We present a case of a true aneurysm of the superior labial artery. A 97-year-old woman visited our department complaining of swelling on the left side of the buccal region. A superior labial aneurysm was identified as the cause of buccal swelling by Doppler ultrasonography, enhanced computed tomography, and dynamic contrast-enhanced magnetic resonance imaging, and we performed surgical resection under general anesthesia. Histological and immunohistochemical examinations confirmed the diagnosis of a true aneurysm of the superior labial artery. The patient remains well 5 years and 3 months after operation. To the best of our knowledge, this is the first reported case of a true aneurysm of the superior labial artery in Japan.
Peripheral odontogenic myxoma of the oral cavity is extremely rare. We present a case of peripheral myxoma arising from the mandibular anterior lingual gingiva in a 55-year-old man. Intraoral examination revealed a solitary, elastic-hard mass on the lingual gingiva of the mandibular in the range of right first incisor to canine, measuring 13mm in diameter. The mucosa of the mass was partially white in color, and the shape of the mass was slightly irregular. Abnormal uptake FDG on PET/CT (SUVmax 9.9) was observed in the anterior mandible. The mass was excised with a margin of healthy gingiva. The histopathologic diagnosis was peripheral odontogenic myxoma. Follow-up for 2 years after excision has shown no evidence of recurrence.
Glycogenic acanthosis (GA) is a benign lesion with glycogen-rich keratinocytes, characterized by small, white, slightly raised plaques. GA is frequently detected in the esophagus, and rarely occurs in the oral cavity. We herein report a case of GA in the bilateral buccal mucosa and lower lip of a 14-year-old male. The patient noticed white lesions in the oral cavity 3 months prior to presentation at a nearby dental office, and was then referred to our hospital for further examination. The lesions showed plaque-like thickening of the mucosa, which was whiter than the surrounding mucosa, and were deeply stained with iodine. The lesions were diagnosed as oral GA histopathologically, and the patient has been under observation. In the five years since the first examination, no changes have been observed regarding macroscopic findings and iodine staining assay.
Since GA presenting in the oral cavity is rare, it is necessary to gather more cases to clarify the clinical features of GA in the future.
Hemorrhagic colitis due to antibiotics has increased with the widespread use of antibiotics for various diseases. The clinical features included sudden onset a few days after the administration of antibiotics, abdominal pain and bloody diarrhea.
We report herein on a case of antibiotic-associated hemorrhagic colitis (AAHC) following administration of sulbactam /ampicillin (SBT/ABPC). A 73-year-old female diagnosed with left cheek cellulitis with a complaint of left cheek swelling received an intravenous infusion of SBT / ABPC.
Three days after administration, severe abdominal pain and watery bloody diarrhea developed. Intestinal wall thickening in the ascending, transverse and sigmoid colon without evidence of appendicitis, intestinal necrosis, or abdominal mass was observed on computed tomography without contrast material.
Gram’s staining revealed dominantly gram negative rods in the feces and the cultures were positive for Klebsiella oxytoca (KO). Clostridium difficile (CD) antigen was negative in the feces. The fever and abdominal pain gradually improved with conservative treatment, including the withdrawal of antibiotics after a gastroenterology consultation, and the bloody diarrhea had resolved within a week. Twelve days following treatment, the symptoms had improved and abdominal ultrasonography showed improved mucosal edema in the ascending, transverse and sigmoid colon, and she was discharged three days later. The patient was followed up for one month, and she showed good progress without a recurrence of inflammation.
We report the experience of treating maxillary gingival cancer with simultaneous carotid endarterectomy for internal carotid artery stenosis. A 72-year-old man was referred to our department with complaints of pain in the left maxillary gingiva. An ulcer lesion with clear demarcation of about 30 × 25mm was observed in the left maxillary gingiva. A biopsy revealed a diagnosis of moderately differentiated squamous cell carcinoma. Preoperative examination revealed a complication of internal carotid artery stenosis. The preoperative diagnosis was maxillary gingival carcinoma (cT4aN0M0) and internal carotid artery stenosis. The internal carotid artery had 90% stenosis and required early treatment. In consultation with neurosurgery, it was suggested that if perioperative management was performed with careful attention to blood pressure control after CEA, simultaneous surgery for oral and maxillofacial surgery would be possible. Thus a tracheotomy was performed under general anesthesia, then, following CEA, left neck dissection, parapharyngeal dissection, lateral pharyngeal lymphadenectomy, partial maxillary resection, and an oral reconstruction using the anterolateral thigh flap were performed. The next day, external jugular vein thrombus at the anastomotic site was confirmed, and reanastomosis was performed. There were no complications such as perioperative cerebral infarction. Four years after the operation, neither progression of vascular restenosis nor tumor recurrence have been observed.
Mammary analogue secretory carcinoma (MASC) is a new conception of the salivary gland tumor proposed by Skalova et al. in 2010. It was described as “secretory carcinoma” in the 2017 edition of the WHO classification of Tumors. In this report, we describe a case of secretory carcinoma (SC) in a 51-year-old woman. She was referred to our hospital because of a painless, movable mass in the lower lip. The lesion was a soft, elastic mass, 10 × 15 mm in size, found within the mucosa of the lower right lip with no vasodilation.
Based on ultrasonography and MRI results, the tumor was suspected to be a benign salivary gland tumor, so we planned a resection biopsy. Histopathological examination revealed a variety of images, including follicular structures resembling thyroid follicles, papillary growth of tumor cells, eosinophilic secretions, and cholesterol clefts. As we suspected a malignant tumor, immunostaining was performed. The results were CK19 (+), S-100 protein (+), p63 (−), and mammaglobin (+). Based on these findings, SC was strongly suspected, so a gene search was performed. As a result, the ETV6-NTRK3 fusion gene was detected, leading to a definitive diagnosis of SC.
In the two years after the operation until now, the patient has been free of recurrence or metastasis and is without disease.
We report a case of subcutaneous and mediastinal emphysema due to laceration of the pharyngeal mucosa with an endotracheal tube.
The patient was an 82-year-old man who underwent a sequestrectomy for left mandibular osteomyelitis. There were no problems in the course up to the second postoperative day, however on the third postoperative day, subcutaneous/mediastinal emphysema appeared in the neck. An X-ray and CT scan showed extensive subcutaneous/mediastinal emphysema. Laceration on the right posterior nasopharyngeal wall was confirmed by optical fiber scope. An antibiotic was administered prophylactically and the patient was followed up. There was no sign of infection, and the subcutaneous emphysema improved. Oral ingestion was started on the fifth day after surgery, and the patient was discharged on the thirteenth day after surgery. The patient had a strong nasal obstruction sensation after surgery, and he frequently blew his nose. It was presumed that during nose blowing air entered from the laceration of the posterior nasapharyngeal wall and caused subcutaneous emphysema and mediastinal emphysema. Emphysema can cause severe dyspnea and mediastinitis, therefore it is important to be prepared for an emergency response.
We report a case of descending necrotizing mediastinitis (DNM) arising from odontogenic infection with emergent airway management. The patient, an 84-year-old woman, was referred to our hospital emergency center due to diffuse submandibular swelling on the right side accompanied with pain. Panoramic X-ray imaging showed a radiolucent area at the root apex of the right upper second molar. Enhanced computed tomography showed an air-dominant abscess spreading to the masticator, submental, submandibular, retrovisceral, pre-tracheal, and vascular visceral spaces and the superior mediastinum. Three hours after presentation, she developed acute respiratory distress and decreased mental status. We performed an emergency intensive care unit (ICU) transfer for early management. The ICU doctor performed endotracheal intubation. The deep cervical and mediastinal areas were drained and extensive debridement was performed by an otolaryngologist. The patient had to undergo four operations for the DNM; treatment was successful, and she was ambulatory at discharge. Appropriate timing of airway management and drainage was important for the successful treatment of DNM. A team approach, in collaboration with other departments, is required for successful treatment.
Background: This study evaluated carbon-ion radiotherapy (C-ion RT) for oral non-squamous cell carcinomas.
Methods: We retrospectively obtained data from 74 patients who underwent C-ion RT for oral malignancies between April 1997 and March 2016. The C-ion RT was administered in 16 fractions at a total dose of 57.6 Gy or 64.0 Gy (relative biological effectiveness).
Results: Forty-three patients had salivary gland carcinomas, 29 patients had mucosal melanoma, and 2 patients had other types of pathologies. The tumors were classified as T1-T3 (24 cases), T4a (21 cases), or T4b (29 cases). The median follow-up was 49 months. The 5-year rates were 78.8% for local control, 36.2% for progression-free survival, and 58.3% for overall survival. Although 10 patients developed grade 3 osteoradionecrosis after C-ion RT, all patients maintained their mastication and deglutition functions after sequestrectomy and prosthesis placement.
Conclusion: C-ion RT was effective for oral non-squamous cell carcinomas and had acceptable toxicities.