We devised a procedure for visually-guided irrigation (VGIR) of the superior joint compartment of the temporomandibular joint (TMJ) for the treatment of closed-lock and other TMJ diseases. A TMJ arthroscopy system using a 1.2-mm diameter rod-lens arthroscope was also developed to perform VGIR under local anesthesia. This paper introduces the arthroscopy system and VGIR procedure. The clinical applicability of VGIR is also discussed on the basis of the quality of arthroscopic findings obtained during VGIR and the incidence and course of complications associated with VGIR, including mechanical trouble. Eighty-five operations involving VGIR were studied. Arthroscopic findings obtained during VGIR were as clear as those obtained by using an arthroscope with a more than 2.0-mm diameter rod-lens, generally used for arthroscopic surgery. The following 7 complications were analyzed: 1) anesthetic trouble, 2) vascular injury, 3) perioperative discomfort, 4) neurological injury, 5) otological injury, 6) infection, 7) mechanical trouble. Complications occurred in 5 of the 85 (5.9%) operations. Two of the 5 complications were postoperative discomfort immediately after VGIR, 1 involved blood clots in the external auditory canal, and 2 were related to instrument breakage. However, no complication required specific treatment or interfered with the VGIR procedure. In conclusion, VGIR is useful clinically because that the procedure is minimally invasive, safe, and provides a highly reliable arthroscopic diagnosis.
To estimate the incidence of disc displacement, disc deformity, and bone changes of the temporomandibular joint in erderly patients with temporomandibular disorders, 55 elderly patients (110 joints) were examined by magnetic resonance imaging. The ages of the patients ranged from 65 to 89 years (average, 70 years). They consisted of 13 men and 42 women. Normal disc position was found in 40 joints (36.4%), anterior disc displacement with reduction in 17 joints (15.5%), and anterior disc displacement without reduction in 53 joints (48.2%) on magnetic resonance imaging. Thirty-eight (71.6%) of the 53 joints with anterior disc displacement without reduction had disc deformity and 33 (62.3%) had bone changes. The frequency of bone changes in the elderly group was higher than that in the younger group. Women had a higher incidence of bone changes than men.
We report a rare case of squamous cell carcinoma of the lower gingiva with extensive melanosis. The patient was a 74-year-old woman who presented with a black lesion on the oral mucosa of the lower lip. A mildly protruding lesion was recognized on the left side of the lower lip, left buccal mucosa, and floor of the mouth. The lesion measured about 4.0 × 0.8cm. There was no associated ulcer or induration: A leukoplakia-like white lesion was found on the lower gingiva around the anterior teeth. The white lesion measured about 2.0 × 0.5cm. Although melanin pigmentation increased after the first visit, there was scant evidence of malignant melanoma. A definite clinical diagnosis therefore could not be made. The lesions were excised totally by surgery. Histopathological examination showed continuous changes from the black lesion to well differentiated squamous cell carcinoma with severe epithelial dysplasia. This is a rare case of hyperkeratosis that resembled pseudohorn cyst. The prognosis of this patient remains good 10 months after operation, without recurrence or metastasis.
Papillary cystadenoma is a rare salivary gland tumor occasionally associated with the minor salivary glands. We encountered a 68-year-old man with a papillary cystadenoma in the retromolar region. The tumor was enucleated under general anesthesia. The histopathological diagnosis was a papillary cystadenoma. Follow-up examinations have shown no evidence of recurrence for 26 months.
We describe the successful use of medical leeches to relieve venous congestion of a free forearm flap after reconstruction in a patient with intraoral carcinoma. A 63-year-old woman consulted our clinic because of an ulcer on the left buccal mucosa. Histopathological examination revealed squamous cell carcinoma. After 60Co radiotherapy of with a total dose of 34 Gy, she underwent bilateral upper neck dissection and resection of the carcinoma. The cheek mucosa was reconstructed by transplantation of a free forearm flap. Because the flap became swollen and black, suggesting venous congestion, the vein connected to the flap was unsutured and anastomosed again on the 5 th day after the operation. However, the patient's condition did not improve. Leech therapy was started on the 4 th day after reanastomosis. A medical leech was applied to the flap for 40 minutes twice daily. After 10 leeches were used in 5 days, the flap apparently recovered and nearly healed. Hirudin contained in the saliva of leech is reported to have various effects, such as vasodilation, anticoagulation, and local anesthesia. The anticoagulative effect was considered the most important for improving the congestion in our patient.
Oral ulcers are caused by several different mechanisms. Sometimes the cause is unknown in elderly patients. We present the case of a patient with multiple persistent oral ulcers of unknown cause. A 74-year-old man was referred to our department for evaluation and treatment of multiple oral ulcers. The largest ulcer measured 38 × 19mm and was located on the tongue. The muscle was exposed. There was no systemic disease, and laboratory studies revealed no abnormalities. Incisional biopsy was done because of suspected malignant lymphoma, but no tumor tissue was found. The ulcers healed within 1 month in response to treatment with steroid ointment and instructions on mouth hygiene and nutrition at our hospital. Since some oral ulcers are caused by local factors whereas others are due to systemic problems, it is important to treat ulcers of unknown cause with multidisciplinary and complementary approaches and to continue long-term follow-up even after cure.