Midfacial degloving approach for management of the maxillary fibrous dysplasia: a case report.

BACKGROUND: Fibrous dysplasia (FD) is a benign bone lesion characterized by the progressive replacement of normal bone with fibro-osseous connective tissue. The maxilla is the most commonly affected area of facial bone, resulting in facial asymmetry and functional disorders. Surgery is an effective management option and involves removing the diseased bone via an intraoral approach: conservative bone shaving or radical excision and reconstruction. CASE PRESENTATION: This case report describes a monostotic fibrous dysplasia in which the patient's right midface had a prominent appearance. The asymmetric maxillary area was surgically recontoured via the midfacial degloving approach under general anesthesia. Follow-up photography and radiographic imaging after surgery showed the structures were in a stable state without recurrence of the FD lesion. Furthermore, there were no visible scars or functional disability, and the patient reported no postoperative discomfort. CONCLUSIONS: In conclusion, the midfacial degloving approach for treatment of maxillary fibrous dysplasia is a reliable and successful treatment option. Without visible scars and virtually free of postoperative functional disability, this approach offers good exposure of the middle third of the face for treatment of maxillary fibrous dysplasia with excellent cosmetic outcomes.

Conservative surgical treatment for ameloblastoma: a report of three cases.

Ameloblastoma treatment varies based on the clinical, histopathologic, and radiographic characteristics. Aggressive surgical treatments, such as marginal or segmental resection, have traditionally been implemented, but some conservative surgical methods are also being introduced, including decompression, enucleation, or curettage. The aim of the present study was to evaluate the possibility of applying these conservative surgical treatments to ameloblastoma and to analyze the prognosis of the procedures and their healing aspects. Among all patients who visited our clinic (Department of Oral and Maxillofacial Surgery, Kyung Hee University Dental Hospital at Gangdong) from 2009 to 2017, three who had undergone conservative surgery were recruited. One of these three patients underwent both excision of the lesion and an iliac bone graft during the same procedure. In the other two patients, due to the size of the lesion, decompression was performed to reduce the size of the lesion, and then conservative surgical treatments followed. As shown in the cases of this study, patients were only treated with conservative surgical methods, such as decompression or enucleation. During the follow-up period, there were no recurrences. In conclusion, the use of conservative surgical treatment in ameloblastoma can be a reliable, safe, and successful method.

A local drug delivery system based on visible light-cured glycol chitosan and doxorubicin⋠hydrochloride for thyroid cancer treatment in vitro and in vivo.

Systemic drug delivery systems (SDDSs) for thyroid cancer treatment are associated with serious side effects including nausea, anorexia, and hair loss as a result of damage to normal tissues. In this study, we investigated the feasibility of a local DDS (LDDS) based on visible light-cured glycol chitosan (GC) hydrogel and doxorubicin⋅hydrochloride (DOX⋅HCl), called GC10/DOX, on thyroid cancer treatment in vivo. Visible light irradiation increased the storage modulus and swelling ratio of the GC10/DOX hydrogel precursor. The release of DOX⋅HCl from GC10/DOX exhibited two unique patterns comprising an initial burst within 18 hours, followed by a controlled and sustained release thereafter. In vitro cell viability testing showed that GC10/DOX had a greater antitumor effect than free DOX⋅HCl and GC10 hydrogel controls. In vivo, local injection of GC10/DOX near tumor tissue led to a superior antitumor effect compared with controls consisting of free DOX⋅HCl intravenously injected to the tail vein of thyroid cancer-bearing mouse and GC10 hydrogel subcutaneously injected near the tumor. Altogether, our results suggest that GC10/DOX may have clinical potential for thyroid cancer treatment.

Anti-inflammatory effect of polydeoxyribonucleotide on zoledronic acid-pretreated and lipopolysaccharide-stimulated RAW 264.7 cells.

Bisphosphonates are generally used as therapeutic agents for bone diseases. However, previous reports on bisphosphonates-related osteonecrosis of the jaw (BRONJ) demonstrated that inflammation triggers and worsens the disease. Recently, polydeoxynucleotide (PDRN), an A2A receptor agonist, has been suggested for the treatment of various diseases and broadly studied for its anti-inflammatory effect. The present study aimed to measure the effect of PDRN on macrophage cells treated with zoledronic acid (ZA) and lipopolysaccharide (LPS). Macrophage cells were cultured with ZA for 24 h, following which they were stimulated with LPS in the presence or absence of varying concentrations of PDRN for 24 h. The cell viability and nitric oxide (NO) production of the cells were analyzed. In addition, protein expression levels were quantified by western blotting. Cell viability was compromised and NO was overexpressed by ZA and LPS stimulation. However, under ZA and LPS stimulation cell viability was enhanced, and NO production, and inducible nitric oxide synthase, interleukin (IL)-1ß, -6, and tumor necrosis factor-α overexpression were suppressed on exposure to PDRN. A2A receptor and vascular endothelial growth factor (VEGF) expression levels increased following PDRN treatment. These results indicate that PDRN treatment of macrophages inhibits the inflammatory cytokines induced by ZA and LPS stimulation. It was hypothesized that the inflammatory cytokines were inhibited through A2A activation by PDRN. In addition, increased VEGF expression may contribute to increased vascularization and subsequently improve the pathological condition in BRONJ. As inflammation and LPS may stimulate the occurrence of BRONJ, the present study postulated that PDRN is possibly a candidate for the therapeutic management of BRONJ by decreasing inflammation and increasing vascularization.

Injectable visible light-cured glycol chitosan hydrogels with controlled release of anticancer drugs for local cancer therapy in vivo: a feasible study.

Currently available chemotherapy is associated with serious side effects, and therefore novel drug delivery systems (DDSs) are required to specifically deliver anticancer drugs to targeted sites. In this study, we evaluated the feasibility of visible light-cured glycol chitosan (GC) hydrogels with controlled release of doxorubicin⋅hydrochloride (DOX⋅HCl) as local DDSs for effective cancer therapy in vivo. The storage modulus of the hydrogel precursor solutions was increased as a function of visible light irradiation time. In addition, the swelling ratio of the hydrogel irradiated for 10 s (GC10/DOX) was greater than in 60 s (GC60/DOX). In vitro release test showed that DOX was rapidly released in GC10/DOX compared with GC60/DOX due to the density of cross-linking. In vitro and in vivo tests including cell viability and measurement of tumor volume showed that the local treatment of GC10/DOX yielded substantially greater antitumor effect compared with that of GC60/DOX. Therefore, the visible light-cured GC hydrogel system may exhibit clinical potential as a local DDS of anticancer drugs with controlled release, by modulating cross-linking density.

Visible Light-Cured Glycol Chitosan Hydrogel Containing a Beta-Cyclodextrin-Curcumin Inclusion Complex Improves Wound Healing In Vivo.

Scarless wound healing is ideal for patients suffering from soft tissue defects. In this study, we prepared a novel wet dressing (ß-CD-ic-CUR/GC) based on the visible light-cured glycol chitosan (GC) hydrogel and inclusion complex between beta-cyclodextrin (ß-CD) and curcumin (CUR). We also evaluated its efficacy in the acceleration of wound healing as compared to that of CUR-loaded GC (CUR/GC). The conjugation of glycidyl methacrylate (GM) to GC for photo-curing was confirmed by ¹H-NMR measurement, and the photo-cured GC hydrogel was characterized by the analyses of rheology, swelling ratio, SEM and degradation rate. After visible light irradiation, the surface/cross-sectional morphologies and storage (G')/loss (G'') moduli revealed the formation of hydrogel with interconnected porosity. The dressing ß-CD-ic-CUR/GC exhibited a controlled release of 90% CUR in a sustained manner for 30 days. On the other hand, CUR/GC showed CUR release of 16%. ß-CD acted as an excipient in improving the water-solubility of CUR and affected the release behavior of CUR. The in vivo animal tests including measurement of the remaining unhealed wound area and histological analyses showed that ß-CD-ic-CUR/GC may have potential as a wet dressing agent to enhance soft tissue recovery in open fractures.

Preparation and Evaluation of Dexamethasone (DEX)/Growth and Differentiation Factor-5 (GDF-5) Surface-Modified Titanium Using ß-Cyclodextrin-Conjugated Heparin (CD-Hep) for Enhanced Osteogenic Activity In Vitro and In Vivo.

The most ideal implant models in the dental and orthopedic fields to minimize the failure rate of implantation involve the improvement of osseointegration with host bone. Therefore, a focus of this study is the preparation of surface-modified titanium (Ti) samples of disc and screw types using dexamethasone (DEX) and/or growth and differentiation factor-5 (GDF-5), as well as the evaluation of their efficacies on bone formation in vitro and in vivo. X-ray photoelectron spectroscopy (XPS), scanning electron microscopy (SEM) and contact angle measurement were used to evaluate the surface chemical composition, surface morphology and wettability, respectively. The results showed that implant surfaces were successfully modified with DEX and/or GDF-5, and had rough surfaces along with hydrophilicity. DEX, GDF-5 or DEX/GDF-5 on the surface-modified samples were rapidly released within one day and released for 28 days in a sustained manner. The proliferation and bone formation of MC3T3-E1 cells cultured on pristine and surface-modified implants in vitro were examined by cell counting kit-8 (CCK-8) assay, as well as the measurements of alkaline phosphatase (ALP) activity and calcium deposition, respectively. MC3T3-E1 cells cultured on DEX/GDF-5-Ti showed noticeable ALP activity and calcium deposition in vitro. Active bone formation and strong osseointegration occurred at the interface between DEX/GDF-5-Ti and host bone, as evaluated by micro computed-tomography (micro CT) analysis. Surface modification using DEX/GDF-5 could be a good method for advanced implants for orthopaedic and dental applications.

Magnetic nanofiber scaffold-induced stimulation of odontogenesis and pro-angiogenesis of human dental pulp cells through Wnt/MAPK/NF-κB pathways.

OBJECTIVE: Magnetic biomaterials have recently gained great attention due to their some intriguing cell and tissue responses. However, little attention has been given to the fields of dental tissue regeneration. In this sense, we aim to investigate the effects of magnetic nanofiber scaffolds on the human dental pulp cell (HDPC) behaviors and to elucidate the underlying signaling mechanisms in the events. METHODS: Magnetic nanofiber scaffolds incorporating magnetic nanoparticles at varying contents were prepared into nanofibrous matrices to cultivate cells. Cell growth by MTS assay, odontoblastic differentiation by alkaline phosphatase (ALP) activity, mineralization, and the mRNA expression of differentiation-related genes of HDPCs, in vitro angiogenesis by migration and capillary tube formation in endothelial cells on the conditioned medium obtained from HDPSCs in the presence or absence of scaffolds. Western blot analysis and confocal immunofluorescene were used to asses signaling pathways. RESULTS: The growth of HDPCs was significantly enhanced on the magnetic scaffolds with respect to the non-magnetic counterpart. The odontogenic differentiation of cells was significantly up-regulated by the culture with magnetic scaffolds. Furthermore, the magnetic scaffolds promoted the HDPC-induced angiogenesis of endothelial cells. The expression of signaling molecules, Wnt3a, phosphorylated GSK-3ß and nuclear ß-catenin, was substantially stimulated by the magnetic scaffolds; in parallel, the MAPK and NF-κB were highly activated when cultured on the magnetic nanofiber scaffolds. SIGNIFICANCE: This study is the first to demonstrate that magnetic nanofiber scaffolds stimulate HDPCs in the events of growth, odontogenic differentiation, and pro-angiogenesis, and the findings imply the novel scaffolds can be potentially useful as dentin-pulp regenerative matrices.

Sedation Protocol Using Dexmedetomidine for Third Molar Extraction.

PURPOSE: The aim of this study was to establish a proper sedative protocol of dexmedetomidine for outpatients. MATERIALS AND METHODS: The study compared compare patients' pain, satisfaction, adverse events, and sedation depth during extraction of third molars using a sedative protocol of intravenous (IV; 1.0 µg/kg) versus intranasal (IN; 1.5 µg/kg) administration of dexmedetomidine. In total, 240 patients were randomized, 160 patients received dexmedetomidine, and data, including the amount of agent used, visual analog scale (VAS) pain score, adverse events, VAS score of patient satisfaction, and bispectral index, were recorded. RESULTS: Patients in the dexmedetomidine groups reported lower VAS pain scores and higher VAS satisfaction scores than patients in the local anesthesia group. There were no statistically meaningful differences between dexmedetomidine groups. Sedation with the IV route was slightly deeper than with the IN route. However, there were no statistically meaningful differences. CONCLUSION: IN or IV administration of dexmedetomidine is recommended as an effective, safe, and competent protocol in outpatient sedative surgeries.

Combined effects of mineral trioxide aggregate and human placental extract on rat pulp tissue and growth, differentiation and angiogenesis in human dental pulp cells.

OBJECTIVE: The aim of this study was to evaluate the combined effects of mineral trioxide aggregate (MTA) and human placental extract (HPE) on cell growth, differentiation and in vitro angiogenesis of human dental pulp cells (HDPCs) and to identify underlying signal transduction mechanisms. In vivo dental pulp responses in rats for a pulp-capping agent were examined. MATERIALS AND METHODS: MTS assay. ALP activity test, alizarin red S staining and RT-PCR for marker genes were carried out to evaluate cell growth and differentiation. HUVEC migration, mRNA expression and capillary tube formation were measured to evaluate angiogenesis. Signal transduction was analysed using Western blotting and confocal microscopy. The pulps of rat maxillary first molars were exposed and capped with either MTA or MTA plus HPE. Histologic observation and scoring were performed. RESULTS: Compared to treatment of HDPCs with either HPE or MTA alone, the combination of HPE and MTA increased cell growth, ALP activity, mineralized nodules and expression of marker mRNAs. Combination HPE and MTA increased migration, capillary tube formation and angiogenic gene expression compared with MTA alone. Activation of Akt, mammalian target of rapamycin (mTOR), p38, JNK and ERK MAPK, Akt, and NF-κB were significantly increased by combining HPE and MTA compared with MTA alone. Pulp capping with MTA plus HPE in rats showed superior dentin bridge formation, odontoblastic layers and dentinal tubules and lower inflammatory cell response, compared to the MTA alone group. CONCLUSIONS: This study demonstrates for the first time that the use of MTA with HPE promotes cell growth, differentiation and angiogenesis in HDPCs, which were associated with mTOR, MAPK and NF-κB pathways. Direct pulp capping with HPE plus MTA showed superior results when compared with MTA alone. Thus, the combination of MTA and HPE may be useful for regenerative endodontics.

Odontoblastic Differentiation, Inflammatory Response, and Angiogenic Potential of 4 Calcium Silicate-based Cements: Micromega MTA, ProRoot MTA, RetroMTA, and Experimental Calcium Silicate Cement.

INTRODUCTION: The aim of this study was to analyze the effects of different calcium silicate-based cements (CSCs) for pulp capping materials including MicroMega MTA (MMTA; MicroMega, Besanchon, France), RetroMTA (RMTA; BioMTA, Seoul, Korea), ProRoot MTA (PMTA; Dentsply, Tulsa, OK), and experimental CSC (ECSC) on odontoblastic differentiation, in vitro angiogenesis, and the inflammatory response in human dental pulp cells. METHODS: Differentiation was evaluated by alkaline phosphatase activity, alizarin red staining, and reverse-transcriptase polymerase chain reaction (RT-PCR) for the marker genes. The levels of inflammatory mediators and cytokines were measured by RT-PCR and an enzyme-linked immunosorbent assay. In vitro angiogenesis was assessed by RT-PCR for angiogenic genes and an endothelial tube formation assay. RESULTS: PMTA, MMTA, and ECSC increased the alkaline phosphatase activity and mineralization nodule formation and up-regulated messenger RNA (mRNA) expression of odontoblastic markers compared with RMTA. In addition, PMTA, MMTA, and ECSC up-regulated the mRNA of angiogenic genes in human dental pulp cells and increased the capillary tube formation of endothelial cells compared with RMTA. However, all CSCs showed similar expression levels of inducible nitric oxide synthase and cyclooxygenase-2 protein as well as proinflammatory mediators such as nitric oxide, prostaglandin E2, tumor necrosis factor alpha, interleukin (IL)-1ß, IL-6, and IL-8 mRNA. CONCLUSIONS: Taken together, our experimental results suggest that all CSCs are favorable materials for pulp capping, but PMTA, MMTA, and ECSC may be recommended over RMTA.

Surface modification of titanium with hydroxyapatite-heparin-BMP-2 enhances the efficacy of bone formation and osseointegration in vitro and in vivo.

Surface-modified titanium (Ti) samples with hydroxyapatite (HAp) and heparin (Hep)-bone morphogenetic protein-2 (BMP-2) complex (Ti/HAp/Hep/BMP-2) were prepared, and their efficacies on the enhancements of bone formation and osseointegration in vitro and in vivo were examined as compared to Ti/HAp and Ti/Hep/BMP-2. The modified surfaces were characterized by X-ray photoelectron spectroscopy (XPS), scanning electron microscopy (SEM) and contact angle goniometry. In vitro studies revealed that MG-63 human osteosarcoma cell lines grown on Ti/HAp/Hep/BMP-2 increased the amounts of alkaline phosphatase (ALP) activity, calcium deposition and the levels of OCN mRNA gene expression as compared to those grown on Ti/HAp, Ti/Hep/BMP-2 or pristine Ti. Moreover, Ti/HAp/Hep/BMP-2 exhibited higher bone volume (BV), bone volume/tissue volume (BV/TV), removal torque value and bone-implant contact (BIC) than Ti/HAp, Ti/Hep/BMP-2 or pristine Ti in vivo. Histological evaluations showed that many desirable features of bone remodelling existed at the interface between Ti/HAp/Hep/BMP-2 and the host bone. Consequently, Ti/HAp/Hep/BMP-2 may have potential for clinical use as dental or orthopaedic implants.

Salvage of the condylar fracture: complication management of mandibular angle ostectomy.

A prominent mandibular angle is considered to be unattractive in Asians because it gives the face a square, coarse, and muscular appearance. Mandibular angle ostectomy has been known to be effective and to satisfy both surgeons and patients. However, a narrow surgical field hinders direct view of the site, making a procedure that is rather difficult to perform. Despite thorough presurgical planning and attention, there can be many complications and unfavorable results. A 21-year-old woman with right condyle process fracture was referred to Kyung Hee University Hospital at Gangdong. The patient was previously treated with mandibular angle reduction surgery at a local clinic. Via an extraoral approach, the condyle process was replaced and fixed using 1 long metal screw and one 2 × 2 square metal plate. We overcame the condylar fracture caused by mandibular angle ostectomy with reasonable reduction of the right condyle.

Quick and accurate measures in negative pressure pulmonary edema: a guideline for orthognathic surgeons.

Perioperative pulmonary edema is a rare complication of maxillofacial surgery. However, this potentially fatal complication may arise during any maxillofacial surgery. Negative pressure pulmonary edema can be caused by upper airway obstruction after operation. When this phenomenon arises, if not treated properly, it progresses rapidly causing fatal outcomes. Because orthognathic surgery is performed mostly on healthy and young patients, surgeons and anesthesiologists might neglect the possibility of such complications. Therefore, we must always take into consideration the possibility of negative pressure pulmonary edema. Careful observation of the patient; accurate knowledge; and active, quick, and noninvasive safe measures are required to treat this malady when it does occur. We report a case of negative pressure pulmonary edema after orthognathic surgery and its successful treatment.

A large sialolith on the parenchyma of the submandibular gland: A case report.

A 45-year-old female was referred to the Department of Oral and Maxillofacial Surgery with the complaint of pain in the right submandibular region and a dry mouth, which had started one week previously. A clinical examination revealed a swelling and tenderness in the right submandibular region. Panoramic radiography and computed tomography identified a sialolith in the submandibular gland. Surgery on the sialolith was subsequently completed under general anesthesia extraorally. A brownish stone was present in the parenchyma of the submandibular gland, measuring 14×10 mm.

Arch coordination does not affect the stability in class III orthognathic surgery patients.

The purpose of this study was to evaluate if the arch coordination manifested by preorthodontics had an effect on the short-term stability after orthognathic surgery by evaluating the B point, menton, overjet, and overbite. The subjects were 10 healthy adult female and male Koreans (mean age, 24.9 years) with insufficient arch coordination and 10 healthy adult female and male Koreans (mean age, 22 years) with sufficient arch coordination. All subjects had sagittal split ramus osteotomy with 1-piece maxillary Le Fort I surgery with/without genioplasty done from the same practitioner at Kyung Hee University Hospital at Gangdong from 2009 to 2011. All arch widths of the maxilla and mandible were measured. Cephalometric tracings of the subjects were made of the presurgical and postsurgical period with a follow-up at 3 months. Relapse was measured according to cephalometric tracing changes using the V-ceph Cephalometric Analysis Software version 5.5(Osstem, Seoul, South Korea). Insufficient arch coordination did not definitively affect the overall treatment outcome. There was significant difference in the horizontal dimensions of the mandible (vertical plane to point B, overjet) in the study group. The study group showed instability in orthodontic factors, whereas skeletal factors were stable. Vertical dimensions (horizontal plane to point B, horizontal plane to menton, overbite) were not statistically significant.

Minimal invasive and cost-effective method in reduction of maxillofacial fracture by using a Foley catheter ballooning technique.

The purpose of this study was to introduce 2 successful cases of orbital inferior wall fracture and maxillary sinus anterior wall fracture using the Foley catheter ballooning technique. One patient is a 43-year-old man with left orbital inferior wall fracture. A window on the sinus was made for visualization, and a Foley catheter was accessed through the natural ostium. The ballooned catheter was inflated to lift the inferior orbital wall rim and stationed for 2 weeks. The window was closed using metal plates and screws. Another patient is a 64-year-old woman with right maxillary sinus anterior wall fracture, nasal fracture, and orbital blow-out fracture. A Foley catheter was accessed through the fractured maxillary sinus and reduced into place and fixed with absorbable plates screws. The technique of stabilization of reduced maxillofacial fractures using a Foley balloon catheter with restorable plates and titanium plates showed stable results. This technique is relatively easy to undergo with minimal or no complications because of reduced operation time. Also, it is cost-effective compared with other materials providing similar results and heightens patient satisfaction.

Involvement of Nrf2-mediated upregulation of heme oxygenase-1 in mollugin-induced growth inhibition and apoptosis in human oral cancer cells.

Although previous studies have shown that mollugin, a bioactive phytochemical isolated from Rubia cordifolia L. (Rubiaceae), exhibits antitumor effects, its biological activity in oral cancer has not been reported. We thus investigated the effects and putative mechanism of apoptosis induced by mollugin in human oral squamous cell carcinoma cells (OSCCs). Results show that mollugin induces cell death in a dose-dependent manner in primary and metastatic OSCCs. Mollugin-induced cell death involved apoptosis, characterized by the appearance of nuclear shrinkage, flow cytometric analysis of sub-G1 phase arrest, and annexin V-FITC and propidium iodide staining. Western blot analysis and RT-PCR revealed that mollugin suppressed activation of NF- κ B and NF- κ B-dependent gene products involved in antiapoptosis (Bcl-2 and Bcl-xl), invasion (MMP-9 and ICAM-1), and angiogenesis (FGF-2 and VEGF). Furthermore, mollugin induced the activation of p38, ERK, and JNK and the expression of heme oxygenase-1 (HO-1) and nuclear factor E2-related factor 2 (Nrf2). Mollugin-induced growth inhibition and apoptosis of HO-1 were reversed by an HO-1 inhibitor and Nrf2 siRNA. Collectively, this is the first report to demonstrate the effectiveness of mollugin as a candidate for a chemotherapeutic agent in OSCCs via the upregulation of the HO-1 and Nrf2 pathways and the downregulation of NF- κ B.

Salvation for hardware failure of resorbable fixation plates in bilateral mandibular angle fractures.

The resorbable fixation system is used for the treatment of facial bone fractures and has many merits. It does not require a fixture removal procedure and is biologically nontoxic. Also, it does not disturb normal growth in growing children. However, there are also many points to be considered, such as resorption time, foreign body reaction, infection rate, or fixation stability depending on the fracture pattern. Because of these factors, there is still controversy over the use of a resorbable system.We present a case of a patient who experienced malunion after using a resorbable fixation system to treat bilateral mandibular angle fracture, which was recovered by corrective osteotomy and vertical ramus osteotomy in our department.