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Oral bacteria may contribute to postoperative infectious complications including postoperative pneumonia or surgical site infection. The aim of this study was to investigate the impact of preoperative dental care on postoperative outcomes among surgical patients under general anesthesia.Retrospective cohort study.We analyzed clinical records of major surgical patients at a university hospital between 2016 and 2018. Subjects were categorized into either the preoperative dental care group, those being referred to dentists by their surgeons based on an individual surgeon's judgment for dental care before surgery, or the control group.The primary outcome was postoperative infectious complications. Secondary outcomes were postoperative inflammation markers (C-reactive protein and fever), and economic outcomes (postoperative length of hospital stay and medical expenses). As the main analysis, the average treatment effects of the preoperative dental care were obtained from the augmented inverse-probability weighting (AIPW) method with consideration of demographics and perioperative risk factors to estimate causal effect of the intervention from the observational data. Then, stratified analyses by age and surgical sites were conducted with the inverse-probability weighting and linear regression methods, respectively.In the AIPW estimation, compared with the control group, the care group saw a significantly lower rate of postoperative infection (average treatment effect -3.02) and shorter fever duration (-2.79 days). The stratified analysis by age revealed significant positive impact of dental care in all age groups, including the highest treatment effects observed among patients younger than 60. Also, treatment effect was observed in wider surgical sites than previously known.This study indicates a significant impact of preoperative dental care on preventing postoperative infection and inflammation. Along with old age or certain types of surgeries in which advantages of dental referral have been already known, preoperative dental referral could be beneficial for broader types of patients.

Neurofibromatosis type 1 (NF1) is an inherited, autosomal-dominant disorder, also known as von Recklinghausen’s disease. This pathology was first described from a series of patients displaying a combination of nervous system tumors and findings such as cafe-au-lait spots, eye lesions, and bone lesions. Oral mucosal tumors are common in association with NF1, but are relatively rare on the lateral border of the tongue. We describe the case of a 17-year-old boy who presented to the Department of Oral and Maxillofacial Surgery at Tokyo Women’s Medical University Hospital with the chief complaint of swelling and pain involving the right lateral border of the tongue. Medical history included NF1 and developmental disorder. Several cafe-au-lait spots were observed on the back, but cutaneous neurofibromas were not apparent elsewhere on the body. Examination of the oral cavity revealed a lobulated lesion involving the right anterior two-thirds of the tongue. Excisional biopsy was performed for an exophytic portion of the right lingual edge of the lesion. Histopathological analysis of the tongue lesion confirmed the diagnosis of neurofibroma. Because the tongue lesion was widespread on the right side and the patient was 17 years old, we performed conservative treatment comprising surgical resection of only the dysfunctional, painful part of the lesion. Three years have elapsed with no sign of exacerbation.

We report a case of lymphoma that developed on the mandibular gingiva and spontaneously regressed after biopsy was performed. The patient was an 87-year-old man who visited our hospital with a complaint of gingival swelling in the left mandibular molar region. We observed an elastic, soft, well-demarcated, granuloma-like mass measuring 30 × 25 mm in size and comprising partially white pseudomembranous areas. We conducted a biopsy, which confirmed a pathologic diagnosis of a diffuse large B-cell lymphoma. Because of age constraints, the patient was monitored without being administered aggressive therapy, and the mass disappeared 20 days after biopsy. We then performed a follow-up biopsy, which revealed the absence of tumor cells. There was no recurrence of lymphoma during the 2.5-year follow-up period.

We studied maxillofacial fractures treated by departments of oral and maxillofacial surgery in Tokyo. A retrospective review of records and radiographs for patients admitted during the 5-year period from 2000 to 2004 was conducted at five departments in Tokyo. Date, age, gender, cause of injury, fracture site, concomitant injury, domestic violence against women, and treatment were reviewed. 674 patients with maxillofacial fractures were admitted. Male-to-female ratio was 3.6 : 1. The most frequent age group was 21–25 years. Fractures of the mandible were most frequent (87%), followed by the maxilla (14%) and the zygomatic bone (12%). Thirty-one percent of fractures were due to traffic accidents, 29% to accidental falls, 23% to violence and 14% to sports. The incidence of maxillofacial fractures caused by traffic accidents was lower, and that caused by falls and violence were higher than in other countries. Seventeen percent of the maxillofacial fracture patients had concomitant injuries. The incidence of domestic violence-related maxillofacial fracture was 1.6% of all cases. These cases were mainly caused by a husband (55%) or a sexual partner (36%). Most patients (67%) were treated by open reduction surgery. However, condylar fracture alone was usually treated by closed reduction surgery.