Search

Keratocystic odontogenic tumor commonly occurs in the posterior body and ramus of the mandible. Rarely, however, it develops in the attached gingiva or alveolar mucosa and exhibits the same histopathologic features. The lesion clinically resembles a gingival cyst in adults. Differential diagnosis is therefore difficult. We encountered a case of keratocystic odontogenic tumor arising in the mandibular gingiva and report it as a peripheral keratocystic odontogenic tumor.A 53-year-old man was referred to our department because of an asymptomatic swelling measuring 6 mm in diameter at the gingiva attached to the labia near teeth 2 3. The swelling was covered with normally appearing mucosa and had a whitish hue. The lesion was fluctuant on palpation and had neither spontaneous pain nor tenderness. The teeth adjacent to the lesion were noncarious, and confirmed pulp vitality by electrical stimulation. The lesion was totally excised with a 1-mm margin of normal gingiva under local anesthesia. The alveolar bone adjacent to the lesion had undergone pressure resorption. Exposure of the root surface of 2 3 was noted intraoperatively. Histopathologically, a cystic space was located within the gingival soft tissue. It was lined by parakeratotic stratified squamous epithelium composed of several cell layers and lacking rete pegs. No recurrence was noted for 6 years.

Mediastinal emphysema is a relatively rare complication of dental treatment. This paper reports a case of mediastinal emphysema arising after CO2 laser irradiation. A 48-year-old woman underwent irradiation with a CO2 laser to treat an alveolar abscess at a dental clinic. On the same day, the patient was referred to our hospital because of difficult breathing and swelling extending from the face to neck. A CT examination revealed mediastinal emphysema. The patient was hospitalized and received anti-inflammatory therapy. The swelling subsided by the 5th day, and she was discharged on the 10th day. We have to master the proper technique for treatment and recognize this complication of CO2 laser irradiation.

Glandular odontogenic cyst (GOC), first described in 1988 by Gardner et. al, is a comparatively rare jawbone cyst of odontogenic origin, which shares some features with both botryroid odontogenic cysts and mucous-producing salivary gland tumors. Although GOC has a high rate of recurrence, cases of recurrence have not been reported in the Japanese literature.This paper describes a case of GOC arising in the mandible of a 58-year-old man. The cyst recurred 12 years after primary treatment. Diagnosis and treatment of the lesion are discussed.

Myoepithelioma is a rare salivary gland tumor that appears mainly in the parotid gland and palate. We report a case of myoepithelioma originating from the buccal gland. A 19-year-old woman presented with a painless elastic hard mass beneath the left buccal mucosa. The mass was well defined and showed no ulcer. The mass was surgically removed under the clinical diagnosis of a benign minor salivary gland tumor. Macroscopically, the tumor was solid and nodular, surrounded by a thin fibrous capsule. Histopathologically, the tumor consisted of spindle-shaped and/or stellate cells with scanty cytoplasm. These tumor cells formed a trabecular structure and small nests in some regions; however a tubular structure was not seen. Immunohistochemistry showed positive staining for cytokeratin, S-100 protein, actin, and GFAP.The tumor was diagnosed as a myoepithelioma arising from the buccal gland.

Reports of iatrogenic foreign bodies in the jaw are rare. Two cases of accidental insertion of broken extracting instruments into the mandible are reported. These accidents occurred during removal of impacted mandibular third molars. One patient was referred on the day of the accident, and the other was referred 2 months after the accident. Radiographs revealed metal foreign bodies in the mandible, separate from the tooth sockets. The objects were removed by enlargement of the tooth sockets. They were a broken elevator and a broken root tip elevator. Healing was uneventful, but one patient had prolonged sensory nerve disturbance of the lower lip.

Fifty-two patients with squamous cell carcinomas of the oral cavity, oropharynx, and maxillary sinus who underwent neck dissection were clinico-pathologically reviewed. Maxillary sinus and tongue carcinomas showed high incidences of lymph node metastases. In contrast, carcinomas of the lower gum and oropharynx had low incidences of lymph node metastases. Of the 36 cases with histologically positive nodes, level 2 was the most frequent site of metastases followed by level 3, level 1, and level 4 at the affected side. Metastasis contralateral to level 2 was not infrequently observed. Non-contiguous nodal sites were observed in 2 patients with bilateral metastases. The largest number of metastatic nodes was 18, but the largest proportion of cases in this series had only one positive node. There was some correlation between the number of involved nodes and the level of metastasis. In relation to T category, many of the T 1 cases had only one affected node, but the numbers of involved nodes varied considerably in T2, T3 and T4 cases. The cumulative 5-year survival rate was 86.7% in pN (+) cases, versus 62.4% in pN (-) cases, and this difference was significant (P

MR imaging is useful in the diagnosis of bilateral internal derangement of the temporomandibular joint. This study was performed to investigate the correlation between clinical symptoms and displacement of the bilateral articular disk in patients with temporomandibular joint disorders (TMJD). A series of 170 patients who had signs and symptoms of TMJDs (TMJ pain, TMJ sound, trismus) were examined bilaterally by MR imaging. One hundred twenty-six patients had only unilateral symptoms, but 55 (44%) of them showed bilateral disk displacement. Among 93 patients with unilateral TMJ pain, 89% showed disk displacement (22 TMJs with reduction, 61 TMJs without reduction) on the symptomatic side, and 44% showed disk displacement on the asymptomatic side. Among 53 patients with unilateral TMJ sound, 96% showed disk displacement (28 TMJs with reduction, 23 TMJs without reduction) on the symptomatic side, and 53% showed disk displacement on the asymptomatic side. In patients with severe trismus (interincisal opening distance

Clinically, more reliable methods of estimating tenderness are needed. A pressure pain meter is an investigative tool for the measurement of tenderness. The purpose of this research was to measure the pressure pain threshold (PPT), and to compare topographic variability in PPT in the maxillofacial regions of normal subjects. PPT is the minimum pressure inducing pain or discomfort. The pressure pain meter consists of a force gauge to which a resin disc with a 1-cm diameter surface is attached. Normal threshold values were established in 22 volunteers (11 women and 11 men), at 6 different sites of the facial skin, including the mental protuberance (surface of the mandible), mental foramen and infraorbital foramen, lateral pole of the condyle, and the temporal and masseter muscles.The results indicated mean PPT in the mental protuberance (surface of the mandible) to be 2144g in women and 2349g in men. PTT at the mental foramen and infraorbital foramen, pole of the condyle (mouth opening phase), and masseter muscle (relaxation phase) were significantly lower than the values measured at the mental protuberance (surface of the mandible) in both sexes.PTT at the pole of the condyle when the mouth was open was significantly lower than that measured when the mouth was closed.PTT at the masseter muscle region in relaxation phase was significantly lower than that measured in contraction phase.

In spite of extensive research, the nature and origin of oral lichen planus (OLP) are still unknown. A clinical examination of 111 cases of OLP is presented. OLP predominantly occurred in middle-aged and elderly patients ranging in age from 40-60 years; 69.4% of the patients were women. The chief complaints of the patients were a sore or burning sensation or white lesions. Many patients seeked consultation after more than 3 month from the onset of disease. Some type of systemic disease was noted in 77 cases (69.4%), and 45 cases (40.5%) used some form of medication. A history of allergy was present in 19 cases (17.1%) and skin lesions were noted in 11 cases (9.9%). The distribution of OLP by site of occurrence was as follows; buccal mucosa 83.8%, upper and lower gingivae 32.4%, tongue 24.3%, lips 19.8%, floor of mouth and palate, less than 10%.These lesions were distributed in a symmetrical or multiple pattern, but OLP predominantly found on the mucous membrane of the vestibule oris. The size of the lesions was often more than 3 cm in diameter. Reticular lesions were most common, followed by atrophic red lesions. Many factors have been reported to cause lichen planus. However, the present clinical study suggests that OLP is caused by other local factors than skin lichen planus.

A case of acinic cell tumor of accessory parotid gland associated with “crystalloid” is presented. The patient was a 69-year-old female who was aware of a small mass of right buccal mucosa for 12 years. She consulted our clinic complaining of repeated swelling of the right parotid region. Oral examination revealed a submucosal elastic hard nodule beneath the right papilla parotidea. The lesion exhibited scattered radiopacity on roentgenogram. Under the clinical diagnosis of infected sialolithiasis in Stensen's duct, curettage was performed intra-orally. After two weeks, the submucosal nodule remained unchanged, then the lesion was excised along with the papilla parotidea under local anesthesia. Stensen's duct involved with the capsulated spheroid tumor was sacrificed and the proximal stump of the duct was sutured to the buccal mucosa. The patient recovered well after surgery.The excised tumor was 15 mm in diameter, and histologically composed of eosinophilic cuboidal cells organizing tubular or acinar structure with poor fibrous stroma. Capsular structure with thin fibrous connective tissue was evident. Characteristic “crystalloid”, which is occasionally found confined in the parotid gland and the origin of which is not known, as well as psammorna body were scattered throughout tumor, and some of the crystalloids had cores consisting of psammoma body. But, there was no sialolith in the specimen. Histopathological diagnosis was acinic cell tumor.The origin of the tumor in tins case was speculated to be accessory parotid gland rather than buccal minor salivary gland upon consideration of findings such as the anatomical relationship between the tumor and Stensen's duct, and identified crystalloid in the tumor. This is the first case reporting the existence of crystalloid in acinic cell tumor.

We describe two unusual cases of necrotizing sialometaplasia of the hard palate in which the lesions were caused by self-induced vomiting. The first patient, a 35-year-old woman, pressed her palate with a spoon to induce vomiting 2 weeks before presentation to our department. The second patient, a 16-year-old girl, was suffering from bulimia and chronic self-induced vomiting. Clinical and pathological findings and causative factors are discussed.

Optimal dose of N-22 (Mofezolac), a new non-steroidal anti-inflammatory agent, was evaluated in a double-blind comparative study on post-exodontic pain, at 3 single dosing levels of 100 mg, 150 mg and 200 mg, respectively. The results are summarized as follows.1) A total of 197 cases subjected for analysis are broken down into a group of 68 cases with a 100mg dose, that of 64 eases with a 150mg dose and that of 65 cases with a 200mg dose, respectively. No significant deviation in clinical background factors of all cases was recognized.2) A total of 189 cases (67 cases-100mg, 60-150mg arid 62-200mg) were subjected for analysis of its efficacy. Analysis by U-test proved both 150 mg and 200mg groups to be significantly superior (P

To overcome the operational diffficulty of TMJ arthroscopy, and to reduce injury during the examination a fine needle fiber arthroscope was developed and clinically applied. The equipment is composed of a fine needle arthroscopic probe and a television monitor system with an output for a videorecorder and camera. The characteristics of this optical system are as follows:1) The fine needle arthroscope (0.8mm in diameter, 20 G) can be inserted into the narrow or tiny TMJ spaces, such as the lower joint compartment and also reduced iatrgenic injury to the joint tissues.2) There is no distortion of the picture or breakage of the scope by bending. The picture is clear enough for diagnostic purpose.3) Using this system it is possible to examine the joint both arthrographically, arthroscopically and to treat TMJ diseases, by means of pumping manipulation technique and injection of appropriate medicines. All of these manipulations are possible using only one insertion of the cannule (18 G) for each articular cavity under local anesthesia. 17 patients (19 TMJ) were examined by this system, and the results obtained are as follows:1) Adhesions were generally seen below the articular tubercle, and they were mostly white membrane like fibrous adhesion without blood vessel, similar lesions with debris were also seen in the lower articular cavity. It was possible to perform arthroscopic detachment by using this approach.2) Two types of disk perforation were observed, one without tissue reaction, the other with fibrous adhesion and granulation tissue.As mentioned above, very favorable results were obtained without any complications.

Clinical usefulness of N-22 (Mofezolac; N), a new non-steroidal antiinflammatory agent, on post-exodontic pain was evaluated at a single dose level of 150mg/time, in a double-blind comparative study, in comparison with Mefenamic acid; M also at a single dose level of 500 mg/time; results are summarized as follows.Of a total of 228 cases, 33 with no onset of post-exodontic pain took neither of the agents and were therefore removed, meaning that 195 cases were subjected for analysis, in comparison with M put under previously well controlled studies. No significant difference in patient background factors between N and M groups was found. Based on the protocol, either N or M was administered alone for evaluation at a single dose level/time. Double dummy method was used in allotment for administration of 4 kinds of test agents-N, NI, N's placebo and M's placebo.Of a total of 193 efficacy evaluable cases (N-96 & M-97), 25.0% of N group and 11.3% of M were rated “Remarkably improved” in final global improvement rate, with N group found significantly superior (P

Clinico-statistical observations on 104 cases of bilateral TMJ disorders are presented. The proportion of bilateral TMJ disorders (BTMJD) to the total patients of TMJ disorders was 23.1 percent. BTMJD occurred most frequently in the twenties and was predominant among female patients. The most common chief complaint was TMJ pain or TMJ sound. There were no significant differences in the age and sex distribution and the chief compaint between BTMJD and unilateral TMJ disorders. Among the initial symptoms of BTMJD, muscle symptoms mostly occurred bilaterally, but TMJ pains occurred unilaterally. TMJ sounds occurred equally in the bilateral and unilateral groups. The period from the onset of BTMJD symptoms to the initial visit to a clinic was longer than that for unilateral TMJ disorders. As for the present condition, most patients of BTMJD had several composit symptoms, TMJ pains+TMJ sounds or TMJ pains muscle symptoms. They rarely presented a similar symptom on both sides. Bilateral TMJ pains and bilateral TMJ sounds were concurrently recognized only in 11 cases. Bilateral TMJ pains and bilateral muscle symptoms were simultaneously recognized only in 11 cases as well. Most of the unilateral TMJ pains were accompanied with TMJ sound on the other side, but many of unilateral TMJ pains were recognized on the same side as that showing unilateral muscle symptoms. Difficulty in opening the mouth wide (

A case of peripheral osteoma in the mandible of a 56-year-old man is described. He noticed a hard mass of the mandible while he was in junior high school. The mass grew gradually, but there were no other symptoms, and he did not consult a doctor for 43 years. Radiographic examination revealed a hen-egg-sized ovoid, radiopaque mass in the floor of the mouth. The mass was removed surgically, and the histopathological diagnosis was osteoma spongiosum characterized by delicate cancellous bone with yellow bone marrow.

So-called static bone defects are usually situated in the molar or angular regions of the mandible. A rare case of a so-called static bone defect which existed in the ascending ramus of the mandible of a 25 year-old female is reported. X-ray findings showed a cyst-like radiolucent lesion in the ascending ramus but computed tomography and magentic resonance imaging proved that the lesion was a defect on the lingual ramus with anomaly of the mandible. Histopathological examination revealed the lesion to contain fatty tissue.

A case of oral lichen planus (lichenoid lesions) caused by a dental nickel alloy isreported. Patch test and X-ray microanalyser (XMA) were useful in distinguishing the causa-tive metal from other dental alloys because many teeth of the patient had been repaired byvarious dental materials.

Multiple granular cell tumors of the oral cavity are very rare. We reported clinical and pathological finding of two granular cell tumors on the left lateral border of the tongue in an 18-year-old female.

Osteopetrosis is a rare disorder characterized by symmetrical systemic sclerosis of skeletal bone which gives rise to susceptibility to fracture and osteomyelitis. Frequently dentition development is affected. A case of osteopetrosis in a 20-year-old female including various forms of dentition disorders i.e., impaction of 765 678 E3 B3, distorted crowns of 5 5, enamel hypoplasia of 43 3 4 4, arrested root development of 35, curved roots of 3 3, delayed root development of 5 and dentigerous cyst of 3, is described. In family history, the parents were consanguinity and the younger brother died of unknown etiology at one year old. Systemic roentogenological examination revealed characteristic findings e.g., sclerosis of the base of skull, “sandwich” appearance of the spine, “bone within a bone” appearance of the epiphises of long bones. By clinical examinations, anemia and cerebral nerve palsy were not observed. The serum calcium, phosphorus, alkaline phosphatase, thyrocalcitonin and parathormone levels were within normal limits. Impacted E3 B and 3 associated with dentigerous cyst were surgically removed under local anesthesia and intravenous dripping infusion of piperacillin. The wounds healed uneventfully. Microscopically, hyperplastic cementum of the root of 3 showed ankylosis with bone. Sclerosed cancellous bone of the mandible was composed of thickened lamellar bone exhibiting mosaic pattern with cement lines.

A case of large mucous cyst occurred under the buccal mucosa of a 47year-old male was reported.Minor salivary gland cysts are usually small, 1cm or less indiameter. This cyst extended from the posterior lip to the, retromolar region, 5cm in diameter. From surgical findings, this cyst originated in the glan dula, labiales.Histological examination revealed a well defined mucous cyst, no epithelial lining. Histopathological diagnosis was an extravasation.

Thirteen cases of actinomycosis in oral and maxillofacial regions were reported. They were histologically diagnosed by detecting sulfur granules in pus and granulomatous tissue. Clinical, bacteriological and histological studies of these cases revealed the following:1. Clinically, five types were recognized: non-abscess indurative type, subcutaneous abscess type, deep abscess type, mandibular ostitis type and secondary infection of cyst type. Subcutaneous abscess type showed the most typical clinical symptoms of actinomycosis.2. Histologically, sulfur granules were detected in all the cases, and typical sulfur granules with club formation were seen in 4 cases. In other cases, club formations were not so clear, and their central mass of granules were variable, i. e., a loosely-tangled mass of filaments, a compact mass of filaments or a mixture of them.3. Bacteriologically, Actinomyces were detected in 4 cases, and Bacteroides and Streptococcus were dominant in isolated strains from pus.4. Treatments of these cases consisted of administration of antibiotics combined with incision, drainage and elimination of predisposing pathologic condition. Penicillins and cephems were mainly administered in duration of 3 days to 3 months. In the non-abscess induration type, the longest term of treatment was needed, although the treatment proved effective eventually.

We recently encountered d 14-year-old male with bilateral odontomas in the lower jaw associated with unilateral mandible cyst. Odontomas and the cyst were removed under general anesthesia, the postoperative course was uneventful.Bilateral odontomas and cystic odontoma are rarely seen, particularly together.The bilateral odontomas appeared related to the change of general and regional conditions associated with the development of the mandibular second molars.

Two cases of verruciform xanthoma are reported with the review of 39 cases in domestic literature. Case 1, a 48-year-old female had a slightly elevated yellowish lesion on lingual aspect of mandibular left premolar-molar gingiva. Case 2, a 40-year-old female had a crescent shaped yellowish area on the gingiva buccal to the mandibular left first molar. Both were uneventful after simple surgical excision. Histologically, pebbly surface was covered by parakeratotic squamous epithelium. Characteristic accumulation of lipid laden foam cells were identified in connective tissue papillae between equally elongated rate pegs to a uniform depth. Especially in case 1, examination with the serial sections revealed gradual transformation to papillary architecture of the squamous epithelium in peripheral portion.The cause of verruciform xanthoma is still uncertain, but mild chronic inflammatory irritation may play the important role of its genesis.

Vascular lesion of the jaws are rare but special consideration should be paid because of the potential for fatality. A case of arteriovenous fistula of the mandible was reported with its course and treatment.A ten year-old girl was admitted to our hospital as an emergency with a bleeding of the left gingiva of the mandible. Orthopantomography showed an irregular radiolucency extending from left canine region to mandibular ramus. Angiography proved arteriovenous fistula of the mandible, and the main vessels to the lesion appeared to be the left external carotid artery and the abnormal extension of right inferior alveolar artery.Operation was postponed because the patient was young and her lesion was very large, so brisk bleeding and danger to her life was predicted during operation. Her course was closely watched for about four years. During this early period, she came several times by ambulance because of gingival bleeding, but during the middle period no gingiva bleeding or radiographically decrease of the lesion were noticed. Although in the latter period, frequent gingival bleeding and lesion enlargement were observed again. She was operated on at age fifteen. The left external carotid artery, afferent and efferent vessels to the lesion were ligated and marginal resection of the left mandible and enucleation of the tumor were carried out. The postoperative course was entirely good and without com

The treatment of facial bone fracture complicated with other severe traumata, head and/or viscera injury, is often postponed because of the emergency care for survival.A case of 45-year-old male who had a chief complaint of malocculusion caused by malunited mid-third facial fracture of Le Fort II and Le Fort II type was reported. Surgical treatment of Le Fort I osteotomy was selected for the correction of malocclusion. In the osteotomy, pre-traumatic occlusion and mandibular position were presumed by the observation of facial expression, mandibular rest position, denture model and roentogen cephalogram, and the position was reproduced by using face bow.

The granular cell tumor is a rare lesion with a predilection for the subcutaneous region and the tongue, it's histogenesis is still controversial. A 59 year-old female presented with a granular cell tumor in the left floor of the mouth.The tumor was excised together with a part of the sublingual gland, but invasion of the Wharton's duct was not observed. In the excised specimen, there was no encapsulation and the tumor had partially invaded the sublingual gland. Beneath the overlying stratified squamous epithelium associated with pseudo-epitheliomatous hyperplasia, the tumor cells had proliferated diffusely and/or were arranged in small nests especially around the peripheral nerve bundles. Scattered axon like dark brown fibrils were seen in the tumor nests after Bodian silver staining. The intracytoplasmic granules of the tumor cell showed either a weak or sometimes a strong PAS positive reaction which was diastase resistant. The tumor cells and Schwann cells were positive when tested by the immunohistochemical method using anti S-100 protein antiserum. Electron microscopical observation revealed granules of various sizes and shapes bounded by a membrane in the cytoplasm of the tumor cell. The tumor nest, which was bounded by a basement membrane, consisted of tightly packed spindle shaped cells with long pseudopodial-like processes. Isolated tumor cells were also found within the basement membrane of peripheral unmyelinated nerve fibers adjacent to Schwann cells and axons.These findings suggest that histogenesis in this case is from Schwann cells of the peripheral unmyelinated nerve fibers.

It is pointed out that minor salivary gland calculi are more common than previously supposed in the English language literature. But in Japan, reports of them are still rare and as far as we know only sixteen cases have been reported.This report contributes three additional cases of sialolithiasis in the minor salivary gland located in the upper lip of elderly persons. They were solitary, firm, freely movable, small masses. Histopathologically, all the calculi revealed similar findings that contained homogenous non mineralized organic matrix. Chronically inflamated granulation tissue surrounded the calculus in 2 cases and the dilated duct surrounded the calculus in 1 case. Chronic lobular inflamation and diffuse lobular fibrosis were common findings.The authors suggested that clinicians and pathologists tend to fail to diagnose the calculi of minor salivary gland if the calculus was small and nonmineralized, and soft tissue inflamation was prominent.