A case of a 34-year-old female with adenoid cystic carcinoma, originated from the left palatal mucosa, was treated in our department and reported. Since she consulted our clinic at first with a complaint of swelling of the left buccal and palatal gum with a letter of a doctor, who asked us to remove 27 because of dental infection, anti-inflammatory treatment was carried out and the symptom disappeared, except a slight swelling of the left palate. Then six years later, she came to our department again with a complaint of ulcer formation in the left palatal region. The histological diagnosis of adenoid cystic carcinoma was decided through biopsy, and the X-ray examination revealed the multiple lung metastasis. So the case was classified as T2N0M1 by UICC. The treatment against the tumor was carried out through the trimodal therapy firstly but without apparent effect. So the total excision of the primary tumor with superhemimaxillectomy was performed, and then plastic surgery with DP-flap was performed
Because of the slow-growing but inoperable lung metastasis, the primary tumor excision was finished resulting in tumor-free findings macroscopically, considering the informed consent and QOL of the female patient with an age of 40 years. About one year later, a composite skin graft on the left upper red lip was performed successfully, from cosmetic and functional view point. Furthermore, a maxillary resection prosthesis was set on the left upper jaw, which brought her a better QOL on function and appearance. She has received an ambulatory examination periodically, taken immunological and antitumor medicament and returned to the social life for 3 years and 6 months.

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The purpose of this study was to investigate histologically the changes of epithelial cells in the tongue which was injured and pained by carcinogen Trp-P-2 (3-amino-1-methyl-5Hpyrido [4, 3-b] indole) or GIu-P-1 (2-amino-6-methyldipyrido [1, 2-a: 3', 2'-d] imidazole) . Hamsters were divided into 10 groups (Groups A-J) . In Groups A and F, the tip of the tongue was painted three times a week with distilled water for 16 weeks. In Groups B, C, G and H, the tip of the tongue was painted three times a week with a 1 % Trp-P-2 solution for 16 weeks. In Groups D, E, I and J, the wound was painted three times a week with with a 1 % GIu-P-1 solution for 16 weeks. At the end of 16 weeks, in Groups A, B, C, D and E, the tip of the tongue was excised with scissors, while in Groups F, G, H, I and J, the tip was not excised. Then, in Groups A and F, the tongue was painted daily with distilled water until the animals were sacrificed. In Groups B and G, the tongue was painted daily with Trp-P-2 solution until the animals were sacrificed. In Groups D and I, the tongue was painted daily with GIu-P-1 solution until the animals were sacrificed. In Groups C, E, H and J, the animals received no treatment until they were sacrificed. Animals of all groups were sacrificed 15 days after the excision or after the end of 16 weeks. The tongue was examined histologically.
1) Group A. The tongues of all animal showed only hyperkeratosis.
2) Groups B and E. One animal in Group B and two in Group E showed changes of slight to moderate lingual epithelial dysplasia. These changes included disorientation of cells. cellular and nuclear pleomorphisms, nuclear hyperchromatism, increased number of mitotic figures, abnormal keratinization, and elongation of epithelial projection. The remaining animals had tongues similar to those of Group A.
3) Groups F, G, H, I and J. The tongues of all animals were normal.
The results of this study indicated that epithelial dysplasia of the hamster tongue was produced by both excision and heterocyclic amine treatment (Trp P-2, GIu-P-1) .

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To relevantly diagnose the histological grade of malignancy before treatment, it is most important to select therapies of lower gingival squamous cell carcinoma. We examined the relationship among each factor of histological grade of malignancy, metastasis of lymph nodes, effectiveness of preoperative treatment, and prognosis of 29 cases of lower gingival squamous cell carcinoma. The histological grade of malignancy was classified according to seven factors, that is, differentiation, nuclear polymorphism, mitosis, mode of invasion, stage of invasion, cellular response, and vascular invasion. Metastasis of lymph nodes is associated with mode of invasion, stage of invasion, and vascular invasion. Effectiveness of preoperative treatment is only correlated with vascular invasion. Poor effectiveness of preoperative treatment induced recurrence and the tendency of metastasis. As a result, their 5-year crude suvival rates were lower. Therefore, in decision of therapeutic strategies for lower gingival squamous cell carcinoma, we should particularly consider mode of invasion, stage of invasion, and vascular invasion.

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Cervical metastasis is occasionally observed in early stage of oral squamous cell carcinoma. This study was carried out to elucidate the difference in histological malignancy and expression of extracellular matrix between metastatic and nonmetastatic cases. There were 31 T1 cases, consisting of 8 with cervical metastasis and 25 with nonmetastasis.
In the metastatic cases, plural and extranodal metastases were frequently observed, leading to a poor prognosis. Primary tumor of metastatic cases showed the following characteristics in comparison with that of nonmetastatic cases :
1) High grade of histological malignancy, judging from mode of invasion, stage of invasion and cellular response, was observed in the metastatic cases.
2) Increased regulation of fibroneticn and tenascin expression and the decreased regulation of decorin expression in tumor stroma were more frequently observed in the metasatic cases.
These results suggest that the T1 case displaying aspects of the high grade of histological malignancy and the characteristic distribuion of extracellular matrices in the tumor stroma is highly potential for metastasis. Consequently, prophylactic neck dissection should be primarily considered in the T1 cases with these aspects.

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[in Japanese]

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Three reconstructed cases using the sensory forearm flap after resection of tongue carcinomas are presented. Return of sensation was achieved within 7, 5 and 3 months respectively. As a sensory forearm flap produces rapid and sure sensory return even in the irradiated graft bed, the flap contributes good postoperative functional rehabilitation of swallowing and speech.

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Twenty-three (8.01%) of 287 cases of locoregionally-controlled malignant tumors of head and neck developed distant metastases. The occurrence of distant metastasis of squamous cell carcinomas is closely related to the occurrence of cervical lymph node metastasis.
A retrospective analysis was performed on the 23 cases of distant metastasis. Of these 23 cases there were many cases of floor of mouth, squamous cell carcinomas, advanced stages and multimodal therapies. Distant metastasis developed earlier in squamous cell carcinomas than salivary gland malignant tumors and sarcomas. The mean survival periods after diagnosis was shorter in squamous cell carcinomas than the others. The common sites of distant metastasis were lung, bone and liver. No relation was found between the metastatic sites and pathological classifications. The 5-year cummulative survival rates were as follows : 13.0% for all cases, 6.7% for squamous cell carcinomas, 33.3% for salivary gland malignant tumors, 40.0% for sarcomas.
As distant metastasis is fatal, it is useful to predict the high risk groups of distant metastasis and to add the adjuvant therapy to locoregional therapy for the high risk cases before developing distant metastasis.

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A clinical study was made of local recurrence after surgery in 22 patients with squamous cell carcinoma of the oral mucosa between 1980 and 1991, and the following results were obtained.
1. Local recurrence occurred in 9 of 22 patients with carcinoma of the tongue. Recurrence often occurred in those who had locally advanced tumor undergoing hemiglossectomy, semi-total glossectomy or total glossectomy.
2. Local recurrence occurred in 7 of 42 patients with carcinoma of the lower gingiva. Recurrence occurred i n those who had T1·T2 tumor undergoing marginal mandiblectomy with intraoral approach, as well as in those who had T4 locally advanced tumor. X-ray findings and histologic grade of malignancy did not correlate with local recurrence.
3. Local recurrence occurred in 4 of 17 patients with carcinoma of the floor of the mouth. Recurrence occurred in those who had T2·T3 tumor undergoing marginal mandibllectomy. Histologic grade of malignancy did not correlate with local recurrence.
4. Local recurrence occurred in 2 of 22 patients with carcinoma of the upper gingiva. There was no recurrence in T1-T3 patients.
5. Only 7 of 22 patients with local recurrence showed good prognosis. The 5-year cumulative survival rate was 34.1%.

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A clinical study was made of 124 patients with squamous cell carcinoma of the oral mucosa who underwent neck dissection between 1980 and 1991, and the following results were obtained :
1. Two of 66 patients ended in neck failure who were intially N+ and underwent resection of the primary tumor and neck dissection simultaneously as initial treatment. These two showed high histologic malignancy and multiple, extended neck metastases.
2. Five of 21 patients ended in neck failure who were initially N+ and underwent interstitial irradiation to the primary tumor followed neck dissection. These five showed moderate or low histologic malignancy and localized neck metastasis initially, but the duration between radiotherapy and neck dissection was long.
3. Five of 29 patients ended in neck failure who were initially NO and underwent neck dissection when late neck metastasis occurred. These five showed moderate or low histologic malignancy but their late metastases were not detected until they were very advanced.
4. None of 8 patients ended in neck failure who underwent neck dissection when local recurrence occurred.
5. These results indicated that establishment of treatment methods for patients with high histologic malignancy and the early diagnosis of neck metastasis using CT and MRI were important.

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Pleomorphic adenoma is the most common tumor of the salivary gland. It occurs most frequently in the major salivary glands, especially in the parotid glands. In the minor salivary glands, it occurs most commonly in the palate and relatively uncommon in the upper lip. We reported three cases of pleomorphic adenoma of the upper lip. They were well-demarcated and movable and could be easily resected under local anesthesia. No recurrence has been noted. They were pathologically diagnosed as pleomorphic adenoma.
In Japanese literature, 39 cases (4.2 %) of 919 minor salivary gland tumors were pleomor-phic adenoma of the lip.
It is considered necessary to set a safety margin for postoperative deformity and dysfunction of the lip.

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A case of carcinoma of the lower alveolus and gingiva in an elderly patient is presented. An 84-year-old woman was referred to our clinic, complaining of both tumor and contact pain at the left lower gingiva. Since the histopathologic diagnosis of moderately differentiated squamous cell carcinoma was made, UFT was administered as an oral antitumor drug after considering both her age rejection of hospitalization, resulting in disappearance of the oral tumor clinically and histolopathologically in four months. But because of hematogenous disturbance, chemotherapy was discontinued after six months. However, the patient tended to take a good course. In conclusion, by the standard for the efficacy of cancer chemotherapy, this case had a state of complete response. This case suggested the clinical usefulness of UFT as chemotherapy for carcinoma of alveolus and gingiva in an elderly patient.

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