日本口腔外科学会雑誌
Online ISSN : 2186-1579
Print ISSN : 0021-5163
ISSN-L : 0021-5163
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選択された号の論文の5件中1~5を表示しています
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  • 中溝 宗永, 稲井 俊太
    2024 年 70 巻 2 号 p. 36-41
    発行日: 2024/02/20
    公開日: 2024/04/19
    ジャーナル フリー
    Most neoplastic causes of cervical lymphadenopathy are metastases from head and neck cancers. For physicians to treat cervical lymphadenopathy, basic knowledge for frequent sites and incidence rates of each primary head and neck cancer is required for appropriate diagnosis and disease control. In p16-positive oropharyngeal cancer(OPC), it is important to note, that cervical metastasis may appear at any stage, even when the primary tumor is still small. It may present as a carcinoma of unknown primary(CUP), and thorough endoscopic examination of the nasopharyngeal cavity, combined with the Modified Killian position, is recommended to identify the potential primary site. Fine needle aspiration of the lymph node may be conducted, if necessary, followed by a biopsy if suspected of malignant lymphoma. Cystic change is another known feature of p16-positive OPC metastasis to lymph nodes. Differential diagnosis include metastasis from thyroid papillary cancer, as well as benign lateral cyst, and differences in their MRI findings may provide hints for diagnosis.
    For metastatic lymph nodes of thyroid papillary cancers, and squamous cell carcinomas of oral cancers and hypopharyngeal cancers, main stream of treatment is to perform selective neck dissection. On the other hand, that of nasopharyngeal cancer and p16 positive OPC is to perform chemoradiotherapy, in consistent with the primary lesion. In this session, diagnosis and treatment of CUP, its relationship with p16-positive OPC in particular, was discussed.
  • 林 孝文, 新國 農, 西山 秀昌
    2024 年 70 巻 2 号 p. 42-48
    発行日: 2024/02/20
    公開日: 2024/04/19
    ジャーナル フリー
    Lymphadenopathy is one of the representative findings of cervical lymph node pathology. Its causes are roughly classified into inflammatory (infectious and reactive), neoplastic (lymph node metastasis, malignant lymphoma, etc.), and others (IgG4-related diseases, etc.). To obtain the diagnosis, various imaging modalities such as CT, MRI, PET and ultrasonography are routinely used. Among them, ultrasonography is widely used for the follow-up study because of its low-cost and no ionizing radiation. In our institution, we visualize and store the still images of the regional lymph nodes (minimal axial diameter of about 3 mm or more)in the submental, the submandibular, the upper deep cervical, the middle deep cervical regions and evaluate other areas as needed. Generally, cervical lymph nodes can be modeled as elliptical shape, and the maximal diameter, minimal diameter and thickness are definable. In our diagnostic report of follow-up period, the maximal axial diameter (the largest), minimal axial diameter (the shortest), and overall morphology are compared with the previous examination. Additionally, with regard to the internal structure of the lymph nodes, we evaluate the emergence and time-course changes of hyper/anechoic (or mixed) area, and the state of blood flow with Doppler and tissue stiffness with strain elastography as appropriate.
    In this article, the roll of ultrasonography in the modern imaging techniques for the diagnosis of cervical lymphadenopathy including non-neoplastic pathology is discussed.
症例報告
  • 林 樹, 土井田 誠, 水井 工, 阿部 幸二郎, 山下 知巳, 牧田 浩樹
    2024 年 70 巻 2 号 p. 49-53
    発行日: 2024/02/20
    公開日: 2024/04/19
    ジャーナル フリー

    We report a case of epithelioid hemangioendothelioma of the lower lip. Epithelioid hemangioendothelioma is a malignant vascular tumor derived from vascular endothelial cells.This tumor affecting the lip is rare. A 34-year-old woman visited our department with the chief complaint of a localized mass in the left lower labial mucosa. An excisional biopsy was performed based on a clinical diagnosis of lower lip tumor. Histopathologically, the lesion was diagnosed as an epithelioid hemangioendothelioma. About one month after the excisional biopsy, an additional resection was performed with a safety margin of about 1 cm. Since it was a curative resection, no postoperative treatment was performed. The postoperative course was uneventful, with no signs of recurrence 32 months after the surgery.

  • 堀 晃二, 小泉 岳, 清水 香澄, 加藤 英治, 奥田 悠大, 新井 直也
    2024 年 70 巻 2 号 p. 54-60
    発行日: 2024/02/20
    公開日: 2024/04/19
    ジャーナル フリー

    It has been reported that bone growth is vigorous in the condylar process of the mandible in children, and that morphological recovery can be obtained even if dislocation occurs due to fracture. Most reports are of unilateral cases, with few reports of bilateral cases. Among these, there is no report on temporal CT observation of the morphological recovery of dislocated condyles after bilateral mandibular condylar fracture (BMCF). Here, we report the recovery process of two pediatric BMCF cases. Case 1 was a 12-year-old boy who fell off a bicycle and hit his chin. Case 2 was a 12-year-old girl who fell and hit her chin at school after losing consciousness. They were diagnosed with BMCF, with all fracture sites being the condylar neck. The fracture type was deviation-dislocation in all condyles. Both cases underwent conservative treatment that consisted of intermaxillary fixation for 10-14 days followed by mouth opening training for 3 months. In both cases, posttreatment CT observation showed resorption of the dislocated mandibular head and vertical bone addition from the fracture margin. Recovery to nearly-normal morphology of the articular process was observed at four years after treatment in Case 1 and at one year after treatment in Case 2. During follow-up observation, no notable temporomandibular joint dysfunction and occlusal abnormality were observed in either case.

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