Gamma knife surgery (GKS) has been employed for treating intractable pain such as trigeminal neuralgia (TN) and pain relief has been gained from the treatment, however, little is understood about the side effects of other sensitivities induced from GKS. We assessed ten patients (four men and six women; mean age 67 years) with TN who were investigated by questionnaire for symptoms and visual analog scale (VAS) of pain, and their threshold of touch sensation was examined using Semmes-Weinstein monofilaments, cold sensation and allodynia before and after GKS. MR and CT images were obtained after a Leksell head frame was applied to the head parallel to the trigeminal nerve. These images were uploaded to a computer system and retro-Gasserian area planned the target was correctly marked on the images of a computer in which gamma planning software was installed. All patients were irradiated with a maximum dose of 90 Gy at retro-Gasserian using a 4mm collimator. The mean±SD of VAS of pain was 8.5±1.3 and 8 patients had facial paresthesia before GKS. All patients experienced a significant reduction in pain without side effects such as effect on the peripheral nerves without 6 month after GKS. Allodynia, facial paresthesia or cold sensation numbness occurred in the patients before GKS disappeared according to complete pain relief. These results suggest that GKS is a safe and effective treatment for TN.
We investigated the effectiveness of feeding and swallowing therapy in 45 patients with dysphagia and reported the factors related to effectiveness. To study the factors, the patients were examined with respect to sex, age, period from onset to beginning of the therapy, therapy period and physical conditions. Logistic regression analysis was used to analyze the correlation between the therapeutic effectiveness and these items. In the 45 dysphagia cases, no improvement of swallowing function was found in 12 cases (26.7%), moderate improvement in 21 cases (46.7%) and good improvement in 12 cases (26.7%). The only factor related to the effectiveness of the therapy was level of dry swallowing (p = 0.005, odds ratio: 6.445). These results indicate that introducing feeding and swallowing therapy, before dry swallowing is lost, is effective for improving swallowing function in patients with dysphagia.
Mandibular prognathic patients who underwent sagittal splitting ramus osteotomy were examined for soft tissue changes after the surgery using a non-contacting three-dimensional optical surface scanner. Eleven females and 7 males without severe facial asymmetry or open-bite were included in this study. Optical surface scans were obtained from all patients preoperatively and 6 months postoperatively, and then evaluated by three-dimensional analyzing software. In all the cases, the soft tissue changes were exclusively found at areas from the lower lip to the border of the chin and were classified into two types: one was focused on the center of the chin, and the other on the lower border of the chin. To access factors associated with the soft tissue changes, the cephalographs taken pre- and postoperatively were three-dimensionally analyzed. The results indicated that the amount of set-back is a significant factor that determines the patterns of soft tissue changes.
Adult T-cell leukemia/lymphoma (ATLL) is induced by human T-lymphotropic virus type 1 (HTLV-1) infection. We report a case of ATLL in the oral cavity as an early symptom. A 58-year-old female was referred to our hospital because of right upper gingival pain. Imaging study revealed a swelling of multiple cervical lymph nodes and a mass lesion destroying the right maxillary bone. Biopsy from a cervical lymph node was done and the pathological diagnosis was T-cell lymphoma. Serologically, anti-HTLV-1 antibody was positive. Southern blot analysis used by the lymphocyte of peripheral blood showed monoclonal proliferation of HTLV-1 provirus DNA. We finally made the diagnosis of ATLL (lymphoma type). She was treated by systematic chemotherapy, and recovered well with no evidence of recurrence for over 2 years.
A 75-year-old female patient presented with painless swelling of the right mandible of one month duration. There were no remarkably abnormal findings of the overlying oral mucosa. Panoramic radiography and CT images indicated diffuse osteodestructive changes on the body of the mandible. However, bone formation was also detected. On T1-weighted MR images, the tumor showed low signal intensity, intermediate on enhanced T1-weighted MR images, and slightly low on T2-weighted MR images. Moreover, in the tumor, small round areas showing low signal intensity on T1-weighted MR images and high signal intensity on enhanced T2-weighted MR images were detected. Because these structures indicated cystic spaces, the mandibular tumor was suspected of an odontogenic malignant tumor or a salivary gland malignant tumor. Histologic examination of the biopsy specimen revealed low-grade mucoepidermoid carcinoma. A hemimandibulectomy, neck dissection on the ipsilateral side and reconstruction of the oral cavity using a rectus abdominis myocutaneous flap were performed. Pathological examination revealed that glandular elements, cystic and duct-like components contained myxoid material produced by mucous cells in the tumor mass, and spicula-like bone formation continuous to the surface of preexisting cortical bone and nonuniform-shaped new bone formations were also seen. A detailed pathological analysis of the whole operation materials indicated central (intraosseous) mucoepidermoid carcinoma of the mandible. The patient received tumor extirpations for distant metastases to the sigmoid colon, thigh muscles, and back skin, and remained alive with lung metastasis for over 5 years after the initial operation. New bone formation and/or bone remodeling were not seen in the 21 cases of central mucoepidermoid carcinoma of the mandible reported in the Japanese literature since 1969.