According to the cancer immunoediting hypothesis, cancer cells select low immunogenicity cancer cells that are less likely to be attacked by the immune system （immune selection） and develop various immunosuppressive mechanisms in the host to escape from the immune system （immune escape） during cancer development. It has become clear that the balance between immune selection and immune escape in each cancer patient results in differences in the tumor microenvironment （TME）, which are immunologically referred to as hot and cold. While immune checkpoint inhibitors （ICIs） have been successfully introduced into the clinic for various types of cancer, more than half of patients treated with ICIs fail to respond, even in combination, due to multiple immunosuppressive mechanisms in the TME. It is therefore necessary to develop more effective cancer immunotherapeutic strategies and define biomarkers for stratifying responders and non-responders via a detailed analysis of the immune responses in each cancer patient. We propose that elucidating the various immunosuppressive mechanisms involved in cancer may lead to the development of appropriate cancer immunotherapy, and thus to immune precision medicine for cancer.

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The causes of trismus are diverse. Polymyositis （PM） is an idiopathic inflammatory myopathy that causes inflammation of the muscles, which is characterized by skeletal muscle weakness and is associated with cardiomyopathy. Here we report our experience of a case that led to cardiac arrest while searching for the cause of trismus, and as a result of autopsy, was considered to be PM. A 78-year-old man presented with trismus and swelling of the cheek. It was nonspecific, but right phlegmon of the cheek had started and antimicrobial therapy was considered. An electrocardiogram showed an abnormality and a cardiologist was consulted, but there were no apparent abnormal findings. As the inflammatory symptom did not improve and other diseases were considered, and cystography MRI was performed. Myositis as a nonspecific systemic disease was suspected and consultation with collagenosis internal medicine was planned. However, cardiac arrest due to lethal arrhythmia suddenly occurred. As a result of autopsy, the histopathological findings were characteristic of PM. PM was suggested as the cause of trismus and cardiac arrest. When examining trismus and swelling of the cheek, differentiation disease does not generally include PM, but it must be recognized as an autoimmune disease that may present with symptoms in the oral region.

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We report a rare case of an impacted maxillary primary first molar. An 8-year-old girl was referred for consultation about an impacted maxillary left primary first molar that needed to be removed. On the first medical examination showed that it was not erupted. A radiographic examination and CT scan image showed that this tooth was impacted with permanent teeth without tumor or cyst. She had no general systemic factors to cause impacted tooth, although she had been a low birth weight infant. We extracted the impacted maxillary primary first molar under general anesthesia. During the operation, we could not detect any local factor. However, the extracted tooth was smaller than the typical size of the maxillary primary first molar, and it was thought that the cause may have been low birth weight. The postoperative course was uneventful with no disturbances, and she has been receiving treatment with orthodontics.

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We present a case of lingual abscess caused by an infection stemming from fish bone penetration.
A 64-year-old woman visited our hospital with chief complaints of swelling of the lingual margin and odynophagia. Owing to severe artifacts produced by a preexisting dental prosthesis, no high-density areas or foreign bodies could be observed on a computed tomography scan. A relatively heterogeneous high-intensity lesion on T2-weighted magnetic resonance imaging was observed in the left lingual margin. Following administration of antimicrobial agents, the abscess was incised, and a foreign body, considered to be a fish bone, was removed. Component analysis revealed that the infection was caused by the fish bone.
Therefore, we recommend that, in such cases, after obtaining a detailed history, fish bone migration should be considered a potential cause of lingual abscesses, even if the foreign body itself is not detected by imaging methods.

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Sphenoid sinus cysts press against adjacent tissues as lesions develop, and they cause symptoms such as ocular abnormalities, headaches, and trigeminal neuralgia. We report a case of a giant sphenoid sinus cyst accompanied with paresthesia and pain on the left side of a patient’s face. The patient was a 56-year-old male who had had surgery for bilateral sinusitis 40 years prior. Around July 2018, he noticed discomfort on the left side of his face and visited a nearby neurosurgeon. He did not have any image inspections but was monitored. His paresthesia and pain worsened, so he was referred to our department by a local dental clinic in September. During his first visit to our department, abnormal paresthesia was observed around the area from his left orbital apex, left cheek to left upper lip. He had sudden electric shock-like pain in the area, and we suspected symptomatic trigeminal neuralgia. Later, an MRI revealed a 3.1×3.8×4.1cm cystic tumor in the left sphenoid sinus. In the department of neurosurgery, a cyst fenestration operation into his sphenoid sinus was performed in October. One and a half years after the operation, his paresthesia and pain have been alleviated, but his symptoms remain.

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We report a case of radical surgery for tongue cancer which was performed 2 weeks after coronary artery revascularization by off-pump coronary artery bypass grafting （off-CABG）. The patient was a 77-year-old man who suffered from tongue cancer （T2N2bM0）, and myocardial infarction （MI） was pointed out at the preoperative ECG. Coronary angiography revealed complete occlusion in the anterior interventricular branch of the left coronary artery （#7） and right coronary artery （#1）, and OMI was diagnosed. Off-CABG was carried out before the tongue cancer surgery. Two weeks after the off-CABG, we performed tracheostomy, subtotal glossectomy, modified left radical neck dissection, and reconstructive surgery with free rectus abdominis muscle flap for the tongue cancer. The clinical course after the surgery was uneventful. Although postoperative radiotherapy was performed for multiple cervical lymph node metastases with 50Gy/25Fr, the patient died from multiple lung metastases 6 months after the tongue cancer surgery.

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Osteoradionecrosis of the jaw （ORNJ）, a late adverse event of radiation therapy, is often irreversible and extremely difficult to treat. Here, we report a case of ORNJ that responded to conservative treatment. A 67-year-old man underwent chemoradiotherapy （CBDCA＋74Gy） in 1999 for recurrent squamous cell carcinoma on the left side of the tongue. Dental implant placement for the left mandible was performed in 2010 at a private dental clinic. Subsequently, since bone exposure and pus discharge occurred at the wounded area, the patient was referred to the Department of Oral and Maxillofacial Surgery. Based on a clinical diagnosis of ORNJ, the implant was removed, and several sequestrectomies were performed. Eventually, in 2016, the patient was referred to our department, as the osteomyelitis had gradually progressed, resulting in cutaneous fistula and pathological fracture. Initially, conservative treatment, such as oral care, local irrigation, antibiotic administration, hyperbaric oxygen therapy （HBOT）, and low-intensity pulsed ultrasound therapy （LIPUST）, were administered, and surgical treatment was scheduled to be performed after this treatment. However, inflammatory findings disappeared with these successful treatments, and additional surgical treatment was no longer required, as the fracture had healed. HBOT may be an adjunctive treatment modality in the management of ORNJ, while LIPUST can enhance the rate of healing in fractured bones by stimulating bone cells to grow and repair. It is suggested that LIPUST in addition to HBOT may be effective for the conservative treatment of ORNJ with pathological fracture.

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Essential thrombocythemia （ET） is a rare disease. It is sometimes complicated with thrombosis and/or bleeding. Controlling the platelet count and antithrombotic therapy are important in the perioperative period because ET can cause bleeding and thrombosis.
We report a case of squamous cell carcinoma of the hard palate with ET in a 78-year-old man. The patient presented with a chief complaint of discomfort in the left palate. Initial examination revealed an erosion of 10×8mm in the left hard palate. Biopsy showed a pathological diagnosis of squamous cell carcinoma. ET had been diagnosed at 55 years of age, and anagrelide was administered. The platelet count was 160.6×10⁴/μl in the preoperative blood test; therefore, we increased the dose of anagrelide in addition to busulfan before surgery. As a result, the platelet count had decreased to 64× 10⁴/μl on the day of surgery. The patient underwent partial resection of the palate in June 2017. The platelet count was 59.3×10⁴/μl by the next day. To prevent thrombosis and bleeding, we administered anagrelide, aspirin, busulfan, and a small amount of heparin. The patient did not experience any perioperative complications and was discharged 11 days postoperatively. At 4 years after surgery, the patient’s prognosis remains good.

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Background: The microbiota in the oral cavity plays a major role in maintaining human health by affecting the immune system and physiology. Previous studies have suggested that an imbalance in the microbiota, termed dysbiosis, contributes to various human diseases such as atherosclerotic cardiovascular disease, however, the relationship between the microbiota of the oral cavity and atherosclerotic plaque has not been clarified.
Methods: We studied both oral and atherosclerotic plaque microbiota by 16S rRNA gene sequencing in 44 patients with acute coronary syndrome. Plaque samples from the culprit coronary arteries were collected by thrombus aspiration performed during emergency coronary angiography.
Results: Bacterial 16S rRNA gene was detected by polymerase chain reaction （PCR） in atherosclerotic plaque in one of the patients. Next, the microbiota of the atherosclerotic plaque in which the 16S rRNA gene was detected and the oral microbiota of the same patient were analyzed by the 16S rRNA metagenomic sequence, and the relationship between the microbiota was examined. Bacteria of 38 genera of 18 families in the atherosclerotic plaque were common with those of the dental plaque, and 64.2％ of the bacteria in the atherosclerotic plaque were detected in the dental plaque.
Conclusion: These findings suggest that some bacteria in the atherosclerotic plaque are derived from the oral microbiota.

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BPs-Related Osteonecrosis of the Jaw（BRONJ） is widely known as a common side effect of oral bisphosphonate （BP） preparations. However, mucosal damage due to local irritation in the upper gastrointestinal tract, including the oral cavity, has also been reported. Here, we report a case of multiple oral mucosal ulcers suspected to be associated with oral BP retention in the mucosa. A 78-year-old woman was hospitalized for anti-neutrophil cytoplasmic antibodies （ANCA）-associated vasculitis and was taking prednisolone. Her medical history revealed scleroderma, interstitial pneumonia, and mild cognitive impairment. Four days after starting oral alendronate, she was referred to our department because of oral pain. Clinical examination revealed multiple oral mucosal ulcers on the left buccal mucosa and bilateral tongue margin. Since her oral condition was poor, active oral care intervention and topical application of steroid ointment was applied. However, the oral mucosal ulcer was exacerbated. We suspected that the oral ulcers were caused by stagnation of oral BP tablets due to her cognitive decline and so requested the prescribing doctor to discontinue the alendronate. Fifteen days after discontinuation, a part of the ulcer started to become epithelized and the ulcer disappeared two months after the discontinuation.

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Bartter syndrome is a rare disorder characterized by hypokalemia. We report our experience of perioperative management of a patient with Bartter syndrome. An 18-year-old woman with Bartter syndrome was referred to our hospital because of malocclusion. At her orthodontist’s office, she had been diagnosed with mandibular protraction and preoperative orthodontics had been started. After completion of preoperative treatment, mandibular osteoplasty was performed under general anesthesia. Considering that hypokalemia might occur during and after the operation, we consulted the attending physician in advance, and continuous administration of potassium was done from the start of the operation. As a result, perioperative hypokalemia did not develop and her general condition remained good.

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We report a case of bronchial obstruction by a tooth fracture fragment in a patient with multiple facial fractures. A 44-year-old woman fell from a condominium and was transported to our hospital. She had multiple bone fractures including maxillofacial lesions （multiple mandibular and maxillary, multiple rib, pelvic, right femoral condylar, and sternal fractures）. On the second day, chest radiographs showed the onset of atelectasis in the right upper pulmonary field, but the oxygenation was within normal range. On the seventh day, she underwent surgical reduction and fixation of the fractures under general anesthesia. Postoperative chest X-ray showed enlarged atelectasis, and immediate bronchoscopy revealed a foreign body in the right bronchus. On CT images, a thin-shaped foreign body was confirmed in the right main bronchus. The foreign body in the airway was successfully removed under bronchoscopy; it was found to be a fractured tooth fragment, which was thought to have been aspirated by the patient at the time of injury. The patient recovered thereafter and is making good progress.

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