We describe a case in which an impacted mandibular wisdom tooth migrated to the mandibular notch. A 50-year-old man visited our department in May 202X with the chief complaint of right mandibular gingival swelling. Computed tomography （CT） revealed that the right impacted mandibular wisdom tooth was near the mandibular notch, with a radiolucent lesion including the crown. Based on a clinical diagnosis of an ectopically impacted wisdom tooth with cystic lesion, in August 202X, under general anesthesia, we performed extraction and enucleation of the ectopically impacted wisdom tooth. The histopathological diagnosis of the extracted tissue was inflammatory granulation tissue. It is now 2 years since we performed the surgery, and the patient has made good progress. In order to determine the cause of the ectopically impacted wisdom tooth, a comparison of panoramic radiographs taken 9 years earlier revealed that the right impacted mandibular wisdom tooth had migrated over time from the right lower second molar central to the vicinity of the mandibular notch.

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Primary hyperparathyroidism causes hypercalcemia due to continuous secretion of parathyroid hormone. Most cases are caused by benign adenoma, and excision of the adenoma is the first choice of treatment. However, in non-surgical cases, bisphosphonate is used to decrease serum calcium level and improve osteoporosis. A 59-year-old female patient complained of right submandibular pain accompanied by an external dental fistula in the right submandibular region and intraoral bone exposure in the right lower premolar region. CT images revealed the sequestrum in the right mandible. The patient had been taking an intravenous bisphosphonate for a relatively long period to improve hypercalcemia and osteoporosis. Therefore, we diagnosed medication-related osteonecrosis of the jaw （MRONJ） Stage Ⅲ, and conservative treatment was started. Since her condition did not improve, surgery was performed under general anesthesia to remove the sequestrum to the extent that fresh bone with bleeding could be confirmed. Postoperatively, the external dental fistula of the right submandibular region was closed, and the exposed bone in the oral cavity was covered with healthy oral mucosa. The patient’s progress is good.

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Jaw actinomycosis is caused by Actinomyces israelii, an indigenous oral bacterium. Here, we report a case of jaw actinomycosis after tooth extraction. The patient was a 35-year-old man who was referred to our hospital in February 20XX for wisdom tooth extraction. The lower left 8 tooth was extracted under local anesthesia. At the end of March 20XX, the patient’s left cheek became swollen, and he was referred to our hospital. The left buccal region showed indurated swelling and difficulty opening the mouth. Blood tests revealed inflammatory reactions. Additional tests for suspected diabetes based on body size reveled HbA1c level of 9.4％ and fasting blood glucose level of 318mg/dL. Osteomyelitis was suspected, and anti-inflammatory treatment was initiated using antimicrobial agents. Since there was no improvement, biopsy was performed, and jaw actinomycosis was diagnosed. The patient had a history of uncontrolled diabetes mellitus, which may have contributed to the disease onset.

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Many patients with Crohn’s disease and other systemic diseases visit a dentist without a definitive diagnosis. Dentists can potentially recognize oral symptoms associated with systemic diseases, enabling the duration of patients’ illnesses to be shortened.
Here, we report a case of an 8-year-old girl diagnosed with Crohn’s disease due to oral symptoms. She had swelling in her upper lip and visited her local dentist, who applied Dexamethasone oral ointment to her lip. However, her symptoms did not improve, and she was referred to our department for further examination and treatment. On close examination, gingivitis and cheilitis granulomatosa related to inflammatory bowel disease were suspected, and the child was referred to the Department of Pediatrics of the hospital the next day for a whole-body examination. Due to inconclusive diagnosis after a close examination at the same department, the patient was referred to the Department of Pediatrics of a certain university hospital for further examination, where, after a close examination, she was diagnosed with Crohn’s disease.
Nutrition therapy with Elental and drug therapy with mesalazine were started. Currently, the patient’s gastrointestinal symptoms and oral lesions have resolved.

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Malignant lymphomas can be challenging to diagnose due to their diverse clinical manifestations. Although rare, they can develop as extranodal lymphomas in the oral cavity. Here, we report the case of a 79-year-old woman who presented to our hospital with right-sided maxillary palatal swelling. Initial examination revealed a soft, elastic lesion that appeared hyperintense on T2-weighted magnetic resonance imaging. Biopsy suggested follicular lymphoma. She consulted a hematologist, but no definitive diagnosis of follicular lymphoma was obtained. The lesion was low-risk according to the Follicular Lymphoma International Prognostic Index and did not meet the Groupe d’Etude des Lymphomes Folliculaires criteria, so we decided to follow her up. Subsequently, a tumor was discovered on the floor of her mouth. Biopsies from both lesions led to a definitive diagnosis of follicular lymphoma. Non-Hodgkin’s lymphomas such as follicular lymphoma can present as localized, diffuse soft tissue swelling and are often asymptomatic. The diagnosis of non-Hodgkin’s lymphoma can be challenging due to its wide range of clinical presentations.
There are few reports of follicular lymphoma occurring with multiple oral lesions, but there are reports of progression to intermediate-grade lymphoma, suggesting the need for ongoing examinations and active surveillance in such cases.

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We report a case of two giant sialoliths in the submandibular duct. The patient was a 48-year-old man with the chief complaint of pain when eating. At the first visit to our hospital, two giant calculi, measuring 26×10mm and 15×9mm, were observed in the left submandibular duct by panoramic radiography and computed tomography. Two giant salivary stones were extracted by the intraoral approach. Over one year has passed since the operation, and the patient’s course remains good. This is a rare case in which two giant salivary stones （＞15mm） in the submandibular duct were removed by the intraoral approach.

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We reported a case of myocardial infarction secondary to mandibular odontogenic infection. A 29-year-old man was admitted to our hospital because of swelling and pain of his face and neck, which was caused by severe periodontitis of the right mandibular molars. A CT showed a low-density area in the submandibular space and neck. Incision and drainage were performed by an extraoral approach. On day 3 of the disease, right upper and lower limb paralysis occurred, and MRA revealed occlusion of the left middle cerebral artery. The patient was transferred to the Department of Neurosurgery, and dual anti-platelet therapy was performed. Subsequently he recovered, but aphasia and upper and lower limb paralysis remained.

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