Prevention of lingual inclination of the transport segment in vertical distraction osteogenesis in the mandible.

Vertical distraction osteogenesis can extend not only to hard tissues but also to soft tissues. There is a tendency to cause progressive lingual inclination of the distracted segment. This study describes a method for preventing the lingual inclination of the transport segment in patients with vertical distraction osteogenesis in the anterior region of the mandible and reports the results of long-term follow-up. The subjects included 5 patients who had severely atrophic ridges in the anterior mandible. In all cases, a part of the mental protuberance was scraped out, and the distractor was placed suitably in a labioinclination beforehand. Therefore, the transport segments did not lean to the lingual side and had long-term stability.

Perioperative intervention by oral medicine team in cardiovascular surgery patients.

In brief, perioperative oral intervention consists of elimination of odontogenic foci and maintenance of oral hygiene in patients undergoing surgery. The importance of oral intervention before, during, and after medical treatments is well-known, especially in cancer patients, because odontogenic foci such as untreated deep dental caries or periodontitis can cause systemic infection in patients with myelosuppression resulting from chemotherapy. Although perioperative oral intervention is currently recommended for patients with cardiovascular disease, its efficacy in this population has not been established. This article consists of three sections: first, we review the current knowledge about the association between dental disease and cardiovascular disease to show the importance of oral hygiene maintenance and the risks of invasive dental procedures in patients with cardiovascular disease; second, we introduce pertinent, but limited evidence concerning the effect of oral care in preventing postoperative pneumonia; and finally, we present the optimal strategy for perioperative oral intervention in cardiovascular surgery patients.

A literature review of perioperative antibiotic administration in surgery for medication-related osteonecrosis of the jaw.

PURPOSE: Few studies exist that focus on the details of perioperative antibiotic administration for surgery to treat medication-related osteonecrosis of the jaw (MRONJ). The regime and duration of perioperative antibiotics applied in published studies were reviewed to clarify appropriate perioperative antibiotic use in MRONJ surgery. METHODS: A literature search was conducted using the MEDLINE database via PubMed. RESULTS: The search resulted in 453 hits on PubMed. After reading the downloaded full-text articles, 17 articles met the inclusion and exclusion criteria. The most common perioperative antibiotic used for MRONJ surgery was a combination of penicillin-based antibiotics and ß-lactamase inhibitor (52.9%), and the second most common regime was penicillin-based antibiotics with metronidazole (17.6%). The duration of administration was 2 weeks postoperatively in nine studies, whereas four studies applied long-term administration (2-6 weeks postoperatively). CONCLUSIONS: Oral and maxillofacial surgeons mostly prefer penicillin-based antibiotics plus ß-lactamase inhibitor or metronidazole for MRONJ surgery. The duration of administration of these medications may be based on empirical experience.

Literature Review of Criteria for Defining Recipient-Site Infection after Oral Oncologic Surgery with Simultaneous Reconstruction.

BACKGROUND: The lack of uniformity of criteria for defining recipient-site infection after oral oncologic surgery with simultaneous reconstruction is problematic despite numerous studies on this issue. This study aimed to investigate the difference in the criteria for defining recipient-site infection after oral oncologic surgery with reconstruction. METHODS: A Medline search was performed via PUBMED using the following combinations of key terms that were tagged in the title, abstract, or both: "surgical site infection-head neck," "surgical site infection-oral cancer," "antibiotic prophylaxis-head neck," and "surgical site infection-oral carcinoma." Search results were filtered between 2005 and 2017. Articles in which there was no mention of the criteria for definition of surgical-site infection were excluded. RESULTS: The number of articles that met the inclusion criteria was 24. The lack of uniformity in the criteria for defining recipient-site infection in each article appeared to be attributable mainly to differences in whether an orocutaneous fistula and superficial incisional infection were regarded as recipient-site infection. CONCLUSION: Reconsideration of the categorization of orocutaneous fistula as infection, regardless of the etiology, and differentiation of superficial and deep incisional infections are necessary for correct assessment of recipient-site infection in oral oncologic surgery.

Orthognathic surgery for occlusal reconstruction of old malunited jaw fracture.

Old malunited jaw fractures of nine patients who underwent orthognathic surgery for occlusal reconstruction were clinically evaluated. Early surgery on fractures of the jaw is the optimal treatment when due attention must be paid to occlusion. Since occlusal revision surgery subsequent to inaccurate diagnosis and inappropriate surgery is certainly very difficult and often unsuccessful, surgeons need to pay special attention to this situation.

Occlusal reconstruction: orthodontic techniques for treatment of jaw fracture.

AIM: Treatment by the multidisciplinary-team approach for jaw fractures, and the role of the orthodontist, are discussed and illustrated through case reports. METHODS: Two cases of jaw fractures treated with orthodontic techniques, as an alternative noninvasive procedure, are presented. One subject with a fresh mandibular fracture did not consent to surgery, despite a good indication for open reduction. The other subject had maljoined mandibular fractures from surgery, with insufficient occlusal consideration. CONCLUSION: Orthodontists, as well as oral surgeons, participate in every stage of the treatment of jaw fractures, including treatment decisions, in-patient management, dietary guidance, etc. Orthodontists also attend surgical operations to determine the most stable occlusion, making possible more detailed occlusal reconstruction.

Effectiveness of photocoagulation using an Nd:YAG laser for the treatment of vascular malformations in the oral region.

OBJECTIVE: The purpose of this study is to make a clinical evaluation of vascular malformations in the oral region treated by photocoagulation with an Nd:YAG laser, to determine its effectiveness. BACKGROUND DATA: The Nd:YAG laser, with a wavelength of 1064 nm in the near-infrared part of the electromagnetic spectrum, has unique characteristics, such as absorption by oxygenated hemoglobin, negligible absorption by water, and a deep depth of penetration, all of which are ideal for performing the photocoagulation of vascular malformations. METHODS: The subjects were 67 patients (69 cases) with vascular malformations in the oral region who visited our hospital from 2004 to 2011, and were treated by photocoagulation using an Nd:YAG laser. They consisted of 23 male patients and 44 female patients, ranging from 7 to 89 years of age. Lesion size was classified for convenience into two groups (<15 mm or ≥ 15 mm) for clinical analysis and evaluation. The lesions were located at sites including the lip, tongue, buccal mucosa, gingiva, mouth floor, and soft palate, and ranged in size from 3 to 42 mm along the major axis. Fifty patients (74.6%) were treated on an outpatient basis, whereas 17 patients (25.4%) were treated in the hospital. All patients were treated using an Nd:YAG laser at an output of 8-15 W under local anesthesia. RESULTS: No patient developed serious complications from this treatment. However, it was necessary to irradiate the laser beam two or more times in cases of deep-seated lesions. CONCLUSIONS: We were able to obtain satisfactory results without clinical complications, using only external irradiation. These results suggest that the Nd:YAG laser is effective for the treatment of vascular malformations in the oral region.

A case of malignant melanoma of the oral cavity alive with liver metastasis for a long period with administration of a biologic response modifier, OK432.

A patient with malignant melanoma of the oral cavity who lived for a long period despite developing liver metastasis is presented. An 81-year-old female was referred to our hospital because of a pigmented tumor of the lower gingiva. Under the clinical diagnosis of malignant melanoma, she underwent bilateral functional neck dissection and marginal mandiblectomy. Histological diagnosis of the operation material was malignant melanoma with regional lymph node metastasis. In spite of loco-regional control, liver metastasis developed at 7 months after the surgery. She then underwent combination chemotherapies with dimethyl triazeno imidazole carboxamide (DTIC), nimustine hydrochloride (ACNU) and vincristin (DAV therapy), or cisplatin, DTIC, ACNU and tamoxifen (DAC-tam), but no marked response was obtained. Considering the advanced age of the patient, immunotherapy with a biological response modifier, OK432, alone was started. After administration of OK432, the metastatic tumor gradually decreased, and she is alive without any clinical symptoms of tumor at 46 months after the detection of liver metastasis, although it is still present on ultrasonic and CT examinations.

Shoulder mobility after spinal accessory nerve-sparing modified radical neck dissection in oral cancer patients.

OBJECTIVE: Radical neck dissection (RND), a standard surgical procedure for lymph node metastasis of head and neck cancer for decades, causes various dysfunctions, such as pain or limited abduction of the shoulder. Various RND modifications have been made to reduce these postoperative dysfunctions, but the effect of preservation of the spinal accessory nerve is still controversial. The aim of this study was to explain our surgical method of sparing the accessory nerve during neck dissection and to clarify the effect of preserving the nerve on reduction in shoulder dysfunction. STUDY DESIGN: One hundred five neck dissections were performed in 90 patients with oral cancer: 4 RNDs and 101 modified radical neck dissections (mRNDs). The spinal accessory nerve was preserved in 96 neck dissections. Dysfunction of the trapezius muscle was evaluated by the limitation of shoulder lateral abduction at 3 months after the operation. RESULTS: All 9 patients with resection of the spinal accessory nerve showed severe shoulder dysfunction, whereas 90 out of 96 with preservation of the nerve maintained normal shoulder function. CONCLUSION: Spinal accessory nerve-sparing neck dissection can reduce postoperative shoulder dysfunction if careful operating procedures are used.