Language：Japanese   Publisher：(公社)日本障害者歯科学会  

Down症候群では、しばしば甲状腺機能異常が認められることが報告されている。今回、全身麻酔下での歯科治療時に甲状腺機能のスクリーニングを行うことによりバセドウ病の加療にいたった症例を経験したので報告する。患者は24歳のDown症候群女性、主訴はむし歯の治療をしてほしいであった。心室中隔欠損症および右室二腔症の修復術後であったが、その他全身的に特記事項は認めなかった。数年前より苛立ちや拒否が強くなり、当センター紹介となった。初診時、患者は歯科治療ユニットに座れず、付添者用の椅子に座らせ診察した。多数歯う蝕を認め、全身麻酔下での歯科治療を計画した。術前検査への拒否も強く、内科主治医への病状照会で得た検査データに問題がなかったため、全身麻酔下に検査(採血、胸部エックス線写真撮影、心電図検査)を施行した。全身麻酔は問題なく行えた。検査結果で甲状腺機能異常を認めたため、内科主治医に精査を依頼した結果、バセドウ病と診断され、ただちに投薬治療が開始された。未治療のバセドウ病は全身麻酔を契機に甲状腺クリーゼを発症する可能性が非常に高く、全身麻酔下での歯科治療は病状が安定するまで延期とした。投薬治療の結果、甲状腺機能が正常化し、治療への協力性もみられつつある。本症例より、特に全身疾患の既往のないDown症候群の患者であっても、合併する可能性の高い疾患については精査を行い、早期に発見することが重要と考えられた。(著者抄録)

Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

INTRODUCTION: Diffuse sclerosing osteomyelitis (DSO) is a rare nonbacterial bone disease associated with recurrent pain and swelling, and its pathogenesis remains unknown. Despite the absence of an established treatment for DSO, bisphosphonates have recently been considered effective in managing this condition. However, the use of zoledronate is off-label, with limited reported cases. Therefore, this study aimed to investigate the effects of zoledronate on pain suppression in DSO. METHODS: This single-arm retrospective study evaluated adult patients diagnosed with mandibular DSO and treated with zoledronate. Patient demographics, pain suppression effect, recurrence, number of zoledronate administration, adverse reactions to zoledronate, and imaging findings were investigated. RESULTS: The study included 18 patients (median age of 59.5 years). Zoledronate effectively suppressed pain in all patients, with a median duration of effect onset of 1 day. Symptom recurrence was observed in 66.7% of patients, with a median time of 29 months from the first zoledronate administration to recurrence. Zoledronate was administered multiple times to 44.7% of patients. The median duration of response was 80 months for patients who experienced relief after a single administration of zoledronate compared to 32 months for those who received multiple administrations (p < 0.001). Adverse reactions, including flu-like symptoms, were observed in 72.2% of the patients, and no medication-related osteonecrosis of the jaw was observed during the follow-up period. CONCLUSIONS: Zoledronate is a relatively safe and effective treatment option for DSO of the mandible. Key Points • Zoledronate effectively suppresses pain in mandibular diffuse sclerosing osteomyelitis. • All condylar lesions recurred after zoledronate administration. • Patients with mandibular canal enlargement required multiple doses of zoledronate. • Adverse reactions to zoledronate administration were minor.

DOI： 10.1007/s10067-025-07438-4

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: Using a severity scale, this study aimed to investigate the treatment behavior of patients with odontogenic infections during the COVID-19 pandemic. MATERIALS AND METHODS: This study included patients admitted for odontogenic deep neck infection (DNI) treatment at a single center in Japan between 2017 and 2022. Participants were divided into two groups: a pre-COVID group before 2019 and a COVID group after 2020. Patient characteristics, clinical data, and DNI severity were compared. RESULTS: During the pandemic, the number of patients with mild DNIs decreased significantly, whereas the number of patients with severe DNIs did not change significantly, resulting in a significant increase in the latter proportion (42/101 (41.6%) vs. 26/43 (60.5%); p=0.045). In addition, the patients in the COVID group were significantly older than those in the pre-COVID group (median 66.0 years vs. 56.0 years; p=0.018). CONCLUSIONS: Our results suggest that patients with odontogenic infections, especially the elderly, may have avoided hospitals until their symptoms became severe during the COVID-19 pandemic.

DOI： 10.7759/cureus.81414

PubMed

Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

INTRODUCTION: Diffuse sclerosing osteomyelitis (DSO) is a non-bacterial osteomyelitis that occurs infrequently and is characterized by recurrent severe pain, swelling of the mandible, and trismus. To date, no effective treatment has been established. Bisphosphonates have been suggested as an efficacious treatment for DSO; however, no prospective studies have examined the effect of bisphosphonate treatment in adults with DSO. This study aims to evaluate the effect of zoledronate on pain suppression in patients with DSO. METHODS: This is a single-center, exploratory, single-arm, prospective interventional study. The participants will include eight patients with DSO of the mandible. The primary endpoint is the change in pain levels before and after zoledronate administration. The secondary endpoints are assessing the efficacy of the clinical course, imaging changes, and safety monitoring. Patients will be enrolled if they are deemed eligible following screening tests and will receive only one 4.0 mg intravenous dose of zoledronate within seven days of enrollment. Study participants will be followed up at one, four, 12, 24, and 48 weeks post-dose or at discontinuation after zoledronate administration. CONCLUSION: This study is the first prospective trial to evaluate the effect of administering a single dose of zoledronate on pain suppression in patients with DSO. We believe this study will lead to the conclusion that zoledronate is an effective treatment for DSO.

DOI： 10.7759/cureus.80739

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

In this study, we aimed to identify risk factors that predict the postoperative need for advanced or prolonged airway management in patients with severe odontogenic deep neck infections (DNIs). This retrospective case-control study included patients of both sexes aged ≥ 18 years who had undergone surgical drainage including debridement of necrotic tissues of odontogenic deep neck abscesses and necrotizing soft tissue infection under general anesthesia between April 2016 and September 2023 at a single center. The patients' characteristics, laboratory tests, and computed tomography (CT) findings were analyzed and compared between the difficult postoperative airway group, which required prolonged intubation or tracheostomy, and the short-term intubation group. Statistical significance was set at P < 0.05. Sixty-four patients required surgical drainage including debridement under general anesthesia. Of them, 7 (10.9%) patients were included in the difficult postoperative airway group. In addition to increased inflammatory markers, the presence of arytenoid edema among laryngeal edema and retro- and parapharyngeal space abscesses on preoperative CT images were identified as risk factors. The presence of pharyngeal space abscesses was significantly associated with laryngeal edema, and the intubation period was longer in patients with more elements relevant to these two factors. Thus, the presence of pharyngeal space abscesses and degree of laryngeal edema on preoperative CT images can be used to predict the complexity of postoperative airway management. Our results suggest that tracheostomy is preferable for patients with retropharyngeal space abscesses, and that patients with parapharyngeal space abscesses and laryngeal edema are desirable to undergo prolonged intubation.

DOI： 10.1007/s10266-024-01041-w

PubMed

Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Osteoradionecrosis of the jaw (ORN) is a late complication of radiation therapy. Radiation-induced fibrosis is the most likely mechanism for developing ORN, and statins are effective against radiation-induced fibrosis. However, no reports have indicated the direct effectiveness of statins in treating ORN. PURPOSE: This study aimed to measure the association between statin exposure and ORN disease resolution. STUDY DESIGN, SETTING, SAMPLE: This retrospective cohort study included patients with ORN diagnosed between January 2008 and December 2020 at the Hospital's Department of Oral and Maxillofacial Surgery. Patients who were immunocompromised or followed up for < 6 months were excluded. PREDICTOR VARIABLE: The predictor variable was statin exposure, which was defined as the use of statins for dyslipidemia. MAIN OUTCOME VARIABLE: The main outcome variable was ORN disease progression status (good prognosis). Patients who showed full recovery and improvement were included in the good prognosis group, and those who showed invariance and deterioration were included in the poor prognosis group. COVARIATES: We analyzed the clinicodemographic including the age of onset, sex, history of smoking, alcohol consumption, history of chemotherapy, tumor site, association with dental treatment, location (maxilla or mandible), the time to ORN onset from radiation therapy, and stage of ORN, and treatment characteristics including hyperbaric oxygen therapy, long-term macrolide administration, and sequestrectomy. ANALYSES: We analyzed the association between statin exposure or covariates and time to ORN improvement using bivariate and multivariate Cox regression. The significance level was set at P = .05. RESULTS: We analyzed 102 patients, and the improvement rate was 32.4%. The favorable prognostic factors were statin exposure (adjusted hazard ratio [HR], 3.71; 95% confidence interval [CI], 1.62 to 8.50; P = .002), onset in the maxilla (HR, 2.15; 95% CI, 1.02 to 4.55; P = .045), and stage 1 of ORN (HR, 2.65; 95% CI, 1.20 to 5.83; P = .016). CONCLUSION AND RELEVANCE: In this study, statin exposure, onset in the maxilla, and stage 1 of Lyons's classification were favorable prognostic factors for ORN. Although this study's findings were insufficient to recommend statin use for ORN, statins may be a novel and effective treatment for ORN.

DOI： 10.1016/j.joms.2024.08.002

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: This study was performed to investigate the association of dental dysplasia with childhood cancer. We examined the occurrence of agenesis, microdontia, and enamel changes of permanent teeth in pediatric cancer survivors. METHODS: Seventy-six patients with pediatric cancer and hematologic diseases were referred to our department for the first time from October 2005 to December 2019. Of these, 17 patients who presented for a checkup in our department fulfilled the study criteria and were analyzed. Clinical examinations and panoramic radiographs were performed to investigate dental dysplasia of permanent teeth. A total of 34 developmental abnormalities (18 missing teeth, 16 cases of microdontia) occurred in 5 patients. The patients' medical records were also analyzed to assess the relationships of specific types of dysplasia with the treatment duration and cumulative drug dose administered. RESULTS: All five pediatric cancer survivors had dental dysplasia; all five had tooth agenesis, and four had microdontia. All five patients were < 4 years of age and had undergone high-dose chemotherapy. CONCLUSION: In this study, childhood cancer survivors who received high-dose chemotherapy before age 4 years experienced the dental dysplasia, including tooth agenesis, microdontia. These findings highlight the need for careful dental monitoring and early intervention in pediatric patients undergoing high-dose chemotherapy. CLINICAL TRIAL NUMBER: This research was conducted in accordance with the Declaration of Helsinki and approved by the Medical Ethics Committee of the Medical University of Kobe (protocol code No. B230066, 1 September 2023).

DOI： 10.1007/s10006-024-01304-4

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The pathological evaluation of cancellous bone at resection margins of mandibular osteoradionecrosis (ORN) has not been well elucidated. Here, we developed a unique classification system for evaluating the degree of bone marrow fibrosis, one of most common pathological features, in patients with mandibular ORN, based on which we investigated its relationship with treatment outcome. METHODS: This study included 15 patients who underwent mandibulectomy and free fibula osteocutaneous flap reconstruction. The extent of mandibulectomy was determined, with safety margins of approximately 10 mm from the apparent osteolytic areas on preoperative computed tomography image. Special staining was performed on thin sections from center of the osteolytic areas (medial area) and bilateral resection margins, and the degree of bone marrow fibrosis was evaluated and investigated its relationship with presence of bone union as a treatment outcome. RESULTS: The degree of bone marrow fibrosis of medial area was significantly higher than those of resection margins. Although most resection margins had collagen fibers which indicate severe fibrosis, all transferred fibula flaps achieved bone union. CONCLUSION: When mandibulectomy is performed with safety margins of approximately 10 mm from the apparent osteolytic areas, all transferred fibula flaps achieved bone union regardless of the degree of bone marrow fibrosis at resection margin. In other words, the association between severe bone marrow fibrosis at resection margins and treatment outcome was not seen. CLINICAL RELEVANCE: Setting safety margins of approximately 10 mm may achieve bone union, but further study is needed.

DOI： 10.1007/s00784-024-06008-3

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

Nanobubbles are studied for their unique properties and possible applications in wound healing processes. This study investigates the effects of hydrogen (H₂), oxygen (O₂), and ozone (O₃) nanobubbles on fibroblast migration and proliferation using in vitro scratch wound healing assays. Fibroblast cells were treated with Dulbecco's Modified Eagle Medium (DMEM) combined with nanobubble solutions, and cell density was measured at 24 and 48 hours. While no significant difference was observed at 24 hours (p=0.52), ozone nanobubbles significantly reduced cell density at 48 hours (p=0.005), indicating cytotoxic effects. Hydrogen and oxygen nanobubble treatments did not show statistically significant differences from the control. These results highlight the cytotoxic effects of ozone nanobubbles on fibroblasts, which may impact their potential application in wound healing. While the study shows the cytotoxic effects of ozone nanobubbles, in vivo wound healing and antimicrobial impacts remain unexplored and warrant further study.

DOI： 10.7759/cureus.74775

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: Mandibular wisdom teeth can occasionally cause infections, which can progress to severe deep neck infections (DNIs) including deep neck abscesses or necrotizing soft tissue infections, which are fatal. This study aimed to identify the radiographic characteristics of mandibular wisdom teeth that developed severe DNIs. METHODS: This study included patients who were admitted for the treatment of severe mandibular wisdom tooth infection between July 2012 and June 2024 at a single center. Patient characteristics, clinical data, and radiographic findings were analyzed and compared between the severe DNI group and mild DNI group including patients with cellulitis or superficial abscess. P < 0.05 was considered significant. RESULTS: Nineteen of 42 patients (45.2%) were included in the severe DNI group. The multivariate analysis showed that the highest odds ratio (OR) was for the presence of a radicular cyst (OR=17.7), followed by the presence of a dentigerous cyst (OR =14.5). The most common mandibular wisdom tooth with a dentigerous cyst in patients with severe DNIs was inverted according to Winter's classification and type IIIC in the Pell and Gregory classification. CONCLUSION: Radiographic characteristics associated with severe DNIs included the presence of radicular and dentigerous cysts in the mandibular wisdom teeth. Especially in dentigerous cysts, deeply impacted teeth should be taken attention.

DOI： 10.7759/cureus.70791

PubMed

Authorship：Lead author,　Corresponding author   Language：Japanese   Publisher：(一社)日本口腔感染症学会  

Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

It is unclear whether normal human skin tissue or abnormal scarring are photoreceptive. Therefore, this study investigated photosensitivity in normal skin tissue and hypertrophic scars. The expression of opsins, which are photoreceptor proteins, in normal dermal fibroblasts (NDFs) and hypertrophic scar fibroblasts (HSFs) was examined. After exposure to blue light (BL), changes in the expression levels of αSMA and clock-related genes, specifically PER2 and BMAL1, were examined in both fibroblast types. Opsins were expressed in both fibroblast types, with OPN3 exhibiting the highest expression levels. After peripheral circadian rhythm disruption, BL induced rhythm formation in NDFs. In contrast, although HSFs showed changes in clock-related gene expression levels, no distinct rhythm formation was observed. The expression level of αSMA was significantly higher in HSFs and decreased to the same level as that in NDFs upon BL exposure. When OPN3 knocked-down HSFs were exposed to BL, the reduction in αSMA expression was inhibited. This study showed that BL exposure directly triggers peripheral circadian synchronization in NDFs but not in HSFs. OPN3-mediated BL exposure inhibited HSFs. Although the current results did not elucidate the relationship between peripheral circadian rhythms and hypertrophic scars, they show that BL can be applied for the prevention and treatment of hypertrophic scars and keloids.

DOI： 10.3390/ijms25042126

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVES: Medication-related osteonecrosis of the jaw (MRONJ) is a severe adverse effect of antiresorptive and/or antiangiogenic agents. As the treatment application for MRONJ is controversial, we aimed to identify the risk factors for poor prognosis and to help determine appropriate management. METHODS: This study included 119 patients. Relevant clinical data were obtained for all the patients. In computed tomography images, osteosclerosis, osteolysis, cortical perforation (buccal or lingual), periosteal reaction, and sequestration were evaluated. RESULTS: Multivariate analyses showed statistically significant associations between poor prognosis in patients with MRONJ and conservative treatment alone (hazard ratio [HR] 1.89), osteolysis (HR 4.67), and the absence of sequestration (HR 5.33). CONCLUSIONS: Conservative treatment alone without clear objectives needs to be avoided, and osteolytic change could be the criteria for surgical intervention. As the boundary between the lesion and vital bone is indistinct, we recommend extensive surgery in cases with unpredictable sequestration.

DOI： 10.1002/hed.27574

PubMed

Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE INC  

Refractory osteomyelitis can lead to recurrent cellulitis and pathological fractures in patients with advanced mandibular osteoradionecrosis (ORN), the optimal treatment for which remains to be established. In addition, difficulties in intake due to trismus and severe pain caused by mandibular ORN may lead to malnutrition and underweight. Therefore, refeeding syndrome (RFS) should be considered when highly invasive surgical procedures are performed. In this report, we discuss the case of an 80-year-old woman with underweight status who had undergone radiotherapy for oropharyngeal malignant melanoma, following which she developed severe pain and a pathological fracture in the right mandible. Given her advanced age and cognitive decline, decisionmaking regarding the treatment plan was difficult. After repeated consultations with the patient and her family members, the treatment priorities were established as pain control, infection control, and increased mouth opening. A segmental mandibulectomy was performed. After nutritional intake was initiated postoperatively, a marked decrease in serum potassium and phosphorus levels was observed. Because there were no symptoms suggestive of RFS, imminent RFS was considered. Appropriate management in accordance with the National Institute for Health and Care Excellence guidelines prevented progression to RFS. Overall, surgery was successful in achieving the initial treatment objectives, and the patient exhibited a general improvement in quality of life. Careful perioperative management for RFS prevention should be considered necessary when performing surgical procedures for advanced mandibular ORN, especially in older adults.

DOI： 10.1016/j.ajoms.2023.04.009

Web of Science

Authorship：Lead author,　Corresponding author   Language：Japanese   Publisher：(公社)日本口腔外科学会  

Language：English   Publishing type：Research paper (scientific journal)  

INTRODUCTION: Necrotizing fasciitis as a complication of medication-related osteonecrosis of the jaw (MRONJ), which we named "ONJ-NF", has been sometimes reported. This study aimed to investigate the usefulness of the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score for predicting ONJ-NF. MATERIALS AND METHODS: We included patients with acute MRONJ who required hospitalization at a single institution from April 2013 to June 2022. They were divided into two groups: patients with ONJ-NF and those with severe cellulitis as a complication of MRONJ, which we named "ONJ-SC." LRINEC scores were compared between the groups and the cut-off value of the score was set by creating a receiver operating characteristic curve. RESULTS: Eight patients with ONJ-NF and 22 patients with ONJ-SC were included. The LRINEC score was significantly higher in patients with ONJ-NF (median: 8.0 points, range 6-10 points) than in those with ONJ-SC (median: 2.5 points, range 0-6 points). A LRINEC score of ≥ 6 points had a sensitivity of 100.0%, a specificity of 77.3%, and an area under the curve of 0.97. Among 6 parameters of LRINEC score, only C-reactive protein (CRP) and white blood cell count (WBC) had significant differences between two groups. Most of the patients with ONJ-NF were rescued by antibiotic therapy and surgical drainage including debridement of necrotic tissues, but unfortunately, one patient did not survive. CONCLUSION: Our results suggested that the LRINEC score may be a useful diagnostic tool to predict ONJ-NF but valuating only CRP and WBC may be sufficient particularly in patients with osteoporosis.

DOI： 10.1007/s00774-023-01441-y

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

Osteoradionecrosis (ORN) often results in pathological fractures through progression. We aimed to identify the risk factors for pathological fracture in patients with mandibular ORN. Seventy-four patients with mandibular ORN were included in this retrospective study. We investigated various risk factors for pathological fracture in patients with mandibular ORN, including number of mandibular teeth with a poor prognosis each at initial evaluation before radiation therapy (RT) and when fracture occurred, and the proportion of antibiotic administration period in a follow-up duration after RT. The rate of occurrence of pathological fractures in patients with mandibular ORN was 25.7%. The median of duration between RT completion and fracture occurrence was 74.0 months. We found that pathological fracture was significantly associated with a larger number of mandibular teeth with a poor prognosis at initial evaluation before RT (P = 0.024) and when fracture occurred (P = 0.009). Especially, a larger number of mandibular teeth with P4 periodontitis, in other words severe periodontal status, was related to pathological fracture in both timings. The proportion of antibiotic administration period in a follow-up duration was also significant risk factor (P = 0.002). Multivariate analyses showed statistically significant associations between pathological fracture and a larger number of mandibular teeth with a poor prognosis when fracture occurred (hazard ratio 3.669). The patient with a larger number of mandibular teeth with P4 periodontitis may have a risk of not only occurrence of ORN but resulting in pathological fracture by accumulation of infection. Surgeons should consider extraction of those teeth regardless of before/after RT if necessary for infection control.

DOI： 10.1038/s41598-023-30735-4

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Empyema is a life-threatening infection often caused by oral microbiota. To the best of our knowledge, no reports have investigated the association between the objective assessment of oral health and prognosis in patients with empyema. MATERIALS AND METHODS: A total of 63 patients with empyema who required hospitalization at a single institution were included in this retrospective study. We compared non-survivors and survivors to assess risk factors for death at three months, including the Renal, age, pus, infection, diet (RAPID) score, and Oral Health Assessment Tool (OHAT) score. Furthermore, to minimize the background bias of the OHAT high-score and low-score groups determined based on the cut-off value, we also analyzed the association between the OHAT score and death at 3 months using the propensity score matching method. RESULTS: The 3-month mortality rate was 20.6% (13 patients). Multivariate analysis showed that a RAPID score ≥5 points (odds ratio (OR) 8.74) and an OHAT score ≥7 points (OR 13.91) were significantly associated with death at 3 months. In the propensity score analysis, a significant association was found between a high OHAT score (≥7 points) and death at 3 months (P = 0.019). CONCLUSION: Our results indicated that oral health assessed using the OHAT score may be a potential independent prognostic factor in patients with empyema. Similar to the RAPID score, the OHAT score may become an important indicator for the treatment of empyema.

DOI： 10.1371/journal.pone.0282191

PubMed

Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Severe odontogenic infections in the head and neck region, especially necrotizing soft tissue infection (NSTI) and deep neck abscess, are potentially fatal due to their delayed diagnosis and treatment. Clinically, it is often difficult to distinguish NSTI and deep neck abscess in its early stage from cellulitis, and the decision to perform contrast-enhanced computed tomography imaging for detection is often a challenge. This retrospective case-control study aimed to examine the utility of routine blood tests as an adjunctive diagnostic tool for NSTI in the head and neck region and deep neck abscesses. METHODS: Patients with severe odontogenic infections in the head and neck region that required hospitalization were classified into four groups. At admission, hematologic and inflammatory parameters were calculated according to the blood test results. In addition, a decision tree analysis was performed to detect NSTI and deep neck abscesses. RESULTS: There were 271 patients, 45.4% in Group I (cellulitis), 22.5% in Group II (cellulitis with shallow abscess formation), 27.3% in Group III (deep neck abscess), and 4.8% in Group IV (NSTI). All hematologic and inflammatory parameters were higher in Groups III and IV. The Laboratory Risk Indicator for Necrotizing Fasciitis score, with a cut-off value of 6 and C-reactive protein (CRP) + the neutrophil-to-lymphocyte ratio (NLR), with a cut-off of 27, were remarkably useful for the exclusion diagnosis for Group IV. The decision tree analysis showed that the systemic immune-inflammation index (SII) of ≥ 282 or < 282 but with a CRP + NLR of ≥ 25 suggests Group III + IV and the classification accuracy was 89.3%. CONCLUSIONS: Hematologic and inflammatory parameters calculated using routine blood tests can be helpful as an adjunctive diagnostic tool in the early diagnosis of potentially fatal odontogenic infections. An SII of ≥ 282 or < 282 but with a CRP + NLR of ≥ 25 can be useful in the decision-making for performing contrast-enhanced computed tomography imaging.

DOI： 10.1186/s12879-022-07934-x

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: The purpose of this study was to investigate the risk factors associated with post-extraction persistent bleeding in patients on warfarin or direct-acting oral anticoagulants (DOACs) and the ability of risk scores to predict post-extraction bleeding. METHODS: Three hundred ninety-one patients taking warfarin or DOACs underwent tooth extractions. Various risk factors for post-extraction bleeding, including number of tooth extraction, with antiplatelet therapy, and risk scores, were investigated by univariate and multivariate analyses. A post-extraction bleeding was classified into grades 1-3. RESULTS: The incidence of post-extraction bleeding was 26.8% (77 out of 287 patients; grade 1: 63, grade 2:14) in patients taking warfarin, and 26.0% (27 out of 104 patients; grade 1: 20, grade 2:7) in patients taking warfarin DOACs. Multivariate analyses showed that multiple teeth extractions and HAS-BLED scores (above 3 points) in patients taking warfarin, and only multiple teeth extractions in patients taking DOAC, were significantly associated with post-extraction bleeding, respectively. CONCLUSION: Most of the post-extraction bleedings were grade 1, which can be stopped by eligibly pressing gauze by surgeons. If patients taking anticoagulants are scheduled to undergo multiple teeth extractions or their HAS-BLED score are above 3 points (if warfarin), we recommend informing patients risk of post-extraction bleeding before operation, taking carefully hemostasis, and instructing patients to bite down accurately on the gauze for longer than usual.

DOI： 10.1007/s10006-022-01039-0

PubMed

Publishing type：Research paper (scientific journal)   Publisher：Wiley  

DOI： 10.1002/micr.30766

Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Non-thrombotic skin paddle necrosis occasionally occurs during mandibular reconstructions with free fibula osteocutaneous flaps. The number of perforators, size of the skin paddle, and ischemia time of the flap are considered as causes of skin paddle necrosis. The importance of donor side selection has also been highlighted. This study aimed to investigate the leading cause of skin paddle necrosis and the optimal reconstructive procedure. METHODS: A total of 66 patients who underwent mandibular reconstruction using a free fibula osteocutaneous flap were retrospectively analyzed. Skin paddle necrosis, number of cutaneous perforators, size of the skin paddle, and ischemia time of the flap were investigated. An incorrect "laterality" was defined as a skin paddle (septum) covering the reconstruction plate. Donor-site morbidity was recorded. RESULTS: Skin paddle necrosis occurred in 15.2% of patients. An incorrect laterality was associated with a higher incidence of skin paddle necrosis (odds ratio, 22.0; 95% confidence interval, 2.5-195; p = .005). Donor-site morbidity was noted in 18.8% of the patients, without any significant difference in terms of the donor side with and without skin graft (p = .592). The postoperative activities of daily living were not affected. CONCLUSIONS: To prevent skin paddle necrosis, donor side selection is an important safety strategy during mandibular reconstruction with free fibula osteocutaneous flap. The postoperative activities of daily living were found to be little affected by differences in the donor side.

DOI： 10.1002/micr.30881

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

Pain is a problematic symptom in patients with osteonecrosis of the jaws (ONJ). Effective pain management in patients with advanced ONJ still remains an unresolved issue. This case series report presents three patients who were referred to the pain clinic for treatment of intractable pain caused by ONJ. Two patients received mandibular nerve blocks and achieved pain relief. After referral to the pain clinic, these two patients underwent segmental mandibulectomy for ONJ. In the third patient, the effect of pain control was limited. Appropriate cooperation between the oral and maxillofacial surgeon and the pain specialist is essential for pain management in patients with advanced ONJ who experience intense pain.

DOI： 10.7759/cureus.26150

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

A standard treatment for osteoradionecrosis (ORN) has not yet been established because of the diversity. Therefore, identifying the risk factors for a poor prognosis is essential. This study retrospectively investigated the factors associated with the prognosis of ORN in 68 patients. Relevant clinical data of all patients were obtained. Of the patients, 16 who underwent extensive surgery underwent histopathological analysis. The necrotic changes of the anterior and posterior margins in the cortical and cancellous bones were investigated. Multivariate analyses showed statistically significant associations between poor prognosis in patients with ORN and high radiation dose (hazard ratio [HR] 1.15), orocutaneous fistula (HR 2.93), and absence of sequestration (HR 2.49). Histopathological analysis showed a viable anterior margin of the middle portion of the cortical bone for all recovered cases; in contrast, most cases (75%) with a poor prognosis showed necrotic changes. The anterior margin of the cancellous bone was viable and resilient to high irradiation, regardless of the prognosis. These results suggest that patients with orocutaneous fistula should receive early surgical intervention, even if the affected area is limited or asymptomatic. In extensive surgery, a sufficient safety margin of necrotic bone, particularly in the anterior region, is required to improve the prognosis.

DOI： 10.3390/ijerph19116565

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

Schwannomas commonly occur in the head and neck region as acoustic neuromas. Facial nerve schwannomas are rare and usually occur in the temporal region. A 57-year-old woman presented with a mass at the right mandibular margin. Magnetic resonance imaging revealed a schwannoma located immediately caudal to the mental foramen. We were initially uncertain whether it arose from the trigeminal nerve or the facial nerve. Excision was performed under general anesthesia. The mass was encapsulated and easily detached from the surrounding tissue. The nerve of origin was identified proximal to the tumor. A facial nerve origin was confirmed as the muscles supplied by the marginal mandibular branch of the facial nerve moved on nerve stimulation. Nerve fibers were not found distal to the tumor, possibly because they had been cut during excision. We believe that this is the first report of a schwannoma arising from the peripheral facial nerve.

DOI： 10.1093/jscr/rjab299

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND:  Intraoperative vasospasm during reconstructive microvascular surgery is often unpredictable and may lead to devastating flap loss. Therefore, various vasodilators are used in reconstructive microsurgery to prevent and relieve vasospasm. Lidocaine is a vasodilator commonly used in microvascular surgery. Although many reports have described its in vitro and in vivo concentration-dependent vasodilatory effects, limited studies have examined the pharmacological effects of lidocaine on blood vessels in terms of persistence and titer. METHODS:  In this study, the vasodilatory effect of lidocaine was examined by using the wire myograph system. Abdominal aortas were harvested from female rats, sliced into rings of 1-mm thickness, and mounted in the wire myograph system. Next, 10, 5, 2, and 1% lidocaine solutions were applied to the artery, and the change in vasodilation force, persistence of the force, and time required to reach equilibrium were measured. RESULTS:  The vasodilatory effect was confirmed in all groups following lidocaine treatment. Although strong vasodilation was observed in the 10% lidocaine group, it was accompanied by irreversible degeneration of the artery. Vasodilation in the 1% lidocaine group was weaker than that in the other groups 500 seconds after lidocaine addition (p < 0.05). Between the 5 and 2% lidocaine groups, 5% lidocaine showed a stronger vasodilatory effect 400 to 600 seconds after lidocaine addition (p < 0.01); however, there was no significant difference in these groups after 700 seconds. Additionally, there was no difference in the time required for the relaxation force to reach equilibrium among the 5, 2, and 1% lidocaine groups. CONCLUSION:  Although our study confirmed the dose-dependent vasodilatory effect of lidocaine, 5% lidocaine showed the best vasodilatory effect and continuity with minimal irreversible changes in the arterial tissue.

DOI： 10.1055/s-0040-1722759

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: This study aimed to evaluate the occurrence and treatment outcome of late complications after free fibula osteocutaneous flap reconstruction for mandibular osteoradionecrosis (ORN). METHODS: We enrolled 15 consecutive patients (14 men, one woman; median age 65 years, range 57-80 years) who underwent free fibula reconstruction for advanced mandibular ORN during 2013-2017 with two or more years of follow-up. Late complications included infection, plate exposure, and recurrence at the resection margin. The effect of perioperative antibiotic administration on late complications was also assessed. RESULTS: Late complications occurred in 33.3% (5/15) of patients, including two infections (local and distant), two plate exposures, and two recurrences (plate exposure and recurrence occurred in one patient). Perioperative antibiotic administration duration did not significantly affect the occurrence of postoperative late complications. All late complications were treated without problems. CONCLUSIONS: Late complications after ORN reconstructive surgery are not uncommon, but can be treated properly.

DOI： 10.7759/cureus.13833

PubMed

Language：Japanese   Publisher：(公社)日本障害者歯科学会  

Down症候群では、しばしば甲状腺機能異常が認められることが報告されている。今回、全身麻酔下での歯科治療時に甲状腺機能のスクリーニングを行うことによりバセドウ病の加療にいたった症例を経験したので報告する。患者は24歳のDown症候群女性、主訴はむし歯の治療をしてほしいであった。心室中隔欠損症および右室二腔症の修復術後であったが、その他全身的に特記事項は認めなかった。数年前より苛立ちや拒否が強くなり、当センター紹介となった。初診時、患者は歯科治療ユニットに座れず、付添者用の椅子に座らせ診察した。多数歯う蝕を認め、全身麻酔下での歯科治療を計画した。術前検査への拒否も強く、内科主治医への病状照会で得た検査データに問題がなかったため、全身麻酔下に検査(採血、胸部エックス線写真撮影、心電図検査)を施行した。全身麻酔は問題なく行えた。検査結果で甲状腺機能異常を認めたため、内科主治医に精査を依頼した結果、バセドウ病と診断され、ただちに投薬治療が開始された。未治療のバセドウ病は全身麻酔を契機に甲状腺クリーゼを発症する可能性が非常に高く、全身麻酔下での歯科治療は病状が安定するまで延期とした。投薬治療の結果、甲状腺機能が正常化し、治療への協力性もみられつつある。本症例より、特に全身疾患の既往のないDown症候群の患者であっても、合併する可能性の高い疾患については精査を行い、早期に発見することが重要と考えられた。(著者抄録)

Other Link： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J02489&link_issn=&doc_id=20210315190007&doc_link_id=%2Fcp2disab%2F2021%2F004201%2F004%2F0053-0059%26dl%3D2&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcp2disab%2F2021%2F004201%2F004%2F0053-0059%26dl%3D2&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_5.gif

Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: In Japan, oral third-generation cephalosporins with broad-spectrum activity are commonly prescribed in the practices of dentistry and oral surgery. However, there are few reports on the appropriate use of antibiotics in the field of oral surgery. This study aimed to evaluate the appropriateness of antibiotic use before and after an educational intervention in the Department of Oral and Maxillofacial Surgery, Kobe University Hospital. METHODS: The use of oral antibiotics was investigated among inpatients and outpatients before and after an educational intervention conducted by the antimicrobial stewardship team. Additionally, the frequency of surgical site infection after the surgical removal of an impacted third mandibular molar under general anesthesia and the prevalence of adverse effects of the prescribed antibiotics were comparatively evaluated between 2013 and 2018. RESULTS: After the educational intervention, a remarkable reduction was noted in the prescription of oral third-generation cephalosporins, but increased use of penicillins was noted among outpatients. There was reduced use of macrolides and quinolones in outpatients. Although a similar trend was seen for inpatients, the use of quinolones increased in this population. Despite the change in the pattern of antibiotic prescription, inpatients who underwent mandibular third molar extraction between 2013 and 2018 did not show a significant increase in the prevalence of surgical site infections (6.2% vs. 1.8%, p = .336) and adverse effects of drugs (2.1% vs. 0%, p = .466). CONCLUSIONS: This study suggests that the judicious use of oral antibiotics is possible through conscious and habitual practice of appropriate antibiotic use. However, further investigation is required to develop measures for appropriate use of oral antibiotics.

DOI： 10.1186/s12903-020-01367-1

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

Advanced mandibular osteoradionecrosis (ORN) sometimes requires extended resection (e.g., hemimandibulectomy). Bacterial infection contributes to ORN pathogenesis. To control infection and determine the extent of debridement required, an understanding of bacterial spread within sites of mandibular ORN is important. The current study used a histopathological approach to assess bacterial colonization in the mandibular condyle and elucidate possible paths of bacterial spread towards the mandibular condyle. Four hemimandibulectomy specimens were selected. Areas of bone destruction were macroscopically assessed and confirmed using hematoxylin and eosin staining. Bacterial presence within mandibular condyle was confirmed with Gram staining. Bone exposure was observed in the molar area in all specimens. Macroscopic bone destruction was apparent especially near the medial side of the cortical wall. Gram staining revealed bacterial colonization of the mandibular condyle in three of the four specimens. In conclusion, bacteria tended to spread posteriorly and through the medial side of the mandibular cortical wall. In patients with advanced ORN, the potential for bacterial colonization of the mandibular condyle should be considered during treatment.

DOI： 10.1155/2021/9998397

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Necrotizing fasciitis (NF) is an acute and life-threatening soft-tissue infection however rarely seen in oro-cervical region. Therefore, the details of oro-cervical NF (OCNF) are not well known. The purpose of this study was to investigate the characteristics of OCNF by comparing it with severe cellulitis of oro-cervical region (OCSC) or NF of other body regions (e.g., limb, perineum, and trunk) (BNF), respectively. MATERIALS AND METHODS: At first, various risk factors for OCNF in oro-cervical severe infection (OCSI; composed of OCNF and OCSC), including neutrophil-to-lymphocyte ratio (NLR) and Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score, were investigated by univariate and multivariate analyses. Next, the differences between OCNF and BNF, including inflammatory markers and mortality, were investigated. RESULTS: In the present study, 14 out of 231 OCSI patients had OCNF. Multivariate analyses of OCSI patients showed that NLR ≥15.3 and LRINEC score ≥6 points were significantly related to OCNF. During the same period, 17 patients had BNF. The OCNF group had significantly higher inflammatory markers than the BNF group when diagnosis, but significantly lower clinical stages at the time and mortality as outcomes. CONCLUSION: We found that compared to BNF, OCNF can be detected at lower clinical stage by using indexes, such as NLR and LRINEC score, besides clinical findings, which may help contributing to patient's relief.

DOI： 10.1371/journal.pone.0260740

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Various antibiotics and analgesics have been reported to interact with warfarin. Reports that investigate the effects of medication taken for just a few days during tooth extraction on the prothrombin time-international normalized ratio are rare. METHODS: A total of 110 patients receiving long-term stable warfarin therapy underwent tooth extraction without interruption of warfarin treatment. INR values were measured 1 month before the tooth extraction, the day of the extraction, and 1 week after the extraction. We investigated the changes in INR values between the day of extraction and 1 week after extraction, as well as the various risk factors for increases in INR values. RESULTS: Before and after tooth extraction, the number of patients taking cefcapene pivoxil, amoxicillin, and azithromycin was 57, 36, and 8, respectively. Nine patients were administered ampicillin before tooth extraction and received amoxicillin after their tooth extraction. One week after tooth extraction, the INR values increased beyond the therapeutic range in 3 out of 110 patients (2.7%). The INR values before tooth extraction in these three patients were close to 3.0. The INR value increased by more than twice as much in 1 out of 110 patients (0.9%). CONCLUSION: Our results suggest that prophylactic antibiotic administration has little effect on INR values when patients on stable warfarin therapy undergo tooth extraction. Surgeons have to take attention if the patients whose INR values are close to 3.0 before their extraction.

DOI： 10.1186/s12903-020-01326-w

PubMed

Language：Japanese   Publisher：フレグランスジャーナル社  

Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVES: One of the treatment goals for osteonecrotic lesions of the jaw, such as medication-related osteonecrosis of the jaw (MRONJ) or osteoradionecrosis (ORN), is restoration of quality of life (QOL). This study aimed to identify symptoms that negatively affect QOL in patients with unhealed MRONJ or ORN. STUDY DESIGN: This cross-sectional study included patients who were previously diagnosed with MRONJ or ORN and who underwent treatment at the Kobe University Hospital between June 2015 and February 2016. Patient QOL was measured by using the Oral Health Impact Profile (OHIP-14). The predictor variable was disease status (stage and healing). The outcome variable was OHIP-14. One-way analysis of variance and Tukey's test were performed. RESULTS: The study included 74 patients (37 men and 37 women; mean age 70 years). Although there was no significant difference between the OHIP-14 scores of unhealed MRONJ and ORN (stages 1-3) and those of healed ones, the "worsened sense of taste" resulted in significant differences among stages in patients with unhealed MRONJ (P = .027) and the "painful mouth aching" in patients with unhealed ORN (P = .041). CONCLUSIONS: Worsened sense of taste and pain negatively affected QOL in patients with unhealed MRONJ and ORN.

DOI： 10.1016/j.oooo.2020.03.051

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Prognostic biomarkers provide essential information about a patient's overall outcome. However, existing biomarkers are limited in terms of either sample collection, such as requiring tissue specimens, or the process, such as prolonged time for analysis. In view of the need for convenient and non-invasive prognostic biomarkers for oral cancer, we aimed to investigate the prognostic values of neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and platelet-to-lymphocyte ratio in patient survival. We also aimed to explore the associations of these ratios with the clinicopathologic characteristics of Japanese oral squamous cell carcinoma patients. METHODS: This study was a non-randomized retrospective cohort study in a tertiary referral center. We included 433 patients (246 men, 187 women) who underwent radical surgery for oral cancers between January 2001 and December 2013. We evaluated various risk factors for poor prognosis including neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and platelet-to-lymphocyte ratio with univariate and multivariate analyses. The disease-specific survival and overall survival rates of patients were compared among the factors and biomarkers. RESULTS: In multivariable Cox proportional hazards analysis, high neutrophil-to-lymphocyte ratio (hazard ratio 2.87, 95% confidence interval 1.59-5.19, P <  0.001), moderately or poorly differentiated histology (hazard ratio 2.37, 95% confidence interval 1.32-4.25, P <  0.001), and extranodal extension (hazard ratio 1.95, 95% confidence interval 1.13-3.35, P = 0.016) were independent predictors of disease-specific survival. High neutrophil-to-lymphocyte ratio (hazard ratio 2.30, 95% confidence interval 1.42-3.72, P <  0.001), moderately or poorly differentiated (hazard ratio 1.72, 95% confidence interval 1.07-2.76, P = 0.025), and extranodal extension (hazard ratio 1.79, 95% confidence interval 1.13-2.84, P = 0.013) were independent predictors of overall survival. CONCLUSIONS: Neutrophil-to-lymphocyte ratio might be a potential independent prognostic factor in Japanese oral squamous cell carcinoma patients.

DOI： 10.1186/s12885-020-07063-1

PubMed

Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

The human skin has previously been described to be affected by light; however, the underlying mechanism remains unknown. OPN4 (melanopsin) expression was first identified in the skin of amphibians; however, whether it is also expressed and functioned in the human skin has not yet been identified. Here, we show that OPN4 was expressed in the human skin tissue and cultures of isolated keratinocytes, melanocytes and fibroblasts. Additionally, Ca2+ influx in vitro and ex vivo and phosphorylation of extracellular signal-regulated kinases 1/2 in human fibroblasts were observed by stimulation of blue light irradiation. Notably, our findings showed that this Ca2+ influx and phosphorylation of extracellular signal-regulated kinases 1/2 are promoted in an intensity-dependent manner, indicating that the light signal is converted to an intracellular signal via OPN4 in the human skin. Overall, in this study we showed that the human skin functions as a photoreceptor by demonstrating that in human skin, the photoreceptive protein was expressed, and photoreception was conducted via photoreceptive protein.

DOI： 10.1111/gtc.12751

PubMed

Language：Japanese   Publisher：(一社)日本口腔感染症学会  

Language：Japanese   Publisher：(一社)日本口腔腫瘍学会  

粘液脂肪腫は極めて稀な脂肪腫の亜型であり、本邦でこれまで報告された口腔内の発生例はわずか4例しかない。われわれは64歳男性の舌縁部に発生した粘液脂肪腫の1例を経験したので報告する。患者は舌の腫脹を主訴に紹介初診された。T1、T2強調像にて11×9×11mmの高信号を認めた。全身麻酔下に舌腫瘍摘出術を行った。病理組織学的所見は、成熟した大小不同の脂肪細胞の増殖からなり、間質に粘液腫様変化を認めたため、舌粘液脂肪腫と診断した。術後1年が経過するが再発は認めていない。(著者抄録)

Other Link： https://search.jamas.or.jp/default/link?pub_year=2019&ichushi_jid=J02382&link_issn=&doc_id=20191224200006&doc_link_id=%2Fdy8ortum%2F2019%2F003104%2F007%2F0203-0206%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdy8ortum%2F2019%2F003104%2F007%2F0203-0206%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND AND OBJECTIVE: Forearm free flaps are used after hemiglossectomy. However, no investigation has been performed on whether oral functions are better preserved when sizes of the resection and reconstruction flap are exact matches, or whether the size of the resection should be changed. We aimed to retrospectively examine whether size differences between the resection and reconstruction flap affect speech and swallowing functions postoperatively, and to determine whether there are more favorable flap size ratios. METHODS: This is a retrospective cohort study of patients undergoing hemiglossectomy using a forearm free flap between 2006 and 2016 at Kobe University Hospital, Japan. The effect of size difference between the resection and reconstruction flap on maintained oral function was assessed. Speech and swallowing functions were assessed, and their correlation with the ratio of the flap size to that of the resected area was determined. With these data, distribution maps of the relationship between the functional level and reconstructed dimension ratio were prepared. The more suitable reconstructed dimension ratio was examined and evaluated. The Fisher exact test, Kruskal-Wallis test, and Scheffe test were used in statistical analyses. RESULTS: Eighty-eight patients underwent hemiglossectomy using a forearm free flap during a 10-year period. Of these cases, 66 patients were included in this study, while 22 were excluded. The ratio of the area of the reconstruction flap to that of the resection site was 0.59-2.79 (median: 1.61). Sixty patients had flaps greater than the resection area, whereas 6 had smaller flaps. Significant differences were found in speech intelligibility and swallowing function when the reconstructed dimension ratio was categorized as follows: ≤1.3, 1.3-1.8, and ≥1.8. CONCLUSION: Our findings suggest that postoperative deterioration of oral functions after hemiglossectomy could be reduced if reconstruction is performed using a forearm free flap with a surface area 1.3 to 1.8 times greater than that of the resection area.

DOI： 10.1016/j.bjps.2019.03.015

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE:  Musculocutaneous flap reconstruction surgery is one of the standard procedures following head and neck cancer resection. However, no previous studies have classified flaps in terms of muscle and fat or examined them after long-term follow-up. The purpose of this study was to estimate the fat and muscle volume changes in musculocutaneous flaps during long-term follow-up. METHODS:  We conducted a retrospective analysis of 35 patients after musculocutaneous flap reconstruction. The total, fat, and muscle volumes of the musculocutaneous flaps were measured using 3-dimensional images. Changes in flap volumes over time (1 month, 1 year [POY1], and 5 years [POY5] postoperatively) were assessed. Flap persistence was calculated using flap volumes at 1 month after reconstruction for reference. RESULTS:  Flap persistence at POY5 was 42.0% in total, 64.1% in fat, and 25.4% in muscle. Muscle persistence was significantly decreased (p < 0.0001). In a multiple regression analysis, decreased body mass index (BMI) of ≥ 5% influenced fat persistence less than muscle persistence at POY1; however, there was no significant difference at POY5. Postoperative radiation therapy was associated with a significant decrease in total flap persistence at POY1 (p = 0.046) and POY5 (p = 0.0097). Muscle persistence significantly decreased at POY5 (p = 0.0108). Age significantly influenced muscle volume at POY1 (p = 0.0072). CONCLUSION:  Reconstruction flaps are well-preserved with high fat-to-muscle ratios. Recommendations for weight maintenance are necessary for patients less than 2 years after surgery due to the influence of BMI on fat persistence. Radiation therapy is necessary for some patients based on their disease state. Intensity-modulated radiation therapy can be offered to reduce scattering irradiation to normal tissues.

DOI： 10.1055/s-0038-1672134

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

In brief, perioperative oral intervention consists of elimination of odontogenic foci and maintenance of oral hygiene in patients undergoing surgery. The importance of oral intervention before, during, and after medical treatments is well-known, especially in cancer patients, because odontogenic foci such as untreated deep dental caries or periodontitis can cause systemic infection in patients with myelosuppression resulting from chemotherapy. Although perioperative oral intervention is currently recommended for patients with cardiovascular disease, its efficacy in this population has not been established. This article consists of three sections: first, we review the current knowledge about the association between dental disease and cardiovascular disease to show the importance of oral hygiene maintenance and the risks of invasive dental procedures in patients with cardiovascular disease; second, we introduce pertinent, but limited evidence concerning the effect of oral care in preventing postoperative pneumonia; and finally, we present the optimal strategy for perioperative oral intervention in cardiovascular surgery patients.

DOI： 10.1007/s11748-018-1020-0

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: Few studies exist that focus on the details of perioperative antibiotic administration for surgery to treat medication-related osteonecrosis of the jaw (MRONJ). The regime and duration of perioperative antibiotics applied in published studies were reviewed to clarify appropriate perioperative antibiotic use in MRONJ surgery. METHODS: A literature search was conducted using the MEDLINE database via PubMed. RESULTS: The search resulted in 453 hits on PubMed. After reading the downloaded full-text articles, 17 articles met the inclusion and exclusion criteria. The most common perioperative antibiotic used for MRONJ surgery was a combination of penicillin-based antibiotics and β-lactamase inhibitor (52.9%), and the second most common regime was penicillin-based antibiotics with metronidazole (17.6%). The duration of administration was 2 weeks postoperatively in nine studies, whereas four studies applied long-term administration (2-6 weeks postoperatively). CONCLUSIONS: Oral and maxillofacial surgeons mostly prefer penicillin-based antibiotics plus β-lactamase inhibitor or metronidazole for MRONJ surgery. The duration of administration of these medications may be based on empirical experience.

DOI： 10.1007/s10006-018-0732-8

PubMed

Language：Japanese   Publisher：(一社)日本口腔感染症学会  

当科で経験した薬剤関連顎骨壊死症例65例(男性15例、女性50例、平均74.9歳)を分析し、転帰に影響する因子について検討した。原疾患別では、悪性腫瘍が23例(35.4%)、骨粗鬆症が39例(60.0%)、悪性腫瘍・骨粗鬆症合併が3例(4.6%)であった。治療法はnonsurgical approach群が35例(53.8%)、conservative surgery群が23例(35.4%)、extensive surgery群が7例(10.8%)であった。転帰については、「症状消失」が38例(58.5%)、Stageが下がった「症状改善」が11例(16.9%)、「症状不変」が7例(10.8%)、Stageが上昇した「症状悪化」は5例(7.7%)、経過観察中に患者が原疾患により死亡した症例が4例(6.3%)であった。原疾患別とリスク製剤休薬・変更の可否で統計学的に有意差が認められ、悪性腫瘍と休薬・変更不可症例では「症状消失」症例が有意に少なかった。また、各Stageに占める「症状消失」症例の割合をみたところ、Stage 0:8/10例(80.0%)、Stage 1:14/17例(82.4%)、Stage 2:14/29例(48.3%)、Stage 3:2/5例(40.0%)であった。

Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: The purpose of this study was to measure the frequency and identify factors associated with delayed socket healing after dental extraction in patients undergoing myelosuppressive chemotherapy for hematologic malignancy. MATERIALS AND METHODS: This prospective cohort study focused on delayed healing after extraction in patients with hematologic malignancy. Sockets with delayed healing were defined as those with intense pain and bone exposure 1 week postoperatively. Patients with and without delayed socket healing were compared using the Fisher exact test and Mann-Whitney U test with some variables. Receiver operating characteristics curve analysis was conducted to define cutoff values for delayed healing. RESULTS: One hundred ninety-four dental extractions in 93 patients (median age, 64 yr; range, 20 to 85 yr) were analyzed. The incidence of delayed socket healing was 7.5% (7 of 93 patients). There was no postoperative bleeding. Older age, type of hematologic malignancy (acute leukemia), shorter time from dental extraction to initiation of chemotherapy, low platelet count or hemoglobin level, requirement for red blood cell concentrate or platelet transfusion, and use of an absorbable hemostatic agent were statistically associated with the occurrence of delayed socket healing. Platelet and hemoglobin cutoffs were 4.6 × 104/μL and 7.7 g/dL, respectively. CONCLUSIONS: Although dental extraction can be safely performed in patients undergoing myelosuppressive chemotherapy for hematologic malignancy, oral surgeons should understand the potential risk for delayed socket healing. When considering dental extraction, patients with hematologic malignancy and low hemoglobin or platelet levels should be informed about the possibility of delayed socket healing.

DOI： 10.1016/j.joms.2018.05.023

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: Pain is one of the most problematic symptoms in patients with osteoradionecrosis of the jaws. This study investigated the associations between pain severity and morphologic alterations of the mandibular canal and inferior alveolar nerve, in respective computerized tomography images and resected specimens of mandibular osteoradionecrosis. STUDY DESIGN: We assessed 14 lesions in 13 patients who underwent segmental mandibulectomy for surgical debridement and simultaneous reconstruction with free fibula flap (1 patient exhibited bilateral lesions). The extent of the mandibular canal bone defect on preoperative coronal computerized tomography images and the number of inferior alveolar nerve fascicles in resected specimens were evaluated. Comparisons were made between the slight pain and extreme pain groups. In most of the patients in the extreme pain group, either mandibular canal bone defects were absent or entire circumferential defects were present; inferior alveolar nerve fascicles were either distinguishable or completely absent in the resected specimens. RESULTS: Although there was no statistically significant association between extreme pain and computerized tomography or histopathologic findings, the histopathologically indistinguishable inferior alveolar nerve fascicles was significantly associated with slight pain. CONCLUSIONS: The degree of degeneration of mandibular canal and inferior alveolar nerve may be associated with pain severity in patients with mandibular osteoradionecrosis.

DOI： 10.1016/j.oooo.2018.03.017

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: A problematic complication after radiation therapy is lymphedema. Development of lymphedema is associated with an increase in lymphatic paracellular permeability. The current study investigated the effects of radiation on intercellular junctions and paracellular permeability in cultured human dermal lymphatic endothelial cells (HDLECs). METHODS AND RESULTS: Double immunofluorescence staining with vascular endothelial (VE)-cadherin and actin immediately after X-ray irradiation (5 or 20 Gy) was performed. Morphological changes induced by irradiation were assessed. Cell viability and paracellular permeability after irradiation were also evaluated. Broad junctions in which VE-cadherin was accumulated at cell-cell contacts and almost colocalized with actin were significantly decreased in a dose-dependent manner in confluent and sparse irradiated HDLECs. Irradiation shortened the width of VE-cadherin-positive areas at the cell-cell contacts. Actin filaments did not colocalize with VE-cadherin after 20 Gy irradiation. Although cell viability was not affected by irradiation, paracellular permeability significantly increased in a dose-dependent manner. CONCLUSIONS: A dose of 5 or 20 Gy irradiation in HDLECs does not affect cell viability, but changes VE-cadherin mediated intercellular junctions and actin structure, resulting in an increase of paracellular permeability. Further investigations on the regulatory proteins involved in radiation-induced changes, which were observed in the current study, may contribute to development of lymphedema therapy.

DOI： 10.1089/lrb.2017.0072

PubMed

Language：Japanese   Publisher：(一社)日本口腔感染症学会  

ガイドライン導入前の当院の抗菌薬予防投与指針に準じて抗菌薬予防投与を行った口腔癌即時再建手術の術後感染発症例を後ろ向きに調査し、術後感染の発症に影響を与える因子について検討した。当科で気管切開術、口腔癌切除術、頸部郭清術および血管柄付遊離皮弁による即時再建術を施行した40例を対象とした。術後感染を認めた症例は40例中12例で、発症率は30.0%であった。基礎疾患の有無による術後感染発症率に有意差は認められず、アルブミン値およびヘモグロビン値との関連もなかった。手術時間での比較では、術後感染を認めなかった症例の平均手術時間が684.1分であったのに対し、術後感染発症例の平均手術時間は785.0分と長く有意差を認めた。また、術中の出血量においても感染を認めなかった症例の平均出血量が671.9mlであったのに対し、術後感染発症例の平均は1050.3mlと多く有意差を認めた。

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: This study aimed to evaluate posttreatment soft-tissue changes in patients with oral cancer with computed tomography (CT). To accomplish that purpose, a scoring system was established, referring to the criteria of lower leg lymphedema (LE). METHODS AND RESULTS: One hundred and six necks in 95 patients who underwent oral oncologic surgery with neck dissection (ND) were analyzed retrospectively using routine follow-up CT images. A two-point scoring system to evaluate soft-tissue changes (so-called "LE score") was established as follows: Necks with a "honeycombing" appearance were assigned 1 point. Necks with "taller than wide" fat lobules were assigned 1 point. Necks with neither appearance were assigned 0 points. Comparisons between patients with LE score ≥1 and LE score = 0 at 6 months postoperatively were performed using the Fisher exact test for discrete variables and the Mann-Whitney U test for continuous variables. Univariate predictors associated with posttreatment changes (i.e., LE score ≥1 at 6 months postoperatively) were entered into a multivariate logistic regression analysis. Values of p < 0.05 were considered to indicate statistical significance. The occurrence of the posttreatment soft-tissue changes was 32%. Multivariate logistic regression analysis showed that postoperative radiation therapy (RT) and bilateral ND were potential risk factors of posttreatment soft-tissue changes on CT images. CONCLUSIONS: Sequential evaluation of "honeycombing" and the "taller than wide" appearances on routine follow-up CT revealed the persistence of posttreatment soft-tissue changes in patients who underwent oral cancer treatment, and those potential risk factors were postoperative RT and bilateral ND.

DOI： 10.1089/lrb.2016.0063

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: The appearance of osteoradionecrosis (ORN) and medication-related osteonecrosis of the jaw (MRONJ) is similar, but clinically important differences between ORN and MRONJ exist. The aim of this study was to compare the clinical data between ORN and MRONJ and to reveal the critical differences between these diseases. METHODS: We retrospectively reviewed the epidemiological data, clinical findings, and treatment in 27 ORN and 61 MRONJ patients. Radiographic signs before the initiation of treatment were also assessed. RESULTS: The median age (P = 0.0474) and the ratio of female to male patients (P < 0.0001) were significantly higher in MRONJ patients. There were significantly more MRONJ patients who reported a history of pain when compared with ORN patients (P = 0.0263). As an aetiological factor, tooth extraction was significantly more relevant to MRONJ than ORN (P = 0.0352). When assessing the radiographic signs on computed tomographic images, periosteal reaction was found only in MRONJ patients (P = 0.0158). Minimal debridement was performed significantly more frequently for MRONJ (P = 0.0093), and by contrast, surgical resection was performed more frequently for ORN (P = 0.0002). CONCLUSIONS: Understanding the clinical and underlying pathological differences between ORN and MRONJ probably contributes to the selection of appropriate treatment for each patient.

DOI： 10.1007/s10006-017-0667-5

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

It was hypothesized that fluorodeoxyglucose (FDG) uptake on post-treatment follow-up positron emission tomography with computed tomography (PET CT; using PET CT to monitor and rule out recurrence and metastasis of head and neck carcinoma) would be useful for detecting and understanding the disease state of osteoradionecrosis (ORN) of the jaw. The present study included 14 patients who developed mandibular ORN following radiation therapy (RT) for head and neck cancer and underwent follow-up PET CT several times following RT. Areas exhibiting FDG uptake were retrospectively assessed on post-treatment follow-up PET CT images and were classified into three types: Spot type: Only spot accumulation of FDG; localized type: Accumulation of FDG restricted to within the bone resorption area; extensive type: Accumulation of FDG extending into surrounding soft tissue. PET classification at the time of clinical diagnosis of mandibular ORN in the 14 patients demonstrated the extensive type in 43%, localized type in 36% and spot type in 21%. An increased area of FDG uptake around the ORN was revealed retrospectively on post-treatment follow-up FDG PET-CT images in 50% of patients. Alterations in PET classification included spot type to localized type in 36% and localized type to extensive type in 14%. A significantly increased number of patients with extensive-type ORN (P=0.026) required surgery. Post-treatment follow-up FDG-PET CT may be useful for early detection and better understanding of ORN.

DOI： 10.3892/mco.2017.1477

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: Few studies evaluate condylar movement following mandibular reconstruction. The main objective of this study was to show that axial four-dimensional computed tomography (4DCT) could visualize bilateral protrusive condylar movement directly. We used axial 4DCT images to assess condylar protrusion in patients who underwent mandibular reconstruction. METHODS: We enrolled seven healthy volunteers (median age 30 years, range 27-38 years) and seven patients (median age 65 years, range 52-80 years), who underwent mandibulectomy (segmental in five, hemi in one, marginal in one) and free flap reconstruction (using the fibula in six and the radial forearm in one). Six study subjects were instructed to masticate a cookie during the 4DCT scan (the seventh made chewing motions). The distance between the most anterior and posterior positions of the bilateral condyles on 4DCT (axial view) images was then measured and compared between controls and patients using the Mann-Whitney U-test. RESULTS: The crosswise difference in the distances of condylar protrusion was significantly greater in patients than in the controls. CONCLUSION: Axial 4DCT images can visualize a bilateral condylar protrusive path. Axial 4DCT images for patients who have undergone mandibulectomy and reconstruction may be useful for evaluation of functional movement of condyles.

DOI： 10.1016/j.jcms.2017.08.025

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The lack of uniformity of criteria for defining recipient-site infection after oral oncologic surgery with simultaneous reconstruction is problematic despite numerous studies on this issue. This study aimed to investigate the difference in the criteria for defining recipient-site infection after oral oncologic surgery with reconstruction. METHODS: A Medline search was performed via PUBMED using the following combinations of key terms that were tagged in the title, abstract, or both: "surgical site infection-head neck," "surgical site infection-oral cancer," "antibiotic prophylaxis-head neck," and "surgical site infection-oral carcinoma." Search results were filtered between 2005 and 2017. Articles in which there was no mention of the criteria for definition of surgical-site infection were excluded. RESULTS: The number of articles that met the inclusion criteria was 24. The lack of uniformity in the criteria for defining recipient-site infection in each article appeared to be attributable mainly to differences in whether an orocutaneous fistula and superficial incisional infection were regarded as recipient-site infection. CONCLUSION: Reconsideration of the categorization of orocutaneous fistula as infection, regardless of the etiology, and differentiation of superficial and deep incisional infections are necessary for correct assessment of recipient-site infection in oral oncologic surgery.

DOI： 10.1089/sur.2017.101

PubMed

Language：Japanese   Publisher：(一社)日本口腔感染症学会  

術後追加療法として化学放射線療法(CRT)を行った口腔癌21例、中咽頭癌26例の計47例(男33例、女14例、平均年齢59.9歳、範囲16～76歳)を対象に、頭頸部癌に対するCRT中の口腔粘膜炎の重症度を予測する因子について、後ろ向きに検討した。CRT中に出現した口腔粘膜炎のGrade別はGrade 2が40例(85.1%)、Grade 3が7例(14.9%)であり、背景因子の比較では栄養学的予後指数(PNI)に有意な群間差を認めた。また、Grade 3出現例ではGrade 2出現例よりも末梢血総リンパ球数、血清アルブミン濃度が有意に低値を示し、算出したCRT開始前のPNIについてROC曲線のカットオフ値は41.1で、AUC:0.86、感度:0.95、特異度:0.71であった。PNIは口腔粘膜炎の重症度を予測する因子となる可能性が示唆された。

Language：Japanese   Publisher：(一社)日本口腔感染症学会  

5年間に入院加療を要した顎口腔領域の重症感染症例40例(平均61.1歳、範囲7～90歳、男性14例)について臨床的に検討した。臨床診断名は蜂窩織炎33例、下顎骨骨髄炎5例、壊死性筋膜炎2例であり、原因疾患は根尖性歯周炎17例、辺縁性歯周炎5例、智歯周囲炎5例などで原因部位は下顎大臼歯部が多かった。起因菌として通性嫌気性菌ではStreptococcus属、偏性嫌気性菌ではPeptostreptococcus属、Prevotella属が多く、抗菌薬投与日数の中央値は5.5日であった。また、下顎臼歯部を原因とする症例は難治性になりやすく、易感染性の基礎疾患を有する症例は抗菌薬投与日数が長くなる傾向にあり、発症から当科受診までの期間が長くなるほど、CRP値が高いほど治療期間が延長する傾向がみられた。早期の消炎手術は治療期間(抗菌薬投与期間)の短縮につながると考えられた。

Language：English   Publishing type：Research paper (scientific journal)  

INTRODUCTION: Odontogenic foci can rarely cause intracranial infection. Hematogenous spread is considered to be the most important pathophysiological mechanism of intracranial infection of odontogenic origin. To investigate the oral origin of intracranial infections, oral surgeons should understand the underlying mechanisms by which oral bacteria spread to the central nervous system. However, there have been very few reports of intracranial infection resulting from odontogenic infection. CASE REPORTS: The authors report the cases of a 64-year-old man, a 68-year-old man, and a 64-year-old woman whose brain abscesses perhaps have arisen from odontogenic foci, because other sources of intracranial infection such as endocarditis and maxillary sinusitis were not found. Bacteriological examination of brain abscess specimens identified Staphylococcus aureus in case 1, Streptococcus constellatus, Fusobacterium nucleatum, and Parvimonas micra in case 2, and Lactobacillus catenaformis, Porphyromonas gingivalis, and F. nucleatum in case 3. All suspected causal teeth had no obvious signs of acute inflammation in all three cases. CONCLUSIONS: Oral surgeons should understand these characteristics of odontogenic brain abscess, in which the potentially causal odontogenic foci often lack acute symptoms. If other origins of infection are not found, it would be better to eliminate the potentially causal odontogenic foci for improvement of oral hygiene, however, the decision making criteria to eliminate suspected causal teeth is needed to be elucidated.

DOI： 10.1007/s12663-016-0915-5

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

Mandibular cortical bone measurement with x-ray imaging is known to be a potentially useful tool in the detection of dimensional changes caused by bisphosphonate. The primary purpose of this study was to assess the meaning and limitation of cortical bone measurement with computed tomography (CT) in patients with medication-related osteonecrosis of the jaw (MRONJ). The investigators obtained DentaScan images of the mandible from 15 patients with MRONJ, 15 patients with a history of antiresorptive agent administration without symptoms of MRONJ (non-MRONJ), and 15 control subjects. The cortical bone width measured on DentaScan images was compared between the three groups (ANOVA and Tukey's test). Interobserver reliability between two observers was also assessed. The values of interclass correlation coefficient were 0.48 in the MRONJ group, 0.29 in the Non-MRONJ group, and 0.34 in control group. The cortical bone widths calculated both by observer 1 and observer 2 were thicker in patients with MRONJ than in the non-MRONJ group and controls. There were significant differences in cortical bone width among the MRONJ, non-MRONJ, and control groups in observer 1 (P < 0.001) and observer 2 (P < 0.001), specifically comparing the MRONJ group with the non-MRONJ group and the control group. Cortical bone width measurement is useful for the distinction between medication-related osteonecrosis of the jaw and normal bone, in spite of the low interobserver reliability.

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVES: Transient receptor potential cation channel (subfamily V, members 1-4) (TRPV1-4) are expressed in skin and neurons and activated by external stimuli in normal mucosae of all oral cavity sites. The oral cavity is exposed to various stimuli, including temperature, mechanical stimuli, chemical substances, and changes in pH, and, notably, the risk factors for oncogenic transformation in oral squamous epithelium are the same as the external stimuli received by TRPV1-4 receptors. Hence, we examined the relationship between oral squamous cell carcinoma (SCC) and TRPV1-4 expression. MATERIALS AND METHODS: Oral SCC patients (n = 37) who underwent surgical resection were included in this study. We investigated the expression of TRPV1-4 by immunohistochemical staining and quantification of TRPV1-4 mRNA in human oral mucosa. In addition, we compared the TRPV1-4 levels in mucosa from patients with SCC to those in normal oral mucosa. RESULTS: The receptors were expressed in oral mucosa at all sites (tongue, buccal mucosa, gingiva, and oral floor) and the expression was stronger in epithelia from patients with SCC than in normal epithelia. Furthermore, alcohol consumption and tobacco use were strongly associated with the occurrence of oral cancer and were found to have a remarkable influence on TRPV1-4 receptor expression in normal oral mucosa. In particular, patients with a history of alcohol consumption demonstrated significantly higher expression levels. CONCLUSION: Various external stimuli may influence the behavior of cancer cells. Overexpression of TRPV1-4 is likely to be a factor in enhanced sensitivity to external stimuli. These findings could contribute to the establishment of novel strategies for cancer therapy or prevention.

DOI： 10.1371/journal.pone.0169723

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: D-index which combines the intensity and duration of neutropenia is reported as a tool for evaluating the dynamics of neutropenia. This study aimed to analyze the relationship between D-index and oral complications (i.e., oral mucositis [OM] and odontogenic infection [OI]) during chemotherapies for hematological malignancies. METHODS: A total of 421 chemotherapeutic courses in 104 patients were analyzed. Chemotherapeutic courses in patients who finished all of the prophylactic dental treatments were defined as "treatment Finish". Chemotherapeutic courses in patients who did not finish prophylactic dental treatments were defined as "treatment not-Finish". OM was evaluated according to the Common Terminology Criteria for Adverse Events, version 4.0. D-index was compared between chemotherapeutic courses with versus without oral complications. RESULTS: D-index was significantly higher in chemotherapeutic courses with grade 1 or 2 OM (p < 0.001) than courses without OM. In contrast, higher D-index did not relate to the development of OI (p = 0.18). The occurrence of OI (p < 0.001) but not OM (p = 0.56) during chemotherapy was significantly higher in chemotherapeutic courses without the completion of dental intervention. CONCLUSIONS: Higher D-index relates to the development of OM. In contrast, OI occurs due to untreated odontogenic foci, and its occurrence does not relate to higher D-index.

DOI： 10.1371/journal.pone.0182021

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: This study aimed to analyze differences in necrotic changes between cortical and cancellous bone in resection margins after segmental mandibulectomy for advanced mandibular osteoradionecrosis. METHODS: Anteroposterior bone specimens from eleven patients who underwent segmental mandibulectomy with simultaneous free fibula flap reconstruction for advanced osteoradionecrosis were analyzed histopathologically for the presence of necrotic bone based on the presence of blood vessels within Haversian canals. RESULTS: Ten of eleven (91%) cortices near the inferior border of the mandible at the anterior margins were necrotic. All cancellous bones at the anterior margins were viable. Seven of eleven (64%) cortices near the inferior border of the mandible at the posterior margins were necrotic. Three of eleven (27%) cancellous bones at the posterior margins were necrotic. CONCLUSION: Necrotic changes are more prevalent in cortices than in cancellous bones in mandibular osteoradionecrosis, probably due to a decrease of periosteal blood supply caused by radiotherapy.

DOI： 10.1155/2017/3125842

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: This study aimed to compare the size of skin paddles, the postoperative course, and donor site complications between primary closure and skin grafts of the free fibula flap donor site. METHODS: Thirty-five consecutive patients were enrolled. Medical records were retrospectively reviewed for risk factors for delayed healing, size of skin paddles, time to resumption of gait with a mobility aid and self-ambulation, early donor site morbidity, and late donor site complaints. RESULTS: The harvested skin paddles were significantly wider in the skin graft group than in the primary closure group (P = 0.02), with no difference in length (P = 0.1). The difference in time to resuming gait with a mobility aid was also significant (P = 0.01), but not the time to self-ambulation (P = 0.9). Two early donor site morbidities (5.7 %) and 12 late donor site complaints (34.3 %) were found. No significant difference in the incidence of early donor site morbidity was observed between two groups. Occurrence of late donor site complaints was not affected by any risk factors. CONCLUSIONS: The width of the harvested skin paddle, but not the length, is one of factors involved in donor site closure. Resumption of gait with a mobility aid, but not self-ambulation, may be delayed in skin graft patients.

DOI： 10.1007/s10006-016-0556-3

PubMed

Authorship：Lead author,　Corresponding author   Language：Japanese   Publisher：(公社)日本化学療法学会  

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Dental rehabilitation with osseointegrated implants in reconstructed mandibles remains one of the most challenging procedures for oral and maxillofacial surgeons. Satisfactory outcome requires appropriate assessment of graft morphology. There are few analyses of the morphology of fibulae in reconstructed mandibles, although cadaver studies on fibular shape have been performed. MATERIALS AND METHODS: In this study, we used postoperative computed tomography to retrospectively evaluate the shape, height, and orientation of fibulae transferred after mandibulectomy in 19 patients. RESULTS: The average height of transferred fibulae was 14.3 mm (range, 10.8-20.5 mm). The cross-sectional morphology of transferred fibulae could be classified into 2 types: apex and nonapex. The former type included knife-edged and triangular shapes; the latter included square and circular shapes. CONCLUSION: When implant insertion is planned in a reconstructed mandible, the orientation of the apex of transferred fibula should be evaluated preoperatively to allow for adjustments in implant procedure because the ridge at the apex of the fibula is narrow.

DOI： 10.1097/ID.0000000000000290

PubMed

Authorship：Lead author,　Corresponding author   Language：Japanese   Publisher：(公社)日本口腔外科学会  

2001年1月～2013年12月に経験した18歳以上の壊死性筋膜炎(NF)10例(男性3例、女性7例、39～81歳、平均65.4歳)、同時期に入院加療した重症蜂窩織炎86例(男性48例、女性38例、18～90歳、平均56.4歳)を対象に、鑑別診断におけるLRINECスコアの有用性について検討した。NF群は女子が多く、重症蜂窩織炎は男性に多いが、両者に年齢、性別で有意差はなく、血液検査データではCRP、CreでNF群と重症蜂窩織炎間に有意差を認めた。頭頸部NFに対するLRINECスコアの有用性については、カットオフ値を6点とすると、感度90%、特異度88.4%、PPV 47.4%、NPV 98.7%、LR+7.7、LR-0.11で除外診断に有用と思われた。

Other Link： https://search.jamas.or.jp/default/link?pub_year=2015&ichushi_jid=J01073&link_issn=&doc_id=20151106310002&doc_link_id=10.5794%2Fjjoms.61.505&url=https%3A%2F%2Fdoi.org%2F10.5794%2Fjjoms.61.505&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：(一社)日本口腔感染症学会  

82歳男。左側口蓋部の腫瘤を指摘された。左側口蓋から左側上顎結節部にかけて25×15mm大の腫瘤を認め、その中心部に潰瘍を認めた。左側口蓋悪性腫瘍の診断で全身麻酔下に口蓋腫瘍切除術を施行した。摘出物の病理組織診断結果は、口蓋嚢胞腺癌であった。軽快退院となったが、外来通院中に撮影したCTにて右側頸部リンパ節に後発転移を認めた。全身麻酔下に右側根治的頸部廓清術変法を施行した。病理組織検査結果は転移が疑われるリンパ節は癌陽性および節外陰性、他リンパ節は癌陰性であった。SBT/ABPCを投与したが、炎症値の著しい上昇を認め、腹部に著明な膨満と軽度圧痛を認めた。CTにて著明な腸管拡張を認めた、中毒性巨大結腸症と診断した。バンコマイシンの経口投与に変更した。内視鏡的脱気術によるガス抜きや肛門バルーン留置による吸引にて、糞便貯留は改善した。

Language：Japanese   Publisher：(一社)日本口腔感染症学会  

2006年2月～2012年3月に歯科口腔外科を受診し6ヵ月以上経過観察したビスホスホネート関連顎骨壊死(BRONJ)症例33例(男性7例、女性26例)を対象に分析し、転帰に影響する因子について検討した。治療法については原因歯の抜歯、抜歯窩掻爬、腐骨分離前の腐骨除去、顎骨切除など外科的処置を行った症例を外科的処置群、保存的処置を行った症例を保存的処置群とした。転帰評価方法は2013年2月時点、症状が消失した症状消失、ステージが改善した症状改善、変わらない症状不変、悪化した症状悪化に分けた。患者背景は性別は女性に多く、年齢は平均70.3(53～85)歳、部位別では上顎9例(27.3%)、下顎22例(66.7%)、上下顎2例(2%)で、下顎に発症した症例が多く、投与経路はBP経口剤が多かった。初診時のステージ分類は2010年のBRONJにおける分類でステージ0が9例、ステージ1が9例(各27.3%)、ステージ2が10例(30.3%)、ステージ3が5例(15.1%)であった。発症の誘因として抜歯による症例が多く占めていた。転帰については症状消失24例(72.7%)、症状改善1例(3%)、症状不変8例(24.2%)であった。転帰に影響する因子はBP注射剤による症例、BP製剤を休薬できなかった症例、全身的危険因子を有する難治例が多い傾向がみられた。

Language：Japanese   Publisher：(一社)日本口腔感染症学会  

29歳女。全身倦怠感を自覚し、市販の感冒薬を内服したが改善せず、左腋窩部の腫脹と38℃台の発熱を認めた。その後、顔面、頸部に小型紅斑が出現し、口唇や口腔粘膜にもびらんを認めた。さらに皮疹の範囲が拡大したため、緊急入院した。スティーブンス・ジョンソン症候群(SJS)の診断でプレドニゾロン製剤の点滴を開始したが、高熱が継続した。皮膚科へ転院し、ステロイドパルス療法と免疫グロブリン製剤静注による併用療法を施行した。口唇および口腔粘膜全体に摂食痛を伴う発赤、びらん、易出血性を認め、さらに嚥下痛も伴っていたため、経口摂取が困難な状態であった。口唇には2%キシロカインゼリーと白色ワセリンを塗布し、口腔粘膜にはキシロカインビスカス含有の含嗽薬で1日5回の含嗽を指導した。口腔管理開始とともに口腔内の疼痛は軽減した。

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Odontogenic diseases can be a risk factor for life-threatening infection in patients with hematologic malignancies during chemotherapy that induces myelosuppression of variable severity. Previous studies noted the necessity of the elimination of all odontogenic foci before hematopoietic stem cell transplantation. To enable planning for the adequate dental intervention, the oral medicine team must understand the general status of patient and the intensity of the chemotherapy, which is sometimes difficult to be fully appreciated by dental staff. Therefore, a simplified grading would facilitate the sharing of information between hematologists, dentists and oral hygienists. This study aimed to introduce our myelosuppression grading of chemotherapies for hematologic malignancies and analyze the timing of occurrence of severe odontogenic infection. METHODS: 37 patients having received various chemotherapies for hematologic malignancies were enrolled. The chemotherapy regimens were classified into four grades based on the persistency of myelosuppression induced by chemotherapy. Mild myelosuppressive chemotherapies were classified as grade A, moderate ones as grade B, severe ones as grade C, and chemotherapies that caused severe myelosuppression and persistent immunodeficiency (known as conditioning regimens for transplant) as grade D. The timing of occurrence of severe odontogenic infection was retrospectively investigated. RESULTS: Two patients (5.4%) had severe odontogenic infections after grade B or C chemotherapy. One occurred after extraction of non-salvageable teeth; the other resulted from advanced periodontitis in a tooth that could not be extracted because of thrombocytopenia. Both were de novo hematologic malignancy patients. During grade D chemotherapy, no patients had severe odontogenic infections. CONCLUSIONS: The simplified grading introduced in this study is considered a useful tool for understanding the myelosuppressive state caused by chemotherapy and facilitating communication between medical and dental staff. During the period around the primary chemotherapy, especially for de novo hematologic malignancy patients who often received grade B to C myelosuppression chemotherapy, caution should be exercised for severe odontogenic infection by the oral medicine team, irrespective of whether invasive treatment is to be performed.

DOI： 10.1186/1472-6831-13-41

PubMed

Language：Japanese   Publisher：(一社)日本口腔診断学会  

14員環マクロライド系抗菌薬の長期投与で効果がみられないびまん性硬化性顎骨骨髄炎(DSO)に対してパミドロネートを投与した5例を対象とし、その有効性と安全性について検討した。内訳は31～62歳の男2例、女3例で、全例が下顎の疼痛を主訴とし、病巣範囲に下顎角部が含まれていた。パミドロネート30mg投与後、4例は投与翌日から、1例は投与7日後に下顎骨の疼痛が消失したが、最短4ヵ月、最長1年11ヵ月で疼痛が再発し、パミドロネートの再投与を要した。また、パミドロネート再投与後は疼痛抑制効果の持続時間が延長する傾向を示し、投与6ヵ月後のパノラマX線写真では骨吸収像の消失と罹患部骨髄の硬化像が認められた。パミドロネート療法はDSOに対して優れた疼痛抑制効果を発揮し、有用な治療法と考えられるが、全例で疼痛が再発していることから、長期にわたる経過観察が必要と考えられた。

Language：Japanese   Publisher：(一社)日本口腔感染症学会  

術前術後に口腔ケアを行い、血管柄付遊離皮弁による即時再建術を施行した口腔癌手術患者45例(男30例・女15例・平均57.3歳)を対象に、術後感染症の発症に関与する因子について検討した。再建に使用した皮弁は前腕29例、腹直筋15例、腹直筋+腓骨1例であった。術後感染症は11例に認め、創感染6例、創外感染(術後肺炎)5例であった。患者背景因子では、性別、年齢(60歳以下と以上)、T分類(T1・T2とT3・T4)、Stage分類(I・IIとIII・IV)で感染症発症頻度に有意差はなかったが、再建皮弁別では前腕平均13.8%、腹直筋46.6%と有意差を認めた。また基礎疾患の有無では、基礎疾患有りの13例は発症頻度46.2%、基礎疾患なしの32例は15.6%で有意差を認めた。術前血清ヘモグロビンおよびアルブミンの値、予防投与抗菌薬の種類と感染症発症との間に関連はなかった。手術時間は感染ありが平均830.3分、なしが713.1分、術中出血量はそれぞれ1295.7g、873.4gといずれも有意差を認めた。

Language：Japanese   Publisher：(一社)日本有病者歯科医療学会  

Language：Japanese   Publisher：(NPO)日本口腔科学会  

Language：Japanese   Publisher：(NPO)日本口腔科学会  

Language：Japanese   Publisher：(NPO)日本口腔科学会  

Language：Japanese   Publisher：(一社)日本口腔感染症学会  

Language：Japanese   Publisher：(NPO)日本口腔科学会  

Language：Japanese   Publisher：(NPO)日本口腔科学会  

Language：Japanese   Publisher：(NPO)日本口腔科学会  

Language：Japanese   Publisher：(一社)日本口腔感染症学会  

Language：Japanese   Publisher：(一社)日本口腔ケア学会  

Language：Japanese   Publisher：(一社)日本口腔ケア学会  

Language：Japanese   Publisher：(一社)日本口腔感染症学会  

Language：Japanese   Publisher：(NPO)日本口腔科学会  

Language：Japanese   Publisher：(NPO)日本口腔科学会  

Language：Japanese   Publisher：(一社)日本口腔感染症学会  

Language：Japanese   Publisher：(NPO)日本口腔科学会  

Language：Japanese   Publisher：(一社)日本口腔感染症学会  

Language：Japanese   Publisher：(一社)日本口腔感染症学会  

Language：Japanese   Publisher：(一社)日本口腔診断学会  

Language：Japanese   Publisher：(一社)日本有病者歯科医療学会  

Language：Japanese   Publisher：(一社)日本口腔内科学会  

Language：Japanese   Publisher：(一社)日本有病者歯科医療学会  

Language：Japanese   Publisher：(一社)日本口腔感染症学会  

Language：Japanese   Publisher：(一社)日本口腔感染症学会  

Language：Japanese   Publisher：(一社)日本口腔感染症学会  

Language：Japanese   Publisher：(一社)日本口腔感染症学会  

Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

Language：Japanese   Publisher：(一社)日本口腔感染症学会  

Language：Japanese   Publisher：(NPO)日本口腔科学会  

Language：Japanese   Publisher：(NPO)日本口腔科学会  

Language：Japanese   Publisher：(一社)日本口腔感染症学会  

Language：Japanese   Publisher：(公社)日本化学療法学会  

Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

Language：Japanese   Publisher：(一社)日本形成外科学会  

Language：Japanese   Publisher：(一社)日本口腔感染症学会  

Language：Japanese   Publisher：(一社)日本形成外科学会  

Language：Japanese   Publisher：(NPO)日本口腔科学会  

Language：Japanese   Publisher：(一社)日本口腔感染症学会  

Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

Language：Japanese   Publisher：(NPO)日本口腔科学会  

Language：Japanese   Publisher：(一社)日本口腔感染症学会  

Language：Japanese   Publisher：(一社)日本口腔感染症学会  

Language：Japanese   Publisher：(公社)日本化学療法学会  

Language：Japanese   Publisher：(NPO)日本口腔科学会  

Language：Japanese   Publisher：(一社)日本歯科薬物療法学会  

Language：Japanese   Publisher：(一社)日本口腔感染症学会  

Language：Japanese   Publisher：(一社)日本口腔感染症学会  

Language：Japanese   Publisher：(一社)日本口腔感染症学会  

Language：Japanese   Publisher：(一社)日本口腔感染症学会  

Language：Japanese   Publisher：(一社)日本口腔感染症学会  

Language：Japanese   Publisher：(一社)日本集中治療医学会  

Language：Japanese   Publisher：(公社)日本口腔外科学会  

Language：Japanese   Publisher：(公社)日本口腔外科学会  

Language：Japanese   Publisher：(NPO)日本顎変形症学会  

Language：Japanese   Publisher：(一社)日本口腔感染症学会  

Language：Japanese   Publisher：九州矯正歯科学会  

Language：Japanese   Publisher：九州矯正歯科学会  

Language：Japanese   Publisher：(公社)日本矯正歯科学会  

Language：Japanese   Publisher：(一社)日本口腔感染症学会  

Language：Japanese   Publisher：(一社)日本歯科薬物療法学会  

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Presentation type：Public lecture, seminar, tutorial, course, or other speech  

Language：Japanese  

Presentation type：Symposium, workshop panel (nominated)  

Language：Japanese  

Language：Japanese  

Presentation type：Symposium, workshop panel (nominated)  

Language：Japanese  

Presentation type：Symposium, workshop panel (nominated)