Treatment methods for bisphosphonate-related osteonecrosis of the jaw (BRONJ) have not been established. Conservative therapy, which was recommended in a position paper published in 2010, does not lead to complete healing in some cases. The treatment method and clinical course of 44 patients with BRONJ, who underwent surgery in our hospital, were investigated, and the following results were obtained: 1) Oral BP was administered in 25 patients, while intravenous BP was administered in 19 patients. Most patients were in stage II. 2) Four patients underwent removal of the necrotic bone only, 37 underwent removal of the necrotic bone as well as the surrounding vital bone, and 3 underwent segmental mandibulectomy. The wound was closed in 35 patients, and packed opened in 9. 3) All 25 patients with oral BP achieved complete remission after surgery. 4) Eleven of 19 patients with intravenous BP achieved complete remission after surgery, and 7 achieved partial remission, although surgical procedure was not effective in one patient. 5) In those who did not achieve complete remission, QOL was improved long term. 6) These findings show that it is appropriate to perform surgical procedures in stage II BRONJ patients.
The trichilemmal cyst is a dermal epithelial cyst and its wall resembles the external root sheath of hair. It is most commonly found on the scalps of elderly women. We report a case of markedly calcified trichilemmal cyst in the submandibular region. A 73-year-old male was referred to our department because of a nodule in the right submandibular region. Extra-oral examination showed a well-defined, firm, freely mobile nodule measuring 20 × 15 mm. A computed tomography scan showed it as a sharp, high-density mass. The nodule was removed under general anesthesia. Histopathological examination revealed a cystic lesion with trichilemmal keratinization in its wall and filled with a calcified structure. Accordingly, trichilemmal cyst was diagnosed. There has been no sign of recurrence since the operation.
We started superselective intra-arterial chemoradiotherapy from the superficial temporal artery in January 2006. When inserting a catheter from the superficial temporal artery, we adjusted the position of the catheter tip and also conducted arterial redistribution, which involves placing a coil in the peripheral artery, in order to localize drug distribution within the tumor. Drug administration was continued for four weeks with 50-100mg/m2/day of 5FU, 20mg/m2/week of CDGP and 15mg/m2/week of TXT. A total of 40Gy of irradiation, 2Gy each, was also given. There were 20 male and 22 female oral cancer patients in this study, totaling 42 cases (stage III: 21, stage IV: 21). The mean age was 68.2 ranging from 43 to 93 years old. There were 39 complete response (CR) and 3 partial response (PR) cases. The response rate was 100%, the overall survival rate was 80.3% and the disease-specific survival rate was 84.6% according to the five-year survival rate by the Kaplan-Meier method. The disease-specific survival rate by stage was 95.2% for stage III and 71.7% for stage IV. The survival rate by region was 80.0% for the tongue (15 cases), 91.7% for the upper gingival and maxillary sinus (12 cases), 75.0% for the lower gingiva (8 cases), 80.0% for the buccal mucosa (5 cases), and 50.0% for the oral floor (2 cases). Although the adverse side effect of Grade 3 or higher mucositis was observed in all cases, hematological toxicity such as leukopenia appeared in only seven cases. Therefore, it is reasonable to conclude that this treatment is effective. It is suggested that this could be a surgery-free treatment for oral cancer.
Gas gangrene is a severe bacterial infection accompanied by gas production by either clostridium genus or non-clostridium genus. A 76-year-old man visited our hospital with complaints of left buccal swelling and trismus. CT examination revealed periapical lesions in the left lower molars and abscess formation with gas retention, extending from the left submandibular space to the temporal fossa. Drainage of the abscess was immediately performed by submandibular, temporal and intraoral incisions, with a concomitant administration of anti-microbial agents. Leukocytosis and increase of body temperature indicated that the patient also was accompanied by systemic inflammatory response syndrome (SIRS). During treatment of the gas gangrene, a diagnosis of dementia and diabetes mellitus was made. Although the dementia and diabetes mellitus delayed his recovery from the infection, he left the ICU 34 days after surgical intervention.
Adenosquamous carcinoma is characterized by both squamous cell carcinoma and true adenocarcinoma. We report a case of adenosquamous carcinoma in the tongue with a high level of serum carcinoembryonic antigen (CEA). A 71-year-old woman visited our hospital because of tumor of the tongue and swelling of the right submandibular region. Clinical examinations revealed a papillary tumor 30 × 25 mm in diameter in the root of the tongue and cervical lymph node metastasis in the right neck without distant metastasis. The histopathological diagnosis of a biopsy specimen was well differentiated squamous cell carcinoma. The patient received radical neck dissection (right side) and tumor resection, after preoperative chemotherapy using cisplatin, docetaxcel and 5-FU. Histopathological examination of the surgical specimen showed adenosquamous carcinoma. In the metastatic lymph node, the tumor invaded out of the node, so she underwent radiotherapy postoperatively. Late development of lymph node metastasis in the contralateral neck was found 8 months after the first operation, so she underwent radical neck dissection (left side). The tumor remained at the carotid bifurcation on the site of the left neck, so the patient underwent brachytherapy. Since the tumor increased again, she received molecular targeted therapy with anticancer agents using cetuximab and paclitaxel. This combination therapy was effective, and has been maintained without critical side effects.
We report a case of metastases from pulmonary adenocarcinoma detected by a total neck dissection specimen for mandibular gingival carcinoma. A 69-year-old man with discomfort in the left mandibular gingiva was referred to our hospital. A granular mass (30 × 23 mm) was located in his left mandibular gingiva. A pressure type of panoramic radiography absorption image was observed in the left mandibular bone. Lymph node metastases were detected in the left submandibular region by CT, US and MRI. CT also revealed an abnormal shadow in the right lung field, which was possibly due to inflammation. A clinical diagnosis of squamous cell carcinoma of the left mandibular gingiva (T2N2bM0) was made, and left total neck dissection and marginal resection of the left mandibular bone were performed. Metastases of pulmonary adenocarcinoma were detected in 13 lymph nodes at levels III, IV, and VB in the total neck dissection specimen. Subsequent treatments for pulmonary adenocarcinoma carried out at the Respiratory Medicine Department included radiation and chemotherapy.