Characteristics of Clinical and Imaging Findings of Epidermoid Cysts under the Skin of the Mental Region

Epidermoid cyst often arises in the fl oor of oral cavity; however, it is relatively rare to arise subcutaneously in the mental region. We reported characteristics of clinical and imaging fi ndings of epidermoid cysts under the skin of the mental region. The patient was a 53-year-old male. He complained of a subcutaneous mass without pain in the left mental region. A palpable soft and movable thumb-sized mass without pain was observed at the fi rst examination. Ultrasound examination revealed a well-demarcated mass with heterogenous hyper-echoic internal echo and posterior echo enhancement. On power Doppler sonography, a small amount of blood supply was found around the periphery of the mass. Plain CT scan revealeda globular soft-tissue mass with peripheral high and central low CT values area. The mass was removed under local anesthesia using intraoral approach. A histopathologic diagnosis was epidermoid cyst. Recurrence is not observed 2 years after surgery. There were only 3 reports of epidermoid cysts in the mental region, including our case in Japan, clinically characteristics of age ranging 20 to 66 years of age and the mean age of 46 years, with 2 males and 1 female. The size wasfrom 20 mm to 12 mm in diameter and from the tip of a thumb up to the tip of a small fi nger. Ultrasound images of the inside of epidermoid cysts that we experienced this time showed enhancement of relatively uniform hyperechoic image and posterior echo, which was characteristically slightly diff erent from fi ndings of epidermoid cysts generally reported

日本人成人におけるパノラマX線写真上の下顎皮質骨と海綿骨構造との関係：コーンビームCTによる分析

Objectives The purpose of this study was to assess the association between the cortical shape of the mandible, as detected on panoramic radiographs, and trabecular bone structure, as assessed by cone-beam computed tomography (CBCT), in Japanese adults. Methods Panoramic radiographs and CBCT images of the mandibles of 50 subjects (18 men, 32 women), aged 45–86 years, were evaluated. An experienced oral and maxillofacial radiologist categorized the cortical shape of the mandible as detected on panoramic radiographs as normal, mildly to moderately eroded, and severely eroded cortices, respectively. All mandibles were scanned using CBCT. Four bone structure parameters of the basal portion of the mandible were calculated in three dimensions using an image-analysis system: total bone volume (mm3); cortical bone volume fraction (%); trabecular bone volume fraction (%); fractal dimension. One-way analysis of covariance with Bonferroni correction was employed to evaluate differences in the four bone parameters among the three cortical shape groups. Pearson’s correlation coefficient was calculated to examine correlations between age and cortical and trabecular bone volume fractions.Results Progression of cortical bone erosion was significantly associated with increased trabecular bone volume fraction (P\0.001) and increased fractal dimension(P = 0.01). Cortical bone volume fraction decreased significantly with age (P = 0.04). However, trabecular bone volume fraction tended to increase with age (P = 0.06). Conclusions The change in the trabecular bone structure of the mandible may differ from that of the general skeleton in Japanese adults.2013博士（歯学）松本歯科大

Association of Self-reported Height Loss and Kyphosis with Loss of Teeth in Japanese Elderly

Study background: Height loss and kyphosis are useful surrogate markers of osteoporotic vertebral fractures in the elderly. Loss of teeth in the elderly also is associated with osteoporosis. These imply the possibility that self-reported these indices may be associated with loss of teeth in the elderly. This study aimed to clarify the associations of self-reported height loss and kyphosis with number of teeth lost in Japanese elderly. Subjects and Methods: Among patients who visited dispensing pharmacies in Matsumoto, Japan, 307 patients (75 men and 232 women) aged 50–97 years participated in the study. They completed a structured questionnaire including covariates related to loss of teeth. Self-reported height loss and kyphosis were simply defined as three categories: no; mild-to-moderate; severe. Results: Analyses of covariance adjusted for covariates revealed that there were no significant differences in the numbers of teeth lost in total, or during the past 1 year among the three self-reported height loss categories. Significant differences were observed in the total numbers of teeth lost among the three self-reported kyphosis categories (p<0.001). Subjects who were conscious of severe kyphosis had significantly larger number of teeth lost (mean ± SEM, 16.1 ± 1.8) than those who were conscious of no kyphosis (8.7 ± 0.6, p<0.001) and mild-to-moderate kyphosis (8.3 ± 0.7, p<0.001). Furthermore, there were significant differences in the number of teeth lost during the past 1 year among the three self-reported kyphosis categories (p=0.031). Subjects who were conscious of severe kyphosis had significantly greater number of teeth lost during the past 1 year (0.9 ± 0.2) than those who were conscious of no kyphosis (0.3 ±0.1, p=0.03). Conclusions: Our results suggest that Japanese elderly with self-reported severe kyphosis may lost more teeth than those without self-reported severe kyphosis

Development of an Ultra-Rapid Diagnostic Method Based on Heart-Type Fatty Acid Binding Protein Levels in the CSF of CJD Patients.

Creutzfeldt-Jakob disease (CJD) is a transmissible, fatal, neurodegenerative disease in humans. Recently, various drugs have been reported to be useful in the treatment of CJD; however, for such treatments to be useful it is essential to rapidly and accurately diagnose CJD. 124 CJD patients and 87 with other diseases causing rapid progressive dementia were examined. Cerebral spinal fluid (CSF) from CJD patients was analyzed by 2D-PAGE and the protein expression pattern was compared with that from healthy subjects. One of three CJD-specific spots was found to be fatty acid binding protein (FABP), and heart-type FABP (H-FABP) was analyzed as a new biochemical marker for CJD. H-FABP ELISA results were compared between CJD patients and patients with other diseases (n = 211). Visual readout accuracy of the Rapicheck((R)) H-FABP test panel for CSF was analyzed using an independent measure of CSF H-FABP concentration. The distribution of H-FABP in the brains of CJD patients was examined by immunohistochemistry. ELISA sensitivity and specificity were 90.3% and 92.9%, respectively, and Rapicheck((R)) H-FABP sensitivity and specificity were 87.9% and 96.0%, respectively. ELISA and Rapicheck((R)) H-FABP assays provided comparable results for 14-3-3 protein and total tau protein. Elevated H-FABP levels were associated with an accumulation of abnormal prion protein, astrocytic gliosis, and neuronal loss in the cerebral cortices of CJD patients. In conclusion, Rapicheck((R)) H-FABP of CSF specimens enabled quick and frequent diagnosis of CJD. H-FABP represents a new biomarker for CJD distinct from 14-3-3 protein and total tau protein.The original publication is available at www.springerlink.co

Dental implant placement performed for two patients with maxillary sinus floor pneumatization

Asymmetry in the size and shape of the sinus is common. Placing dental implants with maxillary sinus floor pneumatization can be challenging. Implant placement is rarely difficult in the anterior maxilla due to insufficient bone volume below the maxillary sinus.The indications and methodology of implant treatment for patients are dependent on the planning of endosseous implant treatment in the esthetic zone with implant therapy and should be based on careful diagnosis.Knowledge and understanding of maxillary sinus floor pneumatization is important to achieve an accurate diagnosis and realize appropriate treatment and management

Radiological study on Garré osteomyelitis of the mandible in a child

We report a case of Garré osteomyelitis of the mandible involving a child. The patient was a 12–year–old girl with symptoms of swelling and pain of the left face. She presented to our hospital with asymmetrical swelling and tenderness and redness from the left cheek to the lower jaw, and tenderness of the left submandibular lymph nodes. Panoramic radiography revealed a well–demarcated radiolucent lesion that continued to the periodontal space of the second molar of the left mandible and was surrounded by a diffuse osteosclerotic area. In addition, cone beam CT images showed an onion peel–like periosteal reaction on the buccal side of the left mandible near this radiolucent lesion. A diagnosis of cellulitis of the left cheek and Garré osteomyelitis of the mandible was determined based on clinical and imaging findings. A cephem antibiotic (D.I.V.) and oral antibacterial drugs were started to improve inflammation. The symptoms promptly improved on the 4th day after the starr of treatment. It was reported that conservative therapy is appropriate treatment to repair tissues from the viewpoint of jaw development as well as the process of tooth formation in children. An early diagnosis based on specific findings like an onion peel appearance on imaging is required for effective treatment of osteomyelitis of the mandible in childhood

A case of intramuscular lipoma of the left buccal region

We report a case of intramuscular lipoma of the left buccal region, along with a review of the relevant literature. Magnetic resonance imaging showed a spindle–shaped mass extending from the canine region to the anterior portion of the masseter muscle in the buccal–alveolar portion of the left mandible. The inner part was visualized as homogeneous high–signal intensity on both T1– and T2–weighted images, and a partial linear region with the same signal intensity as muscle was also observed. The removed tumor measured 35×40×15mm in size, and histopathological findings showed an intramuscular lipoma composed of adipose, muscle and connective tissues. Intramuscular lipomas account for 1.7%–2% of all lipomas, and they very rarely occur in the oral and maxillofacial region. Twenty–three cases with intramuscular lipomas in the oral and maxillofacial region, including our case, have been reported in Japan. The postoperative healing process is generally good. We followed–up our patient after explaining to him the importance of careful, long–term follow–up. It has been only 2 months, to date, since surgery but the outcome appears to be good

A case of mandibular fracture including coronoid process fracture

The incidence of mandibular fractures is the highest among facial bone fractures. Addi-tionally, most of mandibular fractures occur in the mandibular angle and condylar process. On the other hand, the incidence of fracture of coronoid process is extremely low. We experienced a case of mandibular fractures involving mandibular body, condylar process as well as the coronoid process in a man aged 3₉–years–old who had received strong direct external force to the mandible. Mandibular fractures usually occur in the condylar process and mandibular angle because direct external force is more likely to transmit to these re-gions. Based on the classification of mandibular fractures, the incidence of mandibularfractures involving coronoid process increases with an increased number of fractures lines that means complicated fracture. At the viewpoint of anatomical portion, direct external force dose not transmit to coronoid process; however, it is possible that direct external force may transmit coronoid process in the case of complicated fracture. In this case report, we considered the potential mechanism of fracture of coronoid process by using a three–dimensional finite element model of a human mandible stress distribution analysis

A case of keratocystic odontogenic tumor occupying the maxillary sinus

Odontogenic keratocysts show a marked tendency toward proliferation or biological activity compared with jawbone cysts, being a disease highly　recurrent after extirpation, which has been characterized as a cystic tumor. The WHO tissue classification of odontogenic cysts revised in 2005 states that, of previous odontogenic keratocysts, those whose epithelium histologically becomes parakeratotic are keratocystic odontogenic tumors. We encountered a keratocystic odontogenic tumor that had extensively progressed in the right maxillary sinus of a 17–year–old boy. In diagnostic imaging, an opaque image containing an impacted tooth was detected, which seemed to invade the right maxillary sinus. Then, the tumor in the right maxillary sinus was resected with a radical operation under systemic anesthesia. Histopathological tests showed that the tumor was coated with stratified squamous epithelium presenting with parakeratosis, with no inflammation found in the fibrous connective tissues under the epithelium. Consequently, a keratocystic odontogenic tumor was diagnosed. The postoperative course was favorable, with no recurrence as of 1 year and 8 months after the operation

A case of buccal cellulitis caused by a self–bite to the bilateral buccal mucous membrane

Recently, the development of various antibiotics and increasing awareness of oral hygiene have reduced the incidence of serious cellulitis of the cheek, including dental infections. However, some cases invoive serious disease throughout the mediastinal area in elderly patients and those with underlying diseases. This time, we report a case of cellulitis of the cheek due to a bite to the buccal mucosa. The patient was a 10–year–old male. The patient visited hospital and complained of swelling of the left cheek. At the first examination, diffuse redness and swelling accompanied by spontaneous pain and tenderness from the left cheek to surrounding area of the left orbit as well as trismus and swollen lymph nodes in the left submaxillary were noted. A crateriform traumatic ulcer with a diameter of 2.₅ cm and induration likely due to a bite of the left buccal mucosa and accompanied by tenderness were found. CT revealed a high–density region of the buccal fat layer in the left buccal soft tissues as well as extensive and significant swelling and inflammatory reaction. The infusion of antibiotics, draining the abscess through an incision, and the drainage procedure resulted in effective healing of the cellulitis 6 days after admission. 　Traumatic ulcer and cellulitis may recur due to bite. In addition, for the prevention of adverse habits including teeth grinding and clenching, as well as mental factors due to mental tension and frustration, it is very important to not only undergo dental or oral surgical treatments, but also to consult a psychotherapist or psychiatrist