Analysis of the relevant factors associated with oral health-related quality of life in elderly denture wearers.

PURPOSE: The purpose of the present study was to explore the factors related to oral health-related quality of life (OHRQoL) in elderly patients who underwent prosthetic treatment with removable dentures through several objective and subjective examinations and to analyze their interrelationships. METHODS: The current study involved 78 denture wearers, aged 65 years or above, who underwent treatment at the clinic of prosthodontics and undertook routine checkups. The present study used eight age-matched patients with healthy dentition as controls. The following items were evaluated: OHRQoL (Oral Health Impact Profile), main occluding area, maximal occlusal force, masticatory performance, and masticatory ability. Spearman's rank correlation coefficient was used to assess the correlation between the OHIP score and each item and multiple linear regression analysis with the backward elimination method was used to analyze the factors affecting the OHIP score (α = 0.05). RESULTS: The OHIP summary score was significantly correlated with the number of occlusal supports, number of remaining teeth, maximal occlusal force, and the masticatory ability score. The multiple regression analysis revealed that the number of occlusal supports, the number of remaining upper teeth, whether the upper main occluding area was the remaining tooth or not, and the masticatory ability score were the significant independent variables that affected the OHIP summary scores. CONCLUSION: The present study verified the relationship between the OHRQoL and the occlusion of remaining teeth or the items derived from the main occluding areas. The current results suggest that retaining the maxillary first molar is a key factor in the OHRQoL.

Accuracy of removable partial denture framework fabricated by casting with a 3D printed pattern and selective laser sintering.

PURPOSE: The present study aimed to compare the accuracy of removable partial denture (RPD) frameworks fabricated by 3D-printed pattern casting and those fabricated by selective laser sintering (SLS). METHODS: A partially edentulous mandibular model was used for the simulation model. Scanning of the model was performed using a dental scanner. The framework was designed by using CAD software. The 3D-printed resin pattern was formed using a 3D printer and casting was performed (AM-Cast framework), and a direct metal laser sintering machine was used for the framework of SLS (SLS framework). 3D scanning of fabricated two types of framework were performed, and these data were overlapped with design data. Fabrication accuracy was verified using the Mann-Whitney U test to compare the discrepancy between the AM-Cast and SLS frameworks. RESULTS: The range of differences for the AM-Cast and SLS framework were -0.185±0.138 to 0.352±0.143mm and -0.166±0.009 to 0.123±0.009mm, respectively. Statistically significant differences were observed at the rests, proximal plates, connectors, and clasp arms. Regarding the rests, both lateral and medial displacement in the two types framework was observed in relation to the design data. Large lateral discrepancies of the connectors were observed at the joining area on the tooth-supported side of the lingual bar for the AM-Cast framework. Localized discrepancies were observed at the center of the lingual bar for the SLS framework. CONCLUSION: The accuracies of RPD frameworks fabricated by AM-Cast and SLS differ depending on the specific structural component of the RPD.

Rathke Cleft Cyst with Evidence of Rupture into Subarachnoid Space.

BACKGROUND: A Rathke cleft cyst (RCC) with nonhemorrhagic rupture mimicking pituitary apoplexy has been reported rarely. CASE DESCRIPTION: A 52-year-old woman, previously diagnosed with asymptomatic RCC, came to us with a severe headache, along with visual dysfunction and symptoms of pituitary insufficiency. Fluid-attenuated inversion recovery magnetic resonance imaging demonstrated diffuse hyperintensity in the cerebral cisterns, whereas watery clear cerebrospinal fluid was obtained by lumbar puncture. Surgery performed 1 month after onset revealed a nonhemorrhagic lesion, with a final diagnosis of nonhemorrhagic RCC rupture. CONCLUSIONS: We conclude that nonhemorrhagic RCC rupture and subsequent leakage of the contents into subarachnoid space were the underlying pathogenesis in the present case of RCC resembling apoplexy.

Acute Subdural Hematoma in a Judo Player with Repeated Head Injuries.

BACKGROUND: Acute subdural hematoma (ASDH) is the most important cause of severe head injuries occurring during judo practice in Japan. Repeated head injuries have been reported as a cause of fatal ASDH, although the mechanism remains unknown. CASE DESCRIPTION: A 16-year-old boy visited an emergency department with vomiting 3 days after a strong blow to the occipital region during judo practice. Although computed tomography was performed at that time, a small interhemispheric ASDH was overlooked. The patient sustained another head injury 19 days after the first, which led to convulsions and disturbance of consciousness. The ASDH was increased in size on computed tomography. We performed a surgical evacuation, which revealed tearing of a bridging vein, after which the patient showed a good recovery. CONCLUSIONS: It is important to be aware of the possibility of a small ASDH in concussed judo players after an initial impact, which may lead to subsequent fatal ASDH after another impact incident.

[Case Report of a Suspected Extrapontine Myelinolysis due to Hyperglycemic Hyperosmolar Syndrome].

A 68-year-old female, who suffered from depression, fell down the stairs in her house. She was soon transferred to an accident and emergent ward by an ambulance. Two days later, she was transferred and admitted to our hospital. Next day after admission to our ward, her consciousness level changed for the worse. She developed diabetic ketoacidosis, and was administered insulin during reinfusion. Next day, her diabetic ketoacidosis improved;however, her consciousness level was still poor. Brain magnetic resonance imaging(MRI)showed suspected osmotic myelinolysis lesions in the bilateral cerebellar hemisphere and globus pallidus. After conservative therapy, her lesions almost disappeared in 2 months. We diagnosed the lesions as reversible extrapontine myelinolysis.

Normal pressure hydrocephalus caused by a spinal neurinoma at the cauda equina level: a case report.

Neurinomas are common space-occupying lesions located in the spinal canal. Many reports concerning their clinical characteristics, diagnoses, treatments, and operative results have been published. Some case reports have discussed spinal neurinomas located at the cauda equina level. However, there is little information on their natural history. Here, we report a case of spinal neurinoma located at the cauda equina level, which caused normal pressure hydrocephalus (NPH). All symptoms resulting from the NPH were resolved by tumor removal. These findings suggested that if a spinal neurinoma located at the cauda equina level causes symptoms due to NPH, then removal of the tumor should be considered, when appropriate removal procedures are possible.

Spinal subdural hematoma associated with traumatic intracranial interhemispheric subdural hematoma.

A 78-year-old female fell and hit the back of her head on the floor. Head computed tomography (CT) showed right acute interhemispheric subdural hematoma (ISDH). Her left hemiparesis worsened, so partial removal of ISDH was performed. The hemiparesis was improved, but leg monoparesis persisted. Lumbar magnetic resonance imaging showed spinal subdural hematoma (SSDH) at the S1-2 level. Nerve conduction velocity measurements at the knee joint to lower limb showed disappearance of the left peroneal nerve conduction wave, indicating that one of the causes of drop foot was common peroneal nerve palsy. With conservative therapy, her drop foot was gradually improved, then she recovered to walk with a stick and moved to a rehabilitation hospital. Lumbar MR imaging should be performed to rule out SSDH in a patient with posterior fossa subdural hematoma on initial head CT who develops leg palsy.

Neurogenic stress cardiomyopathy following aneurysmal subarachnoid hemorrhage in a very elderly patient--case report.

A 90-year-old woman presented with aneurysmal subarachnoid hemorrhage (SAH) corresponding to Hunt and Hess grade II. Acute congestive heart failure and pulmonary edema developed following uneventful surgical clipping. Serial electrocardiography and echocardiography led to a diagnosis of neurogenic stress cardiomyopathy (NSC), also known as tako-tsubo cardiomyopathy. The outcome was favorable after supportive therapy with respiratory management and diuretic administration. Neurosurgeons treating SAH must take into account the various general treatment strategy options on a case by case basis after prompt recognition of NSC.

Giant frontal mucocele extending into the anterior cranial fossa.

The authors report a patient with a huge frontal mucocele presenting with transient left hemiparesis. Magnetic resonance imaging and computed tomography showed the huge frontal mucocele arising from the frontal sinus extending to the anterior cranial fo ssa. Right middle cerebral artery stenosis was seen on the carotid angiography. The mucocele was treated with Killian's surgery. On the postoperative seventh day, the patient showed massive cerebrospinal fluid leakage that ceased with conservative management. The patient was discharged from the hospital without any neurological deficit. We discuss the clinical symptoms and postoperative course of the huge frontal mucocele with intracranial extension.