Odontogenic keratocyst (OKC) is classified as a developmental cyst derived from odontogenic organs such as enamel organs and dental lamina. The main histological feature of OKCs is keratinization in the cyst wall, sometimes including islands of epithelium that may represent daughter cysts in a thin epithelium lining. Clinically, this disease is characterized by a high frequency of recurrence. In this retrospective study, we examined 91 OKCs treated at the Department of Maxillofacial Surgery, Graduate School, Tokyo Medical and Dental University Hospital between 1981 and 1995. The ages of the patients ranged from 7 to 69 years (mean age, 30.5), and 50 were male and 41 were female. The most common sites were the molar region and ramus of the mandible. Most of the OKCs in the maxillary region were treated by enucleation and primary closure. Most OKCs in the mandibular region were enucleated, and the wound was left open. Marginal mandibulectomy was performed in two patients with large lesions arising in the mandible. The postoperative course was uneventful in 52 cysts (85%), and recurrence occurred in 9 cysts (15%) among 61 cysts followed-up for more than 2 years. Recurrence occurred near the roots of teeth. In most patients, no symptoms were associated with recurrence. Recurrence occurred in 4 patients more than 10 years after operation. Our findings indicate that long-term follow-up and careful treatment of lesions continguous with the roots of teeth are required in patients with OKCs.
Basal cell adenocarcinoma is a rare type of malignant salivary gland tumor found most often in the parotid gland. We present a case of basal cell adenocarcinoma of the minor salivary glands in the palate. Histologically, tumor islands were composed of relatively uniform, monotonous cells, and the tumor invaded blood and lymphatic vessels. Immunohistochemically, the tumor cells showed positiveimmunoreactivities with cytokeratin AE 1, epithelial membrane antigen, vimentin, and S-100 protein.
We report a case of severe trismus due to cicatrical changes in the left temporal region after treatment for liposarcoma. A 51-year-old woman was referred to our hospital because of severe trismus. Mouth opening range was only 8 mm. Computed tomography and magnetic resonance imaging showed no findings of temporomandibular ankylosis. Decreased signal intensity around the left coronoid process was seen on magnetic resonance images. A diagnosis of severe trismus due to cicatrical changes around the left coronoid process was strongly suggested, and coronoidectomy was performed. At operation, the mouth could be opened up to 45mm. A mouth opening range of 40mm has been maintained by the mouth opening training after operation.
Leiomyoma is a benign tumor originating from smooth muscle and most frequently arises in the uterus or alimentary tract. Oral leiomyoma is extremely rare because of the paucity of smooth muscle in the oral cavity. We report a case of leiomyoma that developed in the cheek mucosa. A 44-year-old man presented with a small raised, painless lesion in the mucosa of the left cheek. He had had the lesion for more than 15 years. Leiomyoma was diagnosed on biopsy, the tumor was enucleated under general anesthesia. Histologically, the tumor was composed of spindle cells arranged in interlacing bundles with calcification. The histopathological diagnosis was leiomyoma (non vascular type). This diagnosis was supported by the results of vimentin, α-smooth muscle actin, cytokeratin, and S-100 protein immunostaining. There has been no evidence of recurrence for 38 months after surgery.
Pathogmonic signs of von Recklinghausen's disease include cafe au lait spots and multiple neurofibroma. However, the correlation with bleeding is not well known. A 21-year-old man was referred to our hospital because of a swelling in the left cheek region. He had cafe au lait spots on the skin, and the clinical diagnosis was von Recklinghausen's disease. Magnetic resonance imaging showed enhancement of a mass extending from the left infratemporal fossa to the cheek region. Subsequently, the swelling increased rapidly because of hemorrhage in the tumor mass. To confirm the source of hemorrhage, an open biopsy of the temporal region and cheek was performed. The tumor mass included a large hematoma. Histological examination revealed neurofibroma with hematoma. Spontaneous hemorrhage may have been caused by invasion of neurofibroma tissue into a vessel wall or by tumor infection. Rebleeding has not occurred during 3 years of follow-up.
The development of home-use video systems and digital processing movie systems made it easy and inexpensive to set up a videofluorometry (VF) system for the evaluation of dysphagia. We have set up a VF recording-analyzing system with the use of conventional high-resolution home video sets. We have recently introduced a new digital video recording system and computer-based analysis system, which is more convenient and provides higher-quality images. We evaluated the quality of images, duration of oral stage, duration of pharyngeal stage, and duration of movement of the hyoid bone in patients after operation for tongue cancer. Our digital video system is introduced in this paper.
Reports of iatrogenic foreign bodies in the jaw are rare. Two cases of accidental insertion of broken extracting instruments into the mandible are reported. These accidents occurred during removal of impacted mandibular third molars. One patient was referred on the day of the accident, and the other was referred 2 months after the accident. Radiographs revealed metal foreign bodies in the mandible, separate from the tooth sockets. The objects were removed by enlargement of the tooth sockets. They were a broken elevator and a broken root tip elevator. Healing was uneventful, but one patient had prolonged sensory nerve disturbance of the lower lip.
A rare case of a deep penetrating injury into the submucosal tissue of the cheek is reported. A boy 4 years 7 months old was referred to our hospital because of penetration of his cheek by a chopstick. Clinical examination revealed no abnormality other than the penetrating injury. With the patient under local anesthesia, the chopstick was carefully removed. Follow-up examination revealed no physical sequelae.
A rare case of suppurative arthritis of the temporomandibular joint (TMJ) is reported. A 47-year-old man was referred to our hospital because of diffuse swelling and pain in the right TMJ and malocclusion caused by a left shift of the mandible. The patient had been treated for periodontitis at a dental clinic during the previous 2 months. The swelling and pain increased after extraction of the right upper third molar. A radiograph revealed anterior deviation of the right condyle. The anterior region of the right TMJ showed a low density area on computed tomographic examination. After administration of antibiotics (ABPC+CLDM), lavage of the right TMJ cavity was performed. The results of microbiological examination were negative, and there was no evidence of ankylosis or other disorders of TMJ. The symptoms subsequently resolved. We suspected that the inflammation associated with the upper third molar affected the TMJ and caused the symptoms in this patient.