During the 10-year period from 1990 to 1999, 148 cases of malignant tumors in the oral and maxillof acial regions were seen and treated at the Department of Oral and Maxillof acial Surgery at Saga Medical School. They were reviewed and clinically analyzed.
The male-to-female ratio was 1.8 to 1, and the mean age was 65.5 years. The most commonly affected site in the oral cavity was the tongue (37.2%), followed, in descending order of frequency, by the gingiva (33.1%), floor of the mouth (11.5%), buccal mucosa (8.8%), the palate (6.1%), and so on. Histopathologically, 127 (85.8%) of the cases were diagnosed as squamous cell carcinoma.
According to TNM classification of UICC (1997), 0.7% of patients were classified into Tis, 24.5% into T1, 35.0% into T2, 12.6% into T3, and 27.2% into T4. Fifty-seven patients had a clinically positive neck, and two patients had distant metastasis. A total 0.7% of patients were clinically staged as stage 0, 21.7% as stage I, 22.4% as stage II, 18.2% as stage III, and 37.0% as stage IV.
Sixty-three patients were treated with a combination of chemotherapy, radiotherapy, and surgery, which was predominant in all cases. Kaplan-Meier survival curves showed that the cumulative survival rate of all the patients was 63.1% for 5 years, and 68.6% in the curative treatment group of malignant tumor patients.

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The cases that died of neck failure, among 271 patients with squamous cell carcinoma of the head and neck who underwent radical neck dissection between 1985 and 1999, were studied with respect to the primary site, operation method, period until nodal recurrence, region of nodal recurrence, and mode of metastasis.
The results were as follows:
1) Of 271 patients, 173 cases were found to have pathologically positive neck lymph nodes, and 13 cases died of neck failure.
2) Primary sites in these 13 patients were the tongue in 9 cases, the lower gum in 3 cases, and the mouth floor in 1 case.
The average period until nodal recurrence was 5.3 months, and the nodal recurrence in 12 cases occurred within 1 year after radical neck dissection.
3) Extracapsular spread was seen in 11 cases (84.6%), in which 11 neck sides (78.6%) were affected out of 14 sides.
The average diameter of the longest metastatic lymph node of each case was 33.4 mm. Even in the 3 neck sides without extracapsular spread, there were multiple metastases, with an average number of 14 metastatic lymph nodes, ranging in 3 to 6 regions.
4) Nodal recurrence was seen in the area of radical neck dissection in all cases, and in the site of extracapsular spread or of primary metastatic lymph nodes.
From these results, it was suggested that the prognosis of patients with multiple metastasis in more than three regions or extracapsular spread is poor.

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Clinical examination was performed in 4 cases of malignant melanoma in the oral and maxillof acial region, in the Dapartment of Oral and Maxillof acial Surgery II, Okayama University Dental School. The patients consisted of 2 men and 2 women, of ages from 57 to 75. The tumor location was the lower gingiva in 1 patient, and the palate in 3. According to the criteria of the UICC (1997), 1 case was classified as stage I a, 1 as stage II, and 2 as stage III. All cases underwent surgical excision combined with chemotherapy, immunotherapy, hormonotherapy, or a combination of these modalities. Two cases died of local recurrence or regional lymph node or distant metastasis. Two cases had no evidence of local recurrence or distant metastasis after 14 years 11 months, and 3 years 8 months, respectively.

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Adenoid cystic carcinoma is a pathologically well-defined entity that has been described extensively in the literature. Clinically, patients present with a slowly glowing mass. Recurrences are a major problem and may indicate a fatal prognosis.
We present a 39-year-old man who presented with adenoid cystic carcinoma of the mandible and maxilla, with trismus. Diagnosis was difficult as the massive tumor was not clearly apparent on radiography.

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