ミノガサナイデ ソノ ショウジョウ : アクセイ ビョウヘン ノ カノウセイ ワ アリマセンカ

Patients with orofacial symptoms caused by malignant diseases, which should be treated by medical doctors, sometimes visit dental clinics during the initial consultation. The delay of getting an accurate diagnosis will lead to poor prognosis including death of patients. Therefore, dentists should be able to notice some symptoms related to malignant diseases. The signs and symptoms commonly associated with such patients are as follows. 1) Numb chin syndrome, 2) Swelling of palate and neck without pain, 3) Trismus, and 4) Macroglossia. In this article, we report the process from the initial visit until the accurate diagnosis of the patient with such symptoms, and present some comments about the signs and symptoms that may give us clues of malignancy

ガク ガンメン リョウイキ ニオケル チョウオンパ ガゾウ ヒョウジ リョウイキ ニ カンスル ケントウ

The purpose of this study was to compare the advantages of different fields of view (FOV) between Linear, Sector, and real-time panoramic view (SieScape^TM) in B-mode ultrasonography for the maxillofacial region. This prospective study included 103 maxillofacial examinations of 60 patients with space-occupying lesions and/or suspected of metastatic regional lymph nodes from oral cancer. These lesions were examined by ultrasonographic study with three different kinds of FOV, including Linear, Sector, and SieScape^. These images were digitally recorded and compared. Each examination was classified into 5 maxillofacial anatomical parts, 1) buccal & lip part, 2) parotid gland part, 3) submandibular part, 4) submental & sublingual part, and 5) neck part. The advantage of FOV was evaluated according to these anatomical parts. 1) Buccal & lip part: 16 examinations were collected. Linear and/or sector FOV provided sufficient images for observing the lesion and adjoining anatomical landmarks. 2) Parotid gland part: 7 examinations were obtained. The whole gland could be observed only in SieScape^ in a single image. 3) Submandibular part: 43 examinations were obtained. The whole submandibular gland could be observed in Sector FOV, which was also useful to observe the structure adjoining the mandible, because the slanting ultrasound beam avoided the lingual mandibular bone and the deeper structure of the gland could be observed. Furthermore, for cases with many submandibular lymph nodes, sagittal SieScape^ images provided a suitable reference image for later observation. 4) Submental & sublingual part: Linear FOV provided sufficient images. Sector FOV was also useful, if the lesion was large or located next to the mandible. 5) Neck part: The quality of diagnostic information did not differ between the three kinds of FOVs employed here, since this area was too large to observe in a single image. Furthermore, the exact location was hard to identify in the later evaluation since the anatomic structures did not much differ between upper and middle neck portions. In the ultrasonographic examination of the maxillofacial area, we should select proper FOV to obtain useful diagnostic information

Lingual tonsillolith on PR and CT

Objectives: Lingual tonsilloliths are not as well-known to radiologists than palatine tonsilloliths, although they might be common in clinical practice. The aim of this investigation was to clarify the prevalence and imaging characteristics of lingual tonsilloliths using panoramic radiographs and CT images. Methods: This study included 2244 patients without pathology at the base of tongue who had undergone panoramic radiography and CT of the maxillofacial region. The size, number and position of lingual tonsilloliths relative to the mandible and tongue were evaluated. Results: Lingual tonsilloliths were observed in 33 (1.5%) and 108 (4.8%) of all patients on panoramic radiographs and CT images, respectively. The prevalence was higher in patients aged ≥40 years than in those aged < 40 years (χ2, p < 0.01). They appeared as small, round- or rod-shaped calcified bodies, and they always located closely anterior (1–17 mm) to the anterior border of oropharyngeal airway on panoramic radiographs. Lingual tonsilloliths were superimposed over the surrounding soft tissue inferior to the body of the mandible, posteroinferior to the angle of the mandible and posterior to the mandible in 16 (48.5%), 15 (45.5%) and 1 (3.0%) individual, respectively. A significant correlation was observed between the detectability on panoramic radiographs and size (Spearman’s r = 0.961, p < 0.01) of tonsilloliths, as revealed by CT images. Conclusion: Lingual tonsilloliths commonly appear on CT. They also appear on panoramic radiography and may superimpose the surrounding soft tissue of the mandible. Although lingual tonsilloliths may resemble other pathological calcifications including submandibular sialoliths and lingual osseous cholistoma, they can be differentiated by carefully observing panoramic radiographs. When clinicians detect calcified bodies near the base of tongue, lingual tonsilloliths should be included in the differential diagnoses

Prevalence and Imaging Characteristics of Palatine Tonsilloliths Detected by CT in 2,873 Consecutive Patients

Tonsilloliths are calcified structures that develop in tonsillar crypts. They are commonly detected in daily clinical practice. The prevalence of tonsilloliths was 16 to 24% in previous reports, but it is inconsistent with clinical experience. The aim of this study is to clarify the prevalence, number, and size distribution of tonsilloliths using computed tomography (CT) in a relatively large number of patients. Materials and Methods. We retrospectively reviewed the scans of 2,873 patients referred for CT examinations with regard to tonsilloliths. Results. Palatine tonsilloliths were found in 1,145 out of 2,873 patients (39.9%). The prevalence of tonsilloliths increased with age, and most commonly in patients of ages 50–69. The prevalence in the 30s and younger was statistically lower than in the 40s and older (P < 0.05). The number of tonsilloliths per palatine tonsil ranged from one to 18. The size of the tonsilloliths ranged from 1 to 10 mm. For the patients with multiple CT examinations, the number of tonsilloliths increased in 51 (3.9%) and decreased in 84 (6.5%) of the tonsils. Conclusions. As palatine tonsilloliths are common conditions, screenings for tonsilloliths during the diagnosis of soft tissue calcifications should be included in routine diagnostic imaging

CT imaging of nasopharyngeal and eustachian tube tonsilloliths

Objectives: Nasopharyngeal tonsilloliths (NT) and eustachian tube tonsilloliths (ET) are not as well-known to radiologists as palatine and lingual tonsilloliths. The aim of this investigation was to determine the prevalence and imaging characteristics of NT and ET using CT and panoramic radiographs. Methods: We retrospectively assessed the scans of 2244 patients who underwent consecutive CT and panoramic radiographs of the maxillofacial region. The prevalence, size, number, and position of NT and ET were analysed. Results: NT and ET were detected in 14 (0.6%) and 6 (0.3%) of 2244 patients on CT, respectively, but they were undetectable on panoramic radiographs. No significant difference was found in the prevalence with respect to sex. Although there was also no significant difference in the prevalence among age groups, tonsilloliths were most commonly noted in patients over 40 years old; they appeared as small and round calcified bodies, ranging from 1 to 3 mm in diameter. All NT were found 0 to 3 mm beneath the nasopharyngeal mucosal surface. Conclusions: The prevalence of NT and ET on CT was lower than that of palatine and lingual tonsilloliths. However, since they are encountered more frequently than clinically significant calcifying diseases such as retropharyngeal calcific tendinitis, clinicians should be able to correctly diagnose NT and ET based on their anatomical features

コウクウガン ケイブ テンイ リンパセツ ノ ケンシュツ ニ タイスル チョウオウパ サンジゲン イメージング ノ ユウヨウセイ

Three dimensional ultrasonographic imaging was performed for the cervical lymphadenopathy. Forty lymph nodes with suspicion of metastatic lymphadenopathy out of 20 patients with oral cancers were served for the present study. We could not judge the presence/absence of the metastasis by routine B mode or power Doppler imaging alone. Out of the 40 lymph nodes, 18 metastatic lymphadenopathies were proved histopathologically. Additionally, 11 lymph nodes out of 8 patients with nonspecific reactive lymphadenopathies were included as the control. The pattern of the circumferential blood flow of the lymph nodes was reviewed by the three-dimensional maximum intensity projection (3D MIP) view that was obtained from 3D power Doppler imaging. They were divided into 4 categories ; linear blood flow, mesh like blood flow, spotty blood flow and no circumferential flow. The spotty flow was almost exclusively found in the metastatic lymph nodes. Its accuracy, sensitivity and specificity, positive predictive value and negative predictive value for detecting metastatic lymphadenopathy were 0.73, 0.44, 0.95, 0.89, and 0.68, respectively. This spotty flow was situated at the marginal portion and/or around the lymph nodes by the analysis of the two-dimensional display. We could not differentiate whether it was arterial or venous flow. As the three dimensional sonographic imaging is the time-consuming technique compared to the routine B mode or power Doppler imaging, we cannot routinely perform it. However, it would play a supplementary role for detecting lymph node metastasis, especially if we cannot judge them by the two dimensional imaging alone

Prevalence and imaging characteristics of palatine tonsilloliths evaluated on 2244 pairs of panoramic radiographs and CT images

Objectives: Palatine tonsilloliths incidentally detected on diagnostic imaging should be differentiated from pathologic calcifications to enable correct diagnosis and treatment. The aim of this study is to clarify the prevalence and imaging characteristics of palatine tonsilloliths on panoramic radiographs. Materials and Methods: We retrospectively reviewed 2,244 individuals who underwent pairs of consecutive panoramic radiography and computed tomography (CT) of the head and neck region. The imaging characteristics of palatine tonsilloliths on panoramic radiography were compared with the findings from CT, which was considered the gold standard. Results: Tonsilloliths were detected in 300 (13.4%) and 914 (40.7%) of the 2,244 individuals on panoramic radiographs and CT, respectively. On panoramic radiographs, tonsilloliths were superimposed over the ramus of the mandible at the level coincident with and inferior to the soft palate in 176 (7.8%) and 90 (4.0%) individuals, respectively. Tonsilloliths were also superimposed over the surrounding soft tissue inferior to the body of the mandible, postero-inferior to the angle of the mandible, and posterior to the ramus of the mandible in 33 (1.5%), 26 (1.2%), and 28 (1.3%) individuals, respectively. A significant correlation was observed between the detectability on panoramic radiographs and the size (Spearman r=1.000) and number (Spearman r=0.991) of tonsilloliths, as revealed by CT images. Conclusions: The present results suggest that tonsilloliths are commonly detected on panoramic radiographs. Furthermore, they can be superimposed on both the mandible and the surrounding soft tissue. Clinical Relevance: Clinicians should include tonsilloliths among the differential diagnoses when calcified bodies are detected on panoramic radiographs

Intraoral ultrasonography of tongue mass lesions

Objectives: To demonstrate the usefulness of intraoral ultrasonography (IOUS) for tongue mass lesions, we analyzed surgery cases excluding squamous-cell carcinoma and leukoplakia and compared IOUS and pathological findings. Methods: We used the hospital information system and Radiology Information System to evaluate the IOUS and pathological findings of patients who underwent surgeries for tongue masses in the past 11 years. Results: Surgeries for the tongues were performed in 268 cases. Imaging examinations were carried out in 52 (19.4%) cases including 42 (15.7%) cases by IOUS. The pathological results of the surgeries were as follows: 36 cases were inflammatory lesions, 74 cases were tumours, 131 cases were hyperplasia, 8 cases were cystic lesions and 19 cases were other miscellaneous lesions. On the other hand, the number of patients who received IOUS in the same period was 87, and 42 of them had surgeries. In 32 out of the 42 (76.2%) cases, pre-operative IOUS features matched with pathological results. Most of the haemangiomas and lipomas could be diagnosed by IOUS alone. Conclusions: IOUS of the tongue revealed the nature of the lesions including the border, size, location, depth, the presence or absence of a capsule and the internal structure including vascularity of the mass. The ultrasonographic findings well reflected the histological findings. IOUS is a simple and useful technique that provides additional information beyond inspection, clarifying the internal structure, blood flow and relationships with the adjacent tissues. In this article, we indicated 11 representative cases (fibrous polyp, haemangioma, pyogenic granuloma, lipoma, liposarcoma, chondroma, lymphangioma, schwannoma, neurofibroma, pleomorphic adenoma and amyloidosis) to show the usefulness of IOUS

Inhibition of Amino Acids Influx into Proximal Tubular Cells Improves Lysosome Function in Diabetes

Background Inhibition of glucose influx into proximal tubular cells (PTCs) by sodium–glucose cotransporter 2 inhibitors revealed prominent therapeutic effects on diabetic kidney disease. Collectrin (CLTRN) serves as a chaperone for the trafficking of neutral amino acid (AA) transporters in the apical membranes of PTCs. We investigated the beneficial effects of reduced influx of AAs into PTCs in diabetes and obesity model of Cltrn−/y mice. Methods Cltrn+/y and Cltrn−/y mice at age 5 weeks were assigned to standard diet and streptozotocin and high-fat diet (STZ-HFD)–treated groups. Results At age 22–23 weeks, body weight and HbA1c levels significantly increased in STZ-HFD-Cltrn+/y compared with standard diet-Cltrn+/y; however, they were not altered in STZ-HFD-Cltrn−/y compared with STZ-HFD-Cltrn+/y. At age 20 weeks, urinary albumin creatinine ratio was significantly reduced in STZ-HFD-Cltrn−/y compared with STZ-HFD-Cltrn+/y. Under the treatments with STZ and HFD, the Cltrn gene deficiency caused significant increase in urinary concentration of AAs such as Gln, His, Gly, Thr, Tyr, Val, Trp, Phe, Ile, Leu, and Pro. In PTCs in STZ-HFD-Cltrn+/y, the enlarged lysosomes with diameter of 10 μm or more were associated with reduced autolysosomes, and the formation of giant lysosomes was prominently suppressed in STZ-HFD-Cltrn−/y. Phospho-mTOR and inactive form of phospho-transcription factor EB were reduced in STZ-HFD-Cltrn−/y compared with STZ-HFD-Cltrn+/y. Conclusions The reduction of AAs influx into PTCs inactivated mTOR, activated transcription factor EB, improved lysosome function, and ameliorated vacuolar formation of PTCs in STZ-HFD-Cltrn−/y mice

コウクウ ガク ガンメン アクセイ シュヨウ ノ エンカク テンイ ヒョウカ ニオケル クカンブ CT ケンサ ノ イチズケ

Abdominal CT examinations for the scouting of distant metastasis (DM) of orofacial malignant tumors were retrospectively evaluated, for the purpose of establishing the standard way of examination. Out of 159 patients with oral malignancies, 247 abdominal CT examinations were performed for the purpose of scouting DM. During the examination, intravenous contrast enhancement (CE) was performed in 166 examinations. DM were detected in 13 patients (8.2%). DM were found in 6 at administration, and 8 were late DM. Nine DM were detected out of 166 (5.4%) examinations with CE, and 5 were detected out of 81 (6.2%) examinations without CE. In detecting the DM, no improvement was found by CE. DM attacked lungs in 13, mediastinum in 3, liver in 2, paraaortic lymph nodes in 1, chest wall in 1, and vertebra in 1. Only 2 patients with DM were free from cervical metastasis, and the remainder was combined with cervical metastasis, regardless the status of the primary sites. Conclusions: Abdominal CT was useful for detecting DM. Intravenous CE was not necessary for scouting the DM. Patients with cervical metastasis had a high potential for developing DM