In clinical practice, some patients complain of persistent discomfort or pain during or after root canal treatment. In cases wherein non-surgical retreatment is infeasible, the last available option that can be considered to save the tooth would be periradicular surgery or intentional replantation (IR). Since maxillary molars are anatomically close to the maxillary sinus, the apical surgery may perforate the floor of the maxillary sinus. On the other hand, with IR, tooth fracture may occur while extracting the tooth if the root is curved or if the buccal cortical bone is particularly thick. To help minimize such risk, we chose IR with partial osteotomy performed on the buccal side of the left maxillary first molar and extraction of both the alveolar bone and the tooth. Osteotomy enabled the tooth extraction without causing damages such as fracture to the roots and offered partial protection of the periodontal ligament. Here, we present a case wherein the root apex of a maxillary molar was physically close to the bottom of the maxillary sinus and the buccal cortical bone was thick. IR with partial osteotomy was successful in alleviating symptoms of persistent discomfort and pain.
The main reasons for the unsuccessful autotransplantation of teeth are the failure of initial healing and root resorption. The aim of this study was to elucidate the relationship between donor teeth factors and the prognosis of the transplants in which root resorption occurred. The study evaluated 110 patients with 117 transplants. The successful group included the cases which healed well, with only minor problems. The unsuccessful group included the cases with transplant-loss and progressive problems. The unsuccessful group and minor-trouble cases were judged with the type of problems; i.e. failure of initial healing, root resorption, and others. Root resorption was classified into 3 types; inflammation resorption, replacement resorption and cervical root resorption. The prognostic factors were evaluated to analyze the difference between rapidly progressing root resorption and the stable resorption. There were 20 unsuccessful transplants. In the unsuccessful group, rapidly progressing replacement root resorption was observed in 11 transplants. In the successful group, minor problems such as stable root resorption were found in 16 transplants. At least one of the atypical root shapes (divergent, curve, and hypertrophy), probing pocket depth of more than 4 mm, and/or extrusion were significantly more frequent in the replacement root resorption cases compared to cases with no significant findings. Probing pocket depth of more than 4 mm and/or extrusion, dental caries, history of restoration, root canal treatment were significantly more frequent in rapidly progressing replacement root resorption cases compared to stable root resorption cases. Abnormal root shape, deep periodontal pocket, dental caries, restoration and root canal treatment of donor teeth are factors associated with progressive replacement root resorption after the autotransplantation of teeth.
This study is addressed to define postoperative pattern of blood flow in free microvascular flaps by using a laser Doppler flowmetry (LDF) and to reveal effects of the prostaglandin E1 (PGE1) administration on the blood flow. Postoperative blood flows in the flaps were monitored with LDF in 14 patients, who were administrated PGE1 twice a day for 7 days after the operation. The average blood flow rates in the flaps gradually increased after the operation, reached peak at 7 days after the operation, and then become stable until 21 days after the operation. After the PGE1 administration, the blood flow rates in all of the patients increased within 15min and reached the peak between 75min and 105min. These results suggest that PGE1 is useful to increase the blood flow in the flap. Furthermore, the present study revealed these postoperative patterns of the changes in the blood flow in the flaps, careful monitoring of the flaps with LDF as performed in the present study will provide significant information to identify a disturbance of circulation in the flaps as soon as possible.
A patient with Bernard–Soulier syndrome (BSS), characterized by extremely large platelets, thrombocytopenia and prolonged bleeding time underwent general anesthesia for platelet adhesion aberration. This patient has developed a refractoriness to platelet transfusion due to a frequent transfusion of platelets; however the operation was completed without abnormal bleeding by transfusing HLA-matched platelets during the procedure. BSS is a very rare syndrome so there are no well-defined protocols for the management of perioperative bleeding associated with this syndrome. In this report, we present the detail of the perioperative management for these patients with BSS who has a refractoriness to platelet transfusion.
Juvenile psammomatoid ossifying fibroma (JPOF) is a rare, slowly progressive tumor of the extragnathic craniofacial bones, with a tendency towards locally aggressive behavior and recurrence. The pathognomonic histopathologic feature is the presence of spherical ossicles, which are similar to psammoma bodies. Very few cases in association with secondary aneurysmal bone cyst (ABC) formation have been reported in the literature. Treatment consists of complete surgical removal and incomplete excision has been associated with a high local recurrence rate. The prognosis is good because malignant change and metastasis have not been reported. Authors report a case of JPOF of the mandible with secondary ABC in a 17-year-old male patient.
We have searched for the factor to diagnose malignant potential of epithelial dysplasia. Recent studies have suggested that determination of the expression of cytokeratin 13 and 17 would be useful for the early diagnosis of oral squamous cell carcinoma. In this study, we focused on the diagnosis based on the malignant potential of epithelial dysplasia and evaluated the feasibility of combined assessment of cytokeratin 13 and 17. The expression of cytokeratin 13 and 17 observed in 8 patients with clinically diagnosed T1 or T2 tongue squamous cell carcinoma was analyzed using real-time PCR and immunohistochemical staining of resected specimens. Areas in each specimen were identified as Normal, Dysplasia and Cancer. Real-time PCR showed that the expression of cytokeratin 13 decreased beginning with Dysplasia, whereas the expression of cytokeratin 17 increased beginning with Dysplasia. Immunohistochemical staining revealed that cytokeratin 13-positive cells decreased beginning with Dysplasia, while there were almost no cytokeratin 13-positive cells in Cancer. Conversely, cytokeratin 17-positive cells increased beginning with Dysplasia, and almost all cells were cytokeratin 17-positive in Cancer. These results thus indicate that the expression of cytokeratin 13 and 17 is associated with carcinogenesis in epithelial dysplasia. The findings of this study indicate that assessment of the expression of cytokeratin 13 and 17 might be useful in the diagnosis of malignant potential in epithelial dysplasia. Moreover, evaluating changes in the expression of cytokeratin 13 and 17 could be effective in evaluating surgical margins.
We compared 3 bioabsorbable osteosynthesis plates of different shapes used for fixation after sagittal splitting ramus osteotomy in terms of stress on the plate and the bone segment connection area by 3-dimensional finite element stress analysis. Using a CT apparatus, images from the inferior border of the mandible up to the vertex were obtained, and a 3-dimensional model was produced. Based on this model, a model after bilateral sagittal splitting ramus osteotomy was produced, and subsequently, models of mono-cortical fixation of the proximal and distal bone segments using 3 plate types of different shapes (straight, L-shaped, and box-shaped plates) were fabricated. A load (20.79 kgf) was applied to the bilateral molar areas of the 3 models, and equivalent stress on the plate and the bone segment connection area and distal segment displacement were compared among the 3 models. The maximum equivalent stress (von Mises stress) on the plate was the lowest for the straight plate, followed in order by the box-shaped and L-shaped plates. In particular, in the L-shaped plate, marked stress concentration on the medial side of the bent portion was observed. The box-shaped plate showed the lowest maximum equivalent stress on the mandible and the smallest distal segment displacement. The box-shaped plate has a greater fixation force than the straight or L-shaped plate due to low stress on the bone segment connection area, and may be a useful fixation method to counteract long-term stress on the mandible.
A long tradition of oral epidemiology has identified risk factors for oral health and disease and been used to shape policy. This article will first review the methods of oral epidemiology including the outcomes used, potential risk factors, and survey procedures. It will then summarize the distribution of oral conditions of public health importance (dental caries, periodontal diseases, trauma and oral cancer) and outline geographic, temporal, socioeconomic, and ethnic trends.
Langerhans’ cell histiocytosis is a collective term used to describe a group of enigmatic, proliferative disorders. The natural history of the disease varies from a slow, benign, localized, symptomatic bony or soft-tissue lesion, to a rapidly, progressive, widespread, multiple-organ disorder which is often fatal. Eosinophilic granuloma (EG) accounts for 60–70% of all cases of Langerhans’ cell histiocytosis and can present as solitary (50–75%) or multifocal defects in bone. It occasionally presents as a localized soft-tissue lesion. Multiple treatment options are available but the response is unpredictable. However, no studies show complete resolution following a conservative modality of treatment in the management of EG of condyle and ramus. We describe a case, treated with intralesional injections of triamcinolone acetonide (Tricort 40mg/ml, 6 injections at weekly intervals over 6 weeks), leading to complete resolution of the lesion, along with a brief mention of the review of literature.
Denture fragment inhalation is uncommon. Denture fragment impaction at the glottis is rare. A glottis impaction without incurring airway symptoms is even rare. The populations of elderly wearing denture are significant and abundant. It is important as not to miss the possibility of denture inhalation as the illustrated in this case report. In the event of broken or swallowed denture, all patients warrant a proper upper airway assessment for foreign body until proven otherwise.
The purpose of this article is to describe a case of ameloblastic fibroma (AF) with difficult treatment planning. In the present case, a 12-year-old girl with chief complaint of painless swelling on the right mandibular body was referred to our hospital. The biopsy of the lesion confirmed AF. Although it was a solid tumor, the tumor debulking surgery was applied with corresponding open decompression therapy. However, one month after the debulking surgery, the residual lesion had grown rapidly. Then she was treated by enucleation and repeated dredging with a rapid and sufficient bone formation. A conservative approach, including the dredging method appeared to be successful for the avoidance of a radical surgery in the present case.
Odontogenic keratocyst is one of the most aggressive odontogenic cyst due to its relatively high recurrence rate, fast growth, and its tendency to invade adjacent tissue. The aim of the present study is to analyze retrospectively the clinico-pathological characteristics of the 220 KCOTs cases in 181 and find the relationship among the various factors. And the following data were obtained: patient age ranged from 8 to 77 years with an average of 33.06 years. There were 111 male and 70 female patients. The mandibular angle and ascending ramus was the most frequent site of KCOTs. Swelling, the most presenting sign, was noted in 97 cases, followed by the pain, 85 cases, and 78 cases showed no presenting signs and symptoms. On radiologic findings, the primary KCOTs appeared as a unilocular in 59 cases or multilocular in 39 cases. The KCOTs can achieve the size of which may vary from 1.0cm to 13.0cm, and the mean size was 4.07cm. The KCOTs were associated with the displacement of impacted teeth, the mandibular third molar; 47 cases, was the most frequent impacted teeth. Four patients (2.21%) were confirmed to be associated with nevoid basal cell carcinoma syndrome. Enucleation or curettage was the most common employed treatment modality (164 cases), followed by marsupialization or decompression (17 cases), and lateral decortication (13 cases). The recurrence rate was 10.78%. Most of the recurrences (21 cases) were found during the first 5 years after the first treatment for the KCOTs.
This is the first reported case of an osteolipoma affecting the left lower lip of a 68-year-old Japanese man. It is important to be aware of lipomas, such in the present rare case, to avoid their misdiagnosis.
Invasive fungal sinusitis is still a life-threatening infection in immunocompromised patients. Its onset is rapid and leads to severe complications. We describe a neutropenic patient with acute myeloid leukemia who developed invasive sinus aspergillosis despite receiving prophylactic itraconazole and empirical micafungin. The patient demonstrated apparent clinical findings such as nasal discharge, nasal congestion, and skin and mucosal necrosis. Computer tomography scans strongly demonstrated invasive maxillary sinusitis. Serological examinations for (1-3)-β-d-glucan and Aspergillus galactomannan antigen were positive, suggesting Aspergillus infection. The diagnosis of invasive sinus aspergillosis was confirmed by in situ hybridization using Aspergillus-specific probe in formalin-fixed, paraffin-embedded tissue samples. The causative organism was identified as Aspergillus fumigatus by fungal culture. Despite surgical treatment with drainage and intensive antifungal administration of voriconazole and liposomal amphotericin B, the infection rapidly disseminated to the lungs, resulting in a fatal progression of the condition.
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.
The calcifying epithelial odontogenic tumour (CEOT) is a rare benign odontogenic tumour, firstly described by Pindborg in 1955. It is most commonly intraosseous. To our knowledge, only 16 cases of peripheral CEOTs have been reported in the English literature. We present a rare case of peripheral CEOT observed in a 55-year-old woman. The lesion was seen as a small, painless, soft tissue nodule on the lingual gingiva, clinically diagnosed as epulis or papilloma and subsequently proved to be CEOT histologically. A review of the pertinent reports in the literature concerning this specific lesion is included.
Pulmonary oedema following general anaesthesia or extubation is an uncommon and unpredictable clinical entity. This unusual disease is actually attributed to pulmonary and haemodynamic changes engendered by high negative intra-thoracic pressures during the state of obstructed respiration. We report a case of postoperative pulmonary oedema in a previously healthy 35-year-old female with post-extubation laryngospasm. The patient responded rapidly to conservative management including removal of secretions, re-intubation, oxygen therapy with positive pressure ventilation and administration of diuretics with short term antibiotics. This report emphasizes the importance of rapid identification and proper management of this serious condition.
This report is the case report of a 48-year-old woman who referred to our hospital complaining of a mass at the left maxillary tuberosity and slight trismus. CT and MRI imagings showed a tumor like image with bone absorption of the left maxillary tuberosity. Under general anesthesia, the lesion was excised. Histopathological examination showed low grade mucoepidermoid carcinoma. There is no sign of recurrence or metastasis of the tumor in 5 year after the surgery.
The various treatment modalities involved in the treatment of branchial fistula such as step ladder excision and use of strippers are well described in the literature.
Bisphosphonate (BP) is used widely for the treatment of osteoporosis and other diseases. BP-related osteonecrosis of the jaw (BRONJ) has been recognized recently as a result of the increased use of BP to prevent bone fracture and osteoporosis in elderly people. Much attention has also been given to patients with dental diseases who are administered BP, and ulcers with osteonecrosis are also noted in conjunction with BRONJ [1], [2]. However, oral mucosal ulcers on the tongue or cheek without BRONJ are not common. To our knowledge, only 7 cases of mucosal ulceration have been identified in previous reports published in English and Japanese [3], [4], [5], [6], [7], [8], [9]. Therefore the clinical behavior, treatment and outcome of ulcers are not well documented. In this report, we describe a case of ulcers occurring on the tongue without BRONJ, and discuss the clinical aspects of BP-induced ulcers, including their treatment and potential cause.
