Recently, cooperation between medical and dental care is considered very important in regional comprehensive medical and welfare services. The department of dentistry of a hospital is highly expected to contribute to these social services. However, accurate data on promotional activities by dentistry-related departments, the numbers of full-time dentists, and the actual status of clinical activities are unavailable. We therefore carried out a questionnaire survey to investigate such information and assess the current status of dental departments in hospitals with 250 or more beds.
With the exception of medical and dental university hospitals, we mailed questionnaires to 1,842 hospitals with 250 or more beds that were registered as medical insurance facilities in the seven Regional Bureaus of Health and Welfare in December 2015.
The results were as follows. (1) No responses were obtained from 783 of the 1,842 facilities. The response rate was therefore 42.5%. (2) Among the 783 facilities, 549 facilities (70.1%) promoted their dental-related departments and 231 facilities(29.5%) did not. (3) The proportion of facilities that promoted their dental-related departments increased in parallel to the numbers of beds. For example, the promotion rate was 90% or higher in hospitals with 500 or more beds. (4) The proportion of hospitals that promoted their “departments of dentistry” was higher in facilities with low numbers of beds. In contrast, the proportion of hospitals that promoted their “Departments of Dental and Oral Surgery” increased in large facilities with 500 or more beds. (5) Among the 542 facilities that had dental-related departments, 390 facilities (72%) performed both outpatient and inpatient care. (6) In the 542 facilities, the average number of full-time dentists was 2.5, the average number of full-time dental hygienists was 3.0, and the average number of full-time dental technicians was 0.5. Moreover, the most common number of full-time dentists was 2. (7) Regular members of the Japanese Society of Oral and Maxillofacial Surgeons (JSOMS) served in 440 (81.2%) of the 542 facilities.
A survey reported by the Ministry of Health, Labour and Welfare in 2013 stated that the average number of full-time dentists in moderate-size hospitals was 5 or more. Our survey, however, revealed that the actual average number of full-time dentists was about 2.5 persons in hospitals with 250 or more beds. We confirmed that these data should be useful as basic documentation for promoting new departments of dentistry and oral surgery or for requesting increases in dental staff in hospitals.
We report a case of myxofibrosarcoma of the maxillary bone that showed extensive resorption of bone as an initial symptom. A 20-year-old man was referred to our hospital because of mobility of the right upper molar teeth. Computed tomography showed bone resorption of the right maxilla. An initial biopsy revealed the presence of inflammatory granulation tissue. Seven months after the first examination, newly formed bone appeared in the right maxilla. Subsequently, however, the patient stopped the examinations. Two years after the first examination, he revisited our hospital because of swelling of the right maxilla with spontaneous pain. A biopsy specimen was diagnosed as low-grade fibromyxoid sarcoma. Because surgical treatment was difficult, the patient received heavy particle radiotherapy in another facility. The tumor of the right maxilla then disappeared. However, wide bone necrosis and rupture of an internal carotid artery occurred as an adverse effect of the treatment. Three years 9 months after the first examination, the patient died of carcinomatous peritonitis. After death, application of new immunostaining and genetic analyses excluded the initial diagnosis. Instead, myxofibrosarcoma was diagnosed. In addition, we found a change from low-grade to high-grade malignancy.
Osteomyelitis of the mandible commonly occurs in the mandibular body and is rarely seen in the mandibular condyle. We report a case of actinomycotic osteomyelitis extending from the mandibular ramus to the condyle in a child. A 15-year-old girl was referred to our hospital because of swelling and pain in the left buccal region. Computed tomography (CT) revealed bone resorption and periosteal reaction from the left temporomandibular joint region to the mandibular notch and coronoid process. Based on the CT and magnetic resonance imaging findings, we suspected actinomycotic osteomyelitis of the mandible and then administered penicillin. An abscess was detected in the left parotid masseter region after starting penicillin administration, and necrotic tissue debridement was performed. A group of actinomycetes was identified in the sampled specimen. New bone formation was observed on post-treatment CT, and 99m Tc bone scintigraphy uptake was reduced. Antibiotic treatment was therefore discontinued after approximately 5 months. The patient is currently recovering well without any signs or symptoms of recurrence
Double cancer refers to primary cancers arising in different organs and is classified into synchronous and metachronous types depending on the temporal relation between tumor occurrence and the occurrence interval. The disease is often regarded to be synchronous in cases in which the secondary cancer was demonstrated to have developed within 1 year after the primary cancer and metachronous in cases in which the interval was more than 1 year. In patients with double cancers, it is required to conduct appropriate surgery and strictly manage the postoperative course while considering the degree of malignancy based on the results of early diagnostic examinations. We describe our experience with a synchronous double cancer in a 59-year-old man in whom duodenal cancer was detected during a work-up for a tumor lesion arising in the left side of the palate. The malignant palatine tumor was resected, and the patient was diagnosed with acinar cell carcinoma. The biliary tract cancer was resected through removal of the head of the pancreas and duodenal papilla, as well as liver bed resection; the patient was diagnosed with well-differentiated tubular adenocarcinoma. The palate tumor was diagnosed to be acinar cell cancer. The patient had a past medical history of another synchronous double cancer developing in the bladder and kidney 7 years previously. This was thus a rare case of metachronous double cancers involving 4 organs. The patient has not exhibited recurrence or metastasis as of 4 years and 9 months postoperatively.
Spindle cell carcinoma is a tumor histologically characterized by polymorphic cells comprising mainly spindle-shaped cells that proliferate and present with an image reminiscent of sarcoma. Reports of this carcinoma in the oral cavity region are rare, and there have been no reports, either in Japan or in other countries, of metastasis to the thyroid gland. The authors encountered a case in which spindle cell carcinoma recurred after resection and metastasized to the thyroid gland and describe the outcome. The patient was a 76-year-old man with spindle cell carcinoma of the mandibular gingiva who underwent resection of the borders of the mandible, supraomohyoid neck dissection and reconstruction using a free forearm flap. Eleven months later, however, localized recurrence of the carcinoma was seen in the medial pterygoid muscle. The patient underwent surgery again, followed by postoperative radiotherapy alone. Because metastasis to the right lobe of the thyroid gland was observed, however, the patient underwent total thyroidectomy. One year 5 months after surgery, the patient is doing well, with no further recurrence or metastasis.
Although rare, several cases of sialolith formation around a foreign body have been reported. We report a case of sialolith in the submandibular gland duct, which was suspected to be formed around the nucleus of a fish bone. The patient was a 56-year-old man. His chief complaints were swelling of the right submandibular region and pain while eating. Computed tomography revealed a calculi-like radiopaque substance in the right oral floor region, and sialolithiasis of the right submandibular gland was diagnosed. The sialolith was surgically removed by intraoral incision. Examination of the removed specimen revealed a transparent stick-like material wrapped in the sialolith. The foreign body was histopathologically diagnosed to be bone tissue. On discussion with the patient, he was found to be eating fish every day. Therefore, the foreign body was considered to be a fish bone. However, it was unclear how the fish bone entered Wharton’s duct.
Hypomelanosis of Ito (HI) is a rare neuroectodermal disorder first described by Ito in 1952. We report the case of a boy with unusual facial features, cranial asymmetry, right cleft lip and alveolus, and submucous cleft palate who underwent cheiloplasty for right cleft lip and rhinocanthectomy 3 months after birth. At the age of 1 year, cranial deformation and ventriculomegaly of right cerebral hemisphere were diagnosed on head computed tomography. As a result of a detailed examination, he was given a diagnosis of HI because of hypomelanosis of right face, ventriculomegaly of right cerebral hemisphere, right hemihypertrophy, and psychomotor retardation. At the age of 1 year 9 months, palatoplasty and rhinoplasty were performed. Because HI with ventriculomegaly of the cerebral hemisphere and cleft lip and palate is rare, neurological abnormalities such as psychomotor retardation should be evaluated in depth if skin abnormalities such as hypomelanosis appear.
The -D- blood type is rare. As blood transfusion and pregnancy frequently cause irregular antibodies in patients with the -D- blood type, blood transfusions require the use of the same -D- type blood. Here, we report a case of tongue carcinoma in a patient with the -D- Rh blood type, in whom we performed surgery using preoperatively collected autologous blood. The patient was a 79-year-old woman who was referred to our department with the chief complaint of pain at the left margin of the tongue. On the basis of biopsy and imaging examinations, she was given a diagnosis of squamous cell carcinoma (T2N0M0) , but interviews and blood examinations revealed that the patient had blood type -D-. Therefore, after preservation of 760 mL of autologous blood and 2 units of thawed erythrocyte fluid of the same blood type, left supraomohyoid neck dissection, partial glossectomy, and reconstruction using a pectoralis major musculocutaneous flap were carried out. During surgery, the reconstruction method was changed to a forearm skin flap because of poor circulation of the musculocutaneous flap. The operation time was 20 hours, with blood loss volume of 360 mL. A total of 360 mL and 400 mL of autologous blood were transfused intraoperatively and postoperatively, respectively, but the thawed red blood cell fluid was not used. After the operation, anemia gradually improved, and there were no hemolytic transfusion side effects.
The 2017 WHO classification of Head and Neck Tumors defines solitary intraosseous neurofibroma of the maxilla (SINM) as an admixture of Schwann cells, fibroblasts, perineurial cells, and axons. Abundant soft tissue is observed in the oral and maxillofacial region, and occurrence in the mandible, and especially in the maxilla, is extremely rare. We report a case of SINM occurring in the anterior tooth region of the maxilla. The patient was a 50-year-old woman who had discomfort in the anterior teeth of the left side of the maxilla and was referred to this department by her personal physician. A biopsy was performed, and a neurogenic tumor was suspected. Maxillary tumor resection and bone transplantation were performed with the patient under general anesthesia. The histopathological examination showed strong positivity for vimentin and positivity for S100 and NSE, and neurofibroma was diagnosed. Two years 7 months have passed since surgery, and there has been no sign of recurrence.