Left Submandibular Region Research Articles

ＤＩＣを生じた咽頭，口腔底，頚部ガス壊そ例

A case of gas gangrene of the oral cavity and the neck following pericoronitis is reported. A 47-year-old man who had suffered from pericoronitis of the right lower third molar underwent an incision by a dentist on March 9, 1987. Two days later, he had marked swelling of the oral floor and the left submandibular region with severe sore throat and trismus. He was admitted to the Nagano Red Cross Hospital on March 17. Computed tomography of the neck revealed abundant gas in the soft tissue. Hematological examination showed bleeding tendency. A diagnosis of gas gangrene with disseminated intravascular coagulation (DIC) was made and intravenous administration of antibiotics and gabexate mesilate (FOY) was started. Abscesses of the soft palate and the left lateral neck were successfully drained despite the presence of DIC. Peptococcus and a-streptococcus grew from the cultures of the pus. He recovered uneventfully after the drainage of the abscesses and was discharged on April 24.Early complete surgical debridement with removal of necrotic tissue and administration of antibiotics are thought to be most important for the treatment of gas gangrene.

診断が困難であった顎下部，頚部結核性リンパ節炎の１症例

A case of tuberculous lymphadenitis in the left submandibular and cervical regions is presented.The patient was a 25-year-old female, with a chief complaint of swelling in the left submandibular region.It was diagnosed clinically as tuberculous cervical lymphadenitis or malignant neoplasm.The extirpation of the tumor was performed under general anesthesia, because the tumor had extended rapidly.Histopathologic examination revealed typical tuberculous lesions in the lymphnodes and chronic sialoadenitis.The patient is well without recurrence 9 years after operation.

顎下部脂肪腫の１例 ＭＲＩの有用性

Lipoma is a benign tumor derived from non-epithelial tissue origin and may arise from any portion where fat cells physiologically exist. The authors experienced a case of lipoma of the submandibular region.A 49 year-old woman was admitted to our department with a chief complaint of the swelling of the left submandibular region. The lesion was diagnosed preoperatively as a lipoma based on the clinical findings as well as the image findings of CT scan, echogram and MRI. The tumor was removed under general anesthesia, and diagnosed histologically as a lipoma.The authors will discuss the usefulness of MRI in the differential diagnosis of lipoma in this paper.

手挙大の顎下部類表皮嚢胞の１例

Dermoid and epidermoid cysts occur congenitally by entrapped ectodermal tissue during embryonic development, or adventitiously inflammatory and traumatic implantation of the epithelium.In the maxillo-facial region it is found on the floor of the mouth, especially in the middle, but also occasionally occurs in the submandibular region.We have experienced one case of a relatively large epidermoid cyst in the left submandibular region of a 51 year old woman. The lesion was clinically suspected of a benign tumor of the submandibular gland and was surgically enucleated, but later histopathologically diagnosed as an epidermoid cyst.

嚢胞性リンパ管腫を疑った小児頭大の脂肪腫の１例

Lipoma is a benign tumor derived from non-epithelial tissue origin and may arise from any portion where fat cells physiologically exist. The authors experienced a case of lipoma in a size of an infant's head on the left cervical region. This paper reports this case with a review of literature.The patient, a nine-year-old female child noticed a thumb-tip-sized swelling on her left submandibular region at the age of three year. At that time she consulted a general surgeon because the swelling had gradually grown in size, but did not undergo any treatment being afraid of operative damage and has continued to accept follow-up. She was referred to our departmet from a dentist in the course of conventional dental treatment.At her first visit, the patient was evidently overweight. The swelling was located between left submandibular and post-auricular regions and palpable to its fluctuation and mobility. The data from serum biochemical examination detected her hepatic damage. Puncture biopsy of the liver before our operation revealed fat liver as a causative of abnormal data of chemical analysis.Intra-oral and plain roentgenographic examination yielded no abnormal findings. Cephalic computerized tomography (CT) and ultrasonography disclosed that the mass had a welldemarcated margin having the same homogeneity and low density. Further, vasculatures situating around the tumor were oppressed and emigrated peripherally. The tumor mass profoundly reached to the suprapharyngeal muscles.In the procedure of extirpation under general anesthesia, the mass was encapsulated with fibrous connective tissue which was removed with ease by blunt dissection. The extirpated mass was ovoid in shape, 8×13×2cm in size and weighed 240g. The cut surface was yellow and homogenously solid. Histopathologic specimen revealed that the tumor was a lipoma consisted of mature fat cells. Possitive evidence on the relationship between the lipoma and her obesity and fat liver was not provided by our review of literature.Lipoma on the infant submandibular region is rare and the size of the tumor of this case found to be the largest in Japanese literature.On the diagnosis of this case, CT and ultrasonography were available and effective for the examination of characteristics, location, relation to surrounding tissue and for the selection of the operating method.The patient has favorable postoperative course without any recurrence and had been periodically followed up by the authors.

顎下部に発生した黄色肉芽腫の１例

Only a few cases of xanthogranuloma have been reported in oral and maxillofacial fields. In this paper, we present a case of xanthogranuloma associated with sialolithiasis. A 44-year-old male visited our hospital because of left submandibular region swelling. Salivary stone was found radiographically, in left submandibular salivary gland and duct.Salivary gland extirpation was performed under general anesthesia. During the operation, it was very difficult to distinguish salivary gland from circumference. Pathological examination of salivary gland and mass, which seems to be lymphanode, revealed that these were xanthogranulomatous sialodenitis and xanthogranuloma respectively. Xanthomatosis, including xanthogranuloma, sometime is accompanied with hypercholesterolemia. However, serum cholestorol in this case was within normal limits. We reported a case of xanthogranuloma in submandibular region with a review of literature.

あご・口くう領域に初発症状を呈した悪性リンパしゅの２例

Malignant lymphoma is a neoplasm of lymphoid tissue. Although its favorite site is the head and neck, it occurs, though rarely, in the oral and maxillofacial regionas well.A biopsy of tumor of the head and neck is a principal clue for diagnosis of malignant lymphoma. Once a biopsy diagnosis for malignancy has been established, it is important to undertake a search for all sites of involvement, using a combination of clinical, roentgenographic, laboratory and surgical techniques. After treatment has begun, clinicians should be conscious of patterns of response to treatment, acute morbidity associated with radiotherapy and chemotherapy, and major complications that may result from these forms of treatment.This report includes two cases of malignant lymphoma in the oral and maxillofacial region.Case 1: A 39-year-old woman complained of ulceration on the left buccal gingiva of the molar teeth, and noticed paresthesia of the left lower lip. Enlargement of the lymphnodes of the submandibular, cervical, axillary and inguinal regions could not be detected. Biopsy of the region of ulcer, the cervical vaginal portion and the bone marrow, and other examinations established the diagnosis for non-Hodgkin's lymphoma, diffuse lymphoma, mixed type, stage IV B. Though treated effectively with CHOP, she died of shock two months after appearance of the first symptoms.Case 2: A 77-year-old woman noticed three months prior to the first visit that her left submandibular region had swollen without pain. This lesion was about 7×4 cm and immobile, and suspected to be a tumor of the submandibular salivary gland. Biopsy and other examinations were performed which showed non-Hodgkin's lymphoma, diffuse lymphoma, medium cell type, stage I A. She was treated with chemotherapy (COPP) and radiotherapy (total dose 50 Gy) to the upper part of the left side of the neck. After the treatment, suprahyoid neck dissection was performed. Histopathologically, no evidence of malignancy was found. The postoperative course was uneventful, and there has been no sign of recurrence of the tumor or of metastasis to other organs since discharge.

A Case of First Branchial Cleft Anomaly Associated with Bony External Auditory Canal

First branchial cleft anomalies are rare disorders. A case of a first branchial anomaly with an unusual fistulous tract is presented.The patient was a 6-year-old boy who complained of white gelatinous discharge from his left ear canal and recurrent abscess in the left submandibular region. Otoscopic examination revealed deformity of the tympanic membrane and a downward excavation of the bony external auditory canal at its deepest potion. Hearing was normal and there was no deformity in his left auricle or other parts of the body. The fistulous tract was extirpated. The tract extended upwards from the submandibular wound, passing medially through to the deep parotid gland lobe and opening into the bony external auditory canal. The tract was found to be lined with keratinized squamous epithelium with adnexal structures and accompanied by cartilage at the junction of the auditory canal.In the past literature we could not find a case that had a fistulous opening at the bony external auditory canal and a deformity of the tympanic membrane.We observed collected human fetuses (the fourth to eighth weeks) in order to study these anomalies from the embryological standpoint. We found by chance two other developmental stage fetuses both of which showed duplicated external auditory canal and pinna. After careful comparison with these fetuses, we concluded that the first branchial cleft anomaly with the fistulous tract running through from the submandibular area to the external auditory canal were not derived from these duplication anomalies of the external ear. This type of first branchial cleft anomaly was considered to be closely associated with Reichert's cartilage. In our case we supposed there would be interaction between Reichert's cartilage and the tympanic ring during the latter half of the fetal period.The deformity of the tympanic membrane was believed to be caused by incomplete closure of the foramen of Huschke.

Two Cases of Nodular Fasciitis

Two cases of nodular fasciitis were reported. The first patient was a 51-year-old man, who complained of a tumor of the left submandibular region which had enlarged progressively. The tumor was extirpated surgically. Histologically, a diagnosis was made as nodular fasciitis.The second was a 30 year-old woman. She complained of a tumor of the left lateral neck, occipital pain and numbness of the left arm. The tumor was extirpated surgically. Before histological diagnosis was made, the growth recurred. So the left radical neck dissection was performed. Finally histological diagnosis was established as nodular fasciitis.Some literature concerning nodular fasciitis was reviewed.

3. Primary nasal lymphoma with long survival—possible change to immunoblastic sarcoma. After 25 years

JTK had a nasal polyp removed in 1953 at the age of 28 yr, reported as a lymphosarcoma composed of large, oval, pale-staining cells with prominent nucleoli and surface necrosis containing inflammatory cells and plasma cells. He was treated with radiotherapy and had a clinical recurrence in 1954, but refused treatment. In 1961 and 63 further biopsies were taken of which no record now exists. He remained free of disease till September 1977 when a large polyp was removed from the same site as the previous lesions. A further small ‘granuloma' in the nose was removed a few months later; the histological picture had now completely altered to a very pleomorphic type of tumour with huge cells with huge nuclei and nucleoli and many giant cells. In March 1978 he developed a single lymph node enlargement in the left submandibular region with identical histology. Apart from the nasal lesions the patient is and always has been in excellent health. This man is therefore a case of primary lymphoma of the nose diagnosed 25 years ago with a recurrence 25 years later of the tumour with a remarkable change to a very pleomorphic type. The diagnosis is proffered that this was originally a <i>mid-line malignant reticulosis</i> which is a unique type of primary lymphoma of the nose to be differentiated from malignant mid-line granuloma, lymphosarcoma and plasmacytoma. An alternative diagnosis is that <i>of primary immunocytoma</i> of the nose. The lesion has now developed we believe into an immunoblastic sarcoma 25 years later—there are minor elevations in the immunoglobulin levels, there is pyroninophilia, and immunoperoxidase stains for IgG are positive. This case is considered to be unique.

A CASE OF GANGLIONEUROMA

Ultrastructural and biochemical studies of tumors originated from autonomic nervous system are rare. Ganglioneuroma of a 3.5-year-old girl was examined ultrastructurally and biochemically.The patient noticed soybean sized tumor at the left submandibular region in spring, 1972. She visited a pediatrician being diagnosed as lymphadenitis but received no therapy. Since January 1973, the tumor increased its size gradually. And for further examination, she was referred to our hospital on April 16, 1973.She did not complain of any special symptoms, likely hypertension, hyperhidrosis or diarrhea.The tumor was about 6 x 5cm in size, without adhesion to skin, but with adhesion to underlying tissues.Her left wall of the pharyx was swollen and soft palate was pushed foward. Laboratory data, including intravenous pyelography, were not paticular. Roentogenologically, calcification of the tumor was not observed. Biopsied specimen was revealed ganglioneuroma.Upon surgical exploration on June 4, 1973, the tumor was found between external and internal carotid arteries and vagal nerve, and extending upwards to the base of the skull. The excised tumor was approximately 50 gram in weight and gray-white in color in cross-section. Radical resection of the tumor was successfully performed and the post-operative course was uneventfull.