A clinical study was performed in 50 previously untreated patients with squamous cell carcinoma of the mandibular gingiva who received intra-arterial chemotherapy with radiotherapy as initial treatment at the Second Department of Oral and Maxillofacial Surgery, Faculty of Dentistry Hospital, Iwate Medical University between January 1975 and December 1994. The response to therapy was CR in 64.0% of patients observed after initial treatment, 57.1% in those treated surgically after initial treatment, and 10% in inoperative patients. According to T grade, the rate of CR was 100% for T 1, 90.0% for T 2, 66.7% for T 3, and 51.7% for T 4. Recurrence occurred at the site of the original lesion in 6 patients observed after initial treatment, and could be controlled in 4 of these patients by secondary treatment. In the surgically treated group, recurrence was observed at the site of the original lesion in 4 patients and in the neck in 1, all of whom died of the primary disease. The cumulative 5-year survival rate was 57.6% in all patients, 81.2% in those observed after initial treatment, 57.4% in those treated surgically, and 0% in inoperable patients. According to stage, it was 100% for stage II 75.0% for stage M, and 42.3% for stage IV. Intra-arterial chemotherapy with radiation therapy was extremely effective as initial treatment for squamous cell carcinoma of the mandibular gingiva. This combination is considered to improve the radicality of treatment for primary lesions and to increase the possibility of maintaining continuity of the mandible during surgery.
The present study was one of a series of studies on recovery of oral and maxillofacial function by surgical reconstruction after malignant tumor ablation. The objective of this study was to identify the relations among postoperative conversational ability, resection range, and reconstruction method. The subjects were 74 patients with oral cancer who underwent resection involving the tongue, mouth floor, and mandible. They were classified into Group I (mandibulectomy without glossectomy, n=24), Group II (partial glossectomy, n=8), Group III (hemiglossectomy, n=28), and Group N (subtotal glossectomy, n=14) according to the resection pattern of the tongue. They were then subdivided according to the combined resection range of the tongue, mouth floor, and mandible. The conversational intelligibility (CI) of each patient was rated on a scale from 1 to 5, and the relation between the CI and the resection pattern of the tongue, the combined resection range of the tongue, mouth floor, and mandible, the reconstruction method, and the shape and mobility of the reconstructed tongue was analyzed. The following conclusions were obtained:(1) CI significantly decreased in the order of Groups I and II, III, and N.(2) The CI of all patients in Group I and II was well intelligible (CI score 1) regardless of the resection range and reconstructed method, with little deterioration of daily speech.(3) In Groups III and IV, the CI significantly decreased with an increase in the combined resection range of the tongue, mouth floor, and mandible. In the patients who underwent hemiglossectomy, limiting the mobile tongue, combined with mandibulectomy, articulation ability negatively correlated with the resection range of the mandible from the molar region of the affected side to the anterior tooth region. The CI of almost all patients who underwent hemiglossectomy including the root of the tongue or subtotal glossectomy was poorly intelligible (CI score 3) or generally unintelligible (CI score 4), with severe deterioration of daily speech.(4) There was no significant relation between the CI and the type of flap (forearm flap, pectoralis major myocutaneous flap, rectus abdominis myocutaneous flap) used for reconstruction of the tongue and mouth floor. However, a forearm flap was advantageous with respect to mobility of the tongue.(5) When reconstructing the tongue and mouth floor after hemiglossectomy or subtotal glossectomy, the first priority should be to obtain a sufficient volume (i. e., distention toward the palate) of the reconstructed tongue.
We describe an 86-year-old woman with a large parotid tumor. Ten years previously, she had first noticed a tumor about the size of the tip of the little finger in the right parotid region. The tumor had become very large. Her Hematological examination showed a pattern of severe anemia and undernourishment. Excision of the tumor was carried out, and the excised tumor measured 200×180×150mm and weighed 900g. Histological examination revealed that the tumor was a carcinoma in pleomorphic adenoma. There has been no evidence of recurrence after 3.5 years of follow up.
In the present study, cross-tolerance and factors affecting the antimicrobial susceptibility of gram-positive cocci isolated from odontogenic infections were examined. Viridans streptococci isolated from patients who had previously received antibiotic therapy showed a trend toward resistance as compared with patients who had not received such therapy. Streptococcus showed cross-tolerance to β-lactam agents and erythromycin. This study suggests that care should be exercised to ensure that proper antibiotics are chosen and prescribed to treat odontogenic infections.
Peripheral blood stem cell transplantation (PBSCT) is a new therapeutic technique in which harvested peripheral hematopoietic progenitor cells are used to promote hematopoiesis after marrow ablative chemoradiotherapy. We report the clinical efficacy of chemotherapy followed by PBSCT in 4 patients with malignant lymphoma in the head and neck region. The results were as follows: 1. A median of 2.14×108 mononuclear cells/kg was collected by peripheral blood stem cell harvest (PBSCH). These cells contained a median of 1.08×105 granulocyte-macrophage colony forming units (CFU-GM)/kg and 1.31×106 CD34 positive cells/kg. 2. The dose of chemotherapy could be increased by 1.5 to 1.8 times higher than the initial dose. 3. Clinically, all 4 patients had a complete remission (CR). 4. These results suggest that by promoting hematopoiesis, PBSCT can facilitate salvage chemotherapy with an increased dose in patients with malignant lymphoma in the head and neck region.
Calcifying epithelial odontogenic tumor (CEOT) is a rare odontogenic tumor derived from odontogenic epithelium. We encountered a case of CEOT in the left maxillary premolar region of a 22-year-old woman. Radiographic examination showed a radiolucent lesion with several radiopaque masses the size of grain. Histological examination and a special staining technique indicated a CEOT, considered to be derived from odontogenic epithelium. The patient's postoperative course has been good, with no evidence of recurrence as of about 2 years after the operation.
A rare case of desmoplastic fibroma located eccentrically in the mandible is reported. A 14-year-old boy was referred to our hospital because of enlargement of the right side of the mandible. A panoramic radiograph revealed a radiolucent lesion extending from the mental foramen to the root apex of the first permanent molar and an expanded cortex of the mandible. MRI revealed that the lesion, which showed low signal intensity on T1-weighted spin-echo and slightly high signal intensity on T2-weighted spin-echo, was sandwiched between the subcutaneous fat and the mandible. Surgical enucleation of the lesion was completed intraorally. Histologically, the lesion was composed of mature fibrous tissue consisting of a few fibroblast-like cells in an abundant collagenous matrix stroma. At 9 months postoperatively, the patient is doing well, with no evidence of recurrence.
The present paper describes complex reconstruction of the craniofacial region after extensive resection of a maxillary carcinoma. We performed en bloc craniofacial resection in a 50-year-old man with a primary mucoepidermoid carcinoma of the maxillary sinus that involved the middle of the skull base. The dura and orbital contents were preserved because there was no intracranial or intraorbital tumor invasion. The resulting defect was reconstructed with a free flap, hydroxyapatite and tricalcium phosphate composite, and a titanium mesh plate. Satisfactory shape and function of the face were obtained. There has been no evidence of recurrence as of 24 months postoperatively.
A case of severe obstructive sleep apnea syndrome caused by a dermoid cyst of the floor of the mouth is reported. The patient was a 18-year-old woman with snoring and daytime sleepiness. On MRI, the tongue was pushed posteriorly by the presence of a large cystic lesion. On polysomnography, apnea and hypopnea were observed 526 and 212 times, respectively, during sleep, and the apnea hypopnea index was 82.0. The minimum SpO2 was 74%, and SpO2 decreased below 90% 207 times for a total of 4500 seconds during sleep. On contrast cephalography, the mean pharyngeal airway space was reduced. The diagnosis was severe obstructive sleep apnea syndrome resulting from a dermoid cyst. One week after removal of the cyst, apnea and hypopnea decreased to 67 and 140 times, respectively, and the apnea hypopnea index was 23.0. The minimum SpO2 became 87%, and the number and duration of SpO2 also decreased to 13 times and 170 seconds. No respiratory disturbance was observed 6 months postoperatively. The importance of respiration disturbance studies in patients with lesions causing constriction of the airways is stressed.
A rare case of a penetrating injury extending from the hard palate to the pituitary gland is reported. A 9-month-old infant was referred to our hospital because of a chopstick stuck in his mouth. He had severe oral and nasal bleeding after we removed it and was given a blood transfusion. CT examination revealed circular low-density areas in the subarachnoid cistern.α-Streptococcus was detected in the cerebrospinal fluid. Antibiotics were given, and he was discharged on the 18th day with no complications.
We describe the diagnosis of the temporomandibular joint with closed lock by means of double-contrast spiral computed tomography (CT) with multiplanar reconstruction images (MPR). In patients with closed lock who did not respond to conservative treatment, we performed double-contrast arthrography by conventional X-ray tomography with pumping manipulation therapy. This technique had the limitation that the thin tomogram width produced unclear pictures. Twenty-eight cases that required treatment by pumping manipulation therapy were diagnosed by means of double-contrast spiral CT with MPR. We obtained satisfactory images of the articular cavity and the disc. We conclude that doublecontrast spiral CT with MPR images is useful for diagnosis in the articular disc and cavity.