三 月 十一 日
主持人：陳中和
Functional oral rehabilitation in oral tumor patients
SEKINE Joji Twenty years observation of maxillary reconstruc-tion using revascularized osteocutaneous flap and dental implant MATAGA Izumi
休息
主持人：黃振勳
Ridge preservation or augmentation - the scaffold principle
Victor Fan Immediate implant placement: is it safe and predictable?
張燕清
午餐
主持人：陳信銘
Implant rehablitation in surgically compromised alveolar ridge
高壽延
Esthetic Considerations of Implant Surgery 陳遠謙
休息
主持人：劉崇基
Implant placed immediately through lateral trap-door window procedure to accomplish maxillary sinus elevation without bone graft
陳大為
Platform shifting-truth or myth
方致元 地 點： 中山醫學大學正心樓一樓 112教室 展示時間：一 ○ 一 年 三 月 十、 十一日 三 月 十 日
主持人：高壽延
Managing Cleft Service and Education in Populous Country
ARUMSARI, ASRI Surgery First Orthognathic Approach with Vertical Ramus Osteotomy
Young-Soo Jung 休息
主持人：張陽明
口腔腫瘤綜合序列治療的上海經驗 張陳平 午餐主持人：黃穰基
Our Concept of Hospital Share based on International Medical Collaboration
SETO Kanichi Usefulness of two-stage surgery for benign odontogenic tumors showing large cystic, intraosseous lesions in the mandible
KIMURA Hiroto
休息
主持人：賴聖宗
Orthognathic Surgery in Japan: past, present and future SAITO Chikara 休息 會員大會
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中華民國口腔顎面外科學會第十三屆第二次會員大會暨第二十四次學術研討會
活 動 內 容 一 覽 表 演 講 9:40 10:20 11:00 11:20 12:00 14:00 14:40 15:20 16:00 16:40 17:00 18:30 9:00 9:40 10:20 10:40 11:20 12:00 14:00 14:40 15:20 15:40 16:20 17:00 時間地點 時間地點活 動 內 容 一 覽 表 壁 報 貼 示 時間 三 月 十 、 十一 日 9:00 開始
主持人：林冠州、羅金文
編號
新式骨材：幾丁質/聚甘醇酸水膠可促進拔牙傷口之癒合 蔡怡欣 1 沖洗液對超音波骨刀取得之自體骨的影響 林文仁 2 姿勢與顳顎關節症候群相關性之研究 張婷菡 3 以骨性埋伏齒進行自體齒移植重建前上顎齒列―病例報告 林涵威 4 柯特威爾-路克氏手術不經下鼻道造口：50個病例回顧 黃于真 5 上顎竇之含齒囊腫以及異位牙―病例報告 陳人瑄 6 利用骨板做為骨性錨定來治療嚴重水平阻生第二大臼齒 許經偉 7 以錐狀放射電腦斷層掃描(CBCT)協助先天性鎖骨及顱骨發育不全患者多發性贅生齒之 手術移除―病例報告及文獻回顧 王俊傑 8 另類植體周圍炎之治療―以蓄意齒再植進行植體周圍膿瘍之清創 梁光源 9 44名患者接受不含骨移植之上顎竇增高術植入80根人工植體之五年長期追蹤研究 林依靜 10 人工牙根植入鼻腔之醫源性疏忽 簡杏宜 11 新式複合表面處理SAH技術對牙科植體骨整合之影響評估：動物試驗 張勝惟 12 左側上顎粗隆區之化膿性肉芽腫―病例報告 陳可望 13 以手術方式治療雙磷酸鹽類相關骨壞死之成果―23病例報告 陳畊仲 14 與使用每年一劑zoledronic acid相關的顎骨壞死—兩個病例報告 楊曙亙 15 糖尿病患者因克雷白氏肺炎菌感染造成左臉部蜂窩性組織炎―病例報告 林彥宏 16 齒源性壞死性筋膜炎合併縱膈腔炎—病例報告 黃正鈞 17 顏面神經麻痺—三病例報告 蔡百泰 18 顏面部創傷後之三叉神經神經感覺失能—病例報告 蔣孟達 19 鄉村地區顏面骨骨折特色與住院延長相關因子探討 張起華 20 顎顏面骨折之治療經驗 曾建福 21 右側顳顎關節頭脫位進入中顱窩―病例報告 陳癸菁 22 復發性顳顎關節黏連之手術處理 顏明良 23 經皮顴骨骨釘輔助顴上顎複合體骨折復位 王得方 24 突發性顳顎關節窩內骨塊剝落—病例報告 邱日宥 25 梭狀細胞脂肪瘤 陳睿妍 26節
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中華民國口腔顎面外科學會第十三屆第二次會員大會暨第二十四次學術研討會
地 點：中 山 醫 學 大 學 正 心 樓 二 樓 展示時間：一 ○ 一 年 三 月 十 、 十 一 日活 動 內 容 一 覽 表 壁 報 貼 示 時間 三 月 十 、 十一 日
主持人：程稚盛、蔡樂霖
編號
疣狀黃瘤—病例報告 方家恩 27 下顎神經鞘瘤—病例報告 魏鈴穎 28 顎骨內造釉細胞瘤—病例報告 陳志僑 29 上顎侵犯眼眶底部造釉細胞瘤之切除與重建—病例報告 柳依青 30 Gardner's syndrome早期診斷：一個家族報告 葉崢嶸 31 下顎骨軟骨黏液樣纖維瘤—病例報告 吳吉祥 32 下顎造釉細胞瘤併發肺轉移—病例報告 傅康貴 33 發生於腮腺區的Castleman's disease—病例報告 陳建晟 34 貝克型肌肉萎縮症於上顎囊腫剜除後引發橫紋肌溶解及心跳停止—病例報告 洪孟豪 35 右下顎骨動靜脈畸形—病例報告 吳禕凡 36 左側下顎骨髁頭骨性脂肪瘤—病例報告 何祖銘 37 頦部肌肉內纖維脂肪瘤—病例報告 陳怡睿 38 下顎骨組織細胞增生症—病例報告 于 會 39 以舌唇黏合術治療有上呼吸道阻塞的皮爾羅賓氏症患者—兩個病例報告 呂明怡 40 年輕女性患有復發性骨內巨大細胞肉芽瘤—病例報告 張哲綸 41 左側下顎骨纖維性發育不良—病例報告 吳契璁 42 顎骨漿細胞肉芽腫—病例報告 邵子齡 43 兩側及復發性耳下腺淋巴樣乳頭囊狀腺瘤—兩病例報告 唐宗凡 44 以去頭皮除皺術切線進行耳前區腫瘤摘除術—病例報告 楊芊瑩 45 下顎單囊造釉母細胞瘤—病例報告 徐允中 46 咬合平面未明顯歪斜的顏面不對稱 陳登偉 47 中山醫學大學附設醫院口腔顎面外科正顎手術病例分析 彭芷瑜 48 正顎手術併發暫時性的顏面神經麻痺—病例報告 游竣傑 49 顏面不對稱病人的單純頦緣傾斜—22個病例研究 陳孟延 50 顎顏面手術術後骨化性肌炎—病例報告 粘炳樟 51節
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中華民國口腔顎面外科學會第十三屆第二次會員大會暨第二十四次學術研討會
地 點：中 山 醫 學 大 學 正 心 樓 二 樓 展示時間：一 ○ 一 年 三 月 十 、 十 一 日活 動 內 容 一 覽 表 壁 報 貼 示 時間 三 月 十 、 十一 日
主持人：陳俊明、蔣維凡
編號
下顎根尖下截骨術及雙側下顎骨聯合旁截骨術術後疼痛度之比較 蘇昶瑋 52 雙側下顎骨副骨聯合截骨術之失血量研究 林蔚庭 53 雙自由皮瓣於頭頸癌切除後廣泛顏面缺損之應用 徐偉凱 54 嘴角及唇部重建—病例報告 許文祥 55 應用新式胸鎖乳突肌皮瓣在口底癌患者之重建 陳泓志 56 舌根部鱗狀上皮細胞癌的術後重建 侯俊羽 57 嚴重免疫低下病人口內同時二原發惡性腫瘤之處置—病例報告 沈炯志 58 硼中子捕獲治療與復發性頭頸癌 黃弘昌 59 5-氨基酮戊酸光動力療法為有效治療口腔疣狀癌的另類療法 何念恩 60 顱底手術之顳下區腫瘤切除術—病例報告 楊方瑜 61 原發性上顎瀰漫性大B細胞淋巴瘤—病例報告 黃金聲 62 口腔中非霍奇金氏淋巴瘤—病例報告 何宗訓 63 下顎骨漿細胞瘤—病例報告 莊函屏 64 下顎骨間葉型軟骨肉瘤—病例報告 趙于華 65 上顎部亮細胞瘤—病例報告 洪啟勛 66 上顎無特殊性腺癌—病例報告 陳怡伶 67 下肢滑液膜肉瘤之口內轉移—病例報告 蔡俊益 68 口腔癌中癌幹細胞標記Oct4與Nanog的上升與其cisplatin化療抗藥性呈正相關 蔡樂霖 69 雷公藤內酯醇抑制藥物抗性及提升化療與放療之效果 陳元武 70 口腔癌與神經周圍侵犯及神經生長因子之關聯性 于恩浩 71 經由營養介入提升頭頸癌病患營養狀況指標—體重及攝食量之比率 李俊瑩 72 Rb藉由調控DNMT1之表現以維持間葉幹細胞於靜止狀態並避免其過早衰老 王 瑀 73 探討HIF-1 alpha在口腔鱗狀上皮細胞癌，疣狀乳突增生之表現差異及其與血管增生因子 (CD31，CD34和vWF)之比較 李立慈 74 口腔癌患者血清中血小板衍生性生長因子AA之表現分析 王有宇 75 年輕口腔癌—病例報告 許修銨 76節
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中華民國口腔顎面外科學會第十三屆第二次會員大會暨第二十四次學術研討會
地 點：中 山 醫 學 大 學 正 心 樓 二 樓 展示時間：一 ○ 一 年 三 月 十 、 十 一 日活 動 內 容 一 覽 表 壁 報 貼 示
時間 三 月 十 、 十一 日
主持人：柯政全、柯文昌
編號
Effects of mouth opening exercises for masticatory muscle tendon-aponeurosis hyperplasia
Noriyuki TAKASHI, Nobuo INOUE, Yasunori TOTSUKA J-001
The effect of concurrent chemoradiotherapy of the metastatic lymph node in advanced lower gingival carcinoma
Y Ohiro, K Kuribayashi, Y Ashikaga, M Ono, K Tei, Y Totsuka J-002
MUC1 expression in squamous cell carcinoma of the tongue
H. Itoh, Y. Jinbu, N. Miyagi, Y. Ohyatsu, T. Noguchi, M. Kusama, K. Tsukinoki J-003
Wound dressing method using polyglycolic acid sheet (PGA sheet) and fibrin glue spray for wound surfaces following oral tumor resection
Norito Miyagi, Hiroto Itoh, Yasuhisa Shinozaki, Ryuji Nakayama Yoshiyuki Tsuchiya, Tadahide Noguchi, Yoshinori Jinbu, Mikio Kusama
J-004
A case of prostatic carcinoma that metastasized to the mandible
Yukio ohyatsu, Yoshinori Jinbu, Kei Kashimura, Norito miyagi, Kaoru Ikeda, Hiroto Itoh, Yoshiyuki Tsuchiya, Tadahide Noguchi, Mikio Kusama
J-005
Does the swallowing function recover during the long-term in patients with surgically treated tongue carcinomas? Kanchu Tei, Noriyuki Sakakibara, Yutaka Yamazaki,
Yoichi Ohiro, Mitsunobu Ono, Yasunori Totsuka J-006
A squamous cell carcinoma of the tongue dorsum
Yasunori TOTSUKA, Mitsunobu ONO, Yoichi OHIRO, Kanchu TEI J-007
Reconstruction by pedicled fat-pad flap
Sakuma Kaname, Akadomari Keita and Mataga Izumi J-008
Surgical treatment of accessory parotid gland tumors
Akadomari Keita, Sakuma Kaname and Mataga Izumi J-009
A survey of surgical-orthodontic cases past a decade in the department of maxillofacial surgery of Tokyo medical and dental university
K. KUROHARA, N. ARAI, K. NAKAKUKI, Y. NINAKA, M. HOSOKI, N. TOMOMATSU, Y. MICHI, M. SUZUKI, H. YOSHIMASU, T. AMAGASA and M. YAMASHIRO
J-010
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中華民國口腔顎面外科學會第十三屆第二次會員大會暨第二十四次學術研討會
地 點：中 山 醫 學 大 學 正 心 樓 二 樓 展示時間：一 ○ 一 年 三 月 十 、 十 一 日–I–
目 錄
專題演講
Managing Cleft Service and Education in Populous Country……… 1
Surgery First Orthognathic Approach with Vertical Ramus Osteotomy……… 2
口腔腫瘤綜合序列治療的上海經驗……… 3
Our Concept of Hospital Share based on International Medical Collaboration……… 4
Usefulness of two-stage surgery for benign odontogenic tumors showing large cystic, intraosseous lesions in the mandible……… 5
Orthognathic Surgery in Japan: past, present and future……… 7
Functional oral rehabilitation in oral tumor patients……… 9
Twenty years observation of maxillary reconstruc-tion using revascularized osteocutaneous flap and dental implant………10
Ridge preservation or augmentation - the scaffold principle………11
Immediate implant placement: is it safe and predictable?………12
Implant rehablitation in surgically compromised alveolar ridge………13
Esthetic Considerations of Implant Surgery………14
Implant placed immediately through lateral trap-door window procedure to accomplish maxillary sinus elevation without bone graft………15
Platform shifting-truth or myth………16
貼示論文報告
001 新式骨材：幾丁質/聚甘醇酸水膠可促進拔牙傷口之癒合………17 002 沖洗液對超音波骨刀取得之自體骨的影響………18 003 姿勢與顳顎關節症候群相關性之研究………19 004 以骨性埋伏齒進行自體齒移植重建前上顎齒列―病例報告………20 005 柯特威爾-路克氏手術不經下鼻道造口：50個病例回顧………21 006 上顎竇之含齒囊腫以及異位牙―病例報告………22 007 利用骨板做為骨性錨定來治療嚴重水平阻生第二大臼齒………23 008 以錐狀放射電腦斷層掃描(CBCT)協助先天性鎖骨及顱骨發育不全患者多發性 贅生齒之手術移除―病例報告及文獻回顧………24 009 另類植體周圍炎之治療―以蓄意齒再植進行植體周圍膿瘍之清創………25 010 44名患者接受不含骨移植之上顎竇增高術植入80根人工植體之五年長期追蹤研究 ………26–II– 011 人工牙根植入鼻腔之醫源性疏忽………27 012 新式複合表面處理SAH技術對牙科植體骨整合之影響評估：動物試驗………28 013 左側上顎粗隆區之化膿性肉芽腫―病例報告………29 014 以手術方式治療雙磷酸鹽類相關骨壞死之成果―23病例報告………30 015 與使用每年一劑zoledronic acid相關的顎骨壞死—兩個病例報告………31 016 糖尿病患者因克雷白氏肺炎菌感染造成左臉部蜂窩性組織炎―病例報告…………32 017 齒源性壞死性筋膜炎合併縱膈腔炎—病例報告………33 018 顏面神經麻痺—三病例報告………34 019 顏面部創傷後之三叉神經神經感覺失能—病例報告………35 020 鄉村地區顏面骨骨折特色與住院延長相關因子探討………36 021 顎顏面骨折之治療經驗………37 022 右側顳顎關節頭脫位進入中顱窩—病例報告………38 023 復發性顳顎關節黏連之手術處理………39 024 經皮顴骨骨釘輔助顴上顎複合體骨折復位………40 025 突發性顳顎關節窩內骨塊剝落—病例報告………41 026 梭狀細胞脂肪瘤………42 027 疣狀黃瘤—病例報告………43 028 下顎神經鞘瘤—病例報告………44 029 顎骨內造釉細胞瘤—病例報告………45 030 上顎侵犯眼眶底部造釉細胞瘤之切除與重建—病例報告………46 031 Gardner's syndrome早期診斷：一個家族報告………47 032 下顎骨軟骨黏液樣纖維瘤—病例報告………48 033 下顎造釉細胞瘤併發肺轉移—病例報告………49 034 發生於腮腺區的Castleman's disease—病例報告………50 035 貝克型肌肉萎縮症於上顎囊腫剜除後引發橫紋肌溶解及心跳停止—病例報告……51 036 右下顎骨動靜脈畸形—病例報告………52 037 左側下顎骨髁頭骨性脂肪瘤—病例報告………53 038 頦部肌肉內纖維脂肪瘤—病例報告………54 039 下顎骨組織細胞增生症—病例報告………55 040 以舌唇黏合術治療有上呼吸道阻塞的皮爾羅賓氏症患者—兩個病例報告…………56 041 年輕女性患有復發性骨內巨大細胞肉芽瘤—病例報告………57 042 左側下顎骨纖維性發育不良—病例報告………58 043 顎骨漿細胞肉芽腫—病例報告………59
–III– 044 兩側及復發性耳下腺淋巴樣乳頭囊狀腺瘤—兩病例報告………60 045 以去頭皮除皺術切線進行耳前區腫瘤摘除術—病例報告………61 046 下顎單囊造釉母細胞瘤—病例報告………62 047 咬合平面未明顯歪斜的顏面不對稱………63 048 中山醫學大學附設醫院口腔顎面外科正顎手術病例分析………64 049 正顎手術併發暫時性的顏面神經麻痺—病例報告………65 050 顏面不對稱病人的單純頦緣傾斜—22個病例研究………66 051 顎顏面手術術後骨化性肌炎—病例報告………67 052 下顎根尖下截骨術及雙側下顎骨聯合旁截骨術術後疼痛度之比較………68 053 雙側下顎骨副骨聯合截骨術之失血量研究………69 054 雙自由皮瓣於頭頸癌切除後廣泛顏面缺損之應用………70 055 嘴角及唇部重建—病例報告………71 056 應用新式胸鎖乳突肌皮瓣在口底癌患者之重建………72 057 舌根部鱗狀上皮細胞癌的術後重建………73 058 嚴重免疫低下病人口內同時二原發惡性腫瘤之處置—病例報告………74 059 硼中子捕獲治療與復發性頭頸癌………75 060 5-氨基酮戊酸光動力療法為有效治療口腔疣狀癌的另類療法………76 061 顱底手術之顳下區腫瘤切除術—病例報告………77 062 原發性上顎瀰漫性大B細胞淋巴瘤—病例報告………78 063 口腔中非霍奇金氏淋巴瘤—病例報告………79 064 下顎骨漿細胞瘤—病例報告………80 065 下顎骨間葉型軟骨肉瘤—病例報告………81 066 上顎部亮細胞瘤—病例報告………82 067 上顎無特殊性腺癌—病例報告………83 068 下肢滑液膜肉瘤之口內轉移—病例報告………84 069 口腔癌中癌幹細胞標記Oct4與Nanog的上升與其cisplatin化療抗藥性呈正相關……85 070 雷公藤內酯醇抑制藥物抗性及提升化療與放療之效果………86 071 口腔癌與神經周圍侵犯及神經生長因子之關聯性………87 072 經由營養介入提升頭頸癌病患營養狀況指標—體重及攝食量之比率………88 073 Rb藉由調控DNMT1之表現以維持間葉幹細胞於靜止狀態並避免其過早衰老……89 074 探討HIF-1 alpha在口腔鱗狀上皮細胞癌，疣狀乳突增生之表現差異及其與血管 增生因子(CD31，CD34和vWF)之比較………90 075 口腔癌患者血清中血小板衍生性生長因子AA之表現分析………91
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076 年輕口腔癌—病例報告………92
J-001 Effects of mouth opening exercises for masticatory muscle tendon-aponeurosis hyperplasia ………93
J-002 The effect of concurrent chemoradiotherapy of the metastatic lymph node in advanced lower gingival carcinoma………94
J-003 MUC1 expression in squamous cell carcinoma of the tongue………95
J-004 Wound dressing method using polyglycolic acid sheet (PGA sheet) and fibrin glue spray for wound surfaces following oral tumor resection………96
J-005 A case of prostatic carcinoma that metastasized to the mandible………97
J-006 Does the swallowing function recover during the long-term in patients with surgically treated tongue carcinomas?………98
J-007 A squamous cell carcinoma of the tongue dorsum………99
J-008 Reconstruction by pedicled fat-pad flap………100
J-009 Surgical treatment of accessory parotid gland tumors………101
J-010 A survey of surgical-orthodontic cases past a decade in the department of maxillofacial surgery of Tokyo medical and dental university………102
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專題演講001
Managing cleft service and education in
populous country
Asri Arumsari
Dr. Hasan Sadikin Hospital / Faculty of Dentistry - Pajajaran University / Indonesian Cleft Foundation
The Basic problems of populous country as Indonesia in the term of cleft lip and palate are the quantity of the patients and the geographic spread of Indonesian islands. To overcome the problems, the Indonesian Cleft centre serve as a body that build a mobile cleft team and managing the funding of its operation. The centre has 3 pillars, Indonesian Cleft Foundation, Oral and Maxillofacial Surgery Department- Faculty of Dentistry, Pajajaran University and Dr. Hasan Sadikin Hospital. The mobile cleft team has served for 33 years and more than 13.000 surgeries and the issue of the surgery quality never been dismissed.
The trainees are the member of the team. Along with the education part are the issue of the transfer of knowledge and skills processes and the quality of the surgeries quality as all other cases. The method of the unilateral cleft lip labioplasty are Tennision and Millard, bilateral cleft surgery done by straight-line technique, and the method for palatoplasty is push-back flaps.
Assessment of surgeries result done every month to evaluate the result. The study of Evaluation the post-labioplasty result according to the comprehensive assessment performed by Indonesian Cleft Center team, has been done to revealed the quality of the surgeries in each type of cleft lip. Assessment to the surgeries result done by the trainees, bilateral cleft surgeries assessment gave a better result compare to the unilateral cleft surgeries. This result contrary to the level of difficulty of the case.
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專題演講002
Surgery first orthognathic approach with vertical
ramus osteotomy
Young-Soo Jung, DDS, MSD, PhD
Dept. of OMFS, College of Dentistry, Yonsei University, Seoul, Korea
The orthognathic surgery followed by post-surgical orthodontics without pre-surgical orthodontic treatment known as surgery-first approach (SFA) is being performed nowadays.
The SFA has been previously described in the literature as a surgical technique with LeFort I osteotomy and sagittal split ramus osteotomy (SSRO), which helps maintaining post-operative occlusion with rigid fixation.
However, patients with temporomandibular joint disorder (TMD) are better candidates for intraoral vertical ramus osteotomy (IVRO) surgical technique instead of SSRO.
I am reporting cases with excellent surgical outcomes and resolution of TMD symptoms on patients with mandibular prognathism via SFA utilizing IVRO technique.
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專題演講003
口腔腫瘤綜合序列治療的上海經驗
Comprehensive and Sequential Therapy for Oral
Malignancies--in Shanghai Ninth People’s Hospital
張陳平(Chenping ZHANG)
Department of Oral and Maxillofacial Surgery, Shanghai Ninth Peoples Hospital, Shanghai Jiaotong University Shanghai (200011), China
Oral malignancies still remained significant health problems worldwide. The 5-years relative rate was 47.7% of oral cancer according to NCDB reports. Successful management of oral malignancies required a cooperative or multidisciplinary approach strongly evidence based, ordered rather than randomized, among a broad group of medical disciplines including head and neck surgery, radiation oncology, chemotherapy, molecular targeted therapy and so on.
Radical surgery with our new concept of "Compartment Resection", dominated the treatment regimes. This surgical method could greatly increase the cure rate of the tumor, significantly reduced the recurrence rate, of which core content was to emphasize resection of the starting and ending point or of involved muscle or metaphysis of involved bone with oral complex anatomy. Different sites of the oral cancer had own characteristics. For example, oral cancer in the anatomical sites upon the rima-oris was not easy to complete en-bloc resection of primary tumor and regional lymph nodes, in general, neck dissection should be made after primary tumor resection for the second stage; oral cancer in anatomical sites below the rima-oris was generally advocated for en-bloc resection of the primary tumor - (mandible) - the neck in one-stage.
Radiation therapy was strongly suggested to the patients with advanced-staged tumor. Chemotherapy focused on systemic treatment including induction and post-operative adjuvant chemotherapy. Molecular targeted therapy was the latest hot research. EAGLE research of the role of neo-adjuvant Cetuximab -based chemotherapy followed by surgery and radiotherapy for locally advanced oral/oropharnygeal cancer was in process in our hospital.
Soft and hard tissue reconstruction was indispensable for radical resection. Free flap reconstruction was prior in large and complex defect which included forearm flap, latissimus dorsi myocutaneous flap, pectoralis major myocutaneous flap (PMMF), anterial lateral thigh flap and lateral arm flap, et al. Meanwhile, hard free flaps consisted of fibular myocutaneous flap, iliac myocutaneous flap and scapula myocutaneous flap. The successful rate increased from 92% in 1980's to 98.5% nowadays, 96.8% in average.
Rehabilitation was a continuation of the treatment, including open- mouth training, speech training, swallowing training and other funct -ional training. Rehabilitation and regular follow-up should be subject to the attention of doctors and patients.
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專題演講004
Our concept of hospital share based on international
medical collaboration
Kanichi Seto*, Kazuo Watanabe**
*Director: International Medical Center, *Chairman: Oral Cancer Center **President, CEO
Southern Tohoku General Hospital, Koriyama, Japan
This is aimed to modify the concept of so called "Medical Tourism" based on sightseeing business to "Hospital Sharing based on Medical Collaboration." Recent development and diversification of Medical Science and Skills are more than remarkable with accelerating speed. Now it is impossible for one hospital to be equipped with every new diagnostic and treatment system. On the other hand patients are demanding higher medical quality increasingly. For bridging these gaps there might be no solution but to share the function of advanced hospitals beyond the border.
Hospital Sharing could be formed on condition of the close cooperation between concerned hospitals including interchange of medical staffs. Then the patient could be referred for the purpose of diagnosis or treatment after the discussion between specialists of both hospitals. The patient should be followed up at the original hospital after treatment.
We have just started this new system last year and concluded MOU with highly advanced hospitals in Shanghai, Moscow, Brunei, India and Saudi Arabia.
One of the main advantages of our hospital is the Proton Therapy for cancer patient. We have treated more than thousand cancer patients with good results in two and half years. 40% of indicated patients are Head and Neck Cancer. It is very effective for Oral Cancer especially in conjunction with super selective intra-arterial chemo-radiotherapy.
Japanese government decided to establish BNCT (Boron Neutron Capture Therapy) system in our institute first in the world. This is the newest cell specific irradiation system focused on the recurrent cancer. On this matter it would be talked as a topic in my presentation.
On behalf of Japanese Academy of Maxillofacial Implants I am now promoting to issue an International Personal Document for a patient to be consulted to second Dentist. Hopefully Taiwan Association of OMS would take part in this action.
Any way all these new movement for medical and dental internationalization should be supported by governmental policy of each core country.
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專題演講005
Usefulness of two-stage surgery for benign
odontogenic tumors showing large cystic,
intraosseous lesions in the mandible
Hiroto KIMURA, DDS, PhD
Department of Dentistry and Oral Surgery, Hirosaki University Graduate School of Medicine
Benign odontogenic tumors are found exclusively within the maxillofacial skeleton. We have often encountered large cystic cases of the unicystic ameloblastoma and keratocystic odontogenic tumor (KCOT), because both lesions show slow expansive growth with slight subjective symptoms and spread slowly by infiltration through the intraosseous spaces and erode cortical bone. According to the report of epidemiological study on odontogenic tumors in Japan from 1995 to 2004, ameloblastoma were 1,460 cases (28.3%) and KCOT were 1,258 cases (24.4%) among 5,151 cases of benign odontogenic tumor.
As well known, the objectives of the surgical management of those tumors are the eradication of the lesion, preservation of normal tissue to the extent possible, and restoration of significant tissue loss, form, and function. Recently, some surgeons and pathologists emphasized that the most curative and optimal treatment for the ameloblastoma and/or KCOT was primary resection in the form of segmental or marginal resection. They also recommended that a safety margin of uninvolved bone was approximately 1 to 1.5 cm for cystic lesions, because both lesions were recognized to be invasive and aggressive neoplasms. All surgeons may agree that the surgical procedure should be sufficient to the need, however, in many instances there is disagreement among surgeons and patients about the "conservative" or "radical" surgical approaches to treatment. Therefore, it is clear that great controversy exists regarding the optimal treatment of the ameloblastoma and KCOT.
Indeed surgical method for large tumors in the mandible is segmental resection of jaw with constant safety margin, but such radical operation sacrifice the fundamental function of jaws to result in aesthetic obstruction for patients. Moreover, ameloblastoma and KCOT in the mandible usually occur in adolescent, teenagers, and young adults. Therefore, fenestration technique or marsupialization technique have been often indicated to preserve the masticatory function and to avoid aesthetic damage by radical surgery accompanied with skin incision. In selected cases, two-stage surgical technique of fenestration (decompression) and then total enucleation proved to be a very promising treatment option. The two-stage surgery has been used with very good results, because this technique is significant in reducing the size of cystic lesions as well as in expecting regeneration of the bone surrounding tumors, therefore, it becomes easier to enucleate and to avoid large resection of the mandible. In general, the criteria to decide the treatment procedure is depend on mainly four factors ; size of tumor, radiographical findings, age of patient, and histological classification. Especially in
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the cases of unicystic ameloblastoma, pathohistological variant classification of luminant type or mural type is crucial to the optimal treatment.
The purpose of this lecture is to discuss providing support for primary curative surgical management of the large cystic lesion of ameloblastoma and KCOT. Two-stage surgery by fenestration and then total enucleation is considerably useful for large unicystic ameloblastoma and KCOT in the mandible. The treatment modalities for large cystic, intraosseous odontogenic tumor should not be selected by surgeons' self-satisfaction but by patiens' QOL with fully informed consent.
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專題演講006
Orthognathic surgery in Japan:
past, present and future
Prof. SAITO Chikara, D.D.S., Ph.D.
Division of Reconstructive Surgery for Oral & Maxillofacial Region, Department of Tissue Regeneration & Reconstruction, Course for Oral Life Science, Niigata University Graduate School of Medical and Dental Sciences
Recently, there have been remarkable developments in the treatment of jaw deformities. Nowadays, surgical correction of jaw deformities is performed at maxillofacial surgery clinics throughout Japan. This lecture describes the history of surgical treatment for correction of jaw deformities in Japan. In the 1940s, Kostecka method for mandibular protrusion was introduced by Heizo Nakamura(1894-1980) who was a professor of Tokyo Medical and Dental University. Then, the sagittal splitting method of the mandibular rami for treatment of mandibular prognathism was introduced by Shojiro Takahashi (1924-2007), who was a professor of Tokyo Denntal College, and the results of the first and second cases treated using this method was reported in 1969. Then, orthognathic surgery as a historical background, the development by Prof3ssor Hugo Lorenz Obwegeser (1920- ) of sagittal splitting of the mandibular rami and LeFort I maxillary osteotomy, which are among the most important procedures in modern orthognathic surgery, are introduced. The factors that have influenced the development of the treatment of jaw deformities in Japan are considered,.
A survey of the current status of the treatment of jaw deformities in Japan was carried out. Cards requesting participation in the survey were sent to the members of the Japanese Society for Jaw Demormities (JSJD) and 189 facilities (89 clinics of oral and maxillofacial surgery, three clinics of plastic and reconstructive surgery and 97 orthodontic clinics) answered the questionnaire on the homepage of the JSJD. The Number of patients who received orthognathic surgeries for jaw deformities between April 2006 and March 2007 in 92 clinics of oral and maxillofacial surgery (OMFS) or plastic and reconstructive surgery was 2,926. Regarding the clinical diagnosis the number of patients with mandibular protrusion with/ without open bite and/ or asymmetry was 1977 accounting for 68% of all patients. Regarding surgical techniques, bilateral sagittal split osteotomy (BSSO, 2,069 cases) was most frequent, accounting for 71%, followed by LeFort I osteotomy in 787cases (27%). Intraoral vertical ramus osteotomy. Alveolar osteotomy, genioplasty, distraction osteogenesis and other surgical types were applied in 370 cases (13%), 191 cases (7%), 318 cases (11%), 77 cases (2.6%) and 77 cases (2.6%), respectively. Riged or semi-rigid osteosynthesis systems were used in almost all facilities. The average duration of preoperative orthodontic treatment in non-extraction cases and extraction cases was 13and 18 montha, respectively, and the average duration of postoperative orthodontic treatment was 11 month. The average operation time was 163 minutes and amount of bleeding was 203 ml in BSSO, and those in two jaw surgery were 285 minuets and 512 ml respectively. There was significant correlation between operation
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time and blood loss in BSSO and two jaw surgery. Theaverage duration of hospital stay in mandibular osteotomy cases and two jaw surgery cases was 15 and 17days, respecitively. Intermaxillary fixation in cases using a metal osteosynthesis system those using a bioresorbable osteosynthesis system were done in 67 and 29 clinics, respectively, and the respective average duration of intermaxillary fixations was 10 and 11days. Orthognathic surgery continues to evolve but still relies on a careful aesthetic analysis on which depends the surgical indications. This will be demonstrated with the example of four cases: an isolated maxillary surgery, a mandibular surgery associated with an harmonization by chin-surgery, two simultaneous maxillo-mandibular osteotomies (a Class II asymmetric and an important Class III).
I think that the new surgical method for the jaw deformity will not be developed. In the future, safer orthognathic surgery, computer-aided orthognathic surgery, standardization of the three-dimensional cephalogram, psychological and psychosocial evaluation, gene identification of the maxillofacial deformities and prevention of jaw deformities will become increasingly important at the treatment of jaw deformities.
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專題演講007
Functional oral rehabilitation
in oral tumor patients
Joji George Sekine, D.D.S., Ph.D.
Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
Most mandibular discontinuity defects result from cancer surgery. The goal of reconstructive surgery is to restore mandibular function as well as to normalize facial esthetics. In the past, patients who underwent reconstruction of mandibular continuity were left without dentition or were rehabilitated with removable dentures. Unfortunately, the functional and esthetic results were often poor due to unfavorable intraoral anatomy, even when reconstruction was attempted. After anatomical reconstruction using a bone transplant, functional rehabilitation can be achieved with an implant-supported fixed prosthesis.
The present paper describes the functional oral rehabilitation in 21 oral tumor patients using osseointegrated implants as well as extrusion of impacted teeth. Primary lesions were 11 benign (ameloblastoma and ossifying fibroma) and 10 malignant tumors (squamous cell carcinoma and mucoepidermoid carcinoma). Bone defect was reconstructed by free or vascularized bone grafting or distraction osteogenesis at the same timing or following tumorectomy. Soft tissue defect was also did by pedicled or free flap at the same timing of the primary surgery. Fixtures were placed in the grafted or augmented bone, and abutments were connected 6 to 9 months later together with vestibuloplasty. Mucosal grafts were used to replace the skin flap around abutments. In 2 benign cases, impacted teeth were extruded using orthodontic technique following tumorectomy.
All implants survived during 2 to 17 years' follow-up after loading. In 3 patients, inflammation around the abutment was observed after abutment connection. Inflammatory hyperplasia of the palatal mucosa was treated by CO2 laser ablation, which resulted in mucosal contraction. In one patient, revision surgery including
vestibuloplasty and palatal mucosal grafting was performed with the patient's informed consent because inflammatory hypergrowth of the mucosa around the abutment had persisted for a year in spite of CO2 laser
ablation.
Quality of life, defined as efficiency in chewing, swallowing and speaking, was found to be satisfactory in all present patients. Though we believe that implant therapy as a part of ablative cancer surgery would greatly contribute to oral rehabilitation in oral tumor patients, impacted teeth would also be available for oral rehabilitation in benign cases.
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專題演講008
Twenty years observation of maxillary
reconstruction using revascularized
osteocutaneous flap and dental implant
MATAGA Izumi, DDS, PhD.
Department of Oral and Maxillofacial Surgery, School of Life Dentistry at Niigata, The Nippon Dental University, 1-8, Hamaura-cho, Chuo-ku, Niigata, 951-8580,
JAPAN
Reconstruction of the maxillary bony and soft tissue defects are well known as a challenge in oncologic field. Revascularized osteocuteneous flaps are one of these reconstructive tools and dental implant is easily placed in this bone because no bone resorption is one of big benefits in this manner. We have introduced this procedures scince 1985 and in maxillary reconstruction since 1992. In this series,a case of representative patient who was reconstructed maxilla will be introduced. Patient was 59-y.o., female, visited us for her maxillary anterior gingival tumor with ulcer (T3N0M0).
Biopsy speciemen showed squamous cell carcinoma in April, 1992 and partial maxillectomy according to Le-Fort I ostectomy was performed. Even though prosthesis was fabricated but patient felt unsatisfuction by the leakage of air and water through naso-oral defect. Based on this reason, maxillary reconstruction using revascularized fibular osteoseptocutaneous flap was designed, two island cutaneous paddles; 9 cm fibula in length was harvested, two osteotomies were performed to reform the maxillar arch. Titaneum-mini-plates for the fixation were used between fibula and residual maxillary bone, and 4 endosseous implants were installed in fibula directly. End to end anastomoses between peroneal artery /vein and facial artery/vein through buccal tunnel. Result of this reconstruction was completely succeeded. Removable denture was fabricated with milling bar attachment. She is enjoying not only cosmetics but also regular life styles such as mastication, phonetics and swallowing. No bone resorption and hyperplasia around implant are observed under 20 years function.
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專題演講009
Ridge preservation or augmentation
– the scaffold principle
Dr Victor Fan Tai Weng
Senior Consultant Surgeon, Oral and Maxillofacial Surgery, National University Hospital Singapore
Assistant Professor, Faculty of Dentistry, National University of Singapore
Bone is a precious commodity in implant dentistry and the search for the perfect regeneration continues to excite osteology research in the academic world. The basic concepts and clinical applications of bone grafting and bioscaffolding are discussed in this presentation.
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專題演講010
拔牙後立即植牙:它安全可靠嗎?
Immediate implant placement: is it safe and predictable ?
張燕清(Chang Y C) 三軍總醫院與台北慈濟醫院 口腔顎面外科兼任主治醫師 拔牙後之植牙，因考量到軟硬組織癒合程度而有不同之植入時機，其中立即植牙可縮短不少 治療時間，此優點對醫師與患者具有莫大的吸引力。但有些立即植牙在一段時間後呈現牙齦萎縮 或齒槽骨吸收現象，為降低此風險，必須慎選病例與遵循原則，否則會影響到骨整合與美觀。當 四周骨壁完整、傷口沒有感染、初步穩定性佳、且植體與骨壁間之縫隙較小時，是立即植牙的適 當時機。當條件不理想時，則需視病患傷口之狀況與自身重建能力，決定是否可作立即植牙。本 演講重點即在針對條件不理想時，應有之考量與因應，來選擇適當之治療計畫。
–13–
專題演講011
人工植牙之生物醫學及一般手術原則與牙床骨軟
硬組織極度不良患者之人工植牙及口腔
贋復簡介
Implant rehablitation in surgically compromised
alveolar ridge
高壽延(Shou-Yen Kao) 台北榮總口腔醫學部 本次主題先敘述一般生物學基礎與手術原則再針對特殊條件下之患者與論證。例如自然的嚴 重骨吸收、嚴重車禍外傷後以及口腔腫瘤手術切除部分顎骨之患者牙床骨軟硬組織條件不良，他 們的口腔環境常有牙床高度不足及軟組織條件不良的情形出現；經過適當篩選高度合作的患者仍 然可以用精巧的手術方式來重建牙床以改善口腔環境，有如『逢山開路，遇水架橋』，經過治療 後，最後患者還是有機會獲得人工植牙、贋復重建之機會。但是長期的穩定性與成功卻有賴定期 口腔衛生的維護。 人工植牙是一新興的必須以手術植入人工牙根配合假牙製作的方式，也是一種高級又昂貴的 治療。其成功的要件在於正確的診斷與治療，及患者充分的配合。人工牙根在口腔中一如自己的 牙齒，在植入後更須小心細膩的清潔與照顧才得以保留的長久。根據我們以往的經驗也陸續發表 了十餘篇刊登在國內外知名期刊有關人工植牙的文章及手術技術上的改良，相信未來此項技術能 造福更多牙床骨軟硬組織不良條件的患者。–14–
專題演講012
植牙手術的美觀考量
Esthetic considerations of implant surgery
陳遠謙(Michael Yuanchien Chen)
中國醫藥大學附設醫院-口腔顎面外科
Division of Oral and Maxillofacial Surgery, Taichung China Medical University Hospital
當骨整合(osseointegration)已經不再是問題的時代，便表示植牙醫生必須能夠同時呼應或符合 病人在口腔功能與美觀上的雙重期待；而傳統植牙美觀區的範圍或定義也因此必須有所修正，它 絕不再只是侷限於上顎六顆前牙，因為有些人於開懷大笑時，連第一大臼齒都看得到！甚至有人 會於私下掀開自己的唇頰，欣賞一下所費不眥的植牙成果，這樣的舉動實屬人之常情，我們沒有 任何理由來抱怨這類型的病人是在吹毛求疵！此外，口腔顎面外科醫師亦常遭遇顎顏面外傷或腫 瘤手術後，導致程度不一的口腔內軟硬組織缺損，尤以發生於上顎美觀區的植牙重建更具難度與 挑戰性。 爰此，植牙前仔細的評估與不厭其煩的解說、溝通，無庸置疑會是治療成敗的關鍵，尤其 當病人的選擇是固定式的植牙補綴。除了傳統的二維影像，應把Cone Beam Computed Tomography (CBCT)列為植牙前必備之檢查，而且一定要戴著影像導引板(radiographic guide)做掃描，才能提供 術者掌握理想的牙根植入角度和位置，並能評估該處齒槽骨不足的程度及骨缺損的特性；其次， 應仔細觀察並以照相或錄影方式，紀錄患者臉部各個角度（包括唇鼻角、鼻翼寬度）、笑容時露 齒及露齦的程度及範圍；也要注意植牙區的軟組織條件(如：顏色、角化牙齦帶、繫帶位置)、上 下顎間關係(inter-arch relationship)、咬合面是否傾斜、鄰近牙齒的外形與大小…等。最後羅列出問 題所在，一一找出可行又不會互相牴觸之解決方案，再向病人及家屬詳細說明。筆者將用臨床實 例呈現重建過程，以與口外及植牙界同仁經驗分享。
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專題演講013
側方開窗合併立即植牙而無須補骨之上顎竇提升術
Implant placed immediately through lateral trap-door
window procedure to accomplish maxillary sinus
elevation without bone graft
陳大為(Chen Ta-Wei) 國立陽明大學牙醫學系 本次報告係由單純上顎竇提升術無補骨合併立即植牙的經驗，來探討骨引導再生理論運用在 上顎竇提升術。在過去八年的臨床追蹤結果已證實單純上顎竇提升術的高成功率及可預期性，在 沒有放置骨移植材料的狀況下，空間的創造及維持是上顎竇內骨頭再生的關鍵。空間的創造來自 於謹慎及充分的剝離上顎竇黏膜，並利用植體撐住空間以容許骨細胞長入；而植體的穩定支撐則 來自於殘留骨脊高度，此空間的高度及上顎竇的寬度會決定新骨頭再生所須時間。報告中並將討 論可能影響骨再生的因素：包括上顎竇黏膜破裂，上顎竇內壓力的影響，側面開窗的覆蓋與否， 以及上顎竇感染等。
–16–
專題演講014
Platform shifting-truth or myth
方致元(Fang Chih-Yuan)
萬芳醫學中心口腔顎面外科
Platform shifting(或platform switching)是近年來植牙科學界中的熱門話題。Platform shifting指的 是以直徑較小的支台齒裝載在人工牙根上以形成生物空間，臨床醫師及研究者皆認為這個生物空 間可以有效減少植體周圍骨頭的萎縮，但是骨頭萎縮量減少的原因及機轉為何，則仍眾說紛紜。 本演講將回顧臨床病例、相關臨床文獻及回朔性研究分析，針對Platform shifting對植牙成功率、存 活率及其臨床影響進行分析。
–VI–
–17–
貼示論文報告001
新式骨材：幾丁質/聚甘醇酸水膠可促進
拔牙傷口之癒合
A novel bone substitute: chitosan/γPGA hydrogel
can promote wound healing of extraction socket
蔡怡欣▲(Tsai Y S) 章浩宏(Chang H H) 林俊彬(Lin C P) 郭生興(Kok S H) 李正喆(Lee J J)
臺大醫院口腔顎面外科
Although many bone substitutes have been proposed, so far there still lacks of well accepted bone substitutes with satisfactory and predicted results. Chitosan/γPGA Hydrogel is a chitosan based toxicity free degradable copolymer with antibacterial action and good biocompatibility which may be used as a potential bone substitute. The purpose of this study was to evaluate ability of chitosan/γPGA Hydrogel by radiographic and histological examination in promoting socket healing base on animal test. Thirty-two female Winstar rats with their bilateral upper incisors removed were used in this investigation. Three control groups (No implant insertion, spongostan and chitosan only) and one experiment group (chitosan/γPGA Hydrogel) at four different time points was randomized distributed in sixty-four extraction sockets. The rats were sacrificed later at the time points of 1, 2 ,4, 6 weeks as scheduled for further radiographic and histological evaluations. The results showed that chitosan/γPGA Hydrogel can accelerate bone healing more than the other 3 groups. It seems that Chitosan/γPGA Hydrogel may be a potential bone substitute for extraction socket.
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貼示論文報告002
沖洗液對超音波骨刀取得之自體骨的影響
Influence of irrigant for piezosurgical device on
harvesting bone chips
林文仁▲(Lin W R) 郭生興(Kok S H) 李正喆(Lee J J) 陳信銘(Chen H M) 蔡尚節(Tsai S J) 章浩宏(Chang H H)
臺大醫院口腔顎面外科
To investigate the influence of amount of water irrigation for a piezoelectric device, designed for harvesting autogenous bone chips from intra-oral sites, on chip size, morphology and cell viability. Methods: A total number of 30 samples of cortical bone chips were irrigated with 3 different rate of water for irrigation (1 c.c/ min, 10 c.c./min, 50 c.c./min) by a piezosurgical device were conduct in this study. Bone collector were used to collect the bone chips for further quantity and quality analysis. Morphometrical analysis of the bone chips were used to compare the shape and size of bone chips. Alkaline phosphatase activity (AP) and immunhistochemical staining for osteocalcin (OC) were used to detect the activity of osteoblasts. Results: The amounts of bone harvested from lower irrigation group (1 c.c/min) were much more than high irrigation group (50 c.c./min) with statically significantly. Outgrowth of adherent cells nearby the bone chips was observed 90% of specimens in high rate of water irrigation (50 c.c./min) after 6-18 days, and the confluence of cells were reached after 5 weeks. Whereas only 30% in medium rate of water irrigation (10 c.c./min) and 10% in lower rate of water irrigation (1 c.c./min) of specimens could see an outgrowth of adherent cells in the similar interval. Also more positive staining for AP and OC identified cells were noted in high rate of water irrigation (50 c.c./min) group than medium and lower water irrigation groups with statically significantly. Conclusion: It may be concluded that high water irrigation rate for piezosurgical device using in bone harvest may reduce the amount of bone collection; however, it might improve the effect on viability of cells growing for intraoral bone chips.
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貼示論文報告003
姿勢與顳顎關節症候群相關性之研究
Investigation of the relationship between body
posture and temporomandibular disorders
張婷菡▲(Chang T H) 陳元武(Chen Y W)
三軍總醫院口腔顎面外科
Many practitioners have speculated that poor posture may lead to trunk myofascial pain disorder syndrome (MPDS). Forward head posture is one of the most common forms of poor posture and is related to neck pain. Due to this reason, we suspect that poor posture is accompanying with temporomandibular disorders (TMD). Aim: The aim of this study is to investigate the relationship between body posture and TMD. Materials and methods: Twenty-six healthy adults with MPDS of head and neck region were collected for this study from the patients at Division of Oral and Maxillofacial Surgery, Tri-Service General Hospital since 2010 to 2011. The subjects received muscle relaxant drug and adjustment of body posture. Clinical examination was performed at three stages: prior to the treatment, second and fourth week follow-up. Variables such as visual analogue scale (VAS), tenderness of muscle palpation including temporalis, masseter, and sternocleidomastoid muscle, the angles of the sagittal and coronal cervical spine and the angle of shoulder were evaluated at each stage. Results: With the treatment group, the results showed significant deference of VAS as compared with the control group (p < 0.05) as well as tenderness of muscle also had significant deference as compared with the control group (p < 0.05). Summary: This study had shown that detectable alterations in body posture had the efficacy to alleviate pain and decrease the tenderness of head and neck muscles in TMD patients.
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貼示論文報告004
以骨性埋伏齒進行自體齒移植重建前上顎齒列―
病例報告
Reconstruction of anterior maxillary dentition with
autotransplantation of bony impacted teeth —
a case report
林涵威▲(Lin H W) 郭英雄(Kuo Y S) 曾建福(Tseng C F)
亞東紀念醫院口腔顎面外科 自體齒移植在臨床上常用來取代無法保留之牙齒或重建缺牙區域，雖然此臨床應用早在50年 代就有文獻的探討，但當時對於整個治療過程與作用機制都不甚明瞭，成功率也不符期待，因此 漸漸被臨床醫師從治療選擇中給排除。後來隨著人工植體的蓬勃發展所造成治療模式改變的衝 擊，造成醫師選擇自體齒移植的意願及治療個數更加減少，也無形中增加了病患的經濟負擔。故 提出此病例希望讓自體齒移植再度受到臨床應用及研究，期望能再提高治療的成功率。本文報告 一位15歲原住民男性病例，無任何全身系統性疾病，因上顎前牙埋伏齒由診所轉診至本科就診。 經放射線及臨床檢查發現，病患之右上正中門齒及左上犬齒為骨性埋伏齒，右上側門齒為水平阻 生異位萌發。針對此病患狀況，我們安排於全身麻醉下進行右上正中門齒、側門齒、左上犬齒及 左上乳犬齒拔除，並將右上顎正中門齒、側門齒及左上犬齒進行自體齒移植術。此三顆牙齒在接 受後續根管治療後，目前情況良好，擁有正常功能，於門診持續追蹤觀察中。自體齒移植在適當 條件下，可提供除植牙及假牙贗復以外，重建前上顎齒列的另一選擇。
–21–
貼示論文報告005
柯特威爾-路克氏手術不經下鼻道造口
：50個病例回顧
Caldwell-Luc operation without inferior meatal
antrostomy: a retrospective study of 50 cases
黃于真▲(Huang Y C) 陳文和(Chen W H)
長庚紀念醫院林口院區口腔顎面外科
In the standard Caldwell-Luc operation, an inferior meatal antrostomy is performed to promote sinus drainage. However, inferior meatal antrostomy has been criticized for its additional operation time and wound, early loss of the opening, and risk of injury to the nasolacrimal duct. This study retrospectively reviewed the results of Caldwell-Luc operation without inferior meatal antrostomy in the treatment of odontogenic maxillary sinusitis or odontogenic sinus diseases. Study design: The records of 50 patients who had an odontogenic sinus disease and underwent the Caldwell-Luc operation without inferior meatal antrostomy were reviewed. The data included the patient’s age, sex, surgical indications, surgical condition, and complications. Results: From April 2004 to October 2010, there were 27 men and 23 women aged 14 to 70 (with an average age of 37) who underwent the modified Caldwell-Luc operation. The surgical indications included intrasinus odontogenic cysts (44%), oroantral fistulae with chronic sinusitis (44%), odontoma (4%), odontogenic sinusitis (4%), and foreign bodies in the maxillary sinus (4%). The patients were successfully treated with minimal complications. Conclusion: The modified Caldwell-Luc operation provides easier post-operative care and involves fewer complications. It is not necessary to create the inferior meatal antrostomy in the Caldwell-Luc operation when treating the odontogenic sinus diseases.
–22–
貼示論文報告006
上顎竇之含齒囊腫以及異位牙―病例報告
Dentigerous cyst in the maxillary sinus with
an ectopic tooth — case review
陳人瑄▲(Chen J H) 陳萬宜(Chen M Y)
台中榮民總醫院口腔顎面外科
Dentigerous cyst is the second most common odontogenic cyst, which is a cyst with epithelial lining derived from the epithelial remnants of the tooth-forming organ. Dentigerous cyst is frequently found in the areas of mandibular body and ascending ramus while it is not in the area of maxillary sinus. In the dentigerous cyst in maxillary sinus, the symptoms and signs are various. The treatment is difficult to be performed due to the side effect of post operation. In order to understand and to treat it successfully, we collected 9 cases during the decade between 2000 and 2010 from Oral and Maxillofacial Surgery of Taichung Veterans General Hospital, and we found that the symptoms included swelling, chronic sinusitis and fistula. We used panoramic radiography and 3D images to diagnose, 3D made it easier to observe the location of cyst and teeth. The majority treatment modality was enucleation, and the side effect was often developed oroantral fistula. We will discuss management options for these lesions in the presentation; including the differential diagnoses and treatment.
–23–
貼示論文報告007
利用骨板做為骨性錨定來治療嚴重水平阻生
第二大臼齒
Use of a miniplate for skeletal anchorage in the
treatment of a severely impacted mandibular
second molar
許經偉▲(Shu C W) 陳俊明(Chen C M) 曾于娟(Tseng Y C) 吳崇維(Wu C W) 許瀚仁(Hsu H J) 高雄醫學大學附設中和紀念醫院口腔顎面外科 一位十九歲女性病患，主訴其左下第二大臼齒阻生。臨床檢查及X光攝影發現，病患左下第 二大臼齒及左下第三大臼齒皆為水平阻生齒，且左下第二大臼齒在左下第三大臼齒下方處。此外 左下第二大臼齒牙根根尖三分之一部份位在下齒槽神經血管束下方，為嚴重阻生病例。經評估 後，我們利用骨板做為骨性錨定，並藉由手術方法拔除左下第三大臼齒及手術露出左下第二大臼 齒牙冠，成功利用矯正方法，將左下第二大臼齒拉回正常生理性位置，治療時間共兩年兩個月。 結果我們發現，應用骨板在治療嚴重阻生齒時，可有效做為骨性錨定，藉以輔助完成矯正治療。
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貼示論文報告008
以錐狀放射電腦斷層掃描(CBCT)協助先天性鎖骨及
顱骨發育不全患者多發性贅生齒之手術移除―
病例報告及文獻回顧
Cone beam computer tomography (CBCT) assisting
in surgical removal of multiple supernumerary
teeth in a cleiodcranial dysplasia patient —
report of a case and literature review
王俊傑▲(Wang C C) 郭生興(Kok S H) 李正喆(Lee J J) 張曉華(Chang H H) 蔡迪珊(Tsai D S) 章浩宏(Chang H H) 臺大醫院口腔顎面外科 顱鎖骨發育不全症(CCD)是一種體染色隱性疾病。大部分的CCD的病人會產生恆牙萌發異 常、多發性贅生齒及咬合不正。有關其多發性贅生齒之處理，受限於原有之影像分析，過去多採 局部或保守處理。近年來由於錐狀放射電腦斷層掃描(CBCT)之普及化，其對於牙科治療提供了傳 統環口片或根尖片難以呈現的細微及立體空間資料，CBCT所合成之三維空間立體影像不僅在手術 方面有良好的切面，同時可以呈現許多鄰近牙齒的相關細節。藉由CBCT及相關影像軟體，埋伏齒 跟多生牙可以在術前仔細評估，並確認適當的治療計畫。本病例報告中，我們將提出16歲患有先 天鎖骨顱骨發牙科育不全症女性患者，藉由錐狀放射電腦斷層掃描於術前對於22顆之多發性贅生 齒進行近之術前評估，並以顏色區分出依序要拔除的牙齒，以確認安全之治療計畫及手術指引， 將現階段需移除之贅生齒，安全地予以移除並將多顆阻生之恆齒進行露出手術，術後病人病人恢 復良好，無明顯之併發症，報告中亦針對目前類似的病例相關處置進行文獻回顧，相關之結果認 為藉由錐狀放射電腦斷層掃描之攝影技術，可讓複雜之手術困難度降低，並降低病人的風險，提 高未來後續治療之可行性及成功率。
–25–
貼示論文報告009
另類植體周圍炎之治療―以蓄意齒再植進行植體
周圍膿瘍之清創
Alternative treatment protocol of periimplantitis —
intentional replantation for debridement
of periimplant abscess
梁光源▲(Liang K Y) 國軍岡山醫院口腔顎面外科 植牙治療方興未艾，併發症之發生在所難免，植體周圍感染是其中一大類別。常見之早期 植體感染肇因可分為二大類：一、手術因素：如沖水冷卻不足造成之過熱(overheat)、解剖位置未 注意而穿出骨板或侵犯鼻竇等；二、病患因素：如熬夜免疫低落或糖尿病控制不佳及口腔衛生不 佳等。當感染較嚴重產生齒槽骨破壞而導致植體失去穩定度時，通常需要移除植體並加以清創方 能控制感染；若早期發現感染施予適當清創及投與抗生素大多可以獲得良好控制。本篇報告提出 以蓄意齒再植之方式，移出感染植體之鄰牙並由此缺牙窩進行清創及沖洗，完成之後再將此牙植 回，後續完成根管治療。之後植體及自然牙恢復良好。因植體之穩定度尚佳，故未移除植體使病 患之美觀得以維持，且未進行翻瓣及移除發炎齒槽骨使外觀不受影響。此術式將治療區域縮小， 只花費近半年時間便完成治療。本篇報告提出以蓄意齒再植合併植體周圍清創，成功治療前牙區 早期植牙膿瘍的病例。–26–
貼示論文報告010
44名患者接受不含骨移植之上顎竇增高術植入
80根人工植體之五年長期追蹤研究
A 5-year follow-up of 80 implants in 44 patients placed
immediately after the lateral trap-door window
procedure to accomplish maxillary sinus
elevation without bone grafting
林依靜▲(Lin I C) 張欣如(Chang H J) 高壽延(Kao S Y) 陳大為(Chen T W)
台北榮民總醫院口腔顎面外科
The present study was performed to evaluate the 5-year status of immediately placed implants subjected to maxillary sinus elevation without grafting. Implants were placed in 2004 and 2005. A minimum of 3 mm of residual bone height (RBH) was required. All implants were placed with a sinus elevation performed through a lateral approach by the trap-door, open-window method without placement of any grafting material. Regular follow-up included oral hygiene instruction, periodontal charting, panoramic radiographs, and cone beam computed tomographic scans. The gained bone height (GBH) in the sinus, peri-implant sulcus depth, and marginal bone loss were analyzed statistically. Forty-four patients (26 men, 18 women) with an average age of 58 years received 80 implants, which were followed for 5 years after prosthesis delivery. No patients developed sinusitis or other complications leading to implant loss. The average RBH was 5.06 ± 1.51 mm and the average intrasinus implant length was 7.77 ± 1.7 mm. Survival rates for the implants were 100% after 2 and 5 years. Average GBH was 7.24 ± 1.83 mm at 2 years (range, 3 to 12 mm) and 7.44 ± 1.94 mm at 5 years (P > .05). The average peri-implant sulcus depths were 2.5 ± 0.4 mm at 2 years and 3.1 ± 0.5 mm at 5 years (P < .05). The mean peri-implant marginal bone loss was 1.3 ± 0.3 mm at 2 years and 2.1 ± 0.5 mm at 5 years (P < .05). New bone formation in the sinus was confirmed, and good survival of implants with maxillary sinus elevation by the lateral approach without grafting was observed after 5 years. Attention should be focused on oral hygiene maintenance to ensure peri-implant gingival health.
–27–
貼示論文報告011
人工牙根植入鼻腔之醫源性疏忽
Iatrogenic error: placement of dental implant into
nasal cavity
簡杏宜▲(Hani Surianti) 陳癸菁(Chen K J) 張加明(Chang C M) 張佩穎(Chang P I) 陳遠謙(Chen Y C)
中國醫藥大學附設醫院口腔顎面外科
Thorough pre-operative clinical and radiographic examination prior to implant placement must be done in order to prevent perforation of the vital anatomic structures, such as maxillary sinus floor, mental foramen and mandibular canal. We'd like to present a case of 71 years old female with symptoms and signs of acute cellulitis at L't canine space three days after implant placement at the left maxillary premolar area by her family dentist. Perforation of the L't maxillary sinus floor at implant site, 25 was assumed on the initial panoramic radiograph, however reformatted CT (computed tomography) images showed abscess accumulation in the left nasal cavity and canine space with an extermely queer axial alignment of the dental implants engaging the left inferior nasal turbinate. After parental antibiotic therapy and surgical debridement including removal of the offending dental implant and drainage of the abscess performed under local anesthesia, acute symptoms and signs of infection subsided uneventfully. A case like this surely would bring awareness to our colleagues of the incredible iatrogenic error during implant surgery if thorough preoperative diagnostic procedures are overlooked.
–28–
貼示論文報告012
新式複合表面處理SAH技術對牙科植體骨整合之
影響評估：動物試驗
The effect of AH (Alkali and Heat treatment) surface
treatment on dental implant: an animal study
張勝惟▲(Chang S W) 章浩宏(Chang H H) 郭獻南(Kuo H N) 林怡(Lin Y) 郭子瑄(Kuo T H)
台大臨床牙醫研究所
Over the past few decades, dental implant has become a predictable and widely accepted treatment for fully and partially edentulous patients. Since it will still cost a lot of time in healing process for osseointegartion. Hastening of osseointegartion with modality of new surface treatment may be the crucial goal for implant surgery. The purpose of this study is to evaluate the effect of a new surface treatment [AH (Alkali and Heat treatment)] on osseointegartion. Two different surface treatment implants with same screw design, one surface treatment is AH surface treatment type, the other is SLA (Sand-blasted, Large grit, Acid etched) were compared. Nine beagle dogs were enrolled in this study, six dental implants were inserted in each dog included two experimental groups and one control group The assessments of implants are including clinical evaluation, survival rate, resonance frequency test and photo record. Experimental parameters including resonance frequency test, CBCT scan, X-ray, bone implant contact (BIC) were used to analysis the integration of bone and implant. The dogs were sacrificed at the time interval of 4, 8, 12 weeks for further histological analysis. The preliminary results showed the value of SAH surface treatment group (65.1 ± 12.9) in resonance frequency test is slightly higher than SLA group (53.1 ± 12.5) at the 4 weeks. It seems that the potential for AH chemical modification of the implant surface may possess good biologic events during the osseointegartion process and offer some superiority to implants with an SLA surface.
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貼示論文報告013
