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

We report a case of ameloblastic fibro-odontoma (AFO) in the second molar region of the left mandible of an 8-year-old girl. Cone beam computed tomography revealed a spatial relationship between the lesion and the gubernaculum tract of an unerupted second molar. Histologically, characteristic multinodular growth of discrete tooth germ-like structures supported the non-neoplastic hamartomatous nature of the lesion. The pattern and degree of syndecan-1 and D2-40 immunoexpression in the epithelial component varied, probably reflecting different stages of maturation. In view of the patient’s age (<13 years) and the size of the lesion (<2 cm), the present AFO was likely a developing odontoma.

Adenosquamous carcinoma (ASC) is a rare variant of squamous cell carcinoma (SCC). It is thought to be more aggressive with poorer prognosis than conventional SCCs. Therefore, accurate preoperative diagnosis is crucial for adequate treatment strategy. In this report, we will present a case of ASC arising in left mandibular gingiva of 76-year-old male. Histological examination revealed both SCC component and adenocarcinoma (AdC) component. Also, transition from AdC to short spindle-shaped and pleomorphic cells, which is known as sarcomatoid change, was observed. Immunohistochemical study revealed that SCC component was positive for p40 and negative for Cytokeratin 7 (CK7), whereas, AdC component was negative for p40 and positive for CK7. In area with sarcomatoid change, immunohistochemical analysis revealed that negative expression of both CK7 and E-cadherin but positive expression of Vimentin and nuclear Snail/Slug, indicating the possible role of epithelial-mesenchymal transition (EMT) in AdC to sarcomatoid transition.

Histopathological assessments performed via incisional biopsy or enucleation are necessary for the definitive diagnosis of an odontogenic keratocyst (OKC), an intraosseous odontogenic cyst. However, obtaining an adequate and representative sample through an incisional biopsy is often difficult. Moreover, the disappearance of typical morphological characteristics due to secondary inflammation makes histopathology of the enucleated material difficult. Herein, we present two patients with OKCs whose treatment plans entailed the preparation of smears from luminal aspirates and the performance of an incisional biopsy or enucleation. In one patient, typical histological features of OKC were difficult to determine in the broad area; in the other, the indefinite epithelium lining the cyst’s wall encumbered the accurate histological evaluation of paraffin-embedded sections of a preoperative biopsy specimen. During cytological assessments of luminal contents, smear samples of both patients consistently showed numerous anucleate squamous cells, keratinous debris, and isolated keratinocytes without nuclear atypia. The diagnosis of OKC was finally confirmed using operative samples in both cases. Both patients had no postoperative complications. These cases indicate that cytological assessments performed using the smear technique through the aspiration of luminal contents compensate for the weakness of morphological evaluation by incisional biopsy or enucleation.

Objectives

Consensus has not yet been reached on the therapy for medication-related osteonecrosis of the jaw (MRONJ). We assessed the effectiveness of conservative surgical management, which involves removing the necrotic bone and performing a gingivectomy, followed by localized cleaning to facilitate the separation of the sequestrum. Additionally, we revalidated the treatment algorithm utilized by our department.

Methods

We examined 160 patients diagnosed with MRONJ at three hospitals. The data for this study were collected retrospectively. These patients were followed up for a minimum of 2 years.

Results

The outcome 2 years after starting conservative surgical management was: cure: 117 cases; improvement: 22 cases; unchanged: 12 cases; and deterioration: 9 cases. The cure rate was 72.3% and 83.0% at 2 and 5 years after therapy initiation, respectively, and significantly lower at age ≥ 74 years compared to age < 74 years (P < 0.001), with malignant tumour as the primary disease when compared to osteoporosis (P < 0.001), and with ≥ 4 years of administration compared to < 4 years (P = 0.0301). On multivariate analysis, the trigger (P < 0.05), primary disease (P = 0.001), and administration period (P < 0.01) were independent prognostic factors.

Conclusions

Conservative surgical management is effective for MRONJ regardless of stage, especially in patients with age < 74 years, osteoporosis, and short drug-administration periods, and could become a first-line therapy for all stages.

Objective

Minichromosome maintenance (MCM) protein 2 is critical for the beginning of DNA replication and is a notable marker for proliferating cells. The prognosis and management of ameloblastoma are based on histology and other factors. However, immunohistologic markers capable of detecting recurrence-prone ameloblastoma with a poor prognosis have not been adequately investigated. This study aimed to identify the association between MCM2 overexpression and recurrence prognosis and risk stratification.

Methods

Thirty-two patients who had been diagnosed with ameloblastoma at our department between January 1982 and December 2019 were included in this study. Thirty-two (fifteen follicular, ten plexiform, five unicystic, two desmoplastic) subtype cases were analyzed for immunohistochemical expressions of MCM2 and Ki-67.

Results

Disease-free survival (DFS) analysis revealed that patients with MCM2^high/Ki-67^high ameloblastoma had a significantly shorter median survival time (63 vs. 360 months) and lower DFS survival rate (50.0% vs. 90.0%) than those with MCM2^low/Ki-67^low (p = 0.003). Multivariate analysis revealed that a location (maxillary primary ameloblastoma) and MCM2^high/Ki-67^high were independent risk factors for DFS.

Conclusion

Our results identified MCM2^high/Ki-67^high ameloblastoma as a subgroup with poor recurrent prognosis and DFS. Ameloblastoma should be assessed using immunohistochemical staining. Our study revealed that tumors with a worse recurrent prognosis require appropriate clinical surveillance.

Objectives

Many surgical techniques of the Temporomandibular joint (TMJ) have been devised with little or no reference to the actual diagnosis. So how is it possible to compare treatment outcomes when the diagnosis is lacking? The aim of this article is to review the rationale for surgical procedures of the TMJ with the aid of a surgical classification that has been originally devised and previously published by the author.

Method

The TMJ surgical classification was specifically conceived to match the diagnosis to the surgical treatment and is used in this review as a means of explaining the rationale for TMJ surgery.

Results

To better understand the role of surgery in disorders of the TMJ, we must essentially accept the premise that the most appropriate surgical treatment depends largely on an accurate surgical diagnosis. To that end, the Surgical Classification described in this article is validated with key publications that confirm the importance of matching the diagnosis to the various surgical treatments.

Conclusion

By using a practical surgical TMJ classification that is divided into 5 categories of escalating joint pathology as a guide to diagnosis, future studies can more reliably determine what surgical treatments are most effective for each of the specific diagnostic categories.

Objective

This study investigated the relationship between the external nasal morphology and hard tissue movement in patients who underwent anterior segmental maxillary osteotomy (ASMO) to correct maxillary protrusion correction.

Methods

The study enroled patients with an overjet ≥ 5 mm, and an ANB ≥ 2° who underwent ASMO with or without Le Fort I osteotomy. Linear and angular measurements were performed on computed tomography images obtained preoperatively and one year post-surgery.

Results

The movement of the maxilla at U1 was 6.7 ± 2.9 mm backward and 1.9 ± 2.0 mm upward. Tooth axis inclination of U1 (∠U1 to FH) increased 5.5 ± 6.1°. The nasolabial angle significantly increased from 90.0 ± 16.8° to 101.0 ± 13.2°. No significant differences were observed in alar base width or nasal tip angles. The change of ∠U1 to FH and the backward movement of U1 were relevant factors influencing the change of nasolabial angle.

Conclusions

This study provides insights into the relationship between external nasal morphology and posterior movement of the anterior maxillary segment after ASMO surgery. These findings are significant for predicting post-operative patient profiles.

In osteopetrosis, refractory jawbone osteomyelitis often occurs because of the progression of bone sclerosis, which makes the bone brittle. Herein, we report a case of refractory osteopetrosis-related maxillary osteomyelitis for which conservative therapy and surgical intervention were performed along with imaging evaluation. A 58-year-old woman had maxillary gingivitis for 2 years, for which her tooth was recently extracted. Subsequently, she developed sequestration and oroantral fistula and visited our department. Panoramic radiography, computed tomography, and magnetic resonance imaging (MRI) scans revealed left maxillary osteomyelitis, sinusitis, and sequestration. She had been diagnosed with osteopetrosis in childhood and exhibited sclerotic changes, which were likely caused by osteopetrosis. Bone scintigraphy using Tc-99m-HMDP revealed no increase in tracer uptake in the jawbone. Finally, the patient was diagnosed with osteopetrosis-related left maxillary osteomyelitis and sinusitis; hence, she underwent hyperbaric oxygen therapy, multiple surgeries, and antibiotic therapy. Hepatic dysfunction occurred during the treatment, and a mediastinal tumor was suspected. Thus, fluorodeoxyglucose-positron emission tomography was performed. Further, the patient was diagnosed with extramedullary hematopoietic foci associated with osteopetrosis and hepatic dysfunction due to hepatitis B, there was no Tc-99m accumulation in the maxilla, and hepatitis was treated concurrently. Six months after the final surgery for osteomyelitis, antibiotic therapy was discontinued. Notably, 2 years have passed without exacerbation of osteomyelitis. Moreover, bone scintigraphy using Tc-99m-HMDP did not reveal increased Tc-99m accumulation in the jawbone. In cases of osteopetrosis-related osteomyelitis, interpretation of findings should be done cautiously because Tc-99m may accumulate in an area with active bone metabolism and osteomyelitis may be masked. Refractory osteomyelitis with osteopetrosis requires careful interpretation of MRI and bone scintigraphy scans, and long-term follow-up is required.

Objective

It is known that smoking causes many diseases such as oral and nasopharyngeal cancers, cardiovascular diseases and osteoporosis. With fractal analysis (FA), changes in trabecular bone can be detected. The cavities in the bone can also be evaluated with the lacunarity analysis (LA). In the light of this information, the aim of this study is to investigate how the duration of smoking and the duration of smoking cessation affect bone change in the mandible using FA and LA.

Methods

Panoramic radiographs (PR) of 140 patients were grouped according to the duration of smoking and the duration of smoking cessation. The changes in the mandibular bone were evaluated with both FA and LA, and the results were compared with the control group who never smoked. Kolmogorov-Smirnov test, Mann-Whitney U test and Spearman correlation analysis was used in the analysis.

Results

The smokers’ FA value was significantly lower than the control group and the ex-smokers group. The smokers’ LA value was significantly higher than the control and ex-smokers’ group. The ex-smokers’ FA value was significantly lower than the control group. Both FA and LA values did not differ significantly between the genders. No significant correlation was observed between both FA and LA values and age.

Conclusions

FA values were lower and LA values were higher in smokers. It is thought that in smokers, the trabeculation in the bone decreases and accordingly the intraosseous spaces increase, and the duration of smoking and quitting also affects the internal structure of the bone. PR can be used to evaluate bone structure with FA and LA analysis.

Objectives

The study's objective was to evaluate the results of negative wound therapy as a modality for fascial space infection, including its benefits, limitations, and potential complications.

Materials and Methods

Patients suffering from fascial space infections in the head and neck region that posed a direct threat to the airway were included in the study. Fascial space infections were managed with negative pressure wound treatment. Customized Polyurethane Reticulated Open Cell Foam was employed within wound. The median time of device removal, the volume of drainage fluid, and the healing period were all evaluated.

Result

In this study, a total of 7 individuals with ages ranging from 35 to 79 were enrolled. The average amount of time to remove the Negative wound pressure therapy (NPWT) device was four days (ranging from 3 to 6 days). Within three days following surgery, there was an average amount of drainage fluid of 320 mL (with a range of 180–660 mL), and it took an average of 15 days for the wound to heal completely (ranging from 10 to 21 days).

Conclusion

The amount and frequency of clinician irrigations, the time it took for the white blood cell count to restore to normal levels, and the length of hospitalisation all decreased using negative-pressure wound therapy (vacuum sealing drainage). For patients with head and neck odontogenic fascial space infections, it is thus a potential therapeutic approach.