Japanese Journal of Oral and Maxillofacial Surgery
Online ISSN : 2186-1579
Print ISSN : 0021-5163
ISSN-L : 0021-5163
Volume 55, Issue 4
Displaying 1-10 of 10 articles from this issue
Preface
Invited review article
  • Izumi MATAGA
    2009 Volume 55 Issue 4 Pages 154-162
    Published: April 20, 2009
    Released on J-STAGE: February 24, 2012
    JOURNAL FREE ACCESS
    Clinicians may encounter symptoms of xerostomia, commonly called “dry mouth, ” among patients who take medications, have certain connective tissue or immunological disorders or have been treated with radiation therapy. When xerostomia is the result of a reduction in salivary flow, significant oral complications can occur. Terminology of xerostomia is widely includes one of the symptoms of Sjögren's syndrome (SS) and also accepted as dry mouth included senile xerostomia among geriatric patients due to salivary dysfunction which differ from thirst as the result of hypovolemia according to Asagawa's definition in 1976. Xerostmia and keratoconjunctivitis sicca commonly complicated, lymphocyte infiltration in excretion salivary, larcimal, and sweat glands in Sjögren's syndrome. Senile patients often complaints dryness of the mouth because some drugs related to hypertensives and may occur as a side effect of medications. Classification of this disorder based on each causes is so useful to understand the pathogenesis and attribute to the treatment closed in the future. This review considers the changes in salivary glands associated with ageing and concludes that there is no evidence to show that xerostomia is likely to result from the ageing process alone. The four main factors causing xerostomia are presented as factors affecting the salivary center, factors affecting the autonomic outflow pathway, factors affecting the salivary gland function, and factors producing changes in fluid or electrolyte balance. It can be often seen that the condition is a side-effect of diseases and the drugs used to treat these diseases. Xerostomia often develops when the amount of saliva that bathes the oral mucous membranes is reduced. However, symptoms may occur without a measurable reduction in salivary gland output. The most frequently reported cause of xerostomia is the use of xerostomic medications. A number of commonly prescribed drugs with a variety of pharmacological activities have been found to produce xerostomia as a side effect. Additionally, xerostomia often is associated with Sjögren's syndrome, a condition that involves dry mouth and dry eyes and that may be accompanied by rheumatoid arthritis or a related connective tissue disease. Xerostomia is an uncomfortable condition and a common oral complaint for which patients may seek relief. Complications of xerostomia include oral mucositis, candidiasis or difficulty of swallowing of dry foods such as bread without water. We need to identify the possible causes and provide the patient with appropriate treatment in order to make proper classification of this disorder.
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  • Akira TOYOFUKU
    2009 Volume 55 Issue 4 Pages 163-168
    Published: April 20, 2009
    Released on J-STAGE: August 28, 2012
    JOURNAL FREE ACCESS
    In dry mouth clinic, there are many patients who complained of subjective feelings of dry mouth despite their normal salivation. This dry mouth frequently comorbid with glossodynia or oral dysaesthesia. So far, these complaints have been thought to be ‘psychogenic’. Namely, psychosocial factors and/or individual factors have long been considered as main cause. Even if oral surgeons referred patients to psychiatry clinic, a majority of them wished to avoid consultation, or, would sometimes complain that the dry mouth got worse after medication. Therefore, it is very important and difficult problems for clinical oral surgeons to see how look at these patients and to learn how cope with them.
    From my own years of experience in psychosomatic studies, I think ‘distorted cognition ’ is central to these pathogenesis. These distorted cognition cause dissociations between subjective and objective findings. Moreover, I have propose a hypothesis that neurochemical dysfunction of some sort of neurotransmitter systems and distortions of information-processing in cerebral association area related to thought and memory underlie the distorted cognition.
    Patients with subjective dry mouth never tell a lie about their symptoms, but they have just ‘ neural network error’ in their brain. We should take up to problems of oral discomfort at the root of their complaint.
    If we suspect their complaints as the cause of psychogenic, it might be often unsuccessful in treatment. First of all, to listen carefully to complaints from them is very important, and then we have to do differential diagnosis. If patients are diagnosed the symptom form with distorted cognition, medication using SSRI or SNRI is necessary for reconstruction of impaired neuronal network. Of course oral surgeons have to receive advanced education and training to use psychotropic drugs. At the same time, it is needed for sensitive response to patients and family members.
    The distorted cognition with these patients are associated with dysfunction of neurotransmitter systems and information-processing in peripheral to higher central nervous system. Strange complaints and persistent therapeutic demand are representatives of the distorted cognition. If we regard queer complaints as neural network errors, we can see the psychogenic complaints as distorted cognition.
    At present, this hypothesis cannot be shown objectively, but it might be possible that some new approaches such as brain imaging make mechanisms of the distorted cognition more clear. It is very important to collect evidence-based diagnosis, therapies and pathophysiological mechanism for dry mouth as an oral psychosomatic disorder.
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  • Seiji NAKAMURA
    2009 Volume 55 Issue 4 Pages 169-176
    Published: April 20, 2009
    Released on J-STAGE: August 28, 2012
    JOURNAL FREE ACCESS
    Evaluation of patients complaining of dry mouth symptoms is difficult because it is a common complaint with a variety of causes including Sjögren’s syndrome and several possible means of assessment. Classification and diagnostic criteria of dry mouth have not been established yet, and an establishment of those is thus strongly requested. In this review, “Classification of xerostomia(dry mouth)”proposed by The Committee for Terms and Classifications, The Japanese Association for Oral Mucosal Membrane was introduced and its course and issues were also explained. Furthermore, various approaches to develop novel clinical and laboratory tests, which are useful in the differential diagnosis of dry mouth, were introduces and those future aspects were described.
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Original article
  • ─ Feasibility, problems, and countermeasures for elderly patients with complications ─
    Koji KISHIMOTO, Shoko YOSHIDA, Shohei DOMAE, Tatsuo ONO, Shuko NAKAYAM ...
    2009 Volume 55 Issue 4 Pages 177-183
    Published: April 20, 2009
    Released on J-STAGE: August 28, 2012
    JOURNAL FREE ACCESS
    The oral anticancer agent TS-1 has the advantage of being able to be administered daily, while monitoring the grade of adverse events. Therefore, we used concurrent chemoradiotherapy with TS-1 to treat advanced oral squamous cell carcinomas(OSCCs)in elderly patients with complications. Here, we report feasibility, problems, and counter measures for such patients.
    The subjects were 8 elderly patients with Stage Ⅲ and Ⅳ OSCCs, ranging in age from 68 to 82 years(mean 75.8 years). Each patient had 3 complications on average, and cardiovascular diseases accounted for 33.3 % of all complications. There were 5 primary cases and 3 recurrent cases.
    Radiotherapy(2.0 Gy/fraction/day; 5 days/week)was given to a total dose between 60 and 66 Gy, except in a patient with recurrence in whom the dose was reduced to 50 Gy because of previous radiotherapy. Although the recommended dose of TS-1 was 65 mg/m2/day, the dose was adjusted between 47.5 and 69.1 mg/m2/day according to age and general condition. Oral administration of TS-1 for 2 weeks followed by 1-week rest period comprised one course. Two courses with concurrent radiotherapy were administered.
    Chemoradiotherapy was performed as scheduled in 6 patients. In 2 patients, the administration of TS-1 was interrupted during the second course because of grade 3 leukopenia, but the radiotherapy could be completed. The overall response rate(6 CRs, 1 PR, and 1 death from another disease)was 87.5 %. After a median follow-up of 12.8 months(range 2.2-40.9 months), 6 patients were alive, and 5 patients had no evidence of disease. We could administer TS-1 safely while monitoring the grade of adverse events. However, all patients had grade 3 dermatitis or mucositis, and grade 3 leukopenia and anemia occurred in 2 patients each. One of the causes of these adverse events was suspected to be a high plasma concentration of 5-fluorouracil(5-FU)due to reduced renal function.
    Our results indicate that this therapy may be feasible for elderly patients with advanced oral cancer and complications and become a curative treatment considering QOL in some patients. However, severe dermatitis and mucositis must be carefully treated in these patients.
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Case report
  • Maho MURATA, Masahiro UMEDA, Chikako NISHI, Kazunobu HASHIKAWA, Yu USA ...
    2009 Volume 55 Issue 4 Pages 184-188
    Published: April 20, 2009
    Released on J-STAGE: August 28, 2012
    JOURNAL FREE ACCESS
    Low-grade myofibroblastic sarcoma is an uncommon neoplasm of atypical myofibroblasts with fibromatosis-like features. The lesion has only been characterized in the last two decades, and the concept of neoplastic myofibroblasts remains controversial. We encountered a patient with low-grade myofibroblastic sarcoma of the maxilla.
    A 70-year-old woman was referred to our hospital because of swelling of the anterior maxilla. She had undergone repeated surgical procedures of the lesion at other hospitals. The tumor invaded the hard palate, nasal cavity, bilateral maxillary sinus, and cheek skin. The biopsy specimen showed a low-grade myofibroblastic sarcoma, and she underwent wide resection of the lesion and reconstructive surgery using a free forearm flap. Histologic examination revealed diffuse, fascicular proliferation of spindle cells with focal cellular atypia. The tumor cells showed positive reactions for α-SMA and vimentin, which indicated differentiation to myofibroblasts, and the lesion was diagnosed as a low-grade myofibroblastic sarcoma. The patient is free from tumor 13 months after surgery.
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  • Eisaku UETA, Seiji OHNO, Yoshihisa TATEISHI, Eri SASABE, Tetsuya YAMAM ...
    2009 Volume 55 Issue 4 Pages 189-193
    Published: April 20, 2009
    Released on J-STAGE: August 28, 2012
    JOURNAL FREE ACCESS
    We report a rare case of a malignant granular cell tumor in the maxilla. A 61-year-old woman presented with painless swelling and bleeding of the hard palate. Clinical examinations revealed diffuse swelling of the right side of the hard palate with a necrotic ulcer. CT and MRI showed a tumor-like mass extending from the right maxillary sinus to the palate and nasal cavity. Histopathologically, the tumor consisted of clusters of eosinophilic granular cells exhibiting marked atypia, polymorphism, and vesicular nuclei with a high nuclear-to-cytoplasmic ratio.Immunohistochemical examination revealed that the tumor cells were positive for S100, NSE, CD68, CD57, and vimentin, but not for HMB45, KL1, CAM5.2, EMA, α-SMA, desmin, or MBP. We diagnosed the tumor as a malignant granular cell tumor and performed partial maxillectomy. Seven months after the operation, multiple metastatic lesions were detected in the lungs, liver, scapula, vertebrae, and iliac bone on PET-CT. The patient died 14months after surgery, even though she received 2 courses of chemotherapy with cisplatin and etoposide.
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  • Yumiko TOGO, Mitsuo NISHIDA, Shinya YASUDA, Akiko SUGINAMI, Yasunori O ...
    2009 Volume 55 Issue 4 Pages 194-197
    Published: April 20, 2009
    Released on J-STAGE: August 28, 2012
    JOURNAL FREE ACCESS
    A case of Ewing’s sarcoma arising in the mandible is reported. A 20-year-old man was referred to our clinic because of right cheek swelling and trismus. Magnetic resonance imaging and computed tomography(CT)showed a mass around the right mandiblar ramus. Chest CT and 67Ga-scintigraphy revealed no evidence of distant metastasis. Histopathologically, the mass was diagnosed to be Ewing’s sarcoma/primitive neuroectodermal tumor(PNET).
    Chemotherapy, radiation therapy, and surgery were performed. Although the primary lesion was controlled, the patient died of lung and brain metastases 3 years 3 months after presentation.
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  • Yoshitaka TANIGUCHI, Shinichiro HIRAOKA, Masaaki KIMATA, Kazuhiko URAB ...
    2009 Volume 55 Issue 4 Pages 198-202
    Published: April 20, 2009
    Released on J-STAGE: August 28, 2012
    JOURNAL FREE ACCESS
    Teratoid cyst was first proposed by Meyer in his classification of dysontogenetic cysts of the floor of the mouth. We report a case of congenital teratoid cyst in the floor of the mouth. A 9-day-old boy was referred to us because of congenital swelling of the floor of the mouth. On examination, a hemispherical 25 mm ×25 mm elastic soft, fluctuant mass was observed in the floor of the mouth. On examination of the mass fluid by exploratory puncture, the amylase level was 87 IU/ℓ. Clinically, the lesion was diagnosed as a cyst other than ranula. Therefore, surgical removal of the cyst was performed at 6 months of age. Histopathological examination revealed a teratoid cyst that contained squamous epithelium, hair follicles, sebaeceous glands, sweat glands, fat, salivary gland tissue, striated muscle, and respiratory and gastrointestinal epithelium.
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  • Toshinori IWAI, Yoshiro MATSUI, Sachiyo MITSUNAGA, Kei WATANUKI, Toshi ...
    2009 Volume 55 Issue 4 Pages 203-207
    Published: April 20, 2009
    Released on J-STAGE: August 28, 2012
    JOURNAL FREE ACCESS
    Mandibular cyst is a common benign lesion. Generally, cystectomy is performed after bone removal, the extent of which depends on the size of the cyst. However, incision of the oral mucosa and elevation of the periosteum result in postoperative pain and swelling. To reduce these symptoms, minimally invasive access to the lesion is needed. Recently, an endoscope has been used to enable minimally invasive surgery in the oral and maxillofacial region, such as for the fixation of subcondylar fractures and sialoendoscopy. We report the endoscopically-assisted removal of a mandibular cystic lesion, treated by minimally invasive surgery.
    A 63-year-old man was referred to our department. Panoramic radiography and CT scans showed a cystic lesion with an impacted third molar in the right mandibular ramus. The patient underwent endoscopically-assistedremoval of the mandiblar cystic lesion under general anesthesia. To reduce extensive bone removal and identify the extent of the lesion, we used endoscopes(KARL STORZ, Germany)that were 4 mm in diameter and had tip angles of 30 °and 70 °. First, a 2-cm mucosal incision was made at the anterior border of the mandibular ramus. The periosteum was elevated, and a box-shaped osteotomy was performed. The endoscope was inserted into the lesion. The cystic wall and third molar were identified. Then, complete enucleation of the lesion and tooth was performed under endoscopic guidance. Endoscopically-assisted removal of mandibular cystic lesions enables not only minimally invasive access to lesions, but also allows the removal of lesions to be confirmed.
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