Search

We clinically examined 29 patients with squamous cell carcinoma of tongue, floor of the mouth, and maxillary gingiva who received unilateral functional neck dissection with preservation of the sternocleidmastoid muscle, internal jugular vein, and/or accessory nerve.The 5-year cumulative survival rate of all patients was 80.4%, that of 19 pN (+) patients was 68.6%, and that of 10 pN (-) patients was 100%. Pathologically, 4 metastatic lymph nodes (LNs) were found in 1 patient, 3 LNs in 3 patients, 2 LNs in 6 patients, and 1 LN in 9 patients. LNs were located in level 1 in 5 paitents, level 2 in 12, and level 4 in 2. Extranodular metastatic lesions were found in level 1 in 1 patient and in level 2 in 4. Among the patients with a poor prognosis, 2 LNs were found in 2 patients, 3 LNs in 1, and 4 LNs in 1, extranodular lesions were found in 2 patients, and LNs were located in level 2 in all patients.Our results suggest that functional neck dissection is indicated for patients who have single and movable nodular metastatic lymph node.

We examined occlusal status in 18 patients with mandibular prognathism (mandibular prognathism group) as compared with that of 14 adults with normal occlusion (control group). We also studied changes in occlusal status after orthognathic surgery (1, 3, 6, and 12 months) in the patients with mandibular prognathism. The occlusal contact area, maximum voluntary isometric bite force, and occlusal pressure were recorded using a pressure-sensitive sheet (Dental Prescale ® 30HW type, Fuji Photo Film Co.) and the data were analyzed with an analysis system (FPD-703, Fuji Photo Film Co.).The results were as follows:1) Preoperatively, the mandibular prognathism group had a significantly smaller occlusal contact area and a lower bite force than the control group, but had a higher occlusal pressure.2) Changes in occlusal contact area and bite force were evaluated in the patients with mandibular prognathism from before operation to 12 months after operation. Occlusal contact area and bite force decreased significantly 1 month after operation, increased significantly to preoperative levels 6 months after operation, and were about 40% of preoperative levels 12 months after operation. However, 12 months after operation occlusal contact area was smaller and bite force was lower than those in the control group.3) Occlusal pressure was evaluated in the patients with mandibular prognathism from before operation to 12 months after operation. The value increased significantly 1 month after operation, but decreased subsequently. Twelve months after operation, occlusal pressure in the prognathism group was similar to that in the control group.4) Few studies have used pressure-sensitive sheets. This method permits assessment of occlusal status of all teeth easily and promptly. Pressure-sensitive sheets are useful for understanding occlusal status clinically.

We perfomed a clinicostatistical study of 43 elderly patients with maxillofacialfractures who were over the age of 60 years and a long-term follow-up study of 27 of these cases at The First Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tokyo Medical and Dental University during the 16-year period between 1977 and 1992.Of all maxillofacial fractures, the incidence of fractures in elderly patients was 5.1%. The ratio of men to women was 1.5:1. Falling to the ground was the most frequent cause of fracture. Fractures of the mandibule were common, and the mandibular condyle was the most frequent fracture site. Conservative therapy was usually performed and was found to be successful. The long-term follow-up study demonstrated that recovery of the occlusion was enabled by prosthetic treatment after conservative therapy.

Immunocytochemical localization of the transferrin receptor (TfR) using a monoclonal antibody in HeLa cells was investigated by microscopy and electron microscopy. In addition, changes in transferrin receptor localization evoked by cisplatinum diammine dichloride (CDDP) were examined. The results were as follows:1. In proliferating cells, TfR was found in the cell membrane and electron microscopic investigations revealed that TfR was localized in a scattered fashion in the cell membrane, microvillus-like projections and intercellular vesicles.2. After CDDP treatment, microvillus-like projections and intercellular vesicles were not as prominent as in the control group and the quantity of TfR decreased.3. In some relatively highly degenerated cells by CDDP, many TfRs were demonstrated, suggesting that the mechanism of TfR expression, which reflects the proliferative ability of cancer cells, should be investigated.

This retrospective study about trismus after the release of maxillomandibular fixation was performed in 103 cases of mandibular fracture in our department and the following results were obtained:1. Most cases of trismus were recovered by 12 weeks after the relase of fixation. However, in the group below the age of 30 years recovery took place within 8 weeks.2. Trismus was most frequently found in multiple-line fractures.3. Trismus occurred less frequently in open reduction cases than in closed reduction cases.4. The relative frequency of trismus was unaffected by the presence or absence of condylar fracture.5. There was no definitive relationship between the period of maxillomandibular fixation and the occurrence of trismus.

Rare varieties of malignant fibrous histiocytoma occurring in the maxilla are reported in this study.We observed 3 cases of malignant fibrous histiocytoma by light-and electron-mlcroscopy and examined the histiogenesis.Fibroblast-like cells, histiocyte-like cells, primitive mesenchymal cells, multinucleated giant cells and xanthomatous nucleated giant cells and xanthomatous histiocytes were recognized, and it was suggested that these tumors might be of primitive mesenchymal cell origin. When the clinical course is relatively good, myxoid type and giant cell type were shown and a number of fine granular materials were found in the stroma and rough endoplasmic reticulum.

Histiocytosis X (HX) arising in the oral and maxillofacial region is relatively rare. Here, two cases of HX, i.e., Hand-Schaller-Christian disease (HSC) and Eosinophilic granuloma of bone which occurred in the oral and maxillofacial region are presented with immunohistochemical, light and electronmicroscopic studies.Case 1: a 37-year-old male was referred to our hospital, with the chief complaint of difficulty in chewing and radiolucent lesions in the bilateral mandible. Pathological examination revealed Eosinophilic granuloma of bone.Case 2: a 23-year-old male was admitted to our hospital because of the mobility of the front teeth in the mandible. He had received treatment for HSC since he was 1 year and 6 months old.Electronmicroscopic observations showed a number of proliferated histiocytic cells in both cases and these cells seemed to be Langerhans cells.In the HSC of which the clinical activity seemed to be higher than that of Eosinophilic granuloma, a number of small Birbeck granules were found as compared with in the Eosinophilic granuloma.

4 p-syndrome (Wolf-Hirchhorn syndrome) is a rare congenital abnormality, characterized by delayed growth and development and facial dysmorphism associated with partial deletion of the short arm of chromosome 4 (4p-). Among many clinical findings, cleft lip and/or palate are the major manifestations. This is the case report of a male infant with 4p-syndrome, including a bilateral cleft lip and palate. Physical examination showed severe growth retardation, seizures, deafness, multiple craniofacial defects including a bilateral cleft lip and palate, inguinal hernia, hypoplastic dermal ridges, and so on. Roentgenographic investigation revealed dysplasia of the permanent dentition. Cytogenetic studies showed that the short arm of chromosome 4 was deleted and the band 4p 15.32 or 4p 15.33 was broken, although both parents had normal karyotypes. These findings are common features of this syndrome.Repairs of the bilateral cleft lip and palate were performed at the age of 9 months, 1 year and 4 months, and 3 years and 4 months, respectively. The postoperative course was good.Operations on cleft lip and/or palate for 4p-syndrome patients without serious complications are thought to be generally possible, although careful consideration is required.

Clinical examination was performed in 20 cases of malignant melanoma in the oralregion encountered in the First Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tokyo Medical and Dental University during the 20-year period from 1970 to 1989. The following results were obtained;1. The incidence of malignant melanoma in the oral region was not different between sexes. The tumor was observed mostly in the maxilla and palate.2. From the macroscopic findings the tumors were classified into 5 types as follows; 1) Black nodule type, 2) Non-pigmented nodule type, 3) Radial growth phase type, 4) Black mixed type, and 5) Non-pigmented mixed type. The clinical course of the non-pigmented nodule type was relatively bad, while that of the radial growth phase type was good.3. The clinical course of malignant melanoma in the oral region was generally worse than those of oral squamous cell carcinoma and salivary gland carcinoma. Radiotherapy seemed to be effective in prolonging the life of these patients.

Amelanotic malignant melanoma rarely occurs in the oral cavity. We encountered and treated patient with a nodular amelanotic malignant melanoma arising in the maxilla. An 84-year-old woman was referred to our hospital because of a painless, pedunculated, nonpigmented tumor in the center of the anterior alveolar region of the maxilla. The clinical diagnosis was a benign tumor, and the lesion was excised. However, the histopathological diagnosis was malignant fibrous histiocytoma.Three months later, a small, partially pigmented tumorous lesion appeared in the same region. The tumor was resected, and minute quantities of melanin granules were observed in some tumor cells histologically. The specimen was diagnosed as amelanotic malignant melanoma. We performed immunohistochemical studies, and positive immunoreactivity for HMB-45 was found in each specimen, confirming the diagnosis.Although the patient subsequently underwent rotation radiotherapy to the maxilla, recurrence was found in the nasal cavity and ethmoidal sinuses 13 months after radiation therapy. The tumor grew rapidly, and the patient died 2 years 5 months after presentation.

Hepatocellular carcinoma (HCC) rarely metastasizes to the oral and maxillofacial regions. To our knowledge, only 24 cases have been reported. Two additional cases of metastatic HCC in the oral and maxillofacial regions are reported and related cases reported in the literature are reviewed. A 47-year-old man complaining of swelling of the right TMJ and a 63-year-old man complaining of buccal swelling, in both cases, the primary lesion was diagnosed only after diagnosis of the oral and maxillofacial lesion.

Various studies of oral malignant tumors were reported, but the relationship between their ultrastructure and microscopic and clinical findings is rarely examined. It is said that the attachment of malignant tumor cells is looser than that of normal epithelial cells and that inter-cellular spaces of malignant tumors are wider than those of normal tissue. In this study we examined the ultrastructure of oral squamous cell carcinoma, especially the cell attachment which was taken in Erlangen University (West Germany).All cases used for this study were clinically advanced. Electronmicroscopically the nucleus was irregular and the nuclear cytoplasm ratio was high. In the cytoplasm tonofilaments were well developed and the other organellas were not outstanding. Between the cells, desmosomes and microvilli were seen. In the high cell atypical cases numerous microvilli and few desmosomes were observed and foliate membrane bound cytoplasmic extensions were observed in the intercellular spaces. It was difficult to confirm the relationship between the ultrastructure of the cancer cells and the degree of differentiation.

Mucoepidermoid tumor is found in a high incidence in adults, however, in a relatively low incidence in children. We reported a case of mucoepiderrnoid tumor originated from the minor salivary gland in a 13-year-old girl.The patient visited us with complaining of the swelling in the palate. Under general anesthesia the tumor was resected and the clinical course is good.Histological findings revealed that this case was Grade II according to the Komori's classification.We also referred to 34 cases of mucoepidermoid tumor in the First Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tokyo Medical and Dental University during past the 14 years from 1976 to 1989. The incidence of the mucoepidermoid tumor in children was only 5.9% (2/34) and clinical courses of them are good. The five year survival rate of all the 34 cases was 82.5%.Eventhough the prognosis of the mucoepidermoid tumor is statistically good, the present case seems necessary to follow-up for a long time, considering the moderate differentiation of the tumor.

We encountered a case of Basal cell nevus syndrome in which multiple cysts occurred during long-term follow-up.The patient was a 8-year-old boy. Frontal and temporal bossing, ocular hyperterolism, mandibular prognathism, multiple jaw cysts, pit, calcification of the flax cercbri and bifid-rib were observed.Primordial cyst in tire kit maxilla and follicular cysts in the bilateral mandible were confi rmed 4 years after the operation for the left mandibular cyst. From the histopthological investigation, the process of cyst formations in this ease seemed to be identical with Broca's theory. The growth of the cysts was rapid in a short period of 1-2 years.We performed an enucleation with closure for the c ysts in the maxilla and enucleation with packing open for those in the mandible. No recurrence has occurred up to now, but a long-term follow-up is required in consideration of occurrence and recurrence of the cyst.

A lateral cervical cyst occurred in a 30-year-old man with hemophilia A was reported. The cyst was located in the anterior portion of the sternocleidmastoid muscle, and was adjacent to the parotid gland. Amylase, GOT, GPT, γ-GTP and LDH activities of cyst contents were higher than those in patient's serum samples. Especially the amylase activity was extremely high. Histopathologically, the lining of the cyst wall was consisted of columnar or cuboidal cells. In addition serous gland and lymphocyte accumulation without germinal center were observed in some places of the connective tissue. The electron microscopic view had a strong resemblance to that of Varthin tumor. It is strongly suggested that our case was a parotid retention cyst.

We performed a clinicostatistical study of 102 maxillofacial fractures due to sports during the 17-year period between 1977 and 1993 at The First Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tokyo Medical and Dental University, Japan. Of all maxillofacial fractures, the rate of sports-related fractures was 10.5%. The patients had injuries resulting from 22 different sports, and the most common sport responsible for injury was rugby, followed by skiing, baseball, and soccer. The ratio of males to females was 6:1, and the majority of the patients were between 10 and 29 years old. Fractures of the mandible and the alveolar process were common. Conservative therapy, such as maxillomandibularfixation, was usually performed.

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.

We performed a clinico-statistical study of 617 teeth in 263 patients with traumatic injuries to the teeth who were treated at The First Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tokyo Medical and Dental University, during 10 years between 1983 and 1992.Almost half of all injuries affected the maxillary incisors. The most frequent type of injuries was luxation (65%), followed by crown fracture, avulsion, root fracture, and crown root fracture.Eighty-nine percent of all teeth could be managed successfully by conservative treatment.

We describe a mucous cyst in the submandibular region of a child that was considered to be a congenital lateral cervical cyst.A 6-year-old boy was referred to our department on April 5, 1990 by a general dentist. His chief complaint was swelling in the left submandibular region. The patient's past medical history and family history were noncontributory. The left submandibular swelling had been noticed since November 1988. On clinical examination, a mass (50×30×30mm) was recognized in the swelling. It's border was clearly demarcated, and it did not have a wavy feeling or tenderness. Based on the clinical findings, the lesion was suspected to be a congenital lateral cervical cyst. Under general anesthesia, enucleation of the cyst was performed on July 31, 1990. The cyst wall was thick. Pathological examination revealed a mucous substance in the cyst, and the minor salivary glands were close to the cyst wall. The dibgnosis was therefore a mucous cyst. There has been no recurrence as of 3 years after operation. The cyst was suspected to be a mucous cyst that originated from an ectopic salivary gland.

Basal cell nevus syndrome (BNS syndrome) is considered to be an autosomal dominant hereditary disease, associated with pits of the palm, multiple jaw cysts, calcification of the falx cerebri, and skeletal anomalies.We treated two sisters with BNS syndrome associated with multiple jaw cysts. In their grandmother and other brother and sister, multiple jaw cysts were recognized. It was suggested that genetic factors might play a role in the development of multiple jaw cysts. Moreover, two of six children of the family also had ocular hypertelorism and pits of the palm.

Calculi of the parotid gland are rare. Recently, we encountered a patient with a calculus in the parotid gland and performed structural analysis of the calculus, compared to calculi in the submandibular gland, by scanning electron microscope (SEM), transmission electron microscope (TEM), X-ray microanalyzer and X-ray diffractor.The patient, a 60-year-old female, visited our clinic with the chief complaint of a strange feeling in the right parotid gland. CT scan examination revealed a stone in the parotid gland duct, which was removed under general anesthesia.By X-ray microanalyzer, the detected component elements in calculi were Ca, P, S, Mg, Na, etc. X-ray diffractor and TEM revealed the presence of hydroxyapatite. SEM examination showed a granular or globular structure on the surface of the calculus. Cocci and filamentous microorganisms were seen on the surface. From these investigations, it was difficult to clarify structural differences between calculi in the parotid gland and those in the submandibular gland.

We report a tongue abscess which was suspected to be a tumorous lesion clinicopathologically.The patient was a 62-year-old male. He noticed painless swelling in left sublingual region and came to our department. Pathological examination of a biopsy specimen led to a diagnosis “Metastatic squamous cell carcinoma suspected”. However, as other examinations did not reveal any signs of the tumor in other organs, we removed the entire tongue lesion under local anesthesia. Tumor tissue was not found in the pathological specimens.The origin of the epithelial components noted in the tongue abscess at biopsy is discussed.

Ameloblastoma in the maxilla is relatively rare even though this tumor is most frequently seen among odontogenic tumors.We had a chance to treat a case of ameloblastoma (follicular type) in the maxilla which seemed to be clinically at first a malignant tumor and took primary culture cells from the tumor tissue.Ultrastructural observation of the cells in vivo and in vitro were performed.In the cells in vitro, nucleus was round and nucleolonema in the nucleoli were recognized. In the cytoplasm, many lysosomes were found and the number of rough endoplasmic reticulum was not so large as in vivo.The cells in vitro resembled columnar epithelial cells in vivo.As compared with the active cells in vivo, the cells in vitro had few organella.

Rare varieties of malignant melanoma occurring in the oral area will be shown in this presentation.We observed four cases of malignant melanomas, especially their rough endoplasmic reticulum and melanosomes by transmission electronmicroscopy.We examined the relation between the stages of melanosomes and clinical features of malignant melanomas.The tumor growth of one case was clinically slow as compared with the other cases, and the electronmicroscopic findings revealed many melanosomes of which stages were high and few rough endoplasmic reticulums.The tumor growth of other cases was fast. Their ultrastructures showed many melanosomes of various stages.In the case of which the tumor growth was fastest, numerous rough endoplasmic reticulums were shown.This study suggest that the growth of the malignant melanomas in which the stages of the melanosomes are high are slow.

The histogenesis of the lymphoepithelial (so-called branchial) cyst has been a matter of speculation and controversy for some time. The most popular hypotheses implicate the branchial apparatus, the thymic duct, and parotid salivary gland inculusions in lymph nodes.Lymphoepithelial cysts occurring within the parotid gland are rare developmental anomalies.A lymphoepithelial cyst within the parotid gland in a 52-year-old man is reported.The patient had a six-month history of a gradually enlarging mass lesion anterior to his left ear. A parotid sialogram and computed tomographic examination revealed the presence of a mass lesion in the upper portion of the superficial lobe. The clinical diagnosis was benign parotid tumor. Under general anesthesia, excision was performed. Approximately 5 ml of yellowish fluid was removed and biochemical analysis revealed high activity of LDH and γ-GTP. Histologically, the cyst was lined with squamous epithelium or cuboid epithelium which was surrounded by lymphoid tissue with follicles.There has been no recurrence of the lesion to date, 16 months after operation.

A case of relatively large lipoma of the right neck is reported and thirty-three cases of lipomas treated in our department from 1965 to 1986 are reviewed.A 64-year-old man was admitted to our department complaining of a right neck swelling. The preoperative diagnosis was lipoma based on clinical findings as well as the image findings of CT scan and echogram. The tumor was excised through a cervical skin incision under general anesthesia. It lied between the platysma and the superficial layer of the cervical facia. The enucleated yellow and soft specimen was 12×7×6.5cm in size, and covered with a thin fibrous capsule. The histopathological diagnosis was lipoma. The prognosis has been good for about one year. From our statistical study the distribution by site of 33 lipomas is as follows: eleven cases in the check, five in the lower lip, five in the tongue, three in the submandibular region, two in the gingiva, the floor of the mouth, the soft palate, the preauricular portion each other and one in the neck.Males are more affected than females.76% of the patients are over 40 years of age.

A case of radiation-induced cancer was reported. A 46-year-old man developed buccal mucosal and maxillary cancer (squamous cell carcinoma) 19 years after external radiation therapy for buccal papilloma. Previous irradiation was 60Co, 186.5 Gy. Latent period was 19 years, but 7 years after the irradiation osteomyelitis arose in the mandible. X-ray films of the mandible revealed an osteolytic and osteosclerotic lesion.Conservative treatment of the osteomyelitis was not so effective. Partital resection of the mandible and resection of buccal scar tissue combined with reconstructive surgery of the cheek using a pectoralis major myocutaneous flap were performed in September, 1984. The histological examination of the resected specimen showed squamous cell carcinoma and the ultrastructural study on this case was further performed.In spite of wide excision and intra-arterial chemotherapy combined with irradiation, the patient died of the carcinoma in October, 1986.