To evaluate the influence of operation and irradiation on cell-mediated immunity in patients with primary oral squamous cell carcinoma, several parameters, including NK activity, LAK activity, and IL-2 production, were selected. Twenty-two patients who underwent operation and/or irradiation from 1989 to 1993 were evaluated.
Perioperatively, no significant change of immunologic parameters was observed except increased number of peripheral leukocytes at two weeks after operation. Immediately and/or one month after irradiation, significantly decreased numbers of leukocytes and lymphocytes as well as significantly depressed levels of blastoid transformation of lymphocytes, LAK activity, and IL-2 production were observed. By three months after irradiation, values of immunologic parameters returned to preirradiation values. The number of monocytes and level of NK activity showed little change after irradiation.

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From 1982 to 1992, 29 elderly patients, 80 years old and older, with malignancies in head and neck were treated at the Department of Oral and Maxillofacial Surgery, Yokohama City University. Twelve cases were male and 17 were female, and 26 cases were primary and 3 were secondary. A pathological diagnosis revealed that 26 cases were squamous cell carcinoma (90%) . Frequent sites were the tongue in 7 cases, the buccal mucosa in 6 and the upper gingiva in 4.
As for TNM classification (1987), 2 cases were Stage I, 8 were Stage II, 5 were Stage III and 12 were Stage IV.
The patients were classified into three therapeutic groups, surgery, radiation (curative) and palliative, and the survival rate was studied by the KaplamMeier method. The survival rates of surgery was 15% in 3 and 5 years, radiation was 30% in 3 and 5 years, and palliative was 0 % in one year. The survival rates of curative therapy were as follows : Stage I and II were 50% in 5 years and Stage III and IV were 0 % in 3 years. Unfortunately, 7 cases (50%) died of other causes in the curative group. This was a very high rate and showed traits of malignancy treatment in elderly patients.
From the results, it is most important for elderly patients to undergo appropriate therapy selected by physical and psychological examinations. In fact, performance status was the most helpful information for the evaluation of their conditions. Treatment should maintain the quality of life, especially in elderly patients.

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The lugol staining method using dental iodin glycerin was utilized in the oral cavity, and the stain reactions of oral mucosal lesions and the mechanism of the stain reactions were discussed. The results were as follows :
1) In normal oral mucosa, dental iodine glycerin was retained in nonkeratinized epithelium but not in keratinized epithelium.
2) All malignant and dysplastic epithelium showed the lack of staining with iodine.
3) The stain reaction of nonspecific inflammatory lesion was not uniform.
4) All Lugol stain positive epithelium had large glycogen contents, while Lugol negative epithelium had little or no glycogen contents.
5) There was no clear relationship between the degree of keratinization and the Lugol stain reaction.
From the results of this study, it was concluded that all dysplastic and malignant oral mucosal lesions were detected as areas unstained by the Lugol staining method. It was also suggested that the Lugol stain reaction was closely related to the glycogen content of epithelial cells.

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Free radial forearm flaps were used for reconstruction of oral and oropharynx squamous cell carcinomas in 10 cases. The patients were eight males and two females, and their ages were from 46 to 72 years old, averaging 60.7 years old. As for the site of the primary lesions, five cases were located in the tongue, two in the lower gum and oropharynx, respectively, and one intraosseous of the mandible. The postoperative course was uneventful in nine cases. Total necrosis of the flap was observed in one case, which was considered to be causes by technical error rather than thrombosis. As for the prognosis, five cases survived without recurrence, four died of tumor recurrence, and one died of DIC. The advanced and secondary cases were uncontrolled. As for the postoperative function, most of the cases had little disturbance in mastication, deglutition and articulation. However, they were nearly rehabilitated and considered to have almost satisfactory postoperative oral function.

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One hundred sixty-six cases of intraoral minor salivary gland tumors, histologically diagnosed at the Department of Oral and Maxillofacial Surgery, Hokkaido University School of Dentistry from August 1967 to July 1992, were reviewed and clinically analyzed.
The results were as follows:
1. Benign tumors were 60.8 %, and malignant tumors were 39.2 %.
2. The palate was the most common site, being 62.7 % of all sites.
3. Pleomorphic adenoma were most common, being 59.0 % of all tumors and 97.0 % of benign tumors.
4. Mucoepidermoid carcinoma and adenoid cystic carcinoma were common malignant tumors, being 31.4 % of all tumors and 80.0 % of malignant tumors.
5. Both benign and malignant tumors occurred more frequently in women (60.4 %) and (58.5 %) than men (39.6 %) and (41.5 %) respectively.
6. The average ages were 44.2 years in patients with benign tumor and 53.7 years in patients with malignant tumor. Benign tumors were distributed evenly in all generations, but most malignant tumors occurred in the middle-aged and elder patients.
7. The incidences of pain, ulcer formation, and tumors of 41mm or larger were high in cases of malignant tumors.
8. There were high incidences of malignant tumor in the floor of the mouth, retromolar area, alveolus and tongue.

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Comparative study on 128 cervical lymph nodes (LNs) between preoperative CT images and these histopathological findings was performed in 24 cases of oral and maxillary sinus carcinomas. Based on the CT findings, LNs were classified into three groups : (1) ring, (2) heterogenous, and (3) homogenous enhancement. The results disclosed that the lymphnodes on preoperative CT findings such as ring enhancement showed characteristic histopathological metastasis. The lymph nodes, which were histopathologically metastatic and were found to be characterized by ring enhancement on CT, showed extranodal invasion, and those, which were found to be heterogeneous or homogeneous enhancement on CT, showed histopathologically low advancement. This suggested that the preoperative CT findings of cervical lymphnodes are clinically valuable for the detection of the mode of metastatic nodes such as extranodal invasion.

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A case of multicentric carcinomas in the oral cavity after the occurrence of esophagus carcinoma was reported and discussed. A 56-year-old male with 5 primary cancers, which developed in the esophagus, mandibular gingiva, soft palate, central portion of the dorsal surface of the tongue, and margin of the tongue, was presented. Esophagus carcinoma had been treated with radiation and surgery in another hospital. Four cancers in the oral cavity were treated with chemotherapy and surgery.
Oral multicentric cancers will increase in the future, and there may be many chances to treat them. Therefore, the following are considered important for the improvement of the patient's quality of life.
1) Conservative surgery should be performed to control the oral function as much as possible in accordance with effects of preoperative chemotherapy or radiation therapy.
2) To confirm double cancers, the upper digestive tracts such as esophagus or stomach should be examined using an endoscope in patients with oral cancer.
3) Instruction about restriction of risk factor of canceration, such as smoking, drinking, etc. is necessary.

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Pleomorphic adenoma is the most common salivary gland tumor, and histological pleomorphism of this tumor is one of the most characteristic features. Although small cyst formation in this tumor is sometimes observed, large cyst formation in this tumor is a rare condition.
A case of pleomorphic adenoma, having a relatively large cystic lesion in the left parotid gland in a 28-year-old man, was presented. The adenoma was examined with some imaging methods, and intravenous enhancement of CT was found to be the most useful method for this condition.
The tumor was extracted from the parotid gland. The tumor was 20×20×20 mm in size and had a thickened capsule, including two large cysts. Histologically, the tumor was diagnosed as plemorphic adenoma with large cysts.
The patient had no recurrence for five years.

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Two cases of metastatic carcinoma of the oral region, which are comparatively rare, were reported. Case 1: An 84-year-old woman was referred to our clinic with the chief complaint of left buccal swelling. This case was diagnosed as adenocarcinoma which metastasized to the zygomatic bone from the breast.
Case 2: A 71-year-old man was referred to our clinic with the chief complaint of left buccal and submandibular swelling and pain. The diagnosis was large cell carcinoma which metastasized to the mandibular gingiva from the lung.

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Oral carcinoma seldom metastasizes to the lateral retropharyngeal lymph node, so-called Rouviere lymph node (RN) . In this report, two cases of RN metastasis on bilateral sides from cancer of the oral and maxillofacial region are presented. A 51-year-old male patient developed local recurrence and bilateral neck nodes involvement after receiving partial maxillectomy to resect upper gingival cancer (T1N0) . Although bilateral neck dissection and subtotal maxillectomy were performed, CT revealed a RN metastasis on one side 8 months later. In spite of repeated chemotherapy, another RN metastasis on the opposite side was found by CT after about 6 months. Therefore, the disease was diagnosed as bilateral RN metastases. The other patient was 66-year-old male with maxillary sinus cancer (T3N1) . After radiochemotherapy, partial maxillectomy and upper neck dissection were performed. Nine months after the operation, however, CT revealed a RN metastasis on one side accompanied by involvement of cervical nodes. External radiotherapy to the neck disease was performed ; nevertheless, a RN metastasis on the other side was detected one month later by CT. Thus the disease was diagnosed as bilateral RN metastasis. The prognosis of bilateral RN metastasis in these cases was extremely poor : although the therapy had effects, the patients died with distant metastases about two months later. The causes of RN metastasis are assumed to be alterations of lymphatics induced by the neck dissection and/or tumor emboli. Thus it may be inferred that bilateral metastasis is the result of cross metastasis from tumor in the RN on the contralateral side or systemic metastasis. In conclusion, some cases of oral cancer may require diagnostic imaging of RN.

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Cystic hygroma of the adult is relatively rare, and usually develops in the posterior triangle region of the neck.
An unusual case of cystic hygroma that developed in the midline of a 38-year-old male was reported.

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A case of central giant cell granuloma in the mandible of a 10-year-old boy is reported. X-ray examination revealed an unilocular cystic lesion measuring approximately 40X 40mm in the superior portion of the right mandibular ramus. The mandibular ramus was expanded with cortical bone thinning. Giant cell granuloma was suspected according to the bioptic diagnosis. During the biopsy process serous bloody fluid was aspirated by a puncture and hemorrhage was marked, so the lesion was extirpated by an extraoral approach under general anesthesia. The external carotid artery was tied off temporarily. Sherbet-like bone was recognized around the tumor. The tumor was detached easily from the mandible.
Histopathological examination of the extirpated material disclosed that the lesion was composed mainly of fibroblastic spindle cells and multinucleated giant cells. Many fibroblastic spindle cells were arranged in storiform together with the formation of collagen fibers. Relatively numerous multinucleated giant cells existed unevenly. Dilating capillaries were noticed in the mass. In some areas there were reactive osteoid trabeculae surrounded by osteoblasts.
There has been no evidence of recurrence for 7 years and 10 months postoperatively.

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