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We report an osteoma in the right maxillary sinus that was removed by means of a fiberscopeassisted operation. The patient was a 33-year-old man. His chief complaint was dull pain in the right cheek region. Computed tomography showed a lesion with an ossified rim in the right maxillary sinus. A fiberscopic operation was performed using a 0.8-mm rod-lens fiberscope. Fiberscopic examination of the lesion revealed that the mass was covered by mucosa of the maxillary sinus and that the mass had bony pedicles on the sinus wall. The mass was removed with the patient under local anesthesia. The pathological diagnosis was osteoma. After operation, the pain and swelling were slight. The prognosis remains good 10 months after the operation, with no signs of recurrence. In conclusion, the surgical procedure we used is considered useful since it is minimally invasive.

Oral ulcers are caused by several different mechanisms. Sometimes the cause is unknown in elderly patients. We present the case of a patient with multiple persistent oral ulcers of unknown cause. A 74-year-old man was referred to our department for evaluation and treatment of multiple oral ulcers. The largest ulcer measured 38 × 19mm and was located on the tongue. The muscle was exposed. There was no systemic disease, and laboratory studies revealed no abnormalities. Incisional biopsy was done because of suspected malignant lymphoma, but no tumor tissue was found. The ulcers healed within 1 month in response to treatment with steroid ointment and instructions on mouth hygiene and nutrition at our hospital. Since some oral ulcers are caused by local factors whereas others are due to systemic problems, it is important to treat ulcers of unknown cause with multidisciplinary and complementary approaches and to continue long-term follow-up even after cure.

A case of squamous cell carcinoma of the tongue with metastasis to the lateral lingual lymphnodes is reported. Preoperative computed tomography and magnetic resonance imaging revealed a mass0.5cm in diameter with heterogenous enhanced signal intensity outside of the left genioglossus muscle.Radical neck dissection, partial left glossectomy, and reconstruction with a forearm flap were performedin a pull-through manner after external radiation and chemotherapy. Histopathologically, the mass had alymph-node structure with small cancer nests at the margin.

Mutations of the p53 tumor suppressor gene have been found in about 50% of all human cancers.The relation of p53 status to clinicopathological variables and prognosis has been evaluated; however, it remains controversial in most cancers. Recent studies suggest that malignant potential and biological properties may depend on the region of mutation. It has also been demonstrated that specific regions of mutations within the core domain of p53 protein correlate with poor prognosis in breast cancer, esophageal cancer and colon cancer. To clarify the correlation between mutations within the DNA binding surface regions of p53 and clinical outcome in patients with oral cancer, we analyzed p53 mutations in 91 fresh primary, resected specimens of oral squamous cell carcinomas (SCCs) by polymerase chain reaction-singlestrand conformation polymorphism (PCR-SSCP) and a yeast functional assay.p53 mutations were detected in 36 of 91 (40%) cases. No correlation was found between overall mutations in the p53 gene and clinicopathological variables, clinical outcome, or survival rate. The five-year cumulative survival rate of 18 patients with tumors that had p53 mutations within DNA-binding surface regions (L2, L3, LSH) was significantly lower (52.5%) than that of the 73 other patients (p=0.004). Multivariate analysis, showed that mutations within these regions were independent prognostic factors (p

Metastasis to the lateral retropharyngeal lymph nodes frequently occurs in nasopharyngeal cancers; however, it is very rare in oral carcinomas. This report describes a case of recurrent carcinoma of the lower alveolus with metastasis to retropharyngeal lymph nodes. The patient was an 84-year-old woman who underwent radical neck dissection with marginal resection of the right side of the mandible for a squamous cell carcinoma arising in the lower gingiva (T 2 N 1 M 0). Twenty-five months after the operation, she complained of a mass with ulceration in the floor of the mouth. A smear of the ulcer proved tumor recurrence. Computed tomography and magnetic resonance imaging showed that the mass invaded the tongue, with metastasis to the submental and bilateral metastases to the retropharyngeal lymph nodes. The patient and her family refused salvage treatment. She died of tumor 6 months after recurrence.

To predict indicators of occult neck metastasis, we evaluated clinico-pathological findings in N O cases of squamous cell carcinoma of the tongue by the quantification theory type II. The number of N O cases without local failure from 1974 through 1995 was 88. Biopsy specimens were evaluated pathologically after treatment of the primary lesion alone. Cervical lymph node metastasis subsequently developed in 18 cases. Data analysis, in which occult neck metastasis was considered a dependent variate and clinico-pathological findings as an independent variate, indicated that the invasion pattern was the most significant predictor of cervical lymph node metastasis. The presence or absence of occult cervical lymph node metastasis was correctly predicted in 76.1% of the cases.On analysis by the Anneroth classification, the contribution of morphologic variables to metastasis diminished in the following order: mode of invasion, number of mitoses, degree of keratinization, stage of invasion, lymph-plasmocytic infiltration, and nuclear polymorphism. On analysis of the total score derived from the correlation coefficients, occult neck metastasis was not found in patients with a score of 9 or less. The higher the total score, the higher was the incidence of cervical metastasis.

A case of spindle cell lipoma of the tongue is presented. The patient, a 71-year-old man, had a painless swelling of the tongue. Physical examination revealed two discrete, tender masses in the left ridge of the tongue. These masses were removed surgically. Histopathologically, they consisted of small groups of mature lipocytes separated by spindle cells and of stroma to composed of bundles of collagen fibers and mucinous materials. The spindle cells had a single fusiform nucleus. The histopathological diagnosis was spindle cell lipoma. Spindle cell lipoma commonly arises in the posterior neck, upper back, and shoulders and is extremely rare in the oral cavity. Only nine cases have been reported in the literature.

A 26-year-old woman was referred to our clinic on December 22, 1993, because of limited mandibular movement. Minor restriction of mouth opening was first noticed at 10 years of age, during a dental health examination. The patient became aware of pain and swelling of the right masseter region with decreased jaw movement at the end of November 1993.Clinically, the patient had a square face with prominent masseter muscles and mandibular angles. The interincisal opening was 22mm, with limitated lateral and anteroposterior mobility. A dense band of tissue, which became taut on maximal opening, was palpable along the anterior border of each masseter muscle.The clinical diagnosis was restricted mouth opening due to bilateral hyperplasia of the masseter muscle aponeuorses. Masseter muscle myotomy with aponeurectomy was performed bilaterally by an intraoral approach on May 18, 1995. The aponeuroses extended for three quarters of the length of the masseter muscles, down to the inferior borders of the mandible. The mouth opening improved to 46mm on incision of the aponeuroses.An examination of the patient 3 years after surgery revealed an interincisal opening of 38mm without strain.

A case of non-Hodgkin's lymphoma occurred in the right mandible of 7-year-old boy is presented. He consulted the dental hospital, Hokkaido University with a chief complaint of swelling of the mandible. Histopathological and immunohistochcmical investigations showed that the lesion was malignant lymphoma, lymphoblastic (WF) or diffuse lymphoma, lymphoblastic type (LSG), and T cell phenotype. The clinical classification was stage IIIE, and radiotherapy and chemotherapy were performed. He is still alive without tumor for 6 years from the clinical onset of the disease.

Odontogenic ghost cell tumor, considered to be a solid type of calcifying odontogenic cyst, is a rare entity, and only a few cases have been reported in the English and Japanese literature. Here, we report a case of odontogenic ghost cell tumor in a 59-year-old man. The patient presented with a painless swelling in the mandible. The swelling extended from the first right molar region to the ramus. Radiography revealed a relatively well defined radiolucent lesion containing some irregularly-shaped radiopaque masses and an impacted third molar. Segmental resection and reconstruction with an iliac cancellous bone graft and a titanium mesh plate were performed. Histopathologically, there was evidence of tumor invasion of the periphelial cortical bone, areas consisting of large amounts of calcifying flaky keratin close to masses of ghost cells, and dysplastic dentinoid matrix adjacent to epithelial cell nests. Atypical mitosis was not found. A final diagnosis of “central odontogenic ghost cell tumor” was made. Three years after operation, the patient is well with no signs of recurrence.

Hemangioma occurs most frequently in the head and neck region, but hemangioma in the buccal fat pad region is rare. Here, a case of venous hemangioma with phleboliths in buccal fat pad region is reported. A 22-year-old female consulted the Department of Oral Surgery, Dental Hospital, Hokkaido University with a chief complaint of swelling in her right cheek. MRI showed a mass in the buccal fat pad extending to infratemporal fossa. The lesion had mixed iso-and hight-signal intensities on T 2 WI, but flow voids in the lesion were not seen on proton WI. Plain CT showed the lesion with several round calcifications. Angiography did not demonstrate the feeding vessels or venous pooling of the tumor. The lesion was clinically diagnosed as a buccal hemangioma. It was removed intraorally under general anesthesia. A part of the lesion consisted of mainly small blood vessels conglomerated like a strawberry and the remaining part was a mixture of vessels and fat tissue. Soft X-ray of the extirpated material revealed several round calcified foci. Histologically, the tumor consisted mainly of numerous vessels within adipose tissue of the buccal fat pad. Mature smooth muscle fibers were observed in the outer portion of blood vessels accompanied by phleboliths in some areas. The lesion was diagnosed to be a venous hemangioma with phleboliths.

We report a case of basal cell adenoma of the parotid gland, which is a comparatively rare salivary gland tumor. A 68-year-old woman visited our department complaining of swelling in the right parotid region. The tumor was excised under the diagnosis of a parotid gland tumor. The tumor was located in the superficial lobe of the parotid gland and was surrounded by a fibrous capsule. Histopathologically, the tumor was mainly composed of isomorphic basaloid cells forming solid irregular trabecular structures with occasional ductal or cystic formations. Generally, the stroma was poor and contained no chondroid or mucoid components similar to pleomorphic adenomas.

Carcinoma of the oral cavity arising in children is extremley rare. A case of squamous cell carcinoma of the maxillary gingiva in a 10-year-old boy is presented.The patient visited our departmet on June 20, 1989 complaining of pain and swelling inthe labiogingival region of the right upper jaw. Clinical examination revealed a whitishverrucous growth in the right upper labial gingiva and alveolar mucosa. The growth ex-tended from the central incisor to the deciduous first molar. Radiography showed slightalveolar bone resorption in right upper lateral incisor and deciduous canine region. Inscintigraphy, there was no abnormal uptake. TNM classification was T2N0M0. Biopsyrevealed a well-differentiated squamous cell carcinoma of the gingiva. Marginal resection of the maxilla from the central incisor to the deciduous first molar was performed under generalanestheia. The patient is well without any signs of recurrence 3 years after operation.

A case of osseous choristoma in the radical region of the tongue (in the vicinity of the foramen caecum) in a 53-year-old female is described. This lesion was 8×6mm in size and removed under general anesthesia. Microscopic examination revealed the tumor to be composed of dense lamellar bone with haversian canals, surrounded by thin fibrous connective tissue with stratified squamous epithelium of the lingnal surface.

Sixty-four-year-old male complained of the diffuse brown pigmentation of labial gingiva (3-3). The pathological diagnosis of biopsy specimen was melanosis.A black tuberous solid mass was found in the same site 20 months later during the follow up period. As malignant melanoma was suspected, the extirpation (partial maxillectomy) of the tumor and postoperative adjuvant immunochemotherapy (DAV, OK-432) were done.Six months later, metastasis was found in cervical lymph nodes. Radical neck dissection (RND) was performed and nodal involvements were pathologically recognized.Two years after RND, he died of pneumonia. Neither primary recurrence nor distant metastasis were observed.

This study was undertaken to determine the indication and value of marginal resection of the mandible as a method of treatment for squamous cell carcinoma of the floor of the mouth. Eighteen patients whose primary tumors were treated by utilizing marginal resection at the Department of Oral Surgery of Hokkaido University from 1977 to 1986, were studied clinically and histopathologically. Another ten patients who had undergone resection of the primary tumor by other surgical methods during the same period, were also studied histopathologically.Local recurrence was observed in one case and the 5 year survival rate was 71. 3%. The histopathological study revealed that the cortical bone was eroded or destroyed by tumor tissues in more than half of the cases where the primary tumor had been diagnosed to have gingival invasion, mandibular adhesion or mandibular invasion. Tumor invasion into the periodontal ligament and bone marrow was also found in some cases. However, bone erosion and tumor invasion were limited within a small area, and tumor tissues did not invade beyound the extent which was anticipated before the surgery. These results suggest that some of the squamous cell carcinoma of the floor of the mouth can be removed by marginal resection of the mandible, even if the tumor invades the gingiva, the periosteum and mandible. On the other hand, in cases where the primary tumor had been diagnosed as not having gingival invasion nor mandibular adhesion, varied amounts of fibrous tissues were observed between the tumor tissues and the mandible. This suggests that squamous cell carcinoma of the floor of the mouth can be removed without resecting the mandible, if normal tissue is interposed the tumor and the mandible clinically. However, in some cases, particularly where the lesion was accompanied with infection and/or pain, it might be difficult to ascertain if the tumor had invaded the mandible or not. Therefore, it is recommended that squamous cell carcinoma of the floor of the mouth be removed by utilizing marginal resection of the mandible, if mandibular invasion is doubtful.

A case of unilateral enlargement of the coronoid process of the mandible was presented. The patient was a 37-year-old female and she complained of restricted mandibular movement and swelling of the left zygomatic region. A routine X-ray examination revealed a bony mass at the tip of the left coronoid process. A coronoidectomy was performed intraorally so that the restricted mandibular movement was improved. Computed tomography was extremely useful not only in the diagnosis of this condition but also in deciding the surgical procedure. Histologically, the specimen showed a proliferation of cartilage cells existed in a disordinary arrangement, in general, and enchondral ossification was markedly disturbed, but there was not any degree of cellular pleomorphism or atypia. The histological diagnosis of osteochondroma of the coronoid process was obtained.The nature of this condition has been obscure. Although the majority of reported cases lack the histological evidence of the neoplastic nature, some show a proliferation of the cartilage, cellular pleomorphism or slight atypia of the cartilage cells. Our case suggests this condition has a basically neoplastic nature.

Osteosarcoma is second only to multiple myeroma in the incidence of tumours of bone, but its occurrence in the mandible is relatively rare. This article reports on two cases of osteosarcoma in the mandible.Case 1: A 47-year-old female complained of paresthesia of the right mental region. Osteomyelitis of the mandible was suspected on clinical examination.After extraction of the lower right second molar, the right molar region of the mandible rapidly swelled and tumorous tissue developed in the tooth socket.Radiation therapy was chosen since malignant lymphoma was suspected based on histopathological findings, but the swelling increased. On histopathological re-examination, a diagnosis of osteosarcoma was established. Although high dose methotrexate (MTX)-citrovorum factor (CF) therapy was instituted (100-200 mg/kg) after radical surgery the patient died of pneumonia resulting from lung metastasis.Case 2: A 48-year-old male complained of swelling in the right molar region of the mandible.Examination revealed tumorous tissue with sequestration in the molar region. Based on histologic examination, a diagnosis of fibroosseous lesion was made. Marginal resection of the mandible was performed, but local recurrence was noted 6 months later. Histologic examination of the second biopsy was negative for malignancy, and segmental resection was performed. However, swelling of the mandible recurred soon after the 2nd operation.The patient underwent further surgery, and a final diagnosis of osteosarcoma was reached. High dose MTX-CF therapy was instituted soon after surgery. There has been no sign of recurrence or metastasis in the 2 years since the 3 rd operation.