This study was performed to examine the correlation between expression of active oxygen scavengers of free radicals and the development of Precancerous lesions or carcinoma of the oral epithelium. Methods : Tissue specimens consisted of the gingival and palatal epithelium from normal controls and from patients with lichen planus, leukoplakia, and squamous cell carcinoma (SCC), in cases of SCC, we also examined the associated non-hyperplastic epithelium (NHE) and the hyperplastic epithelium (HE) located between SCC and the NHE. lmmunostaining for copper-zinc superoxide dismutase (CuZn-SOD) and glutathione S-transferase-π (GST-π) was performed by the so-called ABC method.
Results : Expression of CuZn-SOD was detected in the basal cells of the normal oral epithelium, while immunostaining for GST-π was negative. The epithelium from lesions of oral lichen planus gave negative immunoreactions for both enzymes. In leukoplakia, both enzymes were strongly expressed throughout the epithelial cells, and a positive immunoreaction for GST-π was more frequent in cases of leukoplakis with dysplasia (57.1 % of cases) . In SCC, we detected intense immunoreaction specific for both enzymes in all neoplastic cells, and the frequency of immunodetection of GST-π was high (87.5%) . In the HE, we recognized a diffuse positive immunoreaction for CuZn-SOD in some cases, while the NHE was immunoreactive in the basal cells. However, in all layers of the HE and NHE products of the immunoreaction for GST-π were diffusely distributed in 87.5% and 75% of cases, respectively. Co-expression of CuZn-SOD and GST-π was most frequent in the HE, followed by SCC, leukoplakia and the NHE.
Conclusion : Our results suggest that co-expression of both enzymes and, in particular, the expression of GST-π are closely associated with the development of carcinoma in the oral epithelium.

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The correlation between patterns of cervical lymph node metastases and outcome of patient with oral squamous cell carcinoma was studied retrospectively. This study included 42 patients who underwent lymph node dissection, after referral to our clinic between January 1982 and December 1993, and histologically confirmed cervical lymph node metastases without local recurrence.
The results were as follows:
1. The patients with metastatic lymph nodes at only one level above the mid jugular group, those with 3 or less metastatic lymph nodes and extranodal spread to one node at most, and if the patients underwent preoperative chemo-and/or radiotherapy, those showing a histopathological effect of grade II b to IV according to Oboshi-Shimosato's grading system for metastatic lymph nodes had a better prognosis than other patients.
2. Among 42 patients, eleven patients died of cervical failure, seven patients died of distant metastasis, and the remaining twenty-four patients have survived without tumor.
3. The recurrence at cervical lymph node sites, the ipsilateral upper jugular lymph nodes and parapharyngeal nodes, or contralateral cervical lymph nodes were common in this series.
4. Patients with more than three histologically positive nodes were at higher risk for distant me-tastasis.
From these results, it was suggested that parapharyngeal dissection and bilateral neck dissection were required in some cases. Furthermore, in patients with more than three histologically positive node or with more than single extranodal spread, some adjuvant therapy should be applied.

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The postoperative speech function of 24 tongue cancer patients with immediate surgical reconstruction was evaluated. According to T-classification of the tumor, there were 4 cases of T1, 11 cases of T2, 8 cases of T3, and 1 case of T4. Nineteen cases underwent reconstruction with the radial forearm flap, 3 cases pectoralis major myocutaneous flap, and 2 rectus abdominus myocutaneous flap. One-half of the oral tongue was removed in 10 patients, hemiglossectomy in 13 cases, subtotal resection of the tongue in one patient. Speech assessment revealed that the size of the tumor and extent of tongue resection affected the speech function, while there was no significant difference between methods of surgical reconstruction. In cases with forearm flap reconstruction, the postoperative speech function can be estimated before surgery when T-classification and extent of tongue resection can be determined.

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Our department had 56 cases of odontogenic tumors during a period of 14 years and 3 months (1981-95) . These cases were histopathologically diagnosed according to the revised (1992) WHO histological typing of odontogenic tumors and examined clinicostatistically.
1. The cases consisted of ameloblastoma (23 cases, 41.1%), odontoma (22 cases, 39.3%), benign cementoblastoma (3 cases, 5.4%), malignancy (2 cases, 3.6%), clear cell odontogenic carcinoma (1 case), and primary intraosseous carcinoma (1 case) .
2. The tumors were found in 29 males (51.8%) and 27 females (48.2%) . Occurrence of ameloblastoma was predominant in males.
3. The patients' ages at their first visits ranged from 6 to 83 years ; the mean age was 32.1 years. The highest incidence of ameloblastoma was recognized in the fifth decade. Most cases of odontoma were diagnosed within the first two decades of life.
4. The mandibular molar region was the most frequent site of ameloblastoma.

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A case of carcinoma of the lower alveolous and gingiva in an 80-year-old patient is presented. Since the histopathologic diagnosis of squamous cell carcinoma was made, UFT^® was administered as an oral antitumor drug, resulting in the disappearance of the oral tumor clinically and histopathologically in three weeks.
An immunohistochemical study on the expression of metallothionein (MT) and proliferating cell nuclear antigen (PCNA) was conducted.
Expression of MT was observed around in cancer cell nest. Percentage of MT positive cancer cells in the tumor was very low (18.2%) . The profile of distribution of MT in tumors was similar to that of PCNA.

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Morphine has a powerful analgesic effect, but has no ceiling effect. Therefore, it is possible to administer morphine to advanced cancer patients with severe cancer pain until the pain is relieved.
A case of cancer pain management of an advanced adenoid cystic carcinoma patient who was administered a high dose of controlled-release Oral Morphine Sulfate at the outpatient clinic was reported. When morphine was administered increasingly until relief of cancer pain was obtained without causing serious side effects, the dosage of morphine became 2760 mg/day maximum and the duration of administration was twenty-one months. It was useful for improvement of the patient's quality of life to administer a high dose of controlled-release Oral Morphine Sulfate.

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Lymph node metastasis of twenty-two patients with carcinoma of the upper gingiva and/or hard palate were retrospectively analyzed using the CT images obtained by the initial and follow-up studies. Cervical metastasis developed in 10 of 22 cases : in 3 cases initially and in 7 after treatment. Metastasis to the contralateral nodes was observed in 8 cases : 1 case bilaterally in the initial study, 3 bilaterally in the follow-up studies, 3 contralaterally after neck dissection of the initially involved side, and 1 contralaterally in the follow-up study. Contralateral lymph node metastasis may be caused by the lymphatics in the area of the upper gingiva and hard palate running to the other side. Metastases to the lateral retropharyngeal node was observed in 3 cases. Two of them were observed in the cases with cervical node involvement previously or simultaneously, and one in the case of recurrent tumor of the upper gingiva. All three had undergone surgical procedures before metastasis occurred. Metastasis to the lateral retropharyngeal node may be caused by the lymphatics, via the soft palate, through the incisive canal from the anterior upper gingiva and the lymphatics from the palatal surface of the upper gingiva, and the retrograde lymphatic flow in the efferent vessels induced by the residual tumor in the upper neck region and/or neck dissection.

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Among 413 cases of primary squamous cell carcinoma of the oral and maxillofacial region in Oral Surgery Clinic of Saitama Cancer Center between 1975 and 1995, the carcinoma of the upper alveolus and gingiva (22 cases) and hard palate (8 cases) were evaluated clinicopathologically and compared with the carcinoma of the maxillary sinus (30 cases) .
The characteristics of the carcinoma of the upper alveolus and gingiva, and hard palate were as follows : Incidence was 7.9% of 413 cases of primary squamous cell carcinoma of the oral and maxillofacial region, especially low for carcinoma of the hard palate. As for sex, cases of carcinoma were predominantly female. As for the elderly, the mean age was about 70 years. Over half were 1 and 2 by T-classification, but only 36.7% were I and II by stage-classification. Histopathological findings revealed the same number of cases of I and II, all of which had a tendency to cornification, but no III by WHO-classification. The number of cases of types 2, 3, and 4C, but not 1 and 4D, were also almost the same by Yamamoto-Kohama Classification for mode of invasion. Combined therapy of irradiation, reduction surgery, and continuous intraarterial chemotherapy was mainly performed, and partly performed combined therapy of irradiation and reduction surgery using CO2 LASER. Cumulative survival rates of 3 and 5 years were both 78.3%.

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Twenty-seven patients with squamous cell carcinoma of the upper alveolus and gingiva were treated by surgery in our clinic between 1976 and 1996. There were 3 patients with stage I disease, 14 patients with stage II disease, 7 patients with stage III disease, and 3 patients with stage N disease. According to the histological grade proposed by Kohama, there were 9 patients with grade 1 tumor, 9 patients with grade 2 tumor, 8 patients with grade 3 tumor, and one patient with grade 4 tumor. Twenty patients underwent preoperative chemotherapy consising of Bleomycin or in combination with other agents such as Cisplatin or Methotrexatetemporal. There was a 75% response rate, with a median tumor regression rate of 52%, after preoperative chemotherapy Fifteen patients had comfortable chemotherapeutic effects of grade II b or grade III, based on the Ohboshi-Shimosato classification. All patients underwent surgical resection of the maxilla ; resection of the alveolus was performed on only 10 patients and partial maxillectomy on 17 patients. Neck dissection was done concurrently with the resection of the primary lesion in 6 patients. Lymph node metastasis was histologically proven in 4 patients. The five-year cumulative survival rate for all patients was 88%, consisted of 100% for patients with stage I or II disease, and 74% for patients with stage III or IV disease.

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Clinicopathological study was performed to investigate squamous cell carcinoma of the upper alveolus and gingiva and hard palate. From 1980 to 1994, 45 cases of primary squamous cell carinomas were examined. There were 7 (15.6 %) cases of T1, 15 (33.3 %) cases of T2, 9 (20.0%) cases of T3, and 14 (31.1 %) cases of T4 by TNM classification. Combination therapy of the surgery, radiation, and chemotherapy were chosen in 24 (53.2%) of the cases.
The 5-year cumulative survival rate in total cases was 58.9 % (80.0 % in cases of T1, 83.6 % in cases of T2, 40.0% in cases of T3 and 42.8 % in cases of T4) and 60.7 % in combination therapy.
By pathological examinations, there was a close correlation between Y-K classification of behavior and suvival rate. The cumulative 5-year survival rate was 66.6% in cases of Y-K 1-3 and 33.3% in cases of Y-K4C, 4D. By classification of pattern of tumor invasion into alveolar bone and sinus, the cumulative 5-year survival rate was 100.0 % in cases of noninvasive type, 57.1 % in cases of alveolar bone invasion type (p<0. 05) and 44.4% in cases of sinus invasion type (p<0.01) .
These results suggested that invasion types of the primary pathological specimen and pattern of invasion into alveolar bone and sinus may influence convalescence of squamous cell carcinomas of the upper alveolus and gingiva and hard palate.

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A clinicopathological study on squamous cell carcinomas of the upper alveolus and gingiva (17 patients) and the hard palate (9 patients) was performed to evaluate the correlation between the features of the primary lesion and prognosis. The results were as follows:
1. The palatal type in carcinoma of the upper alveolus and gingiva, carcinoma of the hard palate, and the posterior type carcinomas tend to have a high local recurrence rate and uncontrol rate. These clinical types also have a high rate and various aspects of cervical lymphnode metastasis.
2. According to the histopathological malignancy grade, the high malignancy group had a high local recurrence rate and the poor prognosis.
3. The five-year cumulative survival rate of all patients was 71.1 %, 79.6 % with carcinoma of the upper alveolus and gingiva and 55.6 % with carcinoma of the hard palate.
4. The unfavorable prognostic factors were the palatal type of carcinoma of the upper alveolus and gingiva, carcinoma of the hard palate, posterior type, advanced stage, and high histopathologic grade of malignancy.

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