Initial treatment for tongue cancer without metastasis (N0, M0) was clinically evaluated by an indicator of A₀ rate (rate of aliving patient without carcinoma) . All of 82 patients were composed of T1N0 (26 cases), T2N0 (46 cases) and T3N0 (10 cases) .
Initial management for the patients was classified into two groups, surgery (S) and radiotherapy (R) . Contents of the surgery (27 cases) were resection of tongue, resection of tongue with radical neck dissection or en bloc operation of tongue, mouth floor and mandible combined with immediate reconstructive surgery. Contents of radiotherapy (55 cases) were ²²⁶Ra needle, ¹⁹²Ir pin or ¹⁹⁸Au grain. The results were as follows. 1. On T1N0 cases, S and R showed good control of primary lesion. The A₀ rates were 81.8 % and 73.3 % respectively. Frequency of post metastasis to regional lymphonode in S and R was 37.5 % and 35.9% respectively. The main cause of Dc (died of carcinoma) was recurrent cervical metastasis or distant metastasis to the lung. 2. On T2N0 cases, S and R showed similar A₀ rates 76.9 % and 72.7 % respectively. However, in the cases where the tumor size was larger than 3cm, the A₀ rate of S (87.5 %) was higher than that of R (57.1 %) . And recurrence rate of primary lesion in the S group was 0 %, while, that in the R group was 37.5 %. On T3N0 cases, A₀ rates of S and R were 66.7 % and 28.6 % respectively. In the R group, five out of seven cases (71.4 %) showed post metastasis to regional lymphonode. 4. As an initial management for T2N0 cases where the tumor size is larger than 3cm or for T3N0 cases, en bloc surgical resection showed higher A₀ rates than that of radiotherapy

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Induction chemoradiotherapy was preoperatively applied to 64 primary oral squamous cell carcinomas aiming at reductive excision with preservation of the oral functions. The subjected tumors were composed of 2 Ti, 27 T2, 22 T3 and 13 T4. The tumors were treated with both ⁶⁰Co and PLM in 5, PLM+5-FU in 44, 5-FU+CDDP in 1 and PLM+5-FU+CDDP in 14 cases. Clinically, CR was observed in 22, PR (90 90 % remission) in 17, pR' (≥50 %) in 22 and NR (<50%) in 3 cases. Histopathologically, cells of 16 tumors exhibited a Grade N degenerative change, and Grade III, IIb, ha and grade I degeneration were observed in 4, 33, 4 and 1, respectively, having a correlation to the tumor remission rates. Conservative surgery was performed evaluating the tumor response, and surgical extent was divided into 4 grades. Excision of grade I (only observation without surgery or excisional biopsy) and grade II (marginal tongue resection, limited mouth floor or cheek excision and alveolectomy) was applied to 15 cases each, further, operation of grade III (within 1/3 tongue ectomy with limited removal of the surrounding tissues, limited pull through excision, skin-conservated wide cheek excision and above canal mandibulectomy) and grade N (each extended radical excision) was indicated to 22 and 12 cases, respectively. The extirpated defects were immedi-ately supplemented with deltopectoral skin flap and major pectoral musculocutaneous flap in 23 and 4 cases, respectively. Speech was impaired in 15 among 36 tongue and mouth floor tumor cases. Gustatory impairment increased after induction therapies exhibiting recoveries to near the original levels within a year. Resting salivary flow rate subsequently decreased and finally lowered to about 50 % of the original accompaning increase of the viscosity and contrary decrease of secretory IgA level. No local recurrence was resulted except for 10 cases where 6 were secondarily controlled, and 5 year survival rate was estimated as 69.4 %. In conclusion, aggressive induction therapy with synchronous chemo and radiotherapy makes conservative surgery possible, and will minimize cosmetic and functional disabilities. However salivary gland damage and gastatory impairment remain unsolved.

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During the 12 years, from January, 1977 to December, 1988, 23 patients with primary squamous cell carcinoma in the mandibular gum visited our Department of Oral Surgery, Dokkyo University Hospital. Their clinical pathology and therapeutic results will be reported.
1. There were 16 male and 7 female patients (male: female=2.29: 1), and the age at the first examination distributed from 39 to 86 years old with 65.0 years old in average.
2. T classification showed 56.5 % of T₄, 30.4 % of T2, 8.7% of T₁, and 4.3 % T₃. N classification showed 52.2 % of N₁, 30.4 % of N₀, and 8.7 % each of N₂ and N₃, M classification showed 8.7 % of M₁.
3. Absorption of the mandibular bone was found in 13 cases (56.5 %), and the type was erosive in 4 cases and invasive in 9 cases, and the latter showed more extensive absorption.
4. Absorption of the mandibular bone, clinical stage, infiltration pattern, and nuclear DNA pattern were somewhat correlated.
5. 7 cases were treated with single radiation, 4 cases each with single operation, operation+radiation, radiation+chemotherapy, and 2 cases each with operation+chemotherapy, operation +radiation+ chemotherapy.
6. Five-year cumulative survival rate was 43.4 %, and the prognosis seemed likely to be influenced by the degree of tumor growth, and method of therapy.
7. The amount of nuclear DNA at the primary tumor focus was well correlated with the clinical findings and the type of tumor invasion. In the mandibular gum tumor, the nuclear DNA level was a useful index of the degree of malignancy and of the forecast of the prognosis.

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Six patients of oral cancer underwent transplantation of pectoralis major or latissimus dorsi osteomusculocutaneous flap (OMCF) for the immediate reconstruction of defects after tumor resection with block resection of mandible were reviewed. Of these cases, 4 were untreated advanced cancers, 2 were recurrent cancers.
Reconstructive osteomusculocutaneous flaps were composed of pectoralis major-rib OMCF in 1 case, of latissimus dorsi-rib OMCF in 2 cases, and of pectoralis major-sternum OMCF in 3 cases. All cases were successful except for the case of pectoralis major-rib OMCF.
Pectoralis major-sternum OMCF is most useful functionally and aesthetically in the three methods.
Recently it has been reported that micro vascular osteocutaneous transfer using the scapular flap and others are useful for complex mandibular reconstruction, but pedicled OMCF will be of utility value for mandibular reconstruction, due to the fact that it can be raised easily in a short time.

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Spindle cell carcinoma is a relatively rare sarcomatoid tumor occurring often in the oral cavity, lower lip, tongue, floor of mouth and others. Also it has been reported that the patients with chronic renal failure on long-term dialysis have high incidence of neoplasms.
We experienced a case of spindle cell carcinoma on the right margin of the tongue. The patient was a 40-year-old male, who was under artificial dialysis for 4 years because of chronic renal failure.
He found a lump on the right margin of the tongue in August, 1990. He was examined by an internist while beeing treated by artificial dialysis, and then he visited our clinic complaining of a mass on the right margin of the tongue on August 7 th, 1990.
At the first examination, clinical findings revealed a mass of pedunculated polyp measuring about 17mm in diameter on the right margin of the tongue.
On August 23rd, 1990, extirpation of the mass was carried out under local anesthesia on ambulation. The histological diagnosis was spindle cell carcinoma. So tegafur encapsulated with slow-releasing granules (Sunfural S^®) was administered per os and then we performed partial excision of the tongue under general anesthesia on September 14th, 1990.
There is no evidence of recurrence nor metastatic findings in the patient 9 months after the operation.

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An interesting case of malignant parotid tumor with a very long (about 30 years) duration is presented. At the same time this patient had gastric adenocarcinoma, detected only by chance.
In 1986, a 76-year-old man visited our clinic, complaining of spontaneous pain in the right posterior part of the buccal region. Physical examination revealed a gigantic tumor in both the right buccal and the right parotid region and symptoms of facial nerve palsy. After he had undergone subtotal gastrectomy for gastric cancer which had been found out with sudden hematemesis as a clue during the waiting period prior to the admission to our clinic, excision of the parotid tumor was performed. However he died of cachexy about three months after the operation. Histopathologic diagnosis of the surgical specimen was established as poorly differentiated mucoepidermoid tumor (with high malignancy) of the parotid gland, but differential diagnosis with carcinoma in pleomorphic adenoma was difficult.

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Three cases of the metastatic tumors to the oral regions from primary malignant tumors of other organs encountered in our clinic in the last 16 years were reported. Those three cases constituted 1.7% of the malignant tumors of the oral regions treated in our clinic during the same period.
The first case was a 74-year-old man with adenocarcinoma of the prostate gland which metastasized to the mandibular bone. In this case, oral metastatic lesion had been detected before the prostatic carcinoma was diagnosed. Panoramic radiograph showed osteolytic change in the ascending ramus of the right mandible at the first visit, but only 2 weeks after castration calcification was recognized in the same region. And there were no tumor cells in the biopsy specimen of the right mandible one year after castration.
The second case was a 71-year-old woman with adenocarcinoma of the stomach which metastasized to the maxillary gingiva.
The third case was a 78-year-old man with epidermoid carcinoma of the esophagus (Im) which metastasized to the oropharynx.

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Acinic cell carcinoma is an uncommon neoplasm of the salivary glands, accounting for approximately 2-4% of all parotid gland tumor. Their occurrence in minor salivary gland site is exceedingly rare.
A case of acinic cell carcinoma arising in mucosal surface of upper lip was reported, and a review of literature was briefly carried out.
A 44-year-old man was referred to our department, with a painless swelling on the right side of the upper lip. There was no regional lymphadenopathy. At the first examination, the tumor appeared as a mass of about 20×20mm in size, which was histopathologically diagnosed as acinic cell carcinoma.
Under the general anesthesia, the tumor was resected with radical excision by intra-oral approach and reconstructed with splint thickness skin graft. No recurrence or metastasis has been observed after the operation.
we surveyed 54 cases of this tumor of the minor salivary gland in Japanese literature during the period 1955 to 1991.
In these reports, the tumor occurred most frequently in palate (19 cases), followed by retromolar region (9 cases), lip (7 cases), buccal mucosa (7 cases), and others (12 cases) . The tumor yielded a recurrence rate of 21.6 % in the literatures.

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