The purpose of this study was to grasp the trends of new outpatients of the Meikai University PDI Tokyo Dental Clinic. We conducted a statistical analysis of clinical observations using the data and results of medical examinations at the time of the first visit. There were two groups of subjects: 278 new outpatients admitted in 2005 and 254 new outpatients admitted in 2013. The following data were analyzed: 1) age and number of patients in all age groups; 2) gender; 3) place of residence; 4) chief complaint; 5) systemic disease; and 6) response after the first visit.
The analysis showed the following results. The mean age of the new outpatients decreased, from 40.7 to 35.5 years. New outpatients in their 20s accounted for the largest group in both datasets. No difference in gender distribution or place of residence was observed. The prevalent chief complaint was toothache, but its share of total complaints reduced. The proportion of patients with systemic diseases increased. The treatment at the time of the first visit changed from endodontic therapy to medication. From the above results, we were able to grasp the present outpatient trends.

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A biodegradable mesh sheet composed of polygycolic acid (Neoveil^®) has been used for strengthening tissue defects or suturing together with fibrin glue (Bolheal^®) in thoracic surgery and gastro- enterological surgery. Recently, there have been several reports of its application to oral and maxillofacial surgery. In this report, we describe the use of polygycolic acid sheet and fibrin glue spray for an 85-year-old male patient after partial glossectomy and radical neck dissection. The pull-through method was used to fix the remaining tongue to the mandible, and polygycolic acid sheet and fibrin glue were used to close the wound.

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It has been reported that in reconstructive surgery after excision of a maxillary tumor, a pedicled buccal fat pad graft is easier to perform than reconstructive surgery itself, closure of the access hole that arises in the oronasal cavity/paranasal sinus is achieved, and there are relatively few complications, such as dysarthria and eating disorders. The authors report here on a case they experienced, in which reconstruction of the lost portion of the palate after maxillary gingival cancer surgery was performed using a pedicled buccal fat pad graft, and the patient's QOL was improved. The patient was a 65-year-old male. Pain in the maxillary molar region gingiva, bone exposure, and surrounding tissue induration were observed, accompanied by crateriform hemorrhagic ulcers. In a biopsy, a pathological diagnosis of squamous cell cancer was reached. In the CT imaging findings, an osteoclastic image in the maxillary molar region was observed. However, according to the PET findings, metastasis to other regions was not observed. A TNM classification of T₄N₀M₀ was decided upon. The treatment method was a single dose of chemotherapy using TS-1®, and clinically, a partial response (PR) result was obtained. Subsequently, under general anesthesia, partial excision of the maxilla bone and reconstruction of the lost portion with a buccal fat pad were performed. No post-operative complications were observed, no relapse or metastasis, etc. occurred, and the patient is doing well. Epithelialization of the transplanted region was seen within around 7 days, eating/swallowing/conversation were possible, and it was possible to return to society in a comparatively short time. This reconstructive surgery may be a useful method compared to jaw dentures and other reconstructive surgery.

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A 50-year-old male had noticed a mass in the region of the maxillary left molar tooth since about 200X, but had left it untreated. Thereafter, it gradually became difficult for him to remove a maxillary denture, so he visited a nearby dental clinic and was referred to a municipal general hospital. A biopsy was performed and the histopathological diagnosis was fibrous epulis. The lesion was so huge that the patient was referred to the Department of Oral and Maxilla Facial Surgery of the National Defense Medical College for treatment. Clinical findings revealed a 42×35×30mm lesion in the region of the maxillary left molar tooth. Part of the denture was covered with the lesion and the patient was not able to remove it by himself. The tumor was excised under general anesthesia. The progress has been good without recurrence until now 5 years after the operation.

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Recently, many cases of bisphosphonate-related osteonecrosis of the jaw ( BRONJ ) have been reported. BRONJ is usually caused by invasive dental procedures, such as tooth extraction, advanced periodontal disease and prosthetic trauma.
We report a case of spontaneous osteonecrosis of the maxilla induced by internal use of a bisphosphonate that was successfully managed by surgical treatment. A 77-year-old female visited our department with a chief complaint of swelling of the right maxilla. Oral examination revealed mild swelling and pus discharge at the right upper gum, and radiographic examination showed osteonecrosis. She had taken BP pills for 3 years beginning in 2009 because of osteoporosis. We found that the diagnosis was spontaneous BRONJ on reviewing her medical history. After treatment of antibiotics and local irrigation, we removed the sequestrum. Histopathological examination revealed sequestration with attachment of bacteria. She has been followed for 20 months since surgery and continues to do well.

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We report the case of a patient who underwent treatment for phlegmon of the cheek and developed a cerebral infarction. We also review some relevant literature. An 88-year-old woman noticed swelling and experienced pain in her left mandible. The patient visited the cardiology department of a nearby general hospital. After examination, she was diagnosed with exacerbated heart failure and was admitted to the hospital. Although anti-inflammatory treatment was administered, no improvement was observed in her symptoms, so she was referred to our hospital for a more detailed examination and further treatment. The patient was diagnosed with phlegmon of the left cheek and was admitted to our hospital. She was administered antibacterial drugs via an intravenous drip. On day 3 of hospitalization, she underwent extra-oral incision and drainage under general anesthesia. Her postoperative course was satisfactory, however, on day 13, severe right hemiplegia and aphasia were observed, and her consciousness level declined. She was diagnosed with cardiogenic cerebral embolism and was transferred to the neurosurgery department. She received antithrombotic therapy with warfarin. Poor control of perioperative anticoagulation ability was considered to be one cause of the cerebral infarction.

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Perioperative care of dialysis patients who suffer from cancer is difficult because they have a tendency to bleed, decreased immune function, and chronic malnutrition. However, little has been reported regarding the perioperative care of these patients. We report our experience of providing perioperative care for a dialysis patient with tongue carcinoma and cervical lymph node metastasis who was treated with surgical therapy, chemotherapy (5-FU, 500mg/day/body for 5 days + carboplatin 130mg/body for 1 day), and radiotherapy (total 56Gy administered in 28cycles). Perioperative care in this patient was based on selection and dose of the anticancer drug, route of transfusion, and the status of nutrition as well as that of general condition.

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A 57-year-old male with lower gingival carcinoma visited our hospital with chief complaints of occlusal pain in the left lower gingiva and numbness on the left side of the tongue. In 2012, neck dissection, left hemimandibulectomy, reconstruction with metal plates and ALT flap were carried out. Five months after surgery, diplopia of the left eye appeared. A tumor invading the cavernous sinus and orbit was identified by MRI. Chemoradiotherapy was performed. The patient developed systemic metastasis mainly to the spinal cord and died of respiratory failure 14 months postoperatively. In cases of tumor invasion to the mandible causing dysesthesia in the mandibular nerve area, the possibility of afferent invasion should be considered. Hence, assessment of brain nerves is an important factor in postoperative follow-up.

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It is very rare that oral tonsil tissue emerges ectopically, and in cases of ectopic tonsils, the diagnosis is difficult. Oral tonsils, which are composed of ectopic sublingual tonsil tissue, generally manifest as asymptomatic, nonulcerated, freely movable nodules.
We here report a case of a 49-year-old woman with ectopic tonsil tissue on the oral floor. Her main symptom was swelling of the left sublingual hold. Biopsy revealed that part of the epithelium of the specimen was deeply invaginated into the stroma, and lymphoid tissue was observed around the invaginated epithelium, indicating tonsil organization. Accordingly, this case was diagnosed as sublingual oral tonsil.

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