Advances in digital technology are phenomenal and accelerate further, and medical technology and surgical technique are also entering a new stage. Digital data can be reproduced and reproduced with the same precision at any time, any number, at the same time, and has much more convenience and usefulness than conventional analogs. In the fields of oral and maxillofacial surgery, many new digital technology are being developed such as CAD/CAM, navigation surgery, guided surgery, delivery system, custom made medicine, virtual reality, application to education and training, robot surgery, AI etc. It will merge with regenerative medicine, nanotechnology, genetic engineering etc., and it will become more generalized. New ideas and countermeasures based on the situation are required.
Bypass therapy using recombinant activated factor Ⅶ (rFⅦa) or activated prothrombin complex concentrate (APCC) is effective for hemostatic treatment in acquired hemophilia A. We report the case of a 78-year-old man who presented with severe oropharyngolaryngeal hematoma after tooth extraction despite using rFⅦa to manage acquired hemophilia A.
He was referred to our department because of tenderness of the tongue caused by a metal crown of the left mandibular first molar. About 3 months before our first medical examination, the patient was given a diagnosis of acquired hemophilia A, for which he had subsequently received corticosteroids and had undergone bypass therapy using APCC in the Department of Hematology of our hospital. Panoramic radiography revealed chronic apical periodontitis of the same tooth. We consulted a hematologist. For hemostatic management, rFⅦa preparations were transfused before and after the extraction procedure. However, submucosal hematoma and edema developed in the oral floor the next morning and advanced to the root of the tongue and epiglottis on the following 2 days. We urgently performed intratracheal intubation. After that, rFⅦa preparations were transfused every 3 hours, and the patient was extubated 12 days after tooth extraction.
We report a case of desmoplastic ameloblastoma (DA) arising in the maxilla, which was reconstructed using a custom-made titanium mesh tray with particulate cancellous bone and marrow (PCBM) after an autogenous iliac bone graft. The patient was a 35-year-old man who was referred to our outpatient clinic to undergo assessment of a maxillary tumor. A swelling was found between the left lateral incisor and premolars. Radiographic findings showed a “frosted glass-like” lesion. We diagnosed DA on an incisional biopsy. Maxillectomy and reconstruction with an autogenous iliac bone graft were performed in June 2013. In addition, reconstructive surgery using a custom-made titanium mesh tray with PCBM was performed subsequently. After the operation, we placed dental implants and provided the final prosthesis. There has been no recurrence of tumor as of 5 years after the maxillectomy and reconstructive surgery. Furthermore, a good esthetic outcome with recovery of the occlusion function was obtained.
We report a case of osteochondroma of the coronoid process accompanied by long-term restricted jaw opening. The patient, a 51-year-old man, was referred to our hospital because of a 31-year-history of limited mouth opening. The maximum interincisal opening was 20 mm. Panoramic radiography showed a radiographic opacity in the tip of left coronoid process extending to the zygomatic arch. CT showed a left enlarged fungiform coronoid process and deformation of the zygomatic arch. The left coronoid process was excised by an intra-oral approach. Two years and six months postoperatively, the maximum interincisal opening was 42 mm, and there has been no recurrence of the tumor.
We report on a 68-year-old man in whom a catheter-related bloodstream infection associated with an aortic aneurysm developed after intra-arterial chemoradiotherapy for buccal mucosa cancer. On the 18th day of concurrent intra-arterial chemoradiotherapy, he had a fever (body temperature 40°C) associated with an increased white blood cell (WBC) count. Venous blood was collected, and Meropenem was administered after a blood culture (MRSA negative) was performed. A slight fever continued, and intra-arterial catheter infection was suspected. On the 29th day of concurrent intra-arterial chemoradiotherapy, the superficial temporary artery catheter was removed (MRSA negative) with re-catheterization of the occipital artery. Thereafter, an intra-arterial catheter infection was newly suspected on the 15th day after re-catheterization, and the intra-arterial catheter was removed( MRSA detected). Following intra-arterial catheter removal, inflammatory findings tended to improve. On the 15th day after intra-arterial catheter removal, the patient complained of abdominal distention and pain. The WBC and CRP were elevated, and an infected abdominal aortic aneurysm was diagnosed on computed tomography. Abdominal pain worsened even during treatment with vancomycin, and the patient was transferred to a high-level care facility. Owing to the suspicion of impending rupture of the abdominal aortic aneurysm, emergency abdominal aortic resection of the infected segments and autologous vein graft replacement surgery were performed. He showed satisfactory progress thereafter and was discharged 3 weeks after operation.
Dermoid cysts in head and neck region are relatively rare. We report the case of a sublingual and submental type of dermoid cyst arising in an infant. A 5-year-old boy was referred to our department by his pediatrician because of a swelling in the submental region. MRI examination revealed a T1-low and T2-high cystic lesion in the submental and sublingual regions. The lesion penetrated the mylohyoid muscle. The cystic lesion was removed surgically with the patient under general anesthesia. Histopathologically, the cyst wall was lined with stratified squamous epithelium and contained skin appendages such as hair follicles and sebaceous and sweat glands. Histopathological diagnosis of a dermoid cyst was made. The postoperative course was uneventful.
Myoepithelioma is a rare salivary gland tumor that arises mainly in the parotid gland and palate. We report a case of myoepithelioma in the buccal space. A 54-year-old woman presented with a painless elastic-hard mass in the right buccal space. The mass was well defined and showed no ulcer in buccal mucosa. Excisional biopsy was performed under the clinical diagnosis of a tumor in the buccal space. Macroscopically, the tumor was solid and nodular, surrounded by a thin fibrous capsule. Histopathologically, the tumor consisted of spindle cells. Immunohistochemical staining was positive for α-SMA, calponin, CK14, p63, vimentin and S-100 protein. The tumor was diagnosed as a myoepithelioma (spindle cell type) arising in the buccal gland. Healing was uneventful, and no recurrence was noted after 2 years 9 months of follow-up.