The aim of the present study was to analyze hemorrhage after tooth extraction and its risk factors in patients receiving direct oral anticoagulants （DOACs）. We retrospectively reviewed the medical records of 100 patients receiving DOACs who had undergone tooth extraction between January 2017 and April 2019 in institutions entered into the study. Risk factors related to postoperative bleeding were clinically examined. Postoperative hemorrhage occurred in 22 extractions （22.0％）, of which 6 （6.0％） required additional treatments such as hemostat or re-suturing. In univariate analysis, DOACs in combination with antiplatelet drug, multiple tooth extraction and prothrombin time （PT） activity level were significant risk factors for postoperative hemorrhage （p＜0.05）. In multivariate analysis, multiple tooth extraction and prothrombin time （PT） activity level were significant independent risk factors （p＜0.05）. It is suggested that cases of DOACs in combination with antiplatelet drug and/or multiple tooth extraction require careful extraction.
The effectiveness of zinc replacement therapy is reported to be approximately 70％. However, the effectiveness of this therapy in our department has been lower than that reported in the field of otolaryngology. In the present study, we examined the effectiveness of zinc replacement therapy in patients with taste disorder. Forty patients were administered only zinc formulations（Polaprezinc, 150mg/day） for ≥8 weeks. The time until effect, serum zinc level and other parameters were used to evaluate improvement in the taste disorder. In the present study, three cut-off values were determined based on the serum zinc levels. The overall improvement rate among the patients in this study was 50％. The improvement rates by serum zinc level were 57％ at ＜60μg/dl, 56％ at 60-69μg/dl, 60％ at 70-79μg/dl, and 14％ at ≥80μg/dl. There was a significant difference in the improvement rate between the patient groups with serum zinc levels of ＜80 and ≥80μg/dl（57％ vs. 14％, p＜0.05）. The times until effective expression in the 20 subjects with improvement were less than 2 months in 20％ and more than 2 months in 80％, with significant differences among the two groups（p＜0.05）. Polaprezinc was effective in 60％ of the cases where serum zinc level measured in blood tests was less than 80μg/dl. Effectiveness was not observed when the serum zinc level was more than 80μg/dl. Therefore, zinc supplementation therapy should be conducted over the long term after proper selection of the patients.
Hyaline fibromatosis syndrome （HFS） is a very rare autosomal recessive disease with progressive course, characterized by multiple subcutaneous nodules, dermal pigmentation, gingival hypertrophy, joint contracture of varying degree, malabsorption due to villous atrophy and so on. The severity is variable and there is no curative treatment for this disease. Some children with the severe form die in early childhood. The gene responsible for the disease is homozygous or compound heterozygous mutations of capillary morphogenesis gene 2 （CMG2）, also known as anthrax toxin receptor 2 （ANTXR2）. We report a case of HFS of a 1-year-old girl with compound heterozygous mutations of CMG2. She had subcutaneous nodules on the scalp, face, chest, back and perianal skin. She also had lip and soft palate tumors, gingival hypertrophy and contracture of the shoulders, hips, knees and ankles. We resected the tumors at the age of 2 years and 4 months old because the tumors of the lips were increasing. Esthetic and functional improvements were found for more than one year after surgery. But, 18 months later, the lower lip tumor had regrown, and the tumors at other sites are also increasing gradually in number and size. We are still continuing close follow-up.
Methotrexate （MTX） is an anticancer agent and immunosuppressant that is particularly useful in rheumatoid arthritis （RA）. It is frequently used as a standard therapeutic agent for RA. MTX-associated lymphoproliferative disorder （MTX-LPD） is a lymphoma that appears with long-term administration of MTX, and presents with extranodal lesions in the gastrointestinal tract, skin, lungs and soft tissue compared with other lymphomas. Additionally, recent reports have described lesions in oral areas such as the gingiva, tongue and oral floor, but there are no reports of cases in Japan or overseas of MTX-LPD lesions appearing as cystic lesions of the mandible on radiographs. Herein we report a case of MTX-related Hodgkin’s lymphoma which was difficult to distinguish from a cystic lesion in the jaw bone.
Neurofibromatosis type 1 （NF1） has been known as
von Recklinghausen’s disease. NF1 is an autosomal dominant disease with café-au-lait spots and neurofibromas on the skin and various symptoms of the nerves, bones, eyes, and so on. Gastrointestinal stromal tumor （GIST） is generally defined as a mesenchymal tumor from interstitial cells of Cajal. NF1 is the most common genetic syndrome associated with developing GIST. We describe a case of both GIST and tongue neurofibroma found to be associated with NF1. A 63-year-old woman was referred for preoperative oral examination of GIST. She had noticed a tongue mass several years earlier, but had not felt any pain or problem in her daily life. Histopathological examination showed that both GIST and tongue neurofibroma had no characteristic finding associated with NF1. She turned out to be NF1 from postoperative interviews and general findings. In this case, it was not the tongue neurofibroma that resulted in a diagnosis of NF1; this is important because the recurrence rate and complications may differ depending on whether GIST is associated with NF1. A greater awareness of NF1-related diseases such as GIST would lead to more accurate preoperative diagnosis and treatment of oral lesions.
In recent years, reports of subcutaneous and mediastinal emphysema resulting from the use of dental lasers have increased. This paper reports a case of mediastinal emphysema caused by CO2 laser irradiation. The patient was a 76-year-old man who underwent CO2 laser irradiation to treat a gingival abscess between the upper right canine and the first premolar at a dental clinic. During the treatment, his right cheek and right eyelid suddenly became swollen. Subsequently, the swelling spread from the right submandibular region to the neck and he was referred to our hospital. A CT examination revealed subcutaneous emphysema from the right temporal region to the bilateral cervical region, as well as mediastinal emphysema extending to the aortic arch. The patient was hospitalized and received anti-inflammatory therapy. The emphysema had nearly disappeared by the 7th day, and he was discharged on the 8th day. We need to recognize the possibility of mediastinal emphysema caused by CO2 laser irradiation and to know how to treat it appropriately.