Toshikazu Minemura

Reconstruction of the lips, oral commissure, and full-thickness cheek with a composite radial forearm palmaris longus free flap

Reconstruction of the lower and upper lips, commissure, and full-thickness cheek defects using a composite radial forearm palmaris longus free flap with secondary commissuroplasty is described. This flap is useful for reconstruction of the total lower lip as well as larger defects that include full-thickness cheek and the commissure.

Tubular adenocarcinoma of the apex of the tongue.

Abstract This report describes a rare case of tubular adenocarcinoma originating in a minor salivary gland at the apex of the tongue. In addition to adenocarcinoma, this patient suffered from Buergers disease (obstructive thromboangitis) and had an exacerbation in the left forearm during the postoperative period that was successfully treated using intraarterial prostaglandin E1 (PGE1).

Excision of cervical cystic lymphangioma using injection of hydrocolloid dental impression material. A technical case report.

A lymphangioma, arising in an adult patient, was completely removed after injection of hydrocolloid dental impression material. The postoperative course was uneventful, with no sign of foreign-body reaction. The agar impression material, which had excellent tractability during operation, may be used as a filling material, as long as preoperative examinations show that the tumor does not involve major vessels or nerves.

Giant cell reaction to ameloblastoma: an immunohistochemical and ultrastructural study of a case.

Histopathologic, immunohistochemical, and ultrastructural features of the giant cells appearing in the tissue surrounding an ameloblastoma are presented. These giant cells exhibited strong activity of a highly stable form of acid phosphatase, and were positive for alpha-1-antichymotrypsin. Ultrastructurally, the cytoplasm of the giant cells contained numerous mitochondria, and the cell membrane was comparatively smooth. Therefore, it is proposed that these multinucleated giant cells are reactive to the invasion of ameloblastoma and are histiocytic in origin.

Mediastinitis caused by odontogenic infection associated with adult respiratory distress syndrome

A case of descending mediastinitis resulting from dental infection and complicated by adult respiratory distress syndrome (ARDS) is reported. The patient had a long history of heavy drinking. His condition was so serious that he died despite some successful therapies. The cause of ARDS appeared to be aspiration pneumonia. It is extremely rare for oral and maxillofacial surgeons to encounter a patient with ARDS.

Pitfalls in the treatment of delayed lymph-node metastases after control of small tongue carcinomas

Between 1985 and 1992, 13 patients were treated for delayed lymph-node metastases that developed after obtaining control of primary lesions of the tongue. These lesions were treated primarily by radiotherapy or surgical resection; cervical metastases were treated mainly by delayed radical neck dissection (RND). Seven of the 13 patients survived with no evidence of recurrence. The other six patients developed tumors in the neck, and five of these patients died due to uncontrollable disease. In all but one patient, recurrence appeared between the site of the primary lesion and the region of RND, the oral floor and/or the parapharyngeal space. None of the patients with recurrence received radiotherapy in the area between the primary lesion and the site of RND. In contrast, there was no recurrence in patients who received external irradiation to the primary lesion and upper cervical lymph nodes. This review emphasizes the need to direct more attention to the area between the site of the primary lesion and the regional lymph nodes in patients receiving treatment for delayed metastases associated with small carcinomas of the tongue.

Histological Evaluation of an 11-year-old Hydroxyapatite Ceramic Implant in Mandibular Bone

Abstract There are no detailed long-term histological studies of hydroxyapatite implanted in human bone tissue. This report is of histological and radiographic examination of a patient with mandibular bone implanted with hydroxyapatite ceramics after cyst ennucleation and a good clinical course for 10 years. The mandibular bone was resected 11 years after the initial operation because of infection. Histology of the retrieved mandibular bone revealed that bone tissue proliferated into interparticular spaces and attached to the hydroxyapatite ceramics surfaces in the non-infected portion and that hydroxyapatite ceramics disappeared with bone destruction in the infected portion. From the histological results, clinical findings, and chronological radiographic findings for 10 years, it was concluded that hydroxyapatite ceramics could maintain their favourable properties as a bone substitute in human bone for a long time.

Studies of calcium phosphate cements for clinical applications in oral and maxillofacial surgery. Report II: An experimental study of hardened .ALPHA.-TCP/DCPD/TeCP cement in rabbits.

A new system of calcium phosphate cement, consisting of α-tricalcium phosphate (α-TCP), dicalcium phosphate dibasic (DCPD), and tetracalcium phosphate (TeCP), was developed. In this study, columns of hardened cement were implanted on the inferior surface of rabbit mandibles and into the back muscle for 6 months, 1 year, and 1.5 years to evaluate responses of the surrounding tissues and changes in the materials in vivo.Histologic, microradiographic and scanning electron micrographic investigations of the implants in mandibles revealed active bone formation along the surface of the cement and direct contact between new bone and the materials. The cement showed surface irregularities created by resorption, which were remarkable on surfaces bounded by soft tissue.Histologic and microradiographic studies of the implants in back muscles showed the presence of a thin fibrous capsule without inflammatory cell infiltration; resorption was usually more remarkable than that with materials implanted in mandibles.The results of this study suggest that the hardened cement is resorbable in vivo and is highly biocompatibile with living tissues.

A clinical study on relationship between mandibular reconstruction methods and postoperative course. Review of cases using miniplates and reconstruction plates.

1986年1月～1990年12月の間, 信州大学医学部歯科口腔外科において施行された下顎骨再建術にともなって, 金属製プレートが使用された26症例につき検討を加えた。26症例中22症例に対し下顎骨区域切除が, 4症例に対し半側切除が行なわれていた。また原疾患別には悪性腫瘍が19症例, 良性疾患が7症例であった。遊離骨移植, あるいは血管柄付骨移植・複合骨付皮弁等による下顎骨即時再建を行なった症例は7症例で, 同二次再建は9症例, そして再建用金属プレート単独での下顎骨再建は10症例であった。再建の成功率は, 即時再建群100%, 二次再建群77.8%であったが, 再建用金属プレート単独での再建群では40%と低かった。多くの失敗例で認められた術後合併症は, 術後感染 (9例) , 金属プレートの皮膚露出 (3例) , 金属プレートの脱離 (1例) などであった。

Clinical studies of the immediate reconstructive surgery following the radical resection of oral cancers.

1977年から1990年までの14年間に口腔癌54症例に対して56回の根治手術と種々の皮弁・筋皮弁 (64皮弁) を用いて即時再建を行い, これらの症例の臨床的観察を行った。一次症例は32例 (Stage II: 5例, Stage III: 8例, Stage IV: 19例) , 二次症例は22例であった。原発部位は舌が20例, 下顎歯肉が12例, 口底が10例, 頬粘膜と口峡咽頭が5例, 上顎歯肉と顎下腺が1例であった。病理組織型は扁平上皮癌が51例, 唾液腺癌が2例, 未分化癌が1例であった。切除範囲は原発部位と病期により様々であった。再建に用いた皮弁は大胸筋皮弁が31例, DP皮弁が18例, 広背筋皮弁が7例, 前腕皮弁が5例, 胸鎖乳突筋皮弁が2例であった。平均手術時間は8時間50分, 平均出血量は14939, 皮弁の完全生着率は71.4%であった。5年累積生存率は一次症例が51.7%, 二次症例が24.1%, 全症例では42.5%であった。これらの結果より口腔癌進展例において, 切除手術と即時再建の組み合わせは有効な治療法と思われたが, 今後の課題としては適確な治療方針の選択により二次症例を減少させること, 遠隔転移の防止に有効な化学療法の開発, 重複癌の早期発見, 良好な機能回復のための中咽頭の再建法, 生体材料の開発が重要と考えられた。