Hitoshi Ohata

A Large Solitary Fibrous Tumor of the Tongue

A 75-year-old man had consulted with an orthopedic clinic for numbness of the hands and feet. The orthopedist initially suspected cervical spondylosis but referred the patient to the Department of Dental and Oral Maxillofacial Surgery, Tokyo Metropolitan Tama Medical Center. Magnetic resonance imaging showed a large tumor on the tongue. The patient had a medical history of cerebral infarction and spinal stenosis at 10 years and 1 month, respectively, before the tumor was diagnosed. The patient had not perceived any abnormality involving his tongue before magnetic resonance imaging. The tumor appeared on the left dorsal side of the tongue (Fig 1). The surface of the tumor was covered with healthy mucosa. On palpation, the lesion was elastic, firm, well-circumscribed, and painless. Other than the tumor on the tongue, the oral cavity and neck appeared normal. T1-weighted magnetic resonance image visualized the tumor as hypointense, and T2-weighted and short T1 inversion recovery image showed the lesion as isointense compared

Case of Suspected Sialodochitis Fibrinosa (Kussmaul’s Disease)

Here we report a case of Kussmauls disease, or sialodochitis fibrinosa. This rare disease is characterized by recurrent swelling of the salivary glands, which then discharge clots of fibrin into the oral cavity. An 80-year-old man with a history of allergic rhinitis visited our department with the chief complaint of pain in the bilateral parotid gland area on eating. An initial examination revealed mild swelling and tenderness in this region, and indurations could be felt around the bilateral parotid papillae. Pressure on the parotid glands induced discharge of gelatinous plugs from the parotid papillae. No pus was discharged, and there were no palpable hard objects. Panoramic X-ray showed no obvious focus of dental infection, and there was no calcification in the parotid gland region. Magnetic resonance imaging revealed segmental dilatation of the main ducts of both parotid ducts, with no signs of displacement due to sialoliths or tumors, or of abnormal saliva leakage. Two courses of antibiotic therapy resulted in no improvement. During treatment, gelatinous plugs (fibrin clots) obstructing the left parotid duct were dislodged by massage, which prevented further blockage by encouraging salivary outflow. The obstruction persisted in the right parotid duct, however. Therefore, the distal portion of the right parotid duct was partially resected and the opening into the mouth enlarged, which, in combination with massage, prevented further obstruction. The pain and swelling of the parotid gland and discharge of gelatinous plugs improved, with no further recurrence at 12 months postoperatively. This case is presented along with a review of the relevant literature.

Carcinoma of Maxillary Gingiva with Non-specific Cervical Lymph Node Swelling

Swelling of the cervical lymph nodes may indicate lymphadenitis, malignant lymphoma, or metastasis. Lymph nodes larger than 10 mm on computed tomography (CT) are strongly indicative of postoperative metastasis from carcinoma. Here, we report a case of large, inflamed lymph nodes mimicking metastasis. The patient was a 76-year-old woman who experienced discomfort in the left-side maxillary gingiva commencing in August 2011. By September, the area had become painful, causing her to visit the Tokyo Dental College Chiba Hospital, at which time a 75×50-mm swollen ulcer was observed in the maxillary gingiva on the left side. A CT image revealed a neoplastic lesion between the alveolar bone on the left side of the maxilla and the base of the maxillary sinus, together with evidence of osteoclastic activity. The bilateral cervical lymph nodes were Level II and had a uniform interior of approximately 5 mm. The lesion was subsequently excised under general anesthesia. At 34 days postoperatively, CT imaging revealed bilateral 40-mm internal heterogeneous lymphadenopathy at Level II. No inflammation of the maxillary gingiva was observed, however, and blood tests revealed no inflammatory findings. Bilateral cervical lymph node metastasis was diagnosed based on CT and oral cavity observation. Radical neck dissection of left cervical region was performed under general anesthesia. Histopathological examination of the lymph nodes revealed no metastasis at Levels I-V, however. The reason for this increase in lymph node size is discussed.

Our Team’s Safety Management of the Sagittal Splitting Method of the Mandibular Ramus

Orthognathic surgery is performed for congenital anomalies, growth of jaw abnormalities, and tumor and trauma after jaw treatment. The sagittal splitting method of the mandibular ramus is performed most commonly in the world, but resulting complications are increasing. The sagittal procedure and perioperative care have been established, however, complications of orthognathic surgery have been reported in many hospitals. Therefore, we should perform the surgery safely, with careful consideration, and eventually we need to improve the surgery. Our treatment goal is to improve the facial form and to attain appropriate occlusion. Accordingly, we need to understand the patients background as a useful reference for drawing up the treatment plan. This paper reports on a safe sagittal splitting method of the mandibular ramus performed by our team.

Analysis of Needlestick and Similar Injuries over 10 Years from April 2004 at Tokyo Dental College Chiba Hospital

Here we investigated needlestick and similar injuries reported over a 10-year period between April 2004 and March 2014. The purpose of this study was to prevent recurrence and reduce the incidence of such injuries at Tokyo Dental College Chiba Hospital. The Division of Medical Risk Management at Chiba Hospital anonymized the data to protect personal information prior to analysis. A total of 213 injuries occurred over the 10-year period investigated, but the number of cases decreased yearly. Many cases involved dental undergraduate students and dentists, followed by trainee dentists, students at the school of dental hygiene, nurses, dental hygienists, and cleaners. Suture needles, followed by injection needles, were the top two most common injury-causing instruments, contributing to approximately 50% of the total number of such cases. Many injection needle injuries occurred during tidying up, while those caused by suture needles occurred during dental treatment. Taken together, these findings suggest the importance of strict adherence to guidelines provided in safety manuals on error-free procedures and handling of instruments. Improvement in the ability to sense potential risk is essential if such injuries are to be avoided.