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Objective Quality of life (QOL) impairment of patients who visit an outpatient clinic for abdominal symptoms has not been clarified. We investigated symptom-related QOL impairment that led patients to seek medical care. Patients and Methods Abdominal symptom-related QOL was determined using the Izumo scale instrument in 172 patients who visited a clinic for their abdominal symptoms and in 961 healthy subjects who attended an annual health check. Results QOL was more strongly impaired in the patients with abdominal symptoms than in subjects who attended health checks. Patients with heartburn consulted physicians even when QOL impairment was minimal, while those with epigastric fullness tended to consult a physician only when QOL impairment was significant. Conclusion Abdominal symptom-related QOL impairment is considered to lead patients to seek medical care, though different symptoms have varying levels of influence.

Background and Aim: Endoscopic retrograde cholangiopancreatography (ERCP) is a useful diagnostic and therapeutic procedure; however, ERCP occasionally causes post-ERCP pancreatitis. The administration of gabexate mesilate has been reported to be effective for the prevention for post-ERCP pancreatitis when given during and after the procedure. The aim of the present study was to investigate the preventive effect of the novel protease inhibitor ulinastatin on post-ERCP pancreatitis. Methods: One hundred and thirty-nine patients who underwent the ERCP procedure were studied. These patients were randomly divided into three groups based on the agent and dose given during and following the ERCP procedure: gabexate mesilate (900 mg), high-dose ulinastatin (450 000 units) and low-dose ulinastatin (150 000 units). Serum amylase, interleukin (IL)-6 and IL-8 levels and plasma polymorphonuclear leukocyte elastase (PMN-E) activity were measured after ERCP. In addition, post-ERCP hyperamylasemia and post-ERCP pancreatitis were recorded. Results: There were no significant differences in serum amylase, IL-6 and IL-8 levels and PMN-E activity after ERCP procedure between the three groups. Post-ERCP pancreatitis was observed in two (4.3%), three (6.5%) and four (8.5%) cases in the gabexate mesilate, high-dose ulinastatin and low-dose ulinastatin groups, respectively. Multiple logistic regression analysis showed that the addition of endoscopic sphincterotomy during the ERCP procedure was the only significant risk factor for the development of post-ERCP hyperamylasemia and post-ERCP pancreatitis (P = 0.03 and P = 0.04, respectively), but there was no significant difference in the occurrence of post-ERCP hyperamylasemia and post-ERCP pancreatitis between the three groups receiving different preventative treatments. Conclusion: The administration of low- and high-dose ulinastatin has similar effects to high-dose gabexate in the prevention of post-ERCP pancreatitis.

Background: The therapeutic effect of combined administration of prokinetics and histamine H2 receptor antagonists (H2RA) in gastroesophageal reflux disease is reported to be superior to that of monotherapy with H2RA alone. In addition to its acid-suppressing effect, the H2RA nizatidine also has a prokinetic action by suppressing acetylcholine esterase. The present multicenter, randomized controlled study was performed to investigate whether nizatidine is superior to famotidine, which does not suppress acetylcholine esterase activity, in maintenance therapy for erosive esophagitis. In addition, the question as to whether the grade of erosive esophagitis affects the non-recurrence rate during the maintenance therapy with H2RA was also investigated. Methods: Seventy-two patients with endoscopically healed erosive esophagitis after 8 weeks of initial treatment with proton pump inhibitors were randomly divided into two groups. Patients in the nizatidine group were treated with 150 mg nizatidine twice a day (b.i.d.), while patients in the famotidine group were treated with 20 mg famotidine b.i.d. for 6 months. At the end of therapy, and at the time when patients complained of symptoms, endoscopic investigations were repeated to find out whether the esophagitis had recurred. Results: Nizatidine produced a significantly higher non-recurrence rate than famotidine (P = 0.049 in intention-to-treat [ITT] analysis). This difference of remission rate between nizatidine and famotidine was observed mainly in grade B esophagitis (P = 0.016 in ITT analysis). Conclusion: Nizatidine is a more effective H2RA than famotidine in the maintenance therapy of patients with reflux esophagitis.

Background and Aims: Because non-bleeding visible vessels (NBVV) of gastric peptic ulcers have the potential to re-bleed, endoscopic hemostatic treatment may be necessary during the first emergency endoscopy. However, not all NBVV re-bleed, and endoscopic hemostasis sometimes causes fatal side-effects. Therefore, we have evaluated the risk of re-bleeding from various NBVV in gastric peptic ulcers to determine which types should be treated by endoscopy to prevent re-bleeding. Methods: A total of 227 NBVV in 202 patients with gastric peptic ulcers that were endoscopically followed without endoscopic hemostatic procedures were classified by the following factors: vessel color, form, location of the NBVV in the ulcer crater, and location of the ulcer in the stomach. The re-bleeding rate was then analyzed for each type of NBVV. Results: Significantly high rates of re-bleeding were observed in cases with white, protruded and peripheral NBVV. In particular, white NBVV located in the peripheral zone of the ulcer crater were frequent re-bleeding sources. The location of the ulcer in the stomach was not a statistically significant factor in determining re-bleeding rates. Conclusion: We found that white, protruded and peripherally located NBVV in gastric ulcers have a higher chance of re-bleeding if preventive endoscopic hemostatic procedures are not performed.

Background and Aim: Rabeprazole has a faster onset of antisecretory activity than omeprazole and lansoprazole. The aim of the present study was to clarify whether there is any difference in the speed of symptom relief in patients with reflux esophagitis following the administration of these three proton pump inhibitors (PPI). Methods: Eighty-five patients with erosive reflux esophagitis were randomized to receive 8 weeks of 20 mg of omeprazole (n = 30), 30 mg of lansoprazole (n = 25), or 20 mg of rabeprazole (n = 30) once a morning. Daily changes in heartburn and acid reflux symptoms in the first 7 days of administration were assessed using a six-point scale (0: none, 1: mild, 2: mild–moderate, 3: moderate, 4: moderate–severe, 5: severe). Results: The mean heartburn score in patients administered rabeprazole decreased more rapidly than those given the other PPI. Complete heartburn remission also occurred more rapidly in patients administered rabeprazole (compared with omeprazole: P = 0.035, compared with lansoprazole: P = 0.038 by log-rank test). No differences were seen in the rate of endoscopic healing of reflux esophagitis at 8 weeks between the three treatment regimens. Conclusion: Rabeprazole may be more effective than omeprazole and lansoprazole for the rapid relief of heartburn symptoms in patients with reflux esophagitis.

The location of calcitonin gene-related peptide (CGRP) receptors in the rat stomach has not been elucidated. It was recently reported that the CGRP receptor is formed when a calcitonin-receptor-like receptor (CRLR) and receptor activity modifying protein (RAMP) 1 are co-expressed on the cell membrane. The aim of this study was to determine the location and the role of CGRP receptors in the rat gastric mucosa. Gene expressions of CRLR and RAMP1 were investigated by Northern blot analysis, reverse transcription-polymerase chain reaction (RT-PCR), and in situ hybridization. Immunohistochemical stainings for CGRP, somatostatin, gastrin, and chromogranin A were performed. Gastric endocrine cells were collected by counterflow-elutriation and their responses to CGRP were studied. CRLR and RAMP1 mRNA was expressed mainly in small gastric epithelial cells in the pyloric glands. The mRNA expression had a similar distribution to that of D cells. In cultured gastric endocrine cells, CGRP enhanced somatostatin production, while it inhibited the secretion of histamine and gastrin. Our results suggest that CGRP receptors are expressed in D cells in the rat gastric mucosa and control production and secretion of somatostatin.

Background. Helicobacter pylori infection induces T helper-1 immune responses in inflamed mucosa. However, the role of T cell-mediated cytotoxicity in the induction of epithelial apoptosis is still unclear. The aim of this study was to investigate the involvement of the Fas/Fas ligand (Fas/Fas-L) system in the H. pylori-infected gastric corpus. Materials and Methods. Gastric fundic biopsy specimens were taken from patients with and without H. pylori infection. The expression of Fas and Fas-L was examined by immunohistochemistry and RT-PCR. Subsets of gastric infiltrating T cells in the biopsy specimens were studied by immunohistochemistry and flow cytometry. In histological sections, apoptosis was detected by the TUNEL method. We studied the in vitro expression of Fas-L in peripheral T cells after stimulation with H. pylori antigen and interferon-γ (IFN-γ). The Fas-mediated in vitro cytotoxicity of activated T cells was assessed by flow cytometry. Results. The numbers of CD4+ and CD8+ T cells were greater in H. pylori-infected subjects. Fas expression was abundantly increased on fundic gland epithelium, and Fas-L was detected on lamina propria mononuclear cells in H. pylori-infected mucosa. TUNEL-positive epithelial cells were also increased in H. pylori-infected subjects. H. pylori antigen and IFN-γ induced Fas-L mRNA expression in both CD4+ and CD8+ T cells. In cytotoxic assay, activated T cells induced apoptosis in AGS cells, which could be significantly inhibited by neutralizing Fas-L antibody. Conclusions. T cell-mediated cytotoxicity via Fas/Fas-L signaling may contribute to the induction of apoptosis in gastric epithelial cells during H. pylori infection.

Background & Aims: Regenerating (Reg) protein has a trophic effect on gastric mucosal cells. We have shown that Reg gene expression is increased in enterochromaffin-like (ECL) cells during the healing of damaged gastric mucosa around mucosal erosion. This study was designed to explore the stimulants of Reg expression during the healing of gastric mucosal damage. Methods: Time course changes of the expression of genes for various proinflammatory cytokines and Reg were investigated after induction of gastric mucosal lesions in rats. The direct effect of proinflammatory cytokines on Reg gene expression and Reg protein production were investigated in vitro using counterflow elutriation–enriched rat ECL cells. CXC receptor 2 (CXCR-2) expression was investigated in ECL cells by reverse-transcription polymerase chain reaction. Reg gene expression was also investigated in rats treated by the neutralizing antibody of cytokine-induced neutrophil chemoattractant (CINC-2β). Results: During healing, the gene expression of several proinflammatory cytokines and Reg was markedly augmented. Among the proinflammatory cytokines, CINC-2β is the only cytokine in which augmented expression preceded the increase of Reg gene expression. In rats treated with CINC-2β neutralizing antibody, the augmentation of Reg gene expression was significantly inhibited. When ECL cells were incubated with these proinflammatory cytokines, CINC-2β dose-dependently increased Reg messenger RNA and Reg protein in ECL cells. CXCR-2 was identified in isolated ECL cells. Conclusions: CINC-2β, expressed in damaged gastric mucosa, stimulates the production of Reg protein in ECL cells via CXCR-2 and may be involved in the accelerated healing of injured gastric mucosa. GASTROENTEROLOGY 2000;119:1610-1622

Peroxisome proliferator-activated receptor (PPAR) gamma is expressed in human colon cancer, prostate cancer and breast cancer cells, and PPARgamma activation induces growth inhibition in these cells. PPARgamma expression in human gastric cancer cells, however, has not been fully investigated. We report the PPARgamma expression in human gastric cancer, and the effect of PPARgamma ligands on proliferation of gastric carcinoma cell lines. Immunohistochemistry was used to demonstrate the presence of PPARgamma protein in surgically resected specimens from well differentiated, moderately differentiated and poorly differentiated adenocarcinoma. We used reverse transcription-polymerase chain reaction and Northern and Western blot analyses to demonstrate PPARgamma expression in four human gastric cancer cell lines. PPARgamma agonists (troglitazone and 15-deoxy-Delta(12,14)-prostaglandin J2) showed dose-dependent inhibitory effects on the proliferation of the gastric cancer cells, and their effect was augmented by the simultaneous addition of 9- cis retinoic acid, a ligand of RXRalpha. Flow cytometry demonstrated G1 cell cycle arrest and a significant increase of annexin V-positive cells after treatment with troglitazone. These results suggest that induction of apoptosis together with G1 cell cycle arrest may be one of the mechanisms of the antiproliferative effect of PPARgamma activation in human gastric cancer cells.

Transforming growth factor (TGF) beta1 has an antitumorigenic role in the gastrointestinal tract and may be associated with the development of colon neoplasia. In the present study we investigated whether TGF-beta1 production in mucosa is lower in the distal colon, which is where clinical evidence shows that the incidence of colon neoplasia is higher, and whether TGF-beta1 levels were lower in the mucosa of patients with colon adenoma. Production of colon mucosa TGF-beta1 was investigated by means of a 24-hour organ culture with biopsy specimens taken from different segments of the colon of 58 normal subjects by using an enzyme immunoassay. TGF-beta1 production in colon mucosa from locations near the site of sporadic adenoma was also investigated in 46 patients. TGF-beta1 production gradually increased from the rectum to the ascending colon in a statistically significant manner in both normal (r = 0.77, P < .0001) and adenoma-bearing (r = 0.8, P < .0001) mucosa. When TGF-beta1 production was compared between normal and adenoma-bearing mucosa, levels were lower in the latter, although statistically significant results were seen only in the transverse colon (P < .05). TGF-beta1 production has clear site dependency, being lowest in the rectum and highest in the ascending colon. Furthermore, low levels of TGF-beta1 are associated with the development of adenoma. Our results suggest the possibility that this site dependency is associated with the higher epidemiologic incidence of colon neoplasia in the distal colon.

Clinicostatistical investigation was made on about 53 patients with squamous cell carcinoma of the oral cavity who had undergone neck dissection at the Department of Oral and Maxillofacial Surgery, Asahikawa NIcdical College from January 1979 to December 1988.Of the 71 cases of neck dissection, 50 were performed therapeutically, and 21 prophylactically. Metastases to the cervical lymph nodes were histologically confirmed in 33 patients.The majority of the involved nodes were submandibular lymph nodes, superior internal jugular nodes, and mid internal jugular nodes.The five-year-survival rate was 84.1% in patients without metastasis and 46.4% with metastasis.Prognosis was poorer as the number of metastatic nodes and sites increased. Prognosis was poorer as cervical nodes of lower level were involved.Of the 33 cases with cervical lymph node metastasis, eleven cases died of local failure, but only one case died of failure in the neck. This indicates that the prognosis of cases with cervical lymph node metastasis depends upon whether the primary disease is controlled or not.

A case of anaphylaxis to antiseptic povidone-iodine (PVP-I) is presented. When we used the PVP-I for irrigation of the operative wound after the reduction of the zygomatic arch fracture, subsequent severe edematous swelling occurred in the face and neck regions. In order to avoid anaphylactic shock, the operative wound was immediately washed with a large amount of physiological saline solution, and then hydrocortisone and predonisolone were given intravenously.As the results of these treatments, the swelling was rapidly reduced at 4 days later, and period of about 1 month was needed for complete disappearence of symptoms.Intradermal skin test with 0.1mg/ml of PVP-I showed positive reaction, but was negative in the healthy 10 volunteers used as control. Moreover, the reaction of patch testing with 100mg/ml of PVP-I was negative in this patient.From the facts stated above, we may conclude that the patient has an anaphylactic reaction of immediate type to PVP-I.

Pleomorphic adenoma is found in high incidence among various types of tumors in the salivary gland, however, occurrance in the sublingual gland is extremely rare.We report a case of pleomorphic adenoma originated from the sublingual gland.The patient, 24 year old female, complained of swelling in her right sublingual region.Under general anesthesia the tumor was resected with the clinical diagnosis of sublingual gland tumor.The histopathological findings revealed typical pleomorphic adenoma features.The patient had no evidence of recurrence at three years and 2 months follow-up after operation.Sublingual gland pleomorphic adenoma is very rare, and we report of a few remarks and some literature connected with this case.

We studied about 4 cases of unoperated cleft palate patients up to grow-up; 3 cases of cleft lip and palate received lip operation in infancy and 1 case of cleft palate alone.Their maxillofacial patterns, dental arches and occlusal conditions were analyzed by means of lateral roentogenographic cephalogram and measurement of dental cast, and we observed differences compared with normal adults.The results may be summarized as follows:1. The maxilla growth in all patients was distributed in normal range.2. Three patients with cleft lip showed slight inhibition of the outward growth of maxilla, consequently a little constriction was observed in their dental arch, whereas the case of cleft palate alone was nearly normal adult.3. The dentition of front and molar part teeth showed a state of normal occlusion and the maxillo-mandibular were mainteined in good condition.Our results suggested that the maxillar growth capacity in cleft palate patients was similar to that of normal adults.

A 24-year-old female Japanese patient presented with remarkably long roots of retained deciduous anterior teeth and permanent anterior teeth in the upper and lower jaw. Four lower anterior teeth were extracted for esthetic reasons. The patient had no apparent clinical syndrome related to the teeth or jaw, nor did there appear to be a family history of this condition. The extracted teeth and their lengths were as follows: the lower right deciduous lateral incisor was 25.55 mm long (root length, 18.95 mm); the lower left deciduous lateral incisor was 22.10 mm long (root length, 17.25 mm); the lower right deciduous canine was 27.95 mm long (root length, 20.60 mm); and the lower left deciduous canine was 23.90 mm long (root length, 17.65 mm).

The effect of prostaglandin E2 (PGE2) on the proliferation of gastric cancer cells is still unclear. PGE2 receptors are divided into four subtypes — EP1, EP2, EP3, and EP4 — which are coupled to three different intracellular signal-transduction systems. Stimulation of EP2 and EP4 is linked with cyclic adenosine 3′, 5′-monophosphate (cAMP)-dependent protein kinase A (PKA). In some human gastric cancer cells, PGE2 has been suggested to have an antiproliferative effect by way of increased cAMP production. Expression of EP2 and EP4 in human gastric carcinoma cells, however, has not been examined. We examined the expression of EP2 and EP4 and the antiproliferative effects of specific EP2 and EP4 agonists on four different human gastric cancer cell lines. Our data clarified that all the cell lines investigated in this study expressed EP2 and EP4 and that the specific agonists of these receptors induced growth inhibition with an accompanying increase in cAMP production. In summary, gastric cancer cells have EP2 and EP4 receptors, and their selective activation is linked with the decreased cell proliferation. (J Lab Clin Med 2002;140:92-102)

Background and Aim: Helicobacter pylori (H. pylori) infection is known to affect the gastric microcirculation, and cetraxate is reported to accelerate gastric ulcer healing, possibly by augmenting gastric mucosal blood flow (MBF). The aim of this study is to clarify the effect of H. pylori infection and cetraxate on MBF during gastric ulcer healing. Methods: Forty-two patients who had undergone endoscopic mucosal resection (EMR) were studied. Mucosal blood flow was measured by the use of a laser Doppler flowmeter in the surrounding mucosa and at the ulcer margin, before, 1 day, 1 week and 4 weeks after EMR. Helicobacter pylori infection was confirmed by the use of bacterial culture and histology. After EMR, patients were randomly assigned to receive 30 mg lansoprazole (u.i.d; L-regimen) or 30 mg lansoprazole (u.i.d.) with 200 mg cetraxate (q.i.d; LC-regimen) for 4 weeks. Results: The MBF ratio (MBF at ulcer margin/MBF in surrounding mucosa) 1 week after EMR was significantly lower than that before or 4 weeks after EMR only in H. pylori-positive patients treated with the L-regimen. No such decrease in MBF was observed after 1 week in H. pylori-positive patients treated with the LC-regimen or in H. pylori-negative patients. Conclusion: A transient decrease in MBF was detected at the ulcer margin during healing of EMR-induced ulcers in H. pylori-infected patients. Cetraxate seemed to prevent this decrease in MBF.

Prostaglandin E2 (PGE2) plays an important role in the regulation of gastric mucus secretion. We have previously shown that the prostaglandin EP4 receptor (EP4) gene is abundantly expressed in gastric mucus-producing cells. Furthermore, we have shown that EP4 is present in a rat normal gastric mucosal cell line (RGM1) and that PGE2 increases mucus secretion from these cells via EP4. Rebamipide, an anti-gastric ulcer agent, has been reported to promote gastric PGE2 production and mucus secretion. However, it is unclear whether rebamipide influences mucus secretion by altering expression of the EP4 gene. Therefore, we tested the effect of rebamipide on EP4 gene expression in the gastric mucosa. Seven-week-old Wistar rats received oral rebamipide (100 mg/kg) with and without water-immersion restraint stress (WRS). All rats were killed, and their gastric tissues were used to investigate the expression of mRNA for EP4 and cyclooxygenase types 1 and 2. The thickness of the gastric mucus layer was also measured. The effect of rebamipide on EP4 gene expression and PGE2 production in RGM1 cells was also investigated in vitro. Furthermore, the effect of PGE2 on cyclic adenosine monophosphate (cAMP) production by RGM1 cells with or without rebamipide was studied. Oral rebami-pide significantly increased EP4 gene expression in the gastric antrum but not in the corpus after WRS. Furthermore, it increased surface mucus thickness and suppressed ulcer formation in the gastric mucosa after WRS. In vitro, rebamipide significantly augmented EP4 gene expression in RGM1 cells, and PGE2 significantly increased the cAMP production by RGM1 cells incubated with rebamipide. Rebamipide promotes EP4 gene expression and may consequently increase the gastric mucus secretion via EP4 receptors in the rat antral mucosa.

Two cases of salivary calculus in parotid gland duct were reported.Morphological observation on salivary calculi was carried out on the scanning electron microscope (SEM) and X-ray microanalyzer in case No.2.These results of SEM findings were consistent with those of many investigators.The Xray microanalysis showed the salivary calculi contained chemical elements such as Ca and Pions.The results of the present study were discussed together with the literature.

Tuberculosis of the parotid gland is very rare among tuberculosis of the head and neck region.We present a case of tuberculosis of the parotid gland. The patient was a 58-year-old female.There are some methods for treatment of this disease. We treated this patient with antituberculous agents. For 9 months after treatment, no particular abnormality was observed.We discovered fibrous changes in the parotid gland by CT scanning after treatmet, but the outflow of saliva steadily of better.

We experienced a case of peripheral ameloblastoma that developed in the right palatal gingiva adjacent to the first premolor tooth in a 30-year old man.This tumor is a very rare one that develops only in the soft tissues of the tooth bearing areas.It is necessary for the diagnosis to have a detailed histological examination.In this case the excised bone was examined by serial sections. “Peripheral ameloblastoma” in histopathological diagnosis was comfirmed, and we reported this case together with the literature.

Two cases of Basal Cell Nevus Syndrome (BCNS) are reported. They were diagnosed as BCNS because multiple jaw cysts, skeletal anomalies, and many other symptoms accompanied although basal cell nevus was lacked. Cleft lip or cleft palate (bifid uvula) was associated with each case.Accordingly the ratio of association of cleft lip and/or palate is 15.6%, and this is far more than the ratio in the normal population. This fact supports the conclusion by Gorlin and Sedano that association of orofacial clefting does not appear to be due to chance.

Twenty-eight patients with carcinoma of the tongue treated at the Department of Oral and Maxillofacial Surgery, Asahikawa Medical College from 1978 to 1986 were reviewed.The patients ranged in age from 33 to 80 years, and 71. 4 percent were male (20/28). The carcinoma in 26 cases originated in the lateral borders of the tongue. The histopathological diagnosis was squamous cell carcinoma in all cases. In stage grouping of the UICC (1978): 11 cases belonged to stageI, 8 to II, 5 to III, 4 to IV.In early cases of stage I and II, 8 cases were treated mainly by interstitial radiotherapy and 11 cases mainly by surgery. In advanced cases of stage 111 and IV, most of them received surgical treatment combined with pre-operative irradiation. The 5-year survival rate of stage I, II, III, IVwere78.9%, 85.8%, 60%and50%, respectively.In cases of stage 1 and 1I, the cure rate treated by surgery was clearly superior to that by radiation therapy.Cases with metastasis to cervical lymph nodes showed. markedly lower survival rate than those without cervical metastasis. But no case with metastasis to cervical lymph nodes treated by neck dissection died from cervical metastasis. Recurrences of primary lesions or cervical metastasis mostly occurred within 1 year after the treatment.This indicates that we must regularly followup the subsequent history of the patients within 1 year after the treatment.

The plunging ranula is thc rare mucocele that extends to the submandibular region.A case of plunging ranula is presented. Thc patient is a 2-year-old male.Though there are many treatment procedures for this disease, we extraded both the eyst wall and sublingual gland.Two years after the operation, no special abnormality was recognized.We considercd that the analysis of amylase activity in the eyst fluid is valuable for diagnosis, becausc it is higher than that of the serum.

We have clinico-stastically studied 233 cases of maxillo-facial fracture patients who had been treated during the past eight years from January, 1978 to December, 1985.From this study, we obtained the following results:Of all the patients, 185 were male and 48 were female. The male/female ratio was 4: 1. Most of the males were distributed among the ages of 10 to 19 years old (28.3%) and their twenties (26.1%). The number of patients in our department show a tendency to increase every year.The causes of fractures were mostly traffic accidents (44.1%). One hundred eighty-five cases (79.5%) were referred from public or private hospitals, and only 37 cases (15.9%) from dental clinics.Fractures of the mandible alone accounted for 69. 1%. The sites of the mandible fractures were found at the condyle (25.3%), the angle of the mandible (21.9%), and other areas (52.5%).Disturbance of mouth opening were found in 67. 8% of all cases as complications of the fracture, followed by tooth injuries (62.3%), injury of the oral mucosa (36.1%), deformity of occlusion (31.3%) and unconsciousness (24.9%).