The effect of immunotherapy with OK-432 on human oral floor cancer, moderately differentiated squamous cell carcinoma transplanted to nude mice, was examined, comparing different routes of drug administration. One KE/kg of OK-432 was administered every other day for 10 days (total 5 KE/kg) to each animal via three routes : intra-abdominal, subcutis and intra-tumor mass. The size of the tumor was measured every other day, and its presumed weight was calculated. The mice were sacrificed on the 8th day from the last administration of drug, and the tumor tissue was examined histologically.
Tumor proliferation was suppressed in all the groups to which OK-432 had been administered. The suppressive effect was comparatively pronounced in the group of intra-tumor mass administration. Histological examination revealed that in the control group the tumor tissue showed an alveolar proliferative pattern with minimal inflammatory cell reaction in the stroma, whereas the tumor tissue in intra-tumor mass with the drug administration showed prominent necrosis at the center with various reaction of inflammatory cells.
In the two other groups, such degenerative and necrotic changes were not so notable. The details of the anti-tumor effect of OK-432 in intra-abdominal administration are not yet clear. The route of drug administration is considered to be crucial in evaluating the effect of the drug.

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In diagnosing parotid tumors, Magnetic Resonance Imaging (MRI) seems to be markedly superior to CT in the following ways: increased ability to contrast and differentiate between soft tissues; improved imaging of vascular structures without the use of a contrast medium; the possibility of three-dimensional tomography; and the ability to study the basicranial bone or air in the paranasal sinuses without artifacts. In this study, the authors examined the MRI findings in 3 cases of parotidectomy in which observation of the gland of the unaffected side was also made.
(1) The anatomical position of the tumor could be located exactly, and discrimination could also be made between the surrounding tissue and the tumor by the comprehensive examination of each 3-dimenjional image.
(2) The retromandibular vein could be located in all horizontal images. In 1 of the 3 cases, the position of a tumor, whether pars superficialis or pars profunda, could be determined from the position of the vein.
(3) Malignancy could not be determined on the basis of the morphology and inner structure of the tumor.

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Multimodal treatment with hyperthermia for two advanced carcinomas of the buccal mucosa was discribed.
Case 1: A 61-year-old man had squamous cell carcinoma of the well differentiated type (T3N2bM0, UICC 1987) . Five cycles (PEP: total 72.5mg, MMC: total 50mg) of chemotherapy with PM administration were carried out. Simultaneously, primary tumors and cervical metastases were irradiated eighteen times with ⁶⁰Co (total dose: 36Gy) using hyperthermia. OK-432 totalling 44.5 KE was given before surgery.
Following excision of primary tumor and total neck dissection, immediate reconstruction, using D-P flap for full-thickness defects of the cheek was performed.
Case 2: A 69-year-old man had squamous cell carcinoma of the well differentiated type (T4N2bM0) . Chemoradiotherapy was carried out with ⁶⁰Co (total dose: 40.5Gy for the primary tumor, 60.5Gy for cervical metastases) with 1500mg of CDDP, 70mg of PEP and 2000mg of 5-FU were also administered. Simultaneously, hyperthermia for the neck was done 9 times 1 day a week. Before surgery, OK-432 totalling 40.4 KE was given. Both patients were followed for a period of 4-years or 2-years and 7 months, respectively. No recurrence or distant metastasis was detected.

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Clinico-pathological studies of 10 cases of gingival cancer removed after induction chemotherapy were made. Either Bleomycin, Methotrexate or Cisplatin was given to all patients for induction chemotherapy. After induction chemotherapy, we applied various surgical treatments to gingival cancers according to the grade of clinico-pathological malignancy and the surgeries' therapeutic effects and received positive results. Based on the initial clinical and histological findings, it seems there is a very close correlation between induction chemotherapy and the grade of clinico-pathological malignancy.
It seems that upon the first evaluation of the clinical and histological findings, subsequent induction chemotherapy and surgical procedures, taking into account the malignancy grade, will help to improve the prognosis of gingival cancers.

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Pain is one of the most serious problems faced by end-stage cancer patients. In order to control this pain, we have administered several medications in our clinic. In this paper, we evaluate the oral administration of morphine.
For the last 12 years, among the 53 patients who have died of oral cancer in our department, 37 (70%) suffered from severe cancer pain. 9 patients were injected with opioid agonist and/or opioid agonist-antagonist. Opioid agonist was administered orally as codeine to 6 patients, and as morphine to 22 patients. The administration was carried out at timed intervals.
The oral administration of morphine was found to be 100% effective in 10 cases (45.5%), fairly effective in 4, slightly effective in 4 and ineffective in the other 4 cases. The incomplete understanding of morphine's use is thought to be the main reason behind the unrelieved pain. In other words, delay in administering morphine, failure to administer the optimal dose, wrong intervals and inadequate management of side effects seem to be the direct factors relating to the lack of effectiveness.
In conclusion, morphine administered orally is an adequate analgesic if it is used correctly and according to the WHO cancer pain relief program.

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The response to combined CP and radiation therapy (CP+R) for oral cancer, as compared with CMP chemotherapy alone, was reported and discussed.
Nine untreated patients (8 male, 1 female) were treated with CMP therapy, and 12 patients (10 male, 2 female) were treated with CP+R therapy in our hospital from 1986 to 1989. Their ages ranged from 43 to 74 years and the tumors of all patients were histologically diagnosed as spuamous cell carcinoma. Primary tumor sites included the tongue (5), the floor of the mouth (7), gingiva (8) and buccal mucosa (1) . There were 10 T2 primary tumors, 3 T3 primaries, and 8 T4 primaries. Seventeen patients had palpable cervical lymphadenopathy, all with N1 (6), N2 (11) and N3 (0) disease.
In the group treated with CMP therapy alone, CR was achieved in 3 cases and PR in 2 cases with a response rate of 56%. On the other hand, the combined CP+R therapy produced higher clinical efficacy than CMP therapy alone, in which CR was achieved in 6 cases and PR in 5 cases, with a response rate of 92%. Especially in CP+R therapy cases with 2 courses of CP and 40 Gy radiation, the CR rate rose to 50%. In terms of histological effects, response rates of CMP and CP+R were 43% and 80% respectively, and in CP+R therapy cases Grade III and Grade IV were 70% of response cases.
In histological malignancy, CMP therapy alone had no effect on high malignant cases above 16 malignancy points, but combined CP+R therapy had an effect for even high malignant cases as well as low.
The toxicities caused by both therapies were temporary and not severe.
As the result of this study, it was considered that the combined CP+R therapy was highly effective in local control for oral cancer as compared to CMP therapy alone. But its effects for nodal metastasis were not satisfactory, so there remained no effective therapy for them without surgery.

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Thirty patients' cases with malignant salivary gland tumors treated at the Shinshu University School of Medicine's Department of Dentistry and Oral Surgery over the last 24 years (1965.1989) were reviewed. They were 16 males and 14 females, 11 with major salivary gland tumors (6 parotid gland tumors, 5 submandibular gland tumors) and 19 with minor salivary gland tumors (14 palate tumors, 3 buccal mucosa tumors, l tumor on the floor of the mouth, 1 on the tongue), 24 initial visit and 6 secondary visit patients.
Pathologic diagnosis of adenoid cystic carcinoma (ACC) was made in 13 patients, of carcinoma in pleomorphic adenoma (CPA) in 10, of mucoepidermoid carcinoma (MC) in 3, of epidermoid carcinoma (SCC) in 2 and of other types of adenoma in 2. Swelling without pain was the most frequent symptom at the initial visit, other symptoms such as ulcers, pain, induration, trismus and nerve palsy which suggest malignancy of the disease were rare and seen only in the advanced cases. Twenty four cases (80%) were surgically treated; with surgery alone in 16, with radiation in 2, with chemotherapy in 3 and with both in 3.
In 6 secondary visit patients, the duration between inital treatment and the visit to us ranged from 2 to 37 years (mean 12.2 years) . It seems that a long-term follow up is important for malignant salivary gland tumors. In December 1990, 16 patients had survived, 8 had died as a result of their diseases, 2 had died of other diseases, and 4 could not be surveyed. Among the 16 surviving cases, there were 8 with CPA and 6 with ACC; however 3 of ACC patients have had revealed distant metastasis or recurrence.
Therapeutic results were good for CPA and poor for ACC, and better for minor salivary gland tumors than for major salivary gland tumors.

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The subject (female, 63 years old) had been under oral administration of steroids for glaucoma for 5 years. She came to our hospital with the chief complaint of numbness in the right lower lip. Panorama X-P upon the first consultation revealed no bilateral differences in the mandible. Other than generally distributed osteoporotic change, the screening examination revealed no abnormalities such as malignancy-induced bone destruction. Accordingly, we initiated treatment suspecting atypical chronic mandibular myelitis induced by steroid administration. Since the symptom was not relieved, a biopsy was taken to check for neoplastic disease. Pathohistological examination indicated squamous cell carcinoma. Close examination after admission disclosed multiple carcinomatous foci in the lungs and liver. Since surgical treatment was judged inapplicable, the subject was given chemotherapy. However her condition further worsened. Although there were no abnormal findings in the gingival mucosa, a swelling in the right mandible extended itself to the opposite side. Moreover, bleeding began from the gingival margin of the remaining teeth. The subject died 7 months after the first consultation.
This was a case of a patient under steroid administration complicated by osteoporosis and primary cancer of the mandible. These complications made a correct diagnosis difficult. We keenly recognize the difficulty of differential diagnosis between inflammatory diseases and malignant neoplastic diseases under such conditions.

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We have encountered a case of pigmented navus that developed in the mandibular gum of a 27-year old woman. She was first examined on March 27, 1986, with a small tumor mass in the left mandibular gum as the chief complaint. The tumor, measuring 8 by 8 mm, looked like a dome with granular brown spots. There was no tendency for the tumor to grow. The tumor was resected under local anesthesia on March 31 of that year.
Histologically, cell nests composed of clear-bodied nevus cells, were observed. The nevus cells consisted mainly of bodies resembling round cells, although some contained spindleshaped ones. Some nevus cell groups were junctionally growing. The nevus cells showed a potent antigenecity against S-100 protein. We established a diagnosis of pigmented nevus (compound type) .
The patient is progressing favorably after the operation. At present, four years after the operation, no evidence of recurrence is noted.

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We encountered a case of ameloblastona that recurred 40 years after the first operation. We performed hemilateral resection of the mandible and extensive skin resection in combination, and instantly carried out reconstruction using a D-P (deltopectoral) skin flap for the buccal defect resulting from the resection. This paper is a report of our findings.
The patient was a 65-year old woman. Diagnosed as having tumor of the right mandible, she underwent resection 40 years ago. With a recurrence noted 15 years thereafter, she had radiotherapy. At the first visit, a tumor mass 6.5×5.8cm with an ulcer was noted in the skin of the rigth mandible. An ulcer 4.0×2.5cm also formed in the mouth.
X-ray examination revealed a goose egg-sized multicystic bone resorption at the angle of right mandible which was accompanied by pathological fracture. Upon histological examination, ameloblastoma was diagnosed but malignant pattern was observed.
The D-P skin flap was prepared before resection. The intermediate layer of the skin collected from the thigh was transplanted on the reverse side of the skin flap. A total of three operations, with the resection in between, were performed. The patient progressed favorably after each operation. Difficulty in opening the mouth, dysphagia or dysphasia were not observed.
The resected specimen was massive, weighing 114g. Histological findings of the specimen were similar to the results of biopsy. Basically it was of the plexiform type and there was no evidence of malignancy.
The transplanted skin flap in the reconstructed cheek survived both inside and outside the mouth. At present, 6 years and 6 months after the operation, no recurrence has been observed.

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A case of verruciform xanthoma in the palatal mucosa was reported.
The patient was a 46-year-old man with a 1-year history of a rough surface of the palatal mucosa.
Oral examination revealed a well circumscribed and broad based lesion of whitishyellow color, with a granular surface and 15×12 mm in size, in the palatal mucosa of the right upper molar region. No other significant findings were noticed. The lesion was diagnosed as a verruciform xanthoma (papillary type) by histopathologic examination of biopsy material, and was surgically excised.
Histopathologically, the lesion was composed of both hyperparakeratotic stratified squamous epithelium with regularly elongated rete pegs and numerous foamy cells in the connective tissue of inter-rete ridges.
Foamy cells were surrounded by dense connective tissue with partial hyalinization.
No recurrence occurred for 2 years and 6 months after surgical treatment.

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