The overexpression of Epidermal Growth Factor Receptor （EGFR) has been known as an important prognostic factor for head and neck squamous cell carcinoma （HNSCC）. Cetuximab is an anti-EGFR monoclonal antibody. In 2006, Bonner et al reported the clinical usefulness of adding Cetuximab to radiation in the treatment of HNSCC. In 2008, Vermorken et al. reported the efficacy of Cetuximab + systemic chemotherapy （CDDP+5-FU） for treating recurrent/metastatic HNSCC patients.
Cetuximab has been used in Japan since December, 2012 for HNSCC patients. It is required to use Cetuximab in combination with radiotherapy of chemotherapy when treating HNSCC. However, the clinical role of adding Cetuximab to CDDP based chemoradiotherapy has not been verified.
The appropriate direction of using Cetuximab for treating HNSCC needs to be further discussed.

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To evaluate the usefulness of squamous cell carcinoma　（SCC） antigen for screening, prognosis, monitoring the response to surgical treatment, and early detection of recurrence and metastases from oral squamous cell carcinoma　（OSCC）, we investigated the time course of serum levels of SCC antigen in 156 patients with OSCC.
Elevated serum SCC antigen levels were detected in 35 of the 156 patients with OSCC. Preoperative positive rates were low　（22%）. The higher the serum SCC antigen level, the larger was the primary tumor, and the clinical stage and cervical lymph-node metastasis were also more advanced. In patients who tested positive for serum SCC antigen before operation, the serum SCC antigen levels significantly declined after surgery. The SCC antigen level in the recurrent or metastatic group was significantly higher than that in the non-recurrent and non-metastatic group. Receiver operating characteristic　（ROC） curve analysis identified the optimal cut-off value　（1.34 ng/mL） of the preoperative serum SCC antigen to predict recurrence or metastasis of OSCC. The SCC antigen level immediately before the detection of recurrence or metastasis was significantly higher than the mean value after surgery. The optimal cut-off value　（1.40 ng/mL） of the postoperative serum SCC antigen level for suspecting recurrence or metastasis of OSCC was identified by ROC curve analysis.
Our results suggested that the SCC antigen level is related to an increase in tumor volume, metastasis to cervical lymph nodes, and clinical stage. SCC antigen might be a useful prognostic factor. The SCC antigen level might be a useful for evaluating the efficacy of treatments in SCC antigen-positive cases and may facilitate the early detection of recurrence, metastasis, or both. However, because the clinical value of serum SCC antigen as a screening factor for OSCC is low, it might be an auxiliary tool for the screening of OSCC.

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Vascular malformation occurs most frequently in the head and neck region, especially in the lips and tongue, but reports of vascular malformation in the buccal fat pad region are relatively rare. We report a case of vascular malformation in the buccal fat pad. A 64-year-old woman consulted our hospital because of a painless swelling in the right cheek. She presented with an elastic-soft, mobile subcutaneous mass, 20 mm in diameter, in the anterior edge of the masseter muscle of the right cheek. Magnetic resonance imaging showed a wellcircumscribed mass in front of the masseter muscle. The mass showed signal intensity nearly equivalent to that of the muscle on the T1-weighted images and high signal intensity on T2-weighted images. The mass was clinically diagnosed as a tumor in the right buccal region. With the patient under general anesthesia, the lesion was enucleated intraorally. The enucleated specimen, measuring 20×17×13 mm, was elastic-soft and dark red.The histological diagnosis was venous malformation. Five years six months after the operation, no recurrence has occurred.

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The prevalence of supernumerary teeth is about 1 percent, but multiple supernumerary teeth are extremely rare. We report the case of a 15-year-old girl with seven impacted supernumerary teeth detected on panoramic radiographic examination. The panoramic X-ray film showed six supernumerary teeth impacted bilaterally in the canine-premolar region of the mandible and one supernumerary tooth impacted in the right maxillary molar region. On computed tomography, all of the impacted teeth were incompletely developed. We extracted all of the supernumerary teeth under general anesthesia. We pathologically examined the connective tissue surrounding the impacted teeth. Histopathologically, there were many small lumps of odontogenic epithelium in the connective tissue.

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Lipoma is a common benign tumor of the body trunk and extremities, but occurrence in the oral region is relatively rare. Fat necrosis sometimes occurs in normal fat tissue and is rarely found in lipoma. We describe a rare case of lipoma of the tongue with hemorrhagic necrosis. A 68-year-old man presented with a large mass of the tongue, 40×40 mm in size. On magnetic resonance imaging, T1-weighted imaging showed low intensity with marginal high intensity. T2-weighted imaging showed mixed intensity of high and low signals. Fat-suppression T1-weighted imaging revealed no signal decrease, and fat-suppression T2-weighted imaging showed mixed intensity of high and low signals. Contrast T1-weighted fat-suppression imaging showed low intensity. Under general anesthesia, the mass was removed. Histologicaly, nearly the entire tumor was composed of necrotic fat tissue with bleeding. Fat tissue without necrosis was found only marginally. The histopathological diagnosis was lipoma with hemorrhagic necrosis.

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Actinomycosis of the jaw is relatively rare, and few cases arise in the maxilla. In addition, there are few reports of actinomycosis of the jaw in patients who receive bisphosphonates. We report a rare case of bisphosphonate-related osteomyelitis of the maxilla involving Actinomyces infection. The patient was a 71-year-old woman who presented with a diffuse swelling and purulent fistulas in the left maxillary premolar region. Radiographic examination revealed bone destruction with a soft tissue swelling in the maxilla. The suspected clinical diagnosis of this lesion was osteomyelitis or a malignant tumor. A biopsy revealed granulated tissue with colonies of pathogenic microorganisms, and actinomycotic osteomyelitis was diagnosed. Surgical curettage was thus performed, with prolonged administration of penicillin. There has been no recurrence of disease during 6 months of follow-up.

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Common variable immunodeficiency (CVID) is one type of primary immunodeficiency (PID) that is characterized by an impaired ability to produce antibodies, associated with severe and recurrent infections. We report the case of a 31-year-old man who was given a diagnosis of CVID with lack of B cells, decreased neutrophil levels, and disturbed production of T cells. The patient required pulpectomy and third-molar extraction. Although he was receiving prophylactic antibiotic and immunoglobulin replacement therapy at regular intervals to reduce the risk of infection and end-organ damage, we planned to additionally administer an intravenous human immunoglobulin preparation immediately before dental treatment and antibiotics in the perioperative period. Single-visit root canal treatment, immediate filling of the left lower second molar, and extraction of 4 third molars were performed without complications during the perioperative period. There was no severe infection as of 6 months after treatment.

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We report a rare case of fungemia caused by the dematiaceous fungus Exophiala dermatitidis. The patient was a 47-year-old woman with lingual and esophageal cancer. Five years after tumor resection, tongue cancer recurred in September 2011. Malnutrition resulting from this recurrence also caused complications. Radiotherapy was planned to treat the recurrent lesions, and a tracheostomy was performed. A totally implantable central venous access device (CVAD) was also fitted via the chest to enable nutritional management. The tumor initially disappeared in response to radiotherapy, but then metastasized to the circumference of the thoracic aorta. Chemotherapy was subsequently decided on as a course of action. Myelosuppression occurred as a side effect of chemotherapy, and the patient had an ongoing fever. Administration of an antifungal agent and removal of the CVAD alleviated the fever. The detection of Exophiala dermatitidis in the CVAD led to a diagnosis of fungemia caused by Exophiala dermatitidis as opposed to Candida (the usual cause). Analysis of past reports suggests that fungemia caused by Exophiala dermatitidis is extremely uncommon.

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A glandular odontogenic cyst (GOC) is a rare odontogenic cyst, classified as a developmental odontogenic cyst by the WHO in 1992.
We report a case of GOC occurring in the anterior region of the mandible. The patient was a 75-year-old man who presented with pain and swelling of the anterior region of the mandible. Panoramic radiography showed a unilocular radiolucent lesion in the anterior region of the mandible. Enucleation of the lesion was performed. The histopathological diagnosis was GOC.
One year after the operation, there was no sign of recurrence.
We reviewed 18 cases of GOC previously reported in Japan. There were 11 male and 7 female patients, aged 23-72 years (mean 51.7 years). Among these cases, 16 were located in the mandible, and only 2 arose in the maxilla. Radiographically, 9 cases were unilocular, and 9 were multilocular. The cortical bone was perforated in 7 cases and thin in 4. The overall recurrence rate was 11%.

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We report a case of epidermoid cyst arising in the uvula of a 9-month-old male infant. The patient visited our pediatric department because of a common cold, and a tumorous mass of the uvula was detected. He was referred to our department. Clinical examination revealed a yellowish white projection measuring 9 × 9 × 9 mm at the tip of the uvula. There was no problem with movement of the uvula. The clinical diagnosis was a benign cyst, and the lesion was excised under intravenous sedation. It was diagnosed to be an epidermoid cyst.

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