A monocortical mandibular bone grafting procedure for reconstruction of alveolar cleft was developed and assessed prospectively. The procedure was performed by harvesting lateral cortical bone plates from the symphysis and/or mandibular body and then placing these plates on the labial and palatal openings of the alveolar process defect. No particulate bone grafts were packed into the bony cavity. Based on CT findings at 6 months postoperatively, 58 of 70 clefts (82.9 %), including immature bony bridge cases, showed sufficient bone formation at the cleft site in the labio-palatal direction to facilitate migration of the permanent canines and/or lateral incisors. From periapical radiographic findings at the time of last follow-up, 54 of 62 clefts (87.1 %), except nonclassified 8 clefts in which cleft-related teeth were erupting showed ≥ 75 ％ of the root surface of cleft-adjacent teeth was covered with spanning bone. In addition, canines had erupted spontaneously through grafted bone in occlusion for 27 of 29 clefts (93.1 %) in which the cleft-adjacent canine was uncovered with bone during follow-up. Packing of particulate bone grafts in a secondary bone grafting procedure is clearly not a prerequisite for sufficient bone bridge formation and facilitation of teeth eruption, and placement of walls of cortical bone to enclose the defect is adequate for successful secondary alveolar bone grafting in the mixed dentition. Our procedure has advantages in reducing the quantity of bone required per unit volume of cleft defect, and thus could be applicable to larger cleft defects.
Xanthoma is a benign tumor consisting of accumulations of lipid-laden histiocytes associated with fibrous connective tissue. The large spherical tumor cells containing lipids are called foam cells. Xanthoma usually arises in the soft tissue including the skin, tendon sheath, and eyelid. However, xanthoma in the jaw bones is rare. We report a case of xanthoma occurring in the maxilla of a 66-year-old woman. The patient consulted a dental clinic because of spontaneous pain in the left side of the nose. Since an X-ray film demonstrated a cystic lesion in the left incisor region of the maxilla, the patient was referred to our hospital. Panoramic tomography and computed tomography also revealed a cystic lesion in the same area. The clinical diagnosis was an incisive canal cyst. Under general anesthesia, the lesion was extirpated. The removed lesion was a yellowish, elastic-soft mass adhering to the periosteum. Histologically, the lesion consisted of accumulations of foam cells without atypia, scattered foreign body giant cells, and fibrous connective tissue. The pathological diagnosis of the lesion was xanthoma. There was no evidence of recurrence 23 months after surgery.
Amyloidosis is characterized by progressive deposition of amyloid substances in various tissues. A 67-year-old man was referred to our department because of a massive hematoma of the lower lip. On examination,another hematoma appeared on the left buccal mucosa. The patient had a history of deep venous thrombosis and had been receiving anticoagulant therapy for about 3 months. A biopsy of the clinically normal buccal mucosa revealed diffuse deposition of amyloid substances in the mucosal and submucosal stroma, excluding the vessel walls. The massive hematomas in this patient were attributed to the frailty of the oral mucosa caused by amyloid deposition, as well as the effect of anticoagulant therapy.
Primary hyperoxaluria is a congenital, metabolic, autosomal, recessive, and genetic disease that produces excess oxalalic acid. The excess oxalic acid results in calcium oxalate deposition in the kidney, bone, heart,articulations, blood vessels, nerves, and retina. In the oral and maxillofacial region, calcium oxalate crystals deposited in dentin and pulp cause toothache, tooth mobility, and root resorption. A 30-year-old man with suspected primary hyperoxaluria was referred to us because of teeth mobility and occlusal pain. Clinical examination and panoramic tomography showed generalized root resorption and teeth mobility. Teeth fixation with a mouth guard was performed, and poor mastication improved. Primary hyperoxaluria developing in young persons has a poor prognosis. Teeth fixation with a mouth guard is one method that effectively reduces symptoms.
Endogenous fungal endophthalmitis occurs in immunocompromised patients who receive surgical procedures, antineoplastic agents, or immunosuppressants. Delayed initiation of treatment for endogenous fungal endophthalmitis may result in loss of vision. Ninety percent of all patients with endogenous fungal endophthalmitis had a central venous catheter. However, endogenous fungal endophthalmitis can occur in patients without serious general disorders or a central venous catheter. Only three cases of endogenous fungal endophthalmitis associated with malignant tumors have been reported in the field of oral and maxillofacial surgery in Japan. We report a case of endogenous fungal endophthalmitis that developed in a 55-year-old man after surgery for maxillofacial trauma.
Cystadenocarcinoma is an uncommon salivary gland tumor, occurring in the major salivary glands rather than the minor glands. We report a rare case of cystadenocarcinoma arising in the retromolar area and review the literature. A 90-year-old man was referred to our hospital because of a painless mass in the right retromolar region. The mass was firm and cauliflower-like, measuring 18 × 16 mm. Panoramic radiography revealed a radiolucent lesion under the mass in the mandible. Computed tomography showed no evidence of cervical or distant metastasis. A biopsy was carried out for a clinical diagnosis of gingival carcinoma of the right side of the mandible, and cystadenocarcinoma was strongly suspected histopathologically. Marginal mandibulectomy was performed, and the final histopathological diagnosis was low-grade cystadenocarcinoma. There was no evidence of recurrence or metastasis 2 years after operation. Six cases of cystadenocarcinoma arising in the retromolar area have been reported, including the present case.
Cellular Schwannoma is a subtype of Schwannoma, characterized by high cellularity, a largely Antoni A pattern, and absence of well-formed Verocay bodies. We report a rare case of cellular Schwannoma arising in the maxillary sinus. A 44-year-old man was referred to our hospital because of a swelling in the left buccal region. A computed tomographic scan showed a low density lesion in the left maxillary sinus. The clinical diagnosis was a maxillary tumor, and enucleation was performed. Histologically, the lesion was mainly composed of spindle cells showing high cellularity. The lesion contained hyalinization, collections of lipid-laden histiocytes, lymphocytic infiltrates, and hemosiderin deposits. Immunohistochemically, the spindle cells were strongly positive for S-100 protein and negative for GFAP, EMA, and Leu-7. Positive reactions for Ki-67 were found in the nuclei of a few tumor cells. The histopathological diagnosis was cellular Schwannoma.
We rarely find multiple cystic lesions in the human jaw on panoramic radiographs. Multiple cystic lesions caused by keratocystic odontogenic tumors (KCOTs) have often been described in patients with nevoid basal cell carcinoma syndrome (NBCCS) (also called Gorlin syndrome), which is a hereditary condition that is transmitted in an autosomal dominant manner with various types of expression. NBCCS is accompanied by various malformations and tumors in either the ectodermal or mesodermal organs, such as the ribs, and vertebral anomalies, multiple basal cell carcinomas, and KCOTs. A 15-year-old boy presented at our department because of multiple cystic lesions in the maxillomandibular bone. We performed examinations and diagnosed NBCCS. For treatment, we enucleated the multiple KCOTs under general anesthesia and analyzed the PTCH1 gene in both the patient and his parents. As a result, a missense mutation, c.3257T ＞ G（p.L1086R） was found to be the causative mutation in this patient.
It is beneficial for postdoctoral Japanese oral and maxillofacial surgery (OMFS) training to evaluate postdoctoral OMFS programs in other developed countries. Such studies should contribute to improving the quality of oral health in Japan. Currently there have been no research articles introduced for Japanese oral and maxillofacial surgeons that report on the postdoctoral OMFS training programs in the United States of America (USA). We therefore report the current status of oral and maxillofacial surgery training programs in the USA.Eleven topics are discussed. OMFS residency programs in the USA are speciality programs designed for oral and maxillofacial surgeons. Certification by the American Board of Oral and Maxillofacial Surgery is achieved after 4 to 6 years of training. A medical school curriculum is included in 46 of 102 OMFS residency programs. The average duration of the medical school curriculum was 28.4 months. Such curricula are designed to train OMFS residents who possess standard knowledge and techniques. The programs are strictly managed by a program director.