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Volume 54, Issue 4
Displaying 1-16 of 16 articles from this issue
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Masaya NISHIKAWA, Iwai TOHNAI, Noriyuki YAMAMOTO, Takahumi FUKUI, Hiro ...2008 Volume 54 Issue 4 Pages 222-228
Published: April 20, 2008
Released on J-STAGE: April 22, 2011
JOURNAL FREE ACCESSBackground: We recently began using preoperative chemotherapy delivered by superselective intraarterialinfusion via the superficial temporal artery as a treatment for oral cancer. However, catheterization is difficultin some patients because of the presence of a common trunk and angiectopia and hemadostenosis of theexternal carotid artery and tumor nutrient arteries. The purpose of this study was to conduct a clinicoanatomicalinvestigation of the external carotid artery and tumor nutrient arteries by digital subtraction angiography.
Method: We conducted an anatomical investigation of the external carotid artery and its branches in 58 patients (69 sites) by digital subtraction angiography.
Results: There were many variations in the branch patterns of the external carotid artery. In 53.6% of thepatients, branches arose in the order of the superior thyroid, lingual, facial, occipital, and maxillary arteries fromthe proximal side. In 24.6 % of the patients, the lingual artery formed a common trunk with the facial artery. In1.4%, the lingual artery formed a common trunk with the superior thyroid artery. The length of the faciolingualtrunk in 76.5% of the patients was long and anticancer agents flowed into both the lingual and the facial arteries.Severe hemadostenosis of the main trunk of the external carotid artery was observed in 7.2% of the patients.Severe angiectopia of the main trunk of the external carotid artery interferred with catheterization in 5.8 % of thepatients.
Conclusion: These results provide a clinicoanatomical basis for intraarterial infusion via the superficial temporalartery. The noteworthy points for catheterization were the presence and length of the common trunk of the tumornutrient arteries and the existence of angiectopia or hemadostenosis of the external carotid artery.View full abstractDownload PDF (3854K) -
Kenjiro NAGAMINE, Noriyuki YAMAMOTO, Kenji MITSUDO, Hiroaki NISHIGUCHI ...2008 Volume 54 Issue 4 Pages 229-233
Published: April 20, 2008
Released on J-STAGE: April 22, 2011
JOURNAL FREE ACCESSWe have performed daily concurrent preoperative treatment combined with superselective intra-arterialinfusion chemoradiotherapy via the superficial temporal artery (HFT method) using docetaxel (DOC) and cisplatin (CDDP) in patients with oral cancer. Our purpose was to examine the toxicity of this treatment in order toassess its safety.
The study group comprised patients with primary squamous cell carcinoma treated at our hospital. Thirty-ninepatients (28 men, 11 women) with stage II (4 patients), stage III (21 patients), or stage IV (14 patients) oralcancer were treated. Age ranged from 28 to 76 years (median age, 57 years). Primary cancer sites were thetongue (18 cases), mandible gingiva (8 cases), floor of the mouth (6 cases), maxillary gingiva (4 cases), andbuccal mucosa (3 cases).
Radiotherapy (total dose: 40 Gy/4 weks) and HFT method using DOC (total dose: 60 mg/m2, 15mg/m2/week) and CDDP (total dose: 100mg/m2, 5mg/m2/day) were concurrently performed daily, followed bysurgery. Surgery for cancer was performed 4 weeks after preoperative combined therapy.
Toxicity was evaluated according to the common toxicity criteria of the Society of Clinical Oncology. Toxicity ofgrade 4 was hemopoietic dysfunction (1 case), and that of grade 3 was hemopoietic dysfunction (8 case) andstomatitis (11 case). There was no toxicity of grade 3 or higher with regard to liver function, kidney function, respiratorydysfunction, or nausea. The clinical response was CR in 30 cases (76.9 %), PR in 8 (20.5%), and NC in1 (2.6%). The pathological response of the resected tumor was grade III or higher in 34 cases (87.1%). No patient was unable to continue preoperative-combined therapy because of toxicity. These findings suggest thatpreoperative combined therapy is a safe and useful treatment for oral cancer because of its low toxicity.View full abstractDownload PDF (1131K) -
Tomonao AIKAWA, Yukihiro OTA, Seiji IIDA, Yudai MATSUOKA, Kana TAKAO, ...2008 Volume 54 Issue 4 Pages 234-238
Published: April 20, 2008
Released on J-STAGE: April 22, 2011
JOURNAL FREE ACCESSAcromegaly is a relatively rare disease caused by growth-hormone-producing pituitary adenoma orhypertrophy of the pituitary gland.
A 41-year-old woman was referred to the First Department of Oral and Maxillofacial Surgery, Osaka University-Dental Hospital to receive orthodontic treatment because of malocclusion and diastemas. She had a recurrent pituitaryadenoma and received a somatostatin analog to control growth hormone and somatomedin C levels. Thepatient had classic features of acromegaly, including enlarged hands and feet, frontal bossing, prominent upperand lateral orbital ridges, mandibular prognathism, and macroglossia. Although the blood growth hormone levelwas high, the somatomedin C level was within the normal range. After consultation with her doctor, she wasscheduled to undergo orthodontic treatment, followed by orthognathic surgery under the diagnosis of mandibularprognathism and macroglossia. She underwent bilateral sagittal splitting ramus osteotomy with reduction of thetongue by the keyhole method at the age of 46 years. The postoperative course was uneventful.
She has been followed up for 4 years 4 months after orthognathic surgery, without relapse. She has receiveddaily tratment with a somatostatin analog throughout the period.View full abstractDownload PDF (3798K) -
Keiko YOSHIDA, Hiroaki TSUNO, Shigehito WADA, Yoshimi KIM, Makoto NOGU ...2008 Volume 54 Issue 4 Pages 239-242
Published: April 20, 2008
Released on J-STAGE: April 22, 2011
JOURNAL FREE ACCESSWe describe a rare case of systemic vascular malformation not classified as belonging to vascular malformationsyndrome.
A 37-year-old woman was referred to our clinic because of a painless swelling on the left side of the tongue.99mTc-HSAD scintigraphy showed multiple sites of abnormal pooling in the right parotid gland, the right massetermuscle, the dorsum, the right anterior region of the thigh, the left gluteal region, the left knee, and the lumbarregion. The patient was given a diagnosis of a non-syndoromic multiple vascular malformation because vascularmalformation syndrome was ruled out by the results of further systemic examinations. The lesion in the tonguewas extirpated and pathologically diagnosed to be a venous malformation. The lesion in the parotid gland andother systemic lesions have not increased in size 3 years 6 months after the tongue operation.View full abstractDownload PDF (3781K) -
Tomomi YAMASHITA, Yuhki MATSUMOTO, Yuichiro ASAKA, Hiroki MAKITA, Mako ...2008 Volume 54 Issue 4 Pages 243-247
Published: April 20, 2008
Released on J-STAGE: April 22, 2011
JOURNAL FREE ACCESSWe report a case of osteonecrosis of the mandible associated with an oral bisphosphonate (BP) in apatient with osteoporosis and describe its cure.
A 84-year-old woman received oral alendronate sodium hydrate from September 2004 through April 2006. Shewas referred to our department because of a fistula that developed after extraction of the lower right first and secondpremolars in April 2006 by her dentist. Physical examination revealed diffuse swelling of the right mandible, and hypoesthesia was present in the right mental region. Imaging of the lesion revealed an extensive radiolucentarea and a tumor-like mass in the right side of the mandible. Antibiotic therapy was started, and initial biopsy andexcisional biopsy were carried out to rule out malignant lesions. Histopathological examination showed granulationtissue and bone necrosis. BP-associated osteonecrosis of the jaw was diagnosed. BP medication was withdrawn, and conservative therapy was performed. Cure of the lesion, including bone regeneration, was observed 1year later.View full abstractDownload PDF (3956K) -
Toshiharu YAMADA, Kou KAWAHARA, Daisuke SANO, Hiroshi WATANABE, Nobuyo ...2008 Volume 54 Issue 4 Pages 248-252
Published: April 20, 2008
Released on J-STAGE: April 22, 2011
JOURNAL FREE ACCESSWe report a rare case of brain abscess secondary to mandibular odontogenic infection. A 50-year-oldman developed an abscess of the infratemporal fossa, masticatory myositis, and temporal myositis caused bylower first molar marginal periodontitis. Incision and drainage were performed by an intraoral approach, andantibiotics were administered intravenously. On the 8th disease day, vomiting occurred, but responded to anantiemetic drug. On the 9th disease day, extraction of lower first molar and adrasion was performed, resulting inthe alleviation of local symptoms. However, a persistent headache occurred, CT and MRI scans revealed a brainabscess and subdural abscess in the temporal lobe, immediately above the skull internal base. The patient wasgiven a diagnosis of brain abscess caused by odontogenic infection. The abscess almost disappeared after conservativetherapy administered at the department of brain surgery, and no sequelae were noted. The abscess apparentlyexpanded directly and continuously from the skull base through the foramen ovale and foramen spinosum.This case emphasizes the need to diagnose brain abscess and subdural abscess as complications of odontogenicinfection.View full abstractDownload PDF (2531K) -
Yoshio OHYAMA, Kazuki HASEGAWA, Hideo MIYAMOTO, Koichi NAKAKUKI2008 Volume 54 Issue 4 Pages 253-255
Published: April 20, 2008
Released on J-STAGE: April 22, 2011
JOURNAL FREE ACCESSSixteen cases of accidental insertion of foreign bodies into the maxillary sinus are reviewed. Thepatients were referred to our clinic between May 1994 and April 2004. There were many kinds of foreign bodies, such as tooth roots (50%), implants (13%), root canal filling material (6%), a reamer for dental treatment (6%), an interdental brush (6 %), and a fractured elevator (6%). These foreign bodies were removed in 11 ofthe 16 patients. The other 5 patients were followed up without surgical tratment because they had no symptomsor symptoms improved with drug therapy.View full abstractDownload PDF (498K) -
Wataru KATAGIRI, Hisashi HATTORI, Yoichi YAMADA, Kenji ITO, Kiyoshi SA ...2008 Volume 54 Issue 4 Pages 256-260
Published: April 20, 2008
Released on J-STAGE: April 22, 2011
JOURNAL FREE ACCESSBisphosphonates (BPs) inhibit bone resorption and are widely used to treat skeletal complications in patients with the bone metastasis from malignant tumors, osteoporosis, and bone lesions of multiple myeloma. Osteonecrosis of the jaw (ONJ) has been associated with the use of BP. In Japan, zoledronic acid has been used to treat bone lesions of multiple myeloma and bone metastasis from malignant tumors since April 2006. Zoledronic acid has strong bone antiresorptive activity as compared with other BPs such as pamidronate. The number of patients given zoledronic acid and the frequency of ONJ are expected to increase in Japan.
We report a patient with ONJ who was given zoledronic acid to prevent bone lesions of multiple myeloma. A 78-year-old man was referred to our hospital to undergo evaluation of bilateral asymptomatic bone exposure of the maxillary molar regions. MR imaging showed a low-signal-density area in the left maxillary molar region. Histopathologically, a biopsy specimen showed sequestration with attachment of bacteria. A final diagnosis of ONJ was made. Conservative follow-up is being continued, and no symptoms have developed.View full abstractDownload PDF (3622K) -
Tomomichi OZAWA, Yoshiro MATSUI, Kei WATANUKI, Satori FURUSE, Toshio M ...2008 Volume 54 Issue 4 Pages 261-265
Published: April 20, 2008
Released on J-STAGE: April 22, 2011
JOURNAL FREE ACCESSA 72-year-old woman presented with a painful swelling in the mandibular region. An oral examination revealed ulcerated mucosa, exposed devitalized bone, and pus discharge at a tooth-extraction socket, and a radiographic examination showed radiolucency. The patient had bone metastases from breast cancer, and had received incadronate 10 mg iv once every 4 weeks for 1 year 4 months (total dose, 160mg), followed by pamidronate 90mg iv once every 4 weeks for 1 year (total dose, 1, 080mg). Bisphosphonate-induced osteonecrosis of the mandible was diagnosed. Intravenous and oral administration of antibiotics and wound irrigation without surgery were effective for the treatment of acute symptoms and the prevention of relapse. Although the patient was followed up in the department of psychiatry at another hospital, no worsening of symptoms occurred subsequently. The patient died of metastatic breast cancer at that hospital 1 year 4 months after presentation.
This case suggests that bone necrosis should be borne in mind as a potential complication of bisphosphonate therapy.View full abstractDownload PDF (3747K) -
Yukoh MURAKI, Michi FUJITA, Takeshi NISHIKAWA, Manabu HABU, Izumi YOSH ...2008 Volume 54 Issue 4 Pages 266-270
Published: April 20, 2008
Released on J-STAGE: April 22, 2011
JOURNAL FREE ACCESSWe describe 2 patients injured in the maxillofacial region while using a power lawn mower (lawn mower). One patient was a 82-year-old man who accidentally fell while using a lawn mower and collided with the edge of a lawn mower operated by a fellow worker. The upper lip, cheek, neck, and shoulder were severely cut, and the mandible was fractured. The other patient was a 56-year-old woman in whom a fragment of the broken edge of a lawn mower operated by herself stuck the upper lip. The fragment was not noticed, and a tumor developed 2 months later. The tumor containing the fragment was excised.View full abstractDownload PDF (5402K) -
Masatsugu YOSHIDA, Shinji SHIMAZU, Kazutoshi TANI, Masahiro IKEHATA, M ...2008 Volume 54 Issue 4 Pages 271-275
Published: April 20, 2008
Released on J-STAGE: April 22, 2011
JOURNAL FREE ACCESSThis report describes a 42-year-old man with Langerhans' cell histiocytosis of the mandibular condyle. The patient was referred to our hospital in 2005 for a further evaluation of pain in the left temporomandibular joint (TMJ) on mouth opening. This symptom was noted by his general practitioner. The patient was prescribed an analgesic treatment because a temporomandibular disorder was suspected on the basis of his symptoms at presentation. However, the treatment had no effect on his symptoms. Computed tomography a month after presentation showed a region of bone resorption in the left mandibular condyle. Fine needle aspiration biopsy did not lead to a diagnosis. Subsequently, open biopsy yielded a diagnosis of Langerhans' cell histiocytosis. Two years two months after presentation, there is no evidence of recurrence.View full abstractDownload PDF (3821K) -
Mutsuya NOMURA, Atsushi SHINOHARA, Shinya IPPONGI, Masafumi FURUHASHI, ...2008 Volume 54 Issue 4 Pages 276-280
Published: April 20, 2008
Released on J-STAGE: April 22, 2011
JOURNAL FREE ACCESSEosinophilic granuloma (EG) is a cryptogenic disease associated with infiltration of eosinophilic leukocytes (ELs), hyperplasia of histiocytes, and formation of granuloma. We report a case of EG arising in the mandible that spontaneously disappeared after biopsy. The patient was an 11-year-old boy who had pain, trismus, and swelling of the mandible. Computed tomographic examination showed irregular resorption of bone on the left side of the mandible. Histological examination of a biopsy specimen revealed that the lesion consisted of many-ELs and histiocytes. The pathological diagnosis was eosinophilic granuloma. We performed extirpation under general anesthesia 2 months after biopsy. The second histological examination of a surgical specimen revealed granuloma tissue and giant cells. ELs and histiocytes had disappeared. The pathological diagnosis was granuloma.View full abstractDownload PDF (2809K) -
Katsuya AIKO, Satoshi YAMAGUCHI, Yasuyuki MICHI, Kazuto KUROHARA, Hito ...2008 Volume 54 Issue 4 Pages 281-285
Published: April 20, 2008
Released on J-STAGE: April 22, 2011
JOURNAL FREE ACCESSNerve sheath myxoma is a benign tumor originating from the endoneurium. This tumor rarely occurs in the skin, and nerve sheath myxoma involving the oral cavity is extremely rare. Only 19 cases have been reported to date. This report describes a case of nerve sheath myxoma of the buccal softtissues. A 53-year-old man presented with a painless nodule on the right side of the buccal mucosa. The nodule increased gradually over the course of 2 years. At presentation in 2005, the tumor measured 40×20×20mm. Weperformed a biopsy under local anesthesia. Histopathological examination revealed multinodules under the mucosal epithelium. The tumor consisted of spindle cells with a myxoid background that stained with alcian blue.Immunohistochemically, the tumor cells were stained with S-100 protein. These results suggested that the tumor was a nerve sheath myxoma. Therefore, surgical removal of the tumor was performed under general anesthesia. There has been no evidence of recurrence as of 1 year postoperatively.View full abstractDownload PDF (2829K) -
Shuichi SETA, Masayuki TAKANO, Yuuichirou TAKAKU, Takayuki IMAI, Takas ...2008 Volume 54 Issue 4 Pages 286-290
Published: April 20, 2008
Released on J-STAGE: April 22, 2011
JOURNAL FREE ACCESSOsteochondroma usually occurs in long tubular bones and on the condylar process of the mandible in the head and neck region. In particular, osteochondroma of the mandibular condyle can cause malocclusion and facial asymmetry.
We describe a case of osteochondroma arising in the condyle of 29-year-old woman with postoperative malocclusion (occlusal deviation) that was treated by bilateral sagittal splitting ramus osteotomy.
The patient received treatment for a clinical diagnosis of temporomandibular joint disorders (TMD) at several hospitals over the course of 6 years. On preoperative examination, we diagnosed a tumor of the mandibular condyle with skeletal crossbite. To reconstruct the occlusion, we planned two-stage surgery. At the first operation, the tumor was resected. At the second operation, the postoperative malocclusion were repaired by orthognathic surgery. The patient additionally underwent genioplasty to advance the chin.
At the 7-year follow-up, the patient showed a good, stable occlusal relationship, with no tumor recurrence.View full abstractDownload PDF (3477K) -
Takashi USHIODA, Mitsuaki MORIMOTO, Hiroshi OHTSUKA, Naoshi NAKAMURA, ...2008 Volume 54 Issue 4 Pages 291-294
Published: April 20, 2008
Released on J-STAGE: April 22, 2011
JOURNAL FREE ACCESSNicorandil is a potassium-channel activator used to treat angina pectoris in Japan since 1984. It is licensed and has been available in Europe since 1994. Oral ulceration induced by nicorandil was initially reported in France in 1997, and similar cases were reported in foreign countries. In Japan, only a few reports have described oral ulceration induced by nicorandil, and the mechanism of ulceration remains unclear. This paper presents three cases of severe oral ulceration caused by nicorandil. We review the relevant literature.View full abstractDownload PDF (1676K) -
Kitaro ONOZAWA, Hiroyuki KANEKO, Hisashi YANO, Takahito TOMITA, Yuuji ...2008 Volume 54 Issue 4 Pages 295-298
Published: April 20, 2008
Released on J-STAGE: April 22, 2011
JOURNAL FREE ACCESSMyasthenia gravis (MG) is an autoimmune disease of the skeletal neuromuscular junction, leading to a decreased number of postsynaptic acetylcholine receptors. Most MG patients complain of ocular muscle ptosis, diplopia, or both as initial symptoms. However, in extremely rare cases, MG initially presents with disturbed mouth closing. This paper describes a case of MG in a 41-year-old man who first consulted our department because of mouth closing insufficiency. At presentation, the patient's general condition appeared to be normal. He was able to open his mouth to a distance of 39 mm between the upper and lower central incisors. However, he could not bite more than 8 times, after which he needed to use his hand to close his mouth. There were no other symptoms such as temporomandibular disorder. We suspected MG and referred him to the Department of Internal Medicine of our center. Repetitive electromyography with low-frequency stimulation showed a typical decrement in the muscle action potential. The blood titer of anti-acetylcholine receptor antibody was 34 nmol/l. A thymoma was subsequently detected on chest CT. The patient was finally given a diagnosis of MG and received anticholinesterase agents. He was temporarily well. However, malaise gradually developed. After admission to our center, he suddenly had a myasthenic crisis, followed by cardiopulmonary arrest. The myasthenic crisis was managed by mechanical ventilation, immunoadsorption, and steroid pulse therapy, after he was successfully revived by cardiopulmonary resuscitation. Thereafter, he received additional treatment by extended thymectomy and post-irradiation.
The patient has remained well, and there is no further mouth closing insufficiency. MG rarely presents with symptoms associated with the masticatory muscles. We should include MG in thedifferential diagnosis when examining patients with mouth closing insufficiency.View full abstractDownload PDF (1953K)
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