We evaluated the effect of nicotine on osteoinduction by recombinant human bone morphogenetic protein-2 (rhBMP-2). Five micrograms of rhBMP-2 was implanted into the calf muscle of 10-week-old Wistar rats. For 14 days after implantation, nicotine was continuously administered subcutaneously in a dose of 0.1 (group L), 1.0 (group M), or 10.0 (group H) mg/kg/day. In the control group (group C), only physiological saline was administered. On day 21 after implantation, soft radiographs were obtained, and histological and biochemical analyses were performed. The results suggested that a high dose of nicotine pre ents bone formation. In addition, we investigated the effect of nicotine on osteoinduction. For 14 days after rhBMP-2 implantation, nicotine was continuously administered in the dose used in group M. The control group was given only physiological saline. On days 3, 7, 14, and 21 after implantation, soft radiographs were obtained after the injection of contrast media, and histological and biochemical analyses were performed. In the radiographic study with contrast media, there were fewer small capillaries in the rhBMP-2-implanted muscle in the nicotine group than in the control group. Histologically, nicotine reduced new bone and cartilage formation and decreased the number of capillaries. On quantitative biochemical analysis, indices of bone formation in the nicotine group were significantly lower than those in control. These results suggest that the prevention of bone formation by nicotine may be caused by a reduced blood supply to rhBMP-2-implanted muscle.
Jaw relaxation guidance, opening excursive exercises, and arthrocentesis are easy and minimally invasive procedures in patients with closed lock of the temporomandibular joint (TMJ). We describe these three procedure and report their effectiveness in 41 patients with closed lock of the TMJ. Jaw relaxation guidance was done in 17 patients with acute lock of the TMJ. Opening excursive exercises were performed in 12 patients who had chronic lock without severe joint pain. In 12 patients who had chronic lock with severe joint pain, arthrocentesis under sufficient hydraulic pressure and opening excursive exercises were performed. The efectiveness of the procedures was evaluated on the basis of the range of maximum mouth opening and joint pain at maximum mouth opening. Two weeks after these three procedures, the rangeof maximum mouth opening and joint pain at maximum mouth opening improved significantly.Our results indicate that these the rapies are easy and highly effective for the treatment of closed lock of the TMJ.
Calcifying epithelioma is a benign tumor derived from hair matrix cells. We evaluated the clinicopathological characteristics of 6 calcifying epitheliomas between January 1994 and March 2003. Four patients were male, and 2 were female. They ranged in age from 13 to 29 years (mean, 22.8 years). Symptoms comprised tumor formation in 4 patients, and tumor formation with redness of the overlying skin in 2 patients, including 1 with vesicle formation. Clinically, this tumor was easily diagnosed in typical cases. In cases with inflammation or vesicle formation, fineneedle-aspiration cytological examination was helpful for diagnosis. Histopathologically, the tumor consisted of basophilic cells and shadow cells. In addition, calcification, bone formation, and foreign body giant cells were also observed in the tumor.
DiGeorge syndrome (DGA), velocardiofacial syndrome (VCFS), and conotruncal anomaly face syndrome (CTAF) are frequently associated with 22q11.2 deletion syndrome. We report two cases of 22q11.2 deletion syndrome. Two patients had cleft palate, and facial dysmorphism. Fluorescence in situ hybridization (FISH) was used to show deletion of chromosome 22q11.2. Palatoplasty was performed at about two years of age with the patients under general anesthesia. The postoperative course was uneventful in both patients.
We report a case of actinomycosis affecting the buccal mucosa in a patient with systemic lupus erythematosus. A 66-year-old woman with systemic lupus erythematosus presented with a swelling of the lower lip and left cheek. We suspected a salivary gland adenocarcinoma on inspection, palpation, and evaluation of the serum CA19-9 level. Enhanced computed tomography showed the location of the tumor. Other imaging techniques, including magnetic resonance imaging and ultrasonic tomography, were employed to support the clinical diagnosis. We performed a biopsy and histopathologically diagnosed the lesion as actinomycosis. The patient underwent abscess incision several times and received intravenous injections of 3g ABPC daily for 7 days, followed by 400mg of oral ABPC for 4 weeks. There was no sign of recurrence after treatment. Imaging methods were considered useful for the clinical diagnosis of actinomycosis.
Because gun possession is illegal in Japan, gunshot wounds are rare as compared with Western countries. We describe our experience with a patient who had a gunshot wound. The bullet entered the left upper lip, penetrated the faucial isthmus along the left buccal mucosa, and was retained in the posterior cervical region.
We describe a sublingual type of dermoid cyst that caused obstructive sleep apnea syndrome (OSAS). A 20-year-old man was referred to our clinic because of a swelling of the submental region, insomnia, and daytime sleepiness. The clinical diagnosis was a dermoid cyst or an epdermoid cyst accompanied by OSAS. The occurrence of breathing disorders and daytime drowsiness were monitored to evaluate OSAS before and after surgery. The preoperative Apnea-Hypopnea Index (AHI) and Epworth Sleepiness Scale (ESS) were 39 and 14, respectively. The postoperative AHI and ESS were 10 and 1, respectively. After surgery, insomnia and daytime sleepiness improved. As of 3 years after the operation, there is no evidence of recurrence.
We report a case of rheumatoid arthritis of the temporomandibular joint associated with regression of the mandible and anterior open bite. The patient was treated successfully by orthognathic surgery. Case: A 46-year-old woman had chronic rheumatoid arthritis since 1989. The patient visited our hospital in 1994 because of pain in the left temporomandibular joint. Magnetic resonance imaging showed anterior disc displacement without reduction, and arthroscopic lysis and lavage were performed. In 1999, the patient unexpectedly had mandibular condylar destruction accompanied by resorption, with an anterior open bite. In 2001, surgical-orthodontic correction by sagittal split osteotomy and orthodontic treatment were performed. At present, 3 years after orthognathic surgery, the patient's occlusion is stable, with no recurrence of mandibular condylar destruction or resorption.
We report a case of deep vein thrombosis occurred after mandibular reconstruction with a vascularized iliac bone graft. A 30-year-old man was referred to our clinic because of a right mandibular bone defect after segmental resection for ameloblastma of the mandible. Reconstruction with a vascularized iliac bone graft was performed with the patient under general anesthesia. On the 18th day after the operation, leg pain and edema on the left side suddenly occurred. Enhanced computed tomographic and angiographic examinations were performed. The diagnosis was deep vein thrombosis. The patient received heparin and urokinase as anticoagulant therapy and successfully recovered. There has been no evidence of pulmonary embolism.