As points to note in surgical procedures, one can cite accurate diagnosis of surgical indications, appropriate selection of surgical form, precise and prompt basic operations and reasonable intra and postoperative management. The tendency is that only skills are emphasized and knowledge and attitude are disfavored, but it goes without saying that daily improvement is necessary, including a surgeon's personality. For example, it is important to be familiar with the basic anatomical and physiological structures in oral, maxillofacial and neck region and it is also mandatory to understand target disease pathogenesis, determine a type of surgery and consider surgical procedures suitable for the type. When using surgical instruments, proper use is required by knowing correct usage and characteristics. Furthermore, a surgeon needs to always keep in mind surgical stress and "wound healing" in proceeding with a surgery. Points to note viewed from wound healing include: aiming at smooth dissection surface, not crushing tissues, not creating poor circulation areas (tissues whose blood flow is cut off) in a surgical wound, not bringing a foreign body or infection source to a surgical wound and not creating a dead space in a surgical wound. This time, not only surgery types undertaken by Oral Surgery are introduced but also explanations are made while presenting cases in the order of incision, hemostasis, ablation, suture and drainage with an emphasis on the basics of surgery techniques.
The oral cavity is an important organ for humans to live. If cancer arises in the oral cavity, it markedly impairs the QOL. Therefore, the standardization of basic concepts and specific methods for oral cancer treatment is necessary. The clinical practice guidelines based on the characteristics of oral cancers are also necessary. The objectives of this paper are to explaine basic surgical methods and to contribute to the understanding for the treatment of oral cancers and to improve the difference between the institutions of the treatment result. In this paper, oral cancers mean carcinomas originating in the covering mucosa at 6 sites in the oral cavity. They are lingual carcinoma, upper gingival carcinoma, lower gingival carcinoma, buccal mucosal carcinoma, oral floor carcinoma, and hard palate carcinoma. In this time, clinical evaluation of Lugol's iodine staining in the treatment of oral cancer and the significance of safety margins of surgical resection in oral cancer are described first. The basic technique and knacks for surgical treatment of oral cancer arising at 6 sites are described.
A number of recent studies have shown the effectiveness of tubulation, using neural progenitor cells or Schwann cells, for promoting nerve regeneration. However, the use of neural cells from other neural donor tissues can cause potentially serious clinical complications. Therefore, we focused on dental pulp as a new cell source for use in such artificial conditions. Previously, we showed that silicone tubes filled with dental pulp cells (DPCs) promoted facial nerve regeneration in rats. However, the use of silicone tubes requires a secondary removal operation because they may give rise to chronic inflammation and pain. Therefore, to avoid this procedure, a new artificial device was prepared from a degradable Copoly-lactide/glycolide (PLGA) tube containing DPCs, and its effectiveness for repairing gaps in the facial nerves of rats was investigated. A PLGA tube containing rat DPCs embedded in collagen gel was transplanted into a gap in a rat facial nerve. Five days after transplantation, the facial nerves connected by the PLGA tubes containing DPCs were repaired more quickly than the control nerves. The PLGA tubes were resorbed in vivo, and nerve regeneration was observed 2 months after transplantation. Immunostaining showed that Tuj1-positive axons were present in the regenerated nerves 2 months after transplantation, and osmium-toluidine blue staining showed no mineralization of the regenerated nerves in tubes containing myelinated fibers after 9 weeks. PLGA tubes filled with DPCs promoted nerve regeneration and were readily resorbed in vivo.
Alveolar soft-part sarcoma is considered an extremely rare disease in young people, and its tissue origin remains unclear. We report a case of alveolar soft-part sarcoma that developed in the tongue of a child. A 9-year-old boy had a tumor mass on the central dorsum of the tongue since the age of 4 years. It was left untreated for 5 years, until he was referred to our department by a dentist for detailed evaluation and treatment. We observed a hemispherical tumor mass (20 × 30 mm) with elastic hard and indolent properties and an ill-defined border on the central dorsum of the tongue. Histopathological diagnosis based on a biopsy performed under local anesthesia suggested a granular cell tumor, without providing a definitive diagnosis. Subsequently, surgery was performed with the patient under general anesthesia to remove the tongue tumor. An additional excision performed after histopathological examination led to a definitive diagnosis of alveolar soft-part sarcoma. Four years after surgery, the patient is in stable condition without any local recurrence or metastasis.
Plasma cell cheilitis is a rare, benign, inflammatory disorder that is histologically characterized by a dense infiltration of plasma cells within the submucosa. It presents as a circumscribed lesion of the lip. The cause of plasma cell cheilitis is unknown, and the treatment of choice has not been established. We report a case of plasma cell cheilitis in a 59-year-old man who had a swollen and eroded area on his lips and responded well to intralesional steroid injections. Biopsy showed band-like plasma cell infiltration. A diagnosis of plasma cell cheilitis was made after excluding contact dermatitis, lichen planus, bacterial and fungal infections, and an extramedullary plasmacytoma as differential diagnoses. Dramatic improvement was observed after intralesional injections of corticosteroids. The lesion disappeared, and no recurrence has been observed during 5 years of follow-up.
Basaloid squamous cell carcinoma (BSCC), a variant of squamous cell carcinoma (SCC), is characterized by the growth of basaloid tumor cells. The mandibular gingiva is a rare site of BSCC. We present a case of BSCC of the mandibular gingiva. A 52-year-old woman was referred to our hospital because of pain, swelling, and white lesions of the mandible. The lesion was irregularly shaped with induration and extended bilaterally to the gingiva, oral floor, lower lip, and mental region. Since SCC was suggested by a biopsy, the patient received adjuvant chemotherapy, and surgical excision was performed under general anesthesia. Microscopically, the tumor had two components, i.e., basaloid cells and squamous cells. The basaloid component consisted of small cells arranged in lobules, cords, and solid masses. On the basis of the histopathologic findings, a final diagnosis of BSCC was made. There has been no sign of recurrence for 4 years 9 months since treatment. BSCC has been reported to be more invasive and metastatic than SCC. Thus, long-term and careful follow-up is necessary in the present patient.
Isolated hypoglossal nerve palsy is a very rare condition, because the palsy is usually complicated by glossopharyngeal nerve paralysis, vagal paralysis, and accessory nerve paralysis. We report a case of cause-unknown unilateral and isolated hypoglossal nerve palsy. An 81-year-old woman was referred to our department because of articulation disorders. The face was symmetric, and examination of other cranial nerves revealed on abnormality. The left side of the body of the tongue was slightly atrophic, and the tongue deviated to the left when the patient opened her mouth. However, there was no abnormal sensation of the tongue and no abnormal taste perception. Examination of the head and neck by computed tomography, magnetic resonance imaging, and magnetic resonance angiography showed no abnormal findings. Furthermore, routine blood, immunologic, and serologic examinations revealed no evidence of viral infection or autoimmune diseases. On the basis of these results, we diagnosed this case as idiopathic hypoglossal nerve palsy. Approximately 1-year follow-up revealed no change, except for slight progression of the tongue atrophy.
Nevoid basal cell carcinoma syndrome (NBCCS) is a syndrome with autosomal dominant inheritance, and strict management is needed for patients and their families owing to the high incidence of tumors that occurs with advancing age. We clinically studied 14 cases of NBCCS in 10 families that we encountered in our clinic and discussed the appropriate clinical management of NBCCS. The major symptoms in the 14 cases were basal cell carcinoma (BCC) in 3 cases (21.4%), keratocystic odontogenic tumor (KCOT) in 14 cases (100%), palmar or plantar pits in 11 cases (78.6%), falx calcification in 9 cases (64.3%), rib abnormalities in 5 cases (35.7%), and ovarian fibroma in 1 case. No patient had medulloblastoma. The following is considered to be appropriate as clinical management for NBCCS. For patients in whom KCOT is suspected in a department of oral and maxillofacial surgery, NBCCS screening should be performed by examination for pits and by checking family and past medical histories. In patients in whom NBCCS is suspected, examinations should be carried out for falx calcification and rib abnormalities, and further examinations should also be done in a department of dermatology for BCC and in a department of gynecology for ovarian fibroma. It should be explained to patients who meet the diagnostic criteria for NBCCS that family intervention is necessary. For infant born to NBCCS patients, examinations should be carried out from immediately after birth for early detection of medulloblastoma, and periodic examinations should be done for KCOT from the age of about 6 years, when successional teeth start to appear.
We report a case of foreign body impaction in the tongue of a 63-year-old woman with schizophrenia. The patient was referred to our hospital by her dentist because of a swelling of the tongue. At the first visit to our hospital, physical examination revealed a submucosal elastic hard mass, measuring 23 × 20 mm, on the dorsal aspect of the tongue. There was a fistula in the mucosa over the mass. Oral antibiotics were given for a clinical diagnosis of a submucosal tumor with secondary infection, but the inflammation did not resolve completely. Computed tomography and radiography showed a metal crown impacted in the muscle layer of the tongue. The crown and surrounding soft tissue were removed with the patient under local anesthesia. Histopathologically, the resected tissue was inflamed granulation tissue with marked infiltration of neutrophils and proliferation of capillary vessels. No evidence of a neoplastic lesion was observed. A further medical interview made the patient confess to a history of tongue trauma caused by falling about 1 month before presentation to our hospital.