Three essential factors are considered to be necessary for tissue regeneration. The first essential factor is the presence of cells that bear the function of the desired tissue or organ, the second is the presence of signals that promote proliferation and differentiation of the desired cell type, and the third is a scaffold that acts as a foundation for the cells. Of these factors, obtaining stem cells is very important. Currently, there are several different types of stem cells that may be useful in tissue regeneration, including embryonic stem cells（ES cells）, adult stem cells and induced pluripotent stem cells（iPS cells）. ES cells are derived from the inner cell mass of the early blastocyst-stage embryo. Although ES cells are known to differentiate into various functional cells derived from all three germ layers, there are ethical issues, biological limitations and technical difficulties in the application of these cells. Adult stem cells have been identified in adult tissues such as bone marrow, muscle, neural tissue, liver and the adipose tissue. Since there are no ethical problems in their use and since they are relatively easy to collect, adult stem cells may overcome the weak points of ES cells. However, some reports of short cell life spans and limitations in their differentiation potency are distinct disadvantages to the use of adult stem cells. iPS cells, which can be created by transfection of 3 or 4 genes into adult somatic cells, possess a differentiation potency equal to ES cells. iPS cells can overcome the disadvantages of ES cells and adult stem cells, but their biggest drawback is that we have to conduct transfections in order to create these cells. With these points in mind, in this review, the multipotent characteristics of bone marrow stromal cells are documented, and the possibility of their application and a new strategy for tooth regeneration are also discussed.
Purpose: In the present study, we analyzed the usefulness of a DNA probe directed against the alkaline proteinase (ALP) gene of Aspergillus fumigatus to diagnose invasive oral aspergillosis using the in situ hybridization (ISH) technique in patients with hematologic malignancies. Patients and Methods: The ALP probe was tested on tissue specimens from 16 patients with hematological malignancies who had invasive orofacial fungal infections and positive cultures: Aspergillus species in 13 patients as well as Exophiala dermatitis, Trichoderma longibrachiatum, and Candida albicans in 1 patient each. In situ hybridization with the ALP probe was done by using formalin-fixed, paraffin-embedded tissue samples. Results: The ALP probe showed a strong reaction with specimens from all 13 patients who had culture-proven aspergillosis specimens. On the other hand, the ALP probe showed no cross-reactivity with three non-Aspergillus fungi. Conclusions: These findings indicate that ISH using an ALP probe may increase the accuracy of diagnosing invasive oral aspergillosis in patients with hematologic malignancies and facilitate the provision of adequate antifungal treatment.
Cephalic tetanus is a subtype of tetanus, which is associated with cranial nerve palsies and occurs in 1 % to 3 % of tetanus cases. We present a case of cephalic tetanus in an elderly patient with facial nerve palsy as an initial symptom. The patient was a 75-year-old man who had injured his face during gardening. Nine days after the injury, trismus with right facial nerve palsy occurred. Twelve days after the facial injury, he visited our hospital and was admitted immediately. He had severe fatigue, facial nerve palsy, severe trismus, and scabbing and induration at the lesion. CT examination revealed no characteristic findings, such as a fracture or dental infection, except for wood-chip-like materials in the injured area. After that, frequent tonic spasms of the legs occurred, and cephalic tetanus was diagnosed. The spasms developed to general convulsions, and the patient received respiratory care with sedation and tracheal intubation in the ICU. The latency period of tetanus was 9 days, and the onset period was about 84 hours. Chronic obstructive pulmonary disease resulted in severe ventilator-associated pneumonia. In the fourth stage of tetanus, the patient was asked to do mouth-opening exercises and deglutition exercises, and occlusion reconstruction was also performed. He recovered from cephalic tetanus and was discharged from the hospital on day 119 after the onset of disease.
We describe two cases of tetanus. Both patients referred to our hospital because of difficulty in mouth opening. Physical examination revealed severe trismus, dysarthria, and dysphagia in both patients. Patients had no noticeable history of trauma. The patients were given a diagnosis of tetanus on the basis of clinical course and symptoms such as rapidly progressive trismus, dysarthria, and dysphagia. The patients were admitted to our hospital immediately. One patient was given antitetanic human immunoglobulin, tetanus antitoxin, antibiotics, and dantrolen sodium. He recovered without tracheotomy or tracheal intubation, and was discharged on the 25th hospital day. The other patient was given antitetanic human immunoglobulin, tetanus antitoxin, antibiotics, vecuronium bromide, propofol, and magnesol. A tracheotomy was performed in the latter patient because of dyspnea. He discharged on the 26th hospital day. Both patients had no functional sequelae. Tetanus often leads to death when early diagnosis and early treatment are not appropriately performed. Oral surgeons should consider the possibility of tetanus in patients with trismus and examine them carefully.
Adenomatoid odontogenic tumor (AOT) is a relatively rare benign non-invasive odontogenic lesion, which can be subdivided into three variants: follicular, extrafollicular, and peripheral. The follicular type typically shows a well-defined unilocular radiolucency associated with the crown and often part of the root of an unerupted tooth, thus mimicking a dentigerous (follicular) cyst. We report a rare case of follicular type AOT with a funicular structure. A 14-year-old girl was referred for further evaluation of a cystic radiolucent lesion of the mandible. Radiographic examination showed an unilocular radiolucent lesion with focal calcification, including an impacted right permanent canine with an unusual funicular structure that extended to the alveolar crest. We enucleated the lesion and the impacted canine under general anesthesia. Histological examination revealed conspicuous nests or rosettelike structures, as well as a tubular or duct-like appearance formed by cuboidal or columnar cells and calcified structures. These findings confirmed the diagnosis of AOT with an impacted right permanent canine. We speculated that a nutrient canal might be related to the formation of the unusual funicular structure of this tumor.
Iliac bone grafts or titanium meshes with iliac particulate cancellous bone and marrow have been used to reconstruct the mandible. However, it is difficult to reconstruct an ideal three-dimensional mandibular form using these techniques. We describe 2 patients in who reconstruction was performed using a heat-treated oromandibular reconstruction technique after resection of a ameloblastoma of the mandible. Two men aged 70 and 76 years were treated for recurrent ameloblastomas. Cortical bone was obtained as a tray after removing the bone marrow from the resected mandible and was heat-treated in an autoclave for 30 minutes to cause tumor cell death. The cortical bone was returned to its original position and was filled with iliac particulate cancellous bone and marrow (PCBM) . This technique was able to completely reconstruct a three-dimensional mandiblar form and restore the normal shape of the mandible. Heat-treated oromandibular reconstruction is a useful technique that minimizes orofacial deformities.
Pleomorphic adenoma is the most common tumor arising in the salivary glands. Most cases of pleomorphic adenoma occur in the parotid gland, followed by the submandibular gland and minor salivary gland. However, pleomorphic adenoma of the sublingual gland is quite rare. One study has reported that only 0.08 % of pleomorphic adenomas occur in the sublingual gland. We present a case of pleomorphic adenoma in the sublingual gland. A 34-year-old Japanese woman had a swelling localized in the floor of the mouth. We surgically extirpated the tumor under general anesthesia. Pleomorphic adenoma was diagnosed on intraoperative frozen section examination. The tumor was encapsulated and isolated from the surrounding tissues, consistent with the preoperative MRI findings. As of 1 year 9 months after operation, there has been no evidence of recurrence.
Osteoma is a benign tumor consisting of mature bone tissue. A solitary osteoma is classified as peripheral when it arises from the periosteum, central when it arises from the endosteum, and extraskeletal when it arises in soft tissue. Solitary osteomas occur mainly in the craniofacial bones. Peripheral osteomas arising in the condylar process of the mandible are rare. Here, we report a case of peripheral osteoma of the condylar process in a 62-year-old woman who complained of a cosmetic disturbance. The osteoma, 48 X 43 X 37 mm in a diameter, was surgically excised by a submandibular approach. The histopathological diagnosis was a compact osteoma. The patient remains free of recurrence after 1 year.
We report the case of a 9-month-old girl with autoimmune neutropenia in whom pyogenic submandibular lymphadenitis was diagnosed. She visited our hospital for evaluation and treatment of swelling of the left submandibular region, unaccompanied by fever. Hematological examination showed a neutrophil count of 178 cells/μl, indicating severe neutropenia. A CT scan showed abscess formation in the left submandibular region. We performed surgical drainage under general anesthesia. Culture of the drainage fluid revealed methicillin-resistant Staphylococcus aureus. Antibiotics were administered, and the swelling of the submandibular region disappeared. Immunological examination of the serum was positive for neutrophil-binding IgG. This finding suggested that the neutropenia was caused by autoantibodies against neutrophils. Although the neutrophil count increased transiently after treatment with granulocyte colony-stimulating factor for 6 days, neutropenia recurred. Trimethoprim-sulfamethoxazole was given orally every other day for infection prophylaxis. Recurrence of infectious disease, including cervical lymphadenitis, has not occurred up to the present.