Kazuto Kurohara

A Neuroendocrine Tumor in the Maxilla

A 39-year-old man was referred to the Department of Oral and Maxillofacial Surgery at the Graduate School of Tokyo Medical and Dental University Hospital, Tokyo, Japan. He had begun to have painless swelling of the left side of the maxilla 3 months earlier, and the swelling had recently grown noticeably larger. The facial configuration was symmetric on clinical examination, but an intraoral examination showed a hard, well-defined, elastic swelling with a smooth surface on the hard palate. The lesion measured 38 35 20 mm (Fig 1). Contrast-enhanced computed tomography (CT) depicted a mass lesion of 35 mm in diameter expanding to the left sinus. The lesion manifested as an irregular slight enhancement. No metastatic images were observed in the head, neck, or lung. Contrast-enhanced magnetic resonance imaging showed an indistinctly bordered lesion measuring 41 31 28 mm extending from the left maxillary alveolar process in the left palate. This lesion showed intermediate signal intensity on the T1-weighted image and homogeneous high signal intensity on the T2-weighted image (Fig 2). During the patient’s first visit, our clinical impression was suspected salivary tumor of the left maxilla. One week fter the first visit, a small biopsy specimen was collected rom the left hard palatal swelling. Then, at 2 weeks after he first visit, the lesion was preliminarily diagnosed as a uspected synovial sarcoma or undifferentiated carcinoma f the left maxilla based on the first interim biopsy report. About 4 weeks after the first visit, evidence of rapid umor growth prompted us to initiate urgent treatment of he suspected sarcoma. The patient was hospitalized and cheduled for a therapeutic operation. Chemotherapy was dministered for 3 weeks (5-fluorouracil, 250 mg/fr, 5 fr/w, 4,100 mg) after cannulation of the left superficial temporal rtery for delivering 5-fluorouracil through the artery into

Occlusal Force and Nutritional Aspects after Postoperative Intermaxillary Fixation for Jaw Deformities

Objectives : Intermaxillary fixation (IMF) is used to rest the jaws of patients who have undergone orthognathic surgeries for jaw deformities, until the position of the jaws is stabilized. For the duration of the IMF, the patients are unable to consume solid food. Upon the release of the IMF, recovery until ingestion of solid food as a normal diet is gradual in accordance with the ability of mastication. The objective of the present study was to identify the nutritional issues associated with IMF and their influence on the occlusal force after the release of the IMF. Methods : Fifteen patients who underwent orthognathic surgery (sagittal split ramus osteotomy [SSRO] or SSRO combined with Le Fort I osteotomy) and postoperative IMF were measured for the occlusal force and body weight prior to orthognathic surgery, after the release of the IMF, and during their outpatient visits for up to 6 months after discharge. In addition, the date when the participants ate each of the listed food items for the first time after the release of the IMF was gathered from the patient reports during the 6-month post-orthognathic surgery follow-up. The nutrient intake over a month pre-admission and during the postdischarge period was also investigated by the food frequency method. Results : The occlusal force and body weight of the patients were reduced after orthognathic surgery and IMF, which required approximately 3 and 6 months for recovery, respectively. Similarly, the restoration to the regular diet required 3 months. Due to the decrease in the overall quantity of food consumption, the patients’ diet after discharge contained less energy than that during the pre-admission period. Furthermore, their intake of the nutrients related to wound healing was less than the estimated nutritional requirement of a physically unimpaired person. Conclusions : The patients’ food intake was reduced after orthognathic surgery and IMF, and it was associated with the reduction of occlusal force. Therefore, nutritional support, including advice on food choices and cooking methods, for approximately 3 months until the recovery of occlusal force, might be effective in improving the nutritional conditions and promoting wound healing in patients after orthognathic surgery and IMF.

Tissue characterization of head and neck lesions using diffusion-weighted MR imaging with SPLICE

PURPOSE The purpose of this study was to evaluate the usefulness of diffusion-weighted (DW) MR imaging with split acquisition of fast spin-echo signals (SPLICE) in the tissue characterization of head and neck mass lesions. PATIENTS AND METHODS DW MR images of 67 head and neck mass lesions were obtained using SPLICE with b-factors of 0 and 771s/mm(2). The lesions were classified into three categories: 16 cysts, 32 benign tumors, and 19 malignant tumors. After ADC maps were constructed for all lesions, ADC values were calculated and compared among the three categories. RESULTS No case showed severe image distortion on DW MR imaging with SPLICE, and reliable ADC maps and ADC values were obtained in all cases. The mean ADC value of cysts was 2.41+/-0.48 x 10(-3)mm(2)/s, which was significantly higher than that of benign (1.48+/-0.62 x 10(-3)mm(2)/s) and malignant (1.23+/-0.45 x 10(-3)mm(2)/s) tumors (P<0.001). However, there was no significant difference between the ADC values of benign and malignant tumors (P=0.246). When an ADC value of 2.10 x 10(-3)mm(2)/s or higher was used as the diagnostic criterion for cysts, the sensitivity, specificity, and accuracy were 94%, 88%, and 90%, respectively. CONCLUSION SPLICE was considered a recommended DW MR imaging technique for the head and neck. Although ADC values were useful in differentiating cysts from tumors, they contributed little in predicting malignancy.