Journal of Oral and Maxillofacial Surgery Medicine and Pathology最新文献

Objective

Oral appliances (OA) are effective in reducing apnea-hypopnea index (AHI) in patients with obstructive sleep apnea (OSA). However, residual excessive sleepiness (RES) may occur despite successful OA treatment, and there is limited evidence on the cause of this. Furthermore, few studies have examined the association between changes in sleepiness after OA treatment and polysomnography (PSG) parameters. The purpose of this study was to evaluate the prevalence of RES after OA treatment and examine the effects of changes in sleepiness on PSG parameters.

Methods

The study sample included 121 participants who were diagnosed with OSA and had evaluated RES after OA treatment outcomes using PSG. All patients were scored using the Epworth sleepiness scale (ESS) at baseline and after OA treatment, and the association between changes in ESS and PSG parameters were examined statistically.

Results

Approximately 20.5% of OA responders (n = 73) exhibited RES. The ESS change better group (n = 24, ESS decreased by ≥2 points after treatment) exhibited significantly lower baseline lowest SpO₂ values (82.0 ± 7.9 vs. 87.5 ± 4.2; p-value <0.01) and higher baseline CT90 value (2.4 ± 4.0 vs. 0.5 ± 0.9; p-value <.05) compared to the ESS change worse group (n = 19, ESS increased by ≥2 points after treatment). Moreover, the CT90 change rate after OA treatment was also significantly higher in the former group.

Conclusion

OSA patients can exhibit RES despite improvements in AHI after OA treatment. Furthermore, improvements in ESS can potentially help predict hypoxia parameters in PSG.

The tongue is a vital and complex organ responsible for various functions, with sensory and motor properties in oral cavity. Different etiological factors, such as oncological resections, trauma, or lacerations can result in significant tissue loss. Currently, lingual reconstruction is a challenge for surgeons, as it aims to restore speech and swallowing while maintaining its role between the maxillary arches, aesthetic appearance, airway patency, and taste. Therefore, achieving ideal surgical outcomes is essential. A 56-year-old male patient consulted an emergency health center due to an accidental partial glossectomy of the anterior two-thirds of the tongue caused by a traumatic bite. The patient underwent surgical lingual plasty under general anesthesia using a modification of the technique described by Harada et al. Here, we present a case of a patient who underwent a traumatic partial glossectomy of the anterior two-thirds of the tongue, which was successfully reconstructed using a modification of the Harada technique.

Cemento-ossifying fibroma (COF) is a rare benign tumor consisting of fibrous tissue with cementum- or bone-like hard tissue that shows slow, distensible growth without clinical symptoms such as pain, but often results in facial deformity and malocclusion as the tumor grows. In this report, we present a case of a supermassive COF enlarged to the size of an adult's head, with symptoms including dysphagia and feeding difficulties, that was successfully treated surgically.

Objective

Treatment strategy decisions are very difficult in elderly patients with oral squamous carcinoma (OSCC). In this study, the factors that affect treatment strategy decisions and the clinical impact of the G8 screening tool score were retrospectively investigated in elderly OSCC patients.

Methods

The medical records of primary OSCC patients aged 75 years or older were retrospectively reviewed, and 438 patients aged 75 years or older were included in this study. The factors that affect treatment strategy decisions and the clinical impact of the G8 screening tool score were investigated.

Results

Regarding treatment decisions, the elderly OSCC patients with better Eastern Cooperative Oncology Group Performance Status (ECOG-PS) scores and G8 scores of more than 10.5 were treated with the standard treatment with curative intent. The 5-year overall survival (OS) rates of the patients with G8 scores of <10.5 and ≥10.5 were 43.8 % and 60.3 %, respectively (p < 0.01). The 5-year self-reliant survival (SR) rates of the patients with G8 scores of <10.5 and ≥10.5 were 44.9 % and 59.3 %, respectively (p < 0.01). Multivariate analyses revealed that OS and SR were significantly correlated with poorer ECOG-PS and lower G8 scores (<10.5).

Conclusions

These results suggest that pre-treatment evaluations based on the ECOG-PS and G8 screening tool may aid treatment decisions for and prognostic evaluations of elderly OSCC patients.

Osteoblastoma is a benign bone tumor with predominance in those < 20 years of age and rarely occurs in the maxillofacial region. The identification of FOS gene rearrangements in osteoblastomas has been reported, however, a small subset of osteoblastomas do not show FOS gene rearrangements. There are no reports discussing the relationship between age and FOS gene rearrangement in osteoblastomas. We report the case of a 66-year-old female patient with histological features of osteoblastoma in the mandible without FOS gene rearrangement. According to a review of previously reported cases of osteoblastoma, FOS gene rearrangement is significantly less common in patients > 40 years of age (P = 0.041). Osteoblastomas occurring in older adult patients may exhibit pathogeneses different from those of young patients. Further data, including the relationship between age and FOS gene rearrangement, is necessary to clarify the pathogenesis of osteoblastoma.

Massive osteolysis is an extremely rare condition characterized by progressive osteolysis. In this report, we present a case of massive osteolysis in the upper and lower jaws. A 49-year-old man was referred to our hospital because of bone resorption in the jaw of an unknown cause. Panoramic radiography and computed tomography (CT) showed extensive bone resorption in the right lower and left upper jaws. The biopsy specimen revealed marked non-specific inflammatory granulation tissue without any malignant findings.

Although this case lacked significant lymphatic growth in the biopsy specimen, the clinical diagnosis of massive osteolysis was made, and two courses of zoledronic acid, which has been recently reported to be effective in the disease, were administered. CT performed 19 months after the initial examination showed no new osteolysis, and the patient was free of symptoms.

Idiopathic condylar resorption (ICR) is characterized by resorption of the entire mandibular condyle, resulting in a reduced mandibular ramus and skeletal anterior open bite. We applied intermaxillary elastic traction to a patient with early ICR and obtained a stable long-term outcome. The patient was a 16-year-old girl who had noticed an anterior open bite after orthodontic treatment. The anterior open bite was observed with an overbite of − 2 mm and an overjet of + 4 mm. Computed tomography (CT) and magnetic resonance imaging (MRI) showed bilateral mandibular condylar resorption, and clinical diagnosis indicated ICR. An indirect bonded splint (IBS) was placed on the dental arches, and intermaxillary traction with elastic bands was applied continuously except during eating and oral cleaning. After 1 month of traction, complete contact of the upper and lower teeth was confirmed, indicating improvement of occlusion. CT images taken after 1 year of traction showed bone remodeling and cortical bone formation bilaterally in the part of condylar heads. This treatment was applied continuously for 1 more year and intermittently at night for another year to prevent relapse. After 3 years of traction, CT images taken showed a stable morphology of the mandibular condyle with stable occlusion, prompting the termination of the intermaxillary traction and removal of the IBS. Furthermore, 3 years after ending traction, CT and MRI showed no evidence of ICR recurrence, and occlusion was stable. This treatment method could be a useful first-line treatment for early ICR.

Objective

It is expected that the number of patients with mandible fractures will be affected by the global spread of COVID-19 because of a decline in physical activities. The purpose of this study was to investigate characteristics of mandible fractures before and during the COVID-19 pandemic.

Methods

Patients with mandible fracture who visited our department or a nearby associated medical institution were surveyed, with 242 enrolled. The time period was divided into 2017–2019, before the COVID-19 pandemic, and 2020–2022, during the pandemic.

Results

There were 138 cases before and 104 during the pandemic. The majority of patients before the pandemic were teenagers, while the majority during the pandemic were in their 20 s. Before the pandemic, May had the greatest number of patients and the greatest number during the pandemic was in December. A fall was the most common cause of injury during both time periods. Both before and during the pandemic, the most common period of time to visit a doctor following an incident was less than one day. During both time periods, the condyle was the most common fracture site, with surgical therapy the most common treatment strategy used throughout the term of the study.

Conclusions

The number of patients with mandible fractures decreased after the beginning of the pandemic, which is considered to be due to a decrease in social activities associated with refraining from going out due to the declaration of state of emergency. These findings suggest a relationship between social activities and risk of mandible fracture.

Unilateral scissor bite is one of the rare forms of malocclusion that is accompanied by deep bite and collapsed arch. This report describes the treatment of unilateral scissors bite improved by maxillary and mandibular posterior segmental osteotomy with orthodontic treatment. The patient was a 16-year-old woman with unilateral collapsed maxillary and mandibular arch and a scissor bite of the right buccal segment, and without facial asymmetry. At first, intrusion of right maxillary molars with implant miniscrew was planned, but failure to move. To improve, posterior segmental subapical maxillary osteotomy and mandibular corticotomy were applied without changing facial appearance. Following the surgery, the expansion of the collapsed right mandibular segment bucally using an appliance during comprehensive orthodontic treatment was planned. There was no sensory or motor paralysis. After post-surgical orthodontic treatment, her occlusion improved without alteration of facial appearance and disorder of her speech. Transverse widths at the maxillary premolars and first molars were nearly stable over the 4 years postoperative interval in our patient, and her overall long-term stability showed excellent results. To our knowledge, this case was the first case to combinate two segmental subapical osteotomies without Le Fort I and sagittal split ramous osteotomy. The results indicate that this technique is useful for unilateral expansion of distorted mandibular alveolar process and maxillary and mandibular subapical osteotomy with subsequent orthodontic treatment can be used to successfully treat unilateral scissor bite.