In the perioperative period, perioperative infections are the most commonly observed postsurgical complication. For this reason, potent antibacterial drugs with wide spectrums are administered at huge doses for long periods of time, which has resulted in the appearance of microbes with multiple drug resistance. Therefore, we believe an appropriate administration period for preventive antibacterial drugs should be evidence-based. In the present study, we investigated the administration periods for preventive antibacterial drugs as perioperative management using the changes over time of cytokines as preturgical and postsurgical inflammatory signs in orthognathic surgery (sagittal splitting ramus osteotomy) .
The cytokines IL-lβ, IL-6, IFNγ, IL-10, and IL-15 were measured over time and their levels were compared with biological markers of inflammation, such as CRP, which accompany surgical invasion. The level of the inflammatory cytokine IL-6 increased beginning immediately after the surgery and peaked one day after surgery, following which it decreased. IL-15 reached its peak value 2 days after surgery and then it declined. Since IL-6 started to increase immediately after the surgery compared to the WBC count and CRP, it may be possible to use IL-6 early on to assess the degree of invasiveness, while IL-15 is an important cytokine for understanding the biological responses after surgery. Thus, measuring IL-6 and IL-15 is clinically useful for assessing the degree of invasiveness and postsurgical biological response, and it is believed that an administration period for preventive antibacterial drugs of 2 days or less after surgery is appropriate.

View full abstract

Although the importance of pharmacological intervention as early treatment for temporomandibular joint disorders has recently increased, there have been few reports on close investigation of the efficacy, and no efficacy evaluation criteria have been established. The Japanese Society of Oral Therapeutics and Pharmacology established a committee for the standardization of NSAIDs efficacy evaluation for temporomandibular joint pain, and prepared new ‘NSAIDs efficacy evaluation criteria for temporomandibular joint pain’.These criteria are intended to comprehensively evaluate the effects of drugs based on the course of classification of TMJ dysfunction (Kurita et al.) . In this study, we evaluated the effect of amfenac sodium on temporomandibular joint disorders with pain according to these criteria. The mean active maximal mouth openings with and without pain after 2-week administration were 39.9±7.9 and 35.5±8.0 mm, respectively, showing significant increases from those before administration (p<0.05) . The median VAS of pain (on exertion) after 2-week administration was 22.5 mm, and that of the influence on activities of daily life was 12.0 mm, showing significant decreases from those before administration (p<0.05 each) . Regarding changes in the classification of TMJ dysfunction (Kurita et al.) after administration, the numbers of ‘moderate’ and ‘severe’ cases decreased from 33 to 29 and from 37 to 13, respectively, showing marked reductions. This evaluation method is capable of patient-based evaluation of outcomes, and is suggested to be applicable to patients with temporomandibular joint disorders.

View full abstract

Recurrent aphthous stomatitis (RAS) in HIV patients is treated by local application of corticosteroid or oral administration of 40-60 mg/day of prednisone or prednisolone for less than 14 days, as recommended by treatment guidelines. However, when the immune system does not improve, large aphthous stomatitis keeps recurring over a short period of time. We treated an AIDS patient with resistant RAS using long-term prednisolone therapy.
The patient presented with hemophilia B complicated by AIDS. Aphthous stomatitis lesions were 10-15 mm in diameter. Aphthous stomatitis was unresponsive to corticosteroid ointment, but responded to oral administration of prednisolone 40 mg/day for 4-7 days. However, when the immune system became severely compromised, aphthous stomatitis kept recurring over a short period of time.
As a result, 5 mg of prednisolone was administered every other day, and this was successful in suppressing recurrence without adverse effects.
Long-term prednisolone therapy was useful in treating RAS when the immune system was severely compromised. In such treatment, close communication and teamwork is required between the physician and dentist to prevent adverse effects.

View full abstract

Garrè's osteomyelitis of the jaw is characterized by a nonsuppurative form of osteomyelitis involving the formation of periosteal new bone. We report a rare case of Garrè's osteomyelitis associated with perimandibular abscess.
The patient, an 11-year-old girl, came to our clinic complaining of swelling of the left mandible. CT examination revealed bone destruction around the left impacted wisdom tooth and its suited mandibular ramus, as well as overgrowth of bone on the cortex of the mandibular ramus. MR images showed high signal intensity in the left masseter muscle and perimandibular soft tissue. A biopsy specimen was obtained from the expanded cortical regions, and simultaneously, incision and drainage were performed and the causative wisdom tooth and surrounding soft tissue were removed. Subsequent treatment with antibiotics yielded a favorable prognosis with disappearance of the periosteal new bone and restoration of the bone destruction of the wisdom tooth region after 8 months.

View full abstract