Objectives Dry socket and post-extraction pain are typical discomforts experienced by patients after tooth extraction. In this study, we inserted gauze coated with oxytetracycline-hydrocortisone ...ointment into the extraction socket immediately after lower third molar extraction and then evaluated the occurrence of dry socket and post-extraction pain compared with gauze non-insertion. Methods This retrospective study was carried out on patients undergoing lower third molar extraction in the Department of Oral Surgery at Shizuoka Prefectural General Hospital in Shizuoka, Japan from November 2018 to October 2019. A comparison was carried out between a gauze-insertion group and a non-insertion group. The occurrence versus non-occurrence of dry socket was determined, and degree of pain was assessed based on a visual analogue scale (VAS) and on patients reporting the number of loxoprofen sodium oral analgesic tablets (60mg/tablet) that they had taken. Dry socket was defined as patient-reported spontaneous pain that did not subside 1 to 3 days postoperatively. Spontaneous post-extraction pain was recorded four times: on the operative day, on the first postoperative day (POD1), on POD3, and during suture removal (POD7). Results The occurrence of dry socket was lower in the gauze-insertion group than in the non-insertion group (0.9%, 2/215 vs. 19.6%, 9/46, p<0.001). The results also showed that both VAS-defined pain level and the number of analgesic tablets taken were lower in the gauze-insertion group than in the non-insertion group on POD3 and POD7. Conclusions and clinical relevance Inserting gauze coated with oxytetracycline-hydrocortisone ointment into the extraction socket immediately after third molar extraction reduces the occurrence of both dry socket and post-extraction pain.
In rare cases, traumatic injury of the maxillofacial area may cause a hyoid fracture. We treated a rare case of hyoid fracture accompanying comminuted mandibular fracture.
A 71-year-old man who fell ...from scaffolding at a height of 2 m was transported by ambulance to our facility. The patient was diagnosed with mandibular comminuted fracture and hyoid fracture based on computed tomography imaging. Open reduction and internal fixation were performed on the mandibular comminuted fracture. We selected conservative treatment for the hyoid fracture as it was only causing mild odynophagia and laryngeal edema. The patient did not exhibit any dyspnea, subcutaneous emphysema, or bloody sputum. On day 4 of hospitalization, the laryngeal edema and odynophagia had improved. On day 28 of hospitalization, the patient was discharged after progressing favorably postoperatively. At 6 months postoperatively, computed tomography images showed that although the greater horn of hyoid bone had not returned to its proper position, deviation had improved compared to that before surgery, and continuity was confirmed with the cortical bone. Repositioning and osteosynthesis of the mandibular fracture were favorable.
In cases of maxillofacial trauma exhibiting laryngeal trauma injuries such as hyoid fracture, even mild cases have a risk of developing serious dyspnea over time. Physicians should consider carefully monitoring the course of such cases over 48–72 h. The possibility of relatively rare concomitant injuries such as hyoid fracture needs to be taken into account when diagnosing and treating maxillofacial trauma cases.
The Oral Care BC-trial reported that professional oral care (POC) reduces the incidence and severity of oral mucositis in patients receiving everolimus (EVE) and exemestane (EXE). However, the effect ...of POC on clinical response among patients receiving EVE and EXE was not established. We compared outcomes for estrogen receptor-positive metastatic breast cancer patients who received POC to those who had not, and evaluated clinical prognostic factors. All patients simultaneously received EVE and EXE.
Between May 2015 and Dec 2017, 174 eligible patients were enrolled in the Oral Care-BC trial. The primary endpoint was the comparative incidence of grade 1 or worse oral mucositis, as evaluated for both the groups over 8 weeks by an oncologist. The secondary endpoints were progression-free survival (PFS) and overall survival (OS). Data were collected after a follow-up period of 13.9 months.
There were no significant differences in PFS between the POC and Control Groups (P = 0.801). A BMI < 25 mg/m
and non-visceral metastasis were associated with longer PFS (P = 0.018 and P = 0.003, respectively) and the use of bone modifying agents (BMA) was associated with shorter PFS (P = 0.028). The PFS and OS between the POC and control groups were not significantly different in the Oral-Care BC trial.
POC did not influence the prognosis of estrogen receptor-positive metastatic breast cancer patients. Patients with non-visceral metastasis, a BMI < 25 mg/m
, and who did not receive BMA while receiving EVE and EXE may have better prognoses.
The study protocol was registered online at the University Hospital Medical Information Network (UMIN), Japan (protocol ID 000016109), on January 5, 2015 and at ClinicalTrials.gov ( NCT02376985 ).
We report a rare case of venous malformation in the pterygomandibular space. A 49-year-old Japanese woman experienced discomfort on opening her mouth since 3 months but had not sought treatment ...previously. At initial examination, no submandibular lymph node enlargement, trismus, perceptual dysfunction were noted.
The surface mucosa on the lateral wall of the left middle pharynx was normal, and no mass could be palpated in the oral cavity. Panoramic X-ray examination revealed a clearly demarcated, elliptical, radiolucent area on the left mandibular ramus. Computed tomography revealed a clearly demarcated, nearly spherical mass of 17 × 11 × 16 mm near the mandibular foramen of the left mandibular ramus. Magnetic resonance imaging revealed signal hypointensity, which was approximately similar to that of muscle tissues, on T1-weighted images and signal hyperintensity on T2-weighted images. On contrast T1-weighted images, a mass with relatively good contrast effects and some internal areas of low concentration was revealed. A clinical diagnosis of benign tumor in the left pterygomandibular space was made, and enucleation was performed using intraoral approach under general anesthesia. The tumor was dark purple and encapsulated. It showed color-fading and was not pulsatile. Although venous vascular malformation was suspected, en bloc extraction including the capsule could be performed because no adhesion with surrounding tissue or blood vessels was observed. Histopathological diagnosis was venous malformation. Although neurological deficit symptoms in the lower lip and tongue were observed postoperatively, subsequent improvement was noted. Currently, at >5 postoperative years, no recurrence has been found.
Roughened implant surfaces are thought to enhance osseointegration. Torque removal forces have been used as a biomechanical measure of anchorage or osseointegration in which the greater forces ...required to remove implants may be interpreted as an increase in the strength of osseointegration. The purpose of this study was to compare the torque resistance to removal of screw shaped titanium implants having an acid etched (HCl/H2SO4) surface (Osseotite®) with implants having a machined surface. Two custom screw shaped implants, 1 acid etched and the other machined, were placed into the distal femurs of 10 adult New Zealand White rabbits. These implants were 3.25 mm in diameter x 4.00 mm in length without holes, grooves or slots to resist rotation. Following a 2 month healing period, the implants were removed under reverse torque rotation with a digital torque measuring device. Two implants with the machined surface preparation failed to achieve osseointegration. All other implants were found to be anchored to bone. Resistance to torque removal was found to be 4 x greater for the implants with the acid etched surface as compared to the implants with the machined surface. The mean torque values were 20.50 ± 6.59 N cm and 4.95 ± 1.61 N cm for the acid etched and machined surfaces respectively. The results of this study suggest that chemical etching of the titanium implant surface significantly increases the strength of osseointegration as determined by resistance to reverse torque rotation.
Objective:
Postoperative airway obstruction following oral cancer surgery is difficult to predict. Scoring systems used to assess the need for tracheotomy use risk factors as criteria. We aimed to ...examine whether these clinical scoring systems can predict airway obstruction following oral cancer surgery.
Methods:
We assessed 95 patients who underwent oral cancer surgery without tracheotomy under general anesthesia between January 2007 and April 2019. We reviewed multiple factors from the patients’ medical records, including age, sex, tumor site, body mass index, tumor stage, type of surgery, airway management method, Cameron and Gupta scores, and postoperative airway complications.
Results:
Tumors were located in the maxilla (n = 14), buccal mucosa (n = 13), mandible (n = 14), floor of the mouth (n = 6), and tongue (n = 48). Twenty-seven patients (28.4%) were graded as Stage 1, 37 patients (38.9%) as Stage 2, 9 patients (9.5%) as Stage 3, and 3 (3.2%) patients as Stage 4. Nine patients (9.5%) had local recurrences, and ten patients (10.5%) had neck metastases. Postoperative oxygen administration alone failed to improve dyspnea in 4 patients (4.2%). The median Cameron scores between patients with and without airway trouble were not significantly different (P = 0.226). However, a significant difference was observed in median Gupta scores between patients with and without airway trouble (P = 0.01). We created a receiver operating characteristic curve to predict postoperative airway trouble based on the preoperative Gupta score; the area under the curve was 0.856 (95% confidence interval: 0.61-1). A Gupta score cutoff value of 3.0 had a sensitivity of 92.3% and specificity of 75.0%.
Conclusions:
Screening based on the Gupta score appears to be effective in predicting postoperative airway obstruction. We propose that this screening tool can be used to better plan tracheotomy and other airway management strategies during preoperative patient assessment.
In oral cancer surgery, the decision to perform a tracheotomy is often determined by the surgeon. In this study, we investigated the competency of clinical scoring systems in identifying patients who ...require tracheotomy and examined the degree of agreement between the surgeon's decision and the indications of various scoring systems. We identified 110 patients who were surgically treated for oral cancer. Of these, 67 patients (44 men and 23 women) who underwent resection and reconstruction were retrospectively analyzed. To derive the score, we evaluated the endpoint of the airway management score using clinical records and images. We divided the patients into two groups based on the Cameron and Gupta scores (tracheotomy and no-tracheotomy groups) and evaluated the degree of agreement with the surgeon's decision by calculating the κ coefficient. The κ coefficients of the Gupta and Cameron scores were 0.61 (95% confidence interval CI: 0.40-0.82) and 0.60 (95% CI: 0.38-0.82), respectively. The clinical evaluation of the κ coefficient indicated that the Cameron and Gupta scores agreed fairly with the surgeon's decision. In this study, the Cameron and Gupta scores fairly agreed with the decision of experienced surgeons and were confirmed as acceptable guides for making clinical judgments.
We report a case of Erdheim-Chester disease diagnosed as a result of ulceration of the palate. The patient was a 62-year-old male with the chief complaint of contact pain of the palatal mucosa. He ...had a beaded mass on the adductor muscle of the right thigh, which was being treated by an orthopedic surgeon. At the same time, an ulcerative lesion was found on the palate. He was referred to the Department of Oral and Maxillofacial Surgery and treated with a steroid ointment. However, the lesion did not improve and a biopsy was performed two weeks later. The biopathologic finding was similar to that of the soft tissue tumor of the leg, and finally a diagnosis of Erdheim-Chester disease was made. The oral lesions did not improve and the contact pain persisted, so protection of the ulcerated surface was performed with indomethacin spray and a 0.5mm celluloid splint. The contact pain was alleviated and feeding improved. However, although chemotherapy was performed for the tumors in both legs, the treatment was discontinued and palliative care was initiated since his general condition worsened due to the exacerbation of the primary disease, hepatocellular carcinoma.
Carcinoma of the mandibular gingiva is common and can more easily invade the mandibular bone compared with other head and neck cancers. Tumours that approach or involve the mandible usually require ...marginal resection or segmental resection of the mandible. Marginal mandibulectomy was not associated with worse prognosis than segmental mandibulectomy. However, these two conventional surgical methods lead to significant disability including loss of hard and soft tissues, impaired function of speech, swallowing and mastication. Rehabilitation can be difficult or impossible due to the distorted postsurgical anatomy. There are rare clinical studies on the surgical method for the mandibular gingival carcinoma in situ. In this study we introduce a modified surgical method, buccal partial mandibulectomy, focusing on how to keep the alveolar bone crest and lingual gingiva of the lesion in the largest extent for patients with mandibular gingival carcinoma in situ. Being more appropriate than traditional marginal or segmental mandibulectomy, the modified surgical method can not only ablate the whole tumour with negative margin in soft tissue, but also achieve higher quality of postoperative life without tumour recurrence during the longest follow-up time of more than 40 months. Buccal partial mandibulectomy can maintain the jaw continuity and make it possible to achieve an adequate prosthetic rehabilitation such as implant-fixed prothesis.
Aim
Our previous study proposed a technique of inserting gauze coated with oxytetracycline–hydrocortisone ointment into the extraction socket that suppressed the occurrence of dry socket and ...post‐extraction pain compared with the gauze‐free group. In this study, we estimated the incidence of dry socket and post‐extraction infection in patients with ointment gauze insertion and identified predictors of post‐extraction pain and change in maximum opening volume.
Methods
This retrospective study was carried out on patients who underwent lower third molar extraction in the Department of Oral Surgery at a general hospital in Japan.
Results
The incidence of dry socket and infection after tooth extraction was 1.05% and 0.35%. The mean visual analog scale (VAS) on the operative day was 4.15; the VAS for postoperative day (POD)1 and POD7 were 2.28 and 0.55, respectively. The percentage change in maximum mouth opening on POD1 was −9.88%, and that on POD7 was −1.51%. Multivariable analysis indicated that age and Winter position classification were predictors of POD1 VAS, and female sex, smoking, and Winter position classification were predictors of POD7 VAS. Winter position classification and preoperative maximum mouth opening, respectively, were identified as predictors of maximum mouth opening percent change on POD1 and POD7.
Conclusions
The insertion of gauze coated with oxytetracycline–hydrocortisone ointment into the extraction socket of the mandibular third molar showed a low incidence of dry socket and post‐extraction infection. Moreover, the Winter position classification was suggested to be an independent predictor of postoperative pain and the maximum mouth opening percent change.
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