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Nakajo-Nishimura syndrome, which is a specific autoimmune disorder characterized by chronic inflammation, emaciation, and exhaustion, is inherited in an autosomal recessive fashion and is representative of proteasome dysfunction. Its main clinical features include pernio-like red-to-purple skin plaques on the hands and feet, periodic fever, progressive localized atrophy of fat and muscle, emaciation, elongated and thickened fingers and toes, joint contractures, enlarged liver, basal ganglia calcification, and a heliotrope rash. The dental treatment for three patients with Nakajo-Nishimura syndrome is described. Dental extractions and procedures were successfully performed without causing any obvious intraoperative or postoperative complications, although all three patients showed progressive trismus. When performing a dental procedure in patients with proteasome dysfunction, preoperative antibiotic therapy should be given because they are susceptible to infection due to the long-term use of high-dose steroids. Drug-related osteonecrosis of the jaw should also be considered. Proteasome dysfunction is characterized by joint contractures and progressive fat and muscle atrophy; thus, the patients are also likely to have reduced mouth opening, and it is a challenge for them to clean their teeth by brushing, which may lead to the occurrence of dental caries in molars. Therefore, scheduling regular interventions by dentists needs to be considered for patients with proteasome dysfunction.

Postoperative hemorrhage after tooth extraction is a critical and clinically important issue for clinicians and patients receiving anticoagulants. The purpose of the present study was to investigate the prevalence of and risk factors for postoperative hemorrhage after lower third molar extraction in Japanese patients receiving warfarin therapy. A total of 142 patients who underwent lower third molar extraction between January 2010 and December 2016 were included, and their medical records were retrospectively reviewed. The prevalence of and risk factors for postoperative hemorrhage were investigated. The prevalence of postoperative hemorrhage after lower third molar extraction was significantly higher in patients receiving warfarin than in healthy subjects (21.8% vs 0.7%, P

Background No studies have compared the outcomes of direct perineurial suture with vein graft cuff repair and indirect collagen allograft repair of the lingual nerve following an injury. Therefore, we evaluated and compared the outcomes of each over a 1-year observation period. We retrospectively assessed 20 patients who had undergone microneurosurgical repair of unilateral lingual nerve injuries at the Wakayama Medical University Hospital between May 2015 and March 2019. We utilized two different methods for lingual nerve repair, i.e., direct perineurial repair with a vein graft cuff and interpositional collagen allograft repair. Sensory and taste function in the lingual nerve were preoperatively evaluated using a static two-point discrimination test, superficial pain/tactile sensation test, tests for the pressure pain threshold (Semmens-Weinstein monofilament), test for thermal discrimination hot and cold sensation, and a taste discrimination test. These tests were performed again at 6 and 12 months postoperatively. Results Compared to the preoperative conditions, all patients showed improved sensory reactions. Functional sensory recovery outcomes were defined by Pogrel’s criteria, Medical Research Council Scale grades, and functional sensory recovery. In each group, all patients improved after the operation. However, the operation time was significantly shorter for an interpositional collagen allograft repair as compared to that for a direct perineurial repair with a vein graft cuff. Conclusions There were no statistically significant differences between the two repair Methods, except for the operation time. Both methods led to satisfactory results for all criteria. From an economic point of view, direct perineurial repair with a vein graft cuff is meaningful; however, the esthetic effect on the donor site should be considered. Conversely, interpositional collagen allograft repair has the advantage of a greatly shortened operation time.

Background: Surgical site infections (SSI) are associated with increased morbidity and mortality. The purpose of this study was to investigate the ability of perioperative oral management (POM) to reduce the risk of SSI in abdominal surgery. Real-world data collected from 16 Japanese university hospital was reviewed. Methods: The medical records of consecutive 2,782 patients (1,750 men and 1,032 women) who underwent abdominal surgery under general anesthesia in 16 university hospitals were retrospectively reviewed. Detailed information about SSI was assessed and compared between patients with and without POM in univariate and multivariate analyses. Results: SSI were observed in 275 patients (incidence rate: 9.9%) and POM was delivered in 778 patients (28.0%). Univariate analyses revealed that diabetes mellitus, Eastern Cooperative Oncology Group (ECOG) performance status, the American Society of Anesthesiologists (ASA) classification, the surgical site, the preoperative Prognostic Nutritional Index score, POM, the extent of surgery, the operation time, and the amount of intraoperative blood loss were significantly associated with postoperative SSI (Chi-square or Mann-Whitney U-test, p

Background: Postoperative surgical site infections (SSI) can be major complications, which can prolong postoperative treatment. Perioperative oral management (POM) was first covered by Japanese national health insurance system in 2012, and patients that are scheduled to undergo major surgical treatment receive dental and oral management during the perioperative period.Objectives: The purpose of the present study was to investigate the ability of POM to prevent perioperative SSI in patients undergoing abdominal surgery.Methods: The patients’ medical records were retrospectively reviewed, and the effects of POM were investigated in a multicenter analysis involving many cases. Detailed information about SSI was assessed and compared between patients with and without POM in univariate and multivariate analyses. Results: In total, the cases of 2,782 patients (1,750 males 1,032 females) were reviewed. Of these, POM was performed in 778 patients (28.0%). Univariate analyses revealed that diabetes mellitus, Eastern Cooperative Oncology Group (ECOG) performance status, the American Society of Anesthesiologists (ASA) classification, the surgical site, the preoperative Prognostic Nutritional Index score, POM, the extent of surgery, the operation time, and the amount of intraoperative blood loss were significantly associated with postoperative SSI (Chi-square or Mann-Whitney U-test, p

Little research has been conducted into hypoesthesia, and no studies have elucidated the risk factors for refractory hypoesthesia and compared treatment modalities. The purpose of this multicentre retrospective cohort study was to investigate the relationships between various risk factors, treatment modalities, and refractory hypoesthesia. Risk factors for refractory hypoesthesia after oral surgery were evaluated using univariate and multivariate analysis. To minimize the selection bias associated with a retrospective data analysis, a propensity score analysis was performed between the medication and non-medication groups (65 sites in each group). Moderate or severe hypoesthesia (odds ratio 13.42) and no or late administration of ATP/vitamin B12 (odds ratio 2.28) were significantly associated with refractory hypoesthesia. In the propensity score analysis, the incidence rate of refractory hypoesthesia in the medication group was lower than that in the non-medication group (P

Medication-related osteonecrosis of the jaw (MRONJ) is an adverse event that may inhibit the treatment of primary disease and remarkably influence the patient's quality of life. The treatment methods for MRONJ, nonsurgical and surgical, are controversial, with no agreement as to which method provides the best outcome and should therefore be recommended. This multicenter retrospective study aimed to investigate the treatment methods and outcome in a large number of patients with MRONJ in Japan, utilizing propensity score matching analysis. A total of 361 patients with MRONJ, at eight hospitals, were registered in this study retrospectively. Various demographic and treatment-related variables were examined and analyzed to determine their correlation with the treatment outcome. After propensity score matching for treatment methods (nonsurgical versus surgical treatment), 176 patients were analyzed by logistic regression. It was shown that those with low-dose administration of an antiresorptive agent and surgical treatment had better outcomes. Furthermore, in 159 patients who underwent surgical treatment, those who underwent extensive surgery experienced significantly better treatment outcomes than those who underwent conservative surgery. This is the first study to compare treatment methods for MRONJ using propensity score matching analysis. The results indicated that extensive surgical treatment should be performed as first-choice therapy for patients with MRONJ. © 2017 American Society for Bone and Mineral Research.

Background To improve prognosis of pancreatic cancer (PC) patients, the discovery of more reliable biomarkers for the early detection is desired. Methods Blood samples were collected by 2 independent groups. The 1st set was included 55 early PC and 58 healthy volunteers (HV), and the 2nd set was included 16 PC and 16 HV. The 16 targeted metabolites were quantitatively analyzed by gas chromatography/tandem mass spectrometry together with their corresponding stable isotopes. In the 1st set, the levels of these metabolites were evaluated, and diagnostic models were constructed via multivariate logistic regression analysis, leading to validation using the 2nd set. Results In the 1st set, model X consisting of 4 candidates based on our previous report possessed higher sensitivity (74.1%) than carbohydrate antigen 19-9 (CA19-9). Model Y, consisting of 2 metabolites newly selected from 16 metabolites via stepwise method possessed higher sensitivity (70.4%) than CA19-9. Furthermore, combining model Y with CA19-9 increased its sensitivity (90.7%) and specificity (89.5%). In the 2nd set, combining model Y with CA19-9 displayed high sensitivity (81.3%) and specificity (93.8%). In particular, it displayed very high sensitivity (100%) for resectable PC. Conclusions Quantitative analysis confirmed that metabolomics-based diagnostic methods are useful for detecting PC early.

Background Programmed cell death ligand 1 (PD-L1) is an immune checkpoint molecule that attenuates the immune response. PD-L1 contributes to failed antitumor immunity; thereby, blockade of PD-L1 with monoclonal antibody enhances the immune response. Recently, it was reported that PD-L1 was regulated by protein 53 (p53). Besides, cytokeratin 17 (CK17) is thought to be a diagnostic marker of oral squamous cell carcinoma (OSCC). Our aim was to evaluate the correlation between the immunohistochemical expression of PD-L1, p53 and CK17 with clinicopathological characteristics and disease-specific survival in patients with OSCC. Methods A total of 48 patients with OSCC were included in this study. Immunohistochemical staining was performed to evaluate the correlation among the expressions of PD-L1, p53 and CK17, and furthermore the correlation among various clinicopathological factors, PD-L1, p53 and CK17. Results The positive rate of p53, CK17, PD-L1 (tumor cells) and PD-L1 (tumor-infiltrating lymphocytes) was 63.2%, 91.7%, 48.9% and 57.1%. A statistically significant correlation between p53 expression and T stage and TNM stage (p = 0.049, p = 0.03, respectively) was observed. Also, a statistically significant correlation between p53 and PD-L1 (TCs) expression (p = 0.0009) was observed. Five-year disease-specific survival rate was not significantly correlated with gender, TNM stage, p53 expression, PD-L1 expression and CK17 expression. Conclusion The expression of p53 and PD-L1 shows significantly positive correlation in oral squamous cell carcinoma in tumor cells. Also, a significant correlation between p53 expression and T stage and TNM stage was observed. No other significant correlation between PD-L1 staining or CK17 and clinical or pathologic characteristics was identified.

Background The prognosis of recovery following microneurosurgery for injured lingual nerves varies among individual cases. This study aimed to investigate if recovery ratios of sensory and taste functions are improved by the microneurosurgery within 6 months after lingual nerve injury. Methods We retrospectively assessed 70 patients who underwent microneurosurgery at the Wakayama Medical University Hospital for lingual nerve injuries between July 2004 and December 2016. Sensory and taste functions in lingual nerves were preoperatively evaluated using a static two-point discrimination test, an intact superficial pain/tactile sensation test, and a taste discrimination test. They were evaluated again at 12 and at 24 months postoperatively. The abundance ratio of Schwann cells in the excised traumatic neuromas was analyzed with ImageJ software following immunohistochemistry with anti S-100β antibody. Results In early cases (microneurosurgery within 6 months after the injury), recovery ratios of sensory and taste functions were not significantly different at 24 months after microneurosurgery compared with later cases (microneurosurgery more than 6 months after the injury). Meanwhile, the ratio of patients with taste recovery within 12 months after microneurosurgery was significantly decreased in late cases compared with early cases. The abundance ratio of Schwann cells in traumatic neuroma was also significantly lower in later cases. Conclusion Microneurosurgery more than 6 months after lingual nerve injury did not lead to decreased recovery ratio of sensory and taste functions, but it did lead to prolonged recovery of taste. This delay may be associated with a decrease in the abundance ratio of Schwann cells in traumatic neuromas.

Background Through the analysis of clinical data, we attempted to investigate the etiology and determine the risk of severe iatrogenic lingual nerve injuries in the removal of the mandibular third molar. Methods A retrospective chart review was performed for patients who had undergone microsurgical repair of lingual nerve injuries. The following data were collected and analyzed: patient sex, age, nerve injury side, type of impaction (Winter’s classification, Pell and Gregory’s classification). Ratios for the respective lingual nerve injury group data were compared with the ratios of the respective data for the control group, which consisted of data collected from the literature. The data for the control group included previous patients that encountered various complications during the removal of the mandibular third molar. Results The lingual nerve injury group consisted of 24 males and 58 females. The rate of female patients with iatrogenic lingual nerve injuries was significantly higher than the control groups. Ages ranged from 15 to 67 years, with a mean age of 36.5 years old. Lingual nerve injury was significantly higher in the patient versus the control groups in age. The lingual nerve injury was on the right side in 46 and on the left side in 36 patients. There was no significant difference for the injury side. The distoangular and horizontal ratios were the highest in our lingual nerve injury group. The distoangular impaction rate in our lingual nerve injury group was significantly higher than the rate for the control groups. Conclusion Distoangular impaction of the mandibular third molar in female patients in their 30s, 40s, and 50s may be a higher risk factor of severe lingual nerve injury in the removal of mandibular third molars.

Basaloid squamous cell carcinomas (BSCCs) in oral lesions are extremely rare, and the histology is not well understood. Histologically, they are often similar to conventional squamous cell carcinoma (SCC). The present study was designed with an aim to distinguish BSCC from SCC using claudin‑4, occludin, SRY‑box 2 (SOX2) and proliferating cell nuclear antigen (PCNA) immunoreactivities and staining patterns. Three BSCCs (with abundant, with moderate, and without squamous components) specimens and 20 SCC specimens were selected for comparison of their immunoreactivity. These specimens were stained with claudin‑4, occludin, SOX2 and PCNA. In addition to histological analysis, the expression of claudin‑4, occludin and PCNA was determined in oral cancer HSC2 and HSC3 cells with or without SOX2 overexpression, and cell proliferation was determined by XTT assay. Claudin‑4 had strong and occludin had weak immunoreactivity as detected in the membrane of squamous components of BSCC but not in cancer cells. No obvious detection of squamous components and cancer cells were observed in SCC. SOX2 and PCNA immunoreactivities in SCC had dot‑like staining patterns in the nuclei of partial and marginal cancer cells. In contrast, in BSCCs, SOX2 and PCNA had diffuse staining patterns in almost all cancer cells. SOX2 overexpression had little effect on the expression levels of claudin‑4, occludin and PCNA. It also had little effect on the cell proliferation of HSC2 and HSC3 cells. Differences in immunoreactivity and staining pattern may be valuable to distinguish between BSCC and SCC in diagnosis.

Mandibular third molar extractions are common treatment in oral maxillofacial surgery, but risk disturbance of the lingual nerves causing anesthesia, eating difficulty and allodynia, which can seriously reduce patient quality of life. This study investigates the change in allodynia before and after repair in patients with lingual nerve disorder. This retrospective cohort study comprises the 52 patients with affected lingual nerve after third molar extraction at our hospital over a 7-year period. Pre- and postoperative (6 months and 12 months) neurosensory records were analyzed. Fifty-two patients underwent lingual nerve repair and returned for at least 1 year of follow-up. Mean age was 36.8 ± 11.9. Median interval between injury and surgery was 5 (4, 8) months. In 92.9% of those with pain before surgery, allodynia disappeared postoperatively. This study shows that microsurgical lingual reconstructions are effective in patients with preoperative allodynia, but a small number of patients may have remaining allodynia after surgery. Large-scale, more detailed analysis of such cases is required.

The purpose of the present study was to investigate the efficacy of perioperative oral managements (POMs) on perioperative nutritional conditions in patients undergoing surgery with general anesthesia. Medical records were retrospectively reviewed and the effects of POMs were investigated based on a large number of cases using a multicenter analysis. The profile of serum albumin levels was assessed and compared between patients with and without POMs using the multivariate analysis. Seventeen Eleven thousand and one hundred sixty patients (4,873 males and 6,287 females) were reviewed. Of these, 2710 patients (24.3%) had undergone POMs. The results of a multivariate analysis revealed the significant positive effect of POMs on perioperative serum albumin level (change between at admission and discharge, (Estimate: 0.022, standard error: 0.012, P < .0001). Patient gender, age, surgical site, performance status, the American Society of Anesthesiologists (ASA) physical status classification, operation time, amount of blood loss, and serum albumin level at admission were also significant predictors. Adjusted multivariate analysis of the effects of POMs on perioperative change of serum albumin level in all subjects reveled the significance of POMs intervention (estimate: 0.022, standard error: 0.012, P < .0001). These results suggest that POMs exerts significant positive effects on perioperative serum albumin levels in patients underwent surgery under general anesthesia.

Treatment strategies of medication-related osteonecrosis of the jaw (MRONJ) are controversial. Recently, surgical treatment has been reported as superior to nonsurgical treatment, but the contribution discontinued antiresorptive agent use during MRONJ treatment remains unclear. This study aimed to evaluate the efficacy of drug holidays and treatment strategies in MRONJ cases. Four-hundred and twenty-seven patients with MRONJ treated at nine hospitals from 2009 to 2017 were included in this multicenter retrospective study. Multivariate Cox regression analysis showed that the primary disease (osteoporosis or malignant tumor), diabetes, serum albumin, and treatment method (surgical or nonsurgical) were significantly correlated with the cure rate. The cumulative 1-year cure rates in the surgical and nonsurgical treatment groups were 64.7% and 18.2%, respectively. However, discontinuing antiresorptive agents did not influence the treatment outcome in the cohort overall, or in 230 patients after performing propensity score matching among the discontinuation and continuation groups. When stratifying by treatment method, antiresorptive agent discontinuation significantly increased the cure rate in patients with osteoporosis who underwent nonsurgical treatment. In patients with malignant tumors undergoing nonsurgical therapy, discontinuing the antiresorptive agent was associated with a better treatment outcome, but not with statistical significance. In contrast, drug holidays showed no effect on improving outcomes in patients with both osteoporosis and malignant tumors who underwent surgical therapy. Thus, regardless of the primary disease, discontinuing antiresorptive agents during treatment for MRONJ may not be necessary and may be helpful in some cases. Future prospective trials should examine this question further.

Supplemental Digital Content is available in the text, Patients develop a number of oral complications during cancer treatments. Oral bacteria are associated with the onset of dental focal infections and the progression of oral mucositis. Dental focal infections are frequently associated with the systemic onset of bacteremia, sepsis, and pneumonia. The degeneration of oral function with these complications may become an obstacle to cancer treatments. Although comprehensive oral management, including oral care, the removal of dental focal infections, and improvements in oral function with dentures, is conducted for cancer patients in Japan, few studies have assessed its efficacy. The aim of the present study was to investigate the incidence of dental/oral complications in cancer patients with perioperative oral managements (POMs) based on a large number of case series with a multicenter retrospective analysis. The medical records of cancer patients with POMs were retrospectively reviewed and the incidence of oral complications and efficacy of oral management were investigated. A total of 2744 cancer patients with POMs (1684 males and 1080 females, mean age 65.9 ± 13.0 years) were included and investigated in the present study. Among these patients, 2097 (76.4%) started POM before the initiation of cancer treatments, with 2130 (77.6%) receiving oral care only and 391 (14.2%) being subjected to invasive treatments, such as tooth extraction. The incidence of dental focal infections during the period of cancer treatments was 8.2%. The most frequent infection was acute periodontitis, including alveolar abscesses (112 patients, 4.1%). The incidence of grade 2 and 3 oral mucositis was 2.8%. Prolonged fever was observed in 113 patients (4.1%), with 7 having dental focal infections (6.2%). These incidence rates were lower than those reported previously. Based on analyses of a large number of patients, the present results support the efficacy of oral management in cancer patients. However, further studies are needed to establish adequate oral management guidelines for cancer patients.

Root amputation, immunosuppressive therapy, mandibular tooth extraction, pre-existing inflammation, and longer duration of treatment with bone-modifying agents were significantly associated with an increased risk of medication-related osteonecrosis of the jaw. Hopeless teeth should be extracted without drug holiday before the development of inflammation in cancer patients receiving high-dose bone-modifying agents. No studies have comprehensively analyzed the influence of pre-existing inflammation, surgical procedure–related factors such as primary wound closure, demographic factors, and drug holiday on the incidence of medication-related osteonecrosis of the jaw (MRONJ). The purpose of this study was to retrospectively investigate the relationships between these various factors and the development of MRONJ after tooth extraction in cancer patients receiving high-dose bone-modifying agents (BMAs) such as bisphosphonates or denosumab. Risk factors for MRONJ after tooth extraction were evaluated with univariate and multivariate analyses. The following parameters were investigated in all patients: demographics, type and duration of BMA use, whether BMA use was discontinued before tooth extraction (drug holiday), the duration of such discontinuation, the presence of pre-existing inflammation, and whether additional surgical procedures (e.g., incision, removal of bone edges, root amputation) were performed. We found that root amputation (OR = 22.62), immunosuppressive therapy (OR = 16.61), extraction of mandibular teeth (OR = 12.14), extraction of teeth with pre-existing inflammation, and longer duration (≥ 8 months) of high-dose BMA (OR = 7.85) were all significantly associated with MRONJ. Tooth extraction should not necessarily be postponed in cancer patients receiving high-dose BMA. The effectiveness of a short-term drug holiday was not confirmed, as drug holidays had no significant impact on MRONJ incidence. Tooth extraction may be acceptable during high-dose BMA therapy until 8 months after initiation.

Somatosensory evoked fields (SEFs) induced by tongue stimulation can be useful as an objective parameter to assess sensory disturbances in the tongue. However, whether tongue SEFs can be useful as a clinical, objective follow-up assessment method of tongue sensation following oral surgery is unknown. Here we describe two cases in which tongue SEFs were successfully used in clinical assessment. Two patients with unilateral tongue sensory deficits caused by lingual nerve injury during lower third molar extraction were recruited. Both patients underwent surgery to repair the damaged nerve, and all tongue sensory evaluations were made once before and once after surgery. SEFs were recorded by stimulating the affected and unaffected sides of the tongue separately, and cortical activity was evaluated over the contralateral hemisphere. The unilaterality of the deficit was also assessed. In both patients, stimulation of the unaffected side evoked reproducible cortical responses pre- and post-surgery. Both patients also recovered some sensation following surgery, as pre-surgery stimulation of the affected side failed to evoke cortical activity, whereas post-surgery stimulation evoked cortical activity on both sides. Sensation was initially highly lateralized in both patients, but was restored to approximately normal in the post-surgery evaluation. Finally, both patients’ rated their subjective tongue sensations on the affected side over 50% better after the surgical intervention. These cases indicate that tongue SEFs may have a clinical use as an objective parameter for assessing the course of tongue sensory recovery.

Pancreatic cancer is one of the most lethal tumors, and reliable detection of early-stage pancreatic cancer and risk diseases for pancreatic cancer is essential to improve the prognosis. As 260 genes were previously reported to be upregulated in invasive ductal adenocarcinoma of pancreas (IDACP) cells, quantification of the corresponding proteins in plasma might be useful for IDACP diagnosis. Therefore, the purpose of the present study was to identify plasma biomarkers for early detection of IDACP by using two proteomics strategies: antibody-based proteomics and liquid chromatography-tandem mass spectrometry (LC-MS/MS)-based proteomics. Among the 260 genes, we focused on 130 encoded proteins with known function for which antibodies were available. Twenty-three proteins showed values of the area under the curve (AUC) of more than 0.8 in receiver operating characteristic (ROC) analysis of reverse-phase protein array (RPPA) data of IDACP patients compared with healthy controls, and these proteins were selected as biomarker candidates. We then used our high-throughput selected reaction monitoring or multiple reaction monitoring (SRM/MRM) methodology, together with an automated sample preparation system, micro LC and auto analysis system, to quantify these candidate proteins in plasma from healthy controls and IDACP patients on a large scale. The results revealed that insulin-like growth factor-binding protein (IGFBP)2 and IGFBP3 have the ability to discriminate IDACP patients at an early stage from healthy controls, and IGFBP2 appeared to be increased in risk diseases of pancreatic malignancy, such as intraductal papillary mucinous neoplasms (IPMNs). Furthermore, diagnosis of IDACP using the combination of carbohydrate antigen 19–9 (CA19-9), IGFBP2 and IGFBP3 is significantly more effective than CA19-9 alone. This suggests that IGFBP2 and IGFBP3 may serve as compensatory biomarkers for CA19-9. Early diagnosis with this marker combination may improve the prognosis of IDACP patients.

Background: Inflammatory pseudotumor is a rare, benign non-neoplastic lesion. Clinically it behaves as an aggressive lesion, which can be mistaken for malignant tumor. Case presentation: This article presents a rare case of submandibular inflammatory pseudotumor in a 44-year-old man patient. The submandibular mass presented rapid enlargement in one month’s duration after initial examination. The patient was treated with surgery. Histologic examination of the resected specimen showed florid myofibroblastic and fibrohistiocytic proliferations in an inflammatory background. Immunohistochemically, the cells expressed vimentin, α-smooth muscle actin and CD68 indicating a diagnosis of inflammatory pseudotumor. The patient had an uneventful postoperative recovery and no evidence of recurrence. Conclusions: We report a case of inflammatory pseudotumor occurring at the site of submandibular region.

Purpose Pedicle myofascial graft should be considered in contemporary oral and maxillofacial reconstruction for the following reasons: 1 ) the pedicle myofascial unit is reliable and easily handled; 2 ) on the grafted myofascia in the oral cavity, the mucosa regenerates naturally with regard to suppleness and surface characteristics; and 3 ) vascularized myofascial coverage of tissues or materials is useful in some clinical situations. The purpose of this retrospective study was to evaluate the usefulness of this graft material. Patients and Methods Using myofascial flaps from the pectoralis major muscle in 15 patients and from the platysma muscle in 11 patients, several types of reconstructive procedures were conducted in the Department of Oral and Maxillofacial Surgery, Wakayama Medical University. Results Myofascial tissue was used to cover the surgical defect and for regeneration of oral mucosa (24 patients), to prevent exposure of the mandibular reconstruction plate (4 patients), for prevention of wound breakdown and secondary infection in the oral cavity (2 patients), for vascularized coverage of free grafted autologous bone (2 patients), and for protection of large vessels after radical neck dissection (9 patients). Although partial flap necrosis or wound dehiscence was noticed in 3 patients with a platysma-myofascial graft, the healing process of all patients was favorable and required no additional operations. This procedure is most suitable for the reconstruction of small to medium-sized soft tissue defects in the oral cavity, because it induces the formation of nearly normal mucosa through epithelial regeneration without clear scar formation. Conclusions Myofascial flap is a useful option in certain oral and maxillofacial reconstruction cases in which mucosal regeneration and/or vascularized soft tissue coverage are required.

Osseous choristoma is a rare, benign lesion which usually develops in the tongue adjacent to the foramen caecum. This report presents a case occurring in the palatal region, as well as a review of the literature. A differential diagnosis of this condition from other bone-forming lesions of the soft tissue is also discussed.

Epithelial inclusion cysts in the tongue are extremely rare. We describe a case of an epithelial inclusion cyst occurring in the tongue in which it was necessary to differentiate the lesion from a malignant tumor. Clinical observation of the lesion and histopathological findings of biopsy tissue suggested the possibility of a malignant tumor. However, observation after immunohistochemical staining for Ki-67 and p53 ruled out malignancy. The lesion with a margin for safety was excised completely and a follow-up clinical examination at 3 years 4 months revealed no evidence of recurrence.

Extraction of the lower third molars is a common procedure in oral surgery. After the procedure, disturbance of the lingual nerve is rare. In patients with mild injury, conservative treatment with drugs and stellate ganglion block may relieve symptoms. However, in severe cases, microsurgical treatment of the injured lingual nerve should be performed as soon as possible. We operated microsurgically in 3 patients with lingual nerve disorders that occurred after mandibular third molar extraction. After the operation, senses other than taste recovered in all patients, and taste was improved in 2 of the 3 patients. After the operation, 2 patients were satisfied, and the other was almost satisfied. No patient was dissatisfied. The concept for the management of such an iatrogenic lingual nerve injury remains unclear. In addition, we discuss treatment planning for iatrogenic lingual nerve injury

We studied 1809 patients with oral cancer who visited and were treated in 2002 at the 148 institutions certified as training facilities by the Japanese Society of Oral and Maxillofacial Surgeons, which comprise 39 dental university hospitals, 44 medical university hospitals, 64 general hospitals, and 1 unknown institution. The patients were 1071 (59.2%) males and 738 (40.8%) females (male: female ratio, 1.45: 1), who had a mean age of 65.2 years. The tongue (40.2%) was the most common site affected, followed by the gingiva (32.7%), buccal mucosa (10.1%), and oral floor (9.0%). There were 6 cases of intraoral multiple cancer. Histopathologically, squamous cell carcinoma (88.7%) was the most common type, followed by adenoid cystic carcinoma (2.1%), and mucoepidermoid carcinoma (1.7 %). Non-epithelial tumors comprised 1.8% of the total, among which malignant melanoma was the most common type. Cases classified as T2NO were the most common (32.1%), followed by T1NO (21.4%), T4NO (8.0%), and T2N1 (7.6%). Distant metastasis occurred in 17 patients (1.0%). The sizes of the non-epithelial malignant tumors ranged from 1.0 to 7.0cm, with a mean size of 3.7cm.

Objective: To evaluate the effectiveness of immediate simple mandibular manipulation therapy at initial presentation of patients with chronic temporomandibular joint closed lock. Patients and Methods: 305 consecutive patients (76 men and 229 women; age range, 18 to 74 years) were selected based on a clinical diagnosis of temporomandibular joint disc displacement without reduction, otherwise known as closed lock. Patients were randomly divided into 2 groups of 204 study patients who received immediate jaw manipulation and non-steroidal anti-inflammatory drug therapy and 101 controls who received drug therapy only. Treatment success was determined by set criteria for closed lock that included achievement of 36 mm mouth opening and 6 mm lateral excursion. Results: For patients undergoing manipulation in the 18 to 19 years age range, the success rate for treatment given on the day of diagnosis was 100.0%. In the 20 to 49 years age range, the success rate for manipulation was 87.5%, and in the 50 to 59 years age range, the success rate was 78.2%.Treatment given within 1 to 2 days of the onset of closed lock symptoms resulted in 100.0% success and was more than 90.0% if treatment was initiated within 3 weeks of the onset of symptoms. Treatment by manipulation was unsuccessful if given 2 months or more after the onset of symptoms. Conclusions: Simple jaw manipulation for the treatment of closed lock can be useful if applied early after the onset of symptoms, especially for younger patients. Lower success rates correlated with increasing age, and the likelihood of treatment success tended to decrease when the interval between the onset of symptoms and initial treatment increased.

Several cases of ossification or calcification of the articular disc associated with temporomandibular joint synovial osteochondromatosis have been reported previously. However, synovial osteochondromatosis accompanied by ossification of nearly the entise disc is extremely rare.A 58-year-old man was referred to our department because of pain in the left temporomandibular joint. Radiography showed three radiopaque areas in front of the head of the mandibular condyle head. Diagnostic arthroscopic surgery revealed a perforated articular disc and a hyperplastic synovial membrane in the left temporomandibular joint. We carried out open surgery. When the joint cavity was opened, a loose body was seen in the border between the lateral pterygoid muscle and the articular disc. Histopathologically, the articular disc was nearly completely ossified. We diagnosed synovial osteochondromatosis.

高齢で下顎歯肉癌を持つ患者に，原発巣軟組織病変の切除と歯槽部皮質骨のみの骨切除からなる下顎骨温存手術を試みた。本手術は，画像上（パノラマX線写真，CT）で浸潤型吸収像を認めず，ネオアジュバント化学療法に十分に反応した場合に適応した。この概念に沿った手術が4症例に応用されたが，全症例で順調に経過し，良好なQOLを保持していた。

Malignant melanoma in the oral cavity is rare lesion frequently associated with lymph node metastasis, distant metastasis, or both at an early stage.A 75-year-old man was referred to our department for the treatment of primary malignant melanoma of the maxillary gingiva, diagnosed after lobectomy for a metastatic lung tumor. He underwent partial maxillectomy including the primary tumor, combination chemotherapy with DTIC, ACNU, and VCR, and nonspecific immunotherapy with OK-432.As of 3 years 8 months after the start of treatment, neither recurrence nor metastasis has occurred. The outcome has been fairly good, and the patients' quality of life has been maintained.

Primary synovial osteochondromatosis (PSC) is a disease of unknown aetiology. It was reported recently that expression of fibroblast growth factor receptor-3 (FGFR-3) was observed specifically in PSC. We classified six cases of synovial osteochondromatosis (SC) of the temporomandibular joint (TMJ) into two types of SC, PSC (five cases) and secondary synovial osteochondromatosis (SSC) (one case), by means of clinical findings and haematoxylin and eosin stain. The five PSC cases were classified into three different phases according to Milgram's classification. Immunohistochemical staining of FGFR-3 was carried out for each SC case, along with specimens of internal derangement (ID) of the TMJ, and normal articular disc and synovial membrane. FGFR-3 was found in all three phases of PSC, but not in SSC, ID or normal TMJ. Moreover, in a comparison between cultured synovial cells of PSC (Phase III) and ID, reverse transcription-polymerase chain reaction revealed a stronger positive reaction in PSC. These results indicate that the synovial membrane in Phase III PSC can produce cartilage nodules, as in Phases I and II.