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PURPOSE: The purpose of this study was to analyze impalement injuries of the oral cavity in children. PATIENTS AND METHODS: Data on 144 children with impalement injuries in the oral cavity at the Department of Oral and Maxillofacial Surgery, Nara Medical University were analyzed retrospectively. RESULTS: The patients were 93 boys and 51 girls (age range, 7 months to 10 years). One hundred thirty-two patients (91.7%) were younger than 5 years. Injuries occurred frequently by falling onto an object held in the mouth in 77 patients (53.5%). The impaled objects were a toothbrush in 30 patients (20.8%), a cylindrical toy in 27 (18.8%), and chopsticks in 19 (13.2%). The soft palate was frequently involved in 64 patients (44.4%), followed by the hard palate in 26 (18.1%). Computed tomographic examination was performed in 16 patients (11.1%). Observation with or without medication was most frequently chosen in 98 patients (68.1%). Surgical intervention was performed in 46 patients (31.9%), 41 under local anesthesia and 5 under general anesthesia. Admission was required in 12 patients (8.3%). No complications, such as deep infection or neurologic sequelae, were observed. CONCLUSIONS: Most impalement injuries in the oral cavity in children heal spontaneously or with minimal intervention. These children can be followed on an outpatient basis with instructions to their parents about possible complications, except for a few selected cases. Language: en

Purpose This study investigated the biomechanical behavior of the mandible after marginal resection by tensile test in a human cadaveric mandible and finite element (FE) analysis. Materials and Methods Human cadaveric mandibular models after marginal resection were prepared with residual heights of 5, 10, and 15 mm. The strength in each of these mandibular models was examined by tensile testing. In addition, FE models of the mandible after marginal resection were prepared with residual heights of 5, 7.5, 10, 12.5, and 15 mm. Distribution and magnitude of von Mises stress were analyzed by applying bite forces of 151 N as a point load on the incisal region and 355.2 and 478.1 N on the premolar and molar regions on the nonresected and resected sides, respectively. At the molar region of the resected side, bite forces of 368.5 N and 286.9 N (80% and 60%, respectively, of 478.1 N) were also applied. Results On tensile testing, all cadaveric mandibular models were broken at the posterior resection corner. The tensile force was significantly larger in the model with a residual height of 15 mm compared with that of those with a 5- or 10-mm residual height. On FE analysis, von Mises stress was concentrated at the resection corner. The region of maximal von Mises stress concentration in FE models was consistent with that showing destruction on tensile testing. The relationship between the residual height and von Mises stress in the resection area was linear in models of the incisal, premolar, and molar loading on the nonresected side and quadratic in models of the premolar and molar loading on the resected side. The maximal von Mises stress in the resection area was highest during molar loading on the resected side under the present loading condition and exceeded the threshold for the development of pathologic fracture in the model with a residual height of around 10 mm or less. However, the maximal von Mises stress decreased in parallel with the reduction of bite force in the molar region of the resected side. Conclusions The residual height and bite force are critical factors for the prevention of pathologic fracture of the mandible after marginal resection. Currently, a residual height of more than 10 mm and reduction of bite force are recommended to reduce the risk of fracture.

One hundred and three patients with maxillofacial fractures due to work-related accidents were analysed. Ninety-nine patients (96.1%) were male and 4 (3.9%) were female. The average age was 46.8 years (range 18-75 years). The injuries were most commonly sustained during construction (42 patients, 40.8%) followed by agriculture and forestry (31 patients, 30.1%) and manufacturing (15 patients, 14.6%). Being struck by an object was the main cause of injury (43 patients, 41.7%) followed by fall from one level to another (31 patients, 30.1%). Fifty-four patients (52.4%) had fractures in the mandible, 41 (39.8%) in the midface, and 8 (7.8%) in both the mandible and the midface. The most common sites for fractures were the condyle and symphysis in the mandible and zygoma in the midface. The facial injury severity scale ranged from 1 to 6 with an average of 1.99±1.18. There was no difference in the nature of the work being undertaken or the cause of the injury. Fractures in other sites were observed in 22 patients (21.4%). Open reduction and fixation was the most frequent treatment for mandibular fractures (25 patients, 40.3%) followed by maxillomandibular fixation (19 patients, 30.6%). Observation was most commonly used for midface fractures (18 patients, 36.7%) followed by open reduction and fixation (15 patients, 30.6%) and transcutaneous reduction (8 patients, 16.3%).

This report is the case report of a 48-year-old woman who referred to our hospital complaining of a mass at the left maxillary tuberosity and slight trismus. CT and MRI imagings showed a tumor like image with bone absorption of the left maxillary tuberosity. Under general anesthesia, the lesion was excised. Histopathological examination showed low grade mucoepidermoid carcinoma. There is no sign of recurrence or metastasis of the tumor in 5 year after the surgery.

強度の強い化学放射線療法（CRT）を実現可能とし，高い完遂率を得るためには適切な支持療法が必須である。疼痛管理は頭頸部癌CRTの主要な支持療法の一つである。施設や医師に依らず一定の鎮痛効果が得られ，高いCRT完遂率を得る事を目的として，オピオイドを中心とした疼痛緩和プロトコルを作成した。10施設でこの疼痛緩和プロトコルを実施し，その有効性と安全性を評価した。対象は口腔咽頭に50Gy以上照射される部位を含み，白金製剤を中心としたレジメンによる同時併用CRT症例である。110例の症例集積を行い，内101例の適格症例を解析対象とした。Grade 3以上の粘膜炎の頻度は53%だったが，照射完遂率99%，照射休止率13%と極めて良好な結果が得られた。オピオイド使用率は83%，一日最大モルヒネ投与量の中央値は35mg，プロトコル遵守率は92%だった。オピオイドの投与中止を要した例やオピオイドの副作用による照射休止例はなく，安全性にも優れた方法と考えられた。

口腔癌では，初回治療後から再発や転移がなく5年以上経過すれば臨床的に治癒したとみなされる。治療成績も5年生存率で検討されることが多いが，5年以上の経過後に再発する症例もみられる。我々は，根治手術をおこなった進行口腔扁平上皮癌症例の治療成績および経過観察の期間と再発時期との関連について検討を行った。対象は1994年11月から2004年10月までに経験した口腔扁平上皮癌症例312例のうち，Stage III・IVの進行癌で，Stage IIIが76例，Stage IVが40例であり，平均年齢は63.0歳であった。10年累積生存率は77.8%であった。原発巣累積再発率は10年で20.1%であり，頸部累積再発率は10年で12.9%であった。局所再発率は2年で19.0%と最も高く，5年以降で3.4%であった。5年以上経過した症例においても再発症例が存在することから，長期の経過観察の必要性が示唆された。

Runt-related transcription factor 3 (RUNX3) is a transcription factor of the transforming growth factor (TGF)-β superfamily and acts as a tumor suppressor gene, which is silenced by hypermethylation of the promoter region in various cancers. In this study, we examined the expression and methylation status of RUNX3 in the salivary gland cancers pleomorphic adenoma (PA), adenoid cystic carcinoma (ACC) and mucoepidermoid carcinoma (MEC). The cytoplasmic expression rates of RUNX3 in PA, ACC and MEC were 65% (13/20), 22.2% (8/36) and 20.6% (7/34), respectively. Low expression or deletion of RUNX3 in ACC and MEC was significantly associated with tumor progression and poor prognosis. Using microdissected cDNA, we found that RUNX3 mRNA expression was lower in ACC and MEC than in PA and noncancerous salivary glands; furthermore, hypermethylation of RUNX3 was detected more frequently in PA (2/8, 25%), ACC (6/8, 75%) and MEC (7/8, 87.5%) than in noncancerous salivary glands (0/8, 0%). Our results suggest that low expression or deletion of RUNX3 in salivary gland tumors might play a pivotal role in tumorigenesis and tumor progression and poor prognosis in the case of salivary gland ACC and MEC. Recovery of the tumor suppressive function of RUNX3 might inhibit tumorigenesis and cancer progression in the human salivary gland.

The fate of developing tooth buds located in relation to mandibular fractures was investigated in three infancy cases. Three infants, 2 girls and a boy, aged from 1 year and 5-months old to 2 years and 6-months old, were treated for dislocated mandibular fracture in the symphyseal region by manual reduction and fixation with a thermoforming splint and circumferential wiring under general anesthesia. Fracture healing was uneventful in all cases. A few years later, no obvious deformity of the jaw or malocclusion was observed; however, malformation of the crown was found in one of the permanent teeth on the fracture line in the first case. In the second case, no abnormality was observed in one of the permanent teeth on the fracture line, but the effect on the other tooth could not be evaluated due to abnormality of the tooth probably not related to the injury. In the third case, root formation was arrested in one of the permanent teeth on the fracture line and the tooth was lost early after eruption. The development of tooth buds on the fracture line is not predictable and therefore, should be monitored by regular follow up.

Temporomandibular joint disorders (TMD) show complex symptoms associated with inflammation, pain and degeneration of the peripheral tissues including synovium. Although it is believed that excessive mechanical stress on synovium causes development of TMD, the molecular mechanism by which mechanical stress triggers TMD has still remained unclear. In order to examine the effect of mechanical stress on synoviocytes, rabbit synovial cells were cyclically stretched in vitro. The stretch efficiently increased the gene expressions of cyclooxygenase-2 (COX-2), inducible nitric oxide synthase (iNOS) and NF-kappaB responsive reporter gene constructs. The interruption of NF-kappaB activating pathway by inhibitors resulted in the abrogation of those expressions, indicating the pivotal role of NF-kappaB in the mechanical stretch-mediated COX-2 and iNOS expressions. In parallel, the stretch remarkably increased NO production and poly(ADP-ribose) (PAR) synthesis, suggesting that excessive amounts of NO causes DNA injury and in turn activates PAR synthesis by poly(ADP-ribose) polymerase (PARP). The inhibition of PAR synthesis by a PARP inhibitor or a radical scavenger enhanced the mechanical stretch-induced gene expressions in a NF-kappaB-independent manner, implying an involvement of PARP in the gene expression. Taken together, these results demonstrate that mechanical stress on synovial cells not only induces gene expressions of COX-2 and iNOS but also affects PAR synthesis.

Background:In a pilot study, we showed that topical administration of a tetracycline could decrease oral bacteria levels for 6 hours in patients who underwent oral cancer surgery combined with tracheotomy and flap reconstruction. This multicenter, randomized control trial aimed to investigat

UNLABELLED Nonsyndromic cleft lip with or without cleft palate (NSCLP) is one of the most common birth defects. Despite its frequency, the etiology remains largely unknown. Most likely, both genetic and environmental factors contribute to this malformation. A polymorphic gene family, the major histocompatibility complex class I chain-related gene A (MICA), is located about 40 kb centromeric to the HLA-B gene. In this study, we analyzed the association between MICA gene polymorphisms and NSCLP in Japanese patients. METHODS The (GCT)n polymorphism of the MICA gene was investigated in 94 patients with NSCLP and 180 normal controls using polymerase chain reaction amplification and denaturing polyacrylamide gel electrophoresis. RESULTS Our results demonstrate that there are no differences in microsatellite allele frequency between NSCLP patients and controls. However, the microsatellite allele frequency of the MICA-A6 (p = 0.045) allele was increased in male patients, as compared with controls. Further, the MICA-A5 (p = 0.359) allele was also increased in female NSCLP patients. CONCLUSION These results suggest that the microsatellite allele frequencies of the MICA-A6 allele increased in male NSCLP patients. Although the MICA-A5 allele increased in female NSCLP patients, the increase was not statistically significant. These results suggest that the MICA gene could be one of the candidate genes for NSCLP.

Objective: To determine the changes in articular disk position and the temporomandibular joint (TMJ) structure in patients who had an asymmetric setback of the mandible performed by a bilateral sagittal split ramus osteotomy with manual positioning of the condyle. Materials and Methods: Twenty-two patients with skeletal Class III malocclusion being treated at Nara Medical University Hospital were evaluated using clinical examination and pre- and postoperative magnetic resonance images of their TMJs. Results: Changes in articular disk position after asymmetric setback surgery were not statistically significant, although a tendency of anterior displacement in the fossa was noted. The anterior and posterior joint spaces did not show significant changes, whereas the condyle head of the deviated or contralateral side tended to be positioned downward. Conclusion: The asymmetric setback of the mandible with intraoperative manual positioning of the condyle does not significantly change the disk position in the fossa.

The purpose of this study was to clarify the effect of the body profile on the whole saliva flow rate in healthy male and female subjects.The whole saliva flow rate was evaluated under unstimulated (UWSFR) and stimulated conditions by the gum test (SWSFR-GT) and Saxon test (SWSFR-ST), and its correlation with body profiles such as body height (BH), body weight (BW), body surface area (BSA) and body mass index (BMI) was analysed in 100 male and 100 female subjects.The averages of UWSFR, SWSFR-GT and SWSFR-ST and those of BH, BW, BSA and BMI were significantly larger in males than in females (p0.0001). No correlation was observed between any of UWSFR, SWSFR-GT and SWSFR-ST and any of BH, BW, BSA and BMI for either males or females. However, UWSFR, SWSFR-GT and SWSFR-ST were significantly correlated with BH, BW and BSA when data from male and female subjects were combined.The whole saliva flow rate from an individual should only be compared with the data from the group of the same gender.

Purpose This study analyzed the changes in mandibular movement and occlusal condition after conservative treatment for unilateral condylar fractures by use of a sensitive occlusal pressure sheet (Dental Prescale; Fujifilm, Tokyo, Japan) for the evaluation of occlusal condition. Patients and Methods We compared 18 patients conservatively treated for unilateral condylar fracture with 23 control subjects. Mandibular movement and occlusal condition were evaluated at 3 and 6 months after conservative treatment. Results Maximal mouth opening over 40 mm was achieved at 6 months but was not improved to the control level. Recovery of lateral excursion, protrusion, or deviation on mouth opening was also limited at 6 months. Occlusal area, which was reduced at 3 months, had significantly improved at 6 months. The asymmetry index of the occlusal area was significantly improved at 6 months compared with that at 3 months. Mean pressure in the patient group was significantly greater than that in the control group. Total occlusal force, which was reduced at 3 months, was significantly improved at 6 months. The asymmetry index of occlusal force, which was significantly greater than that in the control group, was significantly improved at 6 months. Conclusions Mandibular movement was increased at 6 months despite the slight disturbance in lateral excursion to the nonfractured side and the presence of deviation on mouth opening. Occlusal area and occlusal force improved at 6 months, although mean pressure remained slightly higher than that in the control group.

Conventional clinical treatments with X-rays provide an effective modality for widely various human cancers, however, therapeutic results are sometimes poor. Many mutations have been reported to be in the p53 gene in advanced human cancers. The p53 plays a pivotal role in the pathway which controls apoptosis, cell growth and cell proliferation, and mutations or deletions in the p53 gene lead to resistance to cancer therapy. The involvement of the p53 gene in determining the sensitivity of many cell types toward low linear energy transfer (LET) radiation is now well established. In contrast to low LET radiation, high LET radiation has several potential advantages over X-rays, one of which is the fact that its effects may be independent of cellular p53 gene status. It is conceivable that effective future therapeutic strategies may be designed on the basis of genetic and biochemical events involved in cell death. Therefore, the accurate characterization and quantification of the mode of cell death, such as apoptosis and necrosis, has become increasingly important for the further understanding of the biological effectiveness of high LET radiation. This review discusses the mechanisms of p53-independent apoptosis by high LET radiation.

Objective: To retrospectively investigate haemostatic management of multiple tooth extraction (≥ teeth) inpatients with haemophilia. Patients and Methods: Thirty patients underwent 35 tooth extractions. Haemostatic management was compared between minimal tooth extraction (1 or 2 teeth) and multiple tooth extraction (≥3 teeth) among patients with haemophilia A or B. Among patients with haemophilia A, the activity of plasma factor VIII was increased to about 80% from 1 hour before extraction and was maintained at 50 to 60% at 12, 24, and 48 hours after extraction in the multiple tooth extraction group. In addition, synthetic vasopressin was used in patients with mild or moderate haemophilia A, with 0.4 μg/kg of vasopressin administered 1 hour before extraction and as needed 24 hours after extraction. Among patients with haemophilia B, the activity of plasma factor IX was increased to about 60% from I hour before extraction and was maintained at 30 to 40% at 24 and 48 hours after extraction in the multiple tooth extraction group. Results: No postoperative bleeding was seen in any patients with haemophilia A, but postoperative bleeding was seen for 1 patient in the haemophilia B group. Conclusions: Dental preventive management is important for patients with haemophilia. Haemostasis was achieved for all the patients studied. In the multiple tooth extraction group, the plasma level of factor VIII concentrate was increased for patients with haemophilia A while that of plasma factor IX concentrate was increased for patients with haemophilia B, as part of systemic haemostatic measures. In patients with mild or moderate haemophilia A, vasopressin was also used.

Aims: Regenerating islet-derived family, member 4 (Reg IV) is associated with the progression of various cancers. The aim was to examine Reg IV expression in adenoid cystic carcinomas (ACCs) in salivary glands. Methods and results: Reg IV expression was detected by immunohistochemistry and compared with clinicopathological parameters. Expression of phosphorylated epidermal growth factor receptor (pEGFR), phosphorylated AKT (pAKT) and MUC2 was examined by immunohistochemistry. Reg IV function was assessed with Reg IV antisense S-oligodeoxynucleotides (AS) in ACC3 human ACC cells. Reg IV was expressed by salivary duct epithelia and acinus myoepithelia, but not in squamous epithelia. Reg IV expression was found in 41% (17/41) of ACCs, but in none of 40 oral squamous cell carcinomas (OSCCs) and was associated with nodal metastasis (P = 0.047) and poor prognosis (P = 0.012) in ACCs. Reg IV expression was associated with pEGFR (14/17, 82%) in Reg IV+ ACCs, but had no relationship with pAKT or MUC2 expression in ACCs. Cell growth was inhibited by AS treatment in Reg IV+ ACC3 cells, but not in HSC-4 OSCC cells, whereas in vitro invasion of neither cell types was affected by AS treatment. Conclusions: These results suggest that Reg IV might accelerate cell growth and disease progression of ACCs.

Although mutations in the p53 gene can lead to resistance to radiotherapy, chemotherapy and thermotherapy, high linear energy transfer (LET) radiation induces apoptosis regardless of p53 gene status in cancer cells. The aim of this study was to clarify the mechanisms involved in high LET radiation-induced apoptosis. Human gingival cancer cells (Ca9-22 cells) containing a mutated p53 (mp53) gene were irradiated with X-rays, C-ion (13–100 KeV/µm), or Fe-ion beams (200 KeV/µm). Cellular sensitivities were determined using colony forming assays. Apoptosis was detected and quantified with Hoechst 33342 staining. The activity of Caspase-3 was analyzed with Western blotting and flow cytometry. Cells irradiated with high LET radiation showed a high sensitivity with a high frequency of apoptosis induction. The relative biological effectiveness (RBE) values for the surviving fraction and apoptosis induction increased in a LET-dependent manner. Both RBE curves reached a peak at 100 KeV/µm, and then decreased at values over 100 KeV/µm. When cells were irradiated with high LET radiation, Caspase-3 was cleaved and activated, leading to poly (ADP-ribose) polymerase (PARP) cleavage. In addition, Caspase-9 inhibitor suppressed Caspase-3 activation and apoptosis induction resulting from high LET radiation to a greater extent than Caspase-8 inhibitor. These results suggest that high LET radiation enhances apoptosis by activation of Caspase-3 through Caspase-9, even in the presence of mp53. (Cancer Sci 2008; 99: 1455–1460)

Adult stem cells have been reported to exist in various tissues. The isolation of high-quality human stem cells that can be used for regeneration of fatal deseases from accessible resources is an important advance in stem cell research. In the present study, we identified a novel stem cell, which we named tooth germ progenitor cells (TGPCs), from discarded third molar, commonly called as wisdom teeth. We demonstrated the characterization and distinctiveness of the TGPCs, and found that TGPCs showed high proliferation activity and capability to differentiate in vitro into cells of three germ layers including osteoblasts, neural cells, and hepatocytes. TGPCs were examined by the transplantation into a carbon tetrachloride (CCl4)-treated liver injured rat to determine whether this novel cell source might be useful for cell-based therapy to treat liver diseases. The successful engraftment of the TGPCs was demonstrated by PKH26 fluorescence in the recipient's rat as to liver at 4 weeks after transplantation. The TGPCs prevented the progression of liver fibrosis in the liver of CCl4-treated rats and contributed to the restoration of liver function, as assessed by the measurement of hepatic serum markers aspartate aminotransferase and alanine aminotransferase. Furthermore, the liver functions, observed by the levels of serum bilirubin and albumin, appeared to be improved following transplantation of TGPCs. These findings suggest that multipotent TGPCs are one of the candidates for cell-based therapy to treat liver diseases and offer unprecedented opportunities for developing therapies in treating tissue repair and regeneration.

This report is of a 50-year-old woman with a large multilocular keratocystic odontogenic tumour that regressed after biopsy. At first visit, a swelling involving the right buccal region and right molarto- retromolar region of the mandible was observed. Panoramic and posteroanterior X-ray examination showed a multilocular radiolucent lesion from the right premolar region to the ramus of the mandible causing resorption of the root of the right second premolar tooth. After a clinical diagnosis of ameloblastoma at the right mandible was made, intraoral tissue biopsy was performed. The histological diagnosis was keratocystic odontogenic tumour. However, the patient refused treatment and was lost to follow-up. When she returned to the department 8 years and 5 months later, the multilocular lesion had almost disappeared on panoramic and posteroanterior X-ray examination. Only a few small radiolucent lesions were present. The tissue sample obtained from one of the radiolucent lesions showed inflammation accompanying hyperplastic squamous cells. There were no features indicating odontogenic epithelium.

We report a case of glandular odontogenic cyst (GOC) arising in the mandible. The patient was a 55-year-old woman who presented with a painful swelling of the right premolar region of the mandible.Roentgenographic examination revealed a multilocular radiolucent lesion from the right first molar across themidline to the left second premolar region. The clinical diagnosis was a mandibular cyst. Enucleation of the cystand extraction of the teeth were performed with the patient under general anesthesia. Histological examinationshowed a multicystic lesion partially lined by non-keratinized epithelium with focal plaque-like thickening. Thesurface epithelium included eosinophilic cuboidal and ciliated cells. Cyst-like spaces and glandular structureswere also observed within the epithelium. Epithelial islands were also seen in connective tissue of the cyst.Immunohistochemically, epithelial cells were strongly positive for cytokeratin (CK) 13 and 19, but almost negativefor CK18. The histological diagnosis was GOC. The postoperative course was satisfactory, and no recurrencehas been noted 4 years 6 months after the operation.

Mishima K, Matsuoka H, Yamada E, Yoshikawa T, Shiotani H, Takayama K, Kirita T, Yamamoto K, Sugimura M, Ichijima K: Application of the polymerase chain reaction for the diagnosis of malignant lymphoma of the nasal and oral cavities. J Oral Pathol Med 1998; 27: 43–7. © Munksgaard, 1998. Difficulties are often encountered in the diagnosis of malignant lymphoma of the oral and nasal cavities by histology and immunohistochemistry because these malignancies may be complicated by inflammation and necrosis. In the present study, immunoglobulin heavy chain (IgH) and T-cell receptor (TCR) gene rearrangements were examined by the polymerase chain reaction (PCR) in formalin-fixed and paraffin-embedded specimens obtained from 18 patients; the advantages of this method were evaluated. Twelve of these patients were diagnosed as having malignant lymphoma and six had tumors highly suggestive of malignant lymphoma. Fourteen (78%) of the 18 cases were diagnosed as malignant lymphoma histologically and immunohistochemically. Sixteen (89%) of the 18 cases were shown to be monoclonal by PCR. The four cases that could not be histologically or immunohistochemically diagnosed as malignant lymphoma showed monoclonal gene rearrangement by PCR. As a result, six patients suspected of having a malignant lymphoma were diagnosed as having one. The diagnosis of malignant lymphoma by PCR alone still has various problems. However, when the results of PCR are evaluated together with histopathological and immunohisto-chemical results, PCR makes a useful contribution to the diagnosis of malignant lymphomas of the nasal and oral cavities.

Background: Recently, a new polymorphic gene family called the major histocompatibility complex class I chain-related gene A (MICA) was discovered about 40 kb centromeric to HLA-B gene. The MICA protein, expressed on epithelial cells and many kinds of tumor cells, serves to regulate immune function. The MICA protein is thought to activate immune function on mucosal tissue by binding to NKG2D which is expressed on most natural killer cells, CD8 positive T cells, and gamma delta T cells. An association between MICA gene polymorpisms and the development of oral squamous cell carcinoma (OSCC) has also been reported. Objective: This study was designed to test this association in Japanese patients with OSCC. Methods: The (GCT)n polymorphisms of the MICA gene was investigated in 123 patients with OSCC and 188 normal controls using polymerase chain reaction amplification and denaturing polyacrylamide gel electrophoresis. Results: Five alleles, namely A4, A5, A6, A9, and A5.1, were found in both groups. The phenotype frequency of the MICA-A5.1 allele was significantly higher in patients with OSCC when compared with normal controls (OR 1.707, 95% CI 0.76–3.45, P = 0.042). Also, the microsatellite frequency of the MICA-A5.1 allele was significantly higher in patients with OSCC compared with normal controls (OR 1.664, 95% CI 0.82–3.42, P = 0.021). Lastly, the frequency of the MICA-A5.1 allele was significantly higher in those with lymph node metastasis from OSCC compared with normal controls (OR 2.605, 95% CI 1.14–5.27, P = 0.026). Conclusions: These results suggest that the MICA-A5.1 allele may be associated with an increased susceptibility to OSCC in Japan.

Purpose The purpose of this study is to analyze the characteristics of isolated zygomatic arch fractures and to evaluate the functional and radiological outcomes of the treatment. Patients and Methods Forty patients with isolated zygomatic arch fractures were analyzed clinically. Results The patients were 25 males and 15 females with an average age of 42 years. The cause of injury was traffic accident in 26, followed by fall in 8, sports in 3, and assault in 3. The left side was involved in 25 cases. Fractures were classified into 5 types according to the degree of displacement and loss of bone contact. Reduction was performed in 31 patients, 26 treated by the Gillies temporal approach. Conservative treatment was chosen in 9 patients. The reduction status was excellent in 12 cases, good in 17 cases, and fair in 2 cases. There was no difference in the reduction status in terms of the fracture types or the interval between reduction and injury. Interincisal distance (IID) at maximal mouth opening recovered from 33.4 to 43.8 mm by excellent reduction, from 26.2 to 42.2 mm by good reduction, from 27.5 to 40 mm by fair reduction, and from 41 to 46.6 mm by conservative treatment. Conclusions Good functional and radiological outcomes were obtained in isolated zygomatic arch fractures. Reduction status was not influenced by either the fracture type or the interval between reduction and injury, and recovery of IID was similarly achieved by excellent, good, and fair reduction.

Genetic abnormalities in human oral squamous cell carcinomas (OSCC) were examined using restriction landmark genomic scanning (RLGS), a method of two-dimensional gel analysis allowing detection of amplifications and other aberrations in genomic DNA. DNAs from 11 oral tumours as well as from contiguous normal squamous epithelium, were cleaved with the restriction enzyme Not I, [32p] end-labeled and electrophoretically size-fractionated. Following a second digestion employing Hinf I, the further fragmented DNA was again electrophoretically separated. Five fragments/spots were found amplified in at least 64% (7/11) (chromosome nos. 4, 9-12 or 22) of carcinomas, with one of these spots amplified in 100% (chromosome no. 4) of tumour samples. In addition, six other spots were frequently reduced in at least 55% (chromosome nos. 15 or 9-12) of tumour tissues. Further characterization of these common changes is needed to determine if they represent important alterations in OSCC.

Reg IV（Regenerating gene type IV）は炎症性腸疾患や，胃癌，大腸癌でも発現亢進していることが知られている。さらにはホルモン療法に転移性前立腺癌との関連や早期の膵管癌における血清マーカーとしての有用性についても報告されている。今回25例の唾液腺原発腺様嚢胞癌症例におけるReg IVの発現を免疫組織化学的に検討した結果，Reg IVは腺様嚢胞癌のリンパ節転移および術後の遠隔転移に関与することを見出した。これらのことより，Reg IVは腺様嚢胞癌の転移及び予後予測マーカーとして有用である可能性が示唆された。

Injury by a bear attack mostly occurs in the head and neck region and can be fatal, requiring immediate treatment. In addition to first-aid treatment, preventive measures against infectious and parasitic diseases are also necessary. We report two cases of multiple facial lacerations caused by the same black bear. Patient 1: A 51-yearold woman was attacked by a black bear while trekking and sustained multiple facial lacerations. She was successfully treated under general anesthesia 3 hours after the injury. Patient 2: A 65-year-old man was attacked by the same black bear when he tried to rescue the woman and sustained multiple facial lacerations as well. He was also successfully treated under general anesthesia 5 hours after injury. The clinical course of both patients was uneventful with no infection or sensory or motor nerve dysfunction.

Zinc deficiency is known to be one cause of taste disorders.We report our clinical experience with the administration of polaprezinc to two patients with zinc-deficient taste disorders. The patients had serum zinc deficiency and were given a diagnosis of zinc-deficient taste disorder. In response to 75 mg of polaprezinc twice daily, taste disorder improved parallel to an increase in the serum zinc concentration.Polaprezinc is effective for patients with zinc-deficient taste disorders.

An odontoma is an odontogenic, tumor composed of enamel, dentine, and cementum, commonly less than 30 mm in diameter. We describe a large compound odontoma arising in the left anterior region of the mandible.A 16-year-old boy was referred by an orthopedist to our hospital for evaluation of a radiopaque lesion in the left side of the mandible. Clinical examination revealed a bony-hard swelling in the left anterior region of the mandible at presentation. The left mandibular canine and lateral incisor were not erupted. Radiographic and CT examinations showed a large, circumscribed, radiopaque lesion, measuring 30×40×28mm and surrounded by a thin radiolucent area accompanied by two impacted teeth. There were many small tooth-like structures within the lesion. The clinical diagnosis was odontoma. The tumor and the impacted teeth were surgically removed by an intraoral approach under general anesthesia. The tumor was covered by a thin capsule and consisted of 321 small tooth-like structures. The histopathological diagnosis was a compound odontoma. The clinical course has been uneventful for 4 years 3 months after surgery.

A case of a ferromagnetic foreign body in a medically compromised patient was reported. The patient was a 45-year-old male who consulted our department complaining of a foreign body accidentally impacted in the right cheek. X-ray examination revealed a foreign body at the lateral aspect of the right mandibular ramus. The removal of the foreign body was scheduled, but the patient did not return for the procedure. After 8 years he revisited our department for the removal of the foreign body, because it had been found to be ferromagnetic and a barrier to MRI examination. X-ray examination confirmed the foreign body was located at the same site as 8 years prior. Although the patient was suffering from liver cirrhosis with thrombocytopenia and leukopenia, the foreign body was successfully removed under general anesthesia. The foreign body was 12 × 5 × 1 mm, weighed 0.48 g, and was ferromagnetic. The patient’s postoperative course was uneventful. X-ray examination confirmed the removal of the foreign body. Since the surgery, the patient has been in generally stable condition with no complications. This case was a rare example of a foreign body that needed to be removed for medical examination.

The presence of pathologically positive lymph nodes (pN+) is a well-known prognostic factor in oral squamous cell carcinoma (OSCC). The aims of this retrospective multicenter study were to assess the prognosis of OSCC patients with pN+ disease; to compare the prognosis of patients with pN+ disease who underwent surgery plus radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) with that of patients who underwent surgery only; and to account for biases associated with treatment selection of adjuvant RT or CCRT. The records of 313 OSCC patients with pN+ disease were retrospectively reviewed. The main outcome measures were 5-year disease-specific survival (DSS) and overall survival (OS) rates. To reduce selection biases associated with retrospective data, the treatment groups were evaluated by Cox proportional hazard analysis with propensity score as a covariate. The 5-year OS and DSS survival rates for the entire patient cohort were 51.8 and 59.2 %, respectively. T3–4 stage, closed (

Noonan syndrome, characterized by short stature, facial anomalies, and congenital heart defects, may also be associated with hematopoietic disorders. Craniofacial anomalies in affected patients include hypertelorism and severe open bite associated with masticatory dysfunction. We treated a Noonan syndrome patient with a skeletal open bite. Surgical orthodontic treatment including two-jaw surgery established a good occlusal relationship after correction of severe anemia. Both upper and lower incisors were moved to upright positions, while clockwise rotation of the palatal plane and decreased mandibular plane angle were accomplished. Lower masticatory activity may affect posttreatment occlusion in such cases.

The content of this chapter does not include general textbook or ordinary items understandable by everyone. No general flap elevation or reconstruction method is described. Described are practices of pre- and postoperative management of oral and maxillofacial reconstructive surgery and in the operation room. The sole objective of the practices is to clarify how to prepare reconstruction materials reliably, safely, and efficiently, to restore defecting oral and maxillofacial regions, and maintain the reconstructed condition. This chapter has been written for reconstructive surgeons already performing surgeries at the forefront of the field of oral and maxillofacial reconstructive surgery.

This study investigated factors associated with the onset of methicillin-resistant Staphylococcus aureus (MRSA) infection among patients with head and neck cancer who underwent radical reconstructive surgery. The study group consisted of 103 patients who underwent radical reconstructive surgery between January 1994 to December 2002. They were divided into two groups with respect to the date of surgery: Group I (from January 1994 to December 1997) and Group II (from January 1998 to December 2002). The use of third-generation cephalosporins and imipenem as postoperative antibiotics was restricted after 1998 (Group II). A significantly lower incidence of MRSA was found in Group II than for Group I (p = 0.0069, chi2 test). The following factors were identified as being associated with the onset of MRSA infection: long surgical duration (p < 0.035, Wilcoxon signed-rank test), large hemorrhage (p < 0.049, Wilcoxon signed-rank test), and use of third-generation cephalosporins or imipenem (p < 0.004, chi2 test). MRSA infection was found more often in the surgically reconstructed tongue and floor of the mouth. The use of antibiotics such as vancomycin, wound irrigation, curettage and sequestrectomy were effective in eradicating the infection. MRSA, when it occurred in the maxilla, was mostly limited to colonization.

c b i l g l ngina bullosa hemorrhagica (ABH), first described y Badham, is a disorder characterized by the acute ormation of a blood-filled blister in the oral and ropharyngeal mucosa. Lesions of ABH occur mainly n the soft palate. Elderly patients are usually afected. Lesions are asymptomatic and heal spontaeously without scarring. The pathogenesis of ABH s unknown; however, it may be multifactorial. Loal trauma seems to be a major provoking factor; ther factors such as long-term use of steroid inhalers nd diabetes mellitus also may be contributory. o consistent hematologic or immunopathogenic facors have been found to be associated with ABH. lthough most cases of ABH require no treatment, esions could cause acute airway obstruction. In this report, we describe 11 cases of ABH exerienced in our clinic. We also review the literaure with regard to the clinical features, pathogensis, differential diagnosis, and management of the BH.

This report is of an 8-year-old girl with primary Sjogren's syndrome. Examination revealed the characteristic features of salivary and lacrimal gland dysfunction in addition to laboratory test abnormalities, although the patient did not complain of a feeling of dryness. There was no evidence of extraglandular manifestations or complications of other autoimmune diseases. The patient continues to receive symptomatic treatment for dry mouth and long-term follow-up to monitor any emerging complications.

We isolated dental papilla from impacted human molar and proliferated adherent fibroblastic cells after collagenase treatment of the papilla. The cells were negative for hematopoietic markers but positive for CD29, CD44, CD90, CD105, and CD166. When the cells were further cultured in the presence of beta-glycerophosphate, ascorbic acid, and dexamethasone for 14 days, mineralized areas together with osteogenic differentiation evidenced by high alkaline phosphatase activity and osteocalcin contents were observed. The differentiation was confirmed at both protein and gene expression levels. The cells can also be cryopreserved and, after thawing, could show in vivo bone-forming capability. These results indicate that mesenchymal type cells localize in dental papilla and that the cells can be culture expanded/utilized for bone tissue engineering.

Objectives: The expression of a receptor for advanced glycation end products (RAGE) in lesions developed during rat tongue carcinogenesis by 4-nitroquinoline 1-oxide (4-NQO) and the effect of a selective cyclooxygenase-2 inhibitor, etodolac, were investigated. Methods: The tongue lesions were induced in Fischer 344 rats given 20–30 ppm 4-NQO in their drinking water for 12 weeks and then fed the basal diet containing 150 and 300 ppm of etodolac for 16 weeks, respectively. Results: The incidence of carcinomas in the 4-NQO-alone group was 100%. Etodolac significantly reduced the incidences of carcinomas to 66.7% (p < 0.05) and 50% (p < 0.01) at doses of 150 and 300 ppm, respectively. RAGE protein was immunohistochemically expressed in dysplastic cells and cancer cells of dysplasias and carcinomas. Etodolac significantly decreased the stainability of RAGE protein in dysplasias (p < 0.02) and carcinomas (p < 0.01). The expression of RAGE mRNA analyzed by RT-PCR was clearly detected in carcinomas developing in the 4-NQO-alone group. In carcinomas developing in the etodolac-treated group, RAGE mRNA expression significantly decreased (p < 0.03). Conclusions: These results indicate that RAGE is involved in rat tongue carcinogenesis by 4-NQO and suggest that the chemopreventive effect exerted by etodolac is partly related to the inhibition of RAGE expression.

Schwannoma is a benign tumor originating from Schwann's sheath. Cellular schwannoma is one of the variants of schwannoma, which differs from conventional schwannoma and is extremely rare in the oral and maxillofacial region. We present a case of cellular schwannoma arising in the masseter muscle. The patient was a 58-year-old woman who was referred to our hospital because of swelling of the left cheek. An elastic firm mass, 30mm in diameter, was found in the left cheek. The mass was movable and slightly tender. MRI revealed a well-circumscribed mass within the left masseter muscle. Under a clinical diagnosis of a tumor in the left cheek, the lesion was extirpated under general anesthesia. The tumor was encapsulated and easily removed. It was solid, and the cut surface was yellow. Histopathological examination revealed that the tumor consisted mainly of a proliferation of spindle cells resembling Schwann's cells with an Antoni A type pattern. Verocay bodies were not observed. High cellularity and mitotic activity were characteristic features. A small area with an Antoni B type pattern was also observed. Immunohistochemically, the tumor cells were positive for S-100. On the basis of these findings, the tumor was diagnosed to be a cellular sahwannoma. Recurrence has not been observed for 1 year 4 months after surgery.

Radiotherapy for oral squamous cell carcinomas is limited in its efficacy and in its ability to improve the survival rate in patients at an advanced stage. A protocol is described here which may elevate the therapeutic efficacy of radiation for these cells. The addition of glycerol to the culture medium prior to irradiation of an oral squamous cell carcinoma cell line (Ca9-22) bearing a mutant p53 (mp53) gene was found to increase the radiosensitivity of these cells. A colony formation assay was used to evaluate the effect of glycerol on the radiation sensitivity of Ca9-22 cells. Apoptosis was analyzed using Hoechst 33342 staining, Western blotting, and a DNA ladder formation assay. Glycerol, when present in the culture medium, enhanced the radiation sensitivity and extent of apoptosis following X-irradiation in the Ca9-22 cells, although neither X-rays or glycerol alone increased the extent of apoptosis. Bax protein was accumulated after treatment with X-rays plus glycerol, but not after exposure to X-rays or glycerol alone. A gel mobility-shift assay showed that glycerol restored the DNA-binding activity of mp53 for a p53-consensus sequence to levels similar to that of wild-type p53. These findings suggest that pre-treatment with glycerol may enhance the effectiveness of radiotherapy against oral squamous cell carcinomas bearing an mp53 gene mutation.