Salivary glands secrete saliva containing fluid, electrolytes and proteins such as amylase and mucin into the oral cavity. Such salivary components are essential for the preservation of oral health. Salivary gland consists of two kinds of cells, acinar and duct cells. In salivary acinar cells, secretion of salivary components is regulated by the autonomic nervous system. When the parasympathetic neurons are stimulated, salivary fluid secretion is provoked via the increase in intracellular Ca2+ concentrations. In the case of stimulation of sympathetic neurons, salivary protein release is induced via the increase in the intracellular messenger cyclic AMP. In this paper, the mechanism of salivary secretion is discussed.
The salivary glands are divided into two groups : the major glands （parotid, submandibular, sublingual） and minor glands. All salivary glands may be involved by tumor. In our hospital, salivary gland tumors occur much more commonly in the minor glands （minor glands: 72 ％, major glands: 28 ％）（palate: 53 ％, buccal mucosa:15 ％, lip: 13 ％, gingiva: 9 ％, tongue: 5 ％, oral floor: 5 ％）. In the major salivary glands, the majority of tumors occur in the parotid gland （parotid: 52 ％, submandibular: 43 ％, sublingual: 5 ％）. The majority of salivary glands tumors are benign （benign: 78 ％, malignant: 22 ％）. The pleomorphic adenoma is the most common salivary gland benign tumor. The mucoepidermoid carcinoma is the most common malignant salivary gland tumor.
The surgical approach adopted should remove the benign salivary gland tumor in its entirety with a surrounding cuff of normal tissue. In a superficial lobe pleomorphic adenoma of parotid gland, treatment is a superficial parotidectomy. In deep lobe case, a total parotidectomy is required. Benign submandibular gland tumor is excised with extracapsular dissection and excision of the submandibular gland. The malignant salivary gland tumor requires excision with wide margins and in continuity neck dissection. Most of patients who contract malignant salivary gland tumors need to have reconstructive operations （skin graft, local flap, free flap, nerve graft）.
We evaluated adverse events after administration of TS-1 to patients with oral cancer. The subjects were 29 patients with oral cancer in whom TS-1 was administered as preoperative treatment at our department in 2006 and 2007. Each course of TS-1 （80-120 mg/day）consisted of 14-day drug treatment, followed by a 7-day rest. As adverse events, skin rash occurred in 6 of the 29 patients, oral aphtha, diarrhea, and general malaise in 3 each, pain around the eyeball and myelosuppression in 2 each, and gastric discomfort, oral dryness, taste disorder, and erosion at the angle of the mouth in 1 each. All events were grade as 1 or 2. The incidence of rash has been considered to be lower than that of gastrointestinal disorders or myelosuppression, but was the highest in this study. In 4 of the 6 patients with rash, symptoms improved after the external application of steroids and oral administration of antihistamines and antiallergic drugs, allowing treatment with TS-1 to be continued. Rash occurred early after the start of TS-1 treatment.
We analyzed oral and poster presentations at three recent international congresses: the 12th International Congress on Oral Cancer （ICOOC） and the 24th International College for Maxillofacial Surgery （ICMFS） in 2008, and the 19th International Congress on Oral and Maxillofacial Surgery （ICOMS） in 2009, which were organized by Professor Wei-Liu Qiu in Shanghai.A total of 300 papers related to oral tumors and oral and maxillofacial surgery, were submitted by the People’s Republic of China at the 2008 and 2009 meetings. Many speakers at the main symposia and keynote addresses were from the Universities of Beijing, Shanghai, West China, Wohan, Sun-Yet-Sen, and Forth Military.
We report a case of hydrocele with unusually shaped bone augmentation in the maxillary sinus, which occurred in a 62-year-old man. Computed tomography showed a cystic lesion arising around the apex of the upper left first molar in the left maxillary sinus, surrounded by an ossified mass. The clinical diagnosis was radicular cyst of the upper left first molar and a tumor in the left maxillary sinus. Under general anesthesia, we removed the tumor via the canine fossa and extracted the upper left first molar. The pathological diagnosis was hydrocele, and reactive bone augmentation consisted mainly of compact bone and partially of spongeous bone. As of 4 years after operation, there is no evidence of recurrence.
Myoepithelioma is a rare tumor accounting for 1.5 ％ of all salivary gland tumors. Clinically, myoepithelioma is a slowly growing, painless mass that cannot be distinguished from pleomorphic adenoma.
We report a case of myoepithelioma in the tongue. The patient was a 69-year-old man who had a painless mass in the tongue. Computed tomographic examination showed a well circumscribed mass. The tumor was surgically excised under general anesthesia. The tumor was well encapsulated by a fibrous membrane. Histopathologically,the tumor was composed mainly of plasmacytoid cells without malignant features. Immunohistochemically, the tumor cells showed positive staining for cytokeratin 14, S-100 protein, and vimentin. The tumor was diagnosed as a myoepithelioma arising from the tongue. There was no evidence of recurrence 10 years after operation.
Epithelioid hemangioendothelioma is a vascular neoplasm that typically develops in soft tissue, lung, and liver and is extremely rare in the oral region. We report a case of epithelioid hemangioendothelioma of the incisive papilla region. A 62-year-old woman with a sessile, dark violet mass in the right side of the incisive papilla region visited our hospital. Orthopantomography and occlusal radiography showed no abnormal findings. These clinical findings strongly suggested epulis hemangiomatosa. Therefore, an excisional biopsy was performed under local anesthesia. However, histological examination revealed round or polygonal tumor cells with scattered mitotic figures, suggesting epithelioid hemangioendothelioma. Then, an additional resection with a sufficient safety margin and extraction of both maxillary central incisors were performed under general anesthesia. Immunohistochemical staining of the excisional biopsy specimen showed tumor cells positive for Factor VIII related antigen, CD31, and CD34, which are vascular endothelioma markers. Based on these histopathological findings, the final diagnosis was epithelioid hemangioendothelioma. No tumor cells were detected in the additionally resected specimen. Follow-up examinations have shown no recurrence for 5 years 1 month since the operation.
Sialolithiasis is a disease associated with ectopic calcification, which often occurs in the submandibular gland. Foreign body theory is one of the hypotheses for the formation of a salivary calculus. Sialolithiasis caused by a migrated fish bone serving as a nucleus of a salivary calculus in a deep region is rare. We describe a case of sialolithiasis formed around a foreign body, which was a fish bone, in the transitional zone between the submandibular gland and duct.A 45-year-old woman consulted our hospital because of masticatory pain in the right submandibular region. Radiographic examination showed a pin-like radiopaque body in the same region. Under a diagnosis of sialolithiasis, the right submandibular gland was excised. The calcification, which was formed at the end of a fish bone,existed in the transitional zone between the submandibular gland and duct.