Our aim was to evaluate the clinical efficacy of computed tomography and coronectomy for preventing postoperative inferior alveolar nerve injury after impacted mandibular third molar surgery. Among the patients who visited Kawasaki Medical School Hospital between January 2009 and December 2010, 12 patients with high-risk signs of inferior alveolar nerve injury on panoramic imaging were examined for the extraction of impacted mandibular third molar by computed tomography (CT). CT examinations were performed in order to examine the relationship between the root apex of impacted mandibular third molar and inferior alveolar canal for 16 teeth. Based on the imaging findings,the patients were informed about treatment methods and their consent was obtained. We compared the CT and panoramic findings and discussed the relationship between the impacted third molar and the inferior alveolar nerve. Medical records were also examined for the presence of abnormal postoperative complications. 1) Interruption of the cortical white line of the inferior alveolar canal was identified in 13 panoramic radiographs, and bending of the inferior alveolar canal was observed in 2 panoramic 4) Pogrel MA, Lee JS, Muff DF:Coronectomy: a technique to protect the inferior alveolar nerve. J Oral Maxillofac Surg 62: 1447-1452, 2004 5) Renton T, Hankins M, Sproate C, McGurk M: A randomized controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars. Br J Oral Maxillofac Surg 43: 7-12, 2005 6) Hatano Y, Kurita K, Kuroiwa Y, Yuasa H, Ariji E: Clinical evaluations of coronectomy (intentional partial odontectomy) for mandibular third molars using dental computed tomography: a case-control study. J Oral Maxillofac Surg 67:1806-1814, 2009 7) 後藤新吾,栗田賢一,波多野裕子,黒岩裕一朗, 泉雅浩,有地榮一郎,久保勝俊,前田初彦:下顎 第三大臼歯歯冠部切除術後に歯根摘出に至った症 例の検討.日本口腔外科学会雑誌57:459-465, 2011 8) http://www.jsoms.or.jp/sns/uploads/fckeditor/file/IC/ IC01.doc(2011.10.18) 9) Ay S, Agar U, Bicakci AA, Kosger HH: Changes in mandibular third molar angle and position after unilateral mandibular first molar extraction. Am J Orthod Dentofacial Orthop 129: 36-41, 2006 10) Sencimen M, Ortakoglu K, Aydin C, Aydintug YS, Ozyigit A, Ozen T, Gunaydin Y: Is endodontic treatment necessary during coronectomy procedure? J Oral Maxillofac Surg 68: 2385-2390, 2010

Spindle cell carcinoma is a rare malignant tumour that shows biphasic proliferation of squamous cell carcinoma components and sarcomatoid components of spindle-shaped cells in the same tissue. In addition, cases that a malignant tumour of the head and neck region metastasizes to the thyroid gland are extremely rare. We report an extremely rare case that spindle cell carcinoma of the tongue metastasized to the thyroid gland. A 59-year-old female presented with a polypoid mass in the right margin of the tongue. Based on histopathological diagnosis of spindle cell carcinoma of clinical staging II, a partial glossectomy was performed. Thyroid mass appeared at 5 months after the surgery. She was diagnosis with thyroid gland cancer and a total thyroidectomy was performed. A histopathological diagnosis revealed thyroid gland metastasis. However, a thyroid tumour recurred in the neck at 4 months after the thyroid surgery. The tumour was untreatable, and the patient expired 13 months after the primary resection.

An 84-year-old woman was referred to the hospital complaining of a large movable and massive mass located on her lower lip, which was first noticed approximately five years previously. On examination, the mass was well-defined, elastic soft and measured 45 × 45 × 28 mm in size. The clinical diagnosis was a lipoma, and a complete excision was performed under general anesthesia. The histopathological diagnosis was a fibrolipoma. (Accepted on December 7, 2009)

Gingival cyst of the adult (GCA is a relatively uncommon developmental cyst. Recurrence is not expected following simple excision with minimal margins. A hitherto unreported observation of a case of GCA developing secondarily at the same site of the first excision and an additional discussion of the etiologic factors and differential diagnosis are presented.

A 26‑year‑old male was referred to our hospital complaining of an asymptomatic swelling of the left posterior maxilla. The patient's dental history indicated that his left maxillary third molar had been extracted approximately three years previously. At presentation radiography demonstrated a well‑defined 3.5 cm diameter radiolucency of the left maxilla. The lesion was enucleated and histopathological examination confirmed a diagnosis of unicystic ameloblastoma plexiform type (type 3b.

Pagophagia or ice eating is a particular expression of the more general phenomenon of pica and is closely associated with the development of iron deficiency anemia (IDA. The diagnosis of pagophagia and its treatment are not a common part of oral and maxillofacial practices. This article presents the first reported case of rapid recovery from prolonged pagophagia following treatment for IDA and temporomandibular joint (TMJ disorder accompanied by masked depression.

A 70‑year‑old man was referred to our department with the chief complaint of pain and swelling in the right posterior mandible. Panoramic radiography disclosed a large unilocular radiolucent lesion with distinct borders involving the right mandibular body and ramus extending from the second molar to the upper portion of the ramus. A complete excision was achieved by removing the tumor with the inferior alveolar nerve from the right mandible. Histologically Antoni‑A tissue was the predominant microscopic pattern but it occasionally alternated with Antoni‑B areas. Immunohistochemical staining for S‑100 proteins showed diffusely positive findings. An examination confirmed a diagnosis of an intraosseous schwannoma of the mandible.

Background Oral leukoplakia is a precancerous change developed in the oral mucosa, and the mechanism that oral leukoplakia becomes malignant through atypical epithelium is not known. Here we compared the β-catenin expression detected by immunohistochemical staining in the normal oral epithelium and in the oral leukoplakia with or without dysplasia. Results The normal oral epithelium showed β-catenin expression only in the cell membrane, but not in the nuclei. In the oral leukoplakia without dysplasia, 7 out of 17 samples (41%) showed β-catenin expression in the cell membrane, and 5 samples (29%) showed expression in the nuclei. In the oral leukoplakia with dysplasia, nuclear expression of β-catenin was shown in 11 out of 12 samples (92%). Incidence of nuclear β-catenin expression was significantly different between dysplasia and normal oral epithelium (P < 0.01), and also between oral leukoplakia with dysplasia and those without dysplasia (P < 0.01). Wnt3 expression was detected in the epithelial cell membrane or cytoplasm in oral leukoplakia where nuclear expression of β-catenin was evident, but not in epithelial cells without nuclear expression of β-catenin. Conclusion The components of canonical Wnt pathway, such as Wnt3, β-catenin, and cyclin D1, were detected, implying that this pathway is potentially involved in the progression of dysplasia in oral leukoplakia.

Metastatic oral tumors generally carry a poor prognosis. It is therefore important to consider the patient's quality of life (QOL) when planning treatment of metastatic oral lesions. In this article, we report a case of transverse colon adenocarcinoma that metastasized to the maxilla and cervical lymph nodes 1 year after colorectomy. A 64-year-old man underwent surgery for transverse colon adenocarcinoma in January 2005 and received preoperative chemotherapy followed by secondary surgery because metastases to the iliopsoas muscle appeared in May 2005. Because the patient's serum tumor marker levels increased again in October 2005 and he had swelling in his left maxillary gingiva, he visited our hospital in January 2006. At presentation, the carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) levels were 18.1 and 689.9 ng/ml, respectively. Histological examination of the gingival tumor revealed adenocarcinoma. Because distant metastasis was not detected in addition to the oral and neck lesions, we performed radical surgery of the oral and neck region. After surgery, the serum tumor marker levels of CEA and CA19-9 significantly decreased to 3.9 and 92.5 ng/ml, respectively. The patient is presently alive with no postoperative local recurrence or metastasis to other organs as of December 2006.

The synchronous occurrence of histologically distinct tumors in the same parotid gland is rare, withonly a frequency of 0.2 % based on a report by Turnbull and Frazell. We report a case of pleomorphic adenomaand Warthin's tumor that occurred simultaneously in the same parotid gland.A 55-year-old man presented with a painless swelling in the left parotid region, present for 9 years. The patientvisited our hospital at this time because of a recent increase in the size of the swelling. The mass in the superiorpart of the parotid gland was elastic hard and clearly demarcated. In contrast, the mass in the lower pole of parotidgland was elastic soft and indistinctly demarcated.We evaluated the tumors by 99mTc salivary gland scintigraphy, 67Ga scintigraphy, ultrasonography, parotidsialography, and computed tomographic scanning. We also performed an aspiration biopsy of the tumor in thelower pole of the parotid gland to make a preoperative diagnosis. The tumor in the lower pole of the parotid glandwas strongly suspected to be a Warthin's tumor, while the tumor in the superior part was considered to most likelybe a benign tumor. These tumors were resected by a superficial parotidectomy. As for the histopathologicaldiagnosis, the tumor from the lower pole was confirmed to be a Warthin's tumor, while the tumor in superior partturned out to be a pleomorphic adenoma.

The incidence of pulmonary thromboembolism (PTE) has been increasing, although it remains lower in Japan than in Western countries. We report a case of PTE after free flap reconstruction in a patient with left tongue cancer (T2N2bM0) treated in May 2004.We performed tracheostomy, hemiglossectomy, and neck dissection. The tongue defect was repaired with a free radial forearm flap using a microsurgical vascular anastomosis. Although antithrombolytic therapy with prostaglandin El was started during microsurgery, circulatory disorders of the free flap occurred 2 days after operation. Therefore, we tried removing the intravenous thrombus and performed re-anastomosis, followed by anticoagulant and thrombolytic therapy. However, total necrosis of the flap occurred 5 days after re-operation. We therefore discontinued the anticoagulant and thrombolytic therapy. The following day PTE developed, but we saved the patient's life by immediate treatment, administered by cardiologists and other specialists.Our experience indicates that preventative treatment such as low-dose unfractionated heparin and using elastic stockings or intermittent pneumatic compression until the patient can walk after surgery may be necessary when there is a high risk of PTE.

頸動脈浸潤癌の7例に頸動脈切除後の脳血流を術前に評価する目的で内頸動脈バルーン閉塞試験が行われた。患者の耐性が神経症状, 血管造影, 脳波, 3例は99mTc-HMPAO脳血流SPECTにより評価された。閉塞試験中, 6例は良好な側副血行を認め, 神経症状や脳波の変化も認めなかったが, 99mTc-HMPAO SPECTでは3例中1例に閉塞側の低灌流域が認められた。99mTc-HMPAO SPECT像で対称的な灌流を示した1例に内頸動脈永久閉塞が行われたが脳虚血合併症は起こらず, 閉塞後の123I-IMP SPECTによる脳血流量は40ml/100g/分以上であった。閉塞試験に耐えた6例中3例が頸動脈切除を受け, 2例は血行再建術は行わず, 1例に大伏在静脈移植が行われた。いずれも脳虚血合併症は生じなかった。内頸動脈バルーン試験閉塞下99mTc-HMPAO SPECTによる術前脳血流評価は頸動脈血行再建術の適応決定に有用であることを示唆している。

進展口腔癌切除後の舌, 口底, 中咽頭欠損を遊離組織移植術により再建した41例を対象として, 術後嚥下機能を評価し, 機能的再建術式および誤嚥防止策を検討した。遊離組織移植片は前外側 (内側) 大腿皮弁29例 (71%) , 橈側前腕皮弁5例, 腹直筋皮弁5例, 腓骨皮弁2例が用いられた。口腔舌半側および舌半側欠損の再建は残存舌運動を妨げない方針で, 前大腿皮弁, 腹直筋皮弁, 橈側前腕皮弁のような柔軟な大きな皮弁により再建し, 良好な嚥下機能の回復が得られた。舌亜全摘, 舌全摘後の欠損は大きな前外側大腿皮弁により再建され, 再建舌に膨隆を持たせるために表皮を削除した皮弁近位部が充填された。この再建を受けた5例中3例は高度の嚥下障害が後遺した。再建舌に膨隆を付加し, 舌の沈下を防止する再建術式が必要である。また誤嚥を防止するために喉頭挙上術を再建時に施行すべきである。軟口蓋中咽頭側壁合併欠損は前外側大腿皮弁により再建され, 皮弁の遠位部の脂肪を削除し, 薄くして軟口蓋を修復し, 表皮を削除した近位部は側壁に膨隆を持たせるために充填された。再建軟口蓋は残存軟口蓋と良く同調した運動を示した。この再建術式により良好な鼻咽腔閉鎖と嚥下機能が得られた。

舌根, 中咽頭側壁欠損を遊離組織移植術で再建した18症例の術後嚥下機能を摂取食物形態, 水飲みテスト, Videofluorography により評価し, その再建術式を検討した。舌切除範囲は口腔舌を含め舌根1/2以上, 同側の舌骨上筋群, 口底が切除された。中咽頭側壁は舌切除または下顎枝切除に合併切除された。舌根1/2欠損10例は中咽頭側壁を合併切除しても前大腿皮弁や腹直筋皮弁再建により良好な嚥下機能が得られた。舌根2/3+中咽頭側壁欠損3例は前大腿皮弁で再建しても, 誤嚥が後遺した。舌が温存された中咽頭側壁欠損5例は残存粘膜の縫縮が可能な切除範囲でも遊離皮弁再建の方が術後嚥下機能は良好であった。術後嚥下機能は舌根切除範囲の拡大と共に低下した。その原因は再建舌根部の容積不足による口腔咽頭閉鎖不全と舌骨上筋群広範切除に伴う喉頭挙上障害と考えられた。今後, 再建術式の改良と誤嚥防止術の併施を図る必要がある。

各種の遊離皮弁による舌, 口底再建19症例を対象として術後会話機能, 咀嚼機能, 嚥下機能を切除範囲別に評価し, 遊離皮弁再建術が術後機能に及ぼす影響を検討した。会話機能は切除範囲や遊離皮弁による影響が少なく, 咀嚼機能は切除範囲や皮弁よりも下顎再建に影響を受けた。嚥下機能は舌亜全摘型および中咽頭合併切除型で低下し, videofluorographyにより咽頭通過時間の延長および誤嚥を認めた。また咽頭通過時間の分析より前腕皮弁は前外側大腿皮弁や腹直筋皮弁よりも残存舌運動への影響が大きいことが示唆された。皮弁の選択は残存舌運動の保持と大きな欠損の充填効果が期待できる前外側大腿皮弁や腹直筋皮弁が適応する。

Cementifying fibroma is a relatively rare odontogenic tumor with a predilection for the jaw bone. We reported here 4 cases of cementifying fibroma we had recently encountered.The tumors of all 4 cases were surgically removed. Histopathological examination revealed that the tumorous lesions consisted of various amounts of fibrous tissues with extensive proliferation of cementum-like tissues.Therefore, the tumors were histopathologically diagnosed as cementifying fibromas. The prognosis of these cases are favorable with no sign of recurrence.