論文

© 2018 Asian AOMS(+) ASOMP(+) JSOP(+) JSOMS(+) JSOM(+) and JAMI Myelodysplastic syndrome is an acquired hematopoietic disorder showing symptoms of pre-leukemia and refractory anemia. In the tooth extraction process of such cases, bleeding tendency due to pancytopenia, infection etc., becomes a problem. As such, a cautious approach is required. We have confirmed platelet transfusion refractoriness prior to tooth extraction in a myelodysplastic syndrome patient, and hereby report a case of tooth extraction following human leukocyte antigen (HLA)-compatible concentrated platelet transfusion. The patient was a 55-year-old female who was examined at our department due to a request for the extraction of tooth No. 36. Following consultation at the Hematology Department, platelet transfusion was performed as a pretreatment upon hospitalization. Increased body temperature, chills, shivers, and feelings of discomfort in the pharynx were observed. A close examination was performed due to a lack of increase in platelet count, and revealed platelet transfusion refractoriness caused by anti-HLA antibodies. Therefore, the patient was re-hospitalized and transfused with a platelet concentrate-HLA preparation. One hour later, an increase in platelet count was confirmed and the tooth extraction was performed. There was no evidence of bleeding or infection following extraction, and the prognosis was good.

© 2019 Asian AOMS(+) ASOMP(+) JSOP(+) JSOMS(+) JSOM(+) and JAMI Spindle cell lipomas and pleomorphic lipomas are uncommon and distinct variants of benign lipomas. Although spindle cell lipomas and pleomorphic lipomas were originally considered different entities, the recent WHO classification defines them as spindle cell/pleomorphic lipoma (SCL/PL). This is because of their similar clinical features and the existence of intermediate histopathological features between them. A 77-year-old male presented to our clinic with a painless swelling on the left inferior border of the mandible. Computed tomography revealed a clearly defined mass in the subcutaneous lesion. With a histopathological diagnosis of myxolipoma, demonstrated by biopsy, excisional surgery was performed under general anesthesia. The histopathology revealed SCL/PL with the presence of spindle cells and mature adipocytes. No tumor recurrence had been noted at two year after surgery.

© 2019 The Author(s). Background: Calcium pyrophosphate dihydrate crystal deposition disease is a condition in which calcium pyrophosphate dihydrate crystal is deposited in joint cartilage and ligaments. Calcium pyrophosphate dihydrate crystal deposition disease that involves calcification around the odontoid process of the second cervical vertebra is called crowned dens syndrome. Crowned dens syndrome is accompanied by fever in addition to acute and intense neck, posterior head, and temporal pain; thus, distinguishing crowned dens syndrome may be difficult in the presence of odontogenic infection. To the best of our knowledge, this is the first report describing a patient with crowned dens syndrome with coexisting odontogenic infection. Case presentation: A 75-year-old Japanese woman was examined in the Emergency Department of this hospital due to a chief complaint of worsened buccal swelling on the left side. An odontogenic infection was considered, and she underwent her first examination. She presented with a body temperature of 37.4 °C, marked swelling and tenderness of her left lower eyelid through to her left cheek, and pain on the left temporal area. Blood tests revealed a leukocyte count of 6700/μL and a C-reactive protein level of 7.15 mg/dL. There was swelling and pain around the gingiva and acute purulent apical periodontitis of left maxillary second premolar. Cellulitis of the left cheek was diagnosed. After performing drainage of the pus, antibiotic treatment was initiated. Although her clinical symptoms improved, blood tests on day 9 of hospitalization revealed a leukocyte count of 6500/μL and a C-reactive protein level of 25.62 mg/dL, which were indicative of worsening symptoms. Computed tomography was performed to evaluate remote infection and images revealed a calcification around the odontoid process of her second cervical vertebra. When she was referred to the Orthopedic Surgery Department, pseudogout of the cervical spine was diagnosed. Subsequently, oral acetaminophen was initiated, and both her leukocyte count and C-reactive protein improved markedly. Conclusions: In the presence of persistent fever and abnormally high leukocyte and C-reactive protein indicative of an inflammatory reaction, coexistence of pseudogout should be considered. In particular, when symptoms of temporal pain are present, the possibility of pseudogout of the cervical spine must be considered in the differential diagnosis.

© 2019 The Authors. Oral Science International published by John Wiley & Sons Australia, Ltd on behalf of JapaneseStomatological Society. Objectives: To compare levels of α1-antitrypsin (AT) and lactoferrin (LF) in gingival crevicular fluid (GCF) and on the tongue and determine whether MATATACORO® (MA-T), a stabilized chlorine dioxide solution, affects GCF AT and LF levels. Methodology: The α1-antitrypsin and lactoferrin levels in GCF and on the tongue were measured for 18 elderly patients (mean age: 83 years) and correlations were analyzed. AT and LF levels in GCF were assessed before and 1 hr after treatment with MA-T. Results: The α1-antitrypsin and lactoferrin levels were lower on the tongue than in GCF (median 0.6, 0.4 μg/mL vs median 2.4, 3.6 μg/mL). The respective AT and LF levels in GCF and on the tongue were positively correlated (AT: r =.43, LF: r =.69). GCF AT and LF levels were reduced following MA-T treatment (AT: median 3.6 and 1.9 μg/mL and LF: 2.3 and 0.4 μg/mL pre- and post-treatment, respectively; both P <.01). Conclusion: The α1-antitrypsin and lactoferrin levels in GCF were higher than those on the tongue, but AT and LF were detectable for both sampling types. The reduction in GCF AT and LF levels after MA-T treatment suggests that MA-T could be used to control periodontal inflammation.

© 2019 European Association for Cranio-Maxillo-Facial Surgery Purpose: This study compared the diagnostic accuracy of jaw bone invasion (JBI) of oral cancer observed with three-dimensional (3D) SPECT/CT, CT, and MRI, and evaluated the clinical advantages of 3D SPECT/CT compared to conventional two-dimensional (2D) SPECT/CT. Materials and methods: From April 2014 to January 2018, consecutive 16 oral cancer patients with suspected JBI, who had preoperatively undergone the imaging tests, were retrospectively enrolled. The likelihood of JBI was independently scored by a radiologist and oral surgeon. Using 2D or 3D SPECT/CT images, 20 oral surgeons delineated virtual surgical areas on 3D-printed jaws for 3 cases in which the extent of JBI was fully pathologically confirmed. The surgeons completed questionnaires regarding surgical planning and explanations for patients using Likert scales. Results: JBI was found in 9 patients including 5 (56%) with initial bone invasion. 3D SPECT/CT showed very high negative predictive value (100%) and inter-observer agreement (kappa = 0.917). 3D SPECT/CT was more sensitive than CT and MRI when inconclusive findings for JBI were considered negative. Compared to 2D SPECT/CT, 3D SPECT/CT had greater clinical advantages such as surgical planning and explanation to patients (p < 0.005). Conclusion: 3D SPECT/CT is useful not only for detecting JBI but also for surgical planning.

© 2018 Asian AOMS(+) ASOMP(+) JSOP(+) JSOMS(+) JSOM(+) and JAMI Combination of a pre-auricular-temporal approach and zygomatic osteotomy is a useful surgical approach for major temporomandibular joint tumours; however, additional approaches may be required to remove tumours expanding under the basal part of the condyle. We describe a patient with a large odontogenic myxofibroma of the basal part of condyle that was excised by a combination of pre-auricular-temporal approach with resection of the zygomatic arch and transoral approach. A 22-year-old man was referred to our department with a painless swelling in the left preauricular area. There was a palpable mass around his left condyle. Computed tomography revealed an infiltrative mass that had expanded to the vicinity of the impacted third molar root apex. The patient had strong cosmetic requirements, and we therefore adopted a combination of pre-auricular-temporal approach with zygomatic osteotomy and transoral approach for resection of the tumour. There was minimal intraoperative bleeding, and no sensory loss in the area innervated by the facial nerve. Histopathological analysis of the excised tumour revealed odontogenic myxofibroma. The scar was located in an inconspicuous area that could be hidden by his hair and in the oral cavity. There were no signs of recurrence or neoplastic transformation 7 years after surgical intervention.

© 2018 by The Keio Journal of Medicine. Radical esophagectomy for thoracic esophageal cancer is invasive and frequently results in postoperative pulmonary complications. Postoperative pneumonia is the most common such complication and affects hospital mortality and survival rates. Oral care has been very effective in reducing pneumonia. In Japan, preoperative professional oral care is highly recommended. However, there are few studies on the effect of preoperative improvements in oral hygiene as a result of intervention on the incidence of postoperative pneumonia. The primary end-point of this retrospective study was the incidence of postoperative pneumonia after radical esophagectomy. The oral health levels of 46 patients were individually categorized, and then patients were grouped according to whether they maintained or improved their oral hygiene. At the first dental examination, oral health levels were classified as good in 22 patients and bad in 24. Of the 46 patients studied, 39 patients maintained or improved their oral hygiene (good control group), whereas 7 showed no improvement (bad control group). Postoperative pneumonia occurred in eight patients: four in the good control group and four in the bad control group. Statistical analysis with postoperative pneumonia as a dependent variable showed a significant effect of oral hygiene improvement on the incidence of pneumonia. Logistic regression analysis with this factor as an independent variable demonstrated that the risk of postoperative pneumonia was reduced in the good control group (OR 0.086, 95% CI 0.014-0.529). Therefore, preoperative professional oral care may improve oral hygiene and oral health, which may in turn reduce the incidence of postoperative pneumonia.

© 2018, © The Author(s) 2018. Behçet’s disease is a systemic disorder of unknown etiology. It involves multiple organ systems and is characterized by recurring episodes of oral ulcers as well as ocular, genital, and skin lesions. Oral ulcers can affect tooth brushing and impair proper oral hygiene. As a result, a dental biofilm accumulates, and the condition of the teeth and periodontal tissue deteriorates. The aim of this case report is to highlight the efficacy of periodontal treatment for patients with Behçet’s disease. A 51-year-old man with Behçet’s disease presented with generalized severe periodontitis. After basic treatment of the periodontal tissues, periodontal surgery was performed at several sites with bony defects. However, the patient developed severe stomatitis in the oral mucosa and gingiva after periodontal surgery. Administration of the antimicrobial agent cefdinir had little effect on recovery; however, subsequent administration of sitafloxacin resulted in significant improvement of the stomatitis. This case demonstrates that periodontal therapy is very useful for alleviating the oral signs and symptoms of Behçet’s disease. Systemic antibiotic treatment with sitafloxacin (but not cefdinir) and mechanical debridement were effective in preventing the recurrence of aphthous ulcer outbreaks after periodontal surgery.