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高齢者の摂食・嚥下機能を考える上では,加齢変化による摂食・嚥下機能の予備力低下を考慮する必要がある.特に,加齢による中咽頭拡大という器質的な変化は,咽頭残留の増加などの機能的変化の一因となると考えられている.一方,高齢者の口腔には,上下顎に全部床義歯が装着されていることが多く,義歯の装着と撤去は下顎位を偏位させて,中咽頭の形態に影響を及ぼすと推察されるが,その詳細は明らかになっていない.そこで本研究では,全部床義歯の装着状況が中咽頭の三次元的形態に与える影響を明らかにすることを目的とした.対象は,全部床義歯装着者17名(平均年齢72.9±9.2歳)とした.上下顎全部床義歯装着(上下顎あり),上顎全部床義歯装着(上顎のみ),上下顎全部床義歯非装着(上下顎なし)の3条件において,CBCTによる撮影を行い,三次元解析を用いて1)下顎の位置(FMA),2)舌骨の位置,3)中咽頭の幅径を測定し,各条件間で比較検討を行った.FMAは,上下顎ありに比べて,他の2条件では有意に減少した.舌骨の位置は,上下顎なしでは,上下顎ありに比べ有意に上方また前方に移動した.中咽頭の前後径は,喉頭蓋谷最深点の高さにおいて,上下顎なしでは,他の2条件に比べ有意に増加した.左右径は,上下顎なしでは,上下顎ありに比べ舌背と舌根の境界の高さ,および喉頭蓋谷最深点での高さにおいて有意に増加した.全部床義歯の撤去は,下顎を前上方に回転させ,舌骨を前上方に牽引する.その結果,舌根部が前方移動し,中咽頭の下部が前後左右方向に拡大したものと考えられた.義歯の撤去は,加齢によって生じた中咽頭の拡大という予備力低下のさらなる増悪に通じ,嚥下の際により大きな筋の収縮を必要とさせると考えられた.摂食・嚥下障害を有する高齢者は義歯が必要にも関わらず装着していないことも多く,本研究の結果より,義歯装着の新たな重要性が示された., In rehabilitation for dysphagia in the elderly, it is necessary to take into account both age-related changes and reduced reserve capacity for swallowing. Especially, since it was thought that the oropharyngeal expansion as morphological age-related change causes functional changes such as pharyngeal residue. Wearing complete dentures is common in elderly people, and although wearing and removing dentures is thought to affect the morphology of the oropharynx, the details of this effect remain unclear. The present study aimed to elucidate the relationship between wearing dentures and changes in the hyoid bone position and pharyngeal diameter. The subjects were 17 elderly people fitted with complete dentures who underwent cone-beam computed tomography imaging while wearing maxillary and mandibular dentures (MM), maxillary denture only (OM), and with neither maxillary nor mandibular dentures (ED). Computed tomography images were subjected to analysis of mandibular position (FMA), hyoid bone position, and antero-posterior and left-right oropharyngeal diameters. FMA decreased significantly in the order MM, OM, ED. In the ED condition, the hyoid bone shifted significantly in the antero-superior direction as compared with the MM and OM conditions. Antero-posterior and left-right oropharyngeal diameters in the ED condition were significantly larger than those in the MM condition at the height of the base of the epiglottis. Removal of complete dentures causes an antero-superior shift of the mandible, resulting in an anterior and superior shift of the hyoid bone and the expansion of the inferior part of the oropharynx. These findings suggest that removal of dentures exacerbate reduced reserve capacity for swallowing by age-related changes in the elderly.

症例は66歳，男性．胸部X 線にて左主気管支内にX 線非透過性の陰影を認め，気道異物が疑われたため当科紹介となった．気管支鏡を施行し，左主気管支に嵌頓する義歯を認めた．生検鉗子にて比較的容易に除去されたが，声帯を超えた段階で鉗子から脱落したため，喉頭鏡を使用し耳鼻科用鉗子にて異物を摘出し得た．脳血管障害等を基礎疾患に有する高齢者では，気道異物の危険性に関する本人およびその家族への啓蒙が重要であると考えられた．

When the report that oral care decreased the risk of developing pneumonia (Yoneyama 1999), oral care was regarded as an important tool in perioperative period. So, in the early stages, nurse play leading role in oral care and tend to look only oral cleanliness, dentures were not required. As eating by mouth is important and be able to cure a disease, denture is necessary in perioperative period. To take particular note of candida is needed the reasons why that denture base materials have a relationship with candida species. The key point of oral care, especially with oral candidiasis, is presented in this review.

Dysphagia is a mechanical or functional difficulty in one or more phases of the swallowing process from food ingestion in the oral cavity to a bolus passing through the esophagus. Recent studies have shown that the cause of dysphagia is in the oral phase of swallowing; Therefore there is increasing importance in evaluations of the relationship between oral function and swallowing. Oral functions of oral organs, tongue, jaw, teeth, and cheek, have been studied from the viewpoint of prosthetic dentistry for rehabilitation of the oral structure and function. However, such studies focused on mastication rather than swallowing. In this report, we review recent literature on (1) senescence changes in swallowing of the elderly, (2) dysphagia and oral function, (3) oral prosthesis and swallowing; especially our past studies on the relationship between complete dentures and swallowing in the elderly. In the near future, with the rapid increase of an aged Japanese population, prosthetic dentistry will need more information to be available with respect to oral prostheses for oral feeding functions that include not only mastication but also swallowing data. Furthermore, prosthetic dentistry should research relevancies among oral prostheses, reconstruction of the oral feeding function, and preservation of deconditioning. From this some indications might be found for how to prevent disuse syndrome and aspiration pneumonia. This will be one of the responsibilities of prosthetic dentistry in its contribution to oral rehabilitation for health and long life of the elderly.

Ingested foreign bodies are often found in the esophagus and the upper digestive tract. Most are discharged spontaneously without special excision. Recently the development of endoscopy has enabled excision of the foreign bodies which are not discharged spontaneously. However we sometimes have to carry out surgical treatment when the location and shape of foreign body induces severe complications such as the perforation or penetration of the bowel. We report a case of a penetration due to an ingested denture. An 80-year-old woman came to our hospital having ingested a denture. X-ray revealed a metallic foreign body in the left lower abdomen, which did not move to the anal side for 10 days. Then we did the laparotomy. In this operation it was found that the clasp of the denture had penetrated the sigmoid colon wall and formed an abscess in the mesocolon, sigmoidectomy and drainage were then performed.

野生動物の襲撃は, 時として致命的である。われわれは, 致命的な熊の襲撃を受けた患者の治療を経験したので報告する。患者は, 69歳, 男1生で野生の熊に遭遇し, 刺創および咬創を受け, 当院救急部に担送された。直ちに, 処置が施され, 一命をとりとめることができた。現在, 最終の手術から, 1年6か月が経過したが, 経過は良好である。, Encounters with wild animal are sometimes fatal. We recently treated a patient who was fatally attacked by a bear. A 69-year-old man was scratched and bitten by a wild bear. He received multiple facial fractures with deep lacerations of face and was brought to our emergency room. Primary reconstruction was immediately performed. The operation was successful and gave him a new lease on life. One year 6 months after the last operation, the patient's progress has been uneventful.

Since their invention, rare earth magnets, which are small but provide strong attractive force, have often been used to retain dentures and maxillofacial prostheses. However, magnetic attachments are not without their problems.One problem involves the corrosion of rare earth magnets in oral fluid and the associated risk of a significant loss of magnetic attraction.Another problem involves the magnitude of the attractive force provided by the magnet.Although rare earth magnets are much stronger than conventional magnets, they do not provide adequate attractive force for denture-retaining devices.To increase the attractive force, small encapsulated magnetic attachments with stainless steel yokes were developed.Along with these issues, this article reviews the structure materials, characteristics, and biological properties of magnetic attachments.