Takayoshi Tanaka

Videofluorographic evaluation of dysphagia before and after modification of the flap and scar in patients with oral cancer

Abstract Dysphagia is an important postoperative problem in patients with oral cancer. We evaluated the usefulness of a technique to modify the flap and scar for the alleviation of swallowing disorders. The modifications were made while tongue pressure was being measured to improve excursion of the residual tongue in nine patients. They had been operated on for oral cancer and reconstruction was with a forearm free flap, or the wound was closed primarily. After a 5 ml bolus of liquid barium had been given orally, lingual movement, barium inflow into the pharynx before swallowing, stasis in the epiglottic valleculae, and stasis in the oral cavity after swallowing, were evaluated by videofluorography before and after modification. Oral transit time, pharyngeal transit time, and total transit time were also measured. Lingual movement improved in eight patients. Barium inflow into the pharynx before swallowing improved slightly in all patients. Stasis in the epiglottic valleculae was improved in six patients. Stasis in the oral cavity improved in all patients. Oral transit time and total transit time were significantly shorter after modification of the flap and scar than before operation. Pharyngeal transit time was unchanged. We conclude that our technique for modification of the flap and scar can alleviate postoperative swallowing dysfunction in patients with oral cancer.

Extremely aggressive behavior of central giant cell granuloma after biopsy:a case report

Although central giant cell granulomas (CGCGs) appear to be benign, their radiographic findings are active. These tumors become severely invasive with the stimulus of surgery, resembling malignant tumors. Achieving the correct diagnosis is reportedly difficult because CGCGs are very similar to odontogenic jaw tumors. We herein describe an intriguing case of a 21-year-old male patient who was referred to our outpatient clinic with persistent swelling of the left buccal region. After making a provisional diagnosis of ameloblastoma from panoramic and computed tomography images, a biopsy was performed. Nine days after this operation, the intraoral lesion started to enlarge, causing facial disfigurement. Soon afterward, this lesion was examined by computed tomography, magnetic resonance imaging, and by both bone and tumor scintigraphy. Segmental resection of the mandible was conducted in the hospital, and the histopathological appearance was consistent with CGCG. Although CGCG tends to be indolent, the present case suggests that the stimulus of surgery can trigger clinically invasive behavior more characteristic of malignancy. CGCG exhibits variable features, but with the stimulus of surgery, its clinical behavior becomes extremely invasive, resembling a malignant tumor. The CGCG in the present case showed unusual development and intriguing radiographic and histopathological findings. It is important to be aware of the findings that can help to achieve a correct diagnosis.