The use of C1 inhibitor is effective for preventing attacks of angioedema in HAE patients during the perioperative period. We report the case of a 27-year-old man with hereditary angioedema （HAE） who underwent oral surgery under general anesthesia. The patient was referred to us by a local doctor with a chief complaint of swelling of the gingiva around the left mandibular first molar. We diagnosed him as left mandibular radicular cyst involving the first molar based on the findings from CT and panoramic radiography. The patient underwent cystectomy with apicotomy of the affected root under general anesthesia at the patient’s request. To prevent edema, we injected C1 inhibitor before the surgery according to the HAE guideline. The patient received careful perioperative management and subsequent follow-up, and no complications have been observed.
There are several types of hemostatic dressings available for use in the oral surgery field, one of which is derived from chitosan: the HemCon Dental DressingⓇ （HDD）. Case 1 was an 85-year-old female whose chief complaint was dental pain. The patient was taking warfarin tablets because of a history of cerebral infarction. The right upper maxillary of the first premolar teeth and second premolar teeth were indicated for tooth extraction due to severe chronic periodontitis. Tooth extraction was performed while warfarin tablets were orally administered. Persistent bleeding was seen from the extracted tooth cavity after tooth extraction. The HDD was inserted into the extracted tooth cavity, and compression hemostasis was performed for 10 minutes. Case 2 was a 70-year-old male whose chief complaint was an ill-fitting right mandibular partial denture, with mandibular right alveolar ridge constriction and lacking keratinized gingiva. The right mandibular buccal frenum was excised, and a free gingival graft （FGG） and an expansion of the anterior ridge were performed. While performing the FGG, an HDD was applied to the donor side palate for 10 minutes. We conclude that the HDD is a fast-acting hemostatic agent with both wound healing and antimicrobial properties.
Odontogenic keratocyst （OKC） is an odontogenic cyst that occurs most often around the mandibular third molars and tends to recur frequently. Here, we report a case of OKC that extended into the maxillary sinus in a 9-year-old boy. Computed tomography images revealed a cystic lesion that involved the second molar in the maxillary sinus. The cyst was treated with endoscopic sinus surgery with general anesthesia, by an otorhinolaryngologist. Marsupialization under the nasal meatus was performed because this procedure has relatively little influence on the maxilla and permanent teeth. OKC requires long-term follow-up to monitor for any possible cyst enlargement.
A case of metastasis to the maxillary gingiva from carcinoma of the lung is reported. A 61-year-old man was referred to our department with a mass of the right maxillary gingiva resembling epulis. The patient initially presented with weakness of the right leg. CT showed a subcortical hemorrhage in the left frontal lobe and a pulmonary nodule in the left upper lobe. From these findings, we suspected metastasis to the brain and gingiva from a malignant tumor of the lung. The nodule was not diagnosed histologically by lung biopsy. Total enucleation of the gingival lesion was performed. Because the tumor cells were strongly positive for TTF-1, a diagnosis of metastasis from adenocarcinoma of the lung was made. With the rapid growth of the gingival tumor after surgery, there was uncontrollable hemorrhage from the tumor. Radiotherapy of 35Gy reduced the size of the tumor, resulting in no bleeding complications. Although he received whole brain radiation and systemic chemotherapy for multiple organ metastasis, he died of pulmonary hemorrhage 95 days after admission to the hospital. He was capable of oral food intake until two days before his death. These findings suggest that palliative radiotherapy for gingival metastasis could provide better quality of life.
Recently, endoscopic removal of sialoliths has been introduced to avoid submandibular sialoadenectomy. Furthermore, sialendoscopes enable the removal of foreign bodies or granulation tissues as well as sialoliths. We report here the endoscopic removal of granulation tissue in the hilum of the submandibular gland after a sialolith was discharged spontaneously with pus from the mucosa of the oral floor. A 10-year-old boy with swelling of the right submandibular gland was referred to our department for endoscopic removal of a sialolith of the submandibular gland. Since there was a massive discharge of pus from the mucosa of the oral floor, the patient underwent a computed tomography （CT） scan. Because CT did not show a sialolith, we suspected that swelling of the submandibular gland was caused by granulation tissue in the hilum. Therefore, the patient underwent endoscopic removal of the granulation tissue under general anesthesia. The granulation tissue was completely removed and the surgical time was 57 minutes. The postoperative course was uneventful.
Plunging ranula is a retention cyst formed by mucous extravasation from the sublingual gland and generally treated with sublingual gland excision. Recently, sclerotherapy with OK-432 and compression therapy are known as minimally invasive therapy. In this report, we described our experiences of two plunging ranula cases consequently cured by several percutaneous aspirations with simple compressions.
Although there are numerous reports on surgical treatment of medication-related osteonecrosis of the jaw （MRONJ）, the effectiveness of surgical treatment at an early stage has recently been reported. Here, we report a case of MRONJ in a female patient in her 60s who was successfully managed by surgical treatment with a titanium plate. She was referred to our hospital due to jaw pain while eating. She had been receiving bisphosphonate therapy for osteoporosis and conservative therapy for MRONJ, but her symptoms did not improve and the bone exposure progressed, increasing the risk of pathological fractures of the jaw. We diagnosed her with MRONJ stage 2 and resected the necrotic bone under general anesthesia. We used a titanium plate to reduce the risk of pathological fractures, and applied a polyglycolic acid sheet and fibrin glue spray on the bone surface after resection. The wound was completely coated by a mucous membrane after 11 days. For 24 months after the operation, the patient exhibited no clinical or radiographic evidence of recurrence. The patient wears a full set of upper and lower dentures, and maintains good mastication.
Calcifying epithelial odontogenic tumor （CEOT） is a rare benign tumor that accounts for only 1％ of odontogenic tumors. According to the 2017 World Health Organization Classification of Odontogenic Tumours, cystic variants of CEOT have been occasionally reported. We report a case of a cystic variant of CEOT in the left maxilla. A male in his 20s was referred to our hospital with swelling of the left maxilla. Computed tomography revealed a tumor lesion in the left maxilla with impacted canine and multiple radiopaque bodies. The tumor lesion showed low signal intensity on T1-weighted images and high intensity on T2-weighted images, and the canine equivalent part showed low signal intensity on T1 and T2-weighted images under magnetic resonance imaging. Based on a pathological diagnosis of a surgical specimen as CEOT, the tumor was enucleated, and the impacted canine was extracted under general anesthesia. The postoperative course was uneventful and there have been no signs of recurrence for 3 years after surgery.
We report a rare case of cystic lymph node metastasis originating from mucoepidermoid carcinoma of the sublingual gland. A 64-year-old male was referred to our hospital for the further examination and treatment of cystic cervical lesion and lung metastatic lesions. He had undergone excision of right sublingual primary mucoepidermoid carcinoma 5 years earlier and removal of a recurrent lesion 2 years earlier. At one month before his first visit, image examinations indicated right cystic cervical lesion and left lung metastatic lesions; the maximum standardized uptake value （SUVmax） of FDG-PET/CT was significantly high in the lung lesions, but not in the cervical lesion. We re-examined the cervical lesion by imaging examinations and fine-needle aspiration cytology （FNAC）. Although SUVmax of FDG-PET/CT and FNAC were not positive for malignancy, enlargement and ring enhancement of cystic lymph node were observed. We performed modified radical neck dissection under a clinical diagnosis of cervical lymph node metastasis, then respiratory surgeons carried out endoscopic surgery of lung lesions. The histopathological diagnosis of both lesions was metastatic mucoepidermoid carcinoma.
We report a case of mandibular and maxillary fractures with SULBACILLINⓇ-induced pneumonitis. A man in his sixties fractured the maxilla and mandible in a fall, and was admitted for occlusal deviation. SBT/ABPC was administered to prevent infection, but SpO2 decreased and shadows were found bilaterally in the lungs on chest radiographs. Because DLST was positive, drug pneumonia due to SBT/ABPC was diagnosed. Due to the fracture, early surgery was considered necessary. An operation under general anesthesia was judged to be impossible due to poor ventilation caused by the drug pneumonia. After local anesthesia, only intermaxillary fusion surgery was performed, and after the pneumonia had improved, open reduction and internal fixation were performed under general anesthesia. About 3 years after the operation, there is only a slight deviation on the right side upon opening, and the maximum opening amount is 38 mm. The patient shows no signs of recurrence.
Odontoma, a malformation of the mature dental hard tissue, is the most prevalent odontogenic tumor, accounting for almost 40％ of all such tumors. We herein report a case of large complex odontoma arising at the maxilla which was enucleated via a trans-maxillary sinus approach. The patient was a 30-year-old Japanese man. The right posterior dento-alveolar region of the maxilla showed diffuse swelling. A radiopaque lesion was detected at the right posterior region of maxillary alveolar bone with a dome-like protrusion into the right maxillary sinus on computed tomographic images. The lesion was clinically diagnosed as odontoma. The tumor of 38×30×21mm in size was safely excised via the trans-maxillary sinus without abnormal bleeding or damage to residual teeth under general anesthesia. The histopathological diagnosis was complex odontoma. No recurrence has been observed for more than one year after surgery.
A 62-year-old female presented with a tumor in the left tongue. Tongue cancer （cT1N0M0） was diagnosed and she underwent a partial glossectomy during 201X. Advanced gastric cancer was also identified and treated by total gastrectomy in March 201X. Three years later, cervical lymph node metastases were treated by functional neck dissection. Anemia and pancytopenia were diagnosed in April 201X＋3, which ruled out chemoradiotherapy at the time. She was diagnosed with vitamin B12 deficiency anemia and hypoferric anemia, which were appropriately treated. However, she received radiotherapy alone because her blood cell count did not sufficiently improve. Her white blood cell count increased after 20 months. She is presently doing well without evidence of carcinoma relapse or metastasis.