Yoshiyuki Tsuchiya

Angioleiomyoma of the cheek: a case report.

Angioleiomyoma is a form of subcutaneous vascular leiomyoma that usually occurs in the extremities. Leiomyoma of the oral cavity represents only 0.4% of soft tissue neoplasms and 0.06% of leiomyomas. Isolated cases of angioleiomyoma have been reported in the knee and lower thigh, gastrointestinal tract, genital and renal tract, and brain. Histopathologic examination by biopsy is necessary to establish a diagnosis, and immunohistochemical staining, along with conventional hematoxylin-eosin staining, is important. The differential diagnosis includes hemangioma and angiosarcoma. At present, surgical resection is the standard therapy for leiomyoma, and recurrence is extremely rare. We report a rare case of angioleiomyoma of the cheek in a 45-year-old man. The postoperative course was uneventful, without complications.

Management of a Brain Abscess Presumably Caused by Radiation Osteomyelitis of the Mandible

In this clinical report, we present the management of a brain abscess that was presumed to be caused by radiation osteomyelitis of the mandible. The patient underwent chemoradiotherapy for oropharyngeal carcinoma on the left side at the Department of Otolaryngology of our hospital in 2000. Local recurrence or metastasis did not occur post-treatment. In January 2009, the patient was diagnosed with radiation osteomyelitis of the mandible on the left side, complicated by a pathologic fracture. In July 2011, numbness occurred in the left upper extremity and the patient was transferred to the emergency center of our hospital. A computed tomography scan showed a tumor lesion in the brain that was diagnosed as a brain abscess by magnetic resonance imaging. Neurosurgeons performed burr hole drainage of the abscess, followed by administration of antibiotics. Although impaired fine movements of the left hand remain, progress has been relatively favorable with no recurrence of osteomyelitis or brain abscess post-surgery.

Relationship Between Oral Perception and Habitual Chewing Side for Bare Bone Graft With Dental Implants After Mandibular Reconstruction.

Objective:The purpose of this study was to investigate the relationship between habitual chewing side and perception of the oral mucosa following reconstruction with dental implants. Study Design:Five patients comprised 2 males and 3 females, with ameloblastoma in 2 patients, odontogenic myxoma in 2 patients, and oral squamous cell carcinoma in 1 patient. They were treated using mandibular reconstruction with bare bone graft after segmental resection of the mandible. Perception (tactile, warm, and cold) was measured at 8 points (chin, lower lip, gingiva, and lateral edge of the tongue, bilaterally). Habitual chewing side was evaluated using a computerized index, the first chewing cycle, and a question on chewing. Results:Perception on resected sides was improved at all measurement points for tactile and cold sensitive evaluation, although sensitivities on the resected side remained below the normal range. In the relationship between habitual chewing side and implanted prostheses in reconstructed bone, the chewing side was the resected side in 2 of the 5 patients. When those 2 patients underwent prosthesis implantation after removal of denture, the chewing side changed from the nonresected side to the resected side. Implant prostheses on resected side were suggested to contribute to masticatory function. Perception in those patients was incomplete but was improved compared with other patients. When prosthesis implantation is performed on the reconstructed side, the resected side may become the habitual chewing side. Conclusions:Recovery of perception can influence acquisition of the habitual chewing side.

Evaluation of postoperative changes in vascularized iliac bone grafts used for mandibular reconstruction

Vascularized iliac bone grafts are used for mandibular reconstruction, but the factors affecting graft maintenance are unknown. This study explored the postsurgical changes in vascularized iliac bone grafts in patients who had undergone mandibular reconstruction after segmental resection. The study involved 24 patients (16 men and eight women) with oral tumours or osteoradionecrosis. Thirteen patients required bare bone grafting (BBG) and 11 patients required reconstruction with soft tissue coverage (six with a skin paddle and five with direct closure). The bone graft maintenance rate (with regard to the height of the centre of the graft) was calculated immediately after surgery and at 3, 6, 12, 24, and 36months after surgery. The maintenance rate was significantly lower in the BBG group than in the soft tissue coverage group at 3, 6, 12, 24, and 36months, and in those who were fitted with dentures compared to those who were not at 6, 12, 24, and 36months. Local infection also influenced the maintenance rate, but not significantly so. These findings indicate that the reconstruction technique and denture use can affect the bone graft maintenance rate after mandibular reconstruction with vascularized iliac bone grafts.

Influence of a dosing-time on toxicities induced by docetaxel, cisplatin and 5-fluorouracil in patients with oral squamous cell carcinoma; a cross-over pilot study

ABSTRACT Docetaxel, cisplatin plus fluorouracil (DCF) regimen is a useful chemotherapy, but is sometimes withdrawn due to severe adverse effects (AE). In this study, we examined whether the chronotherapy of DCF regimen could reduce the drugs-induced toxicities in clinical practice. Patients with oral squamous cell carcinoma were enrolled. Chemotherapy started at 10:30 (Morning-dosing) or 18:30 (Evening-dosing) for 5 days by a cross-over design. AE were assessed for 14 days after an initiation of each dosing. The grades of nausea, vomiting and neutropenia were smaller during Evening-dosing than during Morning-dosing. These data suggest that the chrono-chemotherapy might provide a merit for reducing the DCF regimen-related severe AE.

Limitations of Fluoro-2-deoxy-D-glucose—Positron Emission Tomography for Metastatic Neck Disease Secondary to Oral Squamous Cell Carcinoma

Abstract Objective: The objectives of this study were to evaluate the efficacy and limitations of fluoro-2-deoxy- D-glucose—positron emission tomography for metastatic neck disease secondary to oral squamous cell carcinoma. This study specifically examined the limitations of the procedure. Materials and Methods: From April 2004 to October 2007, 35 patients with oral squamous cell carcinoma underwent computed tomography, ultrasound, and fluoro-2-deoxy-D-glucose—positron emission tomography before treatment with neck dissection. After neck dissection, the results of computed tomography/ultrasound and positron emission tomography imaging were correlated with the histopathological findings of the cervical lymph nodes. Results: Positron emission tomography of the cervical lymph nodes was positive for 20 patients, 16 of who were demonstrated to have metastases on histopathological examination. Of the 4 falsepositive results, 3 were reactive lymphadenitis and 1 was sarcoidosis. Positron emission tomography was negative for 15 patients. Two of these patients had false-negative results, as metastatic disease was found at neck dissection. In 1 patient, the metastatic lymph node was largely keratinised, while micrometastasis was evident in the other patient. Pathological findings were compared with imaging results to determine the relative efficacies of positron emission tomography (accuracy, 82.9%; sensitivity, 88.8%; specificity, 76.5%), computed tomography (accuracy, 85.7%; sensitivity, 88.8%; specificity, 82.4%), and ultrasound (accuracy, 88.6%; sensitivity, 88.8%; specificity, 88.2%). There were no significant differences on statistical analysis. Conclusion: Positron emission tomography appears to have significant potential for the detection of lymph node metastasis. However, fluoro-2-deoxy-D-glucose—positron emission tomography should not be used as the sole method of imaging for initial investigation of oral squamous cell carcinoma and cervical lymph node metastasis. The surgical management of neck lymph node metastasis should not be based on fluoro-2-deoxy-D-glucose—positron emission tomography findings alone. Use of other imaging modalities in addition to fluoro-2-deoxy-D-glucose—positron emission tomography should increase the diagnostic accuracy over fluoro-2-deoxy-D-glucose—positron emission tomography alone.

Orthodontic and Surgical Management for Osteoma of the Mandibular Condyle causing Facial Asymmetry and Malocclusion

Abstract This report is of a 43-year-old woman with osteoma of the mandibular condyle causing facial asymmetry and malocclusion. Preoperative orthodontic treatment was performed after a clinical diagnosis of benign tumour of the left mandibular condyle was made. After 9 months of orthodontic treatment, condylectomy was performed under general anaesthesia. Histopathological examination revealed an osteoma. Postoperative orthodontic treatment was performed for 8 months, and the postoperative course has been favourable. The facial asymmetry and malocclusion have improved.