Causes of dysphagia in elderly people are various, and declining swallowing function may cause aspiration pneumonia. Therefore, it is important to properly evaluate oral function and swallowing function of patients with dysphagia in hospitals, nursing home and in-home. In this paper, we introduce videoendoscopic evaluation of swallowing (VE) that is useful for home-visit care, and our recent research, and medical resources for swallowing.
A 44-year-old woman had been monitored by her previous doctor for the progression of oral candidiasis and hyperkeratosis in the molar region of the left mandibular gingiva for 4 years. Tissue biopsy of an exophytic growth revealed squamous cell carcinoma, and she presented to our department for radical treatment. Furthermore, her son had a STAT1 gene abnormality, which is responsible for chronic mucocutaneous candidiasis (CMC). The patient had the same abnormality and was given a diagnosis of CMC. At the first visit to our department, the exophytic tumor had progressed to 25 × 15 mm with possible lymph node metastasis in the left submandibular region. Therefore, gingival carcinoma (cT2N1M0) was diagnosed. Screening of the upper digestive tract revealed thoracoesophageal carcinoma (cT1N0M0). Therefore, radical surgery for these carcinomas was performed on the same day after discussions with gastroenterological surgeons.
Postoperatively, the patient’s condition was good, and the gingiva and esophageal carcinomas are currently under control for 2 years. However, the patient is being carefully monitored owing to the presence of CMC, which acts as a carcinogen.
A pleomorphic lipoma is a rare benign lipomatous tumor that has been defined by Enzinger as a new lipomatous entity. Pleomorphic lipoma mainly arises in the subcutaneous tissue of the neck and shoulders in elderly men, with relatively few reported cases of the tumor in the oral maxillofacial region. We report a case of pleomorphic lipoma arising in the left hard palate mucosa of a 67-year-old man. The lesion was a tender, sharp and pedunculated mass measuring 7 × 7 mm. The tumor was surgically removed including the surrounding normal tissue, and the histopathological diagnosis was pleomorphic lipoma. Microscopic examination histologically revealed a subepithelial admixture of mature adipose tissue and overgrowth of fibrous tissue, scattered with CD34-positive large and multinucleated cells. Four years after surgery, the patient remains recurrence-free and has a good clinical course.
We describe our experience with a case of deep neck abscess induced by periodontitis of the mandibular canine tooth with internal jugular vein thrombophlebitis.
A 77-year-old woman was referred to our hospital because of swelling of the right cheek. Computed tomography (CT) revealed gas bubbles and abscesses from the infratemporal fossa to the lower pole of the thyroid, especially in the retrovisceral space and carotid sheath. The patient was immediately hospitalized to control the infection. We performed a surgical incision and drainage of the abscess to reduce inflammation, and antibiotics were given for 44 days. Moreover, internal jugular vein thrombophlebitis arose from an extended carotid sheath abscess on hospital day 7. We therefore additionally administered anticoagulant therapy. The thrombophlebitis disappeared on hospital day 51. All symptoms improved, and she was discharged after 85 days.
Cytomegalovirus (CMV) is a member of the herpes virus family. Typically, CMV infections pass as a subclinical infection and seldom appear. Here, we report a case of stomatitis with CMV infection in a patient with anaplastic large cell lymphoma (ALCL) after allogeneic bone marrow transplantation (allo-BMT). A 30-year-old woman was given a diagnosis of ALCL in 2011; therefore, she underwent conditioning therapy, allo-BMT, and received immunosuppressive drugs. She had diarrhea, skin erythema, and stomatitis and was given a diagnosis of acute graft-versus-host-disease (GVHD). Accordingly, steroids were administered. Nevertheless, as stomatitis worsened, she was referred to our department. Clinical examination revealed erosion and ulceration on the tongue and buccal mucosa, resulting in the diagnosis of stomatitis with acute GVHD. The use of immunosuppressive drugs and local irrigation was continued. The results for CMV antigenemia and quantification assays were positive on post-BMT day 78. On suspecting stomatitis with CMV infection, a biopsy of the ulcer on the dorsum of the tongue was performed. The histopathological examination revealed stomatitis with CMV infection. Stomatitis was managed with valganciclovir, with no recurrence.
Aneurysmal bone cyst (ABC) is considered a benign osteolytic lesion and often arises in long bones and the vertebral column. ABC rarely arises in the mandibular condyle, and only 16 cases have been reported to date. In this report, we describe a case of ABC arising in the mandibular condyle. A 35-year-old man was referred to our hospital because of a swelling in the right temporomandibular region. Clinical examinations revealed a multilocular radiolucent lesion measuring about φ 20mm in the right mandibular condyle. After virtual operation with a 3D model, we resected the lesion and reconstructed the region with a titanium plate with the patient under general anesthesia. Although there have been no signs of recurrence or functional disorder 12 months after surgery, longer follow-up is required.
A case of multiple sialolithiasis in the submandibular gland and duct is reported. A 71-year-old man was referred to the Department of Oral and Maxillofacial Surgery in our hospital. He had no symptoms in the right submandibular region, but panoramic radiography and computed tomography showed multiple calculi in the right submandibular gland and duct. The patient underwent excision of the right submandibular gland with Wharton’s duct including multiple stones. A total of 332 sialoliths were detected, and the submandibular gland tissues were normal histopathologically. The postoperative period was uneventful, and the patient recovered without any complications. This is a rare case with the largest number of sialoliths ever reported.