顎顔面補綴
Online ISSN : 2435-0389
Print ISSN : 0389-4045
34 巻, 2 号
選択された号の論文の14件中1~14を表示しています
総説
  • 山下 善弘, 高橋 哲
    2011 年 34 巻 2 号 p. 39-42
    発行日: 2011年
    公開日: 2023/06/03
    ジャーナル フリー
    Our treatment for maxillary defects after oral tumor resections has been to fill the defect with well-vascularized autogenous tissues in order to obtain good aesthetic and functional results.
    This study evaluates postoperative functions in post-maxillectomy patients, who have had vascularized free tissue transfer (reconstruction group) or an obturator prosthesis (prosthesis group). The patients were treated in the Department of Oral and Maxillofacial Surgery at KyusKyushu Dental College for maxillary defects after oral tumor resection from January 2003 to December 2010. Seventy seven consecutive post-maxillectomy patients participated in this study. The prosthesis group consisted of sixty cases and the reconstruction group seventeen. The vascularized free tissue transfers were applied as free soft tissue transfers in nine cases and as vascularized scapular grafts, including lattissimus dorsi flaps, in eight cases.
    We implemented this study to compare mastication, speech and deglutition performance using speech function scale, modified water swallowing test and questionnaires for the reconstruction and prosthesis groups.
  • 山下 徹郎, 栃原 義之, 上田 倫弘, 林 信, 浅香 雄一郎, 石山 司, 細川 周一, 久保 雄二, 滝本 紘佑, 中嶋 頼俊
    2011 年 34 巻 2 号 p. 43-46
    発行日: 2011年
    公開日: 2023/06/03
    ジャーナル フリー
    There were 109 cases of maxillary deficiency associated with malignant tumor resection between July 1988 and December 2010. We examined the collaboration between reconstruction and maxillary prosthetics. Among these cases, 1) 58 were of maxillary prosthesis alone, 2) 35 of reconstruction and maxillary prosthetics, and 3) 16 of reconstruction alone. With regard to reconstruction, there were 23 cases of rectus-abdominis muscle flap, 8 of anterolateral thigh flap, 7 of forearm flap, 1 of latissimus dorsi muscle flap, 1 of parascapular skin flap, 7 of combined latissimus dorsi scapular bone flap, 7 of scapula and 1 of D-P flap. Two flaps were used in 2 cases, and 3 in 1. Bone reconstructions for alveolar and palatal were performed in 14 cases. Prosthetic implants were used in 4 maxillary denture cases. Relatively satisfactory results were obtained through functional evaluations, which included bite force by Dental Prescale, Sato’s scoring of chewing, and interviews.
  • —歯科と形成外科のコラボレーション医療をめざして—
    本田 公亮, 浦出 雅裕
    2011 年 34 巻 2 号 p. 47-50
    発行日: 2011年
    公開日: 2023/06/03
    ジャーナル フリー
    Intraoral defects are frequently closed with a dento-maxillary prosthesis in patients who undergo maxillectomy for tumor resection. However, recent advances in microvascular surgery have led to the development of various free flap reconstruction techniques for maxillectomy defects, which are suggested to be more effective for revitalizing velopharyngeal incompetence than prosthetic obturations. Surgical reconstructions of maxillectomy defects are frequently performed by plastic and reconstructive surgeons. However, prosthodontists often experience difficulty in designing an appropriate prosthesis framework because the area reconstructed with a free flap is unsuitable for subsequent prosthetic rehabilitation in order to improve phonetic and masticatory function. For example, it is very difficult to achieve stability of the prosthesis on an area reconstructed with bulky soft tissue. Therefore, collaboration between prosthodontists and plastic and reconstructive surgeons is essential to achieve the therapeutic effects of prosthetic treatment following maxillectomy reconstruction. This paper describes clinical problems and suggestions concerning prosthetic treatment after surgical reconstruction of defects.
  • 小山 重人, 佐々木 啓一
    2011 年 34 巻 2 号 p. 51-54
    発行日: 2011年
    公開日: 2023/06/03
    ジャーナル フリー
    Reassessment and establishment of new treatment approaches for maxillofacial defects are required for improving maxillofacial prosthetic treatment. Maxillectomy patients have functional disorders of mastication, swallowing, speech, and also may have suffered social rejection because of their handicapped appearance. Team management of maxillectomy patients is the standard approach, so we need to construct and practice a maxillofacial rehabilitation system which includes all kinds of related fields, including co-medical staff for mental or social support. However, cooperation between surgery and maxillofacial prosthetic treatment is not sufficient at present. Tohoku University Hospital has conducted both clinical practice and research for all related departments of Tohoku University since 2009. Special treatment teams of medical and dental boundary regions, such as the craniofacial center, the head and neck surgical team, and the swallowing rehabilitation team, have been formed with the help of medical and dental departments. This article describes a new multidisciplinary approach for the treatment for maxillectomy patients based on the experience of cooperation at Tohoku University Hospital.
  • —シンポジウムモデレータ総括—
    塩入 重彰, 久保 吉廣
    2011 年 34 巻 2 号 p. 55-58
    発行日: 2011年
    公開日: 2023/06/03
    ジャーナル フリー
    A symposium entitled “New strategies for maxillectomy defects: collaboration between surgery and prosthetics” was held at the 28th Academic Conference of the Japanese Academy of Maxillofacial Prosthetics on June 3, 2011 in Toyama City. We hereby present a summary of the symposium and report the main points.
    1. The speakers and participants reached a consensus regarding the following issues: 1) prosthetics (indications and limitations of obturators and application of dental implants); and 2) surgical reconstruction (indications and limitations of cutaneous, myocutaneous and osseous free flaps, and combination with obturators and dental implants).
    2. One of the major concerns regarding surgical reconstruction was whether the procedure would postpone the detection of tumor recurrence and lower the survival rate. The two speakers argued that there was no difference between prosthetic and reconstructive groups in regards to tumor recurrence and survival rate and favored surgical reconstruction of aggressive maxillary defects rather than the use of maxillary obturators.
    3. In the 2009 edition of the Guidelines for Maxillofacial Prosthetics, the following “Clinical Question” (CQ) was raised: “Is an obturator more effective than a reconstructive flap in patients with maxillectomy defects?” The statement explaining the degree of recommendation was in agreement with the speakers’ assessment.
    4. Collaboration among prosthodontists, surgeons, and other medical professionals may be simultaneous or time-oriented. The Clinical Pass of medical and dental cooperation, a medical process chart, was suggested to be most efficient for time-oriented collaborations.
原著論文
  • 浅見 和哉, 宮前 真, 尾澤 昌悟, 田中 貴信
    2011 年 34 巻 2 号 p. 59-65
    発行日: 2011年
    公開日: 2023/06/03
    ジャーナル フリー
    We reported the objective evaluation of masticatory function in maxillectomy patients. This study was to assess contributing factors to masticatory performance of patients with mandibular resection.
    Twenty five mandibulectomy patients who had been treated at a maxillofacial prosthetic clinic participated in this study. Their masticatory performance was investigated using gummy jelly, wax cubes, a food questionnaire and Dental Prescale. As for contributing factors, patient age, gender, occlusal support, type of defect, interocclusal relation, tongue defect, reconstruction and mandibular displacement were weighed.
    Pearson correlation and Spearman rank correlation coefficients of the masticatory performance and the contributing factors were analyzed. As a result, increased surface area of the gummy jelly demonstrated significant higher correlations with the occlusal support, age, type of defect, occlusal contact points, masticatory score and interocclusal relation. Moreover, multiple regression analysis revealed that occlusal support and occlusal contact points were strongly related to the recovery of masticatory performance. Continual study with detailed defect classification is needed with a larger sample.
臨床
  • 槙原 絵理, 土生 学, 河野 稔広, 鱒見 進一, 冨永 和宏
    2011 年 34 巻 2 号 p. 66-73
    発行日: 2011年
    公開日: 2023/06/03
    ジャーナル フリー
    A 58-year-old female patient had undergone segmental mandibulectomy, bilateral radical neck dissection and mandibular reconstruction with a scapular osteocutaneous flap after radiotherapy for a malignant tumor of the right lower gingiva with bilateral cervical lymph node metastasis.
    As there were limitations on tongue movement and lip-closing after the operation, oral rehabilitation for dysphagia and lip-closing had been carried out, but this was not sufficient to recover from these dysfunctions. She had also undergone plastic surgery for alveolar ridge augmentation and tongue extension with skin graft, tongue extension and removal of the metal plate in the mentum region.
    Then she was introduced to our clinic for fabricating a dento-maxillary prosthesis. As the shape of the lower right alveolar ridge had been obviously changed, we planned to fabricate a dento-maxillary prosthesis using the flange technique.
    After impression-making and bite-taking, the denture space was made with soft plate wax for the flange technique. Then, lower artificial teeth were arranged in the denture space and functional gum festooning was done. The prosthesis was placed in harmony with the movements of the tongue and surrounding muscles. By using this method, the prosthesis stabilized adequately and the patient’s satisfaction was improved.
一般社団法人日本顎顔面補綴学会 第16回教育研修会講演抄録
一般社団法人日本顎顔面補綴学会 第16回教育研修会座長総括
一般社団法人日本顎顔面補綴学会 第28回学術大会抄録
一般社団法人日本顎顔面補綴学会 第28回総会・学術大会報告
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