Recently, many techniques of reconstructive surgery to correct the tissue defects after abrative surgery of oral and oropharyngeal cancer have been developed. However, their functional effects or indications are controversial because of few reports of objective examination of postoperative function.
Summary of the appropriate methods to evaluate postoperative functions and functional results of oral and oropharyngeal cancers are as follows.
1. Appropriate methods to evaluate postoperative functions are as follows : Synthetical evaluation of oro-nasal separation, one hundred syllable Japanese speech intelligibility test and speech intelligibilty in conversation are good to evaluate speech function. Questionaire interview method, low-adhesive colour-developing chewing-gum method and swallowing examination using water are useful to evaluate function of ingestion.
2. Functional disorders due to surgically acquired maxillary defects are improved by maxillary prostheses usually. Placement of a speech appliance in combination with maxillary obturator prostheses or implant insertion in remaining or reconstructed maxilla are of f ctive to improve insufficient oral functions.
Although overall oral functions of reconstructed and non-reconstructed cases are similar, characteristics of the disorders are different from each other.
3. Surgical reconstruction by a flexible and thin flap like a radial forearm flap and prosthetic obturator combined with speech aid appliance should be applied selectively based on the extent of resection of the soft palate. A bulky flap like a rectus abdominus myocutaneous flap is applicable to a resection of lateral wall of the oropharynx, when tissue defect exted to the deep region.
The dif f ernce in postoperative oral functions between various flaps reconstructed are unclear.
Combined appropriate diagnosing techniques and potimal rehabilitation program are needed to obtain eary improvement of dysphagia frequently observed after surgery.
4. The extent of the tongue and the mouth floor resected and operation site affected the oral functions. Patients resected the lateral part of the tongue and the mouth floor obtain significantly better function than patients resected anterior part of them. The cases resected less than a half of the tongue can obtain excellent oral function by a reconstruction with a flexible flap like a radial forearm flap. But, bulky flap like rectus abdominus myocutaneous flap is useful in subjects resected total or subtotal tongue. Optimal rehabilitation program are needed to improve dysphagia observed frequently in subjects resected large extent of the tongue and the mouth floor.
5. Severe functional disorders are not observed in subjects resected mandible or buccal region usually. Disorder in masticatory function significantly observed after mandibulectomy can be improved by implant insertion in bone grafts.

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To clarify whether primary tumor shape and thickness of T1 and T2 tongue carcinoma, evaluated by intraoral sonography, provides information about subsequent lymph node metastasis, 28 consecutive patients were included in this retrospective study. The shape and thickness of primary tumors were evaluated with a 7.5 MHz convex intraoral transducer. Of the 28 patients, 14 underwent neck dissections, and 10 were proved to have histopathologically metastatic nodes. Primary tumors were divided into two categories according to shape: nodular or wedge-shaped. The wedge-shaped tumors showed a significantly high incidence of subsequent lymph node metastasis. Tumor thickness was measured vertically from the surface to the bottom of the tumor. Using 1.0cm as a cut-off thickness, the accuracy for predicting subsequent lymph node metastasis was 71%. If the rule that patients with wedge-shaped primary tumors had metastatic nodes was applied, the accuracy for predicting subsequent lymph node metastasis was 79%. In conclusion, the shape of primary tumor, evaluated by intraoral sonography, was useful to predict occult lymph node metastasis in patients with T1 and T2 tongue carcinoma.

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Fifty-seven patients with SCC of the lower alveolus and gingiva, treated by surgery after preoperative therapy, were studied, to clarify the correlation between regression rate and histological effects of preoperative therapy, in soft tissue and in the mandible. The results were as follows: 1. cases with good clinical response to preoperative therapy, 75% or more of tumor regression rate tended to have good prognosis. 2. In cases with good clinical response, the histological effects of preoperative therapy on soft tissue tended to be good. 3. The histological findings after preoperative therapy in the mandible were almost the same as those in the soft tissue. 4. In the cases with invasive-type mandible absorption on X ray, viable cancer cells tended to be left in bone marrow after preoperative therapy.

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From 1987 to 1996, we encountered 44 cases of submandibular and sublingual gland tumors at Beijing Stomatological Hospital (affiliate of Capital University of Medical Sciences) . Of 44 cases, the tumor was localized in the submandibular gland in 39 cases, and in the sublingual gland in five cases. Twenty-nine of the 44 cases were benign (27 submandibular glands, and two sublingual glands), and 15 were malignant (12 submandibular and three sublingual glands) .
Histology of the benign tumors demonstrated 26 pleomorphic adenomas and one hemangioma of the submandibular gland, and two papillary cyst adenomas of the sublingual gland. Malignant tumors of the submandibular gland included three mucoepidermoid carcinomas, two adenocarcinomas, two acinic cell carcinomas, and one case each of adenoid cystic carcinoma, myoepithelial carcinoma, carcinoma in pleomorphic adenoma, salivary duct carcinoma, and squamous cell carcinoma. Malignant tumors of the sublingual gland included one case each of acinic cell carcinoma, adenoid cystic carcinoma, and myoepithelial carcinoma.
Benign submandibular gland tumors were resected with the submandibular gland in all cases, except for one secondary case in which the submandibular gland had been resected by a previous surgeon. One of the benign sublingual gland tumors was resected together with both the sublingual and submandibular glands, while the other tumor was resected with the submandibular gland, because the origin of the tumor in this case was estimated to be from the submandibular gland prior to surgery.
Relatively extensive resections with or without neck dissection, and including or not including mandiblectomy, were performed to treat malignant tumors. However, the rate of recurrence of primary lesions was a little high in the submandibular glands.

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Pemphigus vegetans is a subtype of pemphigus vulgaris and a rare autoimmune disease. We report a case of pemphigus vegetans that was clinically difficult to distinguish from carcinoma of the lower gingiva, because bone destruction was noted on X ray.
A 49-year-old man visited our hospital with a swelling of the left lower gingiva. At the first medical examination, he had a 24×16 mm mass of the left lower gingiva, part of which was ulcerated. Bone destruction of the mandible was revealed on X ray. Computed tomography and ultrasonography revealed increased size of cervical lymph nodes. Pathological examination of a biopsy revealed pemphigus vegetans. However, since we could not rule out malignant tumor, resection of the lesion was performed under general anesthesia. The histopathological diagnosis was pemphigus vegetans. The patient's postoperative course was satisfactory, but since there is a possibility of symptoms occurring in other locations, long-term observation is required.

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