Fractures of the mandibular condyle are common and account for 25% to 50% of all mandibular fractures. Even with the development of a consensus on the preference for open reduction and internal fixation (ORIF) of these fractures, the optimal approach to the fracture unit remains controversial. Nine patients with mandibular condylar fractures underwent ORIF using a transmasseteric anteroparotid (TMAP) approach between 2010 and 2016. Here, we describe the approach, including its surgical technique and results. The study group comprised three men and six women who were 26 to 80 years of age. A TMAP approach was indicated for subcondylar or condylar neck fractures. In most cases, successful ORIF was achieved. However, one patient had plate loss. No patient had facial nerve palsy or salivary fistula. This approach adequately exposes the fracture end, enabling completion of ORIF under direct visualization, although it does not present with a large operative field. Moreover, we can extend the skin incision depending on various fracture sites, allowing multiple directional approaches to the fracture site. A TMAP approach is considered to be one of choices for ORIF of mandibular condylar fractures and the indications of this approach should be examined more carefully.
Facial nerve palsy (FNP) following sagittal split ramus osteotomy (SSRO) is rare, but once it occurs, it can be a source of mental and social distress because of functional and cosmetic disturbances. Here, we report a case of peripheral FNP that developed after SSRO for mandibular advancement and was treated by us. The patient was a 22-year-old woman. She had a clinical history of right FNP that occurred when she underwent extraction of her right wisdom tooth before preoperative correction. She underwent bilateral SSRO via a modified version of the Obwegeser technique to correct mandibular retrognathism. The intraoperative course was uneventful. Right FNP developed immediately after the operation. Pharmacotherapy (steroids, vitamin B12, ATP, antiviral drugs) and stellate ganglion blocks (SGB) were administered to reduce the swelling around the facial nerve and promote healing of the facial nerve damage. The symptoms exacerbated 2 days after the operation, but improved from about 7 days after the operation. Given her clinical history of FNP, we thought that she had a high risk of FNP because of hematoma, edema, and local anesthesia around the mandibular ramus. We thought that facial nerve injury was probably caused by compression by the hematoma and edema formation during or immediately after the operation, direct or delayed nerve paralysis caused by the anesthetic solution, and reactivation of herpes simplex virus type 1 (HSV-1) or varicella zoster virus (VZV). The symptoms resolved completely 2 months after the operation, and treatment was completed.
Cowden's syndrome is a rare genodermatosis of autosomal dominant inheritance and variable phenotype, principally characterized clinically by multiple hamartomas in various organs, including the skin, thyroid, and gastrointestinal tract and by an increased risk for the development of malignancy. We report a case of Cowden's syndrome associated with oral squamous cell carcinoma of the lower gingiva. A 65-year-old man was referred to our hospital because of swelling of the right lower gingiva, and a biopsy of the right lower gingiva revealed squamous cell carcinoma. Preoperative upper gastrointestinal endoscopy showed multiple polypoid lesions in both the esophagus and the stomach. In addition, there were papillomatous lesions in the oral mucosa. On the basis of these clinical findings, Cowden's syndrome was suspected. Whole body positronemission tomography and computed tomography showed mass shadows in the right mandible and the right submandibular lymph nodes. Surgery was performed, and the final histopathological diagnosis was squamous cell carcinoma. Taken together, we diagnosed Cowden's syndrome accompanied by oral cancer. The patient is currently under follow-up observation in our department.
Kaposi's sarcoma (KS) is commonly regarded as an acquired immunodeficiency syndrome (AIDS)-related malignancy. It is caused by human herpesvirus 8 (HHV-8), and sexual intercourse between homosexual men is also considered to be greatly involved.
However, KS rarely develops from HHV-8 infection alone and is thought to arise from an opportunistic infection resulting from immunodeficiency, particularly human acquired immunodeficiency virus (HIV). Here, we report a case of non-AIDS-related KS of the maxillary gingiva. A 60-year-old man was given a diagnosis of KS, which was confirmed by biopsy. He presented with a painless swelling that had an unclear dark purple border from the left upper maxillary first molar to the wisdom tooth. HHV-8 infection and a reduction in CD4+ T lymphocytes were observed, but HIV was negative. Idiopathic CD4+ T lymphocytopenia was presumed to be the cause of the reduction in CD4+ T lymphocytes. Radiotherapy was performed for KS of the maxillary gingiva, and the lesion disappeared. The patient received treatment 12 years ago and currently remains free of recurrence.
We report a case of metastatic breast cancer of the mandibular condyle diagnosed by fine needle aspiration (FNA). A 76-year-old woman was referred to our hospital because of persistent pain of the right temporomandibular joint. About 3 years ago, she had undergone a mastectomy for a diagnosis of left-sided breast cancer, and had been receiving endocrine therapy as postoperative adjuvant treatment. Computed tomography (CT) revealed bone resorption of the mandibular condyle. A whole-body examination using positron emission tomography-CT (PET-CT) showed no sign of bone metastasis except in the right mandibular condyle. FNA of the mandibular condyle lesion confirmed the diagnosis of bone metastasis from breast cancer on hematoxylin and eosin staining and immunostaining. The patient was treated with a bone resorption inhibitor and endocrine therapy and she also received radiation therapy to the mandibular condyle. She has survived for more than 1 year 6 months after the definitive diagnosis. Metastatic tumors in the mandibular condyle are rare and difficult to diagnosis, but careful examinations including various imaging studies and immunostaining of FNA specimens in consideration of the history are useful for diagnosis.
Disseminated intravascular coagulation syndrome (DIC) is a pathological condition caused by various underlying diseases and is rarely encountered following hemorrhage in the oral region. In such cases, hemostasis is difficult, and the diagnosis of the causative underlying disease is important for an effective treatment. This report describes a 78-year-old man who was given a diagnosis of prostate cancer with DIC as a result of hemorrhage following tooth extraction. On the basis of the hematologic findings, DIC was diagnosed. Following the administration of a synthetic protease inhibitor and low-molecular-weight heparin, DIC improved. Subsequent examinations revealed the presence of prostate cancer and multiple bone metastases. Follow-up observations were performed at our department for 3 years after the initiation of treatment for prostate cancer, but no recurrence of DIC was noted during this period.
Oral mucosal malignant melanoma (OMM) is extremely rare and has a poor prognosis. Owing to the rarity, it has not yet been possible to establish an optimum treatment modality. The objective of this study was to evaluate the long-term efficacy of carbon-ion radiotherapy (C-ion RT) for OMM. Between 1997 and 2013, 19 patients with OMM were treated with C-ion RT alone. The patients ranged in age from 44 to 84 years (median, 69 years). Nine men and 10 women were included. OMMs were restaged in accordance with the seventh edition of the tumor-node-metastasis (TNM) staging system of the International Union Against Cancer. Before treatment, 14 patients had T3 disease and 5 had T4a disease. Three patients were classified as having N1 disease. All patients were classified as M0. The hard palate was the most frequently involved oral subsite. All patients were treated with 57.6 Gy (relative biological effectiveness) in 16 fractions. The median follow-up period was 61 months (range, 8-190 months). The 5-year local control, overall survival, and progression-free survival rates were 89.5%, 57.4%, and 51.6%, respectively. For local control and overall survival, T classification was found to be a significant prognostic factor. Grade 2 and 3 osteoradionecrosis was observed in three patients and four patients, respectively. The presence of teeth within the planned target volume was a significant risk factor for developing osteoradionecrosis. C-ion RT was a safe and effective treatment option for OMM.