Journal of Oral and Maxillofacial Surgery Medicine and Pathology最新文献

Objective

Treatment strategy decisions are very difficult in elderly patients with oral squamous carcinoma (OSCC). In this study, the factors that affect treatment strategy decisions and the clinical impact of the G8 screening tool score were retrospectively investigated in elderly OSCC patients.

Methods

The medical records of primary OSCC patients aged 75 years or older were retrospectively reviewed, and 438 patients aged 75 years or older were included in this study. The factors that affect treatment strategy decisions and the clinical impact of the G8 screening tool score were investigated.

Results

Regarding treatment decisions, the elderly OSCC patients with better Eastern Cooperative Oncology Group Performance Status (ECOG-PS) scores and G8 scores of more than 10.5 were treated with the standard treatment with curative intent. The 5-year overall survival (OS) rates of the patients with G8 scores of <10.5 and ≥10.5 were 43.8 % and 60.3 %, respectively (p < 0.01). The 5-year self-reliant survival (SR) rates of the patients with G8 scores of <10.5 and ≥10.5 were 44.9 % and 59.3 %, respectively (p < 0.01). Multivariate analyses revealed that OS and SR were significantly correlated with poorer ECOG-PS and lower G8 scores (<10.5).

Conclusions

These results suggest that pre-treatment evaluations based on the ECOG-PS and G8 screening tool may aid treatment decisions for and prognostic evaluations of elderly OSCC patients.

Osteoblastoma is a benign bone tumor with predominance in those < 20 years of age and rarely occurs in the maxillofacial region. The identification of FOS gene rearrangements in osteoblastomas has been reported, however, a small subset of osteoblastomas do not show FOS gene rearrangements. There are no reports discussing the relationship between age and FOS gene rearrangement in osteoblastomas. We report the case of a 66-year-old female patient with histological features of osteoblastoma in the mandible without FOS gene rearrangement. According to a review of previously reported cases of osteoblastoma, FOS gene rearrangement is significantly less common in patients > 40 years of age (P = 0.041). Osteoblastomas occurring in older adult patients may exhibit pathogeneses different from those of young patients. Further data, including the relationship between age and FOS gene rearrangement, is necessary to clarify the pathogenesis of osteoblastoma.

Massive osteolysis is an extremely rare condition characterized by progressive osteolysis. In this report, we present a case of massive osteolysis in the upper and lower jaws. A 49-year-old man was referred to our hospital because of bone resorption in the jaw of an unknown cause. Panoramic radiography and computed tomography (CT) showed extensive bone resorption in the right lower and left upper jaws. The biopsy specimen revealed marked non-specific inflammatory granulation tissue without any malignant findings.

Although this case lacked significant lymphatic growth in the biopsy specimen, the clinical diagnosis of massive osteolysis was made, and two courses of zoledronic acid, which has been recently reported to be effective in the disease, were administered. CT performed 19 months after the initial examination showed no new osteolysis, and the patient was free of symptoms.

Idiopathic condylar resorption (ICR) is characterized by resorption of the entire mandibular condyle, resulting in a reduced mandibular ramus and skeletal anterior open bite. We applied intermaxillary elastic traction to a patient with early ICR and obtained a stable long-term outcome. The patient was a 16-year-old girl who had noticed an anterior open bite after orthodontic treatment. The anterior open bite was observed with an overbite of − 2 mm and an overjet of + 4 mm. Computed tomography (CT) and magnetic resonance imaging (MRI) showed bilateral mandibular condylar resorption, and clinical diagnosis indicated ICR. An indirect bonded splint (IBS) was placed on the dental arches, and intermaxillary traction with elastic bands was applied continuously except during eating and oral cleaning. After 1 month of traction, complete contact of the upper and lower teeth was confirmed, indicating improvement of occlusion. CT images taken after 1 year of traction showed bone remodeling and cortical bone formation bilaterally in the part of condylar heads. This treatment was applied continuously for 1 more year and intermittently at night for another year to prevent relapse. After 3 years of traction, CT images taken showed a stable morphology of the mandibular condyle with stable occlusion, prompting the termination of the intermaxillary traction and removal of the IBS. Furthermore, 3 years after ending traction, CT and MRI showed no evidence of ICR recurrence, and occlusion was stable. This treatment method could be a useful first-line treatment for early ICR.

Objective

It is expected that the number of patients with mandible fractures will be affected by the global spread of COVID-19 because of a decline in physical activities. The purpose of this study was to investigate characteristics of mandible fractures before and during the COVID-19 pandemic.

Methods

Patients with mandible fracture who visited our department or a nearby associated medical institution were surveyed, with 242 enrolled. The time period was divided into 2017–2019, before the COVID-19 pandemic, and 2020–2022, during the pandemic.

Results

There were 138 cases before and 104 during the pandemic. The majority of patients before the pandemic were teenagers, while the majority during the pandemic were in their 20 s. Before the pandemic, May had the greatest number of patients and the greatest number during the pandemic was in December. A fall was the most common cause of injury during both time periods. Both before and during the pandemic, the most common period of time to visit a doctor following an incident was less than one day. During both time periods, the condyle was the most common fracture site, with surgical therapy the most common treatment strategy used throughout the term of the study.

Conclusions

The number of patients with mandible fractures decreased after the beginning of the pandemic, which is considered to be due to a decrease in social activities associated with refraining from going out due to the declaration of state of emergency. These findings suggest a relationship between social activities and risk of mandible fracture.

Unilateral scissor bite is one of the rare forms of malocclusion that is accompanied by deep bite and collapsed arch. This report describes the treatment of unilateral scissors bite improved by maxillary and mandibular posterior segmental osteotomy with orthodontic treatment. The patient was a 16-year-old woman with unilateral collapsed maxillary and mandibular arch and a scissor bite of the right buccal segment, and without facial asymmetry. At first, intrusion of right maxillary molars with implant miniscrew was planned, but failure to move. To improve, posterior segmental subapical maxillary osteotomy and mandibular corticotomy were applied without changing facial appearance. Following the surgery, the expansion of the collapsed right mandibular segment bucally using an appliance during comprehensive orthodontic treatment was planned. There was no sensory or motor paralysis. After post-surgical orthodontic treatment, her occlusion improved without alteration of facial appearance and disorder of her speech. Transverse widths at the maxillary premolars and first molars were nearly stable over the 4 years postoperative interval in our patient, and her overall long-term stability showed excellent results. To our knowledge, this case was the first case to combinate two segmental subapical osteotomies without Le Fort I and sagittal split ramous osteotomy. The results indicate that this technique is useful for unilateral expansion of distorted mandibular alveolar process and maxillary and mandibular subapical osteotomy with subsequent orthodontic treatment can be used to successfully treat unilateral scissor bite.

Primary salivary gland squamous cell carcinoma (SCC) is a very rare malignancy, and such a tumor with sialolithiasis is even rarer. Here, we report a case of 68-year-old man with primary salivary SCC and sialolithiasis. A cystic lesion with a salivary stone was found in the submandibular gland, lined by atypical epithelium with focal invasive focus. The atypical epithelium was positive for cytokeratin 5/6 and p40, and focally positive for p63, cytokeratin 14 and periodic acid-Schiff (PAS) stain. S-100 protein, calponin, α-smooth muscle actin, SOX10 and androgen receptor were negative and no mucin-containing cells were found on PAS with diastase and Alcian blue staining. The Ki-67 labeling index was relatively high. P53 was mostly negative, and no pathogenic TP53 mutations were detected. The diagnosis of primary salivary gland SCC was made. In our review including the present case, the speculated cause of primary salivary gland SCC was squamous metaplasia and dysplasia due to chronic irritation by a salivary stone. Although no cases with recurrence or distant metastasis were identified, more cases and long-term follow-up are needed.

Styloid-stylohyoid syndrome is characterized by discomfort and pain in the pharynx and larynx due to an overly long (≧30 mm) styloid process. Fibrous adhesions between the styloid process and the hyoid bone have been reported in styloid-stylohyoid syndrome, which is extremely rare. Here, we report a case of a 33-year-old woman with no relevant medical history who in January 2022, reported experiencing left submandibular pain and was referred to our hospital. Computed tomography scans (CT) revealed overlong bilateral overlong styloid processes near the hyoid bone (length, approximately 75 mm bilaterally), and she was diagnosed with styloid-stylohyoid syndrome. Bilateral styloidectomy was performed under general anesthesia. The styloid process and hyoid bone on the left side were attached to fibrous connective tissues. The nodule had a pseudo-articular structure. Histopathologically, a transition from bone to cartilage was observed. Eight months postoperatively, the patient was symptom-free.

An eosinophilic ulcer of the oral mucosa is a benign and self-limiting lesion that usually occurs on the tongue and rarely affects the gingiva. We report a case of an eosinophilic ulcer of the mandibular gingiva associated with osteonecrosis. A 43-year-old woman with swelling and pain in the left mandibular molar region was referred to our hospital. She had burned her left mandibular gingiva while eating a hot apple pie 4 days ago. Physical examination revealed diffuse swelling in the left perimandibular region, and intraoral examination revealed mucosal necrosis in the left mandibular molar region. Eosinophilic granulomatosis with polyangiitis was suspected based on the histopathological findings. However, systemic examination revealed no other abnormality, and the patient was finally diagnosed with eosinophilic ulcer. Although the swelling and pain resolved following antibiotic administration and local irrigation, we observed bone exposure in the left mandibular second premolar region 12 days after the patient’s initial visit. Sequestrectomy and tooth extraction were performed under general anesthesia. The patient had no recurrence at 15 months postoperatively. This case demonstrates that an eosinophilic ulcer can occur in the gingiva and alveolar mucosa and cause osteonecrosis. The features of eosinophilic ulcer resemble those of malignant tumors, and careful differential diagnosis is necessary.