Oral-maxillofacial trauma of a geriatric population in a super-ageing country.

BACKGROUND/AIM: World population has been ageing, and oral-maxillofacial trauma of geriatric population is expected to increase. The aim of this study was to analyse the characteristic features of oral-maxillofacial trauma in the geriatric population. MATERIALS AND METHODS: Data from 127 patients aged 65 years old or older, who were treated for oral-maxillofacial trauma at the Department of Oral and Maxillofacial Surgery, Hirosaki University, from 2000 to 2014, were retrospectively analysed. The data from 292 patients aged 20-64 years were used as a comparison. RESULTS: Oral-maxillofacial trauma in the geriatric population had been increasing over 15-year period. The male to female ratio was 1.05:1 in the older group and 2.3:1 in the younger group. In the older group, 117 patients (92.1%) had one or more underlying systemic diseases, and 16 (12.6%) had suffered injuries in association with acute medical disorders. The most common injuries in the older group were bone fractures (46.5%). The ratio of fractures in the older group was lower than in the younger group (69.2%). Trauma in the older group most frequently occurred because of falls from a standing height or lower (52.0%), and the mandible was the most common site of fracture (74.6%). A conservative form of treatment for maxillofacial fractures was most commonly (86.4%) chosen for the older group, whilst surgical treatment was most commonly in the younger group (55.0%). CONCLUSION: Oral-maxillofacial trauma in the geriatric population shows characteristic features in terms of aetiology, patterns and treatment modalities.

Impalement of an unusual foreign body on the temporomandibular joint causing severe trismus.

A penetrating injury by a foreign body is comparatively common in the oral and maxillofacial region. On the other hand, injury to the temporomandibular joint (TMJ) by a foreign object is very rare. The TMJ is an anatomically narrow space surrounded by hard bony processes. An unusual case of trauma with severe trismus caused by a foreign body that impaled the TMJ is reported. A 55-year-old man presented with a 5 × 1-cm laceration to the right cheek caused by a flying object propelled during the use of a lawn mower. The edge of the foreign body had a metallic wire, which became imbedded in the wound. His jaw opening was severely limited. Computed tomography revealed that the foreign body was 3 mm in diameter and was impaled on the articular capsule. The object was successfully removed, and the wound and interior of the TMJ were irrigated. Rehabilitation of mouth opening was started on postoperative day 3. On day 9, mouth opening had improved to 35 mm, and he was discharged. After 1 year, mouth opening was 45 mm with no sign of any TMJ disorders.

Professional oral health care reduces oral mucositis pain in patients treated by superselective intra-arterial chemotherapy concurrent with radiotherapy for oral cancer.

PURPOSE: Oral mucositis (OM) is a painful complication of radiation therapy (RT) for head and neck cancer. OM can compromise nutrition, require opioid analgesics and hospitalization for pain control, and lead to interruption of treatment. Severe oral mucositis appears inevitable in superselective intra-arterial chemotherapy concurrent with radiotherapy (SSIACRT), requiring management of OM for the patient. The objective of this study was to assess the utility of professional oral health care (POHC) for the management of OM in patients undergoing SSIACRT. METHODS: Thirty-three patients were enrolled in this study. The first 17 patients underwent SSIACRT before we created an oral management team, and thus did not receive POHC. The remaining 16 patients received POHC. Fever duration, duration of oral feeding difficulty, opioid usage, duration of opioid administration, duration of hospitalization, and number of hospital days from the end of irradiation to discharge were compared between these two groups. RESULTS: Median total dose of morphine during SSIACRT, median number of hospital days from end of irradiation to discharge, and duration of hospitalization all differed significantly between groups (P < 0.05). Duration of opioid administration, fever duration, and duration of oral feeding difficulty did not differ significantly between groups. CONCLUSIONS: These findings indicate that POHC may reduce opioid use and shorten the hospital stay. Such results might be obtained through infection control by POHC. This report appears to be the first study to evaluate the efficiency of POHC in SSIACRT for oral cancer from the perspective of mucositis pain and opioid use.

Periosteum-derived cells respond to mechanical stretch and activate Wnt and BMP signaling pathways.

The periosteum supplies osteoblasts and nutrients for bone metabolism and is important for osteoblast differentiation and osteogenesis. Recently, periosteum-derived cells have been used for orofacial bone regeneration therapy. However, little is known about the function of the periosteum in physiological bone remodeling. On our hypothesis that the periosteum senses a mechanical stress to induce bone remodeling, we subjected human jaw bone periosteum cells (HJBPCs) to uniaxial stretching for 24 h and characterized their gene expression profiles by microarray analysis. Of62,976 genes detected, 550 genes related to bone metabolism were extracted, and 76 of these genes with large changes in gene expression were short-listed. The results indicated that mechanical stretch in HJBPCs regulated the expression levels of genes involved in the Wingless-type MMTV integration (Wnt) site, bone morphogenetic protein (BMP) signaling pathways, and inflammatory cytokines. We propose that periosteum-derived cells sense mechanical stress and then activate and regulate signals for osteoblast differentiation and osteogenesis.