コウカセイ エシセイ ジュウカクエン オ ハッショウ シタ カガク チシ シュウイエン ノ 1レイ

We present a case of pericoronitis of lower wisdom tooth leading to descending necrotizing mediastinitis. A 52-year-old man visited our hospital because of swelling and pain in buccal region on the right side in spite of chemotherapeutics at a practicing physician, whose diabetic nephropathy had been treated with dialysis treatment by the same physician. Orthopantomography elucidated an impacted wisdom tooth of the right side mandible and osteosclerosis around there. CT revealed inflammatory thickening of subcutaneous fat tissue from buccal to cervical region. In the blood examination, the values of WBCs, RBCs, platelets, CRP, AST, LDH, TG, BUN, creatinine, GLU, K and Ca increased abnormally, while those of hemoglobin, MCV，MCH，MCHC, albumin, Cl, decreased extraordinarily. Immediate medication of antibiotics was worked out under a clinical diagnosis of pericoronitis of lower wisdom tooth, periostitis of the mandible and cervical cellulitis. Nevertheless, rapid inflamation progressed downward; mediastinal abscess was found by CT image taken 6 days later from the beginning of the therapy. Immediately, extraction of pathogenic teeth, cervical drainage, and transcervical and transthoracic mediastinal drainage were performed under a diagnosis of descending necrotizing mediastinitis. Moreover, bacterial examination was performed using a pus specimen derived from abscess; α-Streptococcus and Prevotella intermedia were detected. CT taken 2 weeks later from the beginning of the therapy revealed continuing bilateral pleural and pericardial effusion in spite of intensive care. Unfortunately he was died of multi organ failure caused by septic shock a month later from the beginning of the therapy

イチジルシイ コツキュウシュウ オ トモナッタ シセイ ジョウガクドウエン ノ 1レイ

We present a case of odontogenic maxillary sinusitis with marked perisinuous bone resorption. A 29-year-old man visited to our hospital because of pain in buccal region on left side after extraction of teeth at a dental practitioner. Orthopantomography and CT were performed and revealed inflammatory thickening of maxillary sinus mucosa and marked perisinuous bone resorption. In the blood examination, the values of WBCs and CRP were elevated abnormally. Moreover, bacterial examination was performed using the exudate from maxillary sinus through a fistula after extraction of teeth; α-Streptococcus, Prevotella buccae, Prevotella intermedia, Prevotella melaninogenica and Acinetobacter baumannii were detected. First, medication of antibiotics and irrigation of maxillary sinus was worked out under a clinical diagnosis of odontogenic maxillary sinusitis. These therapies didn't change perisinuous bone resorption for the better. Sequestrum and mucosa of maxillary sinus were biopsied to examine thoroughly; diagnosis of odontogenic maxillary sinusitis was confirmed histopathologically. Moreover, biochemical examination of blood showed normal serum level of specific markers for bone metabolism or Aspergilli. The similar therapies were continued from then and perisinuous bone resorption stopped suddenly for unknown reasons 3 months after these therapies. Time course of perisinuous bone regeneration was found by CT. Finally, operation to close the antrooral fistula with palatal flap was performed. There has been no relapse of inflammation for more than 5 years

バッシゴ シュッケツ オ ケイキ ニ シンダン サレタ コウレイシャ ニオケル センテンセイ ケツユウビョウ A ﾉ 1レイ

Hemophilia A is often diagnosed by gingival change, traumatic injuries, or bleeding after extraction in childhood, but rarely in senior age. We experienced that a 66 year-old man was diagnosed as hemophilia A by bleeding after tooth extraction. He was referred to our hospital for control the bleeding after tooth extraction. Although we tried to stop bleeding by local hemostasis, we repeated to bleed several times. Then we examined the level of hemorrhage factors. As a result, the patient was diagnosed as moderate hemophilia A, and he received recombinant factor VIII intravenously. After that, the bleeding had been stopped completely