著者

小村 健 戸塚 靖則 柴原 孝彦 大関 悟 長尾 徹 原田 浩之

雑誌

日本歯科医学会誌 = Journal of the Japanese Association for Dental Science : JJDS (ISSN:0286164X)

巻号頁・発行日

no.25, pp.54-62, 2006-03-31

被引用文献数

9

著者

小村 健 武宮 三三

出版者

社団法人 日本口腔外科学会

雑誌

日本口腔外科学会雑誌 (ISSN:00215163)

巻号頁・発行日

vol.30, no.9, pp.1360-1368, 1984-09-20 (Released:2011-07-25)

参考文献数

22

被引用文献数

2 3

---

Reestablishment of mandibular continuity following radical surgery for oral cancer has been a challenging task to the head and neck surgeon. Treated autografts such as autofrozen or irradiated bone have been used for primary reconstruction of the mandible.The first 14 consecutive cases in which a mandibular defect was immediately reconstructed with a boiled autogenous mandible are reviewed. The defect consisted of horizontal ramus alone in 5 cases and symphysis with one or both rami in 9. The resected segment of mandibular bone was dissected free of the gross cancer, shaved and boiled in water for fifteen minutes. The treated bone was replanted with internal fixation, then intraoral and surrounding soft tissue defects were reconstructed with pectoralis major or latissimus dorsi myocutaneous flap. It is essential to the success of this procedure that the boiled autograft is enveoped with the muscle of the myocutaneous flap and all dead space is eliminated. The follow-up period ranged from 2 months to 1 year and 7 months, with a 65% success rate. There has been no tumor recurrence originating in the boiled bone. Radiographic examination of reimplanted bone revealed a gradual absorption process, but in some cases showed evidence of neo-osteogenesis at the contiguous area.Primary reconstruction of mandible with reimplantation of the boiled autogenous bone is distinguished by its ease and is a reasonable alternative in cosmetic and functional restoration.

著者

小村 健 武宮 三三 嶋田 文之

出版者

社団法人 日本口腔外科学会

雑誌

日本口腔外科学会雑誌 (ISSN:00215163)

巻号頁・発行日

vol.32, no.2, pp.303-310, 1986-02-20 (Released:2011-07-25)

参考文献数

19

---

Carcinoma of the parotid gland with extracapsular extension and recurrent carcinoma of the gland, which is frequently much more advanced than is clinically discernible, are most difficult and challenging problems to treat.Four patients underwent aggressive radical surgery to achieve adequate margins. In addition to radical parotidectomy and neck dissection, surgery included resection of the masseter muscle, medial and lateral pterygoid muscles, temporal muscle, skin, mandible, temporal bone and other involved structures such as parapharyngeal space.In this series, one tumor was previously untreated and the remaining 3 were recurrent after initial surgery. Histologic type of the tumors was carcinoma in pleomorphic adenoma in 2 patients, adenoid cystic carcinoma in 1, and high-grade mucoepidermoid carcinoma in 1. Two of the recurrent tumors had become more highly malignant than the initial tumors.Histopathologically skin overlying the parotid gland was involved in 2 patients, masticatory muscles in 3, capsule of the temporomandibular joint in 1 and parapharyngeal space in 1. No bony involvement was revealed in the surgical specimens. These histologic findings were satisfactorily correspondent to those of the preoperative CT scan. Nodal involvement of the tumor was histologically confirmed in 3 patients, and metastatic nodes spread in the deep jugular chain from the base of the skull to the middle jugular portion and the spinal accessory chain. In addition to the direct extension of the primary tumor, these nodal findings demanded the dissection of the parapharyngeal space in conjunction with the resection of ascending ramus of the mandible.Three of 4 radically parotidectomized patients were alive with no evidence of disease from 6 to 28 months postoperatively. One patients died of local recurrence 29 months after the operation.

著者

小村 健 武宮 三三

出版者

Japanese Society of Oral and Maxillofacial Surgeons

雑誌

日本口腔外科学会雑誌 (ISSN:00215163)

巻号頁・発行日

vol.31, no.7, pp.1749-1754, 1985

被引用文献数

1 1

---

A 56 year-old male patient with adenoid cystic carcinoma of the right sublingualgland origin was reported. In this case, extensive local resection of the tumor including the dissection of the parapharyngeal space along the lingual and hypoglossal nerves was carried out in combination with radical neck dissection. Surgical treatment was followed by 60 Gy of radiotherapy.<BR>He was free of disease during the follow-up period of 9 months.<BR>Adenoid cystic carcinoma arising in the sublingual gland accounted for 35 cases reported in the literature for the period of 1930-1984.

著者

小村 健 原田 浩之 前田 顕之

雑誌

日本口腔腫瘍学会誌 = Journal of Japan Society for Oral Tumors (ISSN:09155988)

巻号頁・発行日

vol.12, no.4, pp.391-395, 2000-12-15

被引用文献数

1

著者

小村 健 和田 重人 小野 貢伸 嶋田 文之

出版者

社団法人 日本口腔外科学会

雑誌

日本口腔外科学会雑誌 (ISSN:00215163)

巻号頁・発行日

vol.42, no.6, pp.560-565, 1996-06-20 (Released:2011-07-25)

参考文献数

20

被引用文献数

1

---

In squamous cell carcinomas of the oral cavity, spinal accessory lymph node (SALN) metastasis develops infrequently, and the prognosis of the patients with SALN metastasis is extremely poor.In this paper, patients with SALN metastasis of squamous cell carcinomas of the oral cavity were studied retrospectively. The SALN metastasis was histopathologically confirmed in 9 (5.0%) of 179 patients who underwent radical or modified radical neck dissection. The primary sites of their tumors were the tongue in 6 patients, the lower gingiva in 2, and the buccal mucosa in 1. The risk of SALN metastasis was related to the tumor spread into the oropharynx and the differentiation of the tumor, but not related to the T stage. In the patients with SALN metastasis, the mean total number of involved nodes on the affected side of the neck was 9.4. All of these patients had metastases in multiple groups of neck lymph nodes, and the majority had metastases in the upper and middle jugular groups of nodes. The mean number of involved SALNs was 2.0, and the mean size of these nodes was 0.52 cm in diameter.The outcome of treatment in the patients with SALN metastasis was poor: 1 patient was alive with no evidence of disease, and 8 patients died of disease with an average duration of survival of 8.0 months after neck dissection.To improve the prognosis of patients with SALN metastasis, both postoperative irradiation to the neck and intensive adjuvant chemotherapy should be employed.

著者

小村 健 武宮 三三 牧野 修治郎 嶋田 文之

出版者

社団法人 日本口腔外科学会

雑誌

日本口腔外科学会雑誌 (ISSN:00215163)

巻号頁・発行日

vol.38, no.4, pp.604-614, 1992-04-20 (Released:2011-07-25)

参考文献数

31

---

A retrospective review of 6 patients with adenoid cystic carcinoma (ACC) of the submandibular gland treated between 1978 and 1991 was presented. Two patients who underwent aggressive surgery were disease-free, local control failed in 2 patients, and pulmonary metastasis developed in 2 patients without locoregional disease.This study supports the following conclusions:1. The perimeters of ACC are always more extensive than they appear to be clinically, because ACC has a strong tendency to invade the perineural space and extend for long distance.2. In preoperative diagnosis, aspiration cytology is essential for accurate diagnosis. Diagnostic imagings such as sialography, X-ray CT and MRI are helpful in detecting the size and extent of the tumor. RI study is indispensable in detecting the perineural spread3. Surgery is the treatment of choice, and it should be as extensive as possible, with a wide margin of healthy tissue. Radiation therapy, although not curative, plays an important role in prolonging survival and pain relief.4. ACC is characterized by slow growth, frequent recurrence, and systemic spread even after long-term survival without disease, therefore adjuvant chemotherapy should be taken into consideration.

著者

小村 健 牧野 修治郎 小野 貢伸 和田 重人

雑誌

日本口腔科学会雜誌 (ISSN:00290297)

巻号頁・発行日

vol.45, no.1, pp.72-79, 1996-01-10

被引用文献数

8

著者

小村 健 原田 浩之 前田 顕之

出版者

一般社団法人 日本口腔腫瘍学会

雑誌

日本口腔腫瘍学会誌 (ISSN:09155988)

巻号頁・発行日

vol.12, no.4, pp.391-395, 2000-12-15 (Released:2010-05-31)

参考文献数

7

被引用文献数

3 3

---

顎関節部の悪性腫瘍は極めてまれであり, 顎関節に原発するもの, 周囲組織に発生し顎関節に進展するもの, および顎関節に転移するものに大別される。症状は他の顎関節疾患に類似しているが, 進行は急速である。診断には詳細な病歴聴取, 視診, 触診, CT, MRI, 99mTcや67Gaシンチなどの画像診断が必須であり, 確定診断には生検ないし細胞診を必要とする。その中で超音波ガイド下穿刺吸引細胞診は有用である。治療は, 原発性腫瘍では拡大手術が第一選択となり, 経耳下腺的アプローチが有用である。進展性や転移性腫瘍では原発腫瘍の状況により放射線治療, 化学療法あるいは手術を選択し, 転移性腫瘍でもQOLの向上のための手術を検討すべきである。

著者

小村 健 武宮 三三 牧野 修治郎 嶋田 文之

出版者

Japanese Society of Oral and Maxillofacial Surgeons

雑誌

日本口腔外科学会雑誌 (ISSN:00215163)

巻号頁・発行日

vol.38, no.4, pp.604-614, 1992

被引用文献数

2

---

A retrospective review of 6 patients with adenoid cystic carcinoma (ACC) of the submandibular gland treated between 1978 and 1991 was presented. Two patients who underwent aggressive surgery were disease-free, local control failed in 2 patients, and pulmonary metastasis developed in 2 patients without locoregional disease.<BR>This study supports the following conclusions:<BR>1. The perimeters of ACC are always more extensive than they appear to be clinically, because ACC has a strong tendency to invade the perineural space and extend for long distance.<BR>2. In preoperative diagnosis, aspiration cytology is essential for accurate diagnosis. Diagnostic imagings such as sialography, X-ray CT and MRI are helpful in detecting the size and extent of the tumor. RI study is indispensable in detecting the perineural spread<BR>3. Surgery is the treatment of choice, and it should be as extensive as possible, with a wide margin of healthy tissue. Radiation therapy, although not curative, plays an important role in prolonging survival and pain relief.<BR>4. ACC is characterized by slow growth, frequent recurrence, and systemic spread even after long-term survival without disease, therefore adjuvant chemotherapy should be taken into consideration.

著者

小村 健 嶋田 文之 奥村 一彦 柳井 智恵 山下 知巳

出版者

Japanese Society of Oral and Maxillofacial Surgeons

雑誌

日本口腔外科学会雑誌 (ISSN:00215163)

巻号頁・発行日

vol.43, no.5, pp.410-412, 1997-05-20

被引用文献数

2

---

A 58-year-old man with benign lympohoepithelial lesions in the right submandibular and accessory parotid glands is reported.<BR>The patient had no signs or symptoms other than tumors in the right submandibular and accessory parotid glands. He underwent removal of the tumors under the diagnosis of a submandibular gland tumor with cheek tumors. Histological examination of the surgical specimens revealed loss of acinar tissue with lymphocytic cell infiltration. Lymphoid follicles and epimyoepithelial islands were also found in the lymphoid tissues, but no neoplastic changes were evident in the specimens. Based on these findings, all tumors were histopathologically diagnosed as benign lymphoepithelial lesions.<BR>There has been no evidence of recurrence or other systemic diseases as of 34 months after surgery.

著者

小村 健

出版者

口腔病学会

雑誌

口腔病学会雑誌 (ISSN:03009149)

巻号頁・発行日

vol.69, no.4, pp.245-250, 2002-12-30 (Released:2010-10-08)

参考文献数

37

著者

小村 健

雑誌

口腔病学会雑誌 (ISSN:03009149)

巻号頁・発行日

vol.69, no.4, pp.245-250, 2002-12-30

著者

小村 健

出版者

Japanese Society of Oral and Maxillofacial Surgeons

雑誌

日本口腔外科学会雑誌 (ISSN:00215163)

巻号頁・発行日

vol.41, no.7, pp.593-610, 1995-07-20

被引用文献数

16 4

---

The parapharyngeal space is frequently invaded by head and neck cancer throughdirect extension, lymph node metastasis, and neural spread.<BR>"Parapharyngeal dissection" is a method for en bloc resection of theparapharyngealspace.<BR>To clarify the incidence, pattern, and risk factors of parapharyngeal involvement, 75 pa-tients (Stage II: 8, Stage lII: 22, Stage N: 45) who underwent parapharyngeal dissection inconjunction with ablation of the primary tumor and radical neck dissection were studiedclinicopathologically. In addition, the clinical usefulness of parapharyngeal dissection wasevaluated.<BR>The results were as follows:<BR>1. Tumor involvement of the parapharyngeal space was histologically confirmed in 46 pa-tients (61.3%). The primary sites of their tumors were the oral cavity in 27 patients (61.3%), the oropharynx in 9 (60.0%), the major salivary glands in 7 (50.0%), and othersites in 3 (100%).<BR>2. The histologic patterns of the parapharyngeal involvement were direct extension of theprimary tumor in 24 patients, nodal involvement in 8, neural spread in 3, direct exten-sion combined with nodal metastasis in 10, and nodal involvement combined with neural spread in 1.<BR>3. The risk of direct extension was significantly related to the T category, clinical stage, growth pattern, depth of invasion, and lymphatic invasion of the primary tumor.<BR>4. There were six routes of direct extension of the tumor into the parapharyngeal space: anteromedial inferior, anteromedial superior, medial central, anterolateral, postero-lateral, and inferior.<BR>5. Nodal spread was histologically observed in the parapharyngeal nodes, retropharyngeal nodes, and the extended nodes of Kiittner.<BR>6. The risk of nodal involvement was significantly related to the clinical stage of the tumor.<BR>7. Neural spread occurred via the lingual and hypoglossal nerves, and the risk of spread wasrelated to perineural invasion by the primary tumor.<BR>8. Based on X-ray CT scans perfomed preoperatively in 69 patients, direct extension was cor-rectl ydiagnosd in 73.9%, nodal involvement in 98.6%, and neural spread in 0 %.<BR>9. The 5-year locoregional control rate was 82.0% in this series, and 77.4% in patients withhistogically positive parapharyngeal involvement. The cause-specific 5-year survivalrate was 66.1% in this series, and 56.9% in patients with histologically provenparapharyngeal involvement. These results suggested that parapharyngeal dissection wasery useful in the management of patients with parapharyngeal involvement.

著者

小村 健 原田 浩之 島本 裕彰 竹内 洋介 林崎 勝武

雑誌

頭頚部腫瘍 (ISSN:09114335)

巻号頁・発行日

vol.29, no.1, pp.34-40, 2003-03-25

被引用文献数

2

著者

小村 健 原田 浩之 島本 裕彰

出版者

一般社団法人 日本口腔腫瘍学会

雑誌

日本口腔腫瘍学会誌 (ISSN:09155988)

巻号頁・発行日

vol.22, no.2, pp.61-68, 2010-06-15 (Released:2011-10-20)

参考文献数

17

被引用文献数

3 4

---

現在,下顎再建には金属プレート,遊離骨,有茎の骨筋皮弁,血管柄付き骨皮弁が用いられている。こうした中,血管柄付き骨皮弁は成功率が高いこと,骨量に制限がないこと,理想的な形態付与が可能である等,多くの利点を有している。1995年3月から2006年4月の間に遊離血管柄付き骨により下顎再建を施行した57例,59再建について検討した。下顎骨切除に至った原疾患は悪性腫瘍44例,良性腫瘍10例,放射線性下顎骨壊死3例で,Boyd分類による下顎骨欠損はL型が74.6%,軟組織欠損はm型が81.4%と多くを占めた。59再建中,58再建は即時再建であり,1再建のみが二次再建であった。骨皮弁は欠損部の形状と患者の要望とから選択し,16腓骨皮弁,43肩甲骨皮弁を用いた。下顎骨形態付与のために14骨弁に1部位の骨切り,3骨弁に2部位の骨切りを加えた。16腓骨皮弁再建例では,13骨皮弁は生着したが,2皮弁は部分壊死,1皮弁は全壊死を来した。一方,43肩甲骨皮弁再建例では,41骨皮弁が生着し,2骨皮弁が部分壊死を来した。術後の平均開口量は4.1cm,インプラント・義歯装着率は31.6%,常食摂取率は68.4%,顔貌満足率は85.4%であった。以上の結果から,下顎再建には血管柄付き骨が第一選択になるものと判断された。

著者

小村 健

出版者

社団法人 日本口腔外科学会

雑誌

日本口腔外科学会雑誌 (ISSN:00215163)

巻号頁・発行日

vol.41, no.7, pp.593-610, 1995-07-20 (Released:2011-07-25)

参考文献数

75

被引用文献数

1 4

---

The parapharyngeal space is frequently invaded by head and neck cancer throughdirect extension, lymph node metastasis, and neural spread.“Parapharyngeal dissection” is a method for en bloc resection of theparapharyngealspace.To clarify the incidence, pattern, and risk factors of parapharyngeal involvement, 75 pa-tients (Stage II: 8, Stage lII: 22, Stage N: 45) who underwent parapharyngeal dissection inconjunction with ablation of the primary tumor and radical neck dissection were studiedclinicopathologically. In addition, the clinical usefulness of parapharyngeal dissection wasevaluated.The results were as follows:1. Tumor involvement of the parapharyngeal space was histologically confirmed in 46 pa-tients (61.3%). The primary sites of their tumors were the oral cavity in 27 patients (61.3%), the oropharynx in 9 (60.0%), the major salivary glands in 7 (50.0%), and othersites in 3 (100%).2. The histologic patterns of the parapharyngeal involvement were direct extension of theprimary tumor in 24 patients, nodal involvement in 8, neural spread in 3, direct exten-sion combined with nodal metastasis in 10, and nodal involvement combined with neural spread in 1.3. The risk of direct extension was significantly related to the T category, clinical stage, growth pattern, depth of invasion, and lymphatic invasion of the primary tumor.4. There were six routes of direct extension of the tumor into the parapharyngeal space: anteromedial inferior, anteromedial superior, medial central, anterolateral, postero-lateral, and inferior.5. Nodal spread was histologically observed in the parapharyngeal nodes, retropharyngeal nodes, and the extended nodes of Kiittner.6. The risk of nodal involvement was significantly related to the clinical stage of the tumor.7. Neural spread occurred via the lingual and hypoglossal nerves, and the risk of spread wasrelated to perineural invasion by the primary tumor.8. Based on X-ray CT scans perfomed preoperatively in 69 patients, direct extension was cor-rectl ydiagnosd in 73.9%, nodal involvement in 98.6%, and neural spread in 0 %.9. The 5-year locoregional control rate was 82.0% in this series, and 77.4% in patients withhistogically positive parapharyngeal involvement. The cause-specific 5-year survivalrate was 66.1% in this series, and 56.9% in patients with histologically provenparapharyngeal involvement. These results suggested that parapharyngeal dissection wasery useful in the management of patients with parapharyngeal involvement.

著者

小村 健

雑誌

口腔病学会雑誌 (ISSN:03009149)

巻号頁・発行日

vol.68, no.4, 2001-12-30

被引用文献数

4

著者

小村 健 鈴木 晴彦 竹内 洋介 原田 浩之 幡野 和男 戸川 貴史

雑誌

頭頚部腫瘍 (ISSN:09114335)

巻号頁・発行日

vol.27, no.3, pp.663-669, 2001-11-25

被引用文献数

4

著者

小村 健

出版者

Japanese Society of Oral and Maxillofacial Surgeons

雑誌

日本口腔外科学会雑誌 (ISSN:00215163)

巻号頁・発行日

vol.41, no.9, pp.759-766, 1995-09-20

被引用文献数

12 2

---

To clarify both the mechanism of parapharyngeal involvement of head and neck cancers and the clinical usefulness of parapharyngeal dissection, the routes of lymphatic flow from the oral cavity and oropharynx to the parapharyngeal space were studied using activated carbon particles CH40.<BR>The following results were obtained:<BR>1. Lymphatic flow from the posterior portion of the oral cavity and that from the oropharynx reach the parapharyngeal space through lymphatic channels in the submucosa.<BR>2. Among 6 routes of direct parapharyngeal spread of head and neck cancers, the anteromedial inferior, anteromedial superior, medial central, and anterolateral routes were found to have direction-specific routes of lymphatic flow. The flow of the former 3 routes is high, and that of the later route is low. These routes of lymphatic flow were considered to be responsible for the frequent spread of cancers into the parapharyngeal space by direct extension.<BR>3. Lymphatic flow to the parapharyngeal space drains not only into the node of Kuttner but also into the parapharyngeal and retropharyngeal nodes through lymphatic vessels in the parapharyngeal space.<BR>4. Anatomically, these findings suggest that parapharyngeal dissection is very useful in the management of cancers that involve the parapharyngeal space.