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Hyperthermia may be effective for cases of oral squamous cell carcinoma (OSCC) or lymph node metastasis that cannot be otherwise treated. In our hospital, we perform hyperthermia by microwave interstitial heating. The cases of two patients with lymph node metastasis following surgery for OSCC in whom complete response was achieved with this method are presented. Case 1 was a 55-year-old man with right tongue carcinoma (T2N2cM0) who had undergone preoperative chemotherapy followed by radical surgery. Metastasis was subsequently identified in a right lingual lymph node, and surgery was planned, but since the patient did not consent, he was instead treated with chemoradiotherapy. However, since he did not respond sufficiently to this treatment, in the absence of any other alternative, two sessions of hyperthermia alone were administered. The results were good, and 10 years after treatment, there has been no further sign of metastasis or recurrence. Case 2 was a 69-year-old woman who had undergone resection of a carcinoma of the oral floor (T2N0M0). Four months later, metastasis was identified in a right cervical lymph node, and neck dissection was planned, but since the patient did not consent, she was instead treated with chemoradiotherapy. However, she did not respond to this treatment, and the metastatic lesion enlarged, so hyperthermia was performed. Her post-treatment course was uneventful, and five years later there has been no sign of recurrence. Hyperthermia may be an effective means of treatment in patients for whom it is indicated.

Purpose The development of distant metastases (DMs) in patients with oral squamous cell carcinoma (OSCC) leads to dismal prospects for survival. The present study aimed to identify the risk factors for DM development and long-term survival. Patients and Methods The present study was a retrospective cohort study of patients with OSCC at a single institution. The predictor variables were age, gender, lymph node classification, histologic grade, neck dissection, infiltrative growth pattern (INF), vascular/lymphatic invasion, perineural invasion (PI), extranodal extension, local recurrence, nodal metastasis, DMs, interval to the diagnosis of DMs, and surgery for DMs. The primary outcome variables were the 5-year overall survival (OS) and median survival time (MST), which were estimated using the Kaplan-Meier method. Cox hazard models were used to identify the risk factors for DM development. Results The cohort included 526 patients; the data from 402 were available for analysis. Of these 402 patients, 37 developed DMs. On multivariate analysis, clinical N1 (cN1)-cN2 (hazard ratio [HR], 3.36), moderate/poor differentiation (HR, 2.51), INFc (HR, 3.27), vascular/lymphatic invasion (HR, 2.95), and PI (HR, 2.17) were independent predictors of DM development. The 5-year OS was 84.6% for the non-DM patients and 9.7% for the DM patients, with a MST of 16.9 months. In those with DMs with cN0, the 5-year OS was 18.2% and the MST was 37.2 months. For those with DMs with cN1-cN2, the 5-year OS was 4.7% and the MST was 12.9 months. In patients with an interval to the DM diagnosis of 10.0 months or longer, the 5-year OS was 20.0% and the MST was 38.6 months. In the patients with an interval to the DM diagnosis of less than 10.0 months, the MST was 11.7 months. The 5-year OS of the patients who had undergone pulmonary metastasectomy was 60.0% and the MST of the nonsurgery group was 16.0 months. Conclusions In the patients with DMs, stage cN0 and a late interval to DM diagnosis were associated with long-term survival. Pulmonary metastasectomy could be worth considering to improve survival.

Objective Various diseases can involve the oral mucosa, which can make diagnosis difficult. Fluorescence visualization (FV) devices allow non-invasive screening for oral squamous cell carcinoma (OSCC). Although its usefulness has been reported using subjective evaluations, this study aimed to clarify its utility in screening oral mucosal diseases using subjective and objective evaluations. Patients and methods Fifty patients with superficial OSCC or oral lichen planus (OLP) treated at Tokyo Dental College between April 2016 and March 2018 were investigated. Subjective evaluation involved discriminating FV retention from FV loss (FVL), while objective evaluation involved calculation of luminance value (LV) and luminance rate (LR) as luminance of the lesion/luminance of control, and border change rate (BCR) using image-processing software. We calculated the area under the curve (AUC), sensitivity, and specificity using receiver operating characteristic (ROC) analysis. Results In subjective evaluations, FVL was observed in all cases (p = 1.000). In objective evaluations, LV tended to be higher for OSCC than for OLP, but the difference was not significant. LR was significantly higher for OSCC than for OLP. BCR was significantly lower for OSCC than for OLP. In ROC analyses, AUCs for LV, LR, and BCR were 0.613, 0.864, and 0.913, respectively; cut-offs were 97.0, 69.0, and 27.2; sensitivities were 85.0 %, 90.0 %, and 85.5 %; and specificities were 36.7 %, 70.0 %, and 93.3 %. Conclusions Objective evaluations, such as LR and BCR using the FV device, appear to be useful for discriminating between OSCC and OLP.

First bite syndrome (FBS)is characterized by sharp pain in the parotid region at the first bite of a meal which gradually decreases as mastication continues, and is thought to be caused by sympathetic nerve damage. When FBS occurs with no history suggestive of nerve damage, it is classified as idiopathic. A case of idiopathic FBS that was treated effectively with Rikkosan is presented. The patient was an 81-year-old woman who developed sharp pain in the left parotid region with the first bite of every meal in November 2015. With no specific findings, the initial diagnosis was trigeminal neuralgia, but carbamazepine was ineffective. In February 2016, temporomandibular disorder was diagnosed as the cause of masticatory muscle pain and was treated with splinting and loxoprofen sodium, but this was also ineffective. In June 2016, a panoramic radiograph, plain craniocervical magnetic resonance imaging, and blood tests were all negative. Idiopathic FBS was diagnosed and treated by gargling and swallowing Rikkosan before meals and eating bitter or sweet foods first, followed by salty or sour foods. The FBS improved, and after 1 week, she had days with no pain. Rikkosan was discontinued after a month leading to immediate recurrence. The patient was instructed to use half the dose of Rikkosan, which was effective with no side effects. In October 2016, the patient started gargling with Rikkosan. In March 2017, the Rikkosan was discontinued and the dietary strategy was continued with no further recurrence. In this case, idiopathic FBS improved with Rikkosan treatment.

The aim of this study was to investigate 3-dimensional (3D) airway volume in patients with unilateral cleft lip and palate (UCLP) using computed tomography (CT). The study population comprised 15 UCLP patients (UCLP group) scheduled to receive alveolar bone grafts and 15 with impacted teeth (control group). The clinical requirements for a CT scan were met in both groups. Measurements were recorded from 3D reconstructions of Digital Imaging and Communications in Medicine data obtained from the CT images. Airway volume, cross-sectional area, and linear and angular measurements were recorded. Airway volume and cross-sectional area showed no significant difference between the two groups. The narrowest section of the airway in the UCLP group was tighter than that in the control group, however (p=0.017). The results of this study suggest that this difference in the measurements of the narrowest section of the airway is involved in the particular maxillofacial morphology found in UCLP patients.

The purpose of this study was to evaluate the effect of postoperative radiotherapy (RT) on temporal volume changes with a cutaneous free flap (CF) and a myocutaneous free flap (MCF). The subjects were 24 men and 11 women (mean age, 50.5 ± 15.5 years) with tongue or floor of mouth cancer. Twenty-seven cases of CF and eight cases of MCF were selected. The flap volume change of the reconstructed tongue was calculated using computed tomography (CT) images taken immediately and at one year postoperatively using the DICOM image processing software OsiriX®. The reduction rate in flap volume at one year postoperatively was 82.0 ± 15% in CF without RT, 70.3 ± 26.1% in CF with RT, 88.5 ± 14.7% in MCF without RT, and 99.5 ± 16% in MCF with RT. The MCF volume was significantly higher compared to the CF volume. Although postoperative RT reduced the CF volume by 30%, there was only a slight reduction in the MCF volume. We evaluated the effect of postoperative RT on volume reduction in 35 cases of the reconstructed tongue with CF and MCF using a computer-assisted volume rendering technique. In this study, the effect of RT on volume reduction was different between the CF and MCF.

Objective: The present study aimed to determine the structure and morphology of the maxilla in patients with cleft lip and palate to ensure safe Le Fort I osteotomy. Patients: A total of 34 sides of 17 patients with unilateral cleft lip and palate (nonsyndromic cases) were included in this study. The control group included 10 sides of 5 patients who exhibited skeletal mandibular protrusion without malformation. Methods: Finite element analysis was performed to examine the distribution of occlusal force over the maxilla, and continuous 3-dimensional measurement was performed at the sites of stress concentration. Results: In patients with cleft lip and palate, bones at the lateral border of the piriform aperture and the anterior wall of the maxillary sinus were significantly thicker than those in controls ( P < .05). Furthermore, the attachment of the pterygomaxillary junction was wider and thicker ( P < .05), and the anterior distance to the descending palatine artery was shorter ( P < .01) in patients with cleft lip and palate than in controls. Our results further indicated that alveolar bone grafting may significantly influence bone thickness and the attachment state of the pterygomaxillary junction. Conclusions: Our results suggest that the complications of LFI can be reduced in patients with cleft lip and palate by ensuring proper understanding of each patient’s maxillary anatomy and bone thickness, as well as the location of the descending palatine artery and the attachment state of the pterygomaxillary junction.

Here, we report retention following surgical orthodontic treatment in a patient with vertical maxillary excess associated with temporomandibular joint osteoarthritis (TMJOA) and marked mandibular retrusion. The patient was a man aged 20 years 10 months who presented with the chief complaint of maxillary protrusion. The facial profile was of the convex type due to marked mandibular retrusion. In addition, the patient had a gummy smile. Intraoral findings revealed a Class II molar relation, +11 mm overjet, and 0 mm overbite. Mandibular dentition arch length discrepancy showed crowding of -2 mm, and the maxillary dentition showed a spaced arch of +5 mm. Panoramic radiographs confirmed flattening of the condylar head and proliferation of the bone margin. Cephalometric analysis of the skeletal pattern revealed that, horizontally, the maxilla was anterior and the mandible posterior; vertically, a dolichofacial pattern was noted. The anterior maxillary tooth axis was standard, but the anterior mandibular tooth axis showed labial inclination. Based on these findings, skeletal maxillary protrusion associated with TMJOA was diagnosed. Surgical orthodontic treatment comprised bilateral mandibular first premolar extraction with two-jaw surgery and genioplasty. Orthodontic treatment was performed with a multibracket system using a 0.22-slot pre-adjusted edgewise appliance. At 2 years and 11 months after initiation of treatment, the maxilla was transposed 6 mm upwards by orthognathic surgery and the mandible 17 mm anteriorly and 5 mm upwards by counterclockwise rotation. At 3 years and 10 months, the Pogonion was moved 6 mm anteriorly by genioplasty. At 4 years, orthodontic treatment was concluded on confirming satisfactory occlusion and improvement in facial features. At 2 years after completion of treatment, occlusion and the maxillofacial morphology remain stable, with almost no relapse. In addition, no temporomandibular joint disorder symptoms have occurred. Careful comprehensive follow-up observation will be continued.

Verruciform xanthoma (VX), a papillary or wart-like lesion of the mucosa, is histopathologically characterized by papillary projection of the epithelium and an aggregation of foam cells in the lamina propria. Here, we describe a case of VX in the posterior mandibular gingiva, initially suspected to be a benign lesion based on clinical findings and cytology prior to an excisional biopsy. The patient was a 62-year-old man who had visited a local dentist approximately 1 year earlier, presenting with a white lesion in the left posterior mandibular gingiva that resisted removal by scraping. The lesion was left untreated as there were no subjective symptoms. Thereafter, the surface of the lesion roughened and the patient was referred to our department for a comprehensive examination. A circumscribed, granular mass, 15-mm in diameter, with a red and white surface was observed in the left posterior mandibular buccal gingiva. Exfoliative cytology was performed. The diagnosis was a class III lesion. Excisional biopsy was performed under local anesthesia. Histopathological examination led to a diagnosis of VX. At 1 year postoperatively, the patient is making satisfactory progress without recurrence. Verruciform xanthoma is difficult to diagnose preoperatively, and is commonly resected under a clinical diagnosis of papilloma or benign tumor. A benign lesion was also initially suspected in the present case and cytological analysis performed to confirm absence of malignancy. The lesion could not be diagnosed as VX preoperatively. Verruciform xanthoma can be over-diagnosed based solely on cytological examination because it often involves cellular atypia reflecting its characteristic extension of rete pegs and keratinization of surface cells, indicating the need for care in arriving at a definitive diagnosis.

Background In the most cases of oral squamous cell carcinoma (OSCC), oral epithelial dysplasia (OED) is found adjacent to the primary tumor. The delineation of surgical margins for OSCC is critical to minimize the risk for local recurrence. The aim of this study is to demonstrate that the fluorescence visualization (FV)- device can delineated the lesion visualizes OED of adjacent primary tumors by histopathologically comparison to conventional iodine vital staining. Material and methods The study involved 40 patients with superficial tongue squamous cell carcinoma treated from July 2016 to July 2018 at the Oral Cancer Center, Tokyo Dental College. Results Cytokeratin 13 (CK13) expression rate in the area of fluorescence visualization loss (FVL) was significantly lower than that in the area of fluorescence visualization retention (FVR). In addition, CK17, Ki-67, and p53 expression rates were significantly higher in FVL than FVR. There was no significant difference in the delineation rate or area between FVL and iodine-unstained area. High-grade dysplasia was observed most frequently at the FV and iodine-unstained boundary, but no significant pathological differences were found. Conclusion We strongly suggest the FV-guided surgery is a useful method for accurate resection in early-stage tongue squamous cell carcinoma.

The facilities comprising Tokyo Dental College (TDC) -the college itself and its medical institutions at Suidobashi, Ichikawa, and Chiba - have been officially recognized as a center for treating oral cancer. The TDC Oral Cancer Center (OCC) was established on April 1, 2006. It provides comprehensive medical care, including that aimed at recovery of postoperative function, such as restoration of stomatognathic function, dysphagia therapy, and placement of maxillary prostheses. The purpose of this study was to investigate patient trends at TDC-OCC over the 10 years following its establishment in order to determine how the safe and high-quality cancer care already provided might be even further improved. Oral cancer patients attending TDC-OCC between April 2007 and March 2017 were investigated. Clinical information was obtained from medical records and analyzed, including that on patient numbers, age, sex, primary site of tumor, clinical stage, and surgery provided. There were 758 new cases, and the number of new cases showed an annual increase. Among the total number of new patients, 575 (75.9%) represented primary cases. The number of operations also showed an increase, which correlated with the increase in the number of patients. The incidence in oral cancer has increased in several countries, including Japan. Oral cancer can be observed macroscopically and touched. In contrast to with cancers at many other sites, and despite various diagnostic devices for early detection having been developed, however, cases are often advanced when first encountered. Many advanced cases were treated at TDC-OCC, and the number of reconstructive operations following progressive cancer also increased over time.

Objective:The pathogenesis of nonsyndromic cleft lip with or without cleft palate (NSCL ± P) and nonsyndromic cleft palate only (NSCP) may be associated with genetic factors. Although some predisposing genes/loci have been reported, their attributable risk is too small to be clinically meaningful. To clarify the genetic causes and mechanisms of NSCL±P or NSCP, we conducted mutation analysis of target genes using a next-generation sequencing (NGS) approach.Methods:The target genes, IRF6, WNT5A, WNT9B, TP63, MSX1, TFAP2A, PAX9, DLX3, DLX4, and MN1, were selected based on previous reports of potential associations with the development of NSCL±P or NSCP from genome-wide association studies and candidate gene analyses. Mutation analysis was conducted using NGS on 74 Japanese trios (patient and parents) and 18 Japanese patients only families.Results:We detected single-nucleotide variants (SNVs) for 7 genes: IRF6, DLX4, WNT5A, TFAP2A, WNT9B, TP63, and PAX9. The SNVs found on IRF6 and DLX4 were missense mutations, whereas those identified on WNT5A, TFAP2A, WNT9B, TP63, and PAX9 were rare variants in the noncoding region; no de novo mutation was identified in the trio samples. The amino acid change on DLX4 was detected within the highly conserved homeodomain and was predicted to have a deleterious impact on the protein function by in silico analysis.Conclusions:The DLX4 missense mutation c.359C>T (Pro120Leu) was found in 1 Japanese patient with NSCL±P and was located in the homeodomain region. This mutation likely plays a role in the development of NSCL±P in the Japanese population.

The purpose of this study was to investigate three-dimensionally temporal change in flap volume after free flap reconstructive surgery in tongue cancer patients. The results revealed an average change in flap volume of 82.3% at 1 year postoperatively. Change in tongue volume at approximately 6 months postoperatively showed a correlation with triglyceride levels. A correlation was also found between albumin levels and tongue volume at 1 year onwards postoperatively. The goal of such surgery in patients with tongue cancer is to reconstruct a functional tongue. Taking postoperative change in tongue volume into consideration is therefore of importance in minimizing postoperative dysphagia.

To understand the effects of supra-optimal air temperature with adequate total solar radiation on dry matter production in tomato, we quantified morphological and physiological changes in tomato growth under daily mean temperature at 30 °C. After transplanting, we grew tomato plants under a daily mean temperature of 20 °C, 25 °C, or 30 °C in a growth chamber at high light intensity provided by a LED source until the cumulative daily mean temperature (CT) reached 2000 °C. Plants were pinched when CT reached 1000 °C to remove the vegetative growth sink. Total dry matter was significantly lower at 30 °C than in the other treatments, although relative growth rate (RGR) increased with increasing temperature. An RGR increase at 30 °C was associated with greater net assimilation rate and leaf area ratio. Gross photosynthetic rate and utilization of carbohydrates for plant growth also increased with increasing daily mean temperature. At CT 2000 °C, gas-exchange rate at 30 °C was about twice as high as that at 20 °C, though they were similar at CT 1000 °C in spite of difference of daily mean temperature. Accumulation of non-structural carbohydrates in leaves and stems at 30 °C were less than those at 20 °C. We conclude that supra-optimal daily mean temperature (30 °C) increases RGR, because not only the gas-exchange rate was high, but also photosynthetic assimilates are utilized efficiently for plant growth at 30 °C.

Objectives Tokyo Dental College started oral cancer screening in cooperation with a local dental association in 1992. Reveal the usefulness of Countermeasure and Opportunistic Screening Systems for Oral Cancer. The actual results of countermeasure and opportunistic oral cancer screening systems are reported. Materials and Methods Countermeasure screening for the public was performed in each region, and opportunistic screening was performed in a general dental clinic of a cooperating physician. Results In countermeasure screening, 19,721 persons were checked from 1992 to 2018; the gender ratio was 1:3. The close examination rate was 4.45%. The detection rates of oral cancer and oral potentially malignant disorders were 0.13% and 1.85%, respectively. In opportunistic screening, 29,912 persons were checked from 2006 to 2018; the gender ratio was 2:3. The close examination rate was 2.33%. The detection rates of oral cancer and oral potentially malignant disorders were 0.08% and 2.15%, respectively. The close examination rate was significantly lower in opportunistic screening than in countermeasure screening. The oral cancer detection rates and the positive predictive value for cancer were equivalent. In addition, the detection rate of oral potentially malignant disorders was significantly higher in opportunistic screening than in countermeasure screening. Conclusion Oral cancer detection rates were equivalent between countermeasure and opportunistic screenings, and opportunistic screening were more effective on number of participants and the close examination rate, and the detection rate of oral potentially malignant disorders.

Disseminated carcinomatosis of the bone marrow (DCBM) is characterized by diffuse metastasis to bone marrow and sudden mortality. To the best of our knowledge, no studies to date have reported progression of oral squamous cell carcinoma to DCBM. Herein, we report a case of squamous cell carcinoma in the maxillary gingiva suspected of progressing to DCBM. A 64-year-old woman presented with white lesions on the left maxillary gingiva. The lesions were diagnosed as squamous cell carcinoma (T2, N0, M0), and partial maxillectomy performed. Two years and 5 months after surgery, metastasis was noted in the left cervical lymph node and left radical neck dissection carried out. The subsequent diagnosis was right cervical lymph node metastasis and multiple bone metastases. The patient also presented with thrombocytopenia, anemia, and elevated levels of alkaline phosphatase, probably due to metastatic bone disease. Although various antitumor therapies were administered, the patient died 6 months after diagnosis of multiple bone metastases.

The purpose of this study was to investigate factors involved in stress on locking mini-plate/screws used in orthognathic surgery based on patient-specific 3-dimensional finite element analysis. Data were obtained from 10 patients undergoing mandibular advancement by bilateral sagittal split ramus osteotomy. All underwent osteosynthesis with 2.0-mm titanium locking mini-plate/screws. A 3-dimensional finite element model of the mandible was created for each patient and each model subjected to the same loading conditions, which produced different stress values on locking mini-plate/screws. When the contact area of the proximal and distal bone segments was narrower and bone mineral density (BMD) lower, the von Mises stress values on the plate/screws were higher (contact area, p

In the present study, in order to identify novel diagnostic biomarkers for the malignant behavior of oral squamous cell carcinoma (OSCC), we determined the proteomic profiles of several OSCC cell lines and keratinocytes by two-dimensional fluorescence difference gel electrophoresis and liquid chromatography tandem mass spectrometry. The protein expression level of α-1-microglobulin/bikunin precursor (AMBP) was found to be significantly lower in the OSCC cell lines than in the keratinocytes, and a significant decrease in AMBP mRNA expression was confirmed in the OSCC cell lines by RT-qPCR. To investigate the biological function of AMBP in OSCC, the cells were transiently transfected with an AMBP overexpression vector; the AMBP-overexpressing cells exhibited a significantly decreased invasion and migration in comparison to the mock-transfected control cells, although no significant changes in cell proliferation were observed. Immunohistochemistry revealed that the underexpression of AMBP was significantly associated with a high metastatic potential to cervical lymph nodes and a poor overall survival. Thus, the expression of AMBP is an independent predictive factor of cervical lymph node metastasis and a prognostic factor of overall survival, and it is involved in both cell invasion and metastasis in cervical lymph nodes in OSCC.

Basal cell carcinoma (BCC) is a malignant tumor that most often occurs in the head and neck, particularly near the midline skin region. In recent years, several reports have documented the occurrence of BCC in the trunk, axilla, and scrotum. However, BCC arising from the oral mucosa is rare. Through a literature review, we identified 13 cases of BCC arising from the oral mucosa, reported mainly by European and American clinicians. Moreover, 3 of these cases were reported to arise from the buccal mucosa. Herein, we report a case of multifocal superficial type BCC with black pigmentation. An 85-year-old woman was referred by her dentist for evaluation of erythema with black pigmentation in her oral cavity. Histopathology revealed a palisading arrangement of basal-like cells and decreased space between the surrounding tissues at the epithelium. Differentiation from peripheral ameloblastoma was required. Therefore, we performed immunohistological staining. The lesion showed positive staining for Ber-EP4 and negative staining for KL-1. From these results, in combination with a clinical examination, superficial type persistent BCC (in accordance with the World Health Organization classification) was diagnosed. The patient declined surgery but was monitored for a period of over 5 years since the initial diagnosis. During this time, the lesion showed slow growth.

Objective Oral leukoplakia (OL) is classified as a precancerous lesion with potential for malignant transformation. No consensus has been reached regarding appropriate treatment for OL with low-grade dysplasia (LGD). We have often seen that OL with LGD that goes untreated or is excised with insufficient margins develops into squamous cell carcinoma. The aim of this study was to identify the rate of and clarify risk factors for malignant transformation of OL, with a focus on LGD. Methods Consecutive patients with OL with LGD treated between 2000 and 2011 were selected from the medical records of the Department of Oral and Maxillofacial Surgery at Tokyo Dental College, Chiba Hospital, Japan. Differences between clinical characteristics (age, sex, lesion site, smoking habit, alcohol intake, clinical appearance, lesion color, lesion surface, degree of dysplasia and treatment) and malignant transformation were analyzed using Fisher's exact test. Results A total of 115 OL patients with LGD were evaluated. Four cases (3.5%) showed malignant transformation to squamous cell carcinoma. No clinical characteristics showed any significant correlation with malignant transformation. Conclusions Strict follow-up is recommended for OL with LGD to detect oral cancer in the early stage. Biomarkers to identify malignant transformation of leukoplakia are needed to facilitate treatment of these patients and confirm the malignant transformation rate.

Remarkable technological advances have been made in the field of medicine in recent years, one result of which is that a prenatal diagnosis of cleft lip and/or cleft palate (CL/P) is now possible. In this situation, it is extremely important to provide the parents with mental care from the moment they are informed. Here, we describe cases of CL/P treated at our hospital and how such a diagnosis and prenatal counseling are handled. A survey was carried out on 4 cases seen at our department between April 2013 and March 2014. Patients are referred to our department from local or our own obstetrics clinics on a prenatal diagnosis of CL/P based on findings from ultrasonography. If the case is a referral from outside, the patient will first be seen at our own obstetrics department. Our department may then be subsequently requested to provide the parents with prenatal counseling. Effort is made to reassure the parents that postnatal support will be provided, right from the start. Next, the multidisciplinary nature of the treatment process is explained. However, only the essential outline is given at first so as to avoid inducing unnecessary anxiety. A response is also given to any questions the parents may have. Our experience of giving such care leads us to believe that improvements are required in the way that explanations and assistance are provided. The number of cases in which prenatal counseling is required is expected to increase in future.

Interstitial pneumonia is one of the most frequently encountered clinical conditions as an adverse effect caused by peplomycin (PEP). We report our experience of interstitial pneumonia case induced by PEP administration at relatively low dosage (27.5 mg) for lower gingival carcinoma. A 78-year-old male. The patient was diagnosed as carcinoma of the right lower gingiva (T2N0M0). For the course of treatment, a total of 27.5 mg PEP was administered intramuscularly in 6 doses as preoperative chemotherapy from February 2013. The patient developed a fever of over 38 degrees from 2 days before the surgery. As a result of chest X-ray, mild diffuse interstitial change was observed in the both lung fields; therefore, antimicrobial drug was administered after consultation with the Department of Respiratory Medicine. In chest X-ray conducted for reevaluation at 16 days after the initiation of antimicrobial drug administration, the diffuse ground-glass pattern in the both lung fields became worse, and the patient was diagnosed as drug-induced interstitial pneumonia. Steroid therapy was started from the same day. The diffuse ground-glass pattern in the both lung fields became less severe in chest CT obtained at 26 days after the initiation of steroid therapy. Radiotherapy was conducted instead, and the tumor was completely disappeared with irradiation with 80 Gy, and currently the patient is under follow-up. Mechanisms underlying lung toxicity of PEP remains incompletely understood; therefore, it is considered that adequate attention would be required to the development of interstitial pneumonia even if the dose of PEP were not high.

The eruption of a tooth into the nasal cavity is a rare clinical entity. We report a case of an inverted supernumerary tooth in the nasal cavity. A 2-year-old boy was referred to our institution after examination at a local otorhinolaryngology department for otitis media. Radiological examination revealed a tooth-like structure in the right nasal cavity. The tooth was protruding from the floor of the nasal cavity along with granulation tissue. The diagnosis was an inverted tooth in the right nasal cavity. Forceps extraction was performed under general anesthesia.

Conversion disorder is a condition in which psychological stress in response to difficult situations manifests as physical symptoms. Here, we report a case of postoperative coma due to conversion disorder in an elderly oral cancer patient. An 82-year-old woman was referred to Tokyo Dental College Chiba Hospital with a mass lesion on the tongue. A biopsy revealed a well-differentiated squamous cell carcinoma. Surgical treatment was performed for the tongue carcinoma and tracheotomy for management of the airway. On postoperative day 5, the patient exhibited loss of consciousness (Glasgow Coma Scale: E1, VT, M1; Japan Coma Scale: III-300). The patient's vital signs were all normal, as were the results of a full blood count, brain-CT, MRI, and MRA. Only the arm dropping test was positive. Therefore, the cause of the coma was diagnosed as conversion disorder. Seven hours later, the patient showed a complete recovery.

Functional rehabilitation has been reported to improve swallowing. The effect of the presence or absence of such rehabilitation has yet to be compared in oral cancer patients, however. The purpose of this study was to investigate its effect on correlations between the period of hospitalization and the period of tube feeding (from the day of surgery to termination of tube feeding) and period of oral nutrition (from termination of tube feeding to discharge). Body weight was also measured on admission and discharge and the difference calculated. A correlation was observed between period of hospitalization and period of tube feeding in the rehabilitation group, and with the periods of tube feeding and oral nutrition in the non-rehabilitation group. In the rehabilitation group, the period of tube feeding appeared to affect period of hospitalization. On the other hand, termination of tube feeding did not tend to affect period of hospitalization. These results suggest that both periods were factors affecting period of hospitalization in the non-rehabilitation group. Not performing swallowing rehabilitation, therefore, resulted in the period of oral nutrition affecting the period of hospitalization. This suggests that it is essential that nutrients be ingested in moderation after termination of tube feeding, when they are only taken orally. Moreover, these results also indicate that rehabilitation is important in improving quality of life after discharge.

Objective The most commonly used system of classification for the evaluation of histological malignancy in oral squamous cell carcinoma is the Yamamoto–Kohama (Y–K) classification, which focuses on the shape of tumor cell cords at the tumor–host interface, an item also included in the Jakobsson and Anneroth classifications. In this clinical study, we investigated the relationship between mode of invasion as based on the Jakobsson and Y–K classifications and prognosis in patients with tongue squamous cell carcinoma treated at our department. Patients and methods One hundred and sixty-eight of the 193 patients with tongue squamous cell carcinoma treated in at our department over an 11-year period between 2000 and 2010 were included in this study (25 were excluded as the mode of invasion could not be determined according to the Y–K classification). Results According to the Jakobsson classification, 26, 33, 53, and 56 tumors were classified as grades 1–4, respectively. According to the Y–K classification, 26, 33, 53, 31, and 25 tumors were classified as grades 1–3, 4C, and 4D, respectively. Conclusion Patients with grade 4C/4D tumors had many poor prognostic factors, including a pN-positive rate of 73.5%, mortality, recurrence, and late metastasis rate of 44.2%. The tumors in this group exhibited both endophytic and exophytic growth patterns, and the 5-year-survival rate was significantly lower than that in patients with other grade tumors. These results suggest that grade 4C/4D is a useful prognostic factor.

Objective The mode of invasion at the very bottom of a tumor is reported to be the key to its prognosis, as this reflects the relationship with between the tumor cells and the interstices of the host tissue. The purpose of this study was to investigate the correlation between tumor depth (M, SM, MP1, MP2) and various clinicopathological factors in tongue squamous cell carcinoma. Patients and methods The medical records of 193 tongue squamous cell carcinoma patients treated at our hospital between 2000 and 2010 were retrospectively reviewed. Among them, 25 patients were excluded from the analysis as no invasion of muscle tissue was observed, leaving 168 in total. Tumor depth was defined as that as measured from the surface of the mucosa to the very bottom of the tumor. Results Submucosal invasion (SM) was found in 43 cases, shallow invasion of the muscularis propria (MP1) in 83, and deep invasion of the muscularis propria (MP2) in 42. The 5-year survival rate was as follows: 92% in SM, 95% in MP1, and 87% in MP2. Significant differences were observed in survival rate between primary tumor depth (MP group) and mode of invasion; primary tumor depth (MP1) and degree of differentiation; and primary tumor depth (SM) and cervical lymph node metastasis. Conclusions The results suggest that primary tumor depth may be used as a prognostic factor in tongue squamous cell carcinoma.

Human papillomavirus (HPV) infection may be independent risk factor for oral squamous cell carcinoma (OSCC). Many previous studies have also demonstrated the prevalence of HPVs in oral epithelial tissue. However, the relationship of HPV to OSCC is still controversy. The aim of this study was to determine the prevalence of HPV and subtypes in OSCC patients. DNA samples were collected from 93 OSCC tissues. We assessed prevalence of HPV and subtypes involvement in OSCC patients using the Roche Linear Array HPV Genotyping Test. Distribution of each clinical characteristic was compared with HPV status. HPV infection was found in 10 OSCC patients (10.7%). We detected multiple subtypes including high and low risk type in all HPV positive OSCC tissue samples. However, there was no significant correlation between HPV infection and all clinical characteristics. In this study, all HPV positive OSCC samples have more than 2 HPV subtypes. Although it was not reported that infection of multiple subtypes was a risk factor in OSCC, our results suggested that multiple subtypes infection of HPV might be participating in OSCC.

No effective, reliable treatment for stomatitis associated with cancer therapy has been established. This study focused on the its effectiveness of ozone nano-bubble water (ONBW) for the treatment of chemotherapy-induced stomatitis. Oral mucositis was induced in 14-week-old male Sprague-Dawley rats (N = 21). The animals were randomly divided into 3 groups: 7 without treatment (control); 7 treated with physiological salt solution (saline); and 7 treated with ONBW. Animals were weighed on Days 7, 9, 11, and 16. Stomatitis grade evaluation and bacterial count measurements were performed before rinsing in all animals 3, 5, and 10 days after acetic acid irritation (Days 9, 11, and 17 respectively). Weight loss after stomatitis creation was observed in all groups, with significant differences between the control and ONBW groups and between the saline and ONBW groups on Day 16. The stomatitis grade did not worsen during the experimental period in any group, with the lowest grades in the ONBW group on Days 11 and 16. Significant differences were identified between the control and ONBW groups and between the saline and ONBW groups on Days 11 and 16. Oral bacterial counts tended to decrease over time in all three groups, with the greatest decrease in the ONBW group, followed by the saline group. The decrease in the bacterial count was steepest in the ONBW group. Rinsing out the oral cavity with ONBW decreased bacterial counts and encouraged the healing of oral chemotherapy-induced stomatitis. ONBW may be an effective treatment for chemotherapy-induced stomatitis., Highlights • An effective and reliable treatment for stomatitis associated with cancer chemotherapy has not been established so far. • This study aimed to evaluate the effectiveness of ozone nano-bubble water (ONBW) for the treatment of chemotherapy-induced stomatitis. • The efficacy of ONBW for treating chemotherapy-induced stomatitis was studied in a rat model. • Rinsing out the oral cavity with ONBW decreased bacterial counts and encouraged the healing of oral chemotherapy-induced stomatitis. • The present results suggest that ONBW may be an effective treatment for chemotherapy-induced stomatitis in the future.

Aneurysmal bone cysts, benign lesions of bone tissue, are composed of sinusoidal and vascular spaces filled with blood and surrounded by fibrous tissue septa. They are uncommon, occurring usually in the long bones and spine, and only very rarely in the jaw, where approximately 160 cases have been reported, of which two thirds were located in the mandible and one third in the maxilla. We report two rare cases of aneurysmal bone cyst occurring in the mandible. A literature survey revealed 34 cases of this disease in the jawbone in Japan. An analysis of aneurysmal bone cysts of the jaw was performed in 36 cases, including the present ones. The mandible was affected in 28 cases (78%) and the maxilla in 8 (22%). Aneurysmal bone cyst was observed to occur most frequently between the mandibular body and the ramus. Patient age ranged from 6 to 87 years, with a mean age of 27.7 years. Patients under 30 years of age occupied 60% of the total. Treatment options suggested in the literature include percutaneous sclerotherapy, therapeutic embolization, curettage, block resection and reconstruction, radiotherapy, and systemic calcitonin therapy. The extent of surgery will depend on the size and position of the lesion, ranging from simple curettage to extended resection.