Prevention of postoperative pneumonia is important in patients undergoing esophageal cancer surgery. Although the usefulness of perioperative oral care for the prevention of postoperative pneumonia has been reported, factors associated with postoperative pneumonia in esophageal cancer patients receiving perioperative oral care have rarely been identified. We identified the factors associated with postoperative pneumonia in 207 esophageal cancer patients who received perioperative oral care and underwent esophagectomy at our hospital via statistical analysis. The univariate and multivariate analyses revealed age （70 years and above） and onset of recurrent laryngeal nerve paralysis to be the significant factors. Therefore, careful intervention with oral care is essential in esophageal cancer patients with recurrent laryngeal nerve paralysis and/or those aged 70 years and above in the perioperative period.
Twenty-seven super-elderly patients, 90 years old or older, who accounted for 3.6％ of the total of 740 patients with oral cancer referred to our clinic from April 1997 to December 2017, were clinically evaluated. This super-elderly group was compared with each group aged 16–64, 65–74 and 75–89. This group consisted of 6 males and 21 females. Tumors were most frequently located in the lower gingiva（10 cases: 37.0％）, and 91.0％ of histological type was squamous cell carcinoma（20 cases）. By stage classification, stage Ⅳ was the most frequent（13 cases: 59.1％）. 96.3％ of super-elderly patients had systemic medical complications, and performance status（PS） 3 was the most frequent（13 cases: 48.2％）. As for the treatment modality, radical treatments and palliative treatments were performed for 3 cases（11.2％） and 13 cases（48.1％） respectively, and 11 cases（40.7％） were untreated. The ratio of the radical treatment group was significantly lower than that in each group under 90 years old（p＜0.001）. There was a significant difference in the choice of treatment modality by PS and staging（p＜0.05）. The cause-specific survival rate was significantly lower than that in each group under 90 years old（p＜0.001）. There was a significant difference in the cause-specific survival rates between the treated group and untreated group（p＝0.023）. These results suggest that radical treatments and palliative treatments for super-elderly patients over 90 years old can improve the prognosis, and PS and stage classification may be considered when selecting the treatment modality.
The term “Adolescent and Young Adult （AYA） generation” is commonly used in oncology. We retrospectively studied both clinical characteristics and therapy in AYA patients with oral cancer who were between 16 and 40 years old at the initial visit to our department, focusing on clinical items such as gender, age distribution, tumor site, pathological classification, stage, treatment, treatment outcome and social rehabilitation. There were 42 patients （male, 19; female, 23）, accounting for 5.7％ of the total number of patients with oral cancer in our department. Most of them were 35 to 39 years old （median, 30.9 years）. The most frequent site of tumor occurrence was the tongue and the most common histological type of cancer was squamous cell carcinoma, in 29 and 30 AYA patients with cancer, respectively. Most patients had T2NO cancer based on the TNM classification and early stage Ⅱ. Thirty-nine patients underwent radical surgery, including 14 cases of surgery only, 6 of chemo-radiation therapy only, 4 of surgery with chemotherapy, and 2 of surgery with radiation therapy. On the other hand, 9 patients underwent radical radiation therapy, including 5 cases of internal irradiation therapy and 4 of chemo-radiation therapy only. The 5-year overall survival rate in AYA patients with oral cancer （79.67％） was statistically superior to that of older patients （68.48％）（P＝0.034）. Seven patients died of cancer. Treatment outcomes of AYA patients were favorable. Thirty-two AYA patients with oral cancer, except for 2 patients who could not be followed and 1 patient who had continued to receive treatment on the investigation date, returned to society.
Objectives: There are an increasing number of reports that surgical treatment for antiresorptive agent-related osteonecrosis of the jaw （ARONJ） is more effective than conservative treatment, but there are not many reports on conservative treatment for ARONJ. Therefore, we report a clinical analysis of cases that underwent sequestration in conservative treatment for ARONJ. Materials and Methods: In our department, 24 patients with ARONJ who underwent sequestration and 16 patients with ARONJ who did not undergo sequestration among 40 patients who underwent conservative treatment were analyzed retrospectively. If it was possible to stop administering antiresorptive agents, patients stopped receiving it. The 18 patients had received zoledronate or denosumab for metastatic bone tumors or multiple myeloma, and 22 had received bisphosphonates （BPs） for osteoporosis. Results: All patients who underwent sequestration achieved complete cure by epithelization after sequestration. The follow-up period to sequestration in patients receiving zoledronate and denosumab for metastatic bone tumors or multiple myeloma was significantly longer than in patients receiving BPs for osteoporosis. Conclusions: Conservative treatment of waiting for sequestration is a useful procedure for the treatment of ARONJ, if it is possible to stop administering the antiresorptive agents.
A 37-year-old man underwent extraction of bilateral impacted lower third molars under general anesthesia. Two hours after the operation, his right cheek suddenly became swollen after nose-blowing. We recognized rapid swelling from the right cheek to the angle of the mandible and submandibular area and crepitus on palpation over the submandibular area. We diagnosed it as subcutaneous emphysema and administered an intravenous antibiotic. CT analysis on the next day revealed subcutaneous emphysema bilaterally, and the right side one in particular extended to the mediastinum. The air compressed by nose-blowing might have entered the subcutaneous tissue via a bone defect in the extraction socket. After one week, the emphysema had nearly disappeared. We confirmed the complete disappearance after 3 weeks on CT. The main cause of emphysema after extraction of the mandibular third molars is the use of an air-turbine handpiece. However, even when not using an air-turbine handpiece, we should perform treatment with care to avoid emphysema.
Bone scintigraphy has been used for diagnosis of osteomyelitis of the jaw, but there is no index to objectively evaluate uptake value and uptake volume. The development of software for bone SPECT fixed-quantity analysis has enabled various SUV analyses, such as PET imaging. GI-BONE（AZE Co., Ltd., Japan）is novel analysis software for SPECT bone scintigraphy that may be useful for evaluating treatment for osteomyelitis of the jaw. We report a case of monitoring osteomyelitis of the jaw, in which images of the healing process were monitored using GI-BONE. A 71-year-old man was referred to our department presented with swelling and sharp pain in the lower right mandible. Because of bone metastasis due to prostate cancer, zoledronic acid（4mg） had been administrated intravenously 24 times every four weeks for about two years from January 2015. He had spontaneous pain of the mandible and we found two swollen fistulas in the right gingiva; we drained the pus and administered amoxicillin. After one week, swelling of the gingiva had improved and we performed imaging SPECT bone scintigraphy. After eight weeks, we diagnosed it as ARONJ Stage 2. We conducted SPECT bone scintigraphy to monitor the healing process of the osteomyelitis after five months and again after eight months. Then, we analyzed SPECT data using GI-BONE software. The monitoring data showed that SUVmax and MBV（metabolic bone volume） were significantly improved. Eighteen months from the first diagnosis, CT imaging revealed separation of the sequestrum, so we removed it with minor surgery, and ARONJ was healed.