Asian Journal of Oral and Maxillofacial Surgery最新文献

We report herein two cases of bisphosphonate (BP)-related osteonecrosis of the jaws (BRONJ). Case 1 involved a 72-year-old man diagnosed with osteoporosis who was referred to our clinic for evaluation of swelling of the right mandibular gingiva. Clinical examination revealed a fistulous tract with pus discharge that had developed after extraction of the right mandibular first molar by his dentist. Clinical diagnosis was an infectious bone lesion associated with BP therapy. Risedronate sodium hydrate was administered orally at 2.5 mg/day from July 2005 through April 2007. Radiography revealed osteonecrosis of the jaw and a well-demarcated interface between necrotic and vital bone. BRONJ was completely removed with sequestrectomy of the mandible. The patient has been followed for 9 months since surgery and continues to do well. Case 2 involved a 62-year-old woman diagnosed with bone metastases from breast cancer who was referred to our clinic for evaluation of necrotic bone and pus discharge from the left maxillary molar region. The second maxillary left molar had been extracted by her dentist. Pamidronate sodium hydrate was administered parenterally at 90 mg/month from September 2004 through April 2006, and then zoledronate sodium hydrate at 4 mg/month from May 2006 through October 2007. Radiography revealed osteonecrosis of the jaw and maxillary sinusitis. BRONJ was completely removed with sequestrectomy of the maxilla. The patient has been followed for 5 months since surgery and continues to do well. Surgical intervention thus appears warranted to remove necrotic bone in cases of BRONJ.

Metastatic tumors to the oral region are uncommon, and the predominant primary sites are the lung and breast. To our knowledge, only one case of metastatic oral tumor from gallbladder cancer has been reported in the literature. We report a rare case of gingival metastasis from an occult gallbladder cancer.

Malignant fibrous histiocytoma (MFH) of the jaws aggressively invades adjacent tissues with a high local recurrence rate. Although radical excision with adequate tumor-free margins is essential, from the anatomical point of view wide resection is often difficult in the head and neck region. We reported 3 cases of MFH arising in the jaws. All three cases were males with 36–51 years old. One disease occurred in the mandible and the others in the maxilla. All cases underwent wide local excision and followed by adjuvant chemotherapy of 2 cycles consisting ifosfamide (IFO), cisplatin (CDDP) and doxorubicin (DOX). In 2 cases, neither tumor recurrence nor metastasis developed at follow-up of 78 months and 70 months. In one case, the patient died from tumor recurrence at follow-up of 2 months. The effects of combined treatment with surgery and adjuvant chemotherapy for MFH of jaws will be assessed by further follow-up.

Spindle cell carcinoma is considered a subtype of squamous cell carcinoma. There is no effective chemotherapy for cases of recurrence after first-line treatment, and the prognosis is poor. The patient was an 85-year-old man with spindle cell carcinoma after irradiated squamous cell carcinoma of the left lower gingiva. Extended surgery was performed, but 1 month postoperatively recurrence in the contralateral lower lip, cervical lymph node metastasis, and liver metastasis were detected, and treatment with S-1 was started. After 1 month of treatment, the cervical lymph node metastasis had resolved, and the liver metastasis had regressed, but after 4 months of treatment new cervical lymph node metastasis, lung metastasis, and rapid enlargement of the liver metastasis were observed, and led to the patient's death. Treatment with S-1 alone had an adequate antitumor effect temporarily. Further chemotherapeutic trials including S-1 are recommended to treat spindle cell carcinoma.

The purpose of this study was to examine the efficacy of detecting oral squamous cell carcinoma (SCC) using photodynamic diagnosis (PDD), a highly reliable method for tumor diagnosis, through the use of photosensitizers such as talaporfin sodium. Talaporfin sodium (5 mg/kg) was administered to 7 control rats and 43 rats that had ingested the carcinogen 4-nitroquinoline 1-oxide (4NQO). After 8 h, tongues were examined by spectral imaging and measurements were made using a hyperspectral imaging system. On each spectral image, macroscopically lesions and normal regions of the tongue were selected. Lesions comprised squamous cell carcinoma (SCC) in 22 cases, carcinoma in situ (CiS) in 9 cases, and dysplasia in 12 cases. The value Δα was determined as the absorbance spectrum of a lesion compared with normal tissue, or as the difference between Δκ at the posterior of the lingual protrusion and Δκ at the anterior of the lingual protrusion in controls. We compared Δα for SCC, CiS, and dysplasia with controls. The value Δα was (2.4 ± 1.78) × 10⁻² in SCC, (1.2 ± 1.34) × 10⁻² in CiS, (−0.2 ± 0.49) × 10⁻² in dysplasia, and (0.21 ± 0.63) × 10⁻² in controls. Both SCC and CiS showed significant differences from controls (p = 0.037 and p = 0.021, respectively). Histopathological analysis revealed that proliferating cell nuclear antigen (PCNA) expression increased gradually in the following order: controls, dysplasia, CiS, and SCC. Development of PDD using a hyperspectral imaging system may represent a useful technique for detecting oral SCC.

We report a case of a granular cell ameloblastoma appeared 41 years after extirpation of a follicular type ameloblastoma. A 42-year-old woman underwent segmental resection of the right side of her mandible without mandibular reconstruction in 1964. The postoperative course has been uneventful until an otorhinolaryngologist found her right cheek swollen and referred her to us on February in 2005. A fine needle aspiration biopsy revealed the presence of granular cells in the sample. As the radiographic feature implied the recurrence of the previous ameloblastoma, we removed the lesion. The enucleated tumor (4.5 cm × 3.2 cm × 3.3 cm) was a cystic lesion that was encapsulated by a brown fibrous tissue and contained serous fluid. Microscopically, the lesion contained tumor nests consisted of numerous granular cells and some stellate cells, and each nest was surrounded by tall columnar cells. Immunohistochemistry for Ki-67, CD68, α1-antichymotrypsin, cytokeratin, S-100 protein, and p53 was performed on the specimens from both the primary and the recurrent lesions: the incidence of Ki-67-positive nuclei in the recurrent lesion was 5.1%, while that in the primary lesion was 0.5%. Besides, positive signals of both CD68 and α1-antichymotrypsin, indicative of phagocytosis, were broadly localized within tumor cells in the recurrent lesion. Taken these observations together, we assume that the extremely low proliferative potential of the primary tumor cells together with change to granular cells related to apoptosis might cause the tardy growth of the recurrent tumor after the initial tumorectomy.

We report herein a case of quadruple cancer (prostate cancer, gastric cancer, laryngeal cancer, and lip cancer) that developed in a 73-year-old man. We have also reviewed the literature of quadruple cancer including lip and oral cancer.

The patient was a 60-year-old woman. She was referred to the Department of Dentistry and Oral Surgery, for multiple papillomatous proliferations on the oral mucosa. Tumor-like proliferation was found approximately 10 years ago, but she did not have it removed. Papillomatous proliferation appeared on her tongue, upper and lower lips, left and right buccal mucosa, gingiva of the anterior maxilla and pre-molar-mandibula, and gingiva of the hard palate, and she felt her mouth to be dry. Her family history was unremarkable. Her personal history included hypertension. Biopsy revealed papillomatosis and negativity for HPV-16. The dorsa of her hand and nape showed diffuse pigmentation; thus we suspected systemic disease and referred her to the Department of Surgery and the Department of Dermatology. Further investigation suggested stageIV gastric adenocarcinoma with lymphogenous metastasis and multiple papilloma of the esophagus. We also investigated for her symptom of dry mouth and detected Sjögren's syndrome. Thus, we diagnosed neoplastic association type acanthosis nigricans with gastric adenocarcinoma coexisted Sjögren's syndrome. Chemotherapy for gastric adenocarcinoma has initiated. The papillomas on her upper and lower lips were pigmented; therefore we operated several times for functional and esthetic reasons. However, the papillomatous growth did not stop. During chemotherapy, the pigmentation on the dorsa of her hand and nape did not improve, but the papillomatous growth improved.

The use of the novel oral fluoropyrimidine anticancer drug S-1 as a single agent or in combined chemotherapy has been reported to be useful for the treatment of advanced oral cancer. We report two elderly patients with advanced oral cancer who achieved complete response (CR) after concurrent radiotherapy and S-1 chemotherapy. Patient 1 was an 81-year-old woman who had a 50 mm × 40 mm tumor erosion in the right upper gingival region. At 2.5 years after the end of concurrent radiotherapy and S-1 chemotherapy, tumor relapse was observed, although CR continued temporarily. The patient died 3 years after the end of concurrent radiotherapy and S-1 chemotherapy due to tumor relapse and high blood pressure resulting in deterioration of patient condition. Patient 2 was an 89-year-old woman who had a 40 mm × 30 mm tumor ulcer in the right gingiva. Neither relapse nor metastasis was seen, and patient condition remained good for the 3 years after concurrent radiotherapy and S-1 chemotherapy. In both patients, MRI showed that the tumor had deeply invaded the palatal bone, almost reaching the nasal cavity, with metastasis to the right upper superior internal jugular nodes. In both patients, biopsy showed a well-differentiated squamous cell carcinoma. Concurrent radiotherapy and S-1 chemotherapy induced CR without severe adverse effects.