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ObjectiveTo examine the effect of apolipoprotein E (APOE)ɛ4dose on blood–brain barrier (BBB) clearance function, evaluated using an advanced MRI technique and analyse its correlation with brain iron and β-amyloid accumulation in the early stages of the Alzheimer’s continuum.MethodsIn this single-centre observational prospective cohort study, 24APOE ɛ4non-carriers, 22 heterozygotes and 20 homozygotes in the early stages of the Alzheimer’s continuum were scanned with diffusion-prepared arterial spin labelling, which estimates the water exchange rate across the BBB (kw). Participants also underwent quantitative susceptibility mapping, [11C]Pittsburgh compound B-positron emission tomography and neuropsychological testing. Using an atlas-based approach, we compared the regional kwof the whole brain among the groups and analysed its correlation with the neuroradiological and neuropsychological findings.ResultsThe BBB kwvalues in the neocortices differed significantly among the groups (APOE ɛ4non-carriers>heterozygotes>homozygotes). These values correlated with brain iron levels (frontal lobe:r=−0.476, 95% CI=−0.644 to −0.264, p=0.011; medial temporal lobe:r=−0.455, 95% CI=−0.628 to −0.239, p=0.017), β-amyloid loads (frontal lobe:r=−0.504, 95% CI=−0.731 to −0.176, p=0.015; medial temporal lobe:r=−0.452, 95% CI=−0.699 to −0.110, p=0.036) and neuropsychological scores, after adjusting for age, sex andAPOE ɛ4dose.InterpretationOur results suggest that an increasedAPOE ɛ4dose is associated with decreased effective brain-waste clearance, such as iron and β-amyloid, through the BBB.

Perioperative oral management (POM) is used to prevent pneumonia in patients with cancer. However, the factors that expose hospitalized patients to increased risk of developing pneumonia remain unclear. For example, no study to date has compared the incidence of pneumonia in hospitalized patients by cancer primary lesion, or POM implementation, or not. We determined which patients were most likely to benefit from POM and examined the effects of POM on pneumonia prevention and mortality. In a total of 9441 patients with cancer who underwent surgery during hospitalization, there were 8208 patients in the No POM group, and 1233 in the POM group. We examined between-group differences in the incidence of pneumonia and associated outcomes during hospitalization. There was no significant between-group difference in the incidence of pneumonitis, however, patients with lung, or head and neck cancers, demonstrated a lower incidence of postoperative pneumonia. Among patients with lung and pancreatic cancers, mortality was significantly lower in the POM group. POM appears effective at reducing the risk of postoperative pneumonia in patients with certain cancers. Further, mortality was significantly lower in patients with lung and pancreatic cancers who received POM; hence, POM may be an effective adjuvant therapy for patients with cancer.

To investigate the mechanisms underlying the effect of repetitive transcranial magnetic stimulation (rTMS) on post-stroke hemiplegia, we assessed alterations in cerebral glucose metabolism. Five post-stroke hemiplegic patients (three targeted for upper limb impairment and two targeted for lower limb impairment) aged 62.6 ± 6.1 years (mean ± standard deviation) with a duration since stroke onset of 3.5 ± 3.8 years participated in this preliminary study. Cerebral glucose metabolism was measured twice—before and after rTMS with intensive rehabilitation—using positron emission tomography with [18F]fluorodeoxyglucose. The Asymmetry Index (AI) was calculated to assess laterality of metabolism between the lesional and contralesional motor areas. The alteration rates of AI (%ΔAI) were compared between participants in whom rTMS was effective and ineffective. Two of the three upper-limb-targeted patients and one of the two lower-limb-targeted patients showed motor function improvements following rTMS treatment. All three patients who responded to rTMS had improved laterality of cerebral glucose metabolism in motor areas, commonly in the precentral gyrus, with an %ΔAI of approximately 10%. In contrast, the two patients who did not respond to rTMS had no improvements in laterality. These results suggest for the first time that improved glucose metabolism is associated with improved motor function after a combination of rTMS and intensive rehabilitation.

Campomelic dysplasia (CMPD) is a skeletal disorder resulting from SOX9 gene mutations. Palatoplasty is rare due to a high lethality rate in infants from respiratory distress. Our patient had characteristic symptoms of CMPD, including short bowed limbs, macrocephaly, low-set ears, short palpebral fissures, hypertelorism, a flat nasal bridge, a long philtrum, micrognathia, and a cleft palate. We performed a Furlow palatoplasty when the patient was 2 years 9 months of age, after respiratory conditions had stabilized. We reviewed the literature of CMPD cases that underwent palatoplasty and discussed the optimal timing and surgical methods.

Although pure cerebellar ataxia is usually emphasized as the characteristic clinical feature of spinocerebellar ataxia type 6 (SCA6), parkinsonism has been repeatedly described in patients with genetically confirmed SCA6. We conducted a positron emission tomography study using a combination of [18F]fluoro-l-dopa for dopamine synthesis and [11C]raclopride for dopamine D2 receptor function on six genetically confirmed SCA6 patients, both with and without parkinsonism. To the best of our knowledge, this is the first dopamine receptor imaging study of patients with SCA6. Most patients had somewhat decreased dopaminergic function, and this decrease was significant in the caudate nucleus. In addition, one SCA6 patient with parkinsonism had whole striatal dysfunction of both dopamine synthesis and dopamine D2 receptor function. The pathology of SCA6 may not be restricted to the cerebellum, but may also be distributed across various regions, including in both presynaptic and postsynaptic dopaminergic neurons to some degree. Patients with SCA6 may show apparent parkinsonism after the progression of neurodegeneration.

Kendo, a type of fencing using bamboo swords, is one of the most popular Japanese martial arts that is practiced by over four million people worldwide.1 Kendo players wear face masks that protect their heads, but only from front and side attacks (figure 1A). Repetitive head trauma in athletes engaged in contact sports has been associated with development of neurodegenerative disorders.2 Herein, we present the case of kendo player with a history of chronic headache, depression, and cognitive dysfunction, who developed occipital epilepsy followed by generalized tonic-clonic seizures, as a result of repetitive head injuries.

We developed and validated the accuracy of a method to calculate the arterial input function (AIF) from PET images only, without the need for the arterial blood sampling, in the absolute quantitation of functional parametric values inWe extended the method reported by Iguchi et al. (2013) to derive the arterial input function, thus absolute quantitative functional parametric images of cerebral perfusion and oxygen metabolism by a reference tissue approach. We compared shapes of the AIF and reproducibility of the absolute functional values. Existing test data that were carried out with the continuous arterial blood sampling were used for this study.The estimated AIF shapes agreed well with those estimated from the continuous arterial blood sampling. The error range of the absolute quantitative values was approximately ±20%, with a fairly well reproducibility in the relative values being less than 3%.The AIFs by this method were reproducible. Although the absolute quantitative values varied depending on the assumed functional values in the reference region in individual cases, the relative images showed fairly good agreement with the results from the standard technique that employed the arterial blood sampling. The present technique may provide significant contribution to clinical examination.

The mechanism of chronotropic incompetence (CTI), which has been associated with autonomic dysfunction, has not been elucidated in patients without heart failure (HF). Methods: Cardiac PET using (11)C-CGP12177 was performed to investigate the cardiac β-adrenergic receptor density (β-ARD) in 13 patients with CTI without HF and 6 healthy controls. The maximum number of available specific (11)C-CGP12177 binding sites per gram of tissue was calculated in regions of interest using an established graphical method. Results: Peak heart rate was significantly lower in CTI patients than in controls (116.9 ± 11.0 vs. 154.8 ± 14.4 beats/min, P < 0.001). β-ARD of the total myocardium was significantly lower in CTI patients than in controls (4.3 ± 1.7 vs. 7.0 ± 1.7 pmol/mL, P = 0.005). Conclusion: β-adrenergic receptor downregulation was demonstrated in patients with CTI without HF. Decreased β-ARD is a common feature in patients with CTI, with or without HF.

Objective This study aimed to determine if the change in technique of soft palate closure or timing of hard palatal repair induced occlusal changes in patients with complete unilateral cleft lip and palate (CUCLP). Design Retrospective study. Settings A medical and dental hospital in Japan. Subjects A total of 96 patients with CUCLP treated with 2-stage palatoplasty were included in the study and categorized into 3 groups (G1, G2, and G3) according to the protocol used. Interventions G1 underwent soft palate repair using Perko method at 1.5 years of age and hard palate repair using vomer flap procedure at 5.5 years of age. Furlow method was used for soft palate repair in G2 at 1.5 years of age and hard palate repair using vomer flap procedure at 5.5 years of age. The Furlow method was used to repair the soft palate in G3 at 1.5 years of age and vomer flap procedure was used to repair the hard palate at 4 years of age. Main Outcome Measures Two evaluators assessed the dental arch relationship using the modified Huddart/Bodenham (mHB) index on 2 separate occasions. Results Intra- (intraclass correlation coefficient [ICC]: 0.962) and inter-examiner (ICC: 0.950) reliability showed very good agreement. The frequency of crossbite present in the major and minor segments gradually decreased with each change in protocol. Mean segmental scores showed no significant difference between 3 protocols ( P > .05). Good inter-arch alignment occurred with all 3 surgical protocols (G1:82.6%, G2:89.8%, and G3:91.7%). Conclusions There was no significant difference in the dental arch relationship outcomes between the 3 surgical protocols. The dentition status was comparable with all surgical protocols, even after the changes.

Secondary peripheral ameloblastic carcinoma is an odontogenic malignant tumor that arises from benign peripheral ameloblastoma and exhibits cellular atypia. We describe the case of an 82-year-old male referred to our department with a hemorrhagic mass on the right palate that developed 6–7 years earlier. Clinical examination revealed a mass 40 × 30 × 10 mm in size affecting the hard palate that exhibited relatively clear boundaries, granular superficial appearance, and hemorrhaging. Computed tomography and magnetic resonance imaging revealed compressive resorption of the bone surface in contact with the tumor. A biopsy was performed; the histopathological diagnosis of the biopsy was peripheral ameloblastoma without any findings of malignancy. The patient subsequently underwent tumor resection. The resected specimen of peripheral ameloblastoma exhibited malignancy. The histopathological diagnosis was secondary peripheral ameloblastic carcinoma. The recurrence was not confirmed. However, CT imaging performed revealed nodular pulmonary shadows 14 months after surgery. We consulted with the Department of Respiratory Medicine, and a biopsy was planned. However, the biopsy was not performed because the patient was admitted for the treatment of pulmonary tuberculosis. A malignant lesion appeared in the liver 21 months after surgery. The patient developed multiorgan failure during that month and died. A review of seven reported cases demonstrated that our case is typical with regard to clinical course, symptoms, and clinical, imaging, and histopathological findings.

The mechanism of chronotropic incompetence (CI), which has been associated with autonomic dysfunction, has not been elucidated in patients without heart failure (HF). Methods: Cardiac positron emission tomography using 11C-CGP12177 was performed to investigate the cardiac beta-adrenergic receptor density (β-ARD) in 13 patients with CI without HF and six healthy controls. The maximum number of available specific 11C-CGP12177 binding sites per gram of tissue was calculated in regions of interest using an established graphical method. Results: Peak heart rate was significantly lower in CI patients than in controls (116.9 ± 11.0 vs. 154.8 ± 14.4 beats/min, p < 0.001). β-ARD of the total myocardium was significantly lower in CI patients than in controls (4.3 ± 1.7 vs. 7.0 ± 1.7 pmol/mL, p = 0.005). Conclusion: Beta-adrenergic receptor downregulation was demonstrated in patients with CI without HF. Decreased β-ARD is a common feature in patients with CI, with or without HF.

The effects on craniofacial growth of two different soft palate repair techniques in two-stage palatoplasty were investigated. This was a retrospective, cross-sectional cohort study of 68 children with non-syndromic, complete unilateral cleft lip and palate. Thirty-four patients were treated with the modified Furlow method (F-group) and the remaining 34 with the Widmaier-Perko method (P-group). Craniofacial growth was assessed by analyzing 12 angular and 12 linear measurements on lateral cephalograms. Composite facial diagrams from the two groups were compared with those of a control non-cleft group. Angular and linear measurements did not differ significantly between the two groups, implying that the craniofacial morphology was not affected by the difference in soft palate repair technique. However, small differences in anterior nasal spine and posterior nasal spine were found in cleft patients compared with controls. These findings suggest that the modified Furlow and Widmaier-Perko methods have a similar impact on craniofacial growth. Considering speech function, the modified Furlow method provides better craniofacial growth and speech function. However, the long-term effects of both methods on craniofacial growth after growth cessation remain to be determined.

After myocardial infarction (MI), left ventricular (LV) remodelling is observed in noninfarcted LV myocardium. LV remodelling is closely associated with systolic heart failure. Since myocardial dysfunction is related to the downregulation of cardiac postsynaptic beta-adrenergic receptors (β-AR), we hypothesized that a reduction in β-AR density may be manifested in the remote noninfarcted region and such reduction may be related to myocardial systolic dysfunction. Accordingly, we assessed β-AR density with a focus on the remote noninfarcted region. Cardiac PET was performed in 15 patients with a prior MI and 10 age-matched healthy controls using 11C-CGP 12177, a radioligand for β-receptors. The maximum number of available specific 11C-CGP 12177 binding sites per gram of tissue was calculated in regions of interest using an established graphical method. LV regional systolic function was assessed based on peak systolic myocardial strain on the LV wall in the longitudinal direction using two-dimensional ultrasound speckle tracking imaging. LV volumes and LV ejection fraction (EF) were also measured. The LV end-diastolic volume index was significantly larger in patients than in controls (67.8 ± 16.9 vs. 49.1 ± 12.3 ml/m2, p

The authors report a case of adenoid cystic carcinoma (ACC) complicated with sialolithiasis of the submandibular gland. The patient was a 43-year-old female with a history of papillotubular carcinoma of the breast almost at the same time. She had noticed a swelling in her sublingual area for 10 years, which was later diagnosed by her dentist to be due to a sialolith in the left submandibular gland. After several years of observation, the patient was referred to have her left submandibular gland, containing the stone, surgically removed with a diagnosis of atrophic sialadenitis. Histopathologically, the submandibular gland was extensively replaced with fibrous granulation tissue, in which there were small but invasive foci of ACC. The present case indicates that ACC could arise in the background of chronic sialadenitis. It is suggested that long-standing sialadenitis cases should be carefully examined to exclude suspicion of malignancy before surgery.

Left ventricular (LV) remodeling occurs in the remote normal region in the LVs after myocardial infarction (MI) and is closely involved in heart failure. We assessed myocardial oxygen consumption using a clearance rate constant K mono for the time activity curves of 11C-acetate in 15 patients with a prior anterior wall MI, 8 with a prior inferior wall MI, and 10 age-matched normal control subjects. LV end-systolic volume index (ESVI) was determined by echocardiography. The LVESVI was significantly greater in patients with an anterior and inferior MI than in control subjects. The heart rate systolic pressure product did not differ among the groups. K mono in the remote normal region in patients with an anterior MI was significantly less than that in the corresponding area in control subjects (0.055 ± 0.005 vs 0.065 ± 0.008 min−1, P

The aim of this study was to examine the sensibility of NIRS in observation of brain activation during a verbal fluency test. Twenty-three participants were given letter fluency and semantic fluency tests and the hemodynamism was measured by NIRS. Thirty-three pairs of optodes were attached, so they can measure signals from 52 channels consisting of adjacent pairs of emitters and detectors. Results were investigated in terms of the change of blood flow volume value of OxyHb for word generation. The results showed a significant interaction between task (letter fluency and semantic fluency) and cortical area (prefrontal and temporal) in the analysis of variance. Here, the prefrontal area showed marked activation in the left hemisphere during letter fluency task, whereas the temporal area showed activation in the semantic fluency task performance. These findings by NIRS confirmed different cerebral functions between semantic and letter fluency tasks, which were coincident with the findings by previou...

Objective To report a case of blepharo-cheilo-dontic (BCD) syndrome, to compare with the previous cases, and to discuss the possible treatment. Patient The patient was a 14-day-old boy born uneventfully on August 7, 2002. His scalp hair was sparse and curly. A tumor on the top of his head, which was thought to be a dermoid cyst, and a nevus on the back of his left hand were observed. All typical symptoms of blepharo-cheilo-dontic syndrome, such as euryblepharon with ectropion of the lower eyelids, distichiasis, bilateral cleft lip and palate, severe oligodontia, and conical teeth, were observed. Because there was no fatal complication, and growth and development were about normal, it was recommended that a long and active treatment plan be considered for this patient.

われわれの開発した培養複合上皮（皮膚，口腔粘膜）は，動物由来蛋白や3T3マウスfeeder layerを使用せずに完全無血清培地でkeratinocyteを培養した移植材料である。培養細胞を無細胞真皮上に播種して作製される培養複合上皮は，文部科学省高度先進医療開発経費Bの支援のもと，口腔粘膜上皮に関して新潟大学，富山大学，神戸大学の三施設合同で臨床応用され，平成14年～16年の三年間で106症例を数えた。その内52症例が口腔癌もしくはin situであり，結果として90症例で成功し，何らかの理由により16症例で不成功となった。この方法の利点は，異種移植と定義されないこと，理論上将来のプリオン病への危惧がほぼ皆無であること，把持縫合可能な操作性を有すことである。欠点として，無細胞であるが他人の真皮をscaffoldとして使用すること，作製に約一ヶ月を要することである。

We report a case of congenital ranula with frequent recurrences.The patient was a 13-day-old boy who was referred to our clinic because of swelling of the left side of the oral floor. His parents had noticed the swelling, associated with repeated disappearance and recurrence, from birth. The patient was given a diagnosis of mucocele of the oral floor and observed. A stalk-like swelling developed at 4 months of age. Because we suspected a tumor of the oral floor, excisional biopsy was carried out. The pathological diagnosis was granulation tissue. One month after the biopsy, a transparent undulating swelling developed in the left side of the oral floor. At first, the swelling spontaneously disappeared and recurred, but then persisted. We diagnosed a ranula and incised the swelling. Abundant saliva flowed out. Five months after the incision, swelling recurred. Although repeated incisions were made, swelling recurred and resulted in difficulty in eating. Extirpation of the ranula and sublingual glands was performed under general anesthesia. There has been no recurrence of the cyst or dysfunction.We should consider extirpation of the cyst and sublingual glands in infants in whom a ranula is associated with frequent recurrence and dysfunction.

Progressive hemifacial atrophy (PHA) is a self-limited atrophy of subcutaneous tissues (and less frequently of hard tissues) on one side of the face. It is a sporadic, slowly progressing disease whose pathogenesis is still unknown. As a rule the asymmetry caused by PHA (usually of soft tissue) is treated by volume augmentation that involves free tissue grafting or a pedicled flap transfer. We describe a rare case of hard tissue PHA. The atrophic changes occurred in the left molar tooth, maxilla and mandible and were associated with moderate soft tissue atrophy. The left side of the patient's mouth was higher on the right side, and the occlusal plane was severely inclined in spite of normal occlusion. After no alteration and no progression of the atrophy were established, the patient was treated with orthodontic surgery. To correct the inclined occlusal plane and asymmetry profile, we performed a Le Fort I and intraoral vertical ramus osteotomy. In the 3-year follow-up, there were good occlusal balance and improved symmetrical profile without relapse or recurrence of the atrophy. Thus, orthodontic surgery was effective as a first procedure to treat hard tissue atrophy that appeared with moderate soft tissue atrophy.

Background Fatty acid metabolism in patients with myocardial infarction (MI) who undergo coronary reperfusion has not been fully elucidated and was investigated in the present study using positron emission tomography. Methods and Results The clearance rate constant of 11C-acetate (acetate-K mono) and that of 11C-palmitate (palmitate-K mono) from the myocardium were calculated using a monoexponential equation in 14 patients with MI. A total of 155 regions of interest were classified based on coefficient of determination (R2) values of monoexponential curves for 11C-palmitate clearance: well fitted regions (R2 ≥0.5) and poorly fitted regions (R2

To evaluate the accuracy of diagnosing N3 disease using positron emission tomography (PET) with 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG) in patients with pulmonary disease.Twenty patients diagnosed as FDG-PET N3 were enrolled. On FDG-PET, lymph nodes were considered to be positive when increased uptake as compared with that of the surrounding mediastinum was visually observed, or the mean standardized uptake ratio (SUR) was more than 2, 2.5, or 3. On CT, lymph nodes exceeding 1 cm in the shortest diameter were regarded as positive.The PET result was true positive (TP) in 2 patients and false positive (FP) in 18 with an overall accuracy (OA) of 10% using visual criteria. Using an SUR of more than 2.5, the result was TP in 2, FP in 3, and true negative (TN) in 15, the false negative (FN) in 0, with an OA of 85%. CT diagnosis was TP in 2, FP in 9, and TN in 9 with an OA of 55%. The accuracy using the SUR criteria of more than 2.5 was superior to that of CT.Of 20 patients with the diagnosis of PET N3, we found frequent over-diagnosis in nodal staging using the visual criteria.

To compare histological findings of FDG-PET false-positive and true-negative hilar and mediastinal lymph nodes.Sixty-seven lymphnode areas in 11 patients who were diagnosed to have N3 lymph nodes by FDG-PET and underwent surgery were histologically examined, and the histopathological findings in false-positive and true-negative lymph nodes were compared. Lymph nodes with higher accumulation of FDG than the surrounding mediastinum level were judged as positive. On histological sections, proportions of macrophages and lymphocytes, amount of coal dust deposit, presence of silicotic nodules, long- and short-axes of the largest node, and volume of macrophages and lymphocytes were evaluated. Correlations between the above-mentioned factors and FDG accumulation were evaluated.FDG uptake was not correlated with the proportion of macrophages and lymphocytes, coal dust amounts, or the presence of silicotic nodules. The long- and short-axes of the largest node in the false-positive areas were significantly longer than those in the true-negative areas (p = 0.01, and 0.001, respectively). Volumes of lymph nodes (mean +/- SD: 150 +/- 190 mm3) and macrophages (78 +/- 71 mm3) in false-positive areas were markedly larger than those in true-negative areas (68 +/- 87 mm3, p = 0.0009 and 34 +/- 54 mm3, p = 0.0001, respectively). The volume of lymphocytes was also larger in false-positive areas but less markedly.Our study suggested that false-positive results of FDG-PET in hilar and mediastinal lymph nodes were closely related to the size of lymph node and the volume of macrophages.

In order to clarify the pathophysiology of cognitive impairments after mild traumatic brain injury (TBI), we studied cerebral blood flow and metabolism using positron emission computed tomography (PET). Fifty-two patients with mild TBI were divided into three groups based on magnetic resonance images (MRI) findings: normal (group N), diffuse axonal injury (DAI) (group D), and DAI with brain atrophy (group V). PET data were obtained by the steady state method using 15O labeled gases. Regional cerebral blood flow (CBF), oxygen extraction fraction (OEF), and cerebral metabolic rate of oxygen (CMRO2) were measured for each brain area. Higher cortical dysfunction was evaluated using Wechsler Adult Intelligence Scale-Revised (WAIS-R). WAIS-R scores for group V were significantly lower than for group N. In almost all patients, CBF and OEF were within normal ranges, however, CMRO2 was decreased slightly. CMRO2 in all regions of group V except for the bilateral parietal lobes was significantly lower than in group N. We conclude that the severity of higher cortical dysfunction in these cases correlated with a decrease of CMRO2 and the severity of DAI.

We report on two children with infantile condylar fractures, caused by falling from front child seats of bicycles.Patient 1 was a 5-year-old boy, and patient 2 was a 2-year-old boy. Both patients had fractures of the mandible with complete condylar fractures. The first patient had a complete left fracture, and the second patient had complete right and incomplete left fractures.Circumferential wiring with an occlusal plate was performed for fixation of the mandibular body fractures, and mouth opening exercises were started several days after wiring. The occlusal plate was extremely useful, but many potential problems, such as caries or tooth luxation, were considered in patient 1.These patients show that a child riding in a front child seat of a bicycle can sustain a hard blow to the face, head, or both in the event of an accident. Increased external force due to the mother's weight can increase the severity of fractures.

A system for evaluating dementia of the Alzheimer type (DAT) based on magnetic resonance (MR) imaging by means of fuzzy neural networks (FNNs) was investigated. The T1-weighted head MR transverse section images were obtained by a routinely performed examination. Nine slices including the thalamus were analyzed for each subject. Each MR image (MRI) was divided into four parts. The ratio of the brain area to the intracranial area was defined as the atrophy ratio. DAT severity was assessed by the Mini-Mental State (MMS) examination administered to each patient, and the results were used as teaching values for the FNN models. To construct the FNN model with high accuracy, MRI-based input variables were examined. Using atrophy ratios of 9 MRIs based on thalamically fiducial images and the corresponding areal or volumetric data as input variables, highly accurate FNN models were constructed that gave an average error of 1.29 points out of 30 in the MMS scores.

We describe the treatment of an ankylosed infraverted tooth by distraction osteogenesis after Epker's single-tooth dento-osseous osteotomy. There appear to be a number of advantages to this procedure, despite the high surgical invasiveness. This procedure is designed to correct malposition of ankylosed teeth and is more reliable than replantation or subluxation with orthodontic treatment, reported previously to be effective. Furthermore, malpositioned teeth can be transferred irrespective of distance and direction to their correct position. This procedure has a low risk of pulp devitalization and gingival recession. Distraction osteogenesis after single-tooth dento-osseous osteotomy may be a new useful method for treatment of tooth ankylosis.

We investigated the relation of oral and maxillofacial cancer to upper gastrointestinal fiberscopic findings and evaluated the value and reliability of gastrointestinal fiberscopy (GIF). Sixty-two patients with oral and maxillofacial squamous cell carcinoma were examined by GIF in consultation with an internist.The results were as follows:1. The incidence of upper gastrointestinal lesions in patients with oral and maxillofacial cancer was higher than that in the general population.2. There was no relation between the region or the stage of squamous cell carcinoma and the incidence of upper gastrointestinal lesions.3. There were 6 cases (9.7%) of double cancer. There were also many precancerous lesions, such as esophageal dysplasia (3 cases, 4.8%), Barret's mucosa (3 cases, 4.8%), atrophic gastritis (26 cases, 41.9%), and intestinal metaplasia (9 cases, 14.5%). Four cases of active peptic ulcer (6.5%) were also found.4. The incidence of esophageal lesions in patients with smoking and drinking habits was significantly higher than that in patients without smoking habits, drinking habits, or both.In conclusion, it is important to examine the upper gastrointestinal tract of patients with oral and maxillofacial cancer by GIF not only to screen for double cancers but also to detect precancerous lesions and active peptic ulcers.

Basal cell adenocarcinoma was added to the classification of the World Health Organization in 1991 and is considered the malignant counterpart of basal cell adenoma. It is a rare salivary gland tumor and is most often found in the parotid gland, with only two cases reported in a minor salivary gland. To our knowledge, all basal cell adenocarcinomas have been treated by surgical excision, and their outcome has been comparatively good.We report a case of basal cell adenocarcinoma arising in a minor salivary gland in the upper lip. The patient was a 56-year-old man who presented with a right upper lip mass. The mass was found to have widely infiltrated the maxillary alveolus, nasal floor, and the right wing of the nose. We successfully treated it with radiation (66.4 Gy), hyperthermia (8 times), and chemotherapy (5 -FU, CDDP), without lowering of the patient's quality of life.

To study the effects of maxillary advencement surgery, morphological changes were evaluated on the basis preoperative and postoperative cephalograms at rest position in 11 patients with maxillary hypoplasia associated with cleft palate (cleft palate group) and were compared with those in 11 patients with maxillary hypoplasia without cleft palate (control group).1. The amount of advancement in the cleft palate group (4.6±1.4mm) did not significantly differ from that in the control group (5.1±1.0mm).2. The length of the soft palate (PNS-Uv) increased slightly in both groups; however, the mean difference between before and after surgery, in the cleft palate group (2.8mm) was slightly but not significantly less than that in the control group (3.9mm).3. The depth of the pharynx increased in both groups after surgery. There was a significant difference between the control group (5.5mm) and the cleft palate group (2.9mm).4. The inclined angle of the soft palate (∠ANS-PNS-Uv) increased in almost all patients in both groups (5.0 degrees in the cleft palate group and 5.8 degrees in the control group).5. There was no significant difference between the two groups in the change in the shortest distance between the soft palate and the posterior pharyngeal wall after surgery (-0.7mm in the cleft palate group and -0.6mm in the control group).

We retrospectively investigated the clinical findings and treatment of cleft lip, cleft palate, or both associated with chromosomal karyotype aberration. The patients were examined at the Second Department of Oral and Maxillofacial Surgery, Niigata University Dental Hospital between April 1982 and March 1998.The findings obtained were as follows:1. Twelve of 806 patients with cleft lip, cleft palate, or both (1.5%) had chromosomal aberrations. Four of these patients had bilateral cleft lip, alveolus, and palate, and 8 had cleft palate. In 10 primary cases, the incidence of chromosomal aberrations was 4.4%(3/68) in patients with bilateral cleft lip, alveolus, and palate and 5.1%(7/138) in patients with cleft palate.2. Various types of chromosomal aberrations (No.13, 15, 21 numerical abnormalities and No.1, 2, 4, 5, 6, 7, 9, 13, 18, 21 structural abnormalities) were found, but there was no evidence of an association between the type of chromosomal aberration and the type of cleft lip or palate.3. A history of spontaneous abortion was confirmed in the mothers of five patients, and similar chromosomal aberrations in blood relatives were confirmed in two patients.4. Eight patients had major anomalies, and all 12 had minor anomalies. Mental retardation was confirmed in all patients.5. Among 10 patients with primary cleft lip, cleft palate, or both, 1 underwent cheiloplasty and 5 underwent palatoplasty under general anesthesia. After the physical condition of the patient had stabilized, cheiloplasty was carried out at about 1 year of age and palatoplasty at 2 to 3 years of age in close cooperation with pediatricians and anesthesiologists. To minimize trauma, surgery should be done in one step.

Twenty cases of upper gingival carcinoma and 13 cases of hard palate carcinoma were evaluated clinicopathologically. In addition, the relationship between surgical intervention and outcome was also studied.All upper gingival carcinomas were identified as squamous cell carcinoma histologically. In the hard palate, there were various kinds of carcinomas arising mainly from the salivary glands (10/13 cases). Furthermore, almost all cases in the hard palate were welldifferentiated mucoepidermoid carcinomas, classified into the early stages of T 1 or T 2.The 5-year cumulative survival rate of the patients with hard palate carcinoma was 100%. In contrast, the 5-year cumulative survival rate of patients with upper gingival carcinoma was 50.2% among all cases, 66.7% among 9 stage II+III cases, and 32.3% among 11 stage IV cases.Surgical intervention involving tooth extraction in the tumorous area had been done in eight patients with upper gingival carcinoma before their first visit to our institute. Of these patients, seven (87.5%) were classified as T 4, and cervical lymph node metastases were confirmed histologically in five (62.5%). Careful follow-up in thus necessary in such patients.