Injury by a bear attack mostly occurs in the head and neck region and can be fatal, requiring immediate treatment. In addition to first-aid treatment, preventive measures against infectious and parasitic diseases are also necessary. We report two cases of multiple facial lacerations caused by the same black bear. Patient 1: A 51-yearold woman was attacked by a black bear while trekking and sustained multiple facial lacerations. She was successfully treated under general anesthesia 3 hours after the injury. Patient 2: A 65-year-old man was attacked by the same black bear when he tried to rescue the woman and sustained multiple facial lacerations as well. He was also successfully treated under general anesthesia 5 hours after injury. The clinical course of both patients was uneventful with no infection or sensory or motor nerve dysfunction.
Ameloblastoma is one of the most common odontogenic epithelial tumors and occurs chiefly between the ages of 20 and 39 years. Reports of ameloblastoma developing before the age of 6 years are rare. We report a rare case of ameloblastoma in the left mandibular region of a 3-year-old Japanese boy, with a review of the Japanese and English literature on ameloblastoma in children younger than 6 years. Intraoral examination showed a marked painless swelling in the left side of the mandible. Radiographic examination revealed a unicystic radiolucency. To treat the tumor, marsupialization was performed twice, with the patient under general anesthesia. There have been no clinical or radiologic signs of recurrence for 4 years 8 months after the second marsupialization.
Odontoma is the most common odontogenic tumor. However, it rarely occurs in the maxillary sinus. We report an extremely rare case of complex odontoma arising in the posterior wall of the maxillary sinus. A 39-year-old man came to our department because of swelling in the left maxillary anterior region. A dental Xray film showed a round radiolucent lesion in the upper incisal alveolar bone. Panoramic radiography accidentally revealed a round radiopaque mass in the left maxillary sinus. A computed tomographic scan showed a high density mass in the posterior wall of the maxillary sinus. Both lesions were enucleated with the patient under general anesthesia. The resected lesion from the maxillary sinus measured 26×23×21mm and was white and bony hard. The definitive histopathological diagnosis was a complex odontoma. About 1 year after the operation, the patient showed no signs of recurrence.
Keratocystic odontogenic tumors (KCOT) of the maxilla that extensively enter the maxillary sinus are relatively rare. This report describes a case of KCOT arising in the left maxillary sinus that showed histopathological characteristics of aggressive biological behavior. A 27-year-old woman was referred to our clinic for evaluation of a cystic lesion in the maxillary sinus. A CT scan revealed a heterogenious soft tissue density mass that extended widely into the maxillary sinus, resulting in a thinning of the cortical bone of the medial and posterior walls of the maxillary sinus. The cystic lesion was completely enucleated via an intraoral approach under general anesthesia. Histopathologically, the cystic lesion was covered with a parakeratinized stratified squamous epithelium consisting of a few layers. Palisading basal cells with hyperchromatic nuclei, and lamination and mitosis of the nuclei were also found. The histopathological diagnosis was KCOT. Furthermore, immunohistochemical staining for Ki-67 and p53 showed a high rate of positively stained cells at the stratified squamous epithelium with dysplasia. The histopathological characteristics suggested that this case of KCOT had an aggressive biological behavior. There has been no evidence of recurrence during the 11-month follow-up.
Recently, improved techniques for angiography have enabled a catheter to be superselectively placed from the superficial temporal artery to the feeding artery of oral cancer. Superselective intra-arterial infusion can limit the infusion area of anticancer agents as compared with selective intra-arterial injection. High concentrations of anticancer agents around a tumor can more effectively control lesions at the same dosage. Thus, we tried a new technique for superselective intra-arterial infusion with arterial redistribution to the facial artery. Our new technique was as follows. The superficial temporal artery was exposed surgically, and a sheath was inserted. A guide wire and apical bent catheter were inserted in a branch of the facial artery, using digital subtraction angiography as previously described. A micro-catheter was inserted through an apical bent catheter, and embolization of the facial artery with micro-coils was performed at the periphery of the tumor. Finally another catheter coated with heparin was placed in the facial artery. We used this technique to treat a case of carcinoma arising in the buccal mucosa (T3NOMO). Chemotherapy with intra-arterial infusion (5-FU 100-30mg/m2/day, TXT 15mg/m2/week) combined with radiation therapy (total 40 Gy) was given for 4 weeks after surgery. The clinical effect was complete response (CR). Embolization of an ascending branch of the facial artery leads to hemodynamic changes and facilitates the delivery of anticancer agents to the target region with minimal adverse events.