To study the growth characteristics of the nasopharynx as a structural componentinvolved in velopharyngeal function, 61 patients with unilateral cleft lip and palate (UCLP group) and 82 non-cleft controls (NCC group) were compared with respect to growth of the bony nasopharynx. All subjects were divided into four developmental stages according to age (stage 1: at 4 years of age, stage 2: at 8 years of age, stage 3: at 12 years of age, and stage 4: at 17 years of age). Measurements of the antero-posterior and the vertical dimensions were derived from reference lines and points on lateral cephalograms, and the data were analyzed by multivariate analysis and the t-test. The results showed that growth-related changes of the cranial base, the posterior maxilla, and cervical vertebrae were independent, and that the nasopharyngeal triangle which represents the bony limits of the nasopharynx (Ho: cranial base, PMP: posterior maxilla, At: atlas), demonstrated harmonious increase with stage in both the NCC group and the UCLP group. However the PMP in the UCLP group was located more posteriorly and superiorly than that in the NCC group.
The oral floor abscess model in mice was newly created by inoculating the oral floor with pathogens of odontogenic infection. Two pathogens of odontogenic infection, Streptococcus constellatus and Fusobacterium nucleatum, were investigated with respect to virulence, including synergy in mixed infection, on the basis of the rate of abscess formation, mortality rate, and number of bacteria in theabscess, as assessed with this model. Abscess formation was found in single infection with S. constellatus or F. nucleatum. Synergy of virulence was found between S. constellatus and F. nucleatum. The results of the present study suggest that synergy contributes to the onset and worsening of odontogenic infections. Moreover, these results support the clinical microbial finding that odontogenic infections are usually polymicrobial. In conculusion, this oral abscess model might be very useful in the study of odontogenic infections.
We report a case of desmoplastic ameloblastoma in the anterior region of the mandible. The patient was a 44-year-old woman presenting with swelling of the anterior region of the mandible. X-ray examination showed root separation a 3 1 2 1, a cylindroid radiolucent area under the root of 2 + 2, and a honeycomb appearance around this cystic region. A benign tumor was diagnosed clinically, and complete excision was performed with the patient under general anesthesia. Histopathological examination of the surgical specimen showed a follicular type ameloblastoma with a cystic region and a desmoplastic region. Pathologically, The diagnosis was a hybrid type ameloblastoma. There has been no evidence of recurrence as of 16 months after the operation.
Pleomorphic adenoma arises very rarely in the palate of children, although it isthe most common benign salivary gland tumor in adults. This paper describes a case of pleomorphic adenoma arising in the palate of a 9-year-old girl. She was referred to our hospital for evaluation of a swelling in the right side of the palate. The clinical diagnosis was a benign palatal tumor. Histopathological examination of a biopsy specimen, taken with the patient under local anesthesia, revealed a pleomorphic adenoma. The tumor was removed under general anesthesia, and macroscopic examination disclosed a firm, opaline, encapsulated nodule. The microscopic diagnosis of the entire nodule was also pleomorphic adenoma of a palate. Healing was completed by 50 days after the operation, and there has been no clinical evidence of recurrence as of 30 months there after.
This report presents a case of extensive oral cancer suspected to be a granulocyte-colony-stimulating-factor (G-CSF)-producing tumor in a 63-year-old man who complained of dyspnea, dysphagia, and dysmasesis. Laboratory findings on admission showed marked leukocytosis (35, 900/μl) and thrombocytosis (527, 000/μl). Pathological examination of a biopsy specimen revealed an undifferentiated squamous cell carcinoma. Chemotherapy with PEP, CDDP, MTX, UFT, and concurrent irradiation resulted in shrinkage of the tumor and a decrease in the leukocyte and platelet counts. Soon after 10 Gy of radiation had been administered, the serum G-CSF concentration reached the abnormally high level of 329pg/ml and was still 132pg/ml at death about a month later. Over the entire course of treatment, the leukocyte count changed with changes in tumor size. Both findings suggest that the tumor cells produced G-CSF.
Malignant schwannoma arises from the peripheral nervous system. Many of them arise in the leg and arms, and few arise in the oral region. Moreover, there are few reports of schwannoma metastasizing to the oral region from other regions. We report a case of malignant schwannoma that metastasized to the left mandibular gum from the right leg. The patient was a 45-year-old man. On examination, a malignant tumor of unknown origin was discovered, and it had metastasized to bone. On July 8, 1994, a widespread excision of the right leg with, right THA and TKA was carried out. The pathologic diagnosis was a malignant schwannoma; the origin was the right inguinal region. On February 27, 1995, the patient was hospitalized in the internal madicine department because of obstructive jaundice. The left lower gum had swollen considerably. On March 23, he visited our department. The clinical diagnosis was a hem atoma. On March 29, the tumor was removed with the patient under local anesthesia. The pathologic diagnosis was a malignant schwannoma that had metastasized to the oral region. His condition progressively worsened, and he died on April 10.
A case of a central giant cell granuloma arising bilaterally in the mandible of a 19-year-old woman is presented. The patient complained of swelling of the gingiva around the molars of the left mandible. Radiographic examination revealed that the lesion was located in the anterior margin of the ramus of the mandible bilaterally and the apical area between the second premolar and the first molar of the right side of the mandible. The lesion was excised completely under general anesthesia and was diagnosed as a giant cell granuloma on both clinical and histopathological examinations. There has been no evidence of recurrence as of more than one year after surgery. Twenty-seven cases, including our own, have been reported in Japan since 1973. Analysis of these cases revealed that central giant cell granuloma occurs most freguently in teenage girls and that the ramus of the mandible is most commonly involved, Intensive follow-up is required because 19% of these cases have recurred.
We encountered at Yaizu Municipal Hospital a rare case of Burkitt's lymphoma (BL) initially presenting as remarkable gingival swelling of the upper jaw. The patient was a 85-year-old man presenting with gingival swelling of upper jaw and submandibular lymphadenopathy. A biopsy of the gingiva was performed, and the histopathological diagnosis was BL. On serological examinations for Epstein-Barr virus (EB virus), the anti-VCA IgG titer was 5120, and the anti-EBNA titer was 160. The anti-EA IgG titer during the early clinical course increased from 20 to 80. Genetic examinations, by polymerase chain reaction (PCR) revealed EB virus genoma DNA in the tumor cells of the axillary lymph nodes. Chemotherapy reduced the gingival swelling and submandibular lymphadenopathy. However, the patient died of multiple organ failure. This case provides valuable clues to understanding the pathogenesis of BL, which is a rare disease in Japan.
Neuroblastoma is a highly malignant tumor that arises from sympathetic cells. Itis found mostly in infants and easily metastasizes to bone. However reports of neuroblastoma metastasizing to the jaw are very rare. A case of metastatic neuroblastoma of the mandible and cervical lymph nodes is reported. The patient was a 14-year-old boy with a chief complaint of gingival swelling in the left molar region of the mandible. The primary tumor was found in the left adrenal glands.
Extra-abdominal tumors rarely occur in the oral cavity. A case of extraabdominaldesmoid tumor of the maxilla is reported. A 70-year-old woman presented with gingiva swelling of the left upper molar, region. The swelling had been growing rapidly. Radiographs showed resorption of the upper alveolar bone. We suspected a malignant tumor of the maxilla. Partial resection of the left maxilla was performed with the patient under general anesthesia. There has been no evidence of recurrence or metastasis as of about 2 years 2 months after the operation. Histopathologically, the tumor consisted mainly of well differentiated fibroblasts with abundant collagen between the tumor cells. The cells showed no atypia or abnormal mitosis, and oppressively invaded the neighboring osseous tissue. The final diagnosis was extra-abdominal desmoid tumor.
Open vertical osteotomy in the mandibular ramus is the one surgical option for the correction of mandible deformity. It is easy to assume that this procedure is useful for open reduction of condylar fractures. In this paper we describe a new systematic procedure for open reduction of high condylar fractures. The procedure involves vertical subcondylotomy and a new retractor for subcondylotomy to protect the mandibular neurovascular bundle. The major points of this operation are the use of vertical condylotomy, removal of the posterior border of the ramus and plating the condylar head with it, and accurate replacement of the posterior border of the ramus with mini plates prepared before osteotomy.
We studied the cause, status, and treatment of temporomandibular joint (TMJ) dislocation in patients with psychic and cerebral diseases. These diseases were present in 11 (26.2 %) of 42 patients with TMJ dislocation. Psychic disease included 2 cases of mental retardation and 3 of schizophrenia. Cerebral diseases included 1 case of cerebral infarction, 3 of cerebral hemorrhage, 1 of epilepsy, and 1 of Parkinson disease. There were many old patients among those with cerebral diseases. Convulsions characteristically led to TMJ dislocation. There was prolonged dislocation of the TMJ. A reliable treatment was required in patients with these diseases. Therefore, augmentation of the articular tubercle was indicated. It was suggested that incoordination of the masticatory muscles induced TMJ dislocation. Furthermore, extrapyramidal disorders may have been caused by antipsychotic drugs, Parkinson disease, and cerebrovascular disease; convulsions due to epilepsy may lso have been involved.
This paper describes a case of a foreign body of plant origin (bamboo) penetrating into the right buccal region. The patient was a 13-year-old boy, who visited our clinic 18 days after injury. He was complaining of trismus and pus discharge from the penetrating wound. Many papers describe difficulty in locating radiolucent foreign bodies. This case suggested that MRI was useful in locating plant foreign bodies present in the body for a long time.