Dysfunction and aesthetic disorders in the oromandibular region caused by surgical resection cannot be restored to the presurgical state. It is essential to reconstruct a new functional system that matches the defect and can be accepted by the patient after surgery; this is called functional unit reconstruction. In aesthetics, it is crucial to reconstruct the patient’s new facial contours to be acceptable after surgery, which is called framework reconstruction. From the perspective of functional unit philosophy, we know that effective functional reconstruction is not possible by reconstructing the oromandibular region organ-by-organ, one organ at a time, such as the tongue, floor of the mouth, or mandible. It is important to consider the importance of each organ in the overall function of the oromandibular system and to reconstruct it as a functional complex. To reconstruct oromandibular function, oral and maxillofacial surgeons, plastic surgeons, head and neck surgeons, and maxillofacial prosthodontists must share a common understanding of the major themes of “What is eating?” and “What is the facial appearance that patients can accept after surgery?”, and be aware of the aims and objectives of the reconstruction. To achieve this, surgeons must have a deep understanding of oromandibular functions, including masticatory and temporomandibular joint functions. In addition, mandibular reconstruction is facial reconstruction. For this reason, surgeons must have a clear idea of the new facial framework that the patient will accept after surgery.

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Metastatic tumors in the oral cavity are relatively rare, and oral metastasis of pancreatic cancer is extremely rare. Here, we report a case of pancreatic cancer with metastasis to the mandibular gingiva. A 57-year-old woman had a history of diabetes mellitus and lumbar disc herniation. She noticed gingival swelling and bleeding distal to the left mandibular second molar and underwent anti-inflammatory treatment at a local dental clinic. However, owing to no improvement even after 1 month, she was referred to our department for anti-inflammatory treatment and third molar extraction. A 5×10mm protuberant mass was found in the distal gingiva of the left mandibular second molar, and the contrast-enhanced computed tomography image showed contrast enhancement. The cytological diagnosis was low grade squamous intraepithelial lesion （LSIL）, and the biopsy diagnosis was adenocarcinoma. Immunochemical staining was positive for CK7, CK20, and MUC1 and negative for CDX2, PAX8, and MUC2. These results suggested metastatic tumors, such as pancreatic cancer, gastric cancer, and colon cancer. We observed a mass with fluorodeoxyglucose （FDG） uptake in the pancreatic tail, peritoneal dissemination, multiple nodules in both lungs and liver, and multiple FDG uptakes in the spine and pelvis. Based on these findings, we diagnosed the patient with pancreatic cancer and suspected multiple metastases. A definitive diagnosis of adenocarcinoma was obtained based on pancreatic endoscopic ultrasound-guided fine-needle aspiration. Gemcitabine and nab-paclitaxel combination therapy was performed; however, subsequently, the policy was changed to best supportive care, and the patient died 131 days after her first visit.

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This report describes a case of central giant cell granuloma arising in the maxilla treated with superselective arterial embolization. A 16-year-old woman was referred to our department for further examination and treatment of a painless mass in the right maxilla. An incisional biopsy revealed a suspected giant cell lesion. Surgical extirpation and curettage were performed under general anesthesia after superselective arterial embolization because an abundant vascular network in the lesion was detected by imaging examinations. Histopathologically, the lesion was finally diagnosed as central giant cell granuloma. There has been no evidence of recurrence at around 4 years post-operation.

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