Clinical analysis was performed in patients treated with bisphosphonates （BPs） in our clinic. The subjects were 112 patients who were treated in our department from June 2005 to February 2010. Twenty patients developed bisphosphonate-related osteonecrosis of the jaw （BRONJ）. Among these patients, 9 had received oral BPs for more than 1 year, and 11 had received intravenous BPs for more than 3 months. The mandible was involved in 13 patients and the maxilla in 7. Two patients （10.0％） were in stage 0, 3 （15.0％） in stage 1, 12 （60.0％） in stage 2, and 3 （15.0％） in stage 3. Among 92 patients without BRONJ, 38 received surgical treatment, and 54 received oral hygiene control. Seven of the 38 patients who underwent surgical treatment showed delayed healing. They also showed significantly decreased serum levels of N-telopeptide of type I collagen （NTX）. These findings, indicate that patients treated with oral BPs for more than 1 year or intravenous BPs for more than 3 months are at high risk for BRONJ and therefore should be managed carefully. SerumNTX may be an useful predictive marker of BRONJ for the perioperative management of patients treated with BPs.
The present paper analyzed Chinese medical staff （including stomatologists, pharmacists, and nurses）, comprising a total 1782 persons who visited Japan from 1987 through 2006 and were sponsored by the Sasagawa Medical Fellowship. Chinese stomatologists accounted for 88 persons among the total of 1782. Among the 88 stomatologists, 15 were from the 4th Military Medical University, 9 from Jilin University, 8 from Beijing University, and 6 from China Medical University; a total of 25 were from North East China. The departments of Japanese universities attended by Chinese stomatologists included 17 departments of in periodontology and conservative dentistry, 16 departments of oral surgery, 12 departments of prosthetics, 11 departments of orthodontics, and 8 departments of pedodontics at dental and medical schools. Stomatologists who had learned major specialties in Chinese stomatological colleges also majored in similar specialties at the Japanese universities or hospitals. Chinese administrators have been investigating Japanese health science systems, including not only medical technology and clinical medicine, but also several administrative specialties such as medical law, public health, provention of infection diseases, cancer, population research, and budgets from both research and clinical perspectives. Medical staff from central administration in the Government of China have also learned considerably from his or her experience during investigations in Japan. No administration staff of stomatologists were supported by the Sasagawa Fund.
Chondrosarcoma of the temporomandibular joint is relatively rare in the stomatognathic region and is difficult to distinguish from benign tumors. We report a case of chondrosarcoma arising in the head of the mandible. A 56-year-old woman noticed swelling in the temporomandibular joint for 7 years. Because the swelling increased over the last 2 weeks, she was introduced to our hospital. After the diagnosis of a mandibular tumor, an operation was performed under general anesthesia. The capsule of the tumor was absent in some parts on pathohistological examination. Grade III tumor cells were abundant immediately beneath the capsule. Infiltration into the bone was also observed. This tumor was diagnosed as chondrosarcoma. CDDP/DXR combination chemotherapy was performed after surgery. As of 6 years after operation, there has been no evidence of recurrence or metastasis. A mutation of the EXT1 gene, responsible for hereditary multiple exostoses, was identified, suggesting involvement of the tumour suppressor gene EXT1 in this chondrosarcoma.
Basaloid squamous cell carcinoma （BSCC） is a rare aggressive malignant tumor that is a distinct variant of squamous cell carcinoma. It is mostly seen in the supraglottic larynx, hypopharynx, and base of the tongue. The prognosis of this tumor is poor because of its high risk of regional lymph node and distant metastases. In this paper, we report a case of BSCC arising in the tongue. A 58-year-old man was referred to our clinic because of pain and bleeding of the tongue. Clinical examinations revealed a papillary tumor measuring 15×15×12 mm on the right side of the tongue. The histologic diagnosis of the biopsy specimen was BSCC. The tumor was surgically extirpated by partial tongue resection. Chemotherapy and radiotherapy were given postoperatively. The patient’s postoperative course was uneventful, and he is free from disease 5 years 6 months postoperatively.
We report a case of calcium pyrophosphate dehydrate crystal deposition with synovial chondromatosis and calcification of the articular disc in the temporomandibular joint （TMJ）. A 59-year-old-woman was referred to our hospital because of pain in the left TMJ and difficulty in opening and closing her mouth. The first clinical examination revealed that her maximal mouth opening was 18 mm, with open bite at the left molars. Radiological examination revealed a calcified mass in the left TMJ. The clinical diagnosis was synovial chondromatosis. Since arthroscopy showed no abnormal findings in the upper joint space, we tried to open the lower joint space. During surgery, we found a whitish-yellow mass on the lateral side of the capsule. When the lower joint space was opened, two loose solid masses were found in the anterior space. The lower surface of the disc was found to be calcified, and considerable white-yellow deposition was found in its posterior space. The disk, the loose masses, and the deposition were removed. Histological examination showed calcium pyrophosphate dehydrate crystal deposition, chondromatosis, and calcification of the disc. Three years 6 months postoperatively, the patient was found to be free of symptoms, without relapse.
Recently, bisphosphonate-related osteonecrosis of the jaw （BRONJ） is a very severe problem. Although methotrexate （MTX） has been used as standard therapy for patients with rheumatoid arthritis （RA）, MTX-associated lymphoproliferative disorder （MTX-LPD） has been reported recently. We report a suspected case of both BRONJ and MTX-LPD. A 66-year-old woman with osteoporosis and RA was referred to our department for pain after extraction of the right maxillary first molar. MTX and alendronate had been administered to the patient. CT revealed extensive osteonecrosis of the maxilla. The patient was given a diagnosis of BRONJ. Although minimally invasive treatment was performed, the osteonecrosis gradually enlarged. A biopsy of the mucosa of the hard palate was performed to check for tumorous lesions. The atypical cells were positive for CD20, CD30, multiple myeloma oncogene 1 （MUM1）, and EBV-encoded small RNAs-in situ hybridization （EBER-ISH）, and negative for CD15. The pathological diagnosis was diffuse large B-cell lymphoma. Finally, the lesion was diagnosed as MTX-associated LPD （MTX-LPD） in consideration of treatment with MTX. After discontinuation of MTX, the lesion gradually disappeared.
Glucose-6-phosphate dehydrogenase （G6PD） plays an important role in the in vivo consumption of reactive oxygen species. One must exercise caution during the treatment and selection of medicines for any illness in patients with abnormality of this enzyme, because pain and stress caused by surgery and anesthesia combined with the effects of various drugs can cause hemolysis. We describe a patient with G6PD deficiency who had a hemolytic episode caused by pericoronitis of the mandibular third molar. A 32-year-old man had a hemolytic episode after dental treatment, which comprised resin fillings, and was hospitalized because of apparent general malaise. We decided to extract the affected third molar and complete the resin fillings during the course of hospitalization. Red blood cells and hemoglobin reached their lowest levels one week after the resin filling was done, after which recovery became evident. Moreover, the frequency of hemolytic episodes decreased after extraction of the affected third molar. We considered the mandibular third molar pericoronitis and pulpitis as the possible inflammatory causes of the patient’s hemolytic episodes, while the resin filling may have been a drug-related cause. There is also the possibility that oral inflammation caused the hemolytic episodes. Our findings suggest the importance of improved dental hygiene in patients with G6PD deficiency to prevent the occurrence of hemolytic episodes.
An 11-year-old boy accidentally stuck his soft palate by himself with a 46-cm-long branch of bamboo when he was getting on a handmade swing and fell down from it. He removed the branch immediately from the soft palate by himself, and visited Nagano Red Cross Hospital on that day because of oral pain. He was conscious, but presented with rhinolalia and had hyperesthesia of the skin in the region of the maxillary nerve. Examination of the soft palate revealed a bruise 5 millimeters in diameter without bleeding, and a cranial computed tomographic scan revealed no clinically significant findings. During 2 days’ observation in our hospital, he became feverish, complained of headache, and was drowsy with a stiff neck because of secondary bacterial meningitis. Cranial magnetic resonance imaging demonstrated clear traces of the penetrated branch that entered the soft palate and reached the cerebellum. He received antibiotics for 3 weeks and recovered without sequelae. We consider that careful observation is necessary in patients with oral injury, even without any clinically significant symtoms or signs at the time of initial examination, because of occult critical conditions such as bacterial meningitis or central nervous system injury.
Central giant cell granuloma of the jaw is less common than peripheral giant cell granuloma, and it can cause destruction of the bone. We report the atypical case of a 5-year-old boy with a central giant cell granuloma involving both rami of the mandible. The patient consulted our clinic because of a swelling in the right ramus of the mandible. Bilateral bulging of the mandible was observed at initial examination. Computed tomography showed a well-defined, multilocular lesion with bilateral bone destruction from the molar to ramus of the mandible. The diagnosis on an incisional biopsy was central giant cell granuloma. Enucleation of the lesion was performed under general anesthesia. There has been no evidence of recurrence as of 2 years 5 months after the operation.
Although several hypotheses have been proposed for the formation of salivary calculi, such as the inflammation theory, the microbiologic theory, and the foreign-body theory, there have been few case reports of sialoliths in which the etiology is clear. Recently, we encountered an interesting case of a salivary calculus in the submandibular gland duct formed around a hair. A 71-year-old man was referred to our hospital because of painful swelling of the left submandibular region. Radiographic examination revealed a radiopaque spot in the gland. The clinical diagnosis was sialolithiasis of a submandibular gland duct, and the calculus was surgically removed. The patient made an uneventful recovery. Histopathological examination revealed that the removed calculus was formed around the nucleus of a hair.
This report presents a case of carcinoma ex pleomorphic adenoma （Ca-ex-PA） of the buccal region. A 68-year-old man was referred to our hospital because of a mass in the left buccal region. Clinical examination showed an elastic hard, painless, movable mass measuring 50× 40 mm. The overlying skin and mucosal surface were intact and did not adhere to the mass. There was no facial nerve paralysis, and careful examination of the cervical region revealed no palpable lymph node. MR revealed a well-defined, 42 × 31 × 31 mm lesion in the left buccal area, of moderately high intensity on T1-weighted images and high intensity on T2-weighted images. We performed an incisional biopsy via an intraoral approach under local anesthesia, and histological examination of the specimen showed Ca-ex-PA, with the malignant component suspected to be salivary duct carcinoma （SDC）. The tumor was excised via a transbuccal approach under general anesthesia. Pathological findings of the surgical specimen were the same as those of the biopsy specimen, and the tumor was finally diagnosed as non-invasive Ca-ex-PA. As of 2 years 8 months postoperatively, the patient has had no facial nerve paralysis, salivary fistula, or evidence of recurrence or metastasis of disease.
Foreign bodies in the oral and maxillofacial region are often experienced after trauma and dental treatment. We describe a case of acute sialadenitis in the submandibular gland caused by penetration of a fish bone in a 66-year-old woman. She had swelling and spontaneous pain in the right submandibular region after eating a fish. Radiographic examination showed a needle-like radiopaque body in the right submandibular gland. We diagnosed acutesialadenitis in the right submandibular gland caused by a penetrating foreign body and surgically extracted the right submandibular gland. The foreign body measured 15 × 1.5 mm and was a needle-like object. On pathological examination, the foreign body was found to be a fish bone.
Syphilis is a chronic granulomatous disease caused by infection with Treponema pallidum （TP）. We report a case of intractable oral mucosal ulcer of the lower right side of the lip that was suspected to be caused by syphilis. A 27-year-old woman presented with an intractable mucosal ulcer. She had been receiving treatment for syphilis prescribed by a primary care physician and recovered from other symptoms （A few weeks before the first visit to our department, she had oral sex with her partner, who was suspected to have syphilis.）. Although the ulcer was about to heal, we performed a biopsy on the next day. However, no TP was detected. Two weeks later, the ulcer disappeared, and no recurrence has been detected as of 24 months after the first visit. We thought that the underlying disease was primary syphilis caused by local reinfection with TP after resolution of secondary syphilis.