[Show abstract][Hide abstract] ABSTRACT: This article discusses a case of bilateral multiple cervical lymph node metastases of oncocytic carcinoma—an extremely rare neoplasm of the salivary glands—that was found in a 71-year-old Japanese female patient who presented with a painless swelling in the bilateral submandibular regions.Computed tomography demonstrated enlarged bilateral multiple lymph nodes. Multiple metastases to bilateral cervical lymph nodes were clinically suspected, and bilateral neck dissections were performed. The tumor tissue adjoined the submandibular gland with a thin fibrous connective tissue capsule. Histologically, the tumor was predominantly composed of large, round to polyhedral cells with fine granular eosinophilic cytoplasm, which were arranged in solid sheets, islands and cords.Ultrastructural analysis revealed numerous mitochondria with abnormal shapes packed in the cytoplasm of the neoplastic cells. The tumor was diagnosed as oncocytic carcinoma of the submandibular gland with bilateral multiple cervical lymph node metastases. The tumor developed neither recurrence nor distant metastasis for eight years after the operation.
Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology. 01/2013; 25(1):97–100.
[Show abstract][Hide abstract] ABSTRACT: We have previously reported that the histologic mode of invasion of oral squamous cell carcinoma (OSCC) is a significant risk factor for pain. Here we sought to determine whether pain is a risk factor for poor prognosis in patients with OSCC.
We evaluated the relationships between overall survival rates and clinicopathologic variables, including gender, age, T- and N-stages, pathologic findings, and pain in 109 consecutive patients with untreated OSCC.
Of these 109 patients, 40 (37%) reported spontaneous pain. Univariate analysis showed that the overall survival rates of patients with spontaneous pain was significantly lower than those of patients without pain (P = .002). Multivariate analysis revealed that spontaneous pain and N-stage were significant independent predictors of overall survival rates.
This is the first report showing that spontaneous pain before treatment may be associated with poor prognosis in patients with OSCC.
[Show abstract][Hide abstract] ABSTRACT: Restoring shape and functions in patients with total mandibular defect is difficult. We report the use of a fibular bone graft for successful total mandibular reconstruction of a patient with traumatic injury to the mandible. A 56-year-old man experienced a work-related injury to the maxillo-facial region and underwent total mandibular resection. Five years later, he remains satisfied with his facial configuration and has minimal dysfunction in daily activities, including speaking, swallowing, and eating. Evaluation of the functional adaptation of his facial muscles by electromyography (EMG) showed that his orbicularis oris muscle may have compensated for masticatory muscle dysfunctions during mouth opening and swallowing.
Asian Journal of Oral and Maxillofacial Surgery 01/2011; 23(4):196-200.
[Show abstract][Hide abstract] ABSTRACT: Postoperative wound infection (WI) is a main complication after head and neck surgery. Poor oral health may be a risk factor for WI. We therefore assessed the contribution of oral health care in preventing postoperative WI in patients with oral squamous cell carcinoma (OSCC).
A total of 66 consecutive inpatients with OSCC (mean age, 68 years) was divided into two groups that did or did not receive oral health care. There were no significant between group differences in gender, age, or T-, N-, or clinical stage. Patients in the care group were given oral health care plans by doctors of oral medicine, whereas patients in the control group were not. Twenty-three variables were recorded for each patient.
WI was observed in 14/66 patients (21%), three (3/33 = 9%) in the care group and 11 (11/33 = 33%) in the control group (p < 0.025). Univariate statistical analysis showed that 11 factors correlated with WI significantly: T-stage, clinical stage, wearing of dentures, tracheostomy, neck dissection, tissue transplantation, oral health care, preoperative radiation, blood transfusion, operation time, and blood loss. In multiple logistic regression analysis, only two factors were significant independent risk factors for WI: tissue transplantation (p = 0.01; odds ratio, 24.5) and lack of oral health care (p = 0.04; odds ratio, 6.0).
Oral health care may reduce the risk of postoperative WI in patients with OSCC.
Supportive Care in Cancer 03/2010; 19(3):409-16. · 2.09 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The origins and mechanisms of pain arising from oral cancer are important. Oral cancer pain impairs a patient's quality of life. This study was undertaken to elucidate significant risk factors associated with spontaneous pain in patients with untreated oral squamous cell carcinoma (OSCC) before treatment. A total of 113 patients (82 men, 31 women; median age, 64 years) with untreated OSCC were examined. Correlations between spontaneous pain in the primary site and sex, age, primary site, TN stage, clinical stage, and clinical growth type of cancer (exophytic or endophytic), as well as the degree of histological differentiation and the histological mode of invasion were evaluated. At the initial examination, 42 (37%) of patients had spontaneous pain. In univariate statistical analyses, reported pain correlated significantly with patient age and the clinical growth type of the cancer, as well as with the degree of histological differentiation and the histological mode of invasion. Multiple logistic regression analysis showed significant correlations between reported spontaneous pain and the clinical growth type of the cancer (P = 0.0003; odds ratio, 9.5; 95% confidence interval, 2.8-32.3), as well as reported spontaneous pain and the histological mode of invasion (P = 0.0026; odds ratio, 4.7; 95% confidence interval, 1.7-12.7). Clinical and histological endophytic growth patterns of OSCC might be significant risk factors for the presence of spontaneous pain before treatment.
[Show abstract][Hide abstract] ABSTRACT: The purpose of the present study was to investigate the clinical usefulness of the detection of serum p53 antibodies (p53 Abs) in patients with oral squamous cell carcinoma (SCC). Preoperative values of p53 Abs were measured by enzyme-linked immunosorbent assay in 113 patients with primary oral SCC and seropositive patients were reevaluated postoperatively. The positivity rate of p53 Abs was 16%, and the 5-year survival rate of patients positive for p53 Abs was significantly lower than that of patients negative for p53 Abs (56.2% vs. 80.7%; P = 0.018). The preoperative presence of p53 Abs was found to be an independent prognostic factor in a multivariate analysis (P = 0.028, hazards ratio = 3.34), and its positivity was significantly related to secondary cervical lymph node metastases (P = 0.029). Six of nine patients who remained seropositive for p53 Abs through the disease course and the one with seropositive reversion from temporary negative status developed treatment failure. Therefore, the detection of p53 Abs in the serum of patients with SCC may be a useful prognostic marker.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the diagnostic accuracy of fluorodeoxyglucose positron emission tomography (FDG-PET) relative to computed tomography (CT) for detecting metastatic cervical lymph nodes in patients with squamous cell carcinoma of the head and neck (HNSCC), and to ascertain the factors that affect this accuracy.
A total of 1076 lymph nodes obtained from 35 neck dissections in 26 HNSCC patients who preoperatively underwent both FDG-PET and CT were retrospectively analyzed. For pathological metastatic lymph nodes, the lymph node size (short-axis diameter), the ratio of intranodal tumor deposits, and the size of intranodal tumor deposits (maximum diameter of metastatic foci in each lymph node) were histologically recorded.
Forty-six lymph nodes from 23 neck sides were pathologically diagnosed metastases. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of FDG-PET evaluated individually per neck side were 74%, 92%, 80%, 94%, and 65%, respectively, whereas those of CT were 78%, 58%, 71%, 78%, and 58%, respectively. FDG-PET detected 100% of metastatic lymph nodes > or =10 mm, intranodal tumor deposits > or =9 mm, and intranodal tumor deposits with a ratio >75%, whereas no nodes or tumor deposits smaller than 5 mm were detected. The spatial resolution limitations of FDG-PET were responsible for 16 of 20 (80%) false-negative PET results in lymph nodes.
FDG-PET is a useful tool for preoperative evaluation of the neck because it accurately detects metastatic lymph nodes > or =10 mm and has fewer false-positive cases than CT. The high specificity of FDG-PET for lymph node metastases may play an important role in avoiding unnecessary neck dissection.
Annals of Nuclear Medicine 04/2008; 22(3):177-84. · 1.41 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We report a juvenile case of diffuse sclerosing osteomyelitis of the mandible that showed a favorable response to pamidronate, a bisphosphonate derivative. Although conventional treatments had been ineffective for 5 years, pamidronate administration brought about conspicuous improvement both clinically and radiographically. Severe adverse reaction was not found except for low-grade fever and lassitude on the day following administration. During the course of the treatment, however, nonsuppurative osteomyelitis of the right humerus also occurred, leading to the established diagnosis of chronic recurrent multifocal osteomyelitis. Pamidronate therapy was again performed successfully with near disappearance of clinical symptoms. Both bone-specific alkaline phosphatase (bone formation marker) and pyridinoline cross-linked carboxyterminal telopeptide of type I collagen (bone resorption marker) showed a marked decrease with pamidronate therapy, suggesting that pamidronate is useful for the treatment of chronic recurrent multifocal osteomyelitis with inhibitory effect on bone turnover.
[Show abstract][Hide abstract] ABSTRACT: The patient is a 65-year-old man, who underwent curative resection for maxillary sinus carcinoma after chemoradiation. Lung metastases were observed two months following resection, and were treated with S-1 at a dose of 120 mg/day. One course of the S-1 administration regimen consisted of 2 weeks and a 1-week interval. The patient achieved long survival for 527 days with no adverse reaction. Therefore, this treatment on an outpatient basis greatly contributed to his quality of life. We consider S-1 as a first-line anti-cancer drug for tumor dormancy therapy.
Gan to kagaku ryoho. Cancer & chemotherapy 06/2007; 34(5):749-51.
[Show abstract][Hide abstract] ABSTRACT: There have been reports on the migration of teeth or implants into the maxillary sinus, but we know of no report on the migration of a gutta-percha point that had been used to fill a root canal into the ethmoid sinus. We report such a case which presumably migrated through the maxillary sinus.
British Journal of Oral and Maxillofacial Surgery 03/2004; 42(1):58-60. · 2.72 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To investigate the relationship between the efficacy of carbamazepine (CBZ) and the presence of the trigger zone for diagnosis of trigeminal neuralgia (TN). Study design CBZ was administered to 61 patients with suspected TN. All patients underwent intracranial examination by magnetic resonance imaging or computed tomography. The final diagnosis was established by oral and maxillofacial surgeon and neurosurgeon.
Of the 61 patients, 50 were finally diagnosed as having TN and 6 as having atypical facial pain. CBZ was effective for pain relief in 45 of the 50 TN patients (90%), and in 5 of the 11 patients (45%) with other diseases (P <.005). However, CBZ also relieved pain in some patients other than TN. Thirty of the 31 patients (97%) with a distinct trigger zone and 20 of the 30 (67%) without a trigger zone were diagnosed as having TN (P<0.005).
The efficacy of CBZ is an auxiliary indicator of TN and the presence of a distinct trigger zone is a strong indicator of TN.
[Show abstract][Hide abstract] ABSTRACT: Reliable variables to predict the radiosensitivity of each tumor have not been identified. Recent studies have demonstrated that specific regions of mutations within the core domain of p53 protein correlate with responses to chemotherapy and radiotherapy in some tumor types. In this study, we evaluated the relationship between specific p53 mutations and radiosensitivity in 49 patients with oral squamous cell carcinomas (SCCs) who underwent preoperative radiotherapy. Exons 5 through 8 of the p53 gene were examined by polymerase chain reaction-single-strand conformation polymorphism and direct sequencing. We detected p53 mutations in 27 (55.1%) cases. DNA contact mutations were detected in 11 (40.7%) of these 27 cases in L3 loop, loop-sheet-helix motif, and zinc-binding residues. Tumors containing p53 DNA contact mutations had significantly poorer responses to radiation than the other tumors, although no statistically significant difference between tumors with and without p53 mutations was found. These data indicate that DNA contact mutation of p53 could be a useful marker to predict the radioresistance of oral SCCs.
American journal of clinical oncology 11/2003; 26(5):e124-9. · 2.21 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Five types of removable partial dentures (two attachment dentures, two telescopic dentures and one clasp denture) were designed. The two attachment dentures were retained by the rigid-precision attachments with or without a stabilizing arm, and the two telescope dentures were retained with cone telescope crowns with or without cross-arch stabilization. The stresses acting on abutment teeth and denture bases and the movements of denture bases were investigated, and the influences of denture design were clarified. The stress acting on a terminal abutment tooth retained by a rigid-precision attachment or cone telescopic crown was larger than that acting on a terminal abutment tooth retained by a clasp. The attachment dentures tended to concentrate more stress at the terminal abutment tooth than did the telescopic dentures. The stress of denture base of an attachment denture and a telescopic denture was less than that of a clasp denture. There was no difference between the stresses of attachment and telescopic dentures. The displacement of the denture base tended to be less when the denture was designed with a rigid connection for the retainer and with cross-arch stabilization.
Journal of Oral Rehabilitation 06/2003; 30(5):482-7. · 2.34 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In this study, we focused on p53 mutations in specific regions, including DNA-binding surface regions, to clarify the correlation between mutations within the specific regions of p53 and clinical outcomes of patients with oral cancers. We analyzed p53 mutations in 121 fresh primary oral squamous cell carcinomas (SCCs) by polymerase chain reaction-single-strand conformation polymorphism or a yeast functional assay. p53 mutations were detected in 51/121 (42%) cases. Mutation of p53 was not associated with any clinicopathological parameters; however, tumors containing specific p53 mutations, e.g. DNA-binding surface regions (L2, L3 and the LSH motif) and conserved regions (II-V), had significantly poorer prognoses than tumors with mutations outside of those regions. Moreover, locoregional failure, lymph node metastasis and the occurrence of subsequent distant metastasis were also significantly associated with mutations within DNA-binding surface regions. These data indicate that specific mutations of p53 could be important prognostic factors in oral SCCs.
[Show abstract][Hide abstract] ABSTRACT: Mucinous adenocarcinoma is characterized by large pools of extracellular mucin. The tumor has been reported in the nasal cavity, paranasal sinus, breast, colon, stomach, prostate, skin, and lung. Mucinous adenocarcinoma also arises as a primary tumor of the major salivary glands. However, its occurrence is exceedingly rare and has only recently been recognized. Only 9 cases in the major salivary glands have been reported. We present an additional case of MAC in the maxilla that was considered to have developed from a palatal minor salivary gland.
[Show abstract][Hide abstract] ABSTRACT: The design of removable partial dentures (RPDs) is an important factor for good prognostication. The purpose of this study was to clarify the effectiveness of denture designs and to clarify the component that had high rates of failure and complications. A total of 91 RPDs, worn by 65 patients for 2-10 years, were assessed. Removable partial dentures were classified into four groups: telescopic dentures (TDs), ordinary clasp dentures (ODs), modified clasp dentures (MDs) and combination dentures (CDs). The failure rates of abutment teeth were the highest and those of retainers were the second highest. The failure rates of connectors were generally low, but they increased suddenly after 6 years. Complication and failure rates of denture bases and artificial teeth were generally low. Complication and failure rates of TDs were high at abutment teeth and low level at retainers. Complication and failure rates of ODs were high at retainers.
Journal of Oral Rehabilitation 08/2002; 29(7):627-33. · 2.34 Impact Factor