Management of multiple odontogenic keratocysts associated with nevoid basal cell carcinoma syndrome: a case report of 11-year follow-up

Multiple odontogenic keratocysts (OKC) are a distinguishing feature of nevoid basal cell carcinoma syndrome (NBCCS). Owing to the high recurrence rate of syndromes associated OKCs, complete surgical resection is generally recommended as a definitive treatment. Herein, we report the management of multiple OKCs with marsupialization followed by excision with peripheral ostectomy in an NBCCS patient. We then discuss lesion progression over 11 years of annual follow-ups.

Do Certain Conditions Favor the Use of Autogenous Bone Graft Over Bone Substitutes for Maxillary Sinus Augmentation?

PURPOSE@#To investigate whether there are specific surgical or clinical conditions where the use of autogenous bone (AB) is superior to the use of bone substitutes (BSs) for maxillary sinus floor augmentation (MSFA).@*MATERIALS AND METHODS@#We retrospectively analyzed 386 implants after MSFA in 178 patients. The implants were divided into five groups according to the sinus graft material used. Risk factors for implant failure in MSFA, and correlation between residual bone height (RBH) and graft materials in terms of implant survival were investigated. To investigate risk factors for implant failure in MSFA, implant survival according to graft materials, patients' sex/age, surgical site, RBH, healing period prior to prosthetic loading, staged- or simultaneous implantation with MSFA, the crown-to-implant ratio, prosthetic type, implant diameter, and opposite dentition were evaluated.RESULT: The cumulative 2- and 5-year survival rates of implants placed in the grafted sinus (independent of the graft material used) were 98.7% and 97.3%, respectively. None of the investigated variables were identified as significant risk factors for implant failure. There was also no statistical significance in implant survival between graft materials.@*CONCLUSION@#There were no specific surgical conditions in which AB was superior to BSs in terms of implant survival after MSFA.

Maxillary Sinus Floor Augmentation Using Autogenous Tooth Bone Graft in Combination with Platelet-Rich Plasma for Dental Implants: Case Series

PURPOSE: To determine the benefits of autogenous tooth bone (ATB) graft in combination with platelet-rich plasma (PRP) in the rates of success and survival of dental implants placed simultaneously with maxillary sinus floor augmentation (MSFA). MATERIALS AND METHODS: Patients who visited the Department of Oral and Maxillofacial Surgery at Ulsan University Hospital from 2012 to 2014 and underwent simultaneous placement of implants with MSFA using ATB plus PRP were included in the study. Success and survival rates of the implants were evaluated based on the parameters of age and sex of the patient, site, follow-up period, residual bone height before surgery, diameter, and length of implant, sinus mucosa impairment, and postoperative complications. RESULT: A total of 23 patients and 67 implants were included in this study. The average age of the patients was 53.78±10.00 years. The average follow-up period after installation of the prosthesis was 53±5 months. The success and survival rates of the implants after placement of prosthesis were 95.52% and 97.01%, respectively. CONCLUSION: Combination of ATB and PRP showed high overall success rate, and it can be concluded that this combination is a predictable bone graft procedure for MSFA.

Epinephrine-induced lactic acidosis in orthognathic surgery: a report of two cases

Submucosal infiltration and the topical application of epinephrine as a vasoconstrictor produce excellent hemostasis during surgery. The hemodynamic effects of epinephrine have been documented in numerous studies. However, its metabolic effects (especially during surgery) have been seldom recognized clinically. We report two cases of significant metabolic effects (including lactic acidosis and hyperglycemia) as well as hemodynamic effects in healthy patients undergoing orthognathic surgery with general anesthesia. Epinephrine can induce glycolysis and pyruvate generation, which result in lactic acidosis, via β2-adrenergic receptors. Therefore, careful perioperative observation for changes in plasma lactate and glucose levels along with intensive monitoring of vital signs should be carried out when epinephrine is excessively used as a vasoconstrictor during surgery.

Management of Uncontrolled Bleeding after Tooth Extraction: A Case Report of Arteriovenous Malformation

Clinicians must be able to recognize post-extraction complications and treat them in a timely manner; complications that may potentially be life-threatening require special attention. Although arteriovenous malformation (AVM) is a very rare disorder, it may induce life-threatening hemorrhage during surgical intervention in the pertinent site. The present article examines the diagnosis and treatment modalities of AVM based on the case of a patient who was diagnosed with AVM with continuous bleeding after tooth extraction and who was successfully treated.

Role of gingival manifestation in diagnosis of granulomatosis with polyangiitis (Wegener's granulomatosis)

PURPOSE: This report describes a case of granulomatosis with polyangiitis (GPA) in which the gingival manifestation was crucial in both making an early diagnosis and possibly in deciding the approach to treatment. METHODS: A 57-year-old sailor presented to the Department of Dentistry at Ulsan University Hospital complaining of gingival swelling since approximately 2 months. He had orofacial granulomatous lesions and the specific gingival manifestation of strawberry gingivitis. RESULTS: The diagnosis of GPA was made on the basis of clinical symptoms and signs, and confirmed by the presence of the anti-neutrophil cytoplasmic antibody and a positive biopsy. The patient was admitted to the hospital and subsequently placed on a disease-modifying therapy regimen that included methotrexate and prednisone. CONCLUSIONS: Identification of the gingival manifestation of the disease permitted an early diagnosis and prompt therapy in a disease in which time is a crucial factor. Because of its rapid progression and potentially fatal outcome, an early diagnosis of GPA is important. Therefore, dentists should be aware of the oral signs and symptoms of such systemic diseases.

Anatomic Study of Pterygomaxillary Junctions in Koreans

Oromandibular dystonia after dental treatments: a report of two cases

Oromandibular dystonia (OMD) is a rare focal form of dystonia caused by prolonged muscles spasms in the mouth, face, and jaw. OMD can develop after dental treatment, as poorly aligned dentures or multiple tooth extraction may cause an impairment of proprioception in the oral cavity, leading to the subsequent development of dystonia. These repetitive involuntary jaw movements may interfere with chewing, swallowing, and speaking. We report here two cases of OMD after dental procedures.

Use of Peristeum as a Source of Endothelial-like Cells

Progressive Transformation of Germinal Centers in Submandibular Area: Case Report

Effects of Neuromuscular Electrical Stimulation on Distracted Bone after Mandibular Distraction Osteogenesis in Canine Model

Removal of foreign body on cheek using endoscope and C-arm fluoroscopy

Traditional surgery to remove foreign bodies in the face carries a risk of postoperative morbidity with an injury to various anatomical structures, particularly the facial nerve and parotid duct and gland. Endoscopy can be a great aid in the removal of foreign bodies in the maxillofacial region. Surgical intervention using endoscope and/,or intraoperative images can be minimized, allowing the safe and precise removal of foreign bodies, and saving operating time. We report a case of the use of an endoscope and C-arm fluoroscopy guidance system to remove a very small foreign body.

The study of bone density assessment on dental implant sites

INTRODUCTION: Bone density is one of the important factors for the long term success of endosseous implants. The bone density varies from site to site and from patient to patient. A preoperative evaluation of the bone density is quite useful to oral surgeons for planning dental implantation. More accurate information on the bone density will help surgeons identify suitable implant sites, thereby increase the success rate of dental implantation. This study examined the correlation between the bone density measured preoperatively by computed tomography (CT) and the implant primary stability measured by resonance frequency analysis. Furthermore, the effects of the implant sites, gender, age and generalized systemic disorder patients on the bone density and primary implant stability were examined. MATERIALS AND METHODS: One hundred and fourteen patients were selected. None of the patients had undergone a tooth extraction or bone graft history in the previous year. Preoperatively, the patients underwent CT scanning to evaluate the Hounsfield unit (HU), and resonance frequency analysis (RFA) was used to evaluate the implant primary stability at the time of implant installation. All implants were 4.0 mm diameter and 11.5 mm length US II. All patients were recorded and the HU and implant stability quotient (ISQ) value were evaluated according to the sites, gender and age. RESULTS: The highest HU values were found in the mandibular anterior site (827.6+/-151.4), followed by the mandibular molar site (797+/-135.1), mandibular premolar site (753.8+/-171.2), maxillary anterior site (726.3+/-154.4), maxillary premolar site (656.7+/-173.8) and maxillary molar site (621.5+/-164.9). The ISQ value was the highest in the mandibular premolar site (81.5+/-2.4) followed by the mandibular molar site (80.0+/-5.7), maxillary anterior site (77.4+/-4.1), mandibular anterior site (76.4+/-11.9), maxillary premolar site (74.2+/-14.3) and maxillary molar site (73.7+/-7.4). The mean HU and ISQ value were similar in females and males. (HU: P=0.331, ISQ: P=0.595) No significant difference was also found in the age group respectively. However, the correlation coefficients between the variables showed a closed correlation between the HU and ISQ value. CONCLUSION: These results showed close correlation between the bone density (HU) and primary stability value (ISQ) at the time of implant installation (Correlation coefficients=0.497, P<0.01). These results strengthen the hypothesis that it might be possible to predict and quantify the initial implant stability and bone density from a presurgical CT diagnosis. These results strengthen the hypothesis that it might be possible to predict and quantify the initial implant stability and bone density from a presurgical CT diagnosis.

Multicentric melanotic neuroectodermal tumor of infancy: a case report

A melanotic neuroectodermal tumor of infancy (MNTI) is a uncommon osteolytic pigmented neoplasm that primarily affects the jaws of newborn infants. Most patients (> 90%) present with the tumor in the first year of life. Approximately 65% form in the maxilla, 11% in the mandible, 5% in the brain and elsewhere. MNTI is normally benign, but up to 15% may recur and a few have metastasized. Approximately 200 cases of MNTI have been reported but only 2 of them presented as multifocal. A case of MNTI in a 7 month old boy was encountered. The chief complaint was maxillary anterior ridge swelling. The incisional biopsy findings were MNTI. Two months after the first operation, mild swelling of another site was observed. The infant was examined periodically since undergoing two procedures with no recurrence. This case demonstrates the possibility of a multicentric MNTI. We report a multicentric MNTI with a review of the relevant literature.

The study of stability of absorbable internal fixation after mandibular bilateral sagittal split ramal osteotomy

INTRODUCTION: To evaluate the skeletal stability after a bilateral sagittal split osteotomy (BSSO) setback of the mandible fixed with a biodegradable internal fixation device or metal internal fixation device. MATERIALS AND METHODS: Thirty consecutive patients underwent mandibular setback via BSSO. Fifteen patients were fixed with a biodegradable internal fixation device or metal internal fixation device respectively. Posteroanterior (PA) and lateral cephalograms were taken preoperatively and at two days, 5.5 months and 14.5 months postoperatively. The relevant skeletal points were traced and digitized to evaluate the skeletal changes postoperatively. The relapse rates were analyzed and compared statistically. RESULTS: There was no statistically significant differences in postoperative stability between the two groups.(P<0.05) CONCLUSION: The biodegradable internal fixation device may make an effective device alternative to a metal internal fixation device for setback BSSO.

Bone Density and Histomorphometry Assessment of Dental Implant Using Computerized Tomography

Primary Extranodal Marginal Zone B-Cell Lymphoma of Mucosa-Associated Lymphoid Tissue In The Oral Cavity : A Case Report

Schwannoma in the maxillary sinus and buccal space: Case report

Schwannomas are tumors which originate from the neuroectodermal Schwann cell of cranial, intraspinal, peripheral and autonomic nerve sheaths, and they are solitary, benign, slow growing and well encapsulated neoplasm. Schwannomas are usually asymptomatic. No strong gender or age predominance exists. The incidence of extracranial schwannomas in the head and the neck region varies from 25~45%. In addition, schwannomas are rare in the maxillary sinus or buccal space. In this paper, it diagnosed and treated a 54-years old female patient, who had schwannoma in the maxillary sinus derived from infraorbital nerves, the branch of the left trigeminal nerve, and a 19-years old male patient, who had schwannoma arose in the buccal space derived from the buccal branch of the right facial nerve. There was no particular complication except sensory extinction of the nerve in the female patient and paralysis by the nerve in the male patient. It is determined those two cases of schwannoma in the rare portion is valuable and herein, it reports those with literature discussions.

Neurosensory deficit after orthognathic surgery

AIMS:This study was designed to determine the incidence of altered sensation in patients undergoing orthognathic surgery. METHOD: Seventy two patients who underwent orthognathic surgery between January, 1999 and December, 1999 constituted the study group. Seven patients were excluded because of lack of follow up. Sixty five patients were followed using objective and subjective neurologic testing during the period immediately following operation, 1 month, 2 months, 6 months, and 1 year postoperatively. Age ranged from 17 to 38 years, with a mean of 24.5 years. Male patients were 21, female 44. Twenty eight bilateral sagittal splitting ramus osteotomy(BSSRO) of mandible were performed, 35 BSSRO with genioplasty, 2 genioplasties. Information on the degree of intraoperative nerve encounter was obtained from the surgical reports in 47 patients and was divided into the following three categories: (1) the nerve was not encountered in 23 patients; (2) the nerve was exposed in 11 patients; (3) the nerve was exposed and repositioned from the proximal segment in 13 patients. RESULTS: Four patients reported altered nerve sensation of lower lip and/or chin(6.2%) at final follow up. Two patients underwent BSSRO and the other two patients BSSRO with genioplasty. Three of the patients underwent nerve exposure during the operation. CONCLUSION: We suggest that the nerve exposure during the operation might be partly responsible for nerve dysfunction after orthognathic surgery.

Phototoxic effects of low level laser irradiation on human osteosarcoma cells

Photodynamic therapy(PDT) has advanced to clinical trials for the treatment of a variety of solid tumors and presents an alternative treatment option for tumors resistant to chemo-and/or radio-therapy. PDT is based on the combination of laser light of appropriate wavelength and energy to activate a systemically or locally applied photosensitizer that concentrates preferentially in malignant tissues. In this study, phototoxicity of laser EIT 21 was analysed in human osteosarcoma cell(HOS) and the second objective of this study was to determine the ability of laser EIT 21 to induce apoptosis. This study demonstrated that laser EIT 21 had a phototoxicity to HOS cells. In order to examinate whether cell death was induced by necrosis or apoptosis, variety of techniques which assess apoptosis were used. TUNEL assay showed only a few the positive reaction on condensed nuclei. It is hard to find condensed or fragmented nuclei on HOS cells irradiated with laser EIT 21 in Hemastat and AO/EB stain. By DNA electrophoresis, cells also did not show DNA degradation characteristic of apoptosis with a ladder pattern of DNA fragments. Apoptosis-related factors were analyzed by western blotting. The expression of p53 was constant and cells irradiated with laser did not show the caspase-3 and PARP degradation, therefore we suggest that p53 and caspase-3 are not involved in laserinduced cell death.