著者

小村 健 山下 知巳 柳井 智恵 竹内 洋介 鈴木 晴彦 嶋田 文之 和田 勝則

雑誌

頭頚部腫瘍 (ISSN:09114335)

巻号頁・発行日

vol.24, no.1, pp.50-55, 1998-03-25

被引用文献数

2

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.39, no.4, pp.445-451, 1993-04-20 (Released:2011-07-25)

参考文献数

18

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Mandibular reconstruction remains one of the most challenging problems for the head and neck surgeon. Various methods of mandibular reconstruction have been described, including free bone grafts, osteomyocutaneous flaps, free vascularized bone grafts, reimplantation of treated mandibles, and reconstruction using alloplastic materials with particulate cancellous bone and marrow grafts.This paper describes the author's experience using a Dacron-urethane mandibular mesh tray filled with particulate cancellous bone and marrow for mandibular reconstruction.Six patients underwent resection of the mandible for malignant tumors, 7 for benign tumors, and 1 for radiation osteomyelitis.Immediate reconstruction was performed in 7 patients, and 5 of the 7 were successful. Delayed reconstruction was performed in another 7 patients, and 5 of the 7 were successful. The overall success rate was 71%. Mandibular reconstruction was successfully accomplished even following radiotherapy in 4 of 6 patients. The majority of the failures occurred in the first 10 days following surgery and the major factor in failure seemed to be related to intraoperative wound infection.The Dacron-urethane mandibular mesh tray has the advantage of being malleable but stiff, and can be easily cut with scissors to fit the defect. The tray is radiolucent, faciliting follow-up examinations by routine roentgenograms and radionuclide scans. It can be used either before or after radiotherapy.This reconstructive procedure is not technically difficult and does not require expertise in microvascular surgery. In selected patients, this procedure may significantly contribute to cosmetic and functional improvement following radical surgery of the mandible.

著者

小村 健 和田 重人 小野 貢伸 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.42, no.6, pp.560-565, 1996-06-20

被引用文献数

2

---

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.<BR>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.<BR>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.<BR>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 鈴木 晴彦 竹内 洋介 原田 浩之 前田 顕之 嶋田 文之

出版者

Japan Society for Head and Neck Cancer

雑誌

頭頚部腫瘍 (ISSN:09114335)

巻号頁・発行日

vol.27, no.1, pp.49-54, 2001-03-25

被引用文献数

3 1

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舌全摘出例の中には術後の誤嚥を防止するために喉頭全摘出術を併施せざるをえない症例がある。今回, 舌全摘出例における喉頭保存の限界について舌周囲の合併切除範囲との関係から検討した。<br>舌全摘出例における喉頭保存の条件としては, 心肺機能が良好で, 喉頭保存に対するモチベーションが高いことに加え, 上喉頭神経が温存され, 下顎骨の連続性が確保あるいは再獲得され, 中咽頭切除が一側壁までに限局することが挙げられた。また喉頭保存例では喉頭挙上術, 喉頭形成術, 輪状咽頭筋切断術等の誤嚥防止策が有効であるが, 甲状舌骨筋神経の温存は喉頭挙上術を補完する上からも重要と考えられた。

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

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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 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 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

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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.