Early oral squamous cell carcinomas （OSCC） are effectively treated by surgery. Because oral cavity has complicated anatomical structure and function, surgery for OSCC must address extirpation of the primary tumor without losing QOL. Presurgical examinations, including vital staining, endoscopic examination or intraoral ultrasonography, as well as a close clinical examination, are useful to evaluate the malignancy of the OSCC. Tumor should be treated surgically in consideration of its horizontal and vertical extent, and anatomy. Excisional biopsy is a less invasive treatment and is possible to be indicated for early OSCC of T2a or less. Most of early OSCCs can be excised transorally. Postsurgical wounds are repaired simply with a combination of biomaterials or local flaps, and heal without leaving functional disorder.
We report a case of IgG4-related chronic sclerosing sialadenitis （CSS） of the submandiblar gland. A 68-year-old man was found to have left submandibular swelling during postoperative follow-up for tongue cancer. We examined the fine needle aspiration （FNA）, MRI, CT and cervical ultrasonographic findings, and a diagnosis of submandiblar gland tumor/inflammation was suspected. After making this diagnosis, we dissected the submandiblar triangle, which included the ablated submandiblar gland and lymph nodes. The pathological diagnosis was CSS. Thereafter, histochemical analysis demonstrated that more than 50％ of the infiltrated plasma cells were IgG-antibody positive. In addition, a blood examination showed a high serum IgG4 level. Postoperative PET-CT examinations showed a hot spot in the tail of pancreas, suggesting the presence of IgG4-related autoimmune pancreatitis as a complication. At present, more than 2 years 8 months after diagnosis, there has been no exacerbation of autoimmune pancreatitis or onset of any other systemic IgG4-related sclerosing disease.
White sponge nevus is a rare disease that develops in the oral mucosa, which becomes edematous and spongy.
We report two cases of white sponge nevus of the oral mucosa.
Patient 1 was a 25-year-old woman. Her chief complaint was a bilateral sense of incongruity of the buccal mucosa and upper and lower lips. Her father and older brother had similar lesions. She also had a similar lesion on the perineum. The symptoms improved in response to treatment with a cephem antimicrobial agent, which had been prescribed after the biopsy.
Patient 2 was a 44-year-old man. He requested a detailed examination of bilateral white lesions of the buccal mucosa. A biopsy yielded a diagnosis of a white sponge nevus. In this patient, lesions were present in only the oral cavity.
His symptoms responded to treatment with macrolide antibiotics, which had been prescribed after the biopsy.
PHACES syndrome is a neurocutaneous disorder characterized by the coexistence of large hemangiomas of the face and neck and at least one of the following features: posterior fossa malformations, cardiac and arterial anomalies, eye anomalies, and sternal clefting. We report a case who presented with large hemangiomas of face and cardiac anomalies and was given a diagnosis of PHACES syndrome. Large hemangiomas also existed in viscera, and bleeding from visceral hemangioma led to death. Large hemangiomas of face and oral cavity in infants should be carefully examined with PHACES syndrome in mind.
A case of the face gas gangrene complicated by terminal breast cancer is reported. The patient was a 61-year-old woman who referred to our hospital by a dental clinic because of remarkable swelling of the right side of the face. The clinical symptoms and CT findings were consistent with a diagnosis of non-clostridium gas gangrene. We treated the patient with extensive surgical debridement and administration of appropriate antibiotics. These treatments were effective and successful, and she recovered from severe infection. We initially suspected this case to be gas gangrene caused by odontogenic infection, but the extracted molar was not in such bad condition that it could have caused inflammation. We thought that the gas gangrene developed from a lesion of the buccal mucosa.
Acute suppurative arthritis of the temporomandibular joint （TMJ） is infrequently reported. We present a case of acute suppurative arthritis of the TMJ that occurred after a mandibular blow. A 71-year-old woman who was receiving prednisolone and methotrexate to treat rheumatoid arthritis was referred to our hospital because of diffuse swelling and pain in the left TMJ, buccal, and orbital regions. A malocclusion with deviation of the mandible to the contralateral side was found. The arthritis appeared 5 days after the patient had sustained an injury to the mandible. Articular space widening, an abscess of the head of the mandible nearby, and massive swelling of the lateral pterygoid muscle were found on CT scans. The condylar head of the mandible was displaced anteriorly. Approximately 2 ml of pus was aspirated by puncture from the upper joint cavity; however, bacterial culture of the pus was negative. The region of the left infratemporal fossa showed an abcess on CT scans during therapy. Treatment with antibiotics （CTM ＋CLDM, and CFPN-PI ） yielded an excellent result. After healing in response to treatment, no recurrence has occurred for 48 months.
Pseudogout is a disease caused by calcium pyrophosphate dehydrate （CPPD） deposition in a joint and occurs most often in the knee joint. Eighteen reports of pseudogout arising from in the temporomandibular joint （TMJ） have been published in the Japanese literature. We report a rare case of pseudogout in the inferior joint space of the TMJ of a 59-year-old man. He was referred to our department because of pain and trismus in the right TMJ. A computed tomographic scan and a magnetic resonance image of the area showed a calcified mass anterior to the right condylar head. Extirpation of the calcified mass was performed under general anesthesia, and a white, chalky mass was removed. Scanning electron microscopy and X-ray diffraction showed CPPD in the calcified mass. No signs or symptoms of recurrence have occurred after a 1-year follow-up.
We report a rare case of leiomyomatous hamartoma arising in the dorsum of the tongue in a 9-month-old boy. An obstetrician noted a polypoid mass on the dorsum of the tongue at birth. It had not increased in size; however, mastication and swallowing disorders gradually developed with growth. The mass was clinically diagnosed as a benign tongue tumor and surgically removed under general anesthesia. Histopathologically, the mass consisted of scattered smooth muscle fibers and indigenous components of the tongue, such as minor salivary glands and adipose tissue. There was no evidence of encapsulation. On the basis of these findings, a leiomyomatous hamartoma was diagnosed histopathologically. There was no recurrence 1 year 9 months after excision.
Extranodal natural killer/T-cell lymphoma, nasal type (ENKL) characterized by a necrotizing ulcer is an uncommon malignant lymphoma thought to be associated with Epstein-Barr virus infection and expression of CD56. We report a case of ENKL that could be observed from the earliest clinical features of the palatal gingiva. A 27-year-old-woman was referred to our hospital because of painful purpura-like lesions in the left side of the palatal gingiva. The purpura-like lesions developed to a necrotizing ulcer in about 1 week. Microscopic examination of a biopsy specimen demonstrated a lymphocytic infiltrate with increasingly atypical histopathological features. The atypical cells were positive for cytoplasmic CD3ε, granzyme B, and EBER-ISH, but negative for CD20 and CD56. Based on the histopathological findings, a final diagnosis of ENKL was made. The patient received radiotherapy to a dose of 50 Gy and three courses of DeVIC (CBDCA, VP-16, IFO, DEX) chemotherapy. There has been no sign of recurrence for 32 months after treatment. This case shows that purpura-like lesions might be one of the earliest clinical features of ENKL.