In the present study, I investigated the possibility of simply and effectively preparing a prefabricated vascularized bone graft model in the rat (8-week old male Fischer rats and Brown-Norway rats) by using an autologous vessel bundle and allograft bone to reconstruct jaw bone defects. To make prefabricated vascularized bone grafts at ectopic sites, an autologous vessel bundle (saphenous artery and vein) of the Fischer rat was wrapped with the femur of the Fischer rat (control group). The vessel bundle was also wrapped with the femur obtained from the Brown-Norway rat (experimental group). The animals were killed 1, 3, 6, 9, and 12 weeks after surgery, and the osteogenetic process was observed by radiographic, histologic, and electron probe X-ray microanalytic examinations. In conclusion, prefabricated vascularized bone grafts using an autologous vessel bundle and allograft bone were considered a new useful source of vascularized bone grafts.
Magnetic resonance imaging (MRI) and computed tomography (CT) were used to study 15 primary squamous cell carcinomas of the tongue.(The examinations were performed within 1 week or less.) Lesion detectability was compared by means of localization-receiver-operating-characteristic (LROC) curve analysis. The T stages of the subjects were as follows: T 1, 5 cases, ; T 2+T 3, 5 cases; and T 4, 5 cases. Lesion detectability was compared among the following 6 types of images: T 1-weighted spin echo imaging, T 1 group; T 2 weighted spin echo imaging, T 2 group; enhanced MRI (T 1-weighted static or dynamic enhanced images), enhanced MRI group; plain MRI (T 1-and T 2-weighted spin echo images), plain MRI group; plain and enhanced MRI, mixed MRI group; and nonenhanced and/or enhanced CT (soft tissue window level), CT group. Whether a tumor was present or not was ranked by 7 observers according to a 5-point-rating scale and the results were averaged. The sites of all tumors were recorded. As control, 15 patients with no abnormality of the tongue, mandible, or oral floor were examined by CT and MRI. LROC curve analysis indicated that lesion detectability in the mixed MRI group was significantly better than that in the other MRI and CT groups. The T 2 and enhanced MRI group showed similar lesion detectability, which was better than that in the T 1 and CT groups. T 1 tumors were difficult to detect in all 6 groups, but enhanced MRI, especially dynamic enhanced MRI, had the best detectability.
We have used secondary bone grafting since 1982 to augment alveolar clefts in patients with cleft lip or palate. We performed operations in about 600 patients, using autogenous particulate marrow and cancellous bone harvested from the anterior or posterior iliac crest. The optimal age for bone grafting is between 8 and 11 years, before eruption of the ipsilateral permanent canine. Since 1993, we have performed bone grafting in patients 5 to 6 years of age. The objective of this procedure was not only to induce eruption of the ipsilateral canine but also to promote eruption of the ipsilateral incisor in a normal position and to enhance prompt remodeling of grafted bone. We clinically and radiographically evaluated the results of bone grafting. We also studied bone bridge formation in the alveolar cleft regions, including the time of formation. Twenty-five patients, (12 boys and 13 girls) were operated on at 5 (4 patients) or 6 (21 patients) years of age. The mean age of the patients was 6 years 3 months. There were 7 cases of unilateral cleft lip and alveolus, 17 of unilateral cleft of the lip and palate, and 1 of bilateral cleft lip and palate. Bone bridges were formed in the alveolar clefts in 24 of the 25 patients. The clinical and radiographic records obtained for 23 patients showed that bone bridges were formed 3 months after operation on average. Our study suggested that remodeling of the bone in patients 5 to 6 years of age was prompt and had a good outcome. Future investigations should study whether early secondary bone grafting at the ages of 5 to 6 years affects maxillary growth.
A rare case of metastasis of gastric adenocarcinoma to the maxillary gingiva is reported. A 65-year-old man had an epulis-like mass on the incisal region of the maxillary gingiva. The patient had a history of gastric adenocarcinoma, and the lower two thirds of the stomach had been resected. The mass was completely removed, with partial resection of the maxilla. The clinical course was good, with no evidence of recurrence. Histopathological examination showed that the oral tumor was a tubular adenocarcinoma morphologically similar to adenocarcinoma of the stomach. Metastatic tumors to the oral cavity usually arise in the mandible. To our knowledge, only 2 cases of gastric adenocarcinoma metastasizing to the incisal region of the maxillary gingiva, including ours have been reported.
Most acinic cell carcinomas arise from the parotid gland, and involvement of the minor salivary gland is rare. We describe a case of acinic cell carcinoma of the minor salivary gland that was successfully diagnosed by cytologic examination. The patient was an 87-year-old man with a painless mass in the left buccal mucosa. The mass measured 25×20×10mm and was covered with normal mucosa except in the center, where a small ulcer was observed. On palpation, the mass was elastic hard. Computed tomography revealed a relatively well demarcated lesion on the buccal aspect of the maxilla. Cytologically, smears taken from the ulcer consisted of large, overlapping cells with abundant foamy cytoplasm and a large nucleus containing a distinct nucleolus. The cells were sporadically arranged in an acinous pattern. The cytologic diagnosis was acinic cell carcinoma. The tumor was removed en bloc, and there has been no evidence of recurrence or metastasis as of 1 year 8 months postoperatively. The histopathologic diagnosis of the surgical specimen was consistent with the cytologic diagnosis.
Mucoepidermoid carcinoma of the maxillary sinus is rare. We describe a poorly differentiated mucoepidermoid carcinoma originating from the right maxillary sinus of a 65-year-old woman. On presentation, she complained of pus discharge from the right nasal cavity and facial swelling with deformity. Radiographic studies, including a CT scan, suggested a tumor-like image with destruction of the right maxillary sinus. After intraoral opening of the antrum, a histopathological diagnosis of poorly differentiated mucoepidermoid carcinoma was made. The patient received chemotherapy and radiotherapy, but the outcome was poor. The clinical course is described in detail in the text.
According to the classification of the World Health Organization (WHO), primary intraosseous carcinoma (central carcinoma) is defined as a squamous cell carcinoma arising within the jaw, having no initial connection with the oral mucosa, and presumably developing from residues of the odontogenic epithelium. We report a case of central carcinoma occurring in a 69-year-old man. Marsupialization was performed under the diagnosis of residual radicular cyst. Histopathological examination revealed a moderately differentiated squamous cell carcinoma with atypical lining epithelium. A combination of radiation and chemotherapy was given, followed by a partial maxillectomy. Unilateral total neck dissection was performed 3 months after the initial operation. Five years later, the patient has been free of recurrence and distant metastasis.
Cellular schwannoma differs from classic schwannoma because of its increased cellularity, nuclear pleomorphism, and hyperchromatism, lack of Verocay bodies, and occasional mitotic activity. Some cases of cellular schwannoma are confused histologically with malignancy. We present a case of central cellular schwannoma of the mandible. A 33 year-old man referred to us on May 28, 1996 because of discomfort of the labial lower gingiva. Partial resection of the mandible was performed with the patient under general anesthesia on August 8, 1996.
Leiomyoma is a benign tumor arising in smooth muscle. It occurs mainly in the uterus and stomach. However, it rarely occurs in the oral cavity. The patient had noticed swelling of the left side of the buccal mucosa about 7 years previously, but had ignored it. Because the tumor gradually grew larger, he came to our hospital in May 1997. Under the clinical diagnosis of a benign tumor of the left side of the buccal mucosa, we performed enucleation of the tumor under general anesthesia. The histopathlogical diagnosis was vascular leiomyoma. There has been no evidence of recurrence as of 11 months after surgery.
We evaluated the postoperative stability of broad soft tissue pedicle genioplasty. This surgical procedure involves horizontal osteotomy of the inferior border of the mandible while maintaining a musculoperiosteal pedicle. Lateral chephalometric radiographs of 20 patients who underwent broad soft tissue pedicle genioplasty were analyzed to evaluate osseous and soft tissue changes of the chin. We found that the pedicled genial segment had no relapse, and the soft tissue had only slight relapse. In addition, bone remodeling was seen at the symphysis of the genial segment. Broad soft tissue pedicle genioplasty had good postoperative stability.
Three cases of severe odontogenic infection are reported. In case 1, diabetes mellitus (DM) appeared to seriously exacerbate the infection. Gas formation due to bacterial infection occurred in the inflammatory regions of cases 2 and 3. Acute renal failure (ARF) or disseminated intravascular coagulation (DIC) followed these severe infections. Manage-ment of general complications as well as prompt drainage and systemic antibiotic treatment is essential in the management of serious infections.
A 52-year-old man who had lived in Brazil from 1957 through 1994 visited our department on June 17, 1997 because of a rough palate. On presentation, a 63× 29 mm ulcerative granulomatous lesion was observed in the palate. Histopathological examination revealed yeast cells with multiple budding. Paracoccidioidomycosis was diagnosed on the basis of the patients history, histological findings, and a positive reaction for Paracoccidioides brasiliensis antigen on immunodiffusion tests. Paracoccidioidomycosis is endemic in Latin America, and all cases reported in Japan were contracted abroad. This is the 14th case of paracoccidioidomycosis reported in Japan.
A very rare case of allergic stomatitis due to Propolis is reported. A 80-year-old woman was referred to our clinic because of contact pain of the oral mucosa. Erythemas with erosion had developed on the palatal mucosa and tongue 1 day after she had taken Propolis to treat eczema of the foot. The results of blood examinations were within the normal limits. She stated that she kept Propolis in her mouth for about 30 minutes before swallowing. Patch testing showed a positive reaction for Propolis. The diagnosis was allergic contact stomatitis due to Propolis. The erythemas and erosive changes of the oral mucosa disappeared about 14 days after she stopped taking Propolis.
A case of eosinophilic granuloma of the soft tissue arising in the palate of a 65-year-old man is reported. It was an elastic hard lesion measuring about 10mm in diameter. The lesion was removed under a clinical diagnosis of fibroma. Histologically, the lesion was diagnosed as an eosinophilic granuloma of the soft tissue. Ultrastructurally, viruses similar to the herpes virus group, with a diameter of 100nm, were observed in the cytoplasm of histiocytes. These cells were positive for HSV (Herpes Simplex Virus)-Type I antibody on immunostaining. The findings indicate that the lesion was caused by Type I allergy due to HSV Type I infection.
Tuberculosis of the oral region is rare, estimated to account for less than 0.1% of all cases of tuberculosis. Almost all cases of oral tuberculosis are secondary to pulmonary lesions. A case of primary tuberculosis in the submucosa of the upper mucolabial-buccal fold is reported. The patient was a 69-year-old man who presented with a mass in the submucosa of the upper mucolabial-buccal fold on the right side. The mass was excised and was diagnosed histopathologically as tuberculous granuloma. Screening tests were performed to detect lesions in other areas, but no abnormal findings were obtained. Examination of the sputum was also negative. The patient has remained healthy without recurrence for 9 months postoperatively.
A 16-year-old boy presented with a submental mass, which on biopsy proved to bea lymph node with atypical follicular hyperplasia. Seven months after the biopsy, enlarging lymph nodes of left submandibular and left retroauricular region were detected. A second biopsy was performed. After further histological study, this case was correctly diagnosed as lymphadenitis with progressive transformation of germinal centers.
Gingival cysts in adults arise from odontogenic epithelial remnants and are most commonly seen in the canine-premolar region of the mandible. The condition is rare. In Japan, an extensive review of the literature revealed only one reported case to date. We have encountered such a case, and report it here. A 22-year-old man was referred to our department on March 27, 1998 because of gingival swelling in the canine region of the right side of the mandible. He had previously consulted a dental clinic because of tenderness in the same region. The gingival swelling had a diameter of about 3 millimeters. It was hemispheric, the border was clear, and the color was similar to that of the normal gingiva. The patient had no spontaneous pain, only tenderness. The surrounding teeth were all vital, and had no pain on percussion or mobility. A radiographic examination showed no abnormalities. We clinically suspected the swelling to be a gingival tumor. We extirpated the lesion on April 28, 1998 under local anesthesia. A 1-mm margin of normal gingiva was resected concurrently. It was pathologically diagnosed as a gingival cyst in an adult. The postoperative course has been good.
The purpose of this study was to prepare guidelines for dental management in patients undergoing bone marrow transplantation (BMT). Seventy-three of 105 patients who were referred to our outpatient clinic between 1991 and 1997 had dental lesions other than mild gingivitis. There were 128 cases of tooth decay [C 1, 2] in 47 patients, 120 of apical periodontitis in 47 patients, 44 of pericoronitis in 31 patients, 100 of impacted teeth in 30 patients, 19 of tooth decay [C3, 4] in 13 patients, 12 of furcation lesions in 9 patients, and 16 of marginal periodontitis [P 3, 4] in 6 patients. Oral hygiene instructions were given to 105 patients. Scaling was performed in 70 patients. Caries treatment was done for 128 teeth in 47 patients. Fifty-seven teeth were extracted in 28 patients. Root canal treatment was done for 15 teeth in 9 patients. Problems caused by tooth extraction, such as dry socket, occurred in 8 patients. However, it was difficult to solve all dental problems completely because some patients were in poor general condition and because of the short period for dental management. Most cases of asymptomatic postendodontic small periapical lesions and impacted teeth were observed without any treatment.We found that non-treated teeth caused no infectious complications during the BMT period.