Yuri Izumiyama

Access to the maxillary sinus using a bone flap with sinus mucosal and mucoperiosteal pedicles

We describe a procedure for removing lesions in the maxillary sinus using bone flaps with the sinus mucosa and mucoperiosteum. The surgical design is to construct a rectangular trapdoor using 3 consecutive bur-cuts, fracture the upper margin, and lift the bone lid upward. The osteotomy site on the inferior, medial, and lateral sides of the bone lid was exposed subperiosteally, but the mucoperiosteal and sinus mucosal attachments on the superior and central areas of the lid were maintained. Then, following fracture of the upper bone margin, the lid was lifted upward. In this way, the integrity of the mucoperiosteum and sinus mucosa was maintained. Advantages of the bone flap with soft tissue pedicles technique may be quick recovery and restored integrity of the sinus wall, with a low probability of infection because of vascularization of the bone lid. To realize this, a bone flap with both sinus mucosal and mucoperiosteal pedicles is more suitable.

Oral tumor resection and salivary duct relocation with an ultrasonic surgical aspirator.

We describe a procedure of oral tumor resection and salivary duct relocation with an ultrasonic surgical aspirator. After mucosal incision, resection of the underlying musculature was performed using an ultrasonic surgical aspirator. Using the apparatus, the salivary duct was easily exposed without damaging or cutting the duct. After identification of the salivary duct, salivary duct relocation was performed. After resection of the tumor, the artificial dermis was trimmed and sutured to the mucosal edges of the surgical defect. This method is a reliable and simple procedure that can be used to avoid postoperative complications such as salivary fistula or swelling of the gland.

Mandibular Coronoid Hyperplasia: A Case Report

Abstract A case of unilateral coronoid hyperplasia successfully treated by coronoidotomy with prolonged postoperative physiotherapy and reveal the postoperative radiographic changes between the sectioned part of the coronoid process and the mandibular ascending ramus is described. The patient was a 28-year-old man whose maximum mouth opening was 30 mm. A coronoidotomy of the left coronoid process was performed. Nine days after surgery, the patient started physiotherapy with a HU-OSr appliance. After coronoidotomy and physiotherapy, the maximum mouth opening had increased to 43 mm. Radiographic follow-up showed that the coronoid process apparently united with the mandibular ascending ramus, with moderate dislocation and inclination posteriorly. In the case presented, an intraoral coronoidotomy with postoperative physiotherapy for treatment of coronoid process hyperplasia allowed satisfactory and stable results in the correction of coronoid-malar interference.

Repair of oral mucosal defects using artificial dermis: factors related to postoperative scar contracture

OBJECTIVE To clarify wound-healing situations with artificial dermis used for the repair of oral mucosal defects, we investigated the incidence of postoperative scar contracture and studied factors related to cicatrization. STUDY DESIGN Forty patients who underwent repair of oral mucosal defects using artificial dermis participated in this study. The degree of scar contracture was recorded 1 month after surgery. To study the factors related to cicatrization, patient characteristics of sex, age, excision region, fixation used, size of the graft, and number of days for silicon seat removal were examined. Logistic regression analysis was used for analysis of the relationship between cicatrization and patient characteristics. RESULTS One month after surgery, 70% of patients had no contracture, 22.5% of patients had moderate contracture, and 7.5% of patients had severe contracture. A significant correlation was found between cicatrization and the minimum diameter of the artificial dermis (P < .001). CONCLUSIONS Reducing the minimum diameter of the artificial dermis may contribute to a decrease in scar contracture.

Intra-Articular Fracture of the Mandibular Condyle: A Case Report

Abstract The authors describe a case of intra-articular fracture of the left mandibular condyle, successfully treated by the pumping technique in the upper and lower joint cavities, and show arthroscopic findings in these cavities. The patient was a 15-year-old boy whose maximum mouth opening was 30 mm. Computed tomography revealed a left intra-articular sagittal fracture of the condylar head. Aspiration of the hematoma in the upper and lower joint spaces was performed with ten pumping actions. In the upper and lower joint spaces, arthroscopic examination revealed the disappearance of the hematoma. The patient continued opening, protrusive, and lateral excursive exercises. One month after the surgery, the maximal interincisal distance was improved to 45 mm with straight opening. In the case presented, mouth-opening exercises, along with the pumping technique for treatment of an intraarticular fracture of the mandibular condyle, allowed satisfactory and stable results in the improvement of limited mouth movement.

Relationship between the Effectiveness of Arthrocentesis under Sufficient Pressure and Conditions of the Temporomandibular Joint.

Background. The purpose of this study is to investigate the conditions of the temporomandibular joint relative to the effectiveness of an arthrocentesis-like enforced manipulation technique followed by irrigation under high pressure in patients with closed lock. Methods. We performed arthroscopic examination and manipulation followed by irrigation as the initial treatment in 50 joints with closed lock. Relationship between the effectiveness of the procedure and conditions of the temporomandibular joint was statistically analyzed using multiple regression analysis. Results. Significant inverse correlations were found between the extent of improvement in maximum mouth opening after treatment and the initial maximum opening before treatment. There were no significant correlations between improvement of joint pain at mouth opening and in biting and conditions of the temporomandibular joint. Conclusions. Pathologic conditions of the temporomandibular joint did not have an influence on the efficacy of the technique. This result suggests that this procedure has wider application than conventional arthrocentesis.

A combination of three minimally invasive surgical procedures for implant placement in the posterior maxilla with insufficient bone quantity.

We describe a combination of 3 surgical procedures for implant placement in the posterior maxilla with insufficient bone quantity and quality. In these situations, we have performed 3 minimally invasive, safe, and reliable surgical procedures: buccal bone graft with bone harvested from the mandibular molar region, submucous vestibuloplasty using artificial dermis, and bone-added osteotome sinus floor elevation under endoscopic control. These modified procedures can be performed in the office setting under outpatient local anesthesia and may minimize patient discomfort and reduce postoperative complications.

Three minimally invasive procedures for removing lesions in the maxillary sinus.

We describe here 3 minimally invasive procedures for removing lesions from the maxillary sinus using an ultrathin endoscope, microscope, and otoscope.Preoperatively, a lesion in the maxillary sinus was identified by radiographic examination. Then the access hole position and advance direction of the endoscope and forceps were planned. Under local anesthesia, a small incision on the buccal mucosa was made in the planned position. The anterior bony wall of the sinus was exposed subperiosteally, and a small access hole for the insertion of an endoscope was made in the planned position and angled with a fissure bur. After identification of the lesion endoscopically, microscopically, or otoscopically, a forceps was inserted into the sinus cavity through the hole, and the lesion was seized and withdrawn from the sinus.The surgical procedures are suggested to be reliable, easy, and minimally invasive that provide a limited incision and bone removal and respect the integrity of the sinus.

Reconstruction of a defect on the buccal mucosa and prolabium.

We describe the procedure for reconstruction of a defect on the buccal mucosa and the prolabium with a buccal mucosal transposition flap and an artificial dermis graft. The preparation of the flap started with an incision extending from the border of the defect to the corner of the mouth. The pivot point of the flap was near the stump of the excised prolabium. Only the buccal mucosa was elevated from the buccal surface. It was transposed onto the defect of the prolabium and sutured to the edges of the defect. After reconstruction of the prolabium, the artificial dermis was trimmed and sutured to the mucosal and skin edges of the surgical defect. This is an easy and minimally invasive procedure to cover a defect of the buccal mucosa and the prolabium. In our experience, the wound healed with good, functional, and cosmetic results.

Procedure for Tooth Autotransplantation with Bone-added Sinus Floor Elevation

Abstract This report describes a minimally invasive procedure for tooth autotransplantation with bone-added sinus floor elevation for patients with insufficient bone in the posterior maxilla. The procedure was performed in patients whose residual bone height beneath the maxillary sinus floor was insufficient, but whose bone width was sufficient for a donor tooth. Postoperatively, bone formation was seen over the root apex of the transplanted tooth radiographically and stable occlusal function was obtained. The surgical technique is considered reliable and minimally invasive, with limited incision and minimal bone harvest.