Publications by authors named "Shunji Shiiba"

23 Publications

  • Page 1 of 1

A Nasal High-Flow System Prevents Upper Airway Obstruction and Hypoxia in Pediatric Dental Patients Under Intravenous Sedation.

J Oral Maxillofac Surg 2021 Mar 16;79(3):539-545. Epub 2020 Oct 16.

Professor, Division of Dental Anesthesiology, Department of Science of Physical Functions, Kyushu Dental University, Fukuoka, Japan.

Purpose: Upper airway obstruction (UAO) and oxygen desaturation are risk factors for major complications of intravenous sedation (IVS) in pediatric dental patients. This study aimed to investigate the use of a nasal high-flow (NHF) system for the prevention of UAO and oxygen desaturation in pediatric dental patients under IVS.

Methods: The authors implemented a prospective randomized design. Thirty pediatric patients (aged 3 to 12), scheduled for dental treatment under IVS, were enrolled in this study. The subjects were randomly assigned to 1 of 2 groups: patients who received oxygen at 5 L/minute through a nasal cannula (NC group) and patients who received oxygen at 2 kg/L/minute, up to a maximum of 30 L/minute, through the NHF system (NHF group). The predictor variable was flow rate. The primary outcome variable was the need for intervention during treatment, and the secondary outcome variable was the lowest peripheral capillary oxygen saturation values during the procedure. Additional study variables measured included patient age, gender, weight, height, and surgical duration. The Mann-Whitney U test and Fisher exact test were used for statistical analysis, with P < .05 considered as significant.

Results: Both the NC (n = 15; mean age, 6.2 ± 2.3) and NHF (n = 15; mean age, 5.9 ± 2.5) groups had a male:female ratio of 2:1. The use of the NHF system significantly improved the lowest peripheral capillary oxygen saturation values during treatment (P < .05). Jaw lifting, to relieve UAO and facilitate spontaneous breathing, was required in both the NC (n = 10) and NHF (n = 3) groups (P < .05). The need for interventions during treatment was significantly lower in the NHF group (P < .05).

Conclusions: The results of this study suggest that the use of the NHF system can prevent UAO and improve the respiratory condition of pediatric dental patients under IVS.
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http://dx.doi.org/10.1016/j.joms.2020.10.018DOI Listing
March 2021

Effects of stellate ganglion block on postoperative trigeminal neuropathy after dental surgery: a propensity score matching analysis.

Sci Rep 2020 08 10;10(1):13463. Epub 2020 Aug 10.

Division of Dental Anesthesiology, Department of Science of Physical Functions, Kyushu Dental University, 2-6-1, Manazuru, Kokura-kita, Kitakyushu, Fukuoka, 803-8580, Japan.

This study aimed to evaluate the effects of stellate ganglion block (SGB) on postoperative trigeminal neuropathy (TNP) after dental surgery. This was a retrospective study based on the medical records of all patients with postoperative TNP at Kyushu Dental University Hospital from 2014 to 2019. Patients were divided into the SGB group (received SGB) and non-SGB group (did not receive SGB). We evaluated the severity of TNP at 3 months after surgery and the incidence rate of abnormal sensations. Abnormal sensations were counted using patients' reports of uncomfortable symptoms during the treatment, including dysaesthesia, allodynia, and hyperalgesia. A propensity score (PS) matching analysis was performed to evaluate these data. After PS matching, amongst others, the force equivalent values of the Semmes-Weinstein test at 3-months post-treatment were significantly lower in the SGB group than in the non-SGB group (2.00 ± 0.44 vs 2.30 ± 0.48; p < 0.05). In addition, after PS matching, the incidence rate of abnormal sensations during the treatment was significantly lower in the SGB group than in the non-SGB group (10 cases [4.7%] vs 22 cases [10.3%]; p < 0.05). Collectively, the findings support that SGB may improve the recovery from postoperative TNP and reduce the incidence rate of abnormal sensations after dental surgery.
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http://dx.doi.org/10.1038/s41598-020-70533-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7417992PMC
August 2020

Sedation With a Combination of Dexmedetomidine and Midazolam for Pediatric Dental Surgery.

Anesth Prog 2018 ;65(2):124-126

Department of Science of Physical Functions, Division of Dental Anesthesiology, Kyushu Dental University, Kokurakita, Kitakyushu, Japan.

Intravenous sedation (IVS) is commonly used to complete dental treatment for uncooperative pediatric patients. Propofol (PRO) is widely used for IVS because of its short context sensitive half-time and amnestic effect. However, administering PRO to patients who have a history of egg anaphylaxis is still somewhat controversial. The evidence that supports the potential risks for allergic reactions following PRO use in patients with egg allergies is limited with some anesthesiologists recommending against its use in these patients. Alternative drug regimens for procedural sedation in this population are therefore desirable. Dexmedetomidine (DEX), a selective α-2 agonist, has antianxiety and sedative properties and has been widely used not only for procedural sedation with mild inhibitory effects on respiration but also during minor surgeries for its analgesic effect. In this paper, we describe the successful administration of a combination of DEX and low-dose midazolam (MDZ) for sedation in an uncooperative pediatric patient. Both DEX and MDZ have been reported as safe and useful sedatives for dental treatment, and their combination may provide a helpful option for IVS of pediatric patients for whom PRO is not preferred.
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http://dx.doi.org/10.2344/anpr-65-03-14DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6022792PMC
October 2019

Effect of acetaminophen on osteoblastic differentiation and migration of MC3T3-E1 cells.

Pharmacol Rep 2018 Feb 15;70(1):29-36. Epub 2017 Jul 15.

Division of Applied Pharmacology, Department of Health Promotion, Kyushu Dental University, Kitakyushu, Japan. Electronic address:

Background: N-acetyl-p-aminophenol (APAP, acetaminophen, paracetamol) is a widely used analgesic/antipyretic with weak inhibitory effects on cyclooxygenase (COX) compared to non-steroidal anti-inflammatory drugs (NSAIDs). The mechanism of action of APAP is mediated by its metabolite that activates transient receptor potential channels, including transient receptor potential vanilloid 1 (TRPV1) and TRP ankyrin 1 (TRPA1) or the cannabinoid receptor type 1 (CB1). However, the exact molecular mechanism and target underlying the cellular actions of APAP remain unclear. Therefore, we investigated the effect of APAP on osteoblastic differentiation and cell migration, with a particular focus on TRP channels and CB1.

Methods: Effects of APAP on osteoblastic differentiation and cell migration of MC3T3-E1, a mouse pre-osteoblast cell line, were assessed by the increase in alkaline phosphatase (ALP) activity, and both wound-healing and transwell-migration assays, respectively.

Results: APAP dose-dependently inhibited osteoblastic differentiation, which was well correlated with the effects on COX activity compared with other NSAIDs. In contrast, cell migration was promoted by APAP, and this effect was not correlated with COX inhibition. None of the agonists or antagonists of TRP channels and the CB receptor affected the APAP-induced cell migration, while the effect of APAP on cell migration was abolished by down-regulating TRPV4 gene expression.

Conclusion: APAP inhibited osteoblastic differentiation via COX inactivation while it promoted cell migration independently of previously known targets such as COX, TRPV1, TRPA1 channels, and CB receptors, but through the mechanism involving TRPV4. APAP may have still unidentified molecular targets that modify cellular functions.
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http://dx.doi.org/10.1016/j.pharep.2017.07.006DOI Listing
February 2018

Modified Lateral Surgical Approach to the Pterygopalatine Fossa.

J Craniofac Surg 2017 Jun;28(4):1007-1009

*Department of Science of Physical Functions, Division of Maxillofacial Surgery, Kyushu Dental University †Department of Dental Anesthesiology, Kyushu Dental University, Kitakyushu, Japan.

Oral cancer, especially that originates in the maxillary tuberosity, buccal mucosa, and maxillary alveolus, is apt to invade the pterygopalatine fossa, where an intraoral approach is nearly impossible. There are 2 main types of extraoral approach to the pterygopalatine fossa; the anterior approach and the lateral approach. Although the lateral approach has an advantage compared with the anterior approach in terms of cosmetics, after the operation numbness of the lower lip occurs due to the sacrifice of the mental nerve. In the conventional lateral approach, a vertical incision is made in the center of the lower lip; a lateral flap is then elevated with the sacrifice of the mental nerve. The authors introduce here a new lateral approach to the pterygopalatine fossa with preservation of the mental nerve. In the present technique, a vertical incision was made in the corner of the mouth, and a lateral flap was then elevated with preservation of the mental nerve. This technique could also preserve the marginal mandibular branch of facial nerve in patients without a large metastasis in the submandibular lymph nodes. Additionally, expedient mandibular osteotomy, which is applied in the conventional lateral approach, could be omitted in the present technique, thus helping to prevent postoperative infection. The present approach was applied to 5 patients with oral cancer invading the pterygopalatine fossa. The postoperative numbness of the lower lip was estimated using the current perception threshold. The lesions were successfully resected with little numbness of the lower lip, and no postoperative infection occurred in any of the patients. This technique is available as an approach to the pterygopalatine fossa that preserves the mental nerve and can prevent postoperative infection.
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http://dx.doi.org/10.1097/SCS.0000000000003582DOI Listing
June 2017

Anesthetic Management of a Patient With Takayasu Arteritis.

Anesth Prog 2016 ;63(1):31-3

Division of Dental Anesthesiology, Department of Control of Physical Function, Kyushu Dental University, Kitakyushu, Fukuoka, Japan, and.

Takayasu arteritis is a rare chronic progressive panendarteritis involving the aorta and its main branches. Anesthesia in patients with this disease can be complicated by severe uncontrolled hypertension, end-organ dysfunction, and stenosis of major blood vessels. In this case, general anesthesia was induced with sevoflurane and remifentanil without complications. To prevent intraoperative complications, we conducted intubation with a rigid video laryngoscope with careful consideration of the concentrations of analgesics and sedatives used. This case demonstrates the importance of anesthetic techniques for maintaining adequate tissue perfusion without hemodynamic changes in the anesthetic management of patients with Takayasu arteritis.
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http://dx.doi.org/10.2344/14-00006R1.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4751518PMC
May 2016

Comparison of pain tolerance thresholds of upper limb to identify the most appropriate venipuncture site.

J Oral Maxillofac Surg 2015 May 7;73(5):850.e1-5. Epub 2015 Feb 7.

Professor and Department Head, Division of Dental Anesthesiology, Department of Control of Physical Function, Kyushu Dental University, Kitakyushu, Fukuoka, Japan.

Purpose: Venipuncture is often accompanied by pain, which can compromise dental care and foment distrust toward dental care providers. The aim of the present study was to identify sites on the forearm and hand that have the greatest pain tolerance threshold (PTT) during venipuncture.

Materials And Methods: The PTT was estimated in 20 healthy volunteers using a noninvasive nerve conduction threshold device. The subjects self-stimulated 5 sites (median cubital vein, cephalic vein at the cubitus, basilic vein, cephalic vein at the carpus, and superficial dorsal vein) at 2 kHz, 250 Hz, and 5 Hz. We measured the stimulation intensity before the subject deactivated the device. Differences in the average PTT values at each site were compared using the Kruskal-Wallis and Scheffé tests. P <.05 was considered to indicate statistical significance.

Results: The PTT was significantly greater at the superficial dorsal vein than at the basilic vein for all 3 noninvasive nerve conduction threshold frequencies (P < .05). The estimated PTT was significantly greater at the superficial dorsal vein than at the median cubital vein and cephalic vein at the carpus in response to 250-Hz stimulation (P < .05).

Conclusions: The greater PTT of the superficial dorsal vein suggests that venipuncture at this site should result in the lowest pain intensity among all upper limb sites.
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http://dx.doi.org/10.1016/j.joms.2015.01.027DOI Listing
May 2015

A nasal high-flow system prevents hypoxia in dental patients under intravenous sedation.

J Oral Maxillofac Surg 2015 Jun 30;73(6):1058-64. Epub 2014 Dec 30.

Professor, Department of Dental Anesthesiology, Kyushu Dental University, Fukuoka, Japan.

Purpose: Hypoxia is a major complication in dental patients under intravenous sedation (IVS). A nasal high-flow (NHF) system has been reported to achieve effective oxygenation in patients with sleep apnea syndrome. This study investigated the ability of the NHF system to prevent hypoxia in dental patients under IVS.

Materials And Methods: Thirty patients scheduled for dental treatment under IVS were enrolled. Patients were randomly divided into 3 groups: patients spontaneously breathing oxygen at 5 L/minute through a nasal cannula (NC5 group), patients administered oxygen at 30 L/minute through the NHF system, and patients administered oxygen at 50 L/minute through the NHF system. Hypnosis was induced by bolus administration of midazolam (0.05 mg/kg) followed by continuous administration of propofol (target blood concentration, 1.2 to 2 μg/mL). Noninvasive blood pressure, peripheral capillary oxygen saturation (SpO2), heart rate, and bispectral index values were recorded every 2.5 minutes before the induction of anesthesia. Interventions, such as jaw lifting, were recorded during IVS and arterial blood gas analysis was performed at the end of sedation. Patient and surgeon satisfaction with IVS was evaluated by interview.

Results: Minimum SpO2 was lowest in and surgeons were least satisfied with the NC5 group. In addition, interventions were required most frequently in the NC5 group (P < .05). Compared with the NC5 group, use of the NHF system improved partial pressures of oxygen and carbon dioxide in dental patients under IVS (P < .05).

Conclusions: These results suggest that use of the NHF system can prevent hypoxia in dental patients under IVS. Further studies are necessary to determine the appropriate flow rate and indications for NHF in obese patients.
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http://dx.doi.org/10.1016/j.joms.2014.12.020DOI Listing
June 2015

Evaluation of the treatment modalities for neurosensory disturbances of the inferior alveolar nerve following retromolar bone harvesting for bone augmentation.

Pain Med 2015 Mar 22;16(3):501-12. Epub 2014 Dec 22.

Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Miyagi, Japan.

Subjects: The purpose of this study was to evaluate the treatment modalities for neurosensory disturbances (NSDs) of the inferior alveolar nerve occurring after retromolar bone harvesting for bone augmentation procedures before implant placement.

Methods: One hundred four patients, of which 49 and 55 exhibited vertical or horizontal alveolar ridge defects in the mandible and maxilla, respectively, were enrolled. Nineteen patients underwent block bone grafting, 38 underwent guided bone generation or autogenous bone grafting combined with titanium mesh reconstruction, and 47 underwent sinus floor augmentation. Using a visual analog scale, we examined subjective symptoms and discomfort related to sensory alteration within the area of the NSDs in these patients. NSDs were clinically investigated using a two-point discrimination test with blunt-tipped calipers. In addition, neurometry was used for evaluation of trigeminal nerve injury. We tested three treatment modalities for NSDs: follow-up observation (no treatment), medication, and stellate ganglion block (SGB).

Results: A week after surgery, 26 patients (25.0%) experienced NSDs. Five patients received no treatment, 10 patients received medication, and 11 patients received SGB. Three months after surgery, patients in the medication and SGB group achieved complete recovery. Current perception threshold values recovered to near-baseline values at 3 months: recovery was much earlier in this group than in the other two groups. SGB can accelerate recovery from NSDs.

Conclusions: Our results justify SGB as a reasonable treatment modality for NSDs occurring after the harvesting of retromolar bone grafts.
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http://dx.doi.org/10.1111/pme.12618DOI Listing
March 2015

Identification and adjustment of experimental occlusal interference using functional magnetic resonance imaging.

BMC Oral Health 2014 Oct 10;14:124. Epub 2014 Oct 10.

Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan.

Background: The purpose of this study was to use functional magnetic resonance imaging (fMRI) to quantify changes in brain activity during experimental occlusal interference.

Methods: Fourteen healthy volunteers performed a rhythmical tapping occlusion task with experimental occlusal interference of the right molar tooth at 0 mm (no occlusion), 0.5 mm, and 0.75 mm. The blood-oxygen-level dependent (BOLD) signal was quantified using statistical parametric mapping and compared between rest periods and task periods.

Results: In tapping tasks with experimental occlusal interference of 0.75 mm or 0.5 mm, there was clear activation of the contralateral teeth-related primary sensory cortex and Brodmann's area 46. At 0 and 30 minutes after removal of the experimental occlusal interference, the activation clearly appeared in the bilateral teeth-related primary sensory cortices and Brodmann's area 46. At 60 minutes after the removal of the experimental occlusal interference, the activation of Brodmann's area 46 had disappeared, and only the bilateral teeth-related primary sensory cortices were active.

Conclusions: The present results suggest that adjustments for experimental occlusal interference can be objectively evaluated using fMRI. We expect that this method of evaluating adjustments in occlusal interference, combined with fMRI and the tapping task, could be applied clinically in the future.
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http://dx.doi.org/10.1186/1472-6831-14-124DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4200220PMC
October 2014

Non-randomized controlled prospective study on perioperative levels of stress and dysautonomia during dental implant surgery.

J Prosthodont Res 2014 Jul 26;58(3):177-83. Epub 2014 Jun 26.

Department of Oral Reconstruction and Rehabilitation, Kyushu Dental University, Graduate School, Japan. Electronic address:

Purpose: The purpose of this study was to compare pre- and postoperative autonomic activities and changes in salivary stress biomarkers between patients who received only local anesthesia and those who received local anesthesia together with intravenous sedation in dental implant surgery.

Methods: A total of 21 patients were enrolled in this non-randomized controlled prospective study; 7 subjects underwent implant surgery under local anesthesia with intravenous sedation and 14 subjects underwent surgery under only local anesthesia. Stress was evaluated by measuring salivary levels of chromogranin A (CgA) and a spectral analysis of heart rate variability (HRV) at baseline (on a day other than the day of surgery), 1h preoperatively, and 1h postoperatively. HRV analysis yields low- (LF) and high-frequency (HF) components, the LF/HF ratio, and the component coefficient of variance (CCV[HF]), which provide indices of sympathetic and parasympathetic regulatory activity.

Results: CgA levels were significantly higher (p<0.05) at baseline in patients who received sedation than those who did not, but CgA levels did not differ prior to surgery. Also, the values of most parameters, including LF, HF, LF/HF (L/H), and CCV(HF), did not significantly differ between groups or among the three time points. Only ΔL/H and ΔCCV(HF) were significantly lower (p<0.05) at 1h preoperatively in patients who received sedation than those who received only local anesthesia.

Conclusions: CgA levels were high in both groups immediately before surgery, and thus CgA values immediately before surgery may not be a reliable indicator of the need for intravenous sedation. Also, spectral analysis of HRV, especially ΔL/H and ΔCCV(HF), could be useful for assessing tension and anxiety.
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http://dx.doi.org/10.1016/j.jpor.2014.03.006DOI Listing
July 2014

Can the neurovascular compression volume of the trigeminal nerve on magnetic resonance cisternography predict the success of local anesthetic block after initial treatment by the carbamazepine?

Oral Surg Oral Med Oral Pathol Oral Radiol 2014 Jan 24;117(1):e15-21. Epub 2012 Aug 24.

Department of Oral Diagnostic Science, Kyushu Dental College, Kitakyushu, Japan; Center for Oral Biological Research, Kyushu Dental College, Kitakyushu, Japan. Electronic address:

Objectives: Whether NVC volume on magnetic resonance (MR) cisternography might be related to the success of local anesthetic block by tetracaine (TNB) as an additional treatment after carbamazepine (CBZ) treatments in patients with trigeminal neuralgia (TN) was evaluated.

Study Design: Detectable NVC volumes were measured from MR cisternography in 65 patients with TN treated by TNB after CBZ treatments. The correlation between the success of TNB and the NVC volume or the improvement in pain by CBZ was evaluated retrospectively.

Results: A significant difference was found between the improvement in pain by CBZ and the success of TNB, but not between NVC volume on MR cisternography and the success of TNB.

Conclusions: The present results suggest that the success of CBZ as initial treatment, but not NVC volume on MR cisternography, may be a significant predictor of the success of TNB as additional therapy in patients with TN.
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http://dx.doi.org/10.1016/j.oooo.2012.03.029DOI Listing
January 2014

Magnetic resonance angiography with fresh blood imaging for identification of hemangiomas and blood vessels around hemangiomas in oral and maxillofacial regions.

Oral Surg Oral Med Oral Pathol Oral Radiol 2012 Apr;113(4):559-66

Department of Oral Diagnostic Science, Kyushu Dental College, Kitakyushu, Japan.

Objectives: To evaluate fresh blood imaging (FBI), a magnetic resonance imaging technique that does not use contrast, for identifying hemangiomas and feeding arteries in the oral and maxillofacial regions.

Study Design: For 16 patients with hemangiomas, FBI visualizations of hemangiomas and feeding arteries in the oral and maxillofacial regions were compared with those from 3-dimensional (3D) phase-contrast magnetic resonance angiography (PC-MRA). Comparisons were based on the conspicuities of blood vessels and the 3D relationships of hemangiomas with the surrounding blood vessels.

Results: The conspicuity of hemangiomas, feeding arteries, and blood vessels were significantly better with FBI than with PC-MRA. After differentiating arteries from veins, 3D visualizations of hemangiomas and arteries or veins could be performed with FBI.

Conclusions: FBI is a useful method in oral and maxillofacial regions for identifying the relationships between hemangiomas and the surrounding arteries or veins.
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http://dx.doi.org/10.1016/j.oooo.2011.10.003DOI Listing
April 2012

Distinct time courses of microglial and astrocytic hyperactivation and the glial contribution to pain hypersensitivity in a facial cancer model.

Brain Res 2012 May 27;1457:70-80. Epub 2012 Mar 27.

Department of Biosciences, Kyushu Dental College, 2-6-1 Manazuru, Kitakyushu, 803-8580, Japan.

Although recent evidence suggests that central glial hyperactivation is involved in cancer-induced persistent pain, the time course of this hyperactivation and the glial contribution to pain hypersensitivity remain unclear. The present study investigated the time-dependent spatial changes of microglial and astrocytic hyperactivation in the trigeminocervical complex, which consists of the medullary (MDH) and upper cervical (UCDH) dorsal horns, and pain-related behaviors in a rat facial cancer model in which Walker 256B-cells are inoculated into the vibrissal pad. In this model, the tumors grew within the vibrissal pad, from which sensory nerve fibers project into the MDH, but did not expand into the infraorbital region, from which fibers project into the UCDH. Nevertheless, mechanical allodynia and thermal hyperalgesia were observed not only in the vibrissal pad but also in the infraorbital region. Western blotting and immunofluorescence studies indicated that microglia were widely activated in the trigeminocervical complex on day 4 and gradually inactivated by day 11. In contrast, astrocytes were only activated in the MDH on day 4; the hyperactivation later expanded into the UCDH. Daily administration of the glial hyperactivation inhibitor propentofylline beginning on day 4 suppressed the glial hyperactivation on later days. Propentofylline treatment largely prevented allodynia/hyperalgesia in the infraorbital region beginning on day 5, although established allodynia/hyperalgesia in the vibrissal pad was less sensitive to the treatment. These results suggest that central glial hyperactivation, transient microglial hyperactivation and persistent astrocytic hyperactivation, contributes to the development of pain hypersensitivity but not to the maintenance of pain in this model.
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http://dx.doi.org/10.1016/j.brainres.2012.03.039DOI Listing
May 2012

Noninvasive identification of peripheral vessels of oral and maxillofacial regions by using electrocardiography-triggered three-dimensional fast asymmetric spin-echo sequences.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011 Oct 8;112(4):493-501. Epub 2011 Sep 8.

Department of Oral Diagnostic Science, Kyushu Dental College, Kitakyushu, Japan.

Objectives: The aim of this study was to evaluate the 3-dimensional images of thinner main peripheral vessels in oral and maxillofacial regions made without contrast medium by using a new technique, fresh blood imaging (FBI). A second objective was to discern arteries from veins by using the combination of FBI with the subtraction technique.

Study Design: Images from FBI were compared with those from 3-dimensional phase-contrast magnetic resonance angiography (MRA) of blood vessels in 20 healthy subjects. All images were scored for visualization and image quality of the main blood vessels. In addition, appropriate flow-spoiled gradient pulses were applied to differentiate arteries from veins in the peripheral vasculature using a combination of FBI sequences and subtraction between systole- and diastole-triggered images.

Results: The scores of MRA using FBI for the visualization of thin blood vessels were significantly better than those using phase contrast, whereas scores for the visualization of main blood vessels were equal. Additionally, we succeeded in our initial attempt to differentiate arteries from veins with a reasonable acquisition time.

Conclusions: Our initial experience shows that FBI could be a useful method to identify 3-dimensional vasculature and to differentiate arteries from veins among thinner peripheral vessels in the oral and maxillofacial regions without using contrast medium.
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http://dx.doi.org/10.1016/j.tripleo.2011.02.047DOI Listing
October 2011

Importance of magnetic resonance imaging for evaluation of a child with prominent swelling of the facial region after trauma: report of a case.

Dent Traumatol 2011 Aug 18;27(4):300-4. Epub 2011 Apr 18.

Department of Oral Diagnostic Science, Kyushu Dental College, Kitakyushu, Fukuoka, Japan.

In the present case of a 9-year-old girl with prominent swelling in the mental and facial regions after trauma, repeated magnetic resonance (MR) examinations were performed to evaluate areas of incision, because the swelling became worse and more prominent despite intravenous antibiotic treatment. However, there was no evidence of respiratory tract impingement or deformation, including obliteration, on MR imaging. Therefore, surgical treatment involving an incision because of facial region swelling was cancelled, and the intravenous antibiotic therapy was continued. To prevent misdiagnosis and over-treatment of young children with inflammation of the oral and maxillofacial regions, dentists, including pediatric dentists, should be aware of the clinical usefulness of MR examinations. In particular, MR examinations are non-invasive for young children, because there is no X-ray exposure, and they can be used repetitively. At the same time, the present case demonstrated that it is very difficult to understand and predict changes in the inflammation process associated with children's facial trauma.
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http://dx.doi.org/10.1111/j.1600-9657.2011.00985.xDOI Listing
August 2011

Diagnostic significance of characteristic findings on ultrasonography for the stitch abscess after surgery in patients with oral squamous cell carcinoma.

Oral Oncol 2011 Mar 15;47(3):163-9. Epub 2010 Dec 15.

Department of Oral and Maxillofacial Surgery, Kyushu Dental College, Kitakyushu, Japan.

To elucidate the clinical significance of imaging modalities for detection of stitch abscess after surgery in patients with oral squamous cell carcinoma (SCC). In 137 patients with oral SCC suspected of having lymph node metastases, local recurrence of tumor, or stitch abscess after surgery, the characteristic imaging findings related to lymph node metastases, local recurrence of tumor, and stitch abscess on ultrasonography (US), computed tomography (CT), magnetic resonance (MR), and (18)fluorodeoxyglucose (18FDG)-positron emission tomography (PET) images were identified and analyzed. In all six patients with stitch abscess, characteristic findings were demonstrated on US, different from those of metastatic lymph nodes and local recurrence on CT, MRI, and 18FDG-PET images. Our results suggest that ultrasonography may be a very useful tool for diagnosis of postoperative stitch abscess and may help improve the quality of life of oral SCC patients.
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http://dx.doi.org/10.1016/j.oraloncology.2010.10.015DOI Listing
March 2011

A possible case of complex regional pain syndrome in the orofacial region.

Pain Med 2010 Feb;11(2):274-80

Department of Anesthesiology, National Defense Medical College, Tokorozawa, Saitama, Japan.

Objective: To present a case of complex regional pain syndrome (CRPS) type II with sympathetic dysfunction and trophic changes in the orofacial region, which was partially responsive to intravenous ketamine.

Patient: The patient was a 68-year-old man who suffered from inveterate pain with trophic changes of the right face and tongue and vasomotor dysfunction on the right side of the face after ipsilateral trigeminal nerve block. Allodynia and hyperalgesia were observed on the affected side of the face. Pain initially improved after sympathetic nerve block, but similar pain returned that was unresponsive to the same procedure. Repeated intravenous administration of low-dose ketamine preceded by intravenous midazolam alleviated the pain, but trophic changes of the tongue persisted.

Discussion: CRPS in the orofacial region has not been clearly defined and has been infrequently documented. Clinical findings in this patient met the criteria of the International Association for the Study of Pain's and Harden's diagnostic criteria for CRPS. The reason for gradual pain relief after induction of intravenous ketamine therapy was unclear, but the fact that only ketamine and not other various pain medicines or procedures alleviated the pain is important to note.

Conclusion: Distinct cases of CRPS involving the orofacial region are rare. Thorough observations and documentation of signs and symptoms may lead to future standardization of diagnostic criteria and treatment strategies for this disorder.
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http://dx.doi.org/10.1111/j.1526-4637.2009.00777.xDOI Listing
February 2010

Relationship between the curative effects of carbamazepine administration and the neurovascular compression volume of the trigeminal nerve measured using magnetic resonance cisternography.

Clin J Pain 2009 Nov-Dec;25(9):752-9

Department of Oral Diagnostic Science, Kyushu Dental College, Kokurakita-ku, Kitakyushu, Japan.

Objectives: To elucidate the relationship between the extent of pain and neurovascular compression (NVC) volume, measured by magnetic resonance (MR) cisternography, in patients with trigeminal neuralgia. In addition, we aimed to evaluate the relationship between NVC volume and the efficacy of carbamazepine administration in patients with trigeminal neuralgia.

Methods: MR cisternography was performed on 214 patients with clinical signs and symptoms that suggested trigeminal neuralgia retrospectively. The extent of their pain was evaluated using visual analog scales. Next, only carbamazepine was administered as the initial treatment. For the patients with NVC detectable on MR cisternography, the relationship between the extent or nature of the pain and the neurovascular volume was analyzed. In addition, the correlation between the efficacy of carbamazepine treatment and the NVC volume was evaluated retrospectively.

Results: Of the 214 patients evaluated, 144 were deemed to have NVC. In these 144 patients, a significant difference was found between the NVC volume and the curative effects of 100 mg/d carbamazepine. However, no significant correlation was found between the extents of pain by visual analog score or between the daily dosage of carbamazepine and the NVC volume measured by MR cisternography.

Conclusions: Three-dimensional MR cisternography is very useful for detecting the site of NVC in patients with trigeminal neuralgia. NVC measured by this technique may indicate the prognosis after initial treatment. The present results suggest that the evaluation of NVC volume by MR cisternography would be useful in choosing the initial treatment for patients with trigeminal neuralgia.
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http://dx.doi.org/10.1097/AJP.0b013e3181ada29cDOI Listing
January 2010

The importance of clinical features and computed tomographic findings in numb chin syndrome: a report of two cases.

J Am Dent Assoc 2009 May;140(5):550-4

Department of Oral and Maxillofacial Surgery, Kyushu Dental College, Kitakyushu, Fukuoka, Japan.

Background: Dentists need to be aware of the relationship between malignancies and paresthesia or complete loss of sensation in a jaw segment. In particular, dentists should be aware of numb chin syndrome (NCS) and its clinical manifestations, as well as the limitations of using panoramic radiographs to detect the causative malignancy.

Case Description: The authors report two cases of paresthesia in the mental region. No lesions were readily apparent on the patients' panoramic radiographs. To exclude the presence of disease in the mandible that could have been responsible for the NCS, the authors obtained computed tomographic (CT) images. They identified metastases to the mandible from primary malignant tumors elsewhere in the body.

Clinical Implications: To prevent misdiagnosis of NCS, dentists need to be aware of the clinical manifestations of NCS, the need for CT imaging, the shortcomings of panoramic radiographs and the value of obtaining detailed and accurate medical and dental histories from patients.
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http://dx.doi.org/10.14219/jada.archive.2009.0224DOI Listing
May 2009

Cervical plexus block helps in diagnosis of orofacial pain originating from cervical structures.

Tohoku J Exp Med 2006 Sep;210(1):41-7

Department of Oral Diagnosis, Nihon University School of Dentistry, Tokyo, Japan.

Headache associated with cervical lesions is called cervicogenic headache and involves the occiput but not the orofacial region. However, patients occasionally present with orofacial pain accompanied by neck symptoms. This study investigates whether orofacial pain can originate from the neck and whether cervical plexus block can help in diagnosis. We enrolled eight patients suffering from chronic orofacial pain that had not been relieved by dental treatment. Radiographic and magnetic resonance imaging revealed abnormal findings in the neck in seven of them. To identify the origin of the orofacial pain, we firstly blocked peripheral sensory input from the oral cavity and surrounding tissues, followed by that from deep cervical structures. We injected local anesthetics around the painful orofacial region, then to the tender points in the masticatory and superficial cervical muscles (trigger point injection), and consequently around the cervical plexus. Pain was assessed using a pain relief score compared with pre-treatment control values. Local anesthesia in the painful oral region provided insufficient relief whereas trigger point injection significantly relieved pain. The amount of pain relief generated by the deep cervical plexus block was more significant than that produced by any other procedures. We conclude that certain types of orofacial pain originate from cervical structures and that a deep cervical plexus block can be helpful in differentially diagnosing such pain.
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http://dx.doi.org/10.1620/tjem.210.41DOI Listing
September 2006

Utility of magnetic resonance cisternography using three-dimensional fast asymmetric spin-echo sequences with multiplanar reconstruction: the evaluation of sites of neurovascular compression of the trigeminal nerve.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005 Aug;100(2):215-25

Department of Dental Radiology, Kyushu Dental College, Kitakyushu, Japan.

Objective: To evaluate the utility of magnetic resonance (MR) cisternography using 3-dimensional (3D) fast asymmetric spin-echo (FASE) sequences with multiplanar reconstruction (MPR) for detection of the sites of neurovascular compression (NVC) in patients with trigeminal neuralgia.

Study Design: Both MR cisternography with 3D-FASE sequences and MR angiography (MRA) were performed on 150 patients with clinical signs and symptoms that suggested trigeminal neuralgia. Results from the original MR cisternography with 3D-FASE sequences, the original MRA, and 4 reformatted images were used for interpretation. Images with inversion between black and white were used from the MR cisternography with 3D-FASE sequences to evaluate NVC. A diagnosis of NVC was made from the presence of vascular contact with the trigeminal nerve at the root entry zone (REZ) and the nature of the involved vessels. For the patients with NVC detectable on 3D-FASE or MRA images, the relationship between the clinically manifested regions and the NVC sites was also evaluated.

Results: Of the 150 patients evaluated, 89 were deemed to have NVC. Of these 89 patients, 3 underwent surgery that identified the artery that was involved with the trigeminal nerve. The correlation between the clinically manifested regions and the NVC sites was significantly detectable using both 3D-FASE images and MRA in 89 patients with detectable NVC. The correlation coefficient using 3D-FASE imaging was a little higher than that using MRA. Of the 61 patients deemed not to have NVC, 6 were found to have brain tumors that invaded the root entry zone of the trigeminal nerve. However, the remaining 55 patients had no identifiable cause for trigeminal neuralgia. NVC was found in the asymptomatic side in 27 (18%) of the 150 patients with trigeminal neuralgia using MR cisternography with 3D-FASE sequences.

Conclusions: The technique of MR cisternography using 3D-FASE sequences with MPR is more accurate and useful than MRA for detection of the site of NVC in patients with trigeminal neuralgia. Patients with trigeminal neuralgia should be further examined using MR imaging to rule out a brain tumor. Radiologists should understand that a few subjects with no symptoms could show NVC with MR cisternography.
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http://dx.doi.org/10.1016/j.tripleo.2004.12.007DOI Listing
August 2005