We report a case of posterior superior alveolar artery damage caused by local anesthesia in which hemostasis was achieved by transcatheter arterial embolization. The patient was a 50-year-old woman who received local anesthesia for extraction of the maxillary left third molar at a dental clinic. Immediately after delivery of the local anesthetic, a swelling developed on the left side of her face, and the extraction procedure was cancelled. However, the swelling and pain increased; therefore, she was referred to our department. Swelling with dark-colored petechiae were observed from the left periorbital region to the submandibular region, associated with severe pain. Contrast-enhanced computed tomography (CT) and three-dimensional CT angiography suggested bleeding from the posterior superior alveolar artery. The swelling progressed despite pressure hemostasis at the site of arterial injury. Therefore, angiography was performed after consultation with a radiologist. Leakage of the contrast agent from the posterior superior alveolar artery was confirmed, and embolization of the artery using a gelatin sponge was performed. After the procedure, hemostasis was achieved, and bleeding did not recur. The swelling improved within a few days without any complications. Clinicians should consider the possibility of arterial injury caused by local anesthesia for dental procedures and take the necessary precautions. : local anesthesia (局所麻酔) ,hematoma (血腫) ,transcatheter arterial embolization (TAE) (経カテーテル 的動脈塞栓術) ,posterior superior alveolar artery (後上歯槽動脈) 奈良県立医科大学口腔外科学講座 (主任:桐田忠昭教授)
Dysphagia is one of the most common adverse effects associated with oral cancer therapy and could greatly impair postoperative quality of life. The objective of this study was to analyze postoperative swallowing outcomes and factors influencing postoperative swallowing function in patients with advanced oral cancer who underwent primary reconstruction after surgical resection to identify patients at risk of experiencing severe dysphagia after immediate reconstruction of surgical defects, and to determine an ideal approach to provide appropriate perioperative interventions. The swallowing status was evaluated at 4 week postoperatively using the Functional Oral Intake Scale. We also analyzed the effects of patient, tumor, surgical, and other factors on postoperative swallowing function. The study included 67 patients. At 4 weeks postoperatively, 11 patients showed reduced swallowing function, whereas 56 patients showed good swallowing function. The number of resected suprahyoid muscles (odds ratio, 1.55; 95% confidence interval, 1.03–2.32; P=0.035) was an independent factor influencing postoperative swallowing function. Thus, among patients who underwent radical resection of oral cancer with primary reconstruction, those with extensive resection of the suprahyoid muscles were at higher risk of developing postoperative dysphagia. These findings are expected to facilitate increased vigilance for dysphagia, better counseling, and appropriate rehabilitation interventions.
ARIKAWA Sho ・ YAMAKAWA Nobuhiro ・ KIRITA Tadaaki : Intraductal carcinoma (IDC) is a rare salivary gland tumor, classified according to the 4 th WHO Classification of Head and Neck Tumors in 2017. The tumor affects the parotid gland much more frequently than the minor salivary glands. It' s often asymptomatic. We report a case of IDC of the left retromolar trigon occurring in an 81-year-old woman. She was diagnosed with high serum CEA and CA19-9 at a medical examination. Examinations of her gastrointestinal tract, lungs, and mammary glands were conducted, resulting in no abnormal findings. FDG-PET showed abnormal uptake only in the left retromolar trigon, and a painless mass was observed. A biopsy of this tumor indicated it was likely a low-grade salivary gland tumor. The tumor was completely removed, along with sufficient margins. Histological examination revealed that the lesion was composed of alveolar nests showing an expanded duct-like structure surrounded by an intact myoepithelial layer, with no evidence of infiltration. The final diagnosis was IDC. The postoperative course was uneventful and the patient' s serum CEA and CA19-9 levels decreased to within normal range. We believe that serum CEA and CA19-9 levels could be used for the diagnosis and evaluation of therapeutic effect for this tumor.: carbohydrate antigen19-9 (CA19-9) ,carcinoembryonic antigen (CEA) ,intraductal carcinoma (導管内癌) , minor salivary gland (小唾液腺) ,tumor marker (腫瘍マーカー)
奈良県立医科大学口腔外科学講座 (主任:桐田忠昭教授)
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