Journal of Japanese Society of Oral Oncology
Online ISSN : 1884-4995
Print ISSN : 0915-5988
ISSN-L : 0915-5988
Volume 21, Issue 4
Displaying 1-10 of 10 articles from this issue
The 27th Annual Meeting of Japan Society for Oral Tumors
Symposium: Rehablitation and evaluation for post-surgical oral function in oral cancer patients
  • Kazuo Shimozato, Koji Takahashi
    2009 Volume 21 Issue 4 Pages 217
    Published: December 15, 2009
    Released on J-STAGE: March 27, 2012
    JOURNAL FREE ACCESS
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  • Hiroto Itoh, Kaoru Ikeda, Kei Kashimura, Daisuke Orii, Rumi Kawa, Yuki ...
    2009 Volume 21 Issue 4 Pages 218-224
    Published: December 15, 2009
    Released on J-STAGE: March 27, 2012
    JOURNAL FREE ACCESS
    In this study, mainly using biochemical examinations of the blood, we examined the nutritional status of lingual cancer patients requiring reconstructive surgery from among oral cancer patients who underwent surgery. Here, we report on the nutritional status before and after treatment, the nutritional management provided at our department, and the related problems.
    The subjects comprised 35 lingual cancer patients who received inpatient hospital care at our department during the 9 years from 2000 to 2008. We classified the patients according to whether they had undergone any preoperative treatment or any type of flap reconstruction, and assessed their nutritional status based on their weight, total protein levels, and albumin levels. Moreover, in recent years, our department has proactively implemented the use of gastrostomies, and we assessed their usefulness.
    The results showed that in the cases that underwent reconstructive surgery, both the weight and biochemical examination of the blood tended to indicate a significantly low nutritional status compared to when the patients were first admitted to the hospital. Moreover, nutritional management using a gastrostomy, specifically for postoperative management purposes, was easy to carry out.
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  • Masakazu Gotoh
    2009 Volume 21 Issue 4 Pages 225-229
    Published: December 15, 2009
    Released on J-STAGE: March 27, 2012
    JOURNAL FREE ACCESS
    We focused on the motion of the retropharyngeal wall during the swallowing movement to investigate the cause of dysphagia of head and neck cancer patients who underwent surgery. We also devised a method of kinetic analysis using video-fluorography (VF) images on a computer, and compared the results with the dysphagia level.
    The VF image of 29 head and neck cancer patients were analyzed with two-dimensional video measurement software. We calculated the thickness of the retropharyngeal wall of the second, third, and fourth cervical vertebrae during swallowing and measured the time when the thickness was maximum at each vertebra. To measure the dysphagia level, we quantified the remaining contrast media in the epiglottic vallecula or the piriform fossa and the aspiration amount based on interpretation of the VF images.
    Before surgery, all patients showed normal peristaltic motion in which the thickest point of the retropharyngeal wall was moved sequentially from the second to the fourth vertebra. Some patients, however, showed abnormal peristaltic motion after surgery. These cases showed high dysphagia scores with a significant difference from normal peristaltic motion cases.
    Computational analysis of the VF images enabled us to evaluate the motions of the retropharyngeal wall along the time axis. A change in the kinetic pattern of the retropharyngeal wall caused by surgery can be substantially related to dysphagia.
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  • Ryo Ishida
    2009 Volume 21 Issue 4 Pages 230-236
    Published: December 15, 2009
    Released on J-STAGE: March 27, 2012
    JOURNAL FREE ACCESS
    Tokyo Dental College established the Department of Dysphagia Rehabilitation & Community Dental Care in 2008. Dysphagia is caused by various diseases: A major disease is CVA. On the other hand, we have had oral cancer patients in our hospital and most of them have experienced trouble with dysphagia. Dysphagia rehabilitation for postoperative oral cancer patients is one of our main tasks. The essential points for their rehabilitation are 1.) Preventing aspiration pneumonia, 2.) Nutrition, and 3.) Mental support. This manuscript summarizes our main work.
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  • Hideki Sekiya, Yoshiki Hamada, Akiko Fukui, Tomoo Sonoyama, Koji Kawag ...
    2009 Volume 21 Issue 4 Pages 237-244
    Published: December 15, 2009
    Released on J-STAGE: March 27, 2012
    JOURNAL FREE ACCESS
    Assessment for dysphagia in postoperative oral cancer patients is performed based only on the criterion of each hospital. That is why there is no standardized grade for dysphagia or a standard rehabilitation that is based on that grade. We discussed retrospectively the assessment, diagnosis and rehabilitation of 40 cases with severe dysphagia among 176 of our patients with oral cancer to standardize them for oral cancer patients.
    The conclusion was as follows:
    1. The diagnosis of dysphagia: For oral cancer patients, it was necessary to provide a new grade classification without using ready-made grade or scale.
    2. The assessment: Videofluorography (VF) was essential in cases that required indirect therapy first.
    3. The rehabilitation: We judged that it was possible to standardize a rehabilitation that is based on choosing a grade classification.
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  • —Hospitalization for dysphagic patients who were told in other clinics that it would be impossible or extremely difficult to eat orally—
    Koji Takahashi
    2009 Volume 21 Issue 4 Pages 245-254
    Published: December 15, 2009
    Released on J-STAGE: March 27, 2012
    JOURNAL FREE ACCESS
    The department of oral rehabilitation in Showa University dental hospital was established in 2004 to make a significant contribution to the rehabilitation and treatment of patients with oral dysfunction including dysphagia, speech disorders and obstructive sleep apnea syndrome.
    Out of 456 first-visit outpatients who visited our department in 2007, 233 patients had dysphagia, including 59 head and neck cancer patients. Some of these head and neck cancer patients had intractable dysphagia.
    In my presentation, I have presented five head and neck cancer patients with dysphagia who were told in other clinics that it would be impossible or extremely difficult to eat orally. These patients were hospitalized in our department for dysphagia treatment. Evaluation, treatment procedures, and outcomes of these patients were presented.
    I have also pointed out problems concerning dysphagia rehabilitation, and discussed how we manage those problems in our department.
    During the diagnostic process, we detect and record swallowing sounds during VF and VE examination. The sound information is considered as a reference when we use cervical auscultation in our clinical examinations.
    In order to train patients efficiently during treatment, we apply quantitative measures for evaluating functions. Also, we record the training program onto a videotape so the patients will be able to reproduce the program accurately. As a swallow maneuver, we apply the Showa swallow maneuver, which is a combination of three swallow maneuvers.
    Even after recovering from dysphagia, the resistance training should be continued until it is habituated to maintain a high quality diet level. This approach is especially important for the elderly.
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Case Report
  • Analysis of 13 cases with a review of Japanese Literature
    Seiji Asoda, Koji Takamori, Kimio Uchiyama, Hiroshi Iwabuchi, Kentaro ...
    2009 Volume 21 Issue 4 Pages 255-264
    Published: December 15, 2009
    Released on J-STAGE: March 27, 2012
    JOURNAL FREE ACCESS
    Thirteen tumors metastasizing in the oral and maxillofacial region were clinically investigated. Metastatic tumors accounted for 2.3% of overall primary oral malignant tumors (573 cases). The mean age was 60.0 years with a range of 14 to 73 years old. Nine of the 13 patients were male and 4 were female. The primary sites of the tumors included lung (5), kidney (3), colon and rectum (2), and 1 each in the stomach, mammary gland and adrenal gland. The locations of the metastasis included the soft tissues (10) and jaws (3). The usual symptoms of the metastatic lesions were well-demarcated swelling, and paresthesia of the mental region was noted in 2 cases of mandibular metastases. The histlogical types included adenocarcinoma (6) and 3 each for large cell carcinoma and renal cell carcinoma, and 1 for neuroblastoma.
    In 3 cases, the oral metastatic lesion was the first sign of the primary malignant tumor. In 6 cases, the primary tumor was controlled, but multiple metastases were recognized in all cases. Four cases were treated palliatively and radically respectively, but 5 cases did not received treatment after biopsy.
    In addition, in a review of the Japanese literature, 221 well-documented cases of metastatic tumors in the oral and maxillofacial region were analyzed. The most common primary organ was the lung (26.2%) followed by the liver (17.8%), colon and rectum (9.5%) and kidney (9.0%). In 33.7% of cases, the oral lesion was the first sign of the malignant disease.
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Case Reports
  • Junichi Baba, Kenji Mitsudo, Toshinori Iwai, Takafumi Fukui, Sachiyo M ...
    2009 Volume 21 Issue 4 Pages 265-271
    Published: December 15, 2009
    Released on J-STAGE: March 27, 2012
    JOURNAL FREE ACCESS
    We report a case of mucoepidermoid carcinoma of the oral floor treated successfully with daily concurrent chemoradiotherapy using superselective intra-arterial infusion via the superficial temporal artery (STA).
    A 60s male was referred to our department with left mandibular pain and mental nerve palsy. The mass was 34 × 23 mm at the lingual side of left lower molars: A submandibular lymph node has no mobility. A CT scan showed a 42 × 24 mm mass at the lingual side of the mandible. The mass involved the mandible body. A biopsy was performed and the pathological diagnosis was mucoepidermoid carcinoma. The patient underwent superselective intra-arterial infusion via the STA combined with daily concurrent radiotherapy. The total dose of cisplatin was 224 mg, and that of docetaxel was 111 mg. External irradiation was performed five times a week at 1.8 Gy per fraction, for a total of 50.4 Gy. The clinical effect was partial response after the completion of treatments. The patient underwent segmental mandibulectomy, functional neck dissection and reconstruction with fibula osteocutaneous flap, four weeks after the end of intra-arterial chemoradiotherapy. The pathological diagnosis of the resected tumor and lymph nodes was complete response. The patient has been free of disease for 30 months since the operation.
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  • Shohei Kanemaru, Kanae Niimi, Yohei Oda, Tadaharu Kobayashi, Hideyoshi ...
    2009 Volume 21 Issue 4 Pages 273-278
    Published: December 15, 2009
    Released on J-STAGE: March 27, 2012
    JOURNAL FREE ACCESS
    Infantile fibromatosis is a fibromatous lesion that arises in both soft and hard tissues, and occurs rarely in the head and neck region. A three-year-old boy was referred to our clinic because of painful swelling of the left submandibular region. CT scans and MRI revealed a localized perimandibular soft tissue mass, which suggested a malignant tumor, but we could not make a definitive pathological diagnosis from the needle biopsy specimens. The tumor was removed surgically while taking into consideration to avoid disturbing the maxillofacial cosmesis and functions. The pathological findings of the surgical specimen showed a tumor composed of spindle cells with no cellular atypia and mitosis, but showed invasion into the surrounding muscular tissue, and the final pathological diagnosis was infantile fibromatosis. There is no evidence of recurrence for five years postoperatively, but we have to close follow-up carefully because recurrence of the tumor after surgical resection was reported.
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  • Akiko Kumagai, Yu Ohashi, Hideki Hoshi, Toshinari Mikami, Hiroshi Hara ...
    2009 Volume 21 Issue 4 Pages 279-284
    Published: December 15, 2009
    Released on J-STAGE: March 27, 2012
    JOURNAL FREE ACCESS
    A female patient in her 70s was referred to our department because of pain and a mass on the floor of the mouth in the left mandibular molar area. The mass (30×8 mm) extended in the direction of the mandibular ramus, and was palpable in the submucosal area between the lingual gingiva of the left mandibular first molar-equivalent area and the floor of the mouth. Nine years ago, a mass developed in the lingual nerve, and a biopsy performed in a local dental hospital revealed neurofibroma. In the present case, the mass was resected under a tentative diagnosis of a mouth floor tumor. Macroscopic observation showed that part of the lingual nerve was tuberously swollen, and the mass was histologically diagnosed as adenoid cystic carcinoma. As the surgical margin was positive for cancer, mouth floor resection and left supraomohyoid neck dissection were also performed. The results of the histological investigation indicated that this case was a relatively rare one of primary tumor of the sublingual gland. The present case was initially considered to differ from the mass nine years ago. However, we obtained a specimen of the mass taken nine years ago, and judged that it was also adenoid cystic carcinoma. Therefore, it was suggested that the mass in the present case developed from that which previously formed in the lingual nerve through tumor infiltration.
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