Keigo Kudo

Adenomatoid odontogenic tumor associated with calcifying epithelial odontogenic tumor.

A case of odontogenic tumor which contained areas diagnostic for both adenomatoid odontogenic tumor and calcifying epithelial odontogenic tumor arising in the upper left anterior region in a 17-year-old Japanese female is reported. The histopathological observation suggested that the lesion represented primarily adenomatoid odontogenic tumor in which multiple foci of calcifying epithelial odontogenic tumor had developed.

Evaluation of mandibular reconstruction techniques following resection of malignant tumors in the oral region

Over the past 15 years, reconstruction following excision of malignant oral tumors was performed on 27 patients with segmental resection and five patients with hemiresection of the mandible. Following segmental resection, the mandible was reconstructed using an autogenous bone graft in eight patients in whom the surrounding soft tissues were fairly well preserved. Bony union was achieved in six of them. In the remaining two, the graft was removed because of postoperative infection, and one patient underwent secondary bone grafting. A pedicled myocutaneous flap and bone graft was used in seven patients who underwent extensive resection of the surrounding soft tissue. Bony union was achieved in three patients, and one developed pseudoarthrosis. The graft was removed in the remaining three because of postoperative infection. Reconstruction with only a metallic plate for stabilization of the mandible was carried out in six aged or sarcoma-affected patients. In two of them, the postoperative course was uneventful for 4 to 7 years. In the remaining four patients, plate removal was required because of exposure or tumor recurrence. In 5 of 11 patients in whom reconstruction was carried out with a combination of a pedicled myocutaneous flap and metallic plate, the postoperative course was uneventful for 2 to 8 years. Two of these five patients underwent secondary bone grafting. In four of the remaining six patients, the plate was removed because of exposure or improper adaptation to the stump. Two others died of disseminated intravascular coagulation syndrome within 1 month. A prosthesis was used more frequently by patients when reconstruction was performed using a pedicled osteomyocutaneous flap. The metallic reconstruction plate was helpful for restoring mandibular contour.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical application of dental implant with root of coated bioglass: Short-term results

During the last 4 years 73 dental implants with root-coated bioglass to replace one to three teeth in the premolar and molar sites of the mandible were inserted. The bonding ratio between implant and bone was observed clinically 1 year after implantation and installation of the superior structure. This ratio measured 52.4% to 63.3%. An acoustoelectric tester was developed that advanced our skills. The emphasis was placed on a tight fit between implant and surrounding bone.

Clinical course and evaluation of shape and function after reconstruction using various pedicle flaps for oral and maxillofacial defects

In the past 7 years, reconstruction using various pedicle flaps for oral and maxillofacial defects, was carried out for 40 patients. Pectoralis major myocutaneous, deltopectoral and scalp-forehead flaps for large defects, and sternocleidomastoid, cervical island skin and palatal flaps for moderate defects were indicated. As for results, most of the flaps used at the reconstructed site for the defects of soft tissue repaired the shape and patients were satisfied. However, the recovery of functions concerning speech, swallowing or mastication was not always successful with the larger defects, especially after the reconstruction for defects of tongue, floor of the mouth, cheek and mandible for which mandibular reconstruction was performed. It was pointed out that the main causes for less tongue mobility were due to scar contracture after reconstruction, and difficulty of mandibular reconstruction due to postoperative infection were associated factors. Accumulated survival rate of patients for 5 years was 62.6%, in which 38 advanced malignant tumors were reconstructed following surgery. In the clinical course after reconstruction, patients with primary tumors experienced much better results than those with secondary tumors.

Immediate repair ofmandibular defects following surgery for carcinoma of the lower alveolus and gingiva using a pectoralis major osteomyocutaneous flap

During the two years from 1981 to 1983, a pectoralis major myocutaneous island skin flap, with the 5th rib or sternum, has been used for immediate repair of mandibular defects following surgery in five cases of carcinoma of the lower alveolus and gingiva. In these 5 patients with segmental and hemimandibulectomy, immediate mandibular reconstruction was performed simultaneously using a flap with the 5th rib or the sternum. Thereafter, in 3 of them, the contour and function of the mandible were restored by prosthetic appliances. In the remaining 2 patients prostheses could not be used because of mandibular discontinuity due to removal of a portion of the graft because of postoperative infection and pseudo-arthrosis. Mandibular reconstruction using the osteomyocutaneous flap is advantageous in the restoration of the contour and function of the mandible. Some problems concerning the reconstruction will be reported.

Primary malignant melanomas of the oral mucosa

7 patients with primary malignant melanoma of the oral mucosa treated during the past 15 years by extensive resection, and simultaneous neck dissection in 3 of them, are reported. 4 patients died. However, most of the patients stayed alive relatively long postoperatively.

Immediate reconstruction using a scalp-forehead flap for the entire upper lip defect with the application of lyophilized porcine skin to surgical wounds*: A case report of a malignant melanoma in the upper lip and oral mucosa*

A rare extensive malignant melanoma involving the upper lip and maxillary alveolar mucosa was removed by en bloc resection after chemotherapy and radiotherapy. Simultaneous immediate reconstruction of the entire upper lip defect was carried out with a bitemporal pedicle flap which included the scalp and forehead after applying lyophilized porcine skin to the wound where the alveolar bone had been resected, and the bilateral scalp-forehead and thigh donor sites. A partial denture was inserted six months postoperatively. Now, one and a half years after operation, the patient is quite satisfied with his cosmetic appearance and masticatory recovery.

Long-term restoration of masticatory function with fixed mandibular implants in cases of oral cancer.

The results of the present study show that the fixed mandibular implant system enables patients who have operations to treat oral cancer to use a stabilized denture continuously over an extended period of time.

A locally advanced tongue cancer responding to combination chemotherapy with UFT-E granule and Leucovorin tablet.

患者は68歳の女性で, 左側舌側縁に高分化型扁平上皮癌 (T3N0M0) を認めた。初診時よりUFT-E顆粒450mg/日の経口投与を開始し, 腫瘍の縮小傾向がみられたため3週間後よりbiochemical modulationによる腫瘍縮小効果増強を期待しLeucovorin 30mg/日を併用した。腫瘍は臨床的に消失したため, 全麻下に舌部分切除術を施行した。退院後, 義歯を装用し, 会話や嚥下機能にも特に問題ない。現在術後5年2か月を経過しているが再発や転移を認めず良好に経過している。

Comparative evaluation of function after surgery for cancer of the alveolobuccal complex

appliances in the reconstructed oral cavity. Although significantly better results have been reported with the use of osseointegrated implants,* this technique is expensive and is not possible for most of our patients. Therefore, although reconstruction of mandibular defects using vascularized iliac crest grafts is now in routine use at the Tata Memorial Hospital, the benefits of this technique will not be translated into improved masticator-y function until such time as advanced prosthetic techniques can be brought witbin reach of our patients.