Oral lichen planus (OLP), which often affects middle-aged adults, is a disorder of unknown etiology, and is defined as a precancerous condition. We report a clinical analysis of 130 cases diagnosed histopathologically as OLP or suspected OLP in this study. Prediction with regard to gender was noted in 36 males and 94 females with the average age at diagnosis of 65 years. The most frequent chief complaint at the initial examination was contact pain (47.0%), followed by white and/or red lesions without symptoms, discomfort, and burning sensation. Although the majority of cases (88.8%) were clinically diagnosed as OLP, some cases were diagnosed as leukoplakia and pemphigus. The most frequently affected site was buccal mucosa (30.7%), followed by alveolar gingiva and gingivobuccal fold. Reticular/plaque-like type (55.4%) was the most common among the three visual phenotypes. Presence of Candida spp. from an oral swab was examined in 30 cases of OLP patients, and was isolated in 11 cases (36.7%). Although OLP is relatively easy to diagnose on the basis of its characteristic appearance, some cases are diagnosed as other diseases such as leukoplakia and pemphigus, suggesting the difficulty of clinically confirming the diagnosis. Further, it is necessary to pay attention when treating patients with OLP in the presence of Candida spp.
It is generally known that sagittal split ramus osteotomy (SSRO) has greater postoperative stability than intraoral vertical ramus osteotomy (IVRO); however, inferior alveolar nerve (IAN) damage is likely to occur. On the other hand, IVRO has problems with slow postoperative osseous healing and projection of the antegonial notch; however, it is believed that IAN damage is unlikely to occur. The purpose of this study is to compare the osseous healing process of SSRO with IVRO. On the CT image, the SSRO osseous healing process was almost the same as that of IVRO. Projection of the antegonial notch occurred after IVRO, but returned to the preoperative state within half a year of the operation. IVRO postoperative IAN damage did not occur, and the osseous healing process was similar to SSRO. Therefore, it was shown that IVRO is as good an operational procedure for mandibular protraction as SSRO.
The most important aspect when diagnosing oral mucosal diseases is recognizing color changes in the mucous membrane. However, the human brain cannot memorize color information with accurate reproducibility. Recently, fluorescence visualization techniques have been applied in various medical areas including oral squamous cell carcinoma. The present study aimed to determine the feasibility of using a portable auto-fluorescence imaging meter with analysis software for screening oral mucosal diseases. The subjects were healthy volunteers and patients with oral mucosal diseases who visited the Oral and Maxillofacial Surgery Department of Tokyo Dental College Suidobashi Hospital. The colors of normal and abnormal parts of the oral mucosa were measured for each patient using the auto-fluorescence imaging meter, and the color variations were analyzed by dedicated software. The results showed that the meter could differentiate normal from abnormal regions based on color variations. Therefore, the portable auto-fluorescence imaging meter can be used as an adjunctive diagnostic device for screening oral mucosal diseases.
This study investigated relationships between changes in sensory thresholds, subjective symptoms, and mental states over time in 55 patients who had sensory disturbances on their unilateral lower lip and chin. The sensory thresholds were determined by nine different testing modalities which included static light touch, two-point discrimination, warm/cool/heat stimulation, 5-Hz rectangular current stimulation, and current perception thresholds (2,000Hz, 250Hz, 5Hz). Obtained thresholds were classified into five scores (0–4), and the average of the scores for all the tests was calculated as the individual score (average score). To investigate what kind of subjective sensations the patients were experiencing, the McGill Pain Questionnaire (Japanese version) was applied. The degree of hindrance in daily life, degree of subjective sensory abnormality, and daily duration of sensory disturbance were investigated using visual analog scales. To investigate the patient's mental state, we used the Hospital Anxiety and Depression Scale. Neither the changes in subjective symptoms nor the mental states of anxiety and depression showed a significant correlation with recovery in sensory thresholds (i.e., the average scores). The changes in patients' subjective symptoms and mental states were not associated with the appearance/disappearance of hypersensitivity to thermal stimulation or current perception thresholds.
Ameloblastoma occurs most frequently in the jaws intraosseously. However, this odontogenic tumor rarely occurs in extraosseous soft tissue, and such cases are commonly referred to as peripheral ameloblastoma. As characteristic findings are commonly poor in this tumor clinically, it is difficult to diagnose correctly. We experienced a case of peripheral ameloblastoma in the lower gingiva of the canine area that was found by accident. The patient was a man in his 40s. A painless lesion with a papillary surface was found in the lingual gingiva of the mandibular canine, so it was considered to be a papilloma and was removed under local anesthesia. However, findings characteristic of ameloblastoma were obtained pathologically, so the case was diagnosed as peripheral ameloblastoma. No evidence of recurrence was found during eight months of observation after excision.
We report here a case of methotrexate-associated lymphoproliferative disorder (MTX-LPD) diagnosed on detection of gingival ulceration. A 54-year-old woman presented to our clinic with a chief symptom of multiple maxilla-mandibular gingival ulcers. Histopathological diagnosis was MTX-LPD of the Hodgkin-like lesion type along with EBV positivity. The condition was treated by MTX withdrawal during the 3 months of remission. We reviewed reports documenting 24 cases of oral MTX-LPD in Japan. Affected sites included the maxillary gingiva (n=13), the mandibular gingiva (n=4), the maxillary-mandibular gingiva (n=1), tongue (n=3), floor of the mouth (n=2), and lips (n=1). Of these 24 cases, 20 ulcers were severe, with 3 involving bony exposure and a fistula. Histopathological analysis revealed 15 DLBCL cases, a Hodgkin-like lesion case, 2 polymorphous B-cell LPD, a B-cell LPD, a T-cell dominant LPD, a polymorphic LPD, and 3 cases of unknown etiology. Nineteen cases were treated with MTX withdrawal, and 5 cases were treated with MTX withdrawal and chemotherapy. With treatment, 21 patients attained remission, 1 patient died of the primary disease, and 1 other died owing to secondary complications. Twenty cases attained remission with the withdrawal of MTX without recurrence.
Sialoliths commonly occur in the submandibular gland, but rarely in the parotid gland. We report a rare case of intraductal parotid sialoliths that discharged spontaneously from the buccal sinus tract. A 65-year-old male with left buccal swelling was referred to our department for endoscopic removal of two parotid sialoliths. Computed tomography showed sialoliths in the left parotid duct measuring 8.3×6.6×3.1mm and 2.5×2.1×1.4mm in size. Although endoscopic removal was planned, the sialoliths discharged spontaneously from the buccal sinus tract due to acute inflammation 1 month after the first visit. No salivary fistula nor dysfunction of the parotid gland was found thereafter.
Trousseau's syndrome is well known as a thromboembolism found in patients with cancer. This report presents a rare case of synchronous cancer of the oral cavity and stomach diagnosed in association with multiple cerebral infarctions. An 85-year-old man was admitted to the Department of Neurology in Kyoto University Hospital due to sudden onset numbness in his face and arm. MRI revealed multiple small embolisms in the cerebrum and cerebellum. Despite appropriate diagnostic evaluation, the cause of the acute cerebral infarctions remained uncertain. Several days after his admission, the patient complained of discomfort in his mouth and so was referred to the Department of Oral and Maxillofacial Surgery. Clinical examination revealed a hard elastic tumor in the left maxillary molar region. An incisional biopsy yielded a pathological diagnosis of squamous cell carcinoma. In an endoscopic examination of the upper gastrointestinal tract, he was diagnosed with gastric adenocarcinoma. Additionally, PET-CT findings indicated an inoperable gastric tumor with regional lymph node and lung metastases. In view of the patient's poor general condition and progressive disease, he elected to pursue only supportive care. He was then discharged and allowed to return home; the patient continued on supportive care for 2 months before he died.
Fabry disease is a congenital disorder of glycolipid metabolism caused by a reduction or depletion in activity of α-galactosidase A, an intercellular lysosomal enzyme. In this disease, accumulation of glycosphingolipid is observed in the heart, kidneys, blood vessels, skin, cornea, and nerves, which leads to multiple organ dysfunction. We report a case of a patient with typical Fabry disease who underwent extraction of bilateral lower third molars. The patient was a male in his thirties who requested that the operation be performed under general anesthesia. Preoperative assessment revealed mild renal dysfunction without other major problems, and careful and safe perioperative management was performed. A thorough preoperative investigation for patient care around the operation is strongly recommended to prevent cardiovascular, renal and cerebrovascular complications in patients suffering from Fabry disease.
Denosumab, the human monoclonal antibody to RANKL, was approved for the treatment of osteoporosis with its ease of administration once every 6 months. We report a case of a 74-year-old male patient, who has developed chronic osteomyelitis of the jaw possibly associated with a single denosumab dose for the treatment of glucocorticoid-induced osteoporosis. Extensive osteolytic changes associated with diffuse sclerosis and sequester formation were found in the left lower molar region on panoramic X-ray and CT. Subsequently, sequestration was also observed in the left upper molar edentulous region. Based on this case report, we suggest that medical-dental collaboration, sharing of the administered medication record and enlightenment of patients are important for the treatment of anti-resorptive agent-related osteomyelitis/osteonecrosis of the jaw. Additionally, it is suggested that teriparatide might lead to an early healing process.
An external dental fistula involves formation of a fistula or granulation as an excretion pathway in the jaws or face, due to chronic purulent odontogenic inflammation. We describe a case involving a 30-year-old male patient who had an external dental fistula-like scar in the right buccal region. A diagnosis of an external dental fistula, caused by an infected right mandibular first molar, was made; endodontic therapy was performed without symptomatic improvement, and the patient was referred to our university. Tenderness in the masseter region and scarring in the right buccal region were found upon examination. Diagnostic imaging revealed a cylindrical structure suggestive of an external dental fistula in the soft tissues. Removal of the external dental fistula was performed under general anesthesia and the course was good. Patients with an external dental fistula may show symptoms for a prolonged period before a definitive diagnosis is made; however, diagnosis can be facilitated by early, accurate imaging examination.
Methotrexate-associated lymphoproliferative disorder (MTX-LPD) is well known as a lymphoma caused by long-term and low dose administration of methotrexate (MTX) for the treatment of rheumatoid arthritis. In the World Health Organization (WHO) classification, MTX-LPD is categorized into immunodeficiency-related lymphoproliferative disorders. Although tissue types are varied in this disease, most of them are permitted provided Hodgkin's lymphoma and diffuse large B-cell lymphoma. In this report, we highlighted two cases of methotrexate-associated lymphoproliferative disorders in the gingiva. The cases received MTX oral medication for their rheumatoid arthritis treatment during a period of 13–15 years. Physical examination revealed the ulceration of the gingiva with alveolar bone exposure and pathological diagnosis of diffuse large B-cell lymphoma was made. Following MTX interruption, symptoms were completely remitted.
Sialolith commonly occurs unilaterally in the submandibular gland of adults, while submandibular gland stones occur rarely in children. Here we report a case of bilateral submandibular gland stones in a child. A 7-year-old boy had swelling of the left submandibular gland. The patient was referred to our department for endoscopic removal to avoid submandibular gland removal after bilateral hilar stones of the submandibular gland had been diagnosed in another hospital. Because the left stone, 1.7×1.7×1.1mm in size, was located at the orifice of the papilla at the first visit, the stone was removed under local anesthesia. But, the right stone, 3.0×1.6×1.5mm in size, was located at the hilar, and the patient was followed up. Eight months after the initial visit, the patient had swelling of the right submandibular gland. Because the right stone was located at the orifice of the papilla, the right stone was removed under local anesthesia. There was no recurrence after the removal of submandibular gland stones.
The patient was a 79-year-old woman. In August 201X–15, she noted a mass in the floor of the mouth in the left mandibular molar region, and consulted the dental department of a local hospital. The resected mass was diagnosed as neurofibroma. Thereafter, in June 200X–6, she consulted our hospital primarily due to a mass and pain in the same site. In December of the same year, she underwent resection of the floor of the mouth, and the histopathological diagnosis of the resected specimen was primary adenoid cystic carcinoma of the sublingual gland. From January 200X–5, she received postoperative radiotherapy (total dose: 60Gy) and was followed-up. After 5 years, in April 201X, she noted swelling and pain of the floor of the mouth in the left mandibular region. Panoramic radiography showed a fracture line in the left mandible, and radiation-induced osteomyelitis of the mandible was suspected. Although she was treated with antimicrobial medication, around July of the same year, she was admitted to our department due to aggravation of the swelling of the left floor of the mouth and submental region. The mass was diagnosed histopathologically as soft tissue sarcoma, which was suspected to be myogenic, and was considered as radiation-induced sarcoma.