Bilateral temporo-mandibular joint dislocation due to complication of oro-facial dyskinesia

Oro-facial dyskinesia (OFD) is involuntary, abnormal, uncontrolled and stereotyped movements, consisting of forehead furrowing, eye opening and closing, smacking and pursing of the lips, lateral deviation and protrusion of the tongue, and occasionally lateral deviation and protrusion of the jaw.1 OFD is known to have various complications including speech difficulty, chewing and eating disorders, and social embarrassment; facial muscle stiffness, mucosal and gingival traumatic lesions. In addition, it may leads to cranio-mandibular joint (TMJ) complications in the presence of intense and prolonged abnormal movements, with pain and degeneration.1,2 There is no previous report of TMJ dislocation due to OFD. In this report, we describe a patient who developed bilateral anterior TMJ dislocation due to OFD which occurred following intra-cranial hemorrhage (ICH).

Nerve Injury from Overfilled Calcium Hydroxide Root Canal Filling Paste for Maxillary Lateral Incisor Endodontic Treatment

Pseudoaneurysm of the Inferior Alveolar Artery after Surgical Curettage for Keratocystic Odontogenic Tumor: A Case Report

Inflammatory granuloma caused by injectable soft tissue filler (Artecoll)

Artecoll (Artes Medical Inc., San Diego, CA, USA) has recently been developed as a permanent synthetic cosmetic filler. We experienced an inflammatory granuloma resulting from a previous injection of Artecoll at the upper lip, which was regarded as a rare side effect of this filler. A 50-year-old female patient complained of swelling, dull pain, and heat in the right upper nasolabial fold area, which had started one week before her visit to Kyungpook National University Hospital. The patient received topical steroid therapy at a local clinic, which was not effective. At the injection site, a hard nodule was palpated and erythema was observed with mild tenderness. Antibiotic treatment and subsequent incision and drainage did not result in complete cure of the facial swelling, and the facial swelling and pain persisted. Computed tomography showed a lesion approximately 1-cm in size without clear boundaries and relatively increased nodular thickening. Finally, a subdermal lesion was removed via an intraoral vestibular approach. The lesion was diagnosed as inflammatory granuloma by a permanent biopsy. The patient had healed at two months after the filler injection. Although the soft tissue filler is widely used for cosmetic purposes, there is potential for complication, such as the inflammatory granuloma should be considered before treatment.

Evaluation of an Alveolar Bone Graft for Cleft Patients

Toll-like receptor 9-mediated inhibition of apoptosis occurs through suppression of FoxO3a activity and induction of FLIP expression

Synthetic oligodeoxynucleotides (ODN) with a CpG-motif are recognized by Toll-like receptor 9 (TLR9) and pleiotropic immune responses are elicited. Stimulation of macrophages with TLR9 agonist prevented apoptosis induced by serum deprivation through increased expression of FLICE-like inhibitory protein (FLIP). CpG ODN-mediated anti-apoptosis depended on the TLR9-Akt-FoxO3a signaling pathway. Inhibition of TLR9 by small interfering (si) RNA or an inhibitor suppressed CpG ODN-mediated anti-apoptosis. Analysis of signaling pathways revealed that the anti-apoptotic effect of CpG ODN required phosphorylation of FoxO3a and its translocation from the nucleus to the cytosol. Overexpression of FoxO3a increased apoptosis induced by serum deprivation and CpG ODN blocked these effects through FLIP expression. In contrast, siRNA knock-down of FoxO3a decreased apoptosis by serum deprivation. In addition, Akt activation was involved in CpG ODN-induced phosphorylation of FoxO3a, expression of FLIP, and anti-apoptosis. Taken together, these results demonstrate the involvement of Akt-FoxO3a in TLR9-mediated anti-apoptosis and indicate that FoxO3a is a distinct regulator for FLIP expression.

Resveratrol inhibits foam cell formation via NADPH oxidase 1-mediated reactive oxygen species and monocyte chemotactic protein-1

Resveratrol is a polyphenolic compound in red wine that has anti-oxidant and cardioprotective effects in animal models. Reactive oxygen species (ROS) and monocyte chemotactic protein-1 (MCP-1) play key roles in foam cell formation and atherosclerosis. We studied LPS-mediated foam cell formation and the effect of resveratrol. Resveratrol pretreatment strongly suppressed LPS-induced foam cell formation. To determine if resveratrol affected the expression of genes that control ROS generation in macrophages, NADPH oxidase 1 (Nox1) was measured. Resveratrol treatment of macrophages inhibited LPS-induced Nox1 expression as well as ROS generation, and also suppressed LPS-induced MCP-1 mRNA and protein expression. We investigated the upstream targets of Nox1 and MCP-1 expression and found that Akt-forkhead transcription factors of the O class (FoxO3a) is an important signaling pathway that regulates both genes. These inhibitory effects of resveratrol on Nox1 expression and MCP-1 production may target to the Akt and FoxO3a signaling pathways.

Comparision of Mandible Changes on Three-Dimensional Computed Tomography image After Mandibular Surgery in Facial Asymmetry Patients / 영남의대학술지

BACKGROUND: When surgeons plan mandible ortho surgery for patients with skeletal class III facial asymmetry, they must be consider the exact method of surgery for correction of the facial asymmetry. Three-dimensional (3D) CT imaging is efficient in depicting specific structures in the craniofacial area. It reproduces actual measurements by minimizing errors from patient movement and allows for image magnification. Due to the rapid development of digital image technology and the expansion of treatment range, rapid progress has been made in the study of three-dimensional facial skeleton analysis. The purpose of this study was to conduct 3D CT image comparisons of mandible changes after mandibular surgery in facial asymmetry patients. MATERIALS & METHODS: This study included 7 patients who underwent 3D CT before and after correction of facial asymmetry in the oral and maxillofacial surgery department of Yeungnam University Hospital between August 2002 and November 2005. Patients included 2 males and 5 females, with ages ranging from 16 years to 30 years (average 21.4 years). Frontal CT images were obtained before and after surgery, and changes in mandible angle and length were measured. RESULTS: When we compared the measurements obtained before and after mandibular surgery in facial asymmetry patients, correction of facial asymmetry was identified on the "after" images. The mean difference between the right and left mandibular angles before mandibular surgery was 7degrees, whereas after mandibular surgery it was 1.5degrees. The right and left mandibular length ratios subtracted from 1 was 0.114 before mandibular surgery, while it was 0.036 after mandibular surgery. The differences were analyzed using the nonparametric test and the Wilcoxon signed ranks test (p<0.05). CONCLUSION: The system that has been developed produces an accurate three-dimensional representation of the skull, upon which individualized surgery of the skull and jaws is easily performed. The system also permits accurate measurement and monitoring of postsurgical changes to the face and jaws through reproducible and noninvasive means.

Protein Kinase C-alpha Regulates Toll-like Receptor 4-Mediated Inducible Nitric Oxide Synthase Expression

PURPOSE: The nitric oxide (NO) release by inducible nitric oxide synthase (iNOS) is the key events in macrophage response to lipopolysaccharide (LPS) which is suggested to be a crucial mediator for inflammatory and innate immune responses. NO is an important mediator involved in many host defense action and may also lead to a harmful host response to bacterial infection. However, given the importance of iNOS in a variety of pathophysiological conditions, control of its expression and signaling events in response to LPS has been the subject of considerable investigation. MATERIALS AND METHODS: The Raw264.7 macrophage cell line was used to observe LPS-stimulated iNOS expression. The expression of iNOS is observed by Western blot analysis and real-time RT-PCR. Protein kinase C (PKC)-alpha overexpressing Raw264.7 cells are established to determine the involvement of PKC-alpha in LPS-mediated iNOS expression. NF-kappaB activity is measured by IkappaBalpha degradation and NF-kappaB luciferase activity assay. RESULTS: We found that various PKC isozymes regulate LPS-induced iNOS expression at the transcriptional and translational levels. The involvement of PKC-alpha in LPS-mediated iNOS induction was further confirmed by increased iNOS expression in PKC-alpha overexpressing cells. NF-kappaB dependent transactivation by LPS was observed and PKC-alpha specific inhibitory peptide abolished this activation, indicating that NF-kappaB activation is dependent on PKC-alpha. CONCLUSION: Our data suggests that PKC-alpha is involved in LPS-mediated iNOS expression and that its downstream target is NF-kappaB. Although PKC-alpha is a crucial mediator in the iNOS regulation, other PKC isozymes may contribute LPS-stimulated iNOS expression. This finding is needed to be elucidated in further study.

The role of mapk and pkc-delta in phosphatidic acid-mediated intercellular adhesion molecule-1 expression

BACKGROUND: Phosphatidic acid (PA), an important second messenger, is involved in inflammation. Notably, cell-cell interactions via adhesion molecules play a central role in inflammation. This thesis show that PA induces expression of intercellular adhesion molecule-1 (ICAM-1) on macrophages and describe the signaling pathways. MATERIALS AND METHODS: Macrophages were cultured in the presence of 10% FBS and assayed cell to cell adhesion using HUVEC. For the gene and protein analysis, RT-PCR, Western blot and flow cytometry were performed. In addition, overexpressed cell lines for dominant negative PKC-delta mutant established and tested their effect on the promoter activity and expression of ICAM-1 protein by PA. RESULTS: PA-activated macrophages significantly increased adhering to human umbilical vein endothelial cell and this adhesion was mediated by ICAM-1. Pretreatment with rottlerin (PKC-delta inhibitor) or expression of a dominant negative PKC-delta mutant, but not Go6976 (classical PKC-alpha inhibitor) and myristoylated PKC-zeta inhibitor, attenuated PA-induced ICAM-1 expression. The p38 mitogen-activated protein kinase (MAPK) inhibitor blocked PA-induced ICAM-1 expression in contrast, ERK upstream inhibitor didn't block ICAM-1. CONCLUSION: These data suggest that PA-induced ICAM-1 expression and cell-cell adhesion in macrophages requires PKC-delta activation and that PKC-delta activation is triggers to sequential activation of p38 MAPK.

Role of NFkappaB in toll-like receptor 9-mediated matrix metalloproteinase-9 expression

BACKGROUND: CpG DNA plays an important role in immune cell function. This study examined whether the temporal control of toll-like receptor (TLR)9 by CpG DNA can regulate the expression of matrix metalloproteinase-9 (MMP-9). MeETHODS AND MATERIALS: Macrophages were cultured in the presence of 10percent FBS. For the various MMP genes analysis, RT-PCR and real-time PCR were performed. In addition, zymography assay performed for the MMP activity. The phosphorylation assay did for the ERK1/2 and NFkappaB activation, and luciferase promoter assay was for the NFkappaB activity. RESULTS: CpG DNA induced the mRNA expression of MMP-2, MMP-9, and MMP-13, but not of MMP-7, MMP-8, and MMP-12, in a time-dependent manner. Especially, the mRNA expression of MMP-9 was strongly induced by CpG DNA using real-time RT-PCR. The TLR9 inhibitor, chloroquine, suppressed CpG DNA-induced MMP-9 expression and its activity. Moreover, CpG DNA induced the phosphorylation of ERK and the inhibition of ERK by U0126 suppressed CpG DNA-induced MMP-9 expression and its activity. CpG DNA stimulated IkappaB-alpha degradation and luciferase activity. In addition, pretreatment of SN-50, the inhibitor of NFkappaB, strongly blocked the CpG DNA-induced MMP-9 expression and activity. CONCLUSION: These observations suggest that CpG DNA may play important roles in the activation of macrophages by regulating the production of MMP-9 via the sequential TLR9-ERK-NFkappaB signaling pathway.

Methyl-beta-cyclodextrin inhibits cell growth and cell cycle arrest via a prostaglandin E(2) independent pathway

Methyl-beta-cyclodextrin, a cyclic oligosaccharide known for its interaction with the plasma membrane induces several events in cells including cell growth and anti-tumor activity. In this study, we have investigated the possible role of cyclooxygenase 2 (COX-2) in cell growth arrest induced by methyl-beta-cyclodextrin in Raw264.7 macrophage cells. Methyl-beta-cyclodextrin inhibited cell growth and arrested the cell cycle, and this cell cycle arrest reduced the population of cells in the S phase, and concomitantly reduced cyclin A and D expressions. Methyl-beta-cyclodextrin in a dose- and time-dependent manner, also induced COX-2 expression, prostaglandin E(2) (PGE(2)) synthesis, and COX-2 promoter activity. Pretreatment of cells with NS398, a COX-2 specific inhibitor completely blocked PGE(2) synthesis induced by methyl-beta-cyclodextrin, however inhibition on cell proliferation and cell cycle arrest was not effected, suggesting non-association of COX-2 in the cell cycle arrest. These results suggest that methyl-beta-cyclodextrin induced cell growth inhibition and cell cycle arrest in Raw264.7 cells may be mediated by cyclin A and D1 expression.

Treatment in Bimaxillary Prognathism with Anterior Open Bite: A Case Report / 영남의대학술지

In general, the skeletal class III has the characteristics of mandibular overgrowth with a normal maxillary growth or maxillary undergrowth with a normal mandibular growth And clinical and radiographic evaluations of the patient are needed. However, the treatment plan is not dependent on these evaluations alone, because patient's general condition and hope for aesthetics varies. The aim of this report is to consider the treatment of a medically compromised patient with an anterior open bite and skeletal class III, which showed a severe mandibular overgrowth. In 2003, a 17-year-old boy with epilepsy, mental retardation presented at our clinic complaining of concave profile. A clinical examination showed severe mandibular prognathism with an anterior open bite. The radiographic examination revealed a short cranial base, a moderate maxillary overgrowth, severe mandibular overgrowth and skeletal open bite tendency. In 2004, he was verified to have no potential of growth by hand-and-wrist radiographs and an endocrine examination. He completed the preoperative orthodontic treatment and orthognathic surgery (sagittal split ramus osteotomy, genioplasty). He was evaluated on the first visit, the preoperative period and the postoperative period with a clinical and radiographic examination. At the first visit, the patient showed moderate overgrowth of the maxilla, severe overgrowth of the mandible, and a subsequential skeletal open bite. After the preoperative orthodontic treatment (preoperative period), the patient showed the same skeletal problem as before and a decompensated dentition for orthognathic surgery. After orthognathic surgery, his profile had improved, but he had still a skeletal openbite tendency because the maxillary orthognathic surgery was not performed. Severe mandibular prognathism with a maxillary overgrowth and anterior open bite should be treated by bimaxillary orthognathic surgery. However, one-jaw orthognathic surgery on the remaining the skeletal open bite tendency was performed for his medical problem and facial esthetics. This subsequential open bite should be resolved with a postoperative orthodontic treatment.

Clinical Evaluation about the Immediate Implant Replacement after Tooth Extraction / 영남의대학술지

BACKGROUND: Immediate implant placement has become an acceptable treatment for the edentulous area. The advantages of the immediate implant placement include considerable decrease in time from tooth extraction to placement of the finial prosthesis, fewer surgical procedures, and better acceptance of the overall treatment plans. But the success is dependent on the quantity and quality of the extraction socket. The purpose of this study is to evaluate the success of the immediate implant placement. MATERIALS AND METHODS: Twenty-one sites in 16 patients were selected for the evaluation of the immediate implant placement. All of the cases were followed using clinical and radiographic examinations. Criteria of success were the absence of peri-implant radiolucency, mobility, and persistent pain or sign of infection. RESULTS: Of the 21 implants, 13 implants have been succeeded. Of the 13 implants, 10 implants were replaced for the periodontal disease and 3 implants were replaced for the trauma. CONCLUSION: The criteria of the success in immediate implant placement are as follows. 1) Implants placed into fresh extraction sockets have a high rate of survival. 2) Implant should be placed as close as possible to the alveolar crest. 3) Implant placed into available bone beyond the apex have a high success rate.

Differential Sensitivity of Taxol-induced Apoptosis in U2OS and SaOS2 Osteogenic Sarcoma Cells / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Taxol (Paclitaxel) is a new generation of chemotherapeutic drug proven to be effective in the treatment of many cancers. In this study, to further demonstrate the differential effect of the tumor suppressor gene, p53, on the Taxol-induced apoptosis in osteogenic sarcoma cell lines, we used p53-defected SaOS2 cells and wild type p53-expressed U2OS cells. MATERIALS AND METHODS: The cell viability was measured by the XTT assay. To examine whether the differential expressions of p53, in U2OS and SaOS2 cells, were associated with Taxol-induced apoptosis, DNA fragmentation assays were performed on both cytosolic and genomic DNA. Since the cleavage of poly (ADP-ribose) polymerase (PARP) is primarily responsible for apoptosis, the cleavage of PARP, and the expression of cyclin B1, polo-like kinase, Bax, Bcl-xL, Bcl-2 in U2OS and SaOS2 cells were compared by Western blot analyses. RESULTS: The cell viability of the p53-defected SaOS2 cells was markedly decreased with Taxol treatment. Whereas, the cell viabilities due to 6-mercaptopurine and adriamycin were no different between the U2OS and SaOS2 cells. Treatment with Taxol induced a ladder- like pattern of DNA fragments, which is a biochemical hallmark of apoptosis, consisting of multiples of approximately 180-200 base pairs, in a dose-dependent manner in the SaOS2 cells, but insignificantly with the U2OS cells. When the cells were treated with Taxol, the 89 kDa cleavage product of PARP clearly appeared as a function of time in the SaOS2 cells, but not in the U2OS cells. The Taxol-induced apoptosis in p53 defected-osteogenic sarcoma cells was associated with the PARP cleavage as a result of the increased activity of caspase 3, and the high expressions of cyclin B1 and PLK. Bax, as a proapoptotic factor, was increased in the SaOS2cells, but the Bcl-xL and Bcl-2 were decreased when the cells were exposed to 10miceoM Taxol. CONCLUSION: From these results, it was concluded that p53-defected SaOS2 cells are much more sensitive to Taxol-induced apoptosis than p53-expressed U2OS cells.

Results of Maxillary Sinus Elevation for Endosseous Implant Placement / 영남의대학술지

BACKGROUND: Although dental implantation has become widespread and acceptable treatment for dental prosthodontics, maxillary posterior jaw region is often complicated by the pneumatization of the maxillary sinus and physiological resorption of the alveolar bone. When this occurs, the residual bone between the floor of the sinus and the crestal ridge is inadequate for the placement of implants. The sinus elevation procedure provides a way to increase the amount of available bone and to allow the placement of longer implants. MATERIALS & METHODS: We studied 11 patients requiring the implant placements and the maxillary sinus elevation simultaneously from 1996 to 2003 in our clinic. Nine patients were males and two patients were females, aged from 39 to 72(mean=51.6). Four patients had medical compromised states; angina pectoris, diabetes, hypertension, hepatitis. Patients didn't show any pathologic findings clinically or radiographically. We studied the success and survival rate of implants, factors increasing the osseointegrating capacity of implants. RESULTS: The success rate of osseointegration of implants was 93%. At least 6 months after loading on implants, the survival rate of implants was 78.5%. Autogenous bone graft and adequate residual bone height(>6mm) increased survival rate of implants. CONCLUSION: Successful implant placement with maxillary sinus elevation mainly depends on sufficient residual bone height, healthy maxillary sinus, autogenous bone graft.

Results of Maxillary Sinus Elevation for Endosseous Implant Placement / 영남의대학술지

BACKGROUND: Although dental implantation has become widespread and acceptable treatment for dental prosthodontics, maxillary posterior jaw region is often complicated by the pneumatization of the maxillary sinus and physiological resorption of the alveolar bone. When this occurs, the residual bone between the floor of the sinus and the crestal ridge is inadequate for the placement of implants. The sinus elevation procedure provides a way to increase the amount of available bone and to allow the placement of longer implants. MATERIALS & METHODS: We studied 11 patients requiring the implant placements and the maxillary sinus elevation simultaneously from 1996 to 2003 in our clinic. Nine patients were males and two patients were females, aged from 39 to 72(mean=51.6). Four patients had medical compromised states; angina pectoris, diabetes, hypertension, hepatitis. Patients didn't show any pathologic findings clinically or radiographically. We studied the success and survival rate of implants, factors increasing the osseointegrating capacity of implants. RESULTS: The success rate of osseointegration of implants was 93%. At least 6 months after loading on implants, the survival rate of implants was 78.5%. Autogenous bone graft and adequate residual bone height(>6mm) increased survival rate of implants. CONCLUSION: Successful implant placement with maxillary sinus elevation mainly depends on sufficient residual bone height, healthy maxillary sinus, autogenous bone graft.

Non-Surgical Treatment of Mandibular Condylar Fracture with Functional Appliance: Clinical and Radiographic Analysis of 1 Case / 영남의대학술지

Mandibular condylar fracture is common in mandibular fractures. Unlike other facial, skeletal fractures, most of mandibular condylar neck or head fractures are treated with closed reduction and subsequent functional therapy is essential for preventing complications including ankylosis, arthrosis and growth disturbance. From January, 2000 to September, 2002, we have treated 15 cases of mandibular condylar fractures with closed reduction by using functional appliance with bite block. Among these cases, we report a case of 14-year-old female with mandibular condylar neck fracture, resulted in good clinical and radiographic progress.

Radiological Evaluation Of Fracture Line Stability During Functional Loading After Miniplate Fixation Of Mandibular Angle Fractures

After miniplate fixation of mandibular angle fractures, fracture line stability during functional loading was evaluated. Using panoramic radiographs, 15 mandibular angle fracture patients who were treated by open reduction and one miniplate fixation along the external oblique ridge, were evaluated at postoperative 1, 4 and 8 weeks. At each time, 2 radiographs were taken: one taken during maximum biting of hardened silicone sheet on the affected side molar area and the other on the non-affected side. The distraction gap of inferior border of mandible at each time and each side was measured and these data were analysed statistically with clinical findings. The differences of inferior border distraction gap during hardened silicone sheet biting on the affected side molar area and on the non-affected side molar area at 4 week radiographs were smaller than those of 1 week's except one case. At 8 week's radiographs, the fracture lines were so stabilized that it was almost impossible to find the gap differences except one case and there were increased radiopacity along the entire fracture lines. Clinically, bony union was confirmed in all cases during plate removal performed at postoperative 6 month. By statistical analysis(paired t-test), the inferior border distraction gap during biting of hardened silicone sheet on the affected side was significantly reduced during 1 and 4 week interval(p<0.01). The differences of inferior border distraction gap during biting on the affected side molar area and on the non-affected side molar area were also significantly reduced at 1 and 4 week interval(p<0.01). But the inferior border distraction(compression) gap during non-affected side biting was not significantly changed. From these findings, it could be concluded that fracture line stability during functional loading after one miniplate fixation of mandibular angle fractures stems mainly from reduction of inferior border distraction gap during affected side biting on time interval. According to these radiographic and clinical findings, the clinical superiority of one miniplate fixation technique in mandibular angle fracture treatment could be confirmed.

A Lateral Cephalometric Study of Maxillofacial Morphologic Features in Class III Malocclusion Children / 영남의대학술지

BACKGROUND: When we make treatment plan of class III malocclusion children, it is difficult to determine whether we treat it with orthognathic surgery or without orthognathic surgery. To determine that, we must consider many factors, such as cephalometric analysis, growth pattern, family history, and skeletal age. A Harvold cephalometric analysis is useful in determining the amount of discrepancy by comparing the maxillary unit length with mandibular unit length. We tried this study to help the decision of treatment planning in class III malocclusion children by comparison in class III malocclusion and normal occlusion children using a Harvold analysis. MATERIALS AND METHODS: The materials for this study consisted of 20 class III malocclusion children. Cephalometric tracing and measurements were performed by one investigator. The control group consisted of 18 normal occlusion children and lateral cephalograms were obtained from 8.5 to 14.5 years old children biannually. The relationships between class III malocclusion group and normal occlusion group were evaluated statistically. RESULTS: The lower anterior facial heights between two groups were not significantly different, although the lower anterior facial heights of class III malocclusion group was higher than those of normal occlusion group in all age groups. The Maxillary-mandibular unit length differences of class III malocclusion group were significantly higher than those of normal occlusion group(p < 0.05). CONCLUSION: A Harvold analysis was useful to make treatment planning for class III malocclusion children.