To evaluate neck dissection as an initial treatment for the control of neck metastasis, 141 patients with squamous cell carcinoma of the oral cavity who underwent neck dissection were examined.
Eleven (31.4%) of 35 patients who underwent elective dissection had histologically involved nodes, and 60 (56.6%) of 106 patients who underwent therapeutic dissection also had histological evidence of involved nodes. Thus, there were 46 (32.6%) false-positive cases, 11 (7.8%) false-negative cases, and the rate of correct diagnosis for neck metastasis was 59.6%. The five-year cumulative survival for patients without neck metastasis was 85.7%, and the presence of involved nodes reduced the survival rate to 60.4%. Although there was no significant difference in survival rate among patients treated by radical neck dissection (RND), modified RND (mRND), and suprahyoid neck dissection (SHND), patients treated by SHND had a significantly higher incidence of recurrence in the ipsilateral neck than did those treated by RND/mRND. We also found a high prevalence of neck metastases in levels I-III for SCCs of the oral cavity.

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Peripheral squamous cell carcinoma related antigen (SCC), tissue polypeptide antigen (TPA), immunosuppressive acidic protein (IAP), carcinoembryonic antigen (CEA), and antibody-dependent cell-mediated cytotoxicity (ADCC) were measured in patients with oral squamous cell carcinoma (n=44), before and after treatment in order to clarify the clinical significance of these tumor markers.
In this study, SCC, TPA, IAP, and CEA correlated with progression of the disease. Among these tumor markers, IAP showed the strongest correlation with progression of cancer. It seems to be one of the useful markers for cancer screening or monitoring, although the differential diagnosis must include inflammatory diseases. We regard multidisciplinary treatment to be necessary in patients with high TPA levels.

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α-Catenin (α-cat), one of the E-cadherin (E-cad) associated cytoplasmic proteins that forms linkages to the cytoskeleton, regulates the functions of E-cad. Since the expression of E-cad, an intercellular adhesion molecule, has been suggested to contribute to metastasis of the same type of tumor, I hypothesized that the examination of α-cat may also help to evaluate the ability of a tumor to metastasize. In the present study, therefore, the expression of α-cat in oral squamous cell carcinomas (SCCs) obtained by biopsy from 84 patients was examined immunohistochemically with the use of a monoclonal antibody. The relationship between the staining patterns for α-cat and clinicopathological findings was analyzed and compared with that for E-cad.α-Cat showed circumferential staining and/or cytoplasmic staining in SCC cells, while E-cad showed circumferential staining. The expression of α-cat and E-cad was classified as follows: 1) positive, almost all cells were strongly stained and the staining was equivalent to that in normal oral squamous cells; 2) weakly positive, some cells were stained, but the remaning cells were not stained or were weakly stained. 3) negative, almost all cells were not stained. The incidence of metastasis to regional lymph nodes in cases negative for α-cat was significantly higher (66.7%) than that in the combined total of positive and weakly positive cases (23.3%)(p=0.0005). Moreover, the survival rate differed significantly between negative (64.3%) and weakly positive cases (91.3%), as well as between weakly positive and positive cases (100%)(p<0.05). As for E-cad expression, the incidence of metastasis and the survival rate in negative cases were similar to the results obtained for α-cat expression in this study. However, 69%(58/84) of the cases showed weakly positive staining for E-cad, and the incidence of lymph node metastasis in this group was 37.9%(22/58) which was similar to that in all 84 cases (30/84, 35.7%). The results suggests that the rate of lymph node metastasis could not be accurately estimated in more than half of the patients. By additionally performing α-cat staining, α-cat negative cases among weakly positive cases for E-cad were found to have a significantly higher incidence of lymph node metastasis than the combined total of weakly positive and positive cases did (p=0.0423).
In conclusion, the combined examination of α-cat and E-cad expression in oral SCC yields useful information concerning regional lymph node metastasis and prognosis.

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Seven patients with metastatic mandibular tumors are described. The primary tumors in these patients included papillary carcinoma of the thyroid gland, adenocarcinoma of the lung, large cell carcinoma of the lung, osteosarcoma of the tibia, adenocarcinoma of the stomach, neuroepithelioma of the lumbar dura, and adenocarcinoma of the colon. Five patients were older than 60 years of age and 2 were younger than 20 years. In 5 patients metastatic mandibular tumors were confirmed histologically, and in 2 patients metastasis to the mandible was diagnosed radiologically and clinically. Four tumors had metastasis to the mandibular gingiva and 3 had metastasis to the mandibular bone.
Teeth and inflammation of the gingiva were considered to have crucial effects on the development of gingival metastasis. The most common symptoms of gingival metastasis were gingival lumps and swellings resembling an epulis and periodontitis.
Mandibular bone metastasis was noted in the ramus of the mandible. The most common symptoms of mandibular bone metastasis were pain of the mandible and paresthesia of the mental nerve.
Surgical removal was indicated for the metastatic gingival tumors and radiotherapy was the treatment of choice for the mandibular bone metastasis.
The outcome of the patients with metastatic mandibular tumors was very poor: 6 patients died within 6 months, and 1 patient died 7 years and 2 months after treatment.
As the treatment of metastatic mandibular tumors generally carries a poor prognosis, the patient's quality of life (QOL) should be considered when planning treatment.

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One hundred nineteen patients with obstructed abscesses in the oral and maxillofacial region were studied bacteriologically.
Isolates of Streptococcus were identified in detail, and their antimicrobial susceptibilities were assessed. The bacteriologic results suggested that the Streptococcus milleri group including Streptococcus constellatus was the most frequently isolated species of the genus Streptococcus. As for the results of antimicrobial susceptibility, no bacteria was resistant to β-lactam agents. However, we recognized various susceptibity patterns to cephems. Almost all isolates of Streptococci showed good susceptibility to erythromycin, minocycline, and clindamycin, but a few were resistant to these agents. Levofloxacin was less active than other agents.

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The purpose of this study was to examine differences in the effects of the intraamniotic administration of physiological saline between a hysterotomy group (exo utero) and an extrauterine injection (in utero) group. We also checked for variant rugae in mouse embryos in which cleft palate did not develop.
On day 12 or 13 of gestation, 2μl of physiological saline was injected into the amniotic cavities of pregnant mice, either by hysterotomy or by extrauterine injection. The embryos were removed from these mice 18 days later.
The embryo survival rate was low in the hysterotomy group. It was therefore not possible to examine the incidence of cleft palate and variant rugae in this group. The incidence of cleft palate and variant rugae in the extrauterine injection group differed significantly from that in the untreated control group. The results indicate that extra-uterine injection is recommended for intra-aminiotic administration of test compounds in toxicological studies. The features of variant rugae differed largely depending on the gestational age at which surgery was performed. This may be useful as an indicator of teratogenicity.

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A rare case of acinic cell carcinoma originating from the submandibular gland that was associated with lung metastasis is reported. A 56-year-old man was treated by surgery and postoperative radiation therapy; however, lung metastasis was found 3 years and 11 months after initial treatment. This case was retrospectively discussed in this paper.

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We report a case of intra-osseous carcinoma arising from a mandibular cyst. An 81-year-old woman visited our hospital because of a right mandibular swelling. Radiographic examination showed a multilocular radiolucent lesion and bone expansion, extending from the midline to the right mandibular angle. The clinical diagnosis was a mandibular cyst and marsupialization was performed. The histopathological specimen showed a cyst wall with an epithelial layer and connective tissue. After marsupialization, the swelling and the radiolucent area of the mandible decreased. However, about 7 months later, the mesial region of the lesion became swollen again, and it was biopsied. At that time, we obtained a pathological diagnosis of squamous cell carcinoma.
Marsupialization does not permit histopathological examination of all sites of the lesion. Therefore, when it is performed for large mandibular cysts such as in our case, we should consider the posibility of an intra-osseous carcinoma arising from the lesion.

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We describe a patient with tongue squamous cell carcinoma (T₂N₁M₀) who had previously undergone coronary artery bypass grafting because of angina pectoris. The patient was a 75-year-old woman.
Typical symptoms of ischemic heart disease are ofter indistinct or not noticed in elderly patients with low daily activity levels. It is therefore important to non-invasively screen patients scheduled to undergo surgery; such screening should be performed as soon as possible. Ideally, early surgery for cancer should be performed to increases chances for cure. Early surgery was difficult in this patient because of the long time operation and the high risk of uncontrollable hemorrhage.

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Leiomyosarcoma, a malignant lesion of smooth muscle origin, is rare in the oral region.
A case of leiomyosarcoma of the mandible is reported. A 86-year-old woman was referred to our hospital because of a mass in the mandibular incisor region. A hens' egg-sized, elastic hard tumor was found in the mandibular incisor region. Leiomyosarcoma was diagnosed on histopathological examination of a incisional biopsy specimen. Surgical resection was not performed because the tumor showed evidence of extensive invasion and the patient refused surgery. Radiation therapy (40 Gy) and chemotherapy with cisplatin and caffeine were administered. The growth of the tumor was apparently suppressed. However, the patient died 34 months after presentation.

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Synovial osteochondromatosis may occur secondarily to trauma, which causes the connective tissue of the synovial membrane to undergo metaplasia and change to cartilage.
A 54-year-old woman presented with pain in the left temporomandibular joint (TMJ). She reported that she had sustained TMJ trauma by a blow about 35 years previously. Arthrography, CT scan, and MRI showed that the lesion extended to the interior, anterior, and posterior regions of the left TMJ. This case was treated by selected tumor removal with condylectomy.

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A case of odontogenic maxillary sinusitis with many antroliths is reported. A 52-year-old woman was introduced to our hospital for evaluation of an abnormal image on an X-ray film. Computed tomography showed a calcified mass in the right maxillary sinus and thickening of the antral mucosa. Under a clinical diagnosis of odontogenic maxillary sinusitis with antroliths, Caldwell-Luc operation was performed. On opening the right maxillary sinus, turbid and yellow fluid containing many stones shaped like polyhedrons was found. The 47 stones consisted of Ca, P, Mg, Na, S, I, K, Al, and the main component was CaPO₄.

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We report a case of atypical necrotizing lymphadenitis. Necrotizing lymphadenitis has a characteristic clinical pattern of lymphadenopathy of the neck, tenderness of the lymph nodes, fever, and leukopenia. The patient was a 25-year-old man, complaining of only multiple lymphadenopathy in the submental and submandibular regions. The clinical diagnosis was a strong suspicion of tuberculous lymphadenitis or toxoplasmic lymphadenitis because of a positive tuberculin reaction and an elevated antibody titer to Toxoplasma. These lymph nodes were excised and necrotizing lymphadenitis was diagnosed histopathologically and immunohistochemically.

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We report on patient with progressive systemic sclerosis (PSS) who had osseous resorptive changes of the mandibular condyles and angles with induration and atrophy of the adjacent soft tissue. The patient was a 51-year-old woman who had a history of PSS with pulmonary fibrosis for approximately 18 years and had been treated with corticosteroid and oxygen therapy. In addition, tightness of the facial skin, mimic muscles, and masticatory muscles with a mask-like face, classic features of PSS, were seen. There was also limited opening mouth due to microstoma and pain of the temporomandibular joint, with the interincisal distance being 22mm. A panoramic radiograph showed erosion of the condyles and significant resorption of the bilateral mandibular angle and ramus in the region of the insertion of the masseter and medial pterygoid muscles. CT images also revealed marked erosion of the mandibular angles, without destruction of the cortical bone. Anterior displacement of the bilateral disk, rupture of the right disk, and decreased marrow signal intensity of the right condyle on T 1-weighted MR images of the temporomandibular joint were also present. These osseous resorptive changes were suggested to be caused by local pressure from the overlying sclerotic facial skin and the atrophic masseter and medial pterygoid muscles.

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We recently encountered a rare case of posterior disk displacement without reduction of the temporomandibular joint. The disk was successfully repositioned in this case by the pumping manipulation technique.

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Oto-palato-digital syndrome (OPD) is a rare disease. The principal features of OPD are hearing loss, cleft palate, and skeletal dysplasia of the hands and feet.
A one-month-old infant with OPD is descrived. His face showed frontal bossing, hypertelorism, antimongoloid slant of the palpebral fissures, and a broad nasal bridge. The external ears were slightly low-set, and he had conductive hearing impairment. The patient also had a small mouth and glossoptosis with a cleft palate. In general, he had a normal configuration of the fingers, but had giant 2nd toes and left cryptorchidism. Chromosomal studies revealed no abnormalities, and his family history was negative for congenital malformations.

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