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 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

---

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

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

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

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.

著者

金田 多恵子 福田 仁一 迫田 隅男 久志 助義 岩井 貞雄 山田 長敬

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.25, no.5, pp.1112-1117, 1979

著者

橋爪 敦子 中川 洋一 石井 久子 小林 馨

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.50, no.1, pp.1-10, 2004-01-20

参考文献数

19

被引用文献数

7 3

---

We describe the preoperative use of limited cone beam computed tomography (CT) with a dental CT scanner for the assessment of mandibular third molars before extraction. Cone beam CT provides 42.7-mm-high and 30-mm-wide rectangular solid images, with a resolution of less than 0.2mm.<BR>The positional relationship between the mandibular third molars and the mandibular canal was examined by dental CT. Sixty-eight lower third molars of 62 patients whose teeth were superimposed on the mandibular canal on periapical or panoramic radiographs were studied. Dental CT scans clearly demonstrated the positional relationship between the mandibular canal and the teeth. The mandibular canal was located buccally to the roots of 16 teeth, lingually to the roots of 27 teeth, inferiorly to the roots of 23 teeth, and between the roots of 2 teeth. The presence of bone between the mandibular canal and the teeth was not noted in 7 of 16 buccal cases, 24 of 27 lingual cases, and 10 of 23 inferior cases on dental CT scans, suggesting that the cana was in contact with the teeth.<BR>Fifty-nine of the 68 mandibular third molars were surgically removed, and postoperative transient hypoesthesia occurred in 4 patients. Dental CT scans showed no bone between the mandibular canal and the teeth in all 4 patients. Hypoesthesia was not related to the bucco-lingual location of the mandibular canal or to the extent of bone loss between the canal and the teeth. However, hypoesthesia did not occur in patients with bone between the mandibular canal and the teeth. Thus, information on the distance between the canal and teeth on dental CT scans was useful for predicting the risk of inferior alveolar nerve damage.<BR>Because of its high resolution and low radiation dose, cone beam CT was useful for examination before mandibular third molar surgery.

著者

小林 晋一郎 木下 靱彦 本間 義郎 島崎 能理子 川畑 守 黒豆 照雄 志村 介三

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.28, no.6, pp.891-902, 1982

被引用文献数

1

著者

佐藤 直之 川辺 良一 海野 智 石川 好美 大村 進 水木 信之 藤田 浄秀 竹林 茂生

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.8, pp.677-681, 1995-08-20

被引用文献数

10

---

Color Doppler imaging findings were reviewed for 36 lymph nodes in 13 patients with oral cancer who underwent neck dissection. Seventeen lymph nodes were histologically diagnosed as metastatic and 19 as non-metastatic. Color flow was observed in 6 nodes, all of which were non-metastatic. None of the 17 metastatic lymph nodes had color flow. Al-though 13 of the 19 non-metastatic lymph nodes also had no detectable color flow, all of these nodes were less than 10mm in diameter.<BR>These results suggest that normal or inflammatory swollen lymph nodes have color flow detectable with color Doppler imaging, and that metastasis to these nodes leads to the loss of color flow. We conclude that color Doppler imaging facilitates the diagnosis of cervical lymph node matastasis.

著者

北村 旅人 今井 隆生 松尾 隆昌 阿部 厚 塚本 高久 栗田 賢一

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.46, no.8, pp.487-489, 2000-08-20

被引用文献数

3 1

---

Among 90 cases of partial Monosomy of the short arm of chromosome 9 that have been described in the literature, only 4 cases have been reported in Japan. We describe a new case associated with cleft palate. The patient was a 1-month-old girl. She came to our hospital for treatment of cleft palate in 1994. Because of her peculiar facial appearance, including slanted eyes, flat nasal bridge, and prominent forehead, we conducted a chromosome analysis, which revealed a partial monosomy of the short arm of chromosome 9 (9p-syndrome). At the age of 2.5 years, her physical development was favorable, and we performed palatoplasty with the patient under general anesthesia. She is being observed at the department of pediatrics and our department since the operation.

著者

森崎 重規 蔵本 千夏 木津 康博 森本 光明 外木 守雄 山根 源之

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.54, no.3, pp.206-209, 2008-03-20

被引用文献数

1 1

---

Aplastic anemia is a blood disease characterized by pancytopenia due to a decrease in hematopoieticstem cells. We describe a patient who presented with submucosal hematoma of the tongue and was given a diagnosisof aplastic anemia. The patient was a 24-year-old man who visited our department because of a hematoma ofthe tongue. Two days before presentation, a dark reddish tumor with a diameter of 1-2mm was noticed at the leftmargin of the tongue. At presentation, a 20×11mm dark reddish elevation was seen at the left lateral margin ofthe tongue. On the basis of the above course and findings, a hematoma was diagnosed, and blood tests were conducted.A blood disease was suspected. The white blood cell count was 500/μl, the red blood cell count was320×104/μl, the Hb was 11.2g/dl, the Ht was 31.1%, the MCV was 96.9 fl, the MCH was 35.0 pg, the MCHCwas 36.1%, and the platelet count was 0.3×104/μl, indicating pancytopenia. A submucosal hematoma of thetongue accompanied by pancytopenia was diagnosed, and detailed examinations were performed at the hematologydepartment. A bone marrow puncture test showed that the bone marrow cell count was 4, 000/μl and themegakaryocyte count was 0/μl; aplastic anemia was thus diagnosed, and the patient received immunosuppressivetherapy. Even when the onset is gradual, aplastic anemia can be lethal if detection is late and appropriate therapyis not administered. Therefore, if the regional cause of an oral hematoma is not clear, close follow-up is necessary.If systemic factors are suspected, blood tests should be promptly performed.