Adenoid cystic carcinoma (ACC) is generally classified into the following histologic types: tubular, cribriform, and solid. Numerous authors have attempted to correlate the histological characteristics of these tumors with their biological behavior.
I retrospectively compared the image cytometric and immunohistochemical characteristics of formaldehyde-fixed and paraffin-embedded specimens obtaired from 24 cases. The specimens were also classified according to the histological grading system proposed by Szanto et al., the predominant pattern, and the presence or abscence of solid components. The nuclear DNA content of ACC on image cytometric analysis and the immunohistochemical characteristics of p53 protein and WAF 1 protein were studied as compared with clinicopathological findings. The following results were obtained:
1) No correlation was found between the histological classification and clinicopathological findings. However, most patients with tumors characterized by solid components died of cancer-related causes.
2) Tumors with a solid histological pattern and those with distant metastasis were more often associated with DNA aneuploidy, and these tumors had elevated levels of mean DNA index and %-over 4 c.
3) No correlation was found between histological classification and p53 or WAF 1 protein expression. Lymph node metastasis was present in seven carcinomas, none of which expressed WAF 1 protein.
4) Aneuploid carcinomas were related to p53 protein immunoreactivity. There were no relationship between DNA ploidy pattern and WAF 1 protein expression.
5) There was a strong correlation between p53 and WAF 1 protein expression and most tumors that expressed p53 protein did not express WAF 1 protein.
These results suggest that WAF 1 protein expression and image cytometric DNA analysis may be a useful index for assessing the malignant behavior of ACC. Although aneuploid tumors were associated with a solid histological pattern, there was no correlation between histological classification and p53 or WAF 1 protein expression.

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Clinicopathological studies and flow cytometric analyses were performed for 62 cases of odontogenic keratocyst obtained from the file of the Department of Oral and Maxillofacial Surgery, Nihon University School of Dentistry between 1984 and 1998. The Patients ranged in age from 12 to 74 years, and the peak incidence was in the third decade. The male: female ratio was 1.5: 1. Cysts were most frequently found in the third molar region, including the ramus. Most cysts were found incidentally on radiographic examination and appeared as unilocular, smooth bordered, radiolucent lesions. Most lesions were less than 4cm in diameter. Impacted teeth were found in 24 of 70 cysts, and 18.6% of the cysts were associated with root resorption of neighboring teeth. When classified according to the keratin type of the cyst-wall epithelium, most cysts were type II (58.5%).
Flow cytometric analysis was performed for lining epithelial cells isolated from paraffin embedded specimens. Nuclear staining was done with Ki-67 antibody. The Ki-67 antigen labeling rate of odontogenic keratocysts was significantly higher (7.9±5.7%) than that of radicular cysts (2.9±1.3%). The number of cysts with a high Ki-67 antigen labeling rate was higher in type III than in the other three groups. We found a significant correlation between the Ki-67 antigen labeling rate on flow cytometry and the Ki-67 antigen positive cell rate on immunohistochemical examination. An advantage of flow cytometric analysis is that it can precisely enumerate proliferating cells of odontogenic keratocysts.

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To establish a qualitative diagnosis of submandibular gland disease, internal echo levels of 97 submandibular glands were measured under constant conditions by ultrasonography, and the influence of aging, fibrous changes, and adipose tissue content were investigated.
Although there were no sex-related differences in the internal echo levels of 88 healthy glands, there was a trend toward an increased internal echo level with aging.
Histopathologically, 20 glands required extirpation for treatment, and the adipose tissue ratio in these glands was measured.
In 11 glands without fibrous changes, the adipose tissue ratio correlated with the internal echo level. In 9 glands with fibrous changes, there was no correlation between these variables, and the average internal echo level was significantly lower than that of the glands without fibrous changes (P<0.01).
Our results suggest that measurement of internal echo levels may be useful for the qualitative diagnosis of submandibular glands.

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We studied the changes in mandibular bone mineral density (M-BMD) associated with pregnancy and lactation in mice.
Methods
Five female ddy mice were used in each of the following groups: control groups consisting of non-pregnant mice 8, 11, 14, 17 weeks old; pregnant, non-lactating groups consisting of 8-week-old pre-pregnant mice, 11-week old post partum mice, and 14-and 17-week-old puerperal, non-lactating mice; and pregnant, lactating groups, used to investigate the effect of lactation on M-BMD, consisting of 11-week-old post partum mice, and 14-and 17-week-old puerperal, lactating mice (both groups lactating for 3 weeks). Portions of the left mandible were resected, and bone mineral content (BMC) was measured by dual-energy x-ray absorptiometry (DXA; ultrahigh resolution mode, Hologic QDR 1000). Mandibular area (cm 2) was measured with the use of an image analysis program (Ultimage, I & I). Bone mineral density was obtained from BMC and mandibular area. A factorial ANOVA was used for statistical analysis.
Results
1) There was no difference in M-BMD associated with pregnancy.
2) M-BMD was significantly lower in puerperal 14-week-old lactating mice, but this difference rapidly disappeared after lactation was discontinued.

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Dextran magnetite complex (DM) is a colloidal suspension of subdomain particles that efficiently generates heat when exposed to an alternating current (AC) magnetic field. Inductive heating using DM has attracted attention as a new method that can overcome various problems associated with currently available techniques for local hyperthermia. This study was performed to clarify the usefulness of DM for oral cancer hyperthermia.
DM suspension was locally injected into the normal tongue and the tumor-bearing tongue of golden hamsters. The tongues were heated to 43.0-45.0°C by exposure to an AC magnetic field of 500 kHz. The following results were obtained:
(I) Experiment on heating of normal tongue
a) When DM was injected into the tongue in concentrations of 112, 56, and 42mg (as Fe/ml), the tongue temperature reached 43.0°C at 60, 120, and 570 seconds after treatment, respectively.
b) By injecting DM in a concertration of 56mg Fe/ml and changing the intensity of the AC magnetic field, the temperature in the tongue could be maintained at 43.0-45.0°C for 30 minutes. Furthermore, the temperature rise in the rectum, used as control, was only 0.4°C during this period.
c) Histological examination revealed brown uniform DM accumulation in the connective tissue between fibers of the tongue muscle.
(II) Experiment on heating of tumor-bearing tongue
d) The central and marginal temperature of the tumors reached 43.0°C at 180 and 540 seconds, respectively, and both temperatures were maintained at 43.0-45.0°C for 30 minutes.
e) An increase in tumor volume was associated with prolongation of the time required for the central temperature of the tumor to rise to 43.0°C.
f) Histological examination revealed the brown uniform accumulation of DM in the stroma at the tumor margin.
These results suggest that this local hyperthermic system may be useful in the oral region, where the tumor can be directly observed and palpated.

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A case of osteosarcoma is reported. The tumor was localized in the anterior region of the maxilla, where osteosarcoma rarely originates, and was thought to result from malignant transformation of osteochondroma, which had recurred in the same region. The patient was a 45-year-old woman. She underwent tumor enucleation in the anterior region of the maxilla twice, 5 year 4 months and 2 years 10 months previously, to treat exostosis and osteochondroma, respectively. As she noticed a tumor in the same region, she consulted our department again on October 30, 1991. A painless, relatively well-demarcated, bone-like hard tumor measuring 26×20×15mm was detected in the alveolar bone of 3+3. Radiography disclosed a radiopaque area partly exhibiting a sun-ray-like appearance. The pathological diagnosis based on examination of a biopsy specimen was osteochondroma. However, malignancy was suspected because of recurrence and the distinctive radiographic characteristics of the lesion. Thus, partial resection of the maxilla was performed, and a diagnosis of osteosarcoma was finally made. There has been no recurrence or metastasis as of 7 years after operation and the patient remains healthy.

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Squamous odontogenic tumor (SOT) is a rare lesion apparently of odontogenic origin.
Although 40 cases of this tumor have been reported outside of Japan, only 3 cases have been reported domestically. Only 4 cases of SOT with multilocular radiolucency have been described to our knowledge.
We report a case of maxillary SOT in a 29-year-old woman. Radiography revealed an illdemarcated multilocular radiolucency between the left maxillary lateral incisor and the premolar. The lesion was diagnosed as SOT on examination of a biopsy specimen. Partial maxillectomy was performed. The removed specimen measured 25mm×25mm×20mm. There has been no evidence of recurrence as of 6 years 5 months after the operation.

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Two cases of carcinoma in pleomorphic adenoma are reported.
Both patients were 82-year-old women. One had swelling of the right part of the upper lip, and the other had swelling of the left side of the palate. Biopsies were performed, and both lesions were suggested to be carcinoma in pleomorphic adenoma on histopathological examination. Under general anesthesia, the tumors, including the surrounding normal tissue, were excised. The histopathological diagnoses were carcinoma in pleomorphic adenoma. There has been no evidence of tumor recurrence or metastasis after operation.

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Myeloma is a tumorous lesion derived from plasma cells that develops in bone marrow.
Among the different types of myeloma, that localized to 1 bone, such as the spine or jaw, is referred to as solitary plasmacytoma.
Few studies have reported solitary plasmacytoma arising in the mandible.
The authors describe their experience with a case of IgG-κ type solitary plasmacytoma that developed in the right side of the mandible.
The patient was a 42-year-old man who presented with an abnormal sensation at the molar region of the right side of the mandible.
A diagnosis of solitary plasmacytoma was established on the basis of X-ray findings, biochemical and serological data, and pathological examinations. The patient received hemimandibulectomy of the right side of the mandible and postoperative radiotherapy.
The postoperative course has been uneventful as of 8 years 7 months after operation. There has been no evidence of progression to multiple myeloma or local recurrence.
The patient will continue to undergo careful long-term follow-up.

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A 30-year-old woman was seen in September 1995 because of a swelling of the left side of the face and an ulcer in the oral cavity. There was no sensory impairment. Computerized tomography demonstrated a large mass (75×50×50mm) in the medial side of the left parotid gland. The maxilla and the mandible were deformed by the extending tumor. Examination of a biopsy specimen showed a benign pleomorphic adenoma of salivary gland origin. Under general anesthesia the tumor was removed with the left ramus via a cervical approach using a preauricular incision. She remains well with no evidence of tumor recurrence.

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We clinically and histopathologically analyzed 16 patients with cement-ossifying fibroma who presented at our department between 1979 and 1998. Women were 75% more likely to develop this lesion than men: the male: female ratio was 1: 3. The average age on presentation of this tumor was 36.6 years, with a range of 14 to 70 years. This tumor arose in the mandible in 11 patients (57.9%) and in the maxilla in 8 (42.1%). Most of the lesions were located in the molar region. Fifteen tumors were surgically removed, and 4 were treated by extirpation. The prognosis of most patients was favorable, and recurrence occurred in only 1 patient (6.7%).

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A rare case of aggressive fibromatosis with severe trismus arising in the muscular attachment at the infratemporal fossa is described. Radiographic examination by means of MRI and CT showed a massive tumor-like lesion, measuring 22×16mm, inside the left side of the temporal muscle. Coronoidectomy with part of the inner side of the temporal muscle was performed via a preauricular temporal incision. Histopathologically, the resected tumor consisted mainly of sparse fibloblasts with abundant collagen. The tumor spread widely and infiltrated the striated muscles. The tumor cells showed no atypical or abnormal mitosis. No evidence of local recurrence has been detected as of 1 year after resection.

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Barodontalgia is tooth pain initiated by changes in atmospheric or hydraulic pressure. This term was originally used to describe the dental pains experienced by airplane pilots in unpressurized cockpits. Owing to the recent increase in the popularity of scuba diving, barodontalgia has again become an important problem because scuba diving causes hydraulic pressure changes. We report a case of barodontalgia associated with evidence of maxillary sinusitis in the absence of an obvious cause of tooth pain. The patient was a 40-year-old man who had tooth pain in the posterior left side of the maxilla during diving. The clincal diagnosis was barodontalgia. CT showed hypertrophy of the left maxillary sinus membrane. We suspected that the maxillary sinus was involved. Antibiotics were given, and the hypertrophy of the left maxillary sinus membrane resolved. Subsequently, tooth pain during scuba diving disappeared. This case suggests that maxillary sinusitis may cause barodontalgia and that CT is useful in the diagnosis of this condition.

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Cervical necrotizing fasciitis is a rare, severe soft tissue infection. It is usually a polymicrobial infection characterized by rapidly spreading diffuse necrosis of the subcutaneous fatty tissue and fascia. We report a case of odontogenic cervical necrotizing fasciitis in an 80-year-old woman. Despite repeated surgical drainage and antibiotic therapy, severe complications, including coma, ARDS, and DIC, developed, and the patient died of acute renal failure in spite of intensive care.

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A 29-year-old man was referred to our department because of swelling and pain of the left cheek. Initially, incision and drainage was performed under the diagnosis of phlegmon of the left cheek caused by 8 acute periodontitis. The patient had convulsive seizures after 3 days. CT demonstrated an unclear low density area of the left lateral lobe. The patient was given a diagnosis of brain abscess caused by odontogenic infection ad was given antibiotics and antiepileptics. A CT scan obtained 1 month after convulsive seizures demonstrated disappearance of the low density area in the left lateral lobe. No further symptoms have occussed as of 2 years 6 months after the convulsive seizures.

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An extremely rare case of spindle cell lipoma of the cheek is presented. The patient was a 45-year-old woman. Physical examination revealed a mobile, well-demarcated, 10mm-diameter mass in the right cheek. Examination of a biopsy specimen showed proliferation of mature adipocytes, leading to the diagnosis of a lipoma. The tumor started to enlarge 2 and a half years after biopsy. Histologic examination of the removed specimen showed that the tumor was composed of mature adipocytes and spindle cells. A diagnosis of spindle cell lipoma was made.

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We describe two unusual cases of necrotizing sialometaplasia of the hard palate in which the lesions were caused by self-induced vomiting. The first patient, a 35-year-old woman, pressed her palate with a spoon to induce vomiting 2 weeks before presentation to our department. The second patient, a 16-year-old girl, was suffering from bulimia and chronic self-induced vomiting. Clinical and pathological findings and causative factors are discussed.

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Cystic diseases in the temporomandibular joint, such as synovial cysts and ganglions, are rare. We report a case of ganglion in the temporomandibular joint.
A 59-year-old man was referred to The First Department of Oral and Maxillofacial Surgery, Tokyo Medical and Dental University because of a swelling in the preauricular region. The swelling had been noticed for 1 month, but there were no other symptoms on clinical examination. There was no evidence of inflammation around the swelling on laboratory examinations. Ultrasonic and MRI examinations showed a mass with a clearly defined margin between the left parotid gland and condyle. The lesion was clinically diagnosed as cystic disease of the temporomandibular joint. We performed enucleation of the cyst and partial condyloplasty under general anesthesia. The cyst was located in the condylar neck and adhered to the lateral pole of the condyle. The lesion was histopathologically diagnosed as a ganglion. The postoperative course of the patient has been satisfactory with no recurrence, trismus, or paralysis of the facial nerve as of 1 year after the operation.

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