[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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Saliva is an important protective factor in both dentition and oral soft tissue. Xerostomia, a subjective dry mouth sensation, usually due to hyposalivation, may cause burning mouth, sore tongue, speech and mastication difficulties, altered taste sensation, increased tooth decays and oral candidosis.
Xerostomia and aging: Xerostomia is commonly found in older individuals. Although aging does not directly affect salivary gland function, the incidence of disease and drug intake influencing glandular activity increases with age.
Over 600 medication side effects include xerostomia or salivary gland hypofunction. Subjects administrated high daily medication amounts tend to report xerostomia. Because therapeutic medication doses do not damage the salivary gland structure, drug-induced xerostomia is usually reversible.
Xerostomia management: Daily gum chewing which stimulates saliva secretion is recommended, but not the use of drinks or candy including which sugar, accelerates the tooth decay process, which varies inversely with salivary flow.
Medication: M3 muscarinic receptor stimulants pilocarpine and cemivaline are effective, but may cause increased sweating or gastrointestinal and caldiovascular symptoms. To avoid side effects, step-up treatment is recommended, i.e., to start at a low dose and increase the dose progressively until subjects feel relief.
Mouth rinsing with pilocarpine or cemivaline solutions is also recommended. Some studies have shown efficacy of pilocarpine mouthwash in increasing resting salivary flow in both healthy volunteers and sjogren syndrome, sufferers with no adverse effects except drug allergy.
Other medicinal remedies such as saliva substitutes manufactured as sprays or gel are available commercially. Glycerin swabbed onto the oral mucosa is also recommended.

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[in Japanese]

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Lingual papilla examination critical in clinically diagnosing taste dysfunction is facilitated by narrow band imaging (NBI), an optical technique enhancing superficial microvascular architecture. We studied the lingual papillae of subjects with and without taste dysfunction using flexible otorhinolaryngological fiberscopy with NBI. We compared NBI to conventional white-light imaging. Capillaries in lingual papillae contrasted better with surrounding tissue in NBI than in white-light imaging, making fungiform papillae involving blood flow easy to count. Taste-dysfunction sufferers' tongues showed decreased lingual papilla blood flow. We found NBI to be handy and useful in clinically diagnosing taste dysfunction.

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[in Japanese]

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[in Japanese]

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We clarified the efficacy of superselective intraarterial concurrent chemoradiotherapy (IA-CRT) for preserving organs in locally advanced squamous cell tongue carcinoma. Subjects most of whom had subtotal glossectomy indications, numbered 20 with untreated T2 (4 pts) T3 (11 pts), or T4 (5 pts) carcinoma and undergoing 60 to 70 Gy of irradiation (median total dose: 66 Gy) concurrently with 2 cycles of 5FU chemotherapy in 1000 mg/m², continuous 120-hour infusion, and 60 mg/m² of cisplatin was delivered to the lingual artery using the Seldinger technique via the femoral artery. In acute toxicity exceeding than grade 3, mucositis (13 pts) was more serious than leucopenia (4 pts), anemia (1 pt), or diarrhea (1 pt) of the 20, 19 underwent scheduled treatment. Response was good at 95% for local regions and 79% for cervical lymphnodes. Three-year overall survival (OS) was 61% and progression-free survival (PFS) 49% in median follow-up at 35 months (range: 9 to 75 months). A statistically difference existed in three-year OS and PFS: 82-60% for T2-3 and 33% and 0% for T4. Two subjects (T3, T4) underwent received down staging surgery in which half of the tongue was removed with neck dissection, and 1 underwent selective neck dissection alone to preserve the primary site. One was found to have no residual tumor. One underwent postoperative contralateral neck dissection. These three subjects remain alive without recurrence postoperatively. Failure patterns occurred in two subjects with local recurrence and two with post-IA-CRT regional lymphnode recurrence without salvage surgery. All without post-IA-CRT recurrence with or without surgery maintained quality of life (QOL) in swallowing and articulation. IA-CRT can be thus an alternative in treating, T3 to T4 tongue in subjects refusing surgery.

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Objectives: Superselective intraarterial infusion enables high-dose chemotherapeutic agents to be administered via tumor feeding vessels to neutralize and limit the adverse cisplatin effects acceptable. Between 1998 and 2008, we evaluated the efficacy of first-line therapy and adverse events in 30 subjects with oral squamous cell cancer undergoing simultaneous superselective intra arterial high-dose chemotherapy and radiotherapy.
Methods: The 30 subjects—23 men and 7 women aged 40 to 72—consisted of 3 T2, 12 T3, and 15 T4. Four patients had N0, 8 N1, 7 N2b, 8 N2c, and 3 N3 disease. Two were in CS II, 6 III, 17 IVa, and 5 IVb (III>93%, IV: 73%). Superselective intra arterial chemotherapy delivered through the femoral artery used the Seldinger technique. A single cisplatin dose of 100-550 mg/m² (mean 440 mg/m²). Five minutes after intra arterial infusion, sodium thiosulphate (9g/m²) was administered via a peripheral cutaneous vein in the contralateral forearm. Concurrent radiotherapy started on Day 2 at 2 Gy per session for a total of 60 Gy. Two to 3 weeks later, 15 under went the second course of superselective intra arterial chemotherapy after tumor feeding vessels were visualized angiographically.
Results: Four (13.3%) subjects with Grade 3 or greater myelosuppression required G-CSF. Grade 3 or greater mucositis was observed in 57% and Grade 4 mucositis occurred in 5 (16.7%). All adverse effects were reversible and no serious adverse events were prolonged. Among those responding to first-line therapy, 24 of the 30 (80%) achieved CR and 6 (20%) PR, but no SD or NC. Overall response was 100%. Histopathologically, 2 of 9 undergoing postchemoradiotherapy had no tumors. Clinical and pathological CR was 86.7%.
Conclusion: Adverse events associated with this therapy associated events were considered relatively mild and within allowable limits.

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We report a case of presumably benign pleomorphic adenoma metastasizing to multiple lung and bone regions. A 37-year-old woman, seen for left chin swelling, was found to have a salivary gland tumor. Surgical tumor resection in March 1991, yielded a pathological diagnosis of pleomorphic adenoma. Tumors were further resected following 1994, and 1999 relapses, yielding a pathological diagnosis of invasive pleomorphic adenoma. In 2004 and 2005, following her right rib 9 breaks, chest computed tomography showed scan revealed a mass shadow at right rib 9 and multiple mass lung shadows, necessitating surgical tumors removal and yielding a pathological diagnosis of metastasizing pleomorphic adenoma. Pathological findings for all of these tumors were identical. She currently survives with neither recurrence nor presence of metastatic tumors.

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The submental island flap (SIF), an axial patterned flap based on the submental artery and introduced by Martin et al. in 1990, meets criteria for reconstructing of selected head and neck defects for example providing thin, easily and expeditiously harvested axially perfused soft tissue, a rather long pedicle enabling the flap to reach the pharynx, and a virtually invisible donor site, almost always closed primarily and leaving a scar cosmetically acceptable.
We report flap use and surgical techniques for 4 subjects undergoing reconstruction between March and May 2009. Subjects were two each oropharynx and hypopharynx cancer cases. One oropharynx cancer case underwent reconstruction with a bipedicled SIF. Partial flap loss occurred 1 subject, but without major complication. Marginal mandibular nerve function remained intact in all 4.
The SIF is an excellent choice for reconstruction of oropharynx and hypopharynx because of its reliability, versatility, and easy application.

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