Effect of herbal extracts on bone regeneration in a rat calvaria defect model and screening system

OBJECTIVES: The aim of this study was to evaluate the effects of herbal extracts on bone regeneration. Two known samples were screened. MATERIALS AND METHODS: We previously established a rat calvaria defect model using a combination of collagen scaffold and herbal extracts. An 8 mm diameter trephine bur with a low-speed dental hand piece was used to create a circular calvaria defect. The experimental group was divided into 4 classifications: control, collagen matrix, Danshen with collagen, and Ge Gan with collagen. Animals in each group were sacrificed at 4, 6, 8, and 10 weeks after surgery, and bone regeneration ability was evaluated by histological examination. RESULTS: Results revealed that both Danshen and Ge Gan extracts increased bone formation activity when used with collagen matrix. All groups showed almost the same histological findings until 6 weeks. However, after 6 weeks, bone formation activity proceeded differently in each group. In the experimental groups, new bone formation activity was found continuously up to 10 weeks. In the Danshen and Ge Gan groups, grafted materials were still present until 10 weeks after treatment, as evidenced by foreign body reactions showing multinucleated giant cells in chronic inflammatory vascular connective tissue. CONCLUSION: Histological analyses showed that Danshen and Ge Gan extractions increased bone formation activity when used in conjunction with collagen matrix.

Intramuscular hemangiomas on the masseter muscle and orbicularis oris muscle: a report of two cases

Intramuscular hemangioma (IMH) is a rare vascular disease involving skeletal muscle, comprising only 0.8% of hemangiomas. About 10% to 15% of IMHs occur in the head and neck region, mostly involving the masseter muscle. IMH occurs mostly in childhood, but is often not found until unexpected enlargement, pain, or cosmetic asymmetry occurs in adulthood. Several non-surgical treatments including cryotherapy, sclerosant injection, and arterial ligature have been described, but complete surgical resection is the curative intervention. In this report, we present two rare cases of IMH. One IMH case in a 48-year-old male occurred in the masseter muscle feeding from the transverse facial artery. Embolization of the distal branch of the facial artery was first conducted, and then the buccal mass was removed surgically via the intraoral approach. A second IMH case in a 58-year-old female occurred in the orbicularis oris muscle feeding from the superior labial artery, and the mass was excised surgically without embolization.

Intracorporeal reduction of condylar fracture using both pedicled condylar and seperated ramal fragments after vertical ramal osteotomy

The aim of this study is to introduce a surgical technique that can maintain blood supply to prevent condylar resorption in the extracorporeal reduction of condylar fracture. Neither the medial pterygoid muscle on the ramal bone nor the lateral pterygoid muscle on the condylar fragment was detached after vertical ramal osteotomy. Thus, reduction was performed in the intracorporeal state. Therefore, blood supply was expected to be maintained to the fragments of both the condylar and ramal bones. On postoperative radiographs, the anatomical outline of the fractured condyle was well restored, and the occlusion was stable. In the unilateral case, there were no signs of mandibular condylar resorption until postoperative 3 weeks. In the 2 bilateral cases, condylar displacements with plate fractures and screw loosening were observed at postoperative 1 month or 5 months, but radiodensity at the displaced fracture site increased during the follow-up period. Finally, complete remodeling of the condylar fragments with restored anatomic appearance was observed on 8-month or 2-year follow-up radiographs. All cases exhibited good healing aspects with no signs or symptoms of mandibular condylar dysfunction during the postoperative remodeling period after intracorporeal reduction of condylar fracture.

Intracorporeal reduction of condylar fracture using both pedicled condylar and seperated ramal fragments after vertical ramal osteotomy

The aim of this study is to introduce a surgical technique that can maintain blood supply to prevent condylar resorption in the extracorporeal reduction of condylar fracture. Neither the medial pterygoid muscle on the ramal bone nor the lateral pterygoid muscle on the condylar fragment was detached after vertical ramal osteotomy. Thus, reduction was performed in the intracorporeal state. Therefore, blood supply was expected to be maintained to the fragments of both the condylar and ramal bones. On postoperative radiographs, the anatomical outline of the fractured condyle was well restored, and the occlusion was stable. In the unilateral case, there were no signs of mandibular condylar resorption until postoperative 3 weeks. In the 2 bilateral cases, condylar displacements with plate fractures and screw loosening were observed at postoperative 1 month or 5 months, but radiodensity at the displaced fracture site increased during the follow-up period. Finally, complete remodeling of the condylar fragments with restored anatomic appearance was observed on 8-month or 2-year follow-up radiographs. All cases exhibited good healing aspects with no signs or symptoms of mandibular condylar dysfunction during the postoperative remodeling period after intracorporeal reduction of condylar fracture.

Adopting Advance Directives Reinforces Patient Participation in End-of-Life Care Discussion / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: In Korea, most terminal cancer patients have still not been included in end-of-life (EOL) discussions. The purpose of this study was to evaluate the proportion of patients participating in EOL discussions after adopting advance directives. MATERIALS AND METHODS: Medical records of 106 hospice patients between July 2012 and February 2013 were reviewed retrospectively. The proportion of patient participation in EOL discussions, barriers, and favorable factors for completion of advance directives, as well as outcomes of advance directives were evaluated. RESULTS: Patient participation in EOL discussion had increased from 16/53 (30%) to 27/53 (51%) since adopting advance directives (p < 0.001). Median time between completion of an advance directive and death increased from 8 days (range, 0 to 22 days) to 14.5 days (range, 0 to 47 days). Patients' poor condition after late referral was the main barrier to missing EOL discussions; however, family members' concerns about patient's distress was also a main reason for excluding the patient from EOL discussions. In univariate analysis, patient age, education status, and time from diagnosis to completion of an advance directive influenced advance directive completion favorably. Following multivariate analysis, higher education and periods of more than 2 years from diagnosis to completion of an advance directive remained favorable (odds ratio [OR], 9.586, p=0.024 and OR, 70.312; p=0.002). Preferences of all patients regarding cardiopulmonary resuscitation or hemodialysis were carried out by physicians. Orders for nutrition and palliative sedation showed discordance, with concordance rates of 74.2% and 51.6%, respectively. CONCLUSION: Our results suggested that the use of advance directive promote patient participation in EOL discussion.

Prostate adenocarcinoma mandibular metastasis associated with numb chin syndrome: a case report

The purpose of this study is to report a rare case of mandibular adenocarcinoma that was diagnosed due to metastasis from the prostate. Numb chin syndrome (NCS), which was associated with this case, is also discussed. Computed tomography (CT) and an intraoral incisional biopsy of the left mandibular area were performed. Urology consultation, hormone therapy, chemotherapy and follow-up radiographic images were administered. Histological examination of the incised specimen revealed moderately differentiated adenocarcinoma. The Gleason score was 8 (primary 4/secondary 4). Immunohistochemical features and radiographic results confirmed the diagnosis of metastasis from prostate adenocarcinoma, moderately differentiated. The patient's prostate-specific antigen (PSA) level was very high. After hormone treatment, the patient's PSA levels dropped gradually. Seventeen months later, in May 2015, the PSA level was elevated. The 18-month follow-up CT image indicated that the patient's condition was aggravated. Docetaxel chemotherapy was started in June 2015 (18 months later), and the sixth cycle of the therapy is in progress. Oral metastases that originate from prostate adenocarcinoma are rare and can induce various periosteal reactions. Hormone therapy, chemotherapy and close follow-up could be additional, appropriate treatment, and were applied in this case. Finally, NCS is a valuable indicator of metastatic disease in the mandible.

Retiform hemangioendothelioma in the infratemporal fossa and buccal area: a case report and literature review

We report a case of retiform hemangioendothelioma (RH) located in the infratemporal fossa and buccal area in a 13-year-old Korean boy. The tumor originated from the sphenoid bone of the infratemporal fossa area and spread into the cavernous sinus, orbital apex, and retro-nasal area with bone destruction of the pterygoid process. Tumor resection was conducted via Le Fort I osteotomy and partial maxillectomy to approach the infratemporal fossa and retro-nasal area. The diagnosis of RH was confirmed after surgery. In the presented patient, surgical excision was incomplete, and close follow-up was performed. There was no evidence of expansion or metastasis of the residual tumor in the 8 years after surgery. In cases of residual RH with low likelihood of expansion and metastasis, even though RH is an intermediate malignancy, close follow-up can be the appropriate treatment choice over additional aggressive therapy. To date, 29 papers and 48 RH cases have been reported, including this case. This case is the second reported RH case presenting as primary bone tumor and the first case originating in the oromaxillofacial area.

The healing effect of platelet-rich plasma on xenograft in peri-implant bone defects in rabbits / 대한악안면성형재건외과학회지

BACKGROUND: The association of biomaterial combined with repair factor-like platelet-rich plasma (PRP) has prospective values. Bovine-derived xenograft has been identified as an osteoconductive and biocompatible grafting material that provides osseointegration ability. PRP has become a valuable adjunctive agent to promote healing in a lot of dental and oral surgery procedures. However, there are controversies with respect to the regenerative capacity of PRP and the real benefits of its use in bone grafts. The purpose of this study was to assess the influence of PRP combined with xenograft for the repair of peri-implant bone defects. METHODS: Twelve rabbits were used in this study, and the experimental surgery with implant installation was performed simultaneously. Autologous PRP was prepared before the surgical procedure. An intrabony defect (7.0 mm in diameter and 3.0 mm deep) was created in the tibia of each rabbit; then, 24 titanium dental implants (3.0 mm in diameter and 8.5 mm long) were inserted into these osteotomy sites. Thus, a standardized gap (4.0 mm) was established between the surrounding bony walls and the implant surface. The gaps were treated with either xenograft alone (control group) or xenograft combined with PRP (experimental group). After healing for 1, 2, 3, 4, 5, and 6 weeks, the rabbits were sacrificed with an overdose of KCl solution. Two rabbits were killed at each time, and the samples including dental implants and surrounding bone were collected and processed for histological analysis. RESULTS: More newly formed bone and a better bone healing process were observed in control group. The histomorphometric analysis revealed that the mean percentage of bone-to-implant contact in the control group was significantly higher than that of the experimental group (25.23 vs. 8.16 %; P < 0.05, independent-simple t test, analysis of variance [ANOVA]). CONCLUSIONS: The results indicate that in the addition of PRP to bovine-derived xenograft in the repair of bone defects around the implant, PRP may delay peri-implant bone healing.

Odontogenic carcinosarcoma of the mandible: a case report and review

Odontogenic carcinosarcoma is an extremely rare malignant odontogenic tumor with only a few reported cases. It is characterized by a true mixed tumor showing malignant cytology of both epithelial and mesenchymal components. It has been assumed to arise from pre-existing lesions such as ameloblastoma, ameloblastic fibroma, and ameloblastic fibrosarcoma. To date, the reported cases have exhibited considerably aggressive clinical behavior. The case of an odontogenic carcinosarcoma in the mandible of a 61-year-old male is described herein. The tumor destroyed the cortex of the mandible and invaded the adjacent tissues. Treatment was performed by surgical resection and reconstruction. The purposes of this article are to introduce odontogenic carcinosarcoma through this case study, to distinguish it from related diseases and to discuss features of the tumor in the existing literature.

Emphysematous Gastritis with Concomitant Portal Venous Air / 대한소화기학회지

Emphysematous gastritis is a rare form of gastritis caused by infection of the stomach wall by gas forming bacteria. It is a very rare condition that carries a high mortality rate. Portal venous gas shadow represents elevation of intestinal luminal pressure which manifests as emphysematous gastritis or gastric emphysema. Literature reviews show that the mortality rate is especially high when portal venous gas shadow is present on CT scan. Until recently, the treatment of emphysematous gastritis has been immediate surgical intervention. However, there is a recent trend of avoiding surgery because of the frequent occurrence of post-operative complications such as anastomosis leakage. In addition, aggressive surgical treatment has failed to show significant improvement in prognosis. Recently, the authors experienced a case of emphysematous gastritis accompanied by portal venous gas which was treated successfully by conservative treatment without immediate surgical intervention. Herein, we present a case of emphysematous gastritis with concomitant portal venous air along with literature review.

Experience of Advance Directives in a Hospice Center

To protect patient autonomy when confronting death, the importance of advance directives (ADs) has recently became an issue and gradually accepted in Korea. However, in real practice, ADs were not completed by patients but their families in most cases. To analyze the current situation of performing ADs, we reviewed medical charts of 214 terminal cancer patients admitted to the hospice center from October 2012 to September 2013. Seventy-six (35.5%) patients completed ADs. All ADs were completed by patients themselves. The most common reason for not completing ADs was poor physical and/or mental condition. As a proxy, the majority of patients preferred their spouses (55.3%). Few patients wanted life sustaining treatment (1.3%), however palliative sedation was accepted in 89.5%. The median timing of ADs after admission was three (0-90) days, and duration of survival since ADs was 22 (1-340) days. In conclusion, approximately one third of terminal cancer patients completed ADs by themselves. Considering that patient's poor condition is the main reason for not completing ADs, earlier discussion regarding ADs is necessary to enhance patients' participation.

Experience of Advance Directives in a Hospice Center

To protect patient autonomy when confronting death, the importance of advance directives (ADs) has recently became an issue and gradually accepted in Korea. However, in real practice, ADs were not completed by patients but their families in most cases. To analyze the current situation of performing ADs, we reviewed medical charts of 214 terminal cancer patients admitted to the hospice center from October 2012 to September 2013. Seventy-six (35.5%) patients completed ADs. All ADs were completed by patients themselves. The most common reason for not completing ADs was poor physical and/or mental condition. As a proxy, the majority of patients preferred their spouses (55.3%). Few patients wanted life sustaining treatment (1.3%), however palliative sedation was accepted in 89.5%. The median timing of ADs after admission was three (0-90) days, and duration of survival since ADs was 22 (1-340) days. In conclusion, approximately one third of terminal cancer patients completed ADs by themselves. Considering that patient's poor condition is the main reason for not completing ADs, earlier discussion regarding ADs is necessary to enhance patients' participation.

Retrospective study of changes in pharyngeal airway space and position of hyoid bone after mandibular setback surgery by cephalometric analysis / 대한악안면성형재건외과학회지

BACKGROUND: The posterior movement of mandible was known as the main cause of the changes in the pharyngeal airway space (PAS) and the postoperative obstructive sleep apnea (OSA). The purpose of this study was to know the changes of PAS and position of hyoid bone. METHODS: Lateral cephalographies of 13 patients who had undergone sagittal split ramus osteotomy (SSRO) setback surgery were taken preoperatively (T1), postoperatively within 2 months (T2), and follow-up after 6 months or more (T3). On the basis of F-H plane, diameters of nasopharynx, oropharynx, and hypopharynx were measured. The movements of the soft palate, tongue, and hyoid bone were also measured. RESULTS: The amount of mandible setback was 7.5 +/- 3.8 mm. In the measurements of PAS, there was a statistically significant decrease of 2.8 +/- 2.5 mm in nasopharynx (P < 0.01), and 1.7 +/- 2.4 mm in oropharynx (P < 0.01) were observed after surgery. The hypopharynx decreased 1.0 +/- 2.1 mm after surgery and continuously decreased 1.0 +/- 2.8 mm at follow-up. The changes in hyoid bone position showed the posterior movement only after surgery and posteroinferior movement at follow-up. CONCLUSIONS: The PAS such as nasopharynx, oropharynx, and hypopharynx showed relatively high correlation with the amount of mandibular setback. The change of resistance in upper airway may be important for the prevention of OSA after mandibular setback surgery.

Facelift incision and superficial musculoaponeurotic system advancement in parotidectomy: case reports / 대한악안면성형재건외과학회지

Surgical procedures for parotidectomy had been developed to gain adequate approach, prevent morbidity of nerve, and give esthetic satisfaction. We performed two cases of parotidectomy through facelift incision. One case was reconstructed with superficial musculoaponeurotic system (SMAS) flap and sternocleidomastoid (SCM) muscle rotated flap at the parotid bed. In second case, same procedures were performed, but collagen membrane was additionally implanted for prevention of Frey's syndrome. After surgery, two cases showed esthetic results without neck scar and hollow defect on parotid bed area.

A Case of Spontaneous Bacterial Peritonitis with Bacteremia Caused by Shewanella algae

Human infection caused by Shewanella algae is rare, which usually occurred after direct contact with seawater or ingestion of raw seafood in the immunocompromised host. There have been anecdotal reports about Shewanella infections in human, but their pathogenic role and microbiologic data are limited. Here, we report a fatal case of spontaneous bacterial peritonitis with bacteremia due to S. algae in a 57-year-old male with liver cirrhosis who had no history of exposure to seawater or raw seafood. Polymicrobial infection with Streptococcus mitis and Escherichia coli was combined and the patient died in spite of early appropriate antimicrobial therapy and early goal-directed therapy for sepsis.

Primary Amyloidosis with Involvement of Stomach, Duodenum and Colon

We report the case of a 57-year-old woman with abdominal discomfort. The patient had anemia and hypoalbuminemia. Esophagogastroduodenoscopy and colonoscopy revealed diffuse infiltrative lesions at the stomach, duodenum, and ascending colon. Multiple biopsies were taken and histological examination of the biopsies from the stomach, duodenum and colon showed amyloid deposits stained positively with Congo red. Immunohistochemistry study showed positive sign of kappa and lambda chain at light chain stain. In addition, monoclonal components at serum electrophoresis confirmed the diagnosis of amyloid light-chain amyloidosis. The patient was treated with thalidomide and dexamethasone.

An adult asymptomatic pulmonary artery sling / 영남의대학술지

A pulmonary artery sling is a very rare congenital abnormality in which the left pulmonary artery rises from the posterior surface of the right pulmonary artery and then passes between the trachea and the esophagus, causing tracheal compression. It is associated with tracheo-bronchial abnormalities (50%) and cardiovascular abnormalities (30%). It may produce respiratory symptoms through the airway compression of the abnormal left pulmonary artery and congenital abnormalities associated with it. Because most (90%) pulmonary artery sling patients present symptoms during infancy, their condition is often diagnosed in the first year of life. However, a pulmonary artery sling is occasionally found in adults. It is usually asymptomatic and found incidentally. This is a very rare case of an asymptomatic pulmonary artery sling in an adult. A 38-year-old man presented symptoms of mild exertional dyspnea. His spiral computed tomography showed a pulmonary artery sling. He was discharged without specific treatment because his symptoms improved without specific treatment and might not have been associated with a pulmonary artery sling. We report an adult case of an asymptomatic pulmonary artery sling diagnosed via spiral computed tomography, accompanied by a literature review.

Pigmented villonodular synovitis of the temporomandibular joint - computed tomography and magnetic resonance findings: a case report

Pigmented villonodular synovitis (PVNS) is a benign but locally aggressive and destructive disease originating in the synovial membranes. It is a proliferative disorder of unknown etiology. Involvement of the temporomandibular joint (TMJ) is very rare. Computed tomography clearly reveals areas of lytic bone erosion and sclerosis, and also clearly defines the extent of the tumor which is the focal areas of hyperdensity within the soft-tissue mass. Magnetic resonance images invariably show profound hypointensity on both T1- and T2-weighted sequences due to hemosiderin pigmentation. Additionally, high signal intensity on T2-weighted images may indicate cystic loculation of the joint fluid. This case study describes a rare case of PVNS of the TMJ with bone destruction of the mandibular condyle. Complete surgical excision of the lesion was performed through a preauricular approach with temporal extension. During the 10-year follow-up, two more operations were performed due to local recurrence and the fracture of the reconstruction plate. Total joint reconstruction with Biomet was finally performed, and the absence of disease was confirmed with a biopsy report showing fibrosis with hyalinization and mild inflammation of the excised soft tissue from the old lesion.

Condylar Hyperplasia with Long-standing Temporomandibular Joint Dislocation

Tibial bone fractures occurring after medioproximal tibial bone grafts for oral and maxillofacial reconstruction

OBJECTIVES: Oral and maxillofacial defects often require bone grafts to restore missing tissues. Well-recognized donor sites include the anterior and posterior iliac crest, rib, and intercalvarial diploic bone. The proximal tibia has also been explored as an alternative donor site. The use of the tibia for bone graft has many benefits, such as procedural ease, adequate volume of cancellous and cortical bone, and minimal complications. Although patients rarely complain of pain, swelling, discomfort, or dysfunction, such as gait disturbance, both patients and surgeons should pay close attention to such after effects due to the possibility of tibial fracture. The purpose of this study is to analyze tibial fractures that occurring after osteotomy for a medioproximal tibial graft. MATERIALS AND METHODS: An analysis was intended for patients who underwent medioproximal tibial graft between March 2004 and December 2011 in Inha University Hospital. A total of 105 subjects, 30 females and 75 males, ranged in age from 17 to 78 years. We investigated the age, weight, circumstance, and graft timing in relation to tibial fracture. RESULTS: Tibial fractures occurred in four of 105 patients. There were no significant differences in graft region, shape, or scale between the fractured and non-fractured patients. CONCLUSION: Patients who undergo tibial grafts must be careful of excessive external force after the operation.