We have reported methods to directly input patients’ oral examination records into a computer after collecting verbal utterances of dentists examining the oral cavity using a microphone and converting these data into text using speech recognition software. However, there are some barriers to the clinical application of direct verbal input, such as how to start/end input and correct input recognition errors. Therefore, we suggest solutions to these issues.

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Currently, it is known that various abnormal cells including various normal cells and cancer cells form and secrete vesicles having a lipid bilayer membrane, and these membranous vesicles are called extracellular vesicles. Extracellular vesicles are classified into three types: apoptotic bodies, microvesicles, and exosomes. In this paper, we focus on exosomes, which have recently been attracting attention as a new cell-cell communication mechanism, and their formation mechanism. The isolation and purification methods are outlined, mainly regarding their usefulness and future potential in the early diagnosis of cancer, based on the cytobiological characteristics of exosomes.

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Objective：This study evaluated clinical conditions, methods and results of treatment for anti-resorptive agents-related osteonecrosis of the jaw （ARONJ） in patients with osteoporosis.
Patients and Methods：Among 62 patients diagnosed with ARONJ in our clinic during the period from January 2012 to December 2016, 32 patients with osteoporosis who were receiving bisphosphonate or denosumab were enrolled in this study. Stage classification at the time of the first visit, cause of onset, methods, and results of treatment were examined in the enrolled patients. Stage classification was divided into four groups of stage 0 to 3. Treatment and outcome were assessed for each stage.
Results：Eight （25％） patients had ARONJ stage 1, 16 （50％） had stage 2, and 8 （25％） had stage 3. Stage 1 patients received conservative therapy: 50％ demonstrated success; moreover, 100％ of surgically treated patients demonstrated success. Stage 2 patients received conservative therapy: 33.3％ demonstrated success; moreover, 75％ of surgically treated patients demonstrated success. Stage 3 patients, who received conservative therapy, demonstrated failure. 100％ of stage 3 patients demonstrated success after undergoing surgery.
Conclusion：Surgical treatment is useful for ARONJ in patients with osteoporosis for whom conservative therapy was not successful.

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The occurrence rate of malignant myoepithelioma in the oral cavity region is rare. We report here our experience with a case of malignant myoepithelial tumor that occurred in the soft palate. A 76-year-old man presented with a complaint of a mass in the left soft palate. He had been aware of the mass in the left soft palate 15 years earlier, but had left it untreated because there was no pain. However, as it gradually increased in size, he visited a general practitioner and was referred to our department in June 201X. The facial appearance was asymmetrical and there was no swelling of the submandibular lymph node. A mass 40mm in diameter was located in the left soft palate which revealed mucous membrane color and had a clear border. MR imaging revealed an internally non-uniform mass of 40mm diameter in the soft palate, which showed high-signal-intensity areas on T2-weighted images. Malignant tumor was suspected from imaging findings and clinical findings, but the differential diagnosis between benign tumor and malignant tumor was difficult. The clinical diagnosis was a malignant tumor suspected in the left soft palate. Excisional biopsy was performed and the palate tumor was excised surgically under general anesthesia in June 201X. It was diagnosed as malignant myoepithelioma by histopathological findings. Chemo-radiation was performed because extracapsular invasion was recognized histopathologically. Eight years and seven months have passed since the treatment, and the patient is in good condition without any evidence of recurrence or metastasis.

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An 83-year-old woman was referred to our hospital because of a black ulcer of the lower right gingiva. A diagnosis of malignant melanoma （T4aN1M0） was made based on biopsy by a previous doctor and imaging findings, and surgery was scheduled. However, the tumor in the oral mucosa shrank before the surgery. The patient underwent sectional mandibulectomy and right neck dissection on day 26 after initial consultation. Local control was good, but metastasis was found in the contralateral cervical lymph nodes and lungs 8 months after surgery. Chemotherapy was performed in another hospital, but the effect was insufficient and the treatment ended. After that, palliative care was mainly performed, and she died 3 years and 2 months after surgery due to cerebral hemorrhage associated with brain metastasis. Based on the clinical course and histopathological findings of surgical specimens, it was considered that oral primary malignant melanoma had undergone spontaneous partial regression.

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Orthokeratinizing odontogenic cysts （OOC） are keratocystic lesions that often occur in the mandibular molars of males. The frequency of occurrence is rare, and it was clearly classified as an odontogenic keratocyst independent disease in the new classification of odontogenic cysts described under head and neck tumors by the WHO in 2017.
A woman in her thirties was referred to our department for the purpose of examining transparent lesions on a panoramic radiograph around the right maxillary third molar. A biopsy revealed a diagnosis of a right maxillary odontogenic cyst. The patient underwent right maxillary cystectomy under general anesthesia. A large amount of keratinized substance was found in the cyst. The cyst was completely removed and no perforation of the maxillary sinus was observed. The diagnosis was an OOC. No recurrence was observed five months after surgery.

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Primary malignant lymphoma of the salivary glands is a relatively rare disease, accounting for 4.7％ of all malignant lymphomas. Herein, we report a case of a 71-year-old female patient with primary malignant lymphoma in the submandibular gland. Several months ago, the patient visited the hospital, presenting with swelling of the right lower jaw. Computed tomography revealed a well-defined mass in the right submandibular gland, and magnetic resonance imaging showed a low signal on T1-weighted imaging and a slightly high signal on T2-weighted imaging. ⁶⁷Ga scintigraphy also revealed localized accumulation in the right submandibular gland. Ultrasonography showed an internal mixture of anechoic and hypoechoic contents, with confirmation for linear high-intensity echo, and Doppler ultrasonography revealed abundant blood flow and enhanced posterior echo. Moreover, blood tests showed normal values for EBV-IgG antibody （＋）, LDH, and soluble IL-2 receptors. Based on these results, a diagnosis of right submandibular gland tumor was made, and the patient underwent excision of the right submandibular gland tumor under general anesthesia. Histopathological examination revealed MALT lymphoma, and she was subsequently referred to the hematology department. Currently, no recurrence or metastasis has been observed, and the patient has been making good progress. Given the findings of this report, it should be noted that malignant lymphoma originating in the salivary glands has few clinical symptoms, and imaging may mimic well-defined benign neoplastic lesions in a capsule, which often makes preoperative diagnosis difficult.

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Fibrous dysplasia is the dysplasia of osteogenic mesenchymal tissues, of which the lesion development often stops after pubertal growth in many cases. In the present case, fibrous dysplasia of the mandible was suspected at the first consultation when the patient was 14 years old. After long-term follow-up, a propensity of mild buccolingual lesion enlargement and pain in the wisdom tooth inside the lesion area were found and thus tooth extraction was performed. Subsequently, the enlargement of a cyst-like area was observed within the lesion. Since the imaging findings indicated some changes in the internal characteristics, re-enlargement of the lesion and its malignant transformation could not be ruled out, thus requiring careful follow-up.

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Septic arthritis of the temporomandibular joint （SATMJ） is a rare disease, with the main symptoms of pain, swelling, redness, and TMJ malocclusion. In most cases the causative factor is unknown. The present report describes a case caused by bacterial infection revealed by blood culture test results in which the originally infected organ could be identified. The patient was a female in her 60s with the chief complaint of trismus.
At the first visit, tenderness of the right temporomandibular joint and diffuse swelling, as well as trismus were noted. Anterior deviation of the right mandibular condyle was seen in X-ray images and enlargement of the right masticatory muscle was indicated by CT imaging. Streptococcus constellatus was detected in a blood culture test. Following administration of meropenem （MEPM）, the symptoms were improved. This result suggests that bacterial infection associated with chronic periodontitis of the maxillary right second molar may have led to hematogenous infection of the temporomandibular joint in this case.

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An 80-year-old male patient underwent partial resection of the tongue following chemoradiotherapy for his left-sided tongue squamous cell carcinoma （SCC） （T3N0M0）. A blood test 2 months after the operation showed a high SCC antigen level of 9.7ng/mL, but a systemic examination revealed no abnormal findings. Meanwhile, the patient complained of itchiness and dryness of the skin over the entire body, which eventually led to a diagnosis of asteatotic eczema being made upon examination by the Department of Dermatology of our hospital. After his dermatological symptoms had improved with treatment, his serum SCC antigen level normalized, and there were no findings of recurrence and metastasis or cancer in other organs. Therefore, the elevated SCC antigen level was deemed to be a false-positive reaction accompanying the cutaneous lesions. At around 1 year 6 months after surgery, the rash exacerbated again, and approximately 1 year 11 months later when the rash symptoms were the most severe, the SCC antigen level increased to 51.1ng/mL. Although SCC antigen is used as a tumor marker for oral squamous cell carcinoma, it should be kept in mind that it can be elevated in various diseases such as skin diseases.

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We report a case of oral exostosis that showed extensive growth including giant torus palatinus. The patient was a woman in her 60s who was referred by a nearby dental clinical with a chief complaint of removal of the torus palatinus. Although she was anxious about undergoing general anesthesia, the nearby dental clinical had recommended removal of the torus palatinus. Multiple oral exostosis at seven locations in total was detected at the initial diagnosis. The torus palatinus was giant and the mass was about 28×23×13mm in length. Surgical removal of the bony masses was performed under general anesthesia. One year and three months after surgery, the patient still showed no sign of exostoses.

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