Mucous-retention cysts such as mucocele and ranula are caused by mucus extravasation due to rupture of ducts of the major and minor salivary glands. While several techniques have been used to treat retention cysts, micro-marsupialization is a relatively new, less invasive treatment modality. We describe this new method, which is not popular in Japan, and report the clinical outcomes of 13 cases of mucoceles and ranulas treated with this technique. We evaluated the therapeutic value of micro-marsupialization on the basis of cure rate and events such as infection and recurrence. As a result, ten cases (76.9%) showed complete remission of the lesions and three cases including one case of infection required retreatment. Micro-marsupialization seems to be a simple, minimally invasive and effective modality, and is well tolerated by patients. We accordingly suggest that it could be a primary treatment of choice for mucous retention cysts.
Desmoplastic fibroma is a benign fibrous tumor of bone, but shows aggressive behavior and has a high rate of recurrence. We present a case of desmoplastic fibroma arising in the ramus of the mandible. The patient was a 13-year-old boy who had been aware of a painless mass in the right periauricular region for one month. The mass gradually increased in size, and pain on opening the mouth developed. He was referred to our department, and on the initial examination, a bony-hard mass was palpated from the right periauricular region to the cheek. CT detected a clearly demarcated unilocular lesion with homogeneous density in the right ramus of the mandible. The lesion extended from the base of the condyle to the mandibular angle, and occupied two thirds the volume of the ramus of the mandible. Clinically, a right mandibular tumor was diagnosed, and the biopsy was done. On histopathological examination, a desmoplastic fibroma was diagnosed. Right segmental mandibulectomy ranging from the condyle and the coronoid process to the mandibular angle was done with the patient under general anesthesia. Some parts of fascia of the masseter and the medial pterygoid muscle were resected. The resected specimen was elastic hard and measured 55 × 45 × 35mm. The cut surface was solid and grayish white. The histopathological diagnosis was desmoplastic fibroma. There was no evidence of local recurrence or metastasis 9 years after operation.
We report a case of descending necrotizing mediastinitis due to severe odontogenic infection successfully treated by thoracoscopic drainage. A 24-year-old man was referred to our hospital emergency center because of bilateral submandibular swelling and was hospitalized on the same day. He had diffuse swelling and redness from the submandible to neck bilaterally and had difficulty in swallowing. He had spontaneous pain at the third right mandibular molar, but no tenderness, swelling, or pus discharge around the buccal gingiva. Panoramic X-ray images showed a radiolucent area at the root apex of the right mandibular third molar. Enhanced computed tomography revealed a diffuse abscess spreading to the sublingual, submental, and submandibular spaces. The patient underwent a laryngotracheotomy and cervical drainage because he had laryngeal edema. However, an abscess had formed in the anterior mediastinum through the left intercarotic space, and hydrothorax was found. Then, surgical drainage for the deep cervical abscess and endoscopic transthoracic drainage for the descending necrotizing mediastinitis were performed. The treatment succeeded, and he was discharged.
We studied clinically 251 cases of temporomandibular joint dislocation treated at the Department of Oral and Maxillofacial Surgery or the Emergency Department of Kanazawa Medical University during the past 18 years from May 1995 to April 2013 to investigate the actual status and trends of temporomandibular joint dislocation. The following results were obtained: 1 . The patients consisted of 92 males and 159 females. 2 . The age ranged from 2 to 103 years. Fifty patients (19.9%) were in their 80s. 3 . Temporomandibular joint dislocation occurred on both sides in 158 cases (62.9%), only on the right side in 48 cases (19.1%), and only on the left side in 45 cases (17.9%). 4 . Habitual dislocation of the temporomandibular joint occurred in 166 cases (66.1%). 5 . 54 patients (28.4%) directly visited our department. Among patients presenting to the Emergency Department, 25 patients (29.1%) were referred to our department. 6 . In our department, general complications were found in 124 cases (65.3%), and they were mostly associated with cardiovascular, neuropsychiatric, and cerebrovascular disease. 7 . In our department, the treatment methods were only non-invasive reduction in 125 cases (65.8%) and invasive reduction in 65 cases (34.2%).
Solitary fibrous tumor (SFT), first reported in the pleura by Klemperer and Rabin in 1931, is a lesion rarely found in the oral cavity. Recently, SFT has been found and described in extrapleural sites, including the oral cavity. Since histologically benign SFT has a propensity to metastasize, the World Health Organization classification in 2002 categorizes these tumors as tumors of intermediate malignancy. We report a case of SFT in the lower lip of a 67-year-old woman. Histological observation revealed that the tumor was composed of spindle-shaped cells with immunohistochemically positive staining for CD34 and vimentin. Our survey indicated that there is the only 1 report on SFT arising from the lower lip.
With the introduction of the World Health Organization Guidelines (WHO, 1986) and greater awareness of end-of-life care for cancer patients in recent years, the use of morphine has become increasingly more common. Morphine treatment dramatically improves pain control in end-stage cancer patients and enables those patients to spend their final days pain-free at home. However, patients who require 1,000 mg or more of morphine per day for the control of cancer pain are very rare, and it may be difficult to control the pain and maintain the quality of life (QOL) for these patients. We describe a 25-year-old woman with right upper jaw spindle cell carcinoma who had long-term survival with successful chemotherapy, but finally required a dose of 9,000 mg or more of morphine via continuous infusion to reduce pain. She hoped to be cared for at home, and was able to remain at home for about 11 months without any significant side effects.