Journal of the Korean Association of Oral and Maxillofacial Surgeons
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- P-ISSN2234-7550
- E-ISSN2234-5930
- SCOPUS, KCI, ESCI
ISSN : 2234-7550
Vol.50 No.5
Abstract
Angiogenesis is a crucial molecular driver of fibrosis in various inflammatory lesions. Oral submucous fibrosis (OSMF) is a chronic inflammatory fibrotic disorder with malignant potential. The angiogenetic pathways in OSMF remain obscure due to limited research, necessitating an in-depth review. This review aimed to illuminate the cryptic pathogenetic mechanisms of angiogenesis in the disease progression/fibrosis of OSMF and its malignant transformation, providing insights for improved treatment. Extensive literature searches were conducted across an array of databases until October 2023. Original research articles on angiogenesis in OSMF were included, and the risk of bias was assessed using the modified Newcastle–Ottawa scale. RevMan ver. 5.4 (Cochrane Collaboration) was used for data analysis. Thirty-four articles were included for qualitative synthesis and seven for quantitative analysis. Findings revealed that angiogenesis was significantly increased in early-stage OSMF but decreased as the disease advanced. It was also associated with the severity of epithelial dysplasia and malignant transformation. A random-effects model confirmed the upregulation of angiogenesis as a significant risk factor in early-stage fibrosis and malignant transformation. The mounting evidence reinforces that angiogenesis plays a crucial role in the progression of early-stage fibrosis of OSMF and its malignant transformation, opening avenues for diagnostic and therapeutic interventions.
Abstract
Objectives: To compare presurgical skeletal factors and postsurgical relapse patterns between more relapsed (MR) and less relapsed (LR) groups. Materials and Methods: This study retrospectively examined patients who underwent mandibular setback surgery, classifying them into two groups based on the amount of relapse of the pogonion using K-means analysis. Comparisons were conducted by analyzing cephalometric radiographs presurgically (T0), at 1-month post-surgery (T1), and immediately after orthodontic treatment (T2). Results: The MR group at T0 had a lower articular angle and AB to the mandibular plane angle (MPA), higher gonial angle, shorter anterior and posterior facial heights, and shorter Frankfort horizontal plane to the upper incisor and first molar. The articular angle in the MR group increased postoperatively. The Frankfort MPA (FMA) did not differ significantly between the MR and LR groups. Conclusion: Acute articular angle and short facial height with a high gonial angle in the presurgical stage can predict surgical relapse regardless of the FMA.
Abstract
Objectives: Dextrose prolotherapy is one of the most promising minimally invasive interventions for temporomandibular disorder (TMD), particularly in refractory cases where other conservative treatments have failed. The purpose of this study was to demonstrate the efficacy of a new treatment, temporomandibular joint (TMJ) prolotherapy, in patients with TMD to alleviate symptoms. Materials and Methods: A retrospective analysis was conducted on TMD patients with chronic pain who did not respond to conventional treatments. TMJ prolotherapy was performed using hypertonic dextrose in the TMJ area, targeting the retrodiscal attachment tissue, anterior disc attachment tissue, lateral capsule, origin of the masseter muscle, and the stylomandibular ligament. Pain or discomfort intensity in the TMJ was evaluated using a numerical rating scale (NRS). Maximum mouth opening and subjective satisfaction were also analyzed. Results: Nineteen patients (6 males, 13 females, average age 43 years) participated in this study. All patients experienced pain improvement with a maximum of three prolotherapy sessions. The initial mean NRS was 5.7, which ultimately decreased to a final mean TMJ discomfort score of 1.7 postintervention. The patients’ maximum mouth opening increased from an initial 34.5 mm to 38.8 mm, and they reported positive satisfaction with the prolotherapy treatment. The clinical outcomes were positive regardless of main origin of TMD symptoms. Conclusion: Hypertonic TMJ prolotherapy is an effective minimally invasive intervention for TMJ disorders with chronic pain.
Abstract
Objectives: Skeletal class III malocclusion presents either with maxillary retrognathism, mandibular excess, or a combination. Dentoalveolar compensations occur with maxillary incisor proclination and mandibular incisor retroclination. The aim of this study is to quantify the amount of incisal compensation in class III skeletal malocclusion and correlate it to the severity of the skeletal base. Materials and Methods: Eleven angular and 7 linear cephalometric measurements were digitized from 57 patients. Axial inclination of the upper and lower incisors was evaluated for compensation. Pearson’s correlation coefficient was used to determine the dentoalveolar parameter among those measuring upper and lower incisor position and inclination that correlated most highly with the severity of class III. Linear regression analysis was used to identify the quantum of the incisal compensation. Results: Upper incisors were proclined and placed anteriorly. However, correlation analysis suggested a less responsive incisor with progressive change in skeletal base. Lower incisors began to compensate only as the severity of class III increased. For every degree of reduction of ANB angle from normal, the incisor mandibular plane angle (IMPA) and L1-GoMe decreased by 0.79° and the L1-GoGn decreased by 0.81°. Conclusion: The upper incisors contributed more to compensation compared to the lower incisors in a class III skeletal base. As class III severity increased, the upper incisor compensation decreased while that of lower incisors increased. For every degree of reduction in ANB angle, the IMPA and L1-GoMe decreased by 0.79° and the L1-GoGn decreased by 0.81°.
Abstract
Objectives: Traumatic optic neuropathy (TON), a relatively rare condition, can cause visual functional impairment and permanent functional damage. Surgeons should be familiar with its diagnostic criteria and treatment to effectively manage cases of facial trauma with TON. We investigated the feasibility of navigation-assisted endoscopic trans-nasal optic nerve decompression (ETOND) to treat TON in maxillofacial trauma patients. Patients and Methods: We retrospectively analyzed data from the clinical investigation of four consecutive patients, two males and two females with an average age of 75 years, with midfacial fractures and TON between April 2021 and September 2023. All patients had swelling and subcutaneous periorbital hemorrhage accompanied by optic nerve canal and zygomaticomaxillary complex fractures on the affected side. Three patients had lacerations on the lateral eyebrow or upper eyelid. All patients were evaluated by an ophthalmologist for visual impairment; two patients could see hand motion at a 30 cm distance, one patient could perceive light, and one did not have any loss of visual acuity. Among the four patients, three had visual impairment immediately after the injury, and one showed delayed impairment. Results: The patients were treated with navigation-assisted ETOND conducted by an endoscopic rhinologist. Three of the ETONDs were performed along with open reduction and internal fixation (ORIF); the other ETOND was delayed. Orbital reconstruction was performed in three patients. Steroid therapy was administered to two patients, one pre-operatively and one post-operatively. The two patients with pre-operative vision loss showed improved visual acuity post-operatively, and the two patients with no pre-operative visual impairment had no vision loss associated with ORIF for their midfacial fractures. No patient had post-operative complications. Conclusion: Navigation-assisted ETOND can be performed easily by endoscopic rhinologists; and prompt examination, diagnosis, and treatment are important in patients with facial trauma and TON.
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a refractory disease that can lead to severe destruction of the jaw. As there is no standard protocol for treating MRONJ, various treatments have been studied. Teriparatide has been used as an adjunct therapy for MRONJ. However, its effectiveness has not been sufficiently demonstrated for use as a standard treatment for MRONJ. This study aimed to demonstrate the efficacy of teriparatide in treating MRONJ by presenting two successfully treated cases. Each patient received teriparatide therapy with surgical intervention. The appropriateness of teriparatide use was evaluated based on the patient’s systemic condition, and the administration of teriparatide was supervised by a physician. Complete resolution of the lesion was observed clinically and radiographically in both patients. The first patient underwent implant placement at the lesion site. Due to its anabolic properties and ability to stimulate bone remodeling, teriparatide is an effective adjunctive pharmacological treatment for bone healing before and after surgery with associated beneficial effects on bone and mucosal healing.
Abstract
Peripheral ossifying fibroma (POF) is a benign tumor characterized by dystrophic calcification or ossification within the gingiva, primarily affecting the anterior maxilla of females and young adults. Its pathogenesis is unclear but linked to local irritants such as trauma, biofilm, dental calculus, and poorly fitting prostheses. In this study, a 63-year-old male presented at Dankook University Dental Hospital with a large nodular lesion on the left maxillary bucco-palatal gingiva. Preoperative imaging, including panoramic radiography and cone-beam computed tomography, was performed. Surgical excision and histological examination confirmed POF with specific morphological characteristics, including mineralized tissue with varied deposition patterns, mature and immature bone, cementum-like tissue, and dystrophic calcification. In conclusion, POF is a rare oral tumor, more common in younger females, typically presenting asymptomatically on the anterior maxilla. Histopathological analysis is crucial for diagnosis. Standard treatment involves conservative local resection, but recurrence rates range from 8% to 20%, necessitating continuous follow-up. This report aims to enhance understanding of POF by presenting a rare case of a large POF in the maxillary posterior bucco-palatal gingiva of an elderly male.
Abstract
This study discusses laryngospasm following orthognathic surgery and requiring emergency intubation, followed by systemic complications due to a hypoxic event. A 34-year-old male patient underwent orthognathic surgery due to facial asymmetry. When emerging from general anesthesia, blood pressure elevated suddenly, and severe agitation occurred. After extubation, desaturation occurred immediately, resulting in cyanosis and loss of consciousness. An emergency cricothyroidotomy was performed, and oral intubation was required to maintain the airway. The patient was sent to the intensive care unit on a ventilator. On postoperative day 2, the red blood cell count and hemoglobin level decreased significantly. Electrocardiogram showed abnormalities, although vital signs were stable and no bleeding was observed. Laryngospasm often occurs under general anesthesia, resulting in sustained closure of the vocal cords and obstruction of the airway. This condition can be life-threatening, and awareness of the various precipitating factors is important. Orthognathic surgery is a risk factor for laryngospasm because its surgical site affects the airway, and it involves discharge of blood via intraoral wounds. It is important to understand systemic changes occurring after a hypoxic event, and consultation with specialists from various departments should be actively pursued.