Prenatal Counseling on Prenatal Diagnosis of Cleft Lip and/or Cleft Palate at Tokyo Dental College Ichikawa General Hospital.

Remarkable technological advances have been made in the field of medicine in recent years, one result of which is that a prenatal diagnosis of cleft lip and/or cleft palate (CL/P) is now possible. In this situation, it is extremely important to provide the parents with mental care from the moment they are informed. Here, we describe cases of CL/P treated at our hospital and how such a diagnosis and prenatal counseling are handled. A survey was carried out on 4 cases seen at our department between April 2013 and March 2014. Patients are referred to our department from local or our own obstetrics clinics on a prenatal diagnosis of CL/P based on findings from ultrasonography. If the case is a referral from outside, the patient will first be seen at our own obstetrics department. Our department may then be subsequently requested to provide the parents with prenatal counseling. Effort is made to reassure the parents that postnatal support will be provided, right from the start. Next, the multidisciplinary nature of the treatment process is explained. However, only the essential outline is given at first so as to avoid inducing unnecessary anxiety. A response is also given to any questions the parents may have. Our experience of giving such care leads us to believe that improvements are required in the way that explanations and assistance are provided. The number of cases in which prenatal counseling is required is expected to increase in future.

Quantification of negative aesthetic ratings in primary unrepaired unilateral cleft lip infants by modified paired comparison method.

OBJECTIVE: To quantify negative aesthetic ratings in primary unrepaired cleft lip infants by further refining our previously reported paired comparison method. DESIGN: The Thurstone paired comparison method was used to quantify negative aesthetic ratings of plaster facial models selected and ordered according to a table of paired random numbers. PATIENTS, PARTICIPANTS: A total of 30 facial models of unrepaired incomplete unilateral cleft lip infants were used in this study. Raters comprised 20 oral surgeons and anesthesiologists. RESULTS: Quantification of aesthetic ratings for the 30 face models of unrepaired incomplete unilateral cleft lip infants was obtained. The ratings ranged from 0 to 5.08. CONCLUSION: Quantification of the aesthetic ratings for the 30 face models will be used as objective variables in a multivariate analysis in the third stage of this ongoing study.

Intraosseous schwannoma originating in inferior alveolar nerve: a case report.

Schwannomas (neurilemmomas) are benign neoplasms derived from Schwann cells of the neurilemma and appear most frequently on the auditory nerve or peripheral nerves of the skin. They arise in the oral and maxillofacial region infrequently, and very rarely in the center of the jaw. We herein present a case of a rare mandibular intraosseous schwannoma derived from the main trunk of the inferior alveolar nerve in a 33-year-old man. Fusiform expansion in the mandibular canal was observed and a mass showing the target sign in the mandibular canal was confirmed on T2-weighted and Gd contrastenhanced T1-weighted MRI. Based on these findings, an inferior alveolar nerve-derived schwannoma or other benign nervous system neoplasm was diagnosed. A buccal side cortical bone flap in the mandibular molar region was removed to expose the mass, which was then peeled away from the nerve fibers and completely removed. Some inferior alveolar nerve fibers that were connected to the mass were removed at the same time, but the remaining nerve fiber bundle was preserved. Histopathology confirmed the diagnosis of a schwannoma with Antoni type A and Antoni type B regions. Although the patient experienced extremely mild paresthesia in the skin over the mental region and mental foramen at immediately after surgery, this had almost entirely disappeared at 7 years and 4 months later, and there has been no tumor recurrence.

Postoperative evaluation of grafted bone in alveolar cleft using three-dimensional computed tomography data.

Objective : Postoperative evaluation of bone formation in the alveolar cleft by computed tomography imaging has been reported. We quantitatively evaluated bone grafts in the alveolar cleft preoperatively and postoperatively using three-dimensional data and superimposition of images. Subjects : A total of 12 patients with complete unilateral cleft lip and palate (six left-sided and six right-sided) were studied. Methods : Helical computed tomography scans were taken immediately before surgery and at 6 months after surgery and the DICOM files obtained were processed using Mimics and 3-matic software for three-dimensional data analysis. The preoperative and postoperative computed tomography data were superimposed, and the position and length of the unerupted canines and width of the alveolar cleft measured. Results : Strong and significant correlations were observed between bone formation in the alveolar cleft bone graft region and preoperative canine position (r  =  -.766, p < .01) and canine length (r  =  .681, p < .05). Stepwise multiple regression analysis demonstrated that only the preoperative canine position was independently and significantly correlated with bone formation in the alveolar cleft. Conclusion : These results indicate that the optimal timing for surgery is when the canine cusp is close to the alveolar plane.

Three cases of distomolars.

The Frequency with which impacted supernumerary teeth are encountered in a clinical setting is relatively high, with the majority of such cases occurrig in the median maxillary region, and very few in the molar region. In the molar region, mandibular distomolars (fourth molars) are very rare. Although a small number of case reports have described impacted supernumerary distomolars, very few have compared third molars and distomolars. Herein, the authors report two cases involving mandibular distomolars and one case a maxillary distomolar. In each of these cases, the third molar and distomolar were extracted and a macroscopic morphological analysis conducted. The results were then compared with those of the latest available literature.

Congenital epidermoid cyst arising in soft palate near uvula: a case report.

Aberrant ectodermal tissues during the fetal period or acquired aberrant epithelial tissue due to trauma or surgery are thought to cause dermoid and epidermoid cysts. Their incidence is 7.0% in the head and neck region and only 1.6% in the oral cavity, where they mostly present in the floor of the mouth. On the other hand, they are extremely rare in the soft palate and uvula, and only six cases have been reported. Epidermoid cysts grow slowly and asymptomatically, and thus rarely cause oral dysfunction. However, cysts arising in the floor of the mouth can lead to developmental disorders due to impaired suckling and swallowing. This report describes a 4-week-old boy in whom an epidermoid cyst developed in the midline region of the soft palate close to the uvula. Decreased suckling ability led to a poor in body weight, so resection was performed at an early age. The histopathological diagnosis was epidermoid cyst.

Vertical fracture of mandibular condyle treated with intra-articular pumping therapy: a case report.

We report a patient with vertical fracture of the mandibular condyle visualized by computed tomography (CT). A 43-year-old woman visited our department the day after the injury occurred. At the initial examination, she experienced pain in the left temporomandibular joint (TMJ) when opening her mouth. Maximum mouth opening distance was 15 mm. Routine radiography showed normal findings, but CT revealed vertical fracture of the left mandibular condyle. Based on clinical findings, conservative therapy consisting of intra-articular pumping therapy and training for mouth opening was initiated. After 10 days, mouth opening distance increased to 36 mm, and pain in the left TMJ disappeared.