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Morimichi OHYA, Yoichi YAMADA, Keisuke WADA, Kazuyo WATANABE, Ryotaro ...
2004 Volume 50 Issue 10 Pages
559-566
Published: October 20, 2004
Released on J-STAGE: April 22, 2011
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Recently, minimally invasive surgery based on a tissue engineering has become possible. We used an animal model to evaluate a method for bone regeneration by maxillary sinus floor augmentation that uses mesenchymal stem cells (MSCs) and platelet-rich plasma (PRP) instead of an autologous bone graft. The MSCs were isolated from rabbit iliac crest marrow aspirates, and PRP was obtained from peripheral blood. MSCs and PRP complexes were used for grafting. In the control group, autogenous particulate cancellous bone and marrow (PCBM) was collected and mixed with PRP. Histological examination showed that new bone formation was good in both groups at 2 and 4 weeks. At 8 weeks, lamellar bone had formed, but fatty marrow was also observed in both groups.
The present results suggest that MSCs/PRP complexes may be used in place of autogenous bone to promote bone regeneration after maxillary sinus floor augmentation.
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Aoi FUKUDA, Shosuke MORITA
2004 Volume 50 Issue 10 Pages
567-576
Published: October 20, 2004
Released on J-STAGE: April 22, 2011
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Vascularized bone grafts have been widely used to replace bone lost by disease or trauma. While this approach has been generally successful, some problems remain. Autologous bone grafts are limited in supply and can occasionally cause severe surgical trauma. Recently, some studies were undertaken to evaluate the potential of using cultured cells and biomaterials to produce tissue-engineered bone.
We created prefabricated vascularized bone grafts in the femur of rats by the combined use of a collagen sponge scaffold, osteoblasts differentiated from rat bone marrow, and a vascular bundle in a diffusion chamber. In the experimental group, the saphenous vessels of 8-week-old Fischer rats were exposed under general anesthesia and placed on slits cut into the diffusion chamber. Then, a collagen sponge scaffold seeded with osteoblasts was packed into the diffusion chamber. In the control group, the procedure was similar, without the placement of vessels. One, 3, 6, and 9 weeks after operation, the implants were harvested, and new bone formation was assessed histologically and biochemically.
In the experimental group, histological analysis showed active bone formation in the diffusion chamber. Bone formation was confirmed by the presence of osteoblasts lining the surface of new bone. Substantial alkaline phosphatase activity in the composites was detected soon after the procedure. Osteocalcin, detected immediately after implantation, increased slightly later. In contrast, there was no significant bone formation in the control group.
These results suggest that the combination of a collagen scaffold, osteoblasts, and a vascular bundle in the chamber may be a useful method for the prefabrication of vascularized bone grafts.
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combination therapy with two consecutive arthrocenteses followed by mouth opening exercises and non-steroidal anti-inflammatory drug administration
Kensuke NAKATSUKA, Kenichi KURITA, Nobumi OGI, Makoto TAKAISHI, Hiroak ...
2004 Volume 50 Issue 10 Pages
577-584
Published: October 20, 2004
Released on J-STAGE: April 22, 2011
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Arthrocentesis is the surgical treatment of choice for temporomandibular joint (TMJ) disorders. Many studies of arthrocentesis have reported an excellent clinical outcome. No previous report, however, has described the use of multiple arthrocenteses to treat TMJ dysfunction. We evaluated the efficacy of two consecutive arthrocenteses followed by mouth opening exercises during treatment with non-steroidal anti-inflammatory drugs (NSAID) as a primary treatment for TMJ osteoarthritis.
The subjects of this study were selected from a consecutive series of patients with unilateral moderate-to-severe TMJ dysfunction newly diagnosed at the TMD Clinic, Aichi-Gakuin University Hospital during a 1-year period. Thirty-six patients with osteoarthritis as documented by magnetic resonance imaging underwent two consecutive arthrocenteses at a 2-week interval followed by mouth opening exercises and NSAID administration. The patients were postoperatively examined every 2 weeks for 12 weeks. Clinical evaluations included pain-related measures on visual analog scales (VAS, 0-100) and range of motion. At the completion of treatment, patients had sustained pain relief and improved mouth opening. Factors that affected clinical outcome of TMJ function were assessed.
Of the 36 patients who underwent two consecutive arthrocenteses, 28 showed substantially improvement on follow-up at 12 weeks. The range of motion (median) increased from 28 mm to 39.5 mm. VAS pain-scores on mouth opening and chewing significantly decreased from 54 and 53 to 10 and 7, respectively. The interference score for activities of daily life also decreased from 33.5 to 9. A longer duration of TMJ symptoms before the procedure was found to affect the outcome.
Two consecutive arthrocenteses were apparently markedly superior to a single arthrocentesis in alleviating TMJ dysfunction. Pain-free TMJ function was restored in 78% of the patients with this treatment within 12 weeks.
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Wataru MURAOKA, Masako IKAWA, Noboru IMAI, Shinobu IKEUCHI, Soichirou ...
2004 Volume 50 Issue 10 Pages
585-588
Published: October 20, 2004
Released on J-STAGE: April 22, 2011
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Temporal arteritis, also referred to as giant cell arteritis, is a rare disease in Japan. The epidemiological investigation performed by the Ministry of Health and Welfare in Japan in 1998 reported that temporal arteritis occurred at a frequency of 0.65 cases per 100, 000 population. The first symptoms, according to this report, were headache, usually in the temporal region, accompanied by fever, weight loss, and visual disturbance.
A 78-year-old woman with temporal arteritis who had a chief complaint of jaw claudication is reported. Her symptoms at first consultation were bilateral temporal tenderness, funicular swelling of the superficial temporal artery, and an increased erythrocyte sedimentation rate. Because temporal arteritis was suspected, the patient was referred to a neurologist. After admission to the department of neurology, the right temporal artery showed an embolus on digital subtraction angiography and the left temporal artery showed constriction; a biopsy of the right temporal artery was therefore performed by an otolaryngologist. Histopathological examination showed a granulomatous inflammatory lesion with mononuclear cell infiltration associated with Langhans' type giant cells, involving mainly the tunica intima. By the early diagnosis of temporal arteritis and immediate steroid administration, these symptoms markedly improved within 48 hours, and no signs or symptoms have been observed subsequently.
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Yasuhisa SHINOZAKI, Kentaro HOSHI, Yoshinori JINBU, Mikio KUSAMA
2004 Volume 50 Issue 10 Pages
589-591
Published: October 20, 2004
Released on J-STAGE: April 22, 2011
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A 77-year-old man presented with a painless swelling in the right side of the buccal mucosa. A tumor of the buccal mucosa was suspected on the basis of clinical and radiological findings. However, histopathogical examination of a biopsy specimen showed a sialolith accompanied by adhesion of Actinomyces, suggesting that the lesion was caused by minor salivary gland sialolithiasis and actinomycosis. As this condition has not been reported previously, the present case must be extremely rare.
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Noriyuki TAKASHI, Noritaka OHGA, Takamitsu KOSHIKAWA, Masashi TAKANO, ...
2004 Volume 50 Issue 10 Pages
592-595
Published: October 20, 2004
Released on J-STAGE: April 22, 2011
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The aim of this study was to clarify factors affecting the clinical outcomes of conservative treatments for unilateral mandibular condylar fractures. In 41 patients (30 males and 11 females) treated at our hospital, age, sex, clinical findings, image findings, and methods of treatment were investigated. The duration of trismus and mandibular deviation during mouth opening were clinically evaluated. The correlations were studied by multivariate analysis.
The results were as follows:
There were significant correlations between condylar dislocation and the duration of trismus and between the degree of malposition of bone fragments and mandibular deviation during mouth opening.
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Kazutoshi KAMEI, Tomoyuki SAITO, Momoko NAKAMURA, Ko ITO, Motohiro KOB ...
2004 Volume 50 Issue 10 Pages
596-599
Published: October 20, 2004
Released on J-STAGE: April 22, 2011
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Penetrating injuries, especially those involving the palate intraoral region, often occur in children. This is because when children begin to walk, their range of action increases but is unstable; moreover, children frequently play with something stuck in their mouth. Penetrating injuries of the facial region are rare. Many patients recover without brain trauma. We report a case of a penetrating injury of the facial region. A 4-year old girl fell down, and a pair of tweezers penetrated her left cheek and temple. The tweezers was used to feed tropical fish. She was taken to the emergency room without removal of the tweezers. Her consciousness was clear, but she had impaired movement of the left eye and a left-side nosebleed. After a radiographic examination, the tweezers were removed under a local anesthesia. The deep penetration caused cerebrospinal fluid leakage. The bleeding volume was small. The wound was compressed after being sutured. A computed tomographic scan showed no brain injury. Antibiotics were prescribed for several days. As of 22 months after injury, there have been no complications and the outcome is good.
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Shu ISHIBASHI, Yoshiki SUGIYAMA, Yasunori TAKEDA, Hideyuki FURUUCHI, K ...
2004 Volume 50 Issue 10 Pages
600-603
Published: October 20, 2004
Released on J-STAGE: April 22, 2011
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Dentinogenic ghost cell tumor (DGCT) is a rare lesion regarded to be a variant of calcifying odontogenic cyst (COC). However, some investigators recommend that DGCT should be distinguished from COC, because DGCT shows more aggressive behavior than ordinary COC. DGCT trends to occur in elderly persons and is composed mainly of ameloblastoma-like solid epithelial nests containing numerous ghost cells and dentinoid tissue. In this report, we present a case of DGCT in the mandibular molar region.
A 73-year-old woman was referred to us because of a tender tumor mass in the mandibular molar region. An elastic soft oval tumor, measuring 20×12 mm, was found in the gingiva near the lower left third molar. The covering mucosa of the lesion showed slight redness. On the panoramic X ray film, a clearly demarcated semicircular radiolucent lesion with many radiopaque spots was observed in the left side of the mandible. The lesion was excised under local anesthesia. The postoperative course was uneventful, with no recurrence.
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Toshiya OKO, Ryo KINUGAWA, Naoki SAKAUE, Yoshiki ISHIDA, Masahiro UMED ...
2004 Volume 50 Issue 10 Pages
604-607
Published: October 20, 2004
Released on J-STAGE: April 22, 2011
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We present a case of carcinosarcoma arising in the submandibular gland. A 57-year-old man consulted our department in January 2002 because of a swelling in the right submandibular region. He had a past history of a bladder tumor. On initial examination, we recognized induration coincident with the right submandibular gland and Wharton's duct. A biopsy specimen showed a malignant tumor. Magnetic resonance imaging showed no extra-glandular invasion of the tumor, and radioisotope studies demonstrated abnormal accumulation only in the right submandibular region. He underwent resection of the right side of the oral floor and submandibular triangle in March. Histopathological examination of the surgical specimen showed that the tumor consisted of three components, i. e., squamous cell carcinoma, adenocarcinoma, and sarcoma. On immunohistochemical studies, the sarcomatous component showed negative reactions for epithelial markers such as E29, CEA, MNF116, and AE1/AE3. We diagnosed the tumor as carcinosarcoma. Since local recurrence and metastases to the cervical lymph nodes occurred 3 months postoperatively, he underwent further surgery, i. e., radical neck dissection with resection of the oral floor, part of the tongue, and the mandible, followed by immediate reconstruction with a forearm free flap and titanium plate in July. Nine months after the second procedure, a computed tomographic scan showed metastases in the lung. Though he received anticancer drugs intravenously, metastases to the lung increased and further metastases appeared in the skull base, cervical vertebra, inguinal region, and liver. He died of MRSA pneumonia on June 1, 2004.
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Masashi TAKANO, Mitsunobu ONO, Yoichi OHIRO, Kanchu TEI, Yasunori TOTS ...
2004 Volume 50 Issue 10 Pages
608-611
Published: October 20, 2004
Released on J-STAGE: April 22, 2011
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We describe two cases of lower gingival carcinoma deeply invading the mandible that remarkably regressed in response to TS-1 chemotherapy. Patient 1, a 73-year-old woman, presented with hypoesthesia of the right lower lip. Clinical examination revealed an ulcerated lesion with induration in the right lower side of the gingiva. Orthopantomography showed a tumor deeply invading the mandible. Biopsy revealed a well-differentiated squamous cell carcinoma. Electrocardiography showed ischemic heart disease, requiring immediate treatment. She underwent percutaneous transluminal coronary angioplasty (PTCA) before mandiblectomy. Twelve days before the operation, she was given TS-1, because the bone defect worsened despite treatment with UFT during cardiovascular therapy. Patient 2, a 61-year-old woman, presented with an ulcerative lesion in the right lower side of the gingiva. Orthopantomography showed an extensive bone defect in the right side of the mandible. After histopathological diagnosis confirmed squamous cell carcinoma, chemotherapy with TS-1 was started 8 days before the operation. Histopathological findings showed that the tumors in both patients regressed remarkably in response to TS-1.
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Tsutomu KOITABASHI, Hideki KON, Masahide MIZUTANI, Satoshi TAKADA, Tak ...
2004 Volume 50 Issue 10 Pages
612-615
Published: October 20, 2004
Released on J-STAGE: April 22, 2011
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Mucoepidermoid carcinoma, one type of malignant tumor of the salivary glands, consists of mucous, squamous, and intermediate cells, and mainly occurs in the major salivary glands, especially the parotid gland (60 %), and in the minor salivary glands (30 %). Clinically, mucoepidermoid carcinoma with destruction of bone is rare. We report a case of central mucoepidermoid carcinoma of the mandible. A 46-year-old man was referred to our hospital because of swelling of a right mandibular molar. Panorama X-ray film and a computed tomographic scan clearly showed a multilocular radiolucent lesion. The diagnosis on biopsy was mucoepidermoid carcinoma. We performed upper neck dissection, and block resection of the mandible with the patient under general anesthesia. The block resection of the mandible was followed by reconstruction with a mandibular reconstruction plate and a pectoral major musculocutaneous (PMMC) flap. Histologically, the tumor mainly consisted of mucous, squamous cells, and the histopathological diagnosis was mucoepidermoid carcinoma. The patient's postoperative course has been good, with no evidence of recurrence as of about 4 and a half years after the operation.
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Makoto SAKOH, Chitose MURATA, Naoyuki SATO, Takeshi HITOSUGI, Yukiko M ...
2004 Volume 50 Issue 10 Pages
616-619
Published: October 20, 2004
Released on J-STAGE: April 22, 2011
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Multiple myeloma is a disease characterized by the proliferation of tumorigenically transformed plasma cells in bone marrow. It is associated with various symptoms. We describe a patient who was given a diagnosis of multiple myeloma based on the results of systemic tests and showed rapid progression of disease.
The patient was a 65-year-old woman. In September 1999, she noticed that a second molar was mobile and contacted the tongue. Because an ulcer developed in the same area, the patient visited our department for the first time on October, and the tooth was extracted. After extraction, the patient's progress was initially favorable. However, starting about November, swelling and hardening were observed in the anterior third of the tongue. With a suspected diagnosis of glossitis, antibiotic administration was started, but lingual hardening increased, swallowing and feeding problems worsened, and body weight decreased. Consequently, the patient was admitted on December.Tubal feeding was immediately started, and systemic tests were conducted because amyloidosis was suspected. MRI findings did not indicate a tongue neoplasm, and histopathological analysis revealed amyloidosis AA protein. M protein (Bence-Jones kappa type) was detected in serum and urine. Because multiple myeloma was suspected, whole-body plain X-ray imaging was performed, and systemic punched-out lesions were confirmed. On December M, the patient underwent bone marrow aspiration of the sternum and kidney biopsy, and multiple myeloma was diagnosed. On December, VAD therapy was initiated. The patient had a high fever and circulatory failure 8 days after the start of chemotherapy and died 2 days later.
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Yutaka FUKUSHIMA, Yoko MATSUSE, Mamiko YAMAMOTO, Junichi SATO, Nobuoki ...
2004 Volume 50 Issue 10 Pages
620-623
Published: October 20, 2004
Released on J-STAGE: April 22, 2011
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The Laugier-Hunziker-Baran syndrome represents a rare acquired pigmentary disorder of the lips, oral mucosa, and nails. We report two cases showing acquired, benign, macular hyperpigmentation of the buccal mucosa, lips, and fingers. The patients had no family history related to this condition and no history of gastrointestinal disorders or generalized skin disorders. Because of its clinical importance, Laugier-Hunziker-Baran syndrome should be included in the differential diagnosis of pigmentary disorders of the oral mucosa with associated nail involvement. It is particularly important to differentiate this condition from Peutz-Jeghers syndrome.
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Chie FUKAYA, Kaori YAGO, Shiho OOTUKA, Meiko OKADA, Taneaki NAKAGAWA, ...
2004 Volume 50 Issue 10 Pages
624-627
Published: October 20, 2004
Released on J-STAGE: April 22, 2011
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Concool F
®is a chemical mouthwash containing chlorhexidine gluconate that is used for the treatment of periodontal disease and halitosis. We report a case of gingival necrosis caused by incorrect use of Concool F
®A 52-year-old woman was referred to our hospital because of gingival necrosis. One week before presentation, she went to sleep after putting a cotton roll soaked in a large amount of Concool F
®solution (0.36 % chlorhexidine gluconate) on the upper gingiva to reduce bad breath. She noticed bleeding and a painful ulcer in the upper gum from the maxillary right lateral incisor to the left second premolar.
Whenever a mouthwash agent containing chlorhexidine gluconate is used, we must be cautious about its usage and dosage and instruct the patients on proper use.
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