Schwannoma is an ectodermal benign tumor which arises from Schwann cells of the nerve sheath. It sometimes occurs in the maxillofacial region, but intraosseous schwannoma of the maxilla is extremely rare. We report a case involving a 15-year-old female patient who developed intraosseous schwannoma of the maxilla without a capsule. She was referred to our department due to pain in the left upper jaw. A mucosal ulcer with swelling was observed in the left hard palate, and computed tomography revealed a tumor with a clear margin in the maxilla. The lesion was surgically removed under general anesthesia and pathologically diagnosed as schwannoma, Antoni type A without a capsule. The tumor was thought to have arisen intraosseously according to imaging and surgical findings. Observing schwannoma in the maxilla, with no capsule, is extremely rare. No recurrence was observed three years after surgery.

Primary cutaneous γδ T-cell lymphoma (PCGD-TCL) is an extremely rare and aggressive variant of cutaneous lymphoma. PCGD-TCL with initial symptoms in the oral cavity has never been reported. Here, we report a case of PCGD-TCL with initial symptoms in the tongue. A 76-year-old woman visited our department complaining of a mass in the tongue. Magnetic resonance imaging revealed a mass in the left tongue. An incisional biopsy was performed under local anesthesia and a histopathological diagnosis of lymphoma was made. FDG-PET / CT examination detected systemic lesions, including on the skin of the back. The patient was then referred to the department of hematology and a final diagnosis of PCGD-TCL was obtained via biopsy of a mass in her back. The patient received six courses of CHOP therapy. The tumor underwent complete remission and disappeared after treatment. More than three years have passed since the treatment. The patient is being followed up in our department and the hematology department, with no evidence of recurrence.

Multiple myeloma (MM) is a disease characterized by a plasmocytic monoclonal proliferation and an increase in the serum and/or urine of monoclonal immunoglobulin (M-protein) produced. Therefore, it presents various clinical symptoms. We report a case of an MM patient who presented a primary symptom in the mandible, leading to acute kidney injury (AKI). A 75-year-old man was referred to our department as mandibular malignancy was suspected in another hospital. We performed a biopsy to make a definitive diagnosis. Ten days after the biopsy, he was referred for emergency treatment due to fatigue and oral feeding difficulty. A blood examination showed AKI of Cr 13.92 mg/dL. The biopsy result was undetermined, and when checked with a pathologist, a plasma cell tumor was suspected. First, we consulted a nephrologist and he started emergency hemodialysis under hospitalization. Since AKI due to MM was suspected, we then consulted a hematologist and performed additional examinations. The results led to a definitive diagnosis of symptomatic MM (IgG-λ). High-dose dexamethasone therapy was commenced immediately. The treatment was very effective, and hemodialysis was stopped. Nineteen months after the primary therapy, he has been continuing chemotherapy in another hospital, with good ADL.

Gas gangrene is a progressive infectious disease that leads to muscle tissue necrosis. Here we report a patient with head and neck gas gangrene accompanied by septic pulmonary embolism (SPE). The patient was an 80-year-old female who showed swelling and crepitation accompanied by redness in the left temporal region, buccal region, submandibular region, and neck. Blood tests showed a WBC of 23,400/μL and CRP of 18.40 mg/dL. Computed tomography imaging revealed residual roots and periapical lesions at the left lower 4567 and left upper 56, and extensive soft tissue swelling and gas were noted in the left temporal region, masticatory space, submandibular region, and neck. Moreover, multiple nodules partially accompanied by a cavity were noted in the lung, however no abscess was clearly evident in the mediastinum. The patient was diagnosed with extensive head and neck gas gangrene accompanied by SPE, which developed secondary to the odontogenic infection. The patient was then immediately operated upon under general anesthesia to insert incisional drainage in the head and neck region. ABPC/SBT antibiotic was administered intravenously at 9 g/day for three weeks. The inflammation improved with time, and the patient was discharged on the 46^th hospital day.

Head and neck osteosarcomas are rare, accounting for 10% or less of all osteosarcoma. In head and neck osteosarcoma, distant metastasis leads to poor prognosis and there are few reports on surgical resection for pulmonary metastasis. Herein we report a case of mandibular osteosarcoma successfully treated with two surgical resections of pulmonary metastases. A 67-year-old man underwent a segmental resection for mandibular osteosarcoma. We administered postoperative radiotherapy and chemotherapy due to a positive margin of the surgical specimen. The patient developed local recurrence at 18 months after the initial surgery, and subsequently underwent salvage surgery. Six months later, lung metastasis was detected, and a thoracoscopic partial lobectomy was performed. However, recurrence of the lung tumor was detected 10 months postoperatively, and a thoracoscopic upper lobectomy was performed. Sixty-five months after the second lobectomy, no evidence of recurrence or metastasis has been detected. In head and neck osteosarcomas, surgical resection should be taken into consideration in patients with pulmonary metastases.

18q (–) syndrome is a deletion syndrome reported in 1964 by de Grouchy, in which part of the long arm of chromosome 18 is deleted. The incidence rate is said to be one in 40,000 people. 18q (–) syndrome has various phenotypes such as retardation of mental development, a drop in muscle tonus, short stature, hearing loss, limb abnormality, congenital heart disease, and cleft lip and palate. In this case, bilateral cleft lip and palate was observed at birth, and a suckling disorder was reported by the maternity department, so we visited the hospital. At first, cleft lip and palate, low-set ears and interocular dissection were observed, however no systemic abnormal findings were observed.

We report a case of dental infection with septic pulmonary embolism and pyomyositis. A 47-year-old man was referred to our department with swelling of the neck. Extra-oral examination showed redness and swelling of the submental region and the neck. Intraoral evaluation revealed 5 mm of exposed bone and pus discharge in the gums of the left mandibular premolar region. Blood tests showed elevated levels of C-reactive protein (19.29 mg/dL) and procalcitonin (0.81 ng/mL). The patient was hospitalized with the clinical diagnosis of a dental infection. Drainage was performed, and an anti-bacterial medication was administered. Computed tomography revealed a septic pulmonary embolism and a left-sided paraspinal muscle abscess. After consultation with our emergency department, drainage was performed, which alleviated the patient’s clinical symptoms. This case shows that a dental infection has the possibility to spread to multiple organs.

Limb metastasis of malignant tumors, especially metastasis to a phalange of the hand, are extremely rare. According to our investigation, there have only been a few cases of oral cancer with metastasis to phalanges of the hand. We report a case of squamous cell carcinoma of the tongue that metastasized to a phalange of the hand. A 74-year-old man was admitted to our department with the chief complaint of bleeding from the tongue. Under diagnosis of tongue cancer in the left side (cT4aN2cM0 UICC8th), a subtotal tongue resection, bilateral neck dissection, rectus abdominis flap reconstruction, and tracheotomy were performed. Chemoradiotherapy was performed to prevent postoperative recurrence, however lung metastasis was observed eight months after the operation. An upper lobe pulmonary resection was performed, however bone metastasis was found in the left index finger 11 months after the operation. Amputation of the left index finger was performed. The pathological result was squamous cell carcinoma, with similar histological features to the primary cancer of the tongue. It was diagnosed as tongue cancer metastasis to a phalange of the hand. Left renal metastasis and peritoneal dissemination were observed, and the patient died of the primary disease one year and one month after initial surgery.

Disseminated intravascular coagulation (DIC) associated with aortic aneurysm has a reported complication frequency of approximately 4% and is associated with a severe bleeding tendency due to advanced fibrinogenolysis. We report a case of refractory bleeding bite wound of the tongue caused by DIC due to an abdominal aortic aneurysm. The patient was a 91-year-old man with atrial fibrillation and an abdominal aortic aneurysm. Computed tomography revealed an increase in the size of the aneurysm, a DIC score of 6 points, and abnormal D-dimer, resulting in a diagnosis of DIC (fibrinolytic type) caused by the abdominal aortic aneurysm. As for treatment, hemostatis was successfully achieved via an improvement in advanced fibrinogenolysis and coagulation. When treating unexplained hemorrhages in patients with a history aortic aneurysms, it is important to conduct an appropriate screening examination and consider a differential diagnosis of DIC.

Herein we report a case of jugular foramen schwannoma with hypoglossal nerve palsy as a first symptom. A 53-year-old man was referred to our hospital complaining of right-sided swelling, discomfort of his tongue and dysarthria. Magnetic resonance imaging (MRI) at the first visit showed right-sided tongue atrophy and steatosis, however no cerebrovascular disorder or neoplastic lesion that could cause it, and the appropriate examinations did not confirm either diagnosis. Hoarseness and dysphagia were observed five months after the first visit, and a jugular foramen tumor was subsequently indicated on MRI seven months after the first visit. The hypoglossal nerve palsy was considered to be caused by nerve compression due to the jugular foramen tumor. A craniotomy tumor resection was performed ten months after the first visit and schwannoma was diagnosed based on histopathological examination of the specimens. Recurrence was observed, and gammaknife treatment was performed 14 months later, reducing the tumor size. There was no tumor growth four years post-operation, and no worsening of tongue motor function or dysarthria.

Unilateral condylar hyperplasia of the mandible is a rare disorder that causes facial asymmetry and malocclusion. We report a case of active condylar hyperplasia in a patient who underwent a condylar reduction and orthognathic surgery simultaneously. A 28-year-old woman presented with facial asymmetry and cross occlusion of the left molar due to left condylar hyperplasia. A ^99m Tc scintigraphy showed abnormal activity in the left condyle. After preoperative orthodontic treatment, a left condylar reduction and right intraoral vertical ramus osteotomy were performed simultaneously. The facial asymmetry and malocclusion improved, and 11 years after the surgery the patient shows no temporomandibular joint symptoms or recurrence.

Retention cysts of the parotid gland can be caused by trauma, surgery, and infection of the parotid duct or parenchyma. When conservative treatment is not effective, surgical treatment is performed. Since a parotidectomy is very invasive, minimally invasive surgery is required. We report a case of retention cyst of the parotid gland treated successfully by intraoral marsupialization. A 67-year-old man underwent an extraoral removal of a sialolith of the right parotid gland in the otolaryngology department of another hospital 13 years ago. Conservative treatment was performed for postoperative extravasation of saliva from the parotid gland. However, a superficial parotidectomy was performed because the swelling was recurrent. Despite the surgery, a retention cyst of the parotid gland developed. Therefore, the patient was referred to our department for minimally invasive treatment. Although the patient underwent a local injection of OK-432 as conservative treatment, the swelling was recurrent. Therefore, we performed an intraoral marsupialization. The postoperative course was uneventful, and there was no recurrence of the retention cyst. Intraoral marsupialization for retention cysts of the parotid gland is a minimally invasive method without the risk of skin scarring and facial nerve paralysis.

Surgery is the standard treatment for early tongue cancer. After a partial glossectomy, primary closure, skin grafting, or covering with artificial materials is performed. However, these methods may result in distortion, shortening, or narrowing of the tongue and functional impairment. We report a case involving reconstruction using the sliding tongue flap for an anterior tongue defect after a partial glossectomy. A 48-year-old woman with a tongue mass was referred to our department. A 23 × 22 mm tumor was present in the left anterior tongue. A biopsy was performed, and the radiological/pathological diagnosis was squamous cell carcinoma (T2N0M0). The patient underwent a partial glossectomy and sentinel lymph node biopsy under general anesthesia. After the partial glossectomy, reconstruction using the sliding tongue flap was performed. Since histopathological findings showed left cervical lymph node metastasis, a neck dissection was performed. Although the patient’s tongue was shortened slightly after the operation, its movement was generally good. There was no recurrence nor metastasis seven years and seven months after the surgery.

The prevalence of supernumerary teeth is estimated to be about 1%, and patients with three or more supernumerary teeth are very few. Furthermore, cases of fused impacted supernumerary teeth are very rare. In this report we present a case of 14 impacted supernumerary teeth, including two fused supernumerary teeth. A 10-year-old boy was referred to our department for further evaluation of two impacted supernumerary teeth. The patient was followed up closely without treatment, since the supernumerary teeth were impacted deeply in the jaw. When the patient was 16-years-old, a computed tomography scan revealed the development of 14 impacted supernumerary teeth, including two fused supernumerary teeth. Two impacted supernumerary teeth in the premolar region of the mandible were extracted under local anesthesia to prevent adverse effects in the dental arch. When the patient was 20-years-old, the impacted supernumerary teeth showed signs of growth and eruption. Then extraction of the 12 remaining impacted supernumerary teeth, including the two fused teeth, was performed under general anesthesia. The extracted teeth had a histopathological structure consisting of enamel, dentin and pulp. The fused teeth had a single root canal with two pulp chambers. The postoperative course during the six months following the last extraction was satisfactory.

The impact of preoperative malnutrition and sarcopenia on survival in oral squamous cell carcinoma (OSCC) patients remains controversial. We investigated the effects of preoperative nutritional status and abnormalities in body composition on the mortality of OSCC patients. A retrospective study involving 103 patients with OSCC was conducted. Disease-specific survival (DSS) according to the preoperative psoas muscle mass index (PMI) and intramuscular adipose tissue content (IMAC) was evaluated. Univariate and multivariate analyses were performed to determine the predictive performance of the covariates with respect to DSS. The DSS rate in patients with high IMAC and low PMI was significantly lower than in controls. Multivariate analysis revealed that a low preoperative Prognostic Nutritional Index (PNI) and high IMAC were independent risk factors. We demonstrated that preoperative malnutrition and abnormal body composition, such as preoperative skeletal muscle quality, are associated with DSS in OSCC patients. Our study suggests that the evaluation of preoperative malnutrition and skeletal muscle quality would be useful for predicting mortality in patients with OSCC.