Recently, platelet-rich plasma (PRP) has been used clinically to promote bone regeneration and wound healing. However, no study has clearly reported on the activity of PRP after preparation. We established a protocol for the safe production of PRP from small quantities of blood. Various conditions were used for anticoagulants and centrifugal separation speed for blood samples obtained from 23 healthy subjects to investigate optimal concentration conditions. Our results showed that when 20% ACD-A liquid was used as the anticoagulant, PRP was most efficiently obtained by double centrifugation at 800 r. p. m. and 1300 r.p.m. The effectiveness of PRP was confirmed by platelet aggregation reaction and the TGF-β content of PRP after double centrifugation.
Mandibular chronic osteomyelitis with diffuse osteosclerosis is recognized as an intractable infectious disease. We employed decortication and intra-arterial infusion of antibiotics to treat 6 cases. Decortication of the affected mandible was performed with retrograde catherization to the superficial temporal artery of the affected side with the patient under general anesthesia. Antibiotics, IPM/CS or FMOX, were given intra-arterially for 4 to 11 days. In addition, FMOX and PIPC were administered intravenously for 8 to 17 days. CT and MRI were performed postoperatively. Postoperative follow-up ranged from 1 year 6 months to 2 years 5 months. Postoperative MRI showed that bone marrow signals recovered to nearly normal in 4 cases. High-signal areas of bone marrow and osteosclerotic changes remained in 2 cases, but showed improvement. The results were satisfactory, without recurrence in any of the 6 cases.
Superficial mucocele is a variant of the commonly encountered classic type of mucocele. Clinically, it is a small, innocuous, clear, tense vesicle that has a predilection for the soft palate, retromolar region, and buccal mucosa. Histopathologically, it is characterized by extravasation of mucus into the tissues immediately below the epithelium. A few cases of superficial mucocele have been reported, and the lesion has been occasionally misdiagnosed as subepithelial vesiculating disorders such as bullous lichen planus, mucous membrane pemphigoid, or herpes simplex infection. Two cases of superficial mucocele are presented. The first patient was a 47-year-old woman. Multiple vesicles 1 to 3 mm in diameter were observed on her lower lip, buccal mucosa, retromolar region, and soft palate. The second patient was a 45-year-old woman presenting with recurrent small vesicles on the soft palate. Biopsy showed that these lesions had histologic features consistent with those of mucocele. On the basis of clinical findings, superficial mucocele was diagnosed. Differences from common mucocele and the pathogenesis and differential disgnosis of this rare lesion are described.
Thyroglossal duct cyst presents most frequently in the midline of the neck, either at or just below the level of the hyoid bone. We describe a thyroglossal duct cyst appeared on the left submandibular region in a 28-year-old woman. The mass was located in the left submandibular region, above the level of the hyoid bone. This mass moved in a vertical fashion on swallowing. CT and MRI examination revealed a cystic structure extending to the left submandibular region from the base of the tongue. The cystic lesion was removed surgically with the patient under general anesthesia. Histopathological analysis revealed a cyst with a dense fibrotic wall; there was no epithelial cell lining, but many ductal structures consisted of single epithelial cell layer were observed in the cyst wall. The clinical and histopathological findings suggested that the lesion was a thyroglossal duct cyst. There was no evidence of recurrence 4 months after surgery.
Dermoid cyst and epidermoid cyst usually appear as midline swellings in the floor of the mouth. We report a rare case of epidermoid cyst that arose laterally in the root of the tongue. A 4-year-old girl with asymptomatic swelling on the left lateral aspect of the tongue was referred to our hospital. MR imaging showed a clearly defined cystic lesion. The lesion was extirpated with the patient under general anesthesia. Serous fluid and a white caseous substance were contained in the cystic lesion. Histological examination revealed a lining of squamous epithelium with mucous cells and keratin filling the lumen. A histological diagnosis of epidermoid cyst was made. The postoperative course was good, without any complications. There have been only 14 reports of dermoid or epidermoid cysts of the tongue in the English and Japanese literature. Only 4 of these cases arose in the lateral aspect of the tongue. The literature is reviewed, and possible origins of this lesion are discussed.
A case of schwannoma arising in the temporalis muscle is reported. A 55-year-old woman with a painless mass in the left temporal region was referred to our department by her otolaryngologist because of a suspected diagnosis of erectile hemangioma, based on the results of angiography. She had recognized the mass 6 years before her initial visit. On presentation, the mass measured 20 × 10 × 5 mm at rest and it increased in size to 37 × 22 × 10 mm in clenching position. Imaging studies, including CT, MRI, and ultrasound, could not confirm the diagnosis. Initially, she did not consent to undergo surgical resection, and the mass was followed for several years. Four years after presentation, the mass had increased in size to 43 × 33 × 15 mm at rest, and the patient consented to surgical removal. The mass was approached via a preauricular incision, extending to the temporal region. Since the mass was a yellowish encapsulated tumor, a suspicion of hemangioma was ruled out on intraoperative diagnosis. The resected tumor was diagnosed as schwannoma pathologically. Microscopically, the tumor included various stages of degradation, such as myxoid changes and cystic cavity formation, as well as an abundance of small vessels. There has been no sign of recurrence during 5 years of follow-up.
A case of benign hemangioendothelioma occurring in the buccal fat pad of a 2-month-old infant is reported. Two months after birth, her mother noticed a well-demarcated, elastic soft nodule at the left buccal region of the patient. The lesion was excised and histopathologically diagnosed as benign hemangioendothelioma. As of 1 vear 11 months after the oberation. there has been no evidence of recurrence.
A 62-year-old man with an NK/T lymphoma originating in the right side of the upper jaw showed destruction of the hard palate and sino-nasal cavity. Intraoral examination revealed an ulcer with necrotic mucosa covering the area from the right side of the upper gingiva to the midline of the palate. CT scanning demonstrated a lesion on the right side of the sino-nasal cavity, and other clinical findings suggested a lethal midline granuloma. A biopsy specimen was positive for CD3, CD56, and Epstein-Barr virus (EBV), but negative for CD20. On the basis of these findings, a definitive diagnosis of NK/T lymphoma was established, and a course of radiation treatment was prescribed. Thereafter, his general condition deteriorated rapidly, and the patient died approximately 4 months later. In this disease, it is very difficult to establish a correct diagnosis. In situ hybridization study for EBV can contribute to the diagnosis because it can detect very small numbers of neoplastic cells in the early stage of disease.
Paget's disease of bone is characterized by excessive bone resorption in focal areas, followed by new bone formation. The etiology of the disease is not well understood. We report a case of Paget's disease of bone with bacterial infection in both maxillary and mandibular bone. A 48-year-old woman visited our hospital because of pain in the left side of the mandible in November 1991. We removed an impacted supernumerary tooth and sequestrum from the premolar region. She returned to our hospital because of pus discharge from the inferior border of the left side of the mandible in April 2000. Orthopantomography revealed a cotton-wool appearance and sequestra in both maxillary and mandibular bone. The sequestra were surgically removed. The patient returned again because of pain and swelling of the right upper alveolar gingiva in September 2004. Orthopantomography revealed a cotton-wool appearance and sequestra in the right side of the maxilla. We removed the sequestra and performed a biopsy of the bone around the sequestra. A histological diagnosis of Paget's disease of bone was made on the basis of a mosaic pattern with osteogenic and osteoclastic reactions.
We report the case of an impacted tooth in the maxillary sinus that was contiguous with the apical region of the upper second molar. The patient was a 48-year-old woman who presented with mild swelling of the left cheek, accompanied by mobility and gingival swelling and tenderness of the upper second molar region. Radiographic examination showed an impacted tooth in the maxillary sinus that was contiguous with the apical region of the upper second molar. We extracted the impacted tooth with the patient under general anesthesia.
We report an unusual case of tophaceous pseudogout (tumoral calcium pyrophosphate dihydrate crystal deposition disease: CPPD) involving the temporomandibular joint (TMJ). A 76-year-old woman was referred to our hospital because of a tumor-like lesion around the right TMJ on a computed tomographic (CT) scan, taken at the department of neurosurgery to evaluate a head bruise. The patient had had right TMJ clicking sounds without pain for the past 20 years. Recently, she noticed swelling of the right cheek. Because the swelling was painless, the patient received no treatment. The medical history and results of clinical examinations were unremarkable. A CT scan revealed a heterogeneous mass with well circumscribed borders around the right condyle. There was moderately limited translation of the right condyle and slight deviation of the mandible to the right side in open position. The lesion was removed under general anesthesia. The lesion measured more than 4 cm in greatest dimension and had a white chalky appearance. Microscopically, the most distinctive feature was the presence of islands of crystalline material in which individual crystals showed a needlelike configuration. On the basis of these findings, tophaceous pseudogout was diagnosed. There has been no sign of recurrence for 16 months after operation.
It is difficult to restore function by conventional maxillary prosthetic treatment in patients with extensive maxillary defects after cancer ablation. Early functional rehabilitation was attempted by the immediate installation of prostheses supported with an Epitec System after maxillectomy for a malignant maxillary tumor. Before surgery, a stereo-lithographic model of the patient's skull was fabricated on the basis of preoperative CT data analysis, and the region occupied by the tumor was removed from the skull model for presurgical simulation. An Epitec plate was bent and bilaterally fixed to the remaining zygoma bones and the anterior wall of the maxillary sinus to cover the defects in the maxillary alveolar ridge and palate on the skull model. An immediate maxillary prosthesis was also prepared at the same time. A sterilized Epitec plate was fixed to remaining bone with screws immediately after tumor resection, and mushroom-type abutments were connected to the plate. An immediate maxillary prosthesis was placed at the end of surgery. An Epitec System proved to be highly effective for supporting an immediate prosthesis in a patient with a large maxillary defect.
Obstructive sleep apnea syndrome (OSAS) is a life-threatening breathing disorder. We describe a patient with micrognathia and OSAS who underwent mandibular advancement by bilateral mandibular distraction osteogenesis. A 36-year-old man had micrognathia due to neonatal bilateral temporomandibular joint ankylosis. He also had severe OSAS. Conservative treatment for OSAS, such as continuous positive airway pressure, had been attempted at another hospital, but was not successful. Before mandibular distraction, sleep apnea was severe; the apnea hyponea index (AHI) was 63, and the Epworth sleepiness scale (ESS) was 8. After distraction, AHI and ESS greatly improved to 8 and 1, respectively. Cephalometric analysis showed that the widths of the upper airways had increased. In conclusion, mandibular advancement by distraction osteogenesis was effecttive for correcting micrognathia associated with OSAS. There has been no relapse of malocclusion and no recurrence of OSAS for 2 years after the operation.