Japanese Journal of Oral and Maxillofacial Surgery
Online ISSN : 2186-1579
Print ISSN : 0021-5163
ISSN-L : 0021-5163
Volume 45, Issue 4
Displaying 1-19 of 19 articles from this issue
  • Jingo KUSUKAWA, Kenji FUKUDA, Minako YOSHIDA, Tadamitsu KAMEYAMA
    1999 Volume 45 Issue 4 Pages 233-240
    Published: April 20, 1999
    Released on J-STAGE: July 25, 2011
    JOURNAL FREE ACCESS
    To assess the malignant potential of tongue cancer by intraoral ultrasonography, we examined 22 patients with squamous cell carcinoma of the tongue. Ultrasongraphic findings of the lesions were evaluated with respect to shape, border, internal echo, marginal echo, and depth of invasion (usD). Except for 3 tumors with a pathologic depth of invasion (pD) of less than 1 mm, 19 of 22 tumors (86.4%) were detected as hypoechoic lesions on intraoral ultrasonography. When the ultrasonographic and clinicopathologic findings were compared, tumors with diffuse invasion exhibited irregular shapes and diffuse borders on ultrasonography. Tumors with neck metastasis showed irregular shapes, diffuse borders, and hyperechoic marginal echoes. In addition, there was a significant correlation between usD and pD. Seven (58.3%) of 12 tumors with invasion of 8.0mm or more on ultrasonography were associated with neck metastasis.
    In conclusion, intraoral ultrasonographic examination of tongue cancer provides information useful in evaluating tumor extent and malignant potential.
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  • Relationship between the degree of anterior displacement of the articular disc, its reduction, and clinical findings
    Hiromasa MATSUGI, Tokio OSAKI
    1999 Volume 45 Issue 4 Pages 241-251
    Published: April 20, 1999
    Released on J-STAGE: July 25, 2011
    JOURNAL FREE ACCESS
    To determine the position of the anteriorly displaced articular disc, we examined temporomandibular joints by magnetic resonance imaging (MRI) in 54 patients with unilateral temporomandibular joint dysfunction. MRI was done before conservative therapy in the occlusal and maximal open-mouth position. We drew a straight line connecting the lowest point of the articular eminence (point A) and the highest point of the external acoustic pore (point E) by tracing the sagittal view on MRI. On the standard A-E line, points B', C', and D' were sought by dropping perpendicular lines from the deepest point of the glenoid fossa (point B), the highest point of the condylar head (point C), and the most posterior point of the articular disc (point D). We then determined the sagittal position of the articular disc in the glenoid fossa by measuring the distances AD' and C'D' and sought the correlation between these distances and clinical findings. The results were as follows. 1. The distance AD' in 33 patients with MRI-defined irreversible displacement of the disc was shorter than that in 10 patients with reversible displacement (3.7±1.9mm vs 6.8±2.0mm, p<0.0001). In contrast, the distance C'D' in the former was longer than that in the latter (6.0±1.7mm vs 3.4±1.5mm, P<0.0001). Of 29 discs displaced anteriorly less than 5 mm in distance C'D', 19 (66%) had reversible or no displacement. However, 23 (92%) of 25 discs displaced more than 5 mm in distance C'D' had irreversible displacement. 2. Disc deformity and abnormal signal intensity bands in the condylar head closely correlated with distances AD' and C'D'. In 17 patients without disc deformity, mean AD' and C'D' distances were 9.8± 2.7mm and 0.2± 2.8mm, respectively. In 19 and 18 patients with mild to moderate and severe deformity, the mean AD'(C'D') distances were 5.4±1.8mm (4.5±1.6mm) and 2.7±1.8mm (6.8±1.5mm), respectively. 3. Although distance AD' and C'D' did not correlate with clinical symptoms, the degree of anterior disc displacement correlated with the therapeutic effect of conservative therapy. The mean AD' distance (7.3±3.7mm) in 15 patients with a complete response to conservative therapy was longer than that (3.4±1.4mm) in 5 patients with no improvement. These results indicate that the sagittal position of the articular disc can be determined by MRI and that successful conservative therapy is unlikely if anterior disc displacement extends beyond 5 mm from the top of the condylar head, often resulting in irreversible displacement.
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  • Akiko KOBAYASHI, Koji KINO, Yoshiaki OMURA, Tomoaki SHIBUYA, Hidemi YO ...
    1999 Volume 45 Issue 4 Pages 252-260
    Published: April 20, 1999
    Released on J-STAGE: July 25, 2011
    JOURNAL FREE ACCESS
    We examined facial asymmetry in patients with temporomandibular joint disorders (TMD). Cephalometric radiograms obtained from 455 patients with TMD (106 males and 349 females) and 19 controls, including 144 left, 134 right, and 177 bilateral TMD, were reviewed. Asymmetry of the middle and lower parts of the face were evaluated on the basis of landmarks on postero-anterior cephalograms. The results were as follows.
    1. Morphological features of all patients.
    1) Cephalometric indices of the patients showed a normal distribution.
    2) The 4 points ANS, U1, L1, Me deviated to the left.
    3) Some values correlated with each other.
    2. There was no difference in values between all patients and controls. Furthermore, there was no difference in values between the left, right, and bilateral TMD groups and the controls.
    3. The middle and lower third of the face in patients with left TMD patients showed a trend toward left mandibular deviation.
    4. The middle and lower third of the face in patients who had left or right TMD with clicking or crepitus shifted significantly to the noisy side.
    5. Principal component analysis revealed no obvious relation between the side affected by TMD and morphological features; however the middle and lower third of the face tended to shift slightly to the affected side.
    6. The middle and lower third of the face in both patients with TMD and the controls shifted to the left side. Patients with left TMD showed the most marked shift. Because of the correlations among the values, the morphological features of patients with left TMD shifted to the left. The fact that the middle and lower third third of the face shifted significantly to the side with TMJ noise indicated that facial asymmetry was related to clicking or crepitus of the TMJ.
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  • Suwako Hozumi, Hiromitsu KISHIMOTO, Susumu HASHITANI, Yasunao WADA, Ma ...
    1999 Volume 45 Issue 4 Pages 261-265
    Published: April 20, 1999
    Released on J-STAGE: July 25, 2011
    JOURNAL FREE ACCESS
    Nosocomial infections with methicillin-resistant Staphylococcus aureus (MRSA) are one of the most important problems in patients undergoing oral surgery. In this study, we attempted to classify the genotype of MRSA using pulsed-field gel electrophoresis (PFGE) for 22 strains isolated from 8 patients with advanced head and neck cancer. We also classified the phenotype of MRSA strains according to drug sensitivity, coagulase typing, enterotoxin typing, and ability to produce TSST-1. Consequently, 22 strains of MRSA were classified into 9 phenotypes and 5 genotypes. Fourteen strains from 5 patients were classified into 6 phenotypes, although PFGE revealed that these strains had the same genotype. This suggests that drug sensitivity and enterotoxin typing altered each other, although these strains were transmitted from the same source. Four strains in case No.4 and 2 strains in case No.6 had 2 genotypes, suggesting that these infections were transmitted from two different sources in these cases. Two strains with the same phenotype in case No.4 showed different genotypes. It is speculated that microbial substitution occurred, although different strains were transmitted from different sources. These results indicate that classification of genotype by PFGE could provide a useful tool for investigating the source and route of transmission of nosocomial MRSA infections.
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  • Etsuro NOZOE, Tamotsu MIMURA, Simon LEUNG, Asako HAMASAKI, Yasunori NA ...
    1999 Volume 45 Issue 4 Pages 266-268
    Published: April 20, 1999
    Released on J-STAGE: July 25, 2011
    JOURNAL FREE ACCESS
    A case of Cole-Engman syndrome with multiple oral cancers is reported. The patient had reticulated telangiectatic pigmented skin, lack or dystrophy of nails, epiphora, hyperkeratinization of the palms and soles, hyperhidrosis, extensive teeth loss, interstitial pneumonia, mild gastritis, and stenosis of the external urethral ostium, but no anemia or splenomegaly.
    Intraorally, there were a squamous cell carcinoma of the left mandibular gingiva and leukoplakias of the tongue and the right buccal mucosa. After radiotherapy with Co60 in a total dose of 34 Gy and chemotherapy with 6.9g of UFT, the patient underwent resection of the carcinoma by segmental mandibulectomy and bilateral upper neck dissection with removal of the leukoplakias. An additional resection was carried out 4 months later, because of the development of a tumor in the right buccal mucosa. There has been no sign of recurrence 2 and a half years after the second operation.
    A review of the Japanese literature from 1960 through 1998 revealed 37 cases of the Cole-Engman syndrome.
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  • Yoichi KURACHI, Singo YAMAGUCHI, Hitoshi HATORI, Ryutaro KAMIZYO, Masa ...
    1999 Volume 45 Issue 4 Pages 269-271
    Published: April 20, 1999
    Released on J-STAGE: July 25, 2011
    JOURNAL FREE ACCESS
    The development of leukemia after successful treatment of a malignancy is one of the most feared complications.
    We describe a patient with secondary leukemia that developed after chemotherapy and radiotherapy for cancer of the maxilla.
    A 54-year-old man presented in July 1989 with a gingival swelling in the right side of the maxilla. Squamous cell carcinoma was diagnosed on examination of a biopsy specimen. He was treated with a combination of surgery, radiotherapy, and chemotherapy. After complete remission for 3 years, pancytopenia was detected in August 1993, and acute leukemia was diagnosed on examination of a specimen obtained by bone marrow aspiration. Chromosomal analysis showed partial deletion of 5 q-. Chemotherapy failed to induce remission, and the patient died 39 days later.
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  • Hiromasa KAWANA, Shinobu IKEUCHI, Kazuyuki TSUNODA, Taisuke MORI, Seij ...
    1999 Volume 45 Issue 4 Pages 272-274
    Published: April 20, 1999
    Released on J-STAGE: July 25, 2011
    JOURNAL FREE ACCESS
    A case of leiomyosarcoma (LMS) of the palate in an 81-year-old man is reported. The diagnosis was necrotic tissue on examination of a biopsy specimen. Because the tumor was incompletely resected, and LMS was diagnosed postoperatively, subtotal maxillectomy was performed. In 20 days, lymph node metastasis of the neck was detected, and the patient underwent radical neck dissection. However, the patient died of the lung metastasis only 10 months after presentation. Although LMS appears clinically to be well circumscribed, it is highly infiltrative histopathologically. Surgical resection with a wide margin is necessary to avoid recurrence or metastasis of LMS. Six previously reported cases of oral LMS in Japan are reviewed briefly.
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  • Satoshi WATANABE, Tomoaki SAIKI, Tetsuo WAKUDA, Toshinori TANAKA, Taka ...
    1999 Volume 45 Issue 4 Pages 275-277
    Published: April 20, 1999
    Released on J-STAGE: July 25, 2011
    JOURNAL FREE ACCESS
    Inverted papilloma arising from the nasal cavity and paranasal sinuses is a relatively uncommon benign tumor. We report a case of inverted papilloma in the maxillary sinus that developed after extraction of the right upper first and second molars.
    A 42-year-old man was referred to our clinic because of a developing mass, which had been found by a dentist after extraction of the first and second molars on December 21, 1984. Intraoral examination demonstrated an elastic hard mass about the size of the thumb in first and second molar region.
    Radiographic examination revealed a cloudy area in the right maxillary sinus.
    The mass was extirpated with the patient under intravenous sedation. The histopathological diagnosis was inverted papilloma. Examination 10 years after the operation showed on sign of recurrence of the lesion.
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  • Tadashi SAITO, Katsuya OHTAKE, Shinichi SASAKI, Atsushi TAKANO, Katsut ...
    1999 Volume 45 Issue 4 Pages 278-280
    Published: April 20, 1999
    Released on J-STAGE: July 25, 2011
    JOURNAL FREE ACCESS
    Solitary trichoepithelioma is a benign, solitary follicular neoplasm that occurs mainly on the face, but rarely arises in the oral region. A case of solitary trichoepithelioma of the upper lip is reported.
    A 41-year-old man was referred to our department on June 8, 1994, because of swelling of the upper lip and purulent discharge from the extraction socket of the left maxillary second molar. The lesion measured 6×5×4 mm and was covered with normal mucosa with no sign of ulceration. The clinical diagnosis was a benign tumor of the lip. In addition, the presence of a postoperative maxillary cyst was confirmed radiographically. With the patient under general anesthesia, the maxillary cyst and the tumor of the lip were removed. Microscopic exmination showed keratotic cysts with a tendency to pilar formation and islands of basaloid cells embedded in an abundent subepidermal stroma. The histopathological diagnosis was a solitary trichoepithelioma. There has been no evidence of recurrence as of 48 months after operation.
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  • Noriko SAITO, Hiroyuki OKADA, Yoshikazu KAMINO, Fukumitsu YAMAGUCHI, H ...
    1999 Volume 45 Issue 4 Pages 281-283
    Published: April 20, 1999
    Released on J-STAGE: July 25, 2011
    JOURNAL FREE ACCESS
    A submandibular schwannoma in a 5-year-old boy was examined immunohistochemically using MIB-1 antibody. Histopathologically, the tumor cell nuclei formed a palisading pattern, typical of an Antoni type A tumor. MIB-1 positive cells were found mainly at the tumor margin, and the value was 11.9%. The average MIB-1 positive cell rate in juvenile and adult cases was 5.8% and 3.1%, respectively, and this difference was not significant. Cases of schwannoma of the oral and maxillofacial region in Japanese children were also reviewed and discussed.
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  • Akihiko YAMAGUCHI, Hiroaki YOSHIDA, Shigeyuki FUJITA, Mitsuo NISHIDA, ...
    1999 Volume 45 Issue 4 Pages 284-286
    Published: April 20, 1999
    Released on J-STAGE: July 25, 2011
    JOURNAL FREE ACCESS
    A case of MALT lymphoma of the hard palate is reported. A 72-year-old woman visited us because of swelling of the right side of the hard palate. Examination of a biopsy specimen revealed a MALT lymphoma. The tumor was surgically removed. Two and a half years after the operation, there were no signs of recurrence. In this report, the clinical course and histpathological findings are described and discussed.
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  • Kazuhito HORINO
    1999 Volume 45 Issue 4 Pages 287-289
    Published: April 20, 1999
    Released on J-STAGE: July 25, 2011
    JOURNAL FREE ACCESS
    A case of Burkitt's lymphoma is reported. The patient was 48-year-old man, and his chief complaint was pain of the mandibular molars and paresthesia of the lower lip. However, radiographic changes of mandibular bone were very mild on orthopantomography, and 67Ga scintigraphy revealed no 67Ga accumulation. The diagnosis was established by histological examination of the cervical lymph nodes. A typical starry sky pattern due to dispersion of macrophages among tumor cells was recognized. Although he was treated with combined chemotherapy, he died on the 44th day after admission.
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  • Takashi OGAWA, Yoshiaki TAKAHASHI, Hiromi HARAGUCHI, Kouji TAKADA, Hir ...
    1999 Volume 45 Issue 4 Pages 290-292
    Published: April 20, 1999
    Released on J-STAGE: July 25, 2011
    JOURNAL FREE ACCESS
    Traumatic carotid-cavernous fistula (CCF) is a condition that can occur when trauma creates a communication between the carotid artery and the cavernous sinus, producing a syndrome of exophthalmos and hyperemia of the conjunctiva. We describe a patient with CCF who had marked exophthalmos 1 month after sustaining facial fractures. Under radiographic control, we treated the patient by embolization using a detachable balloon catheter and obtained a favorable outcome.
    Although it is rare, CCF should be considered in the evaluation of ocular symptoms in facial fractures.
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  • Kazuo UCHIDA, Masato KOIE, Tomoyasu NAKAMURA, Yousuke JINNO, Yoshinori ...
    1999 Volume 45 Issue 4 Pages 293-295
    Published: April 20, 1999
    Released on J-STAGE: July 25, 2011
    JOURNAL FREE ACCESS
    Psoriatic arthritis is seronegative arthritis associated with skin psoriasis. However, involvement of the temporomandibular joint (TMJ) is very rare. Here, we describe and discuss a case of reankylosis of TMJ secondary to psoriatic arthritis that was indicated for an artificial joint prosthesis.
    A 48-year-old man had TMJ ankylosis secondary to psoriatic arthritis and underwent bilateral TMJ condylectomy in June 1993. After surgery, he could open his mouth 23 mm. He consistently performed jaw exercises, but reankylosis of TMJ developed gradually and the patient could not open his mouth more than 1 mm again. A computed tomographic scan showed complete bony reankylosis of the bilateral TMJs. In October 1996, bilateral condylectomy of TMJ with replacement by an artificial titanium joint prosthesis was performed.
    Postoperatively, the patient was able to open his mouth 25mm, and he continued performing jaw exercises.
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  • Kenji IZUMI, Tadaharu KOBAYASHI, Yoshioki HAMAMOTO, Tsutomu NOMURA, To ...
    1999 Volume 45 Issue 4 Pages 296-298
    Published: April 20, 1999
    Released on J-STAGE: July 25, 2011
    JOURNAL FREE ACCESS
    Seventeen patients with 23 surgically treated ankylotic temporomandibular joints were studied clinically. Including 2 patients with recurrence, high operations, low operations, and gap surgery were performed on 12, 8, and 6 joints, respectively, in patients 6 to 60 years of age. Joints were reconstructed by costochondral grafts and artificial joints in 3 patients (4 joints). Interpositional materials were used in 7 joints in 5 patients. With the exception of 3 patients who underwent joint reconstruction, all patients started postoperative mouth opening exercises within a week after surgery. The maximum mouth opening increased by 6 to 30 mm 4 months to 7 years 9 months postoperatively. The average postoperative maximum mouth opening was greater in patients younger than 16 years of age than in those older than 20 years of age, and there was no re-ankylosis in the former group. Intermaxillary fixation was maintained for 3 weeks postoperatively in the patients who un-derwent reconstruction. Postoperative open bite was encountered in 5 patients. Open bite was controlled by mouth closing exercises, the use of a chin cap and class II elastics, and occlusal adjustment by prosthetic devices. In conclusion, surgical treatment of ankylotic joints should be performed as early as possible in young patients.
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  • Clinical evaluation as a filling material for bony defects
    Gaku YAMAMOTO, Akio TANAKA, KOUZO SAKAMOTO, Tomohiko OGAWA, Takeshi OK ...
    1999 Volume 45 Issue 4 Pages 299-301
    Published: April 20, 1999
    Released on J-STAGE: July 25, 2011
    JOURNAL FREE ACCESS
    We studied, 6 patients in whom bone cavities after cystectomy were filled with autolyzed, antigen extracted, allogeneic (AAA) bone. The patients ranged in age from 28 to 49 years. Cysts developed in the maxilla in 2 patients and the mandible in 4 patients. The cyst type was radicular cyst in 5 patients and follicular cyst in 1 patient. The maximal duration of postoperative follow-up was 24 months. Orthopantomography was performed after surgery. Furthermore, oral examination was performed to investigate abnormal findings. On the basis of radiography and oral examination, the usefulness of AAA bone was evaluated. AAA bone was assessed to be “extremely useful” in 3 patients and “useful” in 3 patients; the usefulness rate was 100%. These results suggest that AAA bone is a safe and effective biomaterial.
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  • Hiroyuki YAMADA, Hiroaki ISHII, Kanichi SETO
    1999 Volume 45 Issue 4 Pages 302-304
    Published: April 20, 1999
    Released on J-STAGE: July 25, 2011
    JOURNAL FREE ACCESS
    A case of pemphigus vulgaris with oral and esophageal involvement in a 41-yearold man is reported. Although there were no skin lesions, the patient had intractable ulcers in the oral cavity. Pemphigus vulgaris was suspected on histopathological examination of a biopsy specimen taken from a bulla of the left side of the maxillary gingiva. Direct immunofluorescence studies showed deposits of IgG and C 3 in the intercellular spaces of the epithelium. Upper gastrointestinal endoscopy, performed because the patient had mild odynophagia, revealed an esophageal ulcer. The histopathological diagnosis was pemphigus vulgaris. Intercellular deposits of IgG and C 3 in the esophageal mucosa were detected by direct immunofluorescence studies. The results of indirect immunofluorescence studies were negative. Of 15 cases of pemphigus vulgaris with esophageal involvement reported in Japan, 4 were in men and 11 were in women; the average age of the patients was 48 years. When esophageal lesions were diagnosed, oral lesions were present in all patients, although skin lesions were found in only 3 patients.
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  • Hisako HIKIJI, Tsuyoshi TAKATO, Takafumi SUSAMI, Yoshiyuki MORI, Yoshi ...
    1999 Volume 45 Issue 4 Pages 305-307
    Published: April 20, 1999
    Released on J-STAGE: July 25, 2011
    JOURNAL FREE ACCESS
    We describe a case of lacrimal sac fistulae with left cleft lip and palate. A congenital lacrimal sac fistula is a rare disorder in which a fistulous tract connects the skin to the common canaliculus or to the lacrimal sac, located just inferior to the medial canthal angle.
    A 12-year-old boy had 1) bilateral congenital lacrimal sac fistulae, 2) cleft lip and palate and 3) hypospadis. He had no paticular family history. With the patient under general anesthesia, a fusiform incision was performed, and the lacrimal sac fistulae were excised. Alveolar bone grafting was performed concurrently. Histologically, the lacrimal sac fistulae consisted of unkeratinized squamous epithelium and connective tissue with inflammatory lymphocytes. Patients with lacrimal sac fistulae, cleft lip and palate, and hypospadia have not been reported previously.
    These findings suggest that lacrimal sac fistulae may be related to congenital malfusions such as cleft lip and palate.
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  • Koichi OKABE, Hideaki SAKASHITA, Masaru MIYATA, Kiichiro SAITO, Yuuko ...
    1999 Volume 45 Issue 4 Pages 308-310
    Published: April 20, 1999
    Released on J-STAGE: July 25, 2011
    JOURNAL FREE ACCESS
    The incidence of supernumerary teeth in the maxillary anterior region is high. We frequently encounter maxillary impacted mesiodens that causes diastema. However, the incidence of supernumerary teeth in the mandibular anterior region is low, and mandibular impacted mesiodens is very rare. Here we describe our experience with such a case. A 9-year-old girl was referred to our department on June 11, 1997 for extraction of a mandibular anterior impacted supernumerary tooth. She had previously consulted a dental clinic for mandibular diastema. A radiographic examination showed an impacted supernumerary tooth between the mandibular central incisors. The direction of eruption was normal. A sagittal tomographic image showed that it was located on the labial side. The surrounding gingiva was normal. We extracted the tooth with the patient under local anesthesia. The extracted tooth measured approximately 9 mm by 3 mm. It was a conical tooth, resembling a central incisor. The patient is doing well.
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