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

Objectives

The present work aimed to examine the early and late histopathological changes occurring in the lower lips of rats, as a result of hyaluronic acid injection, and to determine whether it could really bring us closer to the ideal soft tissue filler material. This research highlights the importance of experimental studies on this subject, since adverse reactions have been observed routinely in dental practice.

Material and methods

The present study was carried out on 36 adult male albino rats and was divided into two equal groups, each consisting of 18 rats; group I (control group) and group II (experimental group). Rats in the experimental group were injected with hyaluronic acid (0.07 ml), whereas rats in the control group were injected with 0.9% sodium chloride.

Results

The results showed inflammation triggered by the injection of hyaluronic acid. On examining the specimens histologically using Hematoxylin and Eosin stains, Toluidine Blue stain and immunohistochemistry with anti-CD68 antibody, there was a significantly greater inflammatory response in the groups at early interval with hyaluronic acid compared with the control (P < 0.0001). Higher collagen formation was also observed with Masson’s Trichrome staining.

Conclusion

The undesirable effects of hyaluronic acid filler injection can be detected at early intervals following its injection. Fortunately, all the undesirable effects are transient and decrease by time, reaching levels comparable to normal. Overall, HA was well-tolerated by tissues, reflecting how this filler material possesses a biocompatible property.

Hereditary angioedema (HAE) with normal C1 inhibitor (C1-INH) (HAE-nC1-INH) is a rare disease that presents with laryngeal edema due to oral surgical procedures. Familial Mediterranean fever (FMF) is a disorder commonly characterized by an autosomal recessive inflammatory process, and manifests in the oral cavity and facial structures. A 50-year-old woman with HAE-nC1-INH and FMF was referred to our department for bone augmentation in the right maxillary molar region. We performed lateral window sinus augmentation under the backup support of an anesthesiologist. A hematologist used intravenous Berinert® and oral Orladeyo® to prevent perioperative angioedema attacks. The postoperative course was uneventful. Regarding surgical intervention in patients with HAE, interdepartmental cooperation is crucial to prevent angioedema attacks and prepare for life-threatening complications. Oral hygiene and occlusion should be considered in the dental implant treatment of patients with FMF. Every oral and maxillofacial surgeon and dental practitioner should familiarize themselves with HAE and FMF.

Objective

Predicting postoperative airway obstruction during oral cancer surgery is difficult. We aimed to investigate the relationship between postoperative airway obstruction and surgery in patients.

Methods

Patients (n = 100, men: 72, women: 28) with oral malignancies who underwent surgery between January 2020 and December 2022 were included. The outcome was postoperative airway obstruction. Age, sex, alcohol, smoking history, BMI, tumor site, T and N classification, stage, surgical method, lymphatic invasion, vascular invasion, perineural invasion, DOI, airway management, occurrence and duration of postoperative airway obstruction were investigated. We defined airway obstruction as confirmed symptoms such as dyspnoea and wheezing, drop in SpO2 below 90 %, stridor auscultation and pharyngeal stenosis by endoscope.

The relationship between airway obstruction and patient characteristics was analyzed using Fisher's exact test. The Kaplan–Meier method was used to assess onset of airway obstruction, and the time to onset of airway obstruction was compared using the log-rank test. Airway obstruction and surgery-related factors were evaluated using Cox regression models.

Results

Airway obstruction occurred in 6 patients within 12 h. Multivariate analysis revealed that age > 65 years, lymphatic invasion and DOI (cut-off value: 7.00 mm) were independent risk factors for occurrence of airway obstruction.

Conclusion

Local resection of tumors ≥ 7 mm in DOI is associated with airway obstruction owing to factors such as swelling associated with deep resection. Age, lymphatic invasion are also associated with airway obstruction, requiring ward management according to the protocols of each institution with attention to postoperative hematoma and edema that may cause airway obstruction.

Objective

This study aimed to study on the MRI findings suggesting intra-articular pathologies in patients with temporomandibular disorders (TMD) undergone successful non-surgical treatments, and to discuss on their intra-articular pathological conditions with clinical symptoms.

Patients and methods

One-hundred eleven TMJs of the consecutive 80 TMD patients were enrolled in this study. These TMJs were classified into the following 3 Groups, Group I: Bilateral 62 TMJs of the 31 patients with masticatory-muscle (MM) symptoms without functional pain, Group II: Affected-side TMJs of the 31 patients with unilateral functional MM pain, Group III: Affected-side TMJs of the 18 patients with unilateral functional TMJ pain. The detection rates of joint effusion (JE), osteoarthritis (OA), and disc displacement (DD) on the MR images were investigated. The correlations of JE, OA, DD, age, and gender were also analyzed.

Results

In each Group, the detection rates of JE, OA, and DD were more than 70%, and no findings of them were sometimes observed. The detection ratio of moderate/marked JE in Group II was significantly higher among the 3 Groups. The significant correlation of JE, OA, and DD was found, and that of OA and age was also observed.

Conclusions

Our results suggest that intra-articular pathologies often occur even in the painless TMJs, and functional TMJ pain sometimes appear even in the TMJs with early-stage OA, which cannot be detected by MRI. Furthermore, the TMJ synovitis occurred in patients with functional MM pain may be more severe than that in the painful TMJ.

Ameloblastic fibroma (AF) is a rare benign tumor, with approximately 80% of AF cases occurring in patients below the age of 22 years. Notably, it is less frequent (16.9%) in patients aged ≤ 10 years. Most cases of AF occur in the mandible, with only a few occurrences in the maxilla. Herein, we report a case of AF in the maxilla of an 8-year-old child. In the present case, AF was suggested to have impaired the development of permanent teeth. Regular checkups, including radiographic examinations starting in childhood, may facilitate early detection of lesions in the maxillofacial region.

Objective

This study aimed to identify the anatomical characteristics of the posterior alveolar canal (PAC) and related maxillary bone using computed tomography (CT).

Methods

The study included 40 Japanese cadavers (70 hemi-heads), comprising 23 males (41 hemi-heads) and 17 females (29 hemi-heads). Simple CT data of the maxillary bone region of the specimens were obtained and analyzed using a measurement software with reference to the Frankfurt horizontal (FH) plane to identify the PAC in the maxillary tuberosity region, alveolar crest (AC), and corner of the inferior crest of the zygomatic process (CICZP). The shortest distances between the PAC and the respective landmarks and the smallest width of the posterior wall of the maxillary sinus (WPWMS) at the PAC level were calculated and analyzed statistically.

Results

Of all specimens, the mean and SD of AC-PAC: 21.4 ± 3.32 mm, horizontal PAC-CICZP: 15.1 ± 2.89 mm, vertical PAC-CICZP: 5.70 ± 3.15 mm, WPWMS: 0.81 ± 0.31 mm, and the coefficients of variation ranged 15.5–55.3%. In the WPWMS, the mean value was statistically smaller in the female group (0.59 mm) than in the male group (0.96 mm) (p < 0.001).

Conclusions

The results showed certain tendencies in the distances between the PAC and the respective anatomical landmarks with large variations. The thickness of the posterior wall of the maxillary sinus was thinner in females than in males. However, it is < 1 mm in both sexes, and external forces caused by trauma or surgery may fracture the posterior wall of the maxillary sinus and damage the posterior superior alveolar artery regardless of sex.

Intravascular papillary endothelial hyperplasia (IPEH) is a benign lesion characterized by reactive proliferation of endothelial cells with papillary formations related to thrombosed blood vessels. IPEH in the oral region is relatively rare, and its clinical picture is not specific. Herein, we report the case of a patient with IPEH of the upper lip who had a favorable outcome. A man in his 40 s presented to our department with a nodule beneath the right upper labial mucosa. Magnetic resonance imaging showed a relatively well-defined mass. Based on the diagnosis of a benign tumor, a total excision with healthy margins was performed. Histopathological and immunohistochemical findings revealed a pure form of IPEH with a Ki-67 labeling index of 20%. No recurrence was observed 1 year postoperatively. Although IPEH in the oral region is relatively rare, and its clinical presentation is nonspecific, based on the clinical diagnosis of benign tumors, adequate excision with clear margins can reduce the risk of recurrence. As Ki-67 can be used to predict the biological behavior and risk of IPEH recurrence, careful follow-up considering the risk of recurrence suggested by the Ki-67 labeling index is needed. Thorough knowledge of IPEH is important for clinicians and pathologists to arrive at a correct diagnosis, which leads to appropriate treatment.

Objectives

To investigate the use of an oral moisture meter to aid in the diagnosis of Sjögren’s syndrome (SS) by measuring the moisture values and salivary flow rate (SFR) simultaneously.

Methods

The SFR and moisture values of the dorsum of the tongue and buccal mucosa were measured in 40 patients with SS and 29 healthy controls using an oral moisture meter. In addition, a visual analogue scale (VAS) was used to determine the degree of subjective oral symptoms (xerostomia, decreased saliva production, drinking during eating, oral pain, dysphagia, and dysgeusia).

Results

The moisture values of the dorsum of the tongue and buccal mucosa were significantly lower in SS patients than in healthy subjects (both p < 0.01). SFR, especially when measured by the spitting test, correlated positively with the moisture values of the dorsum of the tongue (p < 0.0001) and buccal mucosa (p < 0.0003). Furthermore, the sensitivity, specificity, and accuracy of the oral moisture meter measurements of the dorsum of the tongue and buccal mucosa were 92.5%, 68.9%, and 82.6%, and 70.0%, 82.8%, and 73.9%, respectively. The moisture values of the dorsum of the tongue had a moderate negative correlation with the VAS scores of secondary subjective oral symptoms of xerostomia (oral pain, dysphagia, and dysgeusia), whereas a weak negative correlation was observed for subjective oral symptoms directly related to xerostomia (xerostomia and decreased saliva production).

Conclusions

The oral moisture meter accurately reflected the results of the SFR tests and chronic subjective oral symptoms, and therefore might be a diagnostic criterion for SS.

Aquagenic urticaria is a very rare form of physical urticaria with less than 50 cases reported in the medical literature. The condition causes itchy and potentially painful hives to break out whenever the sufferer comes into contact with water, sweat, or tears. A relationship between chronic urticaria and systemic lupus erythematosus (SLE) has been suggested in the literature. However, aquagenic urticaria has rarely been reported in association with other systemic conditions and is not typically a life-threatening condition. There are no documented cases of aquagenic urticaria occurring together with SLE or small vessel vasculitis, or presenting with cutaneous lesions more serious than urticaric wheals. This report presents a rare case of a 43-year-old African-American woman with aquagenic urticaria, who developed unusually painful skin ulcerations and life-threatening wheezing after contact with water, remained misdiagnosed for over five years, and, subsequently developed several serious comorbidities, including SLE. The case seems to suggest that aquagenic urticaria, urticarial vasculitis, and SLE may be related disorders that potentially developed along one spectrum of disease. As diagnosis of the condition is challenging and the use of water intraorally is essential to performing most dental procedures, the article aims to raise awareness of the condition among dentists and physicians and provides tips and suggestions to help manage patients with aquagenic urticaria more effectively.

Response teams, via the rapid response system (RRS), are activated when a patient's condition deteriorates; respiratory, neurological, or cardiac diseases are precursors to unexpected in-hospital cardiac arrest or death. In December 2019, our hospital introduced the RRS to reduce serious adverse events. Herein, we report a case where RRS was initiated twice for a patient who developed septic shock due to cervical necrotizing fasciitis and non-occlusive mesenteric ischemia (NOMI) after the septic shock. In August 2021, a male in his 70 s developed facial swelling, difficulty opening his mouth, and difficulty with oral intake. We observed necrotic skin on the face, soft tissue swelling in the neck, and hypotension. The RRS was initiated, and the patient was immediately admitted to the intensive care unit (ICU) where he was diagnosed with septic shock and necrotizing fasciitis of the neck. The patient underwent surgical necrotic lesion debridement and incisional drainage under general anesthesia. After weaning from shock, owing to his hypotensive and hemorrhagic status, the RRS was requested again. The patient was re-admitted to the ICU and diagnosed with NOMI. His general condition improved, and he was discharged on day 47.