Obwegeser II method was applied to an 18-year-old male patient with severe progenia and open bite.
The reasons for selecting this method were as follows;
1. His lateral cephalometric analysis revealed only excessive mandibular protrusion without any maxillary abnormality.
2. It was necessary for the mandible to be set back 14 mm posteriorly to obtain the ideal intermaxillary occlusion.
3. The anteroposterior width of his mandibular ramus was bilaterally narrow.
4. Furthermore, severe open bite still remained at the end of pre-surgical orthodontic treatment.
Postoperative cephalometric analysis revealed both skeletal stability and harmonious balance.
One of the advantages of this method is that a bigger contact area can be obtained between the two separated bone segments compared with that of sagittal split ramus osteotomy when the width of the mandibular ramus is narrow. In addition, it was suggested that a longer distance between the mandibular second molar and the anterior edge of the mandibular ramus could be a good indication for this operation.

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コルチコステロイド外用剤を目的として合成されたprednisolone 17-valerate 21-acetatc(PVA)の抗炎症作用を主にラットを用いて，betamethasone 17-valerate(BV)，hydrocortisone 17-butyrate(HB)およびprednisolone 17-valerate(PV)などの効果と比較し，外用剤としての有用性を検討した．カラゲニン足浮腫法，カオリン足浮腫法および肉芽腫法によるPVAの抗炎症作用は，背部皮下投与の場合BV，HBなどと比較し極めて弱く，BVの1/15～1/45，HBの1/5～1/15 ，PVの約1/30であった．一方，局所投与によるPVAの効果はBV，HB，PVなどと同等ないし，それ以上であった．また局所投与による肉芽腫法において同時に測定した胸線萎縮作用は，PVAが比較的弱い傾向を示した．さらに，これらコルチコステロイドの軟膏製剤の各種炎症モデルに対する抗炎症作用を検討した．カラゲニン足浮腫法においてPVA軟膏は濃度依存の抑制作用を示し，PVA0.3%軟膏がBV0.12%軟膏と同程度の効果を示した．創傷部肉芽増殖，クロトン油耳浮腫，受身皮膚アナフィラキシーおよび遅延型皮膚炎に対してもPVA0.3%軟膏はBV0.12%およびHB0.1%軟膏と同程度かまたはそれ以上の強い抗炎症作用を示した．さらに創傷部肉芽増殖の実験において全身への影響として胸線萎縮作用を同時に検討したが，PVAのその作用は比較的弱い傾向であった．また，PVA皮下投与による肝グリコーゲンの蓄積，尿および電解質排泄および性ホルモン作用に対する影響は他のコルチコステロイドと同等であり，程度は弱かった．以上の結果から，PVAは局所効果が他と同等かそれ以上に強く，全身への影響は弱いコルチコステロイドであることが明らかにされ，外用剤としての臨床における有用性が示唆された．

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We report a case of bilateral hypertrophy of the masseter muscle, judging from the axial CT. A 14-year-old girl was referred to our clinic complaining of bilateral protrusion around the angular region of the mandible. There was, however, no morphological abnormality in the mandible. Axial CTs revealed that the widest portion of the masseter muscle was 18mm and this volume of the muscle was statistically wider than that of other females of approximately the same age. Under general anesthesia, the bilateral deeper layers of the masseter muscle were intra-orally resected. Training in mouth opening was started at 5 days after the operation, and she achieved an adequate opening range of motion. On axial CTs at one year after her surgery, the volume of the masseter muscle was reduced to 61% compared with the original volume. She was satisfied with the result of the operation, cosmetically and functionally.

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横みぞロール式施肥装置の排出量調節法と排出変動との関係を明らかにするため, 物理的性状の異なる肥料を使用して, 開口部みぞ幅, 回転速度に対する排出特性を検討した。その結果, 排出量は開口部みぞ幅に対して線形回帰, 回転速度に対して対数回帰で近似でき, 開口部みぞ幅, 回転速度の変化に対応する排出容積と排出量との回帰係数は, かさ密度との相関が極めて高いこと, 排出量変動は粒状で, 均一度が高く, 平均粒径の大きい肥料のほうが少ないこと, 排出量の直線性を高めるために施肥装置に必要な条件は, 排出量の調節に対して容積効率が一定となることなどを明らかにした。

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Seventeen cases (28 sites) that underwent alveolar segmental osteotomy were evaluated on the vitality of tooth pulp of the osteotomy site with electrical pulp stimuli and the condition of the periodontal tissues adjacent to cutting lines of alveolar bone after surgery.
The operated sites were distributed in 9 anterior and 3 posterior teeth of the maxilla and in 11 anterior and 5 posterior teeth of the mandible.
The results were as follows: The recovery rates of pulp vitality were gradually increased until 2 years postoperatively.
Finally, their rates were 59.1% in the portions adjacent to the operated site and 96.8% in the other portions.
Among the four sites, those of the posterior portions of the maxilla showed the highest recovery rate and those of the posterior portion of mandible demonstrated the lowest.
There was no clear differentiation of the recovery rate between the bone segment with 6 teeth and the bone segment with 4 teeth.
Even unrecovered teeth, however, demonstrated no color change in almost all cases. Furthermore, a few cases demonstrated periodontal pocket formation, gingival recession, and/or absorption of alveolar bone.
In conclusion, without direct injury to the teeth during operation, pulp sensibility seems to be recovered naturally. Therefore, the distance between the apices of the teeth and the cutting line of osteotomy is a very important factor for protecting tooth vitality.

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The patient was a 52 years, 11 month old male, who came to our hospital with a chief complaint of an occlusion anomaly on the left side. There was previous medical history of excess secretion of growth hormone due to a pituitary gland tumor that caused acromegaly. The patient was in follow up after a lumpectomy. Molar relationships were Angle Class III. Overjet was -4.0mm and an overbite was -2.0mm. Dental arches were spaced in association with macroglossia. Lateral cephalometric analysis showed skeletal mandibular protrusion and an open bite of the left side. Based on these findings the patient was diagnosed as having a skeletal mandibular protrusion with a left sided open bite associated with acromegaly. Glossectomy, Le Fort I osteotomy and sagittal split ramus osteotomy (SSRO) were planned. Le Fort I osteotomy and SSRO were performed after the lower molar width was reduced with a semi-fixed constriction appliance. Postoperative orthodontic treatment and myofunctional therapy were performed for detailing. The treatment period was 2 years and 2 months. The results showed that the spaces caused by macroglossia were closed efficiently. Maxillary and mandibular dental arch widths were coordinated well and a good occlusion with molar relation of Angle Class I was acquired.

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開咬は前歯の挺出,臼歯の圧下,または,その両方により矯正単独で治療されるか,または外科的矯正治療により改善される.開咬症例の治療計画や方法は,患者の年齢や成長様式とともに,開咬のタイプの影響を受ける.今回の臨床報告は,3つのタイプの開咬症例における治療方法とその選択方法について検討した.タイプ1は,歯性の開咬であるが,口腔周囲の筋機能療法を適用し,タイプ2は,下顎骨の時計回りの回転を有する開咬で,包括的矯正治療法を用いた.タイプ3は,骨格的に異常を有するもので,外科的矯正治療を行った.

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A case of acromegaly accompanied by pituitary adenoma in a 35-year-old male is reported. The patient presented with mandibular protrusion, malocclusion and articulate disorder. Prior to oral surgery, a pituitary adenoma was resected at the Department of Neurosurgery. Pre-operative orthodontic treatment was started after growth hormone and insulin-like growth factor I had returned to normal levels. Orthognathic surgery by sagittal split ramus osteotomy (SSRO) was performed, and good occlusion was obtained. Articulate function also improved after orthognathic surgery.

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Two hundred and thirty-one cases (223 patients) undergoing Orthognathic surgery were studied cinico-statistically between January 1985 and December 1994.
The results were as follows:
1. The number of operations have increased recently, 85% of all operations were performed during 10 recent years.
2. The ratio of male to female was 1: 1.73. The age of the cases at operation ranged from 15 to 44 years, and 135 cases (61%) were under 21 years-old.
3. The number of mandibular protrusions was 191 (86%) cases, and 58 cases (26%) were complicated with cleft anomaly.
4. According to the classification of mandibular prognathism (modified Sanborn-Hanada's classification) showed high distribution of maxillary retrusion.
5. The mandibular osteotomy was performed in 182 cases (79%), maxillary osteotomy was performed in only 12 cases (5%), and simultaneous maxillomandibular osteotomy was performed in 37 cases (16%).
6. The blood loss was 621±353ml with bilateral sagittal split ramus osteotomy (SSRO) and 1, 360±471ml with Le Fort-I osteotomy and SSRO. The operating time was 274±78 min. with SSRO and 461±81 min. with Le Fort-I osteotomy and SSRO.
7. Autologous transfusion was applied from 1988, so homologous transfusion was needed in only 3% cases undergoing SSRO and 14% of those undergoing Le Fort-I osteotomy and SSRO.

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Recently, intraoral vertical ramus osteotomy (IVRO) has been applied to patients with jaw deformities as a method for orthognathic surgery in many institutes.
This procedure is relatively easy because the use of special instruments is not necessary and few cases show sensory disturbance in the mental region due to surgical damage of the inferior alveolar nerve. However, the postoperative stability of this method remains unclear. Therefore, to clarify the skeletal (point B) and dental (axis and extrusion) stability of this procedure, the postoperative follow-up data of 12 cases that were treated with IVRO bilaterally were retrospectively investigated.
Point B of the mandible on lateral cephalograms was measured in each case preoperatively, immediately after maxillomandibular fixation (MMF), at MMF removal, and 3 months, 6 months, and 1 year after the operation. In addition, the changes in the upper and lower medial incisors were simultaneously analyzed concerning their axes and extrusion by lateral cephalography and their postoperative occlusal findings were also evaluated.
The results were as follows:
1) The position of point B was remarkably changed posteriorly and inferiorly at MMF removal, and this position was maintained at all follow-up examinations.
2) There were three cases that showed open bite at MMF removal. These cases could obtain good occlusions through postoperative orthodontic treatment.
In conclusion, the results suggested the necessity of skeletal maxillomandibular fixation for good occlusal stability.

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prednisolone 17-valerate 21-acetate(PVA)のマウスにおける各種免疫応答に及ぼす影響をhydrocordsone 17-butyrate(HB)およびbetamethasone 17-valerate(BV)と比較，検討した．これらの薬物の皮下投与によりマウスの脾臓重量，脾臓有核細胞数およびPFC応答は抑制され，PVAの抑制作用はHBと同程度であり，BVより弱かった．これらの薬物のヒツジ赤血球に対する血中抗体価の抑制作用は，IgG抗体に比べて，IgM抗体でより明瞭に認められた，PVAのIgM抗体抑制作用は，HBよりやや低用量でみられたが，BVより弱く，またIgG抗体の抑制はHBと同程度であった．遅延型皮膚反応は，これらの薬物のいずれによっても感作過程に比して誘発過程に薬物を投与した場合に，より低用量で抑制が認められた．また脾臓細胞の各種mitogen反応性に及ぼす3種類の薬物の影響にも差が認められた．すなわち，HBおよびBVは，phytohemagglutinin-P反応性に対して促進的に作用したが，PVAは促進作用も抑制作用も示さなかった．concanavalin A反応性に対する抑制作用は，BVが最も強く，PVAとHBは同程度であったが，lipopolysaccharide反応性の抑制はBVが強く，次いでPVA，HBの順であった．大腸菌に対する感染抵抗性の減弱作用は，PVAが最も弱く，腹腔マクロファージ数の減少も少なかった．以上，マウスの免疫応答に対するPVAの作用は，B細胞，T細胞およびマクロファージの3者に作用する複雑なものであり，細部においてはHBやBVと相違がみられたが，総括的にはcorticosteroidに共通した作用を有し，各種免疫応答に及ぼす影響は，BVよりも弱くHBとほぼ同程度であった．さらに，これらの成績にもとついて，各薬物の免疫担当細胞機能に対する作用について考察した．

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