Osteosarcoma is a malignant tumor in which the cancerous cells produce an osteoid matrix or mineralized bone. Jaw bones are affected in 6% of all osteosarcomas and are the fourth most common site of origin. Surgical treatment of osteosarcoma in elderly patients is rarely reported. Here, we report successful treatment of osteosarcoma arising in the mandible of a 90-year-old man. The patient was referred to our institution for diagnosis and treatment of an oral lesion. Intraoral examination revealed that a hard mass measuring
35
×
27
mm
was located on the floor of the oral cavity, attached to the bone, and its growth displaced the tongue posteriorly. Therefore, he experienced difficulty in speech and swallowing. Biopsy of the mandibular mass was suspicious for chondrosarcoma. Preoperative examination did not detect critical risks for general anesthesia or surgery. Based on a clinical diagnosis of a malignant bone tumor of the mandible, segmental mandibular resection with reconstruction using a titanium plate was performed. Surgical site infection occurred on postoperative day 12, which was resolved by drainage, local irrigation, and administration of antibiotics. There was no delirium or cardiovascular or pulmonary complications. Surgery resolved the patient’s difficulties in speech and swallowing. There was no evidence of tumor recurrence or metastasis 4 years after surgery. This case showed that it was not necessary to exclude surgical treatment merely because the patient was 90 years old. Indications for surgery should be determined individually to improve the patient’s quality of life.
Pseudogout is a disease characterized by calcium pyrophosphate crystal deposition. Involvement of the temporomandibular joint (TMJ) is rare. We herein report a case of tophaceous pseudogout of the TMJ with cranial extension. An 83-year-old woman was referred to our institution for treatment of right TMJ pain. The patient’s medical and family histories were unremarkable. Magnetic resonance imaging showed a mass of about 35 mm in diameter compressing the bottom of the right temporal lobe of the brain. Based on a clinical diagnosis of a right TMJ tumour, biopsy was performed under general anaesthesia. The histopathological diagnosis was pseudogout. Considering the risk of surgically induced brain damage, the patient’s advanced age and her relatively good quality of life, the treatment plan simply involved the observation of the lesion. Fourteen months after biopsy, the patient’s activities of daily living remained unchanged and she had no TMJ pain.
Background
Subcutaneous emphysema is an uncommon incident in dental treatments. This study was designed to investigate the subcutaneous emphysema cases occurred in dental treatments.
Methods
Eleven patients were diagnosed as a subcutaneous emphysema in our hospital from 2011 to 2021. These patients were evaluated for age, sex, medical history, origin tooth, dental procedure, cause, range, healing period, duration of antibiotic, and complication. And it was analyzed statistically whether the age, range, or dental procedure had influences for healing period.
Results
The average age was 48.0 ± 20.0 years. The incidence of subcutaneous emphysema was not related to age but was more common in females. Of the 11 patients, 4 had subcutaneous emphysema that had spread to the chest. It seemed that surgical procedure using an air turbine, or a handpiece is at greatest risk of subcutaneous emphysema. The average healing period, and duration of antibiotics was 8.18 ± 1.78 days, and 10.09 ± 4.30 days, respectively. The statistical results showed a significant difference in the healing period between presence and absence of some medical history.
Conclusions
This study suggests that subcutaneous emphysema is more frequent in surgical procedures using an air turbine or a handpiece, and that the presence or absence of some diseases affects the healing period.
We report a case in which it was difficult to distinguish cervical lymph
node involvement from Hodgkin’s lymphoma vs cervical lymph node
metastasis from tongue cancer. Additionally, we report the
histopathology for a postoperative follow-up biopsy of an enlarged lymph
node in this patient with Hodgkin’s lymphoma in remission.
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