Norihiko Takada

MRI and arthroscopic findings in the temporomandibular joint after mandibulectomy including the unilateral condyle report of two cases

In this report, the MRI and arthroscopic findings in the temporomandibular joint (TMJ) of two patients who underwent partial mandibulectomy including the condyle are presented. The disc and superior joint compartment of the affected TMJs were preserved in both patients. MRI of the affected TMJs without condyle demonstrated that the intermediate zone of the discs was located anteriorly to the summit of the articular eminence. Joint effusion was detected in the superior joint compartment of one patient. Fibrous adhesions were observed arthroscopically in the superior joint compartment of both affected TMJs. In contrast, no specific findings were demonstrated in the contralateral TMJs connected with the residual mandibular fragment.

Report of a case; Paget's disease of the jaws.

症例は35歳, 女性。咀嚼障害を主訴に当科受診した。患老は17歳頃から脱毛が出現し, 20歳頃から歯が脱落した。25歳頃から脱毛は著明になり, 無, 月経になった。体格は肥満が見られ, 頭部は大きく, 顔面は浮腫性に腫大し上眼瞼は下垂していた。口腔内では, 上下歯槽部は膨隆を呈し, 膨隆部は骨様硬であった。残存歯15本と少数で, 動揺は著明であり歯冠部は歯槽骨中に埋没していた。X線的に前頭骨の吸収および硬化の混合像を認め, 上下の歯槽骨が著しく膨隆していた。さらに歯根は肥大し, 歯根膜腔の拡大, 歯槽硬線の消失を示した。CT上では, 頭蓋骨の肥厚, 骨吸収と硬化像, 頭蓋骨内板の吸収像を示した。その他骨シンチグラム, 血液生化学等検査施行するも, 明らかな異常を示さなかった。その後, 抜歯とともに, 上下顎骨の生検から, 抜去歯の歯根肥大は, 根尖セメント質の増生であり, 上顎骨からの組織で, 間質の線維性組織の発達と骨吸収と新生像が認められ, 下顎骨からの組織から, 成熟した骨の中にモザイクパターンが認められたため, 以上の結果からPaget骨病と診断した。しかし脱毛, 無月経等については, 原因不明であった。Paget骨病は顎骨が含まれることは稀であるといわれているが, 組織像から病期の進んだPaget骨病と思われた。さらに続発症として, 骨肉腫などが挙げられるため, 今後注意深い経過観察が必要と思われた。

The Effects of Preoperative Cis -Platinum (CDDP) Therapy for the Purpose of Limb Salvage of Osteosarcoma Evaluated by Multifactor Evaluation Method

The effects of preoperative cis-platinum (CDDP) therapy against the primary tumor of osteosarcoma are evaluated. The cases consist of 48 patients treated between July 1984 and December 1986 at the 19 cooperative institutions. The regular dose of CDDP was 3.0 mg/kg/day and it was administered intra-arterially as far as possible. The drug was administered twice to 23 patients, three times to 24 patients, and four times to one. A multifactor evaluation method was used, which consisted of four primary factors—clinical, graphic, biochemical, and histological findings. The final evaluation was done by synthesizing the evaluation results of these four primary factors. Definite effects were observed in seven cases, and moderate effects in 18 cases. If definite and moderate cases are assumed to be effective, 25 of 48 cases showed a therapeutic effect (52%). The effective ratio was higher in the intra-arterial administration group (68%) than in the intravenous groups (18%). At the time of follow-up (8–37 months), the survival rate of effective cases was 69.6%, whereas in noneffective cases it was 43.1%.