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エプーリスは慢性的な刺激や炎症によって歯肉に発生する反応性の増殖物である。右側上顎歯肉部に発生した巨大なエプーリスの1例を経験したので報告する。患者は42歳男性で，右側上顎歯肉の腫脹を主訴に当科を受診した。当科受診の約4か月前より右側上顎歯肉部の腫瘤を自覚した。その後数回にわたり腫瘤からの出血を認めたため近医にて止血処置を受けていた。口腔内所見では右側上顎に境界明瞭な弾性やや硬の，有茎性の腫瘤を認めた。CT所見では内部に骨様のX線不透過像を有し，右側上顎歯肉から増生する腫瘤を認めた。全身麻酔下に腫瘍切除術を施行した。摘出標本は70×50×28mm大であった。病理組織学的診断は骨形成性エプーリスであった。術後3年3か月を経過した現在，再発の兆候はなく経過は良好である。

Introduction Elongated styloid process syndrome represents a group of symptoms, such as recurrent throat pain and neck pain, caused by elongation of the styloid process. We report a case of elongated styloid process syndrome with prolongation of the superior cornu of the thyroid cartilage. Case presentation A 50-year-old man was referred to our clinic with the chief complaint of discomfort on the right side of his neck. He had no history of any disease. Extraoral findings indicated pain during neck rotation. Computed tomography showed prolongation of the styloid process beyond the mandibular plane and close to the hyoid. Moreover, prolongation of the superior cornu of the thyroid cartilage was detected. The discomfort during rotation of the neck was due to the stimulation by the styloid process. Styloid resection was performed using the extraoral approach under general anesthesia. Conclusion Discomfort in the neck was resolved after operation., Highlights • Elongated styloid process syndrome represents a group of symptoms. • Morphological anomalies or deviations of the thyroid cartilage may cause swallowing discomfort. • Oral and extraoral methods are used as surgical techniques for styloid hyperplasia. • There have been no reports of styloid process prolongation with hypertrophic thyroid cartilage. • There are few reports concerning the prolongation of the superior cornu of the thyroid cartilage.

Bisphosphonate-related osteonecrosis of the jaws (BRONJ) has a major negative effect on the quality of life of patients. However, there is still no consensus on effective treatment strategies for BRONJ. We report a case of BRONJ that was treated surgically.A 57-year-old woman who was given a diagnosis of breast cancer with multiple metastasis was referred to our clinic for evaluation of swelling of the left upper gum. Clinical examination revealed a fistulous tract with pus discharge that had developed after extraction of the upper left first molar at a dental clinic. The clinical diagnosis was an infectious bone lesion associated with bisphosphonate therapy. Conservative therapy with local irrigation and antibiotics was performed, but the lesion progressed and showed ulceration with exposed bone. We therefore determined that surgical intervention should be performed to remove the necrotic bone.A CT revealed extensive osteonecrosis of the maxila and a well demarcated interface between the necrotic and vital bone.The BRONJ was completely removed with sequestrectomy of the maxilla. Pathological evaluation confirmed necrosis of the maxilla. No evidence of metastatic disease was detected. The patient has been followed for 5 months since surgery and continues to do well.

Malignant lymphoma occurs fairly frequently in the oral cavity, but is relatively rare in the mandible. We report a case of malignant lymphoma arising from the middle of the alveolar bone of the mandible. The patient was a 38-year-old man who had a swelling on the middle of the lower alveolus. Histopathological examination of a resected specimen was performed several times, but failed to prove malignant lymphoma. Southern-blot analysis disclosed the clonality of B-cells. We assessed the patient's overall clinical progress and decided to reexamine the surgical specimen. This led to a diagnosis of diffuse large B-cell lymphoma, Stage I E according to the Ann Arbor classification. The patient received combination treatment consisting of chemotherapy with CHOP (R-CHOP) and radiotherapy. There have been no signs of recurrence during the 27 months since treatment.

Objectives. We sought to evaluate the diagnostic efficacy of computed tomography (CT) images in the differentiation between intraosseous malignant tumors and osteomyelitis spreading into the masticator space. Study Design. A retrospective evaluation was carried out by using CT images from 12 patients with intraosseous malignant tumors and 9 patients with osteomyelitis involving the masticator space and accompanying mandibular bone destruction. The following CT observations are discussed: (1) bone destruction pattern subdivided into spotty, gross, or permeative; (2) cortical bone expansion; (3) diffuse osteosclerotic changes; (4) periosteal reaction; (5) masticator muscle involvement; (6) enlargement of the facial muscle; and (7) attenuation in the subcutaneous adipose tissue. Results. The pattern of permeative bone destruction, cortical bone expansion, and the enlargement of both the masseter and medial pterygoid muscles were all observed in patients with malignant tumors. In contrast, diffuse sclerotic change and a periosteal reaction were significant observations in patients with osteomyelitis. Conclusion. The efficacy of CT in establishing a differential diagnosis of malignant tumors or osteomyelitis is supported by this study. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;95:503-509)

The purpose of this study was to assess the ability of serious periodontosis patients to regain satisfactory biting function, using the patients' own teeth, by regeneration of the alveolar bone. Twelve serious periodontosis patients whose alveolar bone was markedly absorbed and whose teeth were quite unstable were treated with replanting of their teeth and grafting of cancellous iliac bone and gingival flaps by the clinical team, which consisted of plastic surgeons and dentists. No patients developed postoperative complications (e.g., infections), and grafted iliac bone took in all patients. The total number of replanted teeth was 65, and only 4 of them fell off (92% take rate). Three to 4 months after surgery, the replanted teeth received prosthetic treatment so that the patients could begin biting. Ten patients were monitored for 5 months or longer, and they started to eat normal food after the fifth month. Regained biting function and satisfaction of having food were almost the same as before the periodontosis became severe in these 10 patients. Regeneration of alveolar bone was confirmed in later radiographs. To date, the maximum follow-up period is 2 years and 8 months (average = 1 year and 6 months). All patients have good biting function, and there have been no findings of absorption of reconstructed alveolar bone or of the root of replanted teeth. This treatment method would be quite useful for patients with serious periodontosis.

舌癌の造影CT画像所見と術前療法効果の関係を知る目的で本研究を行った。1996年から2000年における術前療法後に外科的切除を行った舌扁平上皮癌10例の造影CT像における造影効果と術前療法効果ならびに組織学的所見との比較検討を行った。造影CT像において術前療法前の造影効果が強いほど組織学的治療効果が高い傾向にあった。これらの症例は組織学的にリンパ球浸潤が強く, 血管数が多い傾向にあった。術前療法による造影効果の減少した症例では線維性間質の増生に伴う血管およびリンパ球浸潤の減少がみられ, 造影効果の増強した症例では血管に富んだ肉芽組織の増生がみられた。これらの結果より造影CT像は間質の組織所見を反映し, 術前療法による造影CT像の変化は組織の治療効果による変化を反映している可能性が示唆された。

Plasma-treated lenowoven polyethylene ribbon was used for splinting between teeth around osteotomy lines in anterior segmental dentoalveolar osteotomy. This fixation was continued for 2 to 3 months, during which there was no damage or fall of the ribbon. In addition, the patients were able to eat their usual food, had much less pain in the teeth and oral mucosa, did not feel uncomfortable in the mouth, had no tooth damage or carious teeth, and had a good aesthetic appearance. In all eight jaws (five patients), accurate and strong bone fixation was achieved based on the planned occlusion. Patient complaints and pain were obviously less with this method than other methods. Polyethylene ribbon is quite useful for bone fixation in anterior segmental dentoalveolar osteotomy.

Cells of the human promonocytic cell line U937 were found to be sensitive to hexadecylphosphocholine (HPC), which is a potential anticancer drug. Induction of apoptosis was found in U937 cells after treatment with HPC for 24 to 48 hr. The apoptosis in U937 cells exposed to HPC was increased significantly in the presence of interferon-gamma (IFN-gamma). The augmentation of HPC-induced apoptosis by IFN-gamma is repressed in cells (U937-MP) persistently infected with mumps virus. A persistently infected cell line, U937-MP, showed poor induction of signal transducers and activators of transcription-1alpha (STAT-alpha), STAT-2, p48 and IFN-regulatory factor-1 (IRF-1), which are closely correlated with interferon-alpha (IFN-alpha) and IFN-gamma signaling pathways. Expression of MHC class-I or class-II was augmented by IFN-alpha or IFN-gamma in U937 cells, but not in persistently infected cells. Therefore, it is suggested that the IFN-gamma signaling pathway plays an important role in the augmentation of HPC-induced apoptosis. Mumps virus can suppress the IFN-gamma signaling pathway and subsequent development of apoptosis.

Verotoxin type 2 (VT2) produced by enterohemorrhagic Escherichia coli (EHEC) has been shown to have high cytotoxic potency toward several human B lymphoid cell lines with and without Epstein-Barr virus (EBV). Cell death, apoptosis induced by VT2, is closely correlated with the expression of receptor molecule Gb3/CD77, recognized by the toxin, but not with the infection or presence of EBV. Pretreatment of cells with interferon-alpha (IFN-alpha) for 24 h resulted in augmentation of apoptosis by VT2. Pretreatment within 8 h, however, was not effective. It has been reported that IFN-alpha-induced apoptosis is correlated with the induction of the 2',5'-OAS/RNase L system or dsRNA-activated protein kinase (PKR) or both. We have established persistent infection in both Akata and P3HR-1 cells with mumps virus. The persistently infected cell lines, P3HR-MP2 and Akata-MP2, showed poor induction of 2',5'-OAS and PKR in response to IFN-alpha. Augmentation of VT2-induced apoptosis by IFN-alpha was not found in the cell lines P3HR-MP2 and Akata-MP2. Therefore, these findings were interpreted to indicate that augmentation of VT2-induced apoptosis by IFN-alpha may be mediated by PKR and the 2',5'-OAS/RNaseL system. It is also suggested that mumps virus can suppress apoptosis and establish persistent infection.

1976年4月から1996年3月までの過去20年間に当科にて外科療法を行い, 病理組織学的にエナメル上皮腫と診断された79例について臨床病理学的検討を行った。1.組織型は, follicular type (27例, 34.2%) , plexiform type (26例, 32.9%) の2つが多くを占めていた。2.対象79例中, 保存療法が56/79例 (70.9%) に, 根治療法が23/79例 (29.1%) に施行された。3.再発は9/79例 (11.4%) に認められ, これらのうち4例が初回治療時に比し, 組織型の変化が認められた。

We report a case of mucosal cyst of the maxillary sinus with extensive maxillary bone resorption. A 47-year-old man was referred to our clinic with a chief complaint of a swelling in the left cheek.Radiography revealed a dome-shaped radiopaque shadow at the floor of the left maxillary sinus.The cyst was resected.Histopathological examination revealed a mucosal cyst of the maxillary sinus.Postoperatively, there has no evidence of recurrence as of one and a half years after the operation.

We report an extremely rare case of mandibular parosteal osteosarcoma along with a review of the literature. A 48-year-old woman was referred to our clinic for a painless tumor of the left side of the lower gum. The tumor was excised under local anesthesia and suspected to be a giant cell epulis on histological examination. However, the tumor recurred after three years. A biopsy specimen of the tumor was found to be an osteosarcoma. Partial resection of the mandible was carried out, and no tumor cell was noted in the mandible. The tumor was finally diagnosed to be a parosteal osteosarcoma. Presently, the patient is well and has had no recurence or evidence of matastasis.

The cluster of genes encoding the botulinum progenitor toxin and the upstream region including p21 and p47 were divided into three different gene arrangements (class I–III). To determine the gene similarity of the type E neurotoxin (BoNT/E) complex to other types, the gene organization in the upstream region of the nontoxic-nonhemagglutinin gene (ntnh) was investigated in chromosomal DNA from Clostridium botulinum type E strain Iwanai and C. butyricum strain BL6340. The gene cluster of type E progenitor toxin (Iwanai and BL6340) was similar to those of type F and type A (from infant botulism in Japan), but not to those of types A, B, and C. Though genes for the hemagglutinin component and P21 were not discovered, genes encoding P47, NTNH, and BoNT were found in type E strain Iwanai and C. butyricum strain BL6340. However, the genes of ORF-X1 (435 bp) and ORF-X2 (partially sequenced) were present just upstream of that of P47. The orientation of these genes was in inverted direction to that of p47. The gene cluster of type E progenitor toxin (Iwanai and BL6340) is, therefore, a specific arrangement (class IV) among the genes encoding components of the BoNT complex.