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*******< 今月の症例 >******

Fig. 1 at the age of 16.

Fig. 2 at the age of 23.

Fig. 3 at the age of 27.

口唇炎；舌炎；甲状腺腫： Cheilitis, Glossitis & Goiter:

Goiter  Cheilitis  Glossitis

Goiter: A patient, 27-year-old female, was  referred to us for multiple lymph node  swelling of the neck and submandibular  region. Pt. had had operated on the thyroid 10  years ago. Concerning the tumor Pt. was  referred to the specialist.  Interestingly a cheilitis and a glossitis were  found in the patient concomitantly.  (Actinic) Cheilitis：  Elastic soft, cobblestone appearance, cheilitis. The vermilion margin becomes crusted and indurated, which has been observed for the past five to six years.  Glossitis Chronic painful glossitis with a bright,  lizard-skin-like red tongue related to  nutritional deficiencies。  The glossitis, too, has been observed for the past 5 to 6  years. 27歳、女性、顎下部および頸部の多発性リンパ節腫脹の精査目的に当科を紹介されたものですが、甲状腺、リンパ節腫脹等に関しては10数年前に手術を施行した施設に紹介、転院しまた。 同患者は特異な(光線)口唇炎と舌炎を有していました。いずれも5年以上前から認められるも放置されておりました。ビタミンB欠乏等の素因を有することが考えられます｡

Congenital ankyloglossia and frenectmy   先天性舌強直症 Congenital ankyloglossia and lingual frenectomy   A Female, 72-year-old, was referred us  to have a lingual frenectomy in order to meet the demand of prosthodontics.

片側性顎関節脱臼： Unilateral Dislocation of the Mandible:

Radiographic Examination:Panoramic radiographs of the temporomandibular joint revealed the crest of the right condyle(c) anterior to and superior to the crest of the right articular eminence(e), while the left condylar head was in the glenoid fossa.

Patient:A 81-year-old woman was came to our OPD on November 11, with a dislocation of her mandible that had been present for 7 days. Treatment: To attempt manual reduction of the dislocation was successful. 81歳、女性、7日続く閉口不能による咀嚼障害で当科受診。　　　徒手整復を施術

ベーチェット症候群；再発性潰瘍 Behcet's syndrome; recurrent aphthous ulser (RAU) 31歳,男性.ベーチェット症候群 1998年2月に初発, 2000年７月急性化の為入院（３回目） 主訴：口内痛の為摂食不能 著明な舌の白苔, 小潰瘍を舌, 口唇, 頬粘膜に認める (Fig..1,2,3-5) ファンギゾンを投与，5日後白苔，疼痛は寛解し摂食可となる。 残存する粘膜潰瘍(Fig. 4,5-5) ＊口腔粘膜のアフタ性潰瘍・外陰部潰瘍・大腿部毛嚢炎・ 両側膝関節炎・回盲部潰瘍を認める。 針反応：（陽性）赤沈：（64mm/h, 94mm/2h） CRP：8．5　白血球数21700/ul 写真をクリックしてご覧下さい Fig.. 1-5 再発性小潰瘍 RAU, Behcet's disease Fig. 2-5 白舌苔：カンヂダ症 Behcet's  disease Fig. 3-5 再発性小潰瘍 RAU Behcet's disese Fig. 4-5 再発性小潰瘍 RAU Behcet's disease Fig 5-5 再発性小潰瘍 RAU Behcet's disease Male, 31 years, had a typical case of Behcet’s disease of 2 years duration. Note white coated tongue with apthous ulcer on the tongue at the first examination (Fig. 1,2,3-5). He was started on Fungisone. In a few days the pain and coated tongue was subsided (Fig. 4,5-5).  The onset of present illness goes back to Feb.1998.

remark: Common manifestations (over 90 % of patients) Recurrent oral ulceration (+)  Genital ulceration (+) Eye lesions(uveitis) Less common manifestations Skin rashes and pustules (+) Arthritis of major joints (+) Neurological lesions ----- diffuse and intacranial Haematuria Abdominal discomfort (+)

******<2000年11月 今月の症例>******
集合性歯牙腫
Compound Odontoma

左側上顎乳犬歯の直上に歯牙様塊状物が認められる。犬歯は側方に転位し未萌出の状態である。 Compound odontoma in the left maxillary cuspid area, displacing and preventing it eruption.

摘出された歯牙様硬固物   Tooth forms, single and fused, that were removed.

含歯性 ( 濾胞性 ) 嚢胞 Dentigerous (follicular) Cyst 52歳，男性．左側尾翼下部の無痛性の腫脹を主訴に 当科を紹介され来院．上顎正中部に過剰歯と鼻腔底， 上顎洞に接するX線透過像を認める． Large dentigerous cyst - male, 52 years - that developed from a rudimentalry supernumerary lateral incisor. The technique of choice here was labial marsupialization and removal of the supernumaerary lateral incisor.

顔面神経麻痺 Bell’s palsy-----Facial paralysis 59歳、女性。左側Bell 症候，麻痺性兎眼 （意識的眼裂閉鎖不能） 口笛不能，鼻唇溝の消失，前額部皺の消失が認められる。 Female, 59 years, had a typical case of Bell’s palsy of 3 days duration. Note inability to close the upper lid and turning up of the eyeball (Bell’s sign ) and wrinkle of the forehead. Paralysis of the left side of the lip thus whistling or smiling is not possible. She was started on Predonosolone, 30 mg, two times a day. In 12 days the paralysis was markedly improved.

 

慢性関節リウマチは自己免疫不全状態を背景に持つ慢性の全身性炎症性疾患です。
その主病変は末梢の関節に発症します。顎関節の発症は少なからず診られるとされるのですが、歯科で診ることはやはり希です。
主な病態は滑膜の肉芽腫性病変です。増殖した滑膜は軟骨、軟骨下骨へと浸潤し、関節の破壊を来し関節の変形や運動障害を起こします。
治療方法は抗リウマチ剤-DMARD-等ありますが効果は不確実で原因療法は確立されていません。
急性期では、非ステロイド系抗炎症剤の投与と顎関節の安静、軟らかい食事の摂取、微温湯による湿布などの対症療法です。重症例ではhydroxychloroquine, gold, penicillamine等で疼痛と炎症を制御します。
症状の寛解が認められたら、顎の可動性を確保するために軽度の顎運動を開始します。
顎関節強直症を後遺した時は病勢の停止を待って手術の適応と成ります（顎関節受動術）。

*Legend: Male, 68 years. He's noticed a chronic painless swelling on the l-buccal region for decades of life. He has applied a pressure over it to get relief. CT sialograms revealed Stenon's duct had two large diverticula.

エナメル上皮腫1-3 ameloblastoma 1-3.jpg	エナメル上皮腫2-3 ameloblastoma 2-3.jpg	エナメル上皮腫3-3 ameloblastoma 3-3.jpg	急性下顎骨骨髄炎1-4 osteomyelitis 1-4.jpg
急性下顎骨骨髄炎2-4 osteomyelitis 2-4.jpg	急性下顎骨骨髄炎3-4 osteomyelitis 3-4.jpg	急性下顎骨骨髄炎4-4 osteomyelitis 4-4.jpg	歯牙異所萌出 ectopic eruption.gif

*註
エナメル上皮腫1-3､2-3：左側下顎遇角部より上行枝にわたる症例､開窓し経過観察中
エナメル上皮腫3-3：右側下顎骨体部の症例､開窓法は無効で､切除術の適応例
急性下顎骨骨髄炎1-4：初診､原因歯6の根尖に限局した透過像を認める他所見無し
急性下顎骨骨髄炎2-4：PCを7日投与（4g/日）間欠性疼痛は持続､CLDMに変更し奏功を得る
　　　　　　　　　　　　　　　切痕部より後縁に斜走する透過像と遇角部に斑状透過像
急性下顎骨骨髄炎3-4：通院加療中（CLDM4週間）切痕､遇角部の皮質を含めた骨溶解像が明瞭
急性下顎骨骨髄炎4-4：通院加療中（CLDM6週間）X線透過像は若干不明瞭となる

*Legend
ameloblastoma 1-3: a large radiolucent lesion of the left side of mandible, fenestrated
ameloblastoma 2-3: ib. 1-3, Posteroanterior view demonstrating large, multilocular,
                             expansile radiolucent area.
ameloblastoma 3-3: circumscribed radiolucent area containing mandibular right third molars.
                             fenestrated but failed to response.
acute osteomyelitis 1-4: Panoramic radiograph showing no radiolucent lesion of the mandible.
acute osteomyelitis 2-4:CLDM relieved symptoms and X-P demonstrated radiolucent lesion
                                  around incisula and angular region. (treatment with CLDM, 2 weeks long)
acute osteomyelitis 3-4: radiolucent lesion getting obvious (treatment with CLDM , 4 weeks long)
acute osteomyelitis 4-4: radiolucent lesion getting narrower  (treatment with CLDM, 6 weeks long)

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Fig. 8-1

Fig.8-2

Fig.8-3

Patient. This patient is 21-year-old female.
Chief Complaint. "Localized palatal enlargement with bleeding."
History of Present illness. The existence of a small palatal mass had first been noticed 6 months prior to the first dental consultation. During the interim, it had gradually increased in diameter, asymptomatically. Recently bleeding from the tumor was noted following food up taking.
Intraoral Examination. A loburated, partly pedunculated, soft（like carcass meat), tissue mass, approximately 1.5 by 2.0 by 1.0 cm in diameter, was found at the posterior junction of the hard palate, immediately adjacent to the greater palatine foramen. The epithelium remained intact except for some emerged congestion on the surface (Fig. 8-1).
Operative Technique. The lesion was excised by a circumferential elliptical incision well beyond the base. An incision was made down to the palatal bone. Stay sutures are introduced through healthy palatal mucosa at the edge to facilitate safety dissection. Blunt dissection was used in carrying the incision over the palatal bone, whereby the tumorous mass was freed from its base in toto. The base of the lesion containing vessels was grasped with a hemostat, and a catgut ligature was placed around the vessels. The vessels were cut between the hemostat and the suture. The wound was packed with gauze, stayed with splint.
Hospital Course. The postopertive course was uneventful, and the patient was discharged 4 days postoperatively.

黒毛舌 blackhairytongue.jpg	カンジダ症 candidiasis.jpg	頬粘膜血管腫 hemangioma.jpg	帯状疱疹 herpeszoster.jpg
帯状疱疹 herpeszoster.jpg	帯状疱疹 herpeszoster.jpg	帯状疱疹 herpeszoster.jpg

今月の症例	資料室	ニュース	メールサービス	憩いの部屋	歯科リンク　     & Top