Purpose: To assess the clinical significance of a portable ultrasound system for the diagnosis of lymph node metastasis in patients with oral cancer, we investigated the diagnostic accuracy of sonography as compared with histopathological results. Materials and methods: From January 2007 through July 2008, 26 consecutive patients with oral cancer who underwent neck dissection were studied. A total of 268 sonographically detected lymph nodes were histopathologically evaluated for metastasis, and a side-by-side comparison of lymph nodes between preoperative sonography and histopathology was performed. The portable ultrasound equipment we used was a GE LOGIQ-e with a 5-13 MHz linear transducer. On sonography, a metastatic lymph node was defined as a lymph node with a minimal axial diameter of more than 8 mm that lacked an echogenic hilum, had a heterogeneous internal structure that reflected central necrosis, or both. Results: Of the 268 nodes, 45 nodes were metastatic, and the remaining 223 were non-metastatic on histopathological examination. When the lymph nodes were compared between preoperative sonography and histopathological specimens on a side-by-side basis, the sensitivity, specificity, and accuracy for the detection of metastasis were 64.4 %, 98.7 %, and 92.9 %, respectively. Conclusion: Although the sensitivity was slightly low, our results suggested that the portable ultrasound system was useful for the detection of cervical lymph node metastasis in patients with oral cancer, particularly during postoperative follow-up.
We report a case of hemorrhage due to a panfacial fracture that was successfully treated by embolization of the branches of the external carotid artery. A 39-year-old man had a traffic accident while intoxicated and was admitted to the emergency department. The clinical diagnosis included a panfacial fracture(Le Fort I, II, III, and right mandibular body and symphysis fractures)with associated fractures of the limbs and other bones. The patient had a massive hemorrhage from the oral and nasal cavities. The hemorrhage was controlled temporarily by application of pressure. Dental impressions were taken to prepare for surgical fracture fixation. Immediately after impression taking, hemorrhage from both the nasal cavities and the posterior portion of the maxilla recurred. We attempted to induce hemostasis by gauze packing and Bellock tamponade repeatedly, but complete hemostasis was difficult to achieve. Therefore, embolization of the branches of external caroid artery was performed bilaterally, using the Seldinger technique. Complete hemostasis was achieved after embolization, and the operation was performed at a later date.
Although ameloblastoma is a relatively common jaw tumor, it is rare for an intraosseous ameloblastoma to extend into the covering mucosa and thereby induce papillomatous changes. We report our experience with a 33-year-old man who had a mandibular ameloblastoma with papillomatous proliferations in the gingiva. The gingival mass had a papillary surface and extended across the right mandibular lingual gingiva from the canine region to the first premolar region. A diagnostic biopsy at initial examination revealed ameloblastoma. Marginal resection of the mandible and free iliac bone grafting were performed. Histopathological examination revealed that most of the tumor, a follicular ameloblastoma with papillomatous proliferations in the gingival epithelium, was in the jaw bone. As of 18 months since treatment, the patient remaines well without recurrence.
This report describes a case of carcinoma ex pleomorphic adenoma originating from a recurrent pleomorphicadenoma in a 67-year-old woman. She was referred to our department because of a swelling in the rightcervical region. At presentation, a painless elastic hard tumor measuring 40 X 30mm was located in the right sideof the upper neck. Computed tomography and magnetic resonance imaging showed enhancement of a nodule and a segmentedmass. The biopsy diagnosis was a carcinoma ex pleomorphic adenoma. A radical neck dissection, including the tumor, was performed. Histological examination revealed a rare undifferentiatedcarcinoma. The final diagnosis was a carcinoma ex pleomorphic adenoma because the patient had previouslyundergone a resection of a ipsilateral submandibular pleomorphic adenoma showing atypia and intracapsularinvasion. There has been no sign of recurrence or metastasis for 4 years 8 months postoperatively.