Cat scratch disease (CSD) is a self-limiting infectious disease characterized by lymphadenopathy in a patient with a history of cat contact. CSD is caused by Bartonella henselae infection and is a common cause of regional lymphadenopathy. The manifestations include erythema or papules at the site of injury and regional lymphadenitis in the initial stage of infection. We report the case of an 11-year-old girl who presented with swelling of the parotid and cervical lymph nodes. Magnetic resonance imaging showed extensive lymphadenopathy in the parotid and cervical lymph nodes. She had a history of contact with kittens. Serologic examinations for IgG and IgM titers to Bartonella henselae were performed by an indirect fluorescence assay. This assay revealed positive serum antibody titers for Bartonella henselae. On the basis of these results, CSD was diagnosed, and the patient was given an antibiotic (erythromycin 800 mg/day) for 14 days. After that, the patient recovered, with no recurrence.
There are two types of anti-bone resorptive bisphosphonates, nitrogen-containing bisphosphonates (NBPs) and non-nitrogen containing bisphosphonates (non-NBPs). Since NBPs have much stronger activities than non-NBPs, the former are widely used to treat increased bone resorption (including bone metastasis). In addition to the known inflammatory side effects of NBPs, recent clinical application has been associated with an unexpected side effects, necrosis, and subsequent exposure of jaw bones. We report mandibular osteonecrosis in a 63-year-old woman who had breast cancer with bone metastasis. She was referred to our clinic because of oral pain. The mandible (partly exposed because of necrosis) was surrounded by inflamed soft tissue. She had been taking pamidronate (an NBP) once a month (45mg) for 35 months. In Europe and the United States, several thousand cases of NBP-related osteonecrosis have been reported during the past 3 years. On clinical examination, we diagnosed NBP-related osteonecrosis. This case emphasizes the importance of close communication between oncologists and dentists before and during treatment with NBP. On the basis of the current results of our basic studies of BPs, we discuss possible mechanisms underlying jaw necrosis and means of prevention.
A 58-year-old man was referred to our department because of mandibular pain and facial swelling. Panoramic radiography and CT scans showed mandibular and left subcondylar fractures. The patient underwent endoscopy-assisted reduction and fixation of the subcondylar fracture with an angulated drill and a screwdriver via a transoral approach under general anesthesia. The postoperative course was uneventful, and function was restored soon after the operation.
Thyroglossal duct cyst is a congenital anomaly resulting from retention of a thyroglossal duct during embryonic development. It usually occurs in the midline of the neck and rarely arises in the oral floor. We describe a case of thyroglossal duct cyst occurring in the oral floor of a 51-year-old woman. The chief complaint was an elastic soft mass in the oral floor. We initially diagnosed a cystic lesion in the oral floor on the basis of computed tomographic findings. We enucleated the mass vi a atransoral approach. We did not resected the hyoid bone. Histopathologically, the cyst wall was covered with columnar and stratified squamous epithelium. A thyroid like tissue was found in the connective tissue. We found only 27 cases of thyroglossal duct cyst in the oral floor, including our case, reported in Japan. The postoperative course was uneventful, with no evidence of recurrence for 2 years 6 months after the operation.
A case of surgical ciliated cyst after Le Fort I osteotomy is described. A 32-year-old man who had undergone Le Fort I osteotomy in 1992 was referred to our hospital because of swelling in the left cheek. Radiographic and computed tomographic examinations showed a unilocular cystic lesion in the left side of the maxilla. The lesion was diagnosed as a maxillary cyst. We treated the lesion surgically. The lesion and thin bony wall between the cystic cavity and maxillary sinus were removed, so that the bony cavity commuted with the inferior nasal meatus. The postoperative course was uneventful, and there was no evidence of recurrence 12 months after surgery. On the basis of the clinical course and histopathological findings of the surgical specimen (i.e., the cyst had a thick fibrous wall lined by stratified ciliated columnar or cuboidal epithelium), the lesion was diagnosed as a surgical ciliated cyst.
Angioleiomyoma is a benign tumor of smooth muscle that originates in blood vessels. It usually arises in the limbs of middle-aged women and rarely occurs in the oral cavity. We report a case of angioleiomyoma in the cheek associated with remarkable lipidization. A 48-year-old man was referred to Hiroshima University Hospital because of a 3-month history of a tumor arising in the left cheek. Clinical examination revealed an elastic firm nodule beneath the cheek skin, which was circumscribed and measured about 15 mm in diameter. Ultrasound examination showed a nodule with a clear margin, through which an artery ran. These findings indicated that the lesion was a primary benign mesenchymal tumor. However, the possibility of a metastatic tumor from malignant fibrous histiocytoma (MFH) could not be ruled out because the patient had undergone resection of MFH arising in the left femur. The tumor was extirpated with the patient under local anesthesia. Histopathological examination showed that the tumor had a fibrous capsule and consisted of mature smooth muscle cells, various-sized blood vessels with thick-walled smooth muscle tissue, and mature fat cells. The tumor was diagnosed to be an angioleiomyoma of the cheek associated with marked lipidization. No sign of recurrence was noted 9 months after treatment.
A case of MALT lymphoma arising in the hard palate is reported. A 33-year-old woman was referred to us because of a swelling in the left side of the hard palate. The mass, measuring 31×x18mm, was soft and elastic with a smooth surface. The tumor was surgically removed, and postoperative irradiation was performed. The pathological diagnosis of the specimen was MALT lymphoma. The lesion consisted of small centrocyte-like lymphoid cells. Immunohistological examination showed that the neoplastic cells were positive for CD20 and negative for CD5, CD10, and CyclinDl. Reactivity for Bcl-2 was positive in the neoplastic colonizing B cells, except for the germinal center cells. After surgery Sjögren's syndrome (SS) was diagnosed. Therefore, SS-related MALT lymphoma was suggested in our patient. There has been no recurrence of the lesion as of 1 year after treatment.
Since elderly patients with systemic diseases often undergo tooth extraction, it is difficult to predict the risk of and to optimally treat post-extraction hemorrhage. We report a rare case of persistent hemorrhage that occurred after tooth extraction caused by chronic disseminated intravascular coagulation (DIC) as a complication of dissecting aneurysm. A 69-year-old man who underwent extraction of a maxillary molar had persistent bleeding, which could not be stopped by continuous local treatment to promote hemostasis. After a general examination, we diagnosed chronic DIC caused by an extensive dissecting aneurysm, based on evidence of advanced fibrinogenolysis. Hemostasis was achieved by general treatment for chronic DIC. Appropriate diagnosis and treatment of both local and general conditions are necessary for post-extraction hemorrhage.