A Case of Sublingual Ranula That Responded Successfully to Localized Injection Treatment with OK-432 after Healing from Drug Induced Hypersensitivity Syndrome

A ranula is a mucus retention cyst or pseudocyst caused by leakage of mucus from the sublingual gland and generally occurs in the oral floor. In addition, drug induced hypersensitivity syndrome (DIHS) is a rare but well-recognized serious adverse effect characterized by fever, skin rashes, generalized lymphadenopathy, hepatitis, and hepatosplenomegaly and oral stomatitis. This paper presents the first case of successfully treated sublingual ranula with localized injection of OK-432 after healing from drug induced hypersensitivity syndrome, which has previously been unreported in the literature. We present the case of a 38-year-old Japanese woman with sublingual ranula that responded successfully to localized injection treatment with OK-432 after healing from drug induced hypersensitivity syndrome. She was affected with cutaneous myositis and interstitial lung disease when she was 26 years old. At the age 34 years, she received additional oral treatment of diaminodiphenyl-sulfone due to deterioration of the cutaneous myositis, which resulted in drug induced hypersensitivity syndrome (DIHS) with severe oral stomatitis. Local injection of OK-432 to the ranula may be a very safe and useful treatment method even if the patient has a history of drug allergy and has connective tissue disease such as cutaneous myositis

Bone healing of critical-sized nasal defects in rabbits by statins in two different carriers

Objectives: To evaluate bone healing following implantation of a statin with two different carriers in rabbit nasal bone using histological and immunohistochemical methods. Materials and methods: Twenty adult, male Japanese white rabbits (age: 12-16 weeks, weight: 2.5-3kg) were used in this study. Five bone circular defects (5mm in diameter) per rabbit were created in the nasal bone while preserving the nasal membrane. In the experimental groups, 2.5mg/ml simvastatin dissolved in 0.2ml water with hydrogel was implanted in one group, 2.5mg/ml simvastatin dissolved in 0.2ml water with an atelocollagen sponge (ACS) in the second group with, only the hydrogel in the third group and only an ACS in the fourth group. No material was implanted in the control group. Four animals were killed in each period, at 1, 2, 4, 8 and 12 weeks postoperatively. The parts that had been operated on were removed and prepared for histological assessment. The expression of bone morphogenetic proteins (BMP)-2 and the bone ration was evaluated using histological and immunohistochemical methods. Results: No significant differences were observed between the simvastatin with hydrogel group and the simvastatin with ACS group at 1, 2, 4, 8 and 12 weeks postoperatively regarding expression of BMP-2, although the number of cells that stained positive for BMP-2 in both of the implanted groups increased significantly at 2 and 4 weeks postoperatively in comparison with the control group (P<0.0001). For new bone area ratio, there were no significant differences between the simvastatin with hydrogel groups and the simvastatin with ACS group after 2, 4, 8 and 12 weeks, although these groups showed higher value than control group (P<0.0001). Conclusion: This study suggests that both the simvastatin with hydrogel and simvastatin with ACS implants showed similar BMP-2 expression and new bone formation, and there were no significant differences between the two carriers. To cite this article: , Mukozawa A, Ueki K, Marukawa K, Okabe K, Moroi A, Nakagawa K. Bone healing of critical-sized nasal defects in rabbits by statins in two different carriers., Clin. Oral Impl. Res. xx, 2011; 000-000., doi: 10.1111/j.1600-0501.2010.02135.x © 2011 John Wiley & Sons A/S

Esthetic improvement using conventional orthodontic devices after segmental osteotomy in treatment of malpositioned implants

金沢大学医薬保健研究域医学

Maxillary stability after le Fort i osteotomy using three different plate systems

The purpose of this study was to compare postoperative changes in maxillary stability after Le Fort I osteotomy in three groups: with an unsintered hydroxyapatite (u-HA)/poly-l-lactic acid (PLLA) plate; a PLLA plate; and a titanium plate. Subjects comprised 60 Japanese patients diagnosed with mandibular prognathism. All patients underwent Le Fort I osteotomy and bilateral sagittal split ramus osteotomy. All patients were randomized in groups of 20 to a u-HA/PLLA group, a PLLA plate group and a titanium plate group. Changes in postoperative time intervals between the plate groups were compared using lateral and posteroanterior cephalography. The uHA/PLLA group had significantly larger values than the PLLA group regarding change of mx1-S perpendicular to SN between 3 and 12 months (T3) (P = 0.0269). The uHA/PLLA group had a significantly larger value than the PLLA group regarding change of S-A perpendicular to SN between baseline and 1 month (T1) (P = 0.0257). There was no significant difference in the other measurements. This study suggests that maxillary stability with satisfactory results could be obtained in the u-HA/PLLA, PLLA plate and titanium plate groups, although there was a slight difference between the u-HA/PLLA and PLLA plate systems in Le Fort I osteotomy. © 2012 International Association of Oral and Maxillofacial Surgeons

Changes in the lip closing force of patients with Class III malocclusion before and after orthognathic surgery

The purpose of this study was to examine the changes in lip pressure before and after orthognathic surgery for skeletal Class III patients. The subject groups were 32 female and 31 male patients diagnosed with mandibular prognathism and/or maxillary retrognathism who underwent orthognathic surgery. Control groups consisted of 20 women and 20 men with normal occlusion without dento-alveolar deformity. Maximum and minimum lip closing force was measured with Lip De Cum ® for the control groups and subject groups preoperatively and 6 months postoperatively. The difference between the pre- and postoperative values of the groups was examined statistically. The maximum lip closing force in men was significantly larger than that in women in both the preoperative Class III group (p = 0.0330) and the control group (p = 0.0097). The preoperative Class III group was significantly smaller than the control group in maximum lip closing force in both men (p < 0.0001) and women (p < 0.0001). The postoperative maximum lip closing force was significantly larger than the preoperative value in both men (p = 0.0037) and women (p = 0.0273) in the Class III group. This study suggested that the maximum lip closing force increases after orthognathic surgery in Class III patients. © 2012 International Association of Oral and Maxillofacial Surgeons

Changes in temporomandibular joint and ramus after sagittal split ramus osteotomy in mandibular prognathism patients with and without asymmetry

The purpose of this study was to examine the changes in the temporomandibular joint (TMJ) and ramus after sagittal split ramus osteotomy (SSRO) with and without Le Fort I osteotomy. The subjects consisted of 87 Japanese patients diagnosed with mandibular prognathism with and without asymmetry. They were divided into 2 groups (42 symmetric patients and 45 asymmetric patients). The TMJ disc tissue was assessed by magnetic resonance imaging (MRI) and the TMJ space, condylar and ramus angle were assessed by computed tomography (CT) preoperatively and postoperatively. Medial joint space on the deviation side in the asymmetry group was significantly larger than that in the symmetry group (P = 0.0043), and coronal ramus angle on the non-deviation side in the asymmetry group was significantly larger than that in the symmetry group preoperatively (P = 0.0240). The horizontal condylar angle on the deviation side in the asymmetry group was significantly larger than that in the symmetry group (P = 0.0302), posterior joint space on the non-deviation side in the symmetry group was significantly larger than that in the asymmetry group postoperatively (P = 0.00391). The postoperative anterior joint space was significantly larger than the preoperative value on both sides in both groups (the deviation side in the symmetry group: P = 0.0016, the non-deviation side in the symmetry group: P < 0.0001, the deviation side in the asymmetry group: P = 0.0040, the non-deviation side in the asymmetry group: P = 0.0024). The preoperative disc position could was not changed in either group. These results suggest that significant expansion of anterior joint space could occur on the deviation side and non-deviation side in the asymmetry group as well as on both sides in the symmetry group, although disc position did not change in either group. © 2011 European Association for Cranio-Maxillo-Facial Surgery

Effect of self-setting α-tricalcium phosphate between segments for bone healing and hypoaesthesia in lower lip after sagittal split ramus osteotomy

Aims: The aim of this study was to evaluate hypoaesthesia of the lower lip and bone formation using self-setting α-tricalcium phosphate (Biopex®) between the proximal and distal segments following sagittal split ramus osteotomy (SSRO) with bent absorbable plate fixation. Subjects and methods: The subjects were 40 patients (80 sides) who underwent bilateral SSRO setback surgery. They were divided into a Biopex® group (40 sides) and a control group (40 sides). The Biopex® was inserted into the anterior part of the gap between the segments in the Biopex® group. Trigeminal nerve hypoaesthesia in the region of the lower lip was assessed bilaterally using the trigeminal somatosensory-evoked potential (TSEP) method. Ramus square, ramus length, and ramus width, the square of the Biopex® at the horizontal plane under the mandibular foramen were assessed preoperatively, immediately after surgery, and 1 year postoperatively by computed tomography (CT). Results: The mean measurable period and standard deviation were 9.3 ± 15.7 weeks in the control group, 5.3 ± 8.3 weeks in the Biopex® group, and there was no significant difference. Ramus square after 1 year was significantly larger than that prior to surgery and new bone formation was found between the segments in both groups (P < 0.05). In the Biopex® group, the square of the Biopex® after 1 year was significantly smaller than that immediately after surgery (P < 0.05). Conclusion: This study suggested that inserting Biopex® in the gap between the proximal and distal segments was useful for new bone formation and it did not prevent the recovery of lower lip hypoaesthesia after SSRO with bent absorbable plate fixation. © 2011 European Association for Cranio-Maxillo-Facial Surgery

Assessment of bone healing after Le Fort I osteotomy with 3-dimensional computed tomography

金沢大学医薬保健研究域医学系Purpose: The purpose of this study was to examine bone healing after Le Fort I osteotomy in Class III patients. Patients and methods: The study group consisted of 18 Japanese patients with mandibular prognathism with and without asymmetry, maxillary retrognathism or open bite. A total of 36 sides were examined. Le Fort I osteotomy was performed without a pterygoid osteotome, with an ultrasonic curette used to remove interference at the pterygomaxillary region. Titanium plates (Universal Mid-face fixation module, Stryker, Freiburg, German) were used for four patients, absorbable plates (poly-l-lactic acid (PLLA): NEOFIX®, Gunze, kyoto, Japan) were used for four patients and other absorbable plates (uncalcined and unsintered hydroxyapatite and poly-L-lactic acid (uHA/PLLA): super FIXSORB®MX, Takiron Co. Ltd, Osaka, Japan) were used for 10 patients, in the same manner. Postoperative computed tomography (CT) was analyzed for all patients pre-operatively and 1 year postoperative. The anterior and lateral areas between the maxillary segments were measured with 3-dimensional (3D) CT. Bone healing at the pterygomaxillary region was also assessed. Results: There were no significant differences in the area of bone defect healing among the plate types. The areas of bone defect after 1 year were significantly smaller than that immediately after surgery on the right side (p = 0.0145) and left side (p = 0.0010) in the frontal view and right side in the lateral view (p = 0.0118). Bone healing at the pterygomaxillary junction was found in all cases without artificial pterygoid plate fracture. Fourteen of 22 sides with artificial pterygoid plate fracture by an ultrasonic curette showed bone continuity between the pterygoid plate and posterior part of maxilla. Conclusion: This study suggested that bony healing could occur in spaces between the segments of maxilla and pterygomaxillary regions as well as the region of the anterior and lateral walls in the maxilla, but it is not always complete within 1 year after Le Fort I osteotomy. © 2010 European Association for Cranio-Maxillo-Facial Surgery

Skeletal Stability After Mandibular Setback Surgery: Comparisons Among Unsintered Hydroxyapatite/Poly-L-Lactic Acid Plate, Poly-L-Lactic Acid Plate, and Titanium Plate

金沢大学医薬保健研究域医学系Purpose: The purpose of this study is to compare the time-course changes in condylar long-axis and skeletal stability after sagittal split ramus osteotomy (SSRO) with an unsintered hydroxyapatite (u-HA)/poly-L-lactic acid (PLLA) plate, PLLA plate, or titanium plate. Patients and Methods: Of 60 Japanese patients diagnosed with mandibular prognathism, 20 underwent SSRO with a u-HA/PLLA plate system, 20 underwent SSRO with a PLLA plate system, and 20 underwent SSRO with a conventional titanium plate system. The time-course changes in condylar long-axis and skeletal stability were assessed by use of axial, frontal, and lateral cephalograms. Results: Compared with the u-HA/PLLA group, the titanium group showed a significantly greater change in the right condyle angle between initially and 1 month (P = .0105) and intercondylar axes angle between 1 and 3 months (P = .0013). The PLLA group showed a significantly greater change than the titanium group (P = .0043) and u-HA/PLLA group (P = .0002) in terms of ramus inclination between 1 and 3 months; however, there were no significant differences among the 3 groups in the other measurements for each time interval. Conclusion: This study suggests that there are no significant differences in postoperative time-course changes among a u-HA/PLLA plate system, PLLA plate system, and conventional titanium plate system. © 2010 American Association of Oral and Maxillofacial Surgeons

A hypothesis on the desired postoperative position of the condyle in orthognathic surgery: a review

It is very important to clarify the relationship between a dentofacial structure and a temporomandibular joint (TMJ) structure in orthognathic surgery. Recently, it was reported that the skeletal and occlusal patterns were associated with the TMJ morphology, including the disk position. In orthognathic surgery, some surgeons state that alterations in the condylar position from surgery can lead to malocclusion associated with the risk of early relapse, and also favor the development of temporomandibular disorders. For these reasons, several positioning devices have been proposed and applied, but now there is no scientific evidence to support the use of condylar positioning devices. There are some reasons why scientific evidence cannot be obtained; however, it also includes the question of whether the preoperative position of the condyle is the desired postoperative position. The purpose of this study was to verify the desired condylar position in orthognathic surgery, based on literature on the postoperative condylar position in orthognathic surgery. From the studies reviewed, it was suggested that the preoperative position of the condyle was not the desired postoperative position in orthognathic surgery. © 2012 Elsevier Inc. All rights reserved