Thirty-eight patients with squamous cell carcinoma of the buccal mucosa were treated by surgery at our clinic during the 22-year period from April 1976 through March 1999. The average age of the patients was 61.1 years. The distribution of clinical stage according to the TNM (1997) classification was as follows: stage I, 5 patients; stage II, 12; stage III, 8; and stage N, 13. Thirty-one patients received preoperative chemotherapy consisting of bleomycin alone or in combination with other agents such as cisplatin, methotrexate, or 5-f luorouracil; 5 received preoperative chemoradiotherapy. Response of the primary lesion was evaluated as complete response in 5 patients and partial response in 11. All patients underwent surgical resection. Local and partial excisions were performed via the oral route in 18 patients, through and through excision in 5, and composite operation in 15. Neck lymph node metastasis was histologically confirmed in 12 patients at primary operation and secondary metastasis was confirmed in 2. Primary closure of the surgical defect was done in 10 patients. A local mucosal flap was used in 5 patients, an artifical mucous membrane such as TERUDERMIS® in 14, and a skin graft in 3. Distant flap reconstruction was required in only 6 patients. The local control rate for all patients after initial treatment was 78.9%. Five-year cumulative survival rates calculated by Kaplan-Meier's method were 76.5% for all patients, 100% for those with stage I or III disease, 72.9% for those with stage II disease, and 51.9% for those with stage IVA disease.
We describe our experience with a case of verrucous carcinoma arising in the upper residual ridge. A 71-year-old woman presented with a gingival swelling. On examination, we detected a granular mass in the 7-2 I region and leukoplakia lesions with an irregular surface in the 2+2 region. Radiography showed slight radiolucency of alveolar bone at the 7-2 region. Two biopsies of the mass showed papillomas. The patient underwent excision of the tumor under general anesthesia. The histopathologic diagnosis was verrucous carcinoma. We detected a tumor suppressor gene product, p53. This finding suggested that overexpression of p53 was involved in carcinogenesis. As of more than 5 years after operation, we have found no evidence of recurrence or metastasis.
A case of peripheral odontogenic fibroma occurring in the posterior region of the maxilla in a 7-year-old girl is presented. The patient was referred to our hospital because of a painless swelling in the buccal gingiva at 6 1. Physical examination revealed a localized elastic-hard tumor, with no radiological abnormalities in the adjacent alveolar bone. A biopsy specimen showed proliferation of fibroblastic cells in the submucosal layer. With the patient under general anesthesia, the tumor was resected subperiosteally, and the underlying bone surface was smoothened with a bur. Histologically, the lesion was composed of cellular fibrous connective tissue with scattered regions of cellular strands interwoven with less cellular areas and islands of odontogenic epithelium. The final diagnosis was peripheral odontogenic fibroma. Specific staining demonstrated that the tumor stroma contained large amounts of oxytalan fibers and tenascin. A positive reaction for tenascin was found to be a valuable pathohistological marker that could distinguish between peripheral odontogenic fibroma and calcifying fibrous epulis. As of about 9 years after the operation, there has been no evidence of recurrence.
A case of amyloidosis presenting with multiple nodules in the tongue is reported. A 70-year-old woman with a history of chronic renal insufficiency and receiving long-term hemodialysis complained of tenderness along the margin of her tongue. Clinical examination and palpation demonstrated multiple, firm ash-yellow nodules. Microscopic examination of a biopsy specimen stained with alkaline Congo red revealed orange staining. Under a polarization microscope, green disdiaclast refraction of amyloid proteins was identified. The histopathological diagnosis of the specimen was amyloidosis. The patient has not noticed any symptoms after biopsy and is currently being observed.
We treated two cases of habitual temporomandibular dislocation by the Buckley-Terry procedure using a T-type titanium miniplate. Both patients had mental or cerebrovascular disorders and had recurrent dislocation of the temporomandibular joint. Using an Al Kayat-Bramley type approach to the joint, we applied a bent T-type titanium miniplate to limit the movement of the condyle head. After Buckley-Terry surgical intervention, there was no clinical evidence of recurrent dislocation in either patient. This procedure appears to be a very simple and useful technique for the surgical treatment of habitual temporomandibular joint dislocation.
We report a case of odontogenic maxillary sinusitis with many calculi. The patient was 37-yearold woman who was introduced to our department for treatment of a calcified mass in the right maxillary sinus. Maxillary sinusectomy was performed with the patient under general anesthesia. A total of 55 stones (∅1-5mm) were found in the maxillary sinus. Histopathological study revealed maxillary sinusitis with some fine sequestra in the membrane. Most of the stones had several sequestra as nuclei.
Traumatic myositis ossificans in the masseter muscles has rarely been reported. Traumatic myositis ossificans usually occurs in young males as a result of direct trauma. Wedescribe a 31-year-old man with severe trismus caused by traumatic myositis ossificans. The patient was under confinement for about 3 months and abused his face frequently. As a result, he was unable to open his mouth. The maximum interincisal opening was 5 mm. A hard board-like mass was palpated in bilateral cheeks. Physical examination revealed that he was healthy, except for severe trismus. On laboratory examination, the alkaline phosphatase level was twice the upper limit of normal. Diagnosis was based on clinical findings plus radiography, CT, and 3 D-CT. Partial removal of the masseter was performed, achieving an interincisal opening of 37mm. Surgical specimen showed heterotopic ossification. Postoperatively, he could not open his mouth, because his lip and cheek had cicatrized. Despite active physiotherapy, trismus reappeared. Subsequently, mouth opening training continued. After 10 months, the patient could open his mouth, with a maximum interincisal opening of 35mm.