Synovial chondromatosis of the temporomandibular joint accompanied by loose bodies in both the superior and inferior joint compartments : case report

Synovial chondromatosis (SC) of the temporomandibular joint (TMJ) is a benign lesion characterized by the formation of metaplastic cartilaginous nodules. SC of the TMJ usually only affects the superior joint compartment of the TMJ. We report a rare case of SC of the TMJ affecting the inferior as well as superior joint compartments

Remarkable response of juvenile diffuse sclerosing osteomyelitis of mandible to pamidronate.

We report a juvenile case of diffuse sclerosing osteomyelitis of the mandible that showed a favorable response to pamidronate, a bisphosphonate derivative. Although conventional treatments had been ineffective for five years, pamidronate administration brought about conspicuous improvement both clinically and radiographically. Severe adverse reaction was not found except for low-grade fever and lassitude only on the day following administration. During the course of the treatment, however, nonsuppurative osteomyelitis of the right humerus also occurred, leading to the established diagnosis of chronic recurrent multifocal osteomyelitis. Then, pamidronate therapy was again performed successfully with almost disappearance of clinical symptoms. Both bone-specific alkaline phosphatase (bone formation marker) and pyridinoline cross-linked carboxyterminal telopeptide of type I collagen (ICPT) (bone resorption marker) showed a marked decrease with pamidronate therapy, which suggested that pamidronate is useful for the treatment of chronic recurrent multifocal osteomyelitis with inhibitory effect on bone turnover

Pain may predict poor prognosis in patients with oral squamous cell carcinoma

Objectives: We have previously reported that the histologic mode of invasion of oral squamous cell carcinoma (OSCC) is a significant risk factor for pain. We sought to determine whether pain is a risk factor for poor prognosis in patients with OSCC. Study Design: We evaluated the relationships between overall survival rates (OSRs) and clinicopathological variables, including gender, age, T- and N-stages, pathologic findings, and pain in 109 consecutive patients with untreated OSCC. Results: Of these 109 patients, 40 (37%) reported spontaneous pain. Univariate analysis showed that the OSR of patients with spontaneous pain was significantly lower than that of patients without pain (P = 0.002). Multivariate analysis revealed that spontaneous pain and N-stage were significant independent predictors of OSR. Conclusion: This is the first report showing that spontaneous pain before treatment may be associated with poor prognosis in patients with OSCC

Assessment of cervical lymph node metastases using FDG-PET in patients with head and neck cancer

Objective To evaluate the diagnostic accuracy of fluorodeoxyglucose positron emission tomography(FDG-PET) relative to computed tomography (CT) for detecting metastatic cervical lymph nodes in patients with squamous cell carcinoma of the head and neck (HNSCC), and to ascertain the factors that affect this accuracy.Methods A total of 1076 lymph nodes obtained from 35 neck dissections in 26 HNSCC patients who preoperatively underwent both FDG-PET and CT were retrospectivelyanalyzed. For pathological metastatic lymphnodes, the lymph node size (short-axis diameter), theratio of intranodal tumor deposits, and the size of intranodaltumor deposits (maximum diameter of metastaticfoci in each lymph node) were histologically recorded.Results Forty-six lymph nodes from 23 neck sides werepathologically diagnosed metastases. The sensitivity, specifi city, accuracy, positive predictive value, and negative predictive value of FDG-PET evaluated individually per neck side were 74%, 92%, 80%, 94%, and 65%, respectively, whereas those of CT were 78%, 58%, 71%, 78%, and 58%, respectively. FDG-PET detected 100%of metastatic lymph nodes ≥10 mm, intranodal tumor deposits ≥9 mm, and intranodal tumor deposits with a ratio >75%, whereas no nodes or tumor deposits smaller than 5 mm were detected. The spatial resolution limitations of FDG-PET were responsible for 16 of 20 (80%) false-negative PET results in lymph nodes.Conclusions FDG-PET is a useful tool for preoperative evaluation of the neck because it accurately detects metastatic lymph nodes ≥10 mm and has fewer false-positive cases than CT. The high specifi city of FDG-PET for lymph node metastases may play an important role in avoiding unnecessary neck dissection