Mandibular defects resulting from trauma or resection of malignant tumors are reconstructed by using particulate cancellous bone and marrow(PCBM)graft combined with titanium mesh tray or vascularized bone flap for the purpose of esthetic and functional recovery. Although implants are optimal for the occlusal rehabilitation, their placement requires sufficient mandibular osseous bulk and an appropriate morphology. With the use of vascularized bone graft following the resection of malignant tumors, the reconstructed mandible often becomes narrower than the maxilla due to the extensiveness of tissue defect and the scar contraction resulted from former surgery and radiotherapy. In addition, bone height and width are often insufficient for implant placement because of the intrinsic form the bone flap. Therefore, in these cases, implant therapy can be performed only after augmentation of the grafted bone through bone lengthening or other methods. In secondary reconstruction following the resection of malignant tumors, graft of the vascularized bone flap frequently become difficult due to soft tissue defects or scar contracture. In such cases, a sufficient amount of bone should be grafted after performing tissue expansion using the remaining mandibular bone in advance. In this paper, we report favorable outcomes obtained for the patients who underwent implant therapy after vascularized bone graft using tissue expansion or secondary elongation of reconstructed mandible.
Over 40 years have passed since the concept of osseointegration was first reported. Implant tools are constantly advancing, and more than 30 types of implants are currently being used in Japan. The characteristics of implants vary depending on the manufacturer. As a result, implants are placed in a single step in some cases and in two separate steps in others, and various approaches have been developed to reliably achieve bone union in the surface structure of the implant fixture. In addition, in cases where implant placement is not possible with conventional methods due to bone resorption, a method in which implants are placed after increasing bone mass using treatments such as bone graft, bone lengthening, and bone regeneration has been used in recent years. Furthermore, simulation technologies are also advancing. Simulation of implant placement based on 3-D images obtained from CT data has become possible, as has creation of three-dimensional models.
A case of nasal polyp arosing in the alveolar cleft in a patient with cleft lip and palate is reported. A 31-year old man visited a otolaryngologist because of a swelling at the right alar base. He was referred to our department for a clinical diagnosis of nasoalveolar cyst. Physical examination revealed a scar on the right upper lip following cheiloplasty and diffuse swelling of the nasal floor and gingiva. CT examination revealed a tumor measuring 30 ×40 mm in the alveolar cleft. MRI showed hypointensity on T1-weighted images and hyperintensity on T2-weighted images. A clinical diagnosis of a benign tumor was made, and the tumor was removed with the patient under general anesthesia. The histopathological diagnosis was a nasal polyp. No recurrence was observed after operation.
Although Candida species are normal oral flora, these microorganisms can cause opportunistic infections when the host's resistance is lowered, leading to oral candidiasis. We report a case of bilateral candidiasis with epithelial hyperplasia at the tongue margin, which was considered to be chronic hyperplastic candidosis according to the classification of Lehner. The patient was a 59-year-old man who presented with bilateral tenderness of the tongue. The right-side lesion was 14 ×15 mm in size and peduncular. There were two lesions on the left. One was 14 ×9 mm in size and appeared to be a leukoplakia-like lesion. The adjacent tumor was 10 ×15mm in size and peduncular. All lesions were extirpated and examined histopathologically. The histopathlogical diagnosis was chronic hyperplastic candidosis. Postoperative observation has revealed no recurrent.
Nodular fasciitis is a pseudosarcomatous reactive lesion of fibroblasts/myofibroblasts. It usually develops in the subcutaneous fascia of the extremities and trunk, but rarely arises in the oral mucosal soft tissue. We report a case of nodular fasciitis of the tongue in a 34-year-old man. Intraoral examination revealed a 3-mm, elastic, soft nodular tumor of the dorsum of the tongue. Histopathologic examination showed a diffuse, infiltrative proliferation of plump spindle cells in the submucosa. These cells were immunopositive for vimentin, and negative for α-smooth muscle actin, HHF-35, S-100 protein, and CD34. The Ki-67 labeling index was high, with an average of 19.8 %. Ultrastructurally, spindle cells showed a fibroblastic phenotype with occasional myofibroblastic differentiation. Recurrence was not evident 14 months after simple excision.
A successful case of bisphosphonate-related osteonecrosis of the mandible treated surgically 6 months after terminating bisphosphonate treatment is reported. A 54-year-old woman was referred to our department by her dentist because of diffuse swelling of the left lower gingiva. She noticed swelling of the left molar edentulous region of the mandible, covered with a partial denture, and visited her dentist 4 months before the first visit to our department. Conservative therapy was administered, but symptoms did not improve. Thereafter, she was referred to our department because of an abscess. Her past medical history indicated that she had undergone surgical treatment for breast cancer and was receiving bisphosphonate(zoledronic acid)and hormonal preparations for the treatment of bone metastasis. Physical examination revealed sensory disturbance of the left mental region and abscess formation at the left molar region of the mandible. One month later, the bone of the lesion was exposed.Her past medical history and present illness strongly suggested bisphosphonate-related osteonecrosis of the mandible. Therefore, bisphosphonate administration was terminated, and conservative therapy with antibiotics and local irrigation was carried out. After 6 months of conservative therapy, surgical treatment and hyperbaric oxygen therapy were carried out, because radiographic examination suggested that a removable sequestrum had formed. Histopathological findings indicated a sequestrum, and the postoperative course was uneventful.
A glandular odontogenic cyst(GOC)is a rare odontogenic cyst occurring centrally in the jawbone. Its invasiveness and recurrence rate are high. Differential diagnosis from an ameloblastoma, keratocystic odontogenic tumor, and central mucoepidermoid carcinoma is necessary. Histopathologically, GOC is lined by epithelium of varying thickness, which contains mucous cells and glandular-like structures. We report a case of GOC arising in the molar region of the mandible and review domestic and international reports published in the literatures.The patient was a 57-year-old man. Surgical extirpation was performed. As of 2 years after the operation, his progress is good, with no evidence of recurrence.
We report a case of ameloblastic fibrodentinoma arising in the maxilla. A 2-year-old boy presented for evaluation because of an unerupted primary central incisor. Clinical examination revealed fully erupted primary dentition, with the exception of the left maxillary primary central incisor. Slight enlargement of the alveolar cortical plate was noted in the edentulous area. Periapical radiography revealed an unerupted primary central incisor surrounded by a well-circumscribed area of radiolucency. The clinical diagnosis was a cyst. Enucleation of the cyst and extraction of left primary central incisor were performed with the patient under general anesthesia.Histopathological examination of the cystic lesion revealed a cellular myxomatous stroma containing strands of odontogenic epithelium and dentinoma. The final diagnosis was ameloblastic fibrodentinoma. At the 10-year follow-up evaluation, there was no evidence of recurrence.
Basal cell adenoma is a benign salivary gland tumor that most frequently occurs in the parotid gland.We report a case of basal cell adenoma of the maxillary alveolus in a man aged 62 years. Histopathological examination revealed that tumor was encapsulated with fibrous tissue and had a basal-cell-like appearance with tubulotrabecular growth. Immunohistochemically, the inner tumor cells of the tubulo-ductal structures showed positive immunoreactivity for CK7, and the outer tumor cells showed positive immunoreactivity for alpha SMA and vimentin. Most of the tumor cells were positive for p63. In addition, the MIB-1(Ki-67)labeling index was extremely low. A basal cell adenoma was thus diagnosed.
We describe the very rare case of a 72-year-old woman who had a mass in the floor of the mouth. After admission to our inpatient department, MR imaging suggested that the mass was a tumor of the right sublingual gland. Surgical excision of the sublingual gland tumor was performed with the patient under general anesthesia.The histological diagnosis was follicular lymphoma grade Ⅰ. Follicular lymphoma of the sublingual gland is extremely rare. This is the first report describing a primary follicular lymphoma of sublingual gland in Japan. One year after the operation, the patient remains well, with no evidence of recurrent lymphoma.
We report the case of a salivary duct carcinoma thought to have arisen from a benign tumor of the submandibular gland. The patient was a 72-year-old man. He had a hard, elastic, painless mass measuring 30 ×20mm in the right submandibular region. CT and MRI revealed that the mass spread to the adjacent tissues with a rough margin and ipsilateral cervical lymph node metastases. He underwent excision of the right submandibular gland tumor combined with a radical neck dissection. On histological examination of the surgical specimens, malignant components were observed around hyalinized tissues, which were thought to be remnants of a benign tumor. On the basis of these histological findings, the tumor was diagnosed to be a salivary duct carcinoma, which was highly suspected to have undergone transformation from a benign tumor. The neck specimens had 17 histologically positive nodes, including 12 nodes showing extracapsular spread of tumor. He received postoperative chemoradiotherapy, but local failure with distant metastases developed, and the patient died 10 months after operation.