We retrospectively evaluated the correlation between the clinicopathological features and the clinical course of patients with TxN 0 squamous cell carcinoma of the tongue. From 1987 through 1997, 54 consecutive patients treated at our department were reviewed.
1. Local or cervical recurrence and secondary metastases to the cervical lymph nodes after initial therapy were confirmed in 10 patients (18.5%) and 13 patients (24.0%), respectively. Most cases of secondary metastases occurred within 1 year after therapy. As for tumor size, a higher frequency of recurrence or metastasis was found in advanced T stage, but there was no significant relation between clinical growth pattern and clinical course.
2. Surgical treatment was mainly performed as initial therapy, and prophylactic neck dissection (PND) was done in many patients (34/54), particularly those with advanced T stage, in combination with primary tumor resection. Although concomitant PND was unrelated to overall survival rate, a high frequency of histological lymph metastases (false positive cases) was observed among patients with T 3 discases (4/9, 44.4%).
3. Secondary metastases to the cervical lymph nodes occurred mainly in the upper neck (levels I, II). There was no significant correlation of multiple metastases, or extranodal spread with outcome.
4. Biopsy specimens obtained before initial treatment were histologically evaluated according to two morphologic criteria, differentiation (DIF) and structure (STR). Both criteria yieldcd significantly higher average scores in patients with secondary metastases than in those with a good clinical course. In patients with recurrence, only the average DIF score differed significantly. Furthermore, despite small primary lesions, high grade malignancy (DIF+STR ≥6) was almost consistently associated with secondary metastases to the cervical lymph nodes (four cases of stage T 1). Our results do not necessarily demonstrate a clear correlation between clinical stage and histological grade of malignancy. Further studies should assess the true grade of malignancy and indications for prophylactic neck dissection on the basis of both clinical and histological prognostic factors.

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Recently, tumor markers have been used in diagnosis and assessment of treatment outcome. However, low concentrations of tumor markers are detected in patients with nonmalignant diseases and in healthy subjects. The purpose of this study was to clarify the clinical usefulness of urinary 6-HMP concentrations in the diagnosis of oral cancer. The 6-HMP concentration was measured in patients with oral cancer and those with nonmalignant diseases. In patients with nonmalignant disease, the presence of acute inflammatory diseases correlated with markers of infection. In addition, the usefulness of a combination assay with urinary L-fucose for the diagnosis of oral cancer was evaluated. The results are summarized as follows. 1. Increasing urine volume to 50μ 1 enhanced the sensitivity of the method, and the normal range of urinary 6-HMP concentration was less than 0.079μg/ml in 89 healthy subjects. 2. The sensitivity, specificity, and accuracy of the method in patients with oral cancer were 69.8%, 60.5%, and 63.3%, respectively. 3. In patients with systemic infections, the concentration of 6-HMP correlated with WBC, ESR, and CRP (r<0.01), but it did not correlate with these markers of inflammation in patients with head and neck infection. 4. The positive rates of urinary 6-HMP and urinary L-fucose were 77.1% and 51.1%, respectively, in the combination assay, with urinary L-fucose in 35 patients with oral cancer. With the cornbination assay, the positive rate was enhanced to 82.9%. These results suggest that the measurement of urinary 6-HMP levels provides a useful tumor marker in the diagnosis of oral cancer.

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Hyperthermia has been used to treat cancer. However, hyperthermia has been shown to suppress skin-associated immune responses. To examine the effect of heat on immunologically responsive cells in oral mucosa, mouse tongue was heated by an implant heating system at 43°C for 20 min. The densities of Langerhans cells and Thy-1 positive cells in mouse lingual epithelium rapidly increased after treatment and then returned to a normal level after 7 days. Light microscopy confirmed that Langerhans cells in the tongue epithelium formed clusters with lymphocytic cells, suggesting an active immune response to hyperthermia.

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Schwannoma is an uncommon tumor of the oral and maxillofacial region.
Twenty-nine patients with benign solitary schwannoma of the oral and maxillofacial region are described. These tumors showed no strong predilection for either sex. The tumor occurred in patients 12 to 67 years of age; the average age at diagnosis was 38 years. The tongue is the most commonly affected site in the oral cavity. Degeneration or bleeding of the tumor was observed in 19 patients. Twenty-nine cases of the tumor were encapsulated. There was no recurrence or malignant transformation in 19 patients observed from 2 to 213 months.

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Cervical auscultation (CA) is frequently used to clinically assess dysphagia. CA can distinguish respiratory and swallowing sounds in dysphagic patients from those in normal subjects. This study was done to evaluate the accuracy of CA.
Thirty-seven patients with head and neck cancer were studied. Respiratory and swallowing sounds were detected by two accelerometers and recorded on VHS tape with videofluorographic (VF) images.
Forty-four sound samples were edited and presented to six examiners through headphones. Each sound sample included expiratory sounds before swallowing, sounds produced by swallowing 5 ml barium, and expiratory sounds immediately after swallowing.
Without referring to VF images, each examiner evaluated and classified the sound samples into one of five categories: normal (N), acceptable (Ac), residue (R), penetration (P), and aspiration (A).
To evaluate the accuracy of CA, we assessed the rate of agreement between auditory evaluation and VF images.
The following results were obtained:
1. The average accuracy was 55.3%, but the agreement rate of auditory evaluation with VF images within an error of one category averaged 79.5%.
2. When N and Ac were regarded to have no dysphagia, and R, P, and A were regarded to have dysphagia, the agreement rate between auditory evaluation and VF images averaged 83.5% in the two groups.
3. The agreement rate of A with coughing averaged 89.6%, and the agreement rate of A without coughing averaged 34.8%. However, the agreement rate of auditory evaluation of A without coughing with VF images averaged 76.5% for dysphagia. These results show the effectiveness of CA as a clinical tool for diagnosing dysphagia.

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We compared naso-esophageal (NE) tube feeding with naso-gastric (NG) tube feeding in 30 postoperative inpatients.
Although the time required for NE tube feeding was much shorter than that required for NG tube feeding, no diarrhea occurred as a side effect. Early after the start of NE tube feeding, abdominal distention was reported in 3 patients, and nausea was reported in 1.
Our findings show that NE tube feeding is a good method for patients undergoing oral surgery.

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To investigate the relation between disc displacement of the temporomandibular joint and skeletal structure, 85 patients with jaw deformity were examined by magnetic resonance imaging with respect to disc position and cephalometric analysis.
Disc displacement was found in 48 (61 joints) of 85 patients. No significant correlation was found between the presence of disc displacement and the results of cephalometric analysis, except for the perpendicular distance from the facial midline to the mental spine (p<0.01). These results indicate that mandibular asymmetry might affect the prevalence of disc displacement of the temporomandibular joint on the deviated side.

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One hundred ten cases of odontogenic tumors histologically diagnosed according to the WHO classification (1992) were clinicostatistically evaluated at our clinic over the 23-year period from 1973 to 1996.
The subjects consisted of 55 men and 55 women 40 to 80 years old.
Histologically, the 107 benign tumors comprised 37 ameloblastomas, 36 compound odontomas, 20 complex odontomas, 4 calcifying odontogenic cysts, 3 odontogenic fibromas, 3 odontogenic myxomas, 2 ameloblastic fibro-odontomas, 1 adenomatoid odontogenic tumor, and 1 benign cementoblastoma. The 3 malignant tumors consisted of 2 primary intraosseous carcinomas and 1 malignant ameloblastoma.
Most of the ameloblastomas occurred in the posterior portion of mandible, and many odontomas occurred in the incisor region of both the maxilla and the mandible.
All tumors were treated surgically, and various of procedures were used.
All three odontogenic carcinomas spread extensively throughout the mandible. There has been no evidence of disease in one patient, one patient died of the oral carcinoma, and the other patient died of lung metastasis.

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Radial forearm flaps are often used for reconstruction after the removal of oral cancer. Since the flap is relatively thin and flexible, it is very useful for covering of shallow open defects. However, a relatively conspicuous scar and skin depression remain at the donor site after grafting of split thickness skin. The lateral upper arm free flap is similar to the radial forearm flap, but offers a distinct advantage in that the donor site defect can be closed directly. We used a lateral upper arm free flap to repair intraoral defects in two patients. The first patient had squamous cell carcinoma of the buccal mucosa. A defect of the buccal and lower gingival region was reconstructed with a lateral upper arm free flap. The second patient had a malignant myoepithelioma of the hard palate, and the defect of the maxilla was reconstructed. The post operative course of both patients was good. There was no flap loss, and each donor site of the upper arm was closed with a linear scar, without any limitation of mobility.

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A case of tongue carcinoma metastasizing from esophageal carcinoma is reported. A 50-year-old man drank and smoked neavily since he was 30 years old. Alcoholic liver cirrhosis and esophageal varices were diagnosed at the age of 47 years. Esophageal carcinoma was also diagnosed in May 1999, when he was 50 years old. Soon after that, he noticed a mass at the right edge of the tongue. It was removed, and the histopathological diagnosis was undifferentiated carcinoma metastasizing from the esophagus. Metastases to the brain, lung, pancreas, trochanter major, and eyes were found subsequently, and he died of multiple organ failure and cancerous cachexia on September 6, 1999. To our knowledge, few reports have been published on carcinoma of the esophagus metastasizing simultaneously to the organs described above.

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We encountered a rare case of malignant lymphoma arising bilaterally in the lower jaw. The patient was a 83-year-old man who had a swelling on the left side of the mandible and ulceration on the right side of the mandibular gingiva. Computed tomography and magnetic resonance imaging revealed that the mass in the left side of the mandible was located in the center of the bone. Bone destruction was present in part of the buccal cortex bone. The lesion in the right side of the mandible was located in the gingival submucosa and presented no evidence of bone destruction. Histopathological examination of both lesions indicated malignant lymphoma of diffuse large B cell type. There were no abnormal findings in other regions. The patient underwent radiotherapy, and has been under observation for 8 months, without recurrence.

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A melanotic neuroectodermal tumor of infancy (MNTI) is a rare tumor that usually occurs in infants younger than 1 year of age. It is usually benign, only a few reported cases were malignant. MNTI occurs mainly in the maxilla, but can occur in other parts of the skull, the mandible, brain, epididymis, uterus, and mediastinum. To our knowledge, about 10 cases have been reported in the Japanese literature, and most of them arose in the maxilla. We report a case of MNTI arising in the mandible in a 3-week-old boy. Wide resection of the mandible, including the tumor, was performed. The patient has made an uneventful recovery, and there has been no sign of recurrence or metastasis after surgery.

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We report a case of myoepithelioma arising in the left mandibular notch, between the temporal and the masseter muscle.
A 37-year-woman visited our Department of Dentistry and Oral Surgery because of gradual swelling of the right cheek and trismus of 2 months' duration. A panoramic radiograph showed a radiopaque circumscribed lesion between the coronoid and the articular process. A computed tomographic examination clearly showed a large mass involving the exo-lateral and posterior parts of the coronoid process. The mass was 20mm in diameter. Total enucleation of the mass was performed via the oral cavity with an ostectomy of the coronoid process under general anesthesia. The mass was diagnosed histopathologically as myoepithelioma, which had not been suspected. Given that myoepithelioma generally where glands are located, we believe that occurs the tumor arose from an ectopic salivary gland and developed at its unique location. To our knowledge, no report has previously described a myoepithelioma arising in the same region as ours, including those on pleomorphic adenomas, from which myoepithelioma was distinguished in the revised WHO classification in 1991. We therefore present this rare case with some comments.

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In this article, a recent case of extramedullary plasmacytoma originating in the left maxillary sinus is reported. The patient was a 67-year-old man who presented with swollen gingiva in the left maxillary molar region. Under a suspected diagnosis of malignant tumor of the maxillary sinus, a biopsy was performed. Extramedullary plasmacytoma was suspected. Hematological examination revealed MP (+) of IgG (λ) type. In addition, BJP (-) was indicated by urinalysis. On the basis of the results of whole body autoradiographic examination, plasmacytoma originating in the maxillary sinus was finally diagnosed. Partial excision of the maxilla and postoperative irradiation were given as treatment. The patient's progress has been good.

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Osteochondromas are outgrowths from the epiphyseal regions of bones, particularly the lower end of the femur and upper end of the tibia. In the jaws, solitary growths occur in the coronoid process of the mandible and in the mandibular condyle.
An unusual case of osteochondroma of the mandibular fossa is reported. The patient was a 63-year-old man with recurrent luxation of the temporomandibular joint who had malocclusion, but symmetry of the mandible. A radiographic examination showed a well-circumscribed ovoid radiopacity in the left temporomandibular joint space. Computed and three-dimensional tomographic scans showed a loose body between the left mandibular fossa and the condylar head. On MR imaging, the loose body was found to be chondroid tissue, and the disk was dislocated anteriorly.
Histological examination revealed a cartilage-capped overgrowth with cartilageous ossification, which had apparently arose in the left mandibular fossa.
The patient was followed up for 1 year 3 months. There was no tumor recurrence or temporomandibular joint disorder.

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Lipoma is a benign tumor derived from adipose tissue and may arise from any site where fat cells exist. We describe a very rare case of lipoma with bone and cartilage formation in the submental region.
A 61 year-old woman was admitted to our hospital because of submental swelling. The lesion was diagnosed preoperatively as a lipoma based on the clinical and computed tomographic findings. A histopathological diagnosis of lipoma was made on examination of a biopsy specimen. The tumor was easily enucleated under general anesthesia. Histopathological examination of the surgical specimen showed a lipoma with bone and cartilage formation. The postoperative course was uneventfull, and there has been no recurrence as of 32 months after operation.

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Amyloid is defined as a pathologic fibrous proteinaceous substance which, when deposited between the cells of tissues and organs, leads to various clinical conditions. Immunohistochemistry has allowed for better classification and understanding of the pathophysiology of amyloidosis.
A 70-year-old man was referred to our department because of spontaneous purpura of the skin and hematoma of the oral mucosa. There was no chemical or hematologic abnormality on routine examination. Bence Jones protein was positive in the urine. Bone marrow examination, however, revealed an slightly increased proportion of plasma cells. It was unlikely that the Bence Jones protein was associated with multiple myeloma. Skin biopsy revealed depositions of amyloid, and Congo red stain for amyloid was positive. In addition, immunofluoroecent staining resulted in a diagnosis of AA amyloidosis.
The patient was treated with a combination of colchicine, melphalan, and prednisolone; however, 7 months after initial presentation he died of cardiac failure. Autopsy revealed multiple-organ vascular amyloidosis, and a diagnosis of bullous amyloidosis was made.

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