Japanese Journal of Oral and Maxillofacial Surgery
Online ISSN : 2186-1579
Print ISSN : 0021-5163
ISSN-L : 0021-5163
Volume 56, Issue 7
Displaying 1-13 of 13 articles from this issue
Preface
Invited review articles
  • Masahiro UMEDA, Takahide KOMORI
    2010 Volume 56 Issue 7 Pages 390-397
    Published: July 20, 2010
    Released on J-STAGE: October 31, 2013
    JOURNAL FREE ACCESS
    Most of oral infectious diseases are polymicrobial including anaerobic organisms. Surgical procedure,as well as antibiotics treatment, is necessary especially for patients with severe infection. If proper therapy is not performed, oral infection is still potentially fatal disease.
    Surgical procedure for severe oral infection requires enough understanding about anatomy of space around the jaws and neck, such as the sublingual space, the submental space, the submandibular space, the buccal space, the masticator space, the parapharyngeal space, the retropharyngeal space, and the retrovisceral space. When the parapharyngeal space is involved, infection often spreads through the retropharyngeal and retrovisceral spaces, and may lead to descending necrotizing mediastinitis.
    Twenty-two patients with necrotizing fasciitis originated from oral infection were presented. The most frequent cause was infection of the mandibular molar region. Seven of the 22 patients had diabetes mellitus, although 11 had no general diseases. All patients were diagnosed to have necrotizing fasciitis by CT examination on the first day. Extensive debridement was undergone immediately, and all of them obtained good prognosis.
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  • Kyoji MORIYA
    2010 Volume 56 Issue 7 Pages 398-400
    Published: July 20, 2010
    Released on J-STAGE: October 31, 2013
    JOURNAL FREE ACCESS
    Healthcare workers have faced many viral infectious diseases. Nipah virus and West Neil virus are zoonotic virus (a virus transmitted to humans from animals) . New pandemic influenza A (A/H1N1) pdm 2009 virus has emerged and rapidly spread throughout the world.
    Prevention and control of infectious diseases is widely needed to medical workers. Especially the knowledge and practice of standard precautions are very essential. Prevention HBV HCV and HIV infection by using safety devices is important. Also vaccination against vaccine preventable diseases should be done to healthcare workers.
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Original articles
  • Ryo TAKAGI, Akira KATAKURA, Takahiko SHIBAHARA, Hiroyasu NOMA
    2010 Volume 56 Issue 7 Pages 401-408
    Published: July 20, 2010
    Released on J-STAGE: October 31, 2013
    JOURNAL FREE ACCESS
    We evaluated the prognostic significance of the expression of p16, p21, and cyclin D1 in surgically resected squamous cell carcinomas (SCCs) of the tongue from 52 patients. Patients in this study underwent resection of SCC of the tongue in the Department of Oral and Maxillofacial Surgery, Tokyo Dental College from February 1996 through March 2003. The study group comprised 35 men and 17 women, with an average age of 58.0 years. The average observation period was 2105 days. A high nodal metastasis grade (N) was associated with poor survival (log-rank test, N0/N2 P = 0.0402, N1/N2 P = 0.0180). We sliced sections and performed immunohistochemical staining for p16, p21, and cyclin D1. Specimens with at least one positively stained field were judged to be positive, and positivity was classified into three levels on the basis of expression. In resected tumors, the nucleus positive rates of p16, p21, and cyclin D1 were 32.7 % (17/52), 90.4 % (47/52) , and 76.9 % (40/52), respectively. pN factor was significantly related to outcomes on Cox proportional-hazards multivariate regression analysis (P = 0.006). Survival in patients with cyclin D1 overexpression (cyclin D1 (+++)) was poorer than that in cyclin D1-negative patients (log-rank test, P = 0.0415). There was no significant relation between p16 or p21 expression and outcomes. These results suggest that N factor is a significant prognostic factor in patients with SCCs. In addition, overexpression of cyclin D1 may be related to outcomes.
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  • Tomo YOKOI, Atsushi ABE, Shigeto ISHIHARA, Yosiko ARIJI, Susumu MIZUNO ...
    2010 Volume 56 Issue 7 Pages 409-415
    Published: July 20, 2010
    Released on J-STAGE: October 31, 2013
    JOURNAL FREE ACCESS
    FDG-PET is a useful diagnostic technique in the head and neck region; however, little is known about threshold standardized uptake values (SUV) and there are no definite diagnostic criteria. The purpose of this study was to determine the appropriate threshold SUV by comparing FDG accumulation with MRI and histopathological findings and to establish diagnostic criteria for cervical lymph node metastasis. We evaluated the uptake and measured SUV values of 54 metastatic lymph nodes on FDG-PET images in 12 patients with head and neck squamous cell carcinoma. Size and enhancement patterns were evaluated on MR imaging. We also assessed invasion of the resected lymph nodes. PET had a sensitivity of 72.2 %, a specificity of 98.6 % and an accuracy of 96.1 % at a threshold SUV of 2.5, based on the pathological diagnosis. For small nodes (< 10 mm), sensitivity was 57.6 %. Lymph nodes with FDG accumulation showed a wide range of histopathological invasion.
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  • Hiromasa YOSHIKAWA, Takashi HIGUCHI, Shunsuke FUKUMOTO, Masanori YOSHI ...
    2010 Volume 56 Issue 7 Pages 416-421
    Published: July 20, 2010
    Released on J-STAGE: October 31, 2013
    JOURNAL FREE ACCESS
    The purpose of this study was to clarify whether tooth extraction in accordance with the JCS2004 guidelines has any problems. A total of 213 patients (429 teeth) who were receiving anticoagulant therapy with warfarin and required tooth extraction were examined between 2000 and 2008. The study group comprised 123 men and 90 women. The average age of the patients was 66.8 years, and a total of 429 teeth were extracted. The mean International Normalized Ratio (INR) of the patients and was 1.85 before publication of the JCS2004 guidelines and 2.15 after publication. This difference in the INR was significant (p < 0.01). Before 2004, 37 of 55 patients underwent tooth extraction after stopping warfarin, and 3 had postoperative hemorrhage. After 2004, 144 of 158 patients underwent tooth extraction while continuing warfarin. The mean INR value at the time of extraction was 2.03, significantly higher than the value of 1.48 before 2004. There was no increase in postoperative hemorrhage.Bleeding complications in association with the continuation of warfarin also did not occur. The JCS2004 guidelines recommend maintaining the INR at 1.6 to 3.0, while excluding some patients. Our results suggest that tooth extraction can be done safely in association with the continuation of warfarin therapy if the patient's INR is controlled under optimal anticoagulation conditions.
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  • Takashi SHIGETA, Masahiro UMEDA, Tsutomu MINAMIKAWA, Tomoko KATAOKA, A ...
    2010 Volume 56 Issue 7 Pages 422-427
    Published: July 20, 2010
    Released on J-STAGE: October 31, 2013
    JOURNAL FREE ACCESS
    In consideration of postoperative dysfunction associated with radical neck dissection (RND) , various modifications of RND have recently been reported. We investigated the postoperative patency of the internal jugular vein (IJV) by enhanced computed tomography in 120 patients (136 sides) with oral cancer who underwent IJV-preserving modified radical neck dissections (mRNDs) . The following results were obtained.
    1. Of the 136 sides, 102 (75.0 %) showed a normal IJV, while 26 (19.1 %) showed IJV stenosis, and 8(5.9 %) showed IJV obstruction.
    2 . No patient had clinical symptoms caused by stenosis or obstruction of the IJV.
    3.There were no relations between stenosis or obstruction of the IJV and age, sex, number of metastatic nodes, extranodular invasion, postoperative radiotherapy, or reconstructive surgery.
    4 . Stenosis or obstruction of the IJV occurred significantly more frequently in the left side of the neck than in the right side of the neck.
    5 . Postoperative compressive procedures of the neck because of leakage of the parotid gland saliva, infection,or chyle were considered one of the causes of the IJV obstruction.
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Case reports
  • Takao MUKAI, Kana TAKAO, Reika MATSUURA, Chiaki YAMADA, Hideo YOSHIOKA
    2010 Volume 56 Issue 7 Pages 428-431
    Published: July 20, 2010
    Released on J-STAGE: October 31, 2013
    JOURNAL FREE ACCESS
    Actinomycosis is a specific inflammatory disease involving mixed infection that chiefly shows trismus, board-like swelling, and multiple abscess; however, it has recently become difficult to diagnose actinomycosis bacteriologically and rare for patients to show typical symptoms because of the frequent use of antibiotics. We report a case of maxillary sequestration involving Actinomyces infection after loss of a tooth.
    The patient, a 54-year-old man, visited our hospital because of continuous oozing, swelling, and pain in the maxillary gingiva persisting for 9 months after loss of the right maxillary second premolar. X-ray examination revealed a radiopaque image with an irregular margin in the alveolar bone. The hard tissue in the socket removed surgically for a tentative diagnosis of the maxillary osteomyelitis was diagnosed histologically as maxillary sequestration with Actinomyces infection. Symptoms such as exudates, swelling, and pain in the maxillary gingiva resolved completely after surgery. Currently, 3 years after surgery, the patient has made favorable progress.
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  • Fumikazu NIMURA, Keiichi ARAKAKI, Gousei UEDA, Masaru HIGA, Takeshi KA ...
    2010 Volume 56 Issue 7 Pages 432-436
    Published: July 20, 2010
    Released on J-STAGE: October 31, 2013
    JOURNAL FREE ACCESS
    Clear cell carcinoma (CCC), NOS is a rare malignant tumor that represents less than 1 % of all salivary gland tumors. We report a case of CCC, NOS arising in the floor of the mouth of a 78-year-old woman. The lesion was clinically suspected to be salivary gland tumor, and the patient underwent a resection under general anesthesia. The tumor was diagnosed pathologically as CCC, NOS. At present, the postoperative course is good, with no recurrence of the tumor.
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  • Kazunori KIDANI, Kazuhiko TANIO, Takayuki TAMURA, Motoki NAKABAYASHI, ...
    2010 Volume 56 Issue 7 Pages 437-440
    Published: July 20, 2010
    Released on J-STAGE: October 31, 2013
    JOURNAL FREE ACCESS
    We describe our experience with an interesting case of a salivary calculus in the parotid gland duct that was suspected to be caused by a penetrated fish bone. The patient was a 38-year-old man with swelling and pain in the left buccal region while eating. Radiographic examination showed a radiopaque body in the left buccal region. It was suspected to be a salivary calculus and surgically removed. The foreign body appeared to be a fish bone surrounded by calcification in a parotid salivary duct. The fish bone measured 16 × 0.4 mm and was surrounded by a yellowish white, spindle shaped calcified mass, measuring 4.3 × 2.3 mm. Histopathological examination suggested that a fish bone had penetrated the parotid salivary duct and a sialolith developed around it.
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  • Hiroyuki HONDA, Toshiaki MATSUZAWA, Keiko MORISHITA, Seiji OHNO, Eri S ...
    2010 Volume 56 Issue 7 Pages 441-445
    Published: July 20, 2010
    Released on J-STAGE: October 31, 2013
    JOURNAL FREE ACCESS
    Spindle cell carcinoma is a biphasic tumor consisting of a squamous cell carcinoma component and a sarcomatoid component of spindle cells. We present a case of spindle cell carcinoma arising as a polypoid mass in the tongue of a 66-year-old man, describe the results of immunohistochemical analysis of the epithelial-mesenchymal transition, and review 38 cases reported in the literature to discuss the clinical and therapeutic aspects of this tumor. An elastic-soft polypoid mass approximately 20 × 20 mm in diameter was located in the left margin of the tongue, and an irregular ulcer was noted posterior to the mass. An excisional biopsy was performed under local anesthesia. Histopathological examination of the mass revealed spindle-shaped cells that were immunohistochemically positive for keratin and vimentin, and the mass was diagnosed as spindle cell carcinoma. Histopathological examination of the ulcer revealed squamous cell carcinoma. In the spindle cell carcinoma cells, E-cadherin expression was down-regulated as compared with the squamous cell carcinoma cells, although Snail expression in the spindle cell carcinoma cells was up-regulated. These results suggest that epithelial-mesenchymal transition might play an important role in the pathogenesis of spindle cell carcinoma.
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  • Noriko KANEKO, Hiroyuki MATSUDA, Yusuke MIYATA, Masatoshi ADACHI
    2010 Volume 56 Issue 7 Pages 446-449
    Published: July 20, 2010
    Released on J-STAGE: October 31, 2013
    JOURNAL FREE ACCESS
    Desmoplastic fibroma rarely occurs in the jaw bone. However, we describe our recent experience with this type of desmoplastic fibroma developing in the left angle of the mandible of an 11-year-old girl. The patient had already recognized a lump in the left angle of the mandible about 1 and a half years previously and visited a pediatric clinic, but no definitive diagnosis was made at that time. Because the lump tended to enlarge thereafter, she visited a dental clinic and was then referred to our clinic for a detailed examination. As for the oral findings at admission, a bone-like hard lump was felt in the left angle of the mandible, associated with mild tenderness. Radiographic examination showed a unilocular transparent image with a slightly obscure borderline in the left angle of the mandible. Surgical resection was performed under general anesthesia. The histopathological findings suggested that the lump was composed of fibroblastic cells and collagen fibers. As of 11 months after operation,no local relapse has been noted.
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  • Kei-ichi MORITA, Tsuyoshi KIKUCHI, Fumiko IMAIZUMI, Ayako NEGISHI, Mic ...
    2010 Volume 56 Issue 7 Pages 450-454
    Published: July 20, 2010
    Released on J-STAGE: October 31, 2013
    JOURNAL FREE ACCESS
    We clinically applied a new internal device for maxillary distraction osteogenesis, the Maxillary Distractor System (SYNTHES®). This internal distractor was used in a 17-year-old boy with bilateral cleft lip and palate who underwent maxillary distraction osteogenesis. Before distraction, he presented with a retrognathic maxilla with a minus 11 mm overjet. Following a bilateral alveolar bone graft with iliac bone 5 months before maxillary distraction, a Le Fort I osteotomy was performed, and an internal distractor was placed under general anesthesia. After a 4-day latency period, the maxilla was distracted at a rate of 1 mm/day by two activations per day. After completion of distraction, a cephalometric analysis showed a 15 mm maxillary advencement. After a 4-day consolidation period, the device was removed, and the distracted maxilla was fixed with plates under general anesthesia. The bone formation was evaluated by computed tomography, which showed partial bone formation at the anterior portion of the maxillary sinus 3 months after plate fixation surgery. The occlusion 8 months after plate fixation was satisfactory.
    Because this device incorporates parts of various lengths it has a number of advantages over other internal devices for extensive maxillary distraction.
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