Katsuro Sato

Relationship between oral health status and development of osteoradionecrosis of the mandible: A retrospective longitudinal study

OBJECTIVE Oral health status is a risk factor for postradiation bone complications (also known as osteoradionecrosis [ORN]), and oral health care is an important element in the prevention of this condition. Some authors recommend extracting teeth with a questionable prognosis and either gross mobility or periodontal disease. However, the criteria for making such decisions remain to be elucidated. In addition, the specific details of the association between oral health status and ORN have not yet been clearly demonstrated. The purpose of this study was to clarify the relationship between oral health status and the development of ORN. STUDY DESIGN Thirty-nine head and neck cancer patients whose radiation fields included both the teeth and the mandible were followed for > or = 3 years after radiotherapy. Among these patients, 6 suffered from ORN (ORN group), and the other 33 did not experience the condition (non-ORN group). We analyzed the patient factors, radiation factors, and oral health factors related to the complication. RESULTS The onset of ORN occurred from 18 months to 51 months after radiotherapy. The radiation dose in the oral cavity and the oral health status before radiotherapy were not significant risk factors for ORN. However, the oral health status at 1 year or 2 years after radiotherapy was significantly associated with the development of ORN. The oral health conditions that increased the risk of ORN were > 5 mm periodontal pocket depth, > 40% dental plaque score, > 60% alveolar bone loss level, and a grade 3 radiographic periodontal status. CONCLUSION This is the first report to show the changes in the oral health status before and after radiotherapy regarding the development of ORN. The results support the periodontal status that almost all clinicians agree on as indications for preradiation teeth extraction (namely, periodontal pockets of > 5 mm) to prevent ORN. Good oral health status, especially after radiotherapy, is very important in the prevention of ORN, and we recommend periodical dental management and care by well trained dentists and dental hygienists to avoid the condition.

Treatment of ranula-excision of the sublingual gland versus marsupialization

The purpose of this work is to estimate optimum surgical treatment of ranula according to the type of the lesion. Nine patients with ranula surgically treated between 1989 and 2000 were investigated retrospectively. Six patients had sublingual type ranula and three had submandibular type. In five cases including recurrence cases, the sublingual gland was excised. Marsupialization was performed for four cases, which were superficial, protruded and within 2 cm of diameter. In all cases, histopathological diagnoses were pseudocysts without epithelial lining and there was no recurrence. Almost all ranulas are pseudocysts from the sublingual gland, therefore excision of the sublingual gland is considered to be a reasonable and radical treatment. For the small sublingual type, which is superficial, protruding and smaller than 2 cm in diameter, marsupialization is also a useful modification of surgical treatment of ranula.

Course of IL-1β, IL-6, IL-8, and TNF-α in the Middle Ear Fluid of the Guinea Pig Otitis Media Model Induced by Nonviable Haemophilus Influenzae

To characterize the local response in acute otitis media, courses of interleukin (IL)–1β, IL-6, IL-8, and tumor necrosis factor (TNF) α in middle ear fluid (MEF) of the guinea pig otitis media model induced by nonviable Haemophilus influenzae were investigated with enzyme-linked immunosorbent assay (ELISA) kits. The IL-1β concentration in H influenzae–inoculated ears peaked 24 hours after inoculation. The IL-8 concentration was significantly higher in H influenzae–inoculated ears than in controls 48 and 96 hours after inoculation. The TNF-α concentration in H influenzae–inoculated ears had an initial peak 6 hours after inoculation and had significant late increases 48 and 96 hours after inoculation. The results suggest that IL-1β and TNF-α were produced by middle ear mucosa in the early stage of the experiment by stimulation of bacterial inoculation, which caused subsequent inflammatory cell accumulation, and that IL-8 and TNF-α were produced in the late stage by accumulating inflammatory cells.

Desmoid-type infantile fibromatosis in the mandible: A case report

A 3-year-old boy with desmoid-type infantile fibromatosis arose in the mandible was reported. He was referred to our hospital because of suspected malignant bone tumor of the mandible. Histological examination of an open biopsy specimen was performed followed by tumor resection with marginal mandibulectomy and reconstruction by iliac bone grafting, which caused no functional complications nor mandibular deformity. To treat tumors in the facial skeleton, the surgical procedure should be planned based on the histological diagnosis in order to determine the proper area of resection to prevent functional or cosmetic complications. Especially in children, attention should be taken for benign but clinically resembling malignant rare diseases such as desmoid-type infantile fibromatosis.

Experimental otitis media induced by nonviable Moraxella catarrhalis in the guinea pig model

Moraxella catarrhalis is a normal resident of the human nasopharyngeal flora, but it is also isolated from middle ear fluid of acute otitis media and otitis media with effusion patients. To determine whether M. catarrhalis has direct pathogenicity in the middle ear, heat-killed M. catarrhalis was inoculated into the middle ear bullae of guinea pigs, and the inflammatory response was investigated. Middle ear mucosal histopathology observed in M. catarrhalis-inoculated ears included subepithelial edema, capillary dilatation, thickening of lamina propria mucosa, inflammatory cell and erythrocyte infiltration into the lamina propria mucosa. Inflammatory cell numbers, lysozyme and myeloperoxidase concentrations in the middle ear washing suspensions of M. catarrhalis-inoculated ears were significantly higher than control ears throughout the experiment. Therefore, nonviable M. catarrhalis induced middle ear inflammation and mucoperiosteal histopathology, which might be caused by direct injury of the nonviable bacteria (e.g. lipooligosaccharide or outer membrane proteins) and metabolic products of inflammatory cells.

Malignant lymphoma in the head and neck associated with benign lymphoepithelial lesion of the parotid gland.

Lymphoepithelial lesion is a benign lymphoproliferative disease occasionally arises in the salivary glands, but association with malignant diseases or autoimmune diseases has also been discussed. We herein present three cases of malignant lymphoma arose in the parotid gland and the lacrimal gland, following parotid surgery for benign lymphoepithelial lesion (BLEL) of the parotid gland. Two cases had mucosa associated lymphoid tissue (MALT) lymphoma in the parotid gland; one arose in the ipsilateral parotid gland as a recurrent swelling, and the other arose in the contralateral parotid gland of the previous BLEL surgery. The third case of malignant lymphoma arose in the lacrimal gland on the ipsilateral side, and the following contralateral parotid gland remained BLEL. All three patients were female, and one patient had a past history of Sjögrens syndrome and Hashimotos disease. All three patients were treated by chemotherapy and one patient received additional radiotherapy. To follow-up lymphoproliferative diseases in the salivary glands such as BLEL, careful observation should be made on the same gland, other major salivary glands, and other organs in the head and neck, especially in females with autoimmune diseases.

Middle ear carcinoma originating from a primary acquired cholesteatoma: a case report.

Objectives: To describe middle ear carcinoma originating from the matrix of primary acquired cholesteatoma in a 43-year-old man and to discuss the relationship between middle ear carcinoma and cholesteatoma. Study design: Case report. Setting: Department of Otolaryngology, Head and Neck Surgery of Niigata University Medical and Dental Hospital, which is a tertiary care center, Niigata, Japan. Patient: A 43-year-old man demonstrated symptoms resembling those of cholesteatoma: facial palsy, gradually progressive hearing loss, and chronic draining of the right ear. Other objective findings also supported a finding of cholesteatoma, but a computed tomographic scan and magnetic resonance imaging scan showed a well-enhanced mass and extensive bony erosion in the middle ear. At surgery, a granulous tumor in the mastoid cavity was diagnosed as squamous cell carcinoma, and closely coexisting cholesteatoma was found. Surgical specimen demonstrated carcinoma and cholesteatoma in the same field. Intervention: Radiation and chemotherapy were performed followed-up by mastoidectomy. Conclusion: Because middle ear carcinoma has a poor prognosis, it is important to detect lesions early. It is necessary to consider that middle ear carcinoma arises from not only chronic otitis media or surgical invasion but also from primary acquired cholesteatoma.

Evaluation of mastoid air cell system by three-dimensional reconstruction using sagittal tomography of the temporal bone

The mastoid air cell system has been recognized as an important contributor to the pathophysiology of middle ear inflammatory diseases. Various methods of temporal bone imaging have been designed to investigate the correlation between middle ear disease and mastoid pneumatization. In this study, the mastoid air cell system was reconstructed three-dimensionally from sagittal tomographic images of the temporal bone on X-ray films, using a personal computer to evaluate the mastoid pneumatization in a total of 29 patients with chronic otitis media, adhesive otitis media, adhesive-type cholesteatoma, attic cholesteatoma and cholesterol granuloma, and in five normal subjects as controls. Reconstructed three-dimensional images of the mastoid air cell system and its volume were analyzed. The reconstructed images were helpful in recognizing the three-dimensional solid appearance of the mastoid air cell system. The volume of the reconstructed mastoid air cell system was significantly reduced compared with that in the controls in each of the patient groups. Mastoid pneumatization in the patients with adhesive-type cholesteatoma was significantly suppressed compared with that in the adhesive otitis media patients. Interestingly, the adhesive otitis media group showed cell development at the tip of mastoid process, whereas the group of adhesive-type cholesteatoma did not, suggesting a difference in the pathophysiology in the two diseases. We found that three-dimensional reconstruction of the temporal bone using sagittal tomographic images was useful in evaluating the state of mastoid air cell system development in individual cases and in investigating the pathophysiology in middle ear disease.

Initial presentation and fatal complications of linear IgA bullous dermatosis in the larynx and pharynx

Two cases of linear IgA bullous dermatosis initially presenting as ulcerative lesions in the larynx and pharynx are reported. It was difficult to diagnose and treat the lesions, but they were finally diagnosed from the histopathological findings of accompanying skin lesion specimens. One of the patients required a tracheostomy due to increased airway stenosis by a laryngeal lesion. Despite general corticosteroid administration this could not be completely resolved, although partial opening of the glottis was observed, and the patient died of accidental tracheostomy tube complications during home care. Although there are no reports of this disease in the otolaryngological field, these rare diseases involving the skin and entire body should be considered in the differential diagnosis of laryngeal and pharyngeal ulcerative lesions, including airway stenosis. Furthermore, simple and safe procedures for relieving airway stenosis should be selected for rare and difficult-to-diagnose airway disease, prior to the final diagnosis.

Successful Stereotactic Radiosurgery with the CyberKnife® of a Giant Arteriovenous Malformation of the Tongue: A Case Report

We report a successful outcome for a large arteriovenous malformation (AVM) of the tongue treated with CyberKnife® (CK) image-based stereotactic radiosurgery (SRS). A 56-year-old man presenting with a tongue AVM underwent ligation of the lingual artery and partial resection of the nidus. Sixteen years later, his pulsating submandibular mass had enlarged. An image study revealed a remarkable re-expansion of the nidus involving the tongue and the oral floor, with a volume of 130 ml. CK SRS was performed with 2 fractions. The prescribed marginal dose was 22 Gy. Thirty-four months after SRS, angiography demonstrated complete obliteration of the nidus without major adverse effects. We conclude that CK SRS may be suitable for the treatment of AVMs in the head and neck region.