Yumiko Matsusue

Maxillofacial Fractures in Older Patients

PURPOSE The purpose of the present study was to analyze the trends and characteristic features of maxillofacial fractures in older patients. PATIENTS AND METHODS The data from 247 patients aged 65 years old or older, who were treated for maxillofacial fractures at the Department of Oral and Maxillofacial Surgery, Nara Medical University, from October 1981 to March 2010, were retrospectively analyzed. RESULTS Of the 247 patients, 127 were men and 120 were women; 50 patients had been treated in the first third of the period, 87 in the second, and 110 in the third. Injury had most frequently occurred because of falling on a level surface (n = 126), followed by a traffic accident (n = 84). Of the fractures, 140 were in the mandible, 90 in the midface, and 17 in both. In the mandible, the fracture lines were most frequently observed at the condyle, followed by the body, exclusively in edentulous patients. In the midface, the zygoma was mostly involved. The facial injury severity scale score ranged from 1 to 10 (average 1.81). Injury at other sites of the body was found in 45 patients. Observation was most frequently chosen (n = 127), primarily for those of older age, followed by open reduction and internal fixation in 46 and maxillomandibular fixation in 41 patients. The facial injury severity scale score was greatest in patients treated by open reduction and internal fixation, followed by those treated by maxillomandibular fixation. CONCLUSION Maxillofacial fractures in older patients have been increasing and showed the characteristic features of etiology, patterns, and treatment modalities.

Maxillofacial Fractures Resulting From Falls

PURPOSE The purpose of this study was to analyze maxillofacial fractures resulting from falls in terms of the demographics, the circumstance of injury, the site and severity of fracture, and the treatment. PATIENTS AND METHODS Data of 457 patients treated for fall-related maxillofacial fractures at the Department of Oral and Maxillofacial Surgery, Nara Medical University, Nara, Japan, from 1981 to 2007 were retrospectively analyzed. RESULTS Patients were 163 males and 116 females with an average age of 51.3 years who had fallen on a level surface (simple fall), and 110 males and 68 females with an average age of 31.9 years in falls from a greater height (fall from height), respectively. Fractures of the mandible were more frequently observed than those of the midface. In the mandible, fracture lines were exclusively observed at the condyle, especially in simple falls. In the midface, the zygoma was most frequently involved. Facial Injury Severity Scale ranged from 1 to 6, with an average of 1.78 in simple falls, and from 1 to 9, with an average of 2.04 in falls from height, respectively. These were dependent on the causes and height of the fall. Fractures at the other sites of the body were found in 14 patients (5.0%) with simple falls and 38 (21.3%) with falls from height. Maxillomandibular fixation was most frequently chosen for mandibular fractures and observation for midface fractures. Open reduction and fixation was more frequently chosen in patients with falls from height than those with simple falls and in patients with a higher Facial Injury Severity Scale score. CONCLUSIONS Maxillofacial fractures resulting from falls showed characteristic features in the demographics, the circumstance of injury, and the site and severity of fracture. Treatment was chosen according to these features.

Maxillofacial fractures due to work-related accidents

One hundred and three patients with maxillofacial fractures due to work-related accidents were analysed. Ninety-nine patients (96.1%) were male and 4 (3.9%) were female. The average age was 46.8 years (range 18-75 years). The injuries were most commonly sustained during construction (42 patients, 40.8%) followed by agriculture and forestry (31 patients, 30.1%) and manufacturing (15 patients, 14.6%). Being struck by an object was the main cause of injury (43 patients, 41.7%) followed by fall from one level to another (31 patients, 30.1%). Fifty-four patients (52.4%) had fractures in the mandible, 41 (39.8%) in the midface, and 8 (7.8%) in both the mandible and the midface. The most common sites for fractures were the condyle and symphysis in the mandible and zygoma in the midface. The facial injury severity scale ranged from 1 to 6 with an average of 1.99±1.18. There was no difference in the nature of the work being undertaken or the cause of the injury. Fractures in other sites were observed in 22 patients (21.4%). Open reduction and fixation was the most frequent treatment for mandibular fractures (25 patients, 40.3%) followed by maxillomandibular fixation (19 patients, 30.6%). Observation was most commonly used for midface fractures (18 patients, 36.7%) followed by open reduction and fixation (15 patients, 30.6%) and transcutaneous reduction (8 patients, 16.3%).

Distribution of corticosteroid receptors in mature oligodendrocytes and oligodendrocyte progenitors of the adult mouse brain.

The expression of glucocorticoid receptors (GRs) was investigated immunohistochemically in two different lineages of oligodendrocytes, using carbonic anhydrase (CA) II and neuron glial antigen (NG) 2 as markers of mature oligodendrocytes and oligodendrocyte progenitors, respectively. We focused on the gray matter regions, including CA1, CA3 and the dentate gyrus of the hippocampus, the primary somatosensory cortex barrel field and the basolateral amygdala, and the white matter regions, including the corpus callosum, external capsule and fimbria of the hippocampus. More than 80% of CAII-immunoreactive (IR) cells and more than 95% of NG2-IR cells expressed GRs in various regions of the brain. In contrast, neither CAII-IR cells nor NG2-IR cells expressed mineralocorticoid receptors (MRs) in the same regions. The intensity of GR expression was drastically reduced in CA II-IR cells and NG2-IR cells in the same regions in adrenalectomized mice. Finally, steroid receptor co-activator (SRC)-1 and p300, both of which are cofactors for GR, were expressed in the gray and white matter regions in NG2-IR cells, but not in CAII-IR cells. These results suggest that the expression of GRs in oligodendrocytes and their progenitor cells mediates several functions in vivo, including differentiation and myelination, as a major target of glucocorticoids and their cofactors.

Developmental Changes in Desensitisation of c‐Fos Expression Induced by Repeated Maternal Separation in Pre‐Weaned Mice

Early‐life stress has long‐lasting effects on neuroendocrine and behaviour in adulthood. Maternal separation (MS) is used as a model of early‐life stress and daily repeated MS (RMS) for 3 h during the first two postnatal weeks is widely used in rodent studies. However, it is not fully understood whether early‐life animals desensitise/habituate to repeated stress. In the present study, we investigated the effects of daily RMS for 3 h and acute/single time MS (SMS) for 3 h on the plasma corticosterone level and c‐Fos expression in the brain in mice at different postnatal ages. Mice were subjected to: (i) RMS from postnatal day (PND) 1 to 14 (RMS14); (ii) RMS from PND14 to 21 (RMS21); (iii) SMS on PND14 (SMS14); and (iv) SMS on PND21 (SMS21). Plasma corticosterone and c‐Fos expression were examined on the final day in each experiment. The basal corticosterone levels in RMS14 and RMS21 were equal to those in respective age‐matched controls. After the final separation, the levels were significantly increased and were comparable with those after SMS14 and SMS21, respectively. Histological analysis indicated that c‐Fos expression significantly increased in many brain regions, including the paraventricular nucleus, prefrontal cortex, hippocampus, and basolateral and medial amygdale in both SMS14 and SMS21 mice. However, c‐Fos expression in RMS14 mice significantly increased in many regions, whereas such increases were hardly seen in RMS21 mice. These results indicate that repeated early‐life stress neither increases basal corticosterone, nor decreases the magnitude of the corticosterone response during the first three postnatal weeks, although desensitisation of c‐Fos expression induced by repeated stress is changed during postnatal development.

Whole saliva flow rate and body profile in healthy young adults.

OBJECTIVE The purpose of this study was to clarify the effect of the body profile on the whole saliva flow rate in healthy male and female subjects. STUDY DESIGN The whole saliva flow rate was evaluated under unstimulated (UWSFR) and stimulated conditions by the gum test (SWSFR-GT) and Saxon test (SWSFR-ST), and its correlation with body profiles such as body height (BH), body weight (BW), body surface area (BSA) and body mass index (BMI) was analysed in 100 male and 100 female subjects. RESULTS The averages of UWSFR, SWSFR-GT and SWSFR-ST and those of BH, BW, BSA and BMI were significantly larger in males than in females (p<0.0001). No correlation was observed between any of UWSFR, SWSFR-GT and SWSFR-ST and any of BH, BW, BSA and BMI for either males or females. However, UWSFR, SWSFR-GT and SWSFR-ST were significantly correlated with BH, BW and BSA when data from male and female subjects were combined. CONCLUSION The whole saliva flow rate from an individual should only be compared with the data from the group of the same gender.

Impalement Injuries of the Oral Cavity in Children

PURPOSE The purpose of this study was to analyze impalement injuries of the oral cavity in children. PATIENTS AND METHODS Data on 144 children with impalement injuries in the oral cavity at the Department of Oral and Maxillofacial Surgery, Nara Medical University were analyzed retrospectively. RESULTS The patients were 93 boys and 51 girls (age range, 7 months to 10 years). One hundred thirty-two patients (91.7%) were younger than 5 years. Injuries occurred frequently by falling onto an object held in the mouth in 77 patients (53.5%). The impaled objects were a toothbrush in 30 patients (20.8%), a cylindrical toy in 27 (18.8%), and chopsticks in 19 (13.2%). The soft palate was frequently involved in 64 patients (44.4%), followed by the hard palate in 26 (18.1%). Computed tomographic examination was performed in 16 patients (11.1%). Observation with or without medication was most frequently chosen in 98 patients (68.1%). Surgical intervention was performed in 46 patients (31.9%), 41 under local anesthesia and 5 under general anesthesia. Admission was required in 12 patients (8.3%). No complications, such as deep infection or neurologic sequelae, were observed. CONCLUSIONS Most impalement injuries in the oral cavity in children heal spontaneously or with minimal intervention. These children can be followed on an outpatient basis with instructions to their parents about possible complications, except for a few selected cases.

Maxillofacial fractures sustained in bicycle accidents.

PURPOSE The purpose of this study was to analyze maxillofacial fractures sustained in bicycle accidents by demographics, cause of injury, site and severity of fractures, injuries to other sites of the body, and treatment modalities. PATIENTS AND METHODS Data on 307 patients treated for maxillofacial fractures sustained in bicycle accidents in the Department of Oral and Maxillofacial Surgery, Nara Medical University from 1981 through 2009 were analyzed retrospectively. RESULTS The patients were 166 males and 141 females (average age, 30.9 years). Causes of injury were a fall on a level surface in 169 patients, an automobile accident in 56, fall from 1 level to another in 28, and a motorcycle accident in 24. One hundred seventy-five fractures were observed in the mandible, 117 in the midface, and 15 in the mandible and midface. In the mandible, fracture lines were exclusively observed at the condyle. In the midface, the zygoma was most frequently involved. The Facial Injury Severity Scale ranged from 1 to 7 (average, 1.88). Injuries at other sites of the body were found in 47 patients and were frequently found in automobile and motorcycle accidents. Maxillomandibular fixation was most frequently chosen in 81 patients, followed by observation in 76 and open reduction and internal fixation in 71. The Facial Injury Severity Scale was highest in patients treated by open reduction and internal fixation, followed by those treated by maxillomandibular fixation. CONCLUSIONS Maxillofacial fractures sustained in a bicycle accident frequently occurred by falling on a level surface and were not so serious in most cases; however, in accidents with motor vehicles, injuries to other sites of the body were observed at a higher rate.

Maxillofacial fractures in children.

Abstract Maxillofacial fractures in Japanese children were retrospectively analyzed. The subjects were 287 patients aged 15 years and younger seeking treatment for maxillofacial fractures in the Department of Oral and Maxillofacial Surgery, Nara Medical University. The patients were 186 males and 101 females. Injuries most frequently occurred as a result of traffic accidents in 125 patients, 92 of which were bicycle-related accidents. Injuries by falling from one level to another were found in 49, primarily in younger children. One hundred seventy-nine fractures occurred in the mandible, 100 in the midface, and 8 in both. In the mandible, fractures most frequently occurred in condyle followed by symphysis. In the midface, alveolus was mostly involved. The facial injury severity scale ranged from 1 to 9 with an average of 1.83 and was higher in traffic accidents. Injury to other sites of the body was found in 33 patients, 28 of which occurred in traffic accidents. Observation was most frequently chosen in 84 patients. Intramaxillary fixation was chosen in 79, primarily for alveolar fractures and in younger children. Maxillomandibular fixation was chosen in 62 for mandibular fractures in older children. Open reduction and internal fixation was performed in 40, primarily in older children. The facial injury severity scale was higher in patients treated by open reduction and internal fixation and maxillomandibular fixation. Maxillofacial fractures in Japanese children showed characteristic features primarily depending on their age in terms of etiology, patterns, and treatment modalities.

Atrophic change of tongue papilla in 44 patients with Sjögren syndrome

OBJECTIVE The purpose of this study was to investigate the atrophic change of tongue papilla in Sjögren syndrome (SjS) patients and the correlation with characteristic features of the disease. STUDY DESIGN Atrophic change of tongue papilla, investigated by a digital microscope, was classified from score 0 (normal) to score 6 (severe) and compared among 44 SjS patients, 20 xerostomia patients, and 20 healthy subjects. In SjS patients, correlation of the atrophic score of tongue papilla with characteristic changes in sialometry, sialography, lip biopsy, and serologic tests was also investigated. RESULTS The atrophic score of tongue papilla was significantly higher in SjS patients and correlated with the decrease of salivary secretion, the stage on sialography, and the histologic grade of the minor salivary gland. CONCLUSION Atrophic change of tongue papilla is significant in SjS patients and is correlated with the characteristic features of the disease.