The purpose of this study was to assess changes in prognostic factors related to modification of surgical treatment on the basis of grade of tumor malignancy and to contribute to improved surgical treatment of patients with oral squamous cell carcinoma. Fourhundred three patients with oral squamous cell carcinoma treated by surgery were classified according to treatment period as follows: f irst period, 1976-1986; second period, 1987-1991; and third period, 1992-1997. Three and 5-year cumulative disease-specific survival rates according to treatment period were as follows: first period (n=187), 78.6, 76.3%; second period (n=113), 76.6, 73.7%; and third period (n=103), 88.9, 87.2%. On univariate analysis of survival according to T, N, stage, growth pattern, and mode of invasion, significant differences (P<0.05) were found for all characteristics in the first and second periods, while in the third period no significant difference was found for growth pattern or mode of invasion. Cox regression analysis of disease-specific survival identified the following as independent prognostic factors: mode of invasion (1+2, 3, 4C+4D), growth pattern (exophytic, endophytic), and N (0, 1, 2) in the first period, mode of invasion (1-3, 4C+4D) and N (0, 1, 2+3) in the second period, and only N (0, 1, 2) in the third period. Owing to the improved outcome for highly invasive carcinoma, the prognostic values during the third period differed from those during the first and second periods.
Oral manifestations of HIV infected patients are associated with the onset of AIDS. The management of oral health has a substantial impact on the general condition and prognosis of patients. We studied the oral lesions of nine patients with AIDS, and present three typical cases. As for on the route of HIV transmission, six patients were infected by blood products, and three patients by homosexual contact. Oral manifestations included pseudomembranous candidiasis (5 cases), erythematous candidiasis (1 case), angular cheilitis (5 cases), xerostomia (9 cases), helpes simplex (4 cases), liner gingival erythema (3 cases), gingival bleeding (2 cases), multiple caries (2 cases), and Kaposi's sarcoma (1 case). Appropriate treatment for oral lesions and close cooperation among departments providing treatment are important to maintain and improve the general condition of patients with AIDS.
Salivary duct carcinoma (SDC) is a rare type of salivary gland tumor that was first described by Kleinsasser et al. We reported a case of SDC in the submandibular region of an 83-year-old man. Histologically, the tumor showed comedonecrosis, cribriform and papillary patterns of intraductal growth, and aggressive infiltration into normal tissue. Immunohistochemically, staining for keratin, epithelial membrane antigen (EMA), and gross cystic disease fluid protein (GCDFP-15) was positive, and staining for S-100 protein and calponin was negative. Electron microscopically, two cell types were identified. The first cell type showed electron-lucent cytoplasm with scant organelles. The second cell type showed electron-dense cytoplasm with numerous mitochondria. Myoepithelial cell differentiation was not observed. These findings suggest that SDC is of excretory duct origin.
We encountered a case of recurrent ameloblastoma in soft tissue that appeared 21 years after segmental resection of a tumor. The patient was a 47-year-old woman who had undergone segmental resection and reconstruction of the mandible with iliac bone in 1978. The clinical, radiographic, and histopathological findings suggested that the reccurence originated from the amputated end of the soft tissue. Reccurence may have been caused by seeding of tumor cells into the adjacent periosteum and mucosa. Among 7 patients who underwent radical resection over the past 20 years, 6 had recurrences of ameloblasoma from the amputated end of the soft tissue. The average interval to postoperative recurrence was 14.5 years. Ameloblasoma indicated for segmental resection of the mandible often extends to soft tissue after penetrating bone. Therefore, ameloblastoma should be resected with a safety margin of soft tissue and followed up for 15 to 20 years.
Central giant cell granuloma (CGCG) originating in the ramus of the mandible is relatively rare. We report an atypical case of an 8-year-old boy with CGCG of the left ramus of the mandible. The lesion was first noticed as a slightly painful swelling 1 week before presentation. Orthopantomography showed a poorly defined, unilocular radiolucent lesion. Computed tomography and magnetic resonance imaging, especially T2-weighted images, described the lesion definitely. Enucleation of the lesion was performed under general anesthesia on January 12, 1999. Because a curettage specimen histologically showed multiple granulomatous nodules consisting of proliferations of fibroblasts and infiltrates of macrophages and inflammatory cells as well as numerous multinuclear giant cells, we diagnosed CGCG. The postoperative course was uneventful after conservative management.
We report a case of benign fibrous histiocytoma, a rare lesion in the oral cavity, arising in the cheek. The patient, a 69-year-old woman, had noticed swelling in the right buccal mucosa for about 3 years and was admitted because the swelling had increased. Magnetic resonance imaging showed homogeneous enhancement of the mass in the cheek. The biopsy specimens were pathologically diagnosed benign fibrous histiocytoma, and the lesion excised. There has been no recurrence as of 5 years after excision. Macroscopically, the lesion was an encapsulated mass measuring 30×15×10mm with partial adhesion to muscle. Histological examination revealed mixed proliferation of histiocytic and fibroblastic cells without atypia. The lesion showed a polymorphous population of fibroblastic cells arranged in a vague striated and fascicular pattern. Histiocytic cells were positive for CD68, α 1-antichymotrypsin, and α 1-antitrypsin, and fibroblastic cells were positive for both α-smooth muscle actin and vimentin.
A case of unilateral tongue atrophy caused by idiopathic hypoglossal nerve palsy is presented. A 38-year-old woman noticed atrophy in the left side of the tongue and visited Hokkaido University Dental Hospital. The face was symmetrical, and there was neither facial nerve weakness nor muscle atrophy. The movement of the neck and brachium was not restricted. She had fasciculation and atrophy in the left side of the tongue. When the tongue protruded, it deviated towards the left. The shape and movement of the soft palate were normal. MRI examination revealed atrophy in the left side of the internal muscles of the tongue. The cranial nerves other than the twelfth nerve were normal, and there were no signs of systemic neurological abnormalities. Unilateral tongue atrophy caused by idiopathic hypoglossal nerve palsy was diagnosed.
A 50-year-old man had a 3.0×2.8×1.8cm tumor in the lower gingiva. Abundant formation of bone was seen at the core of the tumor on an X-ray film. There was no evidence of malignancy in a biopsy specimen, but we could not obtain a definitive diagnosis. The tumor was removed with marginal resection of the mandible. The resected specimen was composed of fibrous stromal-tissue-like histiocytes with spindle-shaped fibroblasts, including multinucleated giant cells and collagen fibers. The giant cells of this lesion had smaller, fewer, and less aggregated nuclei than those found in a giant cell tumor. Fibrous bone was also seen. We report this rare case of giant cell epulis with abundant formation of bone.
The patient was a 23-year-old man who had been operated on for ameloblastoma of the mandible 4 years ago. Tumor resection was repeated for a local recurrence 8 months later. Subsequently, no sign of recurrence has been observed. Restoration of the occlusion using osseointegrated implants was planned. Before implant placement, vertical alveolar augmentation by distraction osteogenesis was planned because the alveolar ridge showed severe atrophy in the right premolar and molar regions of the mandible. A boxshaped osteotomy of the alveolar bone was carried out in the premolar and molar region. Then, an alveolar distractor (LEAD System) was fitted on the bone and fixed to both the transport and base segments. After a 7-day recovery period, distraction was done at a rate of 0.8 mm/day for 8 days. Sufficient height of the alveolar process was restored by distraction. The distraction device was then left in place for 23 weeks. New bone formation in the distraction gap was observed at reentry operation for device removal and implant placement. The dental implants were successfully placed into the augmented alveolar bone.
A case of massive nasal hemorrhage due to facial bone fractures accompanied by a skull-base fracture is reported. A 72-year old woman was involved in a traffic accident and was hospitalized at the Critical Care Medical Center on July 30, 1997. The clinical diagnosis included a skull-base fracture, pneumocephalus, traumatic subarachnoid hemorrhage, unconsciousness, a traumatic cavernous stoma of the internal carotid artery, a maxillary fracture (Le Fort II), bilateral zygomatic bone fractures, an ethomonasal fracture, a right rib fracture, a crushed right lung, right hemothorax, and a pelvic fracture. Transcatheter arterial embolization (TAE) of both external carotid arteries was performed to treat hemorrhagic shock due to nasal hemorrhage on admission. Hemostasis and recovery from the hemorrhagic shock were successfully achieved. Maxillofacial trauma sometimes causes massive nasal hemorrhage. Tamponade is usually performed. However, tamponade is contraindicated for nasal hemorrhage in patients with complications such as skullbase fractures or cerebral fluid rhinorrhea. In such patients, TAE of the external carotid artery is the treatment of choice for hemostasis.
Pycnodysostosis is an uncommon hereditary bone disorder characterized by general bone sclerosis, dwarfism, dysplasia of the skull, partial or total aplasia of the terminal phalanges, dysplastic clavicles, and an obtuse mandibular angle. Osteomyelitis of the jaws caused by odontogenic infection also seems to be a characteristic complication of pycnodysostosis. Since the bone is very brittle, oral infection may cause pathological or iatrogenic fractures that are very difficult to control. We report a case of pycnodysostosis in a 40-year-old man, whose mandible was fractured because of osteomyelitis. Segmental mandiblectomy and immediate reconstruction with a titanium plate was performed under general anesthesia. After a year, the clinical course was satisfactory. We discuss the treatment of mandibular osteomyelitis with pycnodysostosis.
We describe our experience with a case of lymphoepithelial cyst in the parotid gland accompanied by pleomorphic adenoma in the oral palate. A 44-year-old man presented with a mass in the oral palate. At presentation, we detected a soft elastic mass on the left side of the hard palate. Magnetic resonance imaging showed a mass in the oral palate. We also identified a high-density area with a clearly demarcated border in the parotid gland. The oral palate tumor was removed by biopsy. Rather than remove the high density area in the parotid gland, we decided to observe its progress. However, the patient complained that the swelling in his cheek felt as if it was growing. Thus, the tumor was removed. The lesion was located deep in the parotid gland and was filled with a yellowish fluid. Histologically, the tumor in the oral palate was a pleomorphic adenoma, and the lesion in the parotid gland was a lymphoepithelial cyst. Although the relation between the tumor in the oral palate and the lesion in the parotid gland is unknown, this case was rare because the lymphoepithelial cyst originated in the parotid gland, and two different diseases concurrently affected different salivary glands.
A case of simple bone cyst (SBC) occurring in the mandibular ramus of a 16-year-old girl is reported. A series of panoramic X-ray pictures obtained over the course of 7 years 6 months showed that the cyst grew along mandibular canal. During this period, the lesion expanded 14 times its initial size. Relatively normal trabeculation was seen on panoramic X-ray film 21 months after fenestration.