Various diseases occur in the stomatognathic system, and performing a definitive diagnostic examination with histopathology is important in diagnosing the condition and establishing a treatment plan. We investigated 89 patients who underwent histopathological examination at our hospital between January 2013 and December 2014. The number of histopathological examinations increased from 32 in 2013 to 57 in 2014. Of these, cases referred by a local dentist increased from 6% in 2013 to 29% in 2014. Most patients were in their 40s and 70s, forming a binomial distribution. We then investigated all cases classified as neoplastic lesions, cystic lesions, inflammatory lesions or other disease. Neoplastic lesions accounted for 40%, cystic lesions 24%, other diseases 24%, and inflammatory lesions 12%. Among neoplastic lesions, odontogenic malignant tumors were 0%, odontogenic benign tumors 3%, non-odontogenic malignant tumors 11%, and non-odontogenic benign tumors 86%. Among the non-odontogenic benign tumors, fibromas were found to be the most common. Among cystic lesions, 8 patients had radicular cysts and 2 had dentigerous cysts. The most common inflammatory lesion was granulation tissue. The most common other disease was lichen planus. This study revealed trends in histopathological examinations within our hospital department.

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We conducted a clinical and statistical survey of new outpatients presenting for medical consultation at the oral diagnosis department of Meikai University Hospital in the two years from 2013 to 2014. The total number of new outpatients in 2013 was 4,438 (1,910 males, 2,528 females) and that in 2014 was 4,321 (1,890 males, 2,431 females), females considerably outnumbering males in both years. In terms of age class, 300 patients were less than 19 years old, and patients in the 20–50-year and in the 70-year age groups numbered about 600 each in both years. In terms of the monthly number of patients seen, many presented between March and July in 2013, and many presented in March, June, and July in 2014. Toothache was the most common complaint in both years. Examination of patients' medical histories revealed an increase of patients with so-called lifestyle-related diseases such as high blood pressure, heart disease, and diabetes. Our findings suggest the need to carry out regular surveys of patient trends in order to address the diversifying needs of local residents.

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A retrospective clinic-statistical study was performed on 474 cases of maxillofacial fractures in the Department of Oral and Maxillofacial Surgery, Saiseikai Yokohamashi Tobu Hospital, between April 2007 and March 2014. The male/female ratio was 3.4：1. The most common age group was the twenties, followed by the teens; these two groups accounted for 35.4% of all subjects. The most frequent cause of injury was traffic accident (34%), followed by a fall (28%). Adolescent and late middle-age subjects often suffered injuries due to traffic accidents, fighting and sports. On the other hand, among the elderly, injuries caused by a fall increased with age. Almost all patients (82%) were referred from the emergency and critical care center in our hospital. The most common fracture sites were zygoma (33.7%), followed by mandible (31.2%) and orbita (23.6%). Open reduction was performed in 50.4% of all fractures, and more frequently in fractures with malocclusion. There were concomitant injuries except for the maxillofacial area in 39% of all maxillofacial fractures. The most common site was cranium (19%), followed by extremities (18%).
Maxillofacial fractures in our hospital are characterized by a high frequency of traffic accidents, midface fractures and concomitant injuries.

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We have occasionally experienced cases with aberrant foreign bodies, such as fish bones or metal fragments of dental materials, in the oral region. Recently, there have been cases of serious injury due to piercing of the nose, lips, and other body parts. We report the case of a 49-year-old man with a needle in the floor of his mouth that had been used to pierce the tongue.
The patient visited our department because of difficulty in swallowing and speaking. Macroscopically, only a slight redness on the right side of the oral floor was seen; the foreign body could not be felt on palpation. Panoramic radiography and computed tomography showed a sharp, straight metallic object extending from the floor of the mouth to the submental region. The object was located in the deep submucosal layer of the oral floor into the right suprahyoid muscles and was surgically removed from the inside of the right anterior belly of the digastric muscle using an extraoral approach. We chose to use general anesthesia because of the risk of bleeding and airway obstruction. The object was a metal needle 5 mm in diameter and 50 mm in length. The postoperative course until 1 year was uneventful.

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A dentigerous cyst is an odontogenic cyst encountered relatively frequently in oral surgery. However, there are rare cases of dentigerous cysts found within the maxillary sinus, which can be caused by an impacted canine. We present the case of a 14-year-old girl who developed a dentigerous cyst due to an impacted canine in her maxillary sinus. Panoramic radiographs revealed a cystic permeation that extended from the right maxillary through the base of the nasal cavity, an impacted canine. Computed tomography images revealed a cystic lesion that included a large impacted canine 50×46×36 mm in the maxillary sinus. Complete removal of the cyst, extraction of the impacted wisdom tooth, first molar, and the impacted canine from the maxillary, and closure of the maxillary fistula were performed endoscopically under general anesthesia. Her post-operative course was good, with no postoperative infections.

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Oral lichen planus is an intractable chronic inflammatory lesion with dyskeratosis, appearing more commonly on the buccal mucosa. Here we describe a case of oral lichen planus starting on the bilateral buccal mucosa in a 70-year-old female patient that showed great improvement. The patient's condition gradually improved after treatment with cepharanthin, an alkaloid agent extracted from Stephania cepharantha Hayata. A review of some additional literature pertaining to probable mechanisms of action is included.

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Here, we report a case of stiff neck as a symptom of cervical dystonia and oromandibular dystonia as a symptom of trismus. The patient was a 37-year-old male who was examined at a nearby dental clinical after noticing some stiffness of the neck and trismus at the same time. However, the cause was unknown and the symptoms were neglected. Thereafter, the symptoms worsened and mouth opening became strongly restricted, making dental treatment impossible. He was thus referred to our institution where he was examined. The maximum mouth opening at the first examination was 28mm. He received mouth opening training, and at the mental department, the dose of tranquilizer was reduced and he was treated with a muscle relaxant. Presently, the maximum mouth opening has improved to 40mm and his progress is under observation.

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We present a case of synovial chondromatosis (SC) of the temporomandibular joint (TMJ) with intracranial extension. SC predominantly affects the knee, hip, elbow and shoulder joints, and SC affecting the TMJ with bone destruction is rare. A 77-year-old man was referred to our department for assessment of tenderness in the right TMJ. Computed tomography and magnetic resonance imaging showed that part of the right mid-cranial fossa had been destroyed and the dura mater was elevated by the lesion. The lesion was removed by surgery under anesthesia and the dura mater was exposed. A temporalis myofascial flap was used to reconstruct the defect and protect the exposed dura mater. No signs of recurrence or postoperative complications have been identified as of 6 years after surgery.

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Carcinoma ex pleomorphic adenoma (Ca ex PA) is a carcinoma arising from a primary or recurrent benign pleomorphic adenoma. In this report, we present a case of a minimally invasive Ca ex PA arising in the submandibular gland. The patient was a 62-year-old man with a chief complaint of pain in the right submandibular region. The clinical diagnosis was a benign tumor in the submandibular gland and surgical resection was performed. The tumor contained a small amount of tumor-cell components, and showed a malignant area and a benign area. The malignant area was poorly differentiated adenocarcinoma, immunohistochemically the tumor cells were positive for HER2, and the Ki-67 labeling index was about 60%. The extent of capsular invasion was 1.4 mm into the adjacent tissues. The benign area was pleomorphic adenoma, negative for HER2, and the Ki-67 labeling index was about 4%. The diagnosis was Ca ex PA, minimally invasive type, although there were nerve and vascular invasions and poor prognostic factors, such as positivity for HER2 and high-grade malignancy components. We performed post-operative radiotherapy. Careful clinical follow-up is necessary.

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Ameloblastoma is a benign odontogenic tumor that originates centrally within the jaw bone, and may rarely occur in the extraosseous region as a peripheral ameloblastoma. We present a case of peripheral ameloblastoma in the posterior maxillary gingiva.
The patient was a man in his 70s. He had noticed a mass in the right maxillary region but had received no medical treatment for 60 years because of no symptoms. He was referred to our department by his dentist. Physical examination revealed a module mass (20×20×5 mm) at the right maxillary molar gingiva. Radiographic examination showed no resorption of the bone. Histological findings of incisional biopsy suggested ameloblastoma and surgical excision was carried out under general anesthesia. A histopathological diagnosis of peripheral ameloblastoma was made. No evidence of recurrence was observed for 12 months following the operation.

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Sialoliths commonly occur in the submandibular gland, and parotid gland sialoliths, especially parenchymal sialoliths, are rare. As a minimally invasive surgery, we report here endoscopic removal of a parenchymal sialolith of the parotid gland under local anesthesia.
A female in her 40s with swelling and pain in the left buccal region was referred to our department for endoscopic removal to avoid extraoral removal after diagnosis of parotid sialolith in another hospital. Computed tomography showed that the parenchymal sialolith of the left parotid gland was 1.7×1.4×1.0 mm in size. The patient underwent endoscopic removal of the sialolith under local anesthesia as minimally invasive surgery. Complete removal was performed and the postoperative course was uneventful without complications such as swelling of the parotid gland.

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Venous malformation often arises in every systemic region. In the head and neck, malformations can be found in the tongue, cheek mucous membrane and lips, but rarely in the muscle. We present a case of venous malformation in the masseter muscle. The patient was a female in her thirties, who presented with the chief complaint of a left submandibular mass and pain that appeared at occlusion. Vascular malformation in the masseter muscle was suspected as the clinical diagnosis, and surgical resection was performed. Within the tumor, several phleboliths were observed. The intramuscular tumor was diagnosed by histopathological examination. To date, the patient has shown an uneventful course. Thus, we demonstrate that it is possible to completely resect the lesion using an extraoral approach.

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Granular cell tumors are rare soft tissue tumors, derived from Schwann cells. About half of them occur in the head and neck, but a case with tumor arising in the zygomatic region has not been reported to our knowledge. We report a case of granular cell tumor arising in the zygomatic region. A 57-year-old woman was referred to our hospital because of cheek swelling. MRI findings showed a benign tumor, so the patient wished follow-up. However, the tumor gradually grew in size for 11 months, as was confirmed by MRI. Since the patient desired removal of the tumor, the operation was performed by the intraoral and subcilial approach. The histopathological diagnosis was granular cell tumor. Judging from the operative finding, we supposed the origin of the tumor to be the zygomaticofacial nerve which is a branch of the maxillary nerve. Twenty-six months after the operation, there was no sign of recurrence.

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Treating fractures of the oral and maxillofacial region restores anatomy, form, and function. Because such fractures often result in a dysmorphic facial appearance and occlusal disorders following surgery, appropriate diagnostic and therapeutic methods are required.
We describe a case of mandibular malunited fracture treated using iliac particulate cancellous bone and marrow graft who was injured by a fall, and presented with a cross bite after returning uncertainties first open reduction and internal fixation.

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Dentigerous cyst is one of the most common odontogenic cysts. The cyst typically occurs in the region of the lower wisdom teeth and maxillary canines, but is rare with an impacted premolar in the sinus. We report a case of a dentigerous cyst arising from an impacted first premolar, occupying the maxillary sinus.
A male in his 40s was referred to our department because of swelling and pain of the right buccal mucosa. Radiographic examination showed a cystic lesion in the entire right maxillary sinus containing the first premolar. A clinical diagnosis of dentigerous cyst in the right maxillary sinus with infection was made. The lesion was removed under general anesthesia. Histopathological examination revealed a dentigerous cyst. The patient has been followed for 30 months since surgery and remains in good condition.

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Methotrexate is widely used as an anchor drug for rheumatoid arthritis. However, there are several reports of methotrexate-associated lympho-proliferative disorders, although most of them describe cases which occurred in maxillary gingiva with additional drugs like bisphosphonate. In particular, in almost all cases osteonecrosis of the jaw occurred in maxillary bone. We report a case of methotrexate-associated lympho-proliferative disorder with jaw necrosis in the mandibular gingiva.
A 71-year-old woman who had been treated for 10 years with methotrexate and steroids for rheumatoid arthritis was found to have pain and ulcer after tooth extraction of the lower cuspid. We suspected this lesion was due to incomplete healing after extraction or tumor, so we performed a biopsy for suspected tumor. The pathological diagnosis was methotrexate-associated lympho-proliferative disorder. After methotrexate therapy was stopped, the local pain disappeared. On day 64 after stopping methotrexate, the tooth with bone necrosis was removed under local anesthesia. After operation, the wound was covered with mucosal epithelium, and there has been no recurrence to date.

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We have built a remote consultation system for patients with oral mucosal disease via e-mail between the Nagasaki Dental Association and the Department of Oral and Maxillofacial Surgery of Nagasaki University Hospital. The system was initially constructed for providing consultation on whether to refer a patient to the University Hospital, but in many cases it was possible to make a clinical diagnosis by photographs sent via e-mail. Although there some problems remain, such as management of personal information, this system is useful for early diagnosis and treatment of oral diseases.

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われわれは不必要な頸部郭清を施行しないことを目的として，早期口腔扁平上皮癌N0症例に対してセンチネルリンパ節生検法を用いて頸部リンパ節転移の有無を診断した。
（方法）2007年から2013年までに当科において臨床病期がI期もしくはII期口腔扁平上皮癌患者38症例のうち2年以上の経過観察が可能であった38症例を対象とした。SLNの同定法としては，手術前日にRIを注入後シンチグラフィーにてSLNの位置と個数の目安を決定し，手術当日はガンマプローブを使用しSLNを同定摘出し，術中迅速病理診断により転移の有無を確定させた。術後の経過観察は，CT，MRI，US，PET-CTによる定期的な画像診断と視診，触診によって行われた。
（結果）SLN同定率は100％であった。SNBが陽性であった症例は4/38例（10.5％）であり根治的頸部郭清術が施行された。SNBが陰性であった症例は34/38例（89.5％）であり原発巣のみ切除された。局所再発を認めた症例は6/38症例（15.7％）であった。局所再発を認めなかった症例は32症例で，そのうち4症例に後発リンパ節転移を認めた。5年全生存率はSNB陽性症例で75％，SNB陰性症例 89.3％であった。
（結論）口腔扁平上皮癌においてセンチネルリンパ節生検は，不必要な頸部郭清を回避するのに有用である。

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