This retrospective study aimed to examine the course and prognosis of medication-related osteonecrosis of the jaw (MRONJ) initially treated conservatively and the effects of various factors affecting ...treatment outcomes. We evaluated 129 patients with MRONJ between January 2008 and December 2018 at a university hospital. The factors examined included sex, age, stage of MRONJ (1–3), type of bone modifying agents (bisphosphonate or denosumab), primary disease (osteoporosis or malignant tumor), medical history (diabetes and rheumatoid arthritis), use of corticosteroids, the trigger of MRONJ (teeth extraction or others), and separation of sequestrum, using logistic regression analysis. Patients with MRONJ were treated conservatively as the initial treatment in accordance with the position paper of the American Association of Oral and Maxillofacial Surgeons. Of the 129 patients, 59 (45.7%) were cured, and the condition of 70 (54.3%) remained unchanged or worsened. The overall cure rates at 12, 36, and 60 months were 25.8%, 50.8%, and 72.4% respectively. The cure rate of stage 1 was lower than that of stages 2 and 3 at 80 months. In multivariate analysis, it was found that 37 (64.9%) of 57 patients with osteoporosis as a primary disease were cured (odds ratio OR, 7.7; 95% confidence interval CI, 2.4–24.4). In addition, 40 (69.0%) of 58 patients with separation of sequestrum were cured (OR, 8.9; 95% CI, 3.4–23.5). The cure rate was significantly higher in patients with osteoporosis than in those with cancer when the treatment outcomes of primary disease were compared using the Kaplan-Meier method (p < 0.01). It was also significantly higher in patients who had separation of sequestrum than in those who did not (p < 0.05). Our results suggest that primary disease and separation of sequestrum were associated with favorable outcomes in patients with MRONJ initially treated conservatively. MRONJ had a poor prognosis with conventional treatment carried according to the stage of the disease. This was especially prominent when conservative treatment was employed for mild cases.
•Of the 129 patients with MRONJ, 59 (45.7%) were cured, and the condition of 70 (54.3%) remained unchanged or worsened.•The cure rate of stage 1 was lower than that of stages 2 and 3 at 80 months.•Primary disease and separation of sequestrum were associated with outcomes in MRONJ initially treated conservatively.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Radical mandible resection causes significant functional and cosmetic impairment. Nonvascularized bone reconstruction and oral rehabilitation using fixed prosthesis with dental implants enabled ...recovery of appearance and mastication function.
Radical mandible resection causes significant functional and cosmetic impairment. Nonvascularized bone reconstruction and oral rehabilitation using fixed prosthesis with dental implants enabled recovery of appearance and mastication function.
Full text
Available for:
FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Neurofibromatosis type 1 (NF1) is an inherited, autosomal-dominant disorder, also known as von Recklinghausen’s disease. This pathology was first described from a series of patients displaying a ...combination of nervous system tumors and findings such as café-au-lait spots, eye lesions, and bone lesions. Oral mucosal tumors are common in association with NF1, but are relatively rare on the lateral border of the tongue. We describe the case of a 17-year-old boy who presented to the Department of Oral and Maxillofacial Surgery at Tokyo Women’s Medical University Hospital with the chief complaint of swelling and pain involving the right lateral border of the tongue. Medical history included NF1 and developmental disorder. Several café-au-lait spots were observed on the back, but cutaneous neurofibromas were not apparent elsewhere on the body. Examination of the oral cavity revealed a lobulated lesion involving the right anterior two-thirds of the tongue. Excisional biopsy was performed for an exophytic portion of the right lingual edge of the lesion. Histopathological analysis of the tongue lesion confirmed the diagnosis of neurofibroma. Because the tongue lesion was widespread on the right side and the patient was 17 years old, we performed conservative treatment comprising surgical resection of only the dysfunctional, painful part of the lesion. Three years have elapsed with no sign of exacerbation.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Background
Oral myofunctional therapy (MFT) is an effective treatment for mild‐to‐moderate obstructive sleep apnoea (OSA) in middle‐aged patients. However, few reports have described its use in ...elderly patients with moderate and severe OSA. Moreover, no studies have examined the relationship between changes in tongue pressure with MFT and the severity of OSA.
Objective
We conducted an interventional study using MFT to evaluate the effect of MFT on middle‐to‐senior‐aged patients with moderate or severe OSA and compared changes in apnoea‐hypopnea index (AHI) and tongue pressure.
Methods
Thirty‐two OSA patients (≥45 years) treated with continuous positive airway pressure (CPAP) were included. MFT was performed in parallel with CPAP. Three days after CPAP discontinuation, polysomnographies were performed and tongue pressures were measured before and after MFT.
Results
Patients were 69.3 ± 1.5 years old. After 6 months of MFT, AHI decreased significantly from 34.7 to 29.0/h (P = .03), while tongue pressure significantly increased from 35.9 to 45.6 kPa (P < .01). Seven patients (22%), including 6 of the 12 patients with moderate OSA (50%), experienced successful CPAP discontinuation.
Conclusions
MFT can be a useful intervention even among middle‐aged to elderly patients with OSA. Increased tongue pressure may have contributed to the AHI improvement.
Clinical trials: Trial registration at www.umin.ac.jp UMIN000027547.
Apnoea‐hypopnea index values were significantly reduced after 6 months of MFT. Tongue pressures were significantly increased after 6 months of MFT. Half of the patients with moderate OSA successfully withdrew from CPAP.
Full text
Available for:
BFBNIB, CMK, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
We describe a case of mandibular gingival carcinoma with hypercalcaemia and leukocytosis caused by tumour-derived parathyroid hormone-related protein (PTHrP) and granulocyte colony-stimulating factor ...(G-CSF). A 54-year-old man presented to our Department of Oral and Maxillofacial Surgery with a chief complaint of a left-sided mandibular gingival ulcer. A 42 mm × 20 mm sized ulcer was found on the left lower molar gingiva. Squamous cell carcinoma was pathologically diagnosed. The patient underwent a hemimandibulectomy, left-sided radical neck dissection, plate reconstruction, pectoralis major musculocutaneous flap reconstruction, and tracheostomy under general anaesthesia. Pathologically, two metastatic lymph nodes were identified. Residual tumour was suspected at the resection margins. Eight weeks after surgery, the patient started postoperative concurrent chemoradiotherapy (CCRT). Two weeks after CCRT, the patient developed hypercalcaemia. Serum levels of PTHrP and G-CSF increased in parallel with the progression of hypercalcaemia and leukocytosis. Immunohistochemical analysis of the surgical specimen showed positivity for G-CSF. Based on these clinical and pathological findings, the patient was diagnosed with hypercalcaemia and leukocytosis associated with malignancy and was treated with denosumab. Irradiation was terminated at 50 Gy because CT showed rapid disease progression. Chemotherapy was initiated, however, four weeks after the start of chemotherapy, a CT scan showed increased metastases and pleural dissemination. Therefore, chemotherapy was discontinued. One week after the chemotherapy was discontinued, the patient died of respiratory failure.
Full text
Available for:
EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Introduction Current literature demonstrated oral myofunctional therapy (MFT) decreased apnea hypopnea indices (AHI) by 50% in middle aged patients (44.5 ± 11.6 years old) with moderate obstructive ...sleep apnea (OSA), however few studies was reported in elder patients with moderate to severe OSA. Methods Twenty eight Japanese patients (19 males and 9 females) with moderate to severe OSA treated with continuous positive airway pressure (CPAP) or oral appliance (OA) for more than 6 months were included and MFT were performed 3 times a day for 6 months with CPAP or OA during sleep. The patients were educated MFT by dentists, described training diary, tongue pressures were calculated and checked their MFT pre, 2, 4 and 6 months after starting FMT with disposable tongue pressure measurement device (JMS, Japan). Polysomnography was studied before and after FMT without CPAP or OA. Results Those ages were 71.0 ± 7.5 years old and body mass indices were 23.6 ± 2.4 Kg/m2. The previous AHI were 34.7 ± 2.5 and AHI did not change significantly with CPAP or OA. The pre and post MFT AHI decreased from 36.2 ± 2.5 to 31.9 ± 2.5, p=0.025. Epworth Sleepiness Scale decreased from 7.5 ± 4.0 to 6.0 ± 3.5, p=0.013. Tongue pressure increased from 37.4 ± 8.5 to 42.7 ± 9.1kPa, p < 0.001, neck circumference decreased from 38.1 ± 3.8 to 37.2 ± 3.4cm, p=0.024. Body weight and waist circumference did not change significantly. Conclusion MFT might support the treatment to elder patients with moderate to severe OSA. Support (If Any)
Dental implant surgery can cause fatal breathing problems due to accidental injury to surrounding tissues. In this paper, we report a case of a hematoma on the floor of the mouth that required ...emergency tracheal intubation due to hemorrhage of the floor of the mouth caused by dental implant surgery.A 53-year-old female underwent vestibuloplasty procedures during second-stage implant surgery on the left mandibular molar at a dental clinic in March 2018. The wound was closed with a releasing incision on the periosteum of the lingual gingiva. After returning home on the same day, she became aware of rapid swelling in the lower part of the jaw and returned to the same clinic. During hemostatic treatment, she complained of respiratory distress. She was transported to our hospital's emergency room. At the time of initial examination, her level of consciousness was JCS (Japan Coma Scale) Ⅰ-1, and she was unable to open her mouth. The swelling was observed from the lower part of the left side of the jaw to the midline of the muscle. There was no active bleeding in the oral cavity. CT showed a 38×27 mm hypo-absorptive area with an air-containing image in the left parapharyngeal space, and the airway deviated to the right and was stenotic. The patient was admitted to the ICU on the same day, and emergency tracheal intubation was performed. SBT/ABPC 6 g, carbazochrome sodium sulfonate hydrate 50 mg, and tranexamic acid 1 g were administered daily. The patient was extubated on hospital day 6 and transferred to the general ward. She was discharged from the hospital on day 14 after good progress.
Osteoclasts are differentiated from hematopoietic mononuclear cells by regulation of the receptor activator of nuclear factor kappa-B (RANK)/receptor activator of nuclear factor kappa-B ligand ...(RANKL)/osteoprotegerin (OPG) system. Medullary bone (MB) that forms in the bone marrow of female birds is remodeled under the control of circulating estrogen (E2) during the laying period. Although the osteoclasts of MB are differentiated from mononuclear cells, the mechanism of osteoclastogenesis is not known. We investigated whether MB osteoclastogenesis is regulated by the RANK/RANKL/OPG system using MB from male quails induced with E2. Bone marrow cells (BMCs) differentiate into osteoclasts that have the ability of bone resorption via stimulation of RANKL/M-CSF, but this ability is suppressed by OPG and differentiation is inhibited by calcinurin inhibitors. We found that BMCs at 3 days after E2 administration had high bone osteoclastogenesis ability and colony forming unit-granulocyte/macrophage (CFU-GM)/colony forming unit-macrophage (CFU-M) formation abilities. We conclude that MB osteoclasts are differentiated from BMCs by the RANK/RANKL/OPG system, and that precursor cells of osteoclasts are increased during MB formation.
Full text
Available for:
EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
PDF
