We have reported methods for directly inputting oral examination records and plaque control records （PCR） into a computer using speech recognition software. However, since the terms and input methods were determined for the straightforward input of each type of record, two software programs, one for oral examination records and one for PCR, were necessary. Therefore, in this study, an input method that is applicable to various examinations was evaluated. Verbalizations of dentists examining the oral cavity were collected using a microphone, and data were converted to text using speech recognition software and directly input into a computer. AmiVoice Ex Clinic was used as the speech recognition software. The tooth numbers were defined as ichiban to hachiban. Oral examination records, PCR, and records of the periodontal pocket depth （1-point method） were produced in 20 cases. Data input was performed 5 times in each case, and the input time was measured. The input recognition error rate was also evaluated. Oral examination records, PCR, and records of the periodontal pocket depth could be verbally input. This method is applicable to the input of various dental examination records.
The authors conducted a clinical analysis of 34 patients with odontogenic infections who required inpatient treatment in our department during the approximately 3.5-year period between April 2014 and September 2017. The patients ranged in age from 15 to 92 years. In the largest number of cases, the infection was caused by molar teeth, and in many cases, the contagion channel for the inflammation was found to be the submandibular gap. In the largest number of cases （21 patients）, the first antimicrobial agent used was ampicillin/sulbactam （ABPC/SBT）. Twenty-two patients received conservative management with antimicrobial medication alone, while 12 patients underwent anti-inflammatory surgery. The mean duration of hospitalization was 8.4 days. In severe cases of odontogenic infection, drug doses and administration intervals must be in line with theories relating to the pharmacokinetics and pharmacodynamics of antimicrobial agents （PK/PD theory）, and antimicrobial agents that take the primary causative organism into consideration need to be administered promptly. Even when the appropriate antimicrobial agent is administered with the patient hospitalized, immobilized, and under nutritional management, the authors also believe that it is important to administer these agents transvenously.
It is reported that patients with oral squamous cell carcinoma （OSCC） frequently suffer multiple primary cancers more than those with other types of malignancy, therefore early detection is important for the successful treatment of oral cancers. We retrospectively analyzed 518 patients with oral squamous cell carcinoma who presented to the Oral Cancer Center of Tokyo Dental College between April 2007 and March 2016 to clinically analyze and investigate the characteristics and prognosis of 48 patients with multiple primary cancers. The incidence of multiple primary cancers in patients with OSCC was 9.3％ and the most frequent location of occurrence was the esophagus （25.0％）, and there were early stage cancers. Oral primary cancers in the floor of the mouth accounted for 32.3％. 62.5％ of synchronous and 78.1％ of metachronous cancers were detected by gastrointestinal endoscopy and contrast CT. There was no significant difference in the 5-year overall survival rate for multiple primary cancers compared with single primary cancers. On the other hand, patients with multiple lung cancer had a significantly lower overall survival rate （log-rank P＜0.01）. In conclusion, early detection by preoperative screening and treatment are important for the long-term survival of patients with multiple primary cancers.
Warthin tumor is a benign salivary gland tumor which usually occurs in the parotid gland, but rarely in the cervical lymph node. We report a Warthin tumor in a contralateral parotid gland lymph node that mimicked metastasis of oral floor cancer on FDG-positron emission tomography/computed tomography （PET/CT）. For treatment of oral floor cancer, a man in his 70s was referred to our department. CT showed a 14×11×9mm mass below the contralateral parotid gland. FDG-PET/CT showed abnormal accumulation （SUVmax＝4.7） of FDG in the mass. Because differential diagnosis of lymph node metastasis and Warthin tumor was difficult, CT lymphography （CTL） was performed. Although CTL revealed one sentinel lymph node in the right submandibular region, there was no lymphatic flow to the contralateral parotid lymph node. Therefore, the patient underwent tumor resection and biopsy of both lymph nodes. The pathological diagnosis of the contralateral parotid lymph node was Warthin tumor. There was no evidence of recurrence and metastasis 11 months after surgery.
Among tumors appearing commonly on the limbs, angiolipomas are frequent in the forearms, but relatively rare in the head and neck region. Here, we report a case of an infiltrating angiolipoma of the cheek. The patient was a 55-year-old male who presented with the chief complaint of right-sided cheek swelling. He visited our department due to cheek swelling in May 201X. Although the tumor border was indistinct from a computed tomography （CT） artifact, the border and neighboring tissues were clear on short-T1 inversion recovery （STIR） cystography magnetic resonance imaging （MRI）. Additionally, biopsy revealed the presence of multiple phleboid blood vessels in mature adipose tissues. Subsequently, the tumor was resected by intraoral incision, and the pathology results identified an infiltrating angiolipoma. A capsule was not present in the tumor, which revealed significant vascular endothelial growth factor （VEGF） levels in the muscular gap upon immunostaining. We judged the addibility of this tumor to be very high. Two years after surgery, we have not observed tumor recurrence and the patient’s prognosis has remained good.
A lipoma is a non-epithelial benign tumor that frequently occurs in soft tissue, and can occur in the oral cavity. The incidence of intraoral lipoma differs at each facility, but there are few reports of a lipoma involving the gingiva or gingivobuccal fold. A fibrolipoma is composed of fibrous tissue within adipose tissue. We experienced one case of a fibrolipoma extending from the mandibular gingiva to the gingivobuccal fold. An imaging examination may be necessary without a clinical diagnosis, when only visual inspection is performed depending on the location of the lipoma. Lipoma occurs most commonly on the buccal mucosa, but we should be aware that it can involve gingival tissues as well.
Recently, endoscopic removal of sialoliths has been introduced to avoid invasive surgery including submandibular sialoadenectomy. Here we report the sialendoscopic removal of a parenchymal sialolith of the submandibular gland as a minimally invasive surgery. A male in his 50s 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 3.6×3.1×1.9mm in size. The patient underwent endoscopic removal of the sialolith under general anesthesia as minimally invasive surgery. The sialolith was completely removed and the postoperative course was uneventful.
Mantle cell lymphoma is a rare lymphoma of B-cell origin characterized by a poor prognosis. We report a case of mantle cell lymphoma diagnosed in a mass of the right buccal mucosa as a primary symptom. A woman in her 70s consulted a dental clinic because of right buccal mucosa caused by accidental biting of the buccal mucosa. After one month, she was referred to our hospital because her buccal mucosa had not changed. We performed occlusal adjustment based on her clinical history, but no improvement was found, so we performed a biopsy. As immunohistochemistry, the biopsy material was positive for CD20, CD79a, CD5, BCL2, CyclinD1, and negative for CD10, CD23, CD56, and CD3, so we made a diagnosis of MCL. After being treated with R-CHOP therapy at our hospital hematology department, she has been treated with maintenance therapy by rituximab, and continues to be followed. Because patients with mantle cell lymphoma very often have no subject symptoms, approximately 90％ are already at stage Ⅲ to Ⅳ. One reason why mantle cell lymphoma has a poor prognosis is that the diagnosis is made at a late stage. We suggest that the treatment of mantle cell lymphoma can be improved by performing immediate biopsy.
Pyogenic granuloma is a non-neoplastic granulomatous lesion developing in skin and mucous membrane as the result of excessive tissue reaction. The pathogenesis of this lesion remains obscure and differential diagnosis is often difficult. We report a case of pyogenic granuloma that developed in a patient taking an immunosuppressant. A 59-year-old male patient had been diagnosed with relapsing polychondritis 8 years ago and had been receiving immunosuppressant therapy at the department of respiratory medicine for 2 years. He was admitted to the hospital due to aggravation of symptoms and received steroid pulse therapy. After the therapy, he suffered from severe oral mucositis and was referred to our department. Multiple erosive lesions were observed in the oral mucous membrane with erythema of the skin around the mouth. The lesions persisted for 5 weeks in spite of local therapy with beclometasone dipropionate and sodium gualenate hydrate gargle. The patient continuously received therapy with steroid and cyclosporine A. After the oral mucositis improved, a granulomatous lesion developed in the tongue and enlarged gradually. The lesion was excised partly and histologically diagnosed as pyogenic granuloma. It is considered that oral mucositis and cyclosporine A may have contributed to the formation of the lesion.
We report a case of implantitis and titanium allergy. The patient was a woman in her 30s. She had received implant treatment at 45 sites extracted 9 years ago at another clinic. The implant was considered to be made of titanium alloy including Fe, Al, and V. The implant had been stable for more than 5 years, but progressive bone resorption occurred 9 years after implant placement. No immune disorder was detected by blood test, and no inflammation was observed in periodontal tissue around the natural teeth, so we suspected a metal allergy to titanium alloy. We performed a patch test and lymphocyte stimulation test. Ti and Au were found to be positive, and Al pseudopositive in the patch test. Ti, Al, Fe, and Pd were found to be positive in the lymphocyte stimulation test. Based on the results of these allergy tests, titanium allergy was strongly suspected. Bone regeneration was observed soon after implant removal. Metal allergy tests were effective for assessing the prognosis of the implant.