Dysgeusia caused by cancer chemotherapy is an adverse event with a high incidence. It is a distressing side effect that can increase stress in patients with cancer, leading to loss of appetite and subsequently malnutrition. In contrast, because the complaints of dysgeusia often improve after withdrawal from chemotherapy, the diagnosis and evaluation of dysgeusia have been based mainly on subjective symptoms. Therefore, there have been few studies using objective taste tests, and the methods used to evaluate taste abnormalities are diverse and qualitative. The finding that hypergeusia, as well as hypogeusia, can occur in patients receiving chemotherapy indicates the importance of taste testing. Furthermore, there is a lack of consensus regarding the efficacy of zinc therapy, which has been established as a common method for the prevention and treatment of dysgeusia caused by cancer chemotherapy. The mechanisms of chemotherapy-induced taste disorders and the prevention and treatment of dysgeusia are still unclear. We would like to emphasize that the use of objective taste assessment allows us to identify individual taste changes by chemotherapy and to provide individual advice on the taste of food; the testing also provides psychological support to the patients as it reassures them that their complaints are taken seriously by medical professionals.

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A clinical statistical survey was carried out using results from interviews at a first examination and laboratory data to gain an understanding of trends among patients at Meikai University PDI Tokyo Clinic. The study participants were 254 and 472 new patients who visited the clinic in 2013 and 2018, respectively. The survey items were 1） average age and number of patients in all age groups, 2） age composition comparison, 3） gender, 4） place of residence, 5） frequency by chief complaint, 6） age-specific complaints, 7） systemic medical history, 8） handling at the first medical examination, and 9） occupation. The results based on a comparison of 2018 and 2013 were as follows. The mean age rose from 35.5 to 40.7 years, although by age group, the majority of patients were in their 20s for both years. No differences in gender or place of residence were found. The most common chief complaint was tooth pain, but the proportion of the total decreased, and the frequency of systemic disorders increased. The most common treatment at first visit was caries treatment in 2013, but it was scaling （cleaning） in 2018. The most common occupation of patients was company employee in both years. These results provide a clearer picture of trends among patients. We plan to keep carrying out surveys of patient trends in the future to provide more finely-tuned dental treatment.

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Methotrexate-associated lymphoproliferative disorder （MTX-LPD） is a lymphoproliferative disorder that occurs in patients taking MTX. Although it is rare to occur in the oral cavity, reports of MTX-LPD have occurred occasionally in recent years. Maxillary gingiva is the most frequently reported site in the oral cavity; lips being affected is rarely reported. This time, we experienced a case of MTX-LPD in the corner of the mouth. The case is a woman in her 60s. She had a history of rheumatoid arthritis and osteoporosis and had been taking methotrexate for 11 years. At the first visit, findings that may have been malignant were observed from the right corner of the mouth to the lower lip, but the examination was conducted with the possibility of MTX-LPD in mind. As a result of a biopsy, MTX-LPD was diagnosed, and improvement was observed only by discontinuing MTX. In this case, we suspected MTX-LPD from the beginning for a case with suspected oral cancer in the corner of the mouth, and we were able to treat it early by diagnosing MTX-LPD by examination. Since the clinical symptoms of MTX-LPD are diverse, it is considered necessary to make a diagnosis with this disease in mind for patients taking MTX.

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We report here our experience with a case of mucoepidermoid carcinoma of the palate difficult to diagnose as a benign or a malignant tumor. The patient was a male in his 20s who was referred to our hospital in February 202X with a complaint of swelling of the left palate. Intraoral findings revealed a light purple color area approximately 20mm in diameter on the left palate. Hemispherical swelling was noted and elastic and soft undulation was palpable. CT findings revealed a soft tissue mass with a diameter of about 17mm and a CT value of about 64HU in the left palate. MRI findings revealed a well-defined mass with a diameter of about 20mm in the left palate. Diffusion-weighted images did not show a significant decrease in diffusion. The T2-weighted image showed a moderately high signal intensity. Diagnostic imaging suggested salivary tumors, hemangiomas, or neurogenic tumors. The tissue biopsy results indicated a salivary gland tumor. In April, resection was performed at the general anesthesia department. Based on the pathological results, a definitive diagnosis of low-grade mucoepidermoid carcinoma was obtained. Ten months after the operation, there was no sign of recurrence and the prognosis was good.

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We report a case of sting wound of the oral mucosa caused by sea urchin spines. A 40-year-old woman visited our hospital because of gingival paresthesia of the right palatal first molar region after eating some octopus sashimi. A foreign body in the gums was self-extracted immediately after the pain was felt. The foreign body was a black spine of about 10mm. Antibacterial agents were administered to prevent secondary infections, and no residual disorders were observed. Scanning electron microscopy revealed that the foreign body was a sea urchin spine.

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We experienced a case of brainstem infarction caused by protein S （PS） deficiency with oral paresthesia as the initial symptom. The patient was a 27-year-old woman with a history of smoking. Initially she realized numbness in the left half of her tongue. As the patient complained of not only hypoesthesia in the oral cavity and left half of the face, but also discomfort in the left upper extremity, cranial nerve disease was suspected. She was referred to the department of neurology. MRI revealed a small lesion on the left dorsal side of the pons, and demyelinating disease was suspected. Although steroid pulse therapy was initiated, the symptoms did not improve. However, on the basis of the repeated MRI result, a pontine infarction was suspected. The paresthesia was gradually improved by pharmacotherapy. During this time, decreased PS level was found and it was determined that she had been taking low-dose pills. This medication was immediately discontinued. The low PS level slowly improved after discharge. On the basis of these findings, we supposed that the onset of brainstem infarction in the present case was due to the acquired PS deficiency caused by multiple factors including low-dose pills and smoking.

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Sialolithiasis is a common finding and occurs mainly in the submandibular gland. We report a case of current sialolithiasis 20 years after removal of the submandibular salivary gland. A 69-year-old woman was referred to our hospital because of swelling in the sublingual area on the right side. A CT revealed the presence of large calculi within the submandibular duct and the total removal of the submandibular gland. With a clinical diagnosis of sialolithiasis in the submandibular duct or the sublingual gland, resection of the calculi was carried out by an intraoral approach under local anesthesia. The postoperative course has been uneventful for one year and three months.

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We herein report a rare case of chronic expanding hematoma （CEH） of the left ala nasi that developed 2 years after a facial injury. A man in his fifties visited our hospital with painless swelling of the left side of his face. An elastic solid mass, approximately 30mm in diameter, was palpable at the inferior portion of the left cheek. Computed tomography revealed a cyst-like lesion surrounded by a thick capsule wall in the left ala nasi. Magnetic resonance imaging showed a heterogeneous lesion with high signal intensity on T2-weighted images. The results of clinical and radiological examinations were consistent with a benign tumor. The mass was excised under general anesthesia. Histopathologically, fibrous tissue was prominent and granulation tissue associated with microvascular proliferation and fibrin were also observed. A diagnosis of CEH was reached based on clinical and histopathological features. The patient has remained free of recurrence for 10 years.

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