Various cutaneous flaps have been used to reconstruct intraoral defects created by tumor resection. Transplanted cutaneous flaps clinically show changes such as color changes and scaling. To better understand the biological conditions of reconstructed flaps that survive in the intraoral environment, patients in whom various periods had passed since reconstruction operations were clinically observed, and biopsy specimens taken from their flaps were examined histologically, histochemically and immunohistochemically.
Seventeen major flaps, including delto-pectoral flaps, pectoral major myocutaneous flaps and forearm flaps, were used to reconstruct intraoral defects remaining after the resection of oral cancer. Irradiated flaps were excluded. Biopsy specimens were taken from both the mid-portion of each flap and the junction between the flap and the surrounding oral mucosa. Histological, histochemical and immunohistochemical examinations were performed as follows. A formalin-fixed specimen was dehydrated and embedded in paraffin. Hematoxylineosin, periodic acid-Schiff with and without diastase digestion, and alcian-blue were used to stain the deparaffinized sections of the specimens. The deparaffinized sections also underwent N-(7-dimethylamine-4-methl-3-coumarinyl) maleimide (DACM) staining to examine the distribution patterns of SH groups and SS linkages of cellular proteins in the epidermis. Immunohistochemically, frozen sections were first cut in a cryostat and stained with monoclonal antibodies. Anti-hair keratin monoclonal antibodies (HKN-2, 4, 5, 6, 7), anti-basal cell epithelioma keratin monoclonal antibodies (BKN-1), K92, and RKSE60 were used.
The clinical features of cutaneous flaps seemed to depend on their location in the oral cavity rather than the period since operation or the kind of flap. Although the horny layer of the epidermis of the flaps showed thinning histologically, the epidermis showed a normal pattern of SH to SS conversion by DACM staining histochemically, as well as normal keratin expression by keratin staining immunohistochemically. The tongue epithelium adjacent to the flaps often showed flattening. Some specific keratins of the tongue epithelium were still recognized but hard keratin was not. Although cutaneous flaps may be influenced by environmental factors in the oral cavity, the flap tissues seem to retain their original cell differentiation.

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Tow hundred eleven patients with previously untreated squamous cell carcinoma of the oral cavity were treated with preoperative chemotherapy followed by definitive surgery between April 1976 and March 1990. A 12.8%(27/211) rate of histologically complete response was achieved. Patients who achieved a histologically complete response had a better 5-year cumulative survival rate than patients who were histogically positive for tumor in the surgically resected specimens (88.3% vs. 61.0%, p<0.025). Clinical and pathological pretreatment characteristics were analyzed to identify factors predictive of a histologically complete response. The malignancy grading was evaluated based upon three different morphological characteristics for tumor cell populations (type of differentiation, cellular atypism, mitotic index) and two characteristics for the tumor-host relationship (mononuclear inflammatory infiltrates, mode of cancer invasion). Negative histology in the surgically resected specimen was significantly correlated with the histological malignancy score (p<0.0001) as well as the T class (p<0.01). These results suggest that special consideration should be given to the histological malignancy score in addition to clinical manifestations in assessing the effect of preoperative chemotherapy and in the surgical treatment of oral squamous cell carcinoma.

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From April 1989 through March 1994, fine needle aspiration biopsies (FNAB's) were performed preoperatively in 43 patients with salivary gland masses (29 parotid, 12 submandibular, 2 sublingual) at the Department of Head and Neck Surgery, Aichi Cancer Center. Of the 43 salivary gland masses aspirated, 9 were malnant and 34 were benign. The sensitivity for FNAB in this study was 88.9 %. Among 9 malignant tumors, 6 were positive for malignancy, on FNAB, 2 were suspicious, and 1 was negative. The specificity was 94.1%, and the accuracy was 93.0 %. These results indicated that FNAB was a highly sensitive and specific screening procedure.
In salivary gland tumors, which were often morphologically heterogeneous, it was a disadvantage that FNAB specimens could derive cells only from a small area. However, this procedure was rapid, safe and relatively painless. Therefore, FNAB can be considered to be a simple, useful method for the initial screening diagnosis of salivary gland masses.

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We have previously reported an exact three-dimensional repositioning technique for external ramus fragments in sagittal split ramus osteotomy using screw fixation. Eighteen patients with mandibular prognathism who underwent sagittal split ramus osteotomy were studied. In one-half of these cases, a circumferential wire fixation (circum group) was performed, and in the other half a screw fixation with this repositioning technique (screw group) was used. These cases were studied with regard to preoperative, postoperative and one-year postoperative changes in lateral roentogenographic cephalometry. The following results were obtained: 1. There was no clockwise rotation of external fragments in the screw group. 2. Internal fragments relapsed anteriorly in the circum, group. 3. At one-year postoperative follow-up, the mandibular length relapsed 15% in the circum group and 4 % in the screw group.
It was suggested that this repositioning technique is effective for preventing postoperative relapse.

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In the field of oral surgery, mandibular resection is often required in patients with various mandibular lesions. Though immediate reconstruction after mandibular resection is desirable to maintain function, mandibular resection should be approached not only in terms of function but also esthetics, i.e., reproduction of facial features. Reconstruction has been performed using autologous bone and various medical artificial materials, but there are no established methods for facial reconstruction.
Since 1987, we have produced 3-dimensional mandibular models based on 2-dimensional CT images taken before surgery for patients in whom marked deformation is expected after mandibular resection. Casting titanium plates are designed using this 3-dimensional model, casted, and used for mandibular reconstruction.
In this study, we report this method and the clinical course and problems of 6 patients treated by this method between 1987 and 1989.
Esthetically, good results were generally obtained after segmental resection. In patients in whom a large amount of soft tissue was resected, or in whom the plate width was short, depression in the skin developed. Concerning mastication function, this method accurately restored the remaining bone and allowed good occlusion on the normal side. These may be important conditions for functional recovery. MKG showed a mandibular movement pattern in which the affected side follows the normal side in patients with extensive invasion to the masseter muscle. This suggested the need for the early initiation of movement practice.

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We report 4 patients who underwent postoperative chemotherapy with CDDP and DTICfor oral malignant melanoma. These patients initially underwent surgical excision of the primary lesions and neck dissection. Multiple regional lymph node metastases were confirmed pathologically in 3 cases. The chemotherapy was performed approximately 4 weeks after surgery. CDDP and DTIC were given daily for 3 days atdoses of 35-50mg/m² and 250-350mg/m², respectively. Thisregimen was performed twice at an interval of 3 or 4 weeks. Side effects were mildto moderate gastrointestinal reactions (nausea and vomiting), thrombocytopenia, leukopenia, anemia, and nephrotoxicity. There was no evidence of recurrence or distant metastasis in any case after 33, 26, 24, and 16 months, respectively.

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A case of oral multicentric carcinoma is reported. The patient was a 51-year-old man who presented with a tumorous nodule at the molar region of the left upper gingiva. The tumor was excised and diagnosed histologically to be verrucous carcinoma. Other tumorous lesions successively arose from the upper anterior gingiva, left buccal mucosa, lip mucosa, right upper gingiva, and right buccal mucosa during the next 15 years. Histopathological examination showed these tumors to be squamous cell carcinomas. They were all treated by local exision, and there has been no further reccurrence. Carcinogenesis caused by “field cancerization” or “field origin of tumors” of the oral mucosa was suggested in this patient.

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A rare case of squamous cell carcinoma of the tongue recurring 33 years after initial treatment is presented. A 60-year-old woman had undergone radiation therapy with cobalt implants for a well-differentiated squamous cell carcinoma of the right lateral border of the tongue in March 1960 and radical neck dissection for metastasis to the right cervical lymph nodes in June 1960 at Kyusyu University Hospital. She was referred to our department for evaluation and treatment of a white, lobulated mass of the right tongue dorsum in March 1993, 33 years after initial therapy. The lesion was histologically diagnosed as a welldifferentiated squamous cell carcinoma, and she was successfully treated by total glossectomy, left functional neck dissection, and immediate reconstruction with a free tensor fascia lata flap. Based on histological and clinical findings, this case was considered to be a late recurrence rather than a radiation-induced cancer.

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Mucoepidermoid carcinoma is a neoplasm originating from the salivary glands. The most common location is the parotid gland in the major salivary glands and the palate in the minor salivary glands.
Recently, we encountered a mucoepidermoid carcinoma occurring in the lower lip. The patient, a 43-year-old woman, complained of a mass in the left lower lip. Intraoral examination revealed a soy-bean sized, elastic soft, painless swelling. For treatment, the tumor was surgically removed along with the surrounding tissue. Histopathologically, the lesion was a low-grade mucoepidermoid carcinoma, and the tumor tissue was composed of mucous cells, epidermoid type cells, and intermediate cells.
The prognosis was fairly good after surgical treatment, and there are no signs of local recurrence or distinct metastasis at present.
We reported this case together with a discussion based on the literature.

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We carried out a clinico-statistical study of 75 patients with hemangioma which was treated and diagnosed histopathologically in our clinic during the 13-year period from April 1980 to December 1992.
The results obtained were as follows. The ratio of males to females was 1: 1.5, indicating a higher prevalence in females than in males. The age at first visit ranged from 1 to 85 years, with a mean age of 47.2 years, and 69.9% were above 40 years. The most common age at the onset of symptoms was the sixth decade, while 6 cases had symptoms at birth. The duration of symptoms was within 1 month in 21 cases, and within 5 years in 17 cases. The most common site was the tongue (25 cases), followed by the cheek (24 cases) and the lower lip (13 cases). Lesion size was less than 20 mm in most cases (82.2%). All lesions were excised and histopathologically diagnosed as cavernous hemangioma in 60 cases and capillary hemangioma in 11 cases. Phleboliths were present in 6 cases.

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A rate case of fibrolipoma of the hard palate is reported.
A 52-year-old man complained of a slowly growing, painless mass on the hard palate. The lesion was diagnosed preoperatively as a benign tumor based on the clinical findings as well as the image on CT scan. The density on CT scan was-33 to +12 Hounsfield units. The tumor was excised under local anesthesia and measured 24×18×17 mm. It was composed of mature fat tissue and had a lobulated structure with large bundles of fibrous connective tissue lying intermediately. The pathologic diagnosis was fibrolipoma. No evidence of recurrence has been noted as of 2 years 6 months after operation.

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To examine the general background of patients with oral lichen planus (OLP), 42 patients with OLP were analyzed. Eleven (26.2%) of the 42 patients had a history of blood transfusion. 54.5% of the patients with a history of blood transfusion and 19% of the 42 OLP patients were positive for viral infection with hepatitis B, hepatitis C, or adult T cell leukemia. Moreover, abnomalities of hepatic function were observed in 45.5% of the 11 patients with a history of blood transfusion and 23.8% of all 42 patients. Metal allergy was detected in 14 of the 19 patients with OLP who were tested. Serological examinations, revealed hyperglobulinemia and abnormal complement levels in 64.3% and 57.1%, respectively, of the 42 patients with OLP. These results suggest that OLP might be a symptom of systemic disease associated with immunological abnormality.

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Sialadenosis, characterized by uniform hypertrophy of the acinar parenchyma of the salivary glands, is associated with a variety of systemic diseases of functional disorders.
This paper describes two cases of sialadenosis, a 20-year-old woman with submandibular gland swelling and a 31-year-old woman with parotid gland swelling. Both of them had endocrine disorders that may be associated with anorexia nervosa.

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We report a case of chronic sclerosing sialadenitis in the sublingual gland.
A 34-year-old woman was referred to our hospital for an indolent mass in the sublingual region. No salivary stone nor foreign matter were found. The histpathological diagnosis was chronic sclerosing sialadenitis. Immunological variable, (RA, IgA, IgG, IgM) were within normal limits postoperatively.

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We used high-strength apatite ceramics, consisting of a hydroxyapatite and tricalcium phosphate implant (Ceratite^®). Ceratite^® was used for bone substitution in a patient undergoing genioplasty. Ceratite^® was considered to be a useful material for the surgical treatment of mandibular deformities.

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Lengthening of the hypoplastic mandible by distraction osteogenesis was performed in patients with hemifacial microsomia to correct facial asymmetry. The patients, two girls aged six and nine years, underwent corticotomy and placement of external bonelengthening devices in the affected rami of their mandibles, which were then maintained in fixation for 10 days to allow callus formation. Following this period, the devices were serially lengthened about 1mm per day. The mandibles were thus expanded about 12mm and 19mm, respectively, and were then retained in postlengthening fixation for 3 months. A series of radiographs showed calcified tissue increasing gradually from the ends of the distraction gaps. The gaps were bridged as early as 2 months after the completion of distraction. The bony union between the separated segments was confirmed after removing the devices. There was no evidence of dysfunction of the ipsilateral inferior alveolar nerves. The distraction osteogenesis technique proved very useful for correcting the mandibular deformity of these patients.

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