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Background Medication-related osteonecrosis of the jaw (MRONJ) is a potentially severe adverse side effect of antiresorptive agents. However, withdrawal of antiresorptive agents in patients with osteoporosis may increase the risk of fractures. The treatment of MRONJ is challenging and standard treatment guidelines have yet to be established. In this study, the aim was to examined whether adjunct daily or weekly teriparatide (TPTD) injections are beneficial for the bone exposure of MRONJ lesions compared to standard conservative management. We also studied the complications and patients’ responses to TPTD therapy. Methods We enrolled 27 patients, from January 2012 until December 2016, with chronic and refractory MRONJ. There were 4 men and 23 women, with 85% of the total number being females. Nine patients who did not select TPTD therapy for several reasons formed the non-TPTD group and the remaining 18 patients were randomly assigned to the daily (n=9) or weekly (n=9) groups. All subjects in both TPTD groups continued standard conservative therapy in addition to their daily or weekly subcutaneous injection of TPTD. The daily group received a daily injection of TPTD (20 μg) and the weekly group received a weekly injection of TPTD (56.5 μg). We evaluated the complications and benefits of TPTD therapy of MRONJ. Results Three patients in the daily group did not complete the study, resulting in six patients in the daily group, nine patients in the weekly group, and nine patients in the non-TPTD group for the final analysis. Each patient in TPTD group demonstrated complete coverage of the exposed bone with normal mucosa. The TPTD group showed a shorter healing period compared to the non-TPTD group. There were no complications of atypical fractures of the femoral head in any patient. Conclusions Daily and weekly TPTD treatment resulted in a shortened treatment period compared with standard conservative therapy with no increase in the rate of complications or worsening of osteoporosis.

Objectives The shapes of gubernaculum tracts (GTs) in molars as accessional teeth remain unidentified. To elucidate imaging peculiarities of GTs in molars with aging on multidetector‐row computed tomography (MDCT). Material and methods This retrospective study was conducted using CT images, including maxillary and mandibular molars, with no abnormal findings from 239 patients. Shapes of alveolar bone, GTs, and dental sacs of the maxillary and mandibular molars were analyzed multi‐sectionally. Correlations between 2‐ and 3‐dimensional imaging figures of GTs in molars and chronological age or stage of molar formation were analyzed. Results Some forms of GTs in maxillary and mandibular third molars were observed. In the early stage, GTs were visualized as bone defect lines on the dentition and grooves on the mesial alveolar crest continuous with the dental sac to mesial tooth bud. GTs of the third molar formed a J‐shape in maxillary teeth and Y‐shape in mandibular teeth in the middle stage, as alveolar bone around the GT developed. In the mature stage, the course of the GT changed to straight and perpendicular. Some GT forms were also identified in first and second molars. Significant correlations were found between GT alterations and chronological age or stage of molar formation. Moreover, tracts continuing from the distal side of mandibular third molars were detected. Conclusions This paper describes the peculiarities and process of progression for GTs in molars, and the existence of tracts continuing from the distal side of mandibular third molars, unlikely dentition with deciduous predecessors. These preliminary data should prove beneficial for studies focusing on GTs in molars.

Cleft lip, with or without a cleft palate, is the most common craniofacial birth defect. Speech disorders, particularly impairment in articulation, are severe problems resulting from the velopharyngeal incompetence associated with a cleft palate. In cases requiring prolonged tracheal cannulation further delays speech and language development, especially during the pre-verbal period of an infant. In this case report, we describe the treatment course of an infant with bilateral cleft lip and palate requiring long-term cannulation. The patient underwent tracheotomy due to laryngotracheal stenosis after cheiloplasty at the age of 1 year. The tracheal cannula was in situ for a period of 6 years (to the age of 6 years). An intensive program of articulation and vocalization practice was performed during the period of tracheal cannulation. Following removal, the patient acquired almost normal speech and language functions. Coordination between several disciplines was critical for treatment to benefit the patient.

The purpose of this study was to elucidate the imaging characteristics of the gubernaculum tracts in successional teeth related to fused deciduous teeth on computed tomography. The imaging findings of 15 gubernaculum tracts in successional teeth related to fused deciduous teeth were retrospectively analyzed using cone-beam computed tomography or multidetector computed tomography. In cases without a congenitally defected successor, the two gubernaculum tracts of two successional teeth related to fused deciduous teeth were fused into one. Gubernaculum tracts (GTs) in mesial successors were vertical, but in distal successors they were inclined to mesial. The major abnormalities of the successional teeth related to fused deciduous teeth were delayed eruption and delayed formation. No inclined mesial successors were found, whereas most of the distal successors were inclined to mesial along with the inclined GT. The gubernaculum tracts of successors with a congenital defect of the other successors were vertical, and such successors had no abnormalities. The present study showed the imaging characteristics of gubernaculum tracts in successional teeth related to fused deciduous teeth. The abnormal eruption of successional teeth related to fused deciduous teeth may be associated with the characteristics of their gubernaculum tracts.

Objective: Cleft palate is among the most frequent congenital defects in humans. While gene–environment multifactorial threshold models have been proposed to explain this cleft palate formation, only a few experimental models have verified this theory. This study aimed to clarify whether gene–environment interaction can cause cleft palate through a combination of specific genetic and environmental factors. Methods: Msx1 heterozygosity in mice ( Msx1+/−) was selected as a genetic factor since human MSX1 gene mutations may cause nonsyndromic cleft palate. As an environmental factor, hypoxic stress was induced in pregnant mice by administration of the antiepileptic drug phenytoin, a known arrhythmia inducer, during palatal development from embryonic day (E) 11 to E14. Embryos were dissected at E13 for histological analysis or at E17 for recording of the palatal state. Results: Phenytoin administration downregulated cell proliferation in palatal processes in both wild-type and Msx1+/− embryos. Bone morphogenetic protein 4 ( Bmp4) expression was slightly downregulated in the anterior palatal process of Msx1+/− embryos. Although Msx1+/− embryos do not show cleft palate under normal conditions, phenytoin administration induced a significantly higher incidence of cleft palate in Msx1+/− embryos compared to wild-type littermates. Conclusion: Our data suggest that cleft palate may occur because of the additive effects of Bmp4 downregulation as a result of Msx1 heterozygosity and decreased cell proliferation upon hypoxic stress. Human carriers of MSX1 mutations may have to take more precautions during pregnancy to avoid exposure to environmental risks.

The objective was to introduce a new technique for visualizing the three-dimensional (3D) movements of velopharyngeal-related muscles using high-speed cine-magnetic resonance imaging (MRI) based on T2-weighted sequences. The evaluation of phonation- and water swallowing-related events was performed in 11 healthy subjects. Specifically, whether cine-MRI could precisely visualize normal velopharyngeal function during these two events was examined. The 3D movements of the soft palate, superior pharyngeal constrictor muscles, and levator veli palatini muscles were visualized in all 11 subjects. A noteworthy finding was that the magnetic resonance signals of the superior constrictor pharyngeal muscles and the levator veli palatini muscles were significantly higher during phonation and during water swallowing than at rest. This initial study suggests that the 3D movements of velopharyngeal-related muscles can be successfully and precisely visualized without side effects. The magnetic resonance signal changes seen in the superior pharyngeal constrictor and levator veli palatini muscles using the technique described here should be useful to develop better methods of evaluation of velopharyngeal function.

A simple sandwich technique using buttons to compress grafted tissue combined with a tie-over technique for intraoral split-thickness skin grafts (STSGs) is introduced. This technique yielded an excellent engraftment rate (90.5%) and no instances of total graft failure were recorded. This simple sandwich technique for STSGs is readily applicable and inexpensive, and the present results show that it would be potentially useful for repair of defects in the oral cavity.

The eruption pathway from the dental follicle to the gingiva for permanent teeth is known as the gubernaculum tract (GT), a physiologic structure thought to play a role in tooth eruption. Cone beam computed tomography and multi-detector computed tomography have recently been used to visualize the GT, with the results indicating that this structure might be related to the normal eruption of teeth. By contrast, curved and/or constricted GTs may lead to abnormal tooth eruption. In addition, complex odontomas have been reported from within the GT or dental sac of unerupted permanent teeth. If an odontoma occurs within the GT, the tooth will not erupt normally. Moreover, the imaging characteristics of the GT from the top of the odontogenic mass to the alveolar crest are extremely useful for making a differential pathological diagnosis and for differentiating between odontogenic and non-odontogenic masses. Therefore, radiological studies on the GT have been attracting increasing attention. Given this background, the present review aims to clarify the imaging characteristics and review recent studies on the GT considering the importance of the research.

Background Tonsilloliths are related clinically to halitosis and tonsillar abscess. However, the dynamics of tonsilloliths over time are unknown. The aim of the study was to evaluate change in the characteristics of tonsilloliths in a time-dependent fashion by follow-up computed tomography (CT). Methods Tonsilloliths were analyzed in 326 CT scan pair sets of initial and at least two follow-up CT examinations of patients with whole palatine tonsils and various diseases of the oral and maxillofacial regions. Results Over the follow-up period, 12.1% of tonsilloliths disappeared. Approximately 26.1% of tonsilloliths changed in size during follow-up, mostly increasing in size. In tonsilloliths that showed enlargement, the mean (± standard deviation) growth rate was 0.61 ± 0.41 mm per year. Approximately 37.3% of tonsilloliths changed position during the follow-up period; of these, movement was toward the respiratory tract in 92% at a mean rate of − 1.38 ± 1.59 mm per year. The calcification levels of almost all tonsilloliths showed dynamic change: HU number increased in 84.3% and decreased in 12.7% of tonsilloliths over the follow-up period. The mean rate of HU increase was 63.8 ± 96.3 HU/year, and the mean rate of HU decrease was − 38.4 ± 66.8 HU/year. Conclusions The calcification levels of all tonsilloliths showed dynamic fluctuation, and a tendency for excretion of tonsilloliths from the body. Their dynamics over time suggest that tonsilloliths may be in a permanently active phase which functions to remove foreign matter.

This study was done to determine whether the sublingual gland ducts could be visualized and/or their function assessed by MR sialography and dynamic MR sialography and to elucidate the clinical significance of the visualization and/or evaluation of the function of sublingual gland ducts by clinical application of these techniques. In 20 adult volunteers, 19 elderly volunteers, and 7 patients with sublingual gland disease, morphological and functional evaluations were done by MR sialography and dynamic MR sialography. Next, four parameters, including the time-dependent changes (change ratio) in the maximum area of the detectable sublingual gland ducts in dynamic MR sialographic images and data were analyzed. Sublingual gland ducts could be accurately visualized in 16 adult volunteers, 12 elderly volunteers, and 5 patients. No significant differences in the four parameters in detectable duct areas of sublingual glands were found among the three groups. In one patient with a ranula, the lesion could be correctly diagnosed as a ranula by MR sialography because the mass was clearly derived from sublingual gland ducts. This is the first report of successful visualization of sublingual gland ducts. In addition, the present study suggests that MR sialography can be more useful in the diagnosis of patients with lesions of sublingual gland ducts.

Nanoparticles are used in industry and medicine, because of their physiochemical properties, such as size, charge, large surface area and surface reactivity. Recently, metal nanoparticles were reported to show cell toxicity on cancer cells. In this study, we focused novel platinum nanoparticles-conjugated latex beads (P2VPs), platinum nanocomposite (PtNCP) beads, and investigated the possibility to incorporate novel anti-cancer effect of these combined nanoparticles. Oral squamous cell carcinoma cell lines, HSC-3-M3 cells were injected subcutaneously into the back of nude mice to produce a xenograft model. PtNCP beads were injected locally and examined by measuring tumor volume and comparing pathological histology. PtNCP beads treatment suppressed tumor growth and identified increasing pathological necrotic areas, in vivo. PtNCP beads inhibited the cell viability of HSC-3-M3 cells in dose-dependent manner and induced the cytotoxicity with extracellular LDH value, in vitro. Furthermore, SEM images were morphologically observed in PtNCP beads-treated HSC-3-M3 cells. The aggregation of the PtNCP beads on the cell membrane, the destructions of the cell membrane and globular structures were observed in the SEM image. Our results indicated that a potential anti-cancer effect of the PtNCP beads, suggesting the possibility as a therapeutic tool for cancer cell-targeted therapy. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 2281-2287, 2019.

Objective The aim of this study was to evaluate the characteristics of diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) values of ranulas. In addition, to elucidate DWI findings and ADC values of other representative masses in and around the floor of the mouth. Study Design DWI findings and ADC values in 35 patients with ranulas and 33 patients with other masses were retrospectively reviewed with a central focus on cystic masses or lesions that may have cyst-like components in and around the floor of the mouth based on the diagnosis of each respective disease. Results Ranulas were all well-defined, homogeneous masses with high signal intensity on DWI. The mean ± standard deviation ADC value of the 35 ranulas was 2.59 ± 0.31 × 10−3 mm2/s. There was a significant difference in ADC values between simple and plunging ranulas. On DWI, most other masses were heterogeneous, and most ADC values, except those for thyroglossal duct cysts, hemangiomas, and pleomorphic adenomas, were significantly lower than those for ranulas. Conclusions The characteristic DWI and ADC findings of ranulas can be determined accurately, and these data can be significantly useful in the differential diagnosis of many kinds of diseases in and around the oral floor.

We evaluated the relationships between depth of invasion (DOI) of tongue cancer, as measured with preoperative T1- and T2-weighted magnetic resonance imaging (MRI) and postoperative histopathologic (Path) specimens, with cervical lymph node metastasis (CLNM) and tumor stage. We also calculated the correlation of MRI and Path DOI measurements.This retrospective study included 101 patients who had squamous cell carcinoma of the tongue and were treated surgically. Two observers measured DOI on all 3 modalities.DOI thresholds for predicting CLNM with high diagnostic efficacy were 6.99 mm and 8.32 mm for MRI and 5 mm for Path. DOI values from all modalities were significantly different for tumors with and without CLNM (P.01) and for the 4 TNM stages (P ≤ .05), with increasing values corresponding to advancement in tumor stage. Addition of DOI changed the T level of many tumors based on the new TNM (tumor-node-metastasis) classification. The correlation coefficient between DOI calculated on each MRI sequence and Path was 0.90.MRI-derived DOI accurately reflected the subsequent metastatic status and degree of progression of tumor stages, with a strong positive correlation to Path values, and may be considered a predictor of tumor stage and CLNM.

Interaction of cyclic naphthalene diimide derivatives (cNDIs), 1–4, with TA-core and c-myc as G-quartet (G4) DNA was studied under dilute or molecular crowding condition. Binding study for TA-core based on an isothermal titration calorimetry showed that 1–4 has 106 M−1 order of binding affinity with the following order: 1 > 4 > 2 > 3 under both conditions. Meting temperature (Tm) of TA-core obtained from the temperature dependence of circular dichroism spectra shows that TA-core was most stabilized by 4, which is in agreement with the result of PCR stop assay and the stabilization effect for 1–3 was correlated with their binding affinity under dilute condition. 3 showed specific growth inhibition of cancer cell line Ca9-22 at

Numerous studies, including our own, have revealed that positron emission tomography–computed tomography (PET/CT) using fluorine-18-labeled fluoro-2-deoxy-d-glucose (18F-FDG) is effective for the diagnosis of oral cancers. Large amounts of new information about primary tumors and metastatic lymph nodes have been acquired, and the use of 18F-FDG PET/CT has been shown to improve diagnostic precision in determining both the pathological characteristics of primary oral cancers and the presence of metastatic lymph nodes. However, substantial variations in 18F-FDG uptake in the oral and maxillofacial regions have been identified, and the differential diagnosis of some oral cancers and metastatic lymph nodes remains difficult for radiologists. Therefore, based on the previous research, the aim of the present study was to review the basic and important points regarding the diagnosis of primary oral cancers and metastatic lymph nodes using 18F-FDG PET/CT.

Objective To prevent the occurrence of postoperative long lip, longitudinal postoperative changes in nasolabial forms of patients with unilateral cleft lip who underwent primary lip repair with or without upward advancement of the nasolabial components were compared. Patients Forty-three subjects (24 unilateral cleft lip and palate [UCLP] and 19 unilateral cleft lip solely, and cleft lip and alveolus [UCL/UCLA]) who underwent primary lip repair with upward advancement of the nasolabial components (NA group) and 30 subjects (16 UCLP and 14 UCL/UCLA) without upward advancement (LA group) were enrolled. Outcome Measures Postoperative photos taken at 1 and 6 months and at 1, 2, and 3 years were used for measuring the heights of the nasal alar base (NBH), the columellar base (CBH), Cupid's peak (CPH), and the upper lip (ULH). The ratios of these measurements between the affected and unaffected sides were calculated in both groups. Results In the LA group, the 3-year postoperative all-items ratios of UCLP were significantly larger than those at 1 month postoperatively, demonstrating drooping of the nasolabial tissues in the affected side (all P < .01). Furthermore, the 3-year postoperative CPH and ULH ratio of UCL/UCLA was significantly larger than that at 1 month postoperatively, demonstrating the long lip ( P < .01). In the NA group, the NBH, CBH, and CPH ratios of both UCLP and UCL/UCLA did not show significant differences between 1 month and 3 years postoperatively. Conclusion Upward advancement of the nasolabial components prevents postoperative long lip.

Background: 18 F-fluoro-2-deoxy-D-glucose ( 18 F-FDG) accumulations are commonly seen in the neck-related muscles of the surgical and non-surgical sides after surgery with neck dissection (ND) for oral cancers, which leads to radiologists having difficulty in diagnosing the lesions. To examine the alterations in 18 F-FDG accumulation in neck-related muscles of patients after ND for oral cancer. Material and Methods: 18 F-FDG accumulations on positron emission tomography (PET)-computed tomography (CT) in neck-related muscles were retrospectively analyzed after surgical dissection of cervical lymph nodes in oral cancers. Results: According to the extent of ND of cervical lymph nodes, the rate of patients with 18 F-FDG-PET-positive areas increased in the trapezius, sternocleidomastoid, and posterior neck muscles of the surgical and/or non-surgical sides. In addition, SUVmax of 18 F-FDG-PET-positive areas in the trapezius and sternocleidomastoid muscles were increased according to the extent of the ND. Conclusions: In evaluating 18 F-FDG accumulations after ND for oral cancers, we should pay attention to the 18 F-FDG distributions in neck-related muscles including the non-surgical side as false-positive findings

Diffuse chronic sclerosingosteomyelitis (DCSO) is a refractory disease, becausethe etiology and pathogenesis remain poorly understood and to determine the border betweenunhealthy boneandhealthybone is difficult. However, progressive inflammation, clinical symptoms and a high recurrence rate of DCSO were the reasons for surgical treatment. We report a case of a 66-year old woman with DCSO of the right side of mandible who was treated with hemimandibulectomy and simultaneous reconstruction by vascularized free fibula flap. After preoperative administration of minocycline for 1 month, the bone fluorescence was successfully monitored by using a Visually Enhanced Lesion Scope (VELscope®). Intraoperatively, we could determine the resection boundaries. We investigated the clinical and histopathological findings. The fluorescence findings were well correlated with histopathological findings. Using a VELscope®was handy and useful to determine the border between DCSO lesion andhealthybone.The free fibula flap under the minocycline-derived bone fluorescence by using a VELscope®offered a good quality of mandibular bone and the successful management of an advanced and refractory DCSO. Key words:Fluorescence-guided bone resection, fibular free flap, osteomyelitis of the mandible, diffuse chronicosteomyelitis, VELscope®.

A Stafne bone defect is a static bone depression in the mandible that is commonly observed in cortical bone near the mandibular angle. We herein present a rare case in which static bone depressions attached to the three major salivary glands were observed on panoramic radiography and computed tomography (CT). The three static bone depressions in the mandible were visualized on a panoramic radiograph and CT as oval radiolucent masses in a 68-year-old man. The CT numbers in the bone depressions ranged from 10 to 50 HU, and they were close to those of the respective salivary glands. Based on the CT numbers, the areas in the bone depressions were determined to be a normal parotid gland, sublingual gland, and submandibular gland. The patient underwent a follow-up examination and did not request further consultation.

Objectives The aim of this study was to determine the usefulness of evaluating the function of swallowing before and after surgery in patients with tongue cancer by using T2-weighted sequences of high-speed continuous magnetic resonance imaging (HSCMRI). Study Design The imaging findings and related parameters on HSCMRI along with those on routine MRI examinations before and after surgery were examined in 19 patients with tongue cancer. In addition, changes in various parameters during 1 year after surgery were evaluated in 10 patients. Results In most patients examined, the direction of flow to the esophagus could be seen on HSCMRI before and after surgery. Significant correlations were observed among 4 parameters and in the responses to a dysphagia questionnaire. Conclusions The results of the present study suggest that the dynamics of swallowing can be directly visualized on HSCMRI by using 4 parameters that permit the evaluation of changes before and after surgery, and this enables objective evaluation of patients' swallowing complaints.

Purpose The purpose of this study was to evaluate the effect of infant orthopedic treatment using Hotz's plate and lip adhesion (LA) on maxillary arch of the patients with complete unilateral cleft lip and palate (UCLP) until 5 years of age. Patients and methods Fifty patients with complete UCLP who were treated in Cleft Lip and Palate Center of Harapan Kita Children and Maternity Hospital, Indonesia, were divided into three groups. Hotz (+) group: 22 patients treated with Hotz's plate until palatoplasty. Hotz–LA group: 14 patients treated with LA at one or two months of age and with Hotz plate until palatoplasty. Hotz (−) group: 14 patients treated without Hotz's plate and LA. Serial dental casts were obtained from each patient at following four time points: first visit, cheiloplasty, palatoplasty, and 5 years of age. Each maxillary dental cast was scanned, and the linear and angular dimensions were measured. Results Maxillary arch width and length of anterior part were larger in the Hotz (+) group than in the Hotz–LA and Hotz (−) groups at the palatoplasty and 5 years of age. The anterior part of the maxillary arch in the Hotz–LA and Hotz (−) groups was smaller and more flattened than that in the Hotz (+) group. Conclusions This study suggests that Hotz's plate prevents the maxillary arch from collapsing after cheiloplasty to the palatoplasty. This effect remained up to 5 years of age. However, the effects of Hotz's plate are negated in patients who underwent LA.

Telomerase activity is present in most cancers and is tightly regulated by the expression of human telomerase reverse transcriptase (hTERT). Hypermethylation in the promoter region of hTERT contributes to the regulation of hTERT expression. In this study, we investigated the methylation and expression of hTERT in oral squamous cell carcinoma (OSCC), oral leukoplakia, and normal oral mucosa. Furthermore, we investigated the significance of hTERT to the clinicopathological findings of OSCC. 35 OSCC, 50 oral leukoplakia (epithelial dysplasia n = 25, squamous cell hyperplasia n = 25), and 10 normal oral mucosa samples were investigated through methylation-specific PCR. Immunohistochemistry was analyzed in 35 OSCC, 50 oral leukoplakia, and 4 normal oral mucosa samples. The methylation and expression of hTERT increased from normal oral mucosa to oral leukoplakia to OSCC. In OSCC, all samples were methylated. However, partial methylation (20%) or unmethylation (80%), but never complete methylation, was observed in normal oral mucosa. Additionally, hTERT expression correlated with cervical lymph node metastasis. These results suggested that the methylation and expression of hTERT is high in oral carcinogenesis and may play an important role in oral cancer. hTERT expression may also be predictive of cervical lymph node metastasis.

Objective To investigate the effects of infant orthopedic treatment and lip adhesion on maxillary growth of patients with bilateral cleft lip and palate (BCLP). Design Prospective longitudinal study. Setting The present study was conducted at the Cleft Lip and Palate Center, Harapan Kita Children and Maternity Hospital, Indonesia, and the Department of Oral and Maxillofacial Surgery, Kyushu University Hospital, Japan. Subjects The study sample consisted of 53 patients with complete BCLP and 10 noncleft patients with other diseases. Patients with BCLP were divided into three groups: H (-), 11 patients treated without Hotz's plate; H (+), 24 treated with Hotz's plate; and LA-H, 18 treated with lip adhesion and Hotz's plate. Methods Serial dental casts were obtained from each BCLP child at the following four time points: first visit, labioplasty, palatoplasty, and 5 years of age. Each maxillary dental cast was scanned, and the linear and angular dimensions were measured. Results and Conclusion Lip adhesion showed a temporary negative effect. In all patients with BCLP, the surgeries affected the growth of the anterior arch width until the age of 5 years. Collapse of the premaxilla following labioplasty in the H (-) group affected the growth of dental arch length until the age of 5 years. Treatment using Hotz's plate prevented collapse of the premaxilla, and the growth of the arch length was comparable to that observed in the noncleft group.

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 15 min and reached the peak between 75 min and 105 min. 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.

In the present study, the effects of bulb type palatal lift prosthesis (bulb-PLP) therapy on nasality and velopharyngeal function (VPF) of patients with velopharyngeal incompetence (VPI) following palatoplasty were longitudinally assessed.The subjects included 18 patients (3 to 52 years of age) who had shown persistent VPI following palatoplasty and who had received bulb-PLP therapy. Nasality and VPF were assessed by perceptual voice analysis, nasometer test, blowing test, and cephalometric radiographic examination. Based on the outcomes of bulb-PLP therapy, the subjects were classified into two groups: the effective group and the ineffective group. Furthermore, the obturating and VPF-activating effects by bulb-PLP therapy were analyzed, and factors relating to different VPF activities were determined.All subjects achieved adequate VPF by wearing a bulb-PLP. After treatment, 10 patients (55.6%) achieved successful activation of VPF without bulb-PLP (the effective group), while persistent VPI remained in 8 patients (the ineffective group). The beginning-blowing ratio of the effective group was significantly greater than that of the ineffective group (P < 0.05) and the velopharyngeal distance (V-P distance) of the effective group tended to be smaller (P = 0.07). Regarding the shape of the bulb head, the angular type was dominant in the ineffective group, while the round type was dominant in the effective group.Bulb-PLP therapy was useful for providing adequate VPF activation. Possible signs of the subsequent effective activation of VPF are considered to be: 1) preexisting adequate VPF on blowing, 2) smaller V-P distance, and 3) synchronized palatopharyngeal movement.

Purpose The management for primary unilateral cleft lip nose deformities has not yet been established. In this study, short-term postoperative nasal forms after presurgical nasoalveolar molding (NAM) followed by primary lip repair for children with complete unilateral cleft lip and palate (UCLP) were evaluated and compared with the nasal forms achieved by treatment without nose correction. Patients and Methods Fifteen patients with complete UCLP who were treated in our department and followed up for more than 1 year (range 1 to 5 yrs) were enrolled. All subjects underwent presurgical orthopedic treatment with NAM, followed by lip repair using Cronin's triangular flap method with medial-upward advancement of nasolabial components with vestibular expansion. Postoperative nasal forms including nostril height and width ratio, ratio of the height of the top of the alar groove, and curvature of the appropriate circle of the nasal ala were evaluated using color photographs. Fifteen patients with complete UCLP who underwent presurgical orthopedic treatment using a Hotz plate followed by lip repair without nose correction served as controls. Results The comparison of postoperative nasal forms demonstrated that the nostril height and width ratio and the height of the top of the alar groove in the correction group were significantly superior compared with those of the controls. Conclusions Our management of cleft lip nose will provide good nasal forms with minimum invasion in patients with UCLP. Long-term follow-up will be necessary to clarify effects on the growth of nasal tissues reconstructed in infancy.

Objective: To evaluate the dental arch relationships of Japanese children with complete unilateral cleft lip and palate (UCLP) and to examine the 5-year-olds’ index for its validity. Design: Retrospective study and comparison with previous reports. Subjects: One hundred thirty-six children with complete UCLP who received primary cheiloplasty and palatoplasty in the Kyushu University Hospital from 1966 to 1999. Materials: Dental models taken from children 53 to 67 months of age and their cephalograms. Methods: Study models were assessed using five scores; 1 = excellent, 2 = good, 3 = fair, 4 = poor, and 5 = very poor, in accordance with the 5-year-olds’ index and also evaluated using Huddart and Bodenham's numerical classification. Dental arch widths, three-dimensional maxillary dental arch form, and lateral cephalograms were traced and measured. The outcome by 5-year-olds’ index was compared with Huddart and Bodenham's numerical classification, dental arch dimensions, and cephalometric measurements. Results: Occlusal outcome evaluated by the 5-year-olds’ index was rated 2.95, which was classified as fair. This index rating showed a significant relationship with numerical classification and dental arch length, but not with dental arch width. The index showed a relationship with mandibular form and position, but not with maxillary position. Conclusion: The occlusal outcome of the cases with UCLP was fair as evaluated using the 5-year-olds’ index. The index evaluates the anteroposterior relationship of maxillary/mandibular dental arches but does not evaluate the collapse of maxillary segments.

Objectives The purposes of this study were to analyze the craniofacial growth in women with an isolated cleft palate, to compare their matured craniofacial form with that of women with normal occlusion, and to survey the factors that influenced the matured craniofacial morphology of the adults with cleft palate during their growth process. Materials and Methods Eighteen women with nonsyndromic isolated cleft palate were chosen from patients who received a palatoplasty at the Kyushu University Hospital, Fukuoka, Japan. Their lateral cephalometric radiographs were taken longitudinally from palatoplasty to adolescence. Fifty women with normal occlusion were chosen as controls. From their lateral cephalographs, linear and angular variables were calculated using the x,y coordinates of 20 skeletal landmarks. Results Maxillary length was shorter and the nasomaxillary complex was positioned more posteriorly in relation to the anterior cranial base of the adults with isolated cleft palate, compared with the controls. The mandible was shorter and was rotated inferiorly and posteriorly. However, remarkable deviation from the average craniofacial growth pattern was not recognized from palatoplasty to adolescence. The factors that influenced the craniofacial growth in the subjects with cleft palate were the forward growth of the A point from 2 to 5 years of age, the downward growth of the Ba point, the anterior upper facial height N-Ans in puberty, and the vertical position of the point Ba at the time of palatoplasty. Conclusion This study provided evidence of the growth tendency and the factors influencing the intermaxillary relationship in subjects with isolated cleft palate. These are significant for orthodontic treatment planning.

We studied patients who had flap necrosis after microsurgical reconstruction for orofacial defects. Among 64 patients, 5 had flap necrosis, resulting in a survival rate of 92.2%. All patients with flap necrosis underwent preoperative therapy. There was no significant difference in average age between patients with flap survival and those with flap necrosis; however, all patients with flap survival were younger than 50 years. The patients with flap necrosis had a significant decrease in postoperative pulse pressure, especially during the first and second postoperative days. Among the 5 patients with flap necrosis, 4 had a decrease in postoperative pulse pressure. Three patients concurrently had swelling in the submandibular and neck regions due to hematoma and underwent decompression procedures. On the basis of these results, we conclude that factors such as the postoperative pulse pressure and hematoma negatively affected flap blood flow.Early detection and elimination of these factors are considered essential.

Objective To characterize the velopharyngeal morphology of patients with persistent velopharyngeal incompetence (VPI) following repushback surgery for cleft palate. Participants Seven patients with moderate to severe VPI following repushback surgery for secondary correction of cleft palate, and 14 patients who had already obtained complete velopharyngeal closure function (VPF) were enrolled. Control data were obtained from the longitudinal files of 20 normal children in Kyushu University Dental Hospital. Main Outcome Measures Skeletal landmarks and measurements were derived from tracing of lateral roentgenographic cephalograms. The measurements included velar length, pharyngeal depth, and pharyngeal height and the ratio of velar length to pharyngeal depth. Additionally, the configuration of the upper pharynx (pharyngeal triangle) involving the cranial base, cervical vertebrae, and the posterior maxilla and also the position of posterior pharyngeal wall (PPW) in the pharyngeal triangle were analyzed. Results The VPI group had a significantly shorter velar length and greater pharyngeal depth, resulting in a smaller length/depth ratio than the controls. The points of PPW and cervical vertebrae of the VPI group were located more posteriorly and inferiorly than those in the group with complete VPF after the primary operation and the controls. The positions of cranial base and maxilla were not significantly different. Additionally, the position of PPW in the pharyngeal triangle was located significantly posteriorly and superiorly in the VPI group, compared with the controls. Conclusions The craniopharyngeal morphology of patients with persistent VPI was characterized by a short palate, wide-based and counterclockwise-rotated pharyngeal triangle, and posteriorly and superiorly positioned PPW. These might be contributory factors for the prediction of VPF before repushback surgery for cleft palate.

Objective The goal of this study was to clarify the efficacy of and indication for re-pushback surgery as secondary treatment for cleft palate. Participants Fifteen patients treated by re-pushback surgery involving intravelar veloplasty (IVV) with buccal mucosal grafting on the nasal surface and followed up more than 6 months were enrolled in this study. Main Outcome Measures Pre- and postoperative velopharyngeal functions were analyzed by perceptual voice analysis, blowing ratio, and nasalance scores during phonation of /i/ and /tsu/. Cephalometric analysis was used to evaluate the relationship between velopharyngeal structure and the outcome of re-pushback surgery. Control data were obtained from the longitudinal files of normal 10-year-old children in Kyushu University Dental Hospital. Results Eight of 15 patients obtained complete velopharyngeal closure (complete group), five patients improved remarkably (improved group), and no effective result was seen in two patients (ineffective group). Nasality disappeared or remarkably improved after the operation in 13 patients. Effective surgical results were found in 86.7% of the patients. Partial flap necrosis was seen in two patients in whom re-pushback surgery was performed using mucosal palatal flaps instead of mucoperiosteal flaps. Preoperative velar length and the length/depth ratio of the re-pushback group were significantly smaller than the controls, but there was no difference after the operation. Furthermore, the preoperative length/depth ratio of the complete group (ranged more than 100%) was significantly greater than those of the other two groups (ranged less than 100%). Conclusion Re-pushback surgery by IVV with free mucous grafting on the nasal surface was effective in managing velopharyngeal incompetence secondarily, improving velopharyngeal structure and function.

Objectives:To elucidate the changes in the distributions of fluorine-18-labelled fluoro-2-deoxy-d-glucose (18F-FDG) accumulation in the tongue muscles of patients following four kinds of surgical operations for tongue cancers.Methods:The changes in the distributions of 18F-FDG accumulations in the tongue muscles on positron emission tomography (PET)-CT, in association with imaging findings on CT and MRI, were retrospectively analyzed before and after four kinds of surgical operations for 50 patients with tongue cancers.Results:18F-FDG-PET-positive areas appeared at the back of the intrinsic muscles of the tongue after invasive surgery for tongue cancers despite the absence of abnormal findings on CT and MRI. A correlation between the standardized uptake value maximum of 18F-FDG in the intrinsic muscles and the degree of invasiveness of the surgical procedures for tongue cancers (r = 0.539, p

There is no standard surgical protocol of bisphosphonate-related osteonecrosis of the jaws (BRONJ), because of the impossibility to visualize this feature intraoperatively. The aim of this study was to introduce how to provide preoperative labeling of the viable bone with minocycline bone fluorescence technique (MBFT) by using VELscope® and investigate histopathologically. The American Association of Oral and Maxillofacial Surgeons (AAOMS) and the Japanese Society of Oral and Maxillofacial Surgeons (JSOMS) now recommend a more conservative treatment strategy. There is no standard surgical protocol of bisphosphonate-related osteonecrosis of the jaws (BRONJ) because of the impossibility to visualize this feature intraoperatively. The aim of this study was to introduce a mechanism providing preoperative labeling of a viable bone using minocycline bone fluorescence technique (MBFT) with VELscope® and to histopathologically investigate. This report describes a surgical technique used in six patients with BRONJ who underwent jawbone resection under minocycline bone fluorescence imaging using VELscope®. Subsequently, we investigated and compared the clinical findings using VELscope® and histopathological findings. Histopathological examinations showed that the non-fluorescent moiety was consistent with the BRONJ lesions. The surgical treatments that were exactly performed using MBFT with VELscope® offered successful management of BRONJ. This bone fluorescence helped to define the margins of resection, thus improving surgical therapy for extended osteonecrosis.