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Aim We conducted a multicenter study to explore the risk factors of developing pneumonia and the effectiveness of perioperative oral management (POM) for the prevention of pneumonia in postsurgical patients. Methods and results A survey covering eight regional hospitals was conducted over 4 years, from April 2010 to March 2014. Using the Diagnosis Procedure Combination database, a target group of 25,554 patients with cancer who underwent surgery was selected and assessed from a population of 346,563 patients without pneumonia on admission (sample population). The study compared the incidence of pneumonia and attempted to identify the significant predictive factors for its occurrence in these patients using multiple logistic regression analysis. Comparative assessment for the occurrence of pneumonia before and after POM implementation showed a significant incidence decrease after POM introduction in the target group, with no such change observed in the sample population. Multiple logistic regression analysis showed that the odds ratio for pneumonia occurrence after POM introduction was 0.44, indicating a reduced risk of pneumonia. Conclusion POM in cancer patients was indeed effective in reducing the incidence of pneumonia in hospitals and thereby helped in preventing pneumonia during hospitalization.

This study was a prospective, multicentre, cohort study on 685 patients who had undergone oncologic surgery. The patients were divided into two groups according to the presence or absence of postoperative pneumonia. The two groups were compared with respect to their background, index operation, food eaten, oral condition, contents of oral care and dental treatment, laboratory data, and bacterial flora. All postoperative pneumonias occurred in six cases within four days postoperatively. The multivariable logistic regression analysis showed that preoperative serum C-reactive protein was the strongest predictor of postoperative pneumonia. In addition, decreased postoperative Candida albicans colonies was an effective predictor of postoperative pneumonia. For patients with predictors of postoperative pneumonia, perioperative strategies for its prevention should be considered in addition to professional oral health care. This study was approved by the National Hospital Organization’s Central Ethics Review Board and was also approved by the directors of the participating institutions.

In April 2012, perioperative oral management (POM) was approved for inclusion in the national health insurance system of Japan to prevent the occurrence of pneumonia, a major complication in cancer patients. The subsequent decrease in the incidence of postoperative pneumonia indicated the prophylactic effect of POM. The constant increase in health expenditure necessitates a cost-effectiveness analysis. In addition, the effect of reducing healthcare costs owing to health technologies must be evaluated. In the present multi-institutional study, the cost-effectiveness analysis of POM was conducted by comparing the incidence of postoperative pneumonia and the healthcare costs between patients who received surgery for malignant tumors before (n = 11,886) and after (n = 13,668) the introduction of POM. Additionally, the effect of reducing healthcare costs was evaluated. Reductions in the number of patients who developed pneumonia, duration of hospitalization, and number of deaths were observed after the introduction of POM. The incremental cost-effectiveness ratio was 111,927 yen, hence the prevention of postoperative pneumonia needs 111,927 yen per patient in healthcare costs. Consequently, a maximum reduction of 250,368,129 yen in healthcare costs was observed between the incremental costs for pneumonia treatment and the cost of POM. These findings indicate that improvements in cost-effectiveness can be expected in the future through the development of procedure and system for POM.

Solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm arising mostly in the pleura. We describe a case of SFT composed of benign and malignant components in the left floor of the mouth of an 88-year-old man presenting with a growing mass. A biopsy was diagnostically inconclusive because immunohistochemical staining for CD34 was negative. Postoperatively, the resected tumor was found to comprise 2 components of different cellularity and atypia. Immunohistochemically, tumor cells in both components were positive for vimentin, bcl-2 and STAT6 but showed opposing immunoreactivity to CD34. The malignant lesion with hypercellularity and atypia contained several small necrotic foci was immunohistochemically negative for CD34, and exhibited a high Ki-67 labeling index. On the other hand, the benign lesion of hypocellularity and no atypia was positive for CD34. Taken together, these findings indicated a rare case of SFT with distinctive histological features of benign and malignant components.

Diagnosis of the exact grade of oral epithelial dysplasia is difficult, and interobserver variations in grading are common. The aim of this study was to investigate the expression patterns of cytokeratins (CKs) in dysplastic oral epithelia, to identify useful double immunostaining diagnostic markers. Immunoexpression of CK13, CK14, CK17, and Ki-67 were investigated in 21 normal epithelial specimens and 146 epithelial dysplasia specimens. In epithelial dysplasia specimens, orthokeratotic dysplasia (OKD) was identified using CK10 immunostaining. Most mild dysplasia specimens were CK13+ and CK17-. In moderate dysplasia, CK13 expression tended to be lower and CK17 expression tended to be higher than in mild dysplasia. All carcinoma in situ (CIS) specimens were CK17+. In differentiated type CIS specimens, CK13 expression was weakly positive. Most epithelial dysplasia specimens were CK14+. There were no significant differences in the expression patterns of CKs between OKD and non-OKD specimens in any of the grades of dysplasia. These results indicate that CK14 expression can be used to detect early epithelial dysplasia, and that CK13 and CK17 expression are useful for detecting neoplastic changes.

Purpose l-[3-18F]-α–Methyltyrosine (18F-FAMT) was developed as an amino acid tracer for PET imaging to provide better specificity than 2-[18F]fluoro-2-deoxy-d-glucose (18F-FDG) PET for cancer diagnosis. We investigated the diagnostic usefulness of 18F-FAMT in oral squamous cell carcinoma (OSCC). The correlation between tumour uptake of 18F-FAMT and L-type amino acid transporter 1 (LAT1) expression was determined.

Objective L-3-[18F]-fluoro-α-methyl tyrosine (18F-FAMT) is an amino acid tracer for positron emission tomography/computed tomography (PET/CT) which specifically transported into cancer cells by L-type amino acid transporter 1 (LAT1). LAT1 overexpression in tumors is significantly correlated with cell proliferation and angiogenesis. 18F-FAMT PET/CT, fluorine-18-fluorodeoxyglucose (18F-FDG) PET/CT and magnetic resonance imaging (MRI) were compared for their diagnostic performance in the detection of bone marrow invasion in patients with oral squamous cell carcinoma (OSCC).

Aquaporins are water channel proteins which enable rapid water movement across the plasma membrane. Aquaporin-5 (AQP5) is the major aquaporin and is expressed on the apical membrane of salivary gland acinar cells. We examined the effects of repeated administration of pilocarpine, a clinically useful stimulant for salivary fluid secretion, and isoproterenol (IPR), a stimulant for salivary protein secretion, on the abundance of AQP5 protein in rat salivary glands by immunofluorescence microscopy and semi-quantitative immunoblotting. Unexpectedly AQP5 was decreased in pilocarpine-administered salivary glands, in which fluid secretion must be highly stimulated, implying that AQP5 might not be required for fluid secretion at least in pilocarpine-administered state. The abundance of AQP5, on the other hand, was found to be significantly increased in IPR-administered submandibular and parotid glands. To address the possible mechanism of the elevation of AQP5 abundance in IPR-administered animals, changes of AQP5 level in fasting animals, in which the exocytotic events are reduced, were examined. AQP5 was found to be decreased in fasting animals as expected. These results suggested that the elevation of cAMP and/or frequent exocytotic events could increase AQP5 protein. AQP5 expression seems to be easily changed by salivary stimulants, although these changes do not always reflect the ability in salivary fluid secretion.

Objective: This multicenter clinical study was to assess the clinical usability of an oral moisture-checking device in detecting the dry mouth patients and evaluating the optimal measurement site. Materials and Methods: The study group comprised 250 patients with dry mouth and 241 healthy volunteer subjects at 13 medical centers. This device was used to measure the moisture degrees of the lingual mucosa and the buccal mucosa. Subjective oral dryness, objective oral dryness, and saliva flow rates were also compared between the two groups. For statistical analysis, receiver-operating characteristic analysis was performed to calculate the area under the curve (AUC). Results: The moisture degree of the lingual mucosa was significantly lower in the dry mouth group (27.2 ± 4.9) than that in the healthy group (29.5 ± 3.1, AUC = 0.653). When a lingual mucosa moisture degree of 31.0 or higher was defined as normal, less than 27.0 as dry mouth, and 27.0 to less than 31.0 as borderline zone of dry mouth, both the sensitivity and the specificity for the diagnosis of dry mouth were close to 80%. Conclusion: These results suggest that the oral moisture-checking device is a usable screening device for dry mouth.

The purpose of this study is to clarify the effect of a heat shock protein 90 inhibitor, 17-allylamino-17-demethoxygeldanamycin (17-AAG), in combination with X-rays or carbon-ion beams on cell killing in human oral squamous cell carcinoma LMF4 cells. Cell survival was measured by colony formation assay. Cell-cycle distribution was analyzed by flow cytometry. Expression of DNA repair-related proteins was investigated by western blotting. The results showed 17-AAG to have synergistic effects on cell lethality with X-rays, but not with carbon-ion beams. The 17-AAG decreased G(2)/M arrest induced by X-rays, but not by carbon-ion beams. Both X-ray and carbon-ion irradiation up-regulated expression of non-homologous end-joining-associated proteins, Ku70 and Ku80, but 17-AAG inhibited only X-ray-induced up-regulation of these proteins. These results show that 17-AAG with X-rays releases G(2)/M phase arrest; cells carrying misrepaired DNA damage then move on to the G(1) phase. We demonstrate, for the first time, that the radiosensitization effect of 17-AAG is not seen with carbon-ion beams because 17-AAG does not affect these changes.

Objective l-3-[18F]-fluoro-α-methyl tyrosine (FAMT) is transported into cancer cells by l-type amino acid transporter 1 (LAT1). The purpose of the present study is to correlate the uptake of FAMT and FDG with the cellular proliferative activity measured by the Ki-67 labeling index (Ki-67 LI) in oral squamous cell carcinoma (OSCC).

Clinical application of FDG-PET in head and neck cancer includes identification of metastases, unknown primary head and neck malignancy, or second primary carcinoma, and also recurrent tumor after treatment. In this study, the additional value of PET/CT fusion images over PET images alone was evaluated in patients with initial staging and follow up of head and neck malignancy.Forty patients with suspected primary head and neck malignancy and 129 patients with suspected relapse after treatment of head and neck malignancy were included. FDG-PET/CT study was performed after the intravenous administration of FDG (5 MBq/kg). Target of evaluation was set at primary tumor, cervical lymph node, and whole body. PET images and PET with CT fusion images were compared. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Results of PET and PET/CT were compared with postoperative histopathological examination, and case by case comparison of PET and PET/CT results for each region was performed. The additional value of CT images over PET only images was assessed. Statistical differences in sensitivity and specificity were evaluated.In the comparative evaluation of 507 targets by PET alone and PET/CT, 401 targets showed agreement of the results. Of the 106 discordant targets, 103 showed a positive result on PET alone and negative result on PET/CT. These results showed a significant difference (p0.01). Sensitivity of PET/CT was slightly higher than that of PET without statistical significance, while specificity of PET/CT was significantly higher than that of PET alone (Initial staging: 90.5% vs. 62.2%, p0.01; Follow up: 97.2% vs. 74.4%, p0.01). In Fisher's direct probability test, a significant difference was noted in the sensitivity (Initial staging: 91.3% vs. 87.0%, p0.01; Follow up: 93.9% vs. 91.4%, p0.01).Combined PET/CT showed improved diagnostic performance than PET alone by decreasing the number of false positive findings in patients with initial staging and follow up of head and neck malignancy.

【背景・目的】 口腔悪性腫瘍は, 治療により摂食嚥下・発音・呼吸などの日常生活にかかわる機能を障害するのみならず, 顔貌という個人のアイデンティティを表す部位にも障害を引き起こす. したがって, より安定した質の高い治療法を選択する必要性が増してきている. 【対象と方法】 2001年1月から2003年12月の3年間に群馬大学歯科口腔外科・歯科にて治療を行った口腔悪性腫瘍症例46例について, 臨床統計学的に検討を行った. 【結 果】 年齢別では, 60歳台が18例 (39.1％) と最も多く, 50歳台から70歳台で38例 (82.5％) であった. 発生部位別では舌が16例 (34.7％), 上下顎歯肉が22例 (47.7％) であった. 病理組織学的には扁平上皮癌が40例 (86.9％) を占めた. 扁平上皮癌はStageII症例が17例 (42.5％) であった. 治療法は, 外科療法を主軸とし, 補助的に放射線療法, 化学療法が施行されていた. 扁平上皮癌症例の5年生存率は71％であり, Stage別では, それぞれStageI : 80.0％, StageII : 85.0％, StageIII : 57.0％, StageIV : 33.0％であった. 【結 語】 高齢の口腔悪性腫瘍症例も増加しており, 全身疾患を考慮した治療法の立案が肝要であると考えられた.

【背景・目的】 顎関節脱臼は, 食事, 欠伸, 歯科治療, 全身麻酔における経口挿管操作などによる過度の開口, 打撲などの外力など, 種々な原因で生じる. 発症は突然であるため, 患者の心理的動揺は大きいと考えられ, 速やかに適切に対処する必要がある. 今回我々は, 顎関節脱臼症例の治療の実態を知るために, 当科に来院した顎関節脱臼症例の臨床統計的検討を行ったので, その概要を報告する. 【対象と方法】 1993年1月から2007年6月までの14年5ヶ月間に当科を受診し, 顎関節脱臼と診断された137名191関節を対象とし, 臨床的資料を調査, 分析した. 【結 果】 性別 ; 男性54名, 女性83名. 年齢別 ; 3歳～99歳 (平均年齢47.2歳). 病態別 ; 急性26例, 習慣性98例 (男性35例, 女性63例), 陳旧性13例. 脱臼原因 ; 歯科治療時, 欠伸時の発症が多かった. 【結 語】 治療法は病態毎に異なるが, 非観血的あるいは, 観血的整復術を施行し, 良好な結果を得ている.

A case of gas gangrene is reported. A 66-year-old man was referred to our hospital because of swelling and dull pain in the right cheek region. He had been receiving treatment for diabetes mellitus, hypertension, and heart failure. Hemodialysis had been performed because of diabetic nephropathy. Antibiotics were given and surgical drainage was performed with the patient under local anesthesia on the first day of hospitalization. A microbiological examination revealed Streptococcus intermedius, Bacteroides species, and Fusobactelium sp. in the abscess. Despite treatment, the swelling and dull pain did not resolve. On the 7th day of hospitalization, a computed tomography examination revealed extended gas bubbles and an abscess in the soft tissues of the submandibular and cervical regions. Surgical drainage was performed under general anesthesia. Microbiological examination of the abscess revealed Gemella sp. and Provotella sp. The patient was discharged after 90 days of hospitalization. This report emphasizes the importance of rapid diagnosis of gas gangrene by computed tomography, followed bysurgical drainage, and the appropriate administration of antibiotics, especially in patients with diabetic nephropathy.

【背景・目的】 先に著者らは口内貯留による各種含嗽剤の薬剤効果を報告した. 今回は含嗽という機械的清掃行為が加えられた場合の一般細菌, カンジダを減少させる効果について検討した. 【対象と方法】 健常成人18名に対し, 水道水, 薬用リステリン®(青色) 原液, 2倍希釈液, 4倍希釈液, 薬用リステリン®(黄色) 原液, 2倍希釈液, 4倍希釈液, ポピドンヨード 30倍希釈液, ハチアズレ®, 3 ％過酸化水素水, ネオステリン・グリーン®50倍希釈液おのおの30mlを含嗽後の唾液を検体とし, 一般細菌, カンジダの培養後, 含嗽剤作用前後のコロニー数を比較した. 【結 果】 一般細菌は, 含嗽前では全例から検出されたが, 含嗽後では50.0～100％で減少した. カンジダは, 含嗽前では23.0～38.0％に検出され, 含嗽後では40.0～100％で減少していた. いずれも薬用リステリン®(青色) 原液, ポピドンヨード30倍希釈液の減少率が高かった. 【結 語】 含嗽剤を用いて含嗽することにより, 一般細菌, カンジダを減少させる効果が認められ, 特に薬用リステリン®(青色) 原液, ポピドンヨード30倍希釈液の効果が高かった.

Background & Aims: Some oral mucosal diseases display clear predispositions toward certain sites of\noccurrence. Oral lichen planus is one such disease, and is thought to have some relationships with cell-mediated immunity leading to a tendency to develop on the buccal mucosa. The aim of this study was\nto investigate the distribution of Langerhans cells in various sites of oral mucosa. Methods: Immunohistochemical\nexamination using an anti-S100 antibody was performed for 47 samples of healthy oral\nmucosa and skin. Results: S100-positive cells were more frequent in lining mucosa than in masticatory\nmucosa. Significantly more S100-positive cells were found in buccal mucosa than in other sites.\nConclusions: Langerhans cells are positive for S100 and are thought to represent antigen-presenting\ncells. These cells were most frequent in buccal mucosa, a result that is in accordance with the predisposition\nof oral lichen planus.

Objectives: To comparel-3-[18F]-fluoro-α-methyltyrosine (FMT)-positron emission tomography (PET) and 2-[18F]-fluoro-2-deoxy-d-glucose (FDG)-PET in the differential diagnosis of maxillofacial tumors.Methods: This study included 36 patients (16 males, 20 females; 31–90 years old) with untreated malignant tumors (34 squamous cell carcinoma, one mucoepidermoid carcinoma, one rhabdomyosarcoma) and seven patients (five males, two females; 32–81 years old) with benign lesions. In all patients, both FMT-PET and FDG-PET were performed within two weeks before biopsy or treatment of the lesions. To evaluate the diagnostic usefulness of FMT-PET and FDG-PET, visual interpretation and semiquantitative analysis were performed. PET images were rated according to the contrast of tumor uptake as compared with background, and were statistically analyzed. As a semiquantitative analysis, standardized uptake values (SUV) of the primary tumors were measured, and the SUV data were analyzed using receiver operating characteristic (ROC) curves.Results: The mean SUV of the malignant lesions were significantly higher than those of the benign lesions in both FMT-PET (2.62±1.58 vs. 1.20±0.30, p

【目 的】 術後疼痛管理において先制鎮痛の有用性が注目されるようになってきた. 今回, 下顎埋伏智歯抜歯後疼痛に対し, 作用機序の異なる非ステロイド性消炎鎮痛薬による先制鎮痛効果について検討した. 【対象と方法】 下顎埋伏智歯抜歯症例33例に対し, 無作為に抜歯開始1時間前にZaltoprofen (抗bradykinin作用を有するcyclooxygenase (COX)-2選択的阻害薬 : Z群), Loxoprofen sodium (COX-2非選択的阻害薬 : L群), Etodolac (COX-2選択的阻害薬 : E群) のいずれか1錠を内服させた後, 抜歯を行い, 薬剤内服6時間後にVisual Analogue Scale (VAS) による疼痛評価を行った. 【結 果】 Z群9例中2例, L群10例中3例では疼痛は発現せず, 鎮痛剤は不要であった. また, 各群の6時間後のVASペインスコアについては, Z, L群は, E群 と比較し, 有意に低い値であった. 【結 語】 下顎埋伏智歯抜歯後の疼痛を管理するための先制鎮痛にはCOX-2のみの阻害では十分とはいえず, COXを非選択的に阻害する薬剤, あるいは抗bradykinin作用をも有する薬剤の方が有用と考えられた.

The recommended S-1 chemotherapy schedule for head and neck cancer is daily treatment for 4 weeks, followed by 2 weeks of rest. However, this can lead to adverse events and sometimes treatment withdrawal. Alternate-day treatment with a pyrimidine anticancer agent is reported to reduce adverse events without compromising anticancer activity. We examined the indication of alternate-day treatment with S-1 for oral cancer. Fifteen patients(3 men and 12 women; average age: 81.3 years)with oral squamous cell carcinoma started consecutive-day treatment with S-1. Treatment had to be interrupted after 0.5-10 courses because of grade2 myelosuppression, hepatorenal and electrolyte disorder, and grade 1 digestive toxicity. After a recovery period of 8-168 days from adverse events, alternate-day treatment with S-1 was started. Adverse events on this regimen were grade 2 leucopenia and hyperbilirubinemia in some patients. It was possible for 10 of the patients to continue this treatment for longer than 1 year or until death, but 5 patients could not continue because of a recurrence of a renal or electrolyte disorder, pneumonia, or disease progression. It is thought that alternate-day treatment with S-1 reduces the incidence of adverse events compared to consecutive-day treatment, and can allow continuous administration. Alternateday treatment with S-1 for female patients aged over 80 years with grade 1 leucopenia and/or thrombocytopenia before administration may help to maintain their quality of life.

【背景と目的】 癌の外科療法の際, センチネルリンパ節を検討することによる縮小手術が望まれている. そこで, 口腔癌においてもセンチネルリンパ節理論が適応できるかを検証した. 【対象と方法】 2002年4月から2003年7月に, 群馬大学歯科口腔外科・歯科で治療した口腔扁平上皮癌症例7例を対象とした. 99mTc標識フチン酸をトレーサーとし, 術前リンパ節シンチグラフィーおよび術中ナビゲーションによるセンチネルリンパ節の同定, 頸部郭清材料から得られたリンパ節の病理組織学的および核医学的検討を行った. 【結果】 7例全例で顎下リンパ節, うち3例は頸部リンパ節もセンチネルリンパ節と同定された. 3例でセンチネルリンパ節は転移陽性であり, うち1例は下流のリンパ節にも転移を認め, 別の1例では郭清範囲より下流に後発転移を生じた. 【結語】 本法によるセンチネルリンパ節の検出は可能であり, 口腔癌においてもセンチネルリンパ節理論が成り立つことが示唆された.

【背景・目的】 歯槽骨の吸収, 喪失は種々の原因によって生じ, 高度の場合には可轍式義歯の安定に大きく影響を生じる. またインプラント埋入は, 感染の問題から非可動性粘膜部に植立させる必要があるため, 歯槽骨高度吸収, あるいは歯槽骨欠損症例では可動性粘膜の位置を移動させる必要が生じる. そこで補綴前処置について検討を行った. 【対象と方法】 1998年3月から2002年10月の4年7ヶ月間に, 群馬大学歯科・歯科口腔外科を受診し, 各種原因により下顎歯槽骨が全顎的に高度に吸収, あるいは欠損した4症例に対し, 歯槽堤を相対的に高める歯槽堤形成術を行った. 【結果】 4症例ともに, 術後義歯装着に必要な顎堤の深さが十分保たれた. オトガイ孔下方移動術を施行した1例は知覚麻痺が軽快した. 【結語】 補綴前処置として相対的歯槽堤形成術およびオトガイ孔下方移動術が有用であることが示唆された.

Mandibular metastatic tumours are uncommon and differential diagnosis is difficult. A 49-year-old man with a metastatic tumour of the mandible from a primary bronchial tumour is reported.

【目的】外科的顎矯正手術前後の咀嚼能率の変化と後戻りについて調査し, 両者の関連性を検討した.【対象と方法】当科での手術前後に咀嚼能率試験を実施した21例を対象とした.咀嚼能率の評価はATP吸光度法により, またこのうち前歯部剪断試験を17例に施行した.さらに頭部X線規格写真にて後戻りを分析した.【結果】術前と比較して術後の咀嚼能率が改善した症例は21例中16例であった.前歯部剪断試験については, 術後1年で17例全例が最高グレード8に達した.またoverbiteの後戻りが多いことが咀嚼能率の改善不良に関与していると思われ, さらに術後に咬合不全が認められた6例のうち5例は, 術後に咀嚼能率の改善しなかった症例でもあった.【結語】術後の咀嚼能率が改善しない場合の原因として, 臼歯部の咬合不全と後戻りによるoverbiteの減少が考えられた.

A case of central mucoepidermoid carcinoma involving the mandible in a 52-year-old man is described. There was a relatively clearly bordered swelling with slight redness accompanied by soft hardness on palpation was found in the left submandibular region. Segmental excision of the left mandible and neck dissection was carried out under general anesthesia and then examined histopathologically. We performed radiation therapy with Co60 (total 60Gy). There was no sign of recurrence six years after the operation.

口底癌患者の術後に生じた摂食・嚥下障害に対し, 上顎シーネタイプの嚥下補助装置が有効であった1症例を経験した.症例, 59歳男性.口底癌 (T2N2cM0) のため当科に入院し, 切除術を施行した.術直後より摂食・嚥下・発音障害が認められた.VF検査から, これら障害の原因が, 舌の可動域減少と体積減少にあると推測された.このため, 摂食・嚥下時に, 舌が口蓋に接触すべきところ, 逆にスペースが残り, 嚥下時に食塊を咽頭方向へ移送しにくい事が原因と考えられた.以上から, 本症例では口腔期における摂食・嚥下障害と診断した.対策としては, 障害となるスペースを消失させる事を考え, これを補うような口蓋部の形態を考えた上顎シーネを患者に装着させた.シーネの装着により摂食・嚥下障害は自他覚的共に改善され, 原疾患の治療も終了したため, 術後2ヶ月, 経口摂取開始後1ヶ月で当科退院となった.

A rare case of suppurative arthritis of the temporomandibular joint (TMJ) is reported. A 47-year-old man was referred to our hospital because of diffuse swelling and pain in the right TMJ and malocclusion caused by a left shift of the mandible. The patient had been treated for periodontitis at a dental clinic during the previous 2 months. The swelling and pain increased after extraction of the right upper third molar.A radiograph revealed anterior deviation of the right condyle. The anterior region of the right TMJ showed a low density area on computed tomographic examination.After administration of antibiotics (ABPC+CLDM), lavage of the right TMJ cavity was performed.The results of microbiological examination were negative, and there was no evidence of ankylosis or other disorders of TMJ. The symptoms subsequently resolved.We suspected that the inflammation associated with the upper third molar affected the TMJ and caused the symptoms in this patient.

【背景・目的】舌小帯肥厚症などの疾患の診断, それらの疾患に対する手術や治療効果の客観的評価のために, 舌可動域測定器を開発し, 自発的舌最大前方可動域を検討する.【対象と方法】舌可動域測定器を開発する.次に健常成人19名を対象とし, 本装置により舌の可動域を測定する.一方, Martin式生体計測器を用いて被験者の身長, 最大頭長, 全頭高, 頬骨弓幅の測定を行う.【結論】独自の舌可動域測定器を開発した.本装置による健常成人19名についての平均自発的舌最大前方可動域は最小21mm, 最大39mm, 平均(28.8±5.4)mmであった.この値と各種生体計測値との問の関連性については, 身長, 頬骨弓幅との間に正の相関関係が認められた(危険率5%).【結果】自発的舌最大前方可動域は平均(28.8±5.4)mmであった.各種生体計測値との間の関連では身長, 頬骨弓幅との間に正の相関関係が認められた (危険率5%).【結語】1.舌可動域測定器を開発した.2.健常成人19名の自発的舌最大前方可動域は(28.8±5.4)mmであった.3.自発的舌最大前方可動域と身長, 頬骨弓幅との問に正の相関関係が認められた(危険率5%).

Amplification ofthe cyclin D 1gene on chromosome 11q13 frequently occurs in head and neck squamous cell carcinomas (SCCs), including oral cancer, suggesting that abnormalities of this gene may play an important role in the genesis or progression of oral SCCs and serve as an important biological marker indicating a poor prognosis. We investigated amplification of thecyclin D 1gene by fluorescencein situhybridization (FISH) of specimens obtained by fine-needle aspiration biopsy of 20 primary oral SCCs. Amplification of cyclinD 1was detected in 6 (30%) of 20 SCCs of the oral cavity and was more frequently found in patients with a poor outcome (p=0.014). These results confirm that amplification of this gene may contribute to the development of oral SCCs. Analysis of amplification of the cyclinD 1gene by FISH in tissues obtained by fine-needle biopsy may be a rapid and useful method for predicting outcome in patients with oral SCCs.

今回我々は, 未治療糖尿病のために, 爪楊枝によるほんの些細な外傷により, 重篤な頬部蜂窩織炎を生じた1症例を経験したので報告する.患者は64歳男性.未治療の糖尿病があり, 爪楊枝により頬粘膜に些細な外傷を受傷.炎症は同部より始まり, 下唇, 口底, 顎下部に急速に広がった.患者は, 切開排膿に続き抗生剤による化学療法, 糖尿病の治療を受けた.今回の報告は, 未治療糖尿病患者の感染症の臨床的症状と治療を示唆する.

Cytogenetic and molecular studies have indicated that a putative tumor suppresor gene (s), which may play an important role in oral squamous cell carcinogenesis, is located on the short arm of chromosome 3 (3 p). We analyzed loss of heterozygosity (LOH) on 3 p, especially the 3 p25-pter region, in 17 oral squamous cell carcinomas (OSCCs) with the use of 5 microsatellite markers and constructed a deletion map for this chromosome arm. LOH at one or more loci was detected in 9 of 17 (53%) tumors. LOH on these region was more common in advanced OSCCs and may be associated with tumor progression. Our data support the notion that one of tumor suppressor gene (s) contributing to the progression of oral squamous cell carcinoma resides on 3 p25-pter.

To determine whether inactivation of the p16 gene mapped to the chromosome 9p21 region is associated with the development of oral squamous cell carcinoma (SCC), we investigated the mutational states of two forms of alternative transcripts (alpha and beta) from the p16 gene in 14 oral SCC cell lines by means of RT-PCR, PCR, direct sequencing and methylation analyses. Alterations of the alpha transcript were detected in all of the cell lines examined: homozygous deletions in three lines; subtle mutations in exons 1 alpha or 2 in four lines; skipping of exon 2 in two lines; hypermethylation of the 5' CpG island of the p16 gene in four lines; and an unknown mechanism in one line. On the other hand, abnormalities of the beta transcript were observed in seven of the 14 cell lines. Nonetheless, the mutations that essentially affect the function of the encoded protein were found only in five cell lines, including three lines with homozygous deletion. There was no cell line having only beta transcript alterations. Thus, alteration of the alpha transcript of the p16 gene was a highly frequent event in oral SCC. Since this type of alteration resulted in gene inactivation through multiple pathways, it may play a major role in the process of oral SCC development.

本研究の目的は口腔白板症の臨床的, 病理組織学的特徴と悪性化を明らかにすること, および口腔早期扁平上皮癌の臨床的特徴を明らかにして望ましい治療成績を獲得することを目的としている。601白板症を有する444患者は臨床的, 病理組織学的に検討された。患者の275名は男性, 169名は女性で, 年齢は19歳～83歳であった。601病変の25%は下顎に, 24.8%は舌に, 20.8%は頬粘膜にみられた。臨床型については, 76.2%はI型 (隆起も発赤もない白板症) , 14%はII型 (発赤を伴った白板症) , 4.8%はIII型 (軽度外向性の白板症) , 5%はIV型 (高度に外向性の白板症) に分類された。II型の悪性化率は最も高く (21.4%) , また舌では16.4%であった。女性の悪性化率は男性より高く, 高齢者の悪性化率は50歳未満のものより高く, 上皮性異形成を伴ったものの悪性化率は伴わないものより高かった。外科の悪性化率は全ての治療法や不治療の中で最も低かった。88扁平上皮癌を有する86患者は臨床的に検討された。88病変中68%は舌にみられた。臨床型に関しては, 34.1%は白斑紅斑混在型に, 21.6%は白斑型と顆粒型にそれぞれ, 分類された。10年累積生存率はおよそ90%であった。

本研究の目的は口腔癌の術後構音機能評価の標準化である。日本語単音節発語明瞭度, 会話明瞭度検査を113名の口腔癌患者についておこない, 74名に質問票を用いた患者の自己評価を行った。これら3つは比較的簡便な方法であり会話機能評価によく用いられてきた。1.単音節明瞭度は評価音節数によって異なっていた。中等度と高度障害例において25音節明瞭度は100音節明瞭度に比べかなり低い値を示した。一方67音節明瞭度は障害の程度に関わらず100音節よりやや高かった。2.軽度障害例において単音節明瞭度と会話明瞭度の相関は弱く, より細やかな尺度を用いた評価法が望まれる。3.患者の自己評価 (自覚的評価) は会話明瞭度 (客観的評価) と一致せず, 患者自身は会話機能を低く評価する傾向にあった。

Diagnosis of the exact grade of oral epithelial dysplasia is difficult, and interobserver variations in grading are common. The aim of this study was to investigate the expression patterns of cytokeratins (CKs) in dysplastic oral epithelia, to identify useful double immunostaining diagnostic markers. Immunoexpression of CK13, CK14, CK17, and Ki-67 were investigated in 21 normal epithelial specimens and 146 epithelial dysplasia specimens. In epithelial dysplasia specimens, orthokeratotic dysplasia (OKD) was identified using CK10 immunostaining. Most mild dysplasia specimens were CK13+ and CK17-. In moderate dysplasia, CK13 expression tended to be lower and CK17 expression tended to be higher than in mild dysplasia. All carcinoma in situ (CIS) specimens were CK17+. In differentiated type CIS specimens, CK13 expression was weakly positive. Most epithelial dysplasia specimens were CK14+. There were no significant differences in the expression patterns of CKs between OKD and non-OKD specimens in any of the grades of dysplasia. These results indicate that CK14 expression can be used to detect early epithelial dysplasia, and that CK13 and CK17 expression are useful for detecting neoplastic changes.

L-[3-(18)F]-α-Methyltyrosine ((18)F-FAMT) was developed as an amino acid tracer for PET imaging to provide better specificity than 2-[(18)F]fluoro-2-deoxy-D-glucose ((18)F-FDG) PET for cancer diagnosis. We investigated the diagnostic usefulness of (18)F-FAMT in oral squamous cell carcinoma (OSCC). The correlation between tumour uptake of (18)F-FAMT and L-type amino acid transporter 1 (LAT1) expression was determined.The study group comprised 68 OSCC patients who underwent both (18)F-FAMT and (18)F-FDG PET. Resected tumour sections were stained by immunohistochemistry for LAT1, CD98 and Ki-67, and microvessel density was determined in terms of CD34 and p53 expression.The sensitivity of primary tumour detection by (18)F-FAMT and (18)F-FDG PET was 98 % and 100 %, respectively. The sensitivity, specificity and accuracy of (18)F-FAMT PET for detecting malignant lymph nodes were 68 %, 99 % and 97 %, respectively, and equivalent values for (18)F-FDG PET were 84 %, 94 % and 94 %, respectively. The specificity and accuracy of (18)F-FAMT were significantly higher than those of (18)F-FDG. The uptake of (18)F-FAMT was significantly correlated with LAT1 expression, cell proliferation and advanced stage. The expression of LAT1 in OSCC cells was closely correlated with CD98 levels, cell proliferation and angiogenesis.(18)F-FAMT PET showed higher specificity for detecting malignant lesions than (18)F-FDG PET. The uptake of (18)F-FAMT by OSCC cells can be determined by the presence of LAT1 expression and tumour cell proliferation.