3 0 0 0 OA 側頸部後方より口角への貫通銃創の1例
- 著者
- 清水 正嗣 水城 春美 福山 義邦 松本 有史 河村 哲夫 柳沢 繁孝
- 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.37, no.7, pp.1380-1384, 1991-07-20 (Released:2011-07-25)
- 参考文献数
- 10
A case with fresh gunshot wound penetrating from the left lateral neck to the mouth angle, which was caused by pistol shooting during a conflict between gangs, was reported and discussed by us.The patient, a 41-year-old male, was shot probably with a 38-caliber revolver from behind. Its entrance was on the left rear of the neck, and the exit hole at the left mouth angle. The route through the body: the bullet passed inside of the mandible, where it caused a crashing fracture of the body in the molar region while breaking the lower prosthesis. But, he was very lucky that the important blood vessels and nerve bundles were not injured, although the route was very close to them. He was transported to our Dept. that same day and operated on under general anesthesia for removing foreign bodies, uniting and fixing the jaw fracture, and also for reconstructing the mouth angle, while we sanitized the wound and sutured the soft tissues at each place. At last, a tracheotomy was performed, to prevent suffocation from postoperative swelling. The progress after the operation was good, and he was discharged three weeks later. After 3 years he is now healthy and in prison.
臨床的には日常の診療において口腔前癌病変ならびに扁平上皮癌を有する患者の記録を行い,症例を重ねてきた.白板症における臨床所見と組織像との比較についてはdysplasiaの有無と発症部位との関連を調査したが,口腔に主として白板症の認められる頬粘膜,歯肉,舌の内では,舌が最もdysplasiaの発現し易い部位であることが本研究によって解明された.組織学的異型度と臨床視診型との関連については紅白斑型に異型を示す症例が目立って観察され,また,異型を示す症例ならびに多発性である症例に再発例が多い事が判明した。白板症が単発性であるか多発性であるかについては,その発症機序についても検索する必要があり,今後の課題の一つである。電気泳動法による分析に関しては等電点電気泳動法(IEF)とSDSポリアクリルアミド電気泳動法を用いてケラチンサブユニットの分析を行ってきたが,これらの分析では,泳動後のゲルを銀染色することにより感度の高い検出が行い得られ,小さな口腔内生検材料においても蛋白の検出が可能となった。しかしながら,口腔白板症ならびに扁平上皮癌組織よりClausenの方法他によって抽出したケラチン分画の分析ではケラチン以外にも数多くの蛋白が検出され,従来行われている二次元電気泳動のみによるケラチンサブユニットの検索法では正確なケラチンの同定が不可能と考えられ,ウエスタンブロッティングによるケラチンの同定が必要となった。現在,ケラチンに対するポリクロ-ナル抗体を用いてケラチンの同定が可能であるが,今後はモノクロ-ナル抗体による同定を行い,正確なサブユニットの構成を明らかにしたい。また,臨床的な予後に差異を生じさせる原因の解明についても,白板症ならびに扁平上皮癌は多様な形態,性質を有する事より,なお多くの生検材料の検索が必要であり,今後も継続していく方針である。
- 著者
- 島原 政司 有吉 靖則 今井 裕 水城 春美 嶋田 淳 古澤 清文 森田 章介 上山 吉哉
- 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.53, no.10, pp.594-602, 2007-10-20
- 参考文献数
- 20
- 被引用文献数
- 32 12
Bisphosphonates are used for the management of bone metastatic disease and hypercalcemia caused by malignancy, as well as the treatment of osteoporosis. Recently, a number of patients with bisphosphonate-associated osteomyelitis and osteonecrosis of the jaws have been reported in the English-language literature. This report describes patients with bisphosphonate-related osteomyelitis and osteonecrosis of the jaws in Japan. The subjects were enrolled using questionnaires sent to 239 institutions certified as training facilities by the Japanese Society of Oral and Maxillofacial Surgeons in 2006. Thirty patients (4 men and 26 women) from 18 different institutions (mean age at diagnosis, 66.9 years) were studied. As for local features, pain with or without swelling was the most common symptom and sign. The mandible was affected in 22 patients, the maxilla in 6, and both jaws in 2. Twenty patients received intravenous bisphosphonates, 8 received only oral bisphosphonates, and 1 received both types of treatment. The reasons for bisphosphonate treatment were bone metastasis from breast carcinoma (13 patients), multiple myelomas (6 patients), osteoporosis (8 patients), and hypercalcemia related to malignancy. More than 50 % of the patients underwent oral surgery including tooth extraction just before or during treatment with bisphosphonates, while 5 patients received no dental treatment. In addition to antibiotic therapy, surgery, including sequestrectomy and curettage, was performed. As for outcome, 8 of the patients were completely cured, while 17 patients remained under treatment at the time of this writing.