Japanese Journal of Oral and Maxillofacial Surgery
Online ISSN : 2186-1579
Print ISSN : 0021-5163
ISSN-L : 0021-5163
Volume 62, Issue 9
Displaying 1-9 of 9 articles from this issue
Preface
Invited review article
  • Norifumi NAKAMURA, Kiyohide ISHIHATA, Juri MURAKAMI
    2016 Volume 62 Issue 9 Pages 432-440
    Published: September 20, 2016
    Released on J-STAGE: December 13, 2016
    JOURNAL FREE ACCESS

    Pediatric oral surgery includes cleft lip and palate repair in infancy, operation for injury of the oral and facial regions, lingual and labial frenectomies, cyst and tumor removal, autogenous bone graft in the alveolar cleft at school age, etc. Additionally, the opportunity in breathing and feeding management of newborn infants with micrognathia may be high for an oral surgeon. A child is not a small-sized adult. The physical structure and physiologic characteristics are different with age, and their behaviors are diverse depending on the development stage in childhood.

     In our experience, complications such as upper airway obstruction, upper respiratory infection, urticaria, dehydration, high fever, and decubitus of the lips were observed on perioperative care for pediatric oral surgery during 2004 and 2013. When upper airway obstruction associated with serious micrognathia or pharynx edema due to an injury is suspected, oral surgeons should note and take into consideration that it may develop into a critical state, and act to ensure safe breathing management. In addition, many complications occur in conjunction with intraoperative mouth gag wearing and the operative procedure during cleft palate repair in infancy.

     We conclude that it is important to understand the physical structure and physiologic characteristics and the diverse behavioral characteristics depending on their development stage of children and infants, and also to know the possible factors that may cause complications when they engage in pediatric oral surgery.

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Original article
  • Saki HAYASHIDA, Yuki MATSUSHITA, Yuki SAKAMOTO, Tomofumi NARUSE, Satos ...
    2016 Volume 62 Issue 9 Pages 441-447
    Published: September 20, 2016
    Released on J-STAGE: December 13, 2016
    JOURNAL FREE ACCESS

     Objectives: Although some systematic reviews of medication-related osteonecrosis of the jaws (MRONJ) showed that surgical therapy was more effective than conservative therapy, treatment strategies for MRONJ have not been established because of the advantages and disadvantages of each type of treatment. We also reported previously that surgical therapy can lead to complete healing in most patients with stage 2-3 MRONJ. However, there remained a small number of patients in whom cure could not be obtained despite surgery. The aim of this study was to investigate the relation between the method of surgery and final outcomes in patients with MRONJ who underwent surgery.

     Materials and methods: Fifty-seven patients with MRONJ who underwent surgery were enrolled in the study. Oral bisphosphonates (BPs) were administered to 35 patients, while intravenous BPs were given to 22. Bone resection including the entire alveolar ridge was performed. The resection included the tooth apex, the buccal and lingual cortical bone at the same height as the apex, and smoothing the sharp edge of the bone. The wound was primarily sutured, in principle.

     Results: Forty-four (77.2%) of 57 patients had complete cure, while 11 had only improvement symptoms, and 2 showed no change. Symptoms subsequently recurred in 8 patients in whom complete cure or improvement had been obtained. Among 10 patients with no change or recurrence, bone resection was inadequate in 9 patients (90%).

     Conclusions: Extensive surgery of the alveolar ridge including buccal and lingual cortical bone is necessary for the successful control of MRONJ.

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Case reports
  • Hidetaka MIYASHITA, Seiji ASODA, Taisuke MORI, Yuka YAMADA, Tomoya SOM ...
    2016 Volume 62 Issue 9 Pages 448-453
    Published: September 20, 2016
    Released on J-STAGE: December 13, 2016
    JOURNAL FREE ACCESS

    Non-islet-cell tumor hypoglycemia (NICTH), a condition characterized by recurrent episodes of hypoglycemia, rarely occurs in association with oral cancer. Here, we report a case of carcinoma of the maxillary gingiva with NICTH caused by paraneoplastic production of insulin-like growth factor II (IGF-II). A 72-year-old man with a painful swelling in the left maxillary region was referred to our hospital. A mass with induration was observed in the buccal and palatal regions from the first premolar to the second molar. The clinical diagnosis was carcinoma of the maxillary gingiva, and a biopsy revealed squamous cell carcinoma. The patient received concurrent radiation and chemotherapy with cisplatin. Three weeks after the completion of treatment, three episodes of hypoglycemia developed despite normal intake of meals. On the basis of the results of endocrinological examinations, typical diseases causing hypoglycemia, such as insulinoma and adrenal insufficiency, were ruled out. Furthermore, decreased IGF-I levels were found, which indirectly revealed an increase in IGF-II levels. On the basis of these findings, we diagnosed this case as carcinoma of the maxillary gingiva with NICTH. Continuous intravenous glucose infusion was needed for 3 months from the diagnosis of NICTH until death. NICTH should be borne in mind as one of the complications that can occur during treatment of oral cancer.

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  • Toru TAKEMOTO, Yuji KABASAWA, Fumihiko TSUSHIMA, Hideaki HIRAI, Ken OM ...
    2016 Volume 62 Issue 9 Pages 454-459
    Published: September 20, 2016
    Released on J-STAGE: December 13, 2016
    JOURNAL FREE ACCESS

    We report a case of chronic expanding hematoma (CEH) in the temporomandibular joint (TMJ) region. A 48-year-old man visited our department because of a mass in the left preauricular region and trismus in November 2012. He had noticed the mass about 2 months previously, which gradually expanded. At initial presentation, examination revealed a hard elastic mass, measuring 22 mm in diameter, in the left preauricular region. The maximum mouth opening was 33 mm. Computed tomography showed a well-demarcated mass lateral to the mandibular condyle, accompanied by condylar bone resorption. On magnetic resonance imaging, the mass showed heterogeneous high signal intensity on T1-weighted images and heterogeneous low signal intensity on T2-weighted images. The mass showed mild uptake on 2-deoxy-2- [18F] fluoro-D-glucose positron emission tomography. Fine needle aspiration yielded a diagnosis of class I. The clinical diagnosis was a suspected tumor in the left TMJ region. The lesion was extirpated with the patient under general anesthesia in December 2012 and was histopathologically diagnosed as hematoma. On the basis of the clinical course and histopathological findings, the lesion was finally diagnosed as CEH. As of about 3 years after surgery, the postoperative course has been uneventful, with no evidence of recurrence.

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  • Yusuke ONOZATO, Hirofumi TOMIOKA, Namiaki TAKAHARA, Toshimitsu OHSAKO, ...
    2016 Volume 62 Issue 9 Pages 460-465
    Published: September 20, 2016
    Released on J-STAGE: December 13, 2016
    JOURNAL FREE ACCESS

    We report a case of tongue cancer accompanied by essential thrombocythemia. A 66-year-old-man was referred to our hospital in November 2014 after he was given a diagnosis of squamous cell carcinoma of the right side of the tongue. He had been receiving hydroxycarbamide and aspirin since the diagnosis of essential thrombocythemia in 2002. The platelet count was 182 × 104/μL at the first medical examination, but started to be controlled by at the level of 40〜60 × 104/μL by increasing the dose of hydroxycarbamide before surgery. The patient underwent tracheotomy, supraomohyoid neck dissection, hemiglossectomy, and reconstruction with a radial forearm free flap in December 2014. He had no perioperative complications and was discharged 40 days postoperatively.

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  • Shoko YOSHIDA, Koji KISHIMOTO, Yurika MURASE, Hiroaki TAKAKURA, Shohei ...
    2016 Volume 62 Issue 9 Pages 466-470
    Published: September 20, 2016
    Released on J-STAGE: December 13, 2016
    JOURNAL FREE ACCESS

    Gardner syndrome, which is an autosomal dominant genetic disorder, is adenomatous polyposis accompanied by osteomas, soft tissue tumors, etc. We describe a large mandibular osteoma arising in a patient with Gardner syndrome.

     A 65-year-old woman was referred to our clinic because of a swelling in the right side of the mandible. She was previously given a diagnosis of Gardner syndrome, and underwent subtotal colectomy and ileoproctostomy because of colonic adenomatous polyposis. A panoramic radiograph and computed tomographic (CT) images showed the presence of multiple radiopaque lesions in both the maxilla and mandible. In particular, a large osteoma measuring 38 × 31 × 30 mm was present in the right mandibular angle region. Furthermore, osteoma was present in the ethmoid sinus and orbital wall, and there were impacted teeth in the left mandibular premolar region. The patient underwent surgical removal of the large osteoma at the right mandibular angle via an extraoral submandibular approach.

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  • Masato YAMAZAKI, Masayuki FUKUDA, Hidemitsu IGARASHI, Yasunori KONNO, ...
    2016 Volume 62 Issue 9 Pages 471-475
    Published: September 20, 2016
    Released on J-STAGE: December 13, 2016
    JOURNAL FREE ACCESS

    The prevalence of supernumerary teeth is not rare, estimated to be about 1%. Most supernumerary teeth are located in the maxillary incisor region, and patients with supernumerary teeth appearing in other regions are rare. Furthermore, individuals who have three or more supernumerary teeth without cleidocranial dysostosis are extremely rare.

     Here we report the case of a 13-year-old girl with 15 supernumerary impacted teeth, which were found on a panoramic X-ray image and computed tomography (CT).

     The panoramic x-ray image showed 15 supernumerary impacted teeth in both sides of the canine and premolar regions of the upper and lower jaws. CT indicated that the roots of all 15 supernumerary teeth were not fully developed, and the teeth were deeply embedded in both sides of the canine and premolar regions of the upper and lower jaws. Because she initially did not have any symptoms, we chose to take a“ wait and see” approach. However, the supernumerary impacted teeth started to show signs of growth and eruption 19 months later and were therefore extracted with the patient under general anesthesia. The extracted supernumerary impacted teeth were histopathologically normal tissues, and the final diagnosis of all 15 teeth was supernumerary impacted teeth.

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Secondary publication
  • Yuichi OHNISHI, Hiroki YASUI, Kenji KAKUDO, Masami NOZAKI
    2016 Volume 62 Issue 9 Pages 476-486
    Published: September 20, 2016
    Released on J-STAGE: December 13, 2016
    JOURNAL FREE ACCESS

    We have previously shown that growth of the oral squamous cell carcinoma cell line SAS is resistant to cetuximab in monolayer culture conditions even though epidermal growth factor receptor (EGFR) was phosphorylated, whereas growth of SAS aggregates was sensitive to cetuximab. In the present study, we demonstrate differences in the EGFR signaling pathways utilized by SAS cells in monolayer and suspension cultures at the molecular level. Cetuximab treatment of SAS cells in monolayer cultures inhibits the phosphorylation of EGFR and ERK and reduces the cell migratory potency, but not cell proliferation. AG1478 treatment reduces the phosphorylation of EGFR, ERK, and AKT, and affects cell growth in monolayer cultures. The phosphorylation levels of EGFR and AKT are significantly higher in SAS cell aggregates than in monolayer cultures. Treatment with cetuximab and AG1478 reduces the growth of SAS aggregates and eliminates the phosphorylation of EGFR and AKT. Furthermore, proliferation of SAS aggregates is also inhibited by LY294002 and MK2206, which are inhibitors of PI3K and AKT, respectively. In addition, treatment with the lipid raft disruptor filipin III reduced the phosphorylation levels of EGFR and Akt in SAS aggregates, but not in SAS monolayer cultures. These results suggest that ligands in the serum stimulate the phosphorylation of EGFR localized in lipid rafts, leading to PI3K-AKT activation, which results in the growth of SAS aggregates, potentially increasing the sensitivity of SAS aggregates to cetuximab.

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