In the present review article, the clinical significance of temporomandibular joint (TMJ) irrigation (Arthrocentesis and visually guided TMJ irrigation [VGIR]) and arthroscopic surgery for chronic closed lock with/without osteoarthritis (OA) was discussed. Based on the published researches on the TMJ irrigation, it is suggested that the TMJ irrigation can significantly reduce the levels of matrix-metalloproteinase (MMP) -3 and vascular endothelial growth factor (VEGF) in the synovial fluid, and improve the severity of arthroscopically observed synovitis. Regardless of the clinical results after TMJ irrigation, however, the severity of OA does not significantly change, and intra-articular fibrous adhesions become worse. Moreover, investigated several pro-inflammatory cytokines in the synovial fluid do not always disappear even after a clinically successful TMJ irrigation. Therefore, the possibility of exacerbation is considered to subsist even in the successful-group patients. On the other hand, since it was suggested that intra-articular fibrous adhesions are not main cause of the symptoms of chronic closed lock, and that the clinical efficacy of simple TMJ irrigation is almost equal to that of arthroscopic surgery, we have made light of the therapeutic significance of arthroscopic surgery. However, it is much useful as a diagnostic modality, and the accumulation of arthroscopic findings could lead to the clinical researches to clarify the pathology of chronic closed lock and to develop the novel therapeutic strategies. Therefore, it would be important that the arthroscopy is applied to the treatment plan at appropriate timing, and VGIR could be a model of clinical application as a useful modality for arthroscopic examination.
The purpose of this study was to examine clinical risk factors of oral leukoplakia that were associated with malignant transformation. A total of 512 patients (554 lesions) with clinical and histopathological diagnoses of oral leukoplakia who presented at our department from 2001 through 2010 were retrospectively studied. They consisted of 278 males and 234 females 11 to 84 years of age (median, 61 years). The mean follow-up was 36 months. The sites of oral leukoplakia included the tongue (176 lesions), gingiva (219 lesions), buccal mucosa (76 lesions), hard palate (50 lesions), soft palate (21 lesions), lips (7 lesions), and floor of the mouth (5 lesions). Squamous cell carcinoma developed in 13 of the 512 patients during follow-up. The development occurred after a mean period of 39 months (range, 9 to 91 months). The sites of malignant transformation included the ventral aspect of the tongue (10 lesions), gingiva (1 lesion), buccal mucosa (1 lesion), and soft palate (1 lesion). In 9 of these 13 malignant lesions, the clinical type of oral leukoplakia was non-homogeneous. The degree of epithelial dysplasia was none (2 lesions), mild (5 lesions), or moderate (6 lesions). On univariate analysis, site, clinical type, and treatment significantly correlated with malignant transformation. On multivariate analysis, these 3 factors retained their statistical significance. The cumulative malignant transformation rate was 5.6% at 5 years and 8.7% at 10 years.
Ectodermal dysplasia (ED), which is classified into three categories (anhidrotic, hypohidrotic, and hidrotic type), is a hereditary disease characerized by abnormal development of ectodermal tissues and organs. In the oral region, anodontia or oligodontia is the main feature of anhidrotic and hypohidrotic ED. However, intraoral symptoms in patients with hidrotic ED have not been reported. We describe a case of hidrotic ED, an uncommon subtype, associated with two large dentigerous cysts, which expanded the maxilla, eroded the maxillary sinuses, and projected into the nasal meatus. The present patient also had impacted teeth and retained deciduous teeth. The postoperative course was uneventful, and the patient was asymptomatic with no signs of recurrence 42 months postoperatively.
An abnormally oriented tooth germ causes root resorption of adjacent teeth, and root curvature and abnormal direction of eruption have also been reported. The present report describes three patients with four abnormally oriented tooth germs treated by surgical rotation. All of the patients were girls, with an average age of 11.3 years at treatment. One upper second premolar and three lower second premolars were treated, and the degrees of tooth development were Ri-R 1/4 according to Moorrees. Axial inclinations of the crowns of the impacted teeth were -92° for the upper premolar and 56° to 78° for the lower premolars. Axial inclination after the operations ranged from 12°to 48°. Natural eruption occurred in three teeth, and one tooth is erupting. However, a constricted pulp cavity was seen in two teeth, and root curvature was seen in one tooth. Our results suggested that surgical rotation of abnormally oriented tooth germs at the initial stage can lead to natural eruption with natural root formation, although abnormalities of pulp cavities and root shape were seen in some of our patients.
Hereditary gingival fibromatosis (HGF) is a rare autosomal dominant disorder characterized by slowly progressive fibrous overgrowth of the gingiva. We report the clinical results of long-term follow-up after gingivectomy in a patient with HGF. A 13-year-old boy was referred to our hospital because of gingival overgrowth. The upper and lower gingiva were severely overgrown. The primary dentition was initially affected, and generalized gum overgrowth caused unerupted permanent teeth. There was no sign of syndrome. His father and two sisters had a similar gingival condition. On the basis of these findings, we diagnosed the lesion as a hereditary gingival overgrowth. A gingivectomy was carried out with the patient under local anesthesia, and there was no recurrence after surgery. Recently, son of sevenless-1 (SOS1) has been reported as a responsible gene for HGF. However, no mutation in SOS1 gene was found in this family.