The relation between extracapsular cervical lymph node extension (ECLNE) and clinicopathological prognostic factors was investigated retrospectively in 19 patients with oral squamous cell carcinoma who had undergone radical neck dissection from 1981 through 1996 at our department.
The results were as follows:
1. Forty-eight patients (52.2%), 102 lymph nodes (8.9%), had cervical lymph node metastasis; in 19 patients (39.6%), 29 lymph nodes (28.4%) were associated with ECLNE.
2. The incidence of ECLNE was high in patients with primary lesions of the maxillary and mandibular gingivae.
3. As for the distribution of involved lymph nodes, the majority were found in Level 2 (upper deep cervical lymph nodes).
4. The averege dimensions of ECLNE were 14.4±6.5mm (shortest diameter) and 20.8±6.7mm (longest diameter).
5. There was a relation between ECLNE and the pathological features (mode of invasion and histological malignancy) of primary lesions.
6. These results suggest that adjuvant therapy, such as postoperative chemotherapy or radiotherapy (or both), and prophylactic neck dissection with primary tumor exicision might be beneficial in patients with grades 4 C, 4 D, and high grade malignancy.

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The purpose of this study was to clarify the factors affecting postoperative resorption of transplanted bone along tooth roots adjacent to the alveolar cleft in patients with cleft lip and/or palate.
We studied radiographs taken before, just after, and at least 6 months after bone grafting to 140 alveolar clefts in 122 patients with cleft lip and/or palate at the First Department of Oral and Maxillofacial Surgery, Kyushu University Dental Hospital from 1987 to 1997. Ninety-two patients received autogenous iliac bone grafts, and 30 received mixed grafts of autogenous bone and hydroxyapatite granules.
The type of transplanted bone resorption was classified into three groups: slight to medium resorption, severe resorption at the center of the alveolar ridge, and severe resorption along the tooth roots adjacent to the alveolar cleft. Changes in the level of the alveolar margin adjacent to the alveolar cleft were traced longitudinally.
Bone resorption was slight to medium in 85% of the patients, severe at the center of the alveolar ridge in 10%, and severe along the roots in 5%. In patients younger than 12 years, bone resorption was less than in older patients. Serious resorption along the tooth roots adjacent to the alveolar cleft was detected in 7 patients, and such changes were often observed at the distal surface of the upper central incisor roots. The level of the alveolar margin in younger patients was maintained at a high level both preoperatively postoperatively, while in older patients the height of the alveolar margin frequently decreased. Although the alveolar margin was elevated by transplanted bone in such patients, the final level of the alveolar margin relapsed to the same level as the initial position.
Our findings suggest that the preoperative condition of periodontal tissue adjacent to the alveolar cleft as well as general and local bone remodeling activity influences the outcome of secondary bone grafting. Therefore, ore, bone grafting before eruption of the upper canines and the maintenance of healthy periodontal tissue are considered important factors in the management of alveolar cleft.

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Clinically, the location of pain in patients with temporomandibular disorders (TMD) is diagnosed by palpation and interview of the patient during mandibular movement. However, some patients cannot clearly indicate the location of the pain. Local anesthesia of the painful region described by the patient is often recommended to block nociceptors and to diagnose the source of pain. However, this method does not consider the time after anesthesia or infiltration of anesthesia into the surrounded tissue with the passage of time.
Aims: The aim of this study was to investigate the influence of the time after superior joint cavity anesthesia on the evaluation of pain in patients with unilateral TMD who have both temporomandibular joint (TMJ) and musculature pain.
Methods: Thirty-five patients (aged 14-75 years) who had TMD with unilateral TMJ and musculature pain were included. Lidocaine was injected directly into the superior cavity. A set of 13 tests was performed before anesthesia, and 1 and 5 minutes after anesthesia: 3 muscle palpation tests, 2 TMJ palpation tests, 6 comprehensive pain tests, and 2 other evaluations.
Results: The pain of the muscle and TMJ significantly decreased in response to joint anesthesia. Joint anesthesia did not affect the results of muscle palpation tests in 14% to 39% of the patients, those of TMJ palpation tests in 29% to 36% of the patients, and those of comprehensive pain tests in 32% to 50% of the patients 1 minute after anesthesia. However, these tests showed no significant pain between 1 minute and 5 minutes after anesthesia except for two of the comprehensive pain tests (chin compression and the distance of mouth opening without pain). Numbness of the front of the pinna, used as an index of the infiltration of anesthetic into the surrounding TMJ, did not differ significantly between before anesthesia and 1 minute after anesthesia, but increased significantly 5 minutes after anesthesia.
Conclusion: Tests designed to locate the source of pain in TMD by the direct injection of an anesthetic into the superior cavity should be carried out 1 minute after anesthesia, before the anesthetic has infiltrated into the surrounding tissue.

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Intraosseous carcinoma of the jaw is an uncommon lesion. This report describes a case of intraosseous squamous cell carcinoma arising from recurrent odontogenic keratocyst of the mandible. A 73-year-old woman was referred to us because of the discomfort of the left side of the mandible. She had undergone cystectomy for a diagnosis of dentigerous cyst. Pathological examination showed odontogenic keratocyst. Four years after cystectomy, discomfort of the left side of the mandible recurred. The left retromolar pad was slightly enlarged and was covered with normal oral mucosa. Radiographic examination revealed a well defined radiolucent lesion in the left side of the mandible. On CT, however, the lesion consisted of a solid mass with irregular margins. Partial mandiblectomy was performed for on a diagnosis of recurrent odontogenic keratocyst or malignant tumor. Histological examination demonstrated a direct transition from the benign epithelial lining of odontogenic keratocyst to squamous cell carcinoma. She made an uneventful recovery, and there has been no sign of recurrence or metastasis as of 3 years after surgery.

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A pedicled buccal fat pad graft was used for reconstruction after resection of oral carcinoma in 11 patients. There were oro-antral or oro-nasal communications (or both) in 6 patients. Three communications were closed completely with a pedicled buccal fat pad, while the others were closed partially. Epithelization of the buccal fat pad started during the first week after operation and was completed by the sixth week. In four patients, the buccal fat pad was covered with a free graft of partial thickness skin or with lyophilized porcine dermis. However, there were no differences in epithelization between the covered cases and the uncovered cases.
Although a buccal fat pad can be used to repair only small defects, it is a simple, useful procedure for reconstruction in patients with various tissue defects.

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This report describes a pedunculated and peripheral osteoma, measuring 49×31×24mm, that arose at the lingual side of the mandibular molars in a 31-year-old man. This was the largest peripheral osteoma arising on the lingual side that we have resected intraorally and the fourth largest we have examined. We clinically examined this case as compared with 8 other cases of large peripheral osteomas of the mandible reported in the Japanese literature.

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A case of parosteal osteoma in the maxillary sinus of a 39-year-old woman is reported. The patient had discomfort in the left side of her cheek. A computed tomography scan showed several highdensity masses in a low density lesion filling the left maxillary sinus. The CT number of the high-density masses was within that of maxillary cancellous bone. The clinical diagnosis was osteoma in the maxillary sinus. The lesion was enucleated by the Caldwell-Luc operation, done with the patient under general anesthesia. The hard masses surrounded by the thickened mucosa of the maxillary sinus were easily removed. The masses had no bony pedicle on the bony sinus wall. The pathological diagnosis was osteoma. In this case, clinical diagnosis was facilitated by measuring the CT numbers of the masses.

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A simple bone cyst associated with a fibro-osseous lesion in the mandible of a 12-year-old girl is reported. All teeth from the central incisor to first premolar on the left side of the mandible, were vital, and none were mobile. There was no cortical expansion. Radiological examination revealed a cyst-like radiolucent area in near the incisors and premolars in the left side of the mandible. This radiolucent area was the size of a thumb tip. Biopsy of the lesion showed blood and a thin membrane. The clinical diagnosis was simple bone cyst. Under general anesthesia, the patient underwent extirpation. In the bone cavity, a tumor was found, and histopathologically, irregular bone trabeculae and fibrous connective tissue were noted. A simple bone cyst associated with a fibro-osseous lesion of the jawbone is not common. Clinical and histopathological examinations suggested this diagnosis in our patient.

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It is not uncommon to reduce the dose or to discontinue anticoagulant agents before tooth extraction in patients who are receiving anticoagulant therapy. However, dose reduction or discontinuance of anticoagulant agents can cause complications such as thromboembolism. Recent recommendations to maintain the usual dosage of anticoagulation regimens have increased the importance of developing reliable procedures for local hemostasis. We used cotton-type atelocollagen to fill tooth extraction cavities in 25 patients who were receiving anticoagulant therapy and evaluated its efficacy. The cavity was sutured in 11 patients, but no other specific procedures, such as hemostatic splints, were used. The thrombotest (TT) levels and PT international normalized ratio (INR) before the operation ranged from 10.2% to 40.2% and from 1.44 to 2.89, respectively. Except for one patient in whom the cotton-type atelocollagen was displaced, we successfully performed primary hemostasis in all patients. There was no problematic postoperative hemorrhage.

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We report on a patient with calcification of the bilateral submandibular and submental lymph nodes. A 40-year-old woman had swelling of the buccal gingiva around 5.Panoramic radiography at presentation showed radiopaque images, one in the right submandibular region and one in the left submandibular region. CT examination showed multiple high density masses that appeared calcified, one in the right submandibular region, two in the left submandibular region, and one in the submental region. We excised the masses from both submandibular and submental regions under general anesthesia, and found that the masses were covered with a thin fibrous tissue coat ; calcified bodies of various sizes had formed in the lymph nodes. Although foreign body giant cells were observed around the calcified bodies, there were no epithelioid cells and no Langerhans' giant cells, which are typically observed in tuberculosis. Ziehl-Neelsen stain was negative. We histopathologically diagnosed the masses as fibrosis with calcification. The clinical course has been good to date, with no recurrence 1 year 5 months postoperatively.

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A case of symmetrical upper buccal nodulus frenuli is reported. A 7 -month-old infant was referred to our hospital for examination of two maxillary gingival noduli. After 1 month, one nodule had shrunk considerably, and the other had shrunk slightly. Frenuli were recognized in connection with both noduli. Under general anesthesia, the lesions were removed. Histologically, both noduli consisted of covering epithelium, fibrous tissue, and striated muscle fibers.
Clinical and histological characteristics suggested that both noduli were nodulus frenuli.

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