In recent years, marked advances have been made in reconstruction after oral oncologic surgery, and various types of reconstructive flaps have been developed. Since maintenance of the eating and swallowing functions after surgery is most important in the oromandibular region, a standard flap should be selected with due consideration to postoperative function. Reconstruction with a vascularized free rectus abdominis musculocutaneous flap (RAM) as the standard flap with swallowing training and swallowing improving surgeries, with consideration of the characteristics of each deglutition phase, was carried out for defects in patients with tongue and/or oral floor cancer requiring extensive oromandibular resection, as well as in those with oropharyngeal cancer treated by resection of the soft palate and the lateral oropharyngeal wall. Here, we describe our swallowing improving treatment, the reconstruction with a RAM, swallowing improvement surgery and the pre- and post-operative swallowing training for maintaining the swallowing and eating functions after extensive oral oncologic surgery. This series of treatments is worth considering before total laryngectomy.
The objective of the present study was to investigate the distribution of static tactile thresholds in healthy individuals, using a Semmes-Weinstein sensory test. The sensory test was conducted on 25 males and females (50 sides) in total. Average age of subjects was 23.8±3.1years.Test sites were the lower lip, oral angle, and mental ramification of the mental nerve. For comparison, the test was also conducted on the index finger. Mean threshold for each test site was as follows: labial inferior rami.2.83±0.76gf/mm2, oral angle rami.2.76±0.47gf/mm2, mental rami. 2.78±0.76gf/mm2, and index finger 3.66±0.71gf/mm2. Statistical analysis showed no significant difference among the three mental nerve sites, but significant differences existed between the index finger and the three mental nerve sites. The above findings suggest that the standard range for filament marking is 1.65-2.44 (2.52-4.23 gf/mm2).
The aim of this study was to investigate the relation of various apoptosis-associated factors with histological grades and clinical features of tongue squamous cell carcinoma (SCC). The subjects were 35 primary cases of tongue SCC: 25 cases had no recurrent tumor, one case had recurrence and 9 cases died. However, 2 cases of double cancer were included: one who had recurrence and one who died. Hematoxylin eosin (HE)-stained sections were examined to determine histological grades according to the WHO classification. TUNEL and immunohistochemical staining for Fas, Fas-ligand (Fas-L), bcl-x (bcl-xL), Bax, cpp32, Rb, p53 and ki-67 were performed, and their immunoreactivities were evaluated. p53-positive cases were screened for p53 mutation using PCRSSCP. The results were as follows: 1. Fas expression in histological grade II cases was lower (p = 0.093) than that in grade I cases. The expression was also decreased in 6 cases who died of tumor within 2 years and 2 cases who had double cancer as compared with other cases (p<0.05). . The labeling index for p53 was significantly higher in 6 cases who died of tumor within 2 years and2 cases who had double cancer as compared to other cases (P<0.05). 3. Labeling indexes for TUNEL, Rb protein and ki-67 and expression of bcl-xL, bak, Fas-L and cpp 32 had no significant relation with grades of tumor differentiation and prognosis. 4. p 53 mutation was observed in exon 6, 7 and 8in 4 cases of 18 p53-positive cases. The number of cases was insufficient to clarify the relation of p53 mutation with histological grades and prognosis. These results suggest that decline of Fas expression and increase of p53 expression indicate progression of histological grade and poor prognosis of tongue SCC.
A healing space is created between the periosteum and the bone while ablating the periosteum and suturing it again to its own position. However, there are no reports mentioning that the healing space can be expanded gradually with the possibility of inducing the formation of new bone. This study examined the possibility of forming new bone by using osteogenesis devices in the healing space. Material and methods: 25 rabbits were used and divided into control and experiment groups; both groups underwent periosteum ablation with an osteogenesis device placed in the healing space of the control group, then the periosteum was sutured in both groups to its own position. Results: The control groups showed revascularization with thin new bone formed in the healing space. On the other hand, all the experimental groups showed expansion in the healing space, with more revascularization beside the original bone compared to the side of the periosteum. The first experimental group was observed after one week of ceasing expansion, and the histological findings showed new bone formation over original bone. In the 2-week and 4-week -groups, the new bone showed much more maturation than the 1-week group. Conclusion: It can be concluded that gradually expanding the healing space between the periosteum and bone might induce the formation of new bone over the original bone surface in the healing space.
Preoperative radiochemotherapy has been carried out for many cases of oral cancers to improve locoregional control. The purpose of this study was to evaluate whether preoperative radiochemotherapy for oral squamous cell carcinomas is beneficial for the patients. A retrospective analysis of 182 patients who had successfully undergone operations at our hospital from April 1982 to March 2001 was performed. Subjects consisted of a preoperative radiochemotherapy group (n=88) and a surgery-only group (n=94). We obtained the following results and conclusions: 1. Preoperative radiochemotherapy for advanced oral squamous cell carcinomas (Stage III, IV) did not contribute to improvement of the survival rate, although it was effective for locoregional control. These results indicated that preoperative radiochemotherapy could decrease the reoperations of recurrences and regional lymph node metastases. Therefore, organ preservations were done in some cases by preoperative radiochemotherapy. 2. The preoperative radiochemotherapy effective group showed a better survival rate than the noneffective group, and the response rate of preoperative radiochemotherapy became an independent predictive factor for the prognosis. The 5-year cause-specific survival rate in Stage III, IV was 88.8% for the effective group and 55.8% for the noneffective group. 3. The cause of death in the noneffective group was mainly local recurrence mostly arising from a deep region of the tumor surgical margin, and 75.0% of the dead cases were cases with mode of invasion 4C or 4D. Therefore, we should consider setting a larger safety margin especially in the deep region of a tumor that is highly invasive and for which radiochemotherapy is not effective.
A case of huge hemangioma from the right soft palate to the pharynx that was treated with injection sclerotherapy by polidocanol is reported. A 61-year-old male was referred to our hospital with the complaint of discomfort of the pharynx region. He had a huge and soft dark purplish mass from the right soft palate to the pharynx, which blanched under pressure. His tumor was diagnosed as hemangioma by macroscopic findings and MRI. Angiographic examination revealed that it was a hemangioma of the low-flow type. So, injection sclerotherapy by 1% polidocanol was performed three times, which resulted in a remarkable shrinking of the tumor, and his unpleasant feeling at the pharynx disappeared. We consider that injection sclerotherapy by polidocanol is a safe, easy and effective treatment for hemangioma of the low-flow type.
Pseudogout is a disease of calcium pyrophosphate dehydrate (CPPD) deposition of joints. It occurs most often in the knee joint. We herein report an extremely rare case of pseudogout arising in the left temporomandibular joint. A 75-year-old female visited our hospital complaining of pain, crepitus and trismus in the left temporomandibular joint. CT and MR images showed irregular and destructive changes of articular surfaces, and a poorly defined peripheral soft tissue component. Excision of areticular capsule and condylectomy of the left temporomandibular joint were performed. After 3 months of follow-up, pain, crepitus and trismus of the left temporomandibular joint disappeared.