Purpose: The orbit, a major esthetic constituent of the face, is important in our social lives. Therefore, a careful approach is required for orbital tumor surgery, during both radical treatment and biopsy. To achieve a wider operative field, we developed a frontal-zygomatic (FZ) approach, in which bone of the superior or inferior wall is resected en block. Methods: The subjects consisted of 42 patients for whom a diagnosis of orbital tumor was made by preoperative diagnostic imaging and histopathological examination. Tumor resection was performed in 16 patients and tumor biopsy in 26. Following the adoption of the FZ approach for surgical intervention, we evaluated the postoperative complications and classified them into one of four categories: diplopia, enopthalmos, paralysis, or scar formation. Results: In all patients, a definite diagnosis was made by surgical intervention, showing that tumor resection and biopsy were useful. Conclusions: Because the FZ approach caused no significant postoperative complications and produced excellent results, we believe that this approach should be followed in most cases other than tumors centering on the orbital apex or extending into the optic canal.

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We report a case of necrotizing sialometaplasia arising as bilateral ulcers in the palate of a 20-year-old Japanese female patient. Based on histopathological and immunohistochemical findings, we discuss how to distinguish the condition from neoplastic lesions such as squamous cell carcinoma or mucoepidermoid carcinoma. Histopathologically, the ulcer bed of granulation tissue contained hyperplastic capillary vessels, inflammatory cell infiltrates, necrotizing and degenerating palatal glands, and squamous metaplasia of ducts and acini leaving lobular structures of the mucous gland. Immunohistochemically, the epithelial islands were positive for pancytokeratin (CK), CK7 and S-100 protein, partially positive for α-smooth muscle actin, and not positive for periodic acid-Schiff reaction. We diagnosed the lesion as a necrotizing sialometaplasia. It healed spontaneously without treatment, and there was no recurrence.

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This paper describes the first documented case of chronic focal sclerosing osteomyelitis accompanied by bony mass protrusion into the maxillary sinus manifested in a 34-year-old Japanese woman. The lesion was a circumscript radiopaque mass in the left maxillary sinus close to the apex of the left upper second molar. The tooth and adjacent molars were vital, and there was no apparent inflammation, though diffuse and sclerotic changes were observed around the left molar region of the maxilla on simple X-ray and CT images. Histopathological examinations of resected tissue showed that the protrusive hard mass was composed of dense bony trabeculae with prominent mature lamella covered by mucosal epithelia of the maxillary sinus with an inner granulation tissue zone, and of fibrous granulation tissue fragments with focal dense inflammatory cells including foamy macrophages and plasma cells and prominent Russell body formations. The patient was finally diagnosed as having chronic focal sclerosing osteomyelitis based on the radiographic and clinicopathological findings. As of about 35 months after the operation, there has been no sign of recurrence.

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Peculiar findings of orofacial actinomycosis mimicking the clinical appearance of a tumor of the upper lip were reported. A 68-year-old woman (case 1) and a 62-year-old woman (case 2) visited our hospitals towards the end of 2004 and 2007; the clinical diagnosis for each patient was upper labial tumor, and the lesions were surgically removed. Histologically, the excised specimens showed granulomas including bacterial colonies consisting of club-shaped filaments that formed a radiating rosette pattern in the submucosal layer. DNA samples were extracted from paraffin sections and examined by PCR for Actinomyces species. The PCR products examined by direct DNA sequencing demonstrated the presence of Actinomyces israelii and Actinomyces gerencseriae in both case 1 and case 2. Finally, pathological diagnoses of actinomycosis were made for each. Actinomycosis mimicking a tumor is very uncommon in the oral mucosa, and the use of PCR is an effective means of early and accurate diagnosis.

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