Asian Journal of Oral and Maxillofacial Surgery最新文献

Soft tissue chondroma of the palate is a rare lesion. We report a rare case of soft tissue chondroma of the hard palate with a review of the literature. A 59-year-old man was referred to our department because of a symptomatic mass on the median anterior margin of the hard palate of 4 year's duration. The lesion was approximately 15 mm × 10 mm × 8 mm in size and pedunculated. The lesion was excised under local anesthesia, and the pathological diagnosis was soft tissue chondroma. The histopathological findings suggested that the heterotopic formation of cartilage was caused by the metaplastic change of mesenchymal cells into chondrocytes. Postoperative wound healing has been uneventful, with no sign of recurrence during 2 years after surgery.

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is frequently induced by intravenous administration of nitrogen-containing bisphosphonates (BPs). Similarities between BRONJ and infected osteonecrosis (ION) with no history of BPs use have been described. The aim of this study is to compare the light microscopical findings of two lesions, especially in the histomorphologic analysis of osteoclasts. We investigated eight patients with intravenous BPs treatment and osteonecrosis, and seven patients suffering from ION with no history of BPs use. The present study found that an increase in the number of hypernucleated, detached osteoclasts may be a diagnostic value for BRONJ associated with intravenous nitrogen-containing BPs therapy.

Objective

We designed a convenient method of selective intra-arterial infusion chemotherapy to treat oral cancer with low-dose 5-fluorouracil.

Patients and methods

Twenty-seven primary cases treated with this method with concomitant external irradiation. The reasons for performing selective continuous intra-arterial infusion were severe systemic disease in four cases, advanced age in seven cases, unresectability in nine cases, preoperative chemotherapy in five cases, and two patients refused surgery.

Results

The overall treatment effects were as follows: complete response in 13 cases, partial response in 12 cases, and no change in two cases. None of the patients experienced disease progression while receiving concurrent chemoradiotherapy. Twenty-three toxic adverse events ranging from grades 1 to 4 developed in 25 patients. A grade 1 complication developed in six patients; oral and/or pharyngeal mucositis developed frequently in 12 patients. Hematologic adverse events such as leukocytopenia or thrombocytopenia were observed in five patients, but no grade 3 or 4 events developed in any patients.

Conclusions

These data indicated that our method is suitable for patients who cannot undergo surgery or systemic chemotherapy due to old age or severe systemic disease.

Epidermoid cysts are infrequently found in the oral and neck region. Among the cases reported, several noted large epidermoid cysts are located in the floor of the mouth, with a maximum size of about 8 cm. Herein, we present a case of a large epidermoid cyst sized 11 cm × 9 cm × 9 cm, which was located in the floor of the mouth and reached the submandibular area across the mylohyoid muscle.

Chondroblastoma is a rare benign cartilaginous neoplasm that typically arises in the epiphysis of long bones. Chondroblastoma in the maxillofacial area is quite rare; and approximately 80 cases of chondroblastoma involving the temporal bone have been reported worldwide. Furthermore, only nine cases of chondroblastoma involving the mandibular condyle have been reported. A 68-year-old female presented with mild hearing loss, trismus, and swelling in the left temporal region. Computed tomography and magnetic resonance imaging revealed a round, solid 60 mm lesion with significant osseous destruction of the petrous and squamous regions of the temporal bone. Histological examination of the biopsy specimen revealed a chondroblastoma. The final clinical diagnosis was chondroblastoma involving the dura and condylar head of the mandible. Total excision of the tumour was undertaken via a combined neurosurgical and oral surgical approach. The patient's post-operative course was uneventful, however, she had dysesthesia in the distribution of the mandibular nerve, and temporary paresis of the frontotemporal branch of the facial nerve. The dysesthesia improved within 1 year but very mild facial palsy continued. She remained clinically and radiographically disease-free during the 48-month follow-up period.

Objective

We have searched for the factor to diagnose malignant potential of epithelial dysplasia. Recent studies have suggested that determination of the expression of cytokeratin 13 and 17 would be useful for the early diagnosis of oral squamous cell carcinoma. In this study, we focused on the diagnosis based on the malignant potential of epithelial dysplasia and evaluated the feasibility of combined assessment of cytokeratin 13 and 17.

Patients and methods

The expression of cytokeratin 13 and 17 observed in 8 patients with clinically diagnosed T1 or T2 tongue squamous cell carcinoma was analyzed using real-time PCR and immunohistochemical staining of resected specimens. Areas in each specimen were identified as Normal, Dysplasia and Cancer.

Results

Real-time PCR showed that the expression of cytokeratin 13 decreased beginning with Dysplasia, whereas the expression of cytokeratin 17 increased beginning with Dysplasia. Immunohistochemical staining revealed that cytokeratin 13-positive cells decreased beginning with Dysplasia, while there were almost no cytokeratin 13-positive cells in Cancer. Conversely, cytokeratin 17-positive cells increased beginning with Dysplasia, and almost all cells were cytokeratin 17-positive in Cancer. These results thus indicate that the expression of cytokeratin 13 and 17 is associated with carcinogenesis in epithelial dysplasia.

Conclusions

The findings of this study indicate that assessment of the expression of cytokeratin 13 and 17 might be useful in the diagnosis of malignant potential in epithelial dysplasia. Moreover, evaluating changes in the expression of cytokeratin 13 and 17 could be effective in evaluating surgical margins.

Background

This study evaluated the reliability of using local pedicled mandibular osteomuscular and facial-cervico-pectoral flaps to fill soft-tissue defects of both the mandible and cheek following debridement.

Methods

Six patients with refractory osteoradionecrosis of the mandible underwent radical resection and reconstruction of type H defects with combined pedicled mandibular osteomuscular and facial-cervico-pectoral flaps. The patients consisted of four men and two women with an average age of 50.5 years (range 48–58).

Results

All of the flaps survived. Function and aesthetics were satisfactory for both the patient and surgeon, and no donor-site problems occurred. The patients were followed for an average of 20.6 months (range 16–24) and recurrence was never encountered.

Conclusions

The pedicled mandibular osteomuscular and facial-cervico-pectoral flaps are technically simple, fast to harvest, and have exceptionally long arcs of rotation. These flaps enabled reconstruction of both composite segmental defects of the mandible and soft-tissue defects of the cheek following debridement.

Pulmonary oedema following general anaesthesia or extubation is an uncommon and unpredictable clinical entity. This unusual disease is actually attributed to pulmonary and haemodynamic changes engendered by high negative intra-thoracic pressures during the state of obstructed respiration. We report a case of postoperative pulmonary oedema in a previously healthy 35-year-old female with post-extubation laryngospasm. The patient responded rapidly to conservative management including removal of secretions, re-intubation, oxygen therapy with positive pressure ventilation and administration of diuretics with short term antibiotics. This report emphasizes the importance of rapid identification and proper management of this serious condition.

Juvenile psammomatoid ossifying fibroma (JPOF) is a rare, slowly progressive tumor of the extragnathic craniofacial bones, with a tendency towards locally aggressive behavior and recurrence. The pathognomonic histopathologic feature is the presence of spherical ossicles, which are similar to psammoma bodies. Very few cases in association with secondary aneurysmal bone cyst (ABC) formation have been reported in the literature. Treatment consists of complete surgical removal and incomplete excision has been associated with a high local recurrence rate. The prognosis is good because malignant change and metastasis have not been reported. Authors report a case of JPOF of the mandible with secondary ABC in a 17-year-old male patient.