The secondary bone graft for patients with a primary alveolar cleft seems to be the procedure of de facto standard. The technique is to be applied before the patient reaches the age of 11, and the suffered canine is not erupted using the autogenous particulate cancellous bone marrow of the iliac crest. However, we have read many articles related to bone grafts, and many controversies still exist. There are four categories of bone grafts: primary bone grafts for infants under two and a half years old, early secondary bone grafts for children two to five years old, secondary bone grafts conducted before the eruption of canines, and late bone grafts conducted after the eruption of canines. The primary bone graft and/or gingivoperiosteoplasty with presurgical orthopedic correction is preferable to a secondary bone graft. Although it is not known whether a primary bone graft reduces the need for a secondary bone graft, there are other benefits with regard to the surgical technique and social adaptation. Moreover, the symmetric alar base configuration is not achieved with a secondary bone graft; we rely on presurgical orthopedics to move the frontal prominence of the maxilla forward. We can now use computed tomography to evaluate the results of bone grafts, although frequent use should be avoided for ethical reasons. In view of the limitations of 2-D film, ordinary dental x-rays still have value. The clinical success rate for secondary bone grafts is more than 80%. It is higher on unilateral clefts than on bilateral clefts, and before the eruption of canines than after their eruption. Secondary bone grafting materials are also taken into consideration. Artificial bone and/or the human recombinant Bone Morphologic Protein -2 are discussed as well as the tibia or the chin bone, etc. because they can prevent morbidity in the harvested area after the bone harvesting. We have to improve the use of artificial materials in order to reduce the burden on patients. Periodontal conditions are most interesting among aged patients with primary alveolar clefts. In almost all references, no susceptibility to periodontal disease among cleft-lip and palate patients was found, even if there was a tooth involved without bone support. Further research is needed, especially on elderly patients who have had bone grafts.
There are two primary locations in the mouth where frenula are identified; lip frenula and cheek frenula exist in the oral vesitibule and a lingual frenulum exists in the oral cavity proper. All frenula appear as a ruffle or fold of the mucous membrane. Few disturbances originate in a morphological abnormality; almost all originate in a malpositioning of the adhesion, and present various symptoms. In cases where abnormal adhesion of the frenulum causes oral problems and treatment is needed, age seems to be an important factor. Ankyloglossia causes breastfeeding difficulties, articulation disorders, pronunciation disorders, and chewing and swallowing difficulties in the infant and young child. An abnormal cheek frenulum, which influences oral hygiene, can lead to gingivitis and periodontitis in young and middle-aged people. An abnormal cheek frenulum interferes with the stability of dentures when teeth are lost in old age; it makes it difficult to set them properly. Because there seem to be many abnormalities in the lingual frenulum and the upper lip frenulum of infants and young children, we focused on assessment, diagnosis and surgical procedures (frenectomy) for both types of abnormality.
The creation of an oral mucoperiosteal flap is essential for minor oral surgery, for example, removal of impacted teeth, apicectomy, enucleation of cystic lesions, etc. It is a basic principle that important structures are displayed clearly during surgery, in order to avoid possible complications at adjacent tissues and/or organs. Therefore, one must ensure there is good surgical exposure by creating an adequately designed flap. However, destruction of normal epithelial attachment should be avoided when planning the incision for the flap. Various techniques have been devised, but many of these have been forgotten. However, it is suggested that some may still be valuable for specific cases of elderly or health-compromised patients who have certain ailments or unusual complications during surgery.
Keratocystic odontogenic tumor (KCOT) is an aggressive lesion with a well-documented predilection for recurrence. This study aims to investigate the reason for the recurrence tendency of KCOT. Material and Methods: The materials were 80 KCOTs in 58 patients. All 80 KCOTs were reviewed histopathologically, and 45 of them in 23 patients were examined immunohistochemically by means of monoclonal antibodies against proliferating cell nuclear antigen (PCNA) ，Ki-67, interleukin-1 α (IL-1 α ) ，and podoplanin. Results: 1. Comparison of sporadic KCOTs with lesions of nevoid basal cell carcinoma syndrome (NBCCS) (1) Histopathologically, the proportion of lesions showing budding proliferation, islands of odontogenic epithelium and daughter cysts was higher for NBCCS than for sporadic KCOTs. (2) Immunohistochemically, the ratio of Ki-67-positive cells in NBCCS lesions was higher than in sporadic KCOTs. The intensity of PCNA immunoreactivity was higher in the basal layer of NBCCS lesions than in KCOTs. However, there was no significant difference in the ratio of IL-1 α -positive cells between NBCCS and sporadic KCOTs. (3) The podoplanin immunoreactivity in NBCCS lesions was more intense than in sporadic KCOTs. 2. Comparison of recurrent and non-recurrent lesions after enucleation (1) Histopathologically, the proportion of lesions showing odontogenic epithelial islands was higher in recurrent KCOTs (45.5%) than in non-recurrent (11.6%) KCOTs. (2) Immunohistochemically, the positivity ratios were higher in recurrent KCOTs than in non-recurrent KC4.4% and 2.8%) and PCNA (55.6% and 44.6%). (3) In sporadic KCOTs, the podoplanin immunoreactivity in recurrent primary lesions was more intense than in non-recurrent lesions. 3. Comparison of the primary KCOTs with or without recurrence and the secondary KCOTs after recurrence (1) Histopathologically, only one lesion of secondary KCOT showed a slight sign of inflammation, in contrast to the high ratio (63.6%) in primary KCOTs. (2) Immunohistochemically, the ratio of IL-1 α -positive cells in secondary KCOTs that showed almost no inflammation was higher than that in primary KCOTs. (3) There were no significant differences in podoplanin immunoreactivity between primary KCOTs and secondary KCOTs after recurrence. Conclusion: The experimental results suggest that any residual epithelial tissue left behind after surgery on the KCOT has a potential to cause proliferation and recurrence. Furthermore, this immunohistochemical study of reactivity for podoplanin supports the contention that KCOT is a benign cystic neoplasm but becomes aggressive when associated with NBCCS.
During the three and a half years from July 2006 to October 2009, we conducted statistical observation of traumas caused by bicycle accidents in children under 16 years of age at the Department of Oral Surgery in the Saitama Medical Center of Saitama Medical University. This report summarizes our study. Twenty-nine (34.9%) of 83 cases of trauma incurred while riding a bicycle involved children under 16 years of age. The ratio of males to females was 13.5:1. The highest incidence was among children nine years of age. The most common cause of injury was falling (n = 21)．The sites of oral injury were: teeth injuries (13 patients, 44.8%)，soft tissue injuries (4 patients, 13.8%)，both teeth fracture and soft tissue injuries (3 patients, 10.3%)，and a combination of alveolar bone fracture, teeth injuries, and soft tissue injuries (1 patient, 3.4%)．Of the 40 cases of teeth injuries, 28 (70%) were in the upper jaw and 12 (30%) were in the lower jaw. The types of tooth injury were as follows: luxation of one tooth (4 patients, 13.8%)，luxation of two teeth (3 patients, 10.3%)，and fracture of one tooth (3 patients 10.3%)．Complications occurred in head injuries (n = 7) and limb injuries (n = 4)．Traumas occurred more frequently on weekends (Saturdays and Sundays) than on weekdays. For the most part, these patients were admitted between 3:00 pm and 6:00 pm.
Ankyloglossia is a commonly observed medical condition of which there has been very little investigation. Our purpose in the present study was to determine the appropriate time to conduct the corrective operation. The study group consisted of 104 children with ankyloglossia, 78 males and 26 females, with an average age of 4.7 years. Speech disorder was the most frequent chief complaint. The patients found it most difficult to pronounce the Japanese syllables beginning with the sound /r/. Frenulectomy was the most frequently performed therapeutic procedure. The results of our investigation indicated that the operation should be performed on patients aged four or older.
A transverse facial cleft is an extremely rare malformation among head and neck abnormalities, which mainly occurs as part of branchial arch syndrome. We present a case of a 34-day-old female infant with bilateral facial clefts accompanied by multiple accessory ears. She visited us in December 2008, with a deformity of the bilateral commissure. Her family and past history were unremarkable. She was born after a full-term pregnancy, and referred to us by her mother’s obstetrician and gynecologist because of facial malformation. Clinical examination revealed bilateral transverse facial clefts and a total of seven skin appendages in the face; three in the anterior part of the left lobe, two in the same part of the right lobe, one in the left commissure and in the right cheek, respectively. She had no micrognathism, and there was no abnormality in the vertebrae or ocular region. A clinical diagnosis of transverse bilateral facial clefts accompanied by multiple accessory ears was made, and the bilateral macrostomia was surgically corrected with multiple Z plastic techniques as well as excisions of the bilateral tags. The clinical course after surgery was satisfactory.
Infants invariably experiment by putting things into their mouth. This report describes four cases of foreign bodies found in the mouths of infants, in which the foreign bodies did not cause injury because they did not enter the body. A fused bead covered the lower anterior tooth crown of a seven-month-old female baby and a cylindrical piece of vinyl covered the upper anterior tooth crown of a two-year-old girl. In both cases, their mothers noticed that their children's teeth had some problems, but did not know what was happening. A zipper slider was stuck between the teeth of a two-year-old boy. In this case, his mother was unable to remove the zipper slider. A conical plastic cap was stuck in the premaxillary palate of a nine-month-old female baby. At first, her parents suspected the sudden appearance of bone in the mouth. In each case, the foreign body was removed safely without any complications. However, accidental ingestion or aspiration could occur if the foreign bodies remained undiscovered by guardians or fell into the throat. Also, prolonged contamination could lead to dentoalveolar trauma in some cases. These cases are peculiar to infants, and are far less likely in adults. To prevent this kind of accident, information and guidance should be disseminated more widely to guardians.
Subcutaneous emphysema is a relatively rare complication in dental treatment. This paper reports a case of subcutaneous emphysema that arose after CO2 laser irradiation. A nine-year-old girl underwent irradiation with CO2 laser to resect the upper labial frenum at a dental clinic. On the same day, the patient was referred to our hospital with facial swelling. CT examination revealed subcutaneous emphysema. The patient was hospitalized and received anti-inflammatory treatment. She was discharged after three days, and the swelling subsided within seven days. Efforts should be made to master the proper technique for using CO2 laser and to recognize the possibility of complication when conducting CO2 laser irradiation.