Guideline to prevent surgical site infection was published from Japanese society of surgical site infection and Japanese society of antibiotics chemotherapy in 2016. In the guideline, antibiotics prophylactic regimen has described in the all field of surgeries including oral surgery and dentistry. In 2018, Japanese society of cardiology published revised version of ‘Prevention and treatment of infective endocarditis (IE)’. In the guideline, antibiotics prophylaxis of IE in dentistry has described extensively. Since proper use of antibiotics for prevention of antimicrobial resistant bacteria production in oral surgeries has not been discussed sufficiently, we oral surgeons should understand the importance of proper antibiotics prophylaxis in oral surgery in accordance with these new guidelines.
Peripheral giant cell epulis is rare in Japan; its prevalence is higher in Western countries. We report on a patient with giant cell epulis and severe hemorrhage-associated anemia. A 39-year-old man with a history of kidney transplantation due to chronic renal failure noticed a swelling in the region of his left mandibular third molar 3 months before his initial visit. However, he did not receive any medical intervention. The site bled repeatedly, and the patient consulted the department of internal medicine. Severe anemia (hemoglobin: 6.1 g/dL) was noted, and the patient was referred to our department for treatment. An exophytic, dark purple growth (approximately 40 × 25 mm) was noted in the left mandibular region, spanning the distance between the second and third molars. After a blood transfusion, the base of the tumor was ligated to ensure hemostasis, and a biopsy was performed. Upper and lower endoscopy was performed to determine other possible hemorrhagic sites; however, no additional lesions were noted. After his anemia improved, tumor resection and extraction of the left mandibular first, second, and third molars were performed with the patient under general anesthesia. Histopathological examination of the tumor confirmed the diagnosis of giant cell epulis. After the first postoperative year, no lesion recurrence has been observed.
Ghost cell odontogenic carcinoma (GCOC), a malignant counterpart of calcifying odontogenic cyst (COC) and dentinogenic ghost cell tumor (DGCT), is extremely rare. We report the case of a large GCOC arising in the mandible. A 50-year-old woman was referred to our hospital because of swelling of the left side of the mandible. Biopsy yielded a diagnosis of odontogenic carcinoma. Imaging findings revealed an extensive radiolucent lesion causing bony destruction of the mandible. In December 2014, we performed bilateral neck dissections and a segmental mandibulectomy with metal plate reconstruction using a fibula osteoseptocutaneous flap. Histopathologically, the lesion was diagnosed as GCOC because it consisted of malignant epithelial tumor and benign features of COC or DGCT. After operation, there has been no sign of recurrence or metastasis for 2 years 6 months.
Sialoliths commonly occur in the submandibular grand, and parotid gland sialoliths are rare. We report the endoscopic removal of a parenchymal sialolith of the parotid gland. A 56-year-old man with right parotid swelling was referred to our department for endoscopic removal of a parenchymal sialolith of the parotid gland. Computed tomography showed that the parenchymal sialolith measured 3.6 × 2.5 × 1.7 mm. Diagnostic sialendoscopy was performed with the patient under local anesthesia, and the parenchymal sialolith was found in the endoscopic view. Therefore, the patient underwent endoscopic removal of the sialolith under general anesthesia as minimally invasive surgery. Complete removal was performed using a microbur and basket, and the postoperative course has been uneventful for 1 year 9 months.
We report a case of lower gingival carcinoma with severe myocardial ischemia that developed during surgery. An 82-year-old man was referred to our hospital because of pain after tooth extraction. The patient had a history of coronary artery bypass graft surgery for angina pectoris 10 years previously and had stable ischemic heart disease. The preoperative laboratory data and the physiological and imaging findings were unremarkable. We planned tumor resection, including mandibular segmental resection and neck dissection, followed by reconstruction with a fibula flap. However, severe myocardial ischemia developed after tumor resection and neck dissection. Intra-aortic balloon pumping was applied to decrease cardiac load and maintain the circulation. Cardiac function recovered, and reconstruction was done using a pectoralis major musculocutaneous flap with plate fixation to minimize surgical invasiveness and decrease the surgical duration. This revised procedure was completed uneventfully, and the patient recovered without further myocardial ischemia or any other sequelae. The patient is currently doing well with no local tumor recurrence or angina pectoris.
Perineurioma is a tumor that originates from the proliferation of perineurial-like cells and is classified into soft tissue perineurioma, which grows on the soft tissue rather than along the nerve, and intraneural perineurioma, which develops within the nerve. Perineurioma is uncommon, and reports of its occurrence in the oral cavity area are exceedingly rare. We describe our experience with a case of intraneural perineurioma derived from the inferior alveolar nerve that developed in the mandible and was resected by sagittal split ramus osteotomy. Here, we report a summary of our experience. A 41-year-old woman visited a clinic to undergo detailed examination of the radiolucent right mandibular ramus. A biopsy was performed, and a neural tumor was diagnosed. The tumor was resected by sagittal split ramus osteotomy with the patient under general anesthesia. Histopathological diagnosis of the resected specimen definitively identified the tumor to be intraneural perineurioma. Sagittal split ramus osteotomy was extremely effective for resection of the neural tumor derived from the inferior alveolar neurovascular bundle. Postoperatively, her occlusion is stable, and she has made satisfactory progress without recurrence as of 24 months after operation.
Lowe syndrome is an X-linked recessive inheritance disease characterized by congenital cataracts, intellectual disability, and renal failure. We report a case of Lowe syndrome associated with congenital missing teeth, impacted teeth, and dentigerous cysts. The patient was a 16-year-old boy seen for pediatric dental management. A panoramic radiograph showed numerous lesions, including missing bilateral mandibular first and second premolars, impacted maxillary bilateral canines and left second premolar, and radiolucent lesions around both mandibular third molars. Based on computed tomographic findings, the radiolucent lesions were suspected to be dentigerous cysts or keratocystic odontogenic tumors. With the patient under general anesthesia, bilateral extraction of the mandibular third molars and extirpation of the cysts were performed. The pathological diagnosis of both lesions was dentigerous cysts. The postoperative progress was good, but expansion of radiolucent areas was detected around both maxillary third molars 2 years after the operation. Bilateral extraction of the maxillary third molars was performed with the patient under general anesthesia. The pathological findings led to the diagnosis of hyperplastic dental sacs as opposed to dentigerous cysts. There have been no clinical or radiographic signs of cyst recurrence and no change in the position of the unerupted teeth during 5 years of follow up.
We report a case of intraosseous lipomas arising in the mandible. A 68-year-old man was referred to our department for evaluation of a radiolucent lesion in the right side of the mandible. The face was symmetric. No swelling of cervical lymph nodes or hyposthesia of the right lower lip was noted. The oral mucous membrane was normal despite many residual roots, and no bone eminence was palpable in the right side of the mandible. Panoramic radiography and computed tomography revealed a unilocular radiolucent lesion measuring 30 x 20 mm at the border of the right side of the mandible. On magnetic resonance imaging, the lesion showed signal intensity as high as that of fat tissue on T1- and T2-weighted images, and the signal intensity was reduced by fat suppression on T2-weighted images. The lesion was diagnosed as an intraosseous lipoma in the mandible and was extirpated via a submandibular approach with the patient under general anesthesia. The surgical specimen was elastic soft and yellowish. Histologically, the lesion consisted of proliferation of lobulated mature adipocytes. Degeneration of adipocytes and fibrosis and calcification were partly observed within the lesion. Nuclear atypia suggesting malignancy was not noted. On the basis of these findings, the lesion was histologically diagnosed to be a lipoma. The postoperative course has been uneventful, with no evidence of recurrence 2 years 10 months after surgery.