A Multidisciplinary Approach to Malocclusion Caused by Facial Multiple Fracture

In the case of multiple facial fractures, a simple open reduction occasionally causes various disorders during healing process after the surgery. Moreover, esthetic disturbance of a facial deformity might be induced. Therefore, the acquisition of facial symmetry and the recovery of occlusal and masticatory functions become increasingly important. This case report presents a successful treatment of facial multiple fracture induced by a car accident. A 20-year-old male was diagnosed with suffered multiple midface and mandibular fractures induced by a car accident. Midface fractures included the LeFort I and II type fractures, as well as sagittal fracture at midline and fractures from right maxillary sinus anterior wall to orbital wall. In the mandible, midline and left body fractures were detected. The patient underwent open reduction and rigid fixation of the fractured left zygoma, comminuted LeFort I and II fractures, and midline and left body of the mandible with intermaxillary fixation by multibracket appliance; maxillary osteotomy with iliac bone grafting; orthognathic two-jaw surgery with coronoid process grafts onto the depressed zygoma; and onlay graft of hydroxyapatite block on mandible. As the result, the multidisciplinary treatments successfully recover functions and esthetics to the satisfactory level of the patient with multiple facial fractures. As treatments for multiple facial fractures are required complexity due to the extent of trauma, multidisciplinary approach under the close cooperation between hospital departments is thought to be important

Treatment of a patient with skeletal open bite and temporomandibular joint disorders

The treatment of severe skeletal anterior open bite is extremely difficult in adults, and orthognathic surgery is generally selected for its treatment. We report the case of an 18-year-old adult patient with skeletal anterior open bite and temporomandibular disorders who was successfully treated using temporary anchorage devices. She had an open bite of -2.0 mm and an increased facial height. Miniplates were implanted in both the maxilla and mandible, and molar intrusion resulted in counterclockwise rotation of the mandible over a period of 12 months. After active treatment, her upper and lower first molars were intruded by approximately 2 mm and her overbite became +2.5 mm. Her retrognathic profile improved with counterclockwise rotation of the mandible. Orthodontic treatment aided with skeletal anchorage is beneficial for intrusion of bimaxillary molars in patients with anterior open bite

Long-term Follow-up of Orthodontic Patient with Cervical Lymphangioma

Aim: To report a treatment case of mandibular deviation caused by congenital cervical lymphangioma with traditional orthodontic techniques, following-up by 10-year retention. Background: Lymphangiomas, developmental anomalies, can induce various disturbances of swallowing, mastication, speech, breathing, and skeletal deformities as well as psychological stress and anxiety for the patient and their family. Lymphangiomas are benign with virtually no possibility of turning into a malignant lesion, so clinical management aims to treat the patient functionally. Case description: A girl, aged 6 years and 4 months, complained about facial asymmetry and anterior crossbite caused by congenital cervical lymphangioma. Her facial profile was the straight type with an adequate lip position. Anterior and right-side posterior crossbites were observed. On the frontal cephalogram, the menton shifted 3.0 mm to the right. A functional appliance with an expander was placed to correct her dental midline deviation and posterior crossbite. After 2-year treatment, the anterior and right-side posterior crossbites were improved. Multibracket treatment began after the growth spurt. After 44-month active treatment, a functional occlusion, including a Class I molar relationship with a proper interincisal relationship, was achieved. A functional occlusion was maintained during a 10-year retention period, while a mandibular downward growth was observed through the retention period. Conclusion: Conventional orthodontic techniques enable functional and stable occlusion even in patients with mandibular deviation caused by congenital cervical lymphangioma, although only using early orthodontic management by itself may have some limitations. Clinical significance: The hybrid technique combining functional appliance and intermaxillary elastics proves to be an effective therapy for correcting occlusal cant and mandibular deviation caused by cervical lymphangioma

アンカースクリューを用いた上下顎前突治療例の長期保定

今回，我々は歯科矯正用アンカースクリューを用いて上下顎歯列全体の遠心移動を行うことで前歯部叢生および上下顎前歯の唇側傾斜を改善し，保定後3年経過時においても安定した咬合関係が維持された症例を経験したので報告する．患者は初診時年齢21歳7か月の女性で，上顎前突および叢生を主訴として来院した．側貌はconvex typeであり，上下口唇の突出と上下顎前歯部に軽度の叢生が認められた．大臼歯関係は両側Angle II級であり，オーバージェットは ＋3.0 mm，オーバーバイトは ＋1.4 mmであった．側面頭部エックス線規格写真より，∠ANBは5.1°とやや大きくskeletal Class IIを呈し，FMAは34.2°とhigh mandibular plane angle caseであった．歯系では，上顎中切歯歯軸傾斜角は標準的な値を示したが，下顎中切歯歯軸傾斜角は唇側傾斜を呈していた．U1 to NA は8.2 mm，L1 to NBは13.0 mmであり，上下顎中切歯はともに唇側に位置していた．治療方針として，上下顎前歯部の叢生および上下顎前歯唇側傾斜の解消のために，小臼歯抜去ではなく上下顎両側大臼歯部に歯科矯正用アンカースクリューを埋入し，上下顎歯列全体の遠心移動を行うこととした．2年9か月の動的治療の結果，前歯部叢生および口元の突出感は解消され，緊密な咬合が獲得された．保定後3年が経過した現在においても安定した咬合関係が保たれている．本症例より，歯科矯正用アンカースクリューを用いた上下顎歯列全体の遠心移動を行っても，長期間の安定が得られうることが示された

Effectiveness of PNAM on nasal form

Objectives: To evaluate the effectiveness of pre-surgical nasoalveolar molding (PNAM) in patients with unilateral cleft lip nasal deformities. Methods: This was a retrospective study involving 29 patients with unilateral cleft lip and palate defects, of whom 13 were treated with palatal devices with nasal stents (PNAM group) and 16 were treated with palatal devices without nasal stents or surgical tapes (control group). Submental oblique photographs and orthodontic models were longitudinally obtained at the initial visit (T1) and immediately before (T2) and after cheiloplasty (T3). Asymmetry of the external nose, degree of columellar shifting, nasal tip/ala nose ratio, nasal base angle, interalveolar gap, and the sagittal difference in the alveolar gap were measured. The study was conducted in the Orthodontic Clinic at Tokushima University Hospital, Tokushima, Japan between 1997 and 2012. Results: At T1, there were no significant intergroup differences in the first 4 asymmetry parameters. At T2, the PNAM group showed a significant improvement in all values compared to the control group. At T3, the PNAM group showed significant improvement in nasal asymmetry and columellar shifting. Model analysis showed significantly greater changes in the inter-alveolar gap and the sagittal difference of the alveolar cleft gap from T1 to T2 in the PNAM group. Conclusion: The use of PNAM is indispensable for pre-surgical orthodontic treatment at the early postnatal age

永久歯の先天的欠如に関する臨床統計調査

永久歯の先天性欠如（以下，先欠とする）は，最も高頻度に発現する顎顔面領域の先天異常であり，様々な不正咬合を引き起こし，交換期における咬合誘導あるいは，永久歯列期における歯の排列に際して苦慮することが多い．しかし，歯科矯正用アンカースクリューの登場により，治療方針に多様性が生まれ，先欠を有する患者に対して，欠損部位・歯数に影響されない，顎顔面骨格形態に則した治療方針が選択できる症例が増加している．このような症例の治療計画を立案する際には，先欠が顎顔面骨格形態へ与える影響を明らかにしておく必要がある．そこで，今回我々は不正咬合患者における第三大臼歯を除く永久歯の先欠の実態把握，ならびに先欠が顎顔面骨格形態に及ぼす影響の解明を目的として臨床統計学的な検討を行った． 2011年4月から2016年3月までの5年間に不正咬合を主訴として徳島大学病院矯正歯科を受診した患者のうち，口唇裂・口蓋裂やその他の先天異常を有する患者，矯正歯科治療の既往を有する患者および先欠の確認が不可能であった患者を除外した653名（男性233名，女性420名）を対象とし，調査を行った．その結果，以下の所見を得た． 1．先欠を有する患者は96名（14.7％）であり，男女比は1.13：1と男性がやや多かった．1人あたりの先欠歯数としては，1歯のみの欠損が最も多く，49.0％を占めた． 2．歯種別発現頻度は，上下顎ともに第二小臼歯，側切歯の順で高かった． 3．先欠を有する患者を上顎先欠群，下顎先欠群，上下顎先欠群に分類し，比較検討を行ったところ，前歯部被蓋関係については，下顎先欠群においてoverjetが最も大きかった．顎骨の前後的位置関係については，下顎先欠群において∠ANBが大きく，∠SNBが小さくなる傾向を認め，上顎先欠群，上下顎先欠群では∠SNAが小さくなる傾向を認めた． 以上の所見より，先欠が顎顔面骨格の成長・発育に影響を及ぼす可能性が示されたことから，先欠に関連した顎顔面骨格形態の特徴を考慮した治療計画の立案が重要であることが示唆された

非症候群性歯牙欠損症における新規PAX9遺伝子変異

PAX9 is a transcription factor expressed in the tooth mesenchyme during tooth morphogenesis. In Pax9-null mice, tooth development is arrested at the bud stage. In humans, heterozygous mutations in PAX9 have been associated with non-syndromic tooth agenesis, predominantly in the molars. Here, we report 2 novel mutations in the paired domain of PAX9, a three-nucleotide deletion (73-75 delATC) and a missense mutation (C146T), in two unrelated Japanese patients with non-syndromic tooth agenesis. The individual with the 73-75del ATC mutation was missing all maxillary molars and mandibular second and third molars. The individual with the C146T mutation was missing the mandibular central incisors, maxillary second premolars, and first molars, along with all second and third molars. Both mutations affected amino acids that are highly conserved among different species and are critical for DNA binding. When both mutants were transfected to COS7 cells, nuclear localization of PAX9 proteins was not affected. However, reduced expression of the mutant proteins and almost no transcriptional activity of the target BMP4 gene were observed, suggesting haploinsufficiency of PAX9 as the cause of nonsyndromic tooth agenesis

口唇裂・口蓋裂患者の歯数異常に関する調査

口唇裂・口蓋裂患者は，軟組織や骨の癒合不全だけでなく，永久歯の先天欠如や過剰などの歯数異常が認められ，歯科矯正学的対応に苦慮することも多い．そこで，口唇裂・口蓋裂患者における永久歯の歯数異常の実態を明らかにすることを目的として，1995年1月から2011年12月までの17年間に出生し，徳島大学病院矯正歯科を受診した口唇裂・口蓋裂患者（症候群を含まない）を対象とした調査を行い，以下の結果を得た． 1．調査資料が揃っている患者101名の男女比は，1：1.02であった． 2．顎裂保有者82名の顎裂部位は，1 ▼ 3の型が最も多く，次いで1 ▼23の型であった．（▼は顎裂部位を示す） 3．永久歯における歯数異常の発現率は63.4％であり，歯の欠如のみを有するものが50.5％，過剰歯のみを有するものは8.9％，歯の欠如と過剰歯をともに有するものは4.0％であった． 4．歯の欠如の歯種別頻度は，側切歯が最も多く，次いで第二小臼歯の順であった． 5．顎裂保有者のみを対象とすると，歯の欠如の発現頻度は披裂側で59.8％，非披裂側で24.3％であった． 以上のことから，口唇裂・口蓋裂患者での先天欠如歯の発現率は高いため，治療計画立案時に補綴治療を含めた包括的歯科治療の必要性が示唆された

22q11欠失症候群モデルマウスの神経発達障害には、マイクロRNAが介在するCxcr4/Cxcl12シグナリングの欠損が寄与する

22q11 deletion syndrome (22q11DS) frequently accompanies psychiatric conditions, some of which are classified as schizophrenia and bipolar disorder in the current diagnostic categorization. However, it remains elusive how the chromosomal microdeletion leads to the mental manifestation at the mechanistic level. Here we show that a 22q11DS mouse model with a deletion of 18 orthologous genes of human 22q11 (Df1/+ mice) has deficits in migration of cortical interneurons and hippocampal dentate precursor cells. Furthermore, Df1/+ mice show functional defects in Chemokine receptor 4/Chemokine ligand 12 (Cxcr4/Cxcl12; Sdf1) signaling, which reportedly underlie interneuron migration. Notably, the defects in interneuron progenitors are rescued by ectopic expression of Dgcr8, one of the genes in 22q11 microdeletion. Furthermore, heterozygous knockout mice for Dgcr8 show similar neurodevelopmental abnormalities as Df1/+ mice. Thus, Dgcr8-mediated regulation of microRNA is likely to underlie Cxcr4/Cxcl12 signaling and associated neurodevelopmental defects. Finally, we observe that expression of CXCL12 is decreased in olfactory neurons from sporadic cases with schizophrenia compared with normal controls. Given the increased risk of 22q11DS in schizophrenia that frequently shows interneuron abnormalities, the overall study suggests that CXCR4/CXCL12 signaling may represent a common downstream mediator in the pathophysiology of schizophrenia and related mental conditions.博士（医学）・乙1331号・平成26年3月17

Support for UNRWA's survival

The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) provides life-saving humanitarian aid for 5·4 million Palestine refugees now entering their eighth decade of statelessness and conflict. About a third of Palestine refugees still live in 58 recognised camps. UNRWA operates 702 schools and 144 health centres, some of which are affected by the ongoing humanitarian disasters in Syria and the Gaza Strip. It has dramatically reduced the prevalence of infectious diseases, mortality, and illiteracy. Its social services include rebuilding infrastructure and homes that have been destroyed by conflict and providing cash assistance and micro-finance loans for Palestinians whose rights are curtailed and who are denied the right of return to their homeland