Japanese Journal of Oral and Maxillofacial Surgery
Online ISSN : 2186-1579
Print ISSN : 0021-5163
ISSN-L : 0021-5163
Volume 57, Issue 8
Displaying 1-8 of 8 articles from this issue
Preface
Invited review article
  • Kenji YUASA
    2011 Volume 57 Issue 8 Pages 434-440
    Published: August 20, 2011
    Released on J-STAGE: June 26, 2014
    JOURNAL FREE ACCESS
    I reported decision tree and imaging procedure for swelling and masses at major salivary gland region, and image findings of salivary gland lesions. Ultorasonography, which is simple and non-invasive procedure, is carried out firstly for diagnosing whether a mass is swelling of salivary gland itself or exists within/around salivary gland. Ultrasonography and MRI are useful for diagnosing whether a mass is benign or malignant. Internal structure and blood flow within a mass on these images are important findings for differentiating malignant from benign mass.
    Sialoadenitis is mostly suspected in case of swelling of salivary gland. Ultrasonography helps to diagnose it, also. For diagnosing obstructive sialoadenitis such as sialolithiasis, Occlusal X-ray examination is performed firstly for detecting sialolith. If not detected it, endoscopy is useful for detecting cause of obstruction.
    Sialography is indicated for Sjögren syndrome, now. However, it is considered that imaging procedue for Sjögren syndrome shift from sialography to ultrasonography and MRI in future. Indication of CT for salivary gland lesions limits to sialolithiasis.
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Original articles
  • Gen AIKAWA, Tadaharu KOBAYASHI, Isao SAITO, Takafumi HAYASHI, Chikara ...
    2011 Volume 57 Issue 8 Pages 441-451
    Published: August 20, 2011
    Released on J-STAGE: June 26, 2014
    JOURNAL FREE ACCESS
    The purpose of this study was to determine the incidence of temporomandibular joint (TMJ) symptoms in patients with jaw deformities and to assess the relationship between TMJ symptoms and craniofacial morphology.
    In 304 patients with jaw deformities (221 females and 83 males, mean age: 21 y), the TMJ was examined clinically and by axial computed tomography (CT). Craniofacial morphology was analyzed on posteroanterior and lateral cephalograms, and the subjects were divided into seven groups: mandibular prognathism (210), mandibular retrusion (51), mandibular asymmetry (16), maxillary retrusion (13), maxillary protrusion (8), maxillary and mandibular protrusion (4), and open bite (2).
    The incidence of disc displacement in females (32.6%) was significantly higher than that in males (19.6%). The incidence of clinical symptoms in patients with mandibular asymmetry was 62.5%, which was significantly higher than the incidences in patients with mandibular prognathism (24.8%) and patients with maxillary retrusion (23.1%). The incidence of disc displacement in patients with mandibular retrusion was 66.7 %, which was significantly higher than the incidences in patients with mandibular prognathism (17.1 %) and patients with maxillary retrusion (23.1%). The incidences of bone changes of the condylar head in patients with mandibular retrusion, mandibular asymmetry, and maxillary retrusion were 47.1%, 43.8%, and 30.8%, respectively, which were significantly higher than the incidence in patients with mandibular prognathism (10.5%). The incidences of disc displacement and bony changes of the condylar head in patients with asymmetry were significantly higher than those in patients without asymmetry. Disc displacement and bony changes of the condylar head were associated with mandibular retrusion, clockwise rotation of the mandible, and lateral shift of the mandible.
    We conclude that disc displacements and bone changes of the condyle are associated with mandibular retrusion and mandibular asymmetry.
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  • Yuri MUROI, Masahiro NAKAJIMA, Yuichi SHOJU, Hiroyuki HAMADA, Machi HA ...
    2011 Volume 57 Issue 8 Pages 452-458
    Published: August 20, 2011
    Released on J-STAGE: June 26, 2014
    JOURNAL FREE ACCESS
    Oral bisphosphonates are the most widely used pharmaceuticals for the prevention and treatment of osteoporosis. Recently, there has been increasing concern about the risks of osteonecrosis of the jaws in patients receiving bisphosphonates. Despite the widespread use of oral bisphosphonates, there has not been a report regarding wound healing after tooth extraction in patients who are receiving oral bisphosphonates. In this study, we surveyed the prevalence of delayed wound healing after extraction in patients receiving oral bisphosphonate therapy. A total of 113 tooth extractions were performed in 44 patients who received oral bisphosphonates from November 2007 to July 2010 in our hospital. Questionnaires were completed by the individual who performed the extraction. The questionnaires included items such as the prognosis, the kind of bisphosphonate, systemic risk factors such as steroid medication, duration of bisphosphonate administration and discontinuation, location of extracted teeth, and the healing period. The prevalence of delayed wound healing was 15 of 113 extractions (13.3 %). The prevalence of delayed wound healing with steroid medication was significantly higher than that without steroids. The prevalence of delayed wound healing in accordance with the guidelines proposed by the Japanese Society of Oral and Maxillofacial Surgeons was significantly lower than that not based on the guidelines. There was one case of bisphosphonate-related osteonecrosis and two cases of delayed infection associated with steroid medication. These results indicated that wound healing after extraction in patients who are receiving oral bisphosphonates, especially in the presence of steroids medication, was delayed. Our findings suggested that informed consent and long-term follow up are necessary after extraction in patients given oral bisphosphonates and steroids. Furthermore, tooth extraction in patients receiving oral bisphosphonates should be performed in accordance with the guidelines proposed by the Japanese Society of Oral and Maxillofacial Surgeons.
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  • Shingo GOTO, Kenichi KURITA, Yuko HATANO, Yuichirou KUROIWA, Masahiro ...
    2011 Volume 57 Issue 8 Pages 459-465
    Published: August 20, 2011
    Released on J-STAGE: June 26, 2014
    JOURNAL FREE ACCESS
    Coronectomy is an effective treatment to avoid inferior alveolar nerve injury (IANI) associated with extraction of mandibular third molars. Extraction of the remaining root is usually not necessary after coronectomy, because it is buried in tissues. However, the remaining root is sometimes removed in patients with wound dehiscence.
    Patients who underwent coronectomy were regularly followed up at our hospital. We examined the remaining roots and surrounding tissue by panoramic radiography. We report 9 patients in whom extractions of remaining roots proved necessary after coronectomy. Of the 9 patients, the remaining roots were extracted because of wound dehiscence in 8 patient (90%) and pulpitis in 1 (10%) for a period of 1 month to 2 years. Acute periapical inflammation did not occur until extraction of the remaining roots in 8 patients with wound dehiscence because the surrounding gingiva was cleaned by the patient. However, in 1 petient with severe pulpitis, we extracted the remaining roots, which were associated with expansion of the periodontal space, but did not migrate away from the inferior alveolar nerve. IANI was not found in any patient. The extracted roots were histologically evaluated in 5 petients. The pulp was vital in 4 of the 5 patients (80%) and non-vital in 1 (20%).
    After coronectomy, we consider evaluation of the need and timing for extraction of the remaining roots to be important. The following are the criteria for extraction of the remaining roots after coronectomy: (1) If the root is exposed to the oral cavity, extraction should not be performed until the remaining roots recede from the inferior alveolar canal, provided that acute inflammation does not occur. (2) In patients with severe pulpitis or inflammation of surrounding tissues, extraction of the remaining roots is done without waiting for the remaining roots to recede from the inferior alveolar canal.
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Case reports
  • Hitoshi FUJII, Hisashi FUJINAMI, Teruyuki KANAZAWA, Shintaro SUZUKI
    2011 Volume 57 Issue 8 Pages 466-470
    Published: August 20, 2011
    Released on J-STAGE: June 26, 2014
    JOURNAL FREE ACCESS
    Keratocystic odontogenic tumor is a benign unicystic or multicystic, intraosseous tumor of odontogenic origin, which is characterized by a lining of parakeratinized stratified squamous epithelium. It can potentially invade and infiltrate surrounding tissues.
    A case of keratocystic odontogenic tumor after extraction of lower impacted wisdom teeth and mandibular osteotomy is reported.
    A 22-year-old woman who had undergone extraction of lower impacted wisdom teeth and mandibular osteotomy was referred to our hospital because of discomfort in the left mandible. Panoramic radiography and computed tomographic side of the scans showed a unilocular cystic lesion (20 mm in diameter) in the left mandibular angle.
    We surgically extirpated the tumor with the patient under general anesthesia.
    Histopathological examination showed a cystic lesion, which contained keratinized tissue and was lined by parakeratinized stratified squamous epithelium. A keratocystic odontogenic tumor was thus diagnosed.
    As of 1 year 7 months after the operation, no recurrence has been detected.
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  • Yuji KATSUMI, Akihiko IIDA, Jun-ichi FUKUDA, Emiko TERAO, Go HASEGAWA, ...
    2011 Volume 57 Issue 8 Pages 471-475
    Published: August 20, 2011
    Released on J-STAGE: June 26, 2014
    JOURNAL FREE ACCESS
    We report a case of a total soft palate defect caused by Wegener’s granulomatosis, treated by application of a speech aid.
    The patient was a 25-year-old man with a tumor accompanied by an ulcer and tenderness of the soft palate. The ulceration was extensive, and the soft palate was perforated. Finally, the soft palate became totally involved and showed an extensive defect. We obtained a biopsy specimen from the granulomatous reddish gingiva, so called “strawberry gums.” Clinical appearance, a positive finding for PR3-ANCA, and histopathological findings led to a diagnosis of the upper respiratory tract-limited form of Wegener’s granulomatosis. Although the symptoms such as ulceration and tenderness were improved by administration of steroids and immunosuppressants, nasal leakage of food and hypernasality were severe. We decided to apply a speech aid. The obturator was adjusted by functional impression of the pharyngeal area, so that the space between the obturator and pharyngeal posterior wall would be narrowed. It took only 2 weeks to complete the speech aid fabrication. Remarkable improvement of velopharyngeal function and speech intelligibility was confirmed on logopedic and phoniatric evaluation.
    We considered application of a speech aid to be effective for a patient with a total soft palate defect caused by Wegener’s granulomatosis who had vascular abnormalities and required long-term administration of steroids and immunosuppressants, because it could be fabricated and applied within a short time, without an invasive procedure.
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  • Rie KODAKA, Kaori YAGO, Manabu YAMADA, Kaori KAMEYAMA, Taneaki NAKAGAW ...
    2011 Volume 57 Issue 8 Pages 476-480
    Published: August 20, 2011
    Released on J-STAGE: June 26, 2014
    JOURNAL FREE ACCESS
    Recently, chronic sclerosing sialadenitis (Küttner’s tumor) has been suggested to be an IgG4-related disease. A 69-year-woman with a painless, bilateral submandibular swelling was referred to our hospital. She was given a diagnosis of Küttner’s tumor in March 2004. We examined a specimen of the submandibular gland by IgG immunostaining. The examination revealed severe infiltration of IgG4-positive plasmacytes. IgG4-related disease was newly diagnosed. Nearly 6 years have passed since the submandibular glands were removed surgically, and the lacrimal glands were bilaterally swollen. We report a case of IgG4-related chronic sclerosing sialadenitis (Küttner’s tumor) with suspected transition to IgG4-related Mikulicz’s disease.
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