The Effects of Maxillomandibular Advancement and Genioglossus Advancement on Sleep Quality

Maxillomandibular advancement (MMA) using a standardized surgical procedure consisting of a LeFort I osteotomy and bilateral sagittal split ramus osteotomy and genioglossus advancement (GA) using a genioplasty improve airway volume, oxygen desaturation, and the AHI in patients with OSA. However, there are few reports on changes in sleep quality following MMA and GA. We assessed the effects of MMA and GA on sleep quality by comparing oxygen desaturation, AHI, and sleep architecture before and after surgery. Methods: Eight patients underwent polysomnography (PSG) and CT scan before and after surgery. Conclusions: Our study finds that %TST and %REM were both increased, while %S1 and NA both decreased. Based on these results, it appears that both the quality and quantity of sleep were improved. MMA and GA improve sleep respiratory disturbance and can also improve sleep quality

日本睡眠歯科学会口腔内装置診療ガイドライン作成委員会の活動報告

Oral appliance therapy was approved by national health insurance in Japan in 2004 and oral appliances（OAs）have since been widely used in the treatment of obstructive sleep apnea（OSA）. We herein described the process of making clinical practice guidelines by the task force of the Japanese Academy of Dental Sleep Medicine as a work report. In Japan, OAs are covered by national health insurance. In consideration of the balance between medical treatment fees and the price of technical materials, we used a single-piece（monoblock）OA that advanced the mandible forward and limited mouth opening in OSA patients in Japan. The Japanese Academy of Dental Sleep Medicine（JADSM）focused on OAs frequently used for the treatment of OSA in Japan, and considered an evaluation of their effects to benecessary. Clinical practice guidelines were developed using the Grading of Recommendations, Assessment, Development, and Evaluation（GRADE）system. We recommend OAs that advanced the mandible forward and limited mouth opening for patients with OSA.However, CPAP should be used by patients for whom it has been indicated. OAs are desirable for those who cannot use CPAP（GRADE 1B, strong recommendation/quality of evidence, “Moderate quality”）. The long-term effects and side effects, OSA severity, and comorbidities of OA therapy were not examined, which represented a limitation to the present study. In future studies, the Japanese Academy of Dental Sleep Medicine plan to update clinical practice guidelines for oral appliances used in OSA

外傷性尿道損傷に対し口腔粘膜グラフトを用いて再建した症例

52歳男性.患者は, 自慰行為による異物挿入での尿道損傷で受診となった.尿溢流とそれに伴う感染により陰茎は約1.5倍に腫脹, 自潰していた.異物除去とデブリードマンをまず施行し, その後は狭窄となった部に対して内尿道切開を施行した.感染消失を確認後は, 尿道と陰茎の再建を行ない, 遊離皮弁として口腔粘膜を摘出し, パッチを当てるように吸収糸による結節縫合で尿道欠損部に補填した.その結果, 良好な排尿が確保され, 現在まで合併症は認められていないA 52-year-old Japanese man was referred to us with a urethral injury caused by masturbation. His penis was swollen and about one and a half times its size due to urine extravasation and infection. Foreign bodies were surgically removed, and debridement and excision of necrotic tissue were performed. After confirming that the infection was under control, we planned the reconstruction of the urethra and penis, following endoscopic urethrotomy for the bulbous urethra stricture. A free graft from the buccal mucosa was harvested, placed over the defect and fixed with interrupted suture as ventral onlay. The patient could achieve satisfactory voiding and no complication was seen during the 18-month follow up. In our experience, buccal mucosa is a useful source of urethral grafting material and excellent results can be expected in case of urethral injury

Reconstruction of maxillary palatal defects after partial maxillectomy using a pedicled buccal fat pad and a nasolabial flap

Abstract The novelty of this procedure is the reconstruction of a maxillary palatal defect with two pedicled flaps: a pedicled buccal fat pad and a nasolabial flap. This use of combination flaps makes the surgery simple, short, and useful for a wide defect.The novelty of this procedure is the reconstruction of a maxillary palatal defect with two pedicled flaps: a pedicled buccal fat pad and a nasolabial flap. This use of combination flaps makes the surgery simple, short, and useful for a wide defect

Trigeminal Schwannoma Presenting with Masticatory Muscle Atrophy: A Rare Case Report

Trigeminal schwannoma (TS) presenting with masticatory muscle atrophy is very rare. Here, we report the case of an 80 year-old male patient with TS presenting with masticatory muscle atrophy in October 2014. The patient had been diagnosed with hypertrophic pachymeningitis and right intracranial TS in 2013 by his neurologist, for which he was treated with steroids. However, his symptoms in the trigeminal innervation region persisted. He visited our department due to difficulty in opening his mouth as well as eating. Surgery was not performed owing to his advanced age and general condition. His trismus was improved by mouth opening training via manual manipulation for three years. We suggest that TS should be considered in the differential diagnosis of patients with masticatory muscle atrophy. Consultation with a neurologist is also essential. Manual manipulation may be an effective non-surgical treatment option for patients with difficulty in mouth opening owing to TS

S-PRG Filler Eluate Induces Oxidative Stress in Oral Microorganism: Suppression of Growth and Pathogenicity, and Possible Clinical Application

Controlling the oral microbial flora is putatively thought to prevent not only oral diseases, but also systemic diseases caused by oral diseases. This study establishes the antibacterial effect of the novel bioactive substance “S-PRG filler” on oral bacteria. We examined the state of oxidative stress caused by the six types of ions released in eluate from the S-PRG filler in oral bacterial cells. Moreover, we investigated the effects of these ions on the growth and pathogenicity of Gram-positive and Gram-negative bacteria. We found that the released ions affected SOD amount and hydrogen peroxide in bacterial cells insinuating oxidative stress occurrence. In bacterial culture, growth inhibition was observed depending on the ion concentration in the medium. Additionally, released ions suppressed Streptococcus mutans adhesion to hydroxyapatite, S. oralis neuraminidase activity, and Porphyromonas gingivalis hemagglutination and gingipain activity in a concentration-dependent manner. From these results, it was suggested that the ions released from the S-PRG filler may suppress the growth and pathogenicity of the oral bacterial flora. This bioactive material is potentially useful to prevent the onset of diseases inside and outside of the oral cavity, which in turn may have possible applications for oral care and QOL improvement

Trigeminal Schwannoma Presenting with Masticatory Muscle Atrophy: A Rare Case Report

Trigeminal schwannoma (TS) presenting with masticatory muscle atrophy is very rare. Here, we report the case of an 80 year-old male patient with TS presenting with masticatory muscle atrophy in October 2014. The patient had been diagnosed with hypertrophic pachymeningitis and right intracranial TS in 2013 by his neurologist, for which he was treated with steroids. However, his symptoms in the trigeminal innervation region persisted. He visited our department due to difficulty in opening his mouth as well as eating. Surgery was not performed owing to his advanced age and general condition. His trismus was improved by mouth opening training via manual manipulation for three years. We suggest that TS should be considered in the differential diagnosis of patients with masticatory muscle atrophy. Consultation with a neurologist is also essential. Manual manipulation may be an effective non-surgical treatment option for patients with difficulty in mouth opening owing to TS

Relationship between the fluorescence intensity of rhodamine-labeled orexin A and the calcium responses in cortical neurons: An in vivo two-photon calcium imaging study

Neural responses to a ligand vary widely between neurons; however, the mechanisms underlying this variation remain unclear. One possible mechanism is a variation in the number of receptors expressed in each neural membrane. Here, we synthesized a rhodamine-labeled orexin A compound, enabling us to quantify the amount of orexin binding to its receptors, OX1 and OX2, which principally couple to the Gq/11 protein. The rhodamine intensity and calcium response were measured under tetrodotoxin application from insular cortical glutamatergic neurons in Thy1-GCaMP6s transgenic mice using an in vivo two-photon microscope. Applying rhodamine-labeled orexin A (10 μM) to the cortical surface gradually and heterogeneously increased both the intensity of the rhodamine fluorescence and [Ca2+]i. Calcium responses started simultaneously with the increase in rhodamine-labeled orexin fluorescence and reached a plateau within several minutes. We classified neurons as high- and low-responding neurons based on the peak amplitude of the [Ca2+]i increase. The rhodamine fluorescence intensity was larger in the high-responding neurons than the low-responding neurons. Preapplication of SB334867 and TCS-OX2-29, OX1 and OX2 antagonists, respectively, decreased the proportion of high-responding neurons. These results suggest that the diverse receptor expression level in neural membranes is involved in mechanisms underlying varied neural responses, including [Ca2+]i increases. Keywords: Gq/11 protein, Hypocretin, Insular cortex, In vivo calcium imaging, Rhodamin