For maxillary sinus-related diseases, dental and oral surgery dealing with adjacent areas and otolaryngology do not often cooperate surgically. This report examined 27 cases of maxillary sinus-related surgery performed from January 2016 to December 2019 by Tokuyama Central Hospital Dental and Oral Surgery and Otolaryngology. The causes of maxillary sinus-related operations were maxillary sinusitis in 20 cases, maxillary bone tumor in 5 cases, anti-resorptive agent-related osteonecrosis of the jaw in one case, and postoperative maxillary cyst in one case. Dental and oral surgery was performed by various methods. However, the otorhinolaryngological procedure was endoscopic sinus surgery or intranasal packing. In addition, all otorhinolaryngological procedures for maxillary sinusitis, which accounted for 74.1% of the causative diseases, were endoscopic sinus surgery. This is an easy method to choose because the operative procedure can avoid hyposensitivity and neuralgia of the buccal region and upper lip, which occur due to radical surgery of the maxillary sinus （Caldwell–Luc method）, and it can obtain physiological healing of the sinus in a minimally invasive way. In order to realize safe and anatomically ideal medical treatment, it was considered important to strengthen cooperation with the otolaryngology department which handles adjacent fields.

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A man in his 60s was referred to our department due to a rectangular opacity near the coronoid process of the mandible detected by panoramic radiography during dental treatment for caries. CT revealed a cylindrical opacity on the lower edge of the left zygomatic bone, and the object was excised. On fluorescence X-ray analysis, the object was a metallic foreign body containing iron as the main component. In addition, the same morphological opacity was observed on a panoramic X-ray photograph taken at a nearby dental clinic 18 years ago.

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Idiopathic thrombocytopenic purpura （ITP） causes gingival bleeding as an initial symptom and therefore the patients often visit a dentist. We report a case of idiopathic thrombocytopenic purpura that started as oral bleeding and developed into cerebral hemorrhage three days later. The patient was an 81-year-old man. He visited our clinic with persistent gingival bleeding that had occurred while he was cleaning his interdental spaces with a toothpick. He had multiple purpura in the upper extremities and petechiae in the lower extremities. Blood tests showed a platelet count as low as 3,000/mm³. The patient was then referred to the hematology clinic in another hospital where bone marrow aspiration revealed the diagnosis of ITP. The patient was hospitalized and treatment with prednisolone DIV 1mg/kg/day was started on the same day. The following day, the platelet count showed no increase, and the patient developed marked oral bleeding. Therefore, high-dose gamma globulin was administered concomitantly. On the second day of treatment, the patient developed hemiparesis of the left side, and head CT revealed extensive cerebral hemorrhage on the right side. Due to deterioration of his general condition, he died on the third day of treatment.

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We report a 51-year-old woman who accidentally swallowed a removable partial denture while taking a supplement and in whom the partial denture was removed by laparoscopic partial denture resection. Many accidentally ingested objects are naturally excreted. However, objects can sometimes stagnate in the upper gastrointestinal tract and lower digestive system and in particular foreign bodies having sharp forms such as clasps can cause serious complications such as gastrointestinal perforation, bleeding, or peritonitis. According to the guidelines for gastrointestinal endoscopy, removable partial dentures are considered to be sharp foreign bodies, for which emergency endoscopy is indicated. In this case, the denture had reached the small intestine and could not be removed by endoscopy because of the slight delay in medical consultation and treatment after the patient’s visit. It seemed that we had to reflect on how we handled that inspection. In addition, if a foreign body is accidentally swallowed for more than 24hours, complications will occur more frequently, so careful follow-up is required. In cases such as this case, blood watching treatment is required. It is necessary to explain to the patient that there is something wrong.

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Pulmonary thromboembolism can lead to shock or sudden death depending on the degree of obstruction, and the life prognosis is poor in severe cases. Here, we describe a case of pulmonary thromboembolism found during treatment for oral ulcer due to severe diabetes. A man in his 60s was referred to our department because of oral ulcer-induced pain. An ulcer with necrotic tissue was observed on the left tongue and gingiva of the left mandibular molar. A blood test revealed high blood glucose levels of 254mg/dL and HbA1c 10.2%, so we consulted with the Department of Diabetic Endocrinology. Subsequently, diabetic ketosis was observed, so he was admitted to the hospital for treatment. Pulmonary thromboembolism was found on chest and abdomen contrast computed tomography images taken after admission, so he was transferred to the Department of Cardiology. Deep vein thrombosis was also observed, so thrombolytic therapy was performed after placement of the femoral vena cava filter, and he was discharged at 30days after admission. In the oral lesion, after debridement of the necrotic tissue under glycemic control, epithelialization of the wound was gradually observed. The final examination was performed 48days after the initial examination.

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Lymphatic malformations are usually detected in infants and children, but rarely in adults. We report a case of submandibular lymphatic malformation in an adult.
A 31-year-old male had been diagnosed with plunging ranula at another hospital and treated with OK-432 percutaneous therapy for 10 years. Because painless submandibular swelling remained, the patient was referred to our department. However, the lesion was diagnosed as lymphatic malformation by radiological findings and aspiration. The patient underwent resection of the lesion via the submandibular approach under general anesthesia. Histopathological examination revealed a lymphatic malformation. There has been no evidence of recurrence for 5 years after surgery.
Lymphatic malformations of the submandibular region in adults are very rare, but it is important to differentiate lymphatic malformation from plunging ranula, and the appropriate treatment should be performed.

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A case of maxillary desmoplastic ameloblastoma is described. The patient was a 48-year-old male who visited the hospital with a chief complaint of bulging left maxillary gingiva. Panoramic radiographs showed both radiopaque and radiolucent findings with unclear margins in the left upper jaw, and magnetic resonance imaging （MRI） revealed a clear non-signal area around the tumor on T1-weighted imaging. A biopsy was conducted and the patient was diagnosed with desmoplastic ameloblastoma. A partial maxillary resection was performed under general anesthesia. The resection limit was set based on the clinical findings, MRI findings, and peri-operative evaluations. Histopathologically, the tumor grew significantly in the regions of the lips and cheeks, advancing out of the bone under the epithelium of the gingival alveolar mucosa, but there was no tumor in the resection stump. The MRI findings were considered useful in setting the resection limits.

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Dermoid cysts commonly occur in the anus and ovaries. The occurrence rate of dermoid cysts in the head and neck area and in the oral cavity is 6.9% and 1.6%, respectively. Dermoid cysts are rarely gigantic and most of them develop in the sublingual area. We report a rare case of a giant dermoid cyst that advanced to the submental area in a 51-year-old woman who visited our hospital with the chief complaint of cervical swelling. Magnetic resonance imaging （MRI） and contrast-enhanced computed tomography （CT） revealed a monocystic lesion that was narrowed at the midline, had symmetrically developed into the submandibular area, and was located between the geniohyoid and the platysma muscle. The size of the lesion was 112×50×30mm. It was clinically diagnosed as a submental dermoid cyst and was enucleated by an extraoral approach under general anesthesia. The cyst wall was thick and its adhesion to the surrounding tissue was unclear, which permitted easy detachment. The histopathological diagnosis was a dermoid cyst. It was reported that most giant dermoid cysts in the oral cavity are of the sublingual type. Giant dermoid cysts also have a risk of malignant transformation. In the present case, there was no evidence of recurrence 5 years after the surgery.

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Multiple endocrine neoplasia （MEN） is a genetic disorder that results in neoplastic lesions in multiple endocrine organs, and is classified into types 1, 2A, and 2B. MEN 1 is an extremely rare disorder that can manifest as 20 or more types of functional and non-functional tumors. In this study, we report a case of buccal mucosal fibrolipoma in a patient with MEN1. The patient was a 52-year-old man whose chief complaint was a mass in the left buccal mucosa. He was being followed up for MEN 1 that had been diagnosed at another hospital. During the initial examination, we observed an 8-mm, soft, elastic, mobile mass in the left buccal mucosa. He was diagnosed with a buccal mucosal tumor, which was then resected under local anesthesia. Histopathological diagnosis revealed that the tumor was a fibrolipoma. Lipomas have been reported as a type of non-functional tumor observed in MEN 1. Lipomas are not rare. However, there have been few reported cases of intraoral mucosal lipomas, and we suspect that the lipoma in this case was a symptom of MEN 1. As of 2 years and 6 months after surgery, no recurrence or new systemic symptoms have been observed.

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Essential thrombocythemia （ET） is a myeloproliferative neoplasm characterized by an increase in platelets owing to abnormalities in bone marrow hematopoietic stem cells. There is a risk of thrombosis and bleeding in perioperative management. We report a case of performing surgery for condylar fracture accompanied by ET. A female in her 40s was injured by being struck on her right cheek. The clinical diagnosis from imaging examinations was right condylar base fracture. Open reduction and internal fixation was the treatment plan. She had been treated with hydroxycarbamide and aspirin since a diagnosis of ET in the past. The platelet count was stable at 100×10⁴/μL or less. She discontinued aspirin one week before surgery and underwent ORIF using a high perimandibular approach. She recovered well after surgery and had no perioperative complications.

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Synovial cyst is a cystic lesion that usually occurs in the periarticular areas of the wrists, knees and ankles, but rarely around the temporomandibular joint （TMJ）. In this report, a case with a synovial cyst that occurred around the TMJ is described. The patient was an 82-year-old woman with the chief complaint of paresthesia of the lower lip, who was referred to our department. T2-weighted magnetic resonance （MR） images revealed two continuous high signal lesions on the inner side of the left mandibular ramus and in the left condyle respectively. Fine-needle aspiration was performed via the oral cavity, and a viscous liquid was aspirated. Then, the paresthesia of the lower lip gradually improved. At 7months after the aspiration, the two high signal lesions on the MR images disappeared. The clinical course and imaging data of this case were consistent with the findings of a synovial cyst, and there was no recurrence on the MR imaging at 2-year follow-up after the aspiration.

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Parotitis is often caused by viral or bacterial infections or salivary stones, and rarely by foreign bodies. In this article, we report a case of parotitis caused by a heterotopic hair in the parotid duct. The patient was a female in her 70s. She came to our hospital because of swelling of the left buccal region 3days prior to her first visit. At the time of the initial examination, there was a mild swelling of the left parotid gland and swelling near the left parotid papilla. The CT scan showed no obvious salivary stone or lesion causing the swelling. When the orifice of the parotid duct was pushed open, a black spot was found. When it was pulled, a filamentous foreign body about 8.5cm in length was removed. It was diagnosed histopathologically as a hair. The swelling disappeared afterwards, and no recurrence of parotitis was observed.

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Langerhans cell histiocytosis （LCH） is a rare condition that is common in children but rarely occurs in adults. Although the treatment plan for LCH differs according to its clinical form, there are some forms for which no therapy has been established. We report a case of LCH involving the mandible of an adult patient in whom the lesion disappeared after a biopsy specimen was obtained for histopathological examination. A 33-year-old man presented to our department with a chief complaint of pain in the left mandibular molar region. Computed tomography （CT） revealed a translucency at a site continuous with the roots of the tooth. Histopathological examination of the biopsy specimen confirmed LCH. 19 months after the biopsy, CT showed bone formation at the biopsy site. Although there is no established treatment for LCH in the oral and maxillofacial region, it may disappear following surgical manipulation such as biopsy, and spontaneous resolution may be expected during follow-up of the patient after biopsy.

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A case of locally invasive nodular fasciitis causing trismus and pain due to rapid growth of lesions after low-level laser treatment at another dental office is presented. The lesion was locally controlled by marginal resection and had no recurrence for 4 years after surgery. Histopathologically, the lesion could not be diagnosed by cytology and biopsy. The final pathological diagnosis after surgical resection was nodular fasciitis. The stump after excision was positive, but no recurrence was observed after surgery. The use of low-level laser therapy requires careful consideration of its indications.

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