In Japan, unintentional injury is still the leading cause of death for some age groups of child in other developed countries. Therefore, childhood injury prevention is the priority subject for maternal and child health which should be taken up by providing with the information of injury prevention to their parents. Of those childhood injury, the status quo of oral area injuries hasn't clarified until now, because the dental clinics haven't been chosen for objects of national annual injury surveillance. However, it has clarified one third of childhood injury was oral area injury from our surveillance in nursery. It is necessary to consider injury prevention of oral area for keeping childhood oral health, same as prevention of tooth decay.
Dentigerous cyst is a pathological lesion commonly encountered in pediatric dental practice. The lesion is known to be usually associated with normal dental germ, but in rare cases can be associated with the germ of supernumerary teeth (SNTs). This report describes a case of dentigerous cyst associated with SNTs in the center of the maxillary bone. Diagnosis from plain radiographs was difficult, but CT images were very helpful for this purpose. The patient, a 5-year-old boy, was referred to our hospital for examination and extraction of impacted SNTs on October 22, 2005. Plain X-ray revealed nothing abnormal except for two impacted SNTs. In consideration of the patient's age and the need for orthodontic care, we decided to simply observe the patient until eruption of the permanent central incisors. After a routine examination on May 7, 2008, we confirmed a delay of upper left central incisor eruption and ectopic eruption of an upper left lateral incisor from a distal position. We therefore decided to extract the SNTs, and evaluated them three-dimensionally using CT. CT demonstrated a sharply delimited round cystic area (∅20mm) containing the crown of one of the SNTs. As the transmission image showed that the cystic lesion was very close to the nasal cavity, we extracted the two SNTs and enucleated the cystic lesion on July 1, 2008, under general anesthesia. First, the SNTs were extracted, and then the cyst was removed as a mass. No perforation to the nasal cavity was found during surgery. The postoperative course was uneventful, without any nasal symptoms. We confirmed that eruption of the upper left central incisor was delayed, with rightward movement of the lateral one month after the operation. CT imaging 3 months after surgery confirmed bone regeneration in the cavity from which the cyst had been removed.
A congenital midline fistula of upper lip is a rare anomaly. We report a case of congenital midline fistula of the upper lip in a 6-year-old girl. No other anomalies were found. Surgical excisions were performed under general anesthesia on May 22 2007. A histopathological examination showed that the duct was covered by squamous epithelium. The Post operative course has been uneventful for 1 year 7months.
This report describes a case of bite wounds on the tongue and buccal mucosa in a boy with Gilles de la Tourette's syndrome (GTS). The boy had developed progressive multiple motor tics on the face, neck, and body. In January 2007, when he was 11 years old, vocal tics associated with simple sound developed. These tics eventually prevented the boy from going to school. Consultation with a pediatric neurological clinic resulted in a diagnosis of GTS, and the patient was managed by medication with Serenace®, Depromel®, and Risperdal®. In spite of the medication, however an oral ulcer, considered to have resulted from a bite wound, developed in August 2007. Therefore, he was referred to our clinic by a physician on February_??_, 2008. Clinical examination showed an ulcer on the left retro-molar region and the front side of the tongue. The wound was thought to have resulted from a self-inflicted bite. Oral splint treatment was applied for 4 weeks in order to prevent any further oral mutilation, and this allowed to heal. Since then, the patient has shown some improvement of the GTS symptoms, and currently there is no evidence of oral mutilation.
Odontoma is a common benign tumor in clinical practice, On the contrary, ameloblastic fibro-odontoma is a rare odontogenic tumor that consists of proliferation of odontogenic epithelium and mesenchymal tissue, the formation of dentine enamel tissue in tumor. We describe a case of odontoma developed in the molar part of the lower jaw in a 8-year-old girl, having difficulty in differentiating ameloblastic fibro-odontoma. She was referred to us with the chief complaint of delayed eruption of the right lower first molar. Panoramic X-ray films revealed a nearly oval unilocular image with irregular radiopaque lesion from the right molar to the ramus of the mandible. Clinical diagnosis was odontoma, and the lesion was enucleated under local anesthesia. Histopathological examination identified irregularly arranged enamel, dentin, and cementum, and intermingled soft tissue component mainly composed of proliferation of fibroblastic cells, partly intermingling with an island of enamel tissue. Although the pathological finding was similar to ameloblastic fibro-odontoma, final diagnosis was made as odontoma. Post operative course was satisfactory and the right lower first molar has gradually erupted.
In clinical oral surgery, we often encounter cases of infants who fall down while holding a toothbrush in their mouth and receive an oral injury from a toothbrush. This particular case was that of a 5-year-old girl who accidentally injured her left buccal mucosa with a toothbrush. After the injury, she was immediately brought to the hospital by ambulance. When she arrived at our hospital, the toothbrush was still embedded in the oral wound. We examined her oral wound by computer tomography (CT). We found that the tip of the toothbrush was located in the vicinity of the left medial pterygoid muscle, and there was neither damage from the toothbrush itself nor on the maxillary artery and basal skull. We removed the toothbrush carefully under local anesthesia, and then cleaned the wound by adequate normal saline and administered antibacterial drugs (SBT/ABPC) intravenously. No serious complications were seen after the treatment. It is strongly suggested that in such a case an immediate examination be conducted by CT in order to avoid severe complications and to insure a good healing process.