In case of ectopic impacted teeth which are located posterior to the mandibular ramus, the extraoral approach is mostly chosen because extensive bone elimination is needed and the operative procedures are complicated when performed intraorally. We herein report a case treated intraorally with the high perimandibular approach for extraction of an ectopic impacted wisdom tooth. The patient was a 34-year-old female, and the tooth was located posterior to the mandibular ramus. Since it appeared to be difficult to treat with the simple intraoral approach, we combined the intraoral approach with the high perimandibular approach which is selected for condylar process fractures and mandibular angle fractures. We were able to extract the tooth safely and follow up for six months without any complications. The high perimandibular approach is considered to be a high-priority procedure among the extraoral approaches from the viewpoint of securing the operative field and reducing complications.
Introduction: The mandibular condyle is a common site of fractures, accounting for approximately 30-50％ of all mandibular fractures. It is an anatomically complex and delicate structure, and the usefulness of surgical treatment for mandibular condylar head fractures has not been clearly established. We performed a retrospective evaluation of patients with condylar head fractures presenting functional impairment, treated with open reduction and internal fixation （OR-IF）.
Patients and Methods: The cases of 11 patients with 11 joints of mandibular condylar head fractures with functional impairment treated with OR-IF at Shimane University Hospital during the period from October 2017 to September 2021 were analyzed. For each patient, the surgery was performed under general anesthesia through a preauricular approach, and the condylar fragment was anatomically reduced and fixed with two or three positioning screws. Age, sex, injury mechanism, concomitant fracture, and complications were reviewed. The functional and structural results were assessed 6 months postoperatively using Nakatomi’s and Kamiya’s assessment scales, respectively.
Results: The patients’ mean age was 68.4 years, and 8 （73％） were male. The most common mechanism of injury was a fall, and all patients had fractures of other sites in maxillofacial bone. Postoperative complications included paralysis of the temporal branch of the facial nerve in two cases, which improved over time. Postoperative evaluations revealed that 72.7％ of the patients achieved complete functional healing, and 90.9％ achieved complete bone healing structurally.
Conclusion: Surgical treatment of mandibular condylar head fractures with functional impairment can be a useful treatment of choice.
When extracting a mandibular impacted third molar, understanding the positional relationship between the third molar and mandibular canal is important for assessing the risk of paresthesia of the inferior alveolar nerve. In particular, dental cone-beam CT （CBCT） is useful for preoperative evaluation.
This study included 637 teeth in 543 cases with a mandibular impacted third molar extracted by both panoramic radiography and CBCT. The relationship of these cases to paresthesia of the inferior alveolar nerve was retrospectively investigated based on the medical records and imaging findings. The study included age, gender, site, years of surgeons’ experience, panoramic radiography findings, and CBCT findings.
The rate of paresthesia of the inferior alveolar nerve associated with tooth extraction was 5.5%. In univariate analysis, there were significant differences in panoramic radiography findings between the class and position of the Pell-Gregory classification, clarity of the upper wall white line of the mandibular canal, the positional relationship between the mandibular canal and root; in CBCT findings of the bucco-lingual position of the root and mandibular canal, the cross-sectional morphology of the mandibular canal, and presence or absence of bone. In multivariate analysis, there were significant differences in the class of the Pell-Gregory classification and the cross-sectional morphology of the mandibular canal.
The present study suggests that CBCT imaging should be considered in cases with Pell-Gregory classification Class Ⅲ on panoramic radiographs and the position of the mandibular impacted third molar and the mandibular canal crossing at the inferior wall of the mandibular canal.
Myofibroma is a relatively rare benign tumor that occurs singly in skin, subcutaneous tissue, muscle, bone, lung, heart, gastrointestinal tract, etc. We report a case of myofibroma on the tongue.
In October 2011, a 74-year-old man presented to us with a nodule on the right side of the tongue. It was approximately 15mm in diameter, had distinct margins, and was hard elastic on palpation. The nodule was painless. The surface of the tongue had normal mucosa. The nodule was extirpated under local anesthesia. The pathological diagnosis was myofibroma. No recurrence was observed at the surgical sites.
Myofibroma is a benign tumor, but has the potential for recurrence and spate. Thus, such tumors should be strictly observed for recurrence.
We report a case of acantholytic squamous cell carcinoma in the left side of the tongue. An 86-year-old woman with contact pain in the left tongue was referred to our hospital with a suspected malignant tumor. The patient had a 25×20mm ulcer with surrounding embankment on the left side of the tongue. On CT, MRI, and US, lymph node metastasis was detected in the left submandibular region, and its depth of invasion （DOI） was 10mm. A biopsy diagnosis of squamous cell carcinoma in the left tongue （T2N1M0） was made, and left modified radical neck dissection and partial resection of the left side of the tongue were performed with the pull-through approach. Histopathological diagnosis of the resected tongue specimen was acantholytic squamous cell carcinoma. No metastases were found in the dissected neck specimen. No postoperative adjuvant therapy was performed because of the patient’s age and lack of lymph node metastasis. Twenty-five months after surgery, the patient presents no recurrence or metastasis.
Lemierre’s syndrome is a rare serious systemic infection that is accompanied by thrombophlebitis of the internal jugular vein and septic embolism triggered by an infection of the head and neck. We report a case of Lemierre’s syndrome which developed after infected root canal treatment. The patient was a 53-year-old man who had worsening swelling of the left cheek since infected root canal treatment performed 4 days earlier. The patient was urgently admitted to the otorhinolaryngology department of our hospital because of suspected cellulitis in the left cheek. Our department was consulted to identify the source of the infection. He had swelling and redness from the left cheek to the periorbital area. Intraoral findings showed that the left mandibular first molar was undergoing root canal treatment, but no inflammation was found in the surrounding gingiva. Blood tests revealed a high inflammatory response with WBC 13,600/μl and CRP 25.98mg/dl. A panoramic radiograph showed an apical lesion on the left mandibular first molar. Contrast-enhanced CT showed thrombotic embolism in the left internal jugular vein and external jugular vein. Based on the above, antibacterial therapy was started with the diagnosis of Lemierre’s syndrome due to dental infection, and the left mandibular first molar, which was the causative tooth, was extracted under local anesthesia. When anticoagulant therapy was started at the same time, the condition improved over time.
The eruption of a tooth into the nasal cavity is a rare clinical entity. Therefore, there are many more case reports from otorhinolaryngologists than from dentists. We report a case of a supernumerary tooth in the nasal cavity. A 12-year-old male was referred to our hospital for extraction of a maxillary central supernumerary tooth. On radiological examination, a tooth-like structure was observed in the left nasal cavity. The diagnosis was an ectopic supernumerary tooth in the left nasal cavity. Extraction was performed under general anesthesia. Histopathological views of the tooth-like hard tissue revealed dentin and pulp, confirming that it was a dental organism.
Spindle cell squamous cell carcinoma is a rare tumor in the oral cavity with an appearance similar to sarcoma, and is classified as a subtype of squamous cell carcinoma. In this study, we report a case of spindle cell squamous cell carcinoma simultaneously occurring in the buccal mucosa and mandibular anterior gingiva after chemoradiotherapy for squamous cell carcinoma.
The patient was a 68-year-old woman who came to our hospital in September 2009 with a complaint of a white lesion on the right buccal mucosa and mandibular anterior gingiva. We diagnosed it as squamous cell carcinoma and performed preoperative concurrent chemoradiotherapy and tumor resection. Local recurrence and new occurrence of squamous cell carcinoma were observed in the right buccal mucosa in May 2011, right lower lip in January 2012, right floor of the mouth in December 2012, right buccal mucosa in June 2013, and mandibular anterior gingiva in November 2013. Therefore, we performed resection and preoperative chemotherapy or concurrent chemoradiotherapy, respectively. In February 2014, masses were found in the right buccal mucosa and mandibular anterior gingiva, and the pathological diagnosis of biopsy was spindle cell squamous cell carcinoma. Therefore, we performed resection. In April of the same year, a leukoplakia was found on the left side of the floor of the mouth. We performed resection, and the pathological diagnosis was squamous cell carcinoma. In June of the same year, recurrence of the tumor was observed in the right buccal mucosa, but the patient did not wish to have surgery and died in August of the same year.