Postoperative patients with head and neck cancer have oral functional disturbances and cosmetic problems that can greatly compromise their QOL. In this report, we investigated the functional disturbances and the socioeconomic changes among postoperative head and neck cancer patients, by means of a questionnaire. Cases were classified into early stages (stage I, II) and advanced stages (stage M, IV), and we evaluated them.
According to this survey, the socioeconomic changes, such as unemployment (8/14: 57.1%) and decreased income (5/14: 35.7%) were due to such dysfunction. We considered it necessary to provide financial support as one procedure to improve their situation. There are a disability authorization system and disability pension as public support for the postoperative patient that has severe dysfunction. We should understand these systems, and we should more effectively make use of them for the patients.

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Based on the Ohboshi Shimosato classification, we examined the effects of preoperative chemotherapy on nuclear DNA content and the mitotic index (MI) in oral squamous cell carcinoma, and attempted to correlate them with patients' survival rates.
Ninety patients with oral squamous cell carcinoma treated by preoperative chemotherapy, followed by surgery, participated in this study. Nuclear DNA content and the MI in tissue samples before and after chemotherapy were measured, using a cell image analyzer.
MI decreased in cases that had a decrease in mean nuclear DNA content after chemotherapy. The decreased mean nuclear DNA content is due to inhibition of growth activity of cancer cells by chemotherapeutic agents, resulting in a larger GO/G1 phase fraction, and it is considered to be a favorable response to chemotherapy. On the other hand, cases with an increase in mean DNA content and a decrease in MI were considered to be due to a G2 or S phase fraction increase, caused by inhibition of DNA synthesis, rather than by accumulation of aneuploid cells. These two types of change appeared to have favorable chemotherapeutic effects on cell kinetics.
The five-year cumulative survival rate was 98% for the good response group (Ohoboshi Shimosato classification: grades II b, III, and IV; n=40). The survival data was not significantly different between these groups, classified according to chemotherapeutic effects on cell kinetics. The five-year cumulative survival rate was 58% for the poor response group (grades I, II a; n=50): 61% for 16 patients with a decrease in mean DNA content, 81% for 18 patients with an increase in mean DNA content and a decrease in MI, and 31% for the remaining 16 patients, who failed to obtain sufficient chemotherapeutic effects on cell kinetics. The survival rate of the latter 16 patients was significantly poor compared with the former two groups.
From these results, it was suggested that this type of analysis was useful for the prognosis of patients with oral squamous cell carcinoma treated by preoperative chemotherapy followed by surgery, and that it offered a unique opportunity to flexibly adjust the modalities of adjuvant therapy.

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CD14はマクロファージのLPS (lipopolysacharide) のレセプターの1つとして知られている。口腔扁平苔癬の発症と進展に細菌性因子の関与の可能性を検討するため, CD14の病変部上皮内における発現について免疫組織学的に検討した。対象は病理組織学的に扁平苔癬と診断された10症例で, 採取部位はすべて頬粘膜, 臨床型は網状型が5例, ビラン型が4例, 環状型が1例であった。一次抗体としてマウス抗ヒトCD14, マウス抗ヒトMac-1を使用し, 蛍光抗体法にて観察した。
その結果, 10症例中7症例において上皮細胞細胞質内にCD14の陽性像が認められた。Mac-1はすべて陰性であった。さらに5例についてウェスタンブロッティング法を用いて検討すると55kDaのCD14のバンドが検出された。
以上の結果より, 口腔扁平苔癬の発症と進展に可溶型CD14の関与が示唆された。

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To investigate preoperative oral motor function, voluntary tongue movements, and articulatory and swallowing functions, were evaluated in 31 patients with ankyloglossia, according to condition severity.
Methods: 1. Voluntary tongue movements were evaluated using four criteria (sticking out the tongue, elevating the tip of the tongue, touching the angles of the mouth with the tongue, and tracing the lips with the tongue). 2. Articulatory functions were evaluated according to types of misarticulation, the diadocochkinetic rate of syllable production, and compensatory movements. 3. Swallowing functions were evaluated by observing for abnormal swallowing habits.
Results: 1. Patients who were slightly tongue-tied showed relatively good voluntary tongue movement. Half of the patients who were moderate tongue-tied showed poor voluntary tongue movement in lateral directions. Patients who were severely tongue-tied showed poor voluntary tongue movement in superior and lateral directions, i. e. all directions except anterior. 2. In articulatory and swallowing functions, patients who were moderately and severely tonguetied exhibited markedly functional disorders.
In conclusion, quantitative evaluation of oral dysfunction associated with ankyloglossia showed marked functional disorders in moderate and severe cases.

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Traumatic facial emphysema is rare in facial trauma. There are various case reports regarding this kind of injury and the route of air intrusion. For diagnosis and treatment, the cause of traumatic facial emphysema must first be considered. We report three cases of traumatic facial emphysema. The first patient, a 16-year-old male, had buccal swelling caused by a facial bruise, and he was diagnosed as having buccal emphysema. The second case, a 21-year-old male, had palpebral swelling and double vision after suffering a facial bruise, and he was diagnosed as having palpebral emphysema. The third case, a 37-year-old male, suffered from double vision and orbital swelling, and he was diagnosed as having orbitopalpebral emphysema accompanying a fracture of the orbital floor. With conservative non-surgical treatment, these symptoms were improved.

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Solitary neurofibroma is a very rare type of benign oral tumor. A 78-year-old female, who had swelling on the right mandibular gingiva, was referred to our department. The tumor surface was smooth and elastic hard to the touch, measuring approximately 10×25mm. The clinical diagnosis was a benign tumor. It was surgically excised, as one block, under general anesthesia.
Histopathologically, it showed notable proliferation of spindle cells mixed with collagen fibers. Furthermore, it reacted positively to immunohistochemical staining with S-100 protein. The histopathological diagnosis was a neurofibroma.
There has been no evidence of recurrence since the operation.

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The usefulness of poly-L-lactide acid (PLLA) screws for fixation in sagittal splitting ramus osteotomy (SSRO) was discussed.
The subjects were 10 patients with mandibular prognathism who underwent SSRO with rigid fixation by PLLA screws between February 1998 and August 1999. The clinical symptoms and X-ray findings of the mandible around screws were evaluated. The postoperative changes of point B, Pogonion and Menton at 3 months following surgery were measured on lateral cephalograms. Thirty patients who underwent SSRO fixed by stainless steel screws were selected as a control group.
X-ray findings revealed osteosclerotic changes around 12 PLLA screws. Concerning the change in the position of measuring points on the mandible, no significant difference was observed between the PLLA group and the control group. No complications were observed clinically.
The results suggested that the PLLA screw is useful for fixation in sagittal splitting ramus osteotomy.

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We report on clinical application of Zygomaticus Implants for the severely resorbed maxilla. There are problems for application of Zygomaticus Implants, number of implants, area of implant placement, preoperative evaluation of the maxillary sinus or correspondence to loading applied to Zygomaticus Implants immediately after stage II surgery.
Using Zygomaticus Implants enables avoiding a bone graft and shortening the treatment term. However, it is necessary to investigate the long-term clinical prognosis.

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Thirty-nine cases of head and neck adenoid cystic carcinoma were treated by radiotherapy at the Department of Radiotherapy, in Hokkaido University Medical Hospital, during the period from 1980 to 1997. Among the 39 cases, one was treated by preoperative radiotherapy, 18 received postoperative radiotherapy, and the other 10 were treated by radiotherapy alone. The local control rate was 69% in 5 years, and 53% in 10 years, and the actuarial survival rate was 70% in 5 years, and 44% in 10 years. Lung metastasis occured in 11 cases (28%).
Tumors that arose from the palate showed good local control when treated by radiotherapy alone.

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To compare the efficacy of treatment for patient's swallowing disorders, a new clinical test series was developed for assessment. This procedure allows the patients swallowing ability without using the instruments, such as videofluorography (VF). The subjects were ten patients who underwent aspiration and penetration using VF. As a result, the following clinical indicators had significance (p<0.05) related to swallowing therapy: tongue, cheek/lip, elevation of the larynx, head position, and cough. Clinical indicators that were not significant (p>0.05) included mouth opening, voice/resonance, and articulation. It is considered that the new clinical test series for assessing swallowing disorders was useful to evaluate the efficacy of swallowing therapy in neurologic patients.

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The purpose of this study was to clarify influences of sizes and textures of foods on the mandibular movement pattern during chewing. The mandibular movement was investigated using a scirognathoanalyzing system in ten normal volunteers. Five foods of two different sizes were prepared and examined with a texture analyzer from the viewpoint of strain force, strain rate, and primary elasticity.
As results, closing speed, lateral shift, anteroposterior movement of the mandible, and number of chewing cycles became larger at chewing larger foods. Hardness and elasticity of the test foods influenced closing speed, lateral and antero-posterior shift, and the number of chewing cycles. These results indicated that size, hardness, and elasticity of foods have a role of afferent stimuli to change the chewing pattern.

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