Data-based prediction of soft tissue changes after orthognathic surgery: clinical assessment of new simulation software.

The aim of the present study was to evaluate the accuracy of a novel simulation software package (OrthoForecast) for predicting the soft tissue profile after orthognathic surgery. The study included 15 patients with facial asymmetry (asymmetry group), 15 with a skeletal class II jaw relationship (class II group), and 15 with a skeletal class III jaw relationship (class III group). Twenty-four feature points were digitized, and the distances between points on the predicted and actual postoperative images were compared. Thirty-seven calibrated evaluators also graded the similarity of the predicted images compared to the actual postoperative photographs. Comparisons between the predicted and actual postoperative images revealed that the mean difference between feature points was 3.1 ± 1.4 mm for the frontal images and 2.9 ± 0.8 mm for the lateral images in the asymmetry group; 2.7 ± 0.9 and 2.1 ± 1.6 mm, respectively, in the class II group; and 1.8 ± 1.2 and 1.7 ± 1.0 mm, respectively, in the class III group. More than half of the evaluators assessed the predicted images as similar to the actual postoperative images in all groups. In conclusion, OrthoForecast can be regarded as useful, accurate, and reliable software to predict soft tissue changes after orthognathic surgery.

Characterization of soluble thrombomodulin fragments in human urine.

The soluble thrombomodulin (TM) subspecies in human urine detected by polyclonal anti-human TM IgG were isolated and characterized. 105, 85, 80, 56, 33, 31 and 28 kDa subspecies under reducing conditions was comparable to 78, 66, 56, 200, 52, 30 and 25 kDa under non-reducing conditions, respectively, in the two-dimensional electrophoresis. Each subspecies under non-reducing conditions, except the 200 and 52 kDa molecules, was constituted of single subspecies, whereas the 200 and 52 kDa molecules were constituted of the tetramer of the 56 kDa subspecies of reducing conditions and a dimer of the 33 kDa subspecies, respectively. NH2-terminal amino acid sequences of the 105, 85 and 80 kDa subspecies maintained Ala1-Pro2-Ala3- of intact human TM, however, 56, 33, 31 and 28 kDa subspecies started from Glu137-Gln138-, Gln214-Gly215-, Ser228-Val229- and Ala240-Ile241-, respectively. All subspecies obtained under non-reducing conditions exhibited cofactor activity for thrombin-dependent protein C activation ranging from 58 to 162 pmol APC/min/nmol TM at 0.4 mM Ca2+ indicating that all of the subspecies maintained the fourth to sixth repeat of epidermal growth factor-like structure of intact TM. 85, 80, 56, 33, 31 and 28 kDa subspecies were suggested to lack both chondroitin sulfate glycosaminoglycan (CSGAG), transmembrane and cytoplasmic domains of intact TM, while 105 kDa subspecies lack only CSGAG from the results of kinetic properties and the interaction with phospholipid vesicles composed from phosphatidylcholine and phosphatidylethanolamine.

Osteochondroma of the mandibular condyle: a case report and review of the literature.

Osteochondroma is rarely found in the oral and maxillofacial regions. A rare case of osteochondroma affecting the mandibular condyle of a 46-year-old Japanese woman is reported. Clinical examination revealed facial asymmetry, malocclusion, and a palpable hard mass in the right temporomandibular joint (TMJ). Radiologically, the lesion was visualized as a radiopaque mass in the same region, but no destructive features were evident. Three-dimensional computed tomography was employed for estimating the stereographic extension of the lesion, which seemed to develop from the anterior portion of the condylar neck, and extend to the condylar head. The patient underwent tumor excision and condyloplasty under a clinical diagnosis of benign TMJ tumor. The histopathological diagnosis was osteochondroma of the mandibular condyle, and the lesion consisted of proliferative bony and hyalinized cartilage-like tissues. Moreover, a cartilage cap, a characteristic feature of osteochondroma, was also observed. Thirty-eight cases of osteochondroma of the mandibular condyle described in the English literature, including the present case, were reviewed. The mean patient age was 39.7 years with a peak in the fourth decade, which was older than patients with tumors in the axial skeleton. There was no sexual predominance for tumors in either the mandibular condyle or axial skeleton. The histopathogenesis of this tumor developing in the mandibular condyle was also discussed.

Mandibular involvement in patients with multiple myeloma.

A survey of changes in the jaw bones of 38 patients with multiple myeloma revealed five cases with mandibular involvement. One case showed a pathological fracture of the mandibular angle, and in another case, a radiolucent area was found in the body of the mandible. These two clinical findings led to the diagnosis of multiple myeloma. The other three cases had no symptoms related to the oral region. All five cases also showed typical "punched-out" lesions in the skull. It is suggested that a skeletal radiologic survey including the jaw should be performed in patients with multiple myeloma.

Modified sagittal split ramus osteotomy with a reciprocating saw and new retractors.

Modified sagittal split ramus osteotomy with new instruments and a reciprocating saw is reported. With this modification, the sagittal separation of the ramus is performed by the reciprocating saw with an original wide-blade buccal retractor and a new lingual retractor, instead of the traditional channeled retractor. The wide-blade retractor is inserted to the buccal aspect of the mandibular ramus, which ensures protection from instrumental injury to the adjacent soft tissues and vessels, and the new lingual retractor, instead of the channeled retractor, is inserted to the lingual aspect of the ramus. The osteotomy line follows that of Dal Pont's modification. Close attention must be paid to the direction of the saw blade. The separated bone plane should be located in the external cortical bone layer of the ramus, so as to avoid injury of the inferior alveolar neurovascular bundle. The osteotomy is completed with the smooth osteotomized interface, which facilitates positioning of the bone segments by the surgeon. The new instruments and the reciprocating saw may provide safe and rapid sagittal split ramus osteotomy.

Soluble Flt-1 gene therapy for peritoneal metastases using HVJ-cationic liposomes.

Many studies have reported a close association between VEGF and tumor angiogenesis. The aim of the present study was to evaluate the effectiveness of gene therapy against cancer, including peritoneal metastasis, using a cDNA encoding a soluble type of Flt-1, one of the VEGF receptors. In a peritoneal metastasis model of MKN45 human gastric cancer cells, mice repetitively treated with intraperitoneal injections of HVJ-Fex, a type of HVJ-cationic liposome encapsulating a plasmid expressing soluble mFlt-1, exhibited smaller disseminated foci with fewer microvessels, thus resulting in a significantly longer survival period than the control mice. In another peritoneal metastasis model using HT1080S cells, a clone of HT1080 human fibrosarcoma cells stably transfected with hVEGF, treatments with HVJ-Fex also reduced the growth of disseminated foci without ascites formation. In conclusion, this study demonstrated that the peritoneal metastases of some cancers were largely dependent on VEGF, and that the repeated intraperitoneal transduction of a soluble flt-1 gene using HVJ-cationic liposomes suppressed peritoneal metastases, thereby contributing to a longer survival period.