Twenty-one patients with squamous cell carcinoma of the oral cavity and the adjacent region were analyzed to evaluata the detectability of cervical lymph nodes using computed tomography (CT) . All were scanned with 4mm or 8mm contiguous sections before they received radical neck dissection. The patients consisted of 17 males and 4 females aged from 37 to 71 years (mean 57.5 years) . Resected lymph nodes were confirmed retrospectively on CT images. The detectability was defined as the percentage of lymph nodes detected by CT to those confirmed by surgery. The detectability of cervical lymph nodes including nonmetastatic ones was 49.5%.
The detectability of metastatic nodes was 87.1%, but it rose to 92.3% when intravenous contrast enhancement was performed.
The metastatic nodes were characterized by the findings of rim enhancement or heterogeneous appearances on CT.
The incidence of metastatic nodes depended on their maximum diameter in axial images.
These results show the clinical importance of CT examination for screening the metastatic cervical lymph nodes in patients with cancer of the oral cavity and the adjacent regions.

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This paper presents the results of a clinico-statistical study of maxillary gingival carcinoma.
From 1975 to 1987, 51 cases of maxillary gingival carcinoma were diagnosed and 46 cases were treated in our clinic. T2 and T4 size carcinomas were predominant in T-classification. Many T4 size carcinomas were shown to be tumorous types by clinical findings and bone resorption invasive types by radiological findings. Gingival carcinomas showing erosive-type bone resorption by radiological findings included many with type 1, type 2, and type 3 criteria based on the mode of invasion according to histopathological analysis. The invasive type tends to show type 3, type 4C and type 4D criteia in the mode of invasion.
Eighteen cases were treated by surgery alone and the 5-year cummulative survival rate of this group was 77%. Thirteen cases were treated with a combination of surgery, radiotherapy and regional intra-arterial infusion chemotherapy, and the survival rate of this group was 70.1%. The five year cummulative survival rate of all the treated cases was 60.9%.
Stage I & II tumors were treated mainly by surgery alone while Stage III & IV tumors were mostly treated by combined therapy. Primary tumor control rate with initial therapy was 71.7%. Overall tumor control rate was 63%. Thirteen cases showed local recurrence in the primary lesion after the initial therapy. Initial regional lymph node metastases were found in 10.9% of the cases, and secondary regional lymph node metastases arisen from initial N0 cases were observed in 14.6%. Secondary distant metastases during clinical course were found in 17.4%. A distinctive feature of maxillary gingival carcinoma was that the interval of tumor recurrence was rather long and distant metastasis was often seen in spite of good local and regional tumor control.

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This paper presents the results of a clinico-statistical study of maxillary sinus carcinomas.
From 1975 to 1987, 46 patients with maxillary sinus carcinoma were examined and 38 cases were treated in our clinic. A majority of the patients were in T3 or T4 according to the new UICC T classification of 1987.
Most of them were treated with a combination of surgery, radiotherapy and regional intra-arterial infusion chemotherapy by 5-FU. Out of 38 treated cases, 17 showed no recurrence of tumors in the primary site of maxillary sinus carcinoma. This represented a local primary tumor control rate of 41.7%. The overall tumor control rate was 50%.
Initial regional lymph node metastases were found in 7.9%, and secondary regional lymph node metastases arisen from initial N0 cases were observed in 28.6%. The five year cummulative survival rate in all the treated cases was 34.7%. Although no significant difference in survival rate was found among different treatment procedures, local tumor control rate was slightly higher in the group which underwent both surgery and chemotherapy in the course of the initial treatment. The dose of 5-FU used in the chemotherapy seems to influence the control rate of primary tumors. The primary tumor control rate and incidence of recurrence were also analyzed along with directional nature of each primary tumor in the maxillary sinus anatomical structure.
Successive surgical procedure in conjunction with combined therapy for the primary tumor is considered highly beneficial. Most cases which developed secondary regional lymph node metastases were considered to be the result of recurrent or residual tumors. For further improvement of treatment results, therefore, extended radiacal resection of maxilla is required in such cases which showed recurrence after initial combined therapy on primary tumors.

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Clinical and pathological studies were undertaken on recurrent cervical lymph node metastasis in oral squamous cell carcinoma. Twenty out of 165 oral s.c.c. patients who had been treated by radical neck dissection proved incurable because of their cervical recurrence. About sixty percent of these uncontrollable twenty patients had N3 (1978, UICC) or N2b (1987, UICC) regional lymph node metastasis. However, five cases which had N1 (1978 and 1987, UICC) metastasis also showed cervical recurrence after radical neck dissection.
Histopathological study revealed that 16 out of these incurable 20 patients had lymph node which showed extranodal spread of cancer cells.
Submandibular and superior internal jugular nodes were frequently metastasized but the latter showed a significantly high rate of cervical recurrence.

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A histological classification and grading of malignancy was evaluated on the initial biopsy specimens from 47 cases of squamous cell carcinoma of the tongue, which were treated by radiotherapy, chemotherapy and surgery in the Oral and Maxillofacial Surgery Department of Kyoto University Hospital from 1973 to 1988. The clinical stages of these cases were defined as follows: six cases were classified as stage I, 15 cases as stage II, 20 cases as stage III and six cases as stage IV. Theer 5-year cumulative survival rates were 100%, 73.3%, 56.1% and 83.3%, respectively, with an average of 71.3%. All cases underwent neck dissection. Group of pN (-) showed a 5-year survival rate of 83.1% and pN (+) group showed a survival rate of 25.0%.
The method employed for histological malignancy grading was that proposed by Anneroth (1987), and the average of their total scores was 13.2±3.6. The materials were classified into three groups: low malignant group (≤9), moderate malignant group (10≤, ≤16) and high malignant group (17≤), and the 5-year cumulative survival rates of these groupes were 100%, 84.0% and 13.3%, respectively.
There was a valid statistical significance in the survival rates within six histological parameters. A close correlation was found between the prognosis and following parameters: “pattern of invasion”, “nuclear polymorphism” and “lympho-plasmocytic infiltration”. But no statistical significance was found between the parameter of the “number of mitoses” and the prognosis.

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For appraisal of preoperative treatment, the effects of combined intraarterial chemotherapy and radiotherapy were evaluated in previously untreated patients with squamous cell carcinoma of the head and neek (experimental group) . The experimental group consisted of 14 patients who received both ⁶⁰Co-radiotherapy (20-30Gy) and intraarterial injection of cisplatin (20 mg/m²/week ×2) and peplomycin (5 mg/body/day×10) before surgery. Ten analogous patients who had received only radiotherapy (20-34Gy) preoperatively in our clinic were used as the control group. Patients in both groups received a radical resection of the tumor 7 to 10 days after the preoperative treatment.
Histological findings of the resected materials were compared in each group. Effectiveness (more than Grade II A in Oboshi's classification) of the preoperative treatment was revealed in significantly greater number in the experimental group (79 %) than in the control group (30 %) . However, some adverse effects such as loss of hair and stomatitis were also significantly greater in the experimental group, but subsided soon after discontinuance of the chemo- or raidotherapy. Moreover, it was suggested that stomatitis, the most frequent adverse effect, could be significantly minimized without disturbing the therapeutic effects, when the dose of radiation was maintained at 20Gy.

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This paper presents data on a typical case of squamous cell carcinoma to emphasize the importance of more careful diagnosis of lesions surrounding teeth.
Following a diagnosis of bone absorption due to anterior tooth marginal periodontitis of the mandible, a hydroxyapatite granules plugging operation was conducted. Later, indolent swelling occurred and the patient's condition was unsatisfactory, so the tooth was extracted and the hydroxyapatite granules curetted. Though the operative wound appeared improved and was covered with mucosa which gave non-specific findings, the gingival swelling remained unchanged. The swelling then spread downward to the lower lip. A biopsy was perfomed and showed squamous cell cartinoma.
The tumor, together with the surrounding healthy tissue and the mandible, was removed surgically, and bleomycin was administered. After three years, there is no evidence of recurrence and the patient's condition is satisfactory.

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This report presents 2 cases of tongue cancer. One was treated by intra- and peritumoral injection of OK-432 and PBO therapy, the other by two courses of PP therapy before and after local injection of OK-432. In both cases, immuno-chemotherapy proved highly effective and seemed to be more successful in patients with tongue cancer who had undergone previous treatment to enhance their immunoresponsibility.

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Fibromatosis, a tumor-like proliferation of fibrous tissue in the soft tissue, is a common tumor found in the limbs and neck, but rarely in the oral and maxillo-facial region.
We discovered a case of f ibromatosis in the left cheek of a 6-month-old male infant.
The patient's mother had found a lump in the left cheek of the patient 2 weeks after its birth. The patient visited our clinic on May 24th, 1990.
The first examination taken revealed a firm 35×30 mm mass adhering to a part of the cheek skin.
CT showed a 25×18 mm mass with an irregular margin, probably connected to the surrounding tissue of left cheek. An echogram showed a heterogeneous and hypoechoic mass. The mass was probably a malignant tumor.
On June 6th, 1990, extirpation of the mass including the surrounding normal tissue was carried out under general anesthesia. The mass was about 40×25×20 mm. The cut surface revealed fullness and a bright yellow color. Microscopically, the mass consisted of spindle cells without neoplasm and revealed fibrous tissue with proliferation of collagen, and was histologically diagnosed as fibromatosis.
There is no evidence of recurrence and / or metastatic findings in the patient 4 months after the operation.

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This paper presents clinical and histopathologic evaluation of the 4 patients who had a recurrence of carcinoma of the mandible after the primary radical operation.
Histopathological diagnosis of all cases was a well differentiated gingival squamous cell carcinoma.
Case 1: A 57-year-old woman. T2NIM0, Stage III. Recurrence occurred a year and a month after operation. Owing to the secondary treatment under fairly good conditions a clinical course of the patient has been satisfactory for 10 years and 8 months.
Case 2: A 46-year- old woman. T4NIM0, Stage IV. Recurrence occurred in the parotid gland 4 months after operation due to severe infiltrative tendency of the tumor. She died of carcinoma.
Case 3: A 59-year-old man. T2N2cM0, Stage IV. Recurrence occurred 2 years and 6 months after operation, when the patient was past cure. He died of carcinoma.
Case 4: A 72-year-old woman. T2NOM0, Stage II. Recurrence occurred 3 months after operation and she died of carcinoma with a severe infiltrative tendency and perineural spread.

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This is a report on a case of reconstructed mandibular osteoradionecrosis. Mandible and oro-cutaneous fistula were both repaired by titanium mesh tray with autogenous bone graft and D-P flap. The patient was a 57-year-old maie who had been operated on for a tumor of the hypopharynx, larynx and esophagus and was given radiation therapy at a total dose of 120 Gy on the face and neck from July 1980 to September 1983. There was an oro-cutaneous fistula on the right submandibular portion, and there also existed a pathologic fracture at the right side of the mandible.
A D-P flap was introduced in this case to close the oro-cutaneous fistula. Delay was made on the deltoid portion of the flap to confirm blood supply into it; three weeks later, the free end of the flap was sutured to the right submandibular portion. The D-P flap was severed at 14 cm from the suture after another three weeks. At that time the flap was rotated and the severed end was sutured to the posterior portion of the submandibular region to form a pedicle flap. A month later, the mandible, including the sequestra, was segmentally resected, and the separated mandibular bone was temporarilly fixed by Roger Anderson's equipment. The mucosal defect was then closed by the posterior portion of the pedicle flap, which was cut at 4.5cm from the anterior end. After a confirmation of the complete closure of the orocutaneous fistula, Roger Anderson's equipment was then replaced by an A-O plate. The facial skin defect was thereupon restored with the remaining parts of the pedicle flaps. Seven months later, the mandible was finally reconstructed with a titanium mesh tray and an autogenous iliac bone graft into it. By these procedures, the patient managed to recover his normal masticatory function.
The etiology of mandibular osteoradionecrosis complicated by the radiation therapy of oral cancer and difficulty of the surgical treatment are discussed.

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