Recently it pays attention to regenerative medicine by the discovery of embryonic stem cells(ES cells)and induced pluripotent stem(iPS)cells. The regenerative medicine aims at restoration of lost healthy tissue by increasing and applying viable cells, and tissues are reconstructed with 3 elements(stem cells, scaffolds, and growth factors), among which‘stem cells’are considered to play the most important role. Although the current gold standard of bone formation and regeneration for severe alveolar bone atrophy associated with tumor resection and trauma is still autologous bone transplantation, it requires injuring a healthy region, giving stress to the patient. Moreover, the amount of tissue sampling is limited, and absorption of grafted bone occurs. To reduce the patient’s burden and consider the aesthetic issue, we attempted to develop a less invasive tissue regeneration method, and have contributed to patients by applying it for alveolar bone regeneration in clinical cases. Since this method uses autologous stem cells and platelets, it can be regarded as a tailor-made medical care. We expanded the indication from alveolar bone regeneration for implant placement to periodontal disease, residual bone defect, and distraction osteogenesis in more than 50 cases including a case in which 6.5 years have passed after treatment. These cases showed that osteogenesis before bone regeneration occurred early.Therefore, alveolar bone regeneration has become a satisfactory treatment method. In addition, regarding anesthetic improvement we succeeded in interdental papillary regeneration for black triangle using stem cells. This treatment is simply applied by infusion, requiring no incision, and repeated application is possible using preserved(bank)cells. Here we will introduce the protocol of clinical application, indications, and outcome of regenerative medicine including the long-term outcomes of the clinical applications, and propose early realization and spread of its practical use based on these clinical outcomes showing the efficacy. Next we also paid attention to milk teeth, which have been discarded as medical waste, as a new source of stem cells, the promising key factor of regenerative medicine. Stem cells collected from milk teeth have potent proliferative ability, compared to those of bone marrow-derived and permanent tooth pulp stem cells, suggesting a possibility of allograft. The possibility of bone regeneration using new stem cells will also be discussed. The development of regenerative medicine for the maxillofacial region represents a social contribution by the dentistry field, and may lead to paradigm shift to the new treatment method.
The secondary correction of cleft lip nasal deformity(CLND)presents difficult surgical problems.Characteristically, nostrils are asymmetric. The present study was aimed to examine and compare the effect of Straith's alar web Z-plasty, Millard's alar web Z-plasty, alar web excision, and lateral V-Y advancement of the alar base for augmentation of the nostril with or without lengthening the columella in CLND. The subjects were 28 patients with unilateral cleft lip, who had secondary nostril correction. The nostril correction methods were Straith's alar web Z-plasty, Millard's alar web Z-plasty, alar web excision, and lateral V-Yadvancement of the alar base. Facial photographs were taken before and 20days after the operation. By using Adobe photoshop, the columella length and the nostril width were measured from the facial frontal photograph and Worm's eye view. The degree of improvement was calculated and statistically analyzed. The degree of improvement of the columella length using Straith's alar web Z-plasty was 70.20 %. And then Millard's alar web Z-plasty was 55.01 %, alar web excision was 39.93 %, and lateral V-Y advancement of the alar base was 16.38 % in order. The degree of improvement of the nostril size using lateral V-Y advancement of the alar base was 55.26 %. And then alar web excision was 52.72 %, Millard's alar web Z-plasty was 34.86 %, and Straith's alar web Z-plasty was 16.06 % in order. Straith's alar web Z-plasty and Millard's alar web Z-plasty resulted in elongation of the columella, equalization of asymmetrical nostril, and enlargement of small nostrils. Alar web excision enlarged nostrils and restored symmetry. Lateral VY advancement of the alar base increased nostril width and enlarged nostrils. These results indicate that the correction of nostrils improve the shape and the symmetry of the nostrils in CLND.
Bisphosphonates(BPs)were first reported to inhibit bone resorption by Fleisch et al. in 1969. BPs are frequently used to treat bone metastatic carcinoma, hypercalcemia, multiple myeloma, and osteoporosis. However, many cases of BP-related osteonecrosis of the jaws(BRONJ)have been reported in the United States since 2003, and similar cases have also been documented in Japan since 2006. The results of the first nationwide survey of BRONJ in Japan were reported in 2007. The present report is the follow-up survey of the previous one in 2007 and describes the present status of the patients after 2 years. Twenty-eight patients were studied because 2 were ineligible. Because 9 patients were completely cured during this follow-up survey, 17 patients(60.8 %)of all patients were completely cured. Nine(52.9 %)of the 17 patients given intravenous BPs and 7(77.8 %)of the 9 patients given oral BPs were completely cured. Surgical treatments, such as sequestrectomy, curettage, and resection of the jaw bone, were performed in 15(88.2 %)of the 17 cured patients and 7(63.6 %)of the 11 non-cured patients. Antibiotic therapy was given to 14(82.4 %)of the cured patients and all of the non-cured patients. Drug holidays of BPs were taken in 9(52.9 %)of the cured patients and 10(90.9 %)of the non-cured patients. Surgical treatments appeared to be performed at a higher rate in the cured patients than in the non-cured patients. In contrast, conservative treatments were given to more non-cured patients than cured patients. These results suggest that surgical treatments may be useful for BRONJ when given at the appropriate time. In addition, BRONJ was shown to be refractory because only 9 of 17 cases were cured in these 2 years.
The outcomes of radical neck dissection have recently improved considerably; postoperative sequelae such as shoulder joint disorders have become a problem. Sequelae of radical neck dissection include decreased range of motion of the upper limbs/neck caused by trapezius muscle disorders, muscular weakness, and impaired ability to elevate the upper limbs. Numbness and pain in the neck/shoulders can also arise.We describe a case of severe, unmanageable cervical pain that arose in a 49-year-old man immediately after total neck dissection for late cervical lymph node metastasis 6 months after undergoing partial tongue dissection to treat cancer of the left side of the tongue. Immediately after surgery, the patient complained of intolerable pain at the site of the cervical skin incision. An anti-inflammatory analgesic drug did not relieve the pain. An antidepressant agent together with physical rehabilitation and trapezius muscle massage were prescribed as supportive therapies for the cervical and shoulder joint disturbances. The cervical pain then subsided. Our experience suggests that the early administration of antipsychotic agents and rehabilitation might be effective for the management of pain after radical neck dissection.
Dermoid cyst is a developmental cyst arising from displaced epithelium. It usually appears in soft tissue and is extremely rare in bone. This report describes a case of dermoid cyst that secondarily arose at the site of an alveolar bone graft in a patient with cleft lip and palate. Alveolar bone grafting was performed at the age of 9 years, and then orthodontic treatment was done at the clinic of an orthodontist. At 22 years of age the patient visited the orthodontist because malalignment of the dental arch had recurred. Radiographic examination revealed a radiolucent area in the alveolar cleft, and the patient was referred to us for alveolar bone grafting. The cyst was surgically removed, and alveolar bone grafting was carried out at the same time. Histologically, the cyst consisted of squamous epithelium and adnexal skin structures, sebaceous glands, and hair follicles. To our knowledge, this is the first reported case of dermoid cyst secondarily arising within the site of a bone graft in a patient of dermoid with cleft lip and palate. We briefly discuss the possible pathogenesis.
Schwannoma is a benign neoplasm arising from the Schwann cells of the neural sheath. It is a relatively rare tumor in the oral region. Schwannoma of the upper lip is extremely rare. We report a case of schwannoma of the upper lip. A 77-year-old woman visited our hospital because of a painless swelling of the left side of the upper lip. Magnetic resonance images showed a well-defined, liquiform lesion that was hypointense on T1-weighted images and hyperintense on T2-weighted images. The lesion was surgically resected. Histopathological examination of the resected tumor revealed a schwannoma, which was mixture of Antoni type A and B. As of 18 months after the operation, there is no evidence of recurrence.
We report the rare case of a mandibular fracture in a patient with acute myeloid leukemia(AML). A 69-year-old man was referred to us because of a mandibular fracture. On admission, the white cell count was 14100/μl with 69.5 % blastoid cells, the hemoglobin level was 6.9 g/dl, and the platelet count was 23000/μl. Bone marrow aspiration revealed hypercellular marrow containing many peroxidase-positive blastoid cells(85.4 %). A mandibular fracture with AML was diagnosed, and we initially planned an operation for the mandibular fracture. However, because infection is known to be the most common cause of death in patients with leukemia, antibiotics were administered in accordance with the guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Subsequently, fixation of the mandible and drainage of the intermandibular space were performed, with no evidence of severe infection in the perioperative period. On postoperative day 13, the patient received induction therapy with cytarabine and idarubicin. Although the leukemia responded well to chemotherapy, the patient died of an intracerebral hemorrhage after consolidation therapy.
An intramuscular lipoma is a deep-seated heterotopic benign mesenchymal tumor that originates in a skeletal muscle and infiltrates the adjacent muscle. It tends to recur after excision. This tumor is also referred to as “infiltrating lipoma" and differential diagnosis from well-differentiated liposarcoma is necessary. Intramuscular lipoma is very rare in the oral and maxillofacial region. We describe a case of intramuscular lipoma occurring in the musculus pterygoideus medialis or lateralis that spread to the infratemporal fossa in association with mental nerve neuropathy in a 59-year-old man. With the patient under general anesthesia, we excised the tumor, including the circumferential tissue. At the 2.5-year postoperative evaluation, numbness had improved, with no evidence of recurrence.
We report a case of carcinoma of the lower lip with superior vena cava syndrome(SVCS)due to secondary metastasis to the mediastinal lymph nodes. The patient, a 77 year-old woman, was referred to our department to treat a tumor in the right side of the lower lip. Histologic examination of a biopsy specimen revealed a well-differentiated squamouse cell carcinoma. The tumor was abraded by en bloc excision surgery with bilateral neck dissection under general anesthesia. Further histological evaluation of an excised specimen revealed a diagnosis of pN2c. Six months later the cancer recurred locally in the left corner of the patient's mouth, and the tumor was removed surgically. Eight months later, edema suddenly developed on the left side of the face, neck, forearm, and back of hand, accompanied by dizziness. A computed tomographic scan of the patient's chest revealed metastasis to the left mediastinal lymph nodes, with occlusion of the left internal jugular vein, brachiocephalic veins, and respiratory tract. The occulded veins were attributed to compression of the superior vena cava by a metastatic tumor. SVCS should be considered whenever edema of the face appears after neck dissection.
The Nd: YAG laser, with a wavelength of 1064 nm in the near-infrared region of the electromagnetic spectrum, has unique characteristics, such as absorption by oxygenated hemoglobin, negligible absorption by water, and a deep depth of penetration, making it ideally suited for the photocoagulation of hemangiomas. Twenty patients with hemangiomas in the oral region that were treated by photocoagulation with a Nd:YAG laser were analyzed and clinically evaluated. The 20 patients included 5 males and 15 females 13 to 89 years of age. Half of the patients were treated in the hospital, while the remaining half were treated on an outpatient basis. The lesions were located in sites such as the tongue, lips and cheeks. The size of the major axis ranged from 3 to 42 mm. With the patients under local anesthesia, the hemangiomas were treated with 10 to 15 W of Nd: YAG laser irradiation.There were few complications, but, it was necessary to irradiate deep-seated hemangiomas two or more times.The results suggested that the Nd: YAG laser is very effective for the treatment of hemangiomas of the oral region.