Multiple oral ulcers caused by incorrect use of oral bisphosphonate in a patient with dementia: A case report.

It is not widely known that incorrect use of oral bisphosphonates (BPs), such as chewing the medication, can cause oral ulcers. An 83-year-old woman with dementia was referred to our clinic with multiple oral ulcers. Blood and histopathological examinations were inconclusive. Further questioning revealed that the patient chewed the oral BP, resulting in oral ulceration. Patients with loss of cognitive function, such as dementia, are at risk of oral ulcers caused by incorrect use of BPs.

Stereotactic radiosurgery in combination with chemotherapy as primary treatment for head and neck cancer.

PURPOSE: The purpose of this study was to investigate the effect of stereotactic radiosurgery on local control and organ preservation in cases of primary head and neck cancer. PATIENTS AND METHODS: In this retrospective study, 14 patients with a mean age of 73 years were treated between March 2006 and September 2007 with stereotactic radiosurgery for the management of primary head and neck cancer. The patients had biopsy confirmation of disease before treatment and all patients were confirmed with squamous cell carcinoma. The staging consisted of T2 (5 cases), T3 (3 cases), T4 (6 cases), N0 (13 cases), and N1 (1 case). Marginal doses were 3,500 to 4,200 cGy in 3 or 5 fractions. The outcome was assessed according to Response Evaluation Criteria in Solid Tumors criteria based on magnetic resonance imaging and positron emission tomography/computed tomography. RESULTS: Significant tumor reduction was noted at the third month of follow-up with 5 complete responses and 9 partial responses. At a mean follow-up of 36 months (range, 14-40 mo) the local control and overall survival rates were 71.4% (10/14) and 78.6% (11/14), respectively. CONCLUSIONS: These results show the feasibility of using stereotactic radiosurgery for primary head and neck cancer and its potential benefit in local control and organ preservation.

Adenosquamous carcinoma development as a recurrence of squamous cell carcinoma in the oral floor: A case report.

RATIONALE: Oral adenosquamous carcinoma (ASC) is rare and its origins are controversial. We here present a patient with oral ASC that developed after surgery for oral squamous cell carcinoma (SCC). PATIENT CONCERNS: A 70-year-old man with SCC on the oral floor underwent surgical resection. However, the enlarged ulcer presented on the oral floor 9 month after surgery. DIAGNOSES: The biopsy of the ulcer revealed a SCC. Imaging examinations detected enhancement of a large lesion expanded to the tongue, but no evidence of regional lymph node or distant metastasis was shown. Based on these results, local recurrence of the cancer was diagnosed (cT4aN0M0). INTERVENTIONS: The surgery for the recurrent tumor was performed. OUTCOMES: The pathological examination of the surgical specimen indicated recurrent tumor was ASC. Thus, histopathological and immunohistochemical analyses of both the initial SCC and the subsequent ASC were performed in an attempt to explore the origin of the ASC. As the results, pathological review of both tumors suggested the subsequent ASC was developed from the tumor cells with adenoid phenotype in the initial SCC. LESSONS: This report suggests that the oral ASC was origin from the oral SCC, which can contribute to new knowledge for pathogenesis of oral cancer.

Malignant external otitis following radiotherapy for oral cancer: A case report.

RATIONALE: Although an ototoxicity is well-known as adverse event of the radiotherapy, it is not widely known that immunosuppressed patients who underwent radiotherapy in head and neck region have risk of malignant external otitis. PATIENT CONCERNS: A 68-year-old man with diabetes, who had been diagnosed as intraosseous squamous cell carcinoma of the right mandible, underwent surgical resection. He received a total of 60 Gy/30Fr postoperative radiation. Four months after the course of radiation, he suffered from right aural fullness, otalgia and otorrhea. DIAGNOSES: Clinical examination revealed granulation and existence of Pseudomonas aeruginosa in the external auditory canal. Computed tomography showed expansive inflammation and erosion in the temporal bone. The patient is elderly and diabetes. These findings led to the diagnosis of malignant external otitis. INTERVENTIONS: The ear irrigation and administration of quinolones were started. Afterwards, fistula was formed in the oral cavity, and connected to the right external auditory canal. Therefore, irrigations were performed not only from ear but also from the oral fistula. OUTCOMES: Eight weeks after starting treatment, the malignant external otitis was completely healed. LESSONS: Physicians should raise awareness of malignant external otitis in immunosuppressed patients with oral cancer after radiotherapy.

A diffuse traumatic neuroma in the palate: a case report.

BACKGROUND: A traumatic neuroma is not a true neoplasm but a reactive proliferation of neural tissue that commonly occurs after the transection or damage of a nerve bundle. Traumatic neuromas are rare in the oral region and usually occur as a solitary nodule of the mental foramen, lower lip, or tongue. This is the first report of a diffuse traumatic neuroma of the palate. CASE PRESENTATION: A 30-year-old Japanese man was referred to our clinic complaining of painful swelling of the left side of his palate. The swelling was diffuse and his pain increased with palpation of his palate. He had no noteworthy medical or family history, and was not aware of any history of trauma or inflammation in his head or neck area. We administered antibiotics and non-steroidal anti-inflammatory drugs because we suspected that his symptoms were the result of inflammation caused by an infection. However, his symptoms did not change. An incisional biopsy was performed, and histopathologic examination indicated that the lesion was a traumatic neuroma. Under general anesthesia the lesion was resected with a 5-mm margin using an electric scalpel because of the diffuse expansion and indistinct borders of the mass. Some tumor cells were observed within the surgical margins of the resected specimen, but there has been no recurrence of either the pain or mass in the 3 years since the surgery. CONCLUSIONS: The location and diffuse nature of this traumatic neuroma are both very rare. While we were initially unsure about the diagnosis and treatment of this mass, the treatment outcome has been good. However, a postoperative recurrence can occur at any time following the excision of a traumatic neuroma, and close long-term follow-up will continue.