Japanese Journal of Oral and Maxillofacial Surgery
Online ISSN : 2186-1579
Print ISSN : 0021-5163
ISSN-L : 0021-5163
Volume 65, Issue 2
Displaying 1-14 of 14 articles from this issue
Preface
Invited review article
  • Tomoki ITAMIYA
    2019 Volume 65 Issue 2 Pages 48-50
    Published: February 20, 2019
    Released on J-STAGE: April 22, 2019
    JOURNAL FREE ACCESS

    In surgical navigation, to accurately know the position of a surgical instrument in a patient’s body is very important. Using transparent smart glasses is very useful for surgical navigation because a surgeon does not need to move his/her line of sight from the operative field. We propose a new application software development method that is able to show a stereoscopic vision of highly precise 3D-CG medical models and surgical instruments using transparent smart glasses for surgical navigation. We used Mixed Reality (MR) which is a concept exceeding Augmented Reality (AR) by using Microsoft® HoloLensTM. In the operation room, the 3D-CG medical model made from patient’s CT/MRI image data is superimposed on the actual patient position. Since the positional relationship between the 3D-CG medical model and surgical instruments is clear, so it is very useful for surgical navigation. Multiple persons can see one 3D-CG medical model at the same time using multiple HoloLensTM. A user can make the application software within only 10 minutes by preparing 3D-CG medical model file. Therefore, surgeon dentists and clinical staff can make the content easily by themselves. As a result, the method can be utilized daily for routine medical treatment and education.

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Case reports
  • Masahiro SAITO, Tomonori HASEGAWA, Shuji TSUCHIDA, Takahiro WAKUI, Dai ...
    2019 Volume 65 Issue 2 Pages 51-56
    Published: February 20, 2019
    Released on J-STAGE: April 22, 2019
    JOURNAL FREE ACCESS

    We describe a case of osteosarcoma of the maxilla followed by the onset of acute lymphoid leukemia after chemotherapy in a 62-year-old woman. She complained of a pedunculated mass in the left side molar region of the maxilla. Panoramic radiography and computed tomography revealed a radiopaque lesion and a soft tissue shadow in the left side of the maxillary sinus, respectively. Continuity between bone and soft tissue shadow was not sharply delineated. Concluding a diagnosis based on these findings was difficult. We performed biopsy twice, and analyses of the biopsy specimens confirmed high-grade osteosarcoma. Three cycles of doxorubicin (Adriamycin) and ifosfamide (AI therapy) were conducted before surgery to excise the tumor that extended to the maxilla, pterygoid plate, and zygomatic bone. The same chemotherapy regimen was repeated twice after the surgical excision. After 5 months of the postoperative chemotherapy, acute lymphoid leukemia developed. Although she received appropriate chemotherapy for acute lymphoid leukemia, she died of sepsis. In patients receiving treatment for osteosarcoma, the onset of secondary leukemia after chemotherapy or simultaneous primary leukemia should be considered during the follow-up period.

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  • Satoshi FUKUZAWA, Toshihiro OKAMOTO, Yuuichi AKAGI, Kenji FUKADA, Tomo ...
    2019 Volume 65 Issue 2 Pages 57-61
    Published: February 20, 2019
    Released on J-STAGE: April 22, 2019
    JOURNAL FREE ACCESS

    We report the case of a gastric trichobezoar found during the treatment of a palatal mucoepidermoid carcinoma in a 14-year-old girl who had experienced maternal neglect. The patient had been subjectively aware of pain in the palatal region since August 2015, at the age of 14-years, but it was never treated. In December 2015, she was examined at a local dental clinic and reffered to the dental and oral surgery department of a local hospital, where a biopsy-based diagnosis of mucoepidermoid carcinoma was made. She was then referred to our department. After detailed examinations, partial maxillectomy was performed with the patient under general anesthesia in January 2016. Abdominal distension was found upon initiation of anesthesia, and it was impossible to insert a gastric tube. Therefore, upper gastrointestinal endoscopy was performed, revealing a large mass of hair. General anesthesia was judged to be manageable, and the surgery was performed. On postoperative day 13, the trichobezoar was removed via a ventrotomy with the patient under general anesthesia in the pediatric surgery department. To date, 18 months after the first operation, there has been no recurrence, metastasis, trichobezoar, or trichophagia.

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  • Kaoru MURAKAMI, Chikashi MINEMURA, Koji YAMAMURA, Yasushi KIMURA, Shum ...
    2019 Volume 65 Issue 2 Pages 62-66
    Published: February 20, 2019
    Released on J-STAGE: April 22, 2019
    JOURNAL FREE ACCESS

    Acanthomatous ameloblastoma is classified as one type of ameloblastoma. There have been only a few reports on acanthomatous ameloblastoma of the maxilla associated with bone tissue in the tumor stroma. This report describes a case of acanthomatous ameloblastoma of the maxilla with bone tissue that developed in a 25-year-old woman. The preoperative results of biopsy at another hospital showed an acanthomatous ameloblastoma. Partial maxillectomy was performed with the patient under general anesthesia in our department. Acanthomatous ameloblastoma was diagnosed on histopathological examination, and bone tissue associated with bone formation and resorption was observed in the tumor stroma. Follow-up examinations have shown no evidence of recurrence as of 7 years after surgery.

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  • Yoshihisa MORISHITA, Shintaro SUZUKI, Syogo HASEGAWA, Kie JINDO, Go KU ...
    2019 Volume 65 Issue 2 Pages 67-71
    Published: February 20, 2019
    Released on J-STAGE: April 22, 2019
    JOURNAL FREE ACCESS

    Airway stents are used to improve dyspnea caused by obstructive/stenotic tracheobronchial lesions. Tracheobronchial stenosis caused by a malignant tumor is found in tracheal, lung, esophageal and thyroid cancer. We report on a patient in whom an airway stent was used to treat tracheal stenosis caused by delayed mediastinal lymph node metastasis of tongue cancer.

     The patient was a 47-year-old-woman who was referred to our hospital for close examination and treatment of a tongue cancer. A clinical diagnosis of left tongue cancer (cT4aN0M0) was made, and we performed a left radical neck dissection, right super-selective neck dissection (level I), subtotal glossectomy, tracheotomy, and reconstructive surgery using a rectus abdominis free flap. A computed tomographic examination 12 months after surgery revealed metastasis to a superior mediastinal lymph node. The metastatic lymph node expanded, and the patient started to present with severe dyspnea due to the development of tracheal stenosis. We therefore placed an airway stent into the trachea. Airway stenting relieved symptoms of severe dyspnea, and we administered TPF chemotherapy, but it was not effective. The tracheal stent we applied enabled the patient to prolong her life for approximately 4 months before she died of the cancer.

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  • Takuma WATANABE, Takehiro WATANABE, Junya SONOBE, Kazuhisa BESSHO
    2019 Volume 65 Issue 2 Pages 72-77
    Published: February 20, 2019
    Released on J-STAGE: April 22, 2019
    JOURNAL FREE ACCESS

    Solitary neurofibroma is relatively rare. We report a case of solitary neurofibroma arising in the mucolabial fold of the maxilla. The patient was a 63-year-old man who had no symptoms, except for a painless swelling in the center of mucolabial fold of the maxilla. Intraoral examination revealed a smooth surface, mobile, well-delimited, and elastic soft mass approximately 10 mm in diameter. The clinical diagnosis was a benign tumor. An excisional biopsy of the tumor was performed with the patient under local anesthesia. The tumor did not adhere to surrounding tissues. Periosteum and a clear continuity with blood vessels and nervelike tissues were not observed. Histologically, the tumor was encapsulated and composed of proliferated spindle cells in a myxomatous stroma. Neither café au lait spots nor similar tumors were observed on systemic examination. The final diagnosis was a solitary neurofibroma. About 1 year and a half after the operation, there is no evidence of recurrence.

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  • Seiichi KUWAJIMA, Masayuki FUKUDA, Akira NAKATA, Masato YAMAZAKI, Hiro ...
    2019 Volume 65 Issue 2 Pages 78-82
    Published: February 20, 2019
    Released on J-STAGE: April 22, 2019
    JOURNAL FREE ACCESS

    Tumor-induced osteomalacia (TIO) is a rare disease associated with bone pain, walk disturbance accompanied by muscular atrophy of limbs, and malnutrition. To our knowledge, only 63 cases of TIO due to maxillofacial tumor have been reported. It is already known that the causative factor, FGF-23, is produced by tumors, resulting in TIO.

     We describe our experience with a 57-year-old woman who had swelling in the palate and walk disturbance accompanied by severe lower limb pain. Hypophosphatemia and hypocalcemia were detected on blood tests. The histopathological diagnosis of the maxillary granuloma was giant cell reparative granuloma, and partial resection of the maxilla was performed given the possibility of TIO. In the 3 weeks after surgery, pain in the lower extremity and walk disturbance improved markedly. Currently, there is no recurrence as of 3 years after surgery, and the course is good.

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  • Yuta ISOZAKI, Yosuke FUKUSHIMA, Tomohisa KITAMURA, Naoki HAYASHI, Tsuy ...
    2019 Volume 65 Issue 2 Pages 83-86
    Published: February 20, 2019
    Released on J-STAGE: April 22, 2019
    JOURNAL FREE ACCESS

    Nodal marginal zone lymphoma (NMZL) is one type of low-grade B-cell lymphoma. It is a rare disease that accounts for 1.8% of malignant lymphomas. We report a case of NMZL in submandibular region. A 52-year-old woman visited our hospital because of general malaise and swelling of the left submandibular region. Two masses about 20 mm in diameter were found in the left submandibular region. Lymphnode biopsy was performed, and the histopathological and immunohistochemical diagnosis was NMZL. Radioimmunotherapy with rituximab and ibritumomab tiuxetan was administered, and a complete response was obtained. There have been no signs of recurrence for 1 year.

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  • Yosuke KOBAYASHI, Kousuke YASUDA, Goro SUGIYAMA, Tomoki SUMIDA, Tomohi ...
    2019 Volume 65 Issue 2 Pages 87-92
    Published: February 20, 2019
    Released on J-STAGE: April 22, 2019
    JOURNAL FREE ACCESS

    In recent years, cervical necrotizing fasciitis has become rare owing to the development of antibacterial agents. However, in the worst-case scenarios, such as cases complicated by uncontrolled diabetes mellitus, death may occur. We report a case of cervical necrotizing fasciitis that was caused by an odontogenic infection and treated with negative pressure wound therapy and subsequent reconstruction of the neck skin defect with a deltopectoral skin flap. A 58-year-old man visited our hospital because of a neck swelling caused by a mandibular third molar. A computed tomographic scan showed abundant gas in the right masticatory space, both submandibular spaces, sublingual spaces, and submental spaces, and the left parapharyngeal space. Surgical debridement was performed with the patient under general anesthesia later that day. The infection was treated by continuous intravenous antibiotic administration and wound irrigation in the intensive care unit. Delayed wound healing and dysphagia were considered as potential complications because a broad skin defect on his neck remained due to the widespread infection. To promote wound closure, negative pressure wound therapy was applied on the 14th postoperative day, and a deltopectoral skin flap was placed on the 32nd postoperative day. His final assessment revealed complete recovery with no further dysphagia or other complications, and he was discharged from our hospital 51 days after admission.

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  • Takeshi KARUBE, Daisuke ARAKI, Shutaro ISHII, Katsuhiro ONIZAWA, Takaz ...
    2019 Volume 65 Issue 2 Pages 93-98
    Published: February 20, 2019
    Released on J-STAGE: April 22, 2019
    JOURNAL FREE ACCESS

    Steroid-induced osteonecrosis is a non-infectious and avascular bone-necrosis disease, which occurs in patients receiving steroids. The common site is the epiphysis of long trunk bones such as the femoral head; however, steroid-induced osteonecrosis rarely occurs in the stomatognathic system. We report a case of suspected steroid-induced osteonecrosis arising in the mandibular condyle. The patient was a 59-year-old woman, who visited a dental clinic because of right preauricular pain, swelling, and trismus. The symptoms disappeared and recurred repeatedly for 8 months. Therefore, she was referred to our hospital for further investigation. Moreover, she had undergone relatively long-term high dose steroid therapy for sudden deafness. Computed tomography revealed osteolytic changes around the right mandibular condyle. Magnetic resonance imaging revealed a lower intensity on T1-weighted images and a high intensity on T2-weighted images around the right mandible condyle area. Moreover, it showed swelling of right masseter muscle, inside and outside pterygoid muscles. Bone scintigraphy demonstrated abnormal diffuse accumulation of technetium-99m methylene diphosphonate (99mTc-MDP) in the region of the right mandible. On the basis of the imaging findings, osteomyelitis of mandible was diagnosed. We administered antibiotics and performed the following surgical treatment with the patient under general anesthesia: right mandibular segmentectomy and reconstruction with a free peroneal osteocutaneous flap. Histopathologic examination of the resected specimen revealed osteonecrosis of the mandible. There was no source of the odontogenic infection. Therefore, possible involvement of steroid-induced osteonecrosis in the development of these symptoms was assumed. The postoperative course was uneventful.

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  • Takashi OGURI, Kou KAWAHARA, Hiroaki NIWA, Tasuku ORIYAMA, Memi OHIRA, ...
    2019 Volume 65 Issue 2 Pages 99-104
    Published: February 20, 2019
    Released on J-STAGE: April 22, 2019
    JOURNAL FREE ACCESS

    Multiple endocrine neoplasia type 2B (MEN2B) is the rarest form of the disease and is known to cause multiple mucosal neuroma in the oral cavity, associated with medullary thyroid carcinoma (MTC) and pheochromocytoma (PC). We describe a 27-year-old man who was referred to our hospital after seeking medical attention of the oral cavity because of dyspnea. Immediately after his arrival, he had cardiopulmonary arrest and received life-saving treatment. On examination, the initial diagnosis was pheochromocytoma crisis attributed to PC. Further oral examinations were required for a suspected thyroid tumor to ascertain the likelihood of MEN2B. Extra-oral findings were bumpy lips, while intra-oral findings were multiple nodules on the tongue, lip mucosa, and maxillary gingiva. Since all results of the biopsy proved mucosal neuroma, the final diagnosis was MEN2B based on the fact that there was MTC. In many cases of MEN2B, neuroma of the oral mucosa often appears to multiply on visible surfaces before the actual onset of MTC, and PC and creates a characteristic complexion. To realize the early diagnosis and effective treatment of MEN2B, it is essential to be adequately aware of the relation between mucosal neuroma and MEN2B.

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  • Kazuaki HASEGAWA, Tatsuo OKUI, Soichiro IBARAGI, Yuki KUNISADA, Shoji ...
    2019 Volume 65 Issue 2 Pages 105-109
    Published: February 20, 2019
    Released on J-STAGE: April 22, 2019
    JOURNAL FREE ACCESS

    Acute hemorrhagic rectal ulcer (AHRU) is a serious disease characterized by sudden onset, painless massive bleeding from a rectal ulcer. We report a case of AHRU that developed during treatment for mandibular actinomycosis.

     The patient was a 79-year-old man. Osteomyelitis of the right side of the mandible developed after extraction of his right lower molar at a private dental clinic.

     The swelling spread from the temporomandibular joint to temporal area. Incision drainage was performed and Actinomyces israelii was detected from pus.

     Antibacterial treatment with benzylpenicillin was given to manage the right mandibular actinomycosis.

     Indolent mass melena occurred 10 days after the antibacterial drug treatment. Lower gastrointestinal endoscopy revealed an ulcer in rectum with arterial bleeding. Surgical clipping was performed.

     We diagnosed this case as AHRU caused by bedrest with the background of arteriosclerosis. Treatment with benzylpenicillin was continued for 2 weeks and followed by the administration of amoxicillin for 6 months.

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  • Shotaro HAMAMOTO, Hirofumi TOMIOKA, Misaki YOKOKAWA, Minoru IKUTA, Kei ...
    2019 Volume 65 Issue 2 Pages 110-114
    Published: February 20, 2019
    Released on J-STAGE: April 22, 2019
    JOURNAL FREE ACCESS

    We report a case of solitary plasmacytoma in the mandibular ramus that transformed into multiple myeloma. The patient was an 81-year-old man who had been aware of a left preauricular mass and was referred to our department in August 2012. A diffuse, elastic and slightly-hard tumor was recognized in the left preauricular region. Panoramic radiography showed multilocular and indistinctly circumscribed bone resorption from the left mandibular ramus to the condylar process. On computed tomography, a indistinctly circumscribed oval lesion was observed at the same region. Fine needle aspiration cytology showed proliferation of plasma cells, and the lesion was diagnosed as a IgA- λ type solitary plasmacytoma, because no evidence of multiple myeloma was found on general examination. The patient received radiotherapy; however, after 11 months the lesion transformed into multiple myeloma. Chemotherapy was administered, and complete remission was obtained. There has been no recurrence for 4 years 1 months.

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