Tadashi Akamatsu

Ameloblastic carcinoma, secondary type: a case report

Malignant variants of ameloblastoma include metastasizing ameloblastoma, which microscopically appears benign but has metastasized and ameloblastic carcinoma that exhibits malignant histopathologic features. Ameloblastic carcinoma is classified into 2 types: a primary odontogenic malignancy and a secondary type resulting from malignant transformation of ameloblastoma. Most secondary ameloblastic carcinomas result from malignant transformation of a primary lesion after repeated postsurgical recurrences. Therefore it is rare to find an untreated secondary type presenting with histologic features of malignant transformation from an earlier benign lesion. We experienced a rare case of ameloblastic carcinoma, secondary type which might arise in an untreated ameloblastoma. The mechanism by which a preexisting benign ameloblastoma goes through a malignant transformation is also described.

The influence of different types of hard-palate closure in two-stage palatoplasty on maxillary growth: cephalometric analyses and long-term follow-up.

Using cephalometric analysis we investigated the influence on maxillary growth of two different types of hard-palate closure in two-stage palatoplasty. In 12 patients with complete unilateral cleft lip, alveolus, and palate, the lip and soft-palate were closed between 3 and 7 months of age. These 12 patients were then assigned to two groups of 6. In one group the hard palate was closed at 1 year 5 to 11 months of age by a vomer flap with a skin graft (VF group, Osadas two-stage palatoplasty) and in the other group it was closed by the mucoperiosteal pushback procedure (PB group). Sella-nasion-point A (SNA) in the VF group at 3 to 4 and after 10 years of age were within normal range and significantly larger than in the PB group. Two patients in the PB group required orthognatic surgery to obtain normal occlusion and a well-balanced profile. We concluded that in two-stage palatoplasty better maxillary growth can be obtained using the vomer flap method than using the pushback procedure.

Postoperative follow-up strategy in patients with oral squamous cell carcinoma.

PURPOSE The duration of follow-up after treatment of oral squamous cell carcinoma and the frequency of routine visits are based on common usage rather than evidence-based practice. The purpose of this study was to determine the appropriate postoperative routine follow-up program in patients with oral squamous cell carcinoma. PATIENTS AND METHODS Three hundred four cases treated curatively mainly by surgery at Tokai University Hospital from 1994 to 2004 were analyzed. A secondary event was defined as a local recurrence, a regional recurrence, a distant metastasis, or a second primary cancer. To evaluate the follow-up program, data on the first tumor recurrence or first second primary tumor in the head and neck region or elsewhere in the body were used. Overall survival rate, disease-specific survival rate, relapse-free rate, and cumulative risk of developing a second primary cancer were estimated by the Kaplan-Meier product limit method. RESULT All relapse cases were detected within 3 years postoperatively, of which 86.3% were detected within 1 year. Most relapses were in the neck, and regional recurrences had a dismal salvage rate. Second primary cancers were constantly detected 1 to 10 years postoperatively. CONCLUSION Follow-up should be performed more frequently in the first year, with 2 weekly follow-ups with monthly ultrasound examinations, and should be continued after 3 years to exclude the development of second primary cancers.

Comparison of mandibular stability after SSRO with surgery-first approach versus conventional ortho-first approach

Abstract Methods: Postoperative mandibular stability in the surgery-first (SF) approach and ortho-first (OF) approach in orthognathic surgery was retrospectively assessed using the lateral cephalo X-P in 38 patients with skeletal Angle Class III malocclusion who underwent sagittal split ramus osteotomy (SSRO). Results: The postoperative mandibular relapse of the two groups observed from T1 (2 weeks after the surgery) to T2 (for the OF group, a year after surgery; for the SF group, the day orthodontic treatment was completed) was compared. The mean (SD) horizontal relapse at pogonion was 0.86 (0.92) mm in the forward direction in the SF group and 0.90 (1.09) mm in the forward direction in the OF group. No significant difference was found in the amount of horizontal movement between the two groups. On the other hand, the mean (SD) vertical relapse at pogonion was 1.59 (2.91) mm in the downward direction in the SF group and 0.14 (1.30) mm in the upward direction in the OF group, showing a significant difference in the amount of movement between the two groups. The degree of completion of the occlusion at T2 in the SF group was compared with that in the OF group by measuring OB, OJ, L1-occlusal plane angle, and interincisal angle. No significant difference was found between the two groups and the post-treatment occlusion was clinically favourable. Conclusion: Although the SF approach has several advantages for patients, the method of operation and fixation should be selected carefully to maintain postoperative mandibular stability.

Multi-Acupuncture Point Injections and Their Anatomical Study in Relation to Neck and Shoulder Pain Syndrome (So-Called Katakori) in Japan.

Katakori is a symptom name that is unique to Japan, and refers to myofascial pain syndrome-like clinical signs in the shoulder girdle. Various methods of pain relief for katakori have been reported, but in the present study, we examined the clinical effects of multi-acupuncture point injections (MAPI) in the acupuncture points with which we empirically achieved an effect, as well as the anatomical sites affected by liquid medicine. The subjects were idiopathic katakori patients (n = 9), and three cadavers for anatomical investigation. BL-10, GB-21, LI-16, SI-14, and BL-38 as the WHO notation were selected as the acupuncture point. Injections of 1 mL of 1% w/v mepivacaine were introduced at the same time into each of these points in the patients. Assessment items were the Pain Relief Score and the therapeutic effect period. Dissections were centered at the puncture sites of cadavers. India ink was similarly injected into each point, and each site that was darkly-stained with India ink was evaluated. Katakori pain in the present study was significantly reduced by MAPI. Regardless of the presence or absence of trigger points, pain was significantly reduced in these cases. Dark staining with India ink at each of the points in the anatomical analysis was as follows: BL-10: over the rectus capitis posterior minor muscle and rectus capitis posterior major muscle fascia; GB-21: over the supraspinatus muscle fascia; LI-16: over the supraspinatus muscle fascia; SI-14: over the rhomboid muscle fascia; and BL-38: over the rhomboid muscle fascia. The anatomical study suggested that the drug effect was exerted on the muscles above and below the muscle fascia, as well as the peripheral nerves because the points of action in acupuncture were darkly-stained in the spaces between the muscle and the muscle fascia.

A blinking periorbital prosthesis using surface electromyographic signals of the orbicularis oculi muscle.

BackgroundRecent advances in human–machine interface technology have enabled the development of multifunctional, primarily orthopedic myoelectric prostheses. We developed a noninvasive blinking periorbital prosthesis that can synchronize with blinking of the intact eyelid by using surface electromyographic signals of the orbicularis oculi muscle.MethodsMyoelectric potentials of the orbicularis oculi muscle while blinking were measured with surface electrodes on the eyelid in four healthy adults. Possible cross talk introduced via the electrodes was also measured and assessed to determine whether cross talk would affect surface electromyographic measurements while blinking.ResultsThe amplitude of the surface myoelectric potential of the orbicularis oculi muscle was sufficiently high for the practical use of blinking prostheses. Our blinking model was successfully synchronized with blinks of the subjects’ eyelids under experimental conditions without cross talk between the orbicularis oculi muscle and other muscles.ConclusionsAlthough our study revealed several problems, the use of surface electromyographic signals could be a promising and useful technique for synchronizing blinking of the prosthetic eyelid with blinking of the intact eyelid.Level of Evidence: Level V, therapeutic study.

Surgical treatment of facial steatocystoma multiplex

Facial steatocystoma multiplex is a rare variant of steatocystoma multiplex, which is characterized by multiple disfiguring cysts on the face and is inherited in an autosomal dominant fashion. Noninvasive treatments are only temporarily effective, but surgery of multiple lesions on the face has a risk of major complications. A 31-year-old man presented with papules distributed over his face. We used a flap method and mini-incisional capsulectomy under general anesthesia. We performed needle aspiration and CO2 laser puncture and squeezing on the man in the outpatient clinic when symptoms recurred. There have been several reports suggesting various options for the management of steatocystoma. However, long-term management remains difficult and there is no definite technique to treat facial steatocystoma multiplex. We think that combined use of these surgical methods should be applied with individual evaluation. Size, location, hardness, mobility, depth, and previous scars should be noted, and the relevant methods should be selected for each cyst.

Anomalous connection of the left posterior renal vein with the left ascending lumbar vein in a Japanese cadaver.

A rare variation was found in one of the two left renal veins in a 94-year-old male cadaver undergoing routine dissection. The characteristic findings in the cadaver included, in addition to the primary left renal vein, the presence of a posterior left renal vein draining to the left ascending lumbar vein without communicating with the inferior vena cava and other renal veins. Variations in the number and arrangement of the vessels terminating in the renal veins are common, but to our knowledge, variation similar to our findings has not been previously reported. This variation may represent an immature form of the complicated development of the renal vessels.