The aim of this study was to investigate the radiographic changes that occur in the pharynx and the positions of hyoid bone in response to use of a mandibular advancement oral appliance (MAOA) in patients with obstructive sleep apnea/hypopnea syndrome (OSAHS). Nine patients in whom OSAHS was diagnosed on polysomnography who had no change in head posture between lateral cephalograms with and without the MAOA were studied. After MAOA insertion, the mean apnea/hypopnea index (AHI) decreased from 50.3 to 16.9, and the mean improvement rate of AHI was 65.2 %. Six of the subjects showed an increase in the anteroposterior diameter of the upper pharynx. The remaining three subjects did not show an increase in this variable, but their AHI decreased. Use of a MAOA apparently caused lateral patency of the upper airway. The position of the hyoid bone in all subjects moved upward, almost perpendicular to the palatal plane. The mean displacement distance in the remaining three subjects was larger than that in the other six subjects. The results of this study suggested that use of a MAOA moves the hyoid bone upward, there by contributing to not only anteroposterior, but also lateral airway patency.
We report the a successful intensive care of a 41-year-old man, who had facial and cervical cellulitis, descending necrotizing mediastinitis, and bilateral pyothorax caused by pericoronitis. Computed tomographic scans showed abscesses extending from the left temporal region and the neck to the mediastinum, with bilateral pleural effusion. Surgical drains were placed in the face, neck, and chest, and several types of antibiotics were administered intravenously. Pus cultures disclosed abundant growth ofStreptococcus constellatesandPrevotella intermedla. The patient received mechanical ventilation with a high concentration of oxygen. Our experience suggested that such severe cases require aggressive chemotherapy with a combination of antibiotics and surgical drainage by a multidisciplinary team of surgeons.
We describe our experience with a case of visual impairment caused by an orbital abscess due to an acute odontogenic maxillary sinus infection in a 31-year-old man. After the treatment of a periapical lesion of the left upper second premolar at a dental clinic, infection progressed to an orbital abscess. He was referred to our hospital by an ophthalmologic clinic. We administered antibiotics, performed maxillary sinus osteotomy, incised the upper and lower eyelids, and extracted the infected tooth to allow pus drainage and irrigation. His condition improved after treatment, but at presentation he had already lost the visual acuity of his left eye. We would like to stress the importance of hospital-clinic coordination and a team approach to medical treatment.
An odontoma is an odontogenic, tumor composed of enamel, dentine, and cementum, commonly less than 30 mm in diameter. We describe a large compound odontoma arising in the left anterior region of the mandible. A 16-year-old boy was referred by an orthopedist to our hospital for evaluation of a radiopaque lesion in the left side of the mandible. Clinical examination revealed a bony-hard swelling in the left anterior region of the mandible at presentation. The left mandibular canine and lateral incisor were not erupted. Radiographic and CT examinations showed a large, circumscribed, radiopaque lesion, measuring 30×40×28mm and surrounded by a thin radiolucent area accompanied by two impacted teeth. There were many small tooth-like structures within the lesion. The clinical diagnosis was odontoma. The tumor and the impacted teeth were surgically removed by an intraoral approach under general anesthesia. The tumor was covered by a thin capsule and consisted of 321 small tooth-like structures. The histopathological diagnosis was a compound odontoma. The clinical course has been uneventful for 4 years 3 months after surgery.
Inflammatory myofibroblastic tumor (IMT) is an uncommon tumor reported to arise in various organs. Pathological diagnosis is difficult to confirm on the examination of specimens. IMT rarely arises in the oral region and is extremely rare in the jaws or maxillomandibular region. We report a case of IMT that arose in the mandible. The patient was a 26-year-old man who presented with spontaneous pain at the right mandibular retromolar area. The initial panoramic radiograph showed a radiolucent lesion near the right lower third molar, with marked root resorption. Tumor was treated by extirpation with tooth, extraction. There ws no evidence of recurrence even after 3 years. IMT is usually benign, but temporal progression with malignant transformation has been documented. Wide excision with long-term clinical follow-up is required.
A case of lung adenocarcinoma with incipient symptoms of paralysis of the hypoglossal nerve is reported, with an emphasis on clinical features. A 52-year-old woman presented with disturbance of tongue movement at the Department of Oral and Maxillofacial Surgery, Komaki City Hospital. The tongue deviated towards the right on protrusion. The clinical diagnosis was paralysis of the hypoglossal nerve with suspicion of a lesion in the base of the skull. On CT and MRI of the head, a bone defect with a tumor was observed in the base of the skull. Bone scintigraphy revealed several hot spots in the thoracic vertebrae. Multiple bone metastases were suspected. A thoracoabdominal CT scan and chest roentgenogram showed a mass in the left lower lobe. The patient was finally given a diagnosis of primary lung adenocarcinoma and multiple bone metastases. Respecting the patient's will, we performed palliative therapy. The lung adenocarcinoma with metastases to the brain and bone has recently grown. The number of patients with cranial nerve disorders caused by metastatic lung adenocarcinomas, is considered to be increasing. Therefore, oral and maxillofacial surgeons should closely observe patients, taking into account important general diseases related to oral symptoms.
Metastasis of renal cell carcinoma to the oral cavity is rare. We report a case of renal cell carcinoma that metastasized to the mandible. A 60-year-old man was referred to our hospital because of spontaneous pain and swelling of the molar region of the left side of the mandible and paresthesia of the left side of the lower lip. Oral examination showed an expansile mass in the third molar region, which was covered with normal mucosa. Computed tomography (CT) demonstrated a large mass with destruction of the bone of the left mandibular ramus. The mass invaded the surrounding soft tissues. The patient had previously undergone a left radical nephrectomy because of renal cell carcinoma. In addition, he had multiple metastatic lesions in the lung. Histological examination of the mandibular tumor showed a clear cell carcinoma similar to the previous renal cell carcinoma. These findings suggested that the oral lesion was a metastatic clear cell carcinoma from the kidney. The mandibular tumor was excised to alleviate the dysphagia caused by the rapidly growing tumor. He has resumed oral intake and shown no sign of recurrence of the oral tumor as of 21 months after surgery.
Clear cell carcinoma, not otherwise specified (NOS), is a rare malignant tumor of salivary gland origin that is composed of clear cells without features characteristic of other neoplasms. We report a case of clear cell carcinoma, NOS, in the retromolar region that arose from the minor salivary glands. The patient was a 45-year-old woman who had a painless swelling of the left molar region of the mandible. MR imaging revealed a mass inside the left mandibular ramus and showed bone resorption. Under a clinical diagnosis of a mandibular tumor, the mass was resected under general anesthesia. The solid and elastic hard tumor mass had a pale yellow cut surface. Histopathologically, the tumor consisted of clear cells containing diastase-digestive PAS-positive granules. The tumor cells were positive for cytokeratin and epithelial membrane antigen, but did not react with myoepithelial differentiation markers. In other abdominal organs, there was no abnormality on CT. On the basis of these features, the tumor was diagnosed as a clear cell carcinoma, NOS, originating from the minor salivary gland. Postoperative radiation therapy was performed for the primary focus with chemotherapy. At present, there has been no recurrence or metastasis of the tumor.
This report describes a case of intravascular papillary endothelial hyperplasia (IPEH) arising in the tongue.A 29-year-old woman was referred to our department because of swelling of the rongue on April 26, 2003. She had noticed a painless nodule 1 month before presentationt.Physical examination revealed a movable, darkpurple nodule, 17×14×12mm in size, on the left side of the tongue.A clinical diagnosis of a benign tumor was made, and excision of the tumor was performed under general anesthesia on July 3.Histopathologically, the lesion was characterized by papillary proliferation of endothelial cells within thrombi. A histopathological diagnosis of IPEH (pure form) was made.The postoperative course was uneventful, and there was no evidence of recurrence 3 years after the operation.
We report a case of von Willebrand disease in a patient with serious anemia, probably caused by chronic gingival bleeding due to marginal periodontitis. A 28-year-old man with von Willebrand disease was referred to our hospital because of general fatigue and edema.Despite continuous gingival bleeding for more than 8 years, the patient had not received hemostatic management; therefore, serious anemia and heart failure occurred. His general condition was improved by administration of adiuretic and heat-treated Factor VIII concentrate (Confact F®) andbloodtransfUsion.Forlocalhemostatis management of the gingival bleeding, periodontal treatment and local hemostasis with the use of a celluloid protector and compression techniques were perfomed during the infusion of Confact F®.The patient's oral hygiene and gingival bleeding improved. This case indicates that periodical oral health care is very important for patients with bleeding disorders, because chronic continuous bleeding can cause serious anemia.