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 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.31, no.7, pp.1749-1754, 1985-07-20 (Released:2011-07-25)

参考文献数

38

被引用文献数

1 1

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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.He was free of disease during the follow-up period of 9 months.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 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

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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

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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

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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

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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

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

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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.