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Volume 66, Issue 4
Displaying 1-6 of 6 articles from this issue
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Yuki KITO, Keiichi I. NAKAYAMA2017 Volume 66 Issue 4 Pages 259-263
Published: 2017
Released on J-STAGE: December 16, 2017
JOURNAL RESTRICTED ACCESSDownload PDF (817K) -
Jiro FUJITA2017 Volume 66 Issue 4 Pages 264-272
Published: 2017
Released on J-STAGE: December 16, 2017
JOURNAL RESTRICTED ACCESSDespite advances in diagnosis, antimicrobial therapy and supportive care modalities, pneumonia remains an important cause of morbidity and mortality. In recent years, changes in the healthcare system have shifted a considerable part of older patient care from hospitals to the community, and the traditional distinction between community – and hospital-acquired infections has become less clear. With this background, pneumonia occurring among outpatients in contact with the healthcare system has been termed healthcare-associated pneumonia. The impairment of airway protective reflexes, i.e., swallowing and cough reflexes, is thought to be one of the major causes of aspiration pneumonia in older people. Anaerobic bacteria are relatively frequent pathogens in pulmonary infections that are associated with aspiration and its associated complications including aspiration pneumonitis, lung abscess, necrotizing pneumonia and empyema. Treatment consists of relatively broad-spectrum antibiotics that can cover anaerobes. In cases with concurrent presence of renal impairment, single-agent therapy is recommended in this specific patient population. In addition, since sitafloxacin has wide-spectrum antibacterial activity against pathogens isolated from patients with aspiration pneumonia, sitafloxacin could be used for the treatment of healthcare-associated pneumonia. To prevent aspiration pneumonia in elderly patients, oral care is very important, and periodical inoculation of the Streptococcus pneumoniae vaccine as well as the influenza vaccine is recommended.View full abstractDownload PDF (4042K)
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Takamichi MORIKAWA, Ayaka KOSUGI, Hiroki BESSHO, Takeshi NOMURA, Akira ...2017 Volume 66 Issue 4 Pages 273-282
Published: 2017
Released on J-STAGE: December 16, 2017
JOURNAL RESTRICTED ACCESSVarious mucosal diseases such as oral potentially malignant disorders （OPMD） and squamous cell carcinoma （SCC） may develop in the oral cavity and are difficult to differentiate. Optical instruments are not invasive and can be repeatedly used. Since 2010, we have used optical instruments effectively to improve diagnosis and treatment. In this study, we conducted subjective and objective evaluations using an optical instrument for distinguishing between leukoplakia and SCC.
Thirty patients diagnosed with tongue SCC and leukoplakia at the Department of Oral and Maxillofacial Surgery, Tokyo Dental College in Chiba, between 2013 and 2015 were selected and evaluated using the optical instrument IllumiScanⓇ.
In the subjective evaluation by the optical instrument, Fluorescence Visualization Loss （FVL） was confirmed in all SCC cases. In the objective evaluation, SCC was lower than leukoplakia in luminance （SCC 37.9 vs leukoplakia 49.9cd/m2）. In coefficient of variation of luminance, SCC was higher than leukoplakia in luminance （SCC 0.23 vs leukoplakia 0.15）. The control was not significant （area of control: SCC 843 vs leukoplakia 832, luminance of control: SCC 50.3 vs leukoplakia 48.5）. Regarding luminance ratio, SCC was lower than leukoplakia in luminance （SCC 62.9 vs leukoplakia 104.1％）. In the objective evaluation, statistical differences were found in luminance, coefficient of variation of luminance and luminance ratio.
It was suggested that subjective and objective evaluations using optical instruments may be useful for differentiating leukoplakia and SCC.View full abstractDownload PDF (4662K) -
Akira SHIMASAKI, Toshihiro OKAMOTO, Chisa SHIBAYAMA, Noriko SANGU, Tom ...2017 Volume 66 Issue 4 Pages 283-288
Published: 2017
Released on J-STAGE: December 16, 2017
JOURNAL RESTRICTED ACCESSIntroduction: Low-urgency patients presenting to the emergency outpatient service can be problematic and can make it difficult for a hospital to accept an ambulance or other high-urgency patients. Consequently, some hospitals have restricted the admittance of low-urgency patients presenting to the emergency outpatient service by introducing an after-hours medical surcharge. In this study, we report the effect of an after-hours medical surcharge at the oral and maxillofacial surgery emergency outpatient service.
Materials and Methods: The subjects were 4,664 emergency patients who presented at the oral and maxillofacial surgery emergency outpatient service at Tokyo Women’s Medical University Hospital over a period of 6 years between April 2006 and March 2013. We compared the number of patients in the emergency service with and without levying an after-hours medical surcharge.
Results: The number of low-urgency patients decreased from 850 patients/year to 612 patients/year following the introduction of the after-hours medical surcharge. The number of patients presenting with teeth disease decreased from 24.7% to 15.4%. The number of patients requiring ambulance transport increased from 11.7% to 15.0%. The number of emergency admissions increased from 3.9% to 5.9%.
Conclusion: The after-hours medical surcharge effectively decreased the low-urgency patients presenting to the oral and maxillofacial surgery emergency outpatient service.View full abstractDownload PDF (801K)
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Tomoaki IMAI, Ken WAKABAYASHI, Akinori TAKESHITA, Yoshiyuki OTA2017 Volume 66 Issue 4 Pages 289-297
Published: 2017
Released on J-STAGE: December 16, 2017
JOURNAL RESTRICTED ACCESSIn the surgical approach to condylar fractures, limited access and risk of injury to the facial nerve are the most common complications. We present the transmasseteric anteroparotid （TMAP） approach for condylar fractures, which was applied to one subcondylar fracture and two lower neck fractures in this study.
The incision was made along the tragus fold extending downward to the inferior margin of the ear lobe, followed by an incision parallel to the mandibular ramus. Dissection was performed anteriorly on the parotid fascia and was continued between the anterior edge of the parotid and the posterior edge of the masseter muscle, with careful retraction of the buccal branch of the facial nerve, leading to the condyle and the posterior border of the ramus. After reduction of the fracture line, the fragment was fixed with titanium plates.
No patient had postoperative facial nerve palsy or parotid fistula. Postoperative reduction status, occlusion, mouth opening, and cosmetic self-assessment were satisfactory. Although confirmation of these outcomes requires additional cases and a clinical comparative study, we suggest that the TMAP approach is an appropriate surgical technique for treatment of condylar fractures.View full abstractDownload PDF (1198K) -
Kaya NARIMATSU, Akihiko IIDA, Takanori KOBAYASHI, Eiko YAMADA, Hisashi ...2017 Volume 66 Issue 4 Pages 298-302
Published: 2017
Released on J-STAGE: December 16, 2017
JOURNAL RESTRICTED ACCESSWe report two cases of peripheral osteoma; these lesions arose on the inner surface of the angle of the left mandible in a 57-year-old woman （Case 1） and a 74-year-old woman （Case 2）. Both patients had sporadic, pedunculated and bony tumors.
In Case 1, we surgically removed the tumor by an extraoral approach under general anesthesia. There have been no complications or recurrences for two years since the surgery. In Case 2, the tumor growth was observed for a decade. Despite our recommendation for this patient to undergo surgery, she refused to give consent; therefore, no operation was performed.
The differential diagnosis of peripheral osteoma includes exostosis; however, these two diagnoses are difficult to distinguish histopathologically. In the previous 32 cases of peripheral osteoma from 26 published reports, each lesion was described as sporadic, unilateral, and pedunculated. A peripheral osteoma seems to possess the features of a developmental anomaly because the sites of onset of the lesions correspond to the growing points of the mandible and the peak incidence is in the third decade of life. However, a peripheral osteoma should be treated as a neoplasm due to its tendency for growth and recurrence.View full abstractDownload PDF (631K)
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