The patient, a 75-year-old man, was referred to our hospital because of discomfort and tenderness of the right temporomandibular joint （TMJ） in April 2010. Computed tomographic （CT） images revealed a large tumor, while 3-dimensional CT showed bone destruction and remarkable deformities in the right mandibular condyle. Surgery was scheduled for September 2010 for a clinical diagnosis of a right mandibular condyle tumor. The tumor was resected surgically by extraoral vertical ramus osteotomy with a simultaneous high condylectomy, and the pathologic diagnosis was synovial chondromatosis of the TMJ. The excised tumor comprised cartilage, and the surface of the mass was covered by a fibrous capsule. Severe condylar resorption and remarkable condylar deformity were confirmed. During the 2.5 years since surgery, periodic observations have shown no evidence of recurrent abnormalities in the TMJ.
Reports on central giant cell granuloma （CGCG） arising in the mandible are relatively rare. We describe a 17-year-old boy with CGCG of the left mandible. The lesion was first noticed as a painless swelling. Orthopantomography showed a multilocular radiolucent lesion in the mandible. A computed tomographic scan showed that the mandible had expanded, and the cortical bone had thinned. A giant cell granuloma was suspected, and a biopsy was performed. The biopsy specimen histologically showed multiple granulomatous nodules associated with proliferation of fibroblasts and infiltration of macrophages, inflammatory cells, and numerous multinuclear giant cells. Because of abnormal bleeding during the biopsy, we prepared an autologous blood transfusion and extirpated the lesion by an intraoral approach with the patient under general anesthesia. During operation, the bleeding volume was 1000 g, and autologous blood transfusion was performed. Reccurence of the lesion wasconfirmed 21 months after operation, and renucleation of the lesion was performed with the patient under general anesthesia. Recurrence of the lesion has not occurred as of 2 years after the second operation.
Calcifying epithelial odontogenic tumor （CEOT） is a rare odontogenic tumor derived from odontogenic epithelium. We describe a 35-year-old man with CEOT in the left mandibular molar region. Panoramic radiography of the left side of the mandible showed a multilocular radiolucent lesion with several radiopaque masses. Computed tomography indicated expansion and thinning of the buccal and lingual cortical bone adjacent to the multilocular lesion in the left side of the mandible. The preoperative histopathological diagnosis on examination of a biopsy specimen was CEOT, which was considered to be derived from the odontogenic epithelium. The patient did not come to our hospital for 2 years, but then returned because the CEOT had enlarged. With the patient under general anesthesia, we performed continuous resection of the mandible and reconstruction with a plate. The postoperative course was uneventful during a follow-up period of 2 years, and there has been no recurrence.
We report a case of fixed drug eruption due to levofloxacin （LVFX） with multiple stomatitis localized in the oral cavity. In late October 2011, a 37-year-old woman was given LVFX for cystitis. The patient experienced discomfort in the oral cavity after 6 hours, and her condition rapidly worsened, with the appearance of multiple stomatitis and erosion on the oral mucosa. On consultation with an otolaryngologist 6 days after starting treatment, she was instructed to discontinue LVFX. However, the condition of the oral cavity did not improve, and she was therefore referred to our section 2 days after discontinuing LVFX. At presentation, the patient’s lips were red, swollen, and blood-encrusted and bled effortlessly on scratching. Multiple stomatitis was apparent with sharp pain on the buccal mucosa, together with a large mucosal erosion on the right dorsal surface of the tongue. However, symptoms involving the skin and mucosa, including the vulva and eyes, were not evident. Furthermore, 2 months previously the patient had a history of similar stomatitis after treatment with LVFX. We gave the patient a diagnosis of a fixed drug eruption due to LVFX. She was hospitalized, and methylprednisolone sodium succinate 750 mg per day was administered for 3 days. Her condition immediately improved, and she was discharged from the hospital after 9 days.
Necrotizing fasciitis is treated by incisional drainage or immediate debridement. Generally, an infected wound should not be sutured or closured, but should be allowed to secondarily heal as an open wound. Treatment of necrotizing fasciitis involving the neck or submandibular region requires careful attention to major blood vessels or nerves. We therefore could not perform debridement radically. The wound should be continuously irrigated or applied ointment, but the presence of a fistula sometimes leads to prolonged wound healing. We describe our experience with an uncontrollable fistula attributed to debridement of submandibular necrotizing fasciitis, although irrigation had been continued for 6 weeks. After performing Negative Pressure Wound Therapy, with a V.A.C.® ATS system good granulation tissue proliferated in 3 days, and the fistula disappeared. The wound completely healed in 1 week. Furthermore, the clinical course has been good, with no recurrence of a fistula after 3 months. We report a case of early healing of an uncontrollable fistula treated by a V.A.C.® ATS system.
The prognosis of patients with cervical recurrence of oral squamous cell carcinoma after neck dissection is extremely poor because additional surgical resection is difficult owing to anatomical factors. In this report, we describe a case of cervical recurrence of tongue squamous cell carcinoma that was clinically eliminated by superselective intra-arterial chemotherapy with concurrent radiotherapy. The patient was a man in his forties who underwent a partial glossectomy for the treatment of tongue cancer of the left side （T2N0M0）. The histopathological diagnosis was moderately differentiated squamous cell carcinoma. On follow-up examination 9 months after the operation, computed tomography and ultrasonographic examination revealed cervical lymph node metastasis on the left side. Modified radical neck dissection of the left side was thus performed. One metastatic lymph node with extracapsular spread was pathologically found in the specimen. Two months after the neck dissection, a metastatic lymph node in the right submandibular region and neck recurrence on the left side were diagnosed. Two cycles of superselective intra-arterial chemotherapy with concurrent radiotherapy were delivered by the Seldinger technique via the femoral artery. The lesions were clinically eliminated after these treatments. There has been no evidence of recurrence or metastasis as of 6 years after therapy.