The use of denosumab, which is an intravenous bisphosphonate, for patients with bone metastatic cancer or multiple myeloma, has been increasing in recent treatments. Those bone modifying agents （BMA） could cause osteonecrosis especially in the jaw, which is called medication-related osteonecrosis of the jaw （MRONJ）. However, there is not yet any standard for the effective treatment or prevention of MRONJ. Therefore, a clinical analysis of dental treatment before applying BMA was performed in patients treated with BMA in our hospital. 252 patients in our hospital from February 2008 to March 2016 were investigated; 191 had received zoledronate and 61 had received denosumab. Fourteen patients （5.6％） developed MRONJ, of which 2.6％ had undergone oral treatment before receiving BMA, and another 10.5％ of patients had already received BMA when they came to our department. Some patients had not undergone any oral examination around the time of BMA treatment. The results showed a lower incidence of MRONJ for cancer patients who underwent an oral examination before receiving BMA than patients already receiving BMA.
Objectives: It is important in the field of dentistry to establish a simple method for evaluating the mineral density of alveolar bone. Therefore, based on conventional microdensitometry techniques, we developed the DentalSCOPE system. The value of alveolar bone density was compared between dual-energy X-ray absorptiometry（DEXA）and the DentalSCOPE system. Methods: Twenty-six hemi-mandibles of 13 mandibles were imaged. Intraoral radiographs of the mandibular premolar region were obtained using X-ray film and an imaging plate（IP）detector. DentalSCOPE has a special X-ray beam indicator in which a special calcium carbonate reference object is embedded. Digitized X-ray film images and IP based digital X-ray images were input into the DentalSCOPE system. DentalSCOPE software measures the image density of the reference object automatically and calculates the mineral density value of an arbitrary region of interest（ROI）. The mineral density of a rectangular ROI in the periapical region of mandibular premolars was evaluated. Then, the mineral density value of the same ROI was measured using the DEXA system. Results: A high correlation coefficient（r＝0.929）was found between the IP detector based DentalSCOPE measurement and the DEXA measurement. The correlation coefficient between the X-ray film based DentalSCOPE measurement and DEXA measurement was high（r＝0.921）as well. Conclusions: It was suggested that DentalSCOPE may be useful for evaluating the mineral density of alveolar bone.
We report a case of condylar fracture with external auditory canal injury. An 87-year-old-woman hit her face hard by falling down while walking, and was transported to the emergency department. She had been bleeding from the right ear region at the first examination. She was examined by computed tomography（CT）and three-dimensional CT（3DCT）. 3DCT showed sagittal fracture of the right condylar head and superolateral dislocation of the right condylar process of the mandible. We performed open reduction and fixation by retromandibular approach under general anesthesia 3 days after the injury. The function of the temporomandibular joint was good 6 months after the operation.
We report an untypical case of herpes zoster localizing to the oral mucosa originated from the 3rd branch of the trigeminal nerve. A 42-year-old woman was referred with complaints of altered sensation in the left mental region and left mandibular pain. Brain and facial MRI scans ordered by the previous clinic were normal. Although typical cutaneous herpetic lesions were not observed, intraoral small erosion and uncomfortable dull pain, which was restricted to a dermatomal distribution of the 3rd branch of the trigeminal nerve, were noted. These findings contributed to a clinical diagnosis of herpes zoster. After starting varacyclovir and prednisolone from the initial visiting day, these symptoms had almost completely disappeared by the 10th day. Although a serological test for varicella zoster virus （VZV） antibody was negative at first, a subsequent examination on the 21st day revealed reactivation of VZV. The patient has not suffered from herpetic sequelae including post-herpetic neuralgia or mandibular osteonecrosis. Even if a patient has no rash or herpetic eruptions on the facial skin, intraoral small erosive lesions and intractable continuous pain with altered sensation consistent with the anatomical localization should be managed in consideration of the possibility of herpes zoster.
We report a case of facial necrotizing soft tissue infection in a patient with pemphigus vulgaris who was receiving steroid treatment. A 68-year-old woman came to our hospital with swelling and pain in the left cheek. She was receiving steroid therapy for pemphigus vulgaris, while diabetes mellitus and steroidal osteoporosis were also present. Computed tomography demonstrated a subcutaneous abscess without gas formation in the left cheek and temporal region. We made an initial diagnosis of facial cellulitis, and treated her with intravenous antibiotics and immunoglobulin, and also made an incision and performed drainage. Furthermore, we debrided the left masseter muscle as it had necrotized, which led to our diagnosis of facial necrotizing fasciitis. Although infrequent, necrotizing soft tissue infection is a highly lethal infection, especially in compromised hosts such as patients with diabetes mellitus and those receiving steroid therapy. Thus, early diagnosis and appropriate treatment are important. In addition, to prevent acute infection from dental bacteria and rapid progression, routine maintenance of a good oral environment and management of general condition are necessary.
During operations under general anesthesia, a muscle relaxant is important to ensure airway management of endotracheal intubation and to secure a clear operation field. Rocuronium was released in October 2007. It is characterized by early effects, no accumulation and the possibility of sustained dosage, and so its usage has increased. However, a high incidence of associated anaphylaxis has been suggested. We report a case of anaphylactic shock due to administration of rocuronium during general anesthesia that was confirmed by skin test results. A 26-year-old woman was scheduled for teeth extraction under general anesthesia. She suffered an episode of anaphylactic shock with a sudden decrease in blood pressure （65/38mmHg） as the main symptom after the introduction of anesthesia and intubation. We decided to cancel the operation and gave adrenaline hydrochloride, hydrocortisone sodium succinate, ephedrine hydrochloride and so on. Her blood pressure rose and she awoke from the anesthesia. After remission, skin test results confirmed that rocuronium was the cause of the anaphylactic shock.In view of the increasing use of rocuronium, oral surgeons should consider the increased risk of anaphylaxis.
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