Traumatic carotid-cavernous sinus fistula （tCCF） is an arteriovenous shunt caused by internal carotid artery rupture in the cavernosus sinus, resulting from head injury. This leads to a triad of symptoms including pulsating exophthalmos, chemosis with conjunctival hyperemia, and orbital bruit. Because of life-threatening problems and local swelling after injury, it is difficult to diagnose tCCF at an early stage. Delayed treatment can cause irreversible neurological and/or ophthalmological damage. Moreover, it may lead to profuse nasal bleeding and even death. Here, we report a rare case of tCCF with a facial fracture after a sports accident.
A 35-year-old man suffered a facial injury by bumping against another player during a baseball game. He had multiple fractures of the mandible and maxilla, but no other fractures, including cranial base fracture, were apparent. Open reduction and fixation of the mandible and conservative reduction of the maxilla were performed under general anesthesia. Exophthalmos and ophthalmoplegia were noted on the 16th day after injury. Diagnostic imaging was performed, and a neurosurgeon diagnosed tCCF. Successful management was achieved with no sequelae by endovascular surgery.
Careful observation and prompt cooperation with specialists are very important for the treatment of maxillofacial trauma.
Pseudotumor with fibrous proliferation is a rare benign nonneoplastic lesion in the oral region. We report a case of intraosseous fibrous pseudotumor of the mandible. A 50-year-old woman was referred to our university hospital to undergo further evaluation of a radiolucent lesion between the lateral incisor and canine of the right mandible. At presentation, no swelling was found in the alveolus of the anterior region of the mandible. A panoramic X-ray photograph revealed a radiolucent lesion causing root separation of the lateral incisor and canine. A computed tomography scan revealed mild bone swelling, a thinned cortex at the labial side of the mandible, and a low-density mass. Histopathological examination of a biopsy specimen suggested fibrous overgrowth. The lesion was intraorally extirpated under general anesthesia. Histopathological examination of the surgical specimen revealed high-density fibrous proliferation without dysplasia. There was virtually no lymphocyte infiltration. Histopathologically, the lesion was diagnosed to be a fibrous pseudotumor. No recurrence has occurred, and bone regeneration at the extirpated region is good 3 years after surgery.
Tumor-induced osteomalacia （TIO） is a rare paraneoplastic syndrome that results in renal phosphate wasting with hypophosphatemia. Recently, it was reported that tumors associated with TIO produce fibroblast growth factor （FGF）-23, identified as the last member of the FGF family, and that excessive action of FGF-23 causes TIO. The tumor responsible for TIO is usually very small, and it is difficult to identify the location of the tumor; therefore, full body examination is required. Our patient was a 39-year-old man who presented with severe bone pain and muscle weakness of 4 years’ duration in the lower limbs. There was no family history of metabolic bone disease. The patient’s laboratory findings revealed hypophosphatemia due to renal phosphate wasting and an unusually high serum level of FGF-23. An abnormal mass was observed in the mandibular gingiva. After surgery, the serum levels of FGF-23 and phosphate rapidly normalized. The pathologic diagnosis of the tumor was phosphaturic mesenchymal tumor mixed connective tissue variant. Six months after the operation, the chronic bone pain affecting the entire body improved to a great extent, and the patient was able to walk without any support. We conclude that overproduction of FGF-23 by the phosphaturic mesenchymal tumor mixed connective tissue variant in the mandibular gingiva caused osteomalacia.
A case of orbital abscess with gas gangrene due to odontogenic infection is reported. Although orbital abscesses are rare, they may result in fatal complications. A 68-year-old woman presented with pain and swelling of the left cheek and lower eyelid. She was unable to open her left eye. Oral examination revealed alveolar gingival swelling due to a periapical lesion of the left upper anterior tooth. Computed tomographic scans confirmed abscess formation in the left orbit and the presence of a gas bubble. The ocular tension was 50 mmHg. On admission to our hospital, the patient started to receive antibiotics （PAPM/BP and CLDM）, the left lower eyelid was incised, and the abscess was successfully drained. Alpha-streptococcus, coagulase-negative staphylococcus, and Prevotella melaniogenica were detected in the suppuration. The patient was given a diagnosis of orbital abscess with gas gangrene due to odontogenic infection extending by way of the orbit.
Cystadenocarcinoma is an uncommon malignant salivary gland tumor that rarely occurs in the retromolar region. In this paper, we report a case of cystadenocarcinoma that caused considerable resorption of the mandible. The patient was a 79-year-old woman who had a painless swelling, measuring 25 × 25 mm, in the left retromolar region. Panoramic radiography revealed a multiple cystic lesion from the molar to ramus of the left side of the mandible. The tumor was excised by mandibular marginal resection. There was or recurrence or metastasis during 3 years of follow-up.
Garré’s osteomyelitis of the mandible is chronic osteomyelitis with proliferative periostitis induced by slow stimulation or infection in young people. Garré’s osteomyelitis caused by deciduous tooth infection is rare. A case of Garré’s osteomyelitis caused by infection of the left second deciduous molar of the mandible, with eruption of permanent teeth after treatment, is reported. An 8-year-old girl came to our hospital because of a painless swelling in the left mandibular angle. X-ray and CT findings showed periosteal reactions and new bone formation, with malposition of the second premolar. Extraction of the decayed teeth and curettage and marsupialization of the premolar lesion were performed under general anesthesia. The histopathologic diagnosis was chronic mandibular osteomyelitis （Garré’s osteomyelitis）. On follow-up, there has been no evidence of recurrence. The periosteal reactions and bone formation surrounding the permanent teeth disappeared as of 1 year after operation.
We report a case of enchondroma of the mandibular condyle. A 31-year-old woman was referred to our department because of pain in the right temporomandibular joint. Panoramic radiography showed enlargement of the right mandibular condyle. Computed tomographic scans revealed a bony mass protruding anteromedially from the right condyle. 99m Tc scintigraphy showed increased uptake in the right condyle. On the basis of these findings, the lesion was clinically diagnosed to be a benign tumor of the mandibular condyle. Condylectomy was performed at the sigmoid notch level through a preauricular approach. The histopathological diagnosis of the surgical specimen was enchondroma. She was kept in maxillomandibular elastic traction and underwent mouth-opening training postoperatively for 3 months, and occlusal adjustment was performed. As a result, the maximum mouth opening was 48 mm, and occlusion was acceptable. There has been no recurrence of the tumor during a follow-up period of 1 year 4 months.
Ganglions are cystic lesions arising in joints such as the wrist and ankle, but rarely occur in the temporomandibular joint. We report a ganglion involving the temporomandibular joint and review the literature on this rare entity. An 80-year-old man presented to a local hospital because of a swelling in the right preauricular region that had persisted for 2 months. He was referred to our hospital for surgical resection of a mass found on MRI. Fine-needle aspiration produced a gelatinous material with a small amount of nonkeratinized squamous epithelium and histiocytes. The mass was clinically diagnosed as a cystic lesion of the right temoporomandibular joint and was surgically resected under general anesthesia. Microscopic examination showed a layered structure of the cyst wall without an epithelial lining, which is consistent with a diagnosis of ganglion. One year after surgery, there has not been any evidence of recurrence.
Basal cell adenoma （BCA） was added to the classification of salivary gland tumors by the WHO in 1991. BCA occurs most frequently in the parotid glands, and BCA of the submandibular glands is relatively rare. We report our experience with BCA arising in the submandibular gland. A 73-year-old man was referred to our department because of a swelling in the right submandibular region. Physical examination revealed a round, hard mass, about 35 mm in diameter, in the submandibular region. On CT, MRI, and US studies, we found a well-circumscribed mass. On the basis of clinical findings, the diagnosis was a benign tumor of the right submandibular gland. Under general anesthesia, resection of the right submandibular gland was performed. Histopathologically BCA is classified into four types: tubular type, trabecular type, and membranous type, and solid type. The most common is solid type. The present case was solid-trabecular mixed type. On postoperative follow-up for 12 months, the patient has remained well without any further abnormal findings or signs of tumor recurrence on clinical examinations to date.
Squamous cell carcinoma arising in the hard palate is relatively uncommon, and cases arising in the mid-portion of the hard palate are particularly rare. We encountered two cases of squamous cell carcinoma that arose in the torus palatinus region of patients with a long history of excessive smoking and drinking. Case 1: A 59-year-old woman consulted our hospital because of an ulcer on the torus palatinus. The ulcer had spread from the posterior side of the torus palatinus to the transitional area between the hard palate and the soft palate. CT examination showed that the tumor had infiltrated to the palatal bone. A full-thickness excision of the hard palate including the mucosa of the nasal floor was performed, and a maxillary prosthesis was fabricated postoperatively. Case 2: A 55-year-old man consulted our hospital because of soreness of the palate. There was a small lesion on the torus palatinus. Radiographic examination showed that the tumor was located only in the mucosa of the torus palatinus. The torus palatinus including the palatal mucosa was excised at its base. No local recurrence or distant metastasis has been noted at the present time in either case, and the postoperative course has been good.