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We report a case of ankylosis in childhood treated by TMJ mobilization with preservation of the condyle and disc. The patient was a 9-year-old boy with a history of a right condylar fracture at the age of 7 years. As the maximal mouth opening had markedly decreased, TMJ mobilization was performed at the age of 13 years. We resected the bony adhesion, retaining the fractured condyle and disc in their displaced position.Five years after surgery, the patient had a maximal mouth opening of 45mm, as well as better contralateral and protrusive movements without any recurrence. Mandibular deviation has gradually improved.

To investigate the effect of enforced manipulation technique on arthrocentesis in patient with intracapsular adhesion of the temporomandibular joint, the clinica effectiveness of the procedure was compared on the basis of arthoscopic findings between an enforced manipulation group and a matched-pair contro group. Ten patients who underwent sufficient enforced manipulation during arthrocentesis comprised the enforced manipulationtion group, and 10 patients without manipulation comprised the control group.One month after the procedure, the range of maximum mouth opening increased by 3 to 15 mm (mean 9.0 mm) in the enforced manipulation group, as compared with 1 to 8 mm (mean 5.3 mm) in the control group. This difference was significant. Our results indicate that the enforced manipulation technique on arthrocentesis contributes to an increased range of mouth opening in patients with intracapsular adhesion of the temporomandibular joint.

Arthroscopic examination with an ultra-thin arthroscope is an easy, minimally invasive procedure for examination of the inside of joints. However, one disadvantage of arthroscopy is the risk of scope breakage in narrow joint spaces. We describe an improved procedure for arthroscopic examination of the upper joint space and describe the findings thus obtained.Arthroscopic examination is done with the patient under local anesthesia in the outpatient clinic. To observe the synovium in the posterior compartment, an 18-gauge needle and a trocar for a 0.8mm rod-lens fiberscope are inserted into the anterior and posterior compartments of the upper joint space, respectively. The articular cartilage of the glenoid fossa and eminence is also observed. Finally, the presence or absence of adhesion in the anterior compartment is examined. In narrowed joint spaces with severe adhesions, injection of normal saline under sufficient pressure is performed to widen the upper joint space. The fiberscope is then advanced from the posterior compartment to the anterior compartment via the lateral paradiscal groove.This procedure enables us to observe synovitis with capillary hyperemia or hyperplasia of the synovium, cartilage changes with fibrillation or exposure of subchondral bone, and the distribution and degree of adhesion.

We describe procedures for arthrocentesis based on arthroscopic findings and report the therapeutic usefulness of these procedures in 46 patients with closed lock of the temporomandibular joint.Arthroscopic examination was done under local anesthesia in the outpatient clinic. An 18-gauge needle and a trocar for a 0.8-mm rod-lens fiberscope were inserted into the anterior and posterior compartments of the upper joint space, respectively. The anterior compartment was then observed with special respect to the presence of adhesion. In joints without adhesion, irrigation was done under low hydraulic pressure. In joints with adhesion, irrigation was performed under sufficient hydraulic pressure (maximum pressure exerted, 40 KPa) to widen the upper joint space. Manipulation was performed after irrigation.Eight weeks after these two procedures, the range of maximum mouth opening increased from 2 to 20 mm and averaged 10.3 mm in 18 patients without adhesion. In 28 patients with adhesion, the increase in maximum mouth opening ranged 3 to 25 mm and averaged 9.1 mm. There was no significant difference in the increase in maximum mouth opening between these two groups.

To clarify risk factors for neck failure, we analyzed the clinical and histopathological findings in node-positive cases of squamous cell carcinoma of the tongue.We reviewed the records of 342 patients with controlled primary tongue lesions who were treated between January 1974 and June 1999 at Chiba Cancer Center Hospital. Two hundred fifty-one patientswho had clinically or pathologically negative nodes or both were excluded from study. Among 91 patients with positive nodes, neck disease was controlled in 81, and neck failure developed in 10.The relations of various factors to the pattern of cervical lymph node metastasis in the 91 patients were investigated by multivariate analysis. Multiple logistic regression analysis showed that the odds ratio for neck failure diminished in the following order: level of metastasis 6.732 (p=.0197), presence of nodal adhesion 3.329, extracapsular spread 2.444, number of positive nodes 1.421, and node size 1.097.Of the 10 patients with neck recurrence, 9 had recurrence in areas confirmed to have positive nodes. Five patients with nodal adhesion had recurrence at the location of nodal adhesion.The presence of lower neck involvement may be a decisive factor for postoperative treatment. Patients with nodal adhesion should receive extended radical neck dissection with a sufficient margin, and postoperative treatment should be considered.

Control of metastatic lymph nodes, especially enlarged nodes with adhesion, is extremely difficult. We treated metastatic lymph nodes with adhesion by intranodal injection (INI) of anticancer agents and obtained prolonged control of metastasis. Sixteen patients with a total of 23 metastatic lymph nodes with adhesion that were not indicated for surgical removal were studied. INI of peplomycin (14.0±10.4mg), CDDP (10.0±0mg), CBDCA (60.0±37.3mg), methotrexate (28.5±27.1mg), and 5-FU (311.1±194.9mg) was given to all, 1, 10, 7, and 8 patients, respectively. External radiation with cobalt 60 (2Gy/time, 42.8±9.7Gy) was given to all but 3 patients. The results obtained were as follows:1. Except for one patient in whom the therapeutic respones could not be evaluated, all subjects had remission of swollen lymph nodes. The remission rates ranged from 99.6% to 14.3%(average, 51.3±27.8%).2. In three patients, metastatic lymph nodes became small enough to be surgically removed without recurrence. Of the remaining 13 patients, 11 had no re-enlargement for at least 3 months after the end of INI.3. Three patients are still alive (observation periods, 57, 6, and 6 months). Eleven patients died of uncontrolled primary lesions, distant metastases, or metastatic lymph nodes despite treatment with INI and radiation. The remaining two patients died of cardiovascular disease and pneumonia.4. Of the 13 patients who died, 6 (37.5% of all patients) survived for 10 months or more from the start of INI, and the remaining 7 survived for about 5 months. The mean duration of survival was 11.8±13.9 months. Finally, INI controlled metastatic lymph nodes although the therapeutic response was unclear in one patient and could not be evaluated in another.In conclusion, INI is an useful treatment for large metastatic lymph nodes that adhere to surrounding tissue and cannot undergo lymphectomy.

We report a solitary fibrous tumor arising in the oral cavity.A 27-year-old woman had been aware of a tumor in the right side of the mandible since January 1998. The tumor was found by her dentist on dental therapy, and she was referred to our department on March 19, 1999. On palpation a spherical tumor 1.5 cm in diameter was found in the gingivobuccal fold of the right mandibular premolar. It was a painless movable tumor and there was no adhesion to the skin or perceptional anomaly. The teeth adjacent to the tumor had no anomaly. Echography and computed tomography showed a clearly demarcated tumor.The tumor was enucleated under local anesthesia on April 7, 1999. Histopathologically and immunohistochemically, it was diagnosed as a solitary fibrous tumor. The patient, who has been followed up on an outpatient basis, has had no recurrence and is making good progress.

We report a case of benign fibrous histiocytoma, a rare lesion in the oral cavity, arising in the cheek. The patient, a 69-year-old woman, had noticed swelling in the right buccal mucosa for about 3 years and was admitted because the swelling had increased. Magnetic resonance imaging showed homogeneous enhancement of the mass in the cheek. The biopsy specimens were pathologically diagnosed benign fibrous histiocytoma, and the lesion excised. There has been no recurrence as of 5 years after excision. Macroscopically, the lesion was an encapsulated mass measuring 30×15×10mm with partial adhesion to muscle. Histological examination revealed mixed proliferation of histiocytic and fibroblastic cells without atypia. The lesion showed a polymorphous population of fibroblastic cells arranged in a vague striated and fascicular pattern. Histiocytic cells were positive for CD68, α 1-antichymotrypsin, and α 1-antitrypsin, and fibroblastic cells were positive for both α-smooth muscle actin and vimentin.

Three-dimensional (3D) analysis of the temporomandibular joint (TMJ) compartment is necessary for diagnosis of internal derangement of the TMJ. We performed contrast-enhanced 3 D-computed tomography (C-3 DCT) in the upper joint compartment of 41 TMJs of 36 patients. C-3 DCT accurately diagnosed adhesion of the upper joint compartment and perforation of the disc in all cases. C-3 DCT facilitates diagnosis by providing a three-dimensional presentation of the entire TMJ compartment, promoting informed consent and understanding by patients. Furthermore, C-3 DCT is a useful diagnostic imaging technique befor arthroscopic surgery of the TMJ.

We clinically studied 30 patients (34 joints) with closed lock who underwent arthroscopic surgery (lysis and lavage operations) of the superior joint compartment of the temporomandibular joint (TMJ). Arthroscopic surgery was studied as compared with arthrocenthesis and pumping manipulation by double-contrast arthrotomography and magnetic resonance imaging (MRI).The results were as follows:1. There was arthrographic evidence of marked narrowing of the anterior recess and lateral portion, of the upper joint compartment in patients who underwent arthrocenthesis and pumping, whereas narrowing of the posterior compartment and medial portion was found in patients who underwent arthroscopic surgery.2. In patients who underwent arthrocenthesis, MRI showed that anterior disk displacement and disk deformity were severer than after arthroscopic surgery.3. There was arthroscopic evidence of extensive synovitis, and osteoarthrosis and adhesionwere severe in the anterior recess.We found that upper joint arthroscopy of the TMJ was an important additional diagnostic method and that arthroscopy was effective in the diagnosis of synovitis and osteoarthrosis within the superior cavity and permitted the observation of adhesion.

A 77-year-old man presented with a painless swelling in the right side of the buccal mucosa. A tumor of the buccal mucosa was suspected on the basis of clinical and radiological findings. However, histopathogical examination of a biopsy specimen showed a sialolith accompanied by adhesion of Actinomyces, suggesting that the lesion was caused by minor salivary gland sialolithiasis and actinomycosis. As this condition has not been reported previously, the present case must be extremely rare.

In the present study, expression of the adhesion molecule CD44 in oral squamous cell carcinoma (SCC) cells was investigated by immunoperoxidase staining of 35 surgically removed SCC lesions. In addition, the relationship between metastasis of SCC to regional lymph nodes and the mode of expression of CD44 in SCC was evaluated. Likewise, the relationships between the mode of expression of CD44 and the T classification, degree of differentiation, and mode of invasion were also assessed.Most SCC lesions were positive for CD44 staining. Among the 35 lesions, 17 were strongly positive for CD44 staining, 16 were moderately positive and 2 were negative. Comparative analysis between the 14 patients with metastasis and 21 patients without metastasis revealed that the strongly positive cases had a significantly higher rate of metastasis (12 of 17 cases, 70.6%) than that of moderately positive or negative (2 of 18 cases, 11.1%). Moreover, it was also suggested that strongly positive cases tended to form multiple metastasis. There was no significant correlation between the mode of expression of CD44 and the T classification, degree of differentiation, and mode of invasion.This study demonstrates the following two points:1. CD44 may play an important role in the metastasis of SCC to regional lymph nodes.2. The examination of CD44 yields useful information about the metastatic potential of SCC.

The diagnostic accuracy of temporomandibular joint arthroscopy was evaluated at autopsy. Arthroscopy was performed in the upper compartment of 36 temporomandibular joints in 18 fresh cadavers to investigate the accuracy of arthroscopic diagnosis of disc perforation and two types of adhesion (band adhesion and pseudowall).Punctures were made by inferolateral, anterolateral, and endaural approaches. Subsequent dissection revealed that eight of nine disc perforations had been accurately diagnosed arthroscopically and that all band adhesions had been diagnosed arthroscopically. Six of seven pseudowalls had been diagnosed, but four pseudowalls had been overdiagnosed arthroscopically.Therefore, the diagnostic accuracy of disc perforation was 97%, that of band adhesion was 100%, and that of pseudowall was 86%. It was concluded that arthroscopic diagnosis of disc perforation or band adhesion was reliable, whereas arthroscopic diagnosis of pseudowall was not reliable. Double-puncture penetrating from two different directions, either an inferolateral-anterolateral approach or an inferolateral-endaural approach, was considered to be significantly more effective for diagnosing disc perforation within the lateral third of the joint.

Although radiographic examination is generally used to diagnose lesions in the temporomandibular joint (TMJ), its reliability is still controversial. In this study, radio tomographic and single-contrast arthro tomographic findings were compared with arthroscopic findings in 34 joints of 28 patients with TMJ closed lock. The patients included 6 males and 22 females. Their ages ranged from 15 to 69 years old, with an average of 33 years.With regard to disk displacement, arthrographic findings agreed with arthroscopic findings in 33 out of 34 joints (97%). Regarding disk movement, both findings coincided in 29 out of 30 joints (97%). On the other hand, concidence of arthrographic and arthroscopic findings in disk deformation, anterior joint compartment adhesion and disk or retrodiscal tissue perforation were 53%, 66% and 74%, respectively. Moreover, tomographic and arthrographic examinations did not show abnormality on the surface of the mandibular fossa or articular eminence.These results suggest that tomography and single-contrast arthrography do not necessarily provide high reliability in the assessment of intracapsular lesions of the TMJ.

Bone defects in the growing period give rise to mandibular growth obstruction. After the bone is resected, the defect in the mandible is reconstructed by means of bone graft or ceramic implantation to maintain mandible form and function, but the effect on mandibular growth has not been studied in detail. So the author has studied experimentally the effects of bone graft and the implantation of 2 types of ceramics, hydroxylapatite (HA) and tricarcium phosphate (TCP), in surgically caused mandible defects growth.Ninety-six 4-week-old WKA rats were used in this study. Of these 36 rats were used for histological study and 60 were divided equally into the 6 following groups: Group 1. Bone was grafted into the defect at the mandibular body inferior border. Group 2. Bone was grafted into the defect at the mandibular ramus center. Group 3. Fibrin adhesion system (Tisseel ® kit) was filled into the bone defect created the same as in group 1. Group 4. Bone was grafted with fibrin adhesion system into the bone defect created the same as in group 1. Group 5. HA was implanted with fibrin adhesion system into the bone defect created the same as in group 1. Group 6. TCP was implanted with fibrin adhesion system into the defect created the same as in group 1. Sixty of the rats were sacrified at 15 weeks of age, decapitated, and the obtained specimens were evaluated by measurement, contact microradiography and radiography.Growth inhibition of the mandible after resection of the mandible inferior border was significantly improved by replantation of the removed bone itself to the resected site, but there was no significant effect on mandible growth when the defect at the mandibular ramus center was filled with bone. Ceramics implantation into the defect of the mandible inferior border showed a similar but not significant effect to that seen in the case of bone replantation.

The par ticlated cancellous bones from ilium are commonly used for the reconstruction of alveolar cleft. Recently, we attempted to make use of fibrin tissue adhesive system (Tisseel) combined with bone grafting in 20 cases, and the results obtained were compared with the previous 11 cases without this adhesive system.In the operation, this adhesive system revealed several technical merits; local hemostatic effect, positioning of particulated cancellous bones, formation of alveolar ridge and adhesion of mucoperiosteal flap to the grafted bones. The grafted bones in 20 cases with this system survived completely except for 1 case, whereas in the previous 11 cases, 3 cases were unsatisfactory. Neither complications nor side effects were observed.

Myelodysplastic syndrome is a blood disorder characterized by anemia, neutropenia, thrombocytopenia, and morphological abnormalities of blood cells. And the bone marrow is normo-or hypercellular.A 54-year-old male with this syndrome was referred to our clinic, complaining of oral bleeding. All wound sealings were successfully performed using the fibrin adhesion system (Beriplas® P) for local hemostasis. Excellent results were obtained in the present case.

Cystic diseases of the oral floor include retention cyst, epidermoid cyst, branchial cyst and thyroglossal duct cyst etc. They resemble each other from the clinically view and thus some difficulties are often encountered in their diagnoses.Thyroglossal duct cyst is a relatively common congenital anomaly which usually occurs in the anterior midline of the neck but rarely occurs in the oral floor. This cyst mostly occurs before twenties but rarely occurs after thirties.The authors recently experienced a case of thyroglossal duct cyst of the oral floor in a 39-year-old man.This type of cyst is generally approached by Sistrunk method which removes the hyoid bone together with the criminal cyst. However, only the cyst was removed in this case because it showed no adhesion to the hyoid bone.

Ankylosis of the temporomandibular joint can be classified into intra-articular and extra-articular ankylosis. We report a rare case of extra-articular ankylosis caused by extensive adhesion of the alveolar process at the left side of maxilla and mandible.A 66-year-old woman visited our clinic with a chief complaint of trismus. She suffered from a feverish disease around the age of 3-4 years, which caused erosion and ulceration of the oral mucosa resulting in the massive adhesion of the alveolar process. At the age of about 50, she completely lost mobility of the mandible.Under general anesthesia, the region of the alveolar process with adhesion was resected. One month and a half later, vestibuloplasty was performed. As of 4 years 6 months postoperatively, there is no evidence of recurrence.

Rheumatoid arthritis (RA) is a chronic inflammatory disease.We have attempted diagnostic arthroscopy in a patient with RA associated with symptoms in the temporomandibular joint.Arthroscopic examination showed synovial hyperplasia, inflammation, chondromalacia, fibrosis, and adhesion of the upper joint space.A biopsy specimen was taken from one region with synovial hyperplasia, and the histological examination revealed chronic inflammatory changes.The histological findings were consistent with the arthroscopic findings.

Recently, we encounted a case of lymphoepithelial cyst with calcification which developed on the floor of the oral cavity. Here, we report the clinical course of this patient. On February 17, 1995, a 24-year-old woman presented at our department because of a mass on the right side of the floor of the oral cavity. Examination revealed an elastic hard mass of 5×5×3 mm in size, which had well-defined margins and a smooth surface mucosa. The mass, which caused neither spontaneous pain nor tenderness, was regarded as a movable tumor because of the absence of adhesion to the surrounding tissues. We performed a tumorectomy under local anesthesia. The pathological diagnosis was a lymphoepithelial cyst with calcification. Five months have passed since the operation. There are no signs of recurrence, and the patient's postoperative course is satisfactory.

To determine the value of the reconstructive method by the autogenous cancellous bone and marrow chip grafts to mandibular defect sites which involved upper areas from Foramen mandibulae, i.e., Ramus mandibulae, Processus condylaris and coronoideus, a study of 56 and the macroscopic, radiographic, histopathologic, and the fluorescent findings of adult dogs was done with the conclusions as follows:1. Although minor osteogenesis was perceived to locally exist at the end of the host bone, no bone formation was observed in nongrafting groups both under the periosteum or nonperiosteum.2. Normal remodelling of Processus condylaris, Caput mandibulae, Processus coronoideus and Ramus mandibulae was viewed for 4 months in grafting groups with periosteum. Caput histologic construction was nearly normal. Hardness of the new bone was sufficient and smooth bony adhesion to the host bone was observed.3. Only the bone grafted proximal to the host bone was fixed and that grafted far from it was absorbed, and functional morphologic recovery of Caput mandibular was found to be negative in grafting groups without periosteum.4. Autogenous cancellous bone and marrow chip grafts were especially efficient, when periosteum exists, and this suggests multiplicated effect between periosteum and the grafted bone. Periosteum effectively acted on inhibiting the surrounding tissue from the invading grafted bone.

Generally, the treatment of sialolithiasis aims at removal of the salivary stone, either intraorally and extraorally. It is thought that many cases of sialolithiasis can be cured by removing the salivary stone, except for some cases in which it is necessary to remove the salivary gland. The authors therefore devised a nonsurgical method by which a salivary stone could be removed safely and with certainty using endoscopy, and applied it clinically. So far 39 cases have been treated by this method and in 33 (84.6%) only the salivary stone has been successfully removed. With regard to extirpation of the salivary stone, this method could be emoloyed regardless of the location of the stone and was effective with stones up to 5mm diameter. The success of this method was affected by the degree of adhesion between the salivary duct and the stone, occlusion of the salivary duct or severe damage to the submandibular gland. It was confirmed that this method is a safe nonsurgical method with a high extirpation rate and should be considered before attempting the usual surgical procedure.

Arthrographic examinations were performed for 40 joints of 39 patients with internal derangement of the temporomandibular joint (TMJ) to analyse disc movement in relation to clinical signs and symptoms in each individual. The inconsistency between the arthrographic and clinical findings was often associated with soft tissue derangements, such as perforation of the articular disc and adhesion of the capsula.Therefore arthrographic examination may be indispensable to elucidate the pathologic conditions more clearly in those cases in which soft tissue derangements of TMJ are suspected or the primary treatment proved to be unsuccessful.

Schwannoma is an endodermal tumor originating in Schwann's cells of myelinated nerves and occurs in the gnathic oral cavity or relatively rate occasions. Schwannoma in the tongue has often been reported but occurrence in the buccal mucous membrane, palate or gingiva in the floor of the mouth is rare.We recently experienced a case of schwannoma in the floor of the mouth with the result described below.The patient, a 63-year-old woman, visited our hospital with a chief complaint of mass in the hypoglottis. She first felt a swelling in the hypoglottis about three months previously without any treatment thereafter because of the absence of pain. However, the patient visited a domestic hospital because she noticed that the mass was growing two weeks before coming to our hospital. She was diagnosed as having a dermotoid cyst and referred to us on December, 6, 1983. Intraoral examination revealed a diffuse tumoid rising in the right floor of the mouth. A walnut-sized mass with relatively clear bordering was palpable. It was elastic in consistency without tenderness. In addition, the mass was movable within the surrounding tissue.Under the clinical diagnosis of dermoid cyst, the tumor was removed under local anesthesia on December 15, 1983. The mass was covered with a thin capsule without adhesion to the surrounding tissue, so that it was easily resected en block. Thus removed mass was spherical, 15×17×12 mm in size, and covered with a capsule with smooth, grey-yellow surface and slightly low elasticity.Pathohistological examination revealed that the mass was a solid tumor covered with a thin capsule consisted of connective tissue, and bordered with interstitial tissue containing fi broblasts and collagenous fibers. In addition, tumor cells arranged and proliferated in a close bundle or palisade fashion, i.e. so called line of soldiers, in some parts, while they arranged in a network fashion in others. From these findings, the tumor was pathologically diagnosed as schwannoma (Antoni type A and B). This kind of tumor occurring in the mouth floor seemed very rare since it has less reported in the literature concerned.

Experiment was conducted on 96 Wistar rats to estimate the clinical utility of the lyophilized nerve which has advantages of being enduring of and easy for long-term storage. After implanting to the unilateral sciatic nerve trunk a piece of lyophilized homograft of the sciatic nerve of 10mm in length, the nerve and the muscles (soleus, extensor digitorum longus and gastrocnemius) were examined from different aspects and were compared with the results after fresh nerve homografting.The results were as follows:1. Macroscopic observations;i) In both the lyophilized and fresh homografts the initial form was well maintained during the observation period of up to 48 weeks. The fresh homografts tended to show stronger adhesion to the surrounding tissues due to intense proliferation of the connective tissue.ii) The muscles were atrophic and pale. Recovery started around the 8th postoperative week, and was almost complete within 48 weeks.2. From the 8th postoperative week electromyographic responses could be evoked by stimulating the sciatic nerve trunk. The latency of the evoked EMG became progressively shorter at a similar pace in both the lyophilized and fresh nerve-grafted groups.3. The wet weight of the muscles in the operated side was lowest on 4th week and showed a gradual recovery to reach a level of 65-83% of the contralateral homonymous muscles. No marked difference was found between the lyophilized and fresh nerve-grafted groups.4. Histological observation revealed no significant difference between the lyophilized and fresh nerve grafts in terms of the overall time course of the progressive regenerated axons entering into the graft. The inflammatory response was more intense in and around the fresh nerve grafts. The number of regenerated axons of the fresh nerve grafts increased more than the lyophilized nerve grafts.5. The degree and the time course of the change in the concentration of the nerve and muscle-related proteins were not much different between the both groups.It can be concluded that the homograft of the lyophilized nerve can be substituted for the fresh nerve homografting for restoration of the nervous and muscular functions, and is even superior to the latter in that it can be easily stored for a long time and causes less inflammatory responses.

Surgical treatment was performed in 12 cases of discopathy of the temporomandibular joint with displacement of the articular disc. Clinical and pathological studies on these cases gave the following results.1. Classification of the type of displacement of the articular disc showed 6 anterio-lateral type cases, 5 anterior type and 1 anterio-medial type.2. In 9 cases, the injury to the articular disc was serious and adhesion to the condylar head was also observed.3. In 2 cases, the articular disc had a horizontal rupture as well as a transverse rupture.4. Rupture of the organizing collagenous fibers of the articular disc was seen in all cases, including 3 cases in which no macroscopic injury to the articular disc was found.

A case was reported of squamous cell carcinoma arising in left upper neck of 61-for 1 year old male.The patient complained that had been suffered painful swelling in left upper neck region for 1 month since he had his left upper teeth extracted.An elastic hard tumor the size of a baby's fist with adhesion underneath was found in the first visit examination.An en-block resection of tumor with adhesive surroundings was performed, though preoperative biopsy showed no evidence of malignancy.Histopathological examination of the specimen revealed that the tumor was squamous cell carcinoma. Even though we had not found tumor cell remained on surgical margin area, 60Co (5, 000 rad) irradiation and Peplomycin (50mg) chemotherapy was performed after the resection. The patient was followed up for 2 years administering Picibanil (5KE/week) and had no local reccurance or metastasis.We concluded that this case was Branchiogenic carcinoma because of the below characteristics;1.Tumor was located between M. sternocleidmastoideus and V.juglaris internal of upper neck region.2.Tumor had cystic cavity with keratinized substance inside.3.Histopathological examination revealed that the cystic structure was not formed by necrosis caused by carcinoma.4.Numbers of lymphoid tissues with germinal center were found in the specimen.5.Even though we tried Otorhinolaryngologic, internal examinations and further research of maxillofacial region, we could not find any primary lesion so that the tumor of the upper neck was deened not metastatic.

This report describes a girl aged one year and nine months with an alveolar soft part sarcoma of the tongue. The patient visited our hospital because a lingual tumor had been found at a pediatric examination four months before first examination. No abnormality was observed in her general condition, but a non-movable, elastic soft, circumscribed tumor of the size of the tip of a small finger was noted in the left part of the dorsum of the tongue. The covering mucosa was normal. No abnormal findings were present in laboratory tests. Resection of the tumor was carried out with general anesthesia under a diagnosis of benign lingual tumor. The tumor could be resected as a mass because there was no adhesion between the tumor and the surrounding tissues. Histological findings revealed that the alveolar structure was clear in most parts of the parenchyma of the tumor, and needle-like diastaseresistant PAS-positive materials were observed within the tumor cells. Electron microscopic findings showed that the tumor cells were closely connected, interdigitated, and contained the basal lamina, desmosomes, and hemidesmosomes. Periodic fibrous granules with limited membranes were observed within the cell body.The postoperative course is uneventful, and as of now, five years after surgery, no sign of recurrence or metastasis has been observed.

This study was undertaken to determine the indication and value of marginal resection of the mandible as a method of treatment for squamous cell carcinoma of the floor of the mouth. Eighteen patients whose primary tumors were treated by utilizing marginal resection at the Department of Oral Surgery of Hokkaido University from 1977 to 1986, were studied clinically and histopathologically. Another ten patients who had undergone resection of the primary tumor by other surgical methods during the same period, were also studied histopathologically.Local recurrence was observed in one case and the 5 year survival rate was 71. 3%. The histopathological study revealed that the cortical bone was eroded or destroyed by tumor tissues in more than half of the cases where the primary tumor had been diagnosed to have gingival invasion, mandibular adhesion or mandibular invasion. Tumor invasion into the periodontal ligament and bone marrow was also found in some cases. However, bone erosion and tumor invasion were limited within a small area, and tumor tissues did not invade beyound the extent which was anticipated before the surgery. These results suggest that some of the squamous cell carcinoma of the floor of the mouth can be removed by marginal resection of the mandible, even if the tumor invades the gingiva, the periosteum and mandible. On the other hand, in cases where the primary tumor had been diagnosed as not having gingival invasion nor mandibular adhesion, varied amounts of fibrous tissues were observed between the tumor tissues and the mandible. This suggests that squamous cell carcinoma of the floor of the mouth can be removed without resecting the mandible, if normal tissue is interposed the tumor and the mandible clinically. However, in some cases, particularly where the lesion was accompanied with infection and/or pain, it might be difficult to ascertain if the tumor had invaded the mandible or not. Therefore, it is recommended that squamous cell carcinoma of the floor of the mouth be removed by utilizing marginal resection of the mandible, if mandibular invasion is doubtful.

We would like to introduce the technique of arthrography used at the upper and lower compartments of TMJ in our Department. Typical cases were represented and some discussious were made.(1) The number of patients suspected to suffer from internal derangements of TMJ and accepted arthrography was 33 cases (37 joints). The results were as follows: 7 normal type joints, 11 clicking type joints (6 early clicking type joints and 5 late clicking type joints), 15 closed lock type joints, and 2 incoordination type. The arthrographic findings of 4 joints were different from the clinical diagnosis. Represented separately were closed lock type 3 joints, late clicking type 1 joints.(2) Complications as morphological disorder of TMJ's soft tissue were seen in all the joints with internal derangements as follows: 29 joints bad thickening or elongation of the disk, 4 joints folding of the disk, 3 joints perforation of the disk, 9 jointsadhesion of the disk (6 adhesion of the upper compartments, 1 adhesion of the lower compartments, and 3 adhesion of upper and lower compartments).(3) In almost all the cases after arthrography, the secondary complications were seen as follows: Incomplete occlusion of arthrogramed side, temporary paralysis of facial nerve, motor pain of arthrogramed side. Three cases of closed lock were discovered.

The following experiments were performed to examine the effect of low-output CO2 laser on wound healing process.Two wounds, incised 2cm in length, were created on the back of rat. One of the wounds was sutured for control group, the other was closed by irradiation of low-output CO2 laser.Hydroxyproline contents were spectrophotometrically determined by Edwards' method, and water contents were estimated at the same time.Histological findings were obtained after staining with hematoxylin and eosin.The results were as follows.On the first day after 200m W irradiation, degenerated layer of tissue and inflamatory response on the surface of wound were observed.On the first day after suture, necrosis and inflamatory response were found.Until 7 experimental days, hydroxyproline contents showed a higher level in irradiated group than in control group.Water contents of two groups varied near the same way.There were few differences in histological findings between irradiated group and control group.In the incised wound, heat stimulation by laser irradiation promoted collagen synthesis and hastened healing.

In floor of the mouth appears mucous cyst, ranula, dermoid-epidermoid cyst, thyroglossal duct cyst, branchial cyst. If it occurs in the sublingual region, we would have some difficulties in diagnosis.This paper reports a case of congenital sublingual and submental type dermoid cysts accompanied by a thyroglossal duct cyst.The patient, a 2 month old baby, was referred to our hospital with complaints of sublingual mass and submental fistula. The operation was performed when he was 6 months, so he didn't have sucking difficulty.The mouth sublingal mass was extirpated and we found and also extirpates a new mass beneath it. The submental fistula was extirpated from outside the mouth.These 3 masses were independent of each other with no evidence of adhesion together.Histopathologically, the sublingual mass and the submental fistula were dermoid cysts and the mass beneath the sublingual mass was a thyroglossal duct cyst.

Epidermoid cyst is a congenital cyst caused by the impaction of embryonal ectoderm and is known to occur with relatively low incidence within the oral cavity, rarely occurring in the jaw bone.The authors have recently experienced one case of epidermoid cyst which developed within the mandible, and report the outline of this case with further discussion in reference to the literature.The patient is a 44-year-old male who visited the hospital on July 14, 1984 complaining of swelling at the left mandibular molar.X-ray revealed a well defined oval, hen egg-sized radiolucency from the distal area of the lower first molar throught the mandibular branch. In biopsy conducted under the clinical diagnosis as mandibular cyst, it was pathologically diagnosed as epidermoid cyst.Accordingly, cyst extirpation was performed under general anesthesia with NLA on August 9, 1984. There was little adhesion between the cystic wall and the surrounding bones and the cyst was easily ablated. The cystic cavity was kept open in accordance to subcativity formation method. The patient has shown a favorable course for these three months following surgery. The authors will continue careful observation on the patient's prognosis.

Measurements of the blood flow kinetics in a healed wound using the laser doppler flowmeter (LDF) and its simultaneous comparative histopathological studies revealed the following interesting results:1) Blood flow for the nylon suture group showed a recovering tendency just postoperatively, and 5 days later, returned to its quasi-normal range with a significant difference from the Tisseel® adhesion group.2) Blood flow for the Tisseel® adhesion group showed only half of that for the nylon suture group on the first postoperative day, and then gradually increased to reach that for the latter group on the 6th postoperative day.3) Histopathological searches revealed that the former group showed a wound healing process a little more retarded than the latter group till the 5th postoperative day.The above results suggest that the present LDF-blood flowmetry constitutes one of the hopeful means for various kinds of researches in future in that together with its consistency with related histopathological findings, it well reflects the peripheral blood flow kinetics and permits sensitive measurements of the tissue blood flow with delicate variability.

We devised a new appliance, an oropharyngeal airway tube combined with a maxillary plate, to correct obstructive sleep apnea in a four-month infant with crouzon, hydrocephalus, and choanal atresia. This appliance was used for six months and had the following outstanding results.1) It is easy to place the tip of the tube at the obstructive portion of the airway.2) The tube does not deviate from the first position even after several usages, which is an improvement on other airways.3) It is possible for infants to keep the tip of the tube in the space of the lower pharynx by adhesion of the plate to the maxilla even if they move very much.4) This appliance can be in the oral cavity for a long time.5) This appliance is easier to put into place and take out compared with other airways.6) The infant tries to push the large appliance out of its mouth, resulting in development of the muscles which correct obstructive sleep apnea.7) This appliance can be also useful in oro-nasal airway stenosis.