Marsupialisation for keratocystic odontogenic tumours in the mandible: longitudinal image analysis of tumour size using 3D visualised CT scans.

The purpose of this study was to determine how keratocystic odontogenic tumours (KCOTs) in the mandible are reduced during marsupialisation, and to predict the best time for secondary enucleation by analysing computed tomography (CT) images. 15 patients with KCOTs were treated with marsupialisation surgery, and 42 series of CT data taken during the marsupialisation process were analysed. CT data were reconstructed in three-dimensional (3D) images. The 3D images were used to measure the diameter and volume, and to analyse the changes that occurred after marsupialisation. Marsupialised KCOTs tended to be reduced equally towards the window in the tumour. The amount of volume reduction per day (V(r)) was reduced in proportion to the volume (V) with the formula V(r)=-0.0029×V. The formula manipulation for V was V=V(0)×e(-0.0029t) (t=duration after marsupialisaton (day)). The volume of marsupialised KCOTs was reduced by half over a 239 day cycle. These results demonstrate that the future shape of marsupialised mandibular KCOTs, under good control, could be predicted with significant accuracy using CT data. This prediction could decrease the prolonged marsupialisation state in patients with KCOTs.

Severity of oral mucositis correlates with the response of oral cancer to preoperative radiochemotherapy.

Oral mucositis is a dose-limiting toxic effect of radiotherapy and chemotherapy on oral cancer. The purpose of the present study is to assess the relationship between tumor response and oral mucositis in preoperative radiochemotherapy for oral cancer retrospectively. Fifty-four cases of oral squamous cell carcinoma were treated with concurrent radiochemotherapy prior to surgery. When oral mucositis was evaluated with the WHO scale, severe oral mucositis (Grades 3 and 4) developed in 22 cases (41%). A more than 50% reduction in tumor size was clinically observed in 38 cases (70%). From histopathological analysis of the surgical specimens all tumor cells observed appeared to be non-viable in 16 cases (29%). The cases with Grade 1, Grade 2, Grade 3 and Grade 4 oral mucositis included 33%, 62%, 85% and 89% of clinical good-response cases and 0%, 24%, 31% and 55% of histopathological good-response cases, respectively. This retrospective study suggests that severe oral mucositis promises a good response of oral squamous cell carcinoma to radiochemotherapy.

Early intervention for infants with autistic spectrum disorders in Japan.

BACKGROUND: To date, many researchers in Japan have assumed that the cause of autistic spectrum disorders is attributable to some disorder in the ability of the child. However, we have been working on the premise that autistic spectrum disorders are brought about by relationship disturbances in early infancy and have been attempting to validate this hypothesis through early intervention. METHODS: We have examined the developmental process of affective communication in infants with autistic spectrum disorders. We have postulated that approach-avoidance motivational conflict (Richer) is the primary factor impeding the development of affective communication and have focused therapeutic intervention on this perspective. RESULTS: As a result, attachment behavior was markedly improved in children, but affective communication with their mothers was not. Examing the mothers' images of themselves in infancy in mother-infant psychotherapy, problems that the mothers had themselves in infacy with attachment behavior to their own mothers affected the mothers' internal representation of their children, leading to active evolution of mother-child interaction and development of affective communication between the mother and child. CONCLUSIONS: In this context, the basis and significance of the internal representation of both parties being determinants in the quality of mother-child communication are discussed. Our goal in early intervention is not the elevation of a child's linguistic-cognitive abilities, but the creation of a comforting relationship in which both parent and child can live securely, without strain.

Interleukin-1alpha-dependent regulation of matrix metalloproteinase-9(MMP-9) secretion and activation in the epithelial cells of odontogenic jaw cysts.

Interleukin-1alpha (IL-1alpha) and matrix metalloproteinase-9 (MMP-9) are thought to be involved in odontogenic cyst expansion. In this study, we investigated the effects of IL-1alpha on the secretion and activation of MMP-9 in odontogenic jaw cysts. An active form of MMP-9 was present in odontogenic keratocyst (6 of 8 cases) fluids more frequently than dentigerous cyst (3 of 10 cases) and radicular cyst (3 of 10 cases) fluids, although proMMP-9 was present in all cyst fluids. Odontogenic keratocyst fragments in explant culture secreted a larger amount of IL-1alpha than dentigerous cyst and radicular cyst fragments in explant culture, and spontaneously secreted both proMMP-9 and an active form of MMP-9. The fragments of dentigerous cysts and radicular cysts secreted a small amount of proMMP-9, but no active form of MMP-9. Exogenously added recombinant human IL-1alpha (rhlL-1alpha) increased the secretion and activation of proMMP-9 in the fragments of dentigerous cysts and radicular cysts. The epithelial cells isolated from odontogenic keratocysts secreted IL-1alpha and proMMP-9 without stimulation. Under the cultivation on a fibronectin-coated dish, rhIL-1alpha increased the secretion of proMMP-9 from the epithelial cells in a dose-dependent manner. Moreover, rhIL-1alpha induced the secretion of proMMP-3 and plasminogen activator urokinase (u-PA) from the epithelial cells, and converted the secreted proMMP-3 to the active form in the presence of plasminogen. The secreted proMMP-9 was also activated in the presence of rhIL-1alpha and plasminogen. Hence, our results suggest that IL-1alpha may up-regulate not only proMMP-9 secretion but also proMMP-9 activation by inducing proMMP-3 and u-PA production in the cyst epithelial cells by autocrine/paracrine regulatory mechanisms.

Levandoski panographic analysis in the diagnosis of hyperplasia of the coronoid process.

The Levandoski panographic analysis of routine panoramic radiographs was developed to improve the diagnosis of hyperplasia of the coronoid process. The ratio of the length of the coronoid process to the condylar process in the Levandoski panographic analysis has a linear relationship with that in the cephalometric analysis (r = 0.75, n = 59). The ratio in patients with hyperplasia of the bilateral coronoid process was significantly greater than that of the control on both sides (P < 0.01). Although the minimum value of ratio in the patients was 1.15, the maximum value of the controls was 1.07. These results show that the Levandoski panographic analysis is useful in the evaluation of hyperplasia of the coronoid process in adults. When a patient complains of limited mouth-opening and the ratio is more than 1.1, further investigations should be made to verify the diagnosis of hyperplasia of the coronoid process.

Dentocraniofacial morphology in parents of children with cleft lip and/or palate.

OBJECTIVE: The purpose of this study was to compare the dentocraniofacial morphology of parents of children with cleft lip and/or palate (CL/P) with that of parents of children without CL/P and to use the results for genetic counseling. PARTICIPANTS: Twenty-five fathers and 40 mothers of Japanese children with CL/P, who also had relatives with CL/P within three generations (experimental group), and 413 pairs of parents of children without CL/P (control) were used in this study. To test the accuracy of the discriminant function, 165 subjects were added to this study (test group). MATERIALS AND METHODS: Sixty-five dental casts were measured by digital sliding calipers, and 1056 frontal and 1056 lateral cephalograms were traced, digitized, and analyzed using analysis of variance (ANOVA) and discriminant analysis. RESULTS: Mesiodistal tooth diameters in parents of children with CL/P did not show any differences from those in parents of children without CL/P. The parents in the experimental group showed a distinct craniofacial morphology: wider interorbital width (IO-IO'), intercoronoid process distance (Cp-Cp'), and nasal cavity width (NC-NC') and larger anterior cranial base length (S-N) and cranial base length (N-Ba). For genetic counseling, a discriminant function was obtained using four significant ratios on ANOVA. The percentage of correct classification using this function on the pooled experimental and control subjects was 67.9. CONCLUSION: The parents in the experimental group showed a special craniofacial morphology, but the results suggest that the discriminant function might not be helpful in genetic counseling.

Synovial chondromatosis of the temporomandibular joint: the effect of interleukin-1 on loose-body-derived cells.

OBJECTIVE: The purpose of this study was to investigate the effect of interleukin-1 on cells from loose bodies of synovial chondromatosis of the temporomandibular joint. STUDY DESIGN: The cells were isolated from uncalcified loose bodies in a case of synovial chondromatosis of the temporomandibular joint and cultured in alpha-MEM medium containing 10% fetal bovine serum. The cells were treated with or without interleukin-1alpha and then stained with toluidine blue. Their conditioned media were analyzed with gelatin zymography to detect matrix-degrading proteinase(s). RESULTS: The cells from loose bodies produced toluidine-blue-stained matrix. When the cells were treated with 100 ng/ml of interleukin-1alpha for 3 days, toluidine-blue-stained matrix was strikingly reduced. Gelatin zymography revealed that interleukin-1alpha-treated cells released 62-kDa gelatinase. CONCLUSIONS: Interleukin-1alpha may lead loose-body-derived cells to degrade the cartilaginous matrix of loose bodies in synovial chondromatosis of the temporomandibular joint.

Numb chin syndrome as an initial symptom of acute lymphocytic leukemia: report of three cases.

This article describes three cases of acute lymphocytic leukemia that presented with mental neuropathy, or so-called "numb chin syndrome," as the initial symptom of the disease. This symptom heralded the initial progression of the disease in the first and second cases and the recurrence of the disease in the third case. In these cases tenderness in the mental foramen, percussion pain of the teeth, loosening and extrusion of the teeth, and radiographic abnormalities were also, if not always, observed in association with mental neuropathy. The radiographic abnormalities included a disappearance of the mandibular canals, an enlarged periodontal ligament space, a loss or thinning of the lamina dura, and a destruction of the alveolar crestal bone. This report indicates that oral manifestations can therefore occasionally play an extremely important role in the early recognition of acute lymphocytic leukemia. The unexplained oral abnormalities such as numbness of the chin and lower lip must thus be considered, potentially ominous indication of acute lymphocytic leukemia.

Multiple pleomorphic adenomas arising in the parotid and submandibular lymph nodes.

We report rare case of multiple pleomorphic adenomas arising in the parotid and submandibular lymph nodes of a 21-year-old man. These tumours were surrounded by lymphoid tissue which was almost identical to that of the cortex of lymph node. The possibility of metastasizing pleomorphic adenomas was discounted because the mitotic activity was low and there were no signs of infiltration. Heterotopic salivary gland tissue was also found in the lymph nodes that contained the tumours, and each tumour expressed a similar immunohistochemical staining pattern to that of the salivary gland tissue. These findings indicate that these pleomorphic adenomas probably arose from the salivary gland tissue within the lymph nodes.

Expression of extracellular matrix in human mandibular condyle.

OBJECTIVE: The age-related expression of the extracellular matrices in human mandibular condyle was examined. STUDY DESIGN: The distribution patterns of types I to V collagens, laminin, fibronectin, fibronectin receptor, and transforming growth factor beta in 34 human mandibular condyles dissected from autopsy specimens were studied by immunohistochemical procedure with special attention on the age-related changes. RESULTS: Type I collagen was detected in the full layer of the condylar cartilage, and a stronger immunoreaction was delineated in the articular and cartilage zone. Types II and III collagen were mainly localized in the fibrocartilage zone. Type IV collagen and laminin were detected not only in the basement membrane of the blood vessels but also in the degenerated lesion where the expression of transforming growth factor beta was also detected. Immunostaining of type V collagen and fibronectin was noted in the perichondrocytic area, whereas that of fibronectin receptor was seen in the chondrocytes. In materials from younger cadavers types I, II, IV and V collagens, fibronectin, its receptor, and laminin showed stronger expression in the degenerative lesions than in the normal portions. In the sections from cadavers over the seventh decade, the immunoreaction of extracellular matrices was weak compared with the younger materials, and no increased reaction of extracellular matrices in the degenerative lesions was detected. In addition, severe osteoarthrosis was frequently seen in the older materials in macroscopic findings. CONCLUSION: These results suggest that the expression of extracellular matrices thus seems to be closely related to aging and degenerative changes in the condyle.

Age-related changes in the human mandibular condyle: a morphologic, radiologic, and histologic study.

PURPOSE: This study determined the osteoarthrotic changes in the human mandibular condyle in relation to aging and the loss of dental occlusal contacts. MATERIALS AND METHODS: Thirty-four condyles obtained at autopsy were studied morphologically, radiologically, and histologically. RESULTS: With advancing age, the articular surface of the mandibular condyle morphologically showed severe degenerative changes. The condyles with these changes tended to be from the side of the mandible with minimal areas of occlusal contact. Radiographically, an irregularity of the cortical bone plate was most commonly seen in the fifth and sixth decades, whereas a polygonal or flattened structure was mainly observed after the seventh decade. CONCLUSION: The histologic findings suggest that a decrease in the cellular components with advancing age may play a critical role in the development of degenerative changes.

Traumatic herniation of the buccal fat pad: report of case.

Traumatic herniation of buccal fat pad in a case of twenty-month-old girl is presented. The lesion has been caused by the fall on the tooth brush in the mouth, and treated with excision and wound sutures.

Complications of miniplate osteosynthesis for mandibular fractures.

Postoperative complications of delayed osteosynthesis with stainless steel miniplates were examined in 110 patients with mandibular fractures. The miniplates were removed in 91 of the patients, even if symptom-free, once sufficient bony union was obtained, and the healing conditions and the surrounding tissues were examined. Malocclusion, exposure of miniplates, delayed union, and infection were observed in 3.6%, 3.6%, 1.8%, and 1.0% of the patients, respectively. The complication rates were within acceptable limits even when treatment was performed later than 24 hours after injury. The healing conditions and the surrounding tissues did not show any serious problems. Thus, at least in short-term retention, stainless steel miniplates seem to be effective and suitable for osteosynthesis of mandibular fractures.

Magnetic resonance imaging of oral and maxillofacial angiomas.

Eleven patients with oral and maxillofacial angiomas (seven hemangiomas and four lymphangiomas) were evaluated with magnetic resonance imaging using a 0.2-T permanent system and spin-echo pulse sequences. These lesions typically had signal intensities that were iso T1-weighted, similar to muscle, and high T2-weighted, greater than subcutaneous fat. Nine tumors had well- or relatively well-defined margins, and seven cases had curvilinear structures of low signal intensities in the masses on T2-weighted images. It was impossible to distinguish hemangiomas from lymphangiomas on MR images. Our experience suggested that most angiomas of oral and maxillofacial regions present special characteristics on magnetic resonance images. It is thought that information obtained with magnetic resonance images can contribute significantly to the evaluation of the extent of these lesions.

Natural course of jaw lesions in patients with familial adenomatosis coli (Gardner's syndrome).

Twenty-three patients suffering from familial adenomatosis coli (FAC) were followed for an average of 7 years (0.11-16.11 years). In 22 patients, jaw lesions including osteomas and/or odontomas were present at the first examination. In 12 patients, some changes occurred; that is, the number and size of the lesions increased. These findings indicate that changes of jaw lesions in FAC patients occur gradually even in adulthood.

Computed tomography of the jaws in familial adenomatosis coli.

Familial adenomatosis coli is known to be associated with tooth impactions, odontomas, and osteomas. Three cases were examined by panoramic radiography and computed tomography. Computed tomography was especially useful for detecting osteomas in the maxilla and also revealed a wavy cortical thickening in the mandible in one instance. The latter finding has been reported for other bones in the body but not previously for the mandible.