Xiaoyan Feng

Kimura’s disease (KD) is a rare chronic inflammatory disorder that commonly occurs in Asian males. It mainly presents as painless subcutaneous masses or lymphadenopathy in the head and neck region. The incidence of KD in the oral cavity is quite rare. We reported a rare case of a 53-year-old male who had KD in his soft palate, hard palate and bilateral tonsils associated with severe sleep apnea. This patient underwent radiotherapy and exhibited a good response to the treatment. Throughout the 12-month follow-up period, the patient’s condition remained satisfactory. Of the other 14 reviewed cases of KD in the oral cavity, the lesions can occur in the buccal mucosa, hard and soft palate, and mouth floor with specific clinical features. We further summarized their manifestations and treatments in order to guide the future identification and management of KD with lesions in the oral cavity.

Skeletal class III malocclusion with severe skeletal disharmonies and arch discrepancies is usually treated via the conventional orthodontic-surgical approach. However, when associated with tooth impaction and periodontal risks, the treatment is more challenging and complex. The esthetic, occlusal, and periodontal stability of the treatment outcome is more difficult to obtain. The 16-year-old female patient in this case was diagnosed with dental and skeletal Class III malocclusion, bilateral impacted maxillary canines, and scalloped thin gingiva. The multidisciplinary management included a segmental arch technique, extracting two premolars, a subepithelial connective tissue graft surgery, and orthognathic surgery. The esthetic facial profile, pleasant smile, appropriate occlusion, and functional treatment results were obtained and maintained in 8-year follow-up.

The physiological homeostasis of the masticatory complex in short-faced patients is too robust to be disintegrated and reconstructed due to the powerful masseter muscle. This study innovatively introduced the botulinum toxin-A (BTX-A) into the field of dental occlusal treatment, providing a novel and minimally invasive therapy perspective for the two major clinical problems in these patients (low treatment efficiency and high rates of complications). In total, 10 adult patients with skeletal low angle seeking occlusal treatment (age: 27.0 ± 6.1 years; 4 males and 6 females) were administered 30–50 U of BTX-A in each masseter muscle and evaluated before and 3 months after injection based on cone-beam computed tomography (CBCT). We found a significant reduction in the thickness of the masseter muscle (MMT) (p < 0.0001). With regards to occlusion, we found a significant increase in the height of the maxillary second molar (U7-PP) (p < 0.05) with significantly flattened occlusal curves (the curve of Spee [COS] (p < 0.01), and the curve of Wilson [COW] (p < 0.05)). Furthermore, the variations in the temporomandibular joint exhibited a significant reduction in the anterior joint space (AJS) (p < 0.05) and superior joint space (SJS) (p < 0.05). In addition, the correlation analysis of the masticatory complex provided the basis for the following multiple regression equation: MMT = 10.08 − 0.11 COW + 2.73 AJS. The findings from our pilot study indicate that BTX-A, as a new adjuvant treatment attempt of occlusal therapy for short-faced patients, can provide a more favorable muscular environment for subsequent occlusal therapy through the adjustment of the biting force and may contribute to the reconstruction of healthier homeostasis of the masticatory complex. However, further research is required to establish the reliability and validity of these findings.

目的：建立智能颈椎骨龄评估系统，初步评估基于锥形线束CT数据的智能颈椎骨龄评估系统的可靠性和临床应用价值。方法：选取60例生长发育期（8~16岁）儿童同时段拍摄的侧位体层片和锥形线束CT作为实验数据。在锥形线束CT上通过Otsu算法提取患者的面部区域，使用三维最小二乘法获得一个矢状面，并在此矢状面上应用超像素算法来对图像进行分割以获取到颈椎区域，随后分别进行手工定点与形态学算法的自动定点，对两组坐标数据进行一致性检验。根据颈椎骨龄分期指南的定义，进行算法设计，建立智能颈椎骨龄评估系统。同时通过同期的侧位体层片进行人工颈椎骨龄判读。采用加权Kappa一致性检验及Gamma相关度检验比较人工侧位体层片颈椎骨龄判读结果与智能颈椎骨龄评估结果，判断智能颈椎骨龄预测系统的临床应用价值。结果：基于锥形线束CT数据自动化捕捉的颈椎形态整体上具有较高的形态识别度，在预测13个点中的8个拐点时，自动定点与人工定点在X轴和Y轴上的Wilcoxon检验结果差异均无统计学意义（均P > 0.05）。同时，智能系统的颈椎骨龄评估结果与人工识别结果有较强的一致性和相关性（加权Kappa值0.877，Gamma值0.991，均P<0.05）。结论：基于锥形线束CT数据进行的自动化颈椎形态捕捉和智能颈椎骨龄预测系统有一定的可靠性，自动化程度高，具有一定的临床应用价值。