We carried out a clinical study of 124 patients for facial bone fractures treated in our department over a 5-year period from November 2009 to September 2014, and obtained the following results.
1. The average age was 41.7±24 years old and the male/female ratio was about 2:1.
2. The majority of the patients were between the ages of 10 and 30, (49.2%) with the peak incidence occurring in those in the 10–19 year-old group (16.1%).
3. The majority of the patients visited our department within 3 days of injury (89.5%).
4. The majority of patients were referred from the Department of Emergency Care in our medical center (58.9%).
5. The most common causes of injury were falls (45.9%) and traffic accidents (34.7%).
6. Mid-facial fractures accounted for 51.7% and mandible fractures for 48.3%.
7. Sixty-two cases (50%) were treated by open reduction surgery.

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We describe our experience with a case of carcinoma ex pleomorphic adenoma. A 54-year-old woman was referred to our hospital because of a painless mass of the left palate that had been present for 10 years. Clinical examination revealed a 20×18×12-mm well-defined, elastic soft mass in the left region of the soft palate. The preoperative incisional biopsy showed pleomorphic adenoma without a malignant component, but the removed tumor included small foci of salivary duct carcinoma within pleomorphic adenoma. After the histological diagnosis of pleomorphic adenoma from the biopsy, the lesion was excised under general anesthesia. Histopathological examination of the excised specimen revealed an encapsulated tumor composed of solid and duct-like proliferation with hyalinous and myxoid extracellular matrices like an incisional biopsy. However, small malignant areas were noticed within the tumor. The carcinomatous elements were composed of nests of cribriform patterns and ductal structures containing necrotic tissues in the lumen. These structures were comprised of large epithelial cells with eosinophilic cytoplasmic granules and enlarged hyperchromatic nuclei, and peripheral mono-layered flattened cells without atypia. The eosinophilic cells and peripheral flattened cells immunohistochemically demonstrated phenotypes of duct luminal cell and myoepithelial cell, respectively. Based on the histological and immunohistochemical findings, the malignant component was diagnosed as salivary duct carcinoma. The present tumor was finally diagnosed as carcinoma ex pleomorphic adenoma. No signs of recurrence have been observed 3 years after surgery.

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Airway stenosis during surgery for oral diseases can result in serious complications, thus making airway management one of the most important aspects of perioperative care. A case of buccal cellulitis, in which airway management was performed using a new type of tracheal cannula, is reported. This new type of tracheal cannula is suitable for patients with physical characteristics, such as obesity and swollen cervical tissues that often result in repeated accidental extubation when using a conventional tracheal cannula. The present patient was a female in her 70’s with chief complaints of pain in the right jaw and difficulty breathing. She was examined at her local dental clinic in February, 201X for pain in the right mandibular first molar; however, her symptoms worsened, and she was subsequently examined in the emergency department of our institution. Her current medical history included angina pectoris and IgA nephropathy treated with hemodialysis. On initial examination, her temperature was 37.7°C, and SpO2 was 94%. Breathing difficulty was evident, and marked swelling was observed from the right buccal area to the neck. Right buccal cellulitis was diagnosed clinically, and she was admitted immediately for incisional drainage under general anesthesia. Tracheostomy was then performed. Following repeated accidental extubations of a conventional tracheal cannula, a new type of tracheal cannula was applied, with which good airway management was subsequently achieved.

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We report a case of a sublingual mucoepidermoid carcinoma. The most frequent site of mucoepidermoid carcinoma is the major salivary glands and in some cases it also develops in the minor salivary glands. However, a case of mucoepidermoid carcinoma on the tongue is quite unusual. The patient was a 60-year-old woman who presented to our department with a chief complaint of feeling sublingual discomfort. The patient's past history included hypertension and hyperlipidemia. An exophytic mass measuring 5×5mm was found on the undersurface of the tongue. At the first medical examination, a clinical diagnosis of tongue neoplasm or mucocele was made. Excisional biopsy under local anesthesia was performed. A pathological diagnosis of mucoepidermoid carcinoma was made. At the time of this report, ten months after the surgery, no recurrence has been observed.

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This case report describes the treatment of central giant cell granuloma that occurred in the molar region of the mandible. A 28-year-old woman presented with a swelling of the right molar area of the mandible and underwent an X-ray and a computed tomography scan of the mandible. These examinations showed bone destruction in the right molar region of the mandible. The patient was diagnosed with giant cell granuloma in the mandibular molar region by biopsy. After resection of the tumor and a graft of particulate cancellous bone and marrow (PCBM) from the ilium under general anesthesia, reconstruction of the right mandibular molar region was performed using a composite mesh plate of hydroxyapatite (HA) particles and poly [L-lactide] (PLLA). At 2.5 years postoperative follow-up, the patient has a good prognosis with no signs of relapse.

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Vitapex^® is known to promote healing of periapical scars and facilitate skeletogenesis. It is used in routine clinical practice as a root canal filling material after pulpectomy or for the treatment of infected root canals. We report a clinical case of overfilling of Vitapex^® from the apical foramen into the mandibular canal that caused inferior alveolar nerve hypoesthesia.
A woman in her twenties presented at a local dental clinic for treatment of an infected root canal of the left mandibular second molar and received a Vitapex^® injection. After the treatment, she presented with sensory disturbance in her left lower lip and mental region. She was introduced to our department 1 week later. She was diagnosed with sensory disturbance in the left lower lip and side of the chin. A panorama X-ray radiograph revealed a radiopaque image suspected to represent a large overfilling of Vitapex^® into the left mandibular canal. After extraction of the left mandibular second molar, the socket was opened. A vitamin B₁₂ formulation was then administered to her, and a series of stellate ganglion blocks was performed. Three months after extraction, radiographic findings revealed that the radiopaque image in the mandibular canal had disappeared, and the sensory disturbance had mostly subsided 4 months after treatment initiation.

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Pleomorphic adenoma, which is the most common benign tumor in the salivary glands, occurs frequently in the parotid gland, but is relatively rare in the lower lip. We report a case of pleomorphic adenoma which developed from the lower lip in a 72-year-old woman. The lesion was an elastic-hard mass measuring 10×15mm which was painless and movable. The clinical diagnosis was a benign tumor of the lower lip. The tumor was completely resected under local anesthesia. The removed tumor was well encapsulated. The histological diagnosis was pleomorphic adenoma originating from a minor salivary gland of the lower lip. The lower lip healed well and there has been no evidence of recurrence after the operation. However, careful long-term follow-up for relapse and malignant change is required.

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Pathologically advanced sclerosing osteomyelitis of the mandible exhibits characteristic findings on imaging studies, such as a diffuse osteosclerotic appearance, an ill-defined border between the cortical bone and bone marrow, and bone apposition around the mandible. However, because neither subjective nor objective symptoms occur in the early stages, many aspects of early imaging findings of sclerosing osteomyelitis of the mandible remain unknown. In this study, we assessed the longitudinal changes in the mandible before the onset of symptoms in patients with sclerosing osteomyelitis of the right mandible, employing computed tomography images taken for follow-up of malignant lymphoma at the Department of Hematology in our hospital. During the early stages after the onset of asymptomatic sclerosing osteomyelitis of the mandible, an increased computed tomography value was observed around the root of the causative tooth. When a radiolucent area appeared around the root apex, opacity around the root was enhanced. After the patient noted inflammatory symptoms in the tissue around the causative tooth, the degree and area of opacity further increased. Bone apposition to the outer surface of the cortical bone and the presence of radiolucent spots in the opaque area were then confirmed.

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Denosumab is a bone antiresorptive agent for use in patients with osteoporosis or metastatic cancer of the bones. A recent meta-analysis revealed that denosumab is associated with an increased risk of developing medication-related osteonecrosis of the jaw (MRONJ) compared with bisphosphonate (BP) treatment or placebo, although the increased risk was not statistically significant between denosumab and BP treatments. This paper presents the case of an 83-year-old man with MRONJ in the left maxilla caused by the use of denosumab for prostate cancer with multiple metastases to lymph nodes, bone and lungs, which improved by minimally invasive treatment after withdrawal of denosumab. The patient was given a subcutaneous injection of denosumab every 4 weeks for a period of 17 months. He had no history of receiving bisphosphonates or radiation therapy. We performed careful examinations and treatment with antibiotics, local irrigation and removal of as many necrotic bone chips as possible every 2 weeks. Finally, the remaining sequestrum was removed 10 months after the cessation of denosumab. The affected area was epithelialized within 19 days.

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Methemoglobinemia is characterized by increased methemoglobin in the circulating blood. Methemoglobin is useless as an oxygen carrier; thus, methemoglobinemia could lead to hypoxemia due to the limited availability of hemoglobin for oxygen delivery. A local anesthetic, propitocaine, is commonly used in dental surgery, and rarely causes methemoglobinemia. We report a case of a 21-year-old female who developed methemoglobinemia following the use of 3% propitocaine with 0.03U/ml felypressin during the extraction of wisdom teeth under general anesthesia. She suffered from long QT syndrome, and propitocaine was used to minimize the influence on hemodynamics. After the administration of propitocaine (total 378mg), pulse oxygen saturation (SpO₂) decreased to 93%. She was once ventilated with 100% oxygen; however, SpO₂ remained between 92–94% during the extraction. An arterial blood gas analysis revealed a methemoglobin value of 6.2%, leading to a diagnosis of methemoglobinemia. Oxygen therapy was administered and SpO₂ improved to 99% and methemoglobin values decreased to normal levels (1.0%) 11 hours after the end of the procedure. Oxygen therapy was completed and the subsequent course was uneventful. Clinicians should be aware that the use of propitocaine in dental surgery may cause methemoglobinemia and that when it occurs, appropriate treatment should be provided immediately.

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