Medical robotics, or the application of robots in the medical field, has become a focus of attention. We have attempted to introduce robotic engineering into the field of dentistry and stomatology, under the name “dental robotics ”, to develop a new area of robotic treatment. In the present study, we focused on physical therapy for mandibular movement disor-ders. Our purpose is to integrate dental medicine with robotic engineering and establish a new objective diagnostic and therapeutic approach as a quantitative system with a high degree of reproducibility. Since 1995, in collaboration with the Department of Mechani cal Engineering, School of Science and Engineering, Waseda University, we have been promoting a joint research project to develop the Waseda Yamanashi Series, a series of robots for training in jaw opening and closing using the mechanism of the “Waseda Jaw” (1986), a masticatory robot which reproduces the human physiological mandibular movement under computer control. As a medical system which enables objective and quantitative evaluation, the Waseda Yamanashi Series has been clinically applied to many cases and its further improvement and development is proceeding. We have used this robot system clinically for training in mouth opening and closing to make a comprehensive study of mandibular movement disor ders, and reported the results.
We examined hemostatic management for tooth extraction in Japanese patients undergoing antithrom botictherapy. The subjects consisted of 57 patients aged from 18 to 91 years old. Forty patients received warfarin therapy including 15 receiving additional antiplatelet drugs. The remaining 17 patients received antiplatelet drugs (aspirin, tichlopidine hydrochloride and cilosta zol).In patients receiving warfarin therapy, 19 pa tientswere controlled in International Normalized Ratio (INR)<2.0, 14 in INR 2.0-2.5 and 7 in INR 2.5-3.0. One-hundred and six teeth were extracted on 65 occasions. All teeth were extracted without reducing the usual antithrombotic therapy, oxidized cellulose was applied and suturing was performed for local hemostasis. Three of 65 cases of tooth extraction showed postoperative hemorrhage (4.6%); two occurred in patients under warfarin therapy, with INR of 2.15 and 2.49, respectively. The other case was a patient who received both aspirin and tichlopidine hydrochlo ride.In these patients, because gingivitis, alveolar and gingival abscess were observed, postoperative hemorrhage appeared to be caused by local inflamma tionrather than antithrombotic therapy. These results suggest that sufficient hemostasis can be obtained in most cases of tooth extraction under anticoagulant therapy with warfarin (INR<3.0) and antiplatelet drugs. An appropriate local hemostatic method can obtain hemostasis in case of postopera tivehemorrhage.
We developed two types of fine sialendoscope, which could be introduced to the submandibular duct through the opening of sublingual caruncula. One is a sialendoscope of 1.1-mm outer-diameter (POLYDIAGNOST GmbH, Germany) with 6000-pixels optic fibers, and it has a working channel to insert a basket forceps and an irrigation channel. The other is a sialendoscope of 1.2-mm outer-diameter (FiberTech Co., Ltd., Japan) with 1600-pixels optic fibers and a working channel. Using these newly developed sialendoscopy systems and a 1.9F basket forceps (Boston Scientific Corporation, USA), we could successfully remove a sialolith of the submandibular gland of a 9-year-old girl.
Four cases of brain lesions which developed symptoms in the region of mouth and jaw are reported. Lesions of three cases were brain tumors, which were acoustic neurinoma, lipoma, meningioma, and cerebral infarction. Symptoms of the mouth and jaw were consciousness of tongue and lip, trigeminal neuralgia, spontaneous pain of eye and maxilla. We are not well-versed in these illnesses. This paper describes the relation of such illnesses with symptoms in the region of the mouth and jaw. As mentioned above, when neuralgia and consciousness of oral mucosa and face are found in patients, we should consider the possibility of brain lesions.
Von Recklinghausen's disease is a syndrome defined by the presence of café-au-lait spots and multiple benign neurofibromas. We report a 12-year-old boy with involvement of the tongue associated with von Recklinghausen's disease. The patient presented with a chief complaint of a mass of the tongue. Clinical examination showed multiple brown pigmented spots of the skin and a painless mass in the left side of the tongue. Clinical diagnosis was a tongue tumor associated with von Recklinghausen's disease, and the tumor was surgically excised. Histopathologically, the specimen was diagnosed as plexiform neurofibroma. No gene abnormality can be found by G-banded analysis and fluorescence in situ hybridization (FISH) analysis. The patient showed no evidence of recurrence during the next 1 year, but careful follow-up is needed because the malignant tumor associated with von Recklinghausen's disease might occur in the oral region.