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Background: Jaw pain and trismus are common clinical symptoms among temporomandibular disorders (TMD) patients. These symptoms by a reason other than TMD may puzzle clinicians. Chronic dental infection can provoke the symptoms. Cancer is a rare cause but serious scenario. This report analysed 4 cases presenting TMD-like symptoms: two with chronic dental infections and two with malignancies. Objectives: This report stresses the importance of differential diagnoses of TMD with imaging diagnostics. Methods: The four patients were initially diagnosed with TMD and referred to TMJ clinic.Chronic dental infections: Case 1 and Case 2 with jaw pain and trismus without response to TMD treatment.Malignancies: Case 3 and Case 4 with progressive symptoms in spite of TMD treatment. Findings: Chronic dental infections -computed tomography (CT) scan revealed infection of dental origin into the infratemporal space in Case 1, and postsurgical infection of infra-masseteric space secondary to maxillary dental extraction in Case 2. Surgical drainage and antibiotics successfully resolved the symptoms in both cases.Malignancies -magnetic resonance imaging and/or CT scan disclosed a destructive mass in the condyle in Case 3, and in Case 4 a large cancer mass occupied the sinus and spreading into the adjacent structures. Pathologic examination confirmed lung metastatic adenocarcinoma in Case 3 and squamous cell carcinoma in Case 4. Both patients underwent chemoradiation, but passed away after four and six months, respectively. Conclusion: It is indispensable that oral surgeons be on the alert to symptoms mimicking TMD. Once any underlying disease is suspected, advanced imaging diagnostics should be considered immediately.

Although pleomorphic lipoma may contain a small number of atypical cells and resembles an atypical lipomatous tumor histologically, it is a tumor characterized by a clinically benign course. Pleomorphic lipoma typically arises in the posterior cervical region, shoulders, and back, with relatively few reported cases of the tumor in the oralmaxillofacial region. We report on a 60-year-old man with a pleomorphic lipoma that developed from the neck to the submandibular region and was left untreated for more than 40 years because the patient was asymptomatic. The tumor was removed together with its fibrous capsule. Twenty months after surgery, the patient remains recurrence-free and has a good clinical course. Among 39 reports of this tumor in Japan that we searched this time, only one case similat to ours was reported, but reports of pleomorphic lipoma arising in the cervical region are rare in Japan. : pleomorphic lipoma (多形性脂肪腫) ，floret cell (花冠状細胞) ，submandibular region (顎下部) 1) 名古屋掖済会病院歯科口腔外科 (主任：足立守安部長) 2) 愛知学院大学歯学部顎口腔外科学講座 (主任：栗田賢一教授) 3) 静岡県立総合病院歯科口腔外科 (主任：林 尚徳主任医長) 1)

22 q 11.2 deletion syndrome is a genetic disease associated with a high rate of various psychiatric disorders in addition to multiple physical diseases. This case report suggested that a multidisciplinary team approach is important for perioperative management of patient with 22 q 11.2 deletion syndrome.