To examine the distribution of hyaluronic acid (HA) in murine temporomandibular jointsynovium, histochemical and immunohistochemical techniques were employed to study the synovial membrane, using hyaluronic acid binding protein (HABP), which specifically binds to HA, and antibodiesagainst CD44, serving as hyaluronan receptor. HABP reactivity was detected in synovial lining cells, collagen fibers, and capillaries. CD44 reactivitywas detected on the cell surface of all synovial lining cells. These results suggest that HA is distributed intemporomandibular synovial tissue and that CD44 expressed as hyaluronan receptor is involved in theregulation of HA.
We report a case of multiple myeloma involving the mandible and gingiva. A 71-year-old manvisited our hospital on June 9, 1999 because of gingival swelling and continuous bleeding from the leftmandibular molar. Clinical examination revealed a soft, smooth, partially erosive mass in the lingualgingiva of the mandible. Slight, but continuous bleeding was observed in the erosive area. The patient appearedto have multiple myeloma of the mandible. On August 20, he had pain during biting, tooth mobility, gingival bleeding from the left mandibular molar, and hypoesthesia of the lower lip. On August 31, thepatient's swollen gingiva was resected, and the first and second molars were extracted from the left sideof the mandible. Histologic examination was also performed. No post-extraction hemorrhage occurred.For almost 4 months after extraction, the patient showed no evidence of oral multiple myeloma, but diedon December 26.
A case of squamous cell carcinoma of the tongue with metastasis to the lateral lingual lymphnodes is reported. Preoperative computed tomography and magnetic resonance imaging revealed a mass0.5cm in diameter with heterogenous enhanced signal intensity outside of the left genioglossus muscle.Radical neck dissection, partial left glossectomy, and reconstruction with a forearm flap were performedin a pull-through manner after external radiation and chemotherapy. Histopathologically, the mass had alymph-node structure with small cancer nests at the margin.
Mucoepidermoid carcinoma, one type of malignant tumor of the salivary glands, is composed ofmucous, squamous and intermediate cells, and mainly occurs as a submucosal lesion in the major salivaryglands, especially the parotid gland. We report a rare tumor arising in the parotid papillary region of aneldery person that was associated with exophytic proliferation. Tumor malignancy is histologically evaluatedon the basis of the relative proportions of mucous cells and squamous cells. Our case had a high proportionof mucous cells, indicating low malignancy and mature type. The tumor apparently arose in the excretingducts of the parotid gland or buccal gland near the parotid papilla and showed polypoid growth tothe oral cavity through the parotid duct.
We report the case of a large mandibular cyst in a patient with severe hemophilia A. The cystresolved in response to conservative treatment. The patient was 8-year-old boy. He presented with swelling of the left side of the mandible. A panoramic X-ray film revealed radiolucency in the left side of the mandible (from the molar region to theramus). Puncture was performed 3 times during replacement therapy with coagulation Factor VIII. After 2 months, the radiolucent region decreased slightly. After 1 year 2 months, the region completelydisappeared. There have been no signs of recurrence for 20 years.
Tetanus often leads to death if early diagnosis and early treatment are not performed. We reporta case of tetanus with trismus and unilateral facial spasm. The patient was a 81-year-old man whowas referred to our hospital because of difficulty in opening his mouth and left eye. Clinical examinationsrevealed severe trismus, unilateral facial spasms, and stiffness of the masseter muscle. However, there wasno symptom of TMJ disease or maxillofacial phlegmon. An injury wound 13cm in length was seen on theright forearm. Blood examinations showed a marked increases in serum creatine phosphokinase activityand leukocytes. These findings were suspected to be caused by tetanus. The patient was admitted to the emergency room of our hospital. A tracheotomy was performed becauseof aspiration pneumonia due to dysphagia and dyspnea. A daily intravenous in fusion of PIPC 4 g was administeredfor 11 days from admission, and 4500 units of antitetanus human immunoglobin was given intravenouslyover the course of 4 days. Oral dantrolen sodium was administered in a dose of 150mg perday. He was discharged after 32 days. There were no functional sequelae. It is important to consider the possibility of tetanus when we treat patients who have difficulty inmouth opening.
We report a penetrating cervical injury with a cervical phlegmon caused by a rusty steel wire. A75-year-old woman presented at our department with considerable swelling of the right cervical region. Shehad a medical history of hypertension and Parkinson's disease. Clinical examination showed that an L-shaped steel wire had entered her neck, and pus exuded from thewound. She received antibiotic therapy and tetanus toxoid. The steel wire was extracted via the entry sitewith the patient under general anesthesia. Foreign bodies must be removed cautiously because sharp edges may damage vital structures. The use of CT scanning was very useful in demonstrating the course of the steel wire before extractionand in confirming the absence of continuous bleeding and hematoma. In this patient, no complication developedafter treatment.