The purpose of this retrospective study was to investigate the usefulness of tracheostomy scoring system in the decision of postoperative airway management in oral cancer patients.

Purpose: The purpose of this study was to compare stability after mandibular setback surgery in patients with skeletal Class III malocclusion with and without presurgical orthodontics.Materials and Methods: This retrospective cohort study included consecutive patients with skeletal Class III malocclusion who underwent only mandibular surgery. Patients treated with the surgery-first approach without presurgical orthodontics (SF group) were compared with a control group (conventional surgery with presurgical orthodontics; CS group) using lateral cephalograms taken preoperatively, immediately postoperatively, and at the time of debonding. Predictor variables (group and timing), outcome variables (cephalometric measurements over time), and other variables, such as baseline characteristics, were evaluated to determine the difference in stability of mandibular positions such as the B point.Results: Sixty-one patients were enrolled in this study (CS group, n=38; SF group, n=23). Baseline demographic variables were similar in the 2 groups except for orthodontic treatment period. The mean setback of the mandible at the B point was similar (CS group, 8.7 mm; SF group, 9.1 mm; difference, P >.05), but the horizontal relapse in the SF group (2.4 mm) was significantly greater than in the CS group (1.6 mm; P <.05). Patients with a horizontal relapse greater than 3 mm comprised 39.1% of the SF group compared with 15.8% of the CS group (P <.05).Conclusion: Mandibular sagittal split ramus osteotomy without presurgical orthodontic treatment was less stable than conventional orthognathic surgery for mandibular prognathism. Before performing a surgery-first approach, skeletal stability needs to be considered. (c) 2014 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 72: 779- 787, 2014

Purpose: Well vascularized pectoralis major myocutaneous flap (PMMF) had been a commonly used versatile flap in reconstructive oromaxillofacial surgery since the 1970s.However, after the advent of microvascular surgery in the 1980s, the PMMF was used less frequently.But, to date, PMMF has been useful and has some advantages such as covering wide defects, covering vital structures, back-up procedure in cases of free flap failure, and reconstruction for radiotherapy patients.The purpose of this study is to evaluate the role, indication, complications, functional, and aesthetic results of this flap in the era of free flap with a literature and chart review.Methods: A retrospective study was conducted of 16 oral cancer patients undergoing reconstructive surgery with PMMF for reconstruction of defects from 2001 to 2012 at Kyungpook National University Hospital.The male to female ratio was 10:6, with a mean age of 63 years (16∼79 years).Basic demographic data, previous treatment history, indications, dimension of the flap, site of reconstruction, postoperative complications, and patients' final status were systemically analyzed from chart review.Results: The pathology of the disease included squamous cell carcinoma in the majority of cases (n=14).The remaining cases were fibrosarcoma and mucoepidermoid carcinoma.Of the 16 PMMF reconstructions, 13 flaps were applied as primary reconstructive procedures, whereas three flaps were; salvage; procedures (vascularized free flap failure).Twelve patients had complications such as wound dehiscence, infection, hematoma, fistula, flap bulkiness, and partial flap necrosis.The higher complication rates showed an association with utilization of the flap in preoperative radiotherapy cases.However, all patients were discharged without failure.Conclusion: In reconstructive oromaxillofacial surgery, the PMMF is still a useful flap for huge defects.In addition, the PMMF can be used as a salvage procedure after vascularized free flap failure and reconstruction for patients with a history of preoperative radiotherapy.

Calcium hydroxide root canal filing paste (vitapex) is widely used as canal filling paste for infected canal. However, chemical burn is possible because of the high alkali base of calcium hydroxide. A 57-year old woman was admitted to our clinic for consistent dull pain and paresthesia in the left upper lip, zygoma and buccal cheek area, which developed during an endodontic treatment of the left lateral incisor. Radiographic finding showed radiopaque material, which exits from the left incisor root apex, and was within the left canine and first premolar buccal soft tissue. The overfilled Vitapex extended to the soft tissue was surgically curetted. The result of the surgical curettage was favorable. Though slight hypoesthesia on the upper lip was still remained, paresthesia on zygomatic and buccal cheek area was completely recovered. As far as we know, this is the first case report of infraorbital nerve damage from overfilled Vitapex material.

Pseudoaneurysms are rare complications of orgthognathic surgery, trauma or other surgical procedures in the head and neck regions. Surgical approach is a routine procedure of bleeding control. However, bleeding control using angiography and embolization can also be an excellent method. We experienced pseudoaneurysm of the inferior alveolar artery occurring after surgical curettage of cystic lesion. The 33-year-old man who underwent surgical curettage of keratocystic odontogenic tumor was presented with severe bleeding in the right mandible ramal inner surface 14 days after the surgical curettage. After hemostasis with vaseline gauze packing and pressure, bleeding temporarily stopped. However, bleeding started after 14 days and soon it has been continued. Finally, the patient was diagnosed as pseudoaneurysm of the inferior alveolar artery from the enhanced-computed tomography images, and angiographic embolization was performed successfully. We report a rare case of pseudoaneurysm of the inferior alveolar artery after benign tumor curettage and review of the previewer's literature.

Introduction: Transient receptor potential ankyrin 1 (TRPA1) is activated by noxious cold (<17 degrees C) and contributes to cold and mechanical hypersensitivity after inflammation and nerve injury. Methods: To investigate whether TRPA1 is involved in the mediation of nociception, including noxious cold and cold hypersensitivity in teeth, we examined the expression of TRPA1 and sodium channel Nav1.8 in human dental pulp using fluorescent and electron microscopic immunocytochemistry. Results: TRPA1 was expressed in a large number of axons branching extensively in the peripheral pulp and in a few axons within the nerve bundles in the core of the coronal pulp and in the radicular pulp. Under electron microscopy, TRPA1 immunoreactivity was typically localized near the plasma membrane of unmyelinated axons in the peripheral pulp, suggesting that in these axons it may act as a functional receptor. The proportion of axons expressing TRPA1 in neurofilament 200-positive axons significantly increased in the painful pulp compared with the normal pulp. TRPA1 was also densely expressed in the processes and the cell body of odontoblasts. A large number of axons coexpressed TRPA1 and Nav1.8. Conclusions: These findings support the notion that TRPA1 is involved in the perception of noxious cold and cold hypersensitivity in human dental pulp and that TRPA1-mediated nociception is primarily mediated by axons and odontoblasts in the peripheral pulp. (J Endod 2012;38:1087-1092)

Abstract The Measurement of Vertical Length from the Root Tip of Maxilla ry Anterior Teeth to Nasal Floor, When Maxillary Anterior Implants Placed Hae-Man Jang, Jin-Wook Kim 1 , Tae-Geon Kwon 1 , Hyun-Joong Jang 1 , Chin-Soo Kim 1 , Sang-Han Lee 1 Department of Dentistry, Graduate School, Kyungpook National Un iversity, 1 Department of Oral & Maxillofacial Surgery, School of Dentistry , Kyunpook National UniversityPurpose: Length measurement from maxillary anterior teeth root tip to n asal floor is incorrect in panoramic radiography. Comparison of cone beam computed tomography (CBCT) and panorami c radiography should be helpful in determining the vertical length.Methods: Sixty nine patients were taken CBCT and panoramic radiography of the maxillary anterior. First measurement is length of parallel lines from the central incisor and latera l incisor root tip to nasal floor on CBCT. Second measurement is length of perpendicular lines from the central incisor and l ateral incisor root tip to nasal floor on CBCT. Third measurement is length from the central incisor and lateral incisor root tip to nasal floor on panoramic radiographys.Results: In the first measurement of the maxillary central incisors, an average of 11.36±2.49 mm in males and 10.49±2.17 mm in females. In the second measurement of the max illary central incisors, 10.41±2.42 mm in males and 9.18±2.08 m m in females. In the third measurement of the maxillary central incisors, 10.71±2.20 mm in males and 9.27±2.10 mm in females. In the first measurement of the maxillary lateral incisors, an average of 13.40±2.04 mm in males and 11.96±2.20 mm in females. In the second measurement of the maxillary lateral incisors, 11.25±1.82 mm in males and 10.06±1.68 mm in females. In the third measurement of the maxillary lateral incisors, 11. 47±2.01 mm in males and 10.13±1.70 mm in females.Conclusion: The vertical length from root tip to nasal floor was longer in male than female ( P＞0.05). First measurement was longer than third measurement ( P＜0.05). This is the actual placement of the implant site measure d on the vertical length than the length of the panorama means that there are a f ew more free. The first measurement was longer than 114% over the third measurement.Key words:Panoramic radiography, Cone-beam computed tomography, Nasal flo or, Dental implants

Objectives: This study sought to investigate the positioning of the posterior superior alveolar artery in relation to the performance of the maxillary sinus bone graft procedure in a Korean population.Materials and Methods: We identified the position of the posterior superior alveolar artery relative to 93 maxillary sinuses in 58 patients and determined the distance from the inferior border of the artery in the premolar and molar areas to the alveolar ridge and sinus floor.Results: The mean distance from the alveolar ridge to the posterior superior alveolar artery in the dentate group (20.62 +/- 3.05 mm in the premolar region, 17.50 +/- 2.84 mm in the molar region) was greater than as compared to the edentulous group (18.83 +/- 2.79 mm in the premolar region, 15.50 +/- 1.64 mm in the molar region), and this difference was statistically significant (P<0.05). In contrast, there was no statistically significant difference (P>0.05) between the mean distance from the sinus floor to the posterior superior alveolar artery in the dentate group (8.21 +/- 2.79 mm in the premolar region, 7.52 +/- 2.07 mm in the molar region) or in the edentulous group (7.75 +/- 3.31 mm in the premolar region, 7.97 +/- 2.31 mm in the molar region).Conclusion: Prior to surgery, it is important to evaluate the position of the posterior superior maxillary artery by using computed tomography scans. The premolar area is safer than the molar area for performing the maxillary sinus bone graft without bleeding.

Objectives: Odontogenic keratocysts (OKCs) have a tendency to recur and possess an aggressive nature. the aim of the present study was to evaluate cytokeratin (CK) expression patterns as a method for the differentiation between dentigerous cysts (DCs) and OKCs, as their histomorphologic appearance are often indistinguishable.Materials and Methods: Formalin-fixed, paraffin-embedded tissue sections of 43 OKCs and 38 DCs were immunohistochemically analyzed with i-solution in a quantitative manner in order to evaluate the immunoreactivity of CK 10, 16 and 17.Results: CK 10 expression was evident in 79.1% of OKCs but found in only 18.4% of DCs (P<0.05), and CK 10 expression was observed to occur more frequently in OKCs (mean 25.45%) than in DCs (2.19%) (P<0.05). The expression of CK 16 was evident in 79.1% of OKCs but found in only 7.9% of the DCs (P<0.05) and CK 16 expression was observed to occur more frequently in OKCs ( mean 4.33%) than in the DCs (0.61%) (P<0.05). The expression of CK 17 was evident in 88.4% of OKCs but seen in only 15.7% of the DCs (P<0.05) and CK 17 expression was observed to occur more frequently in OKCs (mean 31.11%) than in the DCs (2.37%) (P<0.05).Conclusion: The immunohistochemical detection of CK 10, 16 and 17 can be utilized as a valuable biomarker for use in distinguishing between OKCs and DCs, which have clinically significant differential diagnoses.

Introduction The location of parotid gland tumors in the superficial or deep lobes can affect the time and difficulty of operations. Therefore, accurate preoperative evaluation of the tumor location is important for surgical outcomes. Materials and Methods A total of 16 patients with parotid gland tumors and who underwent a parotidectomy between April 2003 and March 2011 were retrospectively reviewed in terms of demographic background, tumor location, surgical treatment, and treatment outcomes. Tumor location was estimated by four landmarks on contrast enhanced computerized tomography scans, which were Conn's arc, the facial nerve (FN) line, the Utrecht line, and the retromandibular vein. Tumor location was confirmed by relative position depending on the facial nerve during surgery. It was assumed positive since the tumor lies in the superficial lobe of the parotid gland, the sensitivity, specificity, positive predictive value, negative predictive value, and efficiency of each landmark were evaluated. Results Our result revealed that the facial nerve line had a sensitivity of 83.3%, specificity of 100%, positive predictive value of 100%, negative predictive value of 71.4%, and efficiency of 87.5%. Some would be more efficient preoperative evaluation methods of the relationship of parotid gland tumors to the facial nerve than others. Conclusion In our study, the FN line was found to be the most reliable analysis method.

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.

Introduction: Very high aggressiveness and recurrence are important clinical characteristics of ameloblastoma compared to the other benign tumors. Therefore, an accurate diagnosis and treatment plan is important. This study examined the association of the clinical findings and recurrence based on the radiological findings of ameloblastoma. In recurrent cases, these results are expected to help in the diagnosis and treatment of ameloblastoma to examine the relevance with the clinical characteristics and radiological features.Materials and Methods: For a clinical (gender, age) and radiological (location, internal pattern, size, perforation, border pattern, impacted tooth, root resorption) evaluation, this study examined 156 cases of 147 patients diagnosed with ameloblastoma, who had been treated and in most cases regularly checked at the department of oral and maxillofacial surgery, Kyungpook National University Hospital, between January 1993 and December 2009. For a recurrent rate evaluation, a more than 3 years follow-up period is needed. Accordingly, 116 patients diagnosed with ameloblastoma between January 1994 and December 2007 were investigated.Results: The recurrence rate in all cases was 6.1% but was 7.8% in cases with follow-up periods more than 3 years. The male-to-female ratio was 3: 2, showing a slight male predilection. Ameloblastoma had a peak occurrence in the second decade of life followed by the fourth decade of life. The mandibular angle area is the most frequent site of ameloblastoma (50.8%) in the jaws. Six cases of unilocular (7.8%) and 3 cases of multilocular (7.7%) ameloblastomas recurred. Seven cases of smooth (10%) and 2 cases of irregular (4.3%) ameloblastomas recurred. No cases of ameloblastomas without perforation of the cortical bone (0%) and 9 cases with a perforation of cortical bone (11.1%) recurred. Four cases of the ameloblastomas with impacted teeth (11.4%) and 5 cases of ameloblastomas without impacted tooth (6.2%) recurred. Seven cases of ameloblastomas with root resorption (10.9%) and 2 cases of ameloblastomas without root resorption (3.8%) recurred.Conclusion: A multiple smooth margin, unilocular ameloblastoma with an impacted tooth, root resorption tends to recur more easily. Therefore, they need to be treated more carefully and require a a longer follow-up.

Introduction: Ameloblastoma is a benign but locally invasive tumor with a high recurrence rate. The aim of this study was to make an easier diagnosis and treatment planning of ameloblastoma. Materials andMethods: From January 1993 to October 2009, 139 cases from 123 patients, who had been diagnosed with ameloblastoma through radiologic and biopsy in the department of oral and maxillofacial surgery of Kyunpook National University, were selected as the subjects in this study. According to the medical charts, 9 factors (age, gender, location, chief complaints, duration, radiographic findings, size and recurrence) concerned in deciding the treatment method and the relevance between each factor and the treatment methods were examined.(Conservative treatments were marsupialization, enucleation, curettage and lateral decortication. Radical treatments included block excision, resection and hemisection)Results: In the patients under the age of 20, 77.14% had conservative treatments, whereas 22.86% underwent radical treatments. In the patients over the age of 20, 44.23% were treated conservatively treatments, and 55.77% underwent radical treatments. For unilocular types, 28.57% had conservative treatments, whereas 71.43% had radical treatments. For the multilocular types, 66.67% underwent conservative treatments, and 33.33% had radical treatments. For the primary cases, 58.68% were treated conservatively and 41.32% had radical treatments. For the recurrent cases, 16.67% and 83.33% underwent conservative and radical treatments, respectively.Conclusion: There was statistical significance in the factors affecting the treatment methods, such as age, radiographic findings and recurrence.

Polymorphous low-grade adenocarcinomas (PLGA) are distinctive salivary gland neoplasms with a propensity to arise from the minor salivary glands. The most frequent location of PLGA is the palate, even though other locations have been described. Previously used terms for PLGA include lobular carcinoma and terminal duct carcinoma.Although the frequency of the tumor is unknown, the recognition of PLGA as an individual tumor has increased with the establishment of specific histopathological criteria characterizing the PLGA.The first choice of treatment is a wide surgical excision including the subjacent bone if necessary. The prognosis is generally good and the recurrence rate ranges from 17% and 22%. Distant metastases is unusual (9%) but occur mainly in the regional lymph nodes.This is a case report of a 67 year old female patient with PLGA who was treated with a wide excision by layers (2 stage) of the lesion including the surrounding bone. We present this case with a review of the relevant literature.

Adenomatoid odontogenic tumors represent 3 to 7 percent of all odontogenic tumors. These tumors are more common in the maxilla than the mandible and usually include the anterior region. Clinically, the most common symptom is painless swelling and the tumor is associated with an unerupted tooth, typically a maxillary or mandibular cuspid. The adenomatoid odontogenic tumor appears radiographically as a unilocular radiolucency around the crown of an impacted tooth, resembling a dentigerous cyst. More often, it contains fine calcifications. Histopathologically, there is a thick wall cystic structure with a prominent intraluminal proliferation of the odontogenic epithelium. The most striking pattern is varying-sized solid nodules of spindle-shaped or cuboidal epithelial cells forming nests or rosette-like structures with minimal stromal connective tissues. Conspicuous within the cellular areas are structures of tubular or duct-like appearance. The duct-like spaces are lined with a single row of cuboidal or low columnar epithelial cells, of which the ovoid nuclei are polarized away from the luminal surface. Small foci of calcification may also be scattered throughout the tumor. These have been interpreted as abortive enamel formations. In some adenomatoid odontogenic tumors, the material has been interpreted as dentoid or cementum.

Introduction: The current study examined the morphological characteristics of maxillary sinus septum by computed tomography (CT).Materials and Methods: Two hundred and four patients (408 maxillary sinuses) who visited dental clinic were evaluated. CT were examined. The height of the septum measured from the sinus floor to the apex of the septum more than 3 mm was defined as "sinus septum".Results: The prevalence of sinus septa was 21.3% (87/408), and 31.4% (64/204) of patients had more than 1 sinus septum. Females showed higher and thinner sinus septa than males. The anatomic location of the septa were distributed in the 2nd molar region (43.7%), 1st molar region (31.0%), 2nd premolar region (21.8%) and 1st premolar region (3.5%). In 57 patients with chronic disease, there was no significant difference between sinus disease and the presence of sinus septa. The loss of remaining teeth and teeth adjacent to the sinus septum area was not related to the presence of sinus septa. Older subjects showed a reduced height and length of the septum, and a thicker septum.Conclusion: These results show that the maxillary sinus septum undergoes atrophy with age.

Purpose: The odontogenic keratocysts demonstrated a high recurrence rate and a biologically aggressive nature. This might be due to un known fac- tors inherent in the epithelium or enzymatic activity in the fibrous wall. Bcl-2 protein is characterized by its ability to inh ibit apoptosis. The aim of this study was to evaluate the expression and distribution of bcl-2 in the OKCs, its possible relationship with the tumorous charact eristics, such as the aggressive nature and high recurrence rate, and its usefulness to differentiate OKCs from dentigerous cysts. Materials and Methods: Formalin fixed paraffin-embedded tissue sections of 53 OKCs, and 44 dentigerous cyst were immunohistochemically ana- lyzed quantitatively for the immunoreactivity of the bcl-2 protein with i-solution. Results: More Bcl-2 expression was observed in the OKCs (mean34.387%) than dentigerous cyst (mean11.144%) with statistical significance (P<0.001). Seventeen and 15 of the 32 OKCs in this study showed positivity in the basal layer and basal/suprabasal layers, respec tively. In dentiger- ous cyst, 2 of 3 showed positivity in the basal cell layer. Conclusion: Considering that bcl-2 over expression may lead to the increased survival of epithelial cells, this study demonstrated a possib le relation- ship between the aggressive nature of OKC and the intrinsic growth potential of its lining epithelium. Furthermore, the basal/s uprabasal distribution of bcl-2 positive cells was observed in some OKCs, which might have a significant impact on the behavior of cysts. The bcl-2 expre ssion of OKCs can be useful for differentiating OKCs from dentigerous cysts.