We assessed the clinical significance of the combined preparation JNS013 and the analgesic efficacy and safety of a single oral dose of JNS013 （Tramadol hydrochloride/acetaminophen combination tablets） as compared with a single dose of tramadol hydrochloride （TRAM） or acetaminophen （APAP） in patients who had pain associated with extraction of a mandibular impacted third molar in a multicenter, double-blind, randomized, active-controlled, parallel-group comparitive study. Efficacy and safety were evaluated in a total of 328 patients who were given the study drugs （JNS013 group: 132 patients, TRAM group: 66 patients, APAP group: 130 patients）. As for the primary endpoint of efficacy, the means ± standard deviations of the total pain relief scores from 0 to 8 hours after administration of the study drugs （TOTPAR 0-8h） were 17.7 ± 7.91 in the JNS013 group, 12.4 ± 8.36 in the TRAM group, and 13.3 ± 8.07 in the APAP group, indicating a significantly higher value in the JNS013 group than in the TRAM and APAP groups. On safety analyses, at least 1 adverse event occurred in 62.1％ （82/132） of patients in the JNS013 group. Major adverse events occurring in the JNS013 group included somnolence 29.5％, nausea 15.2％, dizziness 9.1％, and blood bilirubin increased 9.1％. The severities of most of these adverse events were mild. The symptoms and incidence of adverse events in the JNS013 group were generally similar to those in the TRAM group, while the incidence in the JNS013 group was higher than that in the APAP group. The present study showed that JNS013 was more effective for the management of post-tooth-extraction pain than either uncombined TRAM or APAP, supporting the clinical significance of combination. In addition, the usefulness of the drug for post-tooth-extraction pain was confirmed. JNS013 is expected to provide a new alternative for pain control in the fields of dentistry and oral surgery.
Essential thrombocythemia （ET） is a rare chronic myeloproliferative tumor characterized by an increase in platelets, thrombosis, and a bleeding tendency. Special attention is reguired in cases treated by surgical intervention. We describe the resection of tongue cancer in a patient with ET. A 79-year-old man was admitted to our hospital because of discomfort in the left margin of the tongue. Initial examination revealed an 18 × 11 mm indulated mass arising at the left tongue margin. The clinical diagnosis was suspected tongue cancer. ET had been diagnosed at 66 years of age, and hydroxycarbamide was administered. The preoperative platelet count was 73.4 × 104/μl. Preoperatively, we continued to administer hydroxycarbamide after consulting with the attending physician. We performed an excisional biopsy. The operation was completed without any major problems. Half a day after the operation, diapedetic bleeding occurred. We therefore performed local hemostatic treatment with resuturing. The platelet count increased to 103.5 × 104/μl by the next day. To prevent thrombosis and bleeding, we administered the alkylating agent ranimusstin. Three days later, the platelet count decreased to 63.4 × 104/μl. The postoperative course has been uneventful without bleeding or an increased platelet count. There has been no tumor recurrence for more than 7 years.
Oral radioiodine （131I） therapy is known to be an effective treatment for differentiated thyroid carcinoma, but it can cause salivary gland impairment. We report a case of xerostomia caused by oral radioiodine therapy for thyroid cancer. A 47-year-old woman consulted our hospital because of tongue pain accompanied by xerostomia. The patient had a history of receiving radioiodine therapy for metastatic thyroid carcinoma 3 times （total 9,990 MBq）. Clinical examination demonstrated oral dryness and reduced salivary gland function. On the gum test, the salivary flow was 2 ml in 6 minutes. It was hard to continue chewing for more than 6 minutes because of irritation. A computed tomographic scan showed atrophic changes of both parotid glands. On radioiodine whole-body imaging, uptake of radioiodine was evident in both the parotid and submandibular glands. Based on these findings, xerostomia caused by salivary gland injury due to radioiodine therapy was clinically diagnosed. The salivary gland injury was irreversible, and the patient received symptomatic therapy and pilocarpine hydrochoride. Early intervention to avoid salivary gland injury is important in patients who receive radioactive iodine therapy.
Chronic expanding hematoma （CEH） is a lesion that develops gradually after trauma or surgery. Generally, it arises in the pleural cavity, lower leg, abdomen, or backj occurrence in the head and neck region is uncommon. We report a case of CEH arising in the maxillary sinus of a 47-year-old man who was referred to our hospital for further evaluation of a lesion in the left maxillary sinus. No subjective symptoms were reported at presentation, and he had no remarkable family or past medical history. Panoramic X-ray films showed a radiopaque domeshaped mass in the left maxillary sinus, and computed tomographl demonstrated a well-circumscribed round lesion. The lesion, which was clinically diagnosed as a maxillary tumor, was resected under general anesthesia. Histopathological examination revealed that the tumor consisted of an inner layer of hematoma with capillaries, a middle layer of granulation tissue, and an outer layer of dense fibrous connective tissue with calcification. The histopathological diagnosis of the lesion was CEH. There was no sign of recurrence 19 months after the operation.
We describe a large ameloblastic carcinoma of the mandible with multiple pulmonary metastases. The patient was a 62-year-old woman. In March 1994, she underwent enucleation of a tumor in the anterior part of the mandible at another hospital. The histopathological diagnosis was a typical ameloblastoma. She was lost to followup soon after the operation. In March 2008, she was referred to Hokkaido University Hospital. She had a large hemorrhagic tumor, which projected outside of the mouth. Chest radiography revealed many nodular opacities in both lung fields. In May 2008, we performed a segmental mandibulectomy to improve her quality of life. The histological diagnosis was an ameloblastic carcinoma-secondary type, intraosseous. There has been no sign of tumor recurrence for 2 years postoperatively.
Osteoma is a benign osteogenic lesion characterized by the proliferation of compact or cancellous bone. It can be central or peripheral. This lesion commonly arises in the oral and maxillofacial region, but rarely occurs in the zygomatic arch, where only 1 case has been reported. We present a case of peripheral osteoma arising in the articular tubercle of the temporal bone in a 41-year-old woman. Clinical examination revealed a bony, pedunculated, exophytic mass approximately 20×20 mm in size. The clinical diagnosis was osteoma. Under general anesthesia, surgical resection through a preauricular incision was performed. The histopathological diagnosis was peripheral osteoma. The patient remains free of recurrence after 1 year.
We report a case of solitary fibrous tumor （SFT） of the tongue. The patient was a 58-year-old man who was referred to our hospital because of a swelling on the left side of the tongue in August 2006. A magnetic resonance imaging examination showed a well-demarcated homogenous lesion in the left side of the tongue, with low signal intensity on T1-weighted images and moderate signal intensity on T2-weighted images. A fibroma was suspected on histopathological examination of a biopsy specimen, and surgical excision was performed under general anesthesia. Histopathologically, the tumor was composed of proliferating spindle cells resembling fibroblasts, interstitial collagenous fibers, and microvasculature. The tumor cells were distributed irregularly and were heterogeneous. Immunohistochemically, the tumor cells showed positive staining for CD34, vimentin, and bcl-2, but negative staining for CK AE1/AE3, SMA, and S100 protein. These findings led to a diagnosis of SFT. No recurrence or metastasis has occurred after a follow-up period of 4 years 8 months.
Epidermoid cysts usually arise in the oral floor, but cysts of the chin are rare. We report an epidermoid cyst arising in the chin. The patient was a 66-year-old man with a painless mass lesion of the chin, which had gradually developed over the previous 6 months. On initial examination, the mass lesion was found to be mobile. Magnetic resonance imaging and ultrasound examinations showed a round and homogenous lesion, located in the subcutaneous tissue and measuring 20 mm in diameter. We clinically diagnosed a cystic lesion and performed cystectomy under general anesthesia. The macroscopic findings showed that the lesion was filled with a yellowish semi-solid material, which measured 20 × 15 mm. The surgical specimen was histopathologically diagnosed to be an epidermoid cyst. There have been no signs of recurrence 30 months postoperatively.