Orthodontic and Orthognathic Surgical Correction of a Skeletal Class III Malocclusion

We report here a case of skeletal Class III malocclusion with mandibular prognathism treated with a combination of orthodontic and orthognathic surgery. A 28-year-old woman presented with a cross bite and the inability to incise food; she had no history of trauma or serious illness. She was diagnosed with a skeletal Class III malocclusion and crowded teeth. The left mandibular first molar showing an inappropriate root canal treatment was extracted and the left mandibular third molar was implanted into the first molar extraction space. She was treated with conventional fixed edgewise appliance therapy combined with orthognathic surgery (sagittal split ramus osteotomy). The mandibular prognathism was eliminated. The transplanted tooth remains stable more than 5 years after the procedure

Narrow Band Imaging of Oral Mucosa, Cancer and Pre-cancerous Lesions

Narrow band imaging (NBI) enhances the diagnostic capability of endoscopy for tissue characterization. The procedure uses using narrow-bandwidth filters in a sequential red-green-blue illumination system. The blue filter corresponds to the peak absorption spectrum of hemoglobin and thus emphasizes images of capillary vessels on the surface mucosa. Here, we examined the applicability of the NBI system to evaluate oral mucosa, and the status of 6 patients with oral squamous cell carcinoma and 5 with oral pre-cancerous lesions. Regular, orderly, thin-caliber vessels in the tongue, floor of the mouth, buccal mucosa, soft palate and lip were clearly distinguished by NBI. However, small vessel branches are difficult to evaluate in the gingival and hard palate mucosa. Adding the patterns of capillary branches to find mucosal patterns appeared to improve the diagnostic value for detecting the borders of oral cancer or pre-cancerous lesions by NBI. The vascular pattern revealed by NBI defined the margin of hyperkeratotic lesions. Although appropriate criteria for oral cancer lesions remain to be established, the NBI system should be useful in the diagnosis of patients with oral cancer and pre-cancerous lesions

Comparison of long-term outcomes after trans-catheter aortic valve implantation between patients primarily diagnosed by cardiac murmur and those diagnosed by other reasons.

Careful auscultation is the first step to diagnose aortic stenosis (AS). The aim of this study was to compare clinical outcomes following transcatheter aortic valve implantation (TAVI) between the patients primarily diagnosed by heart murmur and those diagnosed by other reasons. We retrospectively included 258 patients who underwent TAVI in our medical center, and divided those into the murmur group (n = 81) and the other-reason group (n = 177) according to the primary reason for AS diagnosis. The primary endpoint was the major adverse cardiovascular and cerebrovascular events (MACCE), which was defined as the composite of cardiovascular death, hospitalization due to acute decompensated heart failure, and disabling stroke. The murmur group included younger patients than the other-reason group (82.8 year-old vs. 84.0 year-old, P = 0.02). History of AF was more frequently observed in the other-reason group than in the murmur group (21.5% vs. 7.4%, P <0.01). STS score and logistic EuroSCORE were lower in the murmur group than in the other-reason group (STS: 4.7% vs. 7.2%, P <0.01, logistic EuroSCORE: 8.3% vs. 11.2%, P <0.01). The median follow-up period was 562 days. MACCE was more frequently observed in the other-reason group than in the murmur group (27.7% vs. 9.9%, Log Rank P <0.01). The multivariate COX hazard analysis revealed that the AS patients primarily diagnosed by heart murmur was inversely associated with MACCE (HR 0.38, 95%CI 0.17-0.86, P = 0.020). Among AS patients who underwent TAVI, the patients primarily diagnosed by heart murmur were significantly associated with favorable long-term clinical outcomes