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

Objective

Local steroid therapy is the first-line treatment for oral lichen planus (OLP); however, steroid-resistant cases are often observed. Local tacrolimus therapy is a good candidate as an effective treatment option for steroid-ineffectiveness. In this study, we retrospectively investigated the efficacy and safety of local tacrolimus for local steroid-ineffective OLP.

Materials and methods

Twenty one patients with OLP who visited our clinic between January 2017 and December 2022 and received local tacrolimus therapy were included. We evaluated the clinical type, histopathological features, therapeutic efficacy, and side effects. Therapeutic efficacy was assessed by Reticulation/keratosis, Erythema, and Ulceration scores (REUs) and Numerical Rating Scale (NRS) scores and compared between local steroid and tacrolimus.

Results

When we evaluated the clinical characteristics of the patients, red type was predominant (90.5%), and histologically, epithelium thinning was prominent (76.2%). No significant reduction of REUs was observed after steroid treatment (p = 0.227, rate of change score; +0.7%); however, tacrolimus-switching showed a significant effect not only on REUs but also NRS scores (p = 0.0000639, rate of change score; −73.5%). Oral candidiasis (five cases) and irritation (one case) were observed as side effects; however, no patients showed canceration.

Conclusions

Local tacrolimus should be one of the treatment options for steroid-resistant OLP.

Objective

This study aimed to compare the endoscopically assisted transoral approach (EATA) and high perimandibular approach (HPMA) for mandibular condylar fractures.

Methods

We conducted a retrospective study on patients who underwent open reduction and internal fixation using the EATA or HPMA between March 2013 and February 2023 and were followed up for > 6 months. The primary predictor variables were the surgical approach, including the EATA and HPMA. The outcome variables were postoperative mandibular condition, including maximum interincisal opening, occlusion and condylar pain, anatomical reduction, and complications. Other predictive variables were patient characteristics and perioperative fracture conditions. Statistical analyses were performed by comparing patients treated with the EATA and HPMA.

Results

Seventeen and 14 patients who were treated with the EATA and HPMA, respectively, were eligible for this study. Radiological assessments showed that the anatomical reduction in patients treated with the HPMA was significantly better than in those treated with the EATA. Notably, four patients experienced trismus after the EATA and none after the HPMA. One patient experienced malocclusion after the EATA; however, none experienced malocclusion after the HPMA. However, the differences in these mandibular condition between the EATA and HPMA groups were not significant. None of the patients experienced transient or permanent facial nerve palsy.

Conclusions

Significant differences in anatomical reduction between patients treated with the EATA and HPMA are observed; however, the difference in postoperative mandibular condition is not significant between the two approaches. It is essential to choose the appropriate approach based on a thorough preoperative evaluation.

Objective

To explore the appropriate dissection extent for cN1 oral cancer and to summarize neck treatment outcomes.

Methods

The cases of a series of oral squamous cell carcinoma (OSCC) patients with cN1, who underwent radical resection of the primary site and neck dissection (I-V) as the initial treatment at our institution. The distribution of pathological cervical lymph node metastases was analyzed, and the overall survival (OS), disease- specific survival (DSS) and regional control rate were estimated by the Kaplan–Meier method.

Results

Pathological positive cervical lymph nodes were seen in 19 of the 57 patients. Eleven patients had one positive lymph node (pN1), whereas eight patients had multiple positive lymph nodes (pN2b). The most distal cervical metastasis was at level Ⅰ or Ⅱ in 17 cases, at level Ⅲ in one case, and at level IV in one case. There was no patient with cervical metastasis at level Ⅴ. The 5-year OS was 79.9%, the 5-year DSS was 85.3%, and the 5-year regional control rate was 87.5%.

Conclusions

In conclusion, of the 57 patients diagnosed as cN1 oral cancer, there was no patient with cervical metastasis at level Ⅴ, suggesting that level V dissection can be omitted.

In patients with extensive jaw defects, jaw functions, such as mouth opening and occlusion, should be considered during jaw reconstruction in anticipation of implant placement and prosthetic treatment. Herein, we report a case of temporomandibular joint and mandibular bony reconstruction using custom-made trays and particulate cancellous bone and marrow, followed by implant placement. We succeeded in restoring both temporomandibular joint function and occlusion using the reconstruction plate with the condylar head, a mesh tray, and particulate cancellous bone and marrow in a patient with left mandibular reconstruction plate fracture and bony adhesion of the left TMJ.

Objective

The objectives of this systematic review are to assess the efficacy of sialendoscopy alone, without combined surgical approach, in treatment of obstructive salivary gland disease and overall gland preservation.

Methods

PubMed, Cochrane library and Google Scholar were searched up to 30th October 2023. Two reviewers independently screened the articles and included them if they met the inclusion criteria. Any uncertainty and discrepancy regarding any study was discussed among the two review authors and if no harmony was met, then it was resolved by the third author. Studies that used sialendoscopy alone for the management of salivary gland obstruction were selected. Outcome measures included rates of success and overall gland preservation.

Result

22 articles were included in the systematic review. From these 21 articles for success rate and 12 articles for gland preservation were included in meta-analysis. Pooled proportion for success rate and gland preservation was 0.75 (95% CI 68–82) and 0.98% (98% CI 97–99) respectively.

Conclusion

Sialendoscopy is a reliable therapeutic modality in management of non-neoplastic salivary gland diseases. It is effective, non-invasive, safe, and gland preserving.

Objective

Oral squamous cell carcinomas (SCCs) arise from oral potentially malignant disorders (OPMDs), including oral epithelial dysplasia (OED); however, useful detections markers for early detection of OED and oral SCC are lacking. In this study, we aimed to evaluate the sequential mRNA and protein expression patterns of BRD4, c-MYC, TP53, and MUC21 in human oral samples by liquid-based cytology (LBC) and determine whether these markers are useful for early detection of OED and oral SCC when combined with oral cytological screening.

Methods

A total 200 patients were obtained from our hospital between 2020 and 2022. These are samples from same cases with oral cytology and corresponding histological diagnosis. The expression of these markers was examined by immunocytochemistry and mRNA analysis. The percentages of cells with nuclear or cytoplasmic immunostaining were calculated using the labeling index (LI). BRD4, c-MYC, and TP53 mRNA expression levels were upregulated in tissue during progression from a status of negative for intraepithelial lesions or malignancy (NILM) to positive for SCC. BRD4-LI and c-MYC-LI significantly increased in low-grade squamous intraepithelial lesions (LSIL), high-grade squamous intraepithelial lesions (HSIL) and SCC samples, whereas the expression of MUC21 mRNA and MUC21-LI gradually decreased. TP53-LI increased only in SCC samples.

Conclusions

We conclude that monitoring BRD4 and c-MYC expression with immunocytochemistry could improve the early detection of OED and oral SCC.

A solitary circumscribed neuroma is a benign peripheral nerve tumor with a predilection for the skin of the head and neck. Herein, we present a 73-year-old Japanese male with a solitary circumscribed neuroma of the upper lip. Histologically, the tumor comprised densely proliferating Schwann cells and axons that formed fascicles. A thin perineural-derived fibrous capsule surrounded the tumor. Immunohistochemically, the tumor cells were positive for S-100, and neurofilaments indicated the presence of nerve fibers. Fibrous capsules were identified by epithelial membrane antigen staining.

Purpose

Here, the feasibility of orthodontic surgery was determined by obtaining cephalometric and model analyses. To make predictions easier without using these methods, I examined a plan in which AI judged whether orthodontic surgery was possible.

Methods

This study was approved by the bioethics committee of our hospital (No. I459). We included 1766 patients with suspected jaw deformity among those who visited the outpatient clinic of the Department of Oral and Maxillofacial Surgery in Kanazawa Medical University from August 2004 to October 2019. I used medical records to divide patients into those who underwent orthodontic surgery and those who underwent conservative orthodontic treatment. Side profile photographs of the patients were used to train the AI system, and the untrained data were analyzed by AI.

Results

The AI judgments for surgical orthodontic surgery of jaw deformity in patients aged 16 years or younger, aged 17 years or older, and of all ages were 0.630, 0.668, and 0.768 (ROC curves), respectively.

Conclusion

The AI judgement of orthodontic surgery for jaw deformities in patients has high accuracy. Further improvements will require a larger number of subjects, the use of subject scope, image processing methods, and a loss function system.

Objective

The aim of this study was to determine the effect of the oral surgery and dental anesthesia on anxiety in patients, by comparing two anxiety scales. The study designed to evaluate the effect of physical status, age and gender on anxiety and to compare anxiety and need for information.

Methods

A total of 91 patients, categorized as ASA-I and ASA-II based on ASA (American Society of Anesthesiology) scoring, were assessed utilizing the BAI (Beck Anxiety Inventory) and APAIS (Amsterdam Preoperative Anxiety and Information Scale) tests. The groups were compared by using the Mann-Whitney U test, and the Spearman's rank correlation coefficient (p < .05).

Results

BAI, APAIS-A and APAIS-B values were significantly higher in ASA-II individuals compared to ASA-I. APAIS and BAI values were correlated with each other in the ASA-I group, while APAIS-B was not correlated with other values in the ASA-II group. Anxiety scores were higher in female patients. Age was inversely correlated with anxiety, while the need for information did not change.

Conclusion

The APAIS may provide more detailed information to evaluate anxiety in the group with mild systemic disease. The need for information is higher in patients with chronic disease, regardless of their anxiety status.

Schwannoma is a slow-growing benign encapsulated tumor that arises from Schwann cells. Ancient schwannoma is a rare histologic variant characterized by degenerative changes, usually in the context of a schwannoma with long evolution. Intraoral ancient schwannoma is extremely rare. A review of the literature revealed only thirty previously reported cases. This article aims to present and discuss the first case of ancient schwannoma of the anterior mandibular vestibule and to review the relevant literature on intraoral ancient schwannoma.