Shoko Gamoh

Calcifying cystic odontogenic tumor accompanied by a dentigerous cyst: A case report

A calcifying cystic odontogenic tumor (CCOT) is a proliferation of odontogenic epithelium and scattered nests of ghost cells and calcifications that may form the lining of a cyst, or present as a solid mass. It was previously described by Gorlin et al in 1962 as a calcifying odontogenic cyst. Dentigerous cysts are developmental odontogenic jaw cysts, commonly manifesting in the second and third decades of life. The present study reports an asymptomatic case in a 13-year-old boy who was referred to the outpatient clinic of the Osaka Dental University Hospital (Osaka, Japan) for additional investigation of an area of radiolucency in the lower right jaw. X-ray demonstrated a unilocular, well-circumscribed, radiolucent lesion in the mandible, which measured 30×20 mm, with radiopaque structures within it. Enucleation of the lesion with tooth extraction was performed, which histopathologically revealed features of a CCOT and a cyst. To the best of our knowledge, the occurrence of such a lesion has not been previously identified. The present study examined the significance of the case with a brief review of the literature.

Extraordinarily favorable recovery from unilateral condylar fracture in a 4-year-old girl

IntroductionManagement of condylar fractures in children is especially important. If not properly treated, these fractures may lead to serious problems, such as ankylosis of the temporomandibular joint. This article describes an extraordinarily favorable recovery after conservative treatment of a unilateral condylar fracture in a 4-year-old girl.Case presentationA 4-year-old Japanese girl was referred to our institution with a right mandibular condylar fracture caused by a fall. In this article, we report the 2-year follow-up of this case by clinical and radiological evaluations after conservative treatment, highlighting the strategy used.ConclusionsThe outcomes throughout the 2-year follow-up and the remodeling process of the condyle observed on panoramic radiographs and computed tomographic images proved the suitability of the conservative treatment.

Fibrosarcoma of the temporomandibular joint area: benefits of magnetic resonance imaging and computed tomography

Here, we report a case of primary fibrosarcoma in the mandible of a 33-year-old woman with symptoms and radiologic signs mimicking temporomandibular disorder. We also present a literature review of fibrosarcomas in the jaw. CASE REPORT A 33-year-old woman presented with a 1-year history of trismus associated with a clicking noise in the left temporomandibular joint (TMJ). Her chin shifted to the right side when she opened her mouth (Figure 1). Panoramic radiographs (Figure 2, A, B) and magnetic resonance imaging (MRI) scans (Figure 3, A-H) of the TMJ regions showed signs of temporomandibular disorder (TMD), so conventional treatment for TMD was prescribed, including occlusal splints, mouth-opening exercises, and a muscle relaxant for 6 months. When the MRI scout images were analyzed retrospectively, the findings of 2 of 5 scout images were suggestive of tumor (see Figure 3, A, E). The patient was referred again 6 months after the initial visit for investigation of insomnia caused by spontaneous pain in the left TMJ area. She also had paralysis of the lower lip and left chin. She had herpes labialis and gastroenteritis caused by stress. Given the suspicion of malignancy, both MRI and computed tomography (CT) were performed. MRI showed a round, inhomogeneous mass in the pterygomandibular portion of the masticator space, which caused minimal medial narrowing of the left parapharyngeal space (Figure 4, A, B). CT found significant bony erosion of the inner cortex of the left ramus of the mandible (Figure 5). The patient was referred to another hospital for further management because the tumor grew toward the pharyngeal arches. An incisional biopsy was subsequently performed, and the initial diagnosis was a sarcoma based on the histopathologic examination of the biopsy. A definitive histologic diagnosis was reached by exclusion. The tumor was diagnosed as a grade 3 (poorly differentiated) fibrosarcoma using the FNCLCC (Federation Nationale des Centres de Lutte Contre le Cancer) grading system. Histopathologic examination found that the tumor contained spindle cells arranged in compact fascicles that were intersected by various amounts of delicate thin to dense keloid-like collagen. Cell bundles were arranged at acute angles to each other, whereas the presence of fascicles was subtler in other areas. A prominent storiform pattern was not seen (Figure 6). The fibrosarcoma was resected followed by postoperative radiotherapy and chemotherapy. The tumor was removed, along with the left ramus of the mandible, a portion of the left maxilla, a deep part of the parotid gland, and lymph nodes located superior to the omohyoid muscle. The cheek mucosa was reconstructed using a free anterolateral thigh flap (Figure 7). The patient recovered and got married afterward; however, lung metastasis with Fig. 1. Facial photograph. The patient’s chin shifted to the right side when she opened her mouth.

Gas gangrene in the deep spaces of the head and neck visualized on computed tomography images

Cellulitis accompanied by gas gangrene is a rapidly-spreading and potentially fatal infection. Here, we present a case of gas gangrene in the deep spaces of the head and neck in an elderly woman, diagnosed by computed tomography (CT). An 86-year-old woman with Alzheimer’s disease, hypertension, hyperlipidemia, and osteoporosis was referred to our institute by her local dentist. The patient exhibited trismus caused by severe swelling in the left submandibular area. CT images of the head and neck area showed swelling of the cervical tissue with air in the parapharyngeal and masticator spaces. She was treated with antibiotics, followed by drainage. Although the therapy was continued, the patient died from a cardiac complication on hospital day 42. Our case highlights the usefulness of CT for diagnosing gas gangrene in the deep spaces of the head and neck in a woman with Alzheimer’s disease.

Non-contrast computed tomography and magnetic resonance imaging features of mucoepidermoid carcinoma in the salivary glands

BackgroundUse of contrast-enhanced cross-sectional imaging is considered standard practice for investigating mucoepidermoid carcinoma (MEC) in the salivary glands. The purpose of this study was to present the common features of MEC on computed tomography (CT) and magnetic resonance imaging (MRI) without contrast enhancements, and to investigate the possibility of discriminating between MEC and pleomorphic adenoma based on the features observed on both modalities.MethodsTwenty cases of biopsy-confirmed MEC originating in the salivary glands were reviewed and characterized by two oral and maxillofacial radiologists with regard to the following aspects: detectability, margin, border, encapsulation, content, contrast between lesion and masticator muscle, and bone changes.ResultsNinety percent of bone changes caused by MEC were detected by CT and sixty-nine percent of tumor existences were detected by MRI. The lesion border could provide a clue to distinguish MEC from pleomorphic adenoma.ConclusionsObservation of MEC features was possible by both CT and MRI. Among the features, the lesion border could be a clue to distinguish MEC from pleomorphic adenoma.

Clinical outcome after 36 months of treatment with injections of autologous blood for recurrent dislocation of the temporomandibular joint

We investigated the prognosis after three years of treatment for recurrent dislocation of the temporomandibular joint with autologous blood given intravenously in 21 patients with a mean (range) age 64 (17-92) years of whom 16 had coexisting systemic disease. The mean (range) follow up from the first injection was 64 (41-99) months. Eighteen patients had no recurrence during the first 36 months after their first injection, which showed that this minimally-invasive treatment was effective, particularly for those who had conditions that made a mouthpiece or operation unsuitable.

The role of computed tomography and magnetic resonance imaging in diagnosing clear cell ameloblastoma: A case report

Ameloblastoma is the most common and clinically relevant type of odontogenic tumor. Clear cell odontogenic carcinoma is histologically characterized by solid sheets and nests of clear cells, whereas clear cell ameloblastoma (CCAM) is histologically characterized by an ameloblastomatous component intermixed with an extensive clear cell component. A total of 12 reports have been published on the histological etiology for CCAM; however, no reports have made regarding the detailed computed tomography and/or magnetic resonance imaging features of tumors of this type. The present study describes a case of a well-circumscribed 20-mm radiolucent lesion of the anterior mandible that was misdiagnosed as a clear cell odontogenic carcinoma. The study describes the detailed radiological characteristics of a case of CCAM.

Management of infusion reactions associated with cetuximab treatment: A case report

Cetuximab is a drug targeting the epidermal growth factor receptor, which is indicated for the treatment of unresectable advanced or recurrent head and neck or colorectal cancer. Cetuximab also enhances the cytotoxic effects of radiation in squamous cell carcinoma. The severity of infusion reactions (IR) is categorized from grade 1 to 5; grades 3 and 4 are associated with life-threatening reactions (anaphylaxis), whereas grade 5 indicates death. The incidence of grade 3–4 IR with premedication is reported to be 1.1%. We herein describe a case of a 77-year-old man who developed IR during intravenous administration of cetuximab. The patient developed grade 3–4 anaphylaxis with pruritus, rash and urticaria, followed by hypotension and bradycardia. The timely diagnosis and treatment with intravenous infusion of a vasopressor drug and Ringers acetate solution proved to be effective. The case presented herein demonstrated an unfeatured aspect of cetuximab-related IR as dermatological reactions over the entire body followed by circulatory collapse.

Anesthetic Management of a Patient With Multiple Sclerosis

A 54-year-old woman diagnosed with multiple sclerosis (MS) at the age of 19 years was scheduled to undergo temporomandibular joint mobilization. She was currently in a remission phase from her MS but with persistent sequelae, including impaired eyesight and muscle weakness of the limbs. In addition, the blood vessels in her upper limbs were compromised by the formation of internal shunts secondary to vascular prosthesis replacements for plasma exchange therapy in MS. After a previous joint mobilization surgery, her temporomandibular joint developed adhesions with resultant trismus. One of the adverse effects of general anesthesia can be exacerbations of MS symptoms. Minimizing mental and physical stress caused by surgical and anesthetic procedures and maintenance of stable body temperature are important considerations. Awake intubation was performed under sedation with midazolam and fentanyl. After intubation, anesthesia was induced with propofol, remifentanil, and rocuronium. Maintenance of anesthesia was achieved with oxygen-N2O-sevoflurane, remifentanil, fentanyl, and rocuronium. In this case, no adverse events occurred intraoperatively. However, the patient experienced lingering weakness of the limbs in the postoperative period, and activities of daily living of the patient were affected.

Challenging issues in teaching oral radiology to undergraduate students

IntroductionWhen teaching dental radiology to undergraduate dental students, we should ideally cover all of the contemporary radiological fields evenly. However, it has become challenging to provide sufficient instruction within the curriculum compared with past times, because new radiological techniques quickly become popular. In the present study, we classified the questions received from sixth-grade students in Osaka Dental University for the purpose of better understanding the elements of effective teaching.Materials and methodsWe classified the questions received from sixth-grade students in Osaka Dental University using e-mail and the LINE mobile messaging app, from October 2011 to October 2014. The classification was based on the table of contents of Oral and Maxillofacial Radiology, Fifth Edition. In addition, we itemized the questions related to dental radiology set in national dental examinations performed from 2012 to 2015. We then compared the students’ concerns with the contents of the national examinations.ResultsMany questions were related to intraoral radiographic imaging, X-ray generation and projection geometry, radiographic interpretation, radiological protection, contrast-enhanced X-ray examination, panoramic imaging, and side effects of radiotherapy.ConclusionsThe reasons why students had difficulty in understanding specific areas were considered to be the compressed ratio of lecture time and contents, difficulty in giving full scope to the imagination, and lack of chances to observe equipment in clinical use.