Search

A clinicopathological study in 229 patients with postoperative maxillary cysts (POMC)(unilateral: 215 cases. bilateral: 14 cases) is described.The patients were treated at our hospital between 1979 and 1989. The age of the patients ranged from 18 to 72 years, and their average age was 45.2 years. The chief complaints of these patients were swelling and pain, and POMC were diagnosed based on clinical, radiologic and histopathologic findings.The patients were surgically treated by the following procedures: 1) extirpation of cysts (35 cases), 2) marsupialization to the inferior meatus (120 cases), and 3) radical operation according to the Caldwell-Lucs, method (88 cases).Histopathologic examination revealed various patterns of the cyst wall, including ciliated, cuboidal, squamous, and columnar epithelium, as well as a mixture of two or three kinds of these epithelial cells.Radiological examination using contrast media revealed that the from of cysts was either ovoid or irregular.One of the 243 cases showed recurrence. In this case, there was no passage between the cystic and nasal cavity. These findings suggest that sufficient marsupialization to the nasal cavity is important to ensure a favorable outcome.

A case of exostosis at the inferior border of the mandible was reported. The patient was a 66-year-old woman who complained chiefly of painless swelling at the inferior border of the left mandible. Physical examination disclosed a firm and hard mass, adhering to the inferior surface of the mandible. Roentogenograms of the mandible disclosed a cylindric, radiopaque appearance, which extended outward beyond the normal inferior border of the left mandible. The clinical diagnosis was exostosis. Surgical removal of the bony mass was done under local anestl-esia. The bony mass was about 6 mm in diameter and 12 mm in length. Its histopathological diagnosis was also exostosis. Generally, exostosis is not a rare disease, but such cylinder shaped exostosis occurring at the inferior border of the mandible as seen in this case was extremely rare. And we could not find out the cause of the lesion in this case.The patient was last seen about two years after the operation and no evidence of further trouble was found clinically and roentogenologically at that time.

Pycnodysostosis first described by Aoike (1954) and named by Marouteaux and Lamy (1962), is a rare skeletal bone disease. This disease is characterized by dwarfism, failure of closure of cranial sutures, obliquity of mandibular angle and defects of the terminal phalanges.A rare case of pycnodysostosis in 42 year-old woman complicated with maxillary and mandibular osteomye-litis for a long time was reported. This patient suffered severe osteomyelitis following a tooth extraction because of extremely high bone density and abnormal dentition. We discussed the treatment of osteomyelitis associated with pycnodysostosis.

This report was undertaken to reveal the process of changes occuring in the alveolar clefts secondarily transplanted with fresh autogenous particulate cancellous bone and marrow of iliac bone, the frequency of the bone bridge formation in the alveolar cleft, and the time of bone bridging after the operation.The subjects were 87 cases with alveolar clefts, which consisted of 14 cleft lip and alveolus, 55 unilateral cleft lip and palate, and 18 bilateral cleft lip and palate. The average age at the time of bone grafting was 13 years 0 month with a range from 8 years 5 months to 22 years 1 month. The materials used in this investigation were periapical and occlusal radiographs taken before and after the bone grafting.The information obtained was summarized as follows:1. The frequency of the bone bridge formation in the alveolar clefts by one year postoperatively was 84.9% as a whole, and it had a tendency to decrease as the patients age increased.2. The bone bridge formation was completed from three to six months in the majority of the cases, and the average bone bridging time was 5. 4 months after the operation. The completion of the bone bridge formation was likely to delay, as the time of operation was later.3. No significant relation was observed between rate of successful bone formation in the clefts and the sex of the patient or the type of clefts.

In this paper, a 16 year old male case of odontogenic myxofibroma with peculiar calcareous substances in the lower left molar region and mandibular ramus was reported. He had suffered from a swelling without pain in this region. Radiographic examination revealed a multilocular and radiolucent lesion containing a mandibular third molar and uncertain cloudy radiopaque shadows. Boundary of the lesion was radiographically comparatively clear. Extraction of the second molar and removal of the tumor were performed under general anesthesia. The tumor was 6.5×3. 5×4.0cm in size, trancelucent and light brown color, smooth surfaced with soft consistency and cystic lumens containing viscoid fluid.Thin calcareous substances were scattered in the tumor.Microscopically, the tumor consisted of dense fibrous connective and myxomatous tissues. Tumor cells were stellate or spindle shaped, but mitotic figure was not seen. The tumor contained numerous peculiar calcareous substances which varied in size and were of unknown origin. The tumor was diagnosed odontogenic myxofibroma because of the existence of epithelial islands of odontogenic origin and continuation between dental sac of the embedded third molar and tumor tissue. No recurring after treatment.

Secondary bone grafting of alveolar clefts has been performed in 109 cleft palate patients, 55 boys and 54 girls, using the autogenous particulate cancellous bone and marrow of the iliac bone. The patients age range was 8 years 2 months to 28 years 8 months, with a mean age of 12 years 11 months.Before the bone grafting, any malocculusion of the maxillary segments were corrected with orthodontic treatment. Operation was done with simultaneous correction of alveolar clefts and oral-nasal fistulas.The incision made along the clefts margin of the labial site, mucoperiosteal flap was developed.Mucoperiosteum of the fistula was dissected and separated the palatal and nasal portion with scissors. The mucoperiosteum were closed with stiches in each.At this point, nasal and palatal layers of mucoperiosteum had been created. Cancellous bone and marrow were packed into any spaces, and placed in the area of the alar base. After an adequate osseous form was obtained, the labial mucoperiosteum was undermined and relaxed, and closed with stiches. But, the cases of great oral-nasal fistulas, labial sulcus flap used closure of the labial and palatal portion of oral-nasal fistula.Secondary bone grafting of alveolar clefts has following benefits to cleft palate patients.1) Stabilization of the maxillary segment.2) Closure of oral-nasal fistulas.3) Support of the slumping alar base of the nose.4) Restoration of alveolar process and dental arch.5) Provision of bone support for unerupted canine.These advantages of secondary bone grafting were results of short term observation, but, in the future, long term observation is necessary.