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70 巻 (2021)
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70 巻, 1 号
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特別企画記事
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大見 真衣子, 三品 裕司2021 年 70 巻 1 号 p. 1-11
発行日: 2021年
公開日: 2021/03/31
ジャーナル 認証ありThe skeletal system consists of over 200 bones to create a framework to support the body, and each bone displays a distinct shape and size depending on its anatomical location. The jawbone is a unique structure as it serves multiple functions in mastication and differs from other skeletal bones in several aspects. The jawbone originated from cranial neural crest cells and formed through primarily intramembranous ossification, whereas the axial and appendicular skeletons are derived from mesoderm and undergo endochondral ossification. The jawbone is constantly remodeled in response to the mechanical load during mastication. Additionally, some skeletal diseases are only present in the jawbone. Therefore, therapeutic methods used to treat most skeletal diseases may not apply to jawbone diseases.
Bone morphogenetic protein （BMP） signaling plays a critical role in the growth, differentiation and functions of osteoblasts in various in vitro and in vivo experiments. Recent studies have revealed that, however, BMP signaling exerts multiple functions in maintaining bone mass thorough regulation of cellular interaction between bone cells. Therefore, this review focuses on the unique features of the jawbone compared to the long bone and discusses the interaction between BMP signaling and mechano-sensing signaling in bone remodeling.抄録全体を表示PDF形式でダウンロード (985K)
原著
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名生 邦彦2021 年 70 巻 1 号 p. 12-17
発行日: 2021年
公開日: 2021/03/31
ジャーナル 認証ありWe have frequently used NSAIDs including loxoprofen sodium hydrate （loxoprofen） for postoperative pain management in the head and neck region, but loxoprofen inhibits platelet aggregation by inhibiting COX and may cause postoperative bleeding. On the other hand, acetaminophen has little COX inhibitory effect and has a low risk of postoperative bleeding. I examined the relationship between each analgesic and postoperative bleeding in patients in whom a polyglycolic acid sheet was applied to the raw surface after partial glossectomy.
From April 2011 to September 2019, we investigated 47 patients who underwent partial glossectomy followed by covering with a polyglycolic acid sheet and fibrin glue. The patients were divided into two groups, those using acetaminophen or those using loxoprofen, for postoperative pain management, and the analgesic effects were compared between the groups. Next, the relationship between postoperative bleeding and clinical factors including analgesic type was statistically examined.
Of the 47 patients, 11 （23.4％） had postoperative bleeding. There was no statistically significant difference in the frequency of use of analgesics between the groups, and it was considered that the analgesic effects of both groups were equivalent. Postoperative bleeding was significantly higher in the loxoprofen group （33.3％） than in the acetaminophen group （5.9％） （p＝0.033）, indicating the high risk of postoperative bleeding in the loxoprofen group.
Based on the results of this study and other reports, it may be necessary to consider refraining from using NSAIDs containing loxoprofen in patients undergoing this treatment, because NSAIDs are analgesics with a high risk of postoperative bleeding associated with COX inhibitory effects.抄録全体を表示PDF形式でダウンロード (458K)
症例報告
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柴田 章夫, 河原 康, 大平 芽実, 折山 資, 初川 久美子, 丹下 雄貴2021 年 70 巻 1 号 p. 18-25
発行日: 2021年
公開日: 2021/03/31
ジャーナル 認証ありDescending necrotizing mediastinitis is caused by the downward spread of neck infections and is a highly lethal complication of oropharyngeal lesions. This infection previously had a much worse prognosis. We report a case of descending necrotizing mediastinitis caused by odontogenic infection that was successfully treated in an immunocompromised elderly patient. An 87-year-old man had experienced pain in the right mandibular region for 6 days before visiting a dentist. Because the symptoms worsened, with fatigue and swallowing pain, he was referred to our hospital 2 days later. He had a history of autoimmune cerebellar ataxia, and he was being treated with steroids. A clinical examination revealed diffuse swelling and redness from the submandibular area to the superior aspect of the neck, as well as sublingual edema. Contrast-enhanced computed tomography revealed a diffuse, deep cervical abscess spreading to the right sublingual, submandibular, parapharyngeal, and carotid spaces. Thus, necrotizing fasciitis was diagnosed; appropriate antibiotics were administered, and the patient underwent surgical drainage of the abscess under general anesthesia. However, another abscess had formed in the superior mediastinum and extended into the right carotid space. Additional surgical drainage of the second abscess and transcervical drainage for the descending necrotizing mediastinitis were performed. The treatment was successful, and the patient was discharged.抄録全体を表示PDF形式でダウンロード (866K) -
奥井 太郎, 小林 義和, 浦野 誠, 磯村 まどか, 近石 壮登, 佐藤 公治2021 年 70 巻 1 号 p. 26-32
発行日: 2021年
公開日: 2021/03/31
ジャーナル 認証ありWe report a case of mucoepidermoid carcinoma （MEC） occurring in the retromolar salivary gland that was resected based on a diagnosis per the Milan System for Reporting Salivary Gland Cytopathology （MSRSGC）. A 33-year-old man was referred to our hospital with complaints of swelling in the retromolar region. A tumor with a diameter of 13mm was observed in the retromolar region. We performed fine needle aspiration cytology to establish a preoperative diagnosis. The diagnostic report indicated a category IV-B: salivary gland neoplasm of uncertain malignant potential, based on MSRSGC. We resected the tumor assuming benign or low-grade malignancy based on the recommendation for surgical procedures in this system. The specimen was histopathologically diagnosed as a low-grade MEC. There was no recurrence or metastasis three years postoperatively.抄録全体を表示PDF形式でダウンロード (944K) -
青木 義彦, 町田 純一郎, 兵藤 俊介, 佐野 泰斗, 長尾 徹2021 年 70 巻 1 号 p. 33-38
発行日: 2021年
公開日: 2021/03/31
ジャーナル 認証ありWe report a case in which surgical curettage and topical steroid therapy were effective for Langerhans cell histiocytosis （LCH） in the mandible. A 14-year-old boy was referred to our hospital because of swelling and pain in the left side of the mandible. Computed tomography （CT） revealed a fracture in the buccal cortical bone with an unclear boundary at the mandible in the left lower molar, with a lesion that had progressed to the left masseter muscle. A biopsy was performed, and a diagnosis of LCH was obtained. Whole-body examination, including positron emission tomography-CT, was performed, and single-system single-site type （SS type） LCH was diagnosed. Treatment consisted of surgical curettage and topical steroid administration. Steroids were administered locally at each site, taking into consideration the possibility of lesions remaining around the inferior alveolar nerve and the masseter muscle extension area. Three months after the operation, CT findings demonstrated remarkable bone regeneration, and no recurrence was found at 1-year follow-up. Surgical curettage combined with topical steroid administration in SS type LCH seems to be an effective treatment for patients in whom complete curettage is difficult or who have a relatively wide range of lesions.抄録全体を表示PDF形式でダウンロード (1012K) -
髙橋 佑佳, 柳生 貴裕, 山川 延宏, 上田 順宏, 桐田 忠昭2021 年 70 巻 1 号 p. 39-42
発行日: 2021年
公開日: 2021/03/31
ジャーナル 認証ありCongenital factor V deficiency （FVd） is a rare autosomal recessive bleeding disorder with a prevalence of 106. Patients with FVd present with easy bruising, epistaxis, gingival bleeding, and menorrhagia. As no FV-specific concentrate is available, fresh frozen plasma （FFP） remains the main treatment. However, there are few reports on hemostasis management during tooth extraction. We report a case of tooth extraction with local hemostasis in a patient with FVd. The patient was a 40-year-old man. At the age of 6, he was diagnosed with FVd in our pediatric department during the examination of nasal hemorrhage. There was no abnormal bleeding thereafter. He had recently visited a dental clinic because of pain in the bilateral upper molar and was referred to our department for extraction of bilateral maxillary wisdom teeth. As he refused transfusion, we consulted with a pediatrician at our hospital and performed bilateral maxillary tooth extraction under local anesthesia without transfusing FFP. The socket of each tooth was filled with gelatin sponge and the gingival tissue was sutured for hemostasis. The wound was then covered with a plastic splint. No post-extraction bleeding was observed and the patient recovered uneventfully.抄録全体を表示PDF形式でダウンロード (550K) -
隅田 賢正, 児玉 泰光, 鶴巻 浩2021 年 70 巻 1 号 p. 43-48
発行日: 2021年
公開日: 2021/03/31
ジャーナル 認証ありCoronoid process elongation is a gradually progressive condition that presents with trismus. Although surgery is the first-choice treatment, perioperative treatment compliance is important for successful therapy, because postoperative mouth-opening exercise is mandatory in these patients. We report a case of bilateral coronoid process elongation in a 29-year-old woman with mental retardation and social withdrawal, which led to delayed diagnosis and treatment. The patient presented to the dentist for the first time in over a decade with pericoronitis of the left lower third molar. Examination showed bilaterally impacted mandibular third molars with impaired mouth opening. Based on three-dimensional computed tomography, she was diagnosed with bilateral coronoid process elongation and bilaterally impacted mandibular third molars. We performed bilateral coronoid process resection and bilateral mandibular third molar extraction under general anesthesia. Intraoperatively, we observed gliding motion of the bilateral temporomandibular joints, and her mouth opening capacity was 47mm. We introduced mouth-opening exercises 3 days postoperatively, which she temporarily vehemently refused to perform. However, we explained the importance of a consistent training regimen, and she continued it. Currently, the self-extraction volume of 40mm is maintained without any symptom of recurrence of coronoid process elongation.抄録全体を表示PDF形式でダウンロード (698K) -
菅原 圭亮, 西山 明宏, 小谷地 雅秀, 小山 侑, 髙野 正行, 片倉 朗2021 年 70 巻 1 号 p. 49-55
発行日: 2021年
公開日: 2021/03/31
ジャーナル 認証ありSchwannomas are benign neoplasms derived from Schwann cells of the neurilemma and arise in the oral and maxillofacial region infrequently. Solitary intraosseous schwannoma of the mandible is rare. Here we report a case of intraosseous schwannoma of the mandible treated by nerve conduit Nerbridge® intraorally. We evaluated sensory nerves using the Semmes-Weinstein monofilaments test （SW-T） and Sensory Nerve Action Potential （SNAP）. The patient was a 32-year-old female with mandibular tumor. Orthopantomographic and computed tomographic examination showed a radiolucent, well circumscribed lesion of the right body of the mandible. We performed tumor resection intraorally under general anesthesia, and reconstructed the inferior alveolar nerve with a nerve conduit. Histological examination showed that the tumor cells were arranged in a palisading pattern of Antoni type A cells and type B cells. Some tumor cells showed positive reaction for S-100 protein. Neurosensory disturbance of the mental nerve improved 6 months after surgery using SW-T and SNAP, and approximately normally status was recovered after 12 months. Following neurorrhaphy using Nerbridge®, the postsurgical evaluation revealed marked improvement and significant recovery in sensations of the lower lip.抄録全体を表示PDF形式でダウンロード (1081K) -
齋藤 夕子, 上野山 敦士, 池田 順行, 田沼 順一, 林 孝文, 髙木 律男2021 年 70 巻 1 号 p. 56-60
発行日: 2021年
公開日: 2021/03/31
ジャーナル 認証ありLymphoepithelial cyst is a disease characterized by the formation of lymphoid follicles as histopathological features. It is also commonly called lateral cervical cyst or gill cyst, and it often occurs in the lateral neck but rarely in the oral cavity. We report two cases of lymphoepithelial cysts on the lower surface of the tongue and the posterior surface of the tongue. Case 1 was a 67-year-old man who complained of discomfort on both sides of the ventral of the tongue during follow-up after biopsy of a white lesion in the gingiva of the mandibular wisdom tooth. Two red bean-sized masses were found symmetrically across the frenulum of the tongue on the ventral of the tongue and were removed under local anesthesia. Case 2 was a 50-year-old man who visited our department with a chief complaint of swelling behind the dorsum of the tongue. A mobile elastic soft spheroidal mass with a diameter of about 0.4cm was found behind the dorsum of the tongue and was removed under local anesthesia. Cases 1 and 2 were histopathologically cysts lined with non-keratinized or parakeratinized stratified squamous epithelium, and lymphatic tissue with lymphoid follicle formation was found under the epithelium. Histopathological diagnosis was lymphoid epithelial cyst.抄録全体を表示PDF形式でダウンロード (754K) -
藤林 えみ, 横田 祐介, 原 崇之, 松川 誠, 山下 翔平, 古郷 幹彦2021 年 70 巻 1 号 p. 61-65
発行日: 2021年
公開日: 2021/03/31
ジャーナル 認証ありTrisomy-13 is a chromosome aberration syndrome of the autosome aneuploidy and presents multiple visceral malformations and severe developmental delay. A central respiratory disorder is fatal for the patients, so aggressive medical treatments of cardiovascular and gastrointestinal diseases which would not affect their life prognosis used to be avoided from the viewpoint of medical ethics. In recent years, however, it has been reported that some aggressive medical treatments would increase their survival rate, and the validity and significance of these treatments have been actively discussed. Hence, active treatments for cleft lip and palate on trisomy-13 will be needed in the future. We present two representative cases of trisomy-13 with cleft lip and palate and discuss the significance of cheiloplasty, with consideration of the ethical and functional aspects.抄録全体を表示PDF形式でダウンロード (683K)
地方部会
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2021 年 70 巻 1 号 p. 66-72
発行日: 2021年
公開日: 2021/03/31
ジャーナル 認証ありPDF形式でダウンロード (533K) -
2021 年 70 巻 1 号 p. 73-74
発行日: 2021年
公開日: 2021/03/31
ジャーナル 認証ありPDF形式でダウンロード (295K) -
2021 年 70 巻 1 号 p. 75-83
発行日: 2021年
公開日: 2021/03/31
ジャーナル 認証ありPDF形式でダウンロード (594K)
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