The World Health Organization defines primary intraosseous squamous cell carcinoma (PIOSCC) as a squamous cell carcinoma (SCC) arising primarily within the jaws and having no connection with the oral mucosa. Here, we report a case of PIOSCC in which it was difficult to differentiate the condition from pericoronitis of an impacted maxillary wisdom tooth. The patient was a 27-year-old pregnant woman with a pain in the right maxillary wisdom tooth. The pain was diagnosed as pericoronitis of the right maxillary wisdom tooth, and the tooth was extracted under local anesthesia. During extraction, soft tissue was observed in the coronal part of the tooth, and it was diagnosed as SCC arising in a dentigerous cyst. Because the tumor may still be present, surgical resection was performed under general anesthesia. There has been no recurrence or metastasis at the 1-year follow-up. This case was histopathologically considered from being a benign odontogenic tumor to a malignant tumor. However, it revealed an extensive aberrant type and invasion equivalent to SCC. Thus, the histopathological diagnosis was PIOSCC arising from a dentigerous cyst. Although advanced cases of PIOSCC have been published, diagnosis of PIOSCC in the early stages is rare. In this case, we diagnosed pericoronitis of an impacted maxillary wisdom tooth and extracted the tooth. Therefore, we discovered it accidentally. In the early stages, diagnosis can be difficult both clinically and histopathologically.
Objective: This study evaluated the condition of mandibular cancellous and cortical bone on computed tomography (CT) images in order to investigate its relationship with the incidence of neurosensory disturbances (NSD) in the mental nerve region after bilateral sagittal splitting ramus osteotomy (BSSRO). Methods: BSSRO was performed on 58 lateral mandibles in 29 patients. From preoperative CT images, the width endpoints of the transversal bone were measured in region I immediately inferior to the mandibular foramen, region II in the mandibular angle region, and region III distal to the lower second molar. The incidence of NSD immediately after surgery and the residual NSD rate at 1, 3, and 6 months after surgery were investigated. The correlation between incidence of NSD in the mental nerve region and each transversal bone width endpoint immediately after and at 6 months after surgery was also comparatively evaluated. Results: The overall incidence of NSD immediately after surgery was 67.2% (39/58 sides) and the overall residual NSD rate at 1, 3, and 6 months after surgery was 53.4% (31/58 sides), 31.0% (18/58 sides), and 17.2% (10/58 sides), respectively. No significant differences were observed for any width endpoints of the transversal bone measured at regions I or III, but the transversal width of the entire mandible was significantly different in region II between patients with and without NSD at 6 months after surgery (p < 0.05). Conclusion: These findings demonstrate that the transversal width of the entire mandible may be an important factor in predicting NSD incidence.
Perineurioma is a tumor that originates from the proliferation of perineurial-like cells and is classified into soft tissue perineurioma, which grows on the soft tissue rather than along the nerve, and intraneural perineurioma, which develops within the nerve. Perineurioma is uncommon, and reports of its occurrence in the oral cavity area are exceedingly rare. We describe our experience with a case of intraneural perineurioma derived from the inferior alveolar nerve that developed in the mandible and was resected by sagittal split ramus osteotomy. Here, we report a summary of our experience. A 41-year-old woman visited a clinic to undergo detailed examination of the radiolucent right mandibular ramus. A biopsy was performed, and a neural tumor was diagnosed. The tumor was resected by sagittal split ramus osteotomy with the patient under general anesthesia. Histopathological diagnosis of the resected specimen definitively identified the tumor to be intraneural perineurioma. Sagittal split ramus osteotomy was extremely effective for resection of the neural tumor derived from the inferior alveolar neurovascular bundle. Postoperatively, her occlusion is stable, and she has made satisfactory progress without recurrence as of 24 months after operation. : intraneural perineurioma (神経内神経周膜腫) , inferior alveolar nerve (下歯槽神経) , sagittal spit ramus osteotomy (下顎枝矢状分割法) 1) 独立行政法人国立病院機構東京医療センター歯科口腔外科 (主任:大鶴 洋医長) 2) 独立行政法人国立病院機構東京医療センター臨床検査科 (主任:白石淳一科長) 1)
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