Superselective intra-arterial chemotherapy via a superficial temporal artery has become feasible for daily concurrent radiotherapy and chemotherapy in patients with oral cancer. In this study, histopathological effects on metastatic cervical lymph nodes in cases of advanced oral cancer using superselective intra-arterial chemoradiotherapy were evaluated. Thirty-seven oral cancer patients with cervical lymph node metastasis were treated with preoperative chemoradiotherapy using superselective intra-arterial infusion via the superficial temporal artery. The treatment consisted of superselective intra-arterial infusions (docetaxel, total 60 mg/m2; cisplatin, total 100-150 mg/m2) and concurrent radiotherapy (total 40-60 Gy) for 4-6 weeks, followed by surgery. In cases in which the catheter was inserted into the facial artery, grade III or IV (Oboshi-Shimosato classification) in the cervical lymph node metastasis was obtained in 20 (83.3%) of 24 patients. And, forty-six (88.5%) of 52 metastatic lymph nodes showed grade III or IV. This method was an effective regimen for oral cancer with cervical lymph node metastasis.
A retrospective study was performed to investigate the short-term therapeutic efficacy of non-steroidal anti-inflammatory drugs (NSAIDs) on temporomandibular disorders (TMD) with pain. TMD patients with TMJ pain and/or muscle pain were treated with amfenac sodium hydrate (150 mg/day) or loxoprofen sodium hydrate (180 mg/day), and the effects on TMJ pain, muscle pain, and maximum mouth opening range were examined after 7 days of administration. All subjects were classified in accordance with the subtype classification of TMD determined by the Japanese society for the temporomandibular joint following MRI examination. The efficacy rate for the pain was 85.7% in Type I, 87.0% in type II, 68.8% in type IIIa, 52.6% in type IIIb, 75.0% in type IV, respectively. There was no connection between the therapeutic efficacy for the pain and the patient's age. A significant difference of effectiveness was observed among type I, II and IIIb (p < 0.05). As for muscle pain, the therapeutic efficacy rate was 85.7% in no disc displacement group and 50.0 % in disc displacement group, respectively. The effectiveness differed significantly between the no disc displacement group and the disc displacement group (p < 0.05). As for TMJ pain, the therapeutic efficacy rate was 87% in the no disc displacement group, 72.0% in the disc displacement with reduction, 60.0% in the disc displacement without reduction group, respectively, effectiveness was noted to be significantly different between the no disc displacement group and the disc displacement without reduction group (p < 0.05). In patients with trismus (maximum mouth opening range < 40mm), no significant increase of the maximum mouth-opening range was observed after administration of NSAIDs.
Detection thresholds to Semmes-Weinstein monofilaments, 5-Hz rectangular electric stimulation and warming were measured in 38 affected sides of neurosensory disturbance of the lower lip and chin after dental and oral surgery treatment. The ages of the patients ranged from 11 to 72 years. The examination periods were within 1, 6, 12 and 24 months after the nerve injury. The differences in recovery with time and measuring methods were examined. Improvement of sensation was more remarkable within 6 months after the nerve injury than from 6 to 12 months and 12 to 24 months. Though improvement was observed from 12 to 24 months after nerve injury, it was the least among the three periods. The cases with slightly higher threshold than that of the normal side improved within 12 months after the nerve injury. Improvement of the threshold for warm stimulation was slower than for the two other sensory tests throughout the investigation period.
We report a clinical investigation of patients who visited our hospital complaining of tongue pain and were diagnosed as oral candidiasis. Twenty-five patients were diagnosed based on the symptoms and mycological test during the 1 year and 8 month period between April 2007 and December 2008. We administered itraconazole oral solution (ITCZ-OS) to the patients for their symptoms, and used the visual analogue scale to determine the effectiveness of this treatment. Based on symptomatic evaluation, “marked improvement of tongue pain” was observed in 95.0% of the patients with acute pseudomembranous candidiasis, and 89.0% of the patients with chronic atrophic candidiasis, and “improvement” of tongue pain” was observed in 49.0% of the patients with chronic hypertrophic candidiasis. After this treatment, 88.9% of the mycological tests for acute pseudomembranous candidiasis were negative, and 100% of the patients with chronic atrophic candidiasis, and 50.0% of those for chronic hypertrophic candidiasis were negative. These results indicate that itraconazole oral solution appears to be effective in the treatment of oral candidiasis accompanied with tongue pain.
We report a case of long-term (about 10 years) limited mouth opening following a bilateral transtemporal approach for multiple cerebral aneurysms. A 41-year-old man with limited mouth opening was referred to our clinic for treatment. At the first visit, his maximum mouth opening distance was 13 mm between the upper and lower incisors and there were palpable indurations at the bilateral temporal muscles. We diagnosed this situation as a contracture of muscles, and performed bilateral coronoidectomy under general anesthesia. Mouth-opening exercises were started from one day postoperatively, and continued for 7 months. His maximum range of mouth opening is now maintained at 30 mm.
Bisphosphonates (BP) have been widely used to treat bone metastasis from malignant tumors, multiple myeloma and osteoporosis. However, BP can cause avascular bone necrosis of the jaw in some patients. We report a case of continuous resection for BP-associated osteonecrosis of the mandible. An 81-year-old woman was referred to our department with the complaint of painful swelling in the right submandibular region. CT scan of the mandible showed a region of mottled bone and sequestra. Her osteoporosis had been treated with BP. A clinical diagnosis of BP-associated osteonecrosis of the mandible was made. Two months after stopping BP, we performed continuous resection of the mandible and reconstruction with plate. The postoperative course was uneventful during a follow-up period of 17 months and recurrence has not been observed. If we choose the case and perform the operation carefully, it is thought that radical treatment is possible.
If a dental instrument or prosthesis is accidentally swallowed, it is spontaneously excreted within about 4 weeks after passing through the stomach in adults. However, it sometimes requires endoscopic or surgical removal because of obstruction in the gastrointestinal tract. Severe complications such as gastrointestinal perforation, bleeding, ileus, abscess formation and perforative peritonitis are rarely causing by accidental swallowing of foreign bodies, but when they do occur, usually require emergency abdominal surgery. We report a case of a 36-year-old man who accidentally swallowed a piece of broken partial denture. In this case, perforative peritonitis occurred very soon after the accidental swallowing, and an emergency laparotomy for removal was required.
In neonatal medicine, pre-term babies with oral malformation are frequently encountered. We report a successful case of cleft lip and palate in an extremely low birth weight female infant, focusing on the feeding strategy. The female infant was born at 28 weeks gestation and weighed 944 g. Immediately after birth, she showed slight respiratory and circulatory distress, sepsis due to her mother's intra-uterine infection, jaundice and anemia, and she was managed in a neonatal intensive care unit. At first she was fed sufficient amounts of mother's and artificial milk with tubing to prevent respiratory complications and to produce steady rates of growth. Also, she received oral care to facilitate sucking. She achieved a body weight gain to 1800 g at the age of 11 weeks and 1 day from birth, and commenced bottle feeding with a P-type nipple. We applied a palatal obturator (Hotz plate) to achieve optimal alignment of the cleft palate segments at the age of 16 weeks. Later, we performed cheiloplasty and palatoplasty under general anesthesia.
Mikulicz disease is a unique condition involving persistent painless enlargements of lacrimal and salivary glands, but the cause is unknown. Previously, Mikulicz disease was included within the diagnostic category of primary Sjögren's syndrome, but now the concept of this disease has changed, because dryness of the eyes and oral cavity in Mikulicz disease is not so remarkable and is improved in response to glucocorticoid treatment. In cases with Mikulicz disease, the serum concentration of IgG4 is elevated and there is prominent infiltration of plasmacytes, which were shown by the immunoenzyme method to express IgG4, in gland tissue. On the other hand, autoimmune pancreatitis and tubulointerstitial nephritis are all related to IgG4 in their pathogenesis. Mikulicz disease may be a sub-type of systemic IgG4-related plasmacytic disease. A 70-year-old man presented with a chief complaint of bilateral painless submandibular gland enlargement. He had been hospitalized for urethrectomy of interstitial nephritis with retroperitoneal fibrosis at the Urology Department of Tokyo Medical University Hospital 2 months previously. Blood examination revealed high serum IgG4. Needle biopsy of the submandibular gland was performed. Microscopically, severe infiltration of IgG4 positive plasmacytes was recognized in both surgical and needle biopsy specimens of the right submandibular gland. Blood examination also revealed high serum IgG4. We began to administer steroids under a diagnosis of Mikulicz disease with systemic IgG4-related plasmacytic disease. The high serum IgG4 levels decreased, and the bilateral enlargement of the submandibular glands subsided and disappeared.
A rare case of acute septic arthritis of the temporomandibular joint (TMJ) is reported here. A 87-year-old male visited our hospital because of severe pain in the right TMJ region, trismus, eating disorder, and malocclusion. His maximum mouth opening (MMO) was 20mm, and his mandible deviated to the left side 4 mm. Radiographic findings revealed deviation of the right mandible to the anterior-inferior direction. Under clinical diagnosis of acute septic arthritis of the right TMJ, intravenous administration of antibiotics (CEZ: 2 g/day) was started. An MRI was taken in the hospital on day 10, which revealed severe joint effusion in the superior joint compartment. Although we could not obtain pus by puncture from the superior joint compartment, we performed arthrocentesis of the right TMJ. After arthrocentesis, his MMO increased to 40mm, and the malocclusion was cured. We could not detect the origin of the infection in the present case.