A case of maxillary partial aseptic necrosis after Le Fort I osteotomy Publication date: Available online 5 September 2019 Source: Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology Author(s): Hiroshi Kato, Akira Watanabe, Masayuki Takano, Mitsutaka Yoshida, Yasutomo Yajima, Takahiko Shibahara Abstract While orthognathic surgery is now a safe and established procedure, it poses associated complications, similarly to every surgical procedure. Aseptic necrosis is an ischemic complication associated with orthognathic surgery. Although aseptic necrosis is a serious complication, treatment protocol has not yet been established. Herein we reported a case of aseptic necrosis occurring in the maxilla following Le Fort I (LFI) osteotomy. The patient was a 25-year-old woman referred to our hospital with a chief complaint of maxillary alveolar bone exposure. She had been submitted to horseshoe-type LFI osteotomy and bilateral sagittal split ramus osteotomy two months earlier. At initial visit, osseous non-union of the maxilla and exposure of the right anterior maxillary alveolar bone were observed. At first surgery, necrotic alveolar bone and soft tissue were debrided, titanium plates were removed, and a new titanium plate was provided for adequate osteosynthesis in left-side bone gap under general anesthesia. At second surgery, 11.12.13.14 were extracted and alveolus was reconstructed by iliac crest graft. In addition, 21 was extracted under local anesthesia owing to tooth mobility, and root canal treatment to 22.23 was performed. After 6 months, the plates were removed, and four implants were placed. At third surgery, oral vestibular extension operation was performed. Five years following the initial procedure, the patient achieved normal occlusion and dentofacial appearance.

Low-grade myofibroblastic sarcoma of mandible in an infant Publication date: Available online 5 September 2019 Source: Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology Author(s): Ryo Miyazaki, Takaaki Ogawa, Kenjiro Takao, Yuuri Houchi, Mao Tanaka, Fumi Nakai, Akinori Iwasaki, Yumiko Ohbayashi, Minoru Miyake Abstract Low-grade myofibroblastic sarcoma (LGMS) is a rare sarcoma characterized by myofibroblastic differentiation. LGMS can occur at various sites on the body but frequently occurs in the head and neck region, particularly the tongue. LGMS occurs in younger individuals compared to other tumors, but few LGMS cases have developed in early childhood. Wide excision is the first choice; there are a few reports of cases treated by chemotherapy and radiation therapy. Here we describe an extensive LGMS centering on the mandible of a Japanese male who was 1 year and 9 months old at his presentation. We successfully treated his LGMS by a combination of chemotherapy, radiotherapy and surgery.

Osteoid osteoma of mandibular bone: Case report and review of the literature Publication date: Available online 3 September 2019 Source: Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology Author(s): Takashi Maehara, Yuka Murakami, Shintaro Kawano, Yurie Mikami, Tamotsu Kiyoshima, Toru Chikui, Noriko Kakizoe, Ryusuke Munemura, Seiji Nakamura Abstract Osteoid osteoma is a benign bone-forming tumor and characterized by its limited growth potential, not exceeding 2 cm. The radiological hallmark of this tumor is a nidus, which is a small round area of relative radiolucency. Osteoid osteoma can involve any bone but is most commonly found in long bones and is extremely rare in the head and neck region. This disease characteristically presents with dull pain, worse at night, and sometimes relieved with NSAIDs. A 24-year-old Japanese woman presented with spontaneous pain and tenderness on the lingual side of her mandibular second molar on the right side. The patient reported that her pain had gradually increased, becoming more continuous and severe and no longer responding to NSAIDs. An initial panoramic radiograph revealed an oval, internally non-uniform, somewhat obscure boundaries in the right mandible. Computed tomography (CT) scan revealed a sclerotic lesion with a delineated central calcified nidus surrounded by a radiolucent band. The interior of the nidus was a non-uniform, irregularly shaped area of high absorption. The nidus was removed with intralesional curettage under general anesthesia. The histopathology of the specimen consisted of actively proliferating osteoblasts mixed with an interlacing network of immature bone and osteoid trabeculae. Immunohistochemistry revealed that hardly detected osteoblasts or fibrous stromal cells with intense nuclear immunoreactivity for p16 and/or murine double minute 2 (mdm2). We thus distinguished the tumor from Low-grade central osteosarcoma (LGCO) with immunohistochemical findings. The histopathological diagnosis was thus osteoid osteoma.

Importance of professional oral hygiene for prevention of aspiration pneumonia caused by progressive central nervous system disorders in Type 2 Gaucher disease Publication date: Available online 31 August 2019 Source: Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology Author(s): Komatsu Noriko, Watanabe Eri, Yoshimura Rie, Suzuki Yoshiko, Hoshi Kazuto, Takato Tsuyoshi, Yamamoto Keiichi, Fukuta Jinichi Abstract Gaucher disease (GD) is rare that is caused by an enzyme deficiency of lysosomal glucocerebrosidase and is one of the most frequent lysosomal storage diseases. We present here the case of an infant male with Type 2 GD (GD2). GD2 is clinically characterized by precocious and rapid neurological degeneration comprising brainstem involvement associated with hepatosplenomegaly, pulmonary and hematological involvements, and death will be in infancy or early childhood. We performed professional oral hygiene on a patient with GD2, and we contributed to the communication between the patient and his family. Here we report on the oral cavity features in GD2 and how our experience can contribute to the prevention of aspiration pneumonia.

Idiopathic first bite syndrome treated with Rikkosan: A case report Publication date: Available online 31 August 2019 Source: Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology Author(s): Kamichika Hayashi, Takeshi Onda, Satoru Ogane, Takashi Kamio, Hitoshi Ohata, Nobuo Takano, Takahiko Shibahara Abstract First bite syndrome (FBS)is characterized by sharp pain in the parotid region at the first bite of a meal which gradually decreases as mastication continues, and is thought to be caused by sympathetic nerve damage. When FBS occurs with no history suggestive of nerve damage, it is classified as idiopathic. A case of idiopathic FBS that was treated effectively with Rikkosan is presented. The patient was an 81-year-old woman who developed sharp pain in the left parotid region with the first bite of every meal in November 2015. With no specific findings, the initial diagnosis was trigeminal neuralgia, but carbamazepine was ineffective. In February 2016, temporomandibular disorder was diagnosed as the cause of masticatory muscle pain and was treated with splinting and loxoprofen sodium, but this was also ineffective. In June 2016, a panoramic radiograph, plain craniocervical magnetic resonance imaging, and blood tests were all negative. Idiopathic FBS was diagnosed and treated by gargling and swallowing Rikkosan before meals and eating bitter or sweet foods first, followed by salty or sour foods. The FBS improved, and after 1 week, she had days with no pain. Rikkosan was discontinued after a month leading to immediate recurrence. The patient was instructed to use half the dose of Rikkosan, which was effective with no side effects. In October 2016, the patient started gargling with Rikkosan. In March 2017, the Rikkosan was discontinued and the dietary strategy was continued with no further recurrence. In this case, idiopathic FBS improved with Rikkosan treatment.

Alteration of plasma free amino acids’ level in oral squamous cell carcinoma patients using High Performance Liquid Chromatography Publication date: Available online 7 August 2019 Source: Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology Author(s): Pratibha S. Sharma, Kirty R. Nandimath, S.V. Hiremath, Krishna Burde Abstract Objectives Oral cancer inflicts a substantial challenge worldwide being a highly lethal and disfiguring disease. Delayed diagnosis keeps the mortality high. Plasma free amino acids (PFAAs) circulate throughout the body, participating in metabolism. Subsequently, changes in PFAA profile might mirror cancer induced protein metabolism. In this context, this study aims to quantify, compare and correlate PFAAs level in OSCC and control group using High performance liquid chromatography (HPLC). Methods A total of 60 samples: 30 OSCC subjects and 30 age, sex matched healthy controls were taken. Following clinical examination and histopathological confirmation, 5 ml blood was collected in a tube containing EDTA and centrifuged. The PFAAs levels were quantified using HPLC. Results Out of 19 PFAAs, concentration of aspartate, glutamate and arginine were significantly decreased and of asparagine, glutamine and cysteine were significantly increased in OSCC group. Furthermore, comparing well (group I) and moderately (group II) differentiated OSCC group, the level of asparagine was significantly decreased, and of serine significantly increased in group II. Significant alterations were also observed, when group I and II were compared to control group in the following: aspartate, glutamate, asparagine, serine, arginine and cysteine. On comparing stage III, IV OSCC group to control group the levels of aspartate, glutamate, asparagine and cysteine showed significant alterations. Conclusion Altered protein metabolism, as shown in PFAA profile may be employed as a supplementary tool for diagnosing OSCC. Meticulous study of amino acid assays may facilitate in understanding the route of metabolic derangement in OSCC patients.

Development of trismus in a case of temporal arteritis Publication date: Available online 5 August 2019 Source: Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology Author(s): Hiroki Inoue, Motonobu Achiwa, Takashi Takemoto, Kenichi Kurita Abstract Giant cell arteritis, which most frequently occurs in individuals over 50 years of age, is a vasculitis of unknown etiology characterized by inflammation of the carotid arteries and their branches, particularly the temporal arteries. An 85-year-old woman visited our department with chief complaints of pain in the right temporomandibular joint and trismus. She had a history of gastric ulcer, but no notable family history. The left mandibular tooth #12 had been extracted at a local dental office. Subsequently, the patient developed pain in the area extending from the right temporomandibular joint to the occipital region and trismus. As these symptoms did not improve, she was referred to our department. Also, the causative tooth for oral pain was unknown, and so analgesic drugs were prescribed under a provisional diagnosis of suspected temporomandibular disorder. Two days later, the patient returned to us because of fever and worsening malaise. Marked elevation of white blood cell count (12,800/μL) and C-reactive protein level (33 mg/dL) led to emergency hospitalization. The cause of fever was unknown and the patient was therefore systematically examined in the internal medicine department, and giant cell arteritis was suspected. Based on biopsy results, giant cell arteritis was definitively diagnosed. After admission, administration of oral prednisolone was started, and symptoms resolved by the following day. The steroid was then gradually tapered, and no complications occurred. Once giant cell arteritis onset has occurred, some patients will visit the hospital with initial symptoms of trismus and masticatory muscle pain, and so these patients are sometimes first examined at the department of maxillofacial surgery. Despite the low incidence of this condition, severe complications, such as blindness or a dissecting arterial aneurysm, can occur if treatment is delayed, so this condition should always be borne in mind, and early diagnosis and treatment must be ensured.

Comparison of the effectiveness of pain control with two regimens of acetaminophen following uncomplicated intra-alveolar extraction: Olawole W.O1, Okoje V.N1, Ibikunle A.A2, Arotiba J.T1 Publication date: Available online 24 July 2019 Source: Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology Author(s): Wasiu Olalekan Olawole, Victoria Nwebumi Okoje, Adebayo Aremu Ibikunle, Juwon Tunde Arotiba Abstract Paracetamol is a frequently prescribed drug for post-extraction pain control. However, the optimum regimen to be prescribed remains controversial. Thus, a need to determine the efficacy of commonly prescribed regimens arises. This study compared the effectiveness of post-extraction pain control using two regimens of paracetamol. Subjects were randomly distributed into two groups; subjects in group A had postoperative oral administration of acetaminophen 1 g 2 h after the extraction and then 1 g every 8 h for 24 h, while subjects in group B had extended postoperative oral administration of acetaminophen. Thereafter, subjects recorded their postoperative pain experiences. Data were analyzed using IBM SPSS Statistics for Windows version 20. Level of statistical significance was set at P < 0.05. Data from 200 subjects were analyzed. An overall male/female ratio of 1:1.2 and a mean (±SD) age of 44.27 (16.09) years were observed. A comparison of pain experience between groups at all evaluation points revealed no statistically significant difference (p > 0.05). Also, the type and number of teeth extracted exerted no statistically significant influence on pain experience (p > 0.05). There was no significant difference between the effectiveness of post-extraction pain control using the two paracetamol regimens. Therefore, extended administration of paracetamol may be unwarranted.

Surgical ciliated cyst developing after Le Fort I osteotomy: Case report and review of the literature Publication date: Available online 16 July 2019 Source: Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology Author(s): Shunsuke Tanio, Takayuki Tamura, Hiroshi Kasuya, Makoto Kawasaki, Naomi Taniguchi, Kazuma Otsuki, Nobuyuki Fujii, Isamu Kodani Abstract A surgical ciliated cyst, also referred as a locally aggressive lesion, stems from a prior surgery several years later as a delayed complication. It is reported that the cyst develops after orthognathic surgery. A 25-year-old man who had undergone Le Fort I osteotomy and bilateral intraoral vertical osteotomy of the mandible as treatment for jaw deformities in 2013 was referred to our hospital because of a swelling on the right side of the hard palate. Radiography and cone-beam computed tomography examinations revealed a unilocular cystic lesion in the right maxillary alveolus. All the teeth in the maxillary right quadrant were vital to electric pulp testing. Aspiration with an 18-gauge needle extracted rust-colored mucoid fluid. The lesion was diagnosed to be a maxillary cyst. Under general anesthesia, we removed the osteotomy fixation plates and excised the lesion. Histopathological examination revealed a cyst comprising cellular fibrous connective tissue, mainly lined by stratified squamous epithelium; however, the regions of focal pseudostratified columnar and ciliated epithelium were also present. Surgical ciliated cyst was diagnosed on the basis of histopathological, clinical, and radiographical findings. Although surgical ciliated cysts have sparsely been reported after orthognathic surgery, an increased awareness of such possibility is required to avoid delays in diagnosis. This lesion should always be a part of differential diagnosis of symptomatic patients who, in the past, have undergone antral or maxillary orthognathic surgery.

Intra-oral minor salivary gland tumors: A pathological study of 131 cases in the Japanese population Publication date: Available online 15 July 2019 Source: Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology Author(s): Yuichiro Hayashi, Toshinori Iwai, Satomi Sugiyama, Kohei Osawa, Haruka Yoshii, Shuhei Minamiyama, Hiroaki Kitajima, Makoto Hirota, Kenji Mitsudo Abstract Objective Intra-oral minor salivary gland tumors are relatively rare. This study aimed to clarify the frequency and distribution of intra-oral minor salivary gland tumors in Japanese patients. Methods We retrospectively analyzed the histopathological records of 131 patients with minor salivary gland tumors that were surgically treated between 1967 and 2017 at a single institution. Results Of the 131 minor salivary gland tumors, 61 (47%) were benign and 70 (53%) were malignant. The male:female ratio was 1:1.8 for benign cases and 1:1 for malignant cases. Most of the tumors occurred in the palate, followed by the floor of the mouth. The most frequent minor salivary gland tumor was pleomorphic adenoma among benign tumors and adenoid cystic carcinoma among malignant tumors. The rarest minor salivary gland tumors were Warthin tumors and basal cell adenocarcinoma, accounting for only 0.8% of all cases. Conclusions The present study determined the incidence rates of these rare tumors.