There is no absolute proof of which morphological type of non-invasive cancer develops to advanced cancer.
Traditionally, WHO epithelial dysplasia has been used to pathologically diagnose oral epithelial precursor lesions.
In 2005, squamous intraepithelial neoplasia （SIN1-3） were classified parallel to Head and neck tumours classification of WHO.
In the classification, each corresponds to the following: Mild dysplasia to SIN1, moderate dysplasia to SIN2, severe dysplasia and carcinoma in-situ to SIN3.
Oral cavity was discussed as epithelial precursor lesions, early intraepithelial tumor which differentiation is only seen in the surface area, as well as hypopharynx, larynx, trachea, and oropharyngeal.
In our country, this intraepithelial neoplasia was histopathologically known to some pathologist from the early stage. Mostly this was clinically treated as malignant tumor although there is no unified rule countrywide at the moment.
In 2010, oral intraepithelialneoplasia （OIN）/ carcinoma in-situ （CIS） was enrolled to Japan society for oral tumors as histological classification.
Because there are so many classifications that are discussed currently, people are confused of clinical correspondence, interpretation of each and which ones to use.
Sepsis caused by endotoxemia after surgical invasion is acknowledged to be highly problematic. The relation between endotoxemia during oral and maxillofacial surgery and the clinical symptoms of patients remains poorly understood. In this study, we measured endotoxin activity （EA） levels by EA assay in patients who had undergone surgery and evaluated the relation between the EA levels and grade of surgical invasiveness in patients undergoing oral and maxillofacial surgery. In addition, we investigated other laboratory data relevant to EA levels.
The study group comprised 14 patients who received moderately to severely invasive surgery at the Department of Oral and Maxillofacial Surgery, Kagoshima University Hospital from April 2008 through December 2010. The patients were 4 men and 10 women aged 21 to 88 years （average 64 years） and were divided into two categories based on Kimura’s classification, severely invasive surgery （10 patients） and moderately invasive surgery （4 patients）. We measured EA levels at least three times, i.e., before, during, and after surgery and analyzed the relations of EA levels to the grade of surgical invasiveness, WBC （/μl）, CRP (mg/dl）, LDH （U/l）, and PNI.
The EA level during surgery was 0.25 ± 0.20 in the severely invasive surgery group and 0.17 ± 0.08 in the moderately invasive surgery group. Increases in EA levels were detected in 3 patients （0.4-0.59） in the severely invasive surgery group, 2 of whom developed postoperative infections at the surgical site. There was no correlation between EA levels of patients undergoing severely invasive surgery and those undergoing moderately invasive surgery. There was also no correlation of EA levels with surgical duration, bleeding volume, CRP level, or preoperative PNI level, although there was a tendency for EA levels to increase as the preoperative PNI level decreased.
In this study, there was no correlation between EA levels and the grade of surgical invasiveness in the oral and maxillofacial region, indicating that these surgical procedures do not provoke the proliferation of gram-negative bacteria or cause bacteremia. We could not demonstrate the usefulness of EA levels as a marker of inflammation. However, some patients who were malnourished preoperatively showed moderate elevations of EA levels during surgery. Therefore, our findings suggest that perioperative nutritional monitoring is important for preventing postoperative infection.
Although many studies on have reported, bisphosphonate-related osteonecrosis of the jaw （BRONJ） the pathogenesis of BRONJ remains unclear, and appropriate approaches for treatment have not been established to date. The prevention of BRONJ is thus the most important strategy. Invasive dental procedures including tooth extraction are considered one of the most crucial risk factors for BRONJ. Therefore, it would be beneficial to establish a safe method for tooth extraction in patients receiving bisphosphonates （BP） to avoid BRONJ.
We performed 232 extractions in 106 patients treated with oral BP and evaluated their postoperative courses retrospectively. BP was orally administered to 69 patients with osteoporosis （65％）, 13 with RA （12％）, and 5 with SLE （5 ％）. Thirty-four patients （32％） were receiving steroids, 12 （11％） were receiving immunosuppressants, and 7 patients （7 ％） had diabetes mellitus （DM）. Oral BP was used for more than 3 years in 32 patients（30％）. In all patients, extraction sockets showed wound closure without bone exposure within 8 weeks, followed by normal epithelization within 11 weeks after extraction. No case of BRONJ developed. However, 10 patients showed delayed healing with bone exposure in sockets 4 weeks after extraction. We examined the relations of various clinical factors （age; type, duration, and temporary withdrawal of BP; risk factors; anti-inflammatory treatment before extraction; location and type of extraction） to delayed healing. Only the risk factors of steroids, immunosuppressants, and DM were found to be significant independent factors related to delayed healing. Steroids appeared to be one of the most important risk factors for delayed healing. Our results indicate that we should pay more attention to patients receiving oral BP for the treatment and prevention of glucocorticoid-induced osteoporosis.
Composite hemangioendothelioma is a rare vascular tumor. Only 22 cases have been reported previously. We report a case of composite hemangioendothelioma arising in the tongue and review the literature on this lesion. A 38-year-old woman had a mass in the right lateral border of the tongue. It was reddish and approximately 8 mm in diameter. We performed an excisional biopsy. Histological examination revealed a vascular neoplasm composed of a complex admixture of several histological patterns, which were similar to low-grade angiosarcoma, epithelioid hemangioendothelioma, and capillary hemangioma. Tumor cells were exposed at the surgical margins. We diagnosed this lesion to be a composite hemangioendothelioma and re-excised it with a safety margin of 10 mm. There was neither recurrence nor metastasis 36 months after the first excision.
We describe a rare case of desmoplastic ameloblastoma （DA） arising in the mandible of a 47-year-old man. A round, elastic hard, painless mass, measuring 16 mm in diameter, was detected in the right anterior region of the mandible. The surface of the mass was smooth, and the overlying gingival mucosa was normal. Radiographic examinations showed a honeycomb appearance with ill-defined margins. Immunohistochemically, the expression of TGF-β1 and TGF-βreceptor type I was detected in the tumor cells, suggesting that TGF-β1 might have played an important role in the formation of DA. The mass was completely resected through an intraoral approach under general anesthesia, and the postoperative course has been uneventful for 1 year.
We report a case of extramedullary relapse of acute lymphocytic leukemia （ALL） in the maxilla of 22-year-old man after an allogeneic stem cell transplantation. Relapse of ALL usually occurs in either the central nerve system or a testis because these organs are independent of systemic immunity. A complete remission had been achieved temporarily by both induction chemotherapy and stem cell transplantation. One year after transplantation, a relapse occurred with an extramedullary mass in the right side of the maxilla. The patient received chemotherapy and local radiation therapy of the mass because the bone marrow was not involved. Bone marrow relapse occurred about 6 months after the extramedullary relapse. Unfortunately, the patient died of sepsis during re-induction therapy. This case is the first domestic report of an isolated extramedullary relapse of ALL in the maxilla after allogeneic stem cell transplantation.