The purpose of this study was to evaluate morphological changes in temporomandibular joint components by magnetic resonance imaging (MRI, 1.5 Tesla) before and after treatment for closed lock with a stuck disc. A total of 25 joints (25 patients) that were successfully treated and showed marked improvement in range of motion and articular pain after treatment were studied. Each joint was evaluated on the basis of pretreatment and posttreatment MRI findings, including disc mobility, condylar translation, disc reduction, disc shape, degree of disc displacement, bone changes of the condyle, and signal intensity of the posterior disc attachment. Posttreatment MRI revealed that all joints had mobile discs, and the range of the condylar translation had increased. Deformity of the disc and condyle had progressed remarkably. The posterior disc attachment showed low signal intensity. These results suggest that improved disc mobility is indispensable for successful treatment. The results also reveal that the disc, condyle, and posterior attachment showed various changes caused by remodeling.
Polymorphous low-grade adenocarcinoma (PLGA) is a malignant epithelial tumor which exclusively occurs in minor salivary glands. PLGA occurs more frequently in the hard and soft palate than in other locations. It is hard to histologically distinguish PLGA from adenoid cystic carcinoma and pleomorphic adenoma, because there are overlapping histologic features. We describe a case of PLGA in the soft palate of a 65-year-old woman. A clearly demarcated tumor-like swelling measuring 27×24 mm was preoperatively noted. Surgical excision was performed with the patient under general anesthesia. A postoperative diagnosis of PLGA was confirmed histologically and immunohistochemically. The pathological features of PLGA are not fully understood. We also discuss some histopathological aspects of PLGA.
Papillary cystadenocarcinoma is recognized by the World Health Organization (1991) Histological Typing of Salivary Glands Tumors. This lesion rarely occurs in the maxillofacial region. It accounts for less than 0.2% of all salivary gland tumors. We report a rare case of papillary cystadenocarcinoma arising in the upper lip. The patient was a 80-year-old woman with a painless mass in the left upper lip. The lesion was present for about 1 year. The tumor was excised with the surrounding minor salivary glands under local anesthesia. The excised specimen was histologically diagnosed as papillary cystadenocarcinoma, showing invasion to the adjacent minor salivary glands and rupture of the tumor capsule. Because of remaining tumor, additional excision was performed. No sign of recurrence or metastasis has been observed as of about 1 year after operation.
A case of malignant fibrous histiocytoma (MFH) in the maxilla is reported. The patient, a 60-year-old man, presented with diffuse swelling of upper left side of the gingiva after extraction of 7. An elastic soft mass with a smooth surface (40×32mm) was observed in left upper molar region. There was no swelling or hypoesthesia at the left side of the buccal region. Movable lymph nodes 4 mm in diameter were palpable at both sides of the submandibular region. Panoramic X-ray film showed resorption of alveolar bone at the left upper molar region and of the maxillary tubercle. Waters X-ray film revealed a mass protruding into the left maxillary sinus. Computed tomographic (CT) film showed a round mass in the left maxillary sinus, with destruction of the posterior wall. Under a clinicaldiagnosis of maxillary tumor, biopsy was performed. Histologically, the tumor consisted of spindle cells arranged in a storiform pattern. Therefore, a histological diagnosis of MFH was made. The patient was admitted to our hospital, and preoperative transarterial chemotherapy with adriamycin and dacarbazine (ADIC) was administered. The tumor responded partially. He then received partial maxillectomy. After surgery, general chemotherapy with adriamycin and if osf amide (MAI) was given. No severe side effect was observed. The defect of the left side of the maxilla was covered with a prosthesis. No clinical evidence of recurrence was found 2 years 6 months after discharge.
A case of plasmacytoma occurring in the maxilla with transition into multiple myeloma is reported. The patient was a 69-year-old man who had swelling of the right side of the maxillary alveolar process. A biopsy was performed, and the histological diagnosis was plasmacytoma, predominantly IgA-κtype. Because there were no abnormal laboratory findings in serum, urine, bonem arrow, or bones at other regions, the patient underwent radiotherapy to the maxilla. Consequently, the tumor markedly regressed, Since an antrostomy revealed remaining tumor cells, additional radiotherapy was performed. Immediately after radiotherapy, bone scintigraphy demonstrated abnormal uptake throughout the body, including the thoracic and lumbar bones. These findings together with MRI and laboratory test results indicated a transition into multiple myeloma. The patient is now receiving chemotherapy with cyclophosphamide and prednisolone. There is no sign of local tumor recurrence.
A case of MALT lymphoma of the hard palate suggesting an association with Sjogren's syndrome (SS) is reported. A 49-year-old woman was referred to the Department of Dentistry and Oral Surgery, Kawaguchi Municipal Medical Center because of a painless swelling in the right side of the hard plate. The mass, measuring 50×30×15mm, was soft and elastic and had a smooth surface. Magnetic resonance imaging demonstrated a well-defined solitary mass in the right side of the hard plate. The pathological diagnosis of the biopsy specimen was marginal zone B-cell lymphoma, extranodal (MALT-type)(REAL classification). Three cycles of CHOP therapy induced complete remission. Then, 3 more cycles of chemotherapy were given. An examination for dry mouth revealed that she met the diagnostic criteria for SS. An association of the MALT lymphoma with SS was strongly suggested. There has been no evidence of recurrence of the lesion as of 1 year after diagnosis.
Neurilemmomas are rare benign tumors of the oral cavity originating in the sheath of Schwann. Intraoral neurilemmomas are frequently located in the tongue in the head and neck region; rarely, they have been found in the base of the tongue. Ultrastructural studies of neurilemmomas provide morphological evidence supporting the concept that these lesions originate from Schwann cells. We treated a patient with a solitary neurilemmoma in the right side of the base of the tongue and investigated the features of this tumor by electron microscopy. The patient was a 17-year-old boy with a solitary mass in the right side of the base of the tongue. The mass measured 10×10×8mm. The lesion had a clearly demarcated border and was hard and elastic. The mass was surgically resected with the patient under local anesthesia. The histopathological diagnosis was neurilemmoma. Ultrastructural studies showed a complicated interdigitation of cytoplasmic processes, a continuous basal lamina, and Luse bodies. These findings suggest that the tumor originated from Schwann cells.
We describe a 37-year-old woman with Hand- Schüller-Christian disease. She was given the diagnosis by a neurosurgeon because of diabetes insipidus and eosinophilic granuloma of the temporal bone. She subsequently had pain in the mandible. She was given a diagnosis of eosinophilic granuloma in the mandible by an oral surgeon. She underwent curettage of the tumor and received chemotherapy with vinblastine sulfate, etoposide, and prednisolone as well as radiotherapy. Despite treatment, the tumor repeatedly recurred. She was operated on nine times by neurosurgeons and twice by oral surgeons during the past 8 years. She is free of disease 20 months after the latest operation.
Basal cell nevus syndrome is a complex disease characterized by multiple cysts of the jaws, multiple basal cell tumors of the skin, and a high incidence of skeletal abnormalities. Jaw cysts often involve permanent teeth in young patients, and we have to preserve permanent teeth whenever possible. We encountered a 9-year-old boy who had multiple jaw cysts and treated him for 9 years. It was possible to preserve the permanent teeth affected by jaw cysts by means of marsupialization. No growth disturbance of the jaws occurred.
A 47-year-old man was refered to us because of maxillary sinusitis associated with homogenous radiopague images in both maxillary sinuses on panoramic X-ray film obtained at another hospital. Computed tomography suggested that the high density images in the maxillary sinus were calcification associated with aspergillosis infection. As aspergillosis was detected on direct microscopy and fungal culture of specimens taken at sinus surgery and studied by histopathological staining, the lesion was diagnosed as non-invasive aspergillosis of both maxillary sinuses. The route of infection was suspected to be animal feed.
We report a case of recurrent thyroglossal duct fistula. The patient was a 14-year-old boy. At the age of 2 years, he had a simple excision of a thyroglossal duct cyst at other hospital. He had the unusual complaint of small amounts of clear mucoid-like material being discharged from a cervical skin sinus after meals. Examination of the cervical region revealed a 50×2mm transverse scar in the upper part of the neck, including a small fistula in the midline. A fine probe was inserted approximately 1 mm into the fistula. Fistulography demonstrated a complete thyroglossal duct through the hyoid bone to the base of the tongue. Thyroglossal duct excision with partial resection of the hyoid bone was performed under local anesthesia. There has been no recurrence as of 7 months after operation. Histological examination revealed ectopic salivary glands and branching tracts in the genioglossus muscle.
Although dental implant placement into a grafted alveolar cleft is a viable option for reconstruction in patients with cleft lip, cleft palate, or both, the alveolar bone height is sometimes insufficient for implant placement. Here we report on a patient with bilateral cleft lip and palate who underwent vertical augmentation of a grafted alveolar cleft by means of distraction osteogenesis followed by implant placement. The patient, who had received a secondary bone graft to the alveolar cleft, was referred to us for prosthodontic treatment. However, the alveolar bone height was insufficient owing to resorption of the grafted bone. After vertical alveolar bone augmentation by means of an intraoral distraction device, a dental implant was placed into the distraction site 8 weeks after distraction. The final prosthesis was subsequently installed. Although the duration of follow-up is relatively short, the implant was osseointegrated, and the clinical outcome was unevenful. This treatment procedure permits dental restoration in patients who have a grafted alveolar cleft with insufficient alveolar bone height.