed a correct position and normal form of the condylar head in six patients, but resorption of the condylar head was found in two patients. These two patients required extirpation of condylar head for reduction. Since the use of a lag screw decreases the supply of nutrients from the bone marrow of mandibular ramus to the condylar head, the condylar head should not be removed from the surrounding soft tissue during operation.
A case of tetanus is reported. A 70-year-old man, who was a blacksmith, was referred to our hospital because of difficulty in mouth opening. Clinical examinations revealed severe trismus and severe stiffness of the masseter and sternocleidmastoid muscles, but there were no symptoms of TMJ disease or maxillofacial phlegmon. Multiple small wounds were seen on both palms. Blood examinations showed a marked increase in serum creatine phosphokinase activity. These findings led to the clinical diagnosis of tetanus. The patient was admitted to the hospital immediately and received anti-tetanus serum and penicillin-G. A tracheotomy was performed because of holotetanus and dyspnea. He was discharged from on the 39th hospital day. There were no functional sequelae. Tetanus often leads to death when early diagnosis and early treatment are not performed. It is important to keep the possibility of tetanus in mind when we treat patients who have difficulty in mouth opening.
Modified radical neck dissection with preservation of the accessory nerve is often used for elective neck dissection or early-stage neck metastasis. Dissection of the upper neck, requires confirmation of several anatomical landmarks, such as the internal jugular vein, occipital artery, hypoglossal nerve, accessory nerve, vagus nerve, and digastric muscle. During the dissection, surgeons should be aware that the anatomical relations of these landmarks can vary. After the accessory nerve leaves the jugular foramen, it crosses the internal jugular vein and descends obliquely to the trapezius muscle. Variations in the relation of the accessory nerve to the internal jugular vein should be taken in account to perform the dissection correctly. We encountered a patient in whom the accessory nerve passed through the internal jugular vein.