Imaging examinations should be done for various kinds of lesions in the oral and maxillofacial region. The anatomy of this region is complex and various diseases may occur. Recent developments in medical imaging modalities have led to diagnostic improvements in the dental field. In fact, computed tomography, magnetic resonance imaging, ultrasonography, and positron emission computed tomography have been applied for various diseases in the oral and maxillofacial region. Among these modalities, ultrasonography should be the first choice for soft tissue-related diseases in the region because it is noninvasive and easy to use. In particular, ultrasonography is a very useful modality for the diagnosis of metastatic lymph nodes and salivary gland-related diseases. In addition, the clinical application of Doppler and/or elastography could also improve diagnostic accuracy for various diseases in the oral and maxillofacial region, and the application of ultrasonography to the dental field could be extended. In the present review, we explain the usefulness of ultrasonography for various diseases in the oral and maxillofacial region.

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Recently, a relationship between periodontal disease and premature/low-birth-weight infant delivery has been suggested. Here, we investigated whether oral management in women at risk of premature delivery could help reduce rates of premature/low-birth-weight delivery. We retrospectively examined patients admitted to the Hachinohe City Hospital Perinatal Center between October 2014 and October 2015. We assigned 8 pregnant women at risk of premature delivery who had received oral management at our hospital’s Department of Oral and Maxillofacial Surgery to the oral management intervention group; 24 pregnant women at risk of premature delivery who had not received oral management were assigned to the non-intervention group. No significant differences were observed between these two groups upon comparing various parameters by the t-test. Mean C-reactive protein level tended to be lower after oral management intervention than before. In addition, there were no significant between-group differences in the relationship between premature/low-birth-weight delivery and oral management. However, reduction of the rate of premature delivery was observed in the oral management intervention group （Fisher, P＝0.07）. Oral management intervention in the case of a risk of premature delivery could ameliorate inflammation in pregnant women, suggesting the possibility of reducing the rate of premature delivery. Further investigations of the influence of oral management on delivery are needed.

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Maxillary sinus carcinoma occurs most frequently after maxillary gingival cancer. However, malignant tumors arising from cysts are rare. We report a case of maxillary sinus carcinoma, which was thought to have occurred from dentigerous cysts. The patient was a woman in her 30s. From around February 2016, she experienced pain and gingival swelling of the right maxillary molar region and consulted a local doctor. Impacted teeth were found in the maxillary sinus, and she was referred to our hospital with suspected tooth cysts. In the past, she had undergone CT imaging in an examination for brain tumors, and cystic lesions and impacted teeth had been found in the right maxillary sinus. As an intraoral finding, a tumor was found in the right maxillary molar tooth; a biopsy was performed and malignant findings were confirmed. A contrast CT examination revealed extensive expansion of the tumor and impacted teeth in the tumor. Under a diagnosis of maxillary sinus carcinoma, complete resection of the maxilla and reconstruction of the rectus abdominis flap were performed in June 2016. The patient was diagnosed with squamous cell carcinoma by pathological diagnosis. After the surgery, radiotherapy was administered, however, the patient passed away in October 2016. Oncogenesis of an odontogenic cyst is rare, and we suggest that if such a cyst is recognized, early treatment and regular follow-up for a long period after surgery are necessary.

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Angioedema （AE） occurs due to various factors and may be seen as a side effect of drugs. Many causative drugs have been reported, and many antihypertensive drugs are reported to be angiotensin converting enzyme （ACE） inhibitors, but angiotensin Ⅱ receptor antagonists （ARB） are rare. We report one case of the cheek and lower lip in which we speculate that AE was induced by ARB. A 62-year-old man was admitted to our department because of swelling of the right cheek and lower lip. In CT, there was no abnormal finding that seemed to cause the swelling of the cheek and lower lip, and uniform soft tissue concentration was observed. Clinically, AE was considered and oral administration of tranexamic acid 300mg/day was started. We speculated that ARB was the causative drug. We asked the internal medicine about drug exchange. And the drug was discontinued. Swelling of the right cheek and lower lip had disappeared at the time of re-examination 2 weeks later, and recurrence of AE has not been observed since the drug discontinuation.

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A ranula is a mucous cyst caused by obstruction of saliva outflow. The various treatment methods include incision, fenestration, cystectomy, and total sublingual gland removal. In this case, we performed fenestration from the oral cavity as a minimally invasive treatment for a plunging ranula, and achieved good results.
A 9-year-old girl visited our hospital. A blue-purple soft-elastic swelling was found in the right floor of the mouth, and mild swelling was observed in the right submandibular region.
Based on the imaging and clinical findings, we diagnosed the lesion as a sublingual and plunging ranula. The patient and parents wanted minimally invasive treatment; thus, the cyst wall was resected by fenestration under local anesthesia, without suturing the oral mucosal tissue.
To avoid early wound closure, we instructed the patient and her parents to apply a steroid ointment to the wound with a cotton swab. Moreover, we instructed the patient and her parents to press the right submandibular region continuously using a small pillow.
Because a small amount of mucus retention was suspected at the 1st week and 2nd week after the operation, re-puncture and re-aspiration were performed. The patient’s subsequent clinical course was uneventful and her condition was good at one year after the operation.

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Actinomycosis is a chronic purulent granulomatous disease caused by the Actinomyces genus. The age of onset is said to be relatively high after adolescence, but the disease is rare in the pediatric field. We have experienced two pediatric cases of mandibular actinomycosis, and report our findings here.
Case 1 was a 13-year-old female patient, who presented with a complaint of swelling of the left lower molar region. In the CT findings, osteosclerosis and bulging of the left mandibular ramus were observed. A small abscess appeared near the lower jaw angle, and actinomycetes were detected in the bacterial culture. Saucerization and decortication were performed under general anesthesia. Case 2 was a 6-year-old female patient, who presented with a complaint of a tumor-like lesion of the right buccal mucosa. In the MRI finding, a tumor with a signal intensity comparable to that of muscle was confirmed on the right buccal mucosa. Tumorectomy was performed under general anesthesia, and this case was diagnosed histopathologically as actinomycosis.
Our findings suggest that in pediatric cases of refractory osteomyelitis, treatment should be carried out not only by the usual examination methods but also by early bacterial and histopathological examinations.

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Oropharyngeal disease with underlying hematologic disease is commonly seen in daily clinical practice, and may manifest as oropharyngeal bleeding or inflammatory features. In cases with underlying hematologic disease, exacerbation of inflammation from leucopenia and bleeding diathesis from thrombocytopenia are prominent oropharyngeal findings, and blood tests often reveal the underlying disease. Leukemia, particularly acute promyelocytic leukemia （APL）, can be complicated by disseminated intravascular coagulation （DIC） leading to bleeding such as intracranial bleeding. Thus, early diagnosis and treatment can greatly influence prognosis.
We report the case of a 20-year-old man who presented with left buccal phlegmon. Blood testing revealed leucopenia and thrombocytopenia of 3,000/μL and 43,000/μL, respectively, with elevated CRP, FDP, and D-dimer of 12.56mg/dL, 167.6μg/mL, and 34.4μg/mL, respectively. The elevated FDP and D-dimer levels implied DIC due to severe inflammation, but local findings did not suggest any severe infection that could cause DIC; the elevated D-dimer strongly suggested DIC associated with acute leukemia. The severe thrombocytopenia was suggestive of APL, which would require emergency management. He was thus referred urgently to the hematology department on the night of presentation where a definitive diagnosis of APL was made, allowing early treatment.

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Thyroglossal duct cyst is a congenital cyst derived from epithelial remnants of the thyroglossal duct of the fetus and occurs between the foramen cecal of the tongue and the thyroid gland, though it rarely arises in the oral cavity. We report here a case of the cyst occurring in the lower tongue at birth.
The patient, an 11-day-old male infant, was referred by his obstetrician to our department with a chief complaint of swelling in the lower tongue. Physical examination revealed an elastic soft mass of 15mm in diameter at the hypoglottis region, though functional disorders including lactation were not noted. Magnetic resonance imaging （T2 emphasis） showed a 14×12×18mm cystic lesion having a clear boundary in the lower front of the tongue. A clinical diagnosis of lower tongue cyst was made. The removal was carried out under general anesthesia following serial observations until the body weight reached 10kg. Histopathological findings did not contradict the thyroglossal duct cyst. The post-operative course was uneventful.

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There have been previous reports wherein extrusion of the root canal filling material through the root apex during filling of the root canal compressed or damaged the inferior alveolar nerve, causing mental nerve paresthesia. We encountered a case where non-resorbable root canal filling material extruded from the apical foramen into the mandibular canal, causing mental nerve paresthesia, and complete recovery of sensation was achieved through surgical removal of the non-resorbable root canal filling material. The patient was a man in his 30s who visited our clinic with the chief complaint of mental nerve paresthesia. Non-resorbable root canal filling material was found to have escaped into the mandibular canal. Spontaneous recovery could have been expected with resorbable root canal filling material, but spontaneous regression of symptoms, with observation as the only treatment, is not possible with non-resorbable root canal filling materials. Therefore, the non-resorbable root canal filling material was removed surgically, under general anesthesia, and the mental nerve paresthesia was resolved completely at an early postoperative stage.

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Acquired hemophilia A is a rare disease caused by the acquisition of factor Ⅷ inhibitor. Its incidence is reported to be 1.48 cases per million persons, and is often diagnosed on sudden bleeding of subcutaneous or intramuscular tissue. Here, we report a case of acquired hemophilia A diagnosed with submucosal hematoma of the oral cavity.
A male patient in his 70s was referred to our hospital due to growth of an oral hematoma. He did not have any prior history of bleeding. On laboratory tests, the platelet count and prothrombin time were almost normal. However, the activated partial thromboplastin time was longer than normal. We suspected coagulopathy and further examination was done. Then, a decrease in coagulation activity of factor Ⅷ and the presence of factor Ⅷ inhibitor were detected. On hospital day 5, we diagnosed him with acquired hemophilia A and began immunotherapy with prednisolone. On hospital day 16, the submucosal hematoma disappeared. On hospital day 28, factor Ⅷ inhibitor was not detected on laboratory tests. Prednisolone was gradually decreased and there are no longer any symptoms of bleeding and hematoma.

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Denosumab, a human monoclonal antibody directed against the receptor activator of nuclear factor-κB ligand （RANKL）, is used for the treatment of patients with metastatic cancer of the bone or osteoporosis. Recent reports have demonstrated that denosumab can induce osteonecrosis of the jaw, but its epidemiology and pathogenesis have not been fully clarified. This report presents the case of a 70-year-old female with breast cancer exhibiting bone metastases who developed osteonecrosis of the jaw （ONJ） while receiving denosumab. We performed surgical treatment and achieved successful healing.

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Aim: To report a difficult case of medication-overuse headache complication in a patient with orofacial pain following dental treatment.
Case: A patient in her 60s had undergone repair of the left upper first premolar that had lost a filling by a dentist about 6 months prior. As root canal treatment was initiated, the patient started experiencing pain on the left side of the head and face. As she experienced no improvement of symptoms, she visited an otology clinic for a detailed examination, but no cause was identified. Subsequently, the patient was referred to our hospital. At that time, she was frequently taking prescribed loxoprofen. No acute inflammation was found in the tooth, therefore the pain was suspected to be associated with myofascial pain of the left temporal muscle. Simultaneously, the patient suffered an ankle fracture. She underwent treatment in an orthopedic surgery department, which used loxoprofen to treat the pain. Subsequently, head and face pain on the left side worsened. Because the cause was not identified, the patient was referred to the pain clinic department of a general hospital. By then the patient was suffering from tension headache and took analgesics on a daily basis. Based on this, medication-overuse headache was suspected. Loxoprofen was immediately discontinued and goreisan was prescribed as an alternative. Thereafter, the head and face pain on the left side almost disappeared.
Conclusion: Medication-overuse headache may occur due to the overuse of medication in patients with primary headache. Prior to prescribing analgesics, dentists need to understand the patient’s past history of headaches. Drug administration without due consideration should be avoided. Additionally, the patient should also be informed of the risk of medication-overuse headache.

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Xerostomia is a symptom that causes disturbance of eating, dysgeusia, and oral pain due to mouth dryness resulting from a decrease of saliva secretion. Recently, the number of patients visiting dental clinics with a chief complaint of dry mouth has increased, and in April 2009 the division of Oral Diagnosis and General Dentistry at Meikai University Hospital established a Dry Mouth Division. We have since been investigating patients with xerostomia to clarify the causative factors and related lifestyle habits, and ways in which the condition can be improved. Here we report the trends in patients visiting our division over the 8-year period from April 2009 to March 2017.

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