We present a case report of recurrent transvenous and transarterial embolization for mandibular arteriovenous malformation. An 11-year-old female patient experienced hemorrhaging from the left mandibular gingiva since October 2018. In mid-January 2019, she was urgently referred to a local physician owing to persistent bleeding from the same area. Computed tomography revealed osteolytic alterations in the left mandible. The patient was referred to our center for accurate assessment. Suspecting arteriovenous malformation, magnetic resonance imaging was performed, revealing heightened signal intensity in T2-weighted images and decreased signal intensity on T1-weighted images surrounding the left mandible.The patient received transvenous coil embolization and transarterial embolization utilizing cyanoacrylate material. In October 2019, abscess and cutaneous fistula formation were noted due to embolic infection. The introduction artery was treated with transarterial embolization using a gelatin sponge, and mandibular curettage, including the extraction of teeth 33-35, was carried out. Afterward, residual inflammation was detected around the coil in the mandibular molar region on the left side. Therefore, removal of the embolic material and the extraction of teeth 36-38 were performed. Arterial bleeding was identified intraoperatively, requiring transarterial embolization(TAE). At present, the patient exhibits no evidence of lesion recurrence.
Conversion disorder is a psychogenic disorder in which unconscious conflicts are replaced by voluntary motor and sensory physical symptoms. We report a case of conversion disorder after orthognathic surgery. The patient was a 33-year-old female diagnosed with skeletal mandibular prognathism who underwent a mandibular setback through a sagittal split ramus osteotomy. On the second postoperative day she experienced hyperventilation seizures, apneic seizures and loss of consciousness. She was diagnosed with conversion disorder since there was no evidence of organic abnormality in her general condition, and she had a history of seizures and stress in the workplace. Following adjustment of her antipsychotic, anxiolytic and antidepressant medications, the patient has improved to the point where she experiences no difficulty in daily life one year after surgery.
This report describes a case of other iatrogenic immunodeficiency-associated lymphoproliferative disorder (OI-LPD) with extranodal NK/T cell lymphoma, nasal type (ENKL), in the maxillary gingiva of a rheumatoid arthritis(RA) patient. OI-LPD in patients with RA are mostly B-cell type. A 75-year-old woman was referred to our hospital because of nasal obstruction and swelling in the maxillary gingiva. A biopsy was performed, and a diagnosis of ENKL was made. Immunohistochemical staining showed that most of the atypical lymphocytes were positive for CD56. In situ hybridization for Epstein-Barr virus-encoded small RNA(EBER) was positive for tumor cells. She had been receiving methotrexate for RA; it was therefore discontinued, and the lesion disappeared. There has been no sign of recurrence after discontinuation of methotrexate. Malignant lymphomas of NK cell origin are rare, and EBV may be involved in the etiology of ENKL. ENKL has a poor prognosis in most cases. There are few reports of OI-LPD that exhibits the pathological features of ENKL, therefore its pathogenesis is not well understood. Hence a long-term close follow-up of this patient will be necessary.
Occasionally, impacted teeth may migrate within the jawbone after root completion due to the presence of tumors or cysts. However, ectopic impaction of teeth without an identifiable cause is a rare. We report a rare case of an impacted ectopic maxillary canine located at the infraorbital margin in a 13-year-old girl. The impacted canine was located close to the orbit, nasal cavity and maxillary sinus, and considering the possibility of developing ocular symptoms in the future, extraction under general anesthesia was performed. No complications were observed postoperatively. The likely reason for impaction was growth: the canine was single-rooted, had an incomplete root and was impacted in the maxilla, which has a large amount of cancellous bone. Impacted canines may grow upward as in this case and affect the surrounding tissues. Therefore, the necessity of tooth extraction at an early stage should be explained to the patient.