Eisenmenger's syndrome is defined as the process through which an established left-to-right cardiac shunt caused by a congenital heart defect results in pulmonary hypertension and eventual reversal of the shunt into a cyanotic right-to-left shunt. The risk of mortality associated with non-cardiac surgery in patients with Eisenmenger's syndrome is considerable. We describe a patient with Eisenmenger's syndrome who required the extraction of several teeth under general anesthesia.
A 45-year-old woman was referred to our department because of a toothache and decreased dietary intake. Some teeth in the upper and lower jaws were decayed and required extraction. However, the patient had Down's syndrome as a complication, and she strongly refused to treat her teeth. We decided that it was too difficult for us to extract her teeth under local anesthesia. We planned to extract the teeth with the patient under general anesthesia by closely coordinating the procedure with her pediatrician and an anesthesiologist.
Consequently, the patient was treated without substantial changes in her cardiovascular dynamics or aggravation of hypoxemia, and the perioperative period was rendered suitable by close cooperation with her pediatrician and anesthesiologist.
Osteoblastoma is a rare tumor that accounts for less than 1% of all bone tumors and is characterized by the development of osteoblasts and osteoid tissue. It is classified as an intermediate type tumor with local aggressiveness. The tumor mass is usually larger than 2 cm, and there have been no reports of large osteoblastomas in Japan in recent years. We report the case of a large osteoblastoma, including a description of the previously obtained X-ray films.
The patient was a 22-year-old man who visited our hospital with a chief complaint of swelling of the left side of the mandible. The tumor measured 40×40×30 mm, and X-ray films showed a radiolucent image including a calcified body with a clear margin. Osteoblastoma was diagnosed on the basis of two biopsies. Segmental mandibulectomy was performed with the patient under general anesthesia. There has been no recurrence after the operation, and the patient is making good progress. A panoramic X-ray film taken 7 years ago (at 15 years of age) revealed slight bone resorption resembling periodontitis in the region where the tumor had developed. Consequently, there was a high probability that this X-ray film indicated an early stage of this tumor.
Odontomas are benign tumors of odontogenic origin composed of different dental tissues, including enamel, dentine, cementum, and pulp tissue. The World Health Organization classification divides odontomas into complex odontomas and compound odontomas. Compound odontomas rarely occur at multiple sites. We report a case of multiple compound odontomas arising in the maxillary sinuses. A 21-year-old man visited a dental clinic because of the pain of the right maxillary molar region. Pulpectomy was performed for a diagnosis of pulpitis of the upper right first molar. Although the pain disappeared, panoramic X-ray examination revealed a number of small tooth-like calcified structures in the both sides of maxillary sinus floors. The patient was referred to our hospital to clarify the disorder. X-ray films and computed tomographic images showed multiple odontoma-like radiopaque structures in the both sides of the maxillary sinus floors. Surgery was performed with the patient under general anesthesia for a diagnosis of odontoma, and 17 tooth-like structures were removed. The histopathological diagnosis was a compound odontoma. Postoperatively the wounded healed uneventfully.
We report on a 96-year-old woman in whom a wooden foreign body was found in the submandibular region. She was referred to our hospital because of submandibular swelling. History taking indicated that she fell down and hit the region around the left side of the mandible in the garden at home 5 days ago. At initial presentation, a laceration about 8 mm in length with pus discharge was found in the left mental region, accompanied by swelling and redness of the left submandibular region. The clinical diagnosis was wound infection. The patient was admitted to the hospital and given antibiotics with wound washing, but swelling and pus discharge continued. A remaining foreign body was suspected, and on day 9 of hospitalization we performed debridement from the submandibular region with the patient under local anesthesia and found a 50 × 7 mm wooden foreign body. The postoperative course was good, and she was discharged on day 16 of hospitalization. Diagnosis of this case was difficult because the laceration caused by penetration of the linear foreign body was too small, and the patient was an elderly woman injured alone and did not clearly understand the situation caused by the injury.