We established a pair of cell lines derived from the primary lesion (KK-p) and lymph node metastasis (KK-m) of a tongue carcinoma. We compared the profiles of genes expressed in KK-p and KK-m cells by microarray analysis. Seven genes were highly expressed and 26 were poorly expressed in KK-m cells as compared with KK-p cells. The expression ratios of 14 genes were confirmed by real time RT PCR, and the results were similar to those of the microarray analysis. These results suggested that some of the genes identified in this study may be new metastasis-related genes.
The authors report a case of cervical cellulitis and mediastinitis developing from odontogenic infection. A 52-year-old woman visited our clinic because of dyspnea and pain on swallowing. She was given a diagnosis of cervical cellulitis caused by an odontogenic infection of the lower left second and third molars. We administered antibiotics and extracted the lower left second and third molars. However, the patient's condition deteriorated, and the inflammation spread to the contralateral side. Four days later, surgical drainage of the left submental and submandibular regions was performed under general anesthesia. Despite this surgical procedure, a postoperative computed tomographic (CT) scan revealed anterosuperior mediastinitis and thrombosis extending from the right subclavian vein to the brachiocephalic vein. Therefore, transcervical mediastinal drainage, thrombolytic therapy, and placement of a vena cava filter were performed. Subsequently, the patient recovered uneventfully. Our experience indicates that it is important to accurately diagnose rapidly developing lesions and to promptly perform surgery when severe odontogenic infection is encountered.
Fibro-osseous lesions usually occur in bone and rarely arise from soft tissue in the head and neck region.This report describes a rare case of a fibro-osseous lesion occurring in the buccinator muscle. A 12-yearold boy visited Ehime University Hospital because of a painless swelling in the right buccal mucosa. An elastichard, well-defined mass was observed under the right buccal mucosa.On a panoramic X-ray film and a computed tomography scan, an oval radiopaque tumor, measuring 3×2cm, was observed in the region.A biopsy specimen revealed a fibro-osseous lesion with no evidence of malignancy.We extirpated the tumor with the patient under general anesthesia. The tumor was located in the buccinator muscle.Histopathological examination of the surgical specimen revealed ossifying fasciitis with small foci of metaplastic bone and fibrous tissue.The lesion was not contiguous with the mandible.The patient had no discomfort postoperatively and no evidence of recurrence during 7 months of follow-up.
Thyroglossal duct cyst is a congenital anomaly resulting from retention of a thyroglossal duct during embryonic development. Thyroglossal duct cysts usually arise at in the midline of the neck and are rarely found in the oral cavity. We describe an infant who was born with a thyroglossal duct cyst in the oral floor, which interferred with nursing. The patient was a 4-day-old male infant. An elastic soft mass was palpable in the floor of the mouth. The mass was clinically diagnosed as a thyroglossal duct cyst because of its cystic structure on computed tomographic examination. For treatment, the cyst was successfully enucleated via a transoral approach. We did not resect the hyoid bone. Histopathologically, the cyst was covered with columnar and stratfied squamous epithelium. Thyroid tissue was not found. There has been no evidence of recurrence as of 6 years after the operation.
Benign fibrous histiocytoma occurs commonly in the limbs and abdomen and is very rare in the oral region, especially the mandible. A 22-year-old woman presented with pain of the posterior part of the mandible. Radiographs showed a radiolucent lesion extending from the mandibular left second premolar to the left first molar on panoramic radiographs, enlarging the mandibular bone on CT. The clinical diagnosis was a benign tumor of the mandible, and the tumor mass was surgically extirpated. Histological examination revealed mixed proliferations of fibroblastic and histiocytic cells without cell atypism and mytosis. Immunohistochemical and ultrastructural analysis supported the presence of fibroblastic and histiocytic cells. Histopathologically, our case was diagnosed to be benign fibrous histiocytoma. The postoperative course was good, and no sign of recurrence has been noted for 1 year after operation.
Chickenpox is a common infection due to varicella-zoster virus (VZV), which generally occurs in childhood. However, the incidence of chickenpox in adults is increasing because of changes in the social environment. In this paper, we report a case of adult chickenpox with the first symptom in the oral cavity. A 32-year-old Japanese woman presented with palatal ulcerative lesions and many bullae on her skin. The first symptom was continuous spontaneous pain at the left upper molar, present for 15 days before her first visit. Intravenous and oral acyclovir was given for a clinical diagnosis of VZV infection. Although the serum antibody examination showed no evidence of VZV infection, the symptoms led to a diagnose of adult chickenpox.
Sialolithiasis of the minor salivary glands is a rare disease. We report an extremely rare case of multiple sialoliths occurring in the minor salivarly glands of the upper lip and arising bilaterally in the buccal mucosa. A 86-year-old man presented with multiple small nodules arising in the upper lip and occurring bilaterally in the buccal mucosa. He noticed these nodules about 10 years previously. He felt no pain. Multiple small nodules just beneath the normal mucosa were detected on palpation, suggesting multiple calcifications under the oral mucosa. Histopathologically, these lesions were diagnosed as sialolithiasis with chronic inflammation of the minor salivary glands.
Congenital factor V deficiency is a very uncommon disease. We performed tooth extraction in a patient with congenital factor V deficiency. We describe the patient and discuss treatment-related considerations. The patient was a 27-year-old man. Congenital factor V deficiency was diagnosed immediately after birth. Three teeth at the anterior region of the maxilla were extracted while the patient received 5 units of fresh frozen plasma (FFP). After the transfusion of FFP, the serum level of factor V increased from 8% to 33%. The socket of each tooth was filled with oxidized cellulose, and the gingival tissue was sutured. The wound was then covered with an acrylic splint. Hemostasis was easily achieved, and wound healing was uneventful.
A case of chronic type adult T-cell leukemia (ATL) with initial oral lesions in a 68-year-old woman is reported. She was referred to us because of ulceration of the left side of the soft palate and had difficulty in swallowing due to severe contact pain. The initial clinical diagnosis was severe ulcerative stomatitis. After treatment, herpetic stomatitis was followed by a fever and general weakness. Immunological blood examinations revealed positive anti-ATL, abnormal T lymphocytes (so-called flower cells), and the polyclonal integration of human T-cell leukemia virus type 1 (HTLV-1) provirus DNA. At this time, ATL was diagnosed. The initial oral lesions were subsequently thought to be an initial symptom closely associated with immune suppression caused by ATL.
Deep venous thrombosis (DVT) is caused by obstruction of blood flow of the deep vein of the leg and accelerated blood coagulating activity. DVT may occur after an operation. However, there are few reports of DVT associated with surgery of the oral and maxillofacial region, especially in young adults. We report a case of DVT occurring after orthognathic surgery in a 19-year-old woman at our hospital. She had facial asymmetry and underwent Le Fort I osteotomy of the maxilla combined with sagittal splitting ramus osteotomy and intraoral vertical ramus osteotomy of the mandible under general anesthesia. Although she was able to walk the next day, symptoms of DVT appeared 3 days after the operation. On the 18th day after the first operation, surgery to remove the thrombus was performed by cardiovascular surgeons. She was discharged on the 34th day after the first operation. Orthognathic surgery is not free of the risk of DVT, which can cause fatal acute pulmonary thromboembolism. Therefore, it is necessary to prevent DVT after orthognathic surgery, even in young adults.
Three cases of iatrogenic foreign bodies in the maxillary sinus caused by dental treatment are reported. The patients comprised one man and two woman 34 to 66 years old. All patients were referred to us by the department of otorhinolaryngology of our hospital. Their primary dentists had not informed the patients about the foreign bodies. The foreign bodies were dental implants, a fractured instrument (reamer), and root canal filling materials. Maxillary sinusitis at the sites of the foreign bodies was seen in all patients at the initial examination. Each foreign body was surgically removed with the patient under general anesthesia. Recovery was uneventful after the operation.