Mitsumasa Yokota

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)

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.

Investigation of Postoperative Stability of Mandibular Asymmetry Cases

The purpose of the present study was to investigate postoperative stability of asymmetric mandible. We performed a cephalometric radiographic evaluation of postoperative stability on 11 patients who had undergone sagittal splitting ramus osteotomy of asymmetric jaw deformities at our clinic from 1989 to 1991.The results were as follows:1. Measurements of areas of right and left mandible by cephalometric radiograms, particulary those in the lower portion, were very useful to evaluate the postoperative change of mandibular asymmetry. The ratio of left area/right area in the lower portion of the mandible was turned to nearly 50/50 at one year after operation in 7 patients.2. Four of 7 patients, who had a difference of over 7mm in setback between right and left of the mandible and had a horizontal movement of over 6mm at the center of both lower central incisors, exhibited less postoperative horizontal stability.3. Only two of 9 patients, who were given preoperative orthodontic therapy, showed postoperative instability of the mandible.4. The correlation between postoperative horizontal instability and posteroanterior instability of the mandible was not definitely confirmed.

Combined treatment for two advanced carcinomas of the buccal mucosa with local hyperthermia.

頬粘膜進展癌の2例に対し温熱療法を組み入れた集学治療を施行し, 良好な経過を辿っているので報告する。症例1: 61歳, 男性。高分化型扁平上皮癌 (T3N2bM0) で, 治療はPM療法5クール (PEP1回2.5mg計72.5mg, MMC1回10mg計50mg) , 60Co36Gy, 温熱療法を頬部に5回, 頸部に6回, OK-432を総量44.5KE投与し, 左側全頸部郭清, 腫瘍切除, D―P皮弁による頬部全層欠損の即時再建術を施行した。症例2: 69歳男性, 高分化型扁平上皮癌 (T4N2bM0) 。右側浅側頭動脈を用いてCDDP150mg, PEP70mg, 5-FU1回125mg計2000mgを動静注し, 60Co照射を頬部, 頸部にそれぞれ40.5Gy, 60.5Gy併用した。さらに温熱療法を頸部に9回併用し, OK-432を術前に総計40.4KE投与した。1988年6月7日, 右側全頸部郭清, 腫瘍切除, 植皮術を施行した。初診より4年と2年7か月経過した現在、再発・転移なく経過良好である。2例とも重大な合併症も無く, 予定の化学療法, 放射線療法が施行でき, 根治的手術が可能であったことが良好に経過している要因と考えられた。