Asian Journal of Oral and Maxillofacial Surgery最新文献

Epithelial–myoepithelial carcinoma (EMC) is characterized by a biphasic cytomorphology comprising inner duct-forming epithelium and outer, prominently clear, enveloping myoepithelial cells. EMC typically occurs in major salivary glands, but also in the minor glands of the oral mucosa. We report herein a rare case of EMC arising from the intrabuccal mucosa in a 28-year-old man, with no recurrence after surgical excision and postoperative radiotherapy despite of partially positive surgical margin for tumor. The clinical and pathological features of this tumor are discussed.

Objective

The present study reviewed endothelin (ET) as an endothelial vasoconstrictor of three types: ET1, ET2 and ET3 and two receptors (ET_AR, ET_BR). They were involved in bone remodeling, developmental anomalies in the mandibulo-facial area and bone metastasis from cancer of distal organs.

Review topics

The tissue remodeling process has been recognized to have multiple growth factors including endothelins (ETs) and receptors (ETRs). Among ETs, ET-1 is the most potent vasoconstrictor, and it binds to ET_AR or ET_BR. The biophysiological roles of ETs and ETRs are involved not only in vascular tissues but also bone tissue. Promotion of bone formation through ET-1 will take place following dental implant, tooth extraction, destruction osteogenesis and surgical bone loss. ETs and ETRs mediate the normal development of craniovascular structure which eventually migrate to the pharyngeal arch. The CATCH 22 syndrome (cardiac defects, abnormal facies, thymic hypoplasia, cleft palate and hypocalcemia associated with chromosome 22 microdeletion) displayed developmental malformation (3rd and 4th arch). Treacher Collins syndrome, and Pierre Robin sequence and DiGeorge/Velocardic facial syndrome are resemble this CATCH 22 syndrome.

Conclusions

ETs and ETRs related to biological processes in bone remodeling have been beneficial in fracture healing, bone remodeling, orthodontic tooth movement, distraction osteogenesis, surgical or traumatic bone defects and bone metastasis. ETs and ETRs influenced the embryonal development of pharyngeal arch and congenital anomalies like the CATCH 22 syndrome.

Objective

To elucidate the details of impalement injuries of the oral soft tissue in children caused by toothbrush, we present a clinico-statistical study of those encountered in a single institution.

Patients and methods

Children below 13 years old, who visited our oral surgery clinic with the complaint of an impalement injury of oral soft tissue from December of 2001 to August of 2008, were included.

Results

Among two hundred and thirty oral soft tissue injuries, toothbrush (73 cases) was the most frequent object, followed by a stick-like object (51 cases) and eating utensils (27 cases). In toothbrush injuries, the 1-year-olds were most affected and the frequency in boys and girls was 30 cases and 43 cases, respectively. Soft palate (31 cases) was the most frequent site, followed by buccal mucosa (17 cases) and gingiva (7 cases). All of the injuries occurred when the children were in standing position and a fall was the most frequent cause (p < 0.01). Most injuries occurred between 21:00 and 24:00 (35 cases) followed by 18:00 to 21:00 (23 cases). In cases with a laceration that was larger than 10 mm (26 cases), 7 cases were hospitalized the next day for advanced infection.

Conclusion

Toothbrush was the most frequent object responsible for impalement injuries. Caution must be taken while managing a toothbrush injury with a wide laceration to avoid advanced infection. To prevent toothbrush injuries, we recommend that children should use a toothbrush in sitting position.

Upper airway obstruction caused by postoperative hemorrhages or surgical manipulation is one of the life-threatening complications for which oral and maxillofacial surgeons may have to initiate emergency management of the airway. Therefore, oral and maxillofacial surgeons need to be skilled in emergency airway management. However, intubation under these circumstances may be very difficult or impossible using direct visual laryngoscopy techniques. This case report describes a case of successful intubation assisted by a gum elastic bougie for an asphyxiating patient suffering from a severely compromised upper airway.

Fibrous dysplasia is a benign bone lesion characterized by the replacement of normal tissue by fibro-osseous lesions with immature remodeling, which is now thought to be caused by GSα somatic mutation. The disease usually manifests early in life, and its growth is terminated in adulthood. Its malignant transformation is very rare. In the current report, a case of fibrous dysplasia of the mandible undergoing repeated surgery with a long-term follow-up duration is described. After the initial surgery performed at the age of 19 years, surgical reduction was performed eight times with an interval of 1–4 years over a 19-year course. At the age of 38 years, the lesion was still growing, while serum alkaline phosphatase remained within the normal range throughout the entire course. There was no evidence of malignancy on pathological examination. Immunohistochemistry using antibodies detecting bone morphogenetic proteins 2, 4, 6, and 7 (BMP-2, 4, 6, and 7) in order to assess bone growth activity showed positive staining for BMP-4 and 6, which are important markers of bone quality. Examining the expression of different BMP subtypes is useful for characterizing the bone-forming nature of fibrous dysplasia.

When reconstructing hard tissue using an autologous bone graft, it is necessary to harvest more bone than the defect area in order to achieve the proper shape. Harvesting of large amounts of bone is highly invasive, and, as a result, it is desirable to minimize the amount of bone harvesting. In the present study, surgery was simulated using a three-dimensional model to prepare a template for bone harvesting, and then the template was used during surgery for one patient, and the volume of bone harvesting was minimized.

The use of toothbrush, a common commodity recommended by dentists all over the world has significantly reduced the incidence of periodontal infections and dental caries. But along with disease reduction brushing has also added a relative risk factor of injury to oral tissues. Minor injuries may result primarily due to improper brushing techniques, where as major penetrating injuries may occur due to fall of the person with brush in the oral cavity, particularly in children. Penetrating injuries to the oropharyngeal tissue may present as medical emergencies due to the possibility of compromised airway, intracranial trauma, mediastinitis, and emphysema. Also benign-appearing injuries to the soft palate and peritonsillar tissues, due to their close proximity to arterial–venous structure may conceal deeper damage. Due to the gravity of possible complications, careful assessment, early treatment and post-trauma monitoring is essential even if the initial injury appears to be minor, as complications may not manifest immediately. Here we report a case of penetrating intraoral injury caused by a toothbrush.

Postoperative fever is a common problem encountered by surgeons and anesthetists. Most of the time postoperative fevers are self-limiting but may be due to underlying serious pathologies. The febrile response is a complex physiologic reaction to disease involving a cytokine-mediated rise in body temperature, generation of acute-phase reactants, and activation of numerous endocrinologic and immunologic systems. Understanding the basic mechanisms underlying this phenomenon helps to formulate rational approaches to treatment and interventions. In this article, the authors review the basic pathophysiology of postoperative fever, its contributing etiologies, and management approaches based on current evidence relevant to oral and maxillofacial surgery.

Herein, we report a very rare case of pilomatricoma in the perioral region. A 27-year old Japanese female was referred to our clinic with a subcutaneous tumor in the angle of the left side of the mouth. The tumor was observed as a subcutaneous well-circumscribed and bony hard mass, without any changes of the skin surface, while a soft radiographic examination revealed a weak calcifying rounded mass. The tumor was extirpated using an intraoral approach, because of patient request. During the operation, the tumor was found to be partly attached to the surface skin, though easily removed from the surrounding tissue. The tumor was a rounded calcifying mass, 13 mm in diameter, and histologically diagnosed as a pilomatricoma.