We report a rare case of adenoid cystic carcinoma arising at the circumvallate papilla of the tongue. The patient was 66-year-old woman presenting with swelling of the base of the tongue. Biopsy was performed. The histopathological diagnosis was adenoid cystic carcinoma. The tumor was excised by means of an intraoral translingual approach with lateral pharyngotomy. Neither radiotherapy nor chemotherapy was performed. There has been no evidence of recurrence or metastasis for 8 months after surgical treatment.
Metastatic submandibular gland tumors rarely arise from nonsalivary neoplasms. A 62-year-old man found to have small-cell lung carcinoma 1 month previously was referred to our department because of a painless enlargement of the right submandibular gland. An adenoid cystic carcinoma was suspected on the basis of the results of aspiration biopsy. Histpathological examination after partial lung resection and radical neck dissection showed features of small-cell carcinoma, indicating thatthe lesion had metastasized from small-cell lung carcinoma. There was no evidence of local recurrence in the lung or cervical region. However, the patient died of liver metastasis 22 months after presentation. A review of the Englishlanguage literature revealed only two previously reported cases of metastasis from small-cell lung carcinoma to the submandibular gland. To our knowledge, our case is the first to be reported in Japan.
Ameloblastomas sometimes have malignant features clinically, but not pathologically. This report describes lateral skull-base surgery for a case of ameloblastoma. A 66-year-old woman presented with swelling of the maxillary tubercle. She had undergone two operations for a diagnosis of ameloblastoma. CT examination revealed that the tumor mass occupied the infratemporal fossa andinvaded the bone of the skull base. Lateral skull-base surgery was carried out. The skin incision lines included a hairline incision and a sigmoid incision for the parotid gland tumor. After preservation of the facial nerve, lateral craniotomy was performed. The medial surgical margins of the skull base were delineatedbetween the foramen rotundum and ovale. The surgical defect was reconstructed with a rectus abdominis myocutaneous free flap. The diagnosis of the surgical specimen was ameloblastoma, consisting mainly of granular cells. After complete resection of the tumor, there has been no recurrence for 10 months.
Odontogenic fibroma is a rare benign odontogenic tumor derived from mesenchymal components of tooth germ, such as dental papillae, dental follicles, and periodontal ligament. We report on a 34-yearold woman with central odontogenic fibroma arising in the anterior region of themaxilla. The tumor was surgically resected with the patient under general anesthesia. The patient has had no evidence of recurrence as of 1 year after surgical treatment.
Osteoma often occurs in the skull and facial bones, but rares arises in the mandibular ramus. We report a case of peripheral osteoma arising inside the mandibular ramus. The patient was a 37-year-old man who had spontaneous pain at the right parotid region. The tumor was resected extraorally. The pathological specimen showed compact osteoma.
A 37-year old woman presented with swelling of the right cheek and trismus. The patient had had indolent swelling of the right cheek since 1992. The pain had resolved, but the swelling increased. On July 4, 1998, initial examination revealed a soft swelling measuring about 20mm in diameter in normal colored subcutaneous tissue directly below the right zygomatic arch. MRI showed muscle and similar signals on T 1-weighted images and a lobular region showing high signals on T 2-weighted images. Dynamic MRI examination revealed a gradually increasing plateau in which the contrast effects reached a peak after 3 minutes and continued for 20 minutes. These findings were not inconsistent with hemangioma without arteriovenous malformation. On August 19, 1998, the patient underwent surgery. The pathological diagnosis was venous hemangioma. The postsurgical course was good, and there was bilateral symmetry, with no facial nerve palsy or trismus.
A case of central hemangioma arising in the mental region of the mandible in a 35-year-old man is reported.A plain X-ray film and computed tomographic scan demonstrated radiolucency, attributed to ameloblastoma or odontogenic keratocyst. Hemangioma was diagnosed, however, on examination of a biopsy specimen.The tumor was not detected on angiography, whereas magnetic resonance imaging showed a signal intensity indicating a hemangioma in the mandible. Segmental resection of the mandible was performed. Thirty-nine cases of central hemangioma of the jaws previously reported in Japan are reviewed briefly.
Benign lymphoepithelial lesions usually arise in the parotid gland and occur less frequently in the minor salivary gland. Such lesions often develop in patients with Sjö gren's syndrome. We report on a 53-year-old man in whom a solitary benign lymphoepithelial lesion developed in the right side of the palate. An association with Sjö gren's syndrome was strongly suggested.
Progressive systemic sclerosis (PSS), is often associated with oral symptoms such as trismus and ankyloglossia, but there are relatively few reports on resorption of the mandibular bone. Six patients were clinically studied. Four had ankyloglossia, all had trismus, and three had an open bite. In four patients, X-ray films revealed mandibular resorption. Of these four patients, three had resorption of only the condylar process and one had resorption of the condylar process, coronoid process, and mandibular angle. Mandibular resorption had no obvious relation to the duration of PSS, the stage of skin symptoms, or anti-Scl-70 antibody. In PSS, obstructive changes occurs in arterioles. Similar ischemic changes may arise in the arterioles of the masticatory muscle, which is attached to the mandible. Nutritional inbalance in these regions may also cause osteolytic changes, because these arterioles provide nutrients to bone.
We describe a 56-year-old man who consulted our department because of pain in the left temporomandibular joint (TMJ) on June 15, 1999. The patient had fallen down at work and was injured on May 8. The mouth opening distance was 27 mm, and the pain was present in the left TMJ Radiographic examination showed an oblique fracture in the left condyle, and a small piece of bone was displaced anteromedially. The patient had an old left-condylar fracture, and the remaining articular cavity was detected in the left TMJ by superior articular cavity pumping. We perfomed arthroscopic lysis and lavage operation on July 2. The mouth opening distance improved to 38 mm, and the pain disappeared 12 months after surgery. The patient had no problems in daily life.
We describe a 32-year-old woman with oral congelation caused by accidental ice diving. The patient complained of tenderness in the oral cavity. Intraoral examination showed erosion, petechial bleeding, and defects of the oral and lower lip mucosa. The patient was unable to eat solids because of tenderness in the oral cavity. Other symptoms caused by diving were not found. The clinical diagnosis was oral congelation due to acute freezing and ischemia of the oral tissue. The patient was treated with steroid ointment and azunol gargarisma. Erosion disappeared in 7 days and hypoesthesia decreased 4 weeks later. The patient has been followed up for 19 months and continues to show improvement after the treatment.
A 14-year-old boy fell from a fence when he secretly tried to play in a pool at his elementary school. He fell onto stakes, which penetrated the mouth floor. His friends called an ambulance, and the boy was brought to our hospital's emergency room by the rescue team. He was alert, but could not speak because of the stake. His general condition was good, and only one tooth was damaged. There was no damage to other structures, including the salivary ducts. The patient was given general anesthesia, and the stake was removed. The penetrating stab wound was very rare because there was no damage to other structures and because of the stake's direction. Because the thoracic wall was present, the stake could only take two directions to avoid damaging the brain. We believe that this is the first such case to be reported in Japan.
Foreign bodies in the oral and maxillofacial region frequently result from trauma and dental treatment. We report a rare case of an inlay impacted into the tongue. A 48-year-old woman was referred to our hospital because of swelling in the rightlateral surface of the tongue. Ten months previously, an inlay had been removed from the upper right premolars. The inlay became impacted in the tongue and was not removed. Examination of tongue showed a round swelling with definite margins. The swelling was about 6mm in diameter, white, and situated onthe right dorsal surface of the tongue. A hard object measuring about 10mm in diameter was palpated in the posterolateral region. An occlusal radiograph of the region revealed a radiopacity consistent withthe inlay. The clinical diagnosis was a foreign body in the tongue with inflammation of the surrounding tissue. The foreign body in the tongue was surgically removed. It was found to be an inlay. Postoperatively, the patient is doing well, with no evidence of inflammation.