The relationship between doctor and patient has changed very rapidly during the past 20 years. Because of the rapidity of that change, a stable and happy relationship has not been established, and both sides are not fully satisfied with the present situation.
  It is generally believed that the relation between doctor and patient should be as equal as possible, and all medical practice should be done under contract. There are some points in medical practice that are not well suited for contracts, however. First, there is always asymmetry of information between doctor and patient. Even if informed consent is fully practiced, that asymmetry cannot be resolved completely. Second, the subject of a contract in medical practice would be the life and/or health of a patient. Because each patient has only one life, they are very precious for the individual and could not be subject to contract.
  A fiduciary is a different concept from a contract. Under a fiduciary, a trustee must act in a beneficial manner with respect to the beneficiary all the time, without a contract. However, because there are risks of negligence and abuse in a fiduciary, the morality of trustee is essential. If we want to perform medical practice under a fiduciary, the morality of doctors is definitely required.

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  Clefts of the lip and palate are the most common serious congenital anomalies affecting the orofacial region. The prevalence of cleft lip and/or cleft palate in Japan is estimated to be 1 in 500 births. The aim of surgical treatment of cleft lip is to correct the lip deformity and associated problems and thus hide the anomaly, enabling patients to lead a normal life. Many operative techniques have been reported. In this article, the author comments on about three representative operation procedures (DeHaan's method, Millard's method, and Manchester's method). Primary cleft lip repair is the first and one of the most important steps in correcting the lip and nasal deformity often encountered in patients with cleft lip.

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  We need to accomplish not only esthetic restoration of the deformity of the lip, but also functional reconstruction of the orbicularis oris muscle. Many procedures have been developed and modified to result in the best outcomes of cleft lip repair. Among several procedures, the rotation advancement method is personally preferred because it discards a minimal amount of tissue.
  The authors have been performing surgery by the rotation advancement method, which results in a nearly straight scar to improve the outcome of philtrum plasty. We have been using Mimura's design in the vermillion to repair the labial tubercle. We have also been applying the muscle suspension method, which entails suturing the nasal and nasolabial muscle bundles to the anterior nasal spine for functional reconstruction. This report describes our techniques and points out important details.

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  In the 2005 WHO classification, odontogenic keratocysts were divided into keratocystic odontogenic tumors (KCOTs) and orthokeratinized odontogenic cysts (OOCs). KCOT was considered to be a characteristic of nevoid basal cell carcinoma syndrome (NBCCS). It has been pointed out that the high recurrence rate of NBCCS is attributable to genetic influence. In the present study, we examined the clinicopathological and histopathological differences between KCOT and OOC, and furthermore compared the KCOT of NBCCS with non-NBCCS.
  Methods: Thirty-five cases of KCOT and 10 cases of OOC were examined. Immunohistochemical detection was performed using antibodies against podoplanin, bcl-2, CK14 and CK19.
  Results: The clinicopathological features of both lesions were largely consistent with those reported previously. Recurrence was found in the five KCOTs that were associated with NBCCS. On the other hand, OOCs showed no recurrence. In the KCOTs, daughter cysts, budding basal cell proliferation and epithelial nests were histopathologically evident. Immunohistochemical reactivity for podoplanin and bcl-2 was detected in the basal cell membrane and cytoplasm of most cells in the basal and suprabasal layers in KCOTs of non-NBCCS. In NBCCS, strong reactivity was observed in the cell membrane and cytoplasm of most cells in the basal and suprabasal layers. CK14 was detected in the epithelial layer of OOCs.
  Discussion: Clinicopathological and histopathological findings were similar to those documented in previous reports. And immunohistochemical findings suggest that KCOTs have the characteristics of a tumor.
  Conclusion: These findings suggested that KCOTs have tumor-like characteristics, and are different from OOCs.

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  We performed a clinical analysis of 145 children younger than 15 years who had oral and maxillofacial traumatic injuries treated at the Department of Oral and Maxillofacial Surgery, Asahikawa Medical University during the past 5 years (April 2004 to March 2009). The following conclusions were made:
  The ratio of male to female patients was 1.8:1. As for the age distribution, 1-year-old children had the highest incidence of injuries. Analysis of the monthly frequency of injuries showed that September was highest month, and February was the lowest month. Forty percent of the patients visited our hospital on a Saturday, Sunday, or national holiday. The highest proportion of injuries occurred between 15:00 and 18:00. About 87% of the patients visited our hospital directly, and 88.2% of the patients visited our hospital on the day of injury. The causes of injury were falls and drops (66.2%), traffic accidents (8.9%), and sports (7.5%). The most common site of soft tissue injury was the lip, and the most common site of tooth injury was the maxillary anterior primary teeth. Half of the patients were observed without any surgical treatment.

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  We performed clinico-statistical studies of 194 cases of oral and maxillofacial injuries in pediatric patients younger than 16 years at our hospital during the 5-year period from 2004 to 2008.
  The following conclusions were made:
  1. The incidence of injuries in pediatric patients was 40.2% of all pediatric outpatients.
  2. The ratio of boys to girls was 1.3:1.
  3. As for age distribution, 1-year-old patients had a high incidence of injuries, with most injuries (50%) occurring in patients younger than 3 years.
  4. The most common causes of injury were falls and drops (84.5%).
  5. As for the details of trauma, 64.5% had soft tissue injuries.

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  We performed clinico-statistical studies of pediatric inpatients during a 10-year period from April 1999 to March 2008 at the Department of Oral and Maxillofacial Surgery, Asahikawa Medical University. The results were as follows:
1. The total number of patients was 295, consisting of 175 males (59%) and 120 females (41%).
2. The disease classification was cleft lip and palate in 130 patients (44%), impacted teeth in 50 (17%), supernumerary impacted teeth in 24 (8%), cystic lesions of the maxilla or mandible in 20 (7%), dental caries and periodontal disease in 19 (7%), benign tumors in 12 (4%), craniofacial deformities other than cleft lip and palate in 11 (4%), trauma in 7 (2%), and mucous cysts in 3 (1%).
3. Residents of Asahikawa accounted for 35% of the total number of patients; the remaining patients (65%) were from the suburbs of Asahikawa or more distant areas.
4. As for referrals, 126 patients (43%) were introduced to us by departments of pediatrics or obstetrics, and 102 patients (35%) were introduced by dental offices.

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  Cat-scratch disease (CSD) is a zoonosis characterized by lymphadenopathy in a patient with a history of cat contact. CSD is caused by Bartonella henselae infection and is a common cause of regional lymphadenopathy. The manifestations include erythema or papules at the site of injury and regional lymphadenitis in the initial stage of infection.
  We report the case of a seven-year-old boy who presented with swelling of the buccal. CT showed extensive lymphadenopathy in multiple lymph nodes in the buccal and submandiblar regions. He had a history of contact with cats. Serologic examinations for IgG and IgM titers to Bartonella henselae were performed by an indirect fluorescence assay. This assay revealed positive serum antibody titers for Bartonella henselae.
  On the basis of these results, CSD was diagnosed, and the patient was given an antibiotic for 14 days. After that, the patient recovered, with no recurrence.

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  A 16-year-old girl with Bartter's syndrome was referred to our department because of malocclusion in May 2005. A clinical diagnosis of mandibular protrusion with a long face was made. After orthodontic treatment, including extraction of 4 wisdom teeth and 2 fourth molar teeth, she received orthognathic surgery by Le Fort Ⅰ osteotomy and sagittal split ramus osteotomy under general anesthesia (NLA) in December 2007. L-aspartate potassium was administered intravenously in a dose of 10 mEq/h during the operation. Postoperatively, electrolyte imbalance was corrected by administration of potassium and a prostaglandin synthesis inhibitor (indomethacin). Nausea was controlled by treatment with metaclopramide (Primperan^®) and an H2-blocker (Gaster^®). Inter-maxillary fixation was not performed after the operation to prevent aspiration pneumonia due to vomiting. Because of these precautions, the postoperative course was uneventful.

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