We encountered a case of sclerosing odontogenic carcinoma that was difficult to diagnose. The patient was a 57-year-old man who presented with paralysis of the mental region. At his first visit, he was found to have a swelling in the right alveolar part of the mandible, oppressive pain, and dysesthesia of the mental region and tongue. Panoramic radiography revealed a diffuse and poorly marginated radiolucency extending from the right lower canine to the right mandibular ramus. After preoperative chemotherapy, we performed right hemimandibulectomy, selective neck dissection with removal of level Ⅰ lymph nodes, and reconstruction with a fibular osteoseptocutaneous flap with the patient under general anesthesia. Histopathologic examination of the resected specimens led to the diagnosis of sclerosing odontogenic carcinoma. The patient had an uneventful course without any evidence of recurrence 38 months after surgery.
Atypical lipomatous tumor (ALT) is a relatively common soft tissue tumor, but it is extremely rare in the head and neck region, especially in the oral cavity. We report a case of tumor of the tongue that was considered a morphologically atypical lipomatous tumor. A 65-year-old woman was referred to our hospital with a mass on the right side of her tongue. Clinical examination revealed a well-demarcated, movable, elastic-hard, and painless lesion, with a diameter of 15 × 15 mm. We made a provisional diagnosis of a benign tumor and performed an incisional biopsy. The pathological diagnosis was ambiguous, ranging from lipoma to ALT. An excisional biopsy was performed with the patient under local anesthesia with intravenous sedation. Microscopic examination revealed a well-circumscribed lesion, composed of proliferative fat cells with considerable variations in size and shape, as well as many multi-vacuolated lipoblasts. The final histopathological diagnosis was morphologically ALT. We surgically excised an additional 10 mm of the tissue surrounding the tumor with the patient under general anesthesia. The patient has remained free of recurrence and metastasis for 5 years after surgery.
Traumatic carotid-cavernous sinus fistula (t-CCF) is an arteriovenous fistula formed by the tearing of the internal carotid artery running in the cavernous sinus, accompanied by head/maxillofacial injuries. Patients with this disease rarely show spontaneous closure and often require urgent endovascular treatment. We report a case of t-CCF that developed following jaw and zygoma fractures and was successfully treated by manual carotid compression. A 35-year-old man was referred to our hospital to undergo treatment for multiple maxillofacial fractures. On the first day after injury, open reduction and internal fixation of the mandible were conducted with the patient under general anesthesia. On the fifth day after injury, diplopia of the left eye suddenly appeared. On the seventh day after injury, left exophthalmos/edema of the left upper eyelid/left abducens nerve palsy/bilateral ptosis, and hyperemia of the bulbar conjunctiva appeared. On the 15th day after injury, cerebral angiography revealed a definitive diagnosis of t-CCF. Supervised manual carotid compression during the waiting period before endovascular treatment led to improvement in various symptoms from the 19th day after injury. Cerebral angiography, which was performed again for endovascular treatment, revealed that arteriovenous fistula resolved spontaneously. Therefore, treatment was discontinued, and the patient was followed up with a conservative approach. By 9 months after injury, all symptoms, including left oculomotor nerve palsy had disappeared. There was no evidence of recurrence 10 years after injury.
Ossifying fibromyxoid tumor (OFMT) is a tumor of borderline malignant potential that usually arises in the subcutaneous tissue of extremities, trunk, head and neck and is rarely found in the field of dentistry. This tumor was reported by Enzinger et al in 1989, and Schwann cells and cartilage cells have been reported to play important roles in its development, but this remains to be clarified. We report a case of OFMT that arose in the maxillary molars.
The patient was a 44-year-old woman. She presented to our department on noticing swelling of the right maxillary molar gingiva. Radiography showed a slightly unclear bone resorption image and increased impermeability in the right maxillary molar sinus. The results of biopsy led to a diagnosis of OFMT and maxillary sinus aspergillosis. Tumor excision curettage and light maxillary sinus radical therapy was performed with the patient under general anesthesia. The final histopathological diagnosis was OFMT.
It is said that OFMT has a recurrence rate of about 30%, and cases showing lung metastasis in the absence of histologic heteromorphism have been reported. Long-term follow-up is therefore essential. We report a case of OFMT that arose in the maxillary molar region.
Traumatic osteomyositis is a disease in which bone forms ectopically in muscle owing to its traumatic damage caused by severe bruising, contusion, or recurrent weak stimuli. The femoral region and upper arm are the most common regions for the development of traumatic osteomyositis, while it rarely occurs in the head and neck region. Here we report a case of a traumatic osteomyositis arising in the left masseter muscle of a 38-year-old man. He bruised his left cheek and limbs after falling from a personal watercraft. Subsequently, he had swelling of his left cheek as well as trismus. He was referred to our department on the 23rd day after injury. A diffuse elastic hard swelling was found at his left cheek as well as both lower legs and the dorsum of his hands with suggillations. The computed tomographic (CT) images showed hypertrophy of the left masseter muscle with an inner circular high-density region, and magnetic resonance imaging showed a high intensity region with an unclear boundary in the left masseter muscle. PET-CT revealed FDG accumulation not only in the left masseter muscle but also in the peripheral limbs, left eighth rib, third lumbar transverse process, bilateral axillary region, and cervical lymph nodes. Lesions related to autoimmune diseases were ruled out because autoantibodies were negative on blood testing. An excisional biopsy of the left masseter muscle lesion was performed with the patient under general anesthesia, and the histopathological diagnosis was traumatic osteomyositis. Jaw exercises were initiated on the 5th postoperative day. Finally, his jaw opening width completely recovered by 45 mm in the 10th postoperative month. There was no recurrence during the follow-up period.
Sialoliths mainly occur in the major salivary glands and rarely arise in the minor salivary glands. Sialoliths in the lower lip are extremely rare, and only one case of histopathological mucous cyst with sialolith of the lower lip has been reported in Japan including reports from overseas.
We report a case of mucous cyst associated with a sialolith of the lower lip. A 71-year-old woman referred to our university hospital for a tumor mass of the left side of the lower lip. The clinical diagnosis was a benign tumor. We extirpated the tumor. There were no adhesions of the surrounding tissue, and the tumor was extirpated without any problem. Histologically, a cystoid structure was observed. Mucus containing neutrophils and foam cells was stored in the cyst, and it contained calcified material. The histological diagnosis was a mucous cyst with a sialolith of the lower lip. The patient’s postoperative course has been good, with no evidence of recurrence as of 1 years 3 months after surgery.
We report the case of a patient who had sinus arrest caused by the trigeminocardiac reflex (TCR) during mouth-opening exercises. The patient was a 37-year-old woman. Bilateral masticatory muscle tendon-aponeurosis hyperplasia was diagnosed, and bilateral coronoidectomy and aponeurectomy of the masseter muscles were performed with the patient under general anesthesia. After the start of surgery, severe bradycardia occurred during forced mouth opening and dissection of the left masseter muscle. Postoperatively, the patient engaged in mouth-opening exercises, but severe bradycardia occurred when forced mouth opening was performed. The patient was discharged 20 days after operation as she was able to maintain adequate mouth opening. She continued to experience bradycardia and temporary loss of consciousness during mouth-opening exercise, and underwent further investigation in the department of cardiovascular medicine of another university hospital. Holter electrocardiography during at-home rehabilitation therapy revealed that sinus arrest lasting ≥ 3 sec (maximum 7 sec) occurred nine times during mouth-opening exercises. Electrocardiography during these exercises also showed that sinus arrest recurred when a mouth-opening device was used. Although TCR still occurs during maximal mouth opening, by carefully continuing mouth-opening exercises the patient has successfully maintained adequate mouth opening, and her course has otherwise been uneventful.
Metastasis of oral cancer to the mandibular lymph nodes is rare. We report a case of buccal mucosal cancer with mandibular lymph-node metastasis. An 84-year-old man was referred to our department for a left buccal mucosal mass. Intraoral examination showed a 23 × 20-mm protruding lesion in the left buccal mucosa. Incisional biopsy revealed squamous cell carcinoma. We diagnosed squamous cell carcinoma of the left buccal mucosa (cT2N0M0, Stage II) after further evaluation, the patient underwent excision of the left buccal mucosa. We detected a metastatic lymph node that was not connected to the primary tumor; therefore, we diagnosed squamous cell carcinoma of the left buccal mucosa with mandibular lymph-node metastasis (pT2N1M0, Stage III). Recurrence or metastasis has not occurred as of 1 year 11 months postoperatively. The prognosis of mandibular lymph-node metastasis of oral cancer is poor. However, the number of cases is small, and mandibular lymph-node metastasis is not widely known because of its low frequency. Therefore, it may be incorrectly diagnosed as local recurrence. We should consider the possibility of mandibular lymph-node metastasis when diagnosing and treating buccal mucosal cancer or mandibular gingival cancer.
A neurofibroma is a type of benign tumor that arises from a nerve bundle consisting of Schwann cells and proliferating fibroblasts. Multiple tumors often occur in cases of neurofibromatosis (von Recklinghausen’s disease), while an isolated tumor is rare. We report the case of a solitary neurofibroma that developed in the mandible of a 76-year-old woman. Transmission radiographic imaging of a mass in the right mandible seen on panoramic radiography performed as part of a regular medical checkup led the patient to be referred to our hospital. Biopsy findings resulted in a diagnosis of neurofibroma. A surgical procedure was performed, during which the tumor and inferior alveolar nerve vascular bundle were found to be partially in contact, although complete separation was possible. Presently, approximately 5 years after the operation, no recurrence has occurred.
Osteonecrosis of the jaw is a problematic side effect of bisphosphonates or angiogenesis inhibitors. Reports on surgical therapy for medication-related osteonecrosis of the jaw (MRONJ) have recently been published. However, surgical treatment of MRONJ is often difficult for patients undergoing cancer treatment who have poor general status. Oral ingestion becomes difficult, and the quality of life (QOL) declines in patients with progressive MRONJ. We describe a patient with renal cancer who had deteriorated general status due to MRONJ and was treated by mandibular resection and immediate reconstruction. A 75-year-old man treated with bisphosphonate and sunitinib for renal cancer presented with exposed mandibular bone, renal hypofunction, and hyperkalemia due to frequent use of an analgesic. We removed the sequestrum, which allowed oral ingestion and improved his general status. Then, mandibular resection and immediate reconstruction with a free-fibula flap were performed to prevent pathological fractures. However, sunitinib seemed to cause delayed wound healing. Given the cessation period of angiogenesis inhibitors and the amount of time required for wound healing, this surgical approach to MRONJ seemed useful for maintaining the QOL of this patient with renal cancer.
We report a case of ameloblastoma in the maxilla of an 8-year-old child. The patient complained of swelling involving the right side of the maxilla. Computed tomography revealed a unilocular radiolucency involving the second premolar in the right deciduous molar region of the maxilla. The lesion was diagnosed as ameloblastoma by an incisional biopsy. The lesion was enucleated with the patient under general anesthesia. The histopathologic diagnosis was an ameloblastoma, unicystic type. There has been no evidence of recurrence 2 years after surgery.
Although reports of ameloblastomas in the maxilla of patients younger than 10 years are exceptionally rare, adequate diagnosis and treatment should be undertaken while keeping in mind the possibility of this disease occurring in young children.