家兎を用いた下顎骨延長に関する実験的研究 : 特にBMP発現とその意義について

取得学位 : 博士（医学）, 学位授与番号 : 医博甲第1570号, 学位授与年月日 : 平成15年3月25日, 学位授与大学 : 金沢大

頭蓋内腫瘍の診断における遺伝学的解析の有用性とその臨床的意義 : 特に神経細胞腫と乏突起膠腫との鑑別について

取得学位 : 博士（医学）, 学位授与番号 : 医博甲第1541号, 学位授与年月日 : 平成14年6月30日, 学位授与大学 : 金沢大

Use of the Sonopet ultrasonic curettage device in intraoral vertical ramus osteotomy

金沢大学医学部附属病院歯科口腔外科This study was designed to evaluate the usefulness of the Sonopet UST-2001 (Miwatec Co., Ltd., Kawasaki, Kanagawa, Japan) ultrasonic curettage device, and to assess the outcome after intraoral vertical ramus osteotomy (IVRO). Thirteen Japanese adults (age range 20-41 years, mean age 29.6 years) presented with jaw deformities diagnosed as mandibular prognathism and asymmetry; they all underwent IVRO of the mandible. This procedure was followed by ultrasonic bone curettage using the Sonopet to make a guiding notch or groove in the lateral cortex of the ramus without damaging the vessels and nerves. After surgery, the osteotomy line was evaluated by three-dimensional computed tomography. In all patients, osteotomy with the Sonopet device was achieved safely, with minimal bleeding and no major complications. The distal segment could be moved into its ideal position and all patients achieved their ideal profiles. Ultrasonic bone curettage is a safe method for making a guiding groove, without damage to surrounding tissue, prior to complete IVRO. © 2007 International Association of Oral and Maxillofacial Surgeons

Changes in occlusal force after mandibular ramus osteotomy with and without Le Fort I osteotomy

金沢大学医学部附属病院歯科口腔外科金沢大学大学院医学系研究科がん細胞学The purpose of this study was to evaluate the differences in bite force changes and occlusal contacts after sagittal split ramus osteotomy (SSRO) and intraoral vertical ramus osteotomy (IVRO) with and without Le Fort I osteotomy. Sixty female patients with diagnosed mandibular prognathism with or without asymmetry were divided into four groups (SSRO, IVRO, SSRO with Le Fort I osteotomy and IVRO with Le Fort I osteotomy). Bite force and occlusal contacts were measured preoperatively and at 1, 3, 6 and 12 months after surgery with pressure-sensitive sheets. The differences among surgical procedures were examined statistically. Maximum bite force and occlusal contacts returned to preoperative levels after between 3 and 6 months. Regarding time-dependent changes in bite force and occlusal contact area, there were no significant differences among the groups. In conclusion, this study suggests that the combination of IVRO or SSRO and Le Fort I osteotomy does not affect postoperative time-dependent changes. © 2006 International Association of Oral and Maxillofacial surgeons

Stress change on the temporomandibular joint in mandibular prognathism subjects with asymmetry after orthognathic surgery

金沢大学医薬保健研究域医学系The purpose of this study was to evaluate changes in stress on the temporomandibular joint (TMJ) in 80 Japanese subjects (21 males and 59 females, mean age 23.7 years) with mandibular prognathism, with and without asymmetry after orthognathic surgery using the rigid bodies spring model (RBSM). The asymmetric group consisted of 40 subjects whose Mx-Md midline was more than 3 degrees. The remaining 40 subjects formed the symmetric group.The geometry of the stress analysis model was based on frontal cephalograms of the subjects. Menton (Me), the centre point of occlusal force on a line connecting the bilateral buccal cusps of the second molars, and the most lateral, superior, and medial points on the condyle were plotted on a computer display and stress on the condyle was calculated with the two-dimensional RBSM program, Fortran. The degree (force partition) of the resultant force, the direction (angulation), and the displacement (X, Y) of each condyle were calculated and the horizontal displacement (u), the vertical displacement (v), and rotation displacement (θ) of the mandibular body at Me were calculated pre- and post-operatively. The data was analysed using paired and unpaired t-tests.For the vertical (v) and rotational (θ) displacement, the post-operative value was smaller than the pre-operative value (v: P < 0.001, θ: P = 0.0063) in the asymmetric group. For angulation and the X-component, the post-operative value was smaller than that pre-operatively on the deviated (angulation: P = 0.0074, X-component: P = 0.0003) and non-deviated (angulation: P = 0.0024, X-component: P = 0.001) side in the asymmetric group. However, there was no significant difference between the pre- and post-operative value for any parameter in the symmetric group.These findings suggest that surgical correction of mandibular prognathism, with and without asymmetry, could induce an improvement in stress balance on the TMJ in the frontal aspect. © The Author 2010

The Use of an Intermaxillary Fixation Screw for Mandibular Setback Surgery

金沢大学医学部附属病院歯科口腔外科Purpose: To assess skeletal stability after mandibular setback surgery with and without an intermaxillary fixation (IMF) screw. Patients and Methods: The subjects were 40 patients with mandibular prognathism. The subjects underwent sagittal split ramus osteotomy with titanium plate fixation and were divided into 2 groups, 1 with and 1 without an IMF screw. A lateral cephalogram was done preoperatively, immediately after surgery, and 1 month, 3 months, and 6 months postoperatively. The 2 groups were then compared statistically. Results: In the comparison of the time-course change between the 2 groups with repeated measure analysis of variance, there were significant differences in occlusal plane (between subjects, F = 2.517; df = 4; P = .0437) and convexity (between subjects, F = 4.048; df = 4; P = .0038). However, there was no significant difference in the other measurements. Conclusion: This study suggested that in most measurements, there was no significant difference between 2 groups with and without an IMF screw in time-course skeletal change. However, use of IMF screws was helpful for orthognathic surgery as a rigid anchor of IMF. © 2007 American Association of Oral and Maxillofacial Surgeons

The Prevention of Periodontal Bone Loss at the Osteotomy Site After Anterior Segmental and Dento-Osseous Osteotomy

金沢大学医学部附属病院歯科口腔外科Purpose: Degeneration of the gingival margin and periodontal bone loss between segments can occur in various segmental osteotomies. However, treatment and management of these problems have not yet been resolved; improvement of the conventional method is necessary. The purpose of this retrospective study is to evaluate the usefulness and advantage of orthodontic devices in osteotomies. Patients and Methods: Forty Japanese adults presented with jaw deformities diagnosed as mandibular prognathism with maxillary protrusion, bimaxillary protrusion, and anterior crowding. Of these 40 patients, 20 (group 1) underwent anterior segmental osteotomy or dento-osseous osteotomy along with our original orthodontic periodontal management. The remaining 20 (group 2) patients underwent conventional procedures. After surgery, pocket depth and periodontal bone loss at the osteotomy site were evaluated. Results: In all cases of patients who underwent our original technique, degeneration of the gingival marginal and periodontal defects at the osteotomy site were not found. The rate of alveolar bone height in group 1 significantly increased and that in group 2 significantly decreased after maxillary osteotomy (P < .05). Conclusion: This technique may prevent periodontal defects from occurring at the interdental osteotomy site. © 2006 American Association of Oral and Maxillofacial Surgeons

Condylar and disc positions after sagittal split ramus osteotomy with and without Le Fort I osteotomy

金沢大学医学部附属病院歯科口腔外科金沢大学大学院医学系研究科がん細胞学Purpose: The purpose of this study is to examine the changes in temporomandibular joint (TMJ) morphology and clinical symptoms after sagittal split ramus osteotomy (SSRO) with and without a Le Fort I osteotomy. Subjects and Methods: Of 45 Japanese patients with mandibular prognathism, 23 underwent SSRO and 22 underwent SSRO in combination with a Le Fort I osteotomy. The TMJ symptoms and joint morphology, including disc tissue, were assessed preoperatively and postoperatively by magnetic resonance imaging (MRI) and axial cephalography. Results: There were significant differences between pre- and postoperative horizontal changes in the condylar long axis on the right side in the group undergoing SSRO (sagittal split ramus osteotomy) alone. However, there were no other significant differences in pre- and postoperative measurements in this group as compared with the group receiving SSRO plus Le Fort I osteotomy, and the preoperative disc position could not be changed in either group. Conclusion: These results suggest that SSRO, either with or without Le Fort I osteotomy, could not change the preoperative disc position or correct anterior disc displacement, although these procedures did improve the symptoms associated with TMJ dysfunction. © 2007 Mosby, Inc. All rights reserved

Relationship Between the Morphologies of the Masseter Muscle and the Ramus and Occlusal Force in Patients With Mandibular Prognathism

金沢大学医学部附属病院歯科口腔外科Purpose: The purpose of this study was to examine the relationship between the morphologies of the masseter muscle and the ramus and occlusal force in patients with mandibular prognathism. Patients and Methods: The study group consisted of 71 patients with mandibular prognathism. They were divided into 2 groups, consisting of prognathism with or without symmetry, determined by frontal cephalogram analysis. All patients underwent 3-dimensional (3D) computed tomography (CT) and occlusal force was recorded with pressure-sensitive sheets. Results: In the cross-sectional area of masseter muscle, there were no significant differences between the right and left sides in the symmetry and asymmetry groups. In occlusal force, there was no significant difference between the symmetry and asymmetry groups. Occlusal force was not significantly correlated to the cross-sectional area of the ramus, but it was significantly positively correlated to the cross-sectional area of the masseter muscle (P < .05). Conclusion: Occlusal force was associated with the ipsilateral cross-sectional area of masseter muscle in patients with prognathism; however, it was not associated significantly with the degree of mandibular deviation. © 2006 American Association of Oral and Maxillofacial Surgeons

A comparative CT evaluation of pharyngeal airway changes in class III patients receiving bimaxillary surgery or mandibular setback surgery

金沢大学大学院医学系研究科がん細胞学Objective: The purpose of this study was to compare the morphologic changes of the upper airway space in Class III patients who underwent mandibular setback or bimaxillary surgery (maxillary advancement and mandibular setback) by computed tomography at 2 levels: soft palate and base of tongue. Methods: The sample consisted of 47 subjects in 2 groups who had been diagnosed as having Class III skeletal deformities and had been treated by mandibular setback or bimaxillary surgery (maxillary advancement and mandibular setback). Anteroposterior, lateral, and cross-sectional area dimensions of the airway at the level of soft palate and base of tongue were measured pre- and postoperatively on computed tomography images. Results: Anteroposterior dimensions of the airway decreased in both groups (P .05). Conclusions: This study suggests that bimaxillary surgery can prevent narrowing of the upper airway in the correction of Class III deformities in comparison with mandibular setback surgery used as the sole treatment. Computed tomography was valuable in determining the effects of surgical treatment on pharyngeal airway dimensions. © 2008 Mosby, Inc. All rights reserved