Methotrexate （MTX） has been used not only for cancer and leukemia therapy, but also for the treatment of rheumatoid arthritis （RA）. However, some reports caution that MTX might induce MTX-associated limphoproliferative disorders （MTX-LPD）. We report a case of MTX-LPD associated with a gingival ulcer, which led to the diagnosis. A 66-year-old woman was referred to our hospital because of a chronic gingival nlcer of the maxilla. She had been receiving predonisolone （PSL） and MTX for over 12 years to treat RA. She had noticed an upper gingival ulcer 2 months before presentation, which gradually increased in size. Computed tomography showed bone resorption in the anterior region of the maxilla. Reported pathological examination revealed diffuse large B-cell lymphoma and immunohistochemistry supported the diagnosis of MTX-LPD. After stopping MTX,removing the necrotic bone, and antibacterial chemotherapy, the ulcer spontaneously resolved.
A 57-year-old man was referred to our clinic in December 2008 because of painless gingival swelling at the anterior mandibular region. Intraoral examination revealed a defined bony mass with expansion of the labial cortex. Panoramic radiography showed a well-circumscribed, multilocular radiolucent lesion located between the right lateral incisor and the left canine, with displacement of the left incisors of the mandible. Computed tomography indicated expansion and thinning of the labial cortical bone adjacent to the multilocular lesion, with perforation of the cortex. Under general anesthesia, the tumor-like lesion was easily enucleated, and the surface of the bony wound was shaved. The lesion was diagnosed to be a glandular odontogenic cyst （GOC） histopathologically. There has been no sign of recurrence for 1 year postoperatively.
We report a rare case of multiple intracranial abscesses secondary to mandibular odontogenic infection. A 62-year-old man was admitted to our hospital because of general malaise, which developed after swelling of the right cheek, masticatory pain, and trismus. We detected no abnormality in the oral cavity, but hematologic examinations showed elevated levels of white blood cells and C-reactive protein. The patient was hospitalized for further evaluation. A computed tomographic scan revealed multiple intracranial shadows. After consultation with the Department of Neurosurgery, multiple intracranial abscesses secondary to mandibular odontogenic infection were diagnosed. The patient was transferred to the Department of Neurosurgery, and conservative therapy was administered. However, the symptoms worsened. Therefore, drainage by craniotomy was performed to remove the abscess. After surgery, we extracted the right lower second molar as the infection source because a magnetic resonance imaging scan showed no evidence of multiple intracranial abscesses. Subsequently, he recovered well without any sequelae.
Symmetric lipomatosis of the tongue （SLT） is a rare condition related to generalized lipidosis, often caused by chronic alcoholism. It is characterized by multiple lipomatous nodules symmetrically located within the tongue. We report a case of SLT arising in a 62-year-old man with a long history of alcoholic liver cirrhosis. He had multiple soft nodular protrusions on the left margin of the tongue for months, caused by involuntary self-inflicted tongue bites. Although computed tomography showed fatty masses on both sides of the tongue, no elevated tumor mass existed on the right margin. To prevent further tongue biting, the nodules were surgically removed. Histopathologically, the nodules consisted of mature adipose tissue lobules, which were clearly demarcated from the surrounding muscle tissue. Because of the patient’s lipidosis and unusual presentation of multiple lesions, the lesion was finally diagnosed to be SLT. A literature review showed 27 documented cases of SLT, mostly in Asian elderly men, and 73 ％ of all cases were associated with liver failure. SLT can be regarded as reactive hyperplasia of adipocytes in granulation tissue as a response to traumatic stimuli rather than neoplasia. Surgical intervention may be considered when the tongue lesions are traumatic and when perioperative management is indicated.
A case of subcutaneous emphysema of the face and neck region caused by nose blowing after Le Fort I osteotomy is reported.
A 28-year-old woman presented at our hospital because of masticatory and esthetic impairment. She was given a diagnosis of open bite retrognathia. After preoperative orthodontic treatment, Le Fort I osteotomy and bilateral sagittal split ramus osteotomy were performed. After she strongly blew her nose on the second postoperative day,swelling of the left lower eyelid with difficulty in eye opening occurred.
A computed tomographic （CT） scan revealed low-density areas in the subcutaneous tissue of the face to the anterior neck region, and a diagnosis of subcutaneous emphysema was made.
She was given antibiotics for 8 days to prevent infection. Her clinical course improved, and a CT scan obtained on the 8th day showed no free air remaining in the head and neck region.
We believe that the medical personnel should be fully aware of the risk of subcutaneous emphysema following Le Fort I osteotomy. Patients should be explained the reason why certain actions should be avoided to minimize complications.
We report a case of Langerhans cell histiocytosis （LCH） of the mandible that was treated by intralesional injection of corticosteroids. A 57-year-old man was referred to our clinic because of gingival swelling and tenderness around the left molar region of the mandible. Computed tomography revealed a relatively well-defined bone defect and a pathologic fracture in the left body of the mandible. An excisional biopsy was performed, and the lesion was histopathologically diagnosed as LCH. Since the patient refused surgical excision, intralesional injection of corticosteroids was performed. The lesion and the pathologic fracture became undetectable 5 months after the administration of 40mg dexamethasone. There was no recurrence after a follow-up period of 1 year 5 months. Intralesional injection of corticosteroid may be one beneficial option for the treatment of LCH of the mandible.