Kazuhiko Ohgi

Preoperative concurrent chemoradiotherapy plus radical surgery for advanced squamous cell carcinoma of the oral cavity: an analysis of long-term results.

Locoregionally advanced squamous cell carcinomas of the head and neck continue to be a major clinical problem. We demonstrated in 1996 that preoperative concurrent cisplatin- or carboplatin-based chemotherapy and radiotherapy plus radical surgery in advanced oral cancer had minimal toxicity, had high clinical tumor response rates, was well tolerated and produced impressive complete response rates and a high 5-year survival rate. The purpose of the present study was the long-term follow-up of this treatment regimen for advanced oral carcinoma. Forty-eight patients with squamous cell carcinoma of the oral cavity (including soft palate) were treated preoperatively with cisplatin- or carboplatin-based chemotherapy in combination with simultaneous irradiation to a target volume of 40 Gy, and 2-6 weeks later underwent curative surgery. All patients with advanced Stage II (n=7), Stage III (n=22) and Stage IV (n=19) were treated and followed for an average of 7.2 years (range: 61-144 months). The overall actuarial survival of all patients was 81.3% at 5 years and also at 10 years. Progression-free survival at both 5 and 10 years was 84.8% for all patients, and 85.7% for Stage II, 90.0% for Stage III, and 78.9% for Stage IV patients. Progression-free survival rates according to the histopathologic regression grade of primary tumor following preoperative chemoradiotherapy at 10 years were 40. 0% for Grade IIa, 88.9% for Grade IIb, 100% for Grade III, and 87.5% for Grade IV. Patients who achieved good responses histopathologically (Grades IIb, III, IV) had superior survival rates in comparison to patients with extensive residual tumor (Grade IIa) in surgically resected specimens (p=0.0012). A better histologic regression grade was also associated with a higher survival rate even in the long-term analysis. This treatment regimen for advanced oral cancer produced high clinical and pathologic complete response and survival rates with an acceptable acute toxicity profile and lack of late therapeutic complications. The long-term follow-up showed gratifying results even for advanced oral cancers without a substantial increase in distant metastasis and second primary malignancy.

Factors Affecting Mandibular Function after Conservative Treatment of Condylar Fractures

Objective: To investigate the factors affecting mandibular function after conservative treatment of condylar fractures. Patients and Methods: Mandibular functions such as maximal mouth opening, jaw deviation on mouth opening, anterior and lateral excursions, occlusion, and temporomandibular joint symptoms were examined in 49 patients 6 months after conservative treatment of condylar fractures. Results: Good mandibular function was noted in 38 patients (77.6%), but in the other 11 patients (22.4%), at least 1 dysfunction such as mouth opening less than 35 mm, jaw deviation of more than 5 mm on mouth opening, anterior or lateral excursion less than 5 mm, and disturbance in occlusion or temporomandibular joint symptoms was found. Mandibular dysfunction was frequently observed in patients older than 40 years and those with bilateral fractures (p < 0.05). Gender, the presence of associated mandibular fractures, or the treatment method did not affect the outcome. In 41 unilateral patients, subcondylar fractures, dislocated fractures, and those with a reduction in ramus height of more than 8 mm were considered important although not statistically significant. Conclusion: Patient age and bilateral fractures are critical factors affecting outcome, although good mandibular function can be obtained in most patients.

Treatment of Mandibular Fractures in Infants

Abstract This report describes 2 infants with mandibular fractures. Reduction of the fracture and fixation using a thermoforming splint with circummandibular wiring under general anaesthesia is thought to be an adequate surgical method to treat displaced mandibular body fractures in infants.

Clinical and Radiological Outcomes of Condylar Fractures in Children

Abstract Objective: To investigate the clinical and radiological outcomes of 36 patients aged 15 years or younger with condylar fractures. Patients and Methods: Twenty five boys and 11 girls were included in this retrospective study. Treatment for condylar fractures was observation with or without restriction of mouth opening, maxillomandibular fixation, and open reduction. Other mandibular fractures were treated by maxillomandibular fixation or open reduction. Clinical characteristics, including age, sex, cause of injury, location and type of condylar fracture, the presence of associated mandibular fractures, treatment methods, mandibular function, and radiological remodelling of affected condyles after treatment, were reviewed. Results: Clinically, excellent and good mandibular function was observed in 35 patients. Only 1 patient treated surgically was considered to have poor mandibular function due to temporomandibular joint ankylosis. Complete and partial remodelling of the affected condyles was obtained in 13 and 29 condyles, respectively. Complete remodelling was observed only with conservative treatment, with none of the surgically treated condyles showing complete remodelling despite reduction and fixation being perfectly performed. Poor remodelling was observed only in 1 patient, resulting in temporomandibular joint ankylosis. Conclusion: Conservative treatment should be the first choice for condylar fractures in children since clinically excellent mandibular function was achieved for most patients.

Tooth Extraction in Congenital Protein C and Protein S Deficiency — Management of Thrombotic Risk

Abstract Tooth extraction was performed in 1 patient with protein C deficiency and another with protein S deficiency — congenital hypercoagulation disorders. The clinical management of these patients is described.

Risk Factors Affecting Duration of Management of Odontogenic Maxillofacial Cellulitis

Abstract Purpose: To elucidate the risk factors influencing the duration of management of odontogenic maxillofacial cellulitis. Patients and Methods: Forty five consecutive patients with odontogenic maxillofacial cellulitis were enrolled. By a retrospective chart review, the duration of surgical drainage was investigated in relation to the following variables: age, body temperature at presentation, underlying medical conditions (diabetes mellitus and liver disease), number and location of involved surgical spaces, duration from the onset of inflammatory swelling to surgical drainage, and laboratory findings. Results: Age, body temperature, number and location of involved spaces, and duration from the onset of inflammatory swelling to surgical drainage strongly correlated with duration of surgical drainage. Furthermore, patients older than 50 years with a body temperature of 37.8°C or higher, 4 or more involved spaces, deep site infection, duration from the onset of inflammatory swelling to surgical drainage of 6 days or more, and diabetes mellitus indicated significantly longer duration of surgical drainage than other patients. Conclusion: These results contribute to predicting the duration of management of odontogenic maxillofacial cellulitis based on the correlations reported.

Clinico-statistical Analysis of 90 Cases of Salivary Gland Tumors.

1981年10月当科開設より1997年6月までの15年8か月間に奈良県立医科大学口腔外科において病理組織学的に唾液腺腫瘍と診断された90例について臨床統計的検討を行い以下の結果を得た。1. 性別は男性が46例, 女性が44例とほぼ同数であった。2. 平均年齢は良性腫瘍では45.1歳, 悪性腫瘍は56.4歳で, 男女間の平均年齢は良性腫瘍ではほぼ同じであったが, 悪性腫瘍では男性は女性より約25歳高齢であった。3. 組織型では良性腫瘍72例のうち多形性腺腫61例, Warthin腫瘍9例, 筋上皮腫, 嚢胞性リンパ管腫, 各々1例で, 悪性腫瘍18例のうち, 腺様嚢胞癌12例, 粘表皮癌, 基底細胞腺癌, 各々2例, 多形性腺腫内癌, 扁平上皮癌, 各々1例であった。4. 発生部位では大唾液腺原発が36例 (40.0%) , 小唾液腺原発が54例 (60.0%) で, 大唾液腺では耳下腺が25例 (69.4%) と最も多く, 小唾液腺では口蓋が37例 (68.5%) と最も多くを占めた。5. 初診時臨床症状は良性腫瘍では全例に無痛性腫脹が認められた。悪性腫瘍では腫脹に疼痛等, 何らかの症状が合併している症例が多く認められた。6. 治療法は良性腫瘍では全例に手術を施行し, 悪性腫瘍では手術単独療法が4例で, 術前, 術後に放射線, 化学療法を併用したものが11例と多くを占めていた。7. 良性腫瘍では全例に再発は認められず, 良好な結果を示したが, 悪性腫瘍では5年及び10年累積生存率は55.0%で, Stage別ではI, II群100%, III, IV群41.6%, N分類別ではN (1-3) 群46.7%, N (0) 群75.0%であり, 進行例が予後不良であった。