The outcomes of the surgical management of oral malignant tumor treated in our clinic over the past 24 years were analyzed and reviewed regarding the following items ; 1) characteristics of the clinical features of 888 oral malignant tumors, 2) clinicopathological features and treatment results of 481 surgical cases with oral squamous cell carcinoma, 3) treatment methods and results for squamous cell carcinoma over a 21 year period divided into three terms (term 1, 2, 3), 4) systematic treatment of oral squamous cell carcinoma based on biopsy methods, 5) various kind of neck dissection for each N-stage. The disease specific 5-years cumulative survival rate for all 481 cases with oral squamous cell carcinoma was 77.0% and was favorably improved up to 87.2% for the latest (3rd) term. We were led to the conclusion that the improvement in the survival rate was due to employment of excisional biopsy with a safe excised margin by frozen section diagnosis for early cancer, surgery with special reference to stage, malignancy and chemotherapeutic effect, and neck dissection for early lymph node metastasis. The main prognostic factors were N-stage and mode of invasion.

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The factors predisposing to bilateral cervical lymph node metastasis (BLNM) in squamous cell carcinoma (SCC) have not yet been clarified. We tried to explore the mechanism of BLNM from oral and oropharyngeal SCCs.
Of 583 patients with oral or oropharyngeal SCCs, 168 and 27 patients revealed unilateral lymph node metastasis (ULNM) /and BLNM, respectively. ULNMs were observed frequently in floor of the mouth (44.2%) and oropharyngeal SCCs (35.3%), while BLNMs were observed frequently in palatal (27.3%), oropharyngeal (11.8%), and upper gingival SCCs (11.5%) . Carcinomas involving the median region highly metastasized to bilateral lymph nodes compared with those involving the median region (p<0.05) . Both ULNM and BLNM were statistically associated with the advancement of T stage. In addition, there were relationships between the mode of tumor cell invasion and the incidence of ULNM and BLNM.
In two of 17 patients whose primary lesions did not involve the median region and that developed BLNM, ipsilateral neck dissections were done, and lateral lymph nodes metastases occurred after relapse of the primary lesions. In conclusion, these findings revealed that oral carcinomas involving the median region, and carcinomas in the hard palate, oropharynx, and upper gingiva having diffuse modes of tumor cell invasion, have a tendency toward BLNM. And the interception of the lymph vessels by neck dissection on the disease side may bring a risk of opposite side metastasis.

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A 71-year-old woman with gingival carcinoma of the upper jaw who also had dementia, received surgery and some problems informed consent, operative therapy, and others were revealed.
These problems that concered therapy for oral cancer patients with dementia, were as follows ; (1) How to inform them of oral cancer, and what kind of informed consent is needed? (2) Which kinds of therapy are ap propriate? (3) We found some problens such as care after surgical treatment.

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