Prognosis is extremely poor for cases involving lateral retropharyngeal lymph nodes (RPN, so-called Rouviere lymph nodes) with oral squamous cell carcinoma (SCC) . This report concerns an assessment of patients with metastatic RPN and of therapeutic results for RPN metastases. Five patients with SCC arising from the oral mocosa and who were treated at our department during the past 10 years showed positive RPN. The primary sites consisted of two buccal mucosas, one upper alveolus and gingiva, one tongue, and one floor of the mouth. These five patients with positive RPN represented only 1.5 % of the 338 patients with oral SCC, including recurrence, seen at our department during the past decade. RPN metastases were seen in only two (0.6%) of 326 previously untreated patients, but in three (25.0%) in 12 recurences. Out of the four recurrences who underwent a therapeutic neck dissection as secondary treatment, three (75.0%) with RPN metastases had been given external irradiation during previous treatment. Two of five the patients with metastatic RPN had no recurrence at RPN sites. One of them underwent RPN dissection and one patient was treated with conformation radiotherapy, and both are alive without disease. During the same period, elective RPN dissection after preoperative radiotherapy was added to the thrapeutic program for seven selected patients with advanced oral SCC, but none of them had positive RPN. However, active dissection of RPN and/or high dose irradiation should be performed where necessary as indicated by diagnostic imaging.

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Twenty seven cases of mucoepidermoid carcinoma histologically diagnosed at the Department of Oral and Maxillof acial Surgery II, Okayama University Dental School during period of April 1982 to March 1999 were clinicostatistically analyzed. The results were as follows: (1) The subjects were 16 male and 11 female patients. (2) Their mean age was 63.0 years. (3) The primary tumor sites were the major salivary gland in 2 cases and the minor salivary gland in 25 cases. (4) According to the TNM classification, the 27 cases of mucoepidermoid carcinoma were classified into 7 cases of T1, 7 cases of T2 and 13 cases of T4. In stage grouping, 7 cases were in stage I, 7 cases in stage II and 13 cases in stage IV. (5) Surgical treatment was performed for 24 cases. 13 cases were treated with surgery alone and 11 cases with radiation and/or chemotherapy in addition to surgery. (6) The 5-year cumulative survival rates were 69.4% in all cases, 90.9% for the stage I and II group, 46.4% for stage IV group, respectively.

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A 17-year-old woman with the chief complaint of a swelling of the right side of the face and soft palate visited our clinic on May 18, 1999. Magnetic resonance imaging (MRI) demonstrated a large mass extending to the side of the right pharynx. Under general anesthesia the tumor was removed with a midline mandible split approach in July 22, 1999. The tumor was 80mm×60mm×50mm in size, and the histopathological diagnosis was pleomorphic adenoma. The patient remains well with no evidence of tumor recurrence for two years six months.

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In our hospital, a combination of intra-arterial infusion chemotherapy and radiotherapy has been performed to preserve functions and morphology in case of oral cancers. In this study, we report the case in which we performed the combined therapy without surgical therapy at the time of primary treatment, and a good clinical course has been observed to date.
The patient was a 65-year-old female who had a 38×26 mm tumor around the left mandibular alveolar area, whose X-ray showed a bone resorption image reaching the mandibular canal at the first examination. During hospitalization, we performed cannulation into the superficial temporal artery, then performed chemotherapy with PEP (total dose: 48 mg), MTX (total dose: 200 mg), and CDDP (total dose: 100 mg), and radiotherapy (Linac, total dose of irradiation: 40 Gy) . After treatment, the tumor disappeared, and the therapeutic effect was evaluated as complete response based on functional imaging diagnosis using positoron emission tomography. The patient is under maintenance therapy, and no recurrence and metastasis have been observed 2 years and 2 months after treatment.

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We experienced a 44-year-old male patient suspected of parotid lymph node metastasis in image diagnosis of oral floor cancer. The signal strength and type of the left parotid gland tumor were found to be more or less similar to the superior lymph node in the T1 and T2 weighted images in MRI. Ultrasonic tests revealed low echo images of parotid gland tumor in internal parts with slightly vague boundaries. Ga scintigraphy showed mild uptake at the left parotid gland, while Tc-99m salivary gland scintigraphy showed consistent uptake on the left and right sides. Suspecting parotid lymph node metastasis, neck dissection and en blok resection including the left parotid gland tumor were performed combined with frozen section biopsy. Sof t tissue was promptly reconstructed using fore arm flap. The pathological diagnosis of the parotid gland tumor was Warthin's tumor.

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