Journal of the Korean Association of Oral and Maxillofacial Surgeons
- 권한신청
- P-ISSN2234-7550
- E-ISSN2234-5930
- SCOPUS, KCI, ESCI
35권 6호
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Abstract
The purpose of this study is to investigate the effects of alendronate and pamidronate on proliferation and the alkaline phosphatase activity of human bone marrow derived mesenchymal stem cells and to relate the results with bisphosphonate related osteonecrosis of the jaw(BRONJ). With the consent of patients with no systemic disease and undergoing iliac bone graft, cancellous bone was collected to obtain human bone marrow derived mesenchymal stem cells through cell culture. 96 well plate were prepared with a concentration of 104cell/ well. Alendronate and pamidronate were added to each well with the concentration of 10-6M, 10-8M and 10-10M, respectively. Then proliferation capacity of each well was evaluated with the cell counting kit. 24 well plates were prepared with a concentration of 105cell/ml/well and with the bone supplement, alendronate and pamidronate were added with the concentration of 10-6M, 10-8M and 10-10M, respectively on each plate. The plates were cultured for either 24 or 72 hours. Then the cells were sonicated to measure the alkaline phosphatase activity and protein assay was done to standardize the data for analysis. As the concentration of alendronate or pamidronate added to the culture increased, the proliferation capacity of the cells decreased. However, no statistical significance was found between the group with 10-10M of bisphophonate and the control group. Pamidronate was not capable of increasing the alkaline phosphatase activity in all trials. However, alkaline phosphatase activity increased with 24 hours of 10-8M of alendronate treatment and with 48 hours of 10-10M of alendronate treatment. Cell toxicity increased as the bisphosphonate concentration increased. This seems to be associated with the long half life of bisphosphonate, resulting in high concentration of bisphosphonate in the jaw and thus displaying delayed healing after surgical procedures. Alendronate has shown to increase the alkaline phophatase activity of human bone marrow derived mesenchymal stem cells. However, this data is insufficient to conclude that alendronate facilitates the differentiation of human bone marrow derived mesenchymal stem cells. Further studies on DNA level and animal studies are required to support these results.
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Abstract
Those composing temporomandibular joint (TMJ) complex such as the temporal bone, the disc and the mandibular condyle perform their own functions with organic relation. The retrodiscal tissue is the main area of pain induction and contributes to compositional change of synovial fluid. If displacement of the disc lasts long time, not only adaptive changes, but also destructive or degenerative changes may happen. It was reported that these changes and symptoms appear mostly to female rather than male and especially, in the case of patients suffering from TMJ disorder, a large quantity of female sex hormone is found in the joint synovium. And that may play a role in bone resorption and inflammation. Also, the frequency and the intensity of pain perception for female is reported to be much more than for male. In this study, we investigated the expression extents of estrogen receptors (ER) and progesteron receptors (PR) in retrodiscal tissue with immunohistochemistry among the patients received TMJ surgery and compared with MRI findings and surgical findings. We report the relations between the expression of ER in retrodiscal tissue and the pathological change in TMJ, such as inflammation, internal derangement and osteoarthritis.
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Objective: The purpose of this study was to determine whether cyst enucleation would be done after marsupialization of large cystic lesion on the jaws or not, and if so, when it should be done. Patients & Methods: 12 patients with cystic lesion treated by marsupialization only and 10 patients with cystic lesion treated by marsupialization followed by enucleation were examined in this study. Postoperative clinical and radiographic examinations were performed at 1, 4, 7, 10, 13, 16, 19 months on 22 patients. Bone regeneration and reduction rate of the residual cystic cavities and bone density were evaluated with a analysis of digital panoramic radiographs. Also histological evaluation of the healing process was performed on 1 patient. Results: Uneventful healing and spontaneous bony filling of the residual cavities were observed in all cases. Postoperative radiographs showed that the size of the lesions was reduced for a few months, but the reduction rate of the residual cavity was minimized for 13~16 months after marsupialization. The bone density was increased 22.5 % after 19 months. Conclusion: This results suggest that the appropriate timing to perform enucleation would be 13~16 months after marsupialization. The state of healing process could be confirmed by histological examination and radiographic evaluation of bone density. Enucleation after marsupialization could be applied appropriately to reduce the periods of bone healing in large cystic lesion on the jaws.
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Purpose: The aim of this study is to analyze the correlation between incidence of mandibular angle fracture and eruption state of mandibular third molar using clinical and radiographic findings. Materials and Methods: The data were obtained from the clinical and radiographic records of 205 patients who visited the Department of Oral and Maxillofacial Surgery, Chonbuk National University Hospital for treatment of the mandibular fracture. Panoramic radiographies were taken for radiographic examination and the mandibular third molars were classified according to age, gender, position and eruption state. Data were analyzed by a chi-square statistics. Results: In this study, the incidence of mandibular angle fracture had a tendency to be greater when a mandibular third molar was present(p>0.05), but there was not a statistically significant difference. Of the 255 cases with a mandibular third molar, 67 had an angle fractures. Of the 155 cases without a mandibular third molar, 138 had not angle fracture. And the incidence of mandibular angle fracture was high at class B Ⅱ(by Pell & Gregory system) (p<0.05). Conclusion: Although there was not a statistically significant difference, mandibular third molar was more susceptible to mandibular angle fracture. When the reduction of mandibular angle fracture, it was recommended that mandibular third molar should be extracted especially in case of pericoronitis, periodontitis and other infections.
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Purpose: Many patients in anti-platelet therapy have been consulted for bleeding risks before minor oral surgery. However, there has not been anestablished pretreatment protocol for treating these patients. The purpose of this study is to make a protocol for the preoperative management forpatients in anti-platelet therapy. Patients and Methods: The existed consultation pattern of patients was examined in the Department of Oral and Maxillofacial Surgery, YonseiDental Hospital. Based on the observation, a protocol including classification of medical status of patients and the type of oral surgery in need wasintroduced. This protocol had been performed for 6 months. Result: Following this protocol, the frequency of consultation for bleeding risk was decreased. The number of minor oral surgeries with concurrentanti-platelet therapy was increased. There was no severe bleeding event observed among minor oral surgeries that were performed while maintaininganti-platelet therapy. Conclusion: This protocol can be used as a guideline for clinical practice of patients in anti-platelet therapy requiring minor oral surgery.
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There are five principal causes for excessive bleeding in the immediate postextraction phase ; (1) Vascular wall alteration (wound infection, scurvy, chemicals, allergy) (2) Disorders of platelet function (genetic defect, drug-aspirin, autoimmune disease) (3) Thrombocytopenic purpuras (radiation, leukemia), (4) Inherited disorders of coagulation (hemophilia, Christmas disease, vitamin deficiency, anticoagulation drug-heparin, coumarin). If the hemorrhage from postextraction wound is unusually aggressive, and then dehydration and airway problem are occurred, the socket must be packed with gelatine sponge(Gelfoam) that was moistened with thrombin and wound closure & pressure dressing are applied. The thrombin clots fibrinogen to produce rapid hemostasis. Gelatine sponges moistened with thrombin provide effective coagulation of hemorrhage from small veins and capillaries. But, in dental alveoli, gelatine sponges may absorb oral microorganisms and cause alveolar osteitis (infection). This is a case report of bleeding control by continuous rubber strip & iodoform gauze drainage (without gelfoam packing) of active bleeding infection sites of three teeth extraction wounds in a 46-years-old female patient with advanced liver cirrhosis.
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Purpose: In many cases, the erroneous placement of a dental implant brings about undesirable results. Here, the effect of dental implant placement on the success of the final prosthesis was evaluated from the point of view of the prosthodontist. Materials and Methods: All surgical operations were performed by the same oral surgeon with the same surgical protocol and all prosthodontic procedures were performed by the same prosthodontist. The problems faced by the prosthodontist, their causes, and their effect on prosthesis success were identified. The success of the final prostheses was evaluated by the same prosthodontist. Results: Only 53% (238 implants in 105 patients) of dental implants were not associated with prosthodontic problems. Multiple implant placement (more than three implants) was associated more frequently with prosthodontic problems. Conclusions: The data indicate that the satisfactory construction of a prosthesis is highly dependent on the placement of the dental implant in the best possible position. It is strongly recommended that the oral surgeon and the prosthodontist engage in pre-operative discussions to establish a topdown treatment plan, as this will improve implant placement and ultimately the success of the prosthesis.
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Purpose: Simultaneous implantation has been traditionally limited to patients with at least 5 mm of residual bone to ensure that the implant is completely stabilized. This is considered to be one of the most critical factors for primary implant stability and parallelism and, subsequently osseointegration. Recently, improved initial implant stability is provided by advancement of surgical techniques, implant designs and surface treatments. This has led surgeons to extending simultaneous treatment option to patients with below 4 mm of residual bone height, despite the lack of much data. The purpose of this study was to retrospectively evaluate and compare the status of implants which are installed by delayed and simultaneous methods. Material and methods: The subjects were patients(121 patients, 278 implants) who had been operated with sinus lifting from 2003 to 2007 in Sun Dental Hospital. Lateral window approach with autograft and xenograft(1:1 ratio) were carried out for all sinus lifting. 4 types of implant were used. The mean follow up period was 26.3 months(19 - 58 months) in delayed group, and 22.8 months(18 - 43 months) in simultaneous group. Results: The survival rate of implant restoration of this study was 98.2% in delayed group and 91.7% in simultaneous group. In simultaneous group, wide-platform type implants showed 100% survival rate. The total average of marginal bone loss in radiographs was 0.96 ± 0.29 mm in delayed group and 1.02 ± 0.31 mm in simultaneous group. Conclusion: Simultaneous implantation with sinus lifting(below 4mm of residual bone height) could be predictable treatment.
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Metallic bone plates and screws have been commonly used in oral and maxillofacial surgery for internal fixation. However, there are several disadvantages such as atrophy of cortical bone inherent to excessive rigid fixation systems, growth disturbance in growing individual, allergy reaction, interference with radiographic imaging, palpability, thermal sensitibity and the need for subsequent removal. To overcome these disadvantages and avoid additional surgery of removal of plates and screws, there have been many studies of biodegradable plates and screws. But, It also has complication such as foreign body reactions. We have undertaken a clinical and retrospective study on 140 patients in Dept. of Oral and Maxillofacial Surgery, Inha University Hospital from February 2006 to March 2009. The purpose of this study is to report the clinical cases and review of the literatures with biodegradable plates and screws. And we concluded following results. 1. 6 cases(3.4%) of the 177 operation sites(140 patients) experienced complications. 1 case(0.6%) was a failure of initial fixation, 1 case(0.6%) was a postoperative infection, 4 cases(2.3%) were inflammations or foreign body reaction. 2. Postoperative infections, inflammations and foreign body reactions were completely recovered with incision and drainage, supporative care with antibiotic coverage and removal of biodegradable plates. 3. Biodegradable plates and screws provide acceptable rigidity and stability clinically. But, long-term observation is required for the tissue reactions around the biodegradable plates and screws because of long resorption periods of the biodegradable materials.
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Polycythemia vera is one type of myeloproliferative disorder which occurs due to the clonal proliferation of hematopoietic stem cell related to theproduction of leukocyte and megakaryocyte which produces a little less than erythrocyte. Polycythemia vera has a peak incidence in the sixth decadeof life with males affected slightly more frequently than females. Vasquez first described polycythemia vera as an autonomous erythrocytosis in 1892, and a further description, delineation of the disease processand a complete course outline were made in 1899, 1903 and 1938, respectively. Symptoms include pruritus, tinnitus, vertigo, gastrointestinal (GI) pain, and bleeding gums. Hyperuricemia and hyperuricosuria are present in about40% of these patients. Complications are hemorrhage, thrombosis, post-polycythemic myeloid metaplasia, and leukemic transformation. In case of surgery, complicationssuch as hemorrahge and thrombosis are highly likable to happen. We report a case of preoperative and postoperative of a 63-year-old male, who was diagnosed as oral cavity cancer in the mouth floor, with knownhistory of hypertension and polycythemia vera. We considered that conservative management would be an advisable treatment for patients withuncontrolled systemic disease
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Purpose: Dentigerous cyst is the most common intra-osseous lesion of the jaw. Dentigerous cysts can cause delays in eruption of the affected permanent tooth in mixed dentition. It has been suggested that the affected permanent tooth could be erupted spontaneously after the dentigerous cyst was enucleated. But in some cases, orthodontic treatment or autotransplantation technique is known to be required. This study reviews previously performed prognoses of affected permanent teeth, which will lead to a more efficient treatment plan. Patients and Methods: With 28 patients who have undergone cyst enucleation and 10 patients who have undergone autotransplantation, the prognosis of permanent teeth was observed. Results: After cyst enucleation, spontaneous eruption of a permanent tooth was observed in 56.3% patients, orthodontic treatment was performed in 25% patients. The success rate of autotransplantation was 60.0 %. Discussion: The first choice for treatment of dentigerous cyst in mixed dentition is to guide spontaneous eruption of permanent teeth. For cases without enough eruption space, the orthodontic treatment should be considered. Autotransplantation should be considered when the spontaneous eruption is not expected. It should be considered that the rate of successful autotransplantation is decreased on maxilla anterior area.
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Purpose: The aim of this study is to compare volume and revascularization of autogenous block bone grafts in simultaneously cortical perforation of recipient beds and grafts, and only cortical perforation of recipient beds. Materials and methods: Two block bone in 8mm diameter was harvested in both skull using trephine bur on 20 New Zealand white rabbits. Harvested block bone was grafted on both inferior border of mandible. On the left side(experimental side), cortical bone of recipient beds and graft were perforated, and on the right side(control side), the only recipient bed was perforated. The rabbits had been sacrificed and infused the India ink for the observation of revascularization at 20 day and 40 day after surgery. The specimens were processed for H-E staining and quantitative analysis(independent t-test, p<0.01) was made under an optical microscope. In additional, specimens were processed for the observation of revascularization. Results: After 20 days, more bone volume was observed in experimental group, but no significant difference between two groups(p=0.106). There were significantly more bone volume in the experimental group at 40 days after surgery(p<0.01). After 20 days, more discrete vascular sprouts were observed in experimental side, but no difference at 40 days after surgery. Conclusion: We conclude that the cortical perforation of both the recipient beds and grafts improve revascularization at early stage and overall graft persistence.
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These is a cases of chronic suppurative osteomyelitis occurred in the mandibular body to condyle of 48-year-old male patient. Extensive bone destruction was noted on the right mandibular body, angle, ascending ramus, mandibular notch and condylar region. We made a treatment plan that radicular mandibular resection from body to condyle and mandibular reconstruction with vascularized fibular flap at first time. But, we could observe marked bone regeneration with only mild curettage, local wound care and massive antibiotic therapy. So we preserved the anterior ramus portion of mandible. Defected mandibular condyle was reconstructed with costochondral graft. In this paper we present the case of a patient who has chronic osteomyelitis in mandibular area.
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Cemento-osseous dysplasias are a group of disorders known to originate from periodontal ligament tissues and involve, essentially, the same pathological process. They are usually classified, depending on their extent and radiographic appearances, into three main groups. Periapical cemental dysplasia predominantly involves the periapical region of the anterior mandible. Florid cemento-osseous dysplasia presents with multifocal lesions in the tooth bearing or edentulous areas of the maxilla and mandible, often occurring bilaterally with symmetric involvement. Focal cemento-osseous dysplasia exhibits a single site of involvement in any tooth bearing or edentulous area of the mandible or maxilla, with the posterior mandible representing the most common site. We report the clinical, radiographic and histological findings of 3 types of cemento-osseous dysplasia with a review of literatures.
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Odontogenic Myxoma of the jaws is a rare benign tumor derived from embryonic mesenchymal elements of dental anlage. It appears to originate from the dental papilla, follicle or periodontal ligament. Odontogenic Myxoma of the maxilla is less frequent but behaves more aggressively than that of the mandible, because it spreads through the maxillary sinus. Radiographically, the tumors present as unilocular or multilocular radiolucent lesions with well-defined borders with fine, bony trabeculae. On gross examination, the tumor appears as a smooth, glistening, gelatinous, lobulated mass. On microscopic examination, these neoplasms exhibit loose arrangement of stellate-shaped cells. The intercellular substance is a mucinous and homogeneous matrix. We report a case of odontogenic myxoma of the maxilla observed in our clinic with good prognosis after partial maxillectomy.
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Leiomyosarcoma(LMS) is a malignant neoplasm of smooth muscle origin, which accounts for 7 % of all soft tissue sarcomas. The most common sites are the gastrointestinal tract and female genital tract. In contrast, primary LMS of the oral and maxillofacial area is rare due to the paucity of smooth muscle in this region. Especially, LMS of the paranasal sinuses is very rare and has an aggressive clinical behavior. Only 28 cases have been described in the english literature, and of these, only 3 patients treated with surgery had a disease-free survival. A 46-year-old woman came to our department for the evaluation of pain on right midface. After a diagnostic work-up, the lesion was diagnosed as LMS of the right maxillary sinus. The radical surgery was done and chemotherapy combined radiotherapy was followed from post operation 1 month. The patient was disease free at post-operation 1 year. We will report this case with literature review.
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Schwannomas are tumors which originate from the neuroectodermal Schwann cell of cranial, intraspinal, peripheral and autonomic nerve sheaths, and they are solitary, benign, slow growing and well encapsulated neoplasm. Schwannomas are usually asymptomatic. No strong gender or age predominance exists. The incidence of extracranial schwannomas in the head and the neck region varies from 25~45%. In addition, schwannomas are rare in the maxillary sinus or buccal space. In this paper, it diagnosed and treated a 54-years old female patient, who had schwannoma in the maxillary sinus derived from infraorbital nerves, the branch of the left trigeminal nerve, and a 19-years old male patient, who had schwannoma arose in the buccal space derived from the buccal branch of the right facial nerve. There was no particular complication except sensory extinction of the nerve in the female patient and paralysis by the nerve in the male patient. It is determined those two cases of schwannoma in the rare portion is valuable and herein, it reports those with literature discussions.
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Because sublingual region is well-vascularized and sublingual artery is passed throughout this region, it should be careful not to perforate lingual cortex when placing dental implant on mandible. A 83-years-old male complained severe sublingual hematoma, hemorrhage and dyspnea came our outpatient department. He had received dental implant placement in the same day. He needed hemostasis and airway control. If soft tissue of sublingual region and the artery are injured, it may result in life-threatening excessive hemorrhage. In dental implant surgery, especially mandible, we should recognize the accurate shape of mandible and anatomy of sublingual region. It is important to stop anticoagulant agent before surgery. When a patient has airway obstruction, the operator should manage airway quickly.
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Villonodular synovitis, also called pigmented villonodular synovitis, is the benign lesion with the characteristic of locally aggressive proliferation of mononuclear histiocyte and giant cell. Typically it involves single joint, especially about 80% of disease occurs in the knee joint. Villonodular synovitis of the temporomandibular joint is very rare disease. Differential diagnosis includes synovial chondromatosis and tumors of the temporomandibular joint. Optimal treatment consists of complete excision of the mass and removal of the synovium including adjacent affected bony structures. This is a case report of villonodular synovitis developed in the temporomandibular joint.