Maxillary reconstruction using tunneling flap technique with 3D custom-made titanium mesh plate and particulate cancellous bone and marrow graft: a case report

Takano, Masayuki,Sugahara, Keisuke,Koyachi, Masahide,Odaka, Kento,Matsunaga, Satoru,Homma, Shinya,Abe, Shinichi,Katakura, Akira,Shibahara, Takahiko Korean Association of Maxillofacial Plastic and Re 2019 Maxillofacial Plastic Reconstructive Surgery Vol.41 No.-

Background: Reconstructive surgery is often required for tumors of the oral and maxillofacial region, irrespective of whether they are benign or malignant, the area involved, and the tumor size. Recently, three-dimensional (3D) models are increasingly used in reconstructive surgery. However, these models have rarely been adapted for the fabrication of custom-made reconstruction materials. In this report, we present a case of maxillary reconstruction using a laboratory-engineered, custom-made mesh plate from a 3D model. Case presentation: The patient was a 56-year-old female, who had undergone maxillary resection in 2011 for intraoral squamous cell carcinoma that presented as a swelling of the anterior maxillary gingiva. Five years later, there was no recurrence of the malignant tumor and a maxillary reconstruction was planned. Computed tomography (CT) revealed a large bony defect in the dental-alveolar area of the anterior maxilla. Using the CT data, a 3D model of the maxilla was prepared, and the site of reconstruction determined. A custom-made mesh plate was fabricated using the 3D model (Okada Medical Supply, Tokyo, Japan). We performed the reconstruction using the custom-made titanium mesh plate and the particulate cancellous bone and marrow graft from her iliac bone. We employed the tunneling flap technique without alveolar crest incision, to prevent surgical wound dehiscence, mesh exposure, and alveolar bone loss. Ten months later, three dental implants were inserted in the graft. Before the final crown setting, we performed a gingivoplasty with palate mucosal graft. The patient has expressed total satisfaction with both the functional and esthetic outcomes of the procedure. Conclusion: We have successfully performed a maxillary and dental reconstruction using a custom-made, pre-bent titanium mesh plate.

Real-time Eye Detection Method Robust to Facial Pose Variations Using Gradient Directional Features and Particle Filter

Takano, Hironobu,Asano, Masayuki,Nakamura, Kiyomi The Korean Institute of Electrical Engineers 2013 The Journal of International Council on Electrical Vol.3 No.2

In this paper, we propose an eye detection method that is robust to facial pose changes using gradient directional features of brightness and a particle filter. The rejection function of incorrect eye detection in the proposed method allows for the eye detection again even if the eye is incorrectly detected. In this method, to estimate the boundary between the iris and sclera or eyelid, the gradient intensities are calculated by four directional Prewitt filters in four regions. The likelihood used in the particle filter is obtained by averaging the gradient intensities for the specific direction in the four regions and the upper eyelid area. From experimental results, the average detection rates of both eyes for roll, yaw, and pitch angles of the face are more than 90% by using rejection function for incorrect eye detection. The rejection function produces the 4.4%, 4.5%, and 4.9% increases in average detection rates of both eyes for roll, yaw, and pitch facial angles, respectively. The proposed eye detection method can track both eye in real-time (about 20 ms) and is robust to the facial pose changes.

Angular Dependence of the Resistive Upper Critical Field of the Iron-based Superconductor Fe1+(Te,Se) in High Magnetic Fields

Takanori Kida,Masayuki Hagiwara,Yoshikazu Mizuguchi,Yoshihiko Takano 한국물리학회 2013 THE JOURNAL OF THE KOREAN PHYSICAL SOCIETY Vol.62 No.12

We have investigated the angular dependence of the upper critical fields (µ0Hc2) of a single crystalof Fe1+(Te,Se) in pulsed high magnetic fields up to 52 T. At T = 10 K, the µ0Hc2 increases withincreasing , which is the angle between the c-axis and the direction of the applied magnetic field. Using the effective-mass model based on the three-dimensional anisotropic Ginzburg-Landau (G-L)theory, we estimate the effective-mass anisotropy ratio= (mc /mab)1/2 to be 1.6 at 10 K. Thisresult is consistent with that of our previous study on the anisotropy coefficient of the resistiveupper critical field,

A clinico-statistical study of factors associated with intraoperative bleeding in orthognathic surgery

Keisuke Sugahara,Yu Koyama,Masahide Koyachi,Akira Watanabe,Kiyohiro Kasahara,Masayuki Takano,Akira Katakura 대한악안면성형재건외과학회 2022 Maxillofacial Plastic Reconstructive Surgery Vol.44 No.-

Background: Excessive bleeding is a major intraoperative risk associated with orthognathic surgery. This studyaimed to investigate the factors involved in massive bleeding during orthognathic surgeries so that safe surgeriescan be performed. Patients (n=213) diagnosed with jaw deformities and treated with bimaxillary orthognathicsurgery (Le Fort I osteotomy and bilateral sagittal split ramus osteotomy) in the Department of Oral andMaxillofacial Surgery at the Suidobashi Hospital, Tokyo Dental College between January 2014 and December 2016were included. Using the patients’ medical and operative records, the number of cases according to sex, age at thetime of surgery, body mass index (BMI), circulating blood volume, diagnosis of maxillary deformity, direction ofmaxillary movement, operative duration, incidence of bad split, injury of nasal mucosa, and blood type were analyzed. Results: The results revealed that BMI, circulating blood volume, nasal mucosal injury, and operative time wereassociated with the risk of intraoperative massive bleeding in orthognathic surgeries. Chi-square tests and binomiallogistic regression analyses showed significant differences in BMI, circulating blood volume, direction of maxillarymovement, operative duration, and injury to the nasal mucosa. Operative duration emerged as the most important riskfactor. Furthermore, a >4-mm upward migration of the posterior nasal spine predicted the risk of massive bleeding inorthognathic surgery. Conclusions: The upward movement of the maxilla should be recognized during the preoperative planning stage as arisk factor for intraoperative bleeding, and avoiding damage to the nasal mucosa should be considered a requirementfor surgeons to prevent massive bleeding during surgery

Ameloblastic carcinoma of the mandible: a case report

Satoru Ogane,Arisa Fujii,Taiki Suzuki,Kazuhiko Hashimoto,Sadamitsu Hashimoto,Masayuki Takano,Akira Katakura,Takeshi Nomura 대한악안면성형재건외과학회 2023 Maxillofacial Plastic Reconstructive Surgery Vol.45 No.-

Background Ameloblastic carcinoma is a malignant form of ameloblastoma and a very rare odontogenic tumor. We report a case of ameloblastic carcinoma that occurred after removal of a right-sided mandibular dental implant. Case presentation A 72-year-old female patient visited her family dentist with a complaint of pain around a lower right implant placed 37 years previously. Although the dental implant was removed with the diagnosis of periimplantitis, the patient experienced dullness of sensation in the lower lip and was followed up by her dentist, but after no improvement. She was referred to a highly specialized institution where she was diagnosed with osteomyelitis and treated the patient with medication; however, there was no improvement. In addition, granulation was observed in the same area leading to a suspicion of malignancy, and the patient was referred to our oral cancer center. The diagnosis of squamous cell carcinoma was made after a biopsy at our hospital. Under general anesthesia, the patient underwent mandibulectomy, right-sided neck dissection, free flap reconstruction with an anterolateral thigh flap, immediate reconstruction with a metal plate, and tracheostomy. Histological analysis of the resected specimen on hematoxylin and eosin staining showed structures reminiscent of enamel pulp and squamous epithelium in the center of the tumor. The tumor cells were highly atypical, with nuclear staining, hypertrophy, irregular nuclear size, and irregular nuclear shape, all of which were suggestive of cancer. Immunohistochemical analysis showed that Ki-67 was expressed in more than 80% of the targeted area, and the final diagnosis was primary ameloblastic carcinoma. Conclusion After reconstructive flap transplantation, occlusion was re-established using a maxillofacial prosthesis. The patient remained disease-free at the 1-year 3-month follow-up.

Novel condylar repositioning method for 3D-printed models

Sugahara, Keisuke,Katsumi, Yoshiharu,Koyachi, Masahide,Koyama, Yu,Matsunaga, Satoru,Odaka, Kento,Abe, Shinichi,Takano, Masayuki,Katakura, Akira Korean Association of Maxillofacial Plastic and Re 2018 Maxillofacial Plastic Reconstructive Surgery Vol.40 No.-

Background: Along with the advances in technology of three-dimensional (3D) printer, it became a possible to make more precise patient-specific 3D model in the various fields including oral and maxillofacial surgery. When creating 3D models of the mandible and maxilla, it is easier to make a single unit with a fused temporomandibular joint, though this results in poor operability of the model. However, while models created with a separate mandible and maxilla have operability, it can be difficult to fully restore the position of the condylar after simulation. The purpose of this study is to introduce and asses the novel condylar repositioning method in 3D model preoperational simulation. Methods: Our novel condylar repositioning method is simple to apply two irregularities in 3D models. Three oral surgeons measured and evaluated one linear distance and two angles in 3D models. Results: This study included two patients who underwent sagittal split ramus osteotomy (SSRO) and two benign tumor patients who underwent segmental mandibulectomy and immediate reconstruction. For each SSRO case, the mandibular condyles were designed to be convex and the glenoid cavities were designed to be concave. For the benign tumor cases, the margins on the resection side, including the joint portions, were designed to be convex, and the resection margin was designed to be concave. The distance from the mandibular ramus to the tip of the maxillary canine, the angle created by joining the inferior edge of the orbit to the tip of the maxillary canine and the ramus, the angle created by the lines from the base of the mentum to the endpoint of the condyle, and the angle between the most lateral point of the condyle and the most medial point of the condyle were measured before and after simulations. Near-complete matches were observed for all items measured before and after model simulations of surgery in all jaw deformity and reconstruction cases. Conclusions: We demonstrated that 3D models manufactured using our method can be applied to simulations and fully restore the position of the condyle without the need for special devices.

Clinical investigation of patients with jaw deformity with comorbidities

Kiyohiro Kasahara,Teruhide Hoshino,Kei Sugiura,Yuki Tanimoto,Masahide Koyachi,Masae Yamamoto,Keisuke Sugahara,Masayuki Takano,Akira Katakura 대한악안면성형재건외과학회 2022 Maxillofacial Plastic Reconstructive Surgery Vol.44 No.-

Background: With improvements in the safety and stability of surgeries, the number of orthognathic surgeries isincreasing. Most patients who undergo orthognathic surgeries are younger, and the number of orthognathic surgeriesfor patients with comorbidities is also increasing. We report a survey and clinical investigation of patients withcomorbidities who underwent orthognathic surgeries at our department to improve the safety of orthognathicsurgery. Results: The participants included 296 men and 712 women, with a mean age of 28 years (13?19 years, n=144;20?29 years, n=483; 30?39 years, n=236; 40?49 years, n=102; 50?59 years, n=39; ≥60 years, n=4). In total, 347patients underwent one-stage Le Fort type I osteotomy and sagittal split ramus osteotomy (SSRO), 243 underwentSSRO, 287 underwent plate removal, 126 underwent genioplasty and plate removal, and five underwent othersurgeries. In total, 529 patients had comorbidities (52%), including allergic diseases (n=220, 33%), respiratory diseases(n=107, 16%), neurologic and psychiatric diseases (n=69, 10%), gynecologic diseases (n=28, 4%), hematologicdiseases (n=27, 4%), cardiovascular diseases (n=24, 4%), digestive diseases (n=22, 3%), metabolic and endocrinediseases (n=18, 3%), spinal diseases (n=11, 2%), ophthalmologic diseases (n=11, 2%), renal and urological diseases(n=9, 1%), and other diseases (n=117, 18%). Among the patients with comorbidities, 11 with hemorrhagic diatheses(hemophilia and von Willebrand disease), arrhythmia (atrioventricular block), psychiatric disease (adjustment disorder),and metabolic disease (diabetes) required cautious perioperative management. The patient with hemophilia wasmanaged with regular low-dose recombinant factor VIII replacement therapy, and the patient with type I diabetesmellitus was administered continuous insulin infusion and sliding-scale insulin therapy; both patients had an uneventfulcourse. Conclusions: The study findings suggest that with the increase in orthognathic surgeries, oral and maxillofacialsurgeons should adequately manage cases requiring cautious perioperative control and highlight the importance ofpreoperative screening. Despite the well-established safety and postoperative stability of orthognathic surgeries, oralsurgeons should adopt appropriate additional preventive measures for patients with comorbidities.