Treatment planning of head and neck cancer patients has been assisted in recent years by the development of fine-needle aspiration (FNA) biopsy guided by computed tomography (CT) . A case of lower gingival carcinoma with late cervical metastasis of thyroid cancer showed a mass lesion in the retropharyngeal space. The lesion was suspected of metastasizing the thyroid cancer to Rouviere's node. To verify the metastasis, CT-guided FNA biopsy was performed by means of a retromandibular approach. Cytological diagnosis was negative for metastasis, and the result was not inconsistent with the prognosis. The technique used here allows biopsy of the retropharyngeal node in cases where it may otherwise not be accessible.

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The cheek-splitting incision is strongly criticised in the literature because of the aesthetically unsatisfactory result. However, based on our clinical experience in selecting an approach to posterior oral cancer (3 cases), we can affirm that a careful, accurately chosen cheek incision site gives good access to lesions in the posterior oral cavity, with meticulous reconstruction, good healing of the scar is obtained without any functional impairment. For cosmetic reasons, the incision is most suitable in elderly patients with natural facial creases.
The incision is further useful when the oral cancer is located in the posterior oral cavity region and can be resected without elective neck dissection.

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Preoperative fine-needle aspiration cytology (FNAC) of major salivary gland tumors performed on 70 patients were classified by modified Papanicolaou's classification and compared with histopathologic diagnoses of the surgically resected specimens.
Histologically, 21 tumors were malignant and 49 benign.
In this series sensitivity for malignancy (i.e. percentage of aspirates correctly diagnosed as malignant in the presence of malignancy) was 87.5%, specificity (i.e. percentage of aspirates correctly diagnosed as benign in the absence of malignancy) was 97.7%, and overall accuracy was 94.9%.
In 47 cases, histopathologic type of the tumor was diagnosed by FNAC specimens. Sixty percent of malignant tumors and 100% of benign tumors were correctly diagnosed.
No significant complications were associated with any of the aspirations performed on the 70 patients.
Based on these data, preoperative FNAC of major salivary gland tumors is thought to be a safe and useful diagnostic method.

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Non-Hodgkin's lymphoma rarely occurs in extranodal head and neck simultaneously. A case originating from the maxillary sinus and parapharyngeal space is reported. A 77-year-old man had noticed a swelling on his hard palate for 6 weeks. Physical examination revealed an induration on the pharyngeal mucosa as well as a mass on the hard palate. CT and MR studies were performed to define the extent of these lesions. The lesion in the maxillary sinus occupied the cavity and had infiltrated the buccal mucosa, nasal cavity, infratemporal fossa and pterygoid muscles. The other lesion was situated in the parapharyngeal space and pharyngeal mucosal space. However, both modalities failed to identify any continuity between the two lesions. These findings suggested the two lesions might have occurred independently.

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It remains controversial whether oral lichen planus become malignant. We report four cases (three males and one female, average age, 65.5 years) of squamous cell carcinoma suspected to be derived from an oral lichen planus. The site involved were the buccal mucosa, upper gingiva, lower gingiva and tongue, respectively. All showed an erosive appearance macroscopically, and were diagnosed as lichen planus in three cases ; in the remaining case, carcinoma and lichen planus appeared simultaneously. The intervals between the patients' first visits and recognition of squamous cell carcinoma were 33, 49, and 106 months, respectively. One of the patient was smoker and two were drinkers. One patient is now alive and free from tumor, while the remaining patients have died.

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The cystic lymphangioma is a rare tumor of the head and neck. A case of cystic lymphangioma in the right submandibular region of a 6-year-old boy is presented. The tumor, measuring about 8×4 cm, was clinically diagnosed as a plunging ranula on the first examination. The lesion was marsupialized by intraoral approach. Histopathologically, the excised specimen indicated cystic lymphangioma. The tumor was completely enuculeated by extraoral incision. After the operation, there was no evidence of recurrence.

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Both angiosarcomas and hemangioendotheliomas are derived from vascular endothelial cells. They show similar histological features with massive proliferation of atypical endothelial cells. However, angiosarcomas are defined to show a clinical behavior of malignancy ; hemangioendotheliomas, an intermediate behavior between benignity and malignancy. Three cases of these tumors on the gingiva were reported.
Case 1: A 40-year-old woman visited our clinic with a complaint of swelling of the left upper molar gingiva. Most of the tumor had already been excised by another dentist and found to be a hemangioendothelioma. The residual tumor was excised by us, and the patient is presently alive without recurrence. The definitive diagnosis was also a hemangioendothelioma.
Case 2 : A 39-year-old man visited us with a complaint of long-standing ulcer and pain at the median part of the lower gingiva. A biopsy indicated a hemangioendothelioma. A block resection of the mandible with the involved teeth was performed, but the tumor metastasized to the brain and the lung. He died three years and two months after his first visit. The final diagnosis was an angiosarcoma.
Case 3 : A 7-year-old girl was admitted with a chief complaint of gingival swelling at the left lower molar region. A biopsy was diagnosed as a pyogenic granuloma, but the excisional material showed malignancy. A marginal resection of the mandible was performed, but the tumor metastasized to the brain and the lung without recurrence on the gingiva. She died one year and four months after her first visit. The tumor was definitively diagnosed as an angiosarcoma.

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Warthin tumor is a comparatively rare benign epithelial tumor of the salivary gland, which most frequently arises in the parotid gland.
We report a rare case of Warthin tumor involving the bilateral parotid glands, which occurred 9 years after an initial operation on a right parotid Warthin tumor.
The patient was a 69-year-old man who complained of bilateral parotid swelling. The clinical diagnosis was Warthin tumor of the bilateral parotid gland, and the tumors were surgically removed.
The left tumor measured 32×18×17mm, the right tumor, 22×20×18mm.
Histopathological findings were composed of lymphoid tissues with germinal centers and papillaly growth of epithelial elements. The histopathological diagnosis was bilateral Warthin tumors of the parotid glands.
^99mTcO₄^- scintigraphy, ⁶⁷Ga citrate scintigraphy, computed tomography, and ultrasoundsonography were useful to detect Warthin tumor in our case.

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Adult T cell lymphoma in the head and neck region is very rare, however so-called midline lymphomas are almost of the T cell type. Lymphoma in the submandibular gland is extremely rare. A T cell lymphoma occurring in the submandibular region is presented in this article. A 70-year-old woman was referred to our clinic for surgical treatment of a swelling in the left submandibular gland. The gland was indurated and fixed with the surrounding tissues. By palpation, no swelling of the lymph nodes was detected. The gland was extirpated with suspicion of a malignancy, and histological examination of the frozen sections was performed during the surgery. Malignant lymphoma (diffuse, pleomorphic type) was suspected, and neck dissection was avoided. About 1 year after the surgery with adjuvant chemoradiotherapy, lymphadenopathy occurred in the neck and axilla, with the patient dying of the disease in spite of steroid therapy for 4 months. Immunohistochemical stainings revealed tumor cells were positive for CD 3, CD 4 and CD 25. Human T-cell leukemia virus type-1 genome was detected in the PCR-augmented DNA substracted from the extirpated gland. However, the viral DNA was not proven by in situ hybridization. These findings appear to indicate that T cell transformation first occurred in the submandibular region.

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