Among 238 patients with sqamous cell carcinoma of the tongue examined at our clinic during the 12 years between 1981 and 1992, we analyzed 193 who underwent primary radical therapy. The patients were studied with respect to clinical features such as primary lesion, histological malignancy grading, and immunohistochemical characteristics of laminin and Type IV collagen, which are components of the basement membrane. I analyzed the relations between these findings and outcome and studied their usefulness as prognostic factors.
1) Analysis of clinical observations
T 3 and T 4 in the T classification and primary lesions situated in the posterior part and across the median line of the tongue were associated with markedly lower 5-year cumulative survival rates and higher recurrence rates and metastasis rates than the other classes.
2) Evaluation of histological malignancy grading
As for the 5 year cumulative survival rate according to the histological malignancy score, the group with a higher score had a lower survival rate, and the differences between the scores were clearly significant. In addition, the group with the higher score had higher recurrence rates and metastasis rates; consequently, the score reflected the degree of malignancy.
Furthermore, when each classification was analyzed together with the clinical findings, high histological malignancy scores in the T 3 and 4 T classifications and the posterior and across-the-median classifications of the site of the primary lesion on the tongue were associated with lower survival rates. These factors were considered useful in formulating the prognosis.
3) Immunohistochemical study of basement membrane expression
As an indicator of basement membrane expression, the expression of laminin and Type IV collagen, which are major components of this membrane, and the relation to outcome were studied immunohistochemically. As for Type IV collagen, the positive cases had higher 5 year survival rates than the negative cases, but with regard to laminin no significant difference was observed. Cases with negative expression for laminin and Type IV collagen characteristically had high cervical metastasis rates, while those with positive expression for laminin characteristically had high remote metastasis rates.

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Global epidemiological studies have shown that oral cancer is one of the five commonest cancers in males, excluding skin cancer, on the basis of incidence, mortality, and relative frequency data. However, the prevalence of oral cancer varies among different parts of the world and also among different sublocations of the oral cavity. In Japan, deaths from oral cancer account for only 1% to 2% of all cancer deaths. However, the number of deaths and the mortality rate due to oral cancer have increased in recent years.
In the present paper, we report on the epidemiology of oral cancer in Japan. Date used for analysis were mainly derived from the Japanese population statistics from 1950 through 1993, published by the Ministry of Health and Welfare.
The number of annual deaths from “all oral cancers” (lip, oral, oropharyngeal, and salivary gland cancer) showed a 4.5-fold increase (5.2-fold in men and 3.4-fold in women) from 698 to 31554 during the 44 years between 1950 and 1993. The male-to-female ratio also increased from 1.6: 1 to 2.5: 1. The number of deaths increased for all oral cancers excluding lip cancer. Tongue cancer was the most common and contributed to about 40% to 60% of all oral cancer deaths. The crude death rates for men showed an approximately 3.5-fold increase and age-adjusted death rates an approximately 1.5-fold increase during the period between 1950 and 1991. For women, the crude death rates increased steadily (an approximately 2-fold increase in total), while the age-adjusted death rates remained unchanged. In men, the ageadjusted death rates tended to increase for cancers of the oropharynx, salivary gland, floor of the mouth, and gingiva, while it tended to decrease for cancers of the tongue and lip. In women, the same trends were noted as in men, although the changes were smaller. The overall age-specific mortality rates remained virtually unchanged for the age group of 40 to 49 years, but increased in all age groups over 50 years, especially that 65 years or older.
We also attempted to predict morbility and mortality patterns of oral cancers in Japan. The incidence of oral cancers is expected to increase in both sexes, especially in men. Both crude and age-adjusted death rates will increase substantially more in men than in women.

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Chitin has been used as a temporary dressing material for dermal wounds. The properties of chitin for wound repair include hemostatic, analgesic, wound drying, and wound-healing accelerating effects. However, few studies have reported the use of chitin in the oral cavity. In order to investigate the mechanisms of these favorable properties, the influence of chitin on the oral tissue was analyzed as described below. In this study, chitin was tested for its capacity to induce fibronectin production and human gingival fibroblast-like cell (HGF) migration from human peripheral monocytes, and compared with lyophilized porcine dermis (LPDS) and collagen wound dressing (CAS). Fibronectin and HGF chemotactic activity in the supernatants of HGF (FCM) cultured on chitin, LPDS and CAS were examined. Furthermore, macrophage conditioned medium (MCM) was added to HGF culture on each wound dressing material, and the supernatants were examined in a similar manner. Fibronectin production by macrophages was highest when the cells were cultured on LPDS. On the other hand, when MCM was added to the HGF culture on chitin, fibronectin production was strongly induced. When all supernatants were cultured on chitin, HGF chemotaxis was more active than any other material.

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Chitin has been used as a temporay dressing material for dermal wounds. The properties of chitin for wound repair include hemostatic, analgesic, wound drying, and wound-healing accelerating effects. Furtheremore, it has been suggested that wounds treated with chitin have minimal scar formation after healing. However, there have been few studies of the use of chitin in the oral mucosa. In order to investigate the mechanisms of these favorable properties, the influence of chitin on the healing of oral tissue wounds was analyzed as described below. In this study, human gingival fibroblast-like cells (HGF) and macrophages cultured on chitin and other materials, such as lyophilized porcine dermis (LPDS) and collagen wound dressing (CAS), were studied. The growth of human gingival fibroblast-like cells (HGF) and their capacity to induce fibroblast growth factor (FGF) production and, epidermal growth factor (EGF) production in the supernatants of human peripheral monocytes and HGF cultures were analyzed and compared with the results obtained for chitin. Furthermore, macrophage conditioned medium (MCM) was added to HGF culture on each wound dressing material, and the supernatants were examined in a similar manner. HGF growth on each wound dressing material was twice more than control and became confluent for 144 hours. The growth on chitin was the highest of all materials. FGF production by macrophages was highest when the cells were cultured on LPDS. On the other hand, when MCM was added to the HGF culture on each material, FGF production in only LPDS was more than that of control. In the supernatants of HGF cultured on chitin and CAS, FGF production was lower than control. EGF production of macrophages was highest when the cells were cultured on chitin. When HGF was cultured on each material with or without MCM, EGF production was not detected.

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I studied the effects of vitamins on the prevention of cleft palate in A/J mice with the use of an organ culture suspension. Maxillary regions of A/J mouse fetuses (13.5 days) were dissected and cultured in a chemically-defined serum-free medium for 72h.
Each vitamin (β-carotene, vitamin E, folic acid) was added to the medium in concentrations of 0.1, 1.0, and 10μ g/ml.
In the β-carotene groups, the rates of palate fusion were 74.1%(control), 76.2%(0.1μg/ml), 90.0%(1.0μg/ml), and 94.1%(10μg/ml).
In the vitamin E groups, the rates of palate fusion were 53.0%(control), 63.6%(0.1μg/ml), 71.4%(1.0μg/ml), and 80.0%(10μg/ml).
In the folic acid groups, the rates of palate fusion were 60.0%(control), 85.7%(0.1μg/ml), 85.2%(1.0μg/ml), and 100%(10μg/ml).
Significant differences from control were obtained when folic acid was added to the medium in concentrations of 0.1, 1.0, and 10μg/ml.
These results indicate that vitamins, in particular folic acid, have a direct action on the palatal shelves.
Although the mechanism of the effect of vitamins is presently unclear, these results may be useful medically in the prevention of cleft lip, cleft palate, or both.

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We report the following results as we obtained a good outcome with respect to alveolar form and improvement of the nasal septum in primary lip plasty with maxillary surgical correction in 21 patients with unilateral cleft lip and palate.

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In order to three-dimensionally evaluate the morphologic charcteristics of the maxilla in patients with jaw deformities, the accuracy of measurement on three-dimensional images on CT (3-D CT) scans as well as the appropriate CT values for the depiction of the morphologic characteristics of the maxilla were examined. As for the accuracy of measurement of three-dimensional images on CT scans, the difference between the mean value of the measured length and that of the image was 1.5 mm at maximum and 0.4 mm on average.
In addition, no difference was observed in the accuracy of measurements on images taken from the coronal and horizontal directions.
The results suggest that the measurement of distance on three-dimensional images is relatively accurate and efficient for measuring the morphologic characteristics of the maxilla.

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We evaluated glucose metabolism in three patients with oral cancer by Positron emission tomography (PET) using 18 F-fluoro-deoxyglucose (FDG), to investigate the diagnostic usefulness of this method as compared with other imaging methods.
In one case, FDG-PET imaging detected a primary tumor area that could not be detect by other imaging methods. In two cases, quantitative analysis of FDG-PET by using standardized uptake value (SUV) was performed before and after radiotherapy and chemotherapy treatment to evaluate the response to therapy. Both cases showed significant decreases in SUV in their tumors after treatment.

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Thermoradiotherapy has received attention as a new therapy for malignant tumors, and its usefulness has been accepted. This paper describes the use of thermoradiotherapy for an advanced malignant ameloblastoma with lung metastasis; the outcome was good. The case was a 63-year-old man with a tumor in the left side of the mandible and neck. The tumor invaded into the skin at the left side of the neck. Judging from the pattern of tumor invasion, a radical operation was difficult, and thermoradiotherapy was performed. After therapy, the size of the tumor decreased markedly. There has been no evidence of recurrence as of one and a half years after therapy.

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Mucoepidermoid carcinoma is a malignant tumor charaterized by the presence of epidermoid cells, mucus-producing cells, and cells of intermediate type. We report here a rare case of a clear-cell variant of mucoepidermoid carcinoma arising in the left maxillary sinus. A 51-year-old man visited our clinic because of swelling at the left side of the palate and the maxillary region. Magnetic resonance imaging revealed intermediate or high signal intensity on T₁-contrast weighted images in the left maxillary sinus enhanced by Gd-DTPA. Our clinical diagnosis was a malignant tumor in the sinus. Subsequently, a biopsy specimen taken from the left sinus was diagnosed as “mucoepidermoid carcinoma.” Left hemimaxillectomy was performed. Microscopically, the tumor was composed of nests of numerous large clear cells, which stained positively with PAS stain, suggesting the presence of glycogen granules. Some features of mucoepidermoid caricinoma were observed, around the nests. The histological typing of mucoepidermoid carcinoma was therefore clear-cell variant. The prognosis is unclear; we are therefore closely following up the patient.

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A case of lethal neuroleptic malignant syndrome (NMS) occurring after surgery is reported. The patient was a 68-year-old man with schizophrenia who visited us for treatment of a cheek defect resulting from surgery for carcinoma of the maxilla. Speech and swallowing functions had been restored with the use of a denture, but there was leakage of food to the defect. Reconstruction was performed with a forehead flap, with the patient under general anesthesia. Five days after the operation, he began to have a high fever with sweating, hypotension, tachycardia, muscle rigidity, and involuntary movement accompanied by an increase in the serum level of creatinine phosphokinase. The patient was given a diagnosis of NMS. He died of renal failure. Care should be taken to avoid postoperative development of NMS in psychiatric patients.

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Ameloblastoma generally arises in the molar or premolar of the jaw and the mandibular angle, but rarely occurs in the alveolar region.
We report a case of ameloblastoma localized in the mandibular alveolar region.
A 41-year-old woman was reffered to our hospital because of an abnormal color of her gingiva. A dental radiograph showed a radiolucent lesion with a comparatively well-defined border in the interalveolar septum between the right mandibular canine and the first premolar.
Biopsy was performed, and the histopathological diagnosis was ameloblastoma.
Under intravenous sedation, a marginal resection of the jaw was performed at the right mandibular canine and the first premolar region.
There has been no evidence of recurrence as of about one year after operation.

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Osteoma is frequently found in the field of oral surgery. Although most osteomas occur in the maxillary sinus, the condylar head is a rare location for these lesions. The present report describes a case of condylar osteoma. A 47-year-old woman consulted the oral surgery clinic at Kanazawa University on Sept. 19, 1994. Her chief complaint was TMJ discomfort on chewing. Radiographic examination showed osseous hyperplasia at the left condyle. The lesion was resected under general anesthesia on Nov. 15, 1994. Histologic examination revealed that the lesion was an osteoma. The postoperative course was good. Three months after surgery, the patient could open her mouth more than 40mm without discomfort. However, careful follow-up is necessary.

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Lipoma is a benign tumor of non-epithelial origin which may occur almost anywhere on the body. However, lipoma of the parotid gland is a rare tumor, accounting for approximately 1% of all tumors of the parotid gland. We describe a case of lipoma of the superficial lobe of the parotid gland and discuss the usefulness of radiographic imaging.
A 51-year-old woman presented with increasing painless swelling at her right preauricular region. The swelling had increased slowly over a 3-year period. Physical examination revealed a soft mass that was slightly tender on palpation. This tumor was preoperatively diagnosed as lipoma of the parotid gland on the basis of CT scans and MRI. Moreover, Sialogram-CT was useful not only in diagnosis but also in accurately differentiating whether the lesion was an extrinsic or intrinsic tumor of the parotid gland. The tumor was removed surgically, and the histological diagnosis was lipoma.

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A case of CATCH22 syndrome with congenital velopharyngeal incompetence, which is associated with deletions of chromosome 22q11, is reported. The deletions of chromosome 22q11 were detected by fluoresence in situ hybridization (FISH).
The patient had cardiac defects (Ventricular septal defect), an abnormal face, congenital velopharyngeal incompetence and mental retardation.
A speech aid appliance was used to treat velopharyngeal incompetence, and speech therapy was performed for the articulation disorder. Good velopharyngeal closure and speech were obtained.

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Macrostomia arises from anomalies of the first and second branchial arch and often occurs with other anomalies in the external ear, middle ear, temple, maxilla, and mandible. One patient is found among 60, 000 newborns. This syndrome tends to occured preferentially on the right rather than the left side, and bilateral occurrences are rare.
We report a case of macrostomia with obstruction of the jejunum.

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Suppurative arthritis usually occurs by hematogeneous dissemination of an infection localized in some other organ of the body. Much less frequently, bacteria may invade the joint either by direct spread of a neighboring infection or through a perforating injury. We reported an unusual case of suppurative arthritis in the left temporomandibular joint of a 53-year-old woman. The arthritis presented after a certain period after tooth extraction of the left lower 2nd molar tooth, and detachment of the cartilage cap. The joint was surgically removed because of resistance to long-term antibiotic therapy.

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A 81-year-old man was referred for examination of a mass in the mesopharynx. He had been aware of dysphagia and hoarseness for several years. Nasopharyngeal fiberscopic study and CT images revealed a cyst at the root of the tongue, which occupied most of the mesopharynx. Excision of the cyst was carried out. The pathological diagnosis was an epidermoid cyst with relining keratinized squamous epithelium. One year after the operation, there were no signs of recurrence and the patient did not complain of dysphagia or hoarseness.

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