Octacalcium phosphate (OCP) has been suggested to be a precursor of biologic apatite crystals in bones and teeth. Previous studies have shown that synthetic OCP facilitates osteoblastic cell differentiation in vitro. The present study was designed to investigate whether OCP facilitates osteoblastic cell differentiation in vitro as compared with commercially available sintered β-tricalcium phosphate (β-TCP) ceramic, a bone regenerative and biodegradable material used clinically. Mouse-bone-marrow-derived stromal ST-2 cells were cultured on dishes pre-coated with powdered OCP or commercially available sintered β-TCP ceramic. The capacity for proliferation and differentiation was determined up to day 21 of culture. The proliferation of ST-2 cells on OCP coating was inhibited intially, but the cell number increased similar to that of commercially available sintered βTCP ceramic or control culture dishes up to day 14. On the other hand, the alkaline phosphatase activity of ST-2 cells on the OCP coating, a maker of osteoblastic differentiation, was higher than that of commercially available sintered β-TCP ceramic or control up to day 14. Measurement of the mRNA expression level of osteopontin (OPN) by real-time PCR on day 21 of culture showed that the OPN mRNA level of ST-2 cells on OCP coating was higher than that of cells on commercially available sintered β-TCP ceramic. Chemical analysis of the supernatants of the medium after incubation on the coatings of OCP and commercially available sintered β-TCP ceramic revealed distinct patterns: commercially available sintered β-TCP ceramic decreased both Ca^2＋ and inorganic phosphate ion (Pi) concentrations, whereas OCP decreased Ca^2＋ but increased Pi ion concentrations beyond the control. These changes may be derived from the intrinsic physicochemical properties of OCP. The present study demonstrated that OCP facilitates osteoblastic cell differentiation more than that associated with commercially available sintered β-TCP ceramic.

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Paraneoplastic pemphigus (PNP) is an autoimmune mucocutaneous disease associated with lymphoproliferative neoplasms. We report a case of PNP associated with Castleman's disease. A 39-year-old man showed white lesions on both edges of the tongue. The lesions were diagnosed as lichen planus, compatible on the basis of clinical features and histopathological examination. The patient was treated with steroid ointment and azulene gargle for 1 year. However, after mild common cold symptoms, he presented with extensive ulceration and erosions throughout the entire oral mucosa, conjunctivitis, and vesicles on the sole of the foot. Serological examination showed elevated immunoglobulin (Ig) G levels, extremely high titers of anti-nuclear antigen, and positive results for anti-dsDNA and anti-ssDNA. Positive results were also obtained for anti-desmoglein 3, anti-envoplakin,and anti-periplakin. Furthermore, direct immunofluorescence testing showed IgG and C3 deposition in the epidermal intercellular spaces. The past history included lymphoproliferative lesions in the mediastinal space. Castleman's disease was therefore diagnosed. The mucocutaneous lesions were thus considered to be PNP associated with Castleman's disease. Treatment was initiated with predonisolone, and the oral lesions, conjunctivitis, and skin lesions all improved markedly. As of the time of this writing, mediastinal lymphoproliferative lesions remain, and oral lesions have not completely disappeared. We are carefully observing the oral lesions while contiuning treatment with predonisolone.

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It is well known that long-time exposure to the sun harms the DNA of keratinocytes of the skin and causes solar keratosis and squamous cell carcinoma. The lower lip is subject to sun exposure. Dysplastic growth of the epithelium with inflammation and focal elastosis of the lips in response to ultraviolet light is called actinic cheilitis. We report a case of actinic cheilitis clinically suspected to be hemangioma. A 79-year-old woman was referred to Nagasaki University Hospital to examine a mass arising in the right side of the lower lip. A soft darkpurple mass was observed and clinically diagnosed as hemangioma. Since the patient wanted to undergo histological examination of the lesion with minimal esthetic disturbance, excision of the lesion and reconstruction with a local flap were performed under general anesthesia. The lesion was histologically diagnosed as actinic cheilitis.The postoperative course was uneventful, and there has been no esthetic or functional disturbance as of 2 years after the operation.

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Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) is a low-grade Bcell lymphoma. MALT lymphoma is a new disease entity, proposed by Isaacson in 1983. We report a rare bilateral case of MALT lymphomas of the parotid glands occurring after an interval of 11 years. The patient was a 52-yearold man who presented with a swelling in the left preauricular area. The region was surgically excised. The diagnosis was a benign lymphoepithelial lesion of the left parotid gland at that time. No recurrence has occurred in the left parotid gland. Eleven years after the first operation, a swelling developed in the right preauricular area. Partial excision of the right parotid gland was performed. The pathological diagnosis was a MALT lymphoma of the right parotid gland. Given the diagnosis, the excised tissue of the left parotid gland was examined again. A MALT lymphoma of the left parotid gland was diagnosed on histological and immunohistological examinations. The patient remains free of recurrence 3 years after the second operation.

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We describe secondary correction by distraction osteogenesis of the mandible reconstructed with a revascularized scapular osteocutaneous flap. A 40-year-old woman with an edentulous mandible and shortened rami caused by condylar fractures and a malformed mandibular body due to a comminuted fracture reconstructed with an osteocutaneous flap, was referred for occlusal reconstruction. The reconstructed mandible was asymmetric, and micrognathia was present. The mandible was considered too small and malformed to place artificial teeth.Distraction osteogenesis was sequentially performed in both rami vertically for a distance of 10 mm, and the body horizontally for 20 mm and then vertically for 15 mm. The distraction protocol was 0.25-0.5 mm twice daily following a latency period of 7 days. The final outline of the mandible was contoured with a green stick fracture of the regenerated bone in the horizontally distracted region, which was fixed with a reconstruction plate. Six dental implants were placed in the distracted mandibular body.
Osseointegration was achieved, and the palatal mucosa was grafted around the implants for vestibuloplasty. The six implants have supported a cross-arch superstructure for occlusal reconstruction. Four years after the last session of distraction osteogenesis, the contoured mandible has retained a stable size and shape. Distraction osteogenesis was considered effective in contouring the grafted bone orthognathically.

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Mucous membrane plasmacytosis is an unusual non-neoplastic condition involving plasma cell proliferation. The precise etiology, pathogenesis, and treatment of the lesions are unknown. A case of mucous membrane plasmacytosis in the left upper gingiva of a 60-year-old Japanese man is presented. The patient visited our clinic because of a reddish swelling in the left upper molar gingiva. The general history suggested gingival hypertrophy caused by long-term treatment with nifedipine. Gingivectomy was performed with the patient under local anesthesia. Histopathologically, the lesion showed dense infiltration of plasma cells without cellular atypia in the submucosa. Immunohistochemical studies for kappa and lamda light chains showed positive staining, indicating polyclonality. The final diagnosis was therefore mucous membrane plasmacytosis. There was no evidence of recurrence 1 year after excision.

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Oral-facial-digital syndrome is a rare morphologic anomaly with a genetic origin. We report a case of oral-facial-digital syndrome I. The patient was a 1-month-old girl who had a tumor on the tongue, a lobulated tongue, hyperplasia of the cheek frenulum, and a high palate. Functional disorders such as dysphagia were not present. The tumor on the tongue, lobulated tongue, and hyperplastic frenulum of the cheek were treated. There were no complications of the surgical wound after operation. She was followed up at the departments of pediatrics and oral surgery. At the age of 5 years 6 months, her intellectual development was the lower limit of normal, and dysarthria was observed. This syndrome has a good prognosis unless abnormalities develop in the central nervous system. However, our patient requires careful observation because she has a history of the agenesis of the corpus callosum caused by the multiple cysts in the central nervous system.

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Angioedema is sudden local swelling of the lips, eyelids, buccal region and tongue. It is usually induced by drugs. Angioedema is a well-recognized side effect of angiotensin-converting enzyme inhibitors (ACEs), but angioedema associated angiotensin II receptors blockers (ARBs) is very rare. We report a case of angioedema of the tongue and floor of the mouth that was probably induced by an ARB.
A 76-year-old man came to our emergency unit because of acute swelling of the tongue and difficulty breathing.
He had a medical history of hypertension and cerebral infarction, but no allergic disease. He had severe diffuse edematous swelling of the submandibular and cervical regions, an elevated tongue making it difficult to close his mouth, and sialorrhea.
Although urgent computed tomography showed marked swelling of the tongue, there was no evidence of edema in the respiratory tract. Angioedema of the tongue was diagnosed, and hydrocortisone sodium succinate was given intravenously. Within 12 hours the swelling of the tongue and floor of the mouth resolved completely.Candesartan was strongly suspected to have caused the angioedema, and we discontinued it. There has been no evidence of recurrence of the angioedema during the 18 months since candesartan was discontinued.

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A large pleomorphic adenoma arising from the soft palate is rare. We describe a large pleomorphic adenoma of the soft palate in a patient who had sleep apnea and an articulatory disorder.
A 56-year-old man visited our department because of speech difficulty. On physical examination, a large mass in the soft palate was noted. The mass measured 44 mm in diameter. MRI and CT images showed that it expanded into the right pharyngeal space. The pharyngeal port was obstructed, causing both sleep apnea and an articulatory disorder. The lesion was diagnosed to be a pleomorphic adenoma on biopsy. The mass was extirpated by abrasion from the palatal mucosa, because conventional tumor excision along with the total palate mucosa would probably have caused velopharyngeal incompetence. Postoperative polysomnography showed a decrease in the apnea hypopnea index from 59 /hr to 34 /hr and an increase in the lowest percutaneous arterial oxygen saturation from 84 % to 92 %. After mass extirpation, the articulatory disorder disappeared, with no further postoperative dysfunction.

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Lingual osteocartilaginous choristoma is a very rare lesion. In Japan, only 5 cases have been reported previously. We report a case of osteocartilaginous choristoma arising on the dorsum of the tongue. A 58-year-old woman was referred to our clinic because of a painless mass on the dorsum of the tongue. There was a firm mass approximately 10 mm in diameter, covered with normal lingual mucosa on the dorsal surface of the tongue.Extirpation of the tumor was performed with the patient under general anesthesia. The tumor was easily separated from the surrounding lingual tissues. Histopathological examination revealed the characteristics of lamellar bone and hyaline cartilage with adipose tissue. We diagnosed this tumor to be an osteocartilaginous choristoma.The postoperative course was uneventful, with no sign of recurrence for 9 months after surgery.

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Septic pulmonary embolism (SPE) is an uncommon disorder in which an infectious embolic blood clot leads to an infarction in the pulmonary vasculature, potentially causing death. We report the case of a 61-yearold woman with SPE caused by odontogenic infection. She was referred to our department because of limited mouth opening and pain of the left side of the maxilla. Her medical history included diabetes mellitus for the past 10 years. Physical examination showed a high fever (38.8 ゜C) and no chest pain. Laboratory tests showed an elevated white blood cell count <12,600/μl) , an elevated C-reactive protein level (10.65mg/dl), and an HbA1c of 7.7 %. A CT scan at presentation revealed an abscess in the masticator space and SPE in the upper lung field. After consulting pulmonologists, antibiotics were intravenously administered. Twelve days after initial presentation, another CT scan revealed improvement of the abnormal findings in the lung. Thereafter, the clinical course was uneventful, and no signs of recurrence have occurred for 2 years. This case demonstrates the importance of investigating SPE by chest CT in compromised patients who have suppurative foci in the oral and maxillofacial region.

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