At our institute, between 2002 and 2004, lateral retropharyngeal node (LRPN) metastasis was found in three patients with advanced squamous cell carcinoma of the upper gingiva. On sectional images, primary tumors invaded from the gingiva of the molar area to the hard palate, and metastatic nodes, measuring 10 × 10mm, 11 × 8 mm, and 9 × 5 mm in size, respectively, were detected in the retropharyngeal space on the affected side. These cases and seven other cases with upper gingival cancer developing LRPN metastasis reported in Japanese articles were analyzed with an emphasis on the causal lymphatic pathways and clinical characteristics. LRPN metastasis may have derived from the afferent lymphatic channels as the incisive canal · nasal floor-lateral wall of the nasopharynx route in two of the cases and/or as the hard palate-inside to the levator veli palatini muscle route in five cases. In the remaining three, such uncommon metastases may have occurred via an unusual retrograde lymphatic flow caused by neck dissection or multiple neck node metastases. In seven of eight patients with cervical metastasis, LRPN metastasis was detected on the same side. In four of these seven, submandibular and/or upper neck nodes metastases developed simultaneously. In two patients, LRPN metastasis was revealed on the initial sectional images, and immediately after the initial treatment in the other three; these had advanced carcinomas: (r) T3-4, respectively. On the other hand, in four cases with (r) T1-2 carcinomas, LRPN metastasis developed subsequently. Therefore, the lateral retropharyngeal node should be examined carefully on sectional images, whenever upper gingival cancers develop.

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Large defects in the oral cavity due to tumor resection will impair the patient's ability to masticate and speak, thereby adversely affecting the patient's quality of life.
The reconstruction of moderate defects from resections of tumors has been facilitated by the development of myocutaneous flaps which permits immediate reconstruction.
One of the myocutaneous flaps used for reconstruction following moderate tissue loss in the intraoral region is the cervical island skin flap. Here we report twenty cases in which this flap was used for immediate reconstruction after treatment of oral cancers. This study was conducted to investigate the complications and masticatory functions of postoperative oral cancer patients. There were 5 cases (total: 1, partial: 4) of postoperative flap necrosis, which did not require additional surgical repair. However, this reconstructive procedure was able to manage the masticatory and speech functions satisfactorily.
We consider that cervical island skin flap is useful for reconstruction of moderate tissue loss in the oral cavity, because it is simple and can maintain the postoperative functions.

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Multiple primary cancers have been increasing because of diagnostic and therapeutic progress and greater longevity of the guneral population. However, the presence of quintuple or more primary cancers in a single patient is extremely rare.
We report a case of 4-organ quintuple cancer, including oral cancer. The patient was a 47-year-old female who visited the Dental and Oral Medical Center in the Kurume University Hospital with a chief complaint of swelling in the left maxillary gingiva. She had a previous history of bilateral breast cancer with noninvasive ductal carcinoma and invasive ductal carcinoma (scirrhous carcinoma), respectively, and colonal adenocarcinoma. Partial maxillectomy with ipsilateral neck dissection was performed to remove squamous cell carcinoma of the upper gingival, T4N2aM0. Eight months after the primary operation, primary small cell carcinoma of the lung and secondary lymph node metastasis in the contralateral neck were found. Following neck dissection, lung cancer was treated by chemotherapy with VP-16 and CDDP. The pulmonary tumor was enlarged regardless of treatment, and the chemotherapy was discontinued due to severe leucopenia. Afterwards, brain metastasis developed, and the patient is currently receiving gamma knife treatment. However, since the treatment was ineffective, the patient subsequently received whole-brain irradiation. At 19 months after surgery, tumor recurrence was noted at the site of the left maxillectomy, for which TS-1 ® was given palliatively, but no response was achieved. She also had progressive pleural effusion around the lower lobe of the right lung, anddeveloped heart failure due to pneumonia. Later, her condition deteriorated, and she died of respiratory failure.
Since multiple primary cancer will likely further increase in the future, comprehensive examination, including FDG-PET, would be necessary.

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