We examined the effect of perioperative oral function management for 60 head and neck cancer patients （50 males, 10 females） who were treated by chemotherapy and radiation from April 2012 to October 2015 in the otolaryngology department. The patients’ ages ranged from 34 to 81 years old and the most frequent type of cancer was laryngeal cancer （34％）. Twenty-four of these patients （48％） required dental treatment before their cancer treatment and we provided care to more than 90％ of them. The average number of dental visits per patient was 10.
The majority of patients showed decreased saliva after starting the treatment. However, they also showed improved plaque control and a decrease in the number of oral bacteria.
This study suggests that perioperative oral function management for these patients contributed to the successful completion of their cancer treatment by decreasing the side effects of the treatment.

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Accidental perforation of the maxillary sinus during maxillary-molar tooth extraction is not rare. Perforation into the maxillary sinus is cited as one of the complications after tooth extraction that could result in maxillary dental sinusitis and/or oral maxillary sinus fistula, which may remain for an extended period. We report on the progress and treatment of post-maxillary sinus perforations caused by tooth extraction. We investigated 21 patients with maxillary sinus perforation or oral maxillary sinus fistula who visited the Ohu University Hospital （April 2015-March 2017）. A retrospective study was conducted from the medical records and X-ray data of the patients. As a result, 10 out of the 21 cases （47.6％） were male and 11 （52.4％） were female. Of the cases, 13 out of 21 （61.9％） cases of maxillary sinus perforation occurred when the first molar was extracted, while 3 （14.3％） occurred when the second or third molar was extracted. Regarding treatments, surgical closure by mucosal flap or tongue flap was performed in 11 cases （52.4％）, and a combination of closure and dentures in 8 cases （38.1％）.

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We present a case of temporomandibular ankylosis with temporomandibular articulation, myomectomy, and functional improvement. A 59-year-old man, referred to our clinic, presented with low occlusion, eating disorder, and dysarthria. At the age of 48 years, he had sustained a fall from the fourth-floor balcony of his house and was diagnosed with bilateral temporomandibular fractures at another hospital. The bilateral temporomandibular fractures were treated with conservative therapy, followed by mouth-opening exercises. Immediately after discharge, mouth opening of approximately 30mm was noted, but decreased gradually over approximately 10 years since the referral. Computed tomographic images showed joint intraluminal adhesions, diagnosed as bilateral temporomandibular ankyloses, for which temporomandibular joint mobilization surgery was performed under general anesthesia. The bilateral mandibular head was resected and processus muscularis on both sides were excised, resulting in maximum intraoperative mouth-opening. Subsequently, the entire temporal fascia membrane was incised from a fascia valve, which was inserted and fixed into the bilateral maxillary resected tip. Postoperatively, the mouth-opening exercises were continued and occlusion was established with prosthetic treatment. Mouth-opening of 37 mm has been sustained for one year postoperatively without problem.

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Bisphosphonate-related osteonecrosis of the jaw is closely related to actinomycetes infection, and overseas reports have hypothesized that the occurrence of osteomyelitis is due to actinomycete infection in bisphosphonate-induced osteonecrosis.
We encountered a case where osteonecrosis in a patient, who had been administered bisphosphonates, progressed to osteomyelitis of the mandible due to actinomycete infection. Here we report this case and review the related literature. The patient underwent sequestrum removal and the wound was left open. After the surgery, the patient was administered AMPC 750mg/day for 2 months. Bone exposure was not observed 17 months after the surgery.

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We report a case of complex odontoma with non-typical radiographic features, which was located inside the right posterior sinus wall. An 8-year-old boy was referred to our clinic for evaluation of the right sinus. Panoramic radiography showed a cystic lesion-like egg shape on the posterior sinus wall. Computed tomography clearly showed a low-density gourd-shaped mass covered with a high-density shell. The mass was diagnosed to be a maxillary tumor and was removed surgically. The histopathological diagnosis was complex odontoma. We performed a procedure considering maxillary bone growth. The postoperative course has been uneventful with no recurrence. We are conducting follow-up observations for maxillary bone growth.

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Systemic lupus erythematosus （SLE） is an autoimmune disease characterized by diverse systemic inflammatory lesions. The main oral symptoms are ulceration and bleeding spots. We report here a case of SLE with gingival bleeding as the initial symptom. A woman in her fifties was referred to our department for gingival bleeding and thrombocytopenia was identified. Immune thrombocytopenia （ITP） was suspected, and oral administration of prednisolone （PSL） was performed in combination with platelet transfusion. However, this did not achieve the desired effects. Because additional tests showed increased levels of anti-nuclear antibody and anti-DNA antibody and a positive reaction against urine protein, a diagnosis of SLE was made. Treatment with a higher dose of PSL was effective, and she is being maintained on PSL （0.12mg/kg/day） during follow-up.

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The patient was a man in his 40s who visited our department with the chief complaint of pain in the oral cavity and discomfort in the tongue. He had a previous medical history of antiphospholipid antibody syndrome （APS） and regularly visited the hematology department of our hospital. As Candida albicans was detected upon an oral bacterial examination and gargling with fangizon was initiated, improvement of symptoms was observed in 1 week. Six months later, recurrence of pain in the oral cavity, body weight loss due to difficulties with oral intake, continuous slight fever, and exacerbation of local symptoms were observed, so he was admitted to the hematology department. HIV-RNA quantification revealed a high level of 7.7×105 copies/ml. Dark brown Kaposi sarcoma （KS）-like lesions were observed on the palate, abdomen, back, and lower limb skin, so a skin biopsy was performed in the dermatology department. Capillary proliferation and spindle cell proliferation were observed with an increased number of human herpes virus 8 （HHV-8） positive cells in an immunohistopathological study. Consequently, a diagnosis of KS was made, leading to a diagnosis of onset of acquired immunodeficiency syndrome （AIDS）. Highly active antiretroviral therapy for AIDS was initiated, leading to improvement of both local symptoms and general condition.

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We report the case of a woman in her 40s with spindle cell lipoma positioned in the hard palate. The patient consulted our hospital in July 201X for a detailed examination of a hard palate mass, believing that something was wrong. Her dentist found a palate mass and referred her to our clinic in August. Computed tomography （CT） images showed no destruction of the hard palate. Magnetic resonance images （MRI） showed a well-delineated tumor in the hard palate. The clinical diagnosis was a benign tumor, and tumor extirpation was performed with the patient under local anesthesia. The extirpated masses were white-yellowish and elastic relatively hard tissue. There were no atypical cells or atypical mitosis in the specimens. The pathologic diagnosis was spindle cell lipoma. During 4 years of postoperative follow-up, the patient’s course has been good, without relapse. The specific findings on CT and MRI images well characterized the tumor. The combined use of CT and MRI images was helpful in the diagnosis of spindle cell lipoma.

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We present the case of a Japanese woman in her 20s with three wisdom teeth including impacted teeth that were extracted under general anesthesia with heparin bridging after she underwent an artificial valve replacement due to aortic dissection with Marfan syndrome in 201X.
When Marfan syndrome patients have cardiovascular malformations or heart diseases, caries and periodontal disease may cause infective endocarditis, so thorough management is important. Based on findings of intraoral examination and panoramic imaging the patient was diagnosed with pericoronitis of the left maxillary wisdom tooth, partial impaction of the right lower wisdom tooth, and impaction of the left lower wisdom tooth. Heparin bridging and preoperative antibiotic administration were decided in consultation with the doctor who had performed the cardiovascular surgery. The postoperative course was uneventful, and the patient was discharged.

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A case of neuroblastoma metastasized to the maxilla is reported. The patient was a one-year six-month old boy. He was brought to the pediatrics department of our hospital with the chief complaints of prominent fever and swelling of the bilateral cheek. An enormous tumor strongly implicating neuroblastoma was found in the left adrenal glands and metastatic lesions of the mandible and maxilla were considered based on imaging examination. As a result of biopsy from the maxillary lesion, a pathological diagnosis of neuroblastoma was made. Following high-dose chemotherapy, autologous peripheral blood stem cell transplantation was carried out. After the first remission, the residual cystic lesion of the left mandible was removed. Pathologically, scar-like tissues without malignant cells were observed. Four months after surgery, he died from consciousness disorder due to brain metastasis and aspiration pneumonia.

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We report a case of calcification in the bilateral carotid arteries found on panoramic imaging in a patient receiving periodontal treatment. The patient was a male in his sixties, who noticed bleeding when brushing the teeth since several years earlier; his gums became swollen repeatedly but were neglected. Recently, the patient was concerned about fluttering teeth and discomfort upon biting down, and particular difficulty when biting hard food, and became aware of poor occlusion. In early April 200X, the patient visited the department of periodontal disease of our hospital and was diagnosed with severe periodontal disease. Basic periodontal treatment was started, and the symptoms improved approximately 1 year and 6 months later. Imaging examination for reevaluation showed calcification in the bilateral carotid arteries on panoramic imaging. The possibility of atherosclerotic disease was therefore explained to the patient and he was referred to the department of neurosurgery. As a result, a diagnosis of right carotid thrombosis and left carotid artery stenosis was made, and carotid endarterectomy （CEA） was performed. The postoperative course was good, and the patient continuously received treatments for periodontal disease at our university.

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Adenomatoid odontogenic tumor（AOT）is an odontogenic tumor of the jaw, frequently in the anterior region（particularly the canine region）of females in their teens and 20s, causing painless swelling of the jaw. AOT is often accompanied by impacted teeth, and radiography depicts an ovoid, radiolucent area resembling a dentigerous cyst. Here we report a case of maxillary AOT in a 10-year-old girl. Her mother noticed right facial swelling, and the patient visited her local dental clinic in July 201X. Tumor was suspected, and she was referred to our department in August 201X. Extraoral examination showed diffuse swelling from the right ala nasi to the cheek region. Intraoral examination showed unerupted 12 and 13, with prolonged retention of 52 and 53. Gingival swelling and a parchment feeling to the bone were evident in this region. Panoramic X-ray showed a well-defined, unilocular, cyst-like radiolucent area in the right maxilla, with 12 within the lesion and 13 migrated toward the maxillary sinus. Computed tomography showed sandy calcifications within the lesion. The clinical diagnosis was suspected maxillary tumor. Biopsy under local anesthesia histopathologically diagnosed AOT, which was excised under general anesthesia in September 201X. No recurrence has been seen, and postoperative progress has been satisfactory.

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Cases of multiple cancer have increasingly been reported in recent years. We report here a rare case of quintuple cancer including multiple primary oral cancer.
The patient was a 60-year-old male who was introduced by a nearby dental clinical with a chief complaint of pain in the left oral floor. He had a previous history of lung cancer and laryngeal cancer. Tumor resection was performed to remove squamous cell carcinoma in the left oral floor.
Two years after our operation he developed colon cancer and esophageal cancer and was operated on for each. Thereafter, he developed left tongue cancer, a year later right tongue cancer, and three years later right buccal mucosa cancer, and respective operations were performed. The patient had a good clinical course after treatment. All treatments for this case were provided by our hospital. It is considered to be a benefit of general hospitals that good and close cooperation among clinical departments was possible in this case.

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Cetuximab is a molecular target drug used to treat patients in Japan with advanced head and neck cancer. Because cetuximab is an antibody drug, attention must be paid to infusion reactions after injection. We report the case of a patient with oral cancer who suffered a severe infusion reaction after initial cetuximab injection. The patient was a male in his 60s with recurrent left maxillary gingival cancer （rT4aN2bM0, Stage ⅣA）. He was referred to our hospital and chemotherapy with paclitaxel and cetuximab was planned. Fifteen minutes after the initial infusion of cetuximab, the patient had palpitations and hot flash, and then an anaphylactic reaction （loss of consciousness, hypoxia and hypotension）. Therefore, the cetuximab infusion was stopped and emergency medical care was administered, including intratracheal intubation and medication of cardiovascular drugs, and the patient was revived. Although infusion reactions may possibly be prevented by premedication, indication for cetuximab must be carefully considered. When performing cetuximab treatment, it is necessary to prepare for emergency treatment.

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