To study the effects of maxillary advencement surgery, morphological changes were evaluated on the basis preoperative and postoperative cephalograms at rest position in 11 patients with maxillary hypoplasia associated with cleft palate (cleft palate group) and were compared with those in 11 patients with maxillary hypoplasia without cleft palate (control group). 1. The amount of advancement in the cleft palate group (4.6±1.4mm) did not significantly differ from that in the control group (5.1±1.0mm). 2. The length of the soft palate (PNS-Uv) increased slightly in both groups; however, the mean difference between before and after surgery, in the cleft palate group (2.8mm) was slightly but not significantly less than that in the control group (3.9mm). 3. The depth of the pharynx increased in both groups after surgery. There was a significant difference between the control group (5.5mm) and the cleft palate group (2.9mm). 4. The inclined angle of the soft palate (∠ANS-PNS-Uv) increased in almost all patients in both groups (5.0 degrees in the cleft palate group and 5.8 degrees in the control group). 5. There was no significant difference between the two groups in the change in the shortest distance between the soft palate and the posterior pharyngeal wall after surgery (-0.7mm in the cleft palate group and -0.6mm in the control group).
The early development of the mandibular condyle, the temporal bone, and the articular disc in the temporomandibular joint was investigated histologically in the rat from prenatal day 14 through postnatal day 6. Serial sagittal sections of each of these areas were prepared, and aldehyde fuchsin (AF) staining was used for the most part to determine the elastic fiber content of the sections. Semilunar areas, densely stained with AF, were identified on the posterior aspect of the mandibular condyle anlage on prenatal day 16. This region increased with time and developed into elastic fiber bundles of the retrodiscal tissue on postnatal day (P) O. The superior articular cavity developed on prenatal day 20, and the inferior articular cavity appeared on PO. Thus, the articular disc was discernible on PO. The articular disc contained abundant elastic fibers throughout: in the anterior band, the intermediate zone, and the posterior band. The posterior band of the articular disc contained abundant elastic fibers in the inferior region of the sagittal section, and fewer elastic fibers in the superior region. In the retrodiscal tissue a bundle of elastic fibers extended from the inferior region of the disc to the posteroinferior region, where the bundle divided into two branches. One proceeded inferiorly into the perichondrium of the mandibular condyle, and the other coursed superiorly in the posterior region and entered the adventitia of an adjacent large vein.
To investigate the effect of distension and removal of adhesion in the upper joint space after lavage under sufficient hydraulic pressure during arthrocentesis, we measured changes in intra-articular pressure in the joint space and performed arthroscopic examinations during the procedure. Eight patients (8 joints) with closed lock of the temporomandibular joint who underwent arthrocentesis and arthroscopic examination were studied. Adhesion was observed in 5 joints on arthroscopic examination before irrigation; the remaining 3 joints had no adhesion. Changes in intra-articular pressure during irrigation under high pressure (40KPa) were measured in these 8 joints. In 5 joints with adhesion, arthroscopic examination was repeated to confirm whether the adhesion was removed after irrigation. Immediately after application of pressure, the intra-articular pressure in the joints without adhesion was 9.1-14.7 KPa, and that in the joints with adhesion was 10.0-13.3 KPa. After applying pressure to the joints without adhesion, 30 seconds were required until a stable pressure was reached, whereas 2 to 5minutes were required in joints with adhesion. In all 5 joints with adhesion, removal of the adhesion was observed on arthroscopic examination after the intra-articular pressure decreased to a stable level. These results indicate that lavage under sufficient hydraulic pressure, which is a 2-to 5-minute procedure, can widen a narrowed joint space and remove adhesion.
The aim of this study was to evaluate the effectiveness of two-time arthrocentesis and nonsteroidal anti-inflammatory drugs (NSAIDs) as a primary treatment for temporomandibular osteoarthrosis. Twenty-five patients with moderate or severe TMJ dysfunction were selected from a consecutive series of new patients who were examined at the TMD clinic of Aichi-Gakuin University Hospital during a 1 -year period. All patients had unilateral TMJ symptoms and were given a diagnosis of TMJ osteoarthrosis on MR imaging. Arthrocentesis was performed two times at an interval of 2 weeks. The NSAID, an oral cox- 2 inhibitor, was given daily for up to 12 weeks until the patients's ymptoms improved. The patients were postoperatively followed up at 2 -week intervals for 12 weeks. Therapy was continued for 12 weeks unless TMJ symptoms improved within this period. The patients who had no or slight TMJ dysfunction at 12 weeks were classified as improved. Those who had moderate or severe TMJ dysfunction were classified as not improved. The improvement rates were 24%, 28%, 36%, 40%, 44%, and 56% after 2, 4, 6, 8, 10, and 12 weeks, respectively. The combination therapy was evaluated to be effective. However, the improvement in maximal mouth opening was not satisfactory. Thus, additional treatment should be given to increase maximal mouth opening.
To decrease side effects, we used chronomodulation to administer the second course of adjuvant chemotherapy to two patients with advanced oral cancer who had severe side effects during the first course. During the first course, chemotherapy was administered according to a conventional schedule, and during the second course chemotherapy was based on the circadian rhythms of the human body (chronomodulation). The first patient, a 58-year-old woman with squamous cell carcinoma in the left side of the tongue, received two courses of adjuvant chemotherapy (CDDP 80mg/m2, day 1+5-FU 800mg/m2/day, days 1-5) after operation. She had grade 4 stomatitis during the first course, but the side effect improved to grade 2 during the second course. The second patient, a 68-year-old man, received two courses of adjuvant chemotherapy (CDDP 80mg/m2, ADR 50mg/m2/day, CPA 500mg/m2) for lung metastasis from an adenoid cystic carcinoma arising in the floor of the mouth. Grade 2 nausea and vomiting occurred during the first course, but the second course of chronomodulated chemotherapy caused no nausea or vomiting. This therapy, administered in accordance with the theory of chronomodulation, caused fewer side effects and is thus considered a promising treatment for oral cancer.
Squamous cell carcinoma arising in a dentigerous cyst is extremely rare. Diagnosis requires microscopic evidence of the transition from benign cystic epithelium to squamous cell carcinoma. We report a histopathologically documented case of squamous cell carcinoma showing malignant transformation within the wall of a dentigerous cyst. A 43-year-old woman was referred to our department for diffuse swelling of the left cheek associated with a small fistula of the buccal mucosa. Radiographic examination showed a round translucent image containing an impacted tooth in the left side of the maxilla. Squamous cell carcinoma was confirmed by excisional biopsy, and partial maxillectomy was performed. Histopathological examination of the resected specimens showed transition of the normal cystic epithelium to squamous cell carcinoma. The patient has been followed up for 4 years 5 months, with no evidence of recurrence.
Mucoepidermoid carcinoma is a salivary gland tumor. In the major salivary glands, it arises in the parotid gland. In the minor salivary glands, this tumor occurs in the palatine glands. However, mucoepidermoid carcinoma rarely arises in the anterior lingual gland. We report a case of mucoepidermoid carcinoma originating in the anterior lingual gland. A 45-year-old man complained of a mass on the sublingual surface of the anterior lingual gland. The tumor was excised, including some of the surrounding healthy tissue. The histopathological diagnosis was a well-differentiated mucoepidermoid carcinoma. Postoperatively, there has been no local recurrence or distant metastasis.
The free lateral upper arm flap was developed for microvascular repair of small to moderate defects of the extremities. Its application to oral defects is not well documented. This flap has many features: 1) the thickness of the flap is relatively thin and adjustable; 2) the supplying vessels have little variation, and the flap can be raised without sacrificing the main arm vessels; and 3) the donor-site defect can be closed primarily. A 74-year-old woman presented with squamous cell carcinoma of the floor of the mouth (T 2 N 0 M 0). She underwent excision of the tumor with marginal mandibulectomy and supraomohyoid neck dissection. The free lateral upper arm flap was used for repair of the oral defect resulting from removal of the carcinoma. The flap measured 4.5×6.0cm and had a 7.0-cm pedicle. The donor site was closed primarily, with no conspicuous scarring, limitation of mobility, or sensory defects. The recipient site also healed well, and oral function was maintained because the flap was thin and pliable. In conclusion, the free lateral upper arm flap can be widely used for the repair of oral defects because of good functional and esthetic results.
Episodic angioedema associated with eosinophilia (EAE) was first reported by Gleich et al. in 1984. Clinical features of EAE include recurrent edema, urticaria, fever, increased body weight, and peripheral eosinophilia. We encountered a patient with EAE during the treatment of tongue cancer and describe the clinical features and mechanism considered responsible for the development of EAE. A 24-year-old man was given a diagnosis of tongue cancer (T 2 N 0 M 0) and underwent partial resection of the tongue. After the operation, the patient received immunochemotherapy, including UFT and OK-432, as well as radiotherapy. Shortly after beginning treatment, localized edema in the limbs and peripheral eosinophilia developed. In addition, because interleukin (IL)-5 and eosinophil cationic protein (ECP) were detected in serum, EAE was diagnosed. The symptoms disappeared after immunochemotherapy and radiotherapy were withdrawn. Because the symptoms became serious after increasing the dose of OK-432 and the patient showed positivity for OK-432 on examination of lymphocyte blastogenesis, EAE in our patient was attributed to OK-432.
We report two cases of palate myoepithelioma that were diagnosed histologically and immunohistochemically. In addition, the diagnostic reliability and usefulness of aspiration cytology, which had been done preoperatively, is discussed. Both cases were clinically suspected to be pleomorphic adenoma, but aspiration cytology led to a probable diagnosis of myoepithelioma. Aspiration cytology can be helpful and useful for the differential diagnosis of preoperative lesions, as well as for the preparation of research methods and materials.