Fundamental surgical skill in dental implant treatment is significantly important to lead the treatment successful. This is also the base of advanced implant-related surgery normally performed by oral and maxillofacial surgeons. In this review, the series of basic techniques is described especially emphasis on practical skills.
The concept of osseointegration has allowed highly predictable result and the popular use of dental implant therapy. However, implant placement is often difficult in the posterior maxilla due to insufficient bone volume below the maxillary sinus. Boyne and James have developed a technique involving grafting of autogenous bone into the sinus floor by fenestration of the lateral maxillary sinus wall to access and elevate the sinus membrane based on the Caldwell-Luc procedure. In addition, Summers has developed the sinus floor elevation technique using an osteotome by alveolar crest approach. Subsequently, many modified procedures have also been reported. Methods based on the former are called “lateral approach” or “lateral window technique”, while those based on the latter are called “alveolar crest approach” or “osteotome technique”. The lateral approach allows elevation of the maxillary sinus membrane under direct vision, and it is applicable, even if the bone volume is too deficient to obtain primary stability. While the alveolar crest approach is a less-invasive surgical procedure, it has several limitations. It is applicable only when there is enough bone volume to provide primary stability of the implant, and it has to be performed blindly. Regardless of which method is used, the selection of indication, proper diagnosis, and treatment planning are extremely important. The prognosis for implant treatment with maxillary sinus floor elevation is extremely favorable. Consequently, the maxillary sinus floor elevation has been widely accepted as a technique essential for implant treatment in the posterior maxilla.
Free iliac bone(autogenous particulate cancellous bone and marrow: PCBM)grafts play an important role in surgical reconstruction of the oral and maxillofacial region. However, postoperative pain at the bone graft donor site is a common problem. Patients usually have difficulty in walking for about 10 days due to postoperative donor site pain. Getting up from bed and discharge are often delayed. Prolonged hospitalization increases the risk of complications such as deep vein thrombosis and pulmonary embolism. For these reasons, we have used a direct continuous local anesthetic injection system with a disposable injection pump at the site of iliac bone grafts. The advantage of this method is the relief of postoperative donor site pain as compared with analgesics such as diclofenac sodium, resulting in shorter hospitalization.
Most mandibular carcinomas occur in the gingival epithelium. However, some mandibular carcinomas originate from the odontogenic epithelium. Such lesions are called odontogenic carcinomas. Carcinomas primarily occurring in jaw bones are called primary intraosseous squamous cell carcinomas. We report 2 cases of odontogenic carcinoma that occurred primarily in the mandible. Patient 1 was a 69-year-old man without abnormal findings in the oral mucosa. Orthopantomography revealed a radiolucent lesion containing the crown of an impacted tooth. Right hemimandibulectomy, right functional neck dissection, and immediate reconstructive surgery using an A-O plate and a pectoralis major myocutaneous flap were performed. Histopathological examination showed a poorly-differentiated squamous cell carcinoma. Patient 2 was a 56-year-old woman without abnormal findings in the oral mucosa. Orthopantomography revealed a cystic structure containing an impacted tooth in the mandible. Left segmental resection of the mandible, left functional neck dissection, and immediate reconstructive surgery using an A-O plate were performed. Histopathological examination showed a well-differentiated squamous cell carcinoma, and transition of the epithelium of the cyst to squamous cell carcinoma was evident. Although patient 1 died of another disease, the prognosis of patient 2 is good, and niether metastasis nor recurrence has been detected for more than 10 years after surgery.
A case of osseous choristoma arising near the medical pterygoid muscle of a 40-year-old man is described. He had no symptoms and was accidentally found to have well-defined radiopaque masses on panorama radiographs taken by his dentist. The clinical diagnosis was a suspected osteoma near the medial pterygoid muscle. The mass was removed with the patient under general anesthesia. Histological examination showed a well-cricumscribed mass of dense lameller bone with Haversian canals and bone marrow. Osteoblasts surrounded newly formed osseous tissue.
Septo-optic-pituitary dysplasia (SOPD) is a rare disorder first described by de Morsier in 1956. It is a syndrome characterized by optic nerve hypoplasia, hypothalamic pituitary insufficiency, and absence of the septum pellucidum. We report a case of SOPD associated with bilateral cleft lip and alveolus. The patient was a 4-day-old boy. He had pituitary hypoplasia, thyroid insufficiency, micropthalmia, coloboma, cleft lip and alveolus, and premaxillary hypoplasia. At the age of 3 months, we performed primary lip repair. As a postoperative complication, difficulty in oral feeding and ischemic necrosis of the premaxilla occurred. Now at the age of 6 years 1 month, he has no right-sided vision or pituitary insufficiency. The prognosis of patients with SOPD is good, but it is necessary to medically treat pituitary insufficiency as soon as possible. Therefore, early detection of SOPD in patients with cleft lip and/or palate associated with premaxillary hypoplasia and eye manifestations is important.
Exostosis with cysts in the maxillary sinus is extremely rare. We report two cases of exosotosis with cysts in the maxillary sinus. One patient was a 42-year-old woman who was referred to our hospital because of a radiopaque lesion in the right maxillary sinus. Computed tomography showed a high density oval mass with a low density round lesion containing the roots of the right maxillary first and second molars in the maxillary sinus. The mass, measuring 25 × 15 × 15 mm, and soft tissue lesion were removed surgically via the carine fossa under general anesthesia. The histopathological diagnosis was exostosis with a mucous cyst of the maxillary sinus. The other patient was a 29-year-old woman who was referred to our hospital because of gingival swelling and pain of the right upper third molar. Computed tomography showed a high density oval mass with a cystic lesion containing the right maxillary third molar in the right maxillary sinus. The mass, measuring 30 × 23 × 15 mm, and the cyst were removed surgically via the carine fossa under general anesthesia. The histopathological diagnosis was exostosis with a dentigerous cyst.
We report our clinical experience with 10 cases of pemphigus vulgaris(PV)initially arising in the oral mucosa. The patients were 3 males and 7 females, with a mean age of 47.4 years. The patients were classified into a mucosal type(PV-M)group or a mucocutaneous type(PV-MC)group according to their serum levels of antidesmoglein(Dsg)-1 and Dsg-3 autoantibodies. Their clinical features and treatment outcomes were assessed. The most commonly affected sites in the oral cavity were the gingiva and buccal mucosa in both the PV-M and PV-MC groups. Skin involvement was frequent in the PV-MC group(80 %), but not in the PV-M group(40 %). Systemic steroid therapy was given to all of the patients, and both the oral and skin lesions completely disappeared within 1 month. Seven patients had relapses after tapering of the steroid dosage to the maintenance level.All patients with relapse had mucosal lesions in the oral cavity. We examined the serum levels of autoantibodies to Dsg-1 and Dsg-3 and evaluated the correlation between the serum autoantibody level and severity of disease. Patients with severe oral symptoms had higher serum levels of Dsg autoantibodies. However, the severity of the skin lesions was not strongly related to the serum autoantibody levels.
We report a case of focal osseous dysplasia located in the maxillary sinus. A 45-year-old woman was referred to our clinic because of discomfort in the left side of the maxilla. Radiographic examinations revealed a massive mixed radiopaque lesion measuring approximately 3 × 2 cm with an impacted left wisdom tooth in the left maxillary sinus. The lesion was removed under general anesthesia. Histopathological examination of the surgical specimen revealed cementum-like and bone-like material surrounding the impacted tooth. On the basis of the clinical, radiographic and histopathological findings, the lesion was diagnosed as focal osseous dysplasia.
Vitamin K deficiency is an acquired condition associated with blood coagulation disorders. We describe our experience with a case of vitamin K deficiency. A 71-year-old man with an unusual oral hemorrhage who had a wound in his cheek came to our hospital. His medical history included cerebral infarction, cerebral hemorrhage, hypertension, and aspiration pneumonia treated by antibiotics. Oral intake of food was stopped to prevent aspiration pneumonia, and his only energy source was intravenous hyperalimentation. We suspected a blood coagulation disorder because of prolongation of APTT and PT, decreased thrombotest values, and elevated PIVKA-Ⅱ levels on peripheral blood testing. We therefore administered 10 mg of Menatetrenone (vitamin K) intravenously, and consulted with the Department of Hematology in our hospital. The Department of Hematology diagnosed vitamin K deficiency because of decreased Hepaplastin test values and decreased coagulation factor Ⅱ, Ⅹ, and protein C activation levels. These abnormalities were found to be caused by vitamin K deficiency on additional examinations. After vitamin K administration, no unusual oral hemorrhage occurred during hospitalization.
We report a case of multiple myeloma rapidly growing in the maxillary tuberosity. A 58-year-old woman was referred to our hospital because of movement of the left upper first molar. The patient had a history of multiple myeloma and had been receiving chemotherapy at a hematology unit for about 2 years. Three weeks after extraction of the tooth, she visited us again because of a mass in the right maxillary tuberosity. A biopsy revealed that the mass was a myelomatous lesion. She received radiation therapy. However, 2.5 months after initial presentation she died of respiratory failure.
Cell proliferation activity is high immediately above basal cells in odontogenic keratocysts and can be assosiated with epithelial dysplasia. Odontogenic keratocysts can also destroy cortical bone and expand into the surrounding soft tissues, increasing the risk of recurrence. Therefore, odontogenic keratocysts were classified as keratocystic odontogenic tumors (KCOT), excluding cases with normal epithelial keratinization, in the revised classification of odontogenic tumors established by the WHO in 2005. The recurrence rate of KCOT has been reported to be 12 % to 63 %, with a mean value of 23 %. Various reasons for the high recurrence rate have been reported. If KCOT invades and resorbs the cortical bone of the jaw, resection of soft tissue in contact with the lesion is recommended, because tumor cells may remain in the surrounding soft tissue after resection of the bone. However, the recurrence of KCOT from residual tumor cells in soft tissue has not been reported. We describe a patient with recurrent KCOT that arose on an autogenous iliac bone graft following segmental resection of the mandible and iliac bone grafting for reconstruction of mandible. This case emphasizes the importance of treating the tissue surrounding KCOT at the time of resection.
Mucoepidermoid carcinoma, a type of malignant tumor of the salivary glands, is characterized by mucous, squamous, and intermediate cells and mainly arises in the major salivary glands, especially the parotid and palatine glands. We report a rare case of double cancer involving a mucoepidermoid carcinoma and a thymoma, with a review of the literature. A 45-year-old man was referred to our hospital bacause of a feeling of incongruity in the left retromolar region of the mandible. Histologic examination of a biopsy specimen revealed well-differentiated （low-grade malignancy） mucoepidermoid carcinoma. After marginal resection of the mandible, fluorine-18 fluorodeoxyglucose （FDG） positron emission tomography clearly demonstrated strong FDG uptake in the anterior mediastinum （SUV max: 5.8）, which suggested a tumor. The thymus was surgically excised, and the definitive diagnosis was thymoma. These results suggested a rare case of double cancer involving mucoepidermoid carcinoma in the retromolar region and thymoma （WHO Type B2）. There was no evidence of local recurrence or distant metastasis 2 years 1 month after the operation.