Japanese Journal of Oral and Maxillofacial Surgery
Online ISSN : 2186-1579
Print ISSN : 0021-5163
ISSN-L : 0021-5163
Volume 59, Issue 4
Displaying 1-12 of 12 articles from this issue
Preface
Invited review article
  • Kiyoshi HARADA
    2013 Volume 59 Issue 4 Pages 214-222
    Published: April 20, 2013
    Released on J-STAGE: December 02, 2014
    JOURNAL FREE ACCESS
    The surgical treatment of jaw deformity is popular now. And demand level of both patients and orthodontists for the surgical treatment is becoming higher. In order to respond to their demands, it is important for oral surgeons to acquire the right diagnostic method and safe and basic surgical technique for orthognathic treatment. Incorrect diagnosis leads incorrect surgical planning, and higher treatment results cannot be obtained without safe and basic technique for orthognathic surgery.
    The basic orthognathic surgery are sagittal splitting ramus osteotomy (SSRO) of the mandible and Le Fort Ⅰ osteotomy(LF I) of the maxilla. Though these two osteotomy technique are extremely popular, oral surgeons have to operate anatomically high-risk regions during both of them. In addition, special care for patients' air-way is necessary after orthognathic surgery.
    In this review, basic method of surgical planning for dentofacial deformity patients is described first. Then, the basic technique and knacks of two popular osteotomies (SSRO and LF I) are described. The pitfalls and various risks during the two osteotomies are also referred to simultaneously.
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Original article
  • Eiki YAMACHIKA, Masakazu MATSUBARA, Kenichiro KITA, Kiyofumi TAKABATAK ...
    2013 Volume 59 Issue 4 Pages 223-229
    Published: April 20, 2013
    Released on J-STAGE: December 02, 2014
    JOURNAL FREE ACCESS
    Substantial progress has been made in the development of cell therapy; however, there have been no practical applications related to bone regeneration. We analyzed mouse bone-marrow-derived lineage (-) cells and compact bone-derived lineage (-) cells as candidate mesenchymal stem cells (MSCs), and confirmed bone regeneration in vivo. Materials and Methods: Bone marrow-derived cells were collected from the femurs of 5-week-old C57-GFP male mice. Bone marrow-derived cells were harvested by removing the epiphyses and flushing with medium, after which the femurs were broken into approximately 1 mm3 fragments and treated with collagenase II. Cells released from the compact bone were aspirated and cultured with the bone fragments. These cells were cultured in alpha-MEM supplemented with 20% fetal bovine serum at 37℃ in a 5% CO2 humidified incubator for 3 days, and the difference between bone marrow-derived cells and compact bonederived cells was investigated. After 3 days of incubation, cells were labeled with allophycocyanin (APC) antilineage antibody cocktail, analyzed by flow cytometry, and sorted into lineage (+) or lineage (-) populations. Cells that had acquired lineage (-) were then induced to differentiate into osteogenic lineages by incubation with osteogenic media for 3 days. Differentiated cells and 50 mg of beta-TCP were mixed to form an osteogenic pellet. Pellet samples were implanted into subcutaneous pouches of SCID mice and retrieved after 4 weeks. Tissue samples were fixed in 1.5% paraformaldehyde and embedded in paraffin. Sections were stained with hematoxylin and eosin, and immunohistochemical analysis were performed using anti-GFP antibody. Results: Approximately 90% of bone marrow-derived cells expressed lineage markers. However, only 40% of compact bone-derived cells expressed these markers. Both bone marrow-derived and compact bone-derived cells sorted as lineage (-) showed fibroblastic shapes and plastic-adhesion ability. The number of lineage (-) cells from an individual mouse femur was about 10,000 from bone marrow and about 400,000 from compact bone. Moreover, we found that cells isolated from compact bone and sorted as lineage (-) cells were capable of supporting bone formation in vivo. The methods and results described here may facilitate understanding of MSC biology and lead to clinical applications.
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Case reports
  • Takayuki TAMURA, Kazuhiko TANIO, Isamu KODANI, Kazuo RYOKE
    2013 Volume 59 Issue 4 Pages 230-234
    Published: April 20, 2013
    Released on J-STAGE: December 02, 2014
    JOURNAL FREE ACCESS
    We report a case of histiocytic necrotizing lymphadenitis. A 33-year-old woman presented with a swelling in the submental region. A physical examination revealed swelling about 20 mm in diameter in the submental region. The clinical diagnosis was lymphadenitis of the submental region. Magnetic resonance imaging and ultrasonic examination revealed swollen lymph nodes. Treatment with antibiotics was ineffective. On the basis of clinical findings and blood tdsts, it was difficult to make a diagnosis. Under local anesthesia, a biopsy of the submental lymph nodes was performed. Histopathologic examination showed proliferation of lymphocytes and histiocytes, apoptotic bodies, and a necrotic lesion. A definitive diagnosis of histiocytic necrotizing lymphadenitis was made. There was no sign of recurrence for 1 year 8 months.
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  • Souichi YANAMOTO, Toshihiro KAWANO, Satoshi ROKUTANDA, Masaaki MIYAKO ...
    2013 Volume 59 Issue 4 Pages 235-239
    Published: April 20, 2013
    Released on J-STAGE: December 02, 2014
    JOURNAL FREE ACCESS
    Churg-Strauss syndrome is a rare, systemic inflammatory disease characterized by pre-existing type-I allergic symptoms, such as bronchial asthma or allergic rhinitis, and necrotic and granulomatous vasculitis with eosinophilia. We describe our experience with a case of this disease associated with cheek pain.
    A 64-year old man was referred to our hospital because of pain of the cheek and fever of unknown. He had a past history of chronic sinusitis. Computed fomography and magnetic resonance imaging showed bilateral multiple cystic lesions in the maxilla, and a postoperative maxillary cyst with infection was diagnosed initially.
    The patient received antibiotic therapy, but the symptoms did not improve. Blood examinations revealed eosinophilia and an increased serum IgE level. Symptoms of mononeuritis multiplex of the arm and leg, renal disorder, and micro-cerebral hemorrhage developed sequentially, and Churg-Strauss syndrome was given diagnosed. He received prednisolone and high-dose gamma globulin therapy, and the symptoms improved.
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  • Norio ONODA, Takuya TOGO, Homare KAWACHI, Satoru OGANE, Syuuichi NISHI ...
    2013 Volume 59 Issue 4 Pages 240-244
    Published: April 20, 2013
    Released on J-STAGE: December 02, 2014
    JOURNAL FREE ACCESS
    Wegener's granulomatosis is a rare multi-system disease characterized by necrotic and granulomatous changes of the upper or lower respiratory tract and segmental necrotizing glomerulonephritis. Wegener's granulomatosis is considered a type of PR-3-ANCA-associated vasculitis. This disease is defined as an autoimmune disease. Only 2% of all patients develop Wegener's granulomatosis in the oral cavity, which is characterized by strawberry gums.
    We describe a patient with a painful gum ulcer in whom Wegener's granulomatosis was diagnosed at an early stage on the basis of clinical findings of internal medicine and gingival biopsy in collaboration with other departments.
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  • Misa HOSOKI, Yasuyuki MICHI, Chikako HAYASHI, Yuko KATSUKI, Masashi YA ...
    2013 Volume 59 Issue 4 Pages 245-249
    Published: April 20, 2013
    Released on J-STAGE: December 02, 2014
    JOURNAL FREE ACCESS
    Granulocytic sarcoma (chloroma) is a rare extramedullary lesion of malignant myeloid precursor cells. We report a case of granulocytic sarcoma that developed in the submandibular gland as an extramedullary recurrence of acute myeloid leukemia (AML). A 13-year-old boy was referred to our hospital because of a painful mass in the right submandibular region. Magnetic resonance imaging and computed tomography revealed a 49 × 26 mm mass in the right submandibular region. Acute myeloid leukemia (AML) (WHO) classification AML without maturation, FAB M1) developed 2 years previously, and the patient received chemotherapy, allogeneic bone mallow transplantation (BMT), and donor lymphocyte infusion (DLI). He achieved complete remission for 8 months. A biopsy of this mass yielded a diagnosis of granulocytic sarcoma. The tumor shrank in response to local irradiation (6 Gy). However, the patient died of deterioration of general condition. Because patients with leukemia who have extramedullary recurrence are considered to have a poor prognosis, frequent follow-up is necessary in the future.
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  • Masatoshi HOSOHARA, Yuichi EHARA, Shiro TANAKA, Keika GEN, Shinichiro ...
    2013 Volume 59 Issue 4 Pages 250-253
    Published: April 20, 2013
    Released on J-STAGE: December 02, 2014
    JOURNAL FREE ACCESS
    Rett syndrome is found exclusively in young females, and is a progressive neurologic disease characterized by mental retardation, repeated hand-rubbing behavior, and related symptoms. We report a case of trismus that was treated in a patient with Rett syndrome.
    A 14-year-old girl (height, 120 cm; weight 20 kg) presented at Asahi University Hospital in December 2006 because of trismus. Her medical history included epilepsy, patent ductus arteriosus, microcephaly, hypertension, and suspected Rett syndrome since 6 years of age. Trismus had been present for several years. Examination revealed mental retardation, scoliosis, manual stereotyped behavior, developmental disease of the feet, and difficulty in independently walking. Her face was symmetric, with a developed mandible angle. Flaredout maxillary front teeth with attrition and jaw opening of 15 mm were confirmed. Radiologic examination showed hypertrophy of both coronoid processes and slight adhesion in the left temporomandibular joint. Hypertrophy of both coronoid processes was diagnosed clinically, and both were removed. The intraoperative jaw opening was 45 mm. The jaw opening has been maintained at 32 mm as of 5 years 9 months after surgery.
    The case was considered to involve trimus caused by coronoid process enlargement due to development of the masseter and temporal muscles secondary to bruxism.
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  • Naoya KITAMURA, Seiji OHNO, Tomohide YOSHIMURA, Eri SASABE, Tomohiro Y ...
    2013 Volume 59 Issue 4 Pages 254-258
    Published: April 20, 2013
    Released on J-STAGE: December 02, 2014
    JOURNAL FREE ACCESS
    Paraneoplastic pemphigus is an exclusive subset of pemphigus initially reported by Anhalt et al. in 1990. We report a case of paraneoplastic pemphigus initially presenting with oral mucosal erosions and ulcers without an underlying neoplasm that was diagnosed on the basis of clinical, pathological, and immunological findings. The patient was a 67-year-old woman with erosions and ulcers of buccal mucosa, tongue, and lips. Either multiform exudative erythema or pemphigus was suspected, and topical steroid ointment and oral prednisolone were administered. However, oral symptoms did not improve. In addition to the exacerbation of oral mucosal lesions, pale skin erythema appeared on the trunk of the body. Since Stevens-Johnson syndrome was suspected by a dermatologist in our hospital, steroid pulse therapy was administered, followed by chemotherapy with oral prednisolone and cyclosporine A; however, oral mucosal symptoms worsened. Direct immunofluorescence studies showed the deposition of complement in the epidermal basement zone, and indirect immunofluorescence studies indicated the deposition of immunoglobulin G on stained sections of monkey esophagus and rat urinary bladder. Furthermore, immunoblot studies using human kerationocyte extracts revealed autoantibodies against 190kDa (periplakin) and 210kDa (envoplakin) proteins in the patient's serum. Although the patient was finally given a diagnosis of paraneoplastic pemphigus on the basis of these immunological features, no underlying neoplasm could be identified. Oral mucosa and skin symptoms were improved by plasma exchange therapy. However, the patient died of bronchiolitis obliterans approximately 9 months after the initial visit.
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  • Mayu HASEBE, Kazutoshi NAKAOKA, Hiroyuki YAMADA, Yasunori NAKATANI, Ik ...
    2013 Volume 59 Issue 4 Pages 259-264
    Published: April 20, 2013
    Released on J-STAGE: December 02, 2014
    JOURNAL FREE ACCESS
    We report a case of inflammatory pseudotumor arising in the mandible that was difficult to differentially diagnoses.
    A 56 -year-old man visited our clinic because of gingival swelling of the left side of the mandible. Perimandibular inflammation was diagnosed, and the patient underwent incisional drainage and received antibiotics and non-steroidal anti-inflammatory drugs. Transient remission was obtained. Subsequently, however, the gingival swelling rapidly increased, and the left mandibular lateral incisor and second premolar fell out. In additoin, paresthesia of the mental nerve appeared. Although a biopsy suggested that the lesion was an inflammatory pseudotumor, coexistence of a malignant tumor could not be clinically ruled out. Therefore, we decided to perform marginal resection of the left side of the mandible. However, we performed an excisional biopsy because progressive growth of the lesion had gradually subsided. The specimen was consistent with osteomyelitis. The surgical wound healed uneventfully, and no evidence of recurrence has been detected for more than 1 year. Finally, the present case was diagnosed as an inflammatory pseudotumor accompanied by acute mandibular osteomyelitis.
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  • Kazutoshi TANI, Taiichi NISHIMURA, Masaki FUJIMORI, Masuhiko OKADA, Ak ...
    2013 Volume 59 Issue 4 Pages 265-269
    Published: April 20, 2013
    Released on J-STAGE: December 02, 2014
    JOURNAL FREE ACCESS
    We report a case of a large calculus in buccal soft tissue. The patient was a 71-year-old woman. She was referred to our hospital by a dental clinic because of a hard mass in the right buccal mucosa. On the basis of the computed tomographic, magnetic resonance imaging, and sialographic findings, an ectopic calculus in the buccal mucosa was diagnosed. Extirpation of the calculus and its capsule was performed through an intraoral approach with the patient under general anesthesia. Histopathological examination revealed that the calculus was similar to a phlebolith. There has been no evidence of recurrence after the operation.
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  • Seishi YAMAGUCHI, Junichiro MACHIDA, Masashi KIMURA, Akio SHIBATA, Ats ...
    2013 Volume 59 Issue 4 Pages 270-274
    Published: April 20, 2013
    Released on J-STAGE: December 02, 2014
    JOURNAL FREE ACCESS
    Anhidrotic ectodermal dysplasia is rare congenital disorder characterized by hypotrichosis, hypohidrosis, and tooth agenesis. We report on a patient with de novo anhidrotic ectodermal dysplasia who presented with complete absence of primary and permanent teeth. In addition, a misssense mutation leading to an amino acid substitution from arginine to histidine in position 156 of the ectodysplasin A gene, responsible for sex-linked inheritance, was identified. Our results are useful for genetic counseling, and future studies with various types of biological analyses are required to evaluate the activities of the ectodysplasin A gene activity, including other gene-gene interactions.
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