Japanese Journal of Oral and Maxillofacial Surgery
Online ISSN : 2186-1579
Print ISSN : 0021-5163
ISSN-L : 0021-5163
Volume 64, Issue 1
Displaying 1-6 of 6 articles from this issue
Preface
Invited review articles
  • Hiroyuki YONEKAWA
    2018 Volume 64 Issue 1 Pages 2-7
    Published: January 20, 2018
    Released on J-STAGE: March 20, 2018
    JOURNAL FREE ACCESS

    Total maxillectomy, with or without orbital exenteration, is the most commonly performed surgical operation for maxillary sinus cancers. The surgical technique has remained relatively unchanged more than half a century. Total maxillectomy is potentially complicated by injury to the orbital contents, lacrimal drainage, optic nerve, intracranial contents, and may be accompanied by brisk bleeding. A sound understanding of the 3-dimensional anatomy of the maxilla and the surrounding structures is therefore essential. The sequence of the operation should be planned to reserve troublesome bleeding to the end of the procedure.

     The maxillary defect after ablative tumor surgery typically involves the mucosal lining, the midface osseous framework, and the adjacent soft tissue. Reconstruction of this defect remains a considerable challenge because the 3-dimensional architecture of the midface serves both functional and aesthetic roles. The objectives of reconstruction may be to prevent epiphora, to separate the oral cavity from the nose and orbit, to preserve the facial contours, to minimise enophthalmos and diplopia, to maintain a nasal airway, and to restore dentition.

     The author described the technique of total maxillectomy, with or without orbital exenteration and the reconstruction.

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  • Hiroyuki HARADA
    2018 Volume 64 Issue 1 Pages 8-12
    Published: January 20, 2018
    Released on J-STAGE: March 20, 2018
    JOURNAL FREE ACCESS

    In case of cervical lymph node metastasis of the oral carcinoma, neck dissection is the most reliable treatment. Recently, it is reported that dissection of level IIB, IV and V is unnecessary in node positive case of oral carcinoma. However, the validity omitting these levels is controversial. We reviewed the records of 1078 patients with oral carcinoma between 2001 and 2015 at our department. Out of these, 337 patients(31.3%) were found to have pathologically positive node. The most common site was level Ib in 68.8% and level IIa in 68.2%. On the other hands, level IIb was involved in 3.0%, level V in 4.5% and level IV in 6.5% in ascending order. It is possible to omit these regions in neck dissection in some cases depend on pattern of cervical lymph node metastasis. In addition, the surgical anatomy for neck dissection and surgical technique for the anterolateral neck dissection were described in this paper.

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Original article
  • Ryoko YOSHIMI, Yasushi HAYASHI, Kazuyo WATANABE, Kotaro SATO
    2018 Volume 64 Issue 1 Pages 13-18
    Published: January 20, 2018
    Released on J-STAGE: March 20, 2018
    JOURNAL FREE ACCESS

    We have studied data on patients in whom the third molars were extracted during hospitalization in our department to investigate trends in postoperative complications and the relations of dysesthesia to the inferior alveolar nerve and imaging findings on computed tomography. The study group comprised 811 patients (327 males and 484 females) with a mean age of 26.35 ± 10.40 years (range, 13 to 85 years). A total of 2428 third molars (876 maxillary third molars and 1552 mandibular third molars) were extracted. The postoperative complication rate associated with extraction of the mandibular third molars was 9.21%, consisting of 75 cases of infection (4.83%), 65 cases of dysesthesia of the inferior alveolar nerve (4.19%), 2 cases of incomplete cure (0.13%), and 1 case of postoperative bleeding (0.06%). The dysesthesia rate after mandibular third molar extraction was 11.94% among patients considered at high risk who underwent computed tomography (CT), and 1.85% among patients considered at low risk who did not undergo CT. Deformed mandibular canals were found on cross-sectional CT images in all patients who had dysesthesia. The incidence of dysesthesia in the patients who had crescentic highly deformed mandibular canals on the cross-sectional images was significantly higher than that in the other patients. On the other hand, the mandibular canals were not deformed in most of the patients without dysesthesia. More highly deformed mandibular canals were thus associated with a higher risk of dysesthesia.

     These results suggested that the deformation of the mandibular canals are involved in the pathogenesis of dysesthesia and that the assessment of mandibular canal deformation on CT is useful for predicting the risk of the dysesthesia with high accuracy.

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Case reports
  • Akinobu AOKI, Daisaku TOBISHIMA, Masakazu AKIBA, Kosuke TAKAHASHI, Ko ...
    2018 Volume 64 Issue 1 Pages 19-23
    Published: January 20, 2018
    Released on J-STAGE: March 20, 2018
    JOURNAL FREE ACCESS

    Cystic lymphangioma is a benign cystic lesion comprising an inherent malformation of a lymphatic vessel that typically arises in the head and neck by the age of 2 years. This report describes two adult patients with cystic lymphangioma in the maxillary sinus.

     Case 1: A 42-year-old man was referred to our hospital because of a lesion in the left maxillary sinus. Panoramic radiography and X-ray computed tomography(CT) respectively revealed a well-defined radiopacity and a low-density lesion in the left maxillary sinus. We surgically extirpated the lesion with the patient under local intravenous anesthesia with sedation. The histopathological diagnosis was a cystic lymphangioma of the maxillary sinus. The patient has remained free of signs and symptoms for 2 years.

     Case 2: A 49-year-old woman was referred to our hospital because of an unusual feeling in the left maxillary molar in December 2011. Swelling and tenderness were not evident in the left maxillary sinus or alveolar region, but panoramic radiography and X-ray CT respectively revealed a well-defined radiopacity and a low-density region in the left maxillary sinus. We surgically extirpated the lesion with the patient under general anesthesia in December 2012. The histopathological diagnosis was cystic lymphangioma of the maxillary sinus. The condition has not recurred as of 2 years after surgery.

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  • Yoshiki ISHIDA, Akiko YABASE, Daisuke FUJI, Atsuko HASEGAWA, Takahide ...
    2018 Volume 64 Issue 1 Pages 24-28
    Published: January 20, 2018
    Released on J-STAGE: March 20, 2018
    JOURNAL FREE ACCESS

    Cystadenocarcinoma is a rare malignant tumor that accounts for less than 0.2% of all salivary gland tumors. Most cases of cystadenocarcinoma occur in the region of the parotid gland, followed by the minor salivary glands. We report a case of cystadenocarcinoma arising in the region of the sublingual gland. Case patient: a 78-year-old man. Chief complaint: a painless mass located in the left side of the mouth floor. Present illness: a 40 × 20 mm, unmovable, hard elastic mass bulging from the left side of the mouth floor. Findings on magnetic resonance imaging: a relatively well-defined, multilocular mass with significantly high signal intensity was seen on T2-weighted images. The normal left sublingual gland was not detected in the images. Clinical course: An incisional biopsy revealed adenocarcinoma. Based on the clinical diagnosis of a malignant sublingual gland tumor, we performed partial resection of the floor of the mouth and modified radical neck dissection on the left side. Pathologically, cystadenocarcinoma was definitively diagnosed. There has been no sign of recurrence or metastasis as of 9 years after surgery.

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