We developed a new thin rod-lens arthroscope (DRK scope-21) to achieve highly reliable arthroscopy of the temporomandibular joint (TMJ) under local anesthesia in an outpatient setting. In this study, the accuracy of this arthroscope for diagnosis of osteoarthritis (OA) was experimentally evaluated in 21 rabbit knee joints: 17 with OA and 4 without OA. The diagnostic accuracy of this arthroscope for OA based on stereomicroscopic findings was verified by histopathological examination and was compared with the accuracy of MRI and soft X-ray examination. The diagnostic sensitivity of the arthroscope was 100%, the specificity was 80.0%, and the accuracy was 95.2%. These values were higher than those of MRI (sensitivity, 50.0 %; specificity, 40.0 %; accuracy, 52.4%) or soft X-ray examination (sensitivity, 43.8%; specificity, 40.0 %; accuracy, 47.6%). In addition, the arthroscopic diagnosis of the severity of OA was compared with the stereomicroscopic diagnosis, considered the optimal standard. The severity of OA was classified into the following 3 stages: normal, fibrillation, and exposure of subchondral bone. The rate of agreement between arthroscopic diagnosis and stereomicroscopic diagnosis was 90.5%(19/21 joints). In the remaining 9.5%(2/21 joints), there was overdiagnosis by arthroscopy. In conclusion, the present findings show that the DRK scope-21 is highly accurate for diagnosis of OA, with a very low risk of failing to detect OA.
The effects of various administration methods on postoperative biological responses were determined by measuring serum levels of various cytokines. The subjects were 23 patients who underwent sagittal split ramus osteotomy at our department over a 1-year period from 2001 to 2002. These patients were randomly assigned to three groups with respect to dexamethasone (DM) administration: in 8 patients, DM was not administered before or after surgery (Group 1); in 7 patients, 8 mg of DM was administered just before surgery (Group 2); and in 8 patients, 8 mg of DM was administered just before surgery, 4 mg was administered immediately after surgery, and 2 mg was administered at 6 and 12 hours after surgery (Group 3). Clinical characteristics such as age, body weight, surgery time, anesthesia time, hemorrhage volume, transfusion volume, and urine volume were assessed. In addition, the concentrations or detection rates of serum TNF-α, IL-1β, IL-6, IL-8, IL-10, and IL-12 were determined. General blood tests were performed before, immediately after, and 1, 3, and 7 days after surgery. Because the levels of IL-1 βand IL-12 were generally below detection limits, detection rates were calculated for these cytokines. The IL-1βdetection rate in Group 3 was lower than that in the other two groups. The IL-12 detection rate in Group 1 was significantly higher than that in the other two groups, but there were no significant differences between Groups 2 and 3. As for the other cytokines, the TNF-αlevel immediately after surgery in Group 3 was significantly lower than that in Group 1. Similarly, the level of IL-6 1 day after surgery in Group 3 was significantly lower than that in Group 1. Thr levels of IL-10 immediately after surgery in Groups 2 and 3 were significantly higher than that in Group 1. The results showed that DM treatment before and after bilateral sagittal split ramus osteotomy suppressed the production of inflammatory cytokines without compromising immunocompetence. DM treatment before and after bilateral sagittal split ramus osteotomy was thus shown to be useful for attenuating postoperative inflammatory response immediately after surgery.
Improved treatment of elderly inpatients requires evaluation of their systemic status. We performed open reduction of a mandibular fracture under general anesthesia in a patient who had various underlying diseases, such as hypertension, emphysema, cerebral infarction, diabetes mellitus, and dementia. The patient had presented with dementia before hospitalization. To ensure safety, we paid attention to falling, which had caused the mandibular fracture. However, coronary arterial spasm unexpectedly occurred during operation under general anesthesia. After the planned operation, we prevented the onset of spastic angina, and the patient was discharged without any complications. It is essential to carefully confirm systemic status, including emerging symptoms and disease, to ensure safe perioperative management in elderly patients with many underlying diseases such as hypertension, cerebral infarction, and dementia.
Oral lichen planus (OLP) is classified as a precancerous condition according to the WHO histological classification; however, the neoplastic process involved has not been fully elucidated. Only a few cases of malignant transformation of OLP have been reported in Japan, most of which lack sufficient histological data. Although leukoplakia is occasionally associated with verrucous carcinoma, very few reports have documented verrucous carcinoma arising from lichen planus. This report describes a case of verrucous carcinoma considered to have originated from OLP. The patient was a 44-year-old man with OLP. During long-term observation, a tumor developed at the left side of the lower lip and at the left side of the buccal mucosa. The results of histopathological tests confirmed verrucous carcinoma accompanied by OLP.
Osteoma in the maxillary sinus, especially isolated osteoma, is very rare in Japan. We present a case of isolated osteoma in the maxillary sinus that was detected by chance on cephalograms obtained before surgical orthodontic treatment to correct facial asymmetry. There were no signs or symptoms caused by the osteoma. After orthodontic treatment for 3 years, the tumor was removed simultaneously with Le Fort I osteotomy under general anesthesia. The tumor was encapsulated by fibrous tissue and was isolated from the maxillary sinus wall. It measured 28×14×12 mm. Histopathologically, the lesion was diagnosed as an osteoma. There has been no sign of recurrence for 3 years after surgery. Reports of Japanese cases of osteomas of the maxillary sinus are clinicopathologically reviewed.