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Objective The objective of this study was to assess the efficacy of a tobacco cessation intervention conducted by different dental specialists directed at a group of patients with tobacco-related oral diseases or undergoing implant treatment. Methods The study design was a multicentre, nonrandomized prospective cohort study to examine the effects of smoking cessation. The target patients were current smokers (aged ≥20 years) with an oral potentially malignant disorder or periodontitis and those seeking dental implants. A total of 74 patients were enrolled in the study. All dental specialists who participated in the trial completed an e-learning Japan Smoking Cessation Training Outreach Project (J-STOP) tobacco cessation education programme. Nicotine dependence was evaluated by the Fagerstrom Test for Nicotine Dependence. Cessation status was verified biochemically by measurement of salivary cotinine or exhaled carbon monoxide. Tobacco cessation intervention was implemented for 8 weeks with or without nicotine replacement therapy with follow-up for 12 months. Results A total of 61 patients agreed to the tobacco cessation intervention. The mean biochemically confirmed tobacco abstinence rate was 37.7% at month 3, 34.4% at month 6, and 32.8% at month 12. The highest rate of biochemically confirmed tobacco abstinence at month 12 was among patients receiving implant treatment (42.9%) followed by patients with oral potentially malignant disorder (37.1%), and those with periodontitis (21.1%). Conclusion This interventional study demonstrates the challenges encountered and the feasibility of tobacco cessation intervention among Japanese patients attending dental specialists who had completed an e-learning course on smoking cessation. Making tobacco cessation an integral part of patient management by dental specialists requires further evaluation.

Few prospective studies have reported the effects of periodontal therapy on patients who attempted to quit smoking. This study aimed to assess how smoking cessation affects periodontal therapy. Twenty-five smokers with periodontitis were investigated by dividing them into two groups, a smoking cessation support group and a continued smoking group. Those in the support group received counseling and nicotine replacement therapy, followed by periodontal treatment conducted by dentists who had completed an e-learning course on smoking cessation. Clinical parameters were measured at baseline, 3, and 6 months. Most clinical parameters improved for those in the smoking cessation support group. There were no significant improvements in bleeding on probing (BOP) or the number of severe periodontal disease sites in the continued smoking group. Probing pocket depth (PPD) and clinical attachment levels (CAL) at sites that received scaling and root planing (SRP) significantly improved in all subjects. BOP did not improve at reevaluation in the smoking relapse subgroup. Patients in the smoking cessation support program led by dental professionals showed more improvement in BOP than those in the continued smoking group.

Objectives Oral function management has been recognized as important strategy for preventing postoperative complications. In this historical cohort study, we focused on the patients who planed gastrectomy, and investigated the appropriate duration and frequency of preoperative oral care to prevent complications after surgery. Methods Patients who planed surgery for gastric cancer between 2012 to 2018 were enrolled. We defined intensive oral care as initial intervention at least three weeks before surgery and follow-up intervention within a week before surgery. As the primary outcome, the incidence of postoperative infectious complications was compared between the intensive oral care and non- intensive oral care groups. Results A total of 576 patients were enrolled, including 66 with intensive oral care. The incidence of infectious complications was 2/66 (3.0%) in the intensive oral care group and 64/510 (12.5%) in the non-intensive oral care group. After adjusting for confounding factors, patients with intensive oral care exposure had a lower chance of developing postoperative infectious complications (Odds ratio; 0.217, 0.051-0.927). Conclusions Intensive oral care can help prevent postoperative infectious complications after gastrectomy. These findings suggest that appropriate preoperative oral care include at least two interventions: three weeks or more before and within one week before surgery.

A cross-sectional, nationwide survey was conducted in Japan to examine the relationship between tobacco smoking and oral diseases including implant failure. A questionnaire survey was sent to designated facilities by post, and 158 answered questions regarding implant loss. Smoking status, number of implant failures, and other related variables were collected from the participating dentists as secondary data. A total of 1966 patients who were treated with dental implants by participating dentists during the survey period were analysed. Among the total sample, 90 (5%) had early implant loss (≤12 months) and 153 (8%) had late implant loss (>12 months and ≤120 months). The number of pack-years was significantly higher in the total (early and late) implant loss group (31.2±15.9) than in the group with no implant loss (26.1±18.1) (P=0.026). In the multivariate analysis, the number of implants installed, smoking, and pack-years were significant factors for total implant loss. The adjusted odds ratio for implant failure for current smokers compared with never smokers was 2.07 (95% CI 1.19-3.62) for early implant loss and 1.48 (95% CI 0.92-2.37) for late implant loss. This study reaffirms that current smoking is associated with an increased risk of early implant loss, irrespective of the duration of smoking exposure.

Background Perioperative oral management has been reported to be effective for preventing postoperative infectious complications. In addition, severe periodontal disease was identified as the significant risk factor for complications after gastrointestinal surgery. We investigated the bacteriological association between the periodontal pocket, stomach mucosa and drainage fluid to determine whether oral bacteria directly cause intra-abdominal infection after gastrectomy. Methods Patients who were scheduled to undergo surgery for gastric cancer were prospectively enrolled. We evaluated the similarity of bacterial strains in periodontal pocket, stomach mucosa and fluid from drainage tube. Gingival crevicular fluid and dental plaque were collected from the periodontal pocket and cultured to detect bacteria. Specimens from the resected stomach were collected and used for bacterial culturing. Drainage fluid from the abdominal cavity was also cultured. Results All of 52 patients were enrolled. In the periodontal pocket, α-Streptococcus spp., Neisseria sp., and Prevotella sp. were mainly detected. Bacterial cultures in the stomach mucosa were positive in 26 cases. In 20 cases (76.9%), the detected strains were the same as those in the periodontal pocket. Six patients had the postoperative intra-abdominal infection after gastrectomy, and the same bacterial strains was detected in both of drainage fluid and periodontal pocket in two patients with severe periodontal disease. Conclusions We found the bacteriological association that same strain detected in periodontal pocket, stomach and in intra-abdominal drainage fluid after gastrectomy in patients with periodontal disease.

Objective Oral implant loss has been recognized to be associated with smoking. Nicotine is affected by peri-implant soft tissue with vasoconstriction and impaired cellular healing response. However, a gap between preclinical and clinical research outcomes was observed. A cross-sectional, nationwide survey was conducted to examine the relationship between tobacco smoking and oral diseases among the Japanese population. Methods Questionnaire survey sheets were sent to 489 designated facilities by postal mail, and in all, 251 (50.4%) facilities responded. Among these, 246 were valid responses. The following demographic items were corrected: number of implants placed, duration of observation period after implantation, smoking habits, number of cigarettes, smoking duration, drinking habits, diabetes mellitus morbidity, and number of implant failures for those who underwent implantation between January 1, 2012 and December 31, 2012. Pack-years in implant loss were evaluated in three groups: at ≤12 months (early loss group), ≤120 months (late loss group) and >120 months of implant loss (non-implant loss group). Results During the survey period, 1,966 patients were analyzed. The odds ratio for implant failure was 2.20 (95%CI: 1.34–3.63) for current smokers in a selected age group (≤20 years). The pack-years were higher in the late implant loss group (35.7 ± 18.4) than those in the non-implant loss group (26.1 ± 18.1). The result indicated that a higher number of pack-years was associated with late implant loss. However, the number of pack-years was not associated with early implant loss. Conclusions This cross-sectional survey conducted in Japan suggested that smoking is significantly associated with implant failure. Irrespective of the duration of smoking exposure, smoking habit was associated with early implant loss.

The effectiveness of perioperative oral management in gastrointestinal surgery remains unclear. To elucidate the clinical significance of oral care, we investigated the relationship between the oral environment and postoperative infectious complications (POICs) in patients undergoing gastrointestinal surgery. This was a single-institute and historical cohort study of 341 patients. The participants were isolated from consecutive patients undergoing planned radical resection for gastrointestinal carcinoma from January 2016 to June 2017. Dentists assessed the oral environment for periodontal disease, hygiene status, dry mouth, fur on tongue, and tooth stumps. All patients received scaling and tooth brushing instructions. A stepwise logistic regression analysis was conducted to identify risk factors for POICs among the different oral statuses. The surgical procedures performed were gastrectomy in 123 (36.1%), colorectal resection in 185 (54.2%), and pancreatoduodenectomy or others in 38 (11.1%). POICs occurred in 48 patients (14.1%), including deep organ space infection in 20, surgical site infection in 11, anastomotic leakage in 5, urinary tract infection in 4, pneumonia in 2, and others in 6. After adjusting for confounding factors, periodontal disease was isolated as an independent risk factor for POICs (odds ratio 2.091, p = 0.037, 95% confidence interval 1.045–4.183). Other variables of oral environment such as hygiene status, dry mouth, fur on tongue, and tooth stumps did not have a significant impact on POICs. Periodontal disease is a risk factor for infectious complications after gastrointestinal surgery.

Background: Oral health professionals (OHPs) could have an important role in contributing to tobacco-dependence treatment of patients who visit dental clinics. How the public may perceive the role of OHPs in this capacity, however, has not been formally evaluated. The objective of this study was to assess national awareness and receptivity among Japanese in terms of the implementation of tobacco cessation counseling and treatment (TCCT) by OHPs in dental settings covered by National Health Insurance (NHI). The study participants’ awareness and knowledge on tobacco-related health disparities were also examined. Method: A questionnaire survey was used to assess the opinions among patients who visited hospital dental and oral and maxillofacial departments and private dental clinics ( n = 27) spread across several prefectures in Japan on their acceptance if tobacco cessation services were given by dentists and dental hygienists. Result: Overall, 963 survey sheets were eligible for the analysis. To the inquiry on tobacco-related oral diseases (TRODs), majority were aware of tooth staining (85%) and bad breathe (80%). However, less than half of respondents were aware of oral cancer (47%) and only 32% of oral precancer. OHPs were acceptable to the majority of respondents for TCCT: ≥70 age-group (84%), ex-smokers (84%) or never smokers (81%), never drinkers (83%), and students (86%). Paradoxically, current smokers (60%) were less likely to accept OHP for TCCT. However, those willing to quit within a month (89%) were willing to accept any help from OHP than those with no decision to quit (58%) ( p = 0.029). Conclusion: The result of this nationwide survey in Japan supported an expansion of duties of OHPs to provide TCCT to dental patients covered by NHI. Japanese patients who were willing to quit smoking were likely to accept TCCT in a dental setting, supporting the scheme for the introduction of tobacco control in dentistry.

Self injurious behavior (SIB) is a serious health problem. Oral SIB is not uncommon and typically expressed by persistent biting of the oral mucosa and perioral tissues. This case report describes an 11-year-old Japanese boy with functional oral SIB in non-syndromic patients. Some major change had recently occurred in the family routine. Oral lesions included factitial ulcer of the buccal mucosa and tongue. We describe the successful use of a removable dental appliance under the careful observation of oral SIB through intense collaboration between parents, psychologists, and dental staff in addition to psychological therapy.

Extraoral maxillofacial rehabilitation for compromised or lost facial anatomy resulting from the surgical eradication of malignancy, trauma, or congenital anomalies is commonly accomplished with a silicone prosthesis. However, with increasing size and weight, a silicone prosthesis can lose retention. This report presents 2 patient treatments to introduce a fabrication and retention method for a lightweight acrylic resin facial prosthesis. The prosthesis was fabricated by bonding an acrylic resin facial shell to a computer-edited facial image printed with iron-on transfers. The completed prosthesis was attached to the skin with medical-grade double-sided adhesive tape, which maintained a tight marginal seal even when in contact with saliva and water. The strong prosthetic retention of the lightweight prosthesis enabled orofacial and speech rehabilitation, which makes it a promising alternative to the conventional silicone prosthesis, especially for the restoration of extensive maxillofacial defects.

Poly-lactic-glycolic acid (PLGA) is a biocompatible as well as biodegradable polymer and used in various medical applications. In this study, we evaluated efficiency of the specially designed three-dimensional porous PLGA as a scaffold for bone augmentation. First, cell attachment/proliferation, differentiation, and mineralization of Fisher 344 rat marrow mesenchymal stem cells (MSCs) cultured on the PLGA scaffold were analyzed. Viable MSCs were impregnated into pore areas of the scaffold and a moderate increase of DNA contents was seen. High alkaline phosphatase, osteocalcin content, and calcium content of MSCs in PLGA scaffolds under osteogenic differentiation conditions were seen after 14 or 21 days of culture. Subsequently, we implanted the PLGA/MSCs composites on rat calvaria bone for 30 days. Newly formed bone was seen in only the composite PLGA/MSCs implantation group, which had been precultured under osteogenic condition. We also demonstrated that the newly formed bone originated from the donor composites. These results demonstrate that the three-dimensional PLGA scaffold can support osteogenic differentiation of MSCs, and the scaffold combined with osteogenic MSCs can be used for in vivo bone tissue augmentation. © 2008 Wiley Periodicals, Inc. J Biomed Mater Res 2009

SummaryOral lichen planus (OLP) is a refractory disorder of the oral mucosa. Its predominant symptoms are pain and haphalgesia that impair the quality of life of patients. OLP develops via a T cell-mediated immune process. Here, we examined the characteristics of the infiltrating T cells in terms of the T cell receptor (TCR) repertoires, T cell clonality, T cell phenotypes and cytokine production profiles. TCR repertoire analyses and CDR3 size spectratyping were performed using peripheral blood mononuclear cells (PBMCs) and tissue specimens of OLP biopsies from 12 patients. The cytokine expression profiles and T cell phenotypes were measured by real-time quantitative polymerase chain reaction. We observed that there were skewed TCR repertoires in the tissue samples (TCRVA8-1, VA22-1, VB2-1, VB3-1 and VB5-1) and PBMCs (TCRVA8-1, VB2-1, VB3-1 and VB5-1) from OLP patients. Furthermore, the CDR3 distributions in the skewed TCR subfamilies exhibited polyclonal patterns. We observed increases in CD4+ T lymphocytes, interleukin (IL)-5, tumour necrosis factor (TNF)-α and human leucocyte antigen D-related in the OLP tissue specimens. Taken together, the present results suggest that T cells bearing these TCRs are involved in the pathogenesis of OLP, and that IL-5 and TNF-α may participate in its inflammatory process.

This study investigates selected predictors for clinical outcome of temporomandibular joint (TMJ) irrigation in patients with chronic closed lock (CCL).Fifty-six patients with unilateral CCL, who underwent a visually guided TMJ irrigation (VGIR), were enrolled in this study. They were divided into either successful (s-group; n = 38) or unsuccessful groups (u-group; n = 18), according to the clinical success criteria. The investigated predictive factors were age, gender, duration of symptoms before the VGIR, preoperative painless range of mandibular motion, preoperative self-evaluated TMJ pain on visual analog scale (VAS), severity of arthroscopically observed pathologies, and presence and concentrations of a set of pro- and anti-inflammatory cytokines (ie, tumor necrosis factor [TNF]-alpha, interleukin [IL]-1beta, IL-6, IL-8, IL-12, and IL-10) in the aspirated synovial fluid (A-SF). Several comparative analyses and logistic regression analyses were used for statistical studies.The preoperative VAS score, detection rate of IL-8, and concentrations of IL-6 and IL-8 in the A-SF were significantly higher in the u-group (P.05). Conversely, the detection rate and concentrations of IL-10 were significantly higher in the s-group (P.05). The multivariate adjusted odds ratio (OR) showed that the detectable IL-10 in the A-SF (OR, 10.882; P = .047) is significantly predictive for a successful VGIR.The presence of IL-10 in the A-SF is a significant predictor of successful outcome of TMJ irrigation for CCL. Severe TMJ pain and detectable IL-6 or IL-8 in the A-SF seem to indicate a poor outcome after TMJ irrigation.

The case of an isolated right submandibular gland aplasia, detected by computed tomography scan, magnetic resonance imaging, and technetium 99m-pertechnetate scintigraphy, in a 58-year-old man is reported.

Objective: To examine the feasibility of a combination of the blue dye injection method and reverse transcriptase-nested polymerase chain reaction for squamous cell carcinoma antigen mRNA to detect sentinel lymph node metastasis in patients with oral cancer. Patients and Methods: Ten individuals with previously untreated oral cancer participated in the study. Sentinel lymph nodes were identified by the blue dye injection method during neck dissection. We investigated the comparative effectiveness of frozen haematoxylin and eosin section analysis and molecular analysis of squamous cell carcinoma antigen for sentinel lymph node diagnosis. Results: In 8 out of the 10 cases, sentinel lymph nodes were identified. One histologically positive sentinel lymph node also showed positive for squamous cell carcinoma antigen. The remaining 7 histologically negative sentinel lymph nodes were also negative for squamous cell carcinoma antigen. However, in 3 cases, squamous cell carcinoma antigen-positive-non-sentinel lymph nodes were detected despite sentinel lymph nodes being negative for squamous cell carcinoma antigen. Conclusion: Our preliminary results suggest that the combination of the single blue dye injection method and reverse transcriptase-nested polymerase chain reaction for the squamous cell carcinoma antigen mRNA was not very accurate for detection of sentinel lymph node metastasis in patients with oral cancer.

Purpose: The purpose of this study was to construct questionnaires for the dental school setting from freely given patient answers with the aid of text mining, and to confirm the structure, reliability and validity of the questionnaires. Methods: Using these questionnaires, we carried out a survey of the satisfaction of patients treated at the Dental Hospital of the Tsurumi University School of Dental Medicine. A total of 3394 patients participated in the study. To confirm the reliability of inter-item correlations and construct validity, factor analysis was carried out, and items belonging to each factor and Cronbach's alpha coefficients were calculated. Results: Four factors were extracted and 64.0% of the variance was explained by these four factors. All correlation coefficients were >0.85. These four factors were: ‘Treatment’, ‘Communication’, ‘Facilities’ and ‘Appearances’. From structural equation modelling, we determined that overall satisfaction was >0.75 and was statistically significant. Conclusion: The questionnaires used in this study are useful for measuring patient satisfaction in the dental school hospital setting.

Objective This study investigated the correlation of clinical outcomes of temporomandibular joint (TMJ) irrigation with the occurrence and concentrations of tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6, IL-8, IL-12, and IL-10 in the washed-out synovial fluid (SF) in patients with chronic closed lock (CCL) of the TMJ. Study design Thirty-six patients underwent a visually guided TMJ irrigation (VGIR). SF samples were collected immediately before VGIR. The patients were divided into either successful (s-group; n = 25) or unsuccessful groups (u-group; n = 11). The detection rates and concentrations of each cytokine per milligram of total protein in the SF were measured, and then compared between the s- and u-groups. Results All of the investigated cytokines were detectable with various rates, concentrations, and combination patterns. The detection rate and concentrations of IL-6 were significantly higher in the u-group, and those of IL-10 were significantly higher in the s-group. Conclusions The investigated cytokines were suggested to be involved in the pathophysiology of TMJ CCL. The results also suggest that IL-6 in the SF is an indicator of an unsuccessful outcome, and that IL-10 is a significant predictor of a successful outcome of TMJ irrigation for CCL.

Objective This study aimed to explore the clinical course following visually guided irrigation (VGIR) for chronic closed lock (CCL) of the temporomandibular joint (TMJ) as well as the factors of importance for clinical outcome. Evaluation emphasis was placed on the period needed for the patients to reach the success criteria. Study design Sixty-one patients with unilateral CCL comprised the study group. The cumulative success rate of VGIR and the additional surgical treatments following VGIR were studied. The 61 patients were divided into either the good outcome (g) group or poor outcome (p) group on the basis of whether they reached the success criteria within 3 months postoperatively, and clinical and arthroscopic factors were correlated with the clinical outcome of VGIR. Results The cumulative success rate of VGIR increased up to the 6-month follow-up (success rate of 72.1%) but did not change after that point in time. A repeated VGIR (success rate of 87.5%) was performed in 8 patients. Open TMJ surgery (success rate of 87.5%) was performed in 8 patients, 7 of whom had an interfering condylar osteophyte. A pronounced reduction of preoperative painless range of mandibular motion (P-ROM) and advanced osteoarthritis (OA) were more frequently found in the p-group than in the g-group. The multivariate adjusted odds ratio showed that a decreased preoperative P-ROM was significantly predictive for a poor outcome of VGIR. Conclusions The efficacy of VGIR is clinically acceptable as an initial surgical treatment for TMJ CCL. A 6-month follow-up period ought to be sufficient for outcome assessment of VGIR. A pronounced reduction of preoperative P-ROM should be considered as a risk factor for delay of the postoperative improvement, and OA changes may sometimes affect the clinical outcome of VGIR.

We studied 1809 patients with oral cancer who visited and were treated in 2002 at the 148 institutions certified as training facilities by the Japanese Society of Oral and Maxillofacial Surgeons, which comprise 39 dental university hospitals, 44 medical university hospitals, 64 general hospitals, and 1 unknown institution. The patients were 1071 (59.2%) males and 738 (40.8%) females (male: female ratio, 1.45: 1), who had a mean age of 65.2 years. The tongue (40.2%) was the most common site affected, followed by the gingiva (32.7%), buccal mucosa (10.1%), and oral floor (9.0%). There were 6 cases of intraoral multiple cancer. Histopathologically, squamous cell carcinoma (88.7%) was the most common type, followed by adenoid cystic carcinoma (2.1%), and mucoepidermoid carcinoma (1.7 %). Non-epithelial tumors comprised 1.8% of the total, among which malignant melanoma was the most common type. Cases classified as T2NO were the most common (32.1%), followed by T1NO (21.4%), T4NO (8.0%), and T2N1 (7.6%). Distant metastasis occurred in 17 patients (1.0%). The sizes of the non-epithelial malignant tumors ranged from 1.0 to 7.0cm, with a mean size of 3.7cm.

We report on a 51-year-old man with some glass fragments as foreign bodies in the submental region. Five months after injury, he complained of swelling in the mental region, accompanied by purulent discharge and fistula formation in the submental region. Radiographic examination showed part of a glass fragment in the submental region. Detection of glass by conventional radiographic techniques is challenging because glass has a low radiopaque appearance and is usually obscured by overlying bony structures in the maxillofacial region. CT examination showed multiple radiopaque images in the submental region. We measured the CT values of these foreign bodies. The CT value was useful for establishing the diagnosis of glass fragments as foreign bodies in this patient.

Glandular odontogenic cyst (GOC), first described in 1988 by Gardner et. al, is a comparatively rare jawbone cyst of odontogenic origin, which shares some features with both botryroid odontogenic cysts and mucous-producing salivary gland tumors. Although GOC has a high rate of recurrence, cases of recurrence have not been reported in the Japanese literature.This paper describes a case of GOC arising in the mandible of a 58-year-old man. The cyst recurred 12 years after primary treatment. Diagnosis and treatment of the lesion are discussed.

For one year we studied postoperative computed tomograms (CT) and intraoral radiographs for 29 patients with unilateral alveolar clefts. Interdental bone height and the bony boundary on the nasal side were assessed on intraoral films and compared with the evaluation by CT. Twenty-four cases had adequate interdental bone height as assessed by intraoral films. However, 10 of these 24 cases showed insufficient anteroposterior depth on CT. Two of the remaining five cases were also overestimated by the intraoral radiograph. All cases had sufficient bony boundary on the nasal side on intraoral radiography. However, CT showed that bone formation on the nasal side off two cases was significantly worse than that on the non-cleft side. Consequently, about 40% of surgical outcomes may be overestimated by intraoral radiographs. CT therefore seems to give a better assessment of the clinical outcome than intraoral radiographs and should be considered as an adjunct in difficult clinical cases.

We report on a 66-year-old man with adenolipoma of the hard palate. The patient consulted our hospitalfor detailed examination of a palatal mass. Magnetic resonance imaging showed a well-delineated tumor in thepalate. Since CT scanning indicated no bone resorption, the tumor was resected en bloc, with the patient undergeneral anesthesia. Histopathological examination suggested adenolipoma. During 4 years 6 months of postoperativefollow-up, the patient's course has been good, without relapse.

The authors report a case of cervical cellulitis and mediastinitis developing from odontogenic infection.A 52-year-old woman visited our clinic because of dyspnea and pain on swallowing. She was given a diagnosis of cervical cellulitis caused by an odontogenic infection of the lower left second and third molars. We administered antibiotics and extracted the lower left second and third molars. However, the patient's condition deteriorated, and the inflammation spread to the contralateral side. Four days later, surgical drainage of the left submental and submandibular regions was performed under general anesthesia.Despite this surgical procedure, a postoperative computed tomographic (CT) scan revealed anterosuperior mediastinitis and thrombosis extending from the right subclavian vein to the brachiocephalic vein. Therefore, transcervical mediastinal drainage, thrombolytic therapy, and placement of a vena cava filter were performed. Subsequently, the patient recovered uneventfully.Our experience indicates that it is important to accurately diagnose rapidly developing lesions and to promptly perform surgery when severe odontogenic infection is encountered.

We report a case of deep vein thrombosis occurred after mandibular reconstruction with a vascularized iliac bone graft. A 30-year-old man was referred to our clinic because of a right mandibular bone defect after segmental resection for ameloblastma of the mandible. Reconstruction with a vascularized iliac bone graft was performed with the patient under general anesthesia. On the 18th day after the operation, leg pain and edema on the left side suddenly occurred. Enhanced computed tomographic and angiographic examinations were performed. The diagnosis was deep vein thrombosis. The patient received heparin and urokinase as anticoagulant therapy and successfully recovered. There has been no evidence of pulmonary embolism.

Objective To evaluate the clinical outcome of a modified conservative treatment protocol involving intra-articular irrigation and corticosteroid injection into the superior joint compartment (SJC) of patients with fresh mandibular condyle fractures. Study design A total of 26 consecutive unilateral fresh condylar fractures in 26 patients were divided into the intra-articular irrigation (IR) group (14 patients, 14 joints) and the conventional conservative treatment (CC) group (12 patients, 12 joints). In the IR group, the SJCs of the fractured joints were irrigated with saline solution and injected dexamethazone sodium, followed by conventional rehabilitation. In the CC group, patients were treated by closed reduction with intermaxillary fixation (IMF) for 2 weeks, followed by conventional rehabilitation. Clinical outcome at 1 month, 3 months, 6 months, and 1 year after injury was determined by clinical examination of jaw motion, joint pain, and occlusal changes. The posttreatment results were compared with the pretreatment baseline data. Between-group differences in clinical parameters were analyzed. Results There were significant between-group differences in the range of mandibular motion at 1 month and 3 months after injury (1 month, P = .0022; 3 months, P = .0022). In the IR group, joint pain was well relieved from the early stage of treatment. Occlusal changes were found in 1 patient in the IR group and 4 patients in the CC group at 1 year after injury. Conclusions The modified treatment protocol involving intra-articular irrigation and corticosteroid injection into the SJC is a more effective and quick-acting modality than conventional closed reduction with IMF for functional recovery and control of clinical symptoms of patients with unilateral fresh condylar fractures.

A backward distraction osteogenesis (BDO) of the condylar segment for treatment of mandibular ramus deficiency was developed. This report describes the clinical progress of a patient with mandibular ramus deficiency in whom satisfactory occlusion was achieved and maintained by gradual posterosuperior repositioning of the displaced condyles into the glenoid fossae during intermaxillary fixation. Findings of pre- and postoperative clinical and magnetic resonance imaging indicate that the effect of BDO on the temporomandibular joint was negligible.

Lichen planus pemphigoides is a rare bullous disorder with bullae arising from papules of lichen planus and from normal-appearing skin. Oral cavity-limited lichen planus pemphigoides has never been reported. This report presents a 47-year-old woman who had oral mucous membrane pemphigoid with lichen planus. This lesion is not known among existing clinical diagnoses. When considering the heterogeneous nature of lichen planus pemphigoides, this case may be classified as a variant of lichen planus pemphigoides.

我々は頭頸部がん治療において機能回復を最終目標としている。そこで, 確実な原因療法が最重要であるが, 機能温存のために必要最小限の切除を考慮し機能回復に努めている。しかし, 生命医学, 機能回復医学の両面を一人で行うことは一般に困難であるため, 以下のようなチームが必要となる。1) 診断チーム2) 腫瘍治療チーム3) 機能回復チームまた, チームを編成する上で以下の点を考慮している。(1) 一人の指揮者がいること ; 様々な治療が常にこの指揮者にフィードバックされるようにし, 治療体制を見通す。(2) 各々の治療内容の理解。(3) 治療のブラックホールをつくらない。(4) 担当医同士の意思の疎通をよくする。(5) 目の前にいる患者に何ができるかを常に考える。(6) 執刀医を増やし積極的な討論を可能にする。現時点では口腔機能を回復したとは言い難いため, 関連各科が一緒になって取り組むことが不可欠である。また, 心のケアを考えていきたい。

Penetrating injuries, especially those involving the palate intraoral region, often occur in children. This is because when children begin to walk, their range of action increases but is unstable; moreover, children frequently play with something stuck in their mouth. Penetrating injuries of the facial region are rare. Many patients recover without brain trauma. We report a case of a penetrating injury of the facial region. A 4-year old girl fell down, and a pair of tweezers penetrated her left cheek and temple. The tweezers was used to feed tropical fish. She was taken to the emergency room without removal of the tweezers. Her consciousness was clear, but she had impaired movement of the left eye and a left-side nosebleed. After a radiographic examination, the tweezers were removed under a local anesthesia. The deep penetration caused cerebrospinal fluid leakage. The bleeding volume was small. The wound was compressed after being sutured. A computed tomographic scan showed no brain injury. Antibiotics were prescribed for several days. As of 22 months after injury, there have been no complications and the outcome is good.

The Laugier-Hunziker-Baran syndrome represents a rare acquired pigmentary disorder of the lips, oral mucosa, and nails. We report two cases showing acquired, benign, macular hyperpigmentation of the buccal mucosa, lips, and fingers. The patients had no family history related to this condition and no history of gastrointestinal disorders or generalized skin disorders. Because of its clinical importance, Laugier-Hunziker-Baran syndrome should be included in the differential diagnosis of pigmentary disorders of the oral mucosa with associated nail involvement. It is particularly important to differentiate this condition from Peutz-Jeghers syndrome.

Visually guided irrigation (VGIR) is simple joint irrigation with minimally invasive intracapsular inspection through the use of a thin arthroscope. The aims of the present study were to develop VGIR for the superior joint compartment of the temporomandibular joint (TMJ) by using a 1.2-mm-diameter rod-lens arthroscope and to examine the short-term clinical outcomes. The correlation between the clinical outcome of VGIR of the TMJ and intracapsular findings was also evaluated.Twenty patients who underwent VGIR for symptomatic internal derangement of the TMJ (n = 20) were enrolled in this study. The clinical outcome of VGIR was evaluated in terms of the improvement in the painless range of mandibular motion (ROM: interincisal distance in millimeters), and functional jaw pain was evaluated by using a visual analog scale (VAS) ranging from 0 to 100. Painless ROM and VAS scores 6 months postoperatively were compared with the preoperative data. A good clinical outcome was defined as an increased ROM (ROM38 mm) and a decreased VAS score (VAS score20%, and60% of the preoperative level). With respect to these criteria, all joints were classified into either good clinical outcome (GO) or poor clinical outcome (PO) groups. The difference in the distribution of the arthroscopic findings obtained during VGIR, with respect to severity, was analyzed between the GO and PO groups.None of the 20 patients experienced any serious local or systemic complications, including the breakage of instruments. We were able to perform a reliable intracapsular diagnosis during VGIR. Sixteen of 20 patients (80%) had significant improvements in postoperative painless ROM and the VAS score of functional pain, thereby being classified into the GO group. The distribution of the severity of intracapsular findings did not differ significantly between the GO group and the PO group.VGIR is useful for the treatment and diagnosis of internally deranged TMJs. These data suggest that the clinical outcome of TMJ irrigation is not related to the intracapsular condition of the superior joint compartment.

To improve the swallowing function of glossectomized patients with dysphagia after glossectomy, we newly fabricated a bolus-transportable palatal augmentation prosthesis (Trans-PAP), which is mounted with a bolus-transporting device to a conventional palatal augmentation prosthesis (PAP). In this paper, the structure of Trans-PAP is described and its clinical effectiveness for dysphagia in a patient undergoing subtotal glossectomy is reported.The patient was a 57-year-old man who underwent surgical reconstruction using a rectus abdominis myocutaneous flap immediately after subtotal glossectomy. Postoperative dysphagia was mainly caused by dysfunction of the pumping movement of the tongue. A Trans-PAP was applied. The bolus-transportation plate of Trans-PAP can press on the reconstructed tongue by spring action. Consequently, it is possible to compensate for tongue pressure and the pumping movement of the tongue. The results of functional examinations showed that swallowing function was restored by Trans-PAP.

Purpose: The goal of this study was to evaluate the clinical results of simple disc reshaping (SDR) surgery alone for treating dysfunctional internal derangement of the temporomandibular joint. Patients and Methods: Eleven patients with symptomatic unilateral anterior disc displacement with disc deformation were treated using reshaping of the inferior surface of the disc without disc repositioning. This was performed as an open-joint procedure. All patients were evaluated clinically for joint pain and jaw motion 5 years after surgery. Structural changes of the joint tissues such as disc displacement and deformation were evaluated using magnetic resonance imaging. The postoperative results were compared with preoperative findings. Results: Joint pain during mastication or opening was reported by all patients before surgery. In 10 of 11 patients (91%), the joint pain disappeared postoperatively. Preoperatively, all 11 patients had limitation of mouth opening: the mean opening was 24.9 mm (standard deviation [SD], 4.13 mm). Postoperatively, the mean opening increased to 43.0 mm (SD, 3.00 mm). Based on the preoperative magnetic resonance imaging, all cases were diagnosed as anterior disc displacement without reduction and with disc deformation. Five years postoperatively, the disc configuration had maintained the reshaped status with decreased thickness of the deformed disc in 5 patients, and was changed to an almost normal biconcave shape in 3 patients. In the remaining 3 patients, the disc was unchanged from its preoperative condition. The position of the disc was unchanged in 8 patients, and in 3 patients disc position improved to near normal. Conclusion: The 5-year follow-up results suggest that SDR is a stable and favorable surgical procedure. Successful outcomes were attained in 91% of the patients. © 2003 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 61:41-48, 2003

We clinically observed patients treated between January 1999 and December 2001 at the department of oral and maxillofacial surgery after being brought by ambulance to a city emergency hospital. Of 11, 105 patients who were brought by ambulance during that period, 308 (2.8%) underwent oral or maxillofacial surgery. The male: female ratio was 2.1: 1, and more than half of the patients were younger than 30 years. There were 2 peaks in the age distribution: 2 and 21 years of age. Eighty-seven percent of the patients had traumasta such as lacerated wounds of soft tissue, alveolar bone fractures, and tooth luxation. Twenty-five of these patients (8.1%) required treatment under general anesthesia. Two patients with severe odontogenic infections underwent emergency surgery.Several of the patients who were brought to the hospital by ambulance required specialized oral and maxillofacial treatment.

口腔癌患者に対する67Gaシンチグラフィーの診断学的有用性について検討した。対象は口腔癌患者の新鮮例55名である。原発腫瘍, 頸部リンパ節転移, 遠隔転移または重複癌に対する診断精度, 病巣の大きさと診断精度との関係, 病巣の大きさと67Ga集積の強さとの関係, 読影時の問題点について調査した。その結果, 原発腫瘍, 頸部リンパ節転移, 遠隔転移または重複癌に対する感度はそれぞれ44.2%, 28.6%, 25.0%であった。67Gaシンチグラフィーは初期病変の検出には不向きと思われた。67Ga集積の強さと病巣の大きさとの関連性については結論に至らなかった。67Gaシンチグラフィーの読影は, 局在診断における信頼性が低いこと, 生理的集積があること, 非特異的に集積することが問題であった。