Maxillary carcinoma is a common cancer in the oral cavity. The gingiva is the second frequent site following the tongue in the oral cancers. At the first visit, patients often complain a pain and swelling at a primary site.
Histopathologically the squamous cell carcinoma is most dominant, and the adenoid cystic carcinoma is the second in the maxillary carcinoma.
Although the primary site of the maxillary carcinoma can be easily seen and palpated, the tumor invasion to inner part is not seen. So, the diagnostic imaging plays an important role. It is difficult to diagnose metastases to regional neck lymph nodes and distant organs without the diagnostic imaging, which is important for planning the scope of resection and further treatment and for differentiating between normal and metastatic lymph nodes as well as between a recurrence and scars or complications after surgery or radiation therapy.
Diagnostic imaging is performed as part of the routine work-up in the maxillary carcinoma. However, it is difficult to interpret the results at the early stages of the disease.
The following imaging modalities are used in a diagnosis of the maxillary carcinoma; panoramic radiographs, computed tomography(CT), magnetic resonance imaging, PET or PET/CT and ultrasound.
The objective of this article is to describe the maxillary carcinoma as it appears in different imaging methods considering both their advantages and limitations.
Partial maxillectomy is a common procedure for maxillary squamous cell carcinoma. In order to perform a partial maxillectomy safely, accurate knowledge of the clinical anatomy and precise radiological imaging of the tumor is important. Anatomically, maxilla is divided between the front and back according to the development of the primary palate and secondary palate. Furthermore, understanding of the anatomical positioning of the pterygopalatine fossa, infratemporal fossa, masticator space and buccal space is also needed. Currently i mage modality types such as panoramic radiographs, contrast-enhanced computed tomography, contrast-enhanced magnetic resonance imaging, or positron emission tomography are used to detect the extent of tumor infiltration. According to such evaluations, the therapeutic strategy for maxillary squamous cell carcinoma is determined. In cases of surgery, deciding whether to make an intraoral or extraoral incision is required. We use the Weber-Furgeson incision for extraoral operations. When performing a partial maxillectomy, sectional resection in consideration of the anatomical barrier according to extent of the tumor should be applied. On the other hand, chemo-radiotherapy is recommended for non-surgical indications of maxillary squamous cell carcinoma. Common treatment strategies by the national comprehensive cancer network(NCCN) clinical practice guidelines should be followed. Regarding reconstruction after partial maxillectomy, there are various opinions. A maxillary prosthesis, either free flap or osteocutaneous flap, is selected to improve oral functions. In conclusion, treatment for maxillary squamous cell carcinoma varies from tongue and mandible squamous cell carcinoma. Success in surgery can be achieved by taking advantage of a logical and detailed analysis, skilled techniques in surgery and proper selection of better instruments.
Medication-related osteonecrosis of the jaw(MRONJ) is a severe adverse event of antiresorptive therapy with bisphosphonate and denosmab and antiangiogenic therapy with VEGF inhibitors. We treated patients with MRONJ in accordance with the recommendations of the Position Paper published by the American Association of Oral and Maxillofacial Surgeons in 2007. To investigate whether the treatment protocol is optimal, we studied a series of patients with MRONJ treated in Yamaguchi University Hospital and report our clinical findings.
MRONJ was diagnosed in a total of 55 patients from September 2009 through December 2014 in Yamaguchi University Hospital. Conservative treatment was given to 4 patients with Stage 0 MRONJ, 6 patients with Stage 1 MRONJ, and 39 patients with Stage 2 MRONJ. All patients with stage 0 disease had full remission. Clinical symptoms improved in 3 of 6 patients with Stage 1 MRONJ and were stable in the other 3 patients. Among the 39 patients with Stage 2 MRONJ, remission was obtained in 5 patients, improvement in 5 patients and stable disease in 17 cases. The condition of the other 12 patients with stage 2 MRONJ exacerbated. Surgical procedures were performed in 11 of these patients, and 9 patients had remission, 1 had improvement, and 1 had exacerbation. Stage 3 MRONJ was diagnosed in 6 patients, among whom 3 patients underwent surgery. After surgery, 2 patients with stage 3 MRONJ had remission, and the other patient showed improvement.
In conclusion, the results of this series of patients with MRONJ suggest that the treatment protocol based on the Position Paper published in 2007 is reasonable, with the exception of patients who had stage 2 MRONJ that did not respond to conservative treatment. Further studies are necessary to investigate the indications of surgical procedures for Stage 2 MRONJ.
Bullous pemphigoid (BP) and mucous membrane pemphigoid (MMP) are autoimmune subepidermal blistering diseases caused by autoantibodies against basement membrane proteins. BP is clinically characterized by tense blisters within the basement membrane zone of the skin. The mucous membranes are also affected in 10％ to 20% of patients with BP. In contrast, MMP predominantly affects the mucous membranes. The skin is involved in 25％ to 35% of patients with MMP. These patients present to oral surgery institutions because of the onset of oral manifestations as initial symptoms.
We clinically studied 14 patients who presented to our department and were then given a diagnosis of BP(4 patients) or MMP(10 patients) in cooperation with dermatologists between May 2012 and March 2016. Among the 14 patients, 75% of the BP cases and 50% of the MMP cases were correctly diagnosed on the basis of the clinical findings, histological analysis, and the detection of IgG autoantibodies against BP180NC16A in sera on enzyme-linked immunosorbent assay. Because oral mucous lesions in pemphigoid diseases seldom show typical blister formation, we need to consider differential diagnoses of oral mucous diseases. On the other hand, direct immunofluorescence(DIF) and indirect immunofluorescence(IIF) led to a definitive diagnosis in 100% of the patients with BP and 80% of the patients with MMP. DIF and IIF were performed promptly in cooperation with dermatologists in our hospital and enabled early diagnosis in nearly all patients, thus facilitating the early initiation of treatment. In the dental department, we continued oral examinations and management. We endeavored to assess treatment efficacy, choose topical agents, and maintain oral hygiene. Lesions consequently improved in all patients. This study indicated that DIF and IIF were beneficial in definitively diagnosing BP and MMP. Oral surgeons should be familiar with the characteristics and clinical findings of BP and MMP to facilitate the diagnosis and treatment of these diseases.
Acute respiratory distress syndrome(ARDS) is a life-threatening clinical syndrome characterized by hypoxemia and pulmonary edema not fully explained by cardiac failure or fluid overload, caused by various underlying conditions. ARDS has a high mortality rate of 27 to 45 percent. It may be caused by odontogenic infection, but very few patients with ARDS caused by infection after tooth extraction have been reported. Here, we report the case of a patient who had ARDS caused by phlegmon after tooth extraction.
Nodular fasciitis is a reactive proliferative lesion or a benign tumor of fibroblast cells in the subcutaneous tissues. It usually arises in the subcutaneous fascia of the extremities and trunk, but rarely occurs in the oral cavity. It is frequently found to be a rapidly growing mass; hence, care should be taken not to misdiagnose it as a malignant neoplasm. In this report, we describe a case of nodular fasciitis arising in the buccal mucosa of a 24-year-old woman. Intraoral examination revealed a 10-mm elastic, soft nodular tumor in the left buccal region. The overlying mucosa was normal in appearance. The lesion was resected with the patient underwent under general anesthesia in September 2014. Histopathological examination of the surgical specimen revealed a nodular lesion composed of proliferating immature fibroblasts, accompanied by capillary growth and inflammatory cell infiltration. The lesion was finally diagnosed as nodular fasciitis. As of 1 year postoperatively, there has been no sign of recurrence thus far.
Composite hemangioendothelioma is a rare vascular neoplasm of intermediate malignant potential, characterized by complex admixtures of benign, intermediate, and malignant vascular components. Here we describe a case of composite hemangioendothelioma arising in the tongue. An 81-year-old man presented with a several-day history of a mass in the right edge of the tongue. On presentation, a painless, blue-violet, wellcircumscribed tumor mass measuring approximately 10 mm in diameter was found in the right edge of the tongue. Coloration of the mass faded on pressure. There was no swelling or tenderness of the lymph nodes. The mass was surgically excised, including the normal tissue. On histopathological examination, the tumor comprised retiform hemangioendothelioma, epithelioid hemangioendothelioma, and cavernous hemangioma. We diagnosed composite hemangioendothelioma based on the admixture of multiple vascular lesions. There has been no evidence of recurrence or metastasis as of 2 years postoperatively.
Odontogenic myxoma is a relatively rare lesion in the oral and maxillofacial region, and it is a locally invasive tumor. We report a case of odontogenic myxoma that extended into the maxillary sinus in a child who was successfully treated by extirpation and curettage. A 12-year-old girl complained of a swelling in the left cheek region. An elastic-hard swelling measuring approximately 40 × 50 mm was found in the left maxillary region. The clinical diagnosis was an odontogenic myxoma of the left maxillary region. Radiographic and computed tomographic examinations showed an aggressive tumor widely extending into the maxillary sinus and left palatal region, with partial radiopacity in the central region. A pathological diagnosis of odontogenic myxoma was made on a biopsy examination. We extirpated the lesion and performed curettage with the patient under general anesthesia. The patient has had no sign of recurrence for 53 months.