Cevimeline hydrochloride hydrate (cevimeline) is used in the treatment of xerostomia associated with Sjogren's syndrome. However, this medication has muscarinic agonist activity and is associated with several adverse effects, including nausea, vomiting, and diarrhea. Oral rinsing with cevimeline is recommended to avoid these adverse effects, but cevimeline blood concentration after rinsing has not been thoroughly investigated. This study measured blood cevimeline concentration after oral rinsing at a concentration of 30 mg in 50 ml of water and determined that the maximum plasma concentration of 4.04 ± 1.10 ng/ml occurred two hours later, which is longer than the time to maximum concentration after an oral administration of 30 mg. Furthermore, the maximum concentration after rinsing was 5.5% of the maximum concentration after oral administration, and the half-life after rinsing was 6 hours, which is longer than the half-life after oral administration.
Polyglycolic acid (PGA) sheet is a bioabsorbable suture reinforcement consisting of polyglycolide, made of nonwoven fabric with some elasticity. It has been used for strengthening tissue defects or suturing together with fibrin glue in thoracic surgery and gastroenterological surgery. Recently, its application to oral and maxillofacial surgery has been reported. We clinico-statistically evaluated prognostic factors (operation site, excised area, fasting period, attachment days of PGA sheet) in 20 oral surgery patients (20 sites) followed by a technique of covering the wound with a PGA sheet and fibrin glue spray, between September 2010 and September 2011 in our department. There were no significant correlations between fasting period and attachment days of the PGA sheet, or between the excised area and attachment days of the PGA sheet. There were significant differences (p < 0.01) between the operation site and attachment days of the PGA sheet. As a result, the fasting period after the operation was not involved in early detachment of the PGA sheet. To prevent early detachment of the PGA sheet, we considered the attachment position and devised a way of suturing the PGA sheet margin after the sheet was attached to the region not supported by bone. In oral surgery for such patients, appropriate steps are suggested with due consideration for the amount of tissue loss depending on the operation.
Desmoplastic fibroma is a rare benign tumor of bone that is composed of spindle cells with abundant collagen. This tumor mimics the extra-abdominal desmoid tumor of soft tissue both histologically and biologically. Although desmoplastic fibroma is reported to have a high rate of recurrence, cases of recurrence in the head and neck region have not been reported in the Japanese literature and therefore details are not available. We present here a case of desmoplastic fibroma arising in the mandible of a 24-year-old female. After surgical enucleation, she was diagnosed as having desmoplastic fibroma and we put her under a postoperative course. Three years after the operation, a tumor recurred, so we performed continuous resection of the mandible and immediate reconstruction by using an iliac crest bone graft and titanium plate. As of the time of writing, there has been no evidence of local recurrence for eight years after the operation.