研究の目的は下顎歯肉扁平上皮癌の周囲軟組織進展のCT所見と実際の腫瘍進展範囲と比較し, CTによる腫瘍進展の診断能を明らかにすることである。
対象は1992年～1999年の間に九大歯学部附属病院で腫瘍切除術がなされ腫瘍進展範囲が肉眼的または病理組織学的に確定した77例である。各症例の術前のCT像を3名の日本歯科放射線学会認定医が観察し, 周囲軟組織への腫瘍進展の有無について「ある」, 「あるかもしれない」, 「わからない」, 「ないかもしれない」, 「ない」の5段階で評価した。
周囲軟組織への進展部位は, 1) 頤舌筋, 2) 顎舌骨筋, 3) 内舌筋, 4) 内側翼突筋, 5) 咬筋, 6) 唇頬側組織, 7) 広頸筋である。この判定結果を実際の腫瘍進展範囲と比較し, CTによる腫瘍の軟組織進展の正診率を各観察者のROC曲線下の面積Az値の平均値を指標として求めた。結果としてCT像による腫瘍進展の正診率は頤舌筋0.86, 内側翼突筋0.86, 顎舌骨筋0.82, 咬筋0.80, 内舌筋0.76, 唇頬側組織0.71, 広頸筋0.65であった。結論として内舌筋, 唇頬側組織, 広頸筋への進展の判定には視診, 触診を含む臨床所見を参照してCT像を注意深く読影することが必要と考えられた。

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習慣性顎関節脱臼の治療法には, 各種術式が選択されているが, いずれの場合にも侵襲の少ない治療法が望まれる。われわれは, 習慣性顎関節脱臼に対して, 外科的処置の必要な症例では, 顎関節鏡視下手術でのNd-YAGレーザー手術 (1986), 円板縫合・固定術 (1989) を開発して以来, 関節開放を行わない本法を適用してきたのでその概要を報告する。その術式は, 上関節腔を対象に, 関節鏡視ののち, 円板後方から上関節腔後壁の斜走隆起, さらに下顎窩, 結節, 内側壁滑膜部などの上関節腔を鏡視下レーザー手術 (高度先進医療, 厚生省収保5号) により, 新鮮創を形成する。次いで, 鏡視下円板縫合・固定術により関節円板を中心とした後部組織を後壁に牽引, 固定するとともに下顎窩, 結節面を癒着させ, 上関節腔を狭窄あるいは消失させ, 下顎頭運動を制限させる状態とする。本法は, 習慣性顎関節脱臼に対して, 関節を開放せず, また反復施行しうるために従来の開放手術に比べ, 侵襲が少なく, 所期の目的が果たせる方法であり, 最小侵襲外科Minimally Invasive Surgeryとして有用であった。適用は, 1986年から2002年までの17年間に本法を行った23症例35顎関節 (対象は患側顎関節) で, そのうち1症例1顎関節に再発を認め, 再手術を施行した症例を含め, 現在, 全例に再発なく, 良好に経過している。

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A 57-year-old man was referred to our clinic in December 2008 because of painless gingival swelling at the anterior mandibular region. Intraoral examination revealed a defined bony mass with expansion of the labial cortex. Panoramic radiography showed a well-circumscribed, multilocular radiolucent lesion located between the right lateral incisor and the left canine, with displacement of the left incisors of the mandible. Computed tomography indicated expansion and thinning of the labial cortical bone adjacent to the multilocular lesion, with perforation of the cortex. Under general anesthesia, the tumor-like lesion was easily enucleated, and the surface of the bony wound was shaved. The lesion was diagnosed to be a glandular odontogenic cyst （GOC） histopathologically. There has been no sign of recurrence for 1 year postoperatively.

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Osteochondroma is a benign bone tumor covered by a cartilage cap, arising at the external surface of the bone. In the oral and maxillofacial regions, this lesion is known to develop in the mandibular condyle; however, involvement of the temporal bone is rare. We present a case of osteochondroma arising at the articular tubercle of the temporal bone. A 32-year-old man visited our department for evaluation of a mass in the right temporal bone. Radiographic examination revealed a pedunculated exophytic mass continuous with the articular tubercle of the right temporal bone, and the patient was clinically diagnosed with a temporal bone tumor. We performed surgical resection through a preauricular incision under general anesthesia. A histopathological evaluation revealed formation of bone covered by a cartilage cap, which confirmed the diagnosis of osteochondroma. The residual lesion showed no growth two years postoperatively.

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耳下腺および顎下腺部の腫脹や腫瘤を主訴に来院した症例に対して行うべき画像診断の項目およびその診断項目に対して有用な画像検査法の種類について概説を行った。さらに,大唾液腺部の腫脹や腫瘤を主訴として来院した症例に対する画像診断法のdecision treeを示した。

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We have developed an airborne-gravity measurement system using a helicopter as a plat form for the first time in Japan and carried out test measurements around Kawagoe, Saitama Prefecture, Japan. Our airborne-gravity measurement system showed the repeatability of better than 2 meal root-mean-square residuals estimated by comparison between the data on forward and return tracks. We believe our system will contribute much to the gravimetric study over land-sea boundaries as well as in remote areas.

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Soft tissue pathology should be appreciated in diagnosing temporomandibular joint (TMJ) disease. For this purpose, contrast arthrography is useful and we also have introduced double-contrast arthrotomography of the TMJ.
X-ray computed tomography (CT), on the other hand, is well suited to the diagnosis of TMJ disease, because it can clearly delineate both hard and soft tissues. We thus introduce direct sagittal CT of the head with the enhancement of the articular space of the TMJ using negative and positive contrast media and confirmed that this method is very useful for the diagnosis of TMJ disease.
In this paper we principally investigate the suitability of this double-contrast computed tomography of the TMJ.
We conclude that double-contrast CT technique is equally or more useful in some cases than single-contrast CT technique in the diagnosis of TMJ disease.

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Adenomatoid odontogenic tumor (AOT) is a benign epithelial odontogenic tumor that often occurs around a maxilla canine. The tumor generally occurs in the center of the jaw bone, and rarely progress into the maxillary sinus. We report a rare case of AOT that progressed into the maxillary sinus with tooth resorption.

　A 14-year-old female was referred to our hospital with the chief complaint of swelling of the right maxilla. Clinical examination revealed a soft, painless mass from the upper right lateral incisor to first molar region.

　Panoramic X-ray showed a well-defined radiolucent lesion in the right maxillary sinus with root resorption of the upper premolars. Computed tomography revealed progression of the lesion into the maxillary sinus and nasal wall. The patient underwent a tumor resection under general anesthesia. The lesion did not contain the impacted tooth nor any calcified body. The lesion was diagnosed as AOT histopathologically. There has been no sign of recurrence in the 6 years and 4 months after the surgical resection.

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We developed two types of fine sialendoscope, which could be introduced to the submandibular duct through the opening of sublingual caruncula. One is a sialendoscope of 1.1-mm outer-diameter (POLYDIAGNOST GmbH, Germany) with 6000-pixels optic fibers, and it has a working channel to insert a basket forceps and an irrigation channel. The other is a sialendoscope of 1.2-mm outer-diameter (FiberTech Co., Ltd., Japan) with 1600-pixels optic fibers and a working channel. Using these newly developed sialendoscopy systems and a 1.9F basket forceps (Boston Scientific Corporation, USA), we could successfully remove a sialolith of the submandibular gland of a 9-year-old girl.

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関節円板の後方転位と診断した不正咬合の1症例を経験したので, 機能検査所見ならびに画像検査所見を併せて, その概要を報告した。
患者は, 初診時年齢14歳2ケ月の男性である。間欠的な閉口困難感を訴えて当科を受診した。
口腔内診査では, 正中線は上顎に対して, 下顎が左側へ偏位していた。第一大臼歯の咬合関係は, 左側がアングルII級, 右側がアングルIII級傾向であった。
顎関節の症状としては, 閉口末期に右側の顎関節部にひっかかりを感じ, 上下顎を咬み合わせる際に抵抗感を訴えた。また, 開閉口運動時, 右側顎関節部に相反性のクリックが触知された。
機能検査所見ならびに右側顎関節の上下関節腔二重造影CT像による精査の結果, 右側の関節円板後方転位と診断した。
治療経過として, 保存療法により, 後方転位した右側関節円板の整位を試み, 関節円板の整位がなされた顎位で, 上下顎前突ならびに叢生の改善を含めた咬合の再構成を矯正治療により行った。矯正治療に際しては, 臼歯部挙上型スプリントを併用し, 上下顎両側第一小臼歯の抜歯を行い, 歯の移動を開始した。最終的に, 関節腔の拡大を図るため, 臼歯を挺出させる力系を用い, 咬合高径を挙上して治療を終了し, 良好な結果が得られた。

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顎下腺移行部や腺体内唾石には一般的に外切開による顎下腺摘出術が行われる. 顎下腺摘出術の合併症としては頸部の瘢痕の残存, 顔面神経麻痺などが問題となる. そこで低侵襲な顎下腺唾石の治療法として顎下腺管内視鏡を用いた手術を行ったので報告する. いずれも全麻下で, 1例目は移行部唾石, 2例目は腺体内の唾石であった. 1例目は把持鉗子およびバスケット鉗子を用いて破砕しながら除去, 2例目はホルミウム-YAGレーザーを用いて破砕した後に可及的に摘出し腺管を開通しえた. いずれも合併症無く順調に経過している. 顎下腺管内視鏡は低侵襲であり合併症も少なく顎下腺の狭窄をきたす他の疾患に応用できうる有用なツールであると考えた.

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Myoepithelial carcinoma commonly arises in the parotid and palatal glands and consists of spindleshaped, plasmacytoid, epithelioid, and glycogen-rich clear cells. Myoepithelial carcinoma is fairly rare and only accounts for approximately 0.4% of all salivary gland tumors. This report describes a case of myoepithelial carcinoma arising from myoepithelioma in the palate. However, the diagnosis made from a biopsy specimen was myoepithelioma, because the tissue taken from the tumor surface was composed of myoepithelial cells without atypia. The patient was an 83-year-old woman with a chief complaint of a painless swelling in the right side of the palate since November 2009. She was referred to our hospital for comprehensive examination and treatment by her physician in February 2010. Initial examination revealed an elevated mass approximately 17×15 mm in diameter with ulceration of the palatal mucosa. No enlargement of the corresponding lymph nodes was present. The mass was palpable without tenderness. Enhanced computed tomography showed a radiopaque lesion 15 mm in diameter, with no evidence of bone invasion. However, the lesion extended to the medial plate of the pterygoid process. A biopsy specimen showed the characteristics of myoepithelioma, without atypical tumor cells. The tumor cells were densely branched, but nuclear atypia and mitotic figures were not apparent. The lesion was resected, and the surgical defect was covered by a buccal fat pad with the patient under general anesthesia in March 2010. Histopathological examination revealed areas of myoepithelial carcinoma showing cellular atypia and high proliferative activity intermingled with myoepithelioma. A final diagnosis of myoepithelial carcinoma arising from myoepithelioma was established. The patient's postoperative course was uneventful with no functional disturbance, recurrence, or metastasis during 3 years of follow-up.

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In order to approach a small lesion within the temporomandibular joint, the conventional therapeutic treatment is open surgery which has the possible disadvantage of surgical invasion including skin damage and exfoliation. Since 1985 we have applied a method of arthroscopic laser surgery to lesions within the temporomandibular joint because the method has the least surgical invasion. The outline of arthroscopic surgery by Nd-YAG laser is described in this report.
We investigated cases of recurrent dislocation, anterior disc displacement and fibrous adhesion of the temporomandibular joint where conservative therapy was ineffective and double contrasted CT scanning and arthrotomography showed the suspicion of organic changes within the temporomandibular joint cavity.
We examined the upper joint cavity by temporomandibular joint arthroscopy. In cases where results indicated the necessity of surgical operation, we practiced arthroscopic surgery after visualizing the lesion by arthroscopy. The new technique using the double-channel cannula by the needle scope which we recently invented visualized the lesion and we infused NdYAG laser fiber into the cavity for treatment of the area around the intra-articular wall
The separation, removal and vaporization of the adhesive area and cicatrix tissue were effective treatment against fibro-adhesion and fibrous ankylosis. We formed fresh injury by cauterization of the retrodiscal synovial membrane against hypermobility, recurrent dislocation and disc displacement, where we also practiced arthroscopic suturing when necessary. Observation after the operation revealed that we had obtained successful results, thus arthroscopic laser surgery was proven to be beneficial
We reported on arthroscopic laser surgery for temporomandibular joint disorders and the outline of the clinical results of these cases after operations.

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下顎歯肉癌の手術法として下顎骨辺縁切除か下顎骨区域切除かを選択する場合, 下顎骨の上下方向の浸潤範囲が判断の重要な要因の一つとなる。そこで今回, 各種画像診断法による下顎歯肉癌の下顎骨浸潤の有無および範囲の診断における各種画像検査法の特徴と診断性能について考察した。口内法デンタルX線写真は微妙な骨変化を鋭敏に検出し, 感度が高いが偽陽性の割合が高く特異度が低い。パノラマ断層写真は画質的に鮮鋭度が劣るが, 下顎管に達する骨破壊の正診率はパノラマ断層写真単独では82.9%, 口内法デンタルX線写真との組み合わせでは88.6%であり, 下顎骨の上下方向の浸潤範囲を診断するのに有効な検査法である。X線CTの正診率は85.0%であったが, 三次元的な腫瘍の広がりを診断する上で欠かせない検査法である。以上より, 下顎骨の上下方向の浸潤範囲を判定するには口内法デンタルX線写真とパノラマ断層写真を必須として用い, X線CTで補うのが妥当と考えられた。

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