野口 忠秀

32歳女。右顎下部の腫瘤を主訴とした。3～4年前より疼痛を伴う腫瘤が出現し、超音波検査で下顎腫瘍が疑われた。受診時には右側顎下部に26×26mm大で弾性軟の腫瘤性病変を認めたが、神経学的所見や口腔内所見、臨床検査所見、オルソパノラマX線像に異常は認めなかった。しかし、腫瘤はMRI T1強調像で脂肪と同等の信号強度を示し、増強効果を認めないことから、右側顎下部脂肪腫と診断して全身麻酔下に腫瘍摘出術を行い、病理組織学的診断は脂肪腫であった。術後2年4ヵ月経過時点で再発はなく経過良好である。脂肪腫の顎下部発生は稀であり、若干の文献的考察を加えて報告した。

口腔内装置にて治療した中等度から高度の睡眠時無呼吸症候群(SAS)14例(平均52.3歳)を対象とし、その有効性を検討した。簡易睡眠検査による口腔内装置装着前のAHI(無呼吸・低呼吸指数)は平均54.3、睡眠時の経皮的動脈酸素飽和度(SPO2)は平均73.8%であり、全例が日中の眠気を訴えたが、口腔内装置装着後は全例でAHIが改善し、12例でSPO2の改善を認めたほか、自覚症状の改善は7例で認められた。また、N-CPAP療法から口腔内装置への変更は5例で可能であり、中等度症例の改善率は50%、重度症例では30%であった。今回、中等度あるいは高度のSASでも口腔内装置が有効な症例が存在し、特に中等度症例に有効症例を多く認めた。中等度の症例で口腔内装置を希望した症例は適応ありと考えられた。

A 76-year-old man undergoing haemodialysis for chronic renal failure presented with swelling in the right lower gingiva. Biopsy of the oral mass revealed clear cell carcinoma, and whole body computed tomography and magnetic resonance imaging revealed a mass in the left kidney. The patient was treated with local radiotherapy and immunotherapy and remains alive with cancer at the time of writing. © 2009 Asian Association of Oral and Maxillofacial Surgeons.

Objective: The objectives of this study were to evaluate the efficacy and limitations of fluoro-2-deoxy-D-glucose-positron emission tomography for metastatic neck disease secondary to oral squamous cell carcinoma. This study specifically examined the limitations of the procedure. Materials and Methods: From April 2004 to October 2007, 35 patients with oral squamous cell carcinoma underwent computed tomography, ultrasound, and fluoro-2-deoxy-D-glucose-positron emission tomography before treatment with neck dissection. After neck dissection, the results of computed tomography/ultrasound and positron emission tomography imaging were correlated with the histopathological findings of the cervical lymph nodes. Results: Positron emission tomography of the cervical lymph nodes was positive for 20 patients, 16 of who were demonstrated to have metastases on histopathological examination. Of the 4 falsepositive results, 3 were reactive lymphadenitis and 1 was sarcoidosis. Positron emission tomography was negative for 15 patients. Two of these patients had false-negative results, as metastatic disease was found at neck dissection. In 1 patient, the metastatic lymph node was largely keratinised, while micrometastasis was evident in the other patient. Pathological findings were compared with imaging results to determine the relative efficacies of positron emission tomography (accuracy, 82.9% sensitivity, 88.8% specificity, 76.5%), computed tomography (accuracy, 85.7% sensitivity, 88.8% specificity, 82.4%), and ultrasound (accuracy, 88.6% sensitivity, 88.8% specificity, 88.2%). There were no significant differences on statistical analysis. Conclusion: Positron emission tomography appears to have significant potential for the detection of lymph node metastasis. However, fluoro-2-deoxy-D-glucose-positron emission tomography should not be used as the sole method of imaging for initial investigation of oral squamous cell carcinoma and cervical lymph node metastasis. The surgical management of neck lymph node metastasis should not be based on fluoro-2-deoxy-D-glucose-positron emission tomography findings alone. Use of other imaging modalities in addition to fluoro-2-deoxy-D-glucose-positron emission tomography should increase the diagnostic accuracy over fluoro-2-deoxy-D-glucose-positron emission tomography alone. © 2009 Asian Association of Oral and Maxillofacial Surgeons.

Six patients with advanced oral squamous cell carcinoma were treated with preoperative concurrent chemoradiotherapy. Chemotherapy consisting of CDDP (60 to 70 mg/m2, day 1) and 5-FU (600 to 700 mg/m2, day 1 to 5) with concurrent radiotherapy was accelerated hyperfractionation to target volume of 43-63 Gy. The clinical effect of this therapy on the primary tumor and cervical lymph node was examined in patients who visited our university hospital from 1994 to 2004. The five untreated and one recurrence patients were 3 males and 3 females. Their ages ranged from 23 to 76 years. The primary sites were the tongue in 3, lower gingiva in 2, and upper gingiva in 1 patient (s). Five cases were in advanced Stage IV A and 1 case in Stage III. The preoperative clinical responses of primary tumor: 1 case showed a complete response (CR). The response rate was 100%. We did not operate the case because of CR. Histological effect of the primary tumor (according to the grading system of Ohboshi and Shimosato) : 2 patients were CR. Pathological CR rate of primary site was 33%. However, the CR rate of the metastatic lymph nodes was 0%. In terms of adverse effects, all cases developed nausea, mucositis and leucopenia. The most severe were leucopenia (Grade III), sepsis and DIC. This combination chemoradiotherapy has been proven to be very histologically effective for the primary tumor.

下顎骨骨髄炎に対し外科療法に加えて高気圧酸素療法(HBO)を行った5例の治療成績を報告した。治療前の臨床症状は全例に下顎の疼痛・腫脹、2例に下顎骨露出、1例にオトガイ部麻痺を認めた。HBOの加圧回数は11～61回(平均23回)であった。臨床効果は、下顎の疼痛・腫脹は4例で消失し、1例は再燃したが追加HBOを行うことで消失した。下顎骨露出とオトガイ部麻痺はいずれも改善した。有害事象として、3kg以上の体重減少を全例に認め、中耳炎の増悪を1例に認めた。

当科が行っている口腔ケアの取り組みを紹介するとともに、当院の看護師(病棟看護師と手術室看護師)238名を対象とした口腔ケアに関するアンケートの結果を報告した。取り組みの内容は、職員に口腔衛生の知識を普及させるための院内勉強会、糖尿病患者の教育を目的とした歯科疾患に関する講演などである。また、歯科医師と歯科衛生士による口腔ケア回診を行い、病棟の看護師のみでは口腔ケアが困難と判断された患者の口腔内診査や口腔ケア指導を実施している。看護師アンケートの回答を分析した結果、病棟で行われている口腔ケアの問題点として、口腔状態の評価法が看護師間で統一されていないこと、各自さまざまな手技や道具で口腔ケアがなされていることなどが抽出された。

This report is of a 43-year-old woman with osteoma of the mandibular condyle causing facial asymmetry and malocclusion. Preoperative orthodontic treatment was performed after a clinical diagnosis of benign tumour of the left mandibular condyle was made. After 9 months of orthodontic treatment, condylectomy was performed under general anaesthesia. Histopathological examination revealed an osteoma. Postoperative orthodontic treatment was performed for 8 months, and the postoperative course has been favourable. The facial asymmetry and malocclusion have improved. © 2008 Asian Association of Oral and Maxillofacial Surgeons.

Objective: To analyse the relationship between the expression levels of manganese superoxide dismutase, and copper-zinc superoxide dismutase, and clinicopathological parameters in human tongue cancer. Materials and Methods: Oral biopsy specimens of 42 cases of tongue cancer were stained with antihuman manganese and copper-zinc superoxide dismutases, and the degree of staining in tumour cells was evaluated. Clinicopathological information was reviewed and the degree of tumour invasion was divided into four types. Results: The percentage of enhanced manganese superoxide dismutase expression in patients was significantly higher in patients older than 60 years than that in patients younger than 60 years. The percentage of enhanced manganese superoxide dismutase expression was higher in T4 patients versus T1 patients and in patients with lymph node metastasis versus patients without metastasis. A higher percentage of enhanced copper-zinc superoxide dismutase expression was shown in the 2+3 mode of invasion group compared with the advanced mode of invasion (4c+4d) group, and the percentage of reduced copper-zinc superoxide dismutase expression in patients in the 4c+4d group was significantly higher than that in patients in the less invasive group (2+3). The percentage of enhanced copper-zinc superoxide dismutase expression in patients without lymph node metastasis was slightly higher than that in patients with metastasis. Conclusion: These results demonstrate that expression levels of manganese and copper-zinc superoxide dismutases correlate with clinical stage, mode of invasion, and lymph node metastasis in tongue cancer. © 2007 Asian Association of Oral and Maxillofacial Surgeons.

A case of epignathus combined with cleft palate, lobulated tongue, and lingual hamartoma is reported. A newborn female presented with a large skin-covered mass arising from the palate, cleft palate, and lobulated tongue with soybean-sized lingual lesion. The palatal and lingual masses were removed on the 9th day after birth. A cystic lesion was also found oil the nasal septum after removal of the palatal mass; this lesion was resected at its base. Glossoplasty was performed after excision of the lingual lesion. Histologically, the palatal mass was diagnosed as epignathus. The cystic lesion was suspected to be meningothelial tissues oil the basis of hematoxylin-eosin (HE) and immunohistochemical staining: Vimentin and epithelial membrane antigen were positive, and factor VIII was negative. The mass of the tongue dorsum was diagnosed as hamartoma. No recurrence of epignathus or evidence of meningocele have been observed after 5 years of follow up.

This report is of a 65-year-old man with a granulocytic sarcoma presenting as a gingival swelling. The patient was diagnosed as having natural killer-cell acute leukaemia by bone marrow biopsy. The gingival swelling resolved after chemotherapy. © 2006 Asian Association of Oral and Maxillofacial Surgeons.

A 76-year-old man presented with swelling of the right side of the maxilla. Spindle cell sarcoma was diagnosed on examination of a biopsy sample of the right maxillary sinus. We started CYVADIC (cyclophosphamide, vincristine, adriamycin, dacarbazin) chemotherapy. A favorable clinical response was obtained with 4 courses of chemotherapy. Partial resection of the maxilla was followed by 6 courses of CYVADIC therapy, because a small residual tumor was suspected. Histopathological examination revealed no residual tumor cells.<BR>Chemotherapeutic intervention appears to have been effective, with no apparent recurrence of lesions at present, 14 years after chemotherapy.

Human beta-defensin 3 (hBD-3), an antimicrobial peptide, is produced by various epithelial and some nonepithelial tissues. hBD-3 mRNA is widely expressed in oral tissues, including oral epithelium and the salivary glands. Although the localization of hBD-1 and hBD-2 has been well demonstrated in tissue sections, the localization pattern of hBD-3 has not yet been shown. In the present study, we investigated the expression pattern of hBD-3 mRNA by in situ hybridization using specific RNA probes; the signal for hBD-3 was detected in upper spinous and granular layers in normal oral epithelium. In cases of leukoplakia, a strong signal of hBD-3 mRNA was observed in the granular layer. In lichen planus, the signal was strongly detected in the spinous and suprabasal layers. The signals were stronger than those of either normal oral epithelium or leukoplakia. The results indicate that the localization pattern of hBD-3 is very similar to that of hBD-2. hBD-2 and hBD-3 may function together or compensate each other for expressional loss.

We investigated the clinical and histopathologic features of 26 cases of mucocele of the glands of Blandin-Nuhn. There was a female predominance, and most patients were younger than 20 years. Fifteen patients first visited a medical doctor and 9 visited a dentist before being referred to our department. The average duration from the time the lesion was first noticed to the patient's visit was 3.6 months. All lesions were located on the ventral surface of the tongue. In 17 patients, mucoceles were seen at the tip of the tongue, whereas 9 lesions occurred more posteriorly. Lesions were situated at the midline in 19 patients and laterally in 7 patients. All lesions presented as an exophytic mass, often with a polypoid appearance. All mucoceles were histopathologically of the extravasation type, suggesting that trauma may represent a frequent initiating factor.

パラコートは, 除草剤として使われる農薬の一種である。それを誤って飲んだとき, 口内炎が必ず発現する。われわれは, パラコートによる口内炎の9例について報告した。対象は男性2例, 女性7例の計9例である。年齢は, 22歳から65歳で平均47.8歳であった。口腔粘膜症状は, ビランまたは潰瘍である。潰瘍の表面は, 白色の偽膜に覆われていた。病変粘膜の境界は, 明瞭であった。このパラコートをすぐ吐き出した2例では, 限局した粘膜に, ビランまたは潰瘍を認めた。<br>7例は, パラコートを嚥下した後に頻回に嘔吐した。そのため広い範囲に口内炎が発現した。潰瘍は, 1週から3週で上皮化し, 瘢痕の形成はなかった。2例は, 肺線維腫による呼吸不全のため死亡した。

A 35-year-old Japanese woman had recurrent, pruritic, vesicular lesions on the face, neck and upper back as well as erosive lesions of the oral cavity and genitalia. The skin and mucosal lesions healed without scarring upon the systemic administration of corticosteroid and azathioprine. Direct immunofluorescence revealed linear deposits of IgG, IgA and C3 at the cutaneous basement membrane zone. indirect immunofluorescence on 1 M NaCl-split human skin sections demonstrated that the patient's IgG antibodies reacted with the dermal side of the split, while IgA antibodies weakly reacted with the epidermal side. By immunoblot analyses, the patient's serum reacted with the NC1 domain of type VII collagen as well as both the alpha(3)- and beta(3)-Subunits of laminin 5. We regarded our case as a nonscarring subepidermal blistering disease with autoantibodies to both type VII collagen and two different subunits of laminin 5. Such a case has not been previously reported. Copyright (C) 2003 S. Karger AG, Basel.

神経鞘腫と神経線維腫について,鑑別疾患等を含めて臨床的に検討した.対象は16年に受診した10例で,男女比は2:8,平均28歳であった.末梢神経系腫瘍の発生部位は舌4例,口唇および頬粘膜が各2例,歯肉および口蓋が各1例であった.主訴は全症例腫瘤形成であった.初診時の臨床診断と,確定診断の一致は困難であった.手術は全症例摘出術が行われ,再発・悪性化はなかった

Human beta defensin 2 (hBD-2) is a major antimicrobial peptide that is produced by many types of epithelial cells, and is transcriptionally inducible by various proinflammatory agents, such as cytokines and bacteria. Although in vitro studies of the hBDs in oral epithelial cells have been well documented, only little is known about the in vivo pathological state of oral epithelium. We investigated the localization of hBD-2 peptide in tissue sections of oral lichen planus, leukoplakia, candidal leukoplakia and radicular cysts using immunohistochemistry. HBD-2 was stained in both the hyperkeratinized and the granular layers in cases of lichen planus with hyperkeratosis and leukoplakia. Expression in spinous and suprabasal layers was often strong in lichen planus. There were no significant differences in the number of S-100 positive dendritic cells between the widely stained areas and those with limited staining areas in lichen planus. In cases of candidal leukoplakia, the hyphae of candida were mainly detected on the surface of keratinization, which showed only negative or faint staining for hBD-2. These results suggest that hBD-2 is vigorously induced by lichen planus-related inflammation and that it plays an important role in protection from Candida albicans infection; however, it is not a strong chemotactic attractant for Langerhans cells in pathological conditions of oral epithelium.