Actinomycosis is commonly associated with cellulitis caused by the other bacterial infections. It is often in remission before confirming the diagnosis owing to the frequent use of antibiotics. In addition, cases presenting with typical symptoms are decreasing. Therefore, confirmed cases of actinomycosis are becoming rare. We report 2 cases of actinomycosis with bone destruction in the oral and maxillofacial region. They were histologically diagnosed on the detection of sulfur granules. One case had bone destruction in the center of the mandible, and the other had bone destruction in the cortex of the mandible. PAPM was effective in both cases.
A case of unilateral temporomandibular joint (TMJ) pseudoankylosis of a fractured condyle that fused to the mandibular notch is presented. A 6-year-old girl who had a traumatic accident at the age of 1 and a half years developed pseudoankylosis of the right TMJ. After the accident, she was transported to an orthopedic clinic for an X-ray examination. No bone fractures were evident. She had difficulty in opening her mouth after the injury, but no doctors were consulted until she was 3 and a half years old. She then underwent another X-ray examination by an oral and maxillofacial surgeon. The surgeon claimed that she suffered a fracture during the accident and recommended a mouth opening exercise. He later referred the patient to us because the exercise was not effective. The interincisal distance on mouth opening was 15mm at presentation. A panoramic X-ray film and CT examinations showed that a fractured condyle had fused to the mandibular notch struck against a zygomatic arch, resulting in hypomobility of the mandible. The patient underwent open surgery under general anesthesia. The operation included complete resection of the fused condylar segment and a rigid fixation of it to the stump of the condyle with titanium screws. Two years 10 months after surgery, the interincisal distance on mouth opening was 37mm, and no disturbance of jaw development or asymmetry of the face was observed.
Adenomatoid odontogenic tumor (AOT) is a relatively rare benign tumor, accounting for 2% to 7% of odontogenic tumors. AOT is generaly found in the incisor region of the maxilla of young females. It is often misdiagnosed as dentigerous cyst. We report a case of AOT found in the third molar region of the mandible. The patient was a 17-year-old girl who was referred for further evaluation of a cystic radiolucent lesion of the mandible. We diagnosed a dentigerous cyst because the X-ray film and CT examination showed a monolocular radiolucent lesion including an impacted tooth with no calcification. We enucleated the tumor and the impacted lower third molar with the patient under general anesthesia. Histological examination revealed an adenomatoid odontogenic tumor with duct-like structures lined by a single layer of columnar epithelial cells. There was proliferation of spindle-shaped cells, but no clear evidence of typical calcification. There has been no sign of recurrence as of 4 years after the operation.
Angioleiomyoma is a benign tumor of smooth muscle originating in blood vessels. It is usually located in the lower extremities of middle-aged women and rarely occurs in the oral cavity. We report a case of angioleiomyoma developing at the mouth angle. A 71-year-old man noticed a painless tumor at the right angle of the mouth. The tumor was thumb-head size, with a sharp border and elastic hardness. The clinical diagnosis was a benign tumor of the mouth angle. The tumor was surgically resected with the patient under local anesthesia. The resected tumor was solid, white-yellow, and measured 15×10×10mm. Histopathologic examination showed angioleiomyoma, solid type.
Cystadenocarcinoma is an uncommon salivary gland tumor that predominantly occurs in the major salivary glands rather than minor glands. We report a case of cystadenocarcinoma arising in the anterior mandibular gingiva. A 70-year-old man visited a certain hospital because of an intraoral painless tumor. The tumor was initially suspected to be an epulis and was excised with the patient under local anesthesia. The histopathological diagnosis was a cystadenocarcinoma. Eighteen months after the excision, the patient visited our hospital because of lymph node metastasis. Left radical neck dissection was performed. Metastases were histopathologically found in eight lymph nodes, one of which showed extracapsular spread. Moreover, 4 months later, right submandibular lymph node metastasis was detected, and the patient underwent right functional neck dissection. Unfortunately, the tumor recurred in the left side of the neck 29 months after the initial excision, and the patient was given regional radiotherapy.
Mucinous adenocarcinoma is a rare malignant neoplasm characterized by a large amount of extracellular epithelial mucin. In the present report, an extremely rare case of a mucinous adenocarcinoma in a minor salivary gland of the upper lip is described, along with a brief discussion. A 82-year-old woman was referred to our department because of a swelling on the left side of the upper lip on May 20, 2004. She noticed the swelling in September 2003. Physical examination revealed a painless nodule, measuringl4×12mm, on the mucosal side of the lip. The nodule felt elastic, firm, and movable. The skin was intact, without tumor invasion. There was no lymphadenopathy palpable in cervical region. Ultrasonography revealed a homogenous hypoechoic tumor with an illdefined margin. On the basis of these findings, a clinical diagnosis of a tumor in the upper lip was made, and excisional biopsy was performed on June 3, 2004. Histopathological examination showed a malignant neoplasm with characteristics indicating mucin production. A metastatic tumor was thus suspected. Therefore, the patient was examined by taking a detailed history and performing radiography and scintigraphy. However, no malignancy was detected in any other organs. Because subsequent histopathological examination revealed signs of residual tumor cells at the resection margin, additional excision of the tumor and skin was planned under general anesthesia. The postoperative course was uneventful. Histopathologically, the tumor was composed of glandular neoplastic cells that produced a large amount of mucin. Nests, cords, sheets, and clusters of neoplastic cells were found floating in mucin pools separated by fibrous connective tissue bands. The final diagnosis was a mucinous adenocarcinoma of the upper lip.
Osseous and cartilaginous choristoma is a soft tissue mass containing normal-appearing bone and cartilage. We report an extremely rare case of osseous and cartilaginous choristoma in the maxillary gingiva. The patient was a 7-year-old boy who had been aware of a tumor in the maxillary gingiva since 3-years old. At presentation, the tumor was approximately 5 mm in diameter. We diagnosed an osteoma or benign tumor of the gingiva. The tumor was excised with the patient under general anesthesia. Histological examination of the excised specimen revealed that the tumor contained cartilaginous and osseous tissues. The histological diagnosis was an osseous and cartilaginous choristoma of the gingiva.
This report describes a case of Behcet's disease with extensive necrotizing ulcerative stomatitis. A 48-year-old woman became aware of an ulcer in the oral cavity in February 2005. She had been treated by a physician, with no improvement. Therefore, she was referred to our hospital because of multiple ulcer formation in the oral cavity on March 28. Clinical examination revealed multiple ulcerative lesions of the tongue, soft palate, and labial gingiva. Our clinical diagnosis was ulcerative stomatitis of unknown cause, because CT and MRI examinations showed no abnormal findings. She complained of erythema nododum of the lower extremities. We therefore suspected that lesions were caused by systemic disease. We consulted a dermatologist at our hospital, and she was given a diagnosis of Behcet's disease on the basis of genital ulceration and treated with coichicine. An ophthalmologist found no signs of ocular inflammation. She was hospitalized to receive nutrition management with a nasogastric tube on April 11. Following treatment, the oral ulcerative lesion improved, and oral ingestion became possible. The patient was discharged on April 17 and followed up at our department of dermatology.
We report a case of facial nerve palsy that occurred after orthognathic surgery. This is a rare, but serious complication. A 31-year-old woman with mandibular prognathism underwent bilateral intraoral vertical ramus osteotomy. Right facial nerve palsy suddenly developed 3 days after the operation. Although steroid therapy was started immediately, there was no response. Then, stellate ganglion block (SGB) was performed. The facial nerve palsy completely resolved 4 months after the operation. SGB was suggested to be effective for facial nerve palsy occurring after orthognathic surgery.
Basal cell nevus syndrome (BCNS) is frequently accompanied by multiple maxillomandibular cysts. This disease is known to cause several types of maxillofacial deformity, but there are few reports of orthognathic surgery in patients with BCNS. A patient with BCNS who underwent maxillary distraction osteogenesis is described. The patient was a 19-year-old man. He underwent palatoplasty for cleft palate while he was an infant. Maxillary hypoplasia subsequently developed. Le Fort I osteotomy and anterior alveolar osteotomy of the mandible were performed. A RED system and lateral expansion device were used for maxillary advancement and palatal widening. The total advancement was 15mm, and the total lateral expansion was 6 mm. After distraction, orthodontic treatment was continued. At present, 3 years after distraction, an excellent facial outline and occlusal condition have been obtained. After the operation, we have kept the patient under close observation.
The purpose of this study was to evaluate the stability of screw fixation via an intraoral approach after sagittal splitting ramus osteotomy (SSRO). The screw was made of titanium and 2.0 mm in diameter. We examined stability in 5 patients with mandibular prognathism who underwent SSRO via an intraoral approach (S subjects). As controls, 5 patients underwent conventional fixation with poly-L-lactic acid (PLLA) screws 2.7mm in diameter (P subjects), and 10 underwent conventional fixation with titanium screws 2.7mm in diameter (L subjects). The changes at point B, the pogonion, and menton 6 months after surgery were measured on lateral cephalograms. The results were as follows: 1) Stability did not significantly differ between S and P subjects or S and L subjects. Our results indicate no difference in stability between screw fixation via an intraoral approach after SSRO and conventional methods.