Nicorandil is an antianginal drug that was developed in Japan in 1975 and has been widely used. The drug has also been widely used in European countries and North America, but the side effect of oral ulceration induced by Nicorandil has been reported in these countries. The etiology of this side effect remains unknown. In this report, we describe our experience of a case of oral mucosa ulcer induced by Nicorandil in a dialysis patient, and also review the Japanese literature.
One of the complications after radical neck dissection is chylothorax which occurs from leakage of chyle. However, the leakage of chyle after right radical neck dissection is rare. We report a case of chylothorax occurring after right radical neck dissection. A 77-year-old man was given a diagnosis of secondary right cervical lymph-node metastasis from right-sided tongue cancer, and right radical neck dissection performed. On the first postoperative day, a leakage of chyle was diagnosed. We tried to stop the leakage by pressing above the clavicle but could not stop it. On the fourth postoperative day, the amount of chyle per day increased to 2,000ml/day and chest X-ray images showed right pleural effusion. In order to ligate the thoracic duct, reoperation was performed. During the operation, we recognized the stump of the thoracic duct above the clavicle. After the operation, the amount of chyle per day decreased. On the fifth day after reoperation, the amount of chyle per day fell below 100ml/day. When post-operative chylothorax is found, it is important to treat it without delay. But it is necessary to consider the timing of reoperation in consideration of the amount of chyle per day and electrolytes.
We report a case of multiple myeloma with initial symptoms of amyloidosis of the tongue and buccal mucosa. A man in his 60s complained of glossalgia and hypogeusia at initial presentation; general fatigue and dyspnea were also present. Nodular masses with large and small areas of induration were scattered on the dorsum of the tongue. On the basis of biopsy findings, a pathological diagnosis of amyloidosis was made. For the patient’s systemic symptoms, the internal medicine department was consulted. Reduction in the levels of IgG and IgA was observed, and according to findings on bone marrow biopsy, a diagnosis of multiple myeloma was made. However, the patient’s cardiac and respiratory function deteriorated; he suddenly developed VF and died. Our findings suggest that in case of a refractory ulcer or mass lesion on the tongue, it is necessary to consider the possibility of systemic diseases to ensure accurate diagnosis and timely treatment for the patient.
In cases where wisdom teeth approach the mandibular canal, attention must be paid to potential injury of the mandibular canal during extraction. The present patient was a 61-year-old woman, in whom bony impaction of tooth 48 was causing pericoronitis. Computed tomography examination revealed that the inferior alveolar nerve was passing between the tooth roots. We selected a two-stage tooth extraction method. As the first treatment step, we removed the crown of tooth 48. During the second treatment step, we confirmed slight movement of the root and an enlarged periodontal ligament cavity after a 6-month transition period. During extraction of the root, the periapical alveolar bone was first cut using an ultrasonic bone cutting instrument, and root partition was then performed. Surgical invasion into the inferior alveolar nerve and soft tissue was minimized through the use of an ultrasonic bone cutting instrument. In difficult extraction cases such as this, we believe that use of the two-stage extraction method and an ultrasonic bone cutting instrument is effective.
Recently, endoscopic removal of sialoliths has been introduced to avoid invasive surgery including submandibular sialoadenectomy. However, endoscopic treatment is commonly performed under general anesthesia in view of the patient’s tolerance and long surgical time. As a minimally invasive surgery, we report here the endoscopic removal of a parenchymal sialolith of the submandibular gland under local anesthesia. A female in her 70s with swelling in the right submandibular gland was admitted to our department for endoscopic removal of a sialolith of the submandibular gland. Computed tomography showed that the right parenchymal sialolith was 3.1×2.8×2.6mm in size. The patient underwent endoscopic removal of the sialolith under local anesthesia as a minimally invasive surgery. The sialolith was completely removed and the surgical time was 35 minutes. The postoperative course was uneventful.
SAPHO （Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis Syndrome） syndrome is a systemic disease consisting of unexplained pustular skin lesions and osteoarthritic lesions, and was reported by Chamot et al. in 1987. The present study reports a rare case of SAPHO syndrome in an adult male. A 42-year-old male outpatient came to the Department of Oral and Maxillofacial Surgery for a consultation with the chief complaint of persistent pain following extraction of the first premolar on the right side of the lower jaw. Computed tomography （CT） showed diffuse osteosclerosis with indistinct boundaries in the premolar region on the right side of the lower jaw. According to the results of MRI, a low signal area in this region was observed on T1-weighted images, while a high signal area was observed on T2-weighted images. Tc̄99 scintigraphy revealed an increased accumulation in the right lower jaw, bilateral sternoclavicular joints, and finger/toe joints. The patient had a history of palmoplantar pustulosis and chest/joint pain. Blood tests indicated normal values for rheumatoid factors, anti-CCP antibodies, and antinuclear antibodies, whereas an increasing tendency in leukocytes and CRP levels was detected. SAPHO syndrome was strongly suspected, hence macrolide antibiotics （Clarith®） and NSAIDs were prescribed, resulting in improvement of the patient.
Ossifying fibroma （OF） is a benign fibro-osseous tumor comprising bone-like hard tissue. Maxillofacial OF can cause facial asymmetry. However, reduction surgery by the intraoral approach is very challenging and can provide insufficient results. We report here a case in which navigation surgery for maxillary OF provided good facial symmetry by bone reduction based on the preoperative plan. A 15-year-old male with OF the maxilla underwent navigation surgery after preoperative planning including the mirroring method. The patient gained good facial symmetry after surgery, and there was no recurrence for 2 years and 6 months after surgery.
Calcifying epithelioma was reported by Malherbe et al. in 1880 as a benign tumor derived from hair matrix cells. Lesions appear most commonly on the face and neck and are palpated as firm subcutaneous nodules. A female in her 40s had had a mass in her left buccal region since her teenage years which she left untreated because it was asymptomatic. During a dental check-up, she was recommended to visit a clinic for the examination and treatment of her mass. Radiographic examination revealed the presence of calcification in the posterior region of her left mandibular angle. Enucleation was performed under local anesthesia based on a clinical diagnosis of ectopic calcification in the left masseter muscle and parotid gland region. A majority of the epithelial cells were shadow cells. Calcification and bone formation were observed around the shadow cells. The histopathological diagnosis was calcifying epithelioma. As for the postoperative course, no recurrence has been reported after 1 year and 6 months.
Medication-related osteonecrosis of the jaw （MRONJ） arising in the maxilla can cause or exacerbate extant maxillary sinusitis. We describe osteonecrosis with maxillary sinusitis that was treated by sequestrectomy and endoscopic sinus surgery （ESS）. A septuagenarian woman, who was being treated for breast cancer and metastatic bone tumor, had been intravenously administered with zoledronic acid for over one year. She presented with left maxilla pain after tooth extraction elsewhere. The sequestra were completely separated from the maxilla, then sequestrectomy and ESS proceeded. We removed the sequestra from the oral cavity, and confirmed a maxillary sinus-oral cavity fistula. The nasal cavities and maxillary sinus were opened by ESS via the nasal cavity, and defective granulation and morbid mucosa were excised from the maxillary sinus. Removal of the infective source suppressed the maxillary pain and significantly improved the patient’s quality of life compared with her preoperative status. ESS seemed to be helpful to minimize invasion of the jawbone in the case of using resorption suppressant drugs, because the maxillary sinus could be accessed via the nasal cavity.
A patient was diagnosed with pagophagia, a type of pica, during dental treatment and, on suspicion of anemia, was referred to an internal medicine clinic where she was diagnosed with severe anemia. We give a brief review of the literature concerning anemia and pagophagia. The patient was a 46-year-old woman who visited our clinic for dental treatment. Her medical history included noncontributory systemic findings, and she showed no abnormalities in facial features or otherwise. Intraoral findings: Several missing molars, but good overall oral health. Discolored gums presenting with anemic coloring. No abnormalities in the lips or tongue, but dental attrition visible throughout the jaw. Verbal examination revealed pagophagia of about 1kg per day, and so the patient was referred to a local internal medicine clinic on suspicion of anemia. A blood sample revealed Hb 4.0g/dl and a diagnosis of severe anemia was made. The patient was referred to a general hospital in the city for detailed full-body examinations and iron preparation drugs that corrected both the anemia and the pagophagia. The reported rate of anemia associated with pagophagia varies from 0.4 to 24.7％. However, it is clear that there is a link between pagophagia and iron deficiency anemia.
We reported the usefulness of liquid-based cytology for oral mucosal lesions, based on the Bethesda system （Oral Bethesda system）. In November 2015, the Japanese Society of Clinical Cytology published new guidelines for oral cytology, and recommended a new report format for oral cytodiagnosis based on the Bethesda system. In this article, we report the clinical validity of this new format compared to the conventional class classification format in our hospital. Materials and Methods: We obtained biopsy and excision specimens of one hundred and nine patients diagnosed with oral squamous cell carcinoma in our hospital, over a 3-year period between November 2013 and May 2017. We performed cytodiagnosis, and evaluated the site of lesion, sensitivity, and false-negative rate of diagnosis. Results: Cytodiagnosis revealed SCC （Squamous cell carcinoma） in 60 cases （56%）, HSIL （High grade squamous intraepithelial lesion） in 27 cases （25%）, LSIL （Low grade squamous intraepithelial lesion） in 15 cases （14%） and NILM （Negative for intraepithelial lesion or malignancy） in 7 cases （6%）. The sensitivity and false-negative rate using the new reporting format were 94% and 6%, respectively, indicating that the new format is more useful than past criteria. Conclusion: We strongly suggest that liquid-based oral cytology using the new report format based on the Bethesda system is a clinically useful screening diagnostic system, and has clinical value in oral cancer screening.