Toshihiro Kikuta

Clinical characteristics of Mikulicz's disease as an IgG4-related disease

ObjectivesMikulicz’s disease (MD) was considered to be a subtype of Sjögren’s syndrome (SS), based on histopathological similarities. However, recent studies have indicated that patients with MD show high serum IgG4 concentration, and suggested that MD is one of “IgG4-related disease” and distinguishable from SS. Therefore, we clinically and histopathologically examined the disease states of MD and SS in detail.Materials and methodsTwenty patients with Mikulicz’s disease and 18 with SS were comparatively studied to determine clinical characteristics in MD patients.ResultsSialography in MD patients did not show the “apple-tree sign” typically seen in SS. Serologically, high serum IgG4 levels but not anti-SS-A or anti-SS-B antibodies were observed in MD. SS showed lymphocytic infiltration of various subsets with atrophy or severe destruction of the acini, while MD showed selective infiltration of IgG4+ plasma cells with hyperplastic germinal centers and mild acini destruction. Corticosteroid treatment of MD reduced IgG and IgG4 levels and improved salivary function. A negative correlation between disease duration and increasing rate of salivary flow was observed in MD.ConclusionsThese results suggested that the pathogenesis of MD might be different from those of SS. Clinical Relevance: early diagnosis and treatment of MD is important for the improvement of salivary function.

Three lateral osteotomy designs for bilateral sagittal split osteotomy: biomechanical evaluation with three-dimensional finite element analysis

BackgroundThe location of the lateral osteotomy cut during bilateral sagittal split osteotomy (BSSO) varies according to the surgeons preference, and no consensus has been reached regarding the ideal location from the perspective of biomechanics. The purpose of this study was to evaluate the mechanical behavior of the mandible and screw-miniplate system among three lateral osteotomy designs for BSSO by using three-dimensional (3-D) finite element analysis (FEA).MethodsThe Trauner-Obwegeser (TO), Obwegeser (Ob), and Obwegeser-Dal Pont (OD) methods were used for BSSO. In all the FEA simulations, the distal segments were advanced by 5 mm. Each model was fixed by using miniplates. These were applied at four different locations, including along Champys lines, to give 12 different FEA miniplate fixation methods. We examined these models under two different loads.ResultsThe magnitudes of tooth displacement, the maximum bone stress in the vicinity of the screws, and the maximum stress on the screw-miniplate system were less in the OD method than in the Ob and TO methods at all the miniplate locations. In addition, Champys lines models were less than those at the other miniplate locations.ConclusionsThe OD method allows greater mechanical stability of the mandible than the other two techniques. Further, miniplates placed along Champys lines provide greater mechanical advantage than those placed at other locations.

Acute effects of sono-activated photocatalytic titanium dioxide nanoparticles on oral squamous cell carcinoma

Sonodynamic therapy (SDT) is a new treatment modality using ultrasound to activate certain chemical sensitizers for cancer therapy. In this study, effects of high intensity focused ultrasound (HIFU) combined with photocatalytic titanium dioxide (TiO2) nanoparticles on human oral squamous cell line HSC-2 were investigated. Viability of HSC-2 cells after 0, 0.1, 1, or 3s of HIFU irradiation with 20, 32, 55 and 73Wcm(-2) intensities in the presence or absence of TiO2 was measured immediately after the exposures in vitro. Immediate effects of HIFU (3s, 73Wcm(-2)) combined with TiO2 on solid tumors were also examined by histological study. Cytotoxic effect of HIFU+TiO2in vitro was significantly higher than that of TiO2 or HIFU alone with the tendency to increase for higher HIFU intensity, duration, and TiO2 concentration in the suspension. In vivo results showed significant necrosis and tissue damage in HIFU and HIFU+TiO2 treated samples. However, penetration of TiO2 nanoparticles into the cell cytoplasm was only observed in HIFU+TiO2 treated tissues. In this study, our findings provide a rational basis for the development of an effective HIFU based sonodynamic activation method. This approach offers an attractive non-invasive therapy technique for oral cancer in future.

Effects of subthalamic nucleus deep brain stimulation on the swallowing function of patients with Parkinson's disease

1353-8020/

Dysphagia in duchenne muscular dystrophy versus myotonic dystrophy type 1

– see front matter 2012 Elsevier Ltd. http://dx.doi.org/10.1016/j.parkreldis.2012.10.023 Subthalamic nucleus deep brain stimulation (STN-DBS) has become a widely accepted surgical treatment for patients with Parkinson’s disease (PD) associated with medically intractable motor symptoms. However, there have been few quantitative study reports examining swallowing function in patients who have undergone STN-DBS. The present study aimed to investigate a possible relationship between swallowing function and the Unified Parkinson’s Disease Rating Scale (UPDRS) part III (which rates motor function) scores and compare the swallowing function of patients between DBS ON and OFF states using videofluoroscopy (VF). A total of 18 patients (8 males, 10 females; mean age, 66.6 6.2 years; range, 50–76 years; average illness duration,11.6 5.7 years; range, 3–28 years) with advanced PD and clinical swallowing problems who had bilateral DBS electrodes placed in the STN at the Department of Neurology of Fukuoka University Hospital were included. Patients were assessed according to item 7 of the UPDRS part II for swallowing. Their scores were as follows: 1 (rare choking; n 1⁄4 5), 2 (occasional choking; n 1⁄4 5), and 3 (require soft food; n 1⁄4 8). Informed consent was obtained from all participants, and the study was approved by the ethics committee of Fukuoka University Hospital. UPDRS part III and VF findings between the preoperative and DBS ON states with continued medication were compared for 10 of the 18 patients (2 males, 8 females; mean age, 65.9 7.9 years; range, 50–76 years; average illness duration, 8.9 3.5 years; range, 3–15 years). VF examinations were performed 1 week before STNDBS and after 6 months of stimulation. The UPDRS part III motor subscale parameters were assessed by certified neurologists. We evaluated 18 patients to quantitatively compare swallowing function between DBS ON and OFF states after 6 months of STNDBS. VF examination in the DBS OFF state was performed at least 10 min after switching off STN stimulation. In the preliminary study, 5 mL of jelly was used as the test food. In the main study, 5 mL of jelly, honey-thickened water, nectar-

Masticatory dysfunction in patients with myotonic dystrophy (type 1): a 5-year follow-up

In this study we aimed to demonstrate the distinctive features of dysphagia in patients with myotonic dystrophy type 1 (DM1) and Duchenne muscular dystrophy (DMD).

Efficacy and complications of submental tracheal intubation compared with tracheostomy in maxillofacial trauma patients.

Eight patients with myotonic dystrophy type 1, DM1 (age range 45-63 years) were followed for a period of 5 years. Two sets of data analyzing masticatory function and activities of daily living (ADL) were obtained at baseline and at 5 years. The results from both time points were compared. The number of food items considered easy to chew, maximum bite force, occlusal contact area, number of teeth, and ADLs were significantly reduced (p < 0.05) at the second assessment when compared to the first. During the intervening 5 years, six of the eight patients adopted a soft diet. These results suggest deterioration in ADLs and masticatory function of patients with DM1. Continuous evaluation of the feeding ability and the type of diet are necessary for patients with DM1.

Treatment outcome of the two-part semi-rigid oral appliance in obstructive sleep apnea

Submental tracheal intubation is a technique for use in patients with maxillofacial trauma. The purpose of this retrospective study was to evaluate the efficacy and complications of this technique compared with tracheostomy. Twenty-five patients underwent submental tracheal intubation since 2001. Submental tracheal intubation was performed in cases needing intermaxillary fixation complicated by a nasal pyramid or anterior skull base fracture. No severe perioperative or long-term complications were noted. Intra- and postoperative complications were observed in three patients. In one case, the tube was accidentally dislodged into the right main bronchus during submental tracheal intubation. Two patients developed skin infections. Submental scarring was undetectable, except for one patient with slight scarring. Submental tracheal intubation avoids the complications associated with tracheostomy and the difficulty of nasal intubation during intubation and surgery. Therefore, submental tracheal intubation is useful in the intraoperative management of patients with complex maxillofacial trauma. (J Oral Sci 58, 23-28, 2016).

Oral surgery under local anesthesia with dexmedetomidine sedation in a morbidly obese patient with aortic dissection

Abstract Aim The aim of this study was to assess the effectiveness of the two-part semi-rigid oral appliance, Silensor ® (Erkodent, Tuttlingen, Germany) which prevents the mandible from retracting during mouth opening. Materials and methods Ten patients with mild or moderate obstructive sleep apnea (2 males and 8 females; mean age=62.5±10.0 years) were recruited and lateral cephalometric radiographs were taken. The patients underwent polysomnography before and after 3 months of receiving treatment with the Silensor ® . The relationship between the improvement in the polysomnographic variables after the therapy and the cephalometric features was analyzed. Results A significant difference was observed in the apnea–hypopnea index after 3 months of Silensor ® therapy (1st (baseline), 17.1±5.5; 2nd (therapy of Silensor ® ), 11.0±7.2, p =0.011). Furthermore there was a significant positive correlation between the improvement in the degree of slow wave sleep (%) and the mandibular plane angle ( R =0.662, p =0.037), as well as between the improvement in degree of slow wave sleep (%) and the lower face height ( R =0.845, p =0.002). A significant negative correlation was observed between the improvement in degree of sleep efficiency (%) and the soft palate area ( R =−0.809, p =0.005). Conclusion These results suggested that keeping the nasopharyngeal airway space during mouth opening improves apnea–hypopnea index of some patients with mild or moderate obstructive sleep apnea and quality of sleep in obstructive sleep apnea patients with a long lower face height and a small soft palate.

Oral pemphigus vulgaris: Liquid-based cytological findings and pitfalls

We report a case of a morbidly obese man with an aortic aneurysm, in whom dental surgery was performed before elective cardiac surgery. His aortic aneurysm required emergency surgery. However, because of his morbid obesity, elective cardiac surgery was planned. Considering the high risk of infective endocarditis, dental surgery was required. Our patient was at a high risk of aortic rupture caused by hypertension and breathing difficulty in the supine position. Dexmedetomidine (DEX) is an anti-anxiety, sedative, and analgesic medicine that can stabilize circulatory dynamics and minimize blood pressure fluctuations. We administered intravenous DEX for sedation of the patient in Fowlers position. In conclusion, our understanding of the risk factors of DEX enabled us to perform safe invasive oral treatment.