Cheek Swelling Research Articles

内視鏡を用いた耳下腺導管拡張症の観察

We report a 47-year-old male with extreme dilatation of the Stenon's duct resulting from parotid papilla obstruction. He visited our clinic with a painless swelling in his left cheek and oral cavity after eating. The swelling had been present for four months. Physical examination, computed tomography, and magnetic resonance imaging showed that the lesion was due to extreme dilatation of the Stenon's duct. The obstruction was corrected by the surgical creation of a new, larger orifice. The cheek swelling immediately disappeared and has not returned after three months. Endoscopic examination of the Stenon's duct using a dacryoendoscope and nasal endoscope was carried out during surgery. These endoscopes were easily inserted into the Stenon's duct and provided adequate resolution of images of the duct lumen. Inflammatory debris and ductal swelling with hyperemia were observed in the lumen and gradually diminished from the parotid papilla to the parotid gland. In the parotid gland, the lumen was dilated, but did not show debris or ductal swelling. This endoscopic examination was very useful in understanding the etiology of the extreme dilatation of the Stenon's duct.

Buccal fat pad hemorrhage after retrobulbar injection

PurposeTo enable ophthalmologists to recognize and manage buccal fat pad hemorrhage occurring after retrobulbar injection. DesignInterventional case report. MethodsA 52-year-old woman with proliferative diabetic retinopathy underwent left retrobulbar injection before panretinal photocoagulation (PRP). ResultsImmediately after PRP, the patient complained of left cheek swelling. Ocular examination was unremarkable. Computed tomographic imaging studies confirmed the clinical diagnosis of hemorrhage within the buccal fat pad. No hemorrhage was found within the retrobulbar space. The hemorrhage resolved spontaneously without sequelae. ConclusionThis case widens the known spectrum of hemorrhagic complications after retrobulbar injection.

부비동 점액낭종의 임상양상

Background and Objectives: A mucocele is an epithelial-lined, mucus-containing sac completely filling a paranasal sinus and capable of expansion by virtue of dynamic process of bone resorption and new bone formation. It is thought to be secondary to obstruction of the main ostium of the sinus. This obstruction may be the result of inflammation, trauma, osteoma, fibrous dysplasia, or repeated surgery in and around the nasal cavity. Mucocele can occur in any sinuses, but the frontoethmoidal region is most commonly affected. We aimed to evaluate clinical features and treatment results of paranasal sinus mucoceles in Dona-A University Hospital. Patients and Method: We analyzed 46 cases of paranasal sinus mucocele, including postoperative cheek cyst (POCC), which had been operated in Dong-A University Hospital between November 1990 and November 2002. Results: Ethmoid sinus mucocele was most common except POCC. Frontal and ethmoid mucoceles mainly showed ophthalmic symptoms such as exophthalmus, orbital pain, and diplopia, whereas maxillary mucocele mainly showed cheek swelling and nasal obstruction. Endoscopic marsupialization was performed in 20 out of 22 cases except POCC. In most POCCs except 4 cases, endoscopic and Caldwell-Luc approaches were combined. Only 1 out of 46 cases recurred. Conclusion: Ethmoid sinus mucocele was most common except POCC, and mainly showed ophthalmic symptoms. Endoscopic marsupialization was performed in 20 out of 22 cases except POCC, and only 1 case recurred. (J Clinical Otolaryngol 2004;15:93–97)

Inferior meatal antrostomy: is it necessary after radical sinus surgery through the Caldwell-Luc approach?

Purpose In the Caldwell-Luc (CWL) operation, an antrostomy at the inferior meatus is created surgically to promote sinus drainage. This inferior meatal antrostomy (IMA) has been criticized because of the need for an additional time, early loss of the sinusotomy, injury to the nasolacrimal duct, epistaxis from the sphenopalatine artery, and deviation from the normal sinus physiology. This trial was undertaken with specific attention to the question: Is it necessary to perform antrostomy at the inferior meatus after radical sinus surgery through the CWL approach? Materials and methods Thirty-three patients with a dental origin of sinus disease indicating the CWL operation were entered into this trial. They were treated in blocks of 3, in which IMA was not performed in the first and second patients of each successive block. Only the third patient of each block had IMA performed. Cheek swelling, infection, and failure to relieve the patient’s symptoms were the criteria for comparison between patient groups. Cheek swelling was measured by the eye-mouth line and the ear-nose line on the second and fourth day after surgery. Results At no time was there a statistically significant difference in cheek swelling between the treated groups ( P > .05). No infection or failure of treatment was encountered. However, some patients in both groups had numbness or paresthesias of the cheek, upper lip, upper front gingiva, and teeth. These complaints were transient and lasted for several weeks. Conclusion Based on our findings, it does not seem necessary to perform antrostomy at the inferior meatus, provided the patient has a patent osteomeatal complex and no anatomic abnormalities.

小児に発生した耳下腺粘表皮癌の１例

A case of mucoepidermoid carcinoma occurring in the parotid gland of a child is presented. A 12-yearold girl visited our hospital because of a painless swelling of the left cheek. Hypertrophy of the masseter was initially suspected. She did not undergo a further examination by MRI because of mental retardation. She had been followed up clinically for 1 year, until the swelling of the cheek grew rapidly. Then, she was examined by CT and MM under intraveneous sedation, and a parotid tumor was diagnosed.A biopsy specimen revealed mucoepidermoid carcinoma of the parotid gland. She underwent total resection of the left parotid gland, functional neck dissection, and reconstruction of the facial nerve by transplantation of the sural nerve. She has been well for 18 months postoperatively, without recurrence or metastasis, although a moderate degree of facial nerve paralysis remains.We review 16 children with mucoepidermoid carcinoma of the parotid gland, previously reported in the Japanese literature.

術前塞栓術が奏効した上顎洞内血管腫の１例

Cavernous hemangioma rarely arises in the maxillary sinus. A 64-year-old woman was referred to our hospital because of diffuse swelling of the right cheek. CT and MM showed bone destruction of the maxillary sinus. Clinical examination revealed a malignant lesion. Biopsy was done. Histological examination confirmed a diagnosis of hemangioma. We performed operation to extirpate the mass after arterial embolization via the maxillary artery.

頬部皮下に発生したＭＡＬＴリンパ腫例

MALT lymphoma is characterized as a type of low-grade extranodal B cell lymphoma arising from mucosa-associated lymphoid tissue (MALT). It is thought to be associated with autoimmune diseases, e. g., Sjogren's syndrome and Hashimoto's disease, or inflammatory diseases, e. g., Helicobacter pylori infection of the stomach. We report a rare case of MALT lymphoma of the cheek. A 76-year-old woman was referred to our clinic, complaining of swelling of the left cheek. CT and MRI showed a solid mass with a smooth surface in the subcutaneous region of her left cheek. Total resection of the tumor was performed. The tumor was histopathologically diagnosed as MALT lymphoma. No other lesions were detected in systemic examinations. A complete remission was obtained with 4 courses of Rituximab (anti-CD20 monoclonal antibody) therapy and irradiation at 40Gy. The patient is currently free from disease 21 months after surgery.

Subcutaneous Emphysema after Tonsillectomy: A Case Report

We experienced a case of a subcutaneous emphysema after tonsillectomy. The patient, a 24-year-old man, complained of a recurrent sore throat and was diagnosed as having chronic tonsillitis. Pre-operative general examinations revealed no abnormalities. The operation was carried out under general anesthesia. The adhesions between the tonsils and the surrounding tissues were moderate. The bi-lateral tonsils were easily removed. The recovery period was uneventful. On the next morning, marked swelling of the left cheek and submandibular area was noted. On palpation, there was a characteristic crepitation and softness in these areas. The X-ray examination revealed subcutaneous emphysema. There was no finding of airway obstruction. We diagnosed him as having a subcutaneous emphysema and administered antibiotics for 5 days. From clinical findings, the subcutaneous emphysema was thought to be caused by surgical rather than anesthetic factors. The subcutaneous emphysema gradually disappeared. One year after the tonsillectomy, the patient is under observation as an outpatient and is free from any abnormal symptoms. To avoid this kind of complication, we should pay attention to carefully separate the tonsil from its fossa and to make appropriate selection of surgical equipments.

Osteosarcoma and chondrosarcoma of the maxilla

The mean age at presentation was 27 years (range 9–65) with equal sex distribution and half were under 20 years of age (Table 1). Presenting features were rapidly progressive cheek swelling (n = 11), facial pain (n = 6), mass in the hard palate (n = 5), previous dental extraction (n = 5), nasal obstruction (n = 4), proptosis (n = 4), reduction in vision (n = 2), trismus (n = 2), and epistaxis (n = 1). The duration of symptoms varied from 2 weeks to 3 months. Computed tomoscans (CT) were available for 10 of them, and findings varied from predominantly radiolucent, poorly delineated lesions to dense, radio-opaque masses with a sunburst appearance (Fig. 1). Extension to the orbit (n = 4), destruction of the septum with extension to the opposite side (n = 3) and involvement of the skull base (n = 2) were noted. Using AJCC classification they belonged to stage III (n = 6) and stage IV (n = 6). Histological examination showed areas of sarcomatous stroma with direct production of tumour osteoid and bone from malignant connective tissue. The stroma of the tumour was typically composed of anaplastic spindle cells with hyperchromatic nuclei and tumour foci at the periphery of the specimen that were poorly mineralised. Resection with postoperative radiotherapy was the mainstay of treatment (n = 9), resection alone was done in one child, and palliative resection with chemotherapy (n = 2) using cyclophosphamide, vincristine and doxorubicin was administered. Palliative resection was done because both of them had involvement of the skull base. Mean follow-up was 29 months (range 4 months to 6 years). Two patients were lost to follow-up at 4 months and 41/2 years, respectively, 5 were alive without recurrence, and 5 died of local disease or pulmonary metastases. The cumulative probability of 5-year survival calculated by Kaplan–Meier method was almost nil.

放射線誘発性上顎骨骨肉腫例

Radiation-induced osteosarcoma in the head and neak region is very rare. A 68-year-old female, who had been treated with radiation for malignant lymphoma of the right maxillary sinus, presented with right cheek swelling. Imaging examinations demonstrated a huge mass occupying the right nasal cavity and paranasal sinuses. Total maxillectomy was performed, and the tumor was histologically diagnosed as osteosarcoma. Diagnosis and treatment for radiation-induced osteosarcoma in the head and neck is discussed.

上顎洞に発生した粘表皮癌例

A case of mucoepidermoid carcinoma in the maxillary sinus is reported. The patient was an 88-year-old female who complained of swelling of the left cheek. CT scan showed a low density tumor mass in the left maxillary sinus, and the tumor infiltrated into the hard palate. Histopathological examination revealed a high grade mucoepidermoid carcinoma. Although partial maxillectomy performed, she relapsed with a lesion in the maxillary sinus 6 months after the operation. We performed radiotherapy for a total of 50Gy, and the relapsed tumor disappeared completely after irradiation. However, she died of bone metastasis 12 months after radiotherapy.

頬部腫ちょうを初発症状とした上大静脈症候群の１例

A case of superior vena cava syndrome (SVCS) with swelling of the cheek is presented. A 67-year-old man was referred because of painless bilateral swelling of the parotid region. Physical examination revealed no cause of the swelling. However, chest radiographs and computed tomographic scans demonstrated that the superior vena cava was compressed by a mass. On biopsy, the mass was histologically diagnosed as poorly differentiated large cell carcinoma of the lung. Radiotherapy was effective against the tumor, alleviating compression of the superior vena cava, and the cheek swelling concomitantly disappeared. Consequently, the swelling was diagnosed as a component of SVCS subsequent to pulmonary cancer. The present case suggests that SVCS should be included in the differential diagnosis of lesions with cheek swelling.

歯性感染症を契機として一過性Ｌｕｐｕｓ Ａｎｔｉｃｏａｇｕｌａｎｔ陽性が見出された１例

Lupus anticoagulant (LA) is defined as an autoantibody that inhibits phospholipid-dependent blood coagulation, without suppressing individual blood coagulation factors. We encountered a LApositive patient who needed surgical treatment. The patient was a 32-year-old woman who came to our hospital because of right cheek swelling. A right buccal abscess due to 76 periapical periodontitis was diagnosed on the basis of the clinical manifestations and radiographic findings. The activated partial thromboplastin time (APTT) was remarkably prolonged to 65.5 seconds. The blood platelet count, other peripheral blood variables, and chemical data were within the normal range. After performing the cross mixing test and rarefaction prothrombin time (PT) test, the patient was found to be LA positive. She had no autoimmune diseases, such as systemic lupus erythematosus, which frequently accompanies LA, and there was no history of drugs that could induce LA. Thrombosis or thrombocytopenia occur frequently in LA-positive patients. Therefore, we managed her condition during the perioperative period taking this problem into consideration. APTT normalized, and LA became negative after surgery. The transient LA positivity in our case was attributed to infection.

含歯性嚢胞より発生したと考えられたへん平上皮癌の１例

Squamous cell carcinoma arising in a dentigerous cyst is extremely rare. Diagnosis requires microscopic evidence of the transition from benign cystic epithelium to squamous cell carcinoma.We report a histopathologically documented case of squamous cell carcinoma showing malignant transformation within the wall of a dentigerous cyst. A 43-year-old woman was referred to our department for diffuse swelling of the left cheek associated with a small fistula of the buccal mucosa. Radiographic examination showed a round translucent image containing an impacted tooth in the left side of the maxilla. Squamous cell carcinoma was confirmed by excisional biopsy, and partial maxillectomy was performed. Histopathological examination of the resected specimens showed transition of the normal cystic epithelium to squamous cell carcinoma. The patient has been followed up for 4 years 5 months, with no evidence of recurrence.

抗菌薬の投与制限を要した頬部・側頭部壊死性筋膜炎の２例 肝硬変合併例と慢性腎不全合併例

Two cases of necrotizing fasciitis in the cheek and temporal region caused by dental infection and treated with limited doses of antimicrobial agents are reported. Patient 1, a 70-year-old woman with hepatic cirrhosis and diabetes mellitus, had swelling of the right cheek and temporal regions due to pericoronitis of a lower wisdom tooth. Patient 2, a 71-year-old woman with renal insufficiency, had swelling of the left side of the neck, submandibular region, cheek, and temporal region due to pericoronitis of a lower wisdom tooth.Computed tomography demonstrated a gas-forming abscess in the subcutaneous tissue and musclein both patients. The patients were given a diagnosis of necrotizing fasciitis, and surgical drainage was performed. Necrosis of the superficial fascia and subcutaneous tissues wasfound and involved the deep fascia. and muscles. Chemotherapy with a limited dose was started. Daily debridement and irrigation with hydrogen peroxide solution, povidone isodine solution, or benzalkonium chrolide solution, resulted in improvement of symptoms. The importance of early diagnosis followed by appropriate treatment including prompt drainage, localirrigation, administration of antibiotics, and management of general condition is emphasized.

副耳下腺に発生した唾液腺導管癌例

Salivary duct carcinoma is an uncommon, relatively unknown, and clinically aggressive carcinoma of salivary origin. Recently, we treated a rare case of salivary duct carcinoma arising from the accessory parotid gland. The patient was a 68-year-old male who complained of left cheek swelling. The mass was located in left mid-cheek. Fine needle aspiration biopsy and open biopsy of the mid-cheek mass revealed malignant cells, but the pathological diagnosis was not settled. The mass in the mid-cheek was resected en-block including the buccal branches of the facial nerve, the superficial parotid gland, a part of the masseter muscle, and the skin right above the tumor. A pathological examination identified comedo necrosis and a final diagnosis of salivary duct carcinoma was made. The patient was treated with postoperative radiation therapy and has been free of tumors for 10 months.

Ectopic parotid gland as an unusual cause of cheek swelling

Ectopic parotid gland as an unusual cause of cheek swelling

Osteosarcoma metastatic to the mandible: A case report

A case of osteosarcoma that metastasized to the mandibular ramus from the femur in a 36-year-old man is presented. The patient was referred to us for the diagnosis and treatment of swelling of the left cheek. Radiologic examination showed a radiolucent lesion containing radiopaque areas within the left mandibular ramus. The patient previously suffered from a femoral small cell osteosarcoma, which was resected 71 months before our first examination. After induction of general anesthesia, a unilateral mandiblectomy and a simultaneous reconstruction using a titanium plate and an artificial condyle were performed. The postoperative course was uneventful, with satisfactory facial appearance and jaw function. The histopathologic features of the mandibular tumor were identical to those of the femoral tumor. Thus the mandibular lesion was diagnosed as a metastatic small cell osteosarcoma. At 27 months after the operation there had been no recurrence. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;91:452-4)

下顎切痕上にみられた筋上皮腫の１例

We report a case of myoepithelioma arising in the left mandibular notch, between the temporal and the masseter muscle.A 37-year-woman visited our Department of Dentistry and Oral Surgery because of gradual swelling of the right cheek and trismus of 2 months' duration. A panoramic radiograph showed a radiopaque circumscribed lesion between the coronoid and the articular process. A computed tomographic examination clearly showed a large mass involving the exo-lateral and posterior parts of the coronoid process. The mass was 20mm in diameter. Total enucleation of the mass was performed via the oral cavity with an ostectomy of the coronoid process under general anesthesia. The mass was diagnosed histopathologically as myoepithelioma, which had not been suspected. Given that myoepithelioma generally where glands are located, we believe that occurs the tumor arose from an ectopic salivary gland and developed at its unique location. To our knowledge, no report has previously described a myoepithelioma arising in the same region as ours, including those on pleomorphic adenomas, from which myoepithelioma was distinguished in the revised WHO classification in 1991. We therefore present this rare case with some comments.

Massive proptosis of the globe

A 54-year-old woman was referred to the oral and maxillofacial surgery department in July 1996 with a complaint of swelling of the left cheek and paranasal region. The patient initially came to the ophthalmology department several months earlier because of protrusion of her left eye and blurred vision, which she stated had become progressively worse over the past 2 years. The patient also stated that she had been experiencing nasal congestion and fullness of her sinuses for the past 6 to 8 years, for which she had not sought treatment previously.