Intra-articular fracture of the mandibular condyle: a case report.

The authors describe a case of intra-articular fracture of the left mandibular condyle, successfully treated by the pumping technique in the upper and lower joint cavities, and show arthroscopic findings in these cavities. The patient was a 15-year-old boy whose maximum mouth opening was 30 mm. Computed tomography revealed a left intra-articular sagittal fracture of the condylar head. Aspiration of the hematoma in the upper and lower joint spaces was performed with ten pumping actions. In the upper and lower joint spaces, arthroscopic examination revealed the disappearance of the hematoma. The patient continued opening, protrusive, and lateral excursive exercises. One month after the surgery, the maximal interincisal distance was improved to 45 mm with straight opening. In the case presented, mouth-opening exercises, along with the pumping technique for treatment of an intraarticular fracture of the mandibular condyle, allowed satisfactory and stable results in the improvement of limited mouth movement.

Relationship between the Effectiveness of Arthrocentesis under Sufficient Pressure and Conditions of the Temporomandibular Joint.

Background. The purpose of this study is to investigate the conditions of the temporomandibular joint relative to the effectiveness of an arthrocentesis-like enforced manipulation technique followed by irrigation under high pressure in patients with closed lock. Methods. We performed arthroscopic examination and manipulation followed by irrigation as the initial treatment in 50 joints with closed lock. Relationship between the effectiveness of the procedure and conditions of the temporomandibular joint was statistically analyzed using multiple regression analysis. Results. Significant inverse correlations were found between the extent of improvement in maximum mouth opening after treatment and the initial maximum opening before treatment. There were no significant correlations between improvement of joint pain at mouth opening and in biting and conditions of the temporomandibular joint. Conclusions. Pathologic conditions of the temporomandibular joint did not have an influence on the efficacy of the technique. This result suggests that this procedure has wider application than conventional arthrocentesis.

Reconstruction of a defect on the buccal mucosa and prolabium.

We describe the procedure for reconstruction of a defect on the buccal mucosa and the prolabium with a buccal mucosal transposition flap and an artificial dermis graft. The preparation of the flap started with an incision extending from the border of the defect to the corner of the mouth. The pivot point of the flap was near the stump of the excised prolabium. Only the buccal mucosa was elevated from the buccal surface. It was transposed onto the defect of the prolabium and sutured to the edges of the defect. After reconstruction of the prolabium, the artificial dermis was trimmed and sutured to the mucosal and skin edges of the surgical defect. This is an easy and minimally invasive procedure to cover a defect of the buccal mucosa and the prolabium. In our experience, the wound healed with good, functional, and cosmetic results.

Repair of oral mucosal defects using artificial dermis: factors related to postoperative scar contracture.

OBJECTIVE: To clarify wound-healing situations with artificial dermis used for the repair of oral mucosal defects, we investigated the incidence of postoperative scar contracture and studied factors related to cicatrization. STUDY DESIGN: Forty patients who underwent repair of oral mucosal defects using artificial dermis participated in this study. The degree of scar contracture was recorded 1 month after surgery. To study the factors related to cicatrization, patient characteristics of sex, age, excision region, fixation used, size of the graft, and number of days for silicon seat removal were examined. Logistic regression analysis was used for analysis of the relationship between cicatrization and patient characteristics. RESULTS: One month after surgery, 70% of patients had no contracture, 22.5% of patients had moderate contracture, and 7.5% of patients had severe contracture. A significant correlation was found between cicatrization and the minimum diameter of the artificial dermis (P < .001). CONCLUSIONS: Reducing the minimum diameter of the artificial dermis may contribute to a decrease in scar contracture.

Procedures of endoscopic periradicular surgery.

When a tooth with an apical lesion is identified, an apicoectomy is frequently performed when nonsurgical treatment is considered unfeasible or has previously failed. However, the treatment is usually difficult in molars. This article describes a minimally invasive procedure for removing a gutta-percha point under the maxillary sinus mucosa using an ultrathin arthroscope and a visualization approach in apicoectomy using an intranasal endoscope. These surgical techniques using endoscopes are minimally invasive and reliable procedures that provide limited incision and bone removal and respect the integrity of the maxillary sinus.

Access to the maxillary sinus using a bone flap with sinus mucosal and mucoperiosteal pedicles.

We describe a procedure for removing lesions in the maxillary sinus using bone flaps with the sinus mucosa and mucoperiosteum. The surgical design is to construct a rectangular trapdoor using 3 consecutive bur-cuts, fracture the upper margin, and lift the bone lid upward. The osteotomy site on the inferior, medial, and lateral sides of the bone lid was exposed subperiosteally, but the mucoperiosteal and sinus mucosal attachments on the superior and central areas of the lid were maintained. Then, following fracture of the upper bone margin, the lid was lifted upward. In this way, the integrity of the mucoperiosteum and sinus mucosa was maintained. Advantages of the bone flap with soft tissue pedicles technique may be quick recovery and restored integrity of the sinus wall, with a low probability of infection because of vascularization of the bone lid. To realize this, a bone flap with both sinus mucosal and mucoperiosteal pedicles is more suitable.

Mandibular coronoid hyperplasia: a case report.

A case of unilateral coronoid hyperplasia successfully treated by coronoidotomy with prolonged postoperative physiotherapy and reveal the postoperative radiographic changes between the sectioned part of the coronoid process and the mandibular ascending ramus is described. The patient was a 28-year-old man whose maximum mouth opening was 30 mm. A coronoidotomy of the left coronoid process was performed. Nine days after surgery, the patient started physiotherapy with a HU-OS(r) appliance. After coronoidotomy and physiotherapy, the maximum mouth opening had increased to 43 mm. Radiographic follow-up showed that the coronoid process apparently united with the mandibular ascending ramus, with moderate dislocation and inclination posteriorly. In the case presented, an intraoral coronoidotomy with postoperative physiotherapy for treatment of coronoid process hyperplasia allowed satisfactory and stable results in the correction of coronoid-malar interference.

Oral tumor resection and salivary duct relocation with an ultrasonic surgical aspirator.

We describe a procedure of oral tumor resection and salivary duct relocation with an ultrasonic surgical aspirator. After mucosal incision, resection of the underlying musculature was performed using an ultrasonic surgical aspirator. Using the apparatus, the salivary duct was easily exposed without damaging or cutting the duct. After identification of the salivary duct, salivary duct relocation was performed. After resection of the tumor, the artificial dermis was trimmed and sutured to the mucosal edges of the surgical defect. This method is a reliable and simple procedure that can be used to avoid postoperative complications such as salivary fistula or swelling of the gland.

Three minimally invasive procedures for removing lesions in the maxillary sinus.

We describe here 3 minimally invasive procedures for removing lesions from the maxillary sinus using an ultrathin endoscope, microscope, and otoscope.Preoperatively, a lesion in the maxillary sinus was identified by radiographic examination. Then the access hole position and advance direction of the endoscope and forceps were planned. Under local anesthesia, a small incision on the buccal mucosa was made in the planned position. The anterior bony wall of the sinus was exposed subperiosteally, and a small access hole for the insertion of an endoscope was made in the planned position and angled with a fissure bur. After identification of the lesion endoscopically, microscopically, or otoscopically, a forceps was inserted into the sinus cavity through the hole, and the lesion was seized and withdrawn from the sinus.The surgical procedures are suggested to be reliable, easy, and minimally invasive that provide a limited incision and bone removal and respect the integrity of the sinus.

Oral squamous cell carcinomas stimulate osteoclast differentiation.

Matrix metalloproteinases (MMPs) play important roles in the invasion and metastasis to soft tissues of carcinomas including, oral squamous cell carcinomas (SCCs). Although, osteoclastic bone resorption is an important step in bone involvement in a variety of malignancies, the mechanism of bone involvement of oral SCC remains unclear. Once cancer cells arrest in bone, the bone is a storehouse of a variety of cytokines and growth factors and thus provides an extremely fertile environment for cell growth. The bone-invasive oral cancer cell line, BHY, transcriptionally expressed detectable levels of TGF-beta, IL-1beta, IL-8, parathyroid hormone-related protein (PTHrP) and vascular endothelial growth factor (VEGF) mRNAs and failed to express GM-CSF, IL-6, and TNF-alpha. Furthermore, the BHY-conditioned medium greatly upregulated IL-6 and RANKL/ODF mRNA expression in osteoblasts, suggesting a potential indirect stimulation of osteoclastogenesis via the osteogenic lineage. Seven out of eleven patients with carcinomas of the lower alveolus and gingiva showing infiltrative bone involvement expressed PTHrP mRNA. These data suggest that the occurrence of PTHrP may be an indication of developing oral malignant carcinomas.

A combination of three minimally invasive surgical procedures for implant placement in the posterior maxilla with insufficient bone quantity.

We describe a combination of 3 surgical procedures for implant placement in the posterior maxilla with insufficient bone quantity and quality. In these situations, we have performed 3 minimally invasive, safe, and reliable surgical procedures: buccal bone graft with bone harvested from the mandibular molar region, submucous vestibuloplasty using artificial dermis, and bone-added osteotome sinus floor elevation under endoscopic control. These modified procedures can be performed in the office setting under outpatient local anesthesia and may minimize patient discomfort and reduce postoperative complications.

Procedure of endoscopic removal of a gutta-percha point under the maxillary sinus mucosa by using an ultrathin arthroscope.

We describe here a procedure of endoscopic removal of a gutta-percha point under the maxillary sinus mucosa by using an ultrathin arthroscope. In this study, a 1.2-mm-diameter ultrathin arthroscope was introduced for observation into the maxillary sinus. The surgical technique is suggested to be a reliable and minimally invasive procedure that provides limited incision and bone removal and respects the integrity of the sinus.

E1AF expression is closely correlated with malignant phenotype of tongue squamous cell carcinoma through activation of MT1-MMP gene promoters.

E1AF is an ets-oncogene family transcription factor that has been shown to up-regulate multiple MMPs whereas MMP-2, a potent extracellular matrix degrading enzyme, is not up-regulated. We investigated the activation mechanism of MMP-2 in oral squamous cell carcinoma. Chloramphenicol acetyltransferase (CAT) assay was utilized to investigate whether E1AF is able to up-regulate membrane type-1 matrix metalloproteinase (MT1-MMP), which is known to activate MMP-2. Expression of the CAT reporter gene under the control of the MT1-MMP promoter was increased approximately 40-fold by co-transfection with the E1AF expression vector. Real-time RT-PCR study was carried out in 25 patients with tongue squamous cell carcinoma, and the mRNA expression level of E1AF and MT1-MMP was synergistically increased. These results indicate that E1AF positively regulates transcription from MT1-MMP genes, which plays an important role in invasion and metastasis of squamous cell carcinoma of the tongue by converting pro-MMP-2 into active-MMP-2.

Effects of bilateral lingual and inferior alveolar nerve anesthesia effects on masticatory function and early swallowing.

OBJECTIVE: To determine whether bilateral lingual and inferior alveolar nerve anesthesia affects the onset of swallowing including masticatory function. STUDY DESIGN: Twenty young male volunteers were asked to chew and swallow corned beef and then a mixture of corned beef and liquid in their usual manner before and after local anesthesia. The oral and pharyngeal swallowing was investigated using videofluoroscopic examination in a lateral plane. Eight objective indicators including oral containment time, swallowing threshold, and pharynx-to-swallow interval were measured. RESULTS: Oral containment time and total sequence duration, total number of chews, and total number of swallows for the 2 test foods varied significantly between those before and after anesthesia. Individual pharynx-to-swallow intervals varied with both foods without remarkable increases or decreases in the swallow duration and cricopharyngeal opening time. CONCLUSION: Bilateral lingual and inferior alveolar nerve anesthesia may affect early swallowing; changes in the onset of swallowing varied among the participants.