杉浦 康史

【緒言】顎裂部骨移植術は，唇顎口蓋裂の一連の治療において欠かすことのできない重要な手術である。移植骨は腸骨より採取する方法が標準的であるが，術後は腸骨採取部の疼痛による歩行困難や離床の遅れがしばしば問題となる。腸骨採取部の疼痛コントロールは患者のQOL 向上や患者満足度の観点からも重要である。当科では2013 年より顎裂部骨移植術の腸骨採取部に長時間作用型局所麻酔薬であるロピバカイン塩酸塩を使用しており，今回，われわれはその有効性について検討した。【方法】2006 年4 月から2019 年3 月までに自治医科大学附属病院歯科口腔外科･矯正歯科で顎裂部骨移植術を施行した患者101 名（男性60 名，女性41 名），111 顎裂を対象とした。腸骨採取は前腸骨より行い，採取後にロピバカイン塩酸塩を使用しなかった群をNR 群（24 例），ロピバカイン塩酸塩を使用した群をR 群（87 例）として，術後の初回鎮痛薬使用開始時間，歩行開始時期，術後在院日数について検討した。【結果】鎮痛薬の初回平均投与時間はNR 群8.3 時間，R 群8.2 時間であった。また，全体のうち鎮痛薬の内服を必要とした患者割合はNR 群70.8 %，R 群56.3 % であった。平均歩行開始時期はNR 群42.9 時間，R 群23.5時間で，R 群で有意に術後早期の歩行が可能であった。術後在院日数はNR 群5.5 日，R 群2.9 日で，R 群で有意に在院日数が短く，重回帰分析においてもロピバカイン塩酸塩の使用の有無が術後在院日数に有意に影響する結果となった。【考察】アセトアミノフェンやNSAIDs（非ステロイド性抗炎症薬）などの全身的な鎮痛薬投与のみでは体動時の十分な鎮痛が得られず，離床の遅れにつながることがある。今回，腸骨採取後にロピバカイン塩酸塩を使用することで，術後早期の離床と在院日数の短縮が可能であることが示された。ロピバカイン塩酸塩は，持続性のある鎮痛効果が期待でき，腸骨採取部の疼痛コントロールに有効 であるといえた。

埋伏犬歯による前歯の歯根吸収を認めた3例を呈示した。症例1は12歳男児で、症例2は11歳女児で、症例3は16歳女性である。症例1、2は著明な歯根吸収を認めたため切歯を抜歯して犬歯の萌出を誘導した。症例3は両側犬歯による中切歯の歯根吸収を認めたが、疼痛、動揺等の症状が無く中切歯を保存した。埋伏犬歯による切歯の歯根吸収は稀でないが自覚症状が無いため発見時は進行している場合があり、永久歯交換初期からの定期的な画像検査による萌出異常の早期発見が重要である。

Vascular lesions, including hemangiomas and vascular malformations, are common benign diseases. More than 50% originate from blood vessels or vascular structures and are locate in the head and neck region. This study aimed to evaluate the efficiency and safety of a combination of laser treatments for oral venous malformations using ultrasound navigation. This study reports 3 cases of massive vascular malformation in the oral cavity, which were treated by a combination of a multiple spotted transmucosal irradiation technique (the so-called leopard technique) for the superficial layer, and intralesional photocoagulation for the deep layer using a neodymium-doped yttrium aluminum garnet laser, under real-time ultrasound navigation. All cases presented with a venous malformation with multiple blue swellings on the dorsum of the tongue, which had a maximum dimension of over 30 mm. The percent reduction in the size of the lesions was determined by magnetic resonance imaging. All cases showed a decrease in lesion volume of over 80%, without extensive tissue necrosis, 6 to 12 months after the laser treatment. None of the patients experienced any complications, and all were satisfied with the treatment outcome after one irradiation session.The results of this study suggest that laser treatment using ultrasound navigation is a promising approach for the safe and minimally invasive resolution of oral vascular lesions without scarring and loss of normal tissue architecture, sensation, oral function.

BACKGROUND: Osteosarcomas of the head and neck region are rare entities that comprise < 10% of all osteosarcomas. Multimodality treatment of patients with osteosarcoma is well-established for osteosarcoma in long bones, and the benefits of chemotherapy in long bones are clearly known. However, there is no consensus regarding the effects of chemotherapy in cases of head and neck osteosarcoma. The prognostic factor for head and neck osteosarcoma is complete tumor resection with negative margin, which is a radical surgery. However, a clear margin may be difficult to achieve in the head and neck region. CASE PRESENTATION: We present a case of a 69-year-old Japanese woman who developed osteosarcoma of the condyle within the masticator space and infratemporal fossa, which was treated with radical surgery using a modified preauricular and transmandibular approach. Although we recommended adjuvant treatment after surgery, the patient refused this treatment. There was no evidence of local recurrence or distant metastasis through 30 months of follow-up. CONCLUSIONS: Our modified preauricular and transmandibular approach allowed access to the masticator space and infratemporal fossa, thereby increasing complete resection of the tumor and resulting in minimal functional and cosmetic deficits.

The purpose of this study was to evaluate surgical outcomes in elderly patients who had undergone free fibula flap transfer for malignant head and neck tumours. A retrospective chart review was performed to identify patients who had undergone free fibula flap transfer for mandibular reconstruction after malignant tumour resection at Jichi Medical University Hospital between May 2009 and April 2015. Enrolled patients were divided into an elderly group (≥80years old) and a younger group (<80years old). Seventeen patients met the inclusion criteria and were included in the elderly group. Age at surgery ranged from 80 to 92years. Thirteen patients (76.5%) experienced postoperative complications. Surgical site complications occurred in seven patients. The success rate of free fibula flap transfer was 100%. Systemic complications occurred in nine patients, most commonly delirium (n=6). No perioperative mortality was encountered. The overall 1-year survival rate was 94.1% (16/17). No patient reported gait disturbance as a donor site complication or any other major complication. The incidence of postoperative complications did not differ significantly between the elderly and younger groups. Almost no difference in postoperative course was seen between the groups. Elderly patients appear to tolerate free fibula flap reconstruction just as well as younger patients.