Analysis of the sublingual artery using contrast-enhanced computed tomography

This in vivo study aimed to clarify the position of the sublingual artery (SLA) relative to the mandibular bone and to infer the potential risk for injury during dental implant surgery. Contrast-enhanced computed tomography images of the mouth of 50 edentulous patients (100 sides) treated at Tokushima University Hospital were reviewed. Curved planar reconstructed images perpendicular to the alveolar ridge were processed and classified into molar, premolar, canine, and incisor regions. The SLA and its branches were identified, and the distance from the mandible to the SLA was measured. The SLA was located close to the mandible (<2 mm) in the molar, premolar, canine, and incisor segments in 12.0% (95% confidence interval 5.6%-18.4%), 20.6% (12.6%-28.7%), 30.5% (21.3%-39.8%), and 41.8% (28.8%-54.9%) cases, respectively. The SLA was located within ±3 mm craniocaudally to the upper wall of the mandibular canal in the molar and premolar regions in 50% of cases and within ±5 mm craniocaudally to the mylohyoid ridge in the canine and incisor regions in the other cases, with no sex or age-related differences. The vertical distance from the alveolar ridge to the SLA was influenced by sex and age owing to alveolar resorption, indicating that the alveolar ridge is not a reliable reference for predicting SLA position. As the risk of SLA injury always exist during dental implant placement and there is no way to confirm the SLA pathways in a patient, clinicians must avoid injuring the sublingual soft tissue.

Clinical Implant Dentistry and Related Research


A case of fishbone in the tongue that migrated toward the hyoid bone

舌骨近傍に移動した舌内迷入魚骨の1例

Japanese Journal of Oral & Maxillofacial Surgery


Comparison of bioresorbable bone substitutes, carbonate apatite and β-tricalcium phosphate, for alveolar bone augmentation with simultaneous implant placement.


Reconstruction of rabbit mandibular bone defects using carbonate apatite honeycomb blocks with an interconnected porous structure.

Carbonate apatite (COAp) granules are useful as a bone substitute because they can be remodeled to new natural bone in a manner that conforms to the bone remodeling process. However, reconstructing large bone defects using COAp granules is difficult because of their granular shape. Therefore, we fabricated COAp honeycomb blocks (HCBs) with continuous unidirectional pores. We aimed to elucidate the tissue response and availability of COAp HCBs in the reconstruction of rabbit mandibular bone defects after marginal mandibulectomy. The percentages of the remaining COAp area and calcified bone area (newly formed bone) were estimated from the histological images. COAp area was 49.1 ± 4.9%, 30.3 ± 3.5%, and 25.5 ± 8.8%, whereas newly formed bone area was 3.0 ± 0.6%, 24.3 ± 3.3%, and 34.7 ± 4.8% at 4, 8, and 12 weeks, respectively, after implantation. Thus, COAp HCBs were gradually resorbed and replaced by new bone. The newly formed bone penetrated most of the pores in the COAp HCBs at 12 weeks after implantation. By contrast, the granulation tissue scarcely invaded the COAp HCBs. Some osteoclasts invaded the wall of COAp HCBs, making resorption pits. Furthermore, many osteoblasts were found on the newly formed bone, indicating ongoing bone remodeling. Blood vessels were also formed inside most of the pores in the COAp HCBs. These findings suggest that COAp HCBs have good osteoconductivity and can be used for the reconstruction of large mandibular bone defects. The COAp HCB were gradually resorbed and replaced by newly formed bone.

Journal of Materials Science. Materials in Medicine


ピロカルピン塩酸塩を用いた口腔リンス法の有用性と安全性の検討

ピロカルピン塩酸塩を用いた口腔リンス法の有用性と安全性の検討


Alveolar ridge preservation in beagle dogs using carbonate apatite bone substitute


Association of PD L1 and ZEB 1 expression patterns with clinicopathological characteristics and prognosis in oral squamous cell carcinoma

Programmed cell death-1 (PD-1) and its ligand programmed cell death 1 ligand 1 (PD-L1) are immune checkpoint inhibitors that play an important role in the host immune avoidance mechanism of tumors. The relationship between PD-L1 expression and malignancy has been reported in various types of cancer, such as lung and gastric cancer. In addition, epithelial-mesenchymal transition (EMT) of cancer cells is deeply involved in the invasion and metastasis of cancer. It has been reported that zinc finger E-box binding homeobox 1 (ZEB-1), an EMT inducer, contributes to metastasis in pancreatic and colon cancer. The present study aimed to investigate the relationship between the expression patterns of two markers, PD-L1 and ZEB-1, and clinicopathological characteristics and prognosis of oral squamous cell carcinoma (OSCC). Biopsy or surgical excision specimens from 169 patients with OSCC were used in the present study. Immunohistochemical staining with monoclonal anti-PD-L1 antibody and anti-ZEB-1 antibody was conducted. Cases with >1% tumor cells positive for PD-L1 and those with >10% tumor cells positive for ZEB-1 were considered positive, respectively. The findings revealed that individual expression of PD-L1 and ZEB-1 in OSCC was not associated with tumor size, degree of differentiation or Yamamoto-Kohama invasion pattern classification. However, co-expression of PD-L1 and ZEB-1 was associated with higher cervical lymph node metastasis and a lower survival rate. In conclusion, the results of the present study indicated that co-expression of PD-L1 and ZEB-1 could serve as a potential marker for the prognosis of patients with OSCC.


Staged Sinus Floor Elevation Using Novel Low-Crystalline Carbonate Apatite Granules: Prospective Results after 3-Year Functional Loading.


A clinical study on malignant lymphomas arising in the oral region

口腔領域に発症した悪性リンパ腫の臨床的検討

We examined the clinical characteristics of 18 cases of malignant lymphomas arising in the oral region which were diagnosed at our department during the 11 years from 2008 to 2018. The patients consisted of 10 males and 8 females whose mean age was 70.2 years. The primary site was the upper gingiva in 10 cases (55.6%), and the initial symptoms were tumor mass and swelling in 15 cases (83.3%). Only 7 cases (38.9%) were clinically diagnosed as malignant lymphoma at first visit, but the other 11 cases were difficult to diagnose correctly. The various clinical symptoms such as mass formation and ulcer made differential diagnosis difficult, and a definitive diagnosis could not be obtained by only a single biopsy. Therefore, we examined whether blood test results might be used as an indicator of the diagnosis or not. Our results showed that LDH in 8 of 17 cases (47.1%) and sIL-2R in 11 of 16 cases (68.8%) were high values. Furthermore, we examined whether lymphocyte-monocyte ratio (LMR) helped the diagnosis or not. Thirteen of 17 cases (76.5%) showed a low value of LMR. There was a significant difference in LMR compared to non-malignant lymphoma patients. LMR in the blood tests was also considered to be a useful marker for the diagnosis.

2008年から2018年までの11年間に当科で口腔領域に発症した悪性リンパ腫の18例について臨床的特徴を調べた．患者は，平均年齢が70.2歳の男性10例，女性8例であった．原発部位の10例(55.6%)は上顎歯肉で，初期症状は15例(83.3%)で腫瘤と腫脹であった．7例(38.9%)が初診時に臨床的に悪性リンパ腫と診断されたが，その他の11例は正しく診断することが困難であった．腫瘤形成や潰瘍のような様々な臨床症状が診断を困難にしており，1回の生検では確定診断が得られなかった．そこで，血液検査値が診断の指標であるかどうかを検討した．われわれの結果は，17例中8例のLDH(47.1%)と16例中11例のsIL-2R(68.8%)が高い値を示していた．さらに，われわれはリンパ球/単球数比(LMR)が診断に役立つかどうかを調べた．LMRの値は，17例中13例(76.5%)が有意に低く，非ML患者と比較しても有意差を認めた．以上のことより，LMRの血液検査も診断の補助的なマーカーであると考えられた．

Journal of Japan Society for Oral Tumors


Histological comparison of three apatitic bone substitutes with different carbonate contents in alveolar bone defects in a beagle mandible with simultaneous implant installation.

Since bone apatite is a carbonate apatite containing carbonate in an apatitic structure, carbonate content may be one of the factors governing the osteoconductivity of apatitic bone substitutes. The aim of this study was to evaluate the effects of carbonate content on the osteoconductivity of apatitic bone substitutes using three commercially available bone substitutes for the reconstruction of alveolar bone defects of a beagle mandible with simultaneous dental implant installation. NEOBONE, Bio-Oss, and Cytrans that contain 0.1, 5.5, and 12.0 mass% of carbonate, respectively, were used in this study. The amount of newly formed bone in the upper portion of the alveolar bone defect of the beagle's mandible was 0.7, 6.6, and 39.4% at 4 weeks after surgery and 4.7, 39.5, and 75.2% at 12 weeks after surgery for NEOBONE, Bio-Oss, and Cytrans, respectively. The results indicate that bone-to-implant contact ratio was the largest for Cytrans. Additionally, the continuity of the alveolar ridge was restored in the case of Cytrans, whereas the continuity of the alveolar ridge was not sufficient when using NEOBONE and Bio-Oss. Both Cytrans and Bio-Oss that have a relatively larger carbonate content in their apatitic structure was resorbed with time. We concluded that carbonate content is one of important factors governing the osteoconductivity of apatitic bone substitutes.

Journal of Biomedical Materials Research. Part B, Applied Biomaterials


Fabrication of porous carbonate apatite granules using microfiber and its histological evaluations in rabbit calvarial bone defects

Carbonate apatite (CO Ap) granules are known to show good osteoconductivity and replaced to new bone. On the other hand, it is well known that a porous structure allows bone tissue to penetrate its pores, and the optimal pore size for bone ingrowth is dependent on the composition and structure of the scaffold material. Therefore, the aim of this study was to fabricate various porous CO Ap granules through a two-step dissolution-precipitation reaction using CaSO as a precursor and 30-, 50-, 120-, and 205-μm diameter microfibers as porogen and to find the optimal pore size of CO Ap. Porous CO Ap granules were successfully fabricated with pore size 8.2-18.7% smaller than the size of the original fiber porogen. Two weeks after the reconstruction of rabbit calvarial bone defects using porous CO Ap granules, the largest amount of mature bone was seen to be formed inside the pores of CO Ap (120) [porous CO Ap granules made using 120-μm microfiber] followed by CO Ap (50) and CO Ap (30). At 4 and 8 weeks, no statistically significant difference was observed based on the pore size, even though largest amount of mature bone was formed in case of CO Ap (120). It is concluded, therefore, that the optimal pore size of the CO Ap is that of CO Ap (120), which is 85 μm.

Journal of Biomedical Materials Research. Part A


Application of low-crystalline carbonate apatite granules in 2-stage sinus floor augmentation: a prospective clinical trial and histomorphometric evaluation.

The purpose of this study was to elucidate the efficacy and safety of carbonate apatite (COAp) granules in 2-stage sinus floor augmentation through the radiographic and histomorphometric assessment of bone biopsy specimens. Two-stage sinus floor augmentation was performed on 13 patients with a total of 17 implants. Radiographic assessment using panoramic radiographs was performed immediately after augmentation and was also performed 2 additional times, at 7±2 months and 18±2 months post-augmentation, respectively. Bone biopsy specimens taken from planned implant placement sites underwent micro-computed tomography, after which histological sections were prepared. Postoperative healing of the sinus floor augmentation was uneventful in all cases. The mean preoperative residual bone height was 3.5±1.3 mm, and this was increased to 13.3±1.7 mm by augmentation with the COAp granules. The mean height of the augmented site had decreased to 10.7±1.9 mm by 7±2 months after augmentation; however, implants with lengths in the range of 6.5 to 11.5 mm could still be placed. The mean height of the augmented site had decreased to 9.6±1.4 mm by 18±2 months post-augmentation. No implant failure or complications were observed. Few inflammatory cells or foreign body giant cells were observed in the bone biopsy specimens. Although there were individual differences in the amount of new bone detected, new bone was observed to be in direct contact with the COAp granules in all cases, without an intermediate layer of fibrous tissue. The amounts of bone and residual COAp were 33.8%±15.1% and 15.3%±11.9%, respectively. In this first demonstration, low-crystalline COAp granules showed excellent biocompatibility, and bone biopsy showed them to be replaced with bone in humans. COAp granules are a useful and safe bone substitute for two-stage sinus floor augmentation. ICTRP Identifier: JPRN-UMIN000019281.

Journal of Periodontal & Implant Science


Effects of acidic calcium phosphate concentration on setting reaction and tissue response to β-tricalcium phosphate granular cement.

Beta-tricalcium phosphate granular cement (β-TCP GC), consisting of β-TCP granules and an acidic calcium phosphate (Ca-P) solution, shows promise in the reconstruction of bone defects as it sets to form interconnected porous structures, that is, β-TCP granules are bridged with dicalcium phosphate dihydrate (DCPD) crystals. In this study, the effects of acidic Ca-P solution concentration (0-600 mmol/L) on the setting reaction and tissue response to β-TCP GC were investigated. The β-TCP GC set upon mixing with its liquid phase, based on the formation of DCPD crystals, which bridged β-TCP granules to one another. Diametral tensile strength of the set β-TCP GC was relatively the same, at ∼0.6 MPa, when the Ca-P concentration was 20-600 mmol/L. Due to the setting ability, reconstruction of the rat's calvarial bone defect using β-TCP GC with 20, 200, and 600 mmol/L Ca-P solution was much easier compared to that with β-TCP granules without setting ability. Four weeks after the reconstruction, the amount of new bone was the same, ∼17% in both β-TCP GC and β-TCP granules groups. Cellular response to β-TCP granules and β-TCP GC using the 20 mmol/L acidic Ca-P solution was almost the same. However, β-TCP GC using the 200 and 600 mmol/L acidic Ca-P solution showed a more severe inflammatory reaction. It is concluded, therefore, that β-TCP GC, using the 20 mmol/L acidic Ca-P solution, is recommended as this concentration allows surgical techniques to be performed easily and provides good mechanical strength, and the similar cellular response to β-TCP granules. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B, 2019.


Maxillary Sinus Floor Augmentation Using Low-Crystalline Carbonate Apatite Granules With Simultaneous Implant Installation: First-in-Human Clinical Trial.

Carbonate apatite (COAp), an inorganic component of human bone, can be fabricated in chemically pure form from calcium carbonate block via a dissolution-precipitation reaction. A first-in-human clinical trial was conducted in which low-crystalline COAp granules were evaluated for safety and efficacy in sinus floor augmentation and simultaneous implant installation. Procedures were performed in 8 patients (9 implants) with 2 granule sizes: small (300 to 600 μm) and medium (600 to 1,000 μm). Panoramic radiographic assessment was performed immediately after augmentation, 7 ± 2 months after augmentation, 6 ± 2 months after prosthetic loading, and 12 ± 2 months after prosthetic loading. Postoperative healing was uniformly uneventful, with no abnormal bleeding, pain, or swelling, and all implants achieved successful osseointegration. The mean residual maxillary molar bone height was 5.2 ± 0.8 mm preoperatively and increased to 14.0 ± 1.9 mm after augmentation. Implants 9.0 to 11.5 mm in length were placed. The post-augmentation height decreased to 12.4 ± 1.3 mm at 7 ± 2 months; after prosthetic loading, it decreased to 11.9 ± 0.8 mm at 6 ± 2 months and 11.7 ± 0.6 mm at 12 ± 2 months. No abnormal bone resorption of the augmented areas was observed, and bone height supporting the implants was maintained. The overall implant survival rate was 100%, with no implant failures or complications during the first year. Low-crystalline COAp granules were useful and safe for sinus floor augmentation and simultaneous implant installation, providing a promising bone substitute for dental implant surgery.

Journal of Oral and Maxillofacial Surgery


Synergistic effect of surface phosphorylation and micro-roughness on enhanced osseointegration ability of poly(ether ether ketone) in the rabbit tibia.

This study was aimed to investigate the osseointegration ability of poly(ether ether ketone) (PEEK) implants with modified surface roughness and/or surface chemistry. The roughened surface was prepared by a sandblast method, and the phosphate groups on the substrates were modified by a two-step chemical reaction. The in vitro osteogenic activity of rat mesenchymal stem cells (MSCs) on the developed substrates was assessed by measuring cell proliferation, alkaline phosphatase activity, osteocalcin expression, and bone-like nodule formation. Surface roughening alone did not improve MSC responses. However, phosphorylation of smooth substrates increased cell responses, which were further elevated in combination with surface roughening. Moreover, in a rabbit tibia implantation model, this combined surface modification significantly enhanced the bone-to-implant contact ratio and corresponding bone-to-implant bonding strength at 4 and 8 weeks post-implantation, whereas modification of surface roughness or surface chemistry alone did not. This study demonstrates that combination of surface roughness and chemical modification on PEEK significantly promotes cell responses and osseointegration ability in a synergistic manner both in vitro and in vivo. Therefore, this is a simple and promising technique for improving the poor osseointegration ability of PEEK-based orthopedic/dental implants.


Surface plasma treatment and phosphorylation enhance the biological performance of poly(ether ether ketone).

Poly(ether ether ketone) (PEEK) has emerged as an alternative endosseous material to metal implants mainly because of its lack of allergic sensitivity and radiolucency, while maintaining similar mechanical properties with bone. However, a disadvantage of PEEK is its weak osseointegration ability compared with metal implants. To overcome this, we prepared a phosphate group-modified PEEK by plasma treatment and subsequent phosphorylation reaction. Plasma treatment and phosphate modification of PEEK changed its hydrophobic surface to a hydrophilic surface while maintaining the original surface topography and roughness. Phosphate modification increased the bioactivity of rat bone marrow stromal cells (BMSCs), including proliferation, alkaline phosphatase activity, and bone-like nodule formation; however, this effect was negligible in plasma-treated PEEK. In addition, phosphate modification attenuated the phenotypic polarization of lipopolysaccharide-primed RAW264.7 macrophages to an inflammatory phenotype, based on the finding that macrophages on phosphate-modified PEEK produced decreased levels of the inflammatory cytokine and increased levels of the anti-inflammatory cytokine. Finally, in an animal study, phosphate-modified PEEK exhibited a doubled pullout force from the femur bone cavity compared with bare PEEK. Thus, we conclude that phosphate modification can significantly improves the implant-bone bonding strength of PEEK by enhancing BMSCs activity and reducing excessive inflammation.


Compositional and histological comparison of carbonate apatite fabricated by dissolutionprecipitation reaction and Bio-Oss®.

Carbonate apatite (COAp) is an inorganic component of bone. This study aimed to compare the composition and tissue response to of COAp (COAp-DP) fabricated by the dissolution-precipitation reaction using calcite as a precursor and Bio-Oss®, which is widely used in orthopedic and dental fields as a synthetic bone substitute. X-ray diffraction and Fourier transform infrared results showed that COAp-DP and Bio-Oss® were both B-type carbonate apatite with low crystallinity. The average sizes of COAp-DP and Bio-Oss® granules were 450 ± 58 and 667 ± 168μ m, respectively, and their carbonate contents were 12.1 ± 0.6 and 5.6 ± 0.1 wt%, respectively. COAp-DP had a larger amount of CO than Bio-Oss® but higher crystallinity than Bio-Oss®. When a bone defect made at the femur of rabbits was reconstructed with COAp-DP and Bio-Oss®, COAp-DP granules were partially replaced with bone, whereas Bio-Oss® remained at 8 weeks after implantation. COAp-DP granules elicited a significantly larger amount of new bone formation at the cortical bone portion than Bio-Oss® at 4 weeks after the implantation. The results obtained in the present study demonstrated that COAp-DP and Bio-Oss® showed different behavior even though they were both classified as COAp. The CO content in COAp played a more important role than the crystallinity of COAp for replacement to bone and high osteoconductivity.

Journal of Materials Science. Materials in Medicine


Effect of micro-roughening of poly(ether ether ketone) on bone marrow derived stem cell and macrophage responses, and osseointegration.

Poly(ether ether ketone) (PEEK) has emerged as a candidate to replace metal implants because of its satisfactory mechanical properties, radiolucency, and lack of metal allergy. However, PEEK lacks osseointegration ability limiting its clinical applications. To overcome this problem, we prepared PEEK with a micro-rough surface using the sandblast method to modulate its osseointegration property; the sandblast method is simple, cost-effective, and is already applied to clinical metal implants. The surface roughness of the sandblasted PEEK was about 2.3 μm, whereas that of mirror-polished PEEK was 0.06 μm. Rat bone marrow-derived mesenchymal stem cells (RMSCs) showed higher proliferation, osteocalcin (OC) expression and bone-like nodule formation on micro-roughened PEEK compared with those cultured on mirror-polished PEEK, suggesting that micro-roughening facilitated RMSCs proliferation and differentiation. The micro-roughened surface slightly mitigated secretion of inflammatory C-C motif chemokine 2 (CCL-2) from lipopolysaccharide (LPS)-stimulated macrophages, but not of tumor necrosis factor α (TNFα) and interleukin-6 (IL-6). Finally, to compare osseointegration, specimens were implanted in rat femur bone marrow cavities, and then the pull-out force was measured. The pull-out force of micro-roughened PEEK was about four times higher than that of the mirror-polished PEEK. These results showed that micro-roughening of PEEK using the sandblast method was able to improve osseointegration, partly through elevating proliferation and differentiation of RMSCs.

Journal of Biomaterials Science. Polymer Edition


Evaluation of carbonate apatite blocks fabricated from dicalcium phosphate dihydrate blocks for reconstruction of rabbit femoral and tibial defects.

This study aimed to evaluate in vivo behavior of a carbonate apatite (COAp) block fabricated by compositional transformation via a dissolution-precipitation reaction using a calcium hydrogen phosphate dihydrate [DCPD: CaHPO·2HO] block as a precursor. These blocks were used to reconstruct defects in the femur and tibia of rabbits, using sintered dense hydroxyapatite (HAp) blocks as the control. Both the COAp and HAp blocks showed excellent tissue response and good osteoconductivity. HAp block maintained its structure even after 24 weeks of implantation, so no bone replacement of the implant was observed throughout the post-implantation period in either femoral or tibial bone defects. In contrast, COAp was resorbed with increasing time after implantation and replaced with new bone. The COAp block was resorbed approximately twice as fast at the metaphysis of the proximal tibia than at the epiphysis of the distal femur. The COAp block was resorbed at an approximately linear change over time, with complete resorption was estimated by extrapolation of data at approximately 1-1.5 years. Hence, the COAp block fabricated in this study has potential value as an ideal artificial bone substitute because of its resorption and subsequent replacement by bone.


Fabrication of self-setting β-tricalcium phosphate granular cement.

Bone defect reconstruction would be greatly improved if β-tricalcium phosphate (β-TCP) granules had the ability to self-set without sacrificing their osteoconductivity potential. This study aimed to identify a method to permit β-TCP self-setting whilst maintaining good osteoconductivity. When mixed with acidic calcium phosphate solution, β-TCP granules were found to readily set, forming a fully interconnected porous structure. On mixing, dicalcium phosphate dihydrate crystals formed on the surface of β-TCP granules, bridging the granules and resulting in the setting reaction. The setting time of the β-TCP granular cement (β-TCP GC) was approximately 1 min and its mechanical strength, in terms of diametral tensile strength, was approximately 0.8 MPa. The β-TCP GC and β-TCP granules both showed the same level of osteoconductivity within rat calvaria bone defects. At 2 and 4 weeks post-implantation, new bone formation was comparable between the two β-TCP based bone substitutes. We conclude that β-TCP GC has excellent potential for use as a cement in bone defect reconstruction. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 800-807, 2018.

Journal of Biomedical Materials Research. Part B, Applied Biomaterials


Effect of citric acid on setting reaction and tissue response to β-TCP granular cement.

We recently reported that when an acidic calcium phosphate solution is mixed with β-tricalcium phosphate (β-TCP) granules, the resulting dicalcium phosphate dihydrate (DCPD) crystals form bridges between the β-TCP granules, creating a set interconnected porous structure in approximately 1 min. Although this self-setting β-TCP granular cement (β-TCPGC) is useful for clinical applications, the short setting time is a key drawback for handling. In this study, the setting time of β-TCPGC was adjusted with the addition of citric acid, which is a known inhibiter of DCPD crystal growth. As the concentration of citric acid in the acidic calcium phosphate solution increased, the amount of DCPD formation in the set β-TCPGC decreased, and the crystal morphology of DCPD became elongated. β-TCPGC prepared with various citric acid concentrations were used as grafting material in rat calvarial bone defects to evaluate bone regeneration in vivo. Four weeks after implantation, no inflammatory reaction and approximately 20% new bone formation were observed, regardless of the presence or absence of citric acid in the liquid phase of β-TCPGC. We concluded, therefore, that citric acid might be a useful retarder of β-TCPGC setting times.


A Case of Cerebral Infarction During Treatment for Phlegmon of the Cheek

頰部蜂窩織炎の治療中に脳梗塞を発症した1例

We report the case of a patient who underwent treatment for phlegmon of the cheek and developed a cerebral infarction. We also review some relevant literature. An 88-year-old woman noticed swelling and experienced pain in her left mandible. The patient visited the cardiology department of a nearby general hospital. After examination, she was diagnosed with exacerbated heart failure and was admitted to the hospital. Although anti-inflammatory treatment was administered, no improvement was observed in her symptoms, so she was referred to our hospital for a more detailed examination and further treatment. The patient was diagnosed with phlegmon of the left cheek and was admitted to our hospital. She was administered antibacterial drugs via an intravenous drip. On day 3 of hospitalization, she underwent extra-oral incision and drainage under general anesthesia. Her postoperative course was satisfactory, however, on day 13, severe right hemiplegia and aphasia were observed, and her consciousness level declined. She was diagnosed with cardiogenic cerebral embolism and was transferred to the neurosurgery department. She received antithrombotic therapy with warfarin. Poor control of perioperative anticoagulation ability was considered to be one cause of the cerebral infarction.

Japanese Journal of Oral Diagnosis / Oral Medicine


A novel measurement method for the morphology of the mandibular ramus using homologous modelling.

In conclusion, we successfully created a homologous model of the mandibular ramus and demonstrated the effectiveness of this model in the 3D comparison of the ramus morphology between the contralateral and deviated sides in asymmetric mandibles.


口腔領域における骨補填材としての炭酸アパタイトの現状と今後の展開

口腔領域における骨補填材としての炭酸アパタイトの現状と今後の展開

Journal of Japanese Society of Oral Implantology

日本口腔インプラント学会誌