鹿児島大学 · 医歯学総合研究科

研究关键词orthognathic surgery stability・skeletal class III malocclusion・cleft lip nose correction・3D nasal morphology・craniofacial surgical outcomes・speech outcomes in cleft palate・postoperative skeletal morphology・maxillofacial reconstruction

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• Ishihata K., Kibe T., Tezuka M., Seong C.H., Maeda-Iino A., Nozoe E., Nakamura N. . Postoperative stability following orthognathic surgery and final skeletal morphology in class III patients w2022 · 記述言語： 日本語 掲載種別： 研究論文（学術雑誌） 出版者・発行元： Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology Objective: Orthognathic surgery has become useful procedures for patients with cleft lip and palate (CLP) to improve the inharmonious relationship between the maxilla and mandible. The purpose of this study is to assess the postoperative stability and skeletal morphology following orthognathic surgeries for patients with skeletal class III deformity with CLP. Methods: This study retrospectively evaluated the long-term stability of orthognathic surgery and the final profile of skeletal morphology in 30 patients using lateral cephalometric imaging. Sagittal split ramus osteotomy was performed for 10 patients (CLP-S), Le Fort I osteotomy was performed for 5 patients (CLP-L) and two-jaw surgery was performed for 15 patients (CLP-T). As a control, we included 5 patients treated by two-jaw surgery, 7 patients treated by SSRO without CLP and 20 CLP patients with orthodontic treatment alone. Results: In the CLP group at 2 years postoperatively, the mean relapse in SNA was 19.8% (CLP-T) and 18.1% (CLP-L), and the mean relapse in SNB was 17.6% (CLP-S) and 26.9% (CLP-T). No significant differences were observed in the relapse ratio of the same operation between with and without CLP. In comparison of surgical and non-operative patients with CLP, there were significant differences in preoperative skeletal factors, but the profiles were similar at the end of treatment. Conclusion: Our orthognathic surgeries provided the same level of stability for patients with skeletal class III deformity with or without CLP, creating harmonious intermaxillary relationship. DOI： 10.1016/j.ajoms.2022.04.005 Scopus
• Ishihata K., Okawachi T., Kibe T., Tezuka M., Ratman M.F., Nakamura N. . Three-dimensional nasal forms following unilateral cleft-lip nose correction with mandibular ramus cortical bone augmen2022 · 記述言語： 日本語 掲載種別： 研究論文（学術雑誌） 出版者・発行元： Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology Purpose: To observe the pre- and postoperative three-dimensional (3D) nasal morphologies following mandibular ramus cortical bone augmentation (CBA) for a concaved nasal dorsum in definitive correction of an underdeveloped unilateral cleft lip (UCL) nose. Subjects and Methods: Three Japanese women with complete unilateral cleft lip and palate (UCLP) underwent nose correction using CBA on the flat or concaved nasal dorsum in combination with an extended spreader cartilage graft. The measurement items included the nasal dorsal angle, the nasal tip angle, and the x- and z- axis values of the nasal dorsum ridge and nasal tip points. The results were compared with those of thirteen sex- and age-matched women with complete UCLP who underwent the same nasal correction excluding CBA. Postoperative changes in cortical bone were also observed radiographically. Results: The nasal dorsal angle increased and nasal tip angle decreased postoperatively in the patients with CBA, becoming more similar to those of subjects without CBA. Postoperatively, improvement of the lateral nose profile with natural hardness was achieved in three all patients with CBA. 3D analyses of patients with CBA demonstrated an increased height of the nasal dorsum ridge and nasal tip points in the center of the face. Radiological observation revealed remaining transplanted cortical bone, although it became smaller. Conclusions: Mandibular ramus cortical bone augmentation may be one of the options for molding up the severely concaved nasal dorsum on definitive correction of an underdeveloped nose in Asian patients with complete UCLP, without damaging other parts of the body. DOI： 10.1016/j.ajoms.2022.06.007 Scopus
• Yoshimura T., Suzuki H., Takayama H., Higashi S., Hirano Y., Tezuka M., Ishida T., Ishihata K., Amitani M., Amitani H., Nishi Y., Nakamura Y., Imamura Y., Nozoe E., Inui A., Nakamura N. . Prog2022 · 記述言語： 英語 掲載種別： 研究論文（学術雑誌） 出版者・発行元： Frontiers in Pharmacology Background: Better prognostic biomarkers for oral squamous cell carcinoma (OSCC) must be developed, particularly within the realm of clinically and frequently administered tests, to advise appropriate clinical therapy and follow-up. In this study, we retrospectively investigated which of the several inflammation-nutrition indicators might predict the prognosis of patients with OSCC. Methods: The preoperative neutrophil-lymphocyte ratio (NLR), lymphocyte–monocyte ratio (LMR), platelet–lymphocyte ratio (PLR), CRP-albumin ratio (CAR), Glasgow prognostic score (GPS), modified GPS (mGPS), prognostic nutritional index (PNI), controlling nutrition status (CONUT), and modified CONUT (mCONUT) were retrospectively evaluated using blood samples collected 1–5 days before surgery. To estimate the effect on the prognosis of tumor progression, the mean values of the markers between stages I/II and III/IV were used for subgroup analysis. The multivariate Cox proportional hazards model included all independent variables significantly associated with survival in the univariate analysis to determine the independent variables. Results: A total of 112 patients (69 males and 43 females) with primary OSCC who underwent surgical treatment at our hospital were included. There were statistically significant differences in the mean values of monocytes, platelets, and albumin between stages I/II and III/IV. According to the multivariate Cox proportional hazards regression, a low PNI was associated with shorter overall survival (OS) and disease-free survival (DFS); women were associated with shorter DFS. Conclusion: The pretreatment PNI had excellent predictive value for the 5-year OS and DFS of patients with OSCC. Future large-scale prospective studies with a high sample size are needed to verify our findings in OSCC patients. DOI： 10.3389/fphar.2022.996757 Scopus PubMed
• 香西 早苗, 中新 美保子, 稲川 喜一, 井上 信次, 手塚 征宏, 岐部 俊郎, 中村 典史2021 · 記述言語： 日本語 出版者・発行元： (一社)日本口蓋裂学会

• 音声可視化システムを用いた客観的評価に基づく口蓋裂術後の異常構音の病態解明2020 · 配分額： 3770000円 （ 直接経費： 2900000円 、 間接経費： 870000円 ） 口蓋裂術後の異常構音は、コミュニケーション障害を来たしその患者の社会生活において、支障をきたすことも少なくない。異常構音に対しては言語聴覚士による構音訓練が非常に有効で、重要である。その異常構音の病態を詳細に理解し、獲得メカニズムを解明することが出来れば、病態に合わせた構音訓練方法が可能になり、さらには異常構音獲得の予防にもつなげることができると考える。 本研究の目的は、異常構音の中でも発現率の高い口蓋化構音について、その構音位置や構音様式を客観的に評価し、病態をとらえ、さらには鼻咽腔閉鎖機能との関連を経時的に検討し、その病態、獲得メカニズムを解明することである。 令和2年度は口蓋化構音を呈する口蓋裂児の音声データを収集し、NNを用いて、構音点、構音様式を客観的に評価し、合わせてEPGを用いて、構音点の具体的位置を観察することを計画した。 当科で口蓋裂の手術を受け、術後に口蓋化構音を呈している患者26名を対象とし、新版構音検査時の録音音声データを使用した。あらかじめ２名の経験のある言語聴覚士が聴覚判定にて口蓋化構音のある音声を評価し38音選定した。その音について、熊本大学が開発したNNを用いてその構音点を対象音(/t/, /s/)ごとに提示した。 EPGに関しては、機器を扱う会社が災害のため営業しておらず、購入することができず、EPGとの照合ができず、具体的な構音点の観察までは至っていない。
• リアルタイム音声可視化システムを応用した視覚フィードバック口蓋裂言語訓練法の開発2020 · 配分額： 11700000円 （ 直接経費： 9000000円 、 間接経費： 2700000円 ）
• 口腔がん患者のフレイルの多角的評価と縦断的な治療を実現する全人的医療の実践2018 · 配分額： 3640000円 （ 直接経費： 2800000円 、 間接経費： 840000円 ） 高齢がん患者数は年々増加しており、フレイルとサルコペニアの存在が、術後合併症や化学放射線療法の副作用発生リスクの増大、さらには死亡リスクの増大につながるという報告が多い。口腔がん患者におけるフレイル・サルコペニアの実態は報告が少なく、さらに生命予後に与える影響については不明な点が多い。我々は、口腔がん患者を対象とした後方視的研究から、術前の腰部骨格筋量と骨格筋の脂肪化（骨格筋の質の低下）がみられた患者の生存期間の減少を明らかにした。さらに、術前の低栄養と、骨格筋の質の低下がみられることが、生命予後の独立した危険因子であることを明らかにした。
• 音声可視化システムを用いた口蓋裂術後の言語障害に対する新しい応用2016 · 2016年4月 - 2020年3月

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