Falls from heights represent one of the principal causes of multiple injuries and are usually associated with maxillofacial trauma. The aim of this study was to compare the distribution of injuries between patients who have fallen accidentally and those who have jumped from a height, and to reveal the features of the resulting injuries. A total of 494 patients treated in the Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, between June 2009 and May 2019, who were classified as either having fallen (fallers) or who jumped (jumpers) from a height were studied. Fifty-one patients (10.3%) were treated in the Department of Oral and Maxillofacial Surgery, among whom 22 were jumpers and 29 were fallers. Jumpers were younger (mean age, 28.5 vs. 47.0 years), more likely to be female (8 males, 14 females vs. 22 males, 7 females) and sustained significantly more fractures of the jaw (72.7% vs. 31.0%, p=0.043), pelvis (54.5% vs. 13.8%, p=0.002), and lower limbs (77.3% vs. 27.6%, p=0.001). Jumpers tended to land feet-first, resulting in fractures of the lower limbs, pelvis, and jaw. As for treatment, open reduction and internal fixation were conducted in a significantly higher proportion of jumpers than fallers (59.1% vs. 20.7%, p=0.005). In addition, an extraoral surgical approach for the management of mandibular fractures was used in a significantly higher proportion of jumpers than fallers (72.7% vs. 42.9%), reflecting the common injury patterns. The injury patterns identified by this study are expected to facilitate the more rapid assembly of treatment teams.
Fanconi anemia is an inherited genetic disorder characterized by progressive pancytopenia, transition to myelodysplastic syndrome, acute myeloid leukemia, body malformation, and increased risk of certain solid cancers. Among the solid tumors, there is a high incidence of squamous cell carcinoma of the head and neck. Here, we report a case of advanced lower gingival cancer in a patient with Fanconi anemia.
A 30-year-old man was referred to our hospital because he was aware of a painless mass arising in the right mandibular gingiva. In his medical history, the patient was given a diagnosis of Fanconi anemia at the age of 6 years because of pancytopenia. The patient achieved hematological recovery after allogenic hematopoietic stem cell transplantation following a preparative regimen consisting of total body irradiation and cyclophosphamide. The right mandibular tumor (36×27 mm) was diagnosed as lower gingival cancer. The patient underwent bilateral neck dissection, segmental mandibular resection, and total resection of the lower lip (squamous cell carcinoma, pT4aN2cM0). Reconstructive surgery comprised placement of a reconstructive titanium plate, a pectoralis major musculocutaneous flap, and local rotational flaps.
Postoperative adjuvant treatment was not administered. 30 months postoperatively, there was no new lesion, recurrence, or metastasis.
Glucose transporter 1 (GLUT-1) deficiency is a rare metabolic disorder of the brain caused by mutations of GLUT-1 gene and inefficient use of glucose. In this disease, ketogenic diet therapy is necessary to supply ketone bodies instead of glucose as the energy source of the brain. We report a patient with GLUT-1 deficiency who was hospitalized and underwent third molar extraction. This is the first such report in the field of oral and maxillofacial surgery. There was no problem with preoperative starvation testing. Therefore, we performed the operation with the patient under general anesthesia. His teeth were extracted successfully without any complications such as convulsive attacks, hypoglycemia, or unexpected blood levels of ketone bodies. When we treat patients with GLUT-1 deficiency, it is important to closely cooperate with pediatricians, anesthesiologists, pharmacists, and dieticians in the perioperative management of patients.
Perivascular epithelioid cell tumor: PEComa is a group of tumors defined in the WHO classification of bone and soft tissue tumors as “mesenchymal tumors consisting of cells that are associated with blood vessel walls and express markers of melanocytes and smooth muscle”. We report a case of soft palate PEComa. The patient was a 17-year-old boy. The diagnosis of hemangiomatous fibrotic histiocytoma, which is considered to be a benign malignant intermediate tumor, was obtained at a previous doctor, and the patient was referred to our department because of the need for multidisciplinary treatment. A mass lesion with an ulcer was found in the midline of the soft palate. Contrast-enhanced MRI showed the findings of the separated nodule image in the soft palate. Preoperative evaluation of the previous specimen confirmed the diagnosis of PEComa. Since this case was a benign tumor with a relatively good prognosis, we performed resection with consideration for functional preservation. Although one year has passed since surgery, the patient has progressed well without recurrence. PEComa is extremely rare in the oral cavity. This is considered a valuable case for accumulating information in the future.
Nivolumab has various immune-related adverse events, including thyroid dysfunction. We describe a case of maxillary gingival malignant melanoma and lung adenocarcinoma with destructive thyroiditis after administration of nivolumab in a 62-year-old man who received multidisciplinary treatment with heavy particle therapy, surgical therapy, and immunotherapy. When destructive thyroiditis appeared, there were no symptoms but TSH decreased and FT3, FT4 increased in the hematology values. Nivolumab treatment was therefore discontinued in cooperation with endocrinologists. Without thyrotoxicosis, thyroid function normalized two months after discontinuing nivolumab. There has been a continuous cytoreductive effect on maxillary gingival malignant melanoma, and 29 months have passed since the start of treatment, but no metastasis has been observed.
We report a case of refractory idiopathic thrombocytopenic purpura (ITP) in a patient with upper gingival carcinoma treated by modified radical neck dissection who received a thrombopoietin receptor agonist and γ-globulin before operation to increase the platelet count and control hemostasis. A 58-year-old woman was referred to our hospital because of contact pain of the right palatal molar region. A diagnosis of squamous cell carcinoma was obtained on biopsy. The preoperative laboratory tests showed platelet counts of 1.7〜3.1×104/μL. We planned a partial maxillectomy. Before operation, intravenous immunoglobulin (IVIG) was given for 5 days. However, the platelet count did not increase. Thus, she was given a transfusion of platelets and underwent a partial maxillectomy.
Three months after operation, PET-CT showed metastases to the right cervical lymph nodes. She needed to undergo modified radical neck dissection. Before operation, thrombopoietin receptor agonist and γ-globulin were administered. As a result, the platelet count increased to 14.0×104/μL, and she did not require transfusion of platelets. Thrombopoietin receptor agonist and γ-globulin were suggested to be safe and useful for patients with refractory ITP treated surgically.
Inverted ductal papilloma is a rare benign tumor that occurs in the oral cavity and arises from minor salivary gland ducts. In 1982, White et al. first introduced the term “inverted ductal papilloma”. Now, these neoplasms and intraductal papilloma have been classified as subtypes of ductal papilloma in the WHO classification since 2017. We herein report a case of inverted ductal papilloma of the left lower lip showing atypical macroscopic findings that made diagnosis difficult. The patient was 65-year-old man who was referred to our department for a lower lip mass. He had noticed it more than 10 years ago, but had not previously received any diagnosis or treatment. The mass was 20 mm in diameter. Biopsy specimens revealed papillary proliferation of non-atypical squamous cells with mucous cells. A definite diagnosis was difficult on the basis of these findings. Therefore, he received tumor resection under general anesthesia. The histopathological diagnosis was inverted ductal papilloma. There has been no recurrence during 1 year and 6 months after operation.
The present patient, a 59-year-old woman, had been suffering from dark violet masses occurring in her lips and chin. Panoramic radiography showed phleboliths and contrast-enhanced CT showed an enlarged contrast effect with ununiform density in legions. We diagnosed the mases as venous malformations.
We planned sclerotherapy because wide dissection of lesions in the facial esthetic regions was expected to lead to functional disorder.
First, in June 2012, sclerotherapy using dehydrated ethanol was performed to treat venous malformations in the lip and chin. Necrosis of the skin surface occurred after sclerotherapy of the chin, and debridement was performed immediately. Good esthetic and functional outcomes were obtained 30 days after sclerotherapy.
Subsequently, we performed sclerotherapy with foamed polidocanol for her temporal venous malformation.
As a result, sclerotherapy for multiple facial venous malformations resulted in good esthetic and functional outcomes for 6 years.
We report the case of a high-risk patient with refeeding syndrome (RFS) caused by severe odontogenic infection. An 80-year-old man visited our hospital because of a 10-day history of an eating disorder caused by left-sided throat pain. The patient had been receiving a diuretic drug to treat hypertension. Contrast-enhanced computed tomography revealed an abscess extending from the left maxilla to the left parapharyngeal and masticator spaces. Hematological examinations revealed hypokalemia, and he was a high-risk RSF patient given a diagnosis of left pharyngeal cellulitis. Antibiotics were prescribed, and intra-oral surgical drainage was performed with the patient under general anesthesia. We consulted the nutrition support team (NST) and were recommended to perform intervention and to administer supplementary thiamine. Then, nutritional intake of 450 kcal/day was initiated and gradually increased to 1,200 kcal/day. In addition, he received thiamine supplements and underwent daily electrolyte monitoring. On the other hand, the serum phosphate level rapidly decreased on day 3 of hospitalization, and it was corrected with supplementation. Subsequently, we could resolve the severe infection and fortunately avoid the occurrence of RFS by providing appropriate nutritional management.
Chromosomal translocation is one of the most common types of chromosome abnormalities. Chromosomal translocation includes balanced and unbalanced translocation. However, it is difficult to detect balanced translocation because most balanced translocations have no excess or deficiency about genetic information and remain clinically asymptomatic; recently balanced translocation is related to infertility. Among balanced translocation of the 22nd and 11st, t (11;22) (q23.3;q11.2) balanced translocation is considered representative. Generally, in balanced translocation, it is thought that cases with abnormal phenotypes such as malformation are rare. t (11;22) (q23.3;q11.2) balanced translocation has not been reported to be a risk factor for cleft lip and palate. We report a case of t (11;22) (q23.3;q11.2) balanced translocation with unilateral complete cleft lip and palate.
We report a case in which an impacted supernumerary tooth migrated from the mandibular ramus to the mandibular coronoid process. A 19-year-old male underwent a panoramic X-ray for orthodontic treatment at the age of 14 years. An opaque region with a well-defined border was seen at the front edge of the right mandibular ramus. Since the right lower third molar was also present, the opaque region was diagnosed as an impacted supernumerary tooth. Imaging examinations, performed every 2 years, showed that the impacted supernumerary tooth gradually moved from the mandibular ramus to the mandibular coronoid process. Thus, the patient visited our department to undergo detailed examinations and treatment. On panoramic X-ray and CT performed at the patient’s first visit to our department, the impacted supernumerary tooth had a total length (root axis) of about 10 mm, the tooth axis was located at the upper end of the right mandibular coronoid process, and part of the tooth was located outside of the tip of the mandibular coronoid process. Under general anesthesia, the impacted supernumerary tooth was extracted. Since the mandibular coronoid process was thin, it was resected during removal of the supernumerary tooth. There was no trismus or mandibular deviation 1 year after the operation.