Pulmonary metastasis of ameloblastoma is a rare associated with the histopathologically plexiform types of ameloblastoma. In this report, we present an exceptionally rare case of pulmonary metastatic ameloblastoma without local recurrence, emerging 12 years post-initial resection. A female patient, initially diagnosed with mandibular desmoplastic ameloblastoma, revealed masses in both lung fields of the lung on chest radiography, while chest computed tomography revealed more than 10 nodules in both lungs. Histopathological analysis of a lung biopsy specimen revealed a nest-like structure of tumor cells surrounded by highly columnar cells, exhibiting a palisade-like arrangement, and squamous metaplasia.Subsequently, the diagnosis of pulmonary metastatic ameloblastoma was confirmed through immunohistochemical examination. Despite clinical trial treatment with molecular targeted therapy for three years, the lung disease remained clinically stable. This case highlights the need for oral surgeons to recognize that pulmonary metastasis of desmoplastic ameloblastoma can manifest as a late recurrence, extending beyond a decade after initial curative surgery.

Salivary gland hypofunction due to radiation therapy for head and neck cancer or Sjogren syndrome may cause various oral diseases, which can lead to a decline in the quality of life. Cell therapy using salivary gland stem cells is a promising method for restoring hypofunction. Herein, we show that salivary gland like cells can be induced from epithelial tissues that were transdifferentiated from mouse embryonic fibroblasts (MEFs). We introduced four genes, Dnp63a, Tfap2a, Grhl2, and Myc (PTMG) that are known to transdifferentiate fibroblasts into oral mucosa-like epithelium in vivo into MEFs. MEFs overexpressing these genes showed epithelial cell characteristics, such as cobblestone appearance and E-cadherin positivity, and formed oral epithelial-like tissue under air-liquid interface culture conditions. The epithelial sheet detached from the culture dish was infected with adenoviruses encoding Sox9 and Foxc1, which we previously identified as essential factors to induce salivary gland formation. The cells detached from the cell sheet formed spheres 10 days after infection and showed a branching morphology. The spheres expressed genes encoding basal/myoepithelial markers, cytokeratin 5, cytokeratin 14, acinar cell marker, aquaporin 5, and the myoepithelial marker a-smooth muscle actin. The dissociated cells of these primary spheres had the ability to form secondary spheres. Taken together, our results provide a new strategy for cell therapy of salivary glands and hold implications in treating patients with dry mouth. (C) 2021 Elsevier Inc. All rights reserved.

A case of delayed epistaxis from the mucosa behind the right side of the inferior nasal mucosa 11 days after orthognathic surgery by Le Fort I osteotomy is presented. The patient was a 31-year-old man who underwent orthognathic surgery under general anesthesia. No abnormal findings were found during or after the operation. The patient was discharged from the hospital 10 days postoperatively. However, bleeding from the right nasal cavity occurred suddenly on the night after discharge, and he presented to our hospital again. The epistaxis was stopped once by nasal packing containing 0.001% epinephrine and systemic infusion of carbazochrome sulfonic acid and tranexamic acid. However, when the nasal packing was removed the next day, right nasal epistaxis was observed again. Curvature of the nasal septum and thickening of the inferior turbinate mucosa were seen on inspection; although, no active bleeding point was identified. Decreased nasal mucosa thickening and bleeding were observed after nasal packing containing 0.02% epinephrine. When the inside of the nasal cavity was observed endoscopically, an approximately 2 mm laceration was found in the mucosa behind the side wall of the right inferior nasal mucosa, and bleeding from the same part was confirmed. After endoscopic cauterization for hemostasis of the nasal mucosa, no rebleeding was observed. Although delayed epistaxis after Le Fort I osteotomy are often performed CT angiography to confirm the bleeding site, endoscopic cauterization would be primarily useful because of less invasiveness.

Mandibular reconstruction for wide defects remains a challenge. Although vascularized free flaps are the gold standard for wide defects due to excision of mandibular neoplasms, a less invasive, more aesthetic treatment modality should be considered, especially for benign tumors of young patients. Five patients who received a custom-made titanium mesh cage for transplantation of autologous iliac particulate cancellous bone and marrow for the reconstruction of wide mandibular defects due to ameloblastoma were evaluated. Titanium mesh cage was preoperatively customized and prepared by patient-specific modeling for each case. The segmental resection of mandible for each cases was planned by preoperative computer simulation, and precisely performed with intraoperative surgical navigation systems. Thus, customized titanium mesh cage was perfect fit for all cases. All cases were followed-up for at least 1 year. Two patients had a small fistula because of bacterial infection 1 week after surgery. There was no titanium mesh exposure in the fistula, and local irrigation for several days healed it. Although one patient had a small fracture of the titanium mesh cage 6 months after the surgery, mandibular bone continuity was maintained. A viable, less invasive, more aesthetic alternative to the standard bony reconstructive strategy for wide mandibular defects was described. Further studies to modify the mesh cage design for better outcomes and reconsideration of the materials inducing and replacing the new bone are needed.

Although stem cell aging leads to a decline in tissue homeostasis and regenerative capacity, it remains unclear whether salivary gland stem cell function changes during this process. However, the salivary glands are gradually replaced by connective tissue during aging. Here, we show a decline in the stem cell ability of CD133-positive stem/progenitor cells in the salivary glands of aged mice. The CD133-positive cells were isolated from young, adult, and aged mice. The number of CD133-positive cells was significantly decreased in aged mice. They also showed a lower sphere formation capacity compared to young and adult mice. RNA sequencing revealed that CD133-positive cells in aged mice exhibited lower gene expression of several aging-related genes, including FoxO3a, than those in young and adult mice. Salivary gland cells infected with a recombinant lentivirus encoding the FoxO3a gene showed a reduction in oxidative stress induced by hydrogen peroxide compared with those infected with a control virus. Thus, FoxO3a may inhibit stem cell aging via oxidative stress.

Acromegaly is an endocrine disease caused by excessive secretion of growth hormone （GH） after the end of the growth period, due to a pituitary adenoma. Mandibular prognathism, tongue hypertrophy, and bulging of the eyebrow arch are observed in the maxillofacial region. We describe a case with acromegaly for which surgical orthodontic treatment was performed after excision of the pituitary adenoma. A 47-year-old woman who became aware of enlargement of the size of the hands and feet from 35 years old was diagnosed with acromegaly by the Department of Neurosurgery because of a high GH level and a pituitary tumor on MRI. In September 2014, chemotherapy was performed after tumor resection via the nasal cavity. In March 2016, she was referred to the Department of Orthodontics of our hospital for further examination and treatment of malocclusion. Overjet and overbite were −5.0mm and ＋2.5mm, respectively. The occlusal relationship of the molars was Angle class Ⅲ. Angular analysis of lateral cephalometric analysis showed SNA: 80.0°, SNB: 77.0°, ANB: 3.0°, and FMA: 37.9°. Mandibular prognathism was diagnosed based on a Wits appraisal of −7.1. Since there was no clinical activity of acromegaly and hypertrophy of the hard and soft tissues due to acromegaly had stopped, and serum insulin-like growth factor-1 was well controlled by chemotherapy, orthognathic treatment was started in April 2016 and bimaxillary surgery was performed in January 2019. The occlusal relationship was stable and there was no recurrence at 2 years after the surgery. Since acromegaly has various complications, it is necessary to create a treatment plan considering the complications, and to perform extended follow-up due to the potential for recurrence of the disease.

Necrotizing sialometaplasia is a benign lesion affecting the minor salivary glands of the hard palate. This lesion may be clinically and histopathologically confused with malignant lesions. A case of a 47-year-old man who presented with necrotizing sialometaplasia on the left side of the hard palate is herein reported. A biopsy was performed, and the condition was diagnosed based on immunohistochemistry. The lesion receded following treatment with tranexamic acid and sodium azulene sulfonate. The symptom of painful swelling on the hard palate subsided within 10 days. The palatal lesion had disappeared completely 4 months later.

The prevalence of nonsuicidal self-injury (NSSI) in adults is lower than that in adolescents and it is more prevalent in patients with psychiatric disorders. Sleep disturbances such as nightmares are associated with NSSI after accounting for depression; thus, persons with major NSSI sometimes present at medical institutions during the night seeking emergency treatment. Gingival tissues comprise the most frequent target of self-injury of the oral cavity using oral hygiene tools. Most NSSI in the oral cavity is minor because such tools are blunt. Major NSSI such as autoamputation of the tongue is rare. We describe two patients who partially autoamputated the apex of their own tongues using edged tools. Case 1 was a 55-year-old female with depression who had defaulted from psychiatric intervention. She had cut off her tongue using a Japanese kitchen knife and presented with the dry, necrotic amputated portion and blood oozing from the remainder of her tongue. We debrided and sutured the remainder of the tongue without reattaching the amputated portion. Her postoperative course was uneventful, and she was free of adverse events such as functional disability and wound infection. Case 2 was a 69-year-old female with schizophrenia who had defaulted from psychiatric intervention and had cut off her tongue using scissors. The amputated portion of the tongue was lost and the remainder, which was oozing blood, was debrided and sutured. She defaulted on a follow-up appointment. Neither of these patients had suicidal intent. The prevalence of NSSI across all age groups has recently increased, and the risk that self-injury will become normalized has become a concern. Thus, dentists as well as oral and maxillofacial surgeons should be aware of the possibility that patients will present with major NSSI requiring emergency treatment.

1) ，池崎かおり 1) ，堅田 凌悟 1) ，武田 健一 1) ，田中 元博 1) ，栗原 祐史 1) ， 近藤 誠二 2) ，代田 達夫 1) A ankylosis of temporomandibular joint treated by navigation surgery for temporomandibular joint mobilization

Introduction: Squamous cell carcinoma (SCC) of the tongue is a common cancer of the oral region, generally occurring on the lateral surface of the tongue.