Reported are four cases of a stage I tongue carcinoma which recurred in the cervical area after a radical neck dissection (RND). In all cases, the primary lesion was controlled with radium needle implants. Clinically, these tumors manifested endophytic growth and, histologically, had a high malignant grading. In most cases, a latent lymph metastasis appeared within 6 months after initial treatment and an early metastatic lesion developed beyond the capsule of the node. The site of cervical recurrences was located in non treated areas that were outside the range of the RND.
In 17 cases of tumors of the oral cavity, maxillofacial defects were reconstructed immediately after radical surgery using pectoralis major and/or latissimus dorsi myocutaneous flap.The diagnosis for 16 cases were carcinomas of the oral cavity and in these cases (except one with adenocarcinoma) patients had received irradiation therapy prior to the surgery. The only case of benign tumor was buccal region hemangioma.In all of the cases, satisfactory results were obtained though partial necrosis of flap was observed in 3 cases.Previously A-O reconstruction plate was used for a primary repair of mandibular bone defect in our hospital.Recently the authors have experienced the use of a sternum pectoralis major and a rib latissimus dorsi osteocompound flap.However, the curve of rib was opposed to a normal mandibular arch and perforation of pleura may occur during harvesting a sternum or a rib.Myocutaneous flap for repair of wide defect that necessitates mass augmentation seems to be efficient and reliable due to permanent blood supply.On the other hand, one disadvantage is the bulky deformity of the flap which makes functional restoration of the oral cavity more difficult.In our view, some problems which should be considered for reconstructive surgery of head and neck tumor are the following.1) Indication and selection of a flap2) Method for mandibular bone reconstruction3) Muscular volume of a flap and functional restoration
A new system of calcium phosphate cement, consisting of α-tricalcium phosphate (α-TCP), dicalcium phosphate dibasic (DCPD), and tetracalcium phosphate (TeCP), was developed. In this study, columns of hardened cement were implanted on the inferior surface of rabbit mandibles and into the back muscle for 6 months, 1 year, and 1.5 years to evaluate responses of the surrounding tissues and changes in the materials in vivo.Histologic, microradiographic and scanning electron micrographic investigations of the implants in mandibles revealed active bone formation along the surface of the cement and direct contact between new bone and the materials. The cement showed surface irregularities created by resorption, which were remarkable on surfaces bounded by soft tissue.Histologic and microradiographic studies of the implants in back muscles showed the presence of a thin fibrous capsule without inflammatory cell infiltration; resorption was usually more remarkable than that with materials implanted in mandibles.The results of this study suggest that the hardened cement is resorbable in vivo and is highly biocompatibile with living tissues.
Fourteen cases of malignant lymphoma (ML), diagnosed in our depratment over 26 years from 1965 to 1991, were examined clinically, focusing mainly on the intial symptoms. The results were as follows:1) ML Accounted for 4. 5% of all oral malignant tumors.2) The patients consisted of 10 males and 4 females. The majority of them were advanced in age.3) There were 5 nodal cases (35. 7%) and 9 extranodal cases (64.3%).4) In all 5 nodal cases, the initial lesion involved the neck and/or submandibular lymphnodes. In the externodal cases, 3 cases appeared in the gingiva, 2 in the maxillary sinus, 2 in mandibular bone, 1 in the cheek, and 1 in mandibular bone and the front of the ear.5) Swelling was the initial local symptom in all cases.6) The initial clinical diagnoses in the 14 cases were malignant lymphoma in 1 case, malignant tumor in 8 cases, benign tumor in 3 cases, inflammation in 1 case, and inflammation and tumor in 1 case.7) In X-ray examinations, the nodal cases showed no abnormal images. In the extranodal cases, 2 cases with maxillary sinus lesions showed radiopaque areas, and 2 cases with gingiva lesions and 3 with mandibular lesions presented bone destructive changes.8) ML was suspected in 1 of 5 cases by CT examiation and in 4 of 6 cases by ultrasound examination.9) Laboratory examinations indicated cases with high LDH values tended to have a poorer prognosis.
The purpose of this study was to determine the extent to which baseline clinical and radiographic features were associated with long-term outcomes in patients with temporomandibular joint disorder (TMJD).49 patients with unilateral radiographically proven TMJD were available in this study. Self-reported long-term (mean 96.2 months) outcomes (current joint pain, maximum mouth opening and joint noise) after TMJD treatments were assessed by questionnaire. The impact of multiple initial clinical/radiographic findings (gender, age at first visit, time interval between first visit and questionnaire survey, treatment method, disc displacement, disc morphology, disc mobility, condylar bony change and morphology of the articular eminence) on the long-term outcomes was assessed using stepwise multiple regression and logistic regression analysis.Patient age at the first visit was significantly correlated with current joint pain. Disc mobility and morphology of the articular eminence were significantly correlated with current range of maximal mouth opening.The results of this study suggest that patients who appeared symptomatic at a younger age or who initially had a fixed disc were the most likely to have recurrent or persisting clinical signs/symptoms of TMJD after 8 years.
