Japanese Journal of Oral and Maxillofacial Surgery
Online ISSN : 2186-1579
Print ISSN : 0021-5163
ISSN-L : 0021-5163
Volume 66, Issue 2
Displaying 1-5 of 5 articles from this issue
Preface
Invited review articles
  • Satoshi SOEN
    2020 Volume 66 Issue 2 Pages 40-51
    Published: February 20, 2020
    Released on J-STAGE: April 20, 2020
    JOURNAL FREE ACCESS

    Antiresorptive drugs, such as the bisphosphonates and the RANKL inhibitor denosumab, are currently the most widely used osteoporosis medications. These drugs increase bone mineral density (BMD) and reduce the risk of vertebral, nonvertebral and hip fractures in postmenopausal women with osteoporosis. Recently, anabolic therapy with teriparatide was demonstrated to be superior to the bisphosphonate risedronate in postmenopausal women with vertebral fracture. Treatment with the sclerostin antibody romosozumab increase BMD more profoundly and rapidly than alendronate and is also superior to alendronate in reducing the risk of vertebral and nonvertebral fracture in postmenopausal women with osteoporosis. For patients with severe osteoporosis and high fracture risk, bisphosphonates alone are unlikely to be able to provide long-term protection against fracture and restore BMD. For those patients, sequential treatment, starting with anabolic drug, followed by an antiresorptive, will likely provide better long-term fracture prevention and should be the golden standard of future osteoporosis treatment. The concept of a “drug holiday” applies only to patients taking bisphosphonates because of a transient residual antiresorptive effect after discontinuation due to skeletal retention of drug. For non-bisphosphonates, a drug holiday is not appropriate because BMD declines rapidly after treatment is stopped.

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  • Masahiro UMEDA
    2020 Volume 66 Issue 2 Pages 52-60
    Published: February 20, 2020
    Released on J-STAGE: April 20, 2020
    JOURNAL FREE ACCESS

    We describe the treatment and prevention methods for medication-related osteonecrosis of the jaw (MRONJ) based on the results of multicenter clinical trials conducted by the authors.

     The standard treatment for MRONJ is surgery. It is thought that conservative treatment precedes and surgical treatment is performed only in non-healing cases, but conservative treatment not only has a significantly lower cure rate, but there are also cases where the range of necrotic bone rapidly expands during conservative treatment. Therefore, in the case of operable cases, it is better to use early surgical treatment as the first choice treatment.

     Drug holiday of antiresorptive agents prior to MRONJ surgery does not improve the cure rate and therefor is not necessary. In addition, treatment results do not be improved even if antibiotics were given before surgery.

     In MRONJ surgery, it is most important to completely remove the osteolytic lesion on CT image. In patients showing periosteal reaction, the healing rate decreases. The periosteal reaction site should be included in the resected area, but if the necrotic bone in the bone is completely removed, healing may be obtained even if the periosteal reaction site is left.

     In order to prevent the onset of MRONJ, tooth extraction should be performed early if there is an infection source tooth, instead of avoiding invasive dental treatment, Drug holiday of antiresorptive agent before tooth extraction does not reduce the incidence of MRONJ.

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Case reports
  • Itsuki HAYASHI, Koujirou ABE, Makoto TOIDA, Tomomi YAMASHITA
    2020 Volume 66 Issue 2 Pages 61-66
    Published: February 20, 2020
    Released on J-STAGE: April 20, 2020
    JOURNAL FREE ACCESS

    We report a case of pancreatic carcinoma metastasizing to the maxilla. A 65-year-old man with liver, lung, and bone metastases from pancreatic adenosquamous carcinoma visited our department to undergo intraoral examination. Physical examination revealed a radicular cyst of the upper right second premolar tooth, a combined lesion of marginal and apical periodontitis of the right first premolar tooth, and severe marginal periodontitis of the upper right molar teeth. These teeth were extracted, and the radicular cyst was enucleated with the patient under local anesthesia. Histological and immunohistochemical examinations revealed a metastatic lesion of pancreatic carcinoma in the cyst wall. Although local healing was uneventful, the patient died of the primary lesion about 2 months later.

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  • Tsuyoshi KUROBANE, Kensuke YAMAUCHI, Hitoshi MIYASHITA, Hiromitsu MORI ...
    2020 Volume 66 Issue 2 Pages 67-71
    Published: February 20, 2020
    Released on J-STAGE: April 20, 2020
    JOURNAL FREE ACCESS

    Static bone cavities were first reported by Stafne in 1942 and are considered localized bone recesses in the lingual cortical bone of the mandible. This diseased tissue has been reported as salivary gland (mainly submandibular gland) tissue, but its etiology remains unclear; several mechanisms have been proposed, but a consensus has yet to be reached.

     In addition, since it is rare to show enlargement in size, and this disease remains clinically asymptomatic, long-term follow-up observations are often made while evaluating images such as panoramic radiographs and CT without aggressive surgical invasion.

     We studied a static bone cavity that increased in size from a red bean to the tip of the thumb at 4 years 3 months. We performed minimally invasive surgical removal by an endoscopic intraoral approach for definite diagnosis and early recovery after surgery. The pathological diagnosis was adipose tissue, and the patient has no symptoms as of 1 year 7 months after the operation.

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