Purpose: We evaluated 32 patients with either unresectable and locally recurrent oral cancer or oral cancer with distant metastasis who were treated with immune checkpoint inhibitors （ICIs） at the Department of Oral and Maxillofacial Surgery of Hiroshima University Hospital.
Methods: The following data were collected for 24 patients treated with Nivolumab and 8 patients treated with Pembrolizumab: sex, age, primary site, histological type, stage, performance status （PS）, target lesion, number and line of administration, observation period, neutrophil lymphocyte ratio （NLR） immediately before treatment, immune-related adverse events （irAE）, overall response rate （ORR）, disease control rate （DCR）, overall survival （OS）, and progression-free survival （PFS）.
Result: The 1-year OS rate of the 24 patients treated with Nivolumab was 45.8％, and the 1-year PFS rate was 20.0％. The 21 patients treated with Nivolumab who were evaluable for efficacy were 2 complete response （CR）, 1 partial response （PR）, 5 stable disease （SD）, and 13 progression disease （PD; ORR with Nivolumab was 14.2％ and DCR was 38％. The 1-year OS rate and 1-year PFS rate of the 8 patients with Pembrolizumab were both 42.9％. Seven patients were evaluable for response: 2 had PR and 5 had PD, and both ORR and DCR were 28.6％. Of the 32 patients in total, ICIs were discontinued in all but one case due to irAE in seven patients.
Conclusion: ICIs have been used successfully in patients with unresectable local recurrence and distant metastasis of oral cancer. Patients with NLR less than 5.6 immediately before treatment showed significant anti-tumor activity （P＝0.0148）.
True allergy to local anesthetics is rare. We experienced a case with possible true allergy to lidocaine, who underwent extraction of a maxillary wisdom tooth under local anesthesia. We report the summary with a consideration of the literature. A 27-year-old man visited our department with the chief complaint of uncomfortable feeling around the right maxillary wisdom tooth. His past medical history was significant for many drug allergies, including lidocaine products. Under a diagnosis of partial impacted and pericoronitis of the right maxillary wisdom tooth, we planned to extract the tooth. We requested a medical examination and skin test for local anesthetics to a dermatologist in our hospital. A prick test revealed positive reaction to a lidocaine product （1％ xylocaine®）, but negative reaction to a propitocaine product （3％ citanest-octapressin®）. We decided to use the propitocaine product as a local anesthetic, and to extract the tooth under intravenous （IV） sedation to remove his psychological stress. At the beginning of the extraction, we injected 0.2ml of the propitocaine product in the right maxillary gingiva as a challenge test for local anesthetic. After confirming no allergic reaction, we added the local anesthetic and removed the tooth easily. After the extraction, we carefully monitored his condition under hospitalization for one night. His postoperative course was uneventful.
A 66-year-old man presented with difficulty in oral intake because of electric-shock-like pain in the right gingival region. On gingival palpation, the patient experienced intermittent electric-shock-like pain that radiated from the right mandible to the temporal region and lasted for several seconds. General health and oral hygiene status were extremely poor. Magnetic resonance imaging revealed an epidermoid cyst at the right cerebellopontine angle, suggesting right trigeminal neuralgia. He refused to undergo neurosurgery and requested drug therapy with carbamazepine （CBZ）. The dose of CBZ was gradually increased to 400mg/day because of its remarkable effects. Thirty days after treatment initiation, fever and sore throat were noted, and his condition was diagnosed as agranulocytosis through a blood test report. CBZ was discontinued, and granulocyte colony-stimulating factor was administered. We discovered that the patient had consumed CBZ 1000 mg/day for 3 days at his discretion, which resulted in agranulocytosis. However, there was no effect with other drugs, and he again refused surgery or any other treatment. Thereafter, CBZ was administered for one year with frequent blood tests and patient counseling, and no decrease in granulocyte count was observed. CBZ-induced agranulocytosis is caused by toxic or immunological mechanisms. Herein, we report this case of CBZ-induced agranulocytosis, which was possibly mediated by toxic mechanisms and showed a dose-dependent response. Our findings suggest that various measures to improve patient adherence to medication are needed.
Schwannoma, an ectodermal tumor originating from Schwann cells, is occasionally observed in the oral and maxillofacial region, but rarely in the floor of the mouth. We report a case of schwannoma of the oral floor in a 10-year-old child. The patient was a 10-year-old boy who came to our hospital with a chief complaint of swelling in the left floor of the mouth. MRI findings revealed a clearly-defined mass, producing low signal intensity on T1-weighted MR images and high signal intensity on fat-suppressed T2-weighted MR images. Due to suspicion of a salivary gland tumor in the left floor of the mouth, biopsy was performed and the diagnosis of schwannoma was obtained. In July 2020, tumor resection with combined resection of the left oral floor was performed under general anesthesia. Histopathologic examination revealed Antoni A and B mixed type of schwannoma.
Coronavirus disease 2019 （COVID-19） was confirmed in China in December 2019 and has spread worldwide. As of October 1, 2021, approximately 1.7 million people have been diagnosed with COVID-19 in Japan, and at its peak, about 25,000 people were diagnosed per day. In a pandemic, COVID-19 patients may be mixed in with routine patients. Oral and maxillofacial surgery treats a variety of diseases that occur in the oral and maxillofacial region and must differentiate between inflammatory diseases of the oral cavity and COVID-19. In this report, we describe a case of COVID-19 discovered during treatment for pericoronitis of a mandibular third molar. The patient was aware of pain in the right mandibular third molar one day prior to the initial examination, and came to our department the following day. The patient was diagnosed with pericoronitis of the mandibular third molar and started antibiotic treatment. However, she returned to our department 4 days after her initial visit because she was worried about worsening pericoronitis. Although pericoronitis of the mandibular third molar had improved, redness of the pharynx was observed; therefore, we considered the possibility of COVID-19. She was tested and diagnosed with COVID-19 at another hospital. During the COVID-19 pandemic, it is important to distinguish COVID-19 from oral surgical diseases and to take measures to prevent infection.