Arteriovenous malformations (AVM) are rare congenital anomalies of vascular morphogenesis. AVMs are frequently identified at birth, but their presentations vary and diagnosis is often delayed until later in life. AVM of the tongue is extremely rare, and treatment is difficult owing to site-specific characteristics of the disease. We report a case of AVM of the tongue that deteriorated during pregnancy. It had increased in size during pregnancy, and the patient had a check-up at her previous hospital. Postpartum, she was treated by embolization. However, the tongue enlarged and caused uncontrolled bleeding. Therefore, she was transferred to our hospital. We performed embolization of the main nutrient artery three times, but hemorrhage from the tongue did not stop. Finally, we performed surgical resection and free-flap reconstruction. The postoperative course was uneventful without complications, and her swallowing and speech functions were restored not to disturb daily life by rehabilitation. There has been no sign of recurrence as of 3 years 9 months postoperatively.
Extranodal marginal zone lymphoma of the mucosa-associated lymphoid tissue (MALT lymphoma) often occurs in the stomach. Although rare, MALT lymphoma can also occur in the oral cavity. MALT lymphoma is a low-grade lymphoma that can gradually transform into diffuse giant B cell lymphoma. Therefore, local therapy must be administered for localized lesions. A few cases of MALT lymphoma of the palate have been reported, but treatment strategies remain to be established. We report a case of MALT lymphoma in a 74-year-old woman who was successfully treated with radiotherapy and the molecular-targeted drug rituximab. The patient was examined at our department for a tumor extending from the left soft palate to the hard palate. The 20 × 20 mm lesion was painless and slightly elevated with a smooth surface. A pathological diagnosis of MALT lymphoma was established on biopsy. Treatment comprised 39.6 Gy of radiation followed by 8 courses of the molecular-targeted drug rituximab. The tumor showed a complete response, and there were no serious treatment-related adverse events. The patient has remained recurrence-free for 4 years.
This paper introduces a high perimandibular approach for open reduction and internal fixation (ORIF) of condylar fractures and describes its clinical usefulness. This technique is a via-masseter approach to the condylar region via a skin incision along with the inferior outline of the mandible. It was reported that this technique has a lower risk of facial nerve disturbance and provides good accessibility to the fracture site. Eleven patients with 11 condylar fractures underwent ORIF by the present approach. Correct ORIF with good accessibility was achieved in all patients, and no facial nerve disturbance occurred. Moreover, all patients were satisfied with the appearance of their surgical scars and recovered to a normal range of mouth opening.
In conclusion, ORIF of condylar fractures using a high perimandibular approach seems to be a safe and predictable technique that provides excellent clinical results.
Arteriovenous malformation (AVM) is rare in the oral and maxillofacial region, and it is often difficult to manage associated hemorrhage. We report a case of broad AVM in the maxillofacial region that occurred suddenly and was associated with frequent intraoral hemorrhages on the eruption of milk teeth and threatened the patient’s life.
A 2-month-old boy was referred to our hospital because of mandibular swelling. Computed tomography and magnetic resonance imaging revealed an AVM extending from the mandible to the oral floor and tongue. Arterial hemorrhages from the gingiva had been recognized from 8 months of age, and treatment by embolization had been done 9 times between the ages of 8 months and 2 years 10 months. Because hemorrhages were not controlled by embolization, we directly injected cyanoacrylate into the AVM from the age of 2 years 10 months to 7 years. The patient has been treated through 21 admissions since 8 months of age, and the AVM of mandibular bone disappeared at 7 years of age. When the patient was 18 years old, the AVM was not recognized in the mandibular bone, but it was found in soft tissue from the mental to submandibular region.
An 84-year-old woman with left mandibular gingival carcinoma received chemoradiotherapy combining S-1 (100 mg / day for 14 days) with a total dose of 20 Gy of radiotherapy. The patient had frequent diarrhea, severe myelosuppression, and renal dysfunction after therapy.
She was therefore treated in the intensive care unit of our hospital. Abdominal computed tomography (CT) showed edema of the entire intestine, and abdominal endoscopy showed diffuse hemorrhage, mainly in the small intestine. No mucosal duct necrosis was found on histopathological examination, which was also negative for ischemic enteritis. The patient then had bloody bowel discharge, disturbed consciousness, and respiratory depression. Disseminated intravascular coagulation (DIC) was diagnosed. We intubated the trachea and started transfusion and medical treatment for DIC. The treatment reduced the symptoms and the abdominal CT findings. Chemical enterocolitis was suspected, because the endoscopy results, stool culture, and the results of the lymphocyte stimulation test for S-1 were positive. In conclusion, when a patient has frequent diarrhea during S-1 therapy, we should treat it as an aggravation of drug-induced enteritis.
Mucous cysts derived from heterotopic salivary tissue are rare, especially in the middle of the posterior of the tongue. We treated a case of mucous cyst that arose in an ectopic salivary gland in the middle of the posterior of the tongue. We report this case together with a literature review. A 21-year-old woman was referred to our hospital because of a painless swelling in the middle of the posterior of her tongue. Magnetic resonance imaging showed a well-circumscribed ovoid mass. The lesion extended from the posterior of the tongue to the left side of the floor of the mouth under the mucous membrane. A clinical diagnosis of a thyroglossal duct cyst was made, and the Sistrunk operation was performed. The pathological diagnosis was a mucous cyst. The patient’s postoperative course was uneventful, and there were no signs of recurrence during the 24-month follow-up period.
A lingual mandibular bone cavity is an asymptomatic bone defect, which first described by Stafne in 1942. It appears as a well-circumscribed round or oval unilocular radiolucent lesion of the mandibular angle. The peak incidence is in the fifth and sixth decades of life. A well-defined radiolucent area was detected in the left posterior region of the mandible below the mandibular canal on an initial radiographic examination of a 9 -year-old boy at his dental clinic. Two years later, the radiolucent area had expanded on a follow-up radiographic examination. He was referred to our clinic by his dentist for further diagnosis and therapy. A computed tomographic (CT) scan was performed for definitive diagnosis of the lesion. The CT images revealed a lingual cortical bone defect. Therefore, the final diagnosis was a lingual mandibular bone cavity. The patient and his family were informed about the lesion and he was scheduled for follow-up at his dentist’s clinic. After 9 years’ follow-up, there was no radiographic progression.