Purpose: Oral appliance (OA) therapy is indicated for the treatment of obstructive sleep apnea (OSA) in patients with mild-to-moderate OSA. However, since OA therapy has been reported to be effective in some patients with severe OSA, it may not be possible to determine the indications for OA therapy based on the severity alone. The purpose of this study was to determine the indications for OA therapy using endoscopy in awake patients with severe OSA. Methods: The subjects were 36 patients (27 males and 9 females) who were given a diagnosis of severe OSA on all-night polysomnography. A nasoendoscope was inserted with each patient in the horizontal position during nasal breathing, and morphological changes in the airways of the velopharynx, oropharynx, and hypopharynx with mandibular advancement were evaluated. Results: With mandibular advancement, the oropharynx and hypopharynx widened in all patients while the velopharynx widened in 29 patients, but did not widen in 7. The apnea hypopnea index (AHI) reduction rate after OA application was 79.8% (SD, 13.0%) in the group with velopharyngeal widening and 40.6% (SD, 27.0%) in the group without velopharyngeal widening; this difference was significant. In the group with velopharyngeal widening, evaluation of the direction of widening revealed two types: the “all-round type,” characterized by circumferential widening in the anteroposterior and/or lateral directions, and the “lateral dominant type”, characterized by widening mainly in the lateral direction. The AHI reduction rate was 80.1% (SD, 15.0%) for the all-round type and 79.3% (SD, 10.6%) for the lateral dominant type; this difference was significant. Conclusions: 1. With regard to the indications for OA therapy, findings in the velopharynx may be more important than those in the hypopharynx. 2. The effects of OA therapy can be expected in the presence of velopharyngeal widening, irrespective of its direction. Our results suggest that endoscopic evaluation of morphological changes in the velopharynx with mandibular advancement might play an important role in determining whether OA therapy is indicated.
Background: Treatment for oral squamous cell carcinoma (OSCC) is often delayed for various reasons. Time delay prior to treatment can lead to an increased risk of clinical progression, which might compromise the prognosis. We aimed to determine the impact of delayed resection of oral cancer on survival in patients with T1 and T2 OSCC. Material and Methods: This retrospective cohort study was performed in a representative sample of patients (n = 132) with T1 and T 2 OSCC who underwent surgery between 1998 and 2008 at Osaka Dental University Hospital. The number of days from initial presentation at our department to the date of surgical resection was calculated from the patients’ medical records, and the patients were categorized into four groups: group A, 0-21 days; group B, 22-27 days; group C, 28-39 days; and group D, 40 days or longer according to the quartile deviation. The median time from diagnosis to treatment was 27 days. The 5-year survival rate of all patients was 92.2%. The 5-year survival rates in groups A, B, C, and D were 100%, 97.0%, 94.1%, and 78.0%, respectively. There were no significant differences among the 5-year survival rates in groups A, B, and C. However, there were significant differences between groups A, B, C and group D. Treatment delays of 40 days or longer from the initial visit appeared to adversely affect outcomes in this study.
Lingual bone defects are usually asymptomatic local concavities of the lingual cortical bone of the mandible, frequently caused by soft-tissue inclusion. In most cases, the soft tissue is the submandibular gland. Only 7 cases of developing lingual bone defects were previously reported in Japan, but none of these cases involved the sublingual gland. We report a rare case of a developing lingual bone defect associated with the sublingual gland, which we followed up for 21 years. The patient was a 58-year-old man who had a developing lingual bone defect in the anterior right side of the mandible. A panoramic X-ray film showed an oval radiolucent area in the apical region of the lower right canine and first premolar tooth. Moreover, electric pulp testing confirmed that all teeth in the lower-right quadrant were vital. A panoramic X-ray film obtained at a nearby dental clinic demonstrated a radiolucent area 15 years before presentation to our department, and the area showed evidence of gradual expansion. Computed tomography revealed a local concavity in the lingual cortical bone of the right side of the mandible. The concavity measured 13 × 9 mm. The signal intensity of the inner tissue of the bone defect was nearly equivalent to that of the sublingual gland on T1-, T2-weighted magnetic resonance imaging. The suspected clinical diagnosis was a lingual bone defect. We performed an incisional biopsy to rule out a neoplastic lesion, and the histopathological diagnosis was normal sublingual gland tissue. On the basis of these results, the final diagnosis was a developing lingual bone defect associated with the sublingual gland. Two years have elapsed, but there is no swelling or induration in the right sublingual gland. The radiolucent area on the panoramic X-ray film showed decreased radiolucency and increased bone volume. Moreover, computed tomography revealed that the concavity of the bone had shrunk.
Macroglossia is the most prominent oral manifestation occurring in 20% of patients with amyloidosis, but resection of the tongue is rarely needed. We report a case of amyloidosis that presented with remarkable enlargement of the tongue due to amyloidosis, which was successfully resected with excellent cosmetic results. A 74-year-old woman was referred with a 6-month history of progressive enlargement of the tongue, difficulty in closing the mouth, and dysphagia associated with solid food. Amyloidosis with macroglossia was suspected, and biopsy and resection of the tongue were performed. The resected tongue was 100 × 80 × 65 mm and 76.7 g. The histopathological diagnosis was a myloidosis. Immunohistochemical examination of the matrix with monoclonal antibody AA Congo red revealed non-AA-type amyloid deposition. The gross edema of the tongue, which had been present prior to surgery, rapidly and spontaneously resolved over the course of 1 month. The patient was able to shut her mouth. Since chronic inflammation can accelerate the progression of amyloidosis, care must be taken to prevent dysphagia and loss of vocal function. One year 1 month after surgery, the patient died of multiple organ failure caused by heart failure.
Superior mesenteric artery syndrome (SMAS) is a rare cause of upper intestinal obstruction resulting from compression of the horizontal portion of duodenum by the superior mesenteric artery and abdominal aorta. A 54-year-old woman presented with frequent vomiting and sudden abdominal distension while receiving TPF (docetaxel + cisplatin + 5 - fluorouracil) chemotherapy for primary adenoid cystic carcinoma of the buccal region. Abdominal computed tomography (CT) showed distension of the stomach due to compression of the horizontal portion of the duodenum and a narrow angle between the superior mesenteric artery and abdominal aorta. We diagnosed SMAS based on the CT scan findings. The remarkable weight loss occurring during chemotherapy seemed to have caused SMAS. The patient soon improved in response to conservative therapy, such as insertion of a gastric tube and fluid replacement. This case illustrates the importance of considering SMAS in patients who receive chemotherapy, especially those presenting with weight loss.
Dabigatran is a novel oral anticoagulant (NOAC) and a direct thrombin inhibitor. There is limited information available about tooth extraction in patients receiving dabigatran because of its status as an NOAC. We studied the safety of tooth extraction in 19 patients who continued to receive dabigatran. The average age was 72.0 years, and a total of 55 teeth were extracted. The mean active partial thromboplastin time (APTT) was 45.4 seconds. In 1 patient the APTT was prolonged to more than 70 seconds. All patients underwent tooth extraction 6 to 8 hours after taking dabigatran in consideration of the half-life in blood. Postoperative bleeding occurred in the patient in whom the APTT was prolonged to more than 70 seconds. Dabigatran had to be temporarily withdrawn in 1 patient and resumed after the cessation of bleeding. Measurement of APTT before extraction is essential. We consider tooth extraction feasible without the cessation of dabigatran if the patient’s APTT is controlled to less than 2 times the reference value. If the APTT is prolonged to longer than 60 seconds, tooth extraction must be carefully performed.
The prevalence of supernumerary teeth is about 1%, and this condition is often found in the anterior maxillary region. We report a metachronous case of 10 impacted supernumerary teeth. A 14-year-old girl with multiple impacted supernumerary teeth was referred to our hospital for further evaluation. A panoramic X-ray film showed 9 impacted supernumerary teeth in the premolar and molar regions of the maxilla and mandible. During periodic follow-up, a panoramic X-ray revealed the metachronous development of a new supernumerary tooth. Six impacted supernumerary teeth were extracted to prevent adverse effects on the permanent teeth and dental arch. Because a new supernumerary tooth might develop after diagnosis and treatment we are continuing periodic follow-up.