Cyberknife (CK) is one of the treatment options for oral squamous cell carcinoma. However, there are few reports regarding treatment with CK in Japan, and standard criteria defining indications have not been established. We often perform radiation therapy with CK in patients who cannot undergo standard therapy because of extremely advanced disease, high-risk general conditions, refusal of surgery, or other reasons. We retrospectively assessed 32 patients treated from 2006 to 2017 and evaluated the clinical significance. Within 4 months after CK treatment, the response rate was 72%. The overall survival rates at 2 years and 5 years were 42% and 15%, respectively, and the median survival was 23 months. Clinical factors for CK treatment outcomes were explored. The results showed that primary tumor size (T classification), stage, irradiation timing, and planning target volume (PTV) were statistically significant factors. Tumors with a small diameter at the time of primary onset could be controlled similar to surgery in terms of the 3-year survival rate. This study suggested that CK treatment might be an effective treatment for tumor suppression in patients in whom no other treatment was indicated.

We report the use of bony gap arthroplasty to treat temporomandibular joint (TMJ) ankylosis via an intraoral approach using a surgical saw and a pedicled buccal fat pad affording interpositional grafting. A 42-year-old man had severe trismus attributable to TMJ ankylosis caused by an accident at work. Surgery proceeded under general anesthesia induced via nasal intubation. We created an incision at the anterior border of the mandibular ramus and external oblique ridge. After elevation of a mucoperiosteal ramus flap and resection of the coronoid process, a bone gap of about 10 mm was created using a surgical saw. The gap was filled with a pedicled buccal fat pad sutured to the medial pterygoid muscle. Aggressive mouth-opening training commenced on postoperative day 3. The advantages of our technique include a clear intraoral surgical field and simple harvesting of the graft material within the same field. Five years after operation, the extent of mouth-opening was 34 mm, and the postoperative clinical outcome remains favorable.

Carotidynia is a pathological condition that is characterized by idiopathic unilateral neck pain with the possibility of orofacial pain, including the oral cavity. We report our experience with carotidynia, which was a diagnostic dilemma that presented with the chief complaint of a tender mass in the left neck. A 65-year-old woman was referred to our hospital with the chief complaint of a tender mass in the left neck. The patient presented with a pulsatile, extremely tender mass in the left neck and temporal headache on the ipsilateral side. Contrast-enhanced computed tomography (CT) and ultrasonography revealed a carotid artery with a thickened wall at the bifurcation, which was surrounded by a soft tissue shadow. Consequently, we clinically diagnosed carotidynia as a result of differential diagnosis including giant cell arteritis. The neck pain spontaneously resolved in approximately 2 weeks. CT findings 4 and 18 months later showed a reduction in the area of the soft tissue shadow. Thereafter, there was no recurrence of symptoms.

We report our experience with a patient who had thrombophlebitis of the facial vein, which might have been caused by odontogenic infection of the mandibular first molar. A 64-year-old woman presented at our hospital because of swelling of the left cheek.

　Although she received antibiotics from her family dentist for gingival swelling at the left mandibular first molar, her symptoms have exacerbated. At the initial visit to our department, she had diffuse swelling and tenderness from the first molar region to the buccal mucosa. Panoramic radiography showed alveolar bone resorption around the first molar, and cellulitis in the left cheek caused by periodontitis of the first molar region was diagnosed. After the start of continuous intravenous administration of antibiotics, swelling of the left cheek remitted. However, swelling and redness around the left orbit worsened, and contrast-enhanced computed tomography was performed. The findings of poor contrast effect, blood vessel wall thickening and an area of no visualized lumen were observed in the left facial vein. Thus, the diagnosis of thrombophlebitis in the left facial vein was established, and secondary optic neuritis was suspected. Consequently, the patient successfully received continuous intravenous administration of Cefmetazole given for 5 days, which is effective against anaerobic bacteria, followed by 2-week oral administration of Amoxicillin hydrate and potassium clavulanate and 3-month anticoagulant treatment with oral Apixaban.

Ameloblastic fibroma (AF) is rare benign tumor that typically occur in the mandibular molars of young patients. The frequency of AF is 1.5% to 4.5%. According to the World Health Organization classification of 2017, AF are benign mixed tumors composed of odontogenic mesenchyme resembling dental papilla and epithelial tissue resembling odontogenic epithelium. The principal treatment of AF is enucleation of the tumor along with extraction of the involved teeth. Therefore, in young patients, extraction of permanent teeth leads to loss of normal occlusion. We report a case of AF in a young patient, whose jaws was growing, treated conservatively with 8 years of observation, orthodontic treatment including upright surgery. Recurrence of AF has not been noted, and the impacted tooth has erupted to the nomal occlusal plane.

An assumed case of tuberculous cervical lymphadenitis in a 9-year-old boy is reported. The child had severely painful swelling of the left submandibular and submental regions. Contrast-enhanced computed tomography (CT) revealed left submandibular and submental lymph node swelling with an abscess formation. Although he was given antibiotic medication, the cervical swelling grew rapidly. For histopathological diagnosis, the left submandibular lymph node was surgically removed with the patient under general anesthesia. Histopathological examination showed an epithelioid cell granuloma surrounding the caseous necrosis region and Langhans giant cells, and we suspected tuberculous cervical lymphadenitis. He received antituberculous chemotherapy and made good progress.

　Although mycobacterium tuberculosis was not proven in this case, we thought that there was no contradiction in diagnosing tuberculous cervical lymphadenitis clinicopathologically.

Epstein-Barr virus-positive mucocutaneous ulcer (EBVMCU) is a recently recognized B-cell lymphoproliferative disorder that is driven by latent EBV infection and causes discrete ulcerations in the oropharynx, gastrointestinal tract, and skin.

　A 56-year-old Japanese woman with a 1-month history of swelling in the right side of lower gingiva visited our hospital. The patient had a past medical history of rheumatoid arthritis (RA). She had been given a diagnosis of RA in 1981 and had received standard treatment with methotrexate (MTX) (8 mg/week) for more than 26 years (total dose, greater than 3840 mg). Following initial biopsy and withdrawal of the MTX, the area healed spontaneously over a period of several weeks. The morphological and immunophenotype features were in keeping with an EBV-related lymphoproliferative lesion consistent with EBVMCU. We requested discontinuation of methotrexate, and the lesion decreased and symptoms disappeared in 2 months. There was no evidence of recurrence 25 months after discontinuing methotrexate.

Compartment syndrome developing after sagittal split osteotomy (SSRO) is rare, but once it occurs, it can have fatal complications because of rhabdomyolysis and acute renal dysfunction. Here, we report a case of acute lower leg compartment syndrome that occurred after SSRO. The patient was a 17-year-old girl. She underwent bilateral SSRO via the Obwegeser technique to correct mandibular protrusion. Postoperatively, she felt severe pain in her left lower leg, associated with redness and diffuse swelling. The blood creatinine kinase (CK) level increased to 2,674 U/L. Enhanced computed tomography revealed swelling of the left lower leg with a low absorption area of contrast agent. Compartmental pressure measurements on the left leg were as follows: anterior, 70 mmHg; lateral, 72 mmHg; superficial posterior, 25 mmHg; and deep posterior, 70 mmHg. A clinical diagnosis of acute compartment syndrome was made. She underwent a 4-compartment fasciotomy of her left leg. Postoperatively, she underwent intensive care to prevent acute renal dysfunction. As the blood CK level decreased, she was discharged on the 26th postoperative day. One year after the operation, there is no relapse and the clinical course is good. There is no loss of sensation in the left lower leg, and the ability to do light running recovered.

Sialodochitis fibrinosa is a relatively rare disease characterized by repetitive salivary gland swelling and fibrinous plug discharge and was reported in 1879 by Kussmaul. Here, we describe a patient who had sialodochitis fibrinosa in multiple salivary glands.

　A 31-year-old woman was referred to our department for examination and treatment of swelling in the right submandibular region. At the initial visit, swelling and tenderness were observed in the right submandibular region. However, computed tomography and magnetic resonance imaging assessments revealed no abnormal findings. Therefore, we consulted an internist, an otolaryngologist, and a dermatologist, but the cause remained unknown. Gradually, the symptoms disappeared, and the patient discontinued medical follow-up. After 2 years, the symptoms recurred, and the patient returned to our hospital. The swollen area had spread beyond the right submandibular region into the bilateral subparotid regions. We again examined the patient, and noted characteristic findings such as fibrinous plug discharge; therefore, we diagnosed sialodochitis fibrinosa. We provided medical treatment with corticosteroids and antihistamine drugs, and her symptoms improved. The disease has remained stable for 3 years since the initiation of treatment.