Squamous cell carcinoma (SCC) of the maxillary gingiva is rare and there is only a few reports concerning this cancer. Standard treatment of resectable oral SCC, including carcinoma of the maxillary gingiva, is surgery with or without adjuvant therapy. For patients with locally advanced maxillary gingival SCC, extended resection with reconstructive surgery causes loss of oral function and aesthetic loss. We developed retrograde superselective intra-arterial chemotherapy with radiotherapy for advanced oral cancers to preserve organ. This review was conducted to evaluate the outcome of SCC of the maxillary gingiva and efficacy of retrograde superselective intra-arterial chemoradiotherapy for locally advanced maxillary gingival SCC.

The maxilla has an anatomically complex structure, and therefore recovery of morphology and function is not easily achieved in patients who have lost maxillary bone and surrounding soft tissue due to maxillary cancer. Prosthetic approaches have traditionally been used to treat these defect sites by using jaw dentures to achieve functional recovery. Jaw dentures are a useful means of enhancing intraoral stability by maintaining residual teeth and obturator appliances and of quickly improving chewing, swallowing, and speech functions. Meanwhile, recent advancements in reconstructive surgery have led to the active implementation of closure of defect sites by means of various skin flaps and bony reconstruction of the maxilla using grafts such as vascularized iliac flaps or vascularized fibular flaps.

　Various debates are ongoing over which criteria should be used to select the maxillary prosthetic treatment and reconstructive surgical method for maxillary defects after tumor resection. Due to their respective advantages and disadvantages, the treatment method should be chosen with consideration for the patient’s general condition and the state of the defects. Depending on the patient, a combination of both prosthetic treatment and reconstructive surgery may be necessary; the advantages of both treatments should be exploited as much as possible.

　Dental implants have been used in recent years to improve the therapeutic effects of both of these treatments with good outcomes.

The control of cervical lymph node metastasis is extremely important for improving the survival rate in patients with oral squamous cell carcinoma. Many predictive factors of cervical lymph node metastasis have been reported, but a consistent opinion has yet to be obtained. In recent years, tumor budding has been reported to be a prognostic factor in gastrointestinal carcinomas such as colorectal cancer or gastric cancer. Tumor budding is a term that refers to the invasion type of the cancer. Previous studies have shown that tumor budding is associated with lymph node metastases and vascular invasion in colorectal cancer. The present study investigated the association between tumor budding and cervical lymph node metastasis to determine the prognostic significance of tumor budding in oral squamous cell carcinoma.

　A total of 63 cases of stage Ⅰto Ⅱ oral squamous cell carcinoma of the tongue that were surgically excised in the Oral Cancer Center, Tokyo Dental College were studied. The associations of tumor budding with clinicopathological factors and cervical lymph node metastasis were analyzed.

　The cut-off value of tumor budding was determined using a receiver operating characteristic (ROC) curve, and tumor budding was graded as high intensity or low intensity based on the presence and absence of ≥5 or <5 budding foci in hematoxylin and eosin-stained sections. In univariate analysis, differentiation, depth of invasion, lymphovascular invasion, perineural invasion, and tumor budding were risk factors for cervical lymph node metastasis, and in Cox proportion hazard regression analysis, tumor budding (hazard ratio = 6.51, 95% confidence interval = 1.27−33.48） and lymphovascular invasion (hazard ratio = 4.29, 95% confidence interval = 1.19−15.44) were significant risk factors.

　In stage Ⅰ to Ⅱ oral squamous cell carcinoma of the tongue, the possibility that tumor budding and lymphovascular invasion in resected specimens are independent predictive factors of cervical lymph node metastasis was suggested.

　Objectives: Although conservative therapy has usually been performed in patients with medication-related osteonecrosis of the jaw (MRONJ) , studies reporting the superiority of surgical therapy have increased in recent years. Since the establishment of our Department in September 2013, patients with MRONJ have received conservative therapy, but since April 2016 surgical therapy is the rule in our department. We reviewed the treatment methods and outcomes of patients with MRONJ in our department.

　Methods : For 36 patients with MRONJ who were treated in our department, age, gender, affected jaw, stage, trigger, primary disease, type of bone-modifying agent, administration period, diabetes, steroid administration, leukocyte count, serum albumin, drug holiday, treatment method, and outcome were surveyed by reviewing the medical records. Multivariate logistic regression analysis was performed to study the relation between each factor and outcomes.

　Results: Among the 36 patients, conservative therapy was performed in 15 patients and surgical therapy in 21. Complete cure was obtained in one patient (6.7%) who received conservative therapy and 15 (76.2%) who received surgical therapy. In the surgical therapy group, the cure rate was higher in patients who underwent extensive surgery, which removes the surrounding bone as well as necrotic bone, than in patients who underwent conservative surgery, which removes only the necrotic bone. Multivariate analysis showed that the triggering factor (other than tooth extraction) , primary disease (osteoporosis) , and treatment method (surgical therapy) significantly correlated with a higher cure rate.

　Conclusions: Extensive surgery is the best treatment for MRONJ.

We report a case of systemic inflammatory response syndrome (SIRS) caused by multidrug resistant Pseudomonas aeruginosa (MDRP) infection during anti-leukemia chemotherapy. The origin of the infection was suspected because of third molar pericoronitis. A 25-year-old man presented with a chief complaint of right mandibular molar pain. His general condition then rapidly deteriorated. Subsequently, MDRP was detected by both blood culture and swabbing the gingival sulcus exudates in regions surrounding the infected third molar. In this patient, polymyxin B was administered by intravenous injection because of drug susceptibility. The patient was subsequently underwent right mandibular third molar extraction after a good recovery.

We report a case of tongue cancer with late recurrence after the development of therapy-related myelodysplastic syndrome (t-MDS) induced by interstitial brachytherapy. The patient was a 40-year-old man. He recognized white patchy lesions on the right side of the tongue with ulcer formation and haphalgesia and visited our hospital in July 1997. An incisional biopsy was performed in January 1998, and the histopathological diagnosis was a moderately differentiated squamous cell carcinoma. Tongue cancer was diagnosed (T2N0M0) and the patient received interstitial brachytherapy (¹⁹² Ir, total 7,120 cGy). The tumor disappeared after the treatment. In January 2005, he presented to the department of hematology at our hospital with chronic anemia. He was given a diagnosis of t-MDS (refractory anemia) because of pancytopenia and bone marrow hypoplasia with normal karyotype. However, t-MDS of this patient was classified into the low risk group, and the patient underwent follow-up examinations regularly. In March 2014, 16 years after the interstitial brachytherapy, a recurrent lesion with erosion and induration was observed at the primary site of the tongue, and recurrent tongue cancer (rT4aN0M0) was diagnosed. Supraomohyoid neck dissection, subtotal glossectomy, and immediate reconstruction using a rectus abdominis flap were carried out. The postoperative course was uneventful for 3 years of follow-up, and no recurrence or metastasis has been noted since then.

Tuberculosis (TB) , one of the three major infectious diseases, is caused by the tubercle bacillus and has received attention as a re-emerging disease in recent years. Even now, approximately 20,000 people fall ill with TB every year in Japan.

　We report the case of a 77-year-old man with tongue cancer accompanied by tuberculous spondylitis. Multiple bone metastases to thoracic and lumbar vertebrae were initially suspected from a preoperative examination for tongue cancer. Vertebral biopsy revealed positive tubercle bacillus DNA, and tuberculous spondylitis was finally diagnosed in the vertebral body lesion. The patient has been followed up for 1 year 2 months after surgery without the development of tuberculosis, cancer recurrence, or metastasis.

Factor X deficiency is a coagulation disorder caused by lack of factor X, which is a vitamin K-dependent clotting factor synthesized in the liver. The disease can be inherited or acquired. This case report describes a male patient who was given a diagnosis of acquired factor X deficiency after having gingival bleeding. [Case and Progress] An 80-year-old man had undergone detailed examinations for the cause of anemia in another hospital. Hemorrhagic lesions were not found, and gingival bleeding was suspected as the cause of anemia. Therefore, he visited our hospital for further evaluation of gingival bleeding. Because gingival bleeding was caused by periodontal disease, we extracted the right mandibular second molar and left maxillary second molar under local anesthesia. Because of persistent intermittent gingival bleeding, we referred the patient to a hematologist. The blood examination revealed prolonged prothrombin time and decreased factor X activity, and he was given a diagnosis of acquired factor X deficiency on the basis of his past medical history. Although we performed local hemostatic treatment and medical therapy, it took us about 40 days to arrest the hemorrhage.

Osteonecrosis of the jaw is one of the problematic side effects observed during administration of angiogenesis inhibitors in patients receiving treatment for cancer. We report a case of osteonecrosis of the jaw in a patient receiving sunitinib.

　The patient was a 72-year-old man who was referred to our hospital because of exposed bone and contact pain of the tongue. After the clinical diagnosis of osteonecrosis of the jaw, observation and irrigation of the exposed bone were frequently performed. Four months later, the lesion healed. After 1 year, exposed bone was found in other sites ; however, it disappeared a month later.

　The present case suggests that the use of sunitinib can be associated with osteonecrosis of the jaw and indicates that invasive dental treatment and the status of the main disease should be considered when prescribing sunitinib, as is done when prescribing bisphosphonates or denosumab.

Sweet’s Syndrome is a disease characterized by multiple nodules or edematous erythema elevatum of the face, neck, and skin, accompanied by acute fever and peripheral leukocytosis. This disease is considered one of the paraneoplastic syndromes of blood tumors.

　A 50-year-old Japanese man was referred to our department because of oral mucosa hyperplasia. The patient who had the various condition and we performed various examination, but needed long time for definitive diagnosis.

　In this article, we report a case of oral mucosa hyperplasia caused by Sweet’s Syndrome that was difficult to diagnose.

We report a case of hemophilic pseudotumor arising in the maxilla of a 46-year-old man with a history of hemophilia A. The initial symptom was painless swelling in the right buccal region. Intraorally, the alveolus was enlarged buccally in the right canine region. A panoramic X-ray film showed a cystlike radiolucent lesion at the apex of the right maxillary canine. Computed tomography showed marked enlargement of the right side of the maxilla and a well-demarcated multilocular radiolucent lesion. A tumor was suspected, and a biopsy was therefore performed during replacement therapy with coagulation factor. The bone cavity contained a hematoma. After the diagnosis of a hemophilic pseudotumor, enucleation was performed. There has been no sign of recurrence in the 3 years after surgery.

The activation of Wnt signaling has been reported in many types of squamous cell carcinoma. In this study, we used human oral squamous cell carcinoma (OSCC) cells with different metastatic potentials to investigate the involvement of Wnt signaling in metastasis. In addition, we aimed to elucidate the characteristic biological features related to high metastatic potential and to identify new target molecules for the suppression of OSCC lymph node metastasis. We compared SAS-Venus (SAS OSCC cells expressing green fluorescent protein) and SAS-LM8, which is a highly metastatic cell line derived from SAS-Venus by in vivo selection. The SAS-LM8 cell line had greater ability of migration and invasion than did SAS-Venus. Furthermore, a higher number of filopodia-like protrusive structures were produced in SAS-LM8 cells than in SAS-Venus cells, and the levels of active Cdc42 and active RhoA protein were higher in SAS-LM8 cells than in SAS-Venus cells. We did not observe any differences in the expression of Wnt/beta-catenin target genes between the two cell lines ; however, the mRNA levels of Wnt5b were higher in SAS-LM8 cells than in SAS-Venus cells. To confirm the involvement of Wnt5b in migration in OSCC cells, we examined the effects of the siRNA-mediated knockdown of Wnt5b in SAS-Venus cells and SAS-LM8 cells. The siRNA treatment significantly inhibited migration and the formation of filopodia-like protrusive structures. Conversely, when stimulated with Wnt5b, the migration and formation of filopodia-like protrusions were significantly enhanced, and the levels of active Cdc42 and active RhoA proteins also increased. These results indicate that Wnt5b is involved in the migration ability of OSCC cells through active Cdc42 and RhoA.