Left Mandibular Angle Research Articles

えん下困難をきたした過長茎状突起の１例

A case of bilateral extremely elongated styloid processes that caused difficulty in swallowing is reported. The patient was a 44-year-old man who presented to the Department of Dentistry of Kawakubo Hospital because of spontaneous pain around the left mandibular angle and intensive swallowing pain. Radiographic examination bilaterally showed extremely elongated bony rods from the styloid process to the lesser horn of the hyoid bone. Both bony rods were shortened surgically via an extraoral approach. The length of the left excised process was 82 mm and its maximum thickness was 10 mm, while the length of the right one was 48 mm and its maximum thickness was 15mm.

Ｒｅｖｅｒｓｅ ｔｒａｎｓｃｒｉｐｔｉｏｎ ｐｏｌｙｍｅｒａｓｅ ｃｈａｉｎ ｒｅａｃｔｉｏｎ（ＲＴ‐ＰＣＲ）法により血中ｔｙｒｏｓｉｎａｓｅ ｍＲＮＡの陽性所見を得たＬｅｎｔｉｇｏ ｍａｌｉｇｎａ ｍｅｌａｎｏｍａの１例

We report a case of an 88-year-old man with lentigo maligna melanoma. He noticed a blackish pigmented spot on his left mandibular angle twenty years ago. The lesion gradually enlarged reaching 5×3cm sized irregular pigmented patch expanding to his ear lobe. Two 1.6cm and 0.8cm sized nodules were also noted on the pigmented patch. An ulceration was noted on a large nodule. No palpable lmphnode was detected. Surgical resection of the lesion was carried out with 2cm-3cm wide margin. Lymphnode dessection and chemotherapy were not performed. Histological examination revealed a lentigo maligna melanoma with tumor thickness 7mm. A reverse transcription polymerase chain reaction (RT-PCR) was performed before the operation, detecting tyrosinase mRNA in the patient's blood. Total body examination disclosed that he had liver metastasis. The RT-PCR method for the detection of tyrosinase mRNA seems to be a useful tool for evaluation of melanoma with metastatic potential.

The effect of L-dopa on the healing of a rat mandibular defect

aPurpose This study was designed to evaluate the effect of L-dopa on healing of a surgically created bony defect in the adult male rat.Materials and Methods Thirty-six animals underwent surgery to create a 4mm circular defect in the left mandibular angle. They were then randomly divided into two equal groups, one receiving 0.2 g/kg/day of L-dopa for 10 days by orogastric gavage, the other group acting as a control. Six experimental and six control animals were killed at 2 weeks, and five experimental and six control animals were killed at 4 and 6 weeks postoperation. Healing was classified as complete, partial, or incomplete based on gross and radiographic observations.Results Gross observation of the experimental mandibles showed five completely healed defects (31.25%), five partially healed defects (31.25%), and six defects with no healing (37.5%). Control mandibles showed three defects with partial healing (16.67%) and 15 with no healing (83.33%). Radiographs were taken of randomly chosen mandibles in each control and experimental group. Of the six experimental mandibles, one showed no healing, three showed partial healing, and two showed complete healing of the defect. The six control mandibles showed three defects with no bone formation and three with partial healing.Conclusions The data from this study indicate that L-dopa had a promoting effect on the bony healing of defects in the rat mandible.

RESIDENTS PAGE: PATHOLOGY

<h3>Pathologic Quiz Case 1</h3> Fanny Mestdagh, MD; Jos Claes, MD, PhD; Eric Van Marck, MD, PhD; Ingrid Neetens, MD; Paul H. Van de Heyning, MD, PhD, Edegem, Belgium A 38-year-oldman presented with a painless mass situated at the left mandibular angle. It may have been present for 2 years and it had recently enlarged. The patient had no specific ear, nose, or throat symptoms. He had stopped smoking about 3 years earlier. On palpation and inspection of the neck, a mass of approximately 2 to 3 cm was noted in the left parotid gland, with no firmness, erythema, or fixation to the overlying skin. Further clinical examination of the head and neck, including complete endoscopy of the nose, nasopharynx, and larynx, revealed no abnormalities, except for a 2-cm scar posterior to the left ear lobule. Inquiry about the retroauricular scar led the patient to remember that he had

多彩な組織像を示し基礎疾患として線維性骨異形成症が考えられた非定型的顎骨内病変の病理組織学的検討

An 18-year-old girl was referred to our hospital for a painless swelling of the left mandibular angle.Radiographic examinaion revealed a unilocular radiolucent area at the left mandibular angle. Partial resection of mandibule was done under general anesthesia.Histopathologically, some areas of the specimen resembled an aneurysmal bone cyst and a giant cell reparative granuloma, while the major portion was compatible with fibrous dysplasia.The aneurysmal bone cyst and giant cell reparative granuloma in this case were regarded to be secondary phenomena to the primary bone lesion of fibrous dysplasia.

Unusual Differentiation of a Combination Tumor of the Parotid Gland: A Case Report

A 67-year-old female patient developed a slowly growing swelling in the region of the left mandibular angle. This swelling was tender on pressure. Clinical examinations revealed an immobile, circumscribed, palpable node. Sonography showed an inhomogeneous space-occupying mass with a predominantly poor echo in the cranial and dorsal parts of the parotid gland. Intraoperatively the lesion presented as a smooth-bordered, round, capsulated tumor, which was excised "in toto". The postoperative course was uneventful. Histologic examination revealed a salivary gland tumor consisting of two components. Glandular structures corresponding to a Warthin tumor were seen in the center, whereas differentiation in the periphery of the tumor was that of a sebaceous lymphadenoma. Metaplastic sebaceous glands within salivary glands have been occasionally described, but true sebaceous lymphadenomas of the salivary glands are a rarity. A rare variant of Warthin's tumor is its metaplastic type, in which extensive metaplasia of the squamous epithelium is observed. The morphologic parallels as well as the differences seen in our case are described. We believe that it does not meet the criteria of a metaplastic Warthin tumor and have therefore diagnosed a combination tumor of the parotid gland, which is composed of a Warthin tumor component and a sebaceous lymphadenoma component.

勃起性こう筋血管腫の１症例

Hemangioma occurs frequently in the head and neck region.Most hemangiomas are not true tumors but represent a vascular malformation.A case of erectile hemangioma of the masseter muscle with two phleboliths is presented.This case was 38 year-old woman who complained of painless swelling in the left mandibular angle following contraction of the masseter muscle. However this swelling become smaller than 3-4 seconds in spite of continuous contraction. Surface skin color is normal. One oval radiopaque shadow was found in this region by X-ray examination. The external angiogram showed no pooling of contrast medium and hypervascularization.Surgical dissection was performed with an extra-oral method under general anesthesia. The postoperative histopathological diagnosis was cavernous hemangioma. This tumor had two phleboliths. These were analyzed with an infrared spectrometry and observed scanning electron-microscopically after acid etching (0.2 N HCl 20 sec).17 months after surgery, there was no indication of new tumor growth in this region.

第１，第２さい弓症候群の１例

The first and second branchial arch syndrome is a rare anomaly characterized by hypoplasia of mandibular ramus, temporomandibular joint and ear. The hypoplasia involving both skeletal and soft tissues results in severe facial asymmetry increasing progressively. The present paper reports a case of this anomaly.A 28 year-old female was admitted. Clinical examination showed hypoplasia of the middle and lower thirds of the left side of the face, canted mouth and malformed ear. Chin was significantly deviated to the left and retropositioned. Radiographic and CT examinations revealed hypoplasia of left mandibular ramus and angle, coronoid process, temporomandibular joint, muscles of mastication and parotid salivary gland. Intraoral evaluation showed canted occlusal plane with rigid interdigitation of occlusion. Both anteroposterior and lateral cephalometric analyses disclosed three-dimensional hypoplasia and deviation of the upper and lower jaws: that is, upward and posteromedial displacement of the affected malar bone and maxilla, upward and medial displacement of the affected temporomandibular joint, mandibular ramus and angle, deviation to the affected side and retroposition of the chin and the dental midline, canted occlusal plane and so forth.The first treatment consisted of Le Fort I osteotomy, sagittal splitting osteotomy and genioplasty. This corrected the frontal and sagittal asymmetry, but the transverse asymmetry remained because the middle and lower thirds of the unaffected side of the face protruded farther and those of the affected side was more hollowed by the first reatment. At the second treatment iliac bone onlay graft was done on the affected mandibular ramus and angle, and masseter muscle myotomy and posterior and inferior border resection ostectomy of mandible were accomplished on the unaffected side. The two-stage surgery resulted in alignment of the occlusal plane with a more symmetrical face.

口腔領域に生じた線維性組織球腫の３例

Fibrous histiocytoma commonly attacks the limbs, but it is relatively rare in oral lesions. The malignant type of this disease is interesting not only because of the difficulty of histological diagnosis but also because of absence of special clinical signs.We would like to show two cases of malignant fibrous histiocytoma (case 1 and 2) and a benign one (case 3).Case 1. A 55-year-old woman was referred to our department Feb. 16th, 1983 complaining of a large tumor in the right submaxillary region. The clinical examination revealed a fist-sized elastic hard mass in the right submaxillary region. She was treated with irradiation after removal of the tumor, and was irradiated again later. At present, about six years after the treatment, she has no sign of recurrence or metastasis.Case 2. A 55-year-old man was referred to our department Feb. 25th, 1984 complaining of a mass in the left upper molar region. The tumor was hen's egg-sized and elastic hard. He was treated by resection, irradiation and chemo-therapy, but the tumor could not be controlled. He died three years and three months after the treatment.Case 3. A 49-year-old man was referred to our department May 29th, 1985 complaining chiefly of a disagreeable sensation in the left mandibular ramus. There was found in the left mandibular angle region a slight swelling and a multi-locular cystic pattern was observed on X-ray films. Surgical treatment was carried out and the postoperative couse was uneventful.

下顎骨に生じた動静脈ろうの治療経験

Clinical experience of two cases with arteriovenous fistula of mandibleArteriovenous fistula is a vascular lesion showing communication between artery and venos without passing through capillary vessels. It often presents serious problems to the patients and clinicians because of high risk of severe hemorrhage occurring either spontaneously or as d result of unsuitable surgical procedures. This paper described the treatment of two patients who suffered from arteriovenous shunt of mandible.Case 1: A 25 year old man complaining of swelling left, cheek visited our hospital on January 12, 1971. He had been under the care of several surgeons in the past, the previous treatment had induced surgical excision of buccal tissue and ligature of left facial artery. The lesion had spread from the left cheek to the left submandiblar region. It was diagnosed by carotid angiography as arteriovenous malformation. By the first treatment at our clinic in 1971, surgical excision was performed to check region but before long, recurrence was observed at that region. As the succeeding treatments, therefore, cryosurgery and continuous infusion of 5 FU was performed. Scarcely getting good results by those treatments, we did a radical operation including hemimandiblectomy. Consequently no recurrence has been observed till now.Case 2: 55 year old female, complaining of intraoral bleeding, visited our clinic on April 23, 1981. A few weeks before visiting our clinic, she had a sudden attack of intraoral bleeding at night. The next day she visited the clinic and was diagnosed as ameloblastoma of mandible. Examination showed the lack of mucous membrane about 5 mm in size on the left lower alveolar ridge. Pulsation was palpable and a bruit was audible in the region of the left mandibular angle. The lesion was diagnosed as A-V fistula being concerned in artery of mandible, facial artery and vertibral artery by carotid angiography. Radical operation was performed, and over 6 years no signs of recurrence have been found till now.

心因性反応を伴った茎状突起過長症の１例

A case of elongated styloid process with psychogenic reaction is described in this paper. Elongated styloid process, which may be a result of ossification in the area of stylohyoid ligament, sometimes causes various clinically important symptoms. Many authors have reported the cases, incidence and etiologies, and have variously termed this condition according to their view points like Eagle syndrome, styloid-stylohyoid syndrome and so on.This case was a 38-year-old single woman who visited our outpatient clinic with main complaints of discomfortable feeling of throat and pain in the left inner mandibular angle when moved her jaw. The patient had been under neurological and psychosomatic care in a certain hospital because of suspected epilepsy and masked depression.Intraoral and radiological examinations revealed the presence of bilateral elongated styloid processes, while the psychic evaluation suggested a possible involvement of psychogenic reaction in the onset of this symptom.After her bilateral elongated styloid processes were surgically removed (organic factor), the psychogenic reaction was treated in our psychiatric department (mental factor). These treatments relieved all her symptoms.

An Unusual Case of Adenolymphoma of the Parotid Gland

Case Report H.A., aged 70, attended the Surgical Outpatients' Department at Fulham Hospital in 1948, with a large painless swelling in the left parotid region which had gradually increased in size since he had noticed it first about 1943. He declined operative treatment. In March I95I he attended again, for a strangulated right femoral hernia, and agreed during convalescence to have the tumour aspirated as it had grown considerably (Fig. 3). A greenish mucilaginous material was obtained. This continued to issue from the puncture wound and a mild infection occurred which caused sufficient discomfort to make him request removal of the tumour. On examination the swelling in the region of the left mandibular angle was about io: 8: 8 cm. in size, hemispherical and somewhat pendulous, with a smaller similar lump close above the upper pole. The tumours were uniformly soft, smooth and, in large parts, fluctuant. They were mobile in all directions. They were not attached to the overlying skin, nor obviously to bone or underlying soft tissues. They were superficial to the stemomastoid muscle. The large tumour was moderately tender, but after a course of antibiotic treatment the tenderness disappeared. There was a black, sharply limited pit in the skin beneath the ear which looked like a punctum. Based upon site, softness and fluctuation,