The goal of this study was to investigate the effects of various factors on the use of protective stabilization (PS) in patients with cognitive disabilities during dental treatment. An observational, case-control design was used with a case (protective stabilization group or PS group) and a control (usual management group or UM group) to assess a sample of subjects. Forty-eight dental patients were selected from the two groups. Various factors were compared between the groups. The prevalence of patients with profound cognitive disabilities was higher in the PS group (68.7%) than in the UM group (6.2%) (p<0.0001). The odds ratio of using protective stabilization was 6.18 (95% confidence interval, 1.20-31.72) for patients who were prescribed antipsychotic agents. Our results suggest that patients with profound cognitive disabilities and/or prescriptions for antipsychotic medications have more behavioral disturbances during dental treatments and require protective stabilization.

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Endolympathic sac tumor is a rare temporal bone neoplasm, and is considered to be a low-grade adenocarcinoma. Despite its slow growth and low incidence of association with distant metastasis, this tumor often shows aggressive local bone destruction. Herein, we report a rare case. A 52-year-old man with Down syndrome presented with a 6-month history of hemifacial palsy. The initial examination revealed left-sided complete facial nerve palsy. Analysis of the auditory brain stem response indicated deafness on the affected side. The patient had no vertigo or nystagmus. Computed tomography revealed a well-defined osteolytic soft tissue lesion in the left petrous bone. The lesion was seen as a high intensity on both T1-and T2-weighted magnetic resonance images, and showed heterogeneous gadolinium enhancement. The labyrinth was destroyed, and the internal acoustic meatus was indistinguishable. Under a tentative diagnosis of cholesterol glanuloma, transmastoid biopsy was performed. The histopathological diagnosis was endolymphatic sac tumor. The patient eventually underwent removal of the tumor via a trans-middle cranial fossa approach following preoperative arterial embolization. His postoperative clinical course was uneventful, and he was discharged 19 days after the surgery. Although the facial nerve palsy or hearing loss did not recover, no evidence of tumor recurrence has been seen over a postoperative follow-up period of 32 months. A bibliographic review of the clinical/ histopathological characteristics, diagnosis and treatement of endolymphatic sac tumor is presented.

Cases of branchiogenic carcinoma that strictly comply with the diagnostic criteria are rare. Human papillomavirus (HPV)-positive oropharyngeal carcinomas often manifest themselves as large and cystic lymph node metastases with a tiny primary lesion, mimicking branchiogenic carcinoma. We report herein on a case of branchiogenic carcinoma that was considered to be associated with HPV. A 69-year-old man was referred to our department with a 2-week history of right-sided cervical swelling. Computed tomography revealed a multicystic mass measuring 35 mm in diameter in his right neck. The mass contained a small solid region, and a lymph node was seen anteroinferiorly to the cystic mass. Although a fine needle aspiration biopsy showed no malignancy, significant accumulation (SUVmax=5.3) was seen in the solid region of the mass on FDG-PET. We suspected lymph node metastasis, but failed to find a primary lesion with endoscopic and imaging examinations. The patient then underwent a biopsy of the lymph node, which turned out in frozen section analysis to be metastatic squamous cell carcinoma, suggesting cancer of an unknown primary. Conservative neck dissection (levels II-IV) was subsequently performed. The histopathological diagnosis was squamous cell carcinoma arising in a lateral cervical cyst. Immunohistochemically, the tumor was positive for p16, indicating the association with HPV. In order to examine for the presence of HPV-related cancer of the oropharynx, resection and histological examination of the palatine and lingual tonsils was performed, but no malignancy was detected. Under a definite diagnosis of branchiogenic carcinoma, the patient received postoperative concurrent chemoradiotherapy with carboplatin. He has been free from disease for 16 months after treatment. To the best of our knowledge, this is the first case report on a p16-positive branchiogenic carcinoma. The relationship between the carcinogenesis of the lateral cervical cyst and HPV infection is unknown, and remains to be investigated.

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