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The surgical technique and grafting materials used for sinus lift augmentation and simultaneous implant insertion were developed in the mid 1970s. New procedures were developed in the 1980s, in which iliac bone grafts were fixed to the residual ridge with implants. Today, less invasive techniques with lower morbidity have been developed for small bone defects, such as crestal elevation through the implant site. To treat severe atrophy and a bone height of less than 3–5 mm, other approaches are advantageous, such as the Caldwell-Luc entry. Depending on the severity of the situation, iliac crest bone block grafting guarantees high quantities of good bone for sinus augmentation. This report evaluates the usefulness of fixing the iliac crest bone block with implants. This technique significantly reduces the healing and waiting times and the number of operations.

舌全摘，亜全摘に片側中咽頭拡大切除を伴う症例に対して，切除側の咽頭上壁から温存側の舌根に下るスロープ型に舌根部を再建した症例を経験した。長期経過後の形態と機能を，従来のドーム型再建と比較した。ドーム型再建13例，スロープ型再建6例，平均経過観察期間は7年1ヶ月。スロープ型はドーム型と比べて構音機能，嚥下機能とも若干劣るものの，比較的良好な結果が得られた。ドーム型は長期経過後に平坦化して機能が低下する症例が見られたが，スロープ型は長期経過後も形態と機能を維持していた。スロープ型再建では，舌根を挙上する機能を失った中咽頭側壁を皮弁で塞ぎ，機能が温存される側のみで嚥下を行うことになる。るいそう症例などドーム型の形態を長期間維持するのが困難な症例ではスロープ型再建も有効な方法と思われた。

機能的な下顎再建の目的は残存機能維持とインプラントなど新機能の獲得である。術後機能を予測し，再建の目的を明確にしなければならない。下顎再建症例の術後機能を評価し，それぞれに最適の再建方法を検討した。（1）腓骨皮弁で再建した症例の残存臼歯における咬合圧と食事（2）術後機能がプレート破損に及ぼす影響（3）インプラントのための腓骨骨切り位置（4）腓骨の術後吸収とそれに影響を及ぼす因子，を調査し顔貌再建のための軟部組織の重要性も言及した。腓骨皮弁で下顎を再建し6ヶ月以上経過した48例を対象とした。術後食は残存咀嚼筋量よりも残存歯量に強く影響された。患側の全咀嚼筋を切除すると咬合力は正常者の39%に減少したが，残存歯が半分程度あればほぼ通常の食事を摂取するのに必要な200N程度の咬合力が得られた。そのような症例を再建プレートと軟部組織皮弁で再建するとプレートは高い確率で破損すると思われた。下顎骨が反対側の犬歯（頤結節）まで切除されると，前方の顎堤再建のために同側犬歯部で1ヶ所の腓骨の骨切りが必要だった。反対側の頤孔が切除されると，両側犬歯部で2ヶ所の骨切りが必要だった。腓骨の年間吸収量は，咬合圧が300N以上の症例では0.2mm以下であったが，いくつかの要因が骨吸収を強めた。下顎再建において軟部組織再建は機能的，整容的に非常に有効である。腓骨皮弁では，他の皮弁の合併移植が必要であった。

Mesenchymal chondrosarcoma is rare malignant tumor of skeletal and extraskeletal origin. This neoplasm shows aggressive local behavior and has a high metastatic potential. The long-term prognosis is poor.We report a mesenchymal chondrosarcoma occurring in the mandible of a 46-year-old man who had a painless mass in right side of the mandible, measuring 45×15 mm. Pathological examination of a biopsy specimen suggested a spindle cell sarcoma, but the diagnosis was unable to be confirmed. Mesenchymal chondrosarcoma was diagnosed on histopathological examination of the resected specimen. This tumor does not respond to chemotherapy or radiation. Complete resection is essential for a good outcome. The patient was closely observed without any additional treatment, and there has been no evidence of recurrence or metastasis 1 year 4 months after operation.

We reported a rare case of spindle cell lipoma of the tongue. A 56-year-old man was referred to our department because of a painless swelling on the right tip of the tongue. A clinical examination revealed a mobile, well-demarcated, mass of the tongue that measured 35mm in diameter. A histopathological diagnosis of a solitary fibrous tumor was made on examination of a biopsy specimen. The tumor was removed surgically with the patient under general anesthesia. Histopathological examination of the surgical specimen showed a spindle cell lipoma. There have been no signs of recurrence in the approximately 11 months since the operation.

口腔癌治療後の再発症例の初期症状について, 特に疼痛を中心とした自覚的初期症状と再発の関連について検討した。対象は1976年1月から2000年12月までに当科にて根治目的に治療した口腔癌のうち, 局所再発または頸部再発した50例とした。臨床的, または病理組織学的に再発と診断した時期より以前に発現した症状を初期症状とし, その初期症状を自覚症状と他覚症状に分けて, 症状の種類と発現時期を検討した。特に自覚症状については, 口腔癌患者のうち再発・転移ともに認めなかった50症例を対照群として, 発現率を比較した。そして, 最後に自覚症状の治療法別, および進展度による出現率の違いを検討した。結果は, 口腔癌再発症例50例のうち35例, 70%に何らかの自覚症状が発現し, そのうち32例が疼痛で, その発現時期は, 平均で再発診断日の44日前で, 他覚的症状の25日前と比較して, 有意に早期に発現していた。対照群50例と比較した場合, 再発症例は自覚症状の出現率は70%で, 対照群の14%と比較し有意に高頻度に自覚症状が発現し, その自覚症状の出現の有無は, 一次治療の方法や進展度とは関連が小さい結果となった。疼痛を中心とした自覚症状が, 治療法や進展度とは関係なく, 再発の早期発見に有効であり, 患者の訴えの要性を今更ながら再確認する結果となった。

口腔癌に対するRa針組織内照射の適応範囲を検討するため, 根治目的にRa針組織内照射を実施した口腔扁平上皮癌93例を検討した。組織内照射の適用の基準は, 長径5cm以下で深さが2cm以内とした。舌82例, 口底10例, 口唇1例に対しRa針組織内照射を実施した。Ra針全体での局所制御率は92.5%で, 後発転移率は32.3%で外科的治療に劣らない治療成績であった。5年生存率は64.9%で, 局所制御率と後発転移率の結果から考えれば満足できる結果ではなかった。この原因は, 局所再発症例の治療成績の低さによると考えられ, 局所再発と放射線潰瘍を正確に区別し, 早期に後治療を実施することが重要と思われた。初診時にリンパ節転移を認めた症例は, 局所の照射のうちに, 頸部郭清術を実施したが, N1症例の5年生存率が83.3%に対しN2以上では40.6%と大きく低下し有意差を認めた。これらの結果から長径が5cm以下で深さが2cm以内, 初診時N1までであれば, Ra針組織内照射によって, 良好な治療成績が期待できると考えられた。

A cohort survey of the occurrence of multiple primary cancers was carried out in patients with oral cancer (n=310) at Tokyo Metropolitan Komagome Hospital. The subjects consisted of 203 males and 107 females.The incidence of multiple primary cancers over the course of 20 years (1976 to 1996) was 18.4%(n=57).Among 57 multiple primary cancers, 44 primary oral cancers, (77.2%) occurred in the oral cavity, and the specific sites were the tongue (19), gingiva (10), buccal mucosa (7), floor of the mouth (5), soft palate (2), and lip (1).Multiple primary cancers occurred frequently in the esophagus (12), stomach (8), lung (6), hypopharynx (2) in males and in the uterus (3) in females.In esophageal cancer, the O/E ratio of male patients was significantly higher, than that in females, differing by a factor of 39.61 times.In males, primary occurrence in elderly patients was associated with a short period until the occurrence of a second cancer, The development of a second cancer reguired a longer period in younger patients than in older patients, i. e., 4.5 years for 40 years old, 3.3 years for 50 years old, 2.5 years for 60 years old, 1.9 years for 70 years old, and 1.7 years for 80 years old.

1976年5月より1990年12月までの15年間に, 都立駒込病院で治療した19例の頬粘膜扁平上皮癌の一次症例について検討した。患者の平均年齢は70.6歳であった。(1) . UICCによる病期分類はT3, T4の進展症例が多く, NO症例は63.2%, 全例MOであった。(2) .治療法は一次治療法により放射線治療群と手術治療群の2群に分けて検討すると, 放射線治療群が9例 (50.0%) で, 全例が放射線単独であった。併用療法をおこなった症例のうち, 手術前後に照射をおこなったのは2例, 手術単独が3例で, それぞれの局所制御率は放射線治療群が44.4%, 手術前後に照射をおこなったのは0%, 手術単独が100%であった。病期別にはStage IIIが37.5%, Stage IVが100%で, 部位別では頬粘膜57.1%で, 日後部では50%であった。(3) . 19例の頬粘膜癌全体の5年累積生存率は55.1%であった。T分類別の5年累積生存率はT1が66.7%, T2が64.8%, T3が34.3%, T4が53.3%であった。治療法別では, 手術治療群は76.5%と放射線治療群の36.8%より優位であった。

The clinical experience of a patient with a large exostosis who had a chief complaint of difficulty in opening the mouth is reported. Radiographic examinations, especially tomography and a CT scan, were useful in the diagnosis. Surgical removal is the treatment of choice. The lesion is usually approached by a combination of intraoral and buccal routes; we also employed such an approach in this particular case.

To evaluate the conservativeness of low dose rate interstitial irradiation (LII) for cancer of the mobile tongue.Between 1975 and 2002, 100 consecutive patients (71 men, 29 women) underwent LII as curative treatment. Stages were I/IIIII/IV = 16/63/16/4. Seventy-one cases were treated with LII alone and 29 cases treated combined with external irradiation. Median total dose of LH was 70 Gy/7 days.Overall, 5- and 10-year local control and LII-treated patients' survival rates were 93% and 91%, 64% and 57%, respectively. Delayed neck metastases were observed in 21% of initially N0 cases, 56% of which could be salvaged by operation. Early stage and well-differentiated tumors carried better prognoses.LII of cancers of the mobile tongue results in good local control and survival. With careful monitoring of patients to ensure early detection of delayed metastases, LII should allow organ conservation and yield favourable therapeutic results compared with those of surgery.

Cytomegalovirus infection is an opportunistic infections that occurs at an incidence of 40% in acquired immunodeficiency syndrome. It is very rare in the oral cavity. We describe the case of a 39-year-old man who had cytomegalovirus gingivitis. At presentation, the patient complained of pain of the left side of the upper and the right side of the lower gingiva. We found large depressions and edematous granulation tissue at these sites. Large bone defects appeared on panorama X-ray film. Clinically, malignant lymphoma was suspected, but pathological examination revealed cytomegalovirus gingivitis. Ganciclovir was prescribed for 4 weeks, and the right lower third molar was extracted. After treatment, edematous guanulation and gingival pain disappeared. Cytomegalovirus had apparently invaded the endothelium of blood vessels, inducing circulatory failure, which resulted in the formation of large bone defects.

To evaluate the accuracy of imaging diagnosis, we compared cervical lymph nodes with clinical evidence of metastasis on palpation, computed tomography (CT), and magnetic resonance imaging (MRI). The subjects comprised 28 patients with oral cancer who underwent radical neck dissection. The clinical criteria for positive lymph nodes was a diameter of 15mm or more in the submental and submandibular region, or 10mm or more in the deep cervical region. Lymph nodes with ring-like or heterogeneous enhancement on CT or MRI and those that were hard on palpation was also considered positive.Histopathologically, 55 lymph nodes were confirmed to have metastasis. Among these 55 positive nodes, 27 were diagnosed positive by palpation, 35 were diagnosed positive by CT, and 38 were diagnosed positive by MRI. There was a significant difference between palpation and MRI (p

Ablative surgery has been a standard procedure for many years, but during the past few years there has been a significant improvement in our understanding of invasion and metastasis in oral cancer. Each procedure has to be planned individually. Before surgery, every attempt must have been made to arrive at a proper diagnosis, including the exact nature and aggressiveness of the tumor and an analysis of the patient’s genetic background. These procedures and the prognosis will be discussed.

We report a case where Kaposi's sarcoma was seen in the hard palate of a patient with AIDS.Kaposi's sarcoma could be controlled by radiotherapy. During follow-up, no other oral changes were found.There have been few Japanese patients with Kaposi's sarcoma in our hospital. Only one patient has died due to Kaposi's srcoma of the lung.