Multiple primary cancers of the oral cavity are increasing and are considered animportant factor affecting the prognosis of oral cancer, but this condition is poorly understood. To investigate risk factors for this disease, we reviewed 200 patients with oral squamous cell carcinoma who were treated at the Department of Oral and Maxillofacial Surgery, Yokohama City University School of Medicine during the 5 years between 1992 and 1997. Twenty-nine patients (14.5%) had oral multiple primary cancer (14 synchronous and 8 metachronous), and 15 (7.5%) had multiple primary cancer of the upper digestive tract. Odds ratios (ORs) and 95% confidence intervals (CIs) were derived from logistic regression analysis, including sex, smoking, drinking, family history, mucosa adjacent to tumor, and oral leukoplakia. Oral leukoplakia (OR=4.6, C1=1.57-13.33) was associated with oral multiple primary cancer. The OR for women was 3.4 (C1=1.12-10.14) relative to men. A risk factor for the multiple primary cancers of the upper digestive tract was drinking (OR=5.1, CI=1.33-19.31). This study provides evidence that the risk factors for oral multiple primary cancers differ from those of multiple primary cancers of the upper gastrointestinal tract.
Nineteen cases of unilateral cleft lip and nose were measured and evaluated before and after open rhinoplasty with the use of facial plaster models and a high-accuracy threedimensional digitizer (TRISTATION400CNC, Nikon, Tokyo). Surgery was performed from 1990 through 1994. The mean age of the subjects was 18.6 years. Three-dimensional wire-frame models were obtained from facial plaster models, and nasal landmarks were extracted automatically by an original program. The landmarks were evaluated and compared according to three operation techniques:(1) Flying bird group: A flying bird incision was made across the columella, and a tornado incision was made in the nostril. After cartilage reconstruction, complex tissue was transplanted into the nostril. Furthermore, Z-plasty was done across the white lip and the alar base of the affected side.(2) Col. base-graft group: An incision was made in the columella base and nostril rim. After cartilage reconstruction, ear cartilage was transplanted onto the nasal tip, alar, or both (3) Col. base-non-graft group: An incision was made in the columella base and nostril rim. The nasal cartilage was reconstructed without a graft. The nasal tips deviated about 5 mm to the normal side before operation and were corrected after operation in all groups. In the flying bird and col. base-graft groups, the nasal tips moved about 3 mm anteriorly. The difference in the distance between the columelia base and the alar base decreased markedly in the flying bird group. The columella base deviated about 3mm to the normal side before surgery and was corrected after surgery in all groups. In the Col. base-graft group, the columella base protruded inferiorly after operation. No remarkable change was observed in the alar dip in any group. The procedure used in the flying bird group was suggested to result in a better morphological outcome than the procedures used in the col. base with/without graft groups.
We evaluated chewing function in 120 patients with TMJ disorders by scoring the ability of dietary intake, assigning scores of 0 to 40 for 20 kinds of food, and by calculating dietary intake rate for each food. The overall average score was 27.4±9.8 before treatment. The score increased to 36.0±5.6 after treatment. Evaluation of the score with respect to treatment efficacy showed a significant difference between the group that responded to treatment (37.2±4.9) and the group that did not (33.8± 5.9). As for the relation to the clinical classification of the Japanese Society of TMJ (1996), the average score before treatment was significantly higher in type III patients with clicking (33.8±6.8) than in other types (23.0 to 26.4). After treatment, there was no significant difference among the types, although the score increased significantly in every type. Studies of dietary intake rate showed that patients were severely limited in their intake of solid, elastic, and large foods and slightly limited in their intake of soft food before treatment. After treatment, the dietary intake rate increased for all food groups. The rate was almost 100% for group I foods, 88% to 100% for group If, about 80% for group DI, and 68% to 90% for group W. These results showed limitations in intake of solid and elastic foods remained after treatment. As for dietary intake, chewing function in patients with TMJ disorders improved satisfactorily after treatment, and the evaluation of chewing function may reflect the response to treatment of patients with TMJ disorders.
Heat treatment for immediate reimplantation of resected bone was investigated with respect to bone regeneration. Thirty-seven adult Sprague-Dawley rats were used. A cranial bone segment was resected with a trephine and immediately reimplanted after heat treatment at 65°C (pasteurization) or boiling for 30 minutes. Histomorphometric assessment of new bone formation was performed in three groups, receiving implants of untreated fresh, pasteurized, or boiled bone. Eighteen weeks after reimplantation, new bone formation was significantly higher for pasteurized bone and untreated fresh bone than for boiled bone.
A relation between oral lichen planus (OLP) and oral prosthetic metals has been reported because OLP may improve after their removal. However, the criteria for evaluating their involvement in the clinical and histopathological signs of OLP have not been established. We compared the clinical and histological features of 18 cases of OLP that improved after removal of dental metals with those of 18 cases that did not improve clinically after removal. All patients were positive to dental metals on patch testing and had OLP refractory to conventional therapy. Improved cases of OLP were characterized by unilateral involvement of the buccal mucosa, showing a reticular pattern with the formation of erosions and ulcers. Histologically, most cases had remarkable humoral degeneration of the basal cell layer, lymphocytic invasion of the lamina propria, and spongiosis.
We investigated clinical characteristics and treatment outcome in 38 patients with bilateral condylar fractures, which accounted for 17.5% of mandibular condylar fractures. Mandibular body fractures were concurrently present in 24 (63.2%) of 38 cases. Condylar fractures occurred most frequently in the upper neck and head of the cundyle; fractures of the condylar head often showed a longitudinal pattern. When bilateral condylar fractures were conservatively treated, the treatment outcome of bilateral condylar fractures combined with mandibular body fractures was slightly better than that of bilateral condylar fractures alone. These results suggest that mandibular body fractures combined with bilateral condylar fractures might play a role in reducing soft tissue injuries due to external force in temporomandibular joint region.
Leiomyoma is uncommon in the oral cavity. We report a case of leiomyoma that developed in the hard palate of a girl. A 9-year-old girl complained of a swelling on the right side of the palate. The swelled area measured 21×18mm and was elastic hard and slightly red. Computed tomography clearly revealed a demarcated low density area including the palatal root of the right first molar. Pleomorphic adenoma was suspected on the basis of clinical findings. The tumor was resected with the patient under general anesthesia. The histopathological diagnosis was leiomyoma. The patient's postoperative course was satisfactory, but longterm observation is needed.
We clinically analyzed seven patients with eosinophilic granuloma of bone in theoral and maxillofacial region who were treated between 1974 and 1997. Four patients had monostotic eosinophilic granuloma (MEG), and three had polyostotic eosinophilic granuloma (PEG). All patients were men, 23 to 40 years of age at the time of diagnosis. Swelling or pain was the most common symptom at presentation. The osseous lesions occured more frequently in the mandible than in the maxilla. Radiographically, the MEG lesions were radiolucent with well-defined margins. The PEG lesions were comparatively multilocular and radiolucent. Surgical therapy consisting of extraction or curettage was effective against lesions in the four patients with MEG. However, prednisone and radiotherapy were ineffective against the osseous lesions in two patients with PEG.
Myelodysplastic syndromes are a group of clonal hematological disorders characterized by cytopenias and dysplastic changes of hematopoietic cells. These dysplastic features cause refractory anemia and thrombocytopenia. At present, bone marrow transplantation during immunosuppressive treatment is considered the only way to achieve cure. Since it is important to prevent severe infectious diseases during bone marrow transplantation, periodontitis, pericoronitis, and other dental infectious diseases must be treated. In this report, we describe the treatment of periodontitis and pericoronitis in a patient with myelodysplastic syndromes before bone marrow transplantation. A 22-year-old woman was referred to the Department of Oral Surgery, Dental Hospital, Hokkaido University for evaluation of dental infection before bone marrow transplantation. During hemostatic control by infusion of HLA-class I antigen-matched platelet concentrates, the teeth were extracted. No episodes of abnormal bleeding occurred during or after the operation.
We describe a rare case of primary gingival tuberculosis. The patient was a 53-year-old woman who had on intractable undermining ulcer of the maxillary gingiva with submandibular lymph node swelling. Computed tomographic scans ultrasound imaging, and cytologic examination of the lymph nodes suggested a specific type of lymphadenitis. Histopathological examination of the gingival ulcer and systemic examination revealed primary gingival tuberculosis. The patient received chemotherapy with INH, EMB, and RFP. The response was good, and no sign of reccurrence has been found.
We report a case of arteriovenous malformation (AVM) arising in the maxilla. The patient was a 55-year-old man with swelling and unusual hemorrhage in the anterior alveolar part of the maxilla. Digital subtraction angiography (DSA) showed that the arterial supply was from the ipsilateral infraorbital, posterior superior alveolar, and descending palatine arteries. DSA also revealed that the AVM drained into the expanded facial vein. Because of the extreme bend of the feeding arteries, embolization was not possible. Surgical resection of the lesion was successfully performed within 55 minutes. Hemorrhage (213 grams) was controlled by permanent ligation of the infra-orbital artery and electrocautery of the other feeding vessels.