Application of hydroxyapatite-coated implants as support for palatal lift prostheses in edentulous patients with cleft palate: a clinical report.

A palatal lift prosthesis (PLP) is a prosthetic speech aid used to compensate for palatopharyngeal incompetence. However, it requires dental abutments to facilitate its function. In two edentulous patients with cleft palate, hydroxyapatite-coated dental implants were used to increase PLP retention. In both cases, palatopharyngeal closure was obtained and PLP function was deemed effective, as determined by speech evaluation and nasal air flow measurements, for more than 3 years. This treatment is useful for enhancing the retention of a PLP in patients who have few or no remaining natural tooth abutments.

Peri-implant tissue reaction in bone irradiated the fifth day after implantation in rabbits: histologic and histomorphometric measurements.

To evaluate tissue reaction to cobalt 60 irradiation around implant materials used in maxillofacial surgery, 2.0-mm titanium alloy bone screws and 2.0-mm cylindrical solid hydroxyapatite implants were placed in mandibular bone of rabbits and irradiated with a single 15-Gy dose on the fifth postoperative day. Tissue reaction around the implants was examined histologically and histomorphometrically at 7, 14, 28 and 56 days after irradiation. Mature bone was relatively radioresistant, but newly formed bone around both implants was damaged by irradiation in several places. After irradiation, the beginning of bone formation was delayed and the amount of new bone formed was less. Bone-implant contact measured histomorphometrically was less in the irradiated group than in the nonirradiated group. All titanium alloy screws showed bone contact, but two of eight hydroxyapatite implants failed after irradiation, probably the result of loss of primary stability of the cylindrical implants caused by radiation damage to newly formed bone.

Clinicoanatomic examination of the fibula: anatomic basis for dental implant placement.

The advantages of the free vascularized fibular flap include its ability to be shaped with relative ease and to be grafted at the same time tumors are resected, with consequent reduction in operation time. In addition, few complications occur at donor sites. However, a large, systematic, and detailed investigation of clinicoanatomic problems of the fibula has not been performed. Therefore, in the present study, the fibula was examined morphologically and morphometrically, with special attention to regions important in the placement of dental implants. Eighty fibulae obtained from cadavers of 41 Japanese individuals aged 46 to 92 years (mean, 72.7 years) were fixed with 70% alcohol after infusion of about 6 liters of 10% formalin via the femoral artery. Morphometric examination showed the nutrient foramen was located posteriorly in 85.0% of sections, the maximal width of fibular cross sections was 13.1 mm, and the maximal cortical thickness of fibular cross sections was 4.1 mm.

Functional effects of a free jejunum flap used for reconstruction in the oropharyngeal region.

Postoperative articulatory function was assessed in 5 patients who had had radical operations for cancers of the oropharyngeal region with surgical reconstruction using free jejunum flaps. A patient with total resection of the soft palate had the lowest scores of 39.9%. 4 patients with less resection than total removal of the soft palate had good scores (86.0%), and the articulatory dysfunction was limited only in plosive sounds produced in the velar region. A comparative study with glossectomized patients revealed that those who had had resection of the oropharynx achieved excellent articulation except for sounds produced in the velar region. The importance of operative function was stressed, to evaluate indications for the surgical technique for reconstruction of large tissue defects after ablation of head and neck cancers, and to improve the quality of life of those patients.

Factors contributing to skeletal relapse after surgical correlation of mandibular prognathism.

Postoperative follow-up and multiple regression analysis of skeletal relapse following mandibular setback were carried out to clarify the timing and causes of the relapse. The subjects were 24 mandibular prognathism patients. All patients underwent intraoral oblique sagittal splitting osteotomy with circumferential wiring and intermaxillary fixation for 8 weeks. Occlusal splints were not used. Postoperative positional changes of segments were evaluated by lateral cephalograms taken at appropriate intervals. Horizontal relapse was most evident within six months after surgery; vertical relapse seldom occurred. Multiple regression analysis revealed little association between preoperative morphological patterns and postoperative relapse. Although spatial changes of the proximal segment at operation and age of the patient were the best predictors for postoperative horizontal relapse, analysis indicated unsatisfactory prediction of vertical relapse because of its rare occurrence. Based on these results, the aetiology of relapse is discussed and two proposals are suggested for its prevention.

Improvement of speech intelligibility by a secondary operation to mobilize the tongue after glossectomy.

To prove the hypothesis that speech after glossectomy would be improved more by increasing the mobility of the remaining tongue rather than by increasing its volume, the speech intelligibility of 4 glossectomy patients was investigated before and after a secondary operation in which a split skin graft was used to mobilize the residual tongue. In each case, the postoperative speech intelligibility scores were higher than preoperative ones (case 1:83.6 to 97.2%, case 2: 76.6 to 82.5%, case 3: 51.5 to 58.5%, case 4: 30.2 to 49.3%). Sounds produced with the rear portion of the tongue were improved in 3 cases, and plosive and affricative sounds were remarkably improved in all cases. These results were considered to be due to the increased mobility, especially the mid and rear portions of the tongue.

Articulatory function in glossectomized patients with immediate reconstruction using a free jejunum flap.

Postoperative articulation in 18 glossectomized patients was investigated. The subjects were: 5 cases of tongue tumour, 7 cases of tumour of the anterior part of the floor of the mouth and 6 cases of tumour of the lateral part. A new modification of the Freiburger test for speech audiometry was used as test material. Then the articulatory function was assessed according to an overall score based on 180 monosyllables, the manner of production of 171 initial consonants and the place of production of 85 glossal sounds. The cases of tumour of the tongue and the lateral part of the floor of the mouth had excellent scores in all classes of sounds, which were compatible with the normative data. The subjects of tumour of the anterior part of the floor of the mouth had low overall scores, low scores for plosive and affricative sounds, and very low scores for sounds produced with the rear of the tongue. The relation between the site or amount of resection and subsequent articulation was significantly poor in all categories of sounds for the cases of anterior tumour, particularly in the movement of the posterior portion of the tongue even though it was not involved in the operation. In all groups there was a weak negative relation between the amount of resection and postoperative articulation. In reviewing the literature, reconstruction with a free jejunum flap was considered to lead to better articulation than reconstruction by other techniques. The need to assess postoperative function objectively was stressed, to compare the postoperative functions and to determine the indications for the reconstructive technique.

Anatomy of microvascular anastomosis in the neck.

Structural and morphometric investigations of the vessels of the neck region were carried out on 30 cadavers (15 male and 15 female in the age range of 45 to 93 years old) to gain more knowledge of the anatomy for microvascular surgery. Our results briefly are as follows: (1) The non-common-truck type of the external carotid artery (in which each branch arises separately from the external carotid artery) was found in 76.6 percent of cases, the truncus linguofacialis type was found in 21.7 percent, and the truncus thyrolingualis type was found in 1.7 percent. (2) The smallest internal diameter (the average was 1.2 mm) was found in the superficial cervical artery. (3) The largest internal diameter (4.4 mm) was measured in the external carotid artery. (4) The longest arterial section (127.8 mm) was measured between the clavicle and mandibular margin. This vascular section or stem consisted of three parts: the supraclavicular part of the common carotid artery, the proximal section of the external carotid artery, and the first 3 cm of the facial artery. (5) In 46.6 percent of cases, the facial, lingual, and superior thyroid veins joined together and formed a thyrolinguofacialis vein. (6) The type with one external jugular vein accounted for 83.0 percent of cases, and the type with one anterior jugular vein for 67.4 percent of cases. (7) The middle thyroid vein exhibited the smallest internal diameter (average of 2.0 mm). (8) The largest internal diameter (7.9 mm) was measured in the internal jugular vein. (9) The longest vessel to receive a vascular pedicle vein was the external jugular vein, the average length of which was 99.7 mm. (10) The frequency and location of valves in the facial vein were also determined.

Functional effects of intraoral reconstruction with a free radial forearm flap.

Postoperative articulation was investigated in patients who underwent glossectomy and reconstruction with free radial forearm flaps. The methods of evaluation consisted of scores for intelligibility of 100 Japanese syllables and 3 groups of glossal sounds. The glossal sounds, based on palato-lingual contact (lingogram), were useful to evaluate function of the respective parts of the tongue. One patient who had had a partial glossectomy and resection of the floor of the mouth achieved an overall score of 80.5% one year postsurgery, and his glossal sounds were also excellent. Three patients who underwent removal of the floor of the mouth and hemiglossectomy, excluding the root of the tongue, had overall scores ranging from 45.6% to 82.1%. Two of these had particularly low scores for the glossal sounds produced with the rear part of the tongue, and this suggested the necessity for suspension slings to prevent depression of the reconstructed tongue and the floor of the mouth. The hemiglossectomy with partial mandibulectomy had an acceptable score of 68.7%. Chronologically, the glossal sounds produced with the rear part and the blade of the tongue often tended to improve postsurgery.

Speech function following maxillectomy reconstructed by rectus abdominis myocutaneous flap.

Post-surgical maxillary defects have recently been reconstructed by microvascularized free flaps. However, few reports have evaluated the resulting speech function. This study compared the speech intelligibility of four maxillectomy patients who underwent reconstruction by rectus abdominis myocutaneous flaps (RAMCF) with that of four non-reconstructed patients who were treated with split-skin grafts and prostheses, to explore ways of achieving better speech function. Speech function was assessed by a Japanese language speech intelligibility test. Intelligibility scores ranged from 57.3% to 75.8% (mean, 70.4%) in the non-reconstructed group and from 66.2% to 77.2% (mean, 71.0%) in the reconstructed group. An analysis of articulatory manners and sites revealed that speech disorders resulted mainly from poor oronasal separation in the non-reconstructed group and from incorrect linguopalatal contact in the reconstructed group, especially for linguodentoalveolar and linguovelar sounds. Therefore, for higher speech function in the reconstructed group, dentoalveolar and palatal contours of the maxilla must be restored as closely as possible. This must also be done in patients whose maxillae are reconstructed by other types of microvascularized myocutaneous or cutaneous flaps that have similar postoperative palatal contours.

Palatal opening of the nasopalatine duct. A case report.

An unusual case of patent nasopalatine duct appearing in the central region of the hard palate in a young adult is reported. The origin and clinical symptoms of this anomaly are discussed.

Marked enlargement of the jaws in secondary hyperparathyroidism--a case report.

A case of facial deformity and malocclusion due to secondary hyperparathyroidism is presented. Treatment consisted of parathyroidectomy, followed by recontouring of the maxilla and mandible with additional dental treatment. A 3-D reconstruction of the computed tomography (CT) scan was helpful in evaluating the facial deformities and in treatment planning.

Congenital velopharyngeal incompetence in Kabuki make-up syndrome.

The Kabuki make-up syndrome is characterized by peculiar cranio-facial abnormalities, including cleft lip and palate. A case with velopharyngeal incompetence in a 7-year-old boy is reported. The significance of a possible association of this syndrome with congenital velopharyngeal incompetence is also discussed.

Tissue reaction around miniplates used for the fixation of vascularized iliac crest bone grafts.

MATERIAL/METHOD: In six miniature pigs revascularized autologous iliac crest bone grafts were fixed with two 2.0 mm titanium miniplates to a defined defect in the angle of the mandible. Tissue reaction around the implants was examined histologically and histomorphometrically at 2, 4, and 8 weeks after surgery. RESULTS: According to the evaluation of fluorescence microradiography, the cortical and medullary circulation and healing processes of bone in the vicinity of the implanted material were not disturbed after 2 weeks. At 4 weeks after surgery osseous healing occurred at the mandibula/graft interface. The histomorphometric results for the calculated percentage of direct bone/screw contact at 2 weeks were 24% with the grafted bone and 53% with the mandible. Intensive bone formation was observed in all parts of the graft by 4 weeks. The results of direct bone/screw. contact at 4 weeks were 56% and 64% and at 8 weeks 75% and 77% for the grafted and the mandibular bone, respectively. CONCLUSION: With 2.0 mm titanium miniplates used in the animal model, stable osteosynthesis and osseous healing was evident after 8 weeks of surgery. In addition, intensive remodeling of the transplanted bone without signs of creeping substitution was noted, and the bone/screw contact of the miniplate system increased with time.

Bone reactions around hydroxyapatite-coated implants in ovariectomized rats.

OBJECTIVE: The purpose of this study was to investigate bone reaction after implantation in an estrogen-deficient state by examining the changes in bone reactions within tissue surrounding implants in ovariectomized rats. STUDY DESIGN: Ninety-six 12-week-old female Wistar rats were used in the study; they were divided into 2 groups, an ovariectomized group and a sham-operated group. Hydroxyapatite-coated implants were placed in the proximal metaphyses of the tibiae 21 days after surgery. The tibiae were examined histologically by undecalcified sections at various intervals from 7 to 168 days after surgery. RESULTS: In the cortical bone area of the ovariectomized rats, the procedure did not induce any apparent changes in bone volume around the implant or in bone contact with the implant in comparison with the sham-operated rats. In contrast, both bone volume around the implant and contact of the implant with new bone were significantly decreased in the cancellous bone area in the ovariectomized rats in comparison with the sham-operated rats. CONCLUSIONS: Ovariectomy did not seriously affect bone healing after the placement of implants in cortical bone areas, but it reduced the bone contact ratio and the bone in the cancellous bone area.

[Studies on the host factors in the outbreak of odontogenic infection--the background factors of patients and the effect of serum after sleep deprivation on PMN chemotaxis].

These studies were carried out to investigate the background factors in the outbreak of acute infection of odontogenic origin. In the clinical study, fifty patients who suffered from acute odontogenic infection were compared with fifty symptom free controls with chronic odontogenic inflammation. The subjects were asked whether they had basal disease or not, and were given a series of questionnaires about the episodes of recent life changes (f.e. busy, decrease of sleeping time, travel etc) to measure the incidence of these background factors. In the experimental study, the effect of serum after 24 hours sleep deprivation on PMN chemotaxis in vitro was studied in six young volunteers. Chemotactic assays were performed with the modified Boyden chamber method. Results obtained were as follows: 1) The basal diseases were observed in 16 cases (32%) with acute odontogenic infection, and in 14 cases (28%) of controls. The incidence was not different statistically between both groups. 2) The incidence of background episodes in the patients were noted in 39 cases (78%) of patients and 10 cases (20%) of the controls (p less than 0.01). The predominant factor in these episodes were busy (36%), and decrease of sleeping time (30%) in the patient group. 3) Serum of all 6 subjects obtained after sleep deprivation showed depressed effects on PMN chemotaxis to chemotactic factor. (P less than 0.05). 4) Pre-exposure levels were regained in five of the six subjects within seven days after terminating the visil. These results suggest that fatigue plays a major role in the susceptibility to acute odontogenic infection by the alternation of PMN chemotaxis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Fundamental and clinical studies of long acting amoxicillin granules in oral and maxillofacial surgery infections].

Long acting amoxicillin granules (L-AMPC), a newly developed presentation of amoxicillin (AMPC), maintains an effective blood level for an extended period. The following results were obtained from fundamental and clinical studies of L-AMPC. Serum and gingiva levels of AMPC were measured in 5 patients at 2 (Patient 1), 3 (Patient 2), 4 (Patient 3), 5 (Patient 4) and 6 (Patient 5) hours. Serum levels were 4.1, 5.2, 3.0, 1.7 micrograms/ml and 1.2 micrograms/ml respectively, and gingiva levels were 1.3, 2.6, 2.1, 1.1 micrograms/g and 1.1 micrograms/g respectively. Twenty-five patients with oral and maxillofacial infections containing maxillary or mandibular osteitis were treated with L-AMPC. Clinical efficacy was assessed according to the criteria of numerical judgement established by the Japanese Society of Oral Surgery (1973) and also by the global evaluation of the clinician. In numerical judgement there were 1 excellent case, 19 good cases and 5 poor cases (efficacy ratio; 80%). The clinician's assessment was 4 excellent cases, 17 good cases, 3 fair cases and 1 poor case (84%). Although 2 slight side effects, diarrhea and black hairy tongue were observed, both treatments were completed without problem. L-AMPC therapy (b.i.d.) showed good prolonged tissue levels and satisfactory clinical results.

[Clinical studies on TMS-19-Q.O tablets, the preparation of a new macrolide antibiotic, in the field of oral surgery].

Multicenter clinical trial or TMS-19-Q.O tablet was performed to evaluate the usefulness in oral surgery. The results obtained were as follows: Clinical efficacy was assessed by clinical points. The patients entered into the trial were 77 cases with periodontitis, 23 with pericoronitis, 92 with osteitis of jaw and 18 with other infections, and the each effective rates were 80.5, 60.9, 83.7 and 72.2%, respectively. Overall effective rate was 79.0%. Isolation frequency of organisms were 33.8% in periodontitis, 34.8% in osteitis of jaw and 17.4% in pericoronitis. Bacteria isolated were aerobic organisms (63.1%) and anaerobic organisms (36.9%). TMS-19-Q.O tablet was well tolerated, and no adverse reaction was observed.

[Clinical evaluation of cefuroxime axetil in acute dental infections. Double blind comparative study vs. cefaclor].

To evaluate objectively clinical efficacy, safety and usefulness of cefuroxime axetil (CXM-AX) in acute dental infections (periodontitis, pericoronitis and gnathitis), we carried out a comparison study using cefaclor (CCL) as the control. Both drugs were orally given after meals in a dose level of 250 mg (potency) t.i.d. for 3-7 days. 1. Clinical efficacy rates in all the treated cases were 81.6% (102/125) in the CXM-AX group and 82.5% (104/126) in the CCL group according to the assessment by physicians in charge, and 89.6% (112/125) and 83.3% (105/126), respectively, according to the assessment based on scores. No significant difference was found between the 2 treatment groups. In clinical efficacy (assessment by score) classified by background factors, efficacy rate in the CXM-AX group (90.6%, 58/64) was significantly higher (P less than 0.05) than that in the CCL group (75.0%, 48/64) in cases receiving no surgical treatment on the first day of drug administration. Other background factors than the above (no surgical treatment) factor or scores on the first day of drug administration, however, did not appear to influence clinical efficacies of 2 treatment groups. 2. As for the bacteriological response in all the treated cases, elimination rate in the CXM-AX group was 73.7% (28/38) and that in the CCL group, 78.3% (36/46), without significant difference between the 2 groups. 3. Regarding the safety, no significant difference was found between the 2 treatment groups. Adverse reactions were observed in 1 out of 128 cases (0.8%) in the CXM-AX group and 6 out of 132 cases (4.5%) in the CCL group. Abnormal laboratory test values were noted in 8 out of 86 cases (9.3%) in the CXM-AX group and 5 out of 91 cases (5.5%) in the CCL group. None of these differences between 2 treatment groups was statistically significant. 4. Usefulness rates in all the treated cases were 81.6% (102/125) in the CXM-AX group and 81.7% (103/126) in the CCL group, thus significant difference was observed between the 2 groups. From the above results, CXM-AX is considered to be a useful drug like CCL in the treatment of acute dental infections.

[Studies of the concentration of cefoxitin in oro-maxillary tissues and serum (author's transl)].

We studied cefoxitin (CFX) concentration of oro-maxillary tissues in rats and in 18 patients by means of bioassay method. In rats, the highest peak concentrations were observed in the gingiva and buccal mucosa followed by the tongue, submaxillary gland, lower jaw bone and the masseter muscle in the order listed. In patients, the highest peak concentrations were observed in the maxillary sinus mucosa and peak concentrations in oro-maxillary tissues were from 1/5 to 2/3 of the corresponding serum concentrations. Further study is needed to elucidate the reason for the high peak CFX concentration in the maxillary sinus mucosa and the apparent delayed peak concentration in the salivary gland.