森 良之

口腔腫瘍切除後に生じた口腔内組織の拘縮に対し，骨延長術を用いて，上下顎の歯列弓の適合を得るための再建顎の二次的延長や下顎骨再建のためのスペース確保を目的とした軟部組織の拡大などが行われている。これにより，再建下顎へのデンタルインプラントを利用した義歯装着が可能となり，機能的回復が得られるようになった。

多施設共同研究を行うことを前提に口唇口蓋裂患者に対する歯科矯正治療に関するアンケート調査用紙を作成し，東京大学医学部附属病院において動的歯科矯正治療を終了した片側性口唇口蓋裂患者 36名を対象に調査した結果，以下の結果を得た。回答者数は25名で，回収率69.4%であった。<br>1）歯科矯正治療を考えたきっかけは，外科・言語の先生の勧めが多かった。<br>2）治療を考えた理由は，歯ならびが多かったが，しゃべりにくいことを挙げた人も多かった。最も治療に期待したことでは，見た目の歯ならび，顔つきといった美的効果を挙げた人が多かった。<br>3）治療中には，多くの人が痛み，食べにくさ，しゃべりにくさ，歯みがきの大変さを感じていた。<br>4）治療後には，回答した全員が前歯の歯ならびが良くなったと答え，約2/3が顔つきが良くなったと答えた。また8割以上が良く咬めるようになったとし，約8割がしゃべりやすくなったと答えた。<br>5）回答者全員が治療を受けて良かったと答えた。<br>6）7割以上が通院の負担が大きいと答えた。<br>7）顎裂部骨移植，顎矯正手術，矯正装置など，治療内容に関する回答は正確さを欠くことが考えられた。<br>以上のことより，回答したすべての患者は治療結果に満足しているようであった。また，歯科矯正治療は言語機能にも好影響を与えると思われた。しかし，口腔衛生管理，治療の効率化については改善の余地があると考えられた。

We describe the very rare case of a 72-year-old woman who had a mass in the floor of the mouth. After admission to our inpatient department, MR imaging suggested that the mass was a tumor of the right sublingual gland. Surgical excision of the sublingual gland tumor was performed with the patient under general anesthesia.The histological diagnosis was follicular lymphoma grade Ⅰ. Follicular lymphoma of the sublingual gland is extremely rare. This is the first report describing a primary follicular lymphoma of sublingual gland in Japan. One year after the operation, the patient remains well, with no evidence of recurrent lymphoma.

Alveolar ridge augmentation by bone grafting has been carried out for a localized alveolar ridge defect to complete oral rehabilitation with endosseous implants. This procedure has several disadvantages, such as morbidity of the donor site or lack of soft tissue. On the other hand, distraction osteogenesis makes it possible to augment an alveolar ridge without bone grafting and allows simultaneous soft tissue expansion. Therefore this technique seems to be useful for alveolar ridge augmentation in patients undergoing dental implant treatment. However, in this procedure, several problems still remain such as infection or resorption of transport segment. Consequently we should make a deliberate choice for alveolar ridge augmentation.

Ameloblastoma is a typical benign odontogenic tumor that occurs in the jaw. Common treatment methods for cystic ameloblastoma include fenestration, in which the cystic cavity is exposed to the oral cavity by resecting a part of the cyst wall along with the mucosa and bone, and the dredging method, in which the tumor is totally resected and the surface of the bone wound is covered with a piece of gauze or other material. In the latter method, bone regeneration is promoted by repeatedly extirpating scar tissue, which inhibits osteogenesis, at appropriate intervals. Although segmental resection and other types of jaw resection are performed in patients with recurrence, resection of the inferior alveolar nerve with reconstruction using a bone graft is required. We describe the surglcal excision of an ameloblastoma that recurred in the posterior part of the mandibular ramusafter treatment by the dredging method. We used an extraoral approach in which the lateral cortical bone of the mandibular ramus was removed without performing segmental resection. The morphology and function of the jaw were preserved by this method. We report on a patient who was treated by this operative procedure.

A 20-year-old man was referred to our department because of severe pain while eating. Physical examination revealed an erosion and ulcer in the oral cavity. He had been treated for aplastic anemia on an outpatient basis at the Department of Cell Therapy and Transplantation Medicine of our hospital. He had received bone marrow transplants twice. Subsequently, graft-versus-host disease (GVHD) developed, and treatment with cyclosporine was started. Biopsy ruled out the possibility that the lesion in the oral cavity was caused by GVHD. Gingival hyperplasia was noted 8 months later, and granulomatous epulis was diagnosed. The patient&#039;s general condition subsequently deteriorated, and mucosal proliferation spread throughout the oral cavity. Biopsy yielded a diagnosis of post-transplantation lymphoproliferative disorder (PTLD). We describe our experience with this rare case of PTLD.

We report a case of van der Woude syndrome associated with Hirschsprung disease. The patient was delivered vaginally. Our department was consulted because of cleft lip and palate (CLCP). After cheiloplasty, the department of pediatric surgery was consulted because of continuous vomiting. Hirschsprung disease was diagnosed.&lt;BR&gt;Hirschsprung disease occurs in 1/5, 000 live births and is caused by defective development of embryonic neural crest cells at the vagal level, leading to intestinal obstruction. The patients show severe vomiting and constipation, but owing to improved surgical techniques, the number of curable patients is increasing. Our patient received radical treatment and has no difficulty in eating or excretion at present.&lt;BR&gt;Several reports have described patients with CLCP and Hirschsprung disease, and all have had mental retardation. Moreover, there are several syndromes associated with both CLCP and Hirschsprung disease, such as Goldberg-Shprintzen syndrome, Waardenburg syndrome, and Smith-Lemli-Opitz syndrome. Each syndrome has their own differential diagnosis, but our patient did not meet the diagnostic criteria. We gave our patient a diagnosis of van der Woude syndrome combined with Hirschsprung disease for the present.&lt;BR&gt;However, mental retardation cannot be ruled our in this patient, and he might have other congenital malformations that have not been identified. If so, he may have a subtype of a syndromic disease.

The surgical treatment of a patient with hereditary angioneurotic edema (BANE) is described in the present report. HANE is an autosomal dominant hereditary disease that causes acute and local submucocutaneous edema. It is a very rare disease in Japan and has been reported in only 20 femilies.&lt;BR&gt;The subject was a 24-year-old woman with right upper pericoronitis who had been given a diagnosis of HANE at the age of 13 years. Patients with HANE often have fatal laryngeal edema during dental treatment such as extraction of teeth. Therefore, our patient received ginigivectomy after being hospitalized. Postoperatively, she had mild respiratory distress, but it was controlled by intravenous drip infusion of C 1 esterase inhibitor. When treating patients with HANE, we should take sufficient measures to avoid the development of edema, even when treatment is minimally invasive. Furthermore, sufficient preparation for urgent tracheotomy is necessary owing to the risk of laryngeal edema.

We report a rare case of anaphylactic shock during tooth extraction. The patient had atopic dermatitis for about 20 years. Although the serine IgE level was high, the results of drug lymphocyte stimulation tests (DLST) against all ingredients in the local anesthetics were negative.&lt;BR&gt;However, when we performed skin-tests against sodium metabisulfite and para-oxy benzoic acid methyl, small amounts of which were contained in the local anesthetics, sodium metabisulfite induced an allergic reaction.&lt;BR&gt;We conclude that this was a rare case of anaphylaxis caused by sodium metabisulfite in a patient with atopic dermatitis.&lt;BR&gt;We should be especially cautious when we use local anesthetics in patients with atopic dermatitis.

We report a case of recurrent thyroglossal duct fistula. The patient was a 14-year-old boy. At the age of 2 years, he had a simple excision of a thyroglossal duct cyst at other hospital. He had the unusual complaint of small amounts of clear mucoid-like material being discharged from a cervical skin sinus after meals. Examination of the cervical region revealed a 50×2mm transverse scar in the upper part of the neck, including a small fistula in the midline. A fine probe was inserted approximately 1 mm into the fistula. Fistulography demonstrated a complete thyroglossal duct through the hyoid bone to the base of the tongue. Thyroglossal duct excision with partial resection of the hyoid bone was performed under local anesthesia. There has been no recurrence as of 7 months after operation. Histological examination revealed ectopic salivary glands and branching tracts in the genioglossus muscle.

We report a rare case of myofibroma arising in the mandibular gingiva in an adult. Myofibroma is a solitary fibroblastic proliferative neoplasm occurring primarily in infants and children. The patient was a healthy 28-year-old woman with a painless mass in the right lower premolar region. Radiographic examination showed radiolucency with an ill-defined border. The tumor was resected with a margin of adjacent tissue and teeth. There was no sign of recurrence at 18 months&#039; follow-up. Microscopic examination revealed irregular proliferation of spindle-shaped cells. A pericytoma-like pattern was found in the center of the tumor. Immunohistochemically, tumor cells were positive for vimentin and HHF-35. On the basis of these findings, the tumor was diagnosed as a myofibroma.

We report a very rare case of undifferentiated sarcoma of the tongue in a pregnant woman. Cancer will develop in 1 per 1000 to 1500 pregnant women. Although malignancies including uterine cervical cancer, breast cancer, gastric cancer, and leukemia have been reported during pregnancy, head and neck cancer is rare. The patient was a 34-year-old pregnant woman referred to our clinic because of a painless mass in the right side of the tongue. Examination of the oral cavity revealed a 25×20mm, nontender, elastic soft mass in the right side of the tongue. A T 2-weighted magnetic resonance image showed areas of high signal intensity. Resection of the tumor and skin grafting were performed under general anesthesia at 27 weeks&#039; gestation. There has been no local recurrence or metastasis as of 29 months after operation. Histopathologically, the tumor was composed of small histiocyte-like cells and large round cells with myxomatous components, but without any differentiating features. Immunohistochemically, the large tumor cells stained positively only for vimentin. On the basis of these findings, the tumor was diagnosed as an undifferentiated sarcoma.

In cleft lip and palate patients, functional and esthetic correction of severe dentofacial deformity may require not only Le Fort I maxillary osteotomy but also rhinoplasty.&lt;BR&gt;We investigated the order of these two kinds of surgeries in 6 cases with cleft lip and palate. In three cases, Le Fort I maxillary advancement was preceded by open rhinoplasty with a cantilever iliac bone graft (Group A). In the other 3 cases, open rhinoplasty was preceded by Le Fort I maxillary advancement (Group B). The changes of nasal tip protrusion, the nasolabial angle, and the nostril form were evaluated in nasal morphology. Measurements were performed using facial photographs and lateral cephalograms.&lt;BR&gt;In group A, nasal tip protrusion was decreased after the two surgeries. On the other hand, it was clearly increased after the two surgeries in group B. The nasolabial angle showed various change patterns in both groups. The final nostril form was better in group B than in group A. These results suggested that open rhinoplasty with a cantilever iliac bone graft before Le Fort I maxil lary advancement may lead to a better surgical outcome in nasal shape.

口唇口蓋裂などの先天異常や顎変形症等の発育異常,顎骨骨折および口腔腫瘍術後の症例などに対し咀嚼,嚥下,発音などの口腔顎顔面領域の機能と形態の回復を目的とした種々の技工製作物の果たす役割は大きい。これらの技工製作物のうちで現在当科で製作しているものを紹介し,その位置づけ,適応,製作法について概説する。

We describe a case of lacrimal sac fistulae with left cleft lip and palate. A congenital lacrimal sac fistula is a rare disorder in which a fistulous tract connects the skin to the common canaliculus or to the lacrimal sac, located just inferior to the medial canthal angle.&lt;BR&gt;A 12-year-old boy had 1) bilateral congenital lacrimal sac fistulae, 2) cleft lip and palate and 3) hypospadis. He had no paticular family history. With the patient under general anesthesia, a fusiform incision was performed, and the lacrimal sac fistulae were excised. Alveolar bone grafting was performed concurrently. Histologically, the lacrimal sac fistulae consisted of unkeratinized squamous epithelium and connective tissue with inflammatory lymphocytes. Patients with lacrimal sac fistulae, cleft lip and palate, and hypospadia have not been reported previously.&lt;BR&gt;These findings suggest that lacrimal sac fistulae may be related to congenital malfusions such as cleft lip and palate.

The authors describe a typical case of Treacher-Collins syndrome with bilateral cleft lip and palate and polypoid lesions in the retromolar region.A 2-month-old boy had an antimongoloid slant of the eyes with colobomas, depressed cheeks, small jaws, auricular anomalies, conductive deafnesscleft lip and palate, and a hairy tongue.The family history was negative.A tracheostomy was performed 1 month after birth to manage airway obstruction due to TMJ-mandibular deficiency.A Hotz-type plate was used to improve nursing 2 months after birth.Cleft lip was repaired 6 months after birth.Bilateral polypoid lesions (20×10×7mm), in the retromolar region were removed at the same time.They consisted of unkeratinized squamous epithelium, submucosa, salivary glands, and striated muscles, similar to soft palate tissues.Treacher-Collins syndrome is generally characterized by bilaterally symmetrical abnormalities of structures within the first and second branchial arches. Polypoid lesions in the retromolar region have not been reported so far. Cleft lip is found only in 2% to 6% of patients with this syndrome.The findings in this case may have resulted from severe deformities in the first and second branchial arches.