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Peritoneal dialysis can be performed at home, and the transfer of solutes in the blood and other body fluids is slow compared to hemodialysis, reducing the load on the circulatory organs and lessening the frequency of hospital visits. We encountered a male patient in his 70s on peritoneal dialysis for end-stage renal failure who developed obsolete mandibular fracture-associated pseudarthrosis accompanied by osteomyelitis, which was treated with noninvasive reduction and fixation using circumferential wiring after the resolution of inflammation. The inflammation was resolved by an intravenous drip infusion of ampicillin and lavage of the local region through the fistulated region during hospitalization, and sequestrum was removed under local anesthesia. After the disappearance of drainage from the fistula, the mandibular fracture was fixed with circumferential wiring (noninvasive reduction and fixation) using a mandibular resin base (occlusion is possible). For noninvasive reduction and fixation of a midline fracture, a 6-week fixation period is usually necessary after surgery, but in this case it was fixed for 3 months after surgery because of the presence of infection and bone defect. In jaw bone infection in patients on long-term dialysis, high sensitivity to infection and incomplete cure occur due to a decline in cell-mediated immunity, renal osteodystrophy (ROD), and chronic kidney disease (CKD)-mineral and bone disorder. In the present patient, infection complicated the odontogenic source of infection and fracture, which may have protracted the condition. When jaw bone infection is noted in a patient on long-term dialysis, it is important to closely cooperate with the dialysis physician and select the administration method and dose corresponding to the route of administration and metabolism of antimicrobial agents in order to minimize the influence on the renal function. For the local region, infection control by oral hygiene management and cleaning is important, targeting treatment and management while avoiding the use of any antimicrobial agent.

We report a pediatric case aged 10 years with Granulicatella adiacens-associated chronic mandibular osteomyelitis. The causative pathogen was uncertain because polymicrobial species were detected from the bacterial culture in bone marrow fluid. In contrast, G. adiacens was predominantly identified in the clone library analysis of the bacterial 16S rRNA gene sequence. Vancomycin to which G. adiacens was reported to be susceptible was not administrated sufficiently to this patient because of its adverse event, whereas linezolid and ciprofloxacin was alternatively effective for the treatment of chronic mandibular osteomyelitis.

Object The aim of this study was to assess our diagnosis system for cervical node metastasis for oral squamous carcinoma (OSCC) based on the combined results of computed tomography (CT), magnetic resonance imaging (MRI), ultrasonography (US), and 18-fluorodeoxyglucose positron emission ( 18 F-FDG-PET/CT). Methods 106 patients with primary OSCC who underwent surgical treatment were divided into 3 groups. In group 1, cervical node metastasis was diagnosed by disunity combinations of diagnostic devices. In groups 2 and 3, it was assessed according to a set of diagnostic criteria that included the results of the CT/MRI, US and 18 F-FDG-PET/CT. In group 2, node status was considered negative when the results of both CT/MRI and US were negative. In group 3, node status was considered negative when the results of both CT/MRI and US were negative and the maximum standardized uptake value determined via 18 F-FDG-PET/CT was Results 67 patients were diagnosed as cN0. 50 cN0 patients adopted the wait and watch policy, 12 of whom (24.0%) developed cervical node metastasis without recurrence at the primary site. Metastasis rates after surgery improved 33.3%, 23.5%, and 13.3% in groups 1, 2, and 3, respectively. In contrast, positive predict value (PPV) were worst (50.0%, 40.0% and 33.3%). Conclusions Our diagnosis system reduces the rate of cervical lymph node metastasis after surgery.

Background Oral cavity is a reservoir of various respiratory pathogens, and poor oral hygiene is associated with an increase in anaerobic bacteria in oral cavity. In addition, it positively relates higher risk of developing pneumonia and increased pneumonia-related mortality. However, the association between poor oral hygiene and increase in obligate anaerobes in the lungs of pneumonia patients is unclear. Methods A total of 39 patients with pneumonia in whom bronchoscopic examination and oral hygiene evaluation were performed were prospectively enrolled. The microbiota of the bronchoalveolar lavage fluid (BALF) directly obtained from the pneumonia lesion was analysed by the clone library analysis. In addition, oral hygiene evaluations were performed using oral hygiene index (OHI), tongue coating score, oral dryness, and community periodontal index of treatment needs (CPITN). The association between the detection of oral streptococci and obligate anaerobes and oral hygiene status was evaluated. Results Using the clone library analysis of BALF, the phylotypes of oral streptococci and obligate anaerobes were detected in 31 (79.5%) and 26 (66.7%) patients, respectively. Increased oral dryness, OHI, and CPITN, but not the tongue coating score, significantly correlated with higher rate of detection of obligate anaerobes, although no significant associations between the detection of oral streptococci in the lungs and each oral hygiene evaluation were observed. Significantly higher number of obligate anaerobes were detected in the lungs in patients with total oral hygiene score of ≥ 5 (P = 0.008). Conclusion Poor oral hygiene is associated with increased obligate anaerobes in the lungs of patients with pneumonia.

We describe the successful use of medical leeches to relieve venous congestion of a free forearm flap after reconstruction in a patient with intraoral carcinoma.A 63-year-old woman consulted our clinic because of an ulcer on the left buccal mucosa. Histopathological examination revealed squamous cell carcinoma. After 60Co radiotherapy of with a total dose of 34 Gy, she underwent bilateral upper neck dissection and resection of the carcinoma. The cheek mucosa was reconstructed by transplantation of a free forearm flap.Because the flap became swollen and black, suggesting venous congestion, the vein connected to the flap was unsutured and anastomosed again on the 5 th day after the operation. However, the patient's condition did not improve.Leech therapy was started on the 4 th day after reanastomosis. A medical leech was applied to the flap for 40 minutes twice daily. After 10 leeches were used in 5 days, the flap apparently recovered and nearly healed.Hirudin contained in the saliva of leech is reported to have various effects, such as vasodilation, anticoagulation, and local anesthesia. The anticoagulative effect was considered the most important for improving the congestion in our patient.

To ensure reliable surgical margins, intraoperative frozen section histological analysis (FS) has been performed since October, 2005 as follows: i) the orientation at the anatomical position and extent of the tumor are shared between oral pathologists and oral surgeons using imaging evaluations and pathological pictures and the planned site of sampling for intraoperative FS is confirmed; ii) a tumor team is organized and the team marks the tumor area and sets the resection range to correct the setting errors of the resection range among operators; iii) vital Lugol staining is applied to the lesion prior to tumor resection, the surgical margin is set based on the non-stained region and the extent of the tumor is macroscopically confirmed in the maximum cross-sectional surface of the resected specimen; and iv) FS is performed using samples from resected specimens to confirm the mucoepithelium and safety margin of the deep stump. The aim of this study was to evaluate the usefulness of our FS method. The treatment outcomes of oral squamous cell carcinoma were retrospectively investigated in patients treated prior to (Group 1) and after (Group 2) the introduction of our FS method. The recurrence rate of the primary lesions was high (17.3%) in Group 1, but decreased significantly in Group 2 (6.9%). Regarding clinicopathological factors, the condition of the surgical margins was associated with recurrence of the primary lesion in Group 1, but not in Group 2. In conclusion, our FS method appears to be useful for resecting tumors with reliable safety margins.

We introduced concurrent neoadjuvant chemoradiotherapy (CCRT) with S-1, an oral fluoropyrimidine, as treatment for oral squamous cell carcinoma (OSCC) from October 2005. The clinical usefulness and medical safety of CCRT with S-1 (S-1 group) for OSCC were analyzed and compared with CCRT using super-selective intra-arterial infusion (AI group). The subjects in the S-1 group underwent external irradiation, at a total dose of 30 Gy, with S-1 chemotherapy. The AI group received cisplatin (CDDP) or carboplatin (CBDCA) combined with daily radiotherapy at a total dose of 40 Gy. The histological effects and disease-specific survival rates were almost equivalent in the S-1 and AI groups. Adverse events were less frequent in the S-1 group, while hematological toxicity, including anemia, thrombopenia and pharyngeal edema, was observed in the AI group. The results of this study indicate that CCRT combined with S-1 is a more effective and safer treatment for OSCC than AI.

A Clinical evaluation was carried out on 68 patients who underwent orthognathic surgery from 1981 for 10 years in the Second Department of Oral and Maxillofacial Surgery, Kagoshima University. The results were as follows:1. The male-female ratio was 1: 2.2. The average age was 20, 8 years.3. Mandibular prognathism was the most predominant diagnosis (66%). Ten (14%) out of 68 patient were accompanied with cleft palate.4. The extent of mandibular set back in sagittal splitting osteotomy was 10.5mm on the right side and 10.1mm on the left side in average.5. Excision on the tongue in patients with possible macroglossia. The excised areas were 274.2mm2 in average (ranged from 180mm2 to 400mm2).6. In sagittal splitting osteotomy, rigid fixation by use of metal or sapphire screws were employed with the maneuver for repositioning the mandibular condyle. In Le Fort I osteotomy, iliac bone graft and fixation with a miniplate and zygomatic suspension were employed.7. The operation time for sagittal splitting mandiblectomy was 5hr. 41min. in average (ranged from 3hr. 12min. to 8hr. 26min.), and in bimaxillary osteotomy was 7hr. 12min. in average (ranged from 7hr. 17min. to 9hr.58min.).8. The mean blood loss was 537.2ml in the sagittal splitting mandiblectomy (ranged from 114m1 to 2140ml), 1041ml in bimaxillary surgery (ranged from 494ml to 2910ml).9. The routine period of intermaxillary fixation in our department was 14 days for sagittal splitting mandiblectomy, and 21 days for Le Fort I osteotomy.

The aim of this study was to analyze the relationship between the maximum standardized uptake value (SUVmax) of 18F-fluoro-2-deoxyglucose-positron emission tomography (FDG-PET) and the effects of neoadjuvant chemoradiotherapy in oral squamous cell carcinoma (OSCC), and to identify the possible biological background of this association. Thirty-seven patients with OSCC, who underwent preoperative FDG-PET followed by cancer treatment with neoadjuvant chemoradiotherapy, were enrolled in this study. The various histological effects following neoadjuvant chemoradiotherapy were compared to the SUVmax in the primary OSCC. These effects were also compared to the immunohistochemical staining score of hypoxia-inducible factor-1alpha (HIF-1alpha), glucose membrane transporter (GLUT)-1 and vascular endothelial growth factor (VEGF) in the biopsy specimen. Furthermore, we analyzed the chemosensitivity of KB-3-1 cells to cisplatin under hypoxic conditions using the MTT assay. A negative correlation was observed between the SUVmax and the histological effects following neoadjuvant chemoradiotherapy (p

Small cell carcinoma (SCC) in the head and neck region is an extremely rare high-grade malignant tumor. The authors report a case of an SCC occurring in the left buccal region. An 85-year-old man exhibited left cheek swelling that rapidly increased in size. Histopathological examination revealed invasive growth of an SCC into the musculo-adipose tissue. Immunohistochemically, the tumor cells were positive for cytokeratin (AE1/AE3), neuron-specific enolase (NSE) and CD56, but negative for cytokeratin 20. The patient received chemotherapy and radiotherapy, which resulted in marked regression of the tumor. Surgical resection was performed. The serum levels of NSE and pro-gastrin-releasing peptide (pro-GRP) increased and multiple metastases of the tumor occurred 1 month after surgery. SCCs tend to exhibit aggressive invasion and metastasis so chemotherapy for the whole body is recommended to prevent dissemination of the tumor cells. Serum levels of NSE and pro-GRP are considered to be useful tumor markers for understanding the status of the tumor and the clinical symptoms.

A clinico-statistical analysis was carried out on the 341 patients with primary cleft lip and palate who visited our clinic during the 10-year period since 1981.The results were as follows:1. The body weight at birth of 324 patients averaged 3, 061. 6 g (ranged from 1, 350 to 4, 380 g). The incidence of low-weight babies less than 2, 500 g accounted for 10. 8 percent of the patients, which was higher than in the normal.2. The mean age of the 290 mothers at delivery was similar to the normal distribution. High-aged mothers over 35 years old accounted for 6. 6 percent. No relationship was suggested between the mother's age and the occurrence of cleft lip and palate.3. Bottle feeding was being used in most patients at the first medical examination (72.4% of 301 patients).4. Other congenital malformations were detected in 71 patients (20.8% of all 341patients). The cleft palate (CP) group showed the highest incidence among the three (CP, CL and CLP) groups.5. A family history was found in 49 (14. 4%) of 341 patients.

An osseous choristoma occurring on the tongue of a Japanese 11-year-old girl is reported. The lesion was a polypous mass, measuring about 8×8×5 mm, in the centroposterior region of the tongue. The lesion was removed under general anesthesia.Histologically, the lesion consisted of dense lamellar bone with Haversian canals and bone marrow. It was surrounded by a thin layer of fibrous conective tissue and covered by stratified squamous epithelium. The origin of this lesion was discussed briefly, referring to the literature.