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Introduction: Sclerosing odontogenic carcinoma(SOC)is a rare malignancy first reported by Koutlas in 2008 and was classified as an odontogenic carcinoma according to the World Health Organization(WHO)classification in 2017. In this report, we describe a rare case of SOC in the maxilla of a patient who underwent radical tumor resection via partial maxillectomy and immediate reconstruction using an ulnar forearm flap., Case: A 55-year-old woman was referred to our department with the chief complaint of swelling of the right maxillary gingiva. Initial examination revealed swelling of the right maxillary gingiva. Contrast-enhanced CT, MRI, and PET-CT showed no metastatic lesions other than the primary lesion. Histopathological examination revealed a strong suspicion of SOC(cT4aN0M0, Stage ⅣA). Surgical treatment was selected for histopathological analysis. The patient underwent tracheotomy, partial maxillectomy, and reconstruction using an ulnar forearm flap under general anesthesia. The postoperative pathological diagnosis was SOC(pT4aN0M0, Stage ⅣA). One year postoperatively, the treatment course was uneventful, with no evidence of recurrence or metastases. The patient was satisfied with the facial aesthetics and swallowing function of the denture., Conclusion: A good outcome was obtained using radical tumor resection and immediate reconstruction of the maxillary SOC.

The supraclavicular artery island flap(SCAIF)is a pedicled fasciocutaneous flap primarily based on the supraclavicular artery and vein. It is commonly utilized in head and neck cancer reconstructive surgery due to its extensive reach, vascular reliability, and simple harvesting technique. This report presents three cases in which SCAIF was employed for soft tissue reconstruction following oral cancer resections. In Case 1, an 80-year-old female patient with right maxillary gingival carcinoma (cT3N2bM0)underwent tracheostomy, right modified radical neck dissection(MRND), partial maxillectomy, and reconstruction using SCAIF. Case 2 involved a 63-year-old male patient diagnosed with left tongue carcinoma(cT2N1M0), who underwent tracheostomy, left MRND, partial glossectomy, and SCAIF reconstruction. In Case 3, a 73-year-old female patient with right lower gingival carcinoma(cT3N2bM0)underwent tracheostomy, bilateral neck dissection, marginal mandibulectomy, and SCAIF reconstruction. In all cases, postoperative wound healing was satisfactory. The SCAIF proved to be a valuable option for reconstructing soft tissue defects after oral cancer surgery, resulting in reliable outcomes and functional restoration.

The number of patients and families who wish to spend their final moments at home is increasing, and in the future, there may be more opportunities to provide end-of-life care for oral cancer at home. We report our experience with palliative treatment for a terminal oral cancer patient with dementia who wished for home palliative care. The patient was an 87-year-old male with a history of Alzheimer's dementia and chronic heart failure. In late September 2022, he visited a nearby internal medicine clinic with complaints of loss of appetite and pain in the right maxillary gingiva and was referred to a tertiary medical institution in the prefecture for further examination and treatment. At the initial visit, a 40×30 mm easily bleeding ulcerative lesion was observed in the right maxillary molar gingiva. Based on various examinations, he was diagnosed with squamous cell carcinoma of the right maxillary gingiva(cT4bN0M0, Stage ⅣB). However, due to dementia and severe cardiac dysfunction, he was not eligible for chemoradiotherapy and a plan for palliative treatment was made. The patient strongly wished for treatment at home and at a local hospital, and palliative treatment with a view to home palliative care was initiated. He was admitted to our internal medicine department in mid-November. Our department continued local treatment for the tumor and specialized oral care by a dental hygienist, but he passed away due to cardiac arrest in early January 2023. Although the patient passed away before transitioning to home care, smooth implementation of home palliative care requires cooperation not only from hospitals but also from the entire community, and the establishment of a comprehensive home medical support system is crucial.

Immune checkpoint inhibitors are known to produce immune-related adverse events(irAE)that require medical management. Herein, we report a case of a patient treated with pembrolizumab who experienced a Grade 3 interrupted skin disorder. The patient is a 67-year-old female diagnosed with right maxillary gingival squamous cell carcinoma(cT4aN0M0, Stage ⅣA)and underwent partial right maxillectomy, right extended supra-omohyoid neck dissection, and maxillary reconstruction using a forearm flap. Six months postoperatively, late lymph node metastases with extracapsular spread was found in the right buccal lymph node and the left neck, and the patient underwent right buccal lymphadenectomy and left modified radical neck dissection. After postoperative combined chemoradiotherapy(cisplatin plus IMRT)followed by 13 courses of cetuximab plus paclitaxel, a recurrent lesion was found in the right buccal region. After 8 courses of pembrolizumab, a skin rash appeared on the forearm, chest, and back, which was diagnosed as Grade 3 irAE, requiring hospitalization. The patient was re-instituted after waiting for improvement of the skin disorder. The pembrolizumab at 75% reduction dose was re-administrated, and the patient has been followed up so far.

Dysphagia is a major postoperative complication in patients with locally advanced oral cancer. In this case report, we describe the effect of the hyoid bone suspension technique on the preservation of swallowing function after total glossectomy and pectoralis major musculocutaneous flap reconstruction for locally advanced tongue cancer. Case: A 72-year-old Japanese male was diagnosed with advanced squamous cell carcinoma on the left side of his tongue(cT4aN2cM0, cStage ⅣA). Under general anesthesia, the patient underwent a tracheotomy, bilateral modified radical neck dissection type Ⅲ, total glossectomy, and reconstruction with a left pectoralis major musculocutaneous flap(PMMC flap). Intraoperatively, the PMMC flap was designed to have a heart shape of 11×6 cm and was elevated. Subsequently, holes were made at the lower edge of the mandible, and the hyoid bone was suspended and fixed to the mandibular border using 2-0 nylon sutures. The postoperative course was uneventful; the flap was completely engrafted and was in good condition. The hyoid bone suspension technique can reproduce the pharyngeal phase of swallowing, and the palatal augmentation prosthesis helps to improve food mass feeding and preserve the swallowing function.

The treatment of advanced lower gingival carcinoma requires postoperative chemoradiotherapy; therefore, simultaneous hard-tissue reconstruction may not be indicated. In these cases, mandibular reconstruction is performed using a temporal reconstruction plate and various skin flaps. Herein, we reported 2 cases of advanced lower gingival carcinoma treated with a novel computer-assisted patient-specific, fully custom-made mandibular reconstruction plate system(Cosmofix®)in combination with a pedicle/free flap. In case 1, an 80-year-old female patient was diagnosed with right lower gingival carcinoma( cT4aN3bM0, Stage ⅣB). Under general anesthesia, she underwent tracheostomy, bilateral neck dissection, segmental mandibulectomy, and mandibular reconstruction using Cosmofix® in combination with an ulnar forearm free flap. In case 2, an 81-year-old male patient was diagnosed with right lower gingival carcinoma(cT4aN2bM0, Stage ⅣA). The patient underwent maintenance dialysis and required minimally invasive surgery using a pedicle flap. Under general anesthesia, the patient underwent tracheostomy, right modified radical neck dissection, segmental mandibulectomy, and mandibular reconstruction using Cosmofix® in combination with a pectoralis major myocutaneous flap. Postoperative facial morphology, occlusion, eating, swallowing, articulation, and other dysfunctions were minimal in both the cases. Adjuvant chemoradiotherapy was recommended. In conclusion, the utilization of the Cosmofix® system enabled both esthetic and functional reconstruction following segmental mandibulectomy for advanced lower gingival carcinoma.

In Japan, the incidence of double cancers is increasing due to the rise in cancer prevalence in the super-aging society, and the frequency is particularly high among patients with head and neck cancer. To the best of our knowledge, there has been only 1 reported case of metachronous double cancer with parotid gland cancer and tongue squamous cell carcinoma, and herein we report the outline of this case. The patient was a 70-year-old male with a smoking history. In 2017, a total parotidectomy and neck dissection for adenocarcinoma of the right parotid gland were performed at the otolaryngology department, followed by concurrent chemoradiotherapy as postoperative therapy. Pathological examination revealed adenocarcinoma NOS(pT4aN2bM0, Stage ⅣA). There was no recurrence or metastasis, and the patient was recovering well. However, in October 2022, the patient presented to the hospital with a chief complaint of pain at the right margin of the tongue. At the initial consultation, an ulcerative lesion with a slightly unclear boundary and maximum diameter of approximately 15 mm was observed on the right margin of the tongue. Since epithelialization was observed in some regions, it was diagnosed as intractable stomatitis and the patient was put under observation for the time being. With no signs of healing during the follow- up examination a month later and considering the possibility of malignant tumors, a total excision of tongue lesion was performed. Pathological examination revealed well-differentiated squamous cell carcinoma(pT1N0M0, Stage Ⅰ). Going forward, we plan to conduct careful follow-up observations with the possibility of further metachronous double cancer occurrences in mind.

Radical tumor resection for oral cancer can cause morphological and esthetic disorders and oral and maxillofacial dysfunction and maintaining a social life could become challenging, especially in the adolescents and young adults(AYA)generation. Conversely, chemoradiotherapy for young patients may cause adverse reactions such as impaired fertility and late side effects of radiation. Therefore, treatment should be performed cautiously. We report a case of AYA generation patient who underwent salvage surgery and maxillofacial reconstruction for recurrent tongue cancer after super-selective intra-arterial chemoradiotherapy. The patient was a 30-year-old woman who was 20 weeks pregnant. She was diagnosed with Stage Ⅲ squamous cell carcinoma of the right tongue, cT3N0M0. After abortion, the patient underwent super-selective intra-arterial chemoradiotherapy and achieved a complete response. However, 13 years later, a recurrence of Stage ⅣA tongue cancer, r- cT4aN2bM0, was reported. Additionally, the patient had osteoradionecrosis. We performed radical tumor resection(bilateral neck dissection plus subtotal glossectomy plus segmental mandibulectomy)and maxillofacial reconstruction with a fibula flap. Subsequently, we performed occlusal reconstruction treatment using dental implants. Three years postoperatively, no tumor recurrence was observed, and the patient was satisfied with the restored morpho-aesthetic and maxillo-oral functions.

Multidisciplinary treatment, combining ablative surgery and reconstruction, radiotherapy, and chemotherapy, is used to treat advanced oral cancers. In this study, we report a case of extensive osteoradionecrosis of the mandible following multidisciplinary treatment for tongue cancer, in which a computer-assisted, patient-specific custom-made cutting guide and reconstruction plate(TruMatch® )were used to improve the patient's facial morphology and oral-maxillofacial functioning. A 70-year-old man received multidisciplinary treatment for squamous cell carcinoma of the left side of the tongue (cT3N2bM0, cStage ⅣA)at a previous hospital. Seven years postoperatively, bilateral osteoradionecrosis of the mandible developed, and the patient was referred to our department for further treatment. Since the lesions were extensive, we planned reconstructive surgery using the TruMatch® system in collaboration with the plastic surgery department of our hospital. Surgery was performed precisely and accurately according to the preoperative simulation. Postoperatively, the patient's recovery was uneventful. The TruMatch® system enables us to achieve good morphological and comprehensive functional oral-maxillofacial reconstruction.

We report a case of advanced lower gingival carcinoma treated with a computer-assisted custom-made surgical guide and reconstruction plate system(TruMatch®)in combination with a pectoralis major myocutaneous flap. In a 74-year-old male patient, a neoplastic lesion with a 30×30 mm periapical induration was observed around an extraction socket of left mandibular third molar. After various examinations, we diagnosed lower gingival carcinoma(cT4aN2bM0, Stage ⅣA). The patient was a paraplegic with a spinal cord injury, and reconstruction of mandible with free flap was not indicated, requiring minimally invasive surgery. Therefore, a surgical guide and reconstruction plate were prepared preoperatively using the Tru- Match® system. Under general anesthesia, the patient underwent tracheostomy, left modified radical neck dissection, segmental mandibulectomy, and reconstruction of the mandible using this system in combination with a pectoralis major myocutaneous flap. Postoperatively, the patient had minimal dysfunction. Currently, at 18 months follow up postoperatively, good prognosis was observed. In conclusion, this is a useful surgical system with accurate and less invasive surgery for segmental mandibulectomy of advanced lower gingival carcinoma.

Recently, the number of survivors that had oral cancer has increased, but deterioration in the quality of life of patients concerning oral function and cosmetic appearance has become problematic. Prosthodontic dentures usefully treat jaw defects after maxillary resection for cancer, but advances in microsurgery have rendered the possibility to reconstruct maxillary defect and oral cavity using a microvascular flap. Here, we describe 2-stage treatment after 35 years postoperatively. We restored the maxillofacial function using microvascular flaps and partial denture. The patient was a 59-year-old woman who underwent left lateral maxillectomy 35 years previously to treat an advanced left maxilla gingival carcinoma. A maxillary prosthesis was applied, requiring repeated adjustments and refabrications. The patient visited to obtain improvements for oral and maxillofacial functions and long-term quality of life. The left maxillary bone defect was 45×50 mm in area. Collaborating with the Department of Plastic and Reconstructive Surgery, the patient underwent reconstructive treatment using a microvascular forearm flap and partial denture. The patient's progress was excellent; eating, swallowing, and articulation improved. For 1 year postoperatively, the patient was satisfied with the results.

Many patients with mental retardation have a limited awareness of abnormalities in the oral cavity, making early detection of oral cancer difficult. Moreover, during examination and treatment, these patients may not understand well-intentioned verbal explanations and may express their anxiety through nonverbal communication. Herein we discuss a case in which favorable results were obtained when surgical treatment was performed on a maxillary gingival carcinoma patient with mental retardation. The patient was a 61-year-old man who was admitted to our hospital with maxillary gingival pain. A biopsy revealed well-differentiated oral squamous cell carcinoma(cT4aN0M0, Stage ⅣA). Hemi-maxillectomy was performed and postoperative recovery was uneventful. A maxillary prosthesis was provided for oral rehabilitation. At the 5-year follow-up, there were no signs of recurrence or metastasis. This case illustrates the importance of collaboration between oral maxillofacial surgeons and specialists from related departments for the comprehensive management of patients with mental retardation.

In April 2020, a state of emergency was declared because of the pandemic, and the public was instructed to refrain from leaving their homes. Consequently, this stirred up anxiety about visiting medical institutions. Here, we describe a case of tongue carcinoma that developed from an oral precancerous lesion into a malignant transformation owing to the effects of refraining from medical examinations caused by the pandemic. The patient was a 62-year-old woman. In March 2020, the patient became aware of a mass at the tongue's margin and was referred to our department. An excisional biopsy was performed, and a diagnosis of inflammatory change was made. The following month, a white ulcerative lesion was found, and another excisional biopsy was performed; therefore, a diagnosis of left tongue leukoplakia without epithelial dysplasia was made. The patient was scheduled for surgery; however, refused treatment and consultation because of the pandemic. In September 2021, the patient revisited our department on her own volition because an ulcerative lesion with indistinct borders and induration was found at the left lingual margin. Upon close examination, a diagnosis of left tongue squamous cell carcinoma(cT2N2bM0, Stage ⅣA)was made. In October 2021, radical tumor resection and reconstruction were performed. After 8 months postoperatively, the patient is currently well.

We report a case of functional recovery following incisional cheiloplasty for the management of lower labial edema that developed after bilateral neck dissection with preservation of the one-side internal jugular vein and postoperative chemoradiotherapy. An 81-year-old woman underwent partial maxillectomy for the treatment of maxillary gingival cancer(squamous cell carcinoma, cT1N0M0, Stage Ⅰ)in April 2013. In July 2013, she underwent bilateral neck dissection(right, modified; left, radical)for bilateral cervical lymph node recurrence with an extra-nodal spread and received postoperative chemoradiotherapy( CDDP 75 mg/m2×3 course and total radiotherapy dosage of 66 Gy). Thereafter, the patient's condition progressed without recurrence or metastasis; however, the lower labium became edematous, and severe labial dysfunction was observed. Therefore, lower labial incisional cheiloplasty was performed under local anesthesia in October 2020. An excision area of 160×14 mm was determined on the inner side of the lower labium, and excision was performed with a steel blade scalpel. Lip closure became possible one week after the operation. Seven months after the operation, the patient recovered labial function and was satisfied with the outcome.

The Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, has been conducting mass screening of oral cancer using oral abrasion cytology by oral surgeons in eastern Shimane prefecture for public awareness and its early detection. As a result, 3(0.09%)cases of oral cancer were identified. Case 1: The patient was diagnosed with well-differentiated squamous cell carcinoma in the floor of the mouth(pT1N0M0, Stage Ⅰ)after undergoing Matsue city oral cancer screening in 2016. Case 2: The patient underwent oral cancer screening in Izumo city in 2018 and was diagnosed with verrucous carcinoma in the back of the tongue(pT1N0M0, Stage Ⅰ). Case 3: The patient was diagnosed with highly differentiated squamous cell carcinoma of the palate(pT1N0M0, Stage Ⅰ)after undergoing the Izumo city oral cancer screening in 2019. Awareness of oral cancer is important, and cancer screening by oral surgeons using cytology is highly useful and should be continued in the future.

Introduction: Pedicled flaps are used in orofacial defect reconstruction in older patients and patients with underlying diseases. The submental island flap(SIF)is one type of cervical pedicled flap; however, the modified submental island flap (MSIF), which includes mylohyoid muscle, is a simpler and safer type. Here, we report a clinical study of orofacial defect reconstruction using the MSIF following oral cancer resection., Patients and Methods: From January 2019 to December 2020, we retrospectively examined 10 cases of reconstruction using the MSIF following oral squamous cell carcinoma resection., Results: The study population consisted of 7 men and 3 women with a mean age of 76.0(66-88)years. The primary sites were lower gingiva(n=5), tongue(n=3), and buccal mucosa in(n=2). Surgical procedures included marginal mandibulectomy( n=3), segmental mandibulectomy(n=1), partial glossectomy(n=2), hemiglossectomy(n=1), buccal mucosa resection(n=2), and combined partial glossectomy and segmental mandibulectomy(n=1). The average flap size was 61.4×36.0 mm. The average time of flap elevation was 32.4(23-50)minutes. During orofacial surgery using the MSIF, organs adjacent to the primary site could also be reconstructed. There were no complications in any patients., Conclusion: The MSIF is useful for orofacial defect reconstruction in older patients and patients with underlying diseases.

Radical excision, a common oral cancer treatment, produces variable postoperative results depending on the specialized tissues involved and the extent of the cancer. Furthermore, the material selected for reconstruction also influences functional outcomes. Oral dysfunction due to postoperative tissue loss is more common with advanced cancer; therefore, early detection and treatment are important. To improve oral cancer awareness and early detection, mass oral cancer screenings led by maxillofacial surgeons in cooperation with the Shimane prefecture and local dental associations were conducted. We describe the mass screening methods and describe a case of tongue cancer that was detected and treated as a result of our screening efforts.

Oral leukoplakia is the most common premalignant and potentially malignant lesion of the oral mucosa. Several studies have reported that the prevalence of oral cancer in young people is increasingly rapidly. The patient in this report was a 47- year-old man who complained of left tongue discomfort. At the first visit, the clinical diagnosis was oral leukoplakia, and a follow-up examination was planned with a view to partial resection. However, at the follow-up, biopsy revealed squamous cell carcinoma. He underwent partial resection. Two months after the surgery, metastasis to the lymph node was detected. The patient underwent radical neck dissection and concurrent chemoradiotherapy. At the 3-years follow-up, there was no sign of recurrence or metastasis.

In recent years, the opportunity to treat oral cancer in elderly patients has been increasing because of the increased lifespan of individuals. Standard treatment for advanced tongue cancer involves reconstruction of the tongue with a free vascularized flap. However, this may not always be suitable for elderly patients because the procedure is lengthy and invasive and also because of their medical history. We report 2 cases of elderly patients undergone oral floor reconstruction with digastric muscle bipedicle flap for advanced tongue cancer. In case 1, an 86-year-old woman underwent pull-through ablation surgery with partial glossectomy and modified radical neck dissection for the treatment of left-sided tongue cancer(well-differentiated squamous cell carcinoma, cT3N2bM0, Stage ⅣA). In case 2, a 93-year-old man underwent pull-through ablation surgery with hemiglossectomy and suprahyoid neck dissection for treatment of right-sided tongue cancer(verrucous carcinoma, cT3N0M0, Stage Ⅲ). In both patients, the flap was sutured to the mandibular border, mandibular periosteum and surrounding tissue, and the intraoral mucosa and neck were isolated. Compared to the reconstruction of the tongue with a free vascularized flap, the procedure used in these 2 cases was shorter and caused less bleeding. Moreover, the patients exhibited no postoperative dysfunction, and clinical outcome remained favorable. We believe that oral floor reconstruction with digastric muscle bipedicle flap at the bottom of the mouth was effective in reducing surgical stress and restoring oral function in very elderly patients.

Oral leukoplakia is the most common premalignant or potentially malignant lesion in the oral mucosa. This retrospective study examined 67 lesions from 62 patients with clinical diagnoses of oral leukoplakia who underwent surgical excision in our department from 2015 to 2017. The patients comprised 22 men and 40 women. The most common location of the lesion was the lower gingiva, followed by the tongue, upper gingiva, buccal mucosa, palate, and lip. The most common clinical type was the white-spotted, followed by erythroleukoplakia, hillock, and verrucous types. Histopathologically, 16 lesions were oral intraepithelial neoplasia, whereas five were squamous cell carcinoma. The data identified several characteristics of oral leukoplakia that predict a high risk of malignant transformation and require aggressive surgical resection.

The pedicled pectoralis major myocutaneous(PMMC)flap, used for the reconstruction of surgical defects in advanced oral cancer resection, is versatile and can be obtained without a highly-invasive procedure. However, flap utility is limited by an unstable blood supply and the relatively high rate of partial necrosis of the skin island. Thus, the use of microvascularized free flaps has become more common in patients requiring oral-maxillofacial reconstruction. Detailed angiographic studies revealed the 3-dimensional vascular anatomy of the PMMC flap. This allowed us to obtain a modified, heart-shaped flap with a skin island that includes the intramuscular vascular networks between the pectoral branches of the thoracoacromial vessels and the intercostal perforators of the internal mammary vessels, thus ensuring a sufficient blood supply and stable survival of the flap. We have used this technique since 2015 to treat 7 patients with locally advanced or recurrent(salvage)oralcancer. None developed critical flap problems, and survival of the total skin island was successfully obtained in all cases. Transfer of the heart-shaped PMMC, including the multiple intercostal perforators from the internal mammary vessels, may contribute to a stable blood supply of the skin island and therefore can be effective for advanced oral cancer reconstruction.