Stromal fibrosis occurs as a host reaction to invasion and proliferation of cancer cells, and cancer cells are activated through their interaction with proliferating fibroblasts. However, the detailed mechanism remains to be clarified. In this study, we investigated the influence of FGF-2, which is excessively expressed in cancer cells at the invasive front, on the proliferation of fibroblasts and invasion and proliferation of cancer cells in vitro. The culture supernatant of three cell strains of human oral squamous cell carcinoma (OSC-20: type 3; OSC-19: type 4C; and HOC313: type 4D), among which the mode of cancer invasion differed, promoted proliferation of human normal gingival fibroblasts (HGF-1) . In particular, the culture supernatant of HOC313 cells markedly promoted proliferation of HGF-1 cells, and FGF-2 expression in the supernatant was more marked than in the culture supernatant of OSC-20 and OSC-19 cells. Furthermore, Recombinant Human FGF-2 (50ng/ml) promoted not only proliferation of HGF-1 cells but also invasion and proliferation of each cancer cell, and the levels of OSC-19 and HOC313 cells were significantly higher than the control values (p<0.05) . In an in vitro invasion model, addition of an FGF-2-neutralizing antibody (2μg/ml) inhibited invasion of OSC-20 and OSC-19 cells. These results suggest that highly invasive squamous cell carcinoma cells produce FGF-2 and promote invasion and proliferation activity of cancer cells via autocrine, whereas it is involved in the proliferation of fibroblasts via paracrine.

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It is important to clarify the risk factors of dysphagia after surgical procedures for oral cancer to indicate the operation, in order to gain informed consent of patients and for rehabilitation for swallowing. This report describes qualitative and quantitative analyses before and after surgical procedures, and investigates the changes of swallowing function. Of 33 patients who received surgical procedures for stage I or II lingual cancer, nine cases were studied and their swallowing function was evaluated by videofluorography taken pre-operatively, post-partial glossectomy and post delayed neck dissection. The qualitative analysis showed that the residual amount in vallecula and pyriform sinus was increased and an unequal passage was observed during pharyngeal transit in those patients after neck dissection. As for the quantitative analysis, no significant difference was observed in pre-operation, post-partial glossectomy and delayed neck dissection. We found that neck dissection might influence the swallowing function, but it was not an absolute factor for aspiration.

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The selection of treatment is difficult in cases with hemangioma in the oral and maxillofacial region, in the order to preserve the preoperative function and esthetics of the organs. We planned to treat two cases of hemangioma in the tongue, lower lip and buccal mucosa with direct ethanol injection therapy. As these two cases were classified as lowflow type by hemangioma preoperative Dynamic MRI, we decided to treat these two cases with direct ethanol injecttion therapy. We achieved the reduction or disappear ance of the tumor without any functional or esthetic disorders.

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As the number of elderly people has increased, the number of oral cancer patients who are of advanced age and with dementia has increased. From the experience of three cases of oral cancer patients with dementia, the following issues were revealed.
It is very difficult to take care of the patients during hospitalization, because there is difficulty in communicating with them and they cannot understand their disease and necessity of the treatment. Treatment is severely restricted due to various factors including physical conditions and dementia. Furthermore, it is difficult to gain positive cooperation of family members, which makes the treatment harder.
When making the treatment plan for patients with dementia, it is important to consider not only the stage of the tumor, general condition and complications, but also age, degree of dementia, QOL and family's preference.

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