aizawa takako

In recent years, some reports on postoperative computed tomography evaluations of secondary bone grafting into the alveolar cleft have been published. Here, we report a retrospective study on the prognostic factors of bone bridge formation after secondary bone grafting into the alveolar cleft, evaluated with computed tomography.<br>In 13 cases, we evaluated the bone bridge formations at a total of 9 points: each of the 3 points of the buccal, central, and palatal sites in 3 different height slices of the central incisor in the cleft side (root tip, middle, and alveolar crest).<br>The frequencies of bone bridge formations were as follows: all cases in middle/buccal, 9 (69.2%) in middle/central, 8 (61.5%) each in root tip/buccal and alveolar crest/central, 6 (46.2%) in alveolar crest/buccal, 5 (38.5%) in middle/palatal, 4 (30.8%) in alveolar crest/palatal, and 3 (23.1%) each in root tip/central and root tip/palatal. Moreover, a univariate logistic regression analysis clearly showed that the preoperative width of the alveolar cleft could be a predictive factor of postoperative bone bridge formation in the central and palatal regions at the middle height of the tooth root.

In our center, oral surgeons discuss presurgical orthodontic treatments and the preferable timing for alveolar bone grafting (BG) with orthodontic dentists.<br>We evaluated the results of BG retrospectively.<br>Objects and methods: Among cases given BG in 2007-2010, we focused on 27 unilateral cleft lip alveolar (UCLA) cases and 58 unilateral cleft lip alveolar and palate (UCLP) cases, and investigated the gender distribution, age at surgery, cleft width, presence and eruption of lateral incisors in the cleft side, eruption and root formation of canines in the cleft and non-cleft sides at surgery, weight of transplanted bone, and marginal bone level obtained, and compared them between the UCLA and UCLP groups.<br>Results: 1. There were 13 males and 14 females with UCLA, and 35 males and 23 females with UCLP. Age at surgery was 118.4+/-20.5 (92-171) months in the UCLA group, and 119.1+/-14.7 (89-168) months in the UCLP group. There was no significant difference in gender distribution or age at surgery between both groups.<br>2. Cleft width (at alveolar crest and nasal floor) was 5.7+/-2.3 and 12.1+/-4.5mm in the UCLA group, and 7.3+/-2.7 and 14.6+/-3.9mm in the UCLP group. Weight of transplanted bone was 2.1+/-1.0g in the UCLA group, and 2.5+/-1.0g in the UCLP group. Thus, there were significant differences between both groups (<i>p</i> < 0.05).<br>3. At surgery, canines erupted in 8 UCLA and 5 UCLP cases in the cleft side. There was a significant difference between both groups (<i>p</i> < 0.05).<br>4. Canine root formation was more than half full in 14 UCLA and 11 UCLP cases in the cleft side, in 13 UCLA and 12 UCLP cases in the non-cleft side. Canine root formation was significantly faster in the UCLA group than the UCLP group in both sides (<i>p</i> < 0.05). <br>5. For the evaluation of marginal bone level, Enemark's level of more than 2 was obtained in 96.3% of UCLA and 98.3% of UCLP cases. There was no significant difference between both groups. <br>Conclusion: In this study, significant differences were detected in cleft width, weight of transplanted bone, eruption of canines in the cleft side, and root formation of canines in the cleft and non-cleft sides at surgery between both groups, but marginal bone formation was excellent in both groups.

The Cleft Lip and Palate Centre of Fujita Health University Hospital was started in 1992, and it has been treating congenital anomalies of the jaw and face including cleft lip and palate.<br>A long period, various knowledge and good techniques are required for treating cleft lip and palate. With the team approach, it is important how the team is managed and operated. The styles of the medical treatment team can be considered as follows: (a) relay system, (b) conductor system, (c) coordinator system, (d) assembly system, etc.<br>The Fujita Health University Hospital Cleft Lip and Palate Centre currently uses (c) the coordinator system. More than 1600 patients have been treated so far. In future, it is necessary to create a more exact and efficient team system.

Pierre Robin sequence (PRS) is a condition that presents with symptoms such as microgenia, glossoptosis, and respiratory disorder caused by upper airway obstruction, and is often associated with cleft palate.<br>Respiratory and feeding management is necessary immediately after birth, and there is often distress during perioperative management, speech and swallowing training. <br>We retrospectively examined 26 cases of PRS who attended our center from 2006 through 2010. The PRS cases were classified into three groups: non syndromic (ns) PRS or syndromic (s) PRS in relation to the presence of determined syndromes, and unique (u) PRS, with unidentified congenital anomalies. The following results were obtained. <br>1. There were 10 males and 16 females: 14 cases of ns PRS, 10 cases of s PRS, and 2 cases of u PRS. <br>2. The age at first visit varied from 1 to 291 days. The weights at birth were 2,932±447g in ns PRS, 2,850±571g in s PRS, 1,607±804g in u PRS. There was no significant difference between ns PRS and s PRS. <br>3. As for the management of respiratory and feeding disability, in stage I (from neonates to six months) , tracheal intubation was needed in 1 case and tube feeding in 10 cases for ns PRS, tracheostomy was needed in 3 cases and tube feeding in 8 cases for s PRS, and tracheal intubation and tube feeding was needed in 1 case for u PRS. <br>In stage II (from 1 year to 18 months; period considered the appropriate time for surgery) , no respiratory or feeding management was needed for ns PRS and u PRS. In contrast, for s PRS, tracheostomy was maintained in 3 cases and tube feeding was continued in 6 cases. <br>4. As for the palatoplasty, for ns PRS and u PRS, palatoplasty was performed at the age of 24.9±7.0 months and 40.5±4.9 months respectively, in all cases. On the other hand, in s PRS, palatoplasty was not necessary in 1 case, was performed in 1 case, was planned in 2 cases, and has not been performed in 6 cases. <br>Post-operative hemorrhage was encountered in an ns PRS case as a perioperative complication.

Russell- Silver syndrome (RSS) is a syndrome characterized by intrauterine growth retardation, short stature without postnatal catch up growth, inverted triangular face with relative large head. Though orthodontic treatment may be performed for the malocclusion caused by growth disturbance and right - left asymmetry of viscerocranium, cleft palate is rarely complicated.<br>We report a case of RSS with cleft palate. The patient was 6-months girl at initial visit to our center, she was born at 39 weeks gestation in August 2007. At birth, her weight was 1,334 g, her height was 39 cm, Apgar score were 4/8. Because of extremely low birth weight, she was transported to the nearest municipal hospital in the following day. She had no problem in breathing and no abnormal findings were detected in the echocardiography. Though cleft palate was confirmed, suckling was possible. No abnormal findings were detected in head CT and MR imaging. She discharged in November, 2,315 g weighted. Though tube feeding was applied, weight gain was poor. She was referred to our center in February 2008, as it was thought that poor suckling was due to cleft palate. We made palatal plate and took a wait-and-see approach with pediatricians. From the appearance of growth delay, inverted triangular face with normal head circumference, asymmetry of the length of lower limb, RSS was suspected. We had cytogenetic analyses, epigenetic mutation of the H19-DMR on chromosome 11p was identified, diagnosis of RSS were confirmed with characteristic clinical features. Development delay was not obvious including speech, so we performed palatoplasty in September 2010, when she was 3 years and 1 month old, 6,365 g in weight. Mouth breadth was narrow, opening was limited, intubation was possible, but Dingman mouth gag was inapplicable. 20mm mouth opening was obtained by forced opening with utility mouth gag, she was operated while pulling and displacing her tongue. Postoperative complications were absent, speech therapy had started. The evolving of epigenetics elucidated the pathogenesis and the way for early diagnosis for RSS. In the treatment of RSS infants with cleft palate, it was thought to be important to respond in well considering for the pathogenesis.

We studied the effect and validity of medical intervention for submucous cleft palate (SMCP) in our center retrospectively.<br>Object: Fifty SMCP cases were referred to our center between April 1992 and December 2008. Of these SMCP cases, 36 were examined, and 14 with complications which affected operation and speech therapy were excluded.<br>Method: SMCP is defined as a congenital deformity in which there is imperfect muscle union across the velum, if they do not satisfy the Calnan's triad. Their gender, age at first visit, chief complaint, complications, Calnan's triad, length and mobility of soft palate, and medical interventions (operation and speech therapy) were investigated.<br>Results: There were 17 males and 19 females, and the age at first visit varied from 8 days to 6 years and 3 months. Chief complaints were morphologic defects such as cleft in 21 cases and functional disability such as speech disturbance in 15. Complications were found in 22 cases; chief complications were as below: mental retardation in 11 cases, 22 q 11.2 deletion syndrome in 4, first and second branchial arch syndrome in 4 (2 cases with auditory imperfections), and Robin's sequence in 3 (combined OSAS in one). Clinical symptoms were: imperfect muscle union across the velum in 36 cases, uvula bifida in 28, deficiency in the bone of the posterior edge of the hard palate in 22, and all of the Calnan's triad in 20. Eighteen cases showed short palate, and palatal lift was poor in 14 cases. Operation was necessary in 19 cases. In 17 cases without surgery, 12 required speech therapy. The effects of speech therapy were: improvement in 10 cases and slight improvement in 2. Satisfactory speech was acquired before starting school, excluding a case speech therapy was started after 5 years. In the operated cases, palatoplasty was performed. In one case, a pharyngeal flap was combined. In 15 cases speech therapy was necessary. The effect of medical intervention was: improvement in 12 cases, slight improvement in one, and no change in 2. For the 2 no-change cases, a PLP was applied in one, and a pharyngeal flap was applied additionally in the other. In 15 cases with surgery, excluding the 2 no-change cases and 2 cases operated after 5 years, satisfactory speech was acquired before starting school.<br>Conclusion: Excluding the 2 cases in which the speech evaluation after primary operation showed no change, the other cases could acquire satisfactory speech before starting school, provided medical intervention was started within 5 years. We conclude that the medical intervention in our center is appropriate.

A clinico-statistical investigation was conducted with 1112 cleft lip and/or palate patients (excluded 18 cases in which data were inadequate) in the Cleft Lip and Palate Center, Fujita Health University Hospital, since its foundation in April 1992.<br>The results were as follows:<br>1) Primary cases were 1073, secondary cases were 39, and average number of patients registered per year was 75.5 from 1993 to 2006.<br>2) The distribution by cleft type was: 368 cases (33.1%) with unilateral CL (A) P, 279 cases (25.1%) with unilateral CL (A), 275 cases (24.7%) with CP, 157 cases (14.1%) with bilateral CL (A) P, 26 cases (2.3%) with bilateral CL (A), and 7 cases (0.6%) with others.<br>3) The average number of operations per year from 1993 to 2006 was as follows: chelioplasty (primary lip operation) 61.7, palatoplasty (one stage operation for CP) 13.1, palatoplasty (soft palate in two stage operation) 26.5, palatoplasty (hard palate in two stage operation) 23.4, secondary alveolar bone graft 17.8, and secondary operation for velopharyngeal incompetence 3.<br>4) The number of patients registered for speech evaluation and training was 741 until June 2007.

This report presents a case of extensive oral cancer suspected to be a granulocyte-colony-stimulating-factor (G-CSF)-producing tumor in a 63-year-old man who complained of dyspnea, dysphagia, and dysmasesis. Laboratory findings on admission showed marked leukocytosis (35, 900/μl) and thrombocytosis (527, 000/μl).<BR>Pathological examination of a biopsy specimen revealed an undifferentiated squamous cell carcinoma. Chemotherapy with PEP, CDDP, MTX, UFT, and concurrent irradiation resulted in shrinkage of the tumor and a decrease in the leukocyte and platelet counts. Soon after 10 Gy of radiation had been administered, the serum G-CSF concentration reached the abnormally high level of 329pg/ml and was still 132pg/ml at death about a month later. Over the entire course of treatment, the leukocyte count changed with changes in tumor size. Both findings suggest that the tumor cells produced G-CSF.

A male newborn was referred to Fujita Health University Hospital shortly after birth because of a huge tumor, 80×50×40mm in size, extending from his mouth. A great number of tumors were found throughout his body. Alimentary and respiratory difficulties and the risk of septicemia due to the oral tumor necessitated excision of the tumor when the patient was 3 days old. The tumor was composed mainly of undifferentiated, small, round cells, which had partly formed rosettes around blood vessels. A fibrous stroma and myxoid changes were found in some parts of the tumor. After histological, immunohistological, and electron-microscopical examinations, the tumor was diagnosed as an unclassified sarcoma. After an initial response to aggressive chemotherapy, most of the remaining tumors grew to the extent that it seemed incredible that the boy was still alive at nearly 1 year of age

A rare case of a 2-year-old girl with encephalocele is reported. She was admitted at birth to the department of pediatric surgery because of a hydrocele and a left buccal tumor. The buccal tumor was irradiated up to 30 Gy under a tentative diagnosis of a low malignant neurogenic tumor. A V-P shunt operation was performed for the hydrocele. The tumor gradually enlarged postoperatively, resulting in facial asymmetry. An ulcer formed in the buccal mucosa because of close contact with ID. The patient was referred to our department because of the buccal ulcer and facial deformity. The buccal tumor was of the size of a hen's egg and had an irregular surface. Intraorally, it was multilobulated and extended to the palate and pharyngeal space. Before surgery, an encephalocele was suspected on the basis of imaging findings, including 3 D-CT and MRI. ID extraction and partial resection of the lesion were performed. Degenerated brain tissue with calcification was identified pathologically. For six years postoperatively, the patient has been free from severe complications and can lead normal life.

At the Cleft Palate Center, School of Medicine, Fujita Health University,127 newborns (76 males and 51 females) with cleft lip and/or palate fitted with palatal plates right after birth underwent cleft lip surgery as early as possible and/or cleft palate surgery at an average age of 12 - 15months. They were continuously followes up until their dentitions were complete. Anomalies in the number of decidous teeth were investingated by means of dental casts and radiographs and compared with the records of 1122 kindergarten children representing a normal distribution of dentitions.<BR>1. The congenital absence of the lateral incisor on the side in which the cleft was found in 11.8%of the children by the age of 3 years was the most conspicuous sign of insuffient number of teeth. Congenital teeth were found in 3.1% of them, but all of the teeth fell out within a couple of weeks. Between the two groups of children, there was no significant difference in the loss of mandibular teeth and teeth in the non-cleft part of the denitition This was attributed to the superior dental hygiene in the children who were followed up.<BR>2. Supernumerary teeth were found in 23 (18.1%) of the patients, They grew particulary often in 34.1% of the patients with a cleft lip or a cleft lip and alveolus.<BR>3. Between the two groups of children, there was no significant difference in the incidence of fused teeth. However, the incidence of twin teeth was significantly higher in these patients than in other children. They grew particurally often in patients with cleft lip or cleft lip and alveolus; 24 of 48such children had either supernumerary or twin teeth.

A 49-year-old woman was referred to our department on April 18, 1990 for a continuous burning pain in her gingiva near the upper left molar. She complained that the pain had been provoked by endodontic therapy of her upper left second molar. The pain had persisted for the past three years despite medical treatment.<BR>She had no clinical disorders other than pain. The characteristics of her pain and the patient's history of minor nerve injury caused by dental treatment led to a diagnosis of reflex sympathetic dystrophy (RSD).<BR>Stellate ganglion block was effective. However, more than 200 procedures were required to eliminate all pain.

There have been various reports on dental problems in juvenile diabetic patients, but none has clearly shown how to deal with these children from the point of view of dental care. We performed oral examinations on 62 children with diabetes and investigated how to maintain their dental health.<BR>The results and conclusions were as follows:<BR>1) There was no significant difference in the incidence of dental caries between the patients with diabetes and normal subjects, although some reports have shown a higher rate in diabetic children.<BR>2) There was a tendency for gingivitis to be worse in children in the higher grades of elementary school or in junior high school. Marked deposits of dental plaque and calculus were observed. It thus appears necessary to conduct periodic dental check-ups and to build up a daily self-care routine through dental health guidance and treatment.<BR>3) If possible, annual radiography should be performed to prevent dental caries or chronic inflammation of the jaws associated with oral infections. Juvenile diabetic patients should thus undergo proper dental health guidance and treatment to reduce the physical, mental, and financial burden of dental caries.