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Accessory parotid glands are salivary tissue collections seen as separate glandular mass detached from the main parotid gland lying on the masseter muscle. It develops from the branching of the blind end of the parotid tube and by glandular proliferation of secretory and stromal structures. They are anatomical variations seen in the mid cheek region with a frequency of 21% to 56% found in autopsy studies. The following case report depicts a case of accessory parotid gland presenting as a mid-cheek mass in the right buccal mucosa.

Trismus can have intra- and extra-articular causes. Extra-articular trismus can be caused by head and neck cancers and associated treatments, oral submucous fibrous, odontogenic infection, trauma and so on. However, scar contracture due to major recurrent aphthous stomatitis (RAS) has not been reported previously as a cause of trismus. We performed Z-plasty for surgical treatment of severe trismus caused by acquired scar contracture from major RAS and achieved good results. A 40-year-old woman was referred to our department for a checkup of major RAS in the right buccal mucosa. Clinical examination revealed that maximum interincisal opening was 15 mm, with no increase under assisted opening and no pain in the temporomandibular joints. Intraoral examination showed major RAS on the right buccal mucosa had already resolved and a dense right retromolar scar band was seen running from the maxillary mucobuccal fold to mandibular mucobuccal fold. The diagnosis was trismus due to scarring from refractory major RAS. The patient underwent Z-plasty scar reorientation and temporal muscle tendolysis. On postoperative day 1, the patient’s mouth was opening to 30 mm and the patients was advised to keep on performing the jaw-opening exercise using a mouth-opening training apparatus. At the 6-month follow-up, mouth opening increased to 42 mm. Trismus without pain can result from scar contracture due to major RAS, and early surgery to increase mouth opening may be necessary for quality of life in these cases.

A 67-year-old female presented at our hospital with an indolent tumor in the buccal mucosa region. A spherical and movable, elastic soft tumor of approximately 10 mm was found under the right buccal mucosa. Contrast-enhanced magnetic resonance imaging revealed a 14 × 13-mm mass with smooth edges and a non-uniform contrast effect. She was diagnosed with a benign tumor of the buccal mucosa region, and a tumorectomy was performed. Histopathological examination revealed a cyst-like enlargement with visible vasculature. Because the tumor was isolated, she was finally diagnosed with a venous aneurysm (VA).

Objective Myxomas are rare benign mesenchymal soft tissue tumors that seldom affect the head and neck area. The present report describes a rare case of intramuscular myxoma of the oral cavity and briefly reviews the literature regarding the occurrence of these lesions in the maxillofacial area. Study Design A 59-year-old patient was referred for the development of a slow-growing tumefaction in the right buccal mucosa in the previous 12 months. Magnetic resonance imaging was performed to characterize the lesion’s dimensions and its relationship with the surrounding structures, and it revealed intramuscular localization in correspondence with the medial pterygoid muscle. Incisional biopsy was carried out to aid in the final diagnosis. Results Histology revealed the presence of an intramuscular myxoma, characterized by discontinuous margins and locally infiltrating muscular fibers. A second surgery was performed to totally remove the lesion. Follow-up at 6 months did not show any signs of recurrence. A literature search was performed to retrieve data on the incidence of oral intramuscular myxomas. Conclusions To the best of our knowledge, this is the first case of intramuscular myxoma of the medial pterygoid muscle reported in the literature. Although rarely encountered, intramuscular myxomas should be considered when performing differential diagnoses of soft tissue masses at the level of the masticatory muscles.

ResumoAs malformações arteriovenosas (MAV) são alterações congênitas dos vasos sanguíneos e, em casos raros, surgem apenas na idade adulta. A MAV apresenta comunicação direta entre uma artéria e uma veia que passam pelo leito capilar. Elas podem ocorrer em qualquer área do corpo e têm início e progressão graduais. O objetivo deste estudo é apresentar um caso cirúrgico de malformação arteriovenosa envolvendo a mucosa jugal direita de um paciente masculino de 16 anos de idade, tratado cirurgicamente em conjunto com o serviço de Cirurgia Vascular. O resultado pós-operatório foi satisfatório e a inter-relação entre os serviços de Cirurgia Maxilofacial e Vascular foi essencial para a realização de um procedimento cirúrgico mais seguro e previsível.Palavras-chave: Malformação arteriovenosa; cirurgia Maxilofacial; interdisciplinaridadeAbstractThe arteriovenous malformations (AVM) are congenital alterations of the blood vessels, and in rare cases, they develop only in adulthood. AVM present direct communications between an artery and a vein bypassing the capillary bed. They can occur at any area of the body and have gradual onset and progression. The aim of this study is to present a surgical case of arteriovenous malformation involving the right buccal mucosa of a 16-year-old male, which was managed with Vascular Surgery service. The postoperative result was satisfactory and interrelationship between Maxillofacial and Vascular Surgery services was essential for a safer and more predictable surgical procedure.Key-words: Arteriovenous malformation; Maxillofacial Surgery; interdisciplinarity

A foreign body granuloma of the buccal mucosa induced by honeybee sting was reported. The patient was an 82-year-old female who presented with a submucous mass at the right buccal mucosa. The mass was 20 mm in diameter, elastically firm, partly mobile without pain or tenderness, and covered with almost normal mucosa. MR image did not delineate the lesion clearly. Under clinical diagnosis of a benign tumor, the lesion was excised under local anesthesia. The excised lesion was14×11×9 mmin size and solid and yellowish in cut surface. Histologically, the lesion consisted of granulomatous tissue with a few narrow, curved, eosinophilic structures compatible with decomposed fragments of a honeybee sting and was diagnosed as a foreign body granuloma, although the patient did not recall being stung.

The congenital deficiency of pectoralis major muscle is quite uncommon. Only a few cases are described in the literature that too in cadavers. Recently, we came across a case of deficient pectoralis major while harvesting pectoralis major myocutaneous (PMMC) flap for reconstruction following right composite resection for carcinoma of the right buccal mucosa in a 50-year-old female. The external appearance of the anterior chest wall was normal. During surgery, we found that the clavicular head and sternal portion of the sternocostal head of the right pectoralis major muscle were absent and the costal portion of the sternocostal head was deficient over the medial aspect. A normal pectoralis minor was present. This deficiency may be congenital in nature. We present this case to highlight this uncommon condition, and this may be the only case report till now wherein deficient pectoralis major was used for PMMC flap reconstruction of oral cavity defect.

Patient N.J.E., a 69-year-old black male liver recipient, complained of pain in the oral cavity. Clinical examination revealed ulcerated lesions on the dorsal surface of the tongue, right buccal mucosa, and lower right vestibule. In view of clinical findings and medical history, the diagnostic hypothesis suggested an oral infection. The culture was carried out with the purpose of microbiologic analysis (swab) along with incisional biopsy of tongue lesion, leading to a diagnosis of Actinomyces infection. The patient was treated with specific antimicrobials, oral topical solutions, and, as an adjuvant, antimicrobial photodynamic therapy (aPDT). aPDT consisted of daily application of the photosensitizer on the lesions, and after 5 minutes, the low-level light laser was applied in the visible red spectrum (660 nm) with fixed power of 100 mW and energy density of 6 J/cm². After 15 days, good clinical tissue recovery was observed; however, because of other systemic complications, the patient died.

Cysticercosis is a recognized fatal disease to the humans. Taenia solium, a larval stage of pork tapeworm that causes cysticercosis which is an important cause of morbidity in the world. This case report shows the clinical presentations of an atypical case of cutaneous cysticercosis on the right buccal mucosa and its management. It presents the importance of thorough knowledge, proper investigation, symptomatic management with improved treatment regimens and important role of minimally invasive surgery. Its outcome and the treatment options mainly depend on the number, location, size and stage of parasites, as well as on the immune response of the host.

An 81-year-old white female, with no history of smoking or drinking, reported persistent pain and increase in lesion size in the last 3 months. Intraoral exam showed an exophytic nodular and ulcerated lesion in the region of left labial commissure, 1.5 cm in size and of soft consistency; next to the lesion, there was an extensive white plaque. A white plaque with striated appearance was also observed on the right buccal mucosa. An incisional biopsy was performed in the nodular area with the histopathologic diagnosis of squamous cell carcinoma. The patient was referred to the head and neck service for treatment. This carcinoma case may have been preceded by oral lichenoid lesions and proliferative verrucous leukoplakia and these lesions should be detected during clinical exam and followed closely, as they carry a higher risk for malignant transformation and carcinoma arising from them and may show better prognosis if detected early.

Orofacial foreign body reactions are adverse effects to cosmetic fillers that are often used for esthetic purpose. Case 1 involved a 76-year-old woman with a painless swelling in the upper lip lasting 1 year. Case 2 involved a 53-year-old woman presenting multiple painless normal-colored nodules of unknown duration located in the lower lip mucosa. Case 3 involved a 77-year-old woman with a painless nodule in the right buccal mucosa of unknown duration. All patients admitted having undergone a cosmetic procedure in the past. Microscopically, all cases showed variable-sized empty microcysts, surrounded by a mixture of histiocytes, collagen bundles, multinucleated giant cells, and inflammatory cells. Patients are under follow-up after treatment that consisted of surgical excision of the material. Foreign body reactions to cosmetic fillers are uncommon in the orofacial region.

The increasing demand for cosmetic procedures in the orofacial area results in a growing number of complications, including the development of foreign body granulomas. A 55-year-old woman presented with submucosal and subcutaneous nodules that were firm on palpation, which had arisen approximately 30 days earlier in the right buccal mucosa and in the face (cervical, submentonian, and submandibular regions). The diagnostic hypothesis was lymphoma, but after the clinical examination, the patient reported having undergone facial filling procedure 1 year before. Ultrasonography showed nodular images suggestive of reactive granulomas. Preoperative tests were requested, and incisional surgical biopsy was performed. Histologic analysis showed granulomatous reactions associated with the use of hyaluronic acid (accumulation of amorphous basophilic material) and polymethylmethacrylate (refringent material, without dye impregnation). The patient was unaware of the facial filling with polymethylmethacrylate.

A 34-year-old Filipino woman presented with a 3-day history of fever, coryza, cough, sore throat, conjunctivitis and rash following a visit to the Visayas, Philippines, 2 weeks earlier. At fever onset, she noted a maculopapular rash on her face and upper chest, which subsequently spread to her trunk and arms. On the right buccal mucosa, 2 mm ulcer-like white spots (figure 1) and multiple white plaques, described as ‘grains of salt on a red background’ (figure 2 …

Oncocytic carcinoma is an extremely rare malignancy of minor salivary gland. The biological behaviour, management and prognosis are not well established due to its rarity and paucity of published literature. We report a case of 32 year old man presented an ulcerated growth measuring 1cm in size in right buccal mucosa along with enlarged left submandibular lymphadenopathy. The diagnosis was suggestive of oncocytic carcinoma of minor salivary gland by cytology and subsequently confirmed by excisional biopsy.

Studies have shown that topical 5-aminolevulinic acid-mediated photodynamic therapy (ALA-PDT) can be used successfully for the treatment of oral verrucous hyperplasia (OVH). Studies have also demonstrated that cryotherapy could be used as a treatment modality for OVH lesions. In this case report, we tested the efficacy of topical ALA-PDT, combined with cryogun cryotherapy, for an extensive OVH lesion on the right buccal mucosa of a 65-year-old male areca quid chewer. The tumor was cleared after six treatments of combined topical ALA-PDT and cryogun cryotherapy. No recurrence of the lesion was found after a follow-up period of 18 months. We suggest that our combined treatment protocol may be effective in treating OVH lesions. The treatment course may be slightly shortened with this combined protocol and was well tolerated by the patient.

A 55 year old male patient came for routine dental examination. History revealed that he was a heavy tobacco chewer for the past 20 years. During examination, several radiating white lines were found on top of a slightly grey background, in relation to the right buccal mucosa. The location of the lesion clearly coincided with the site of placement of quid. A differential diagnosis of lichen planus, oral lichenoid reaction and discoid lupus erythematosis were considered. On microscopic examination, there was focal perivascular infiltrate and plasma cells in the connective tissue. After correlating clinically, a diagnosis of "lichenoid reaction" was confirmed. Oral lichenoid reactions (OLR) can occur as a result of contact of an irritant such as tobacco. OLR to tobacco and betel nut products presents as a unilateral, wavy, nonelevated, non scrapable white lesion. These lines are arranged in tree like configurations or in the form of a lacy network- Wickham's striae. Wickham's striae most often are a diagnostic sign of lichen planus and lichenoid reaction. The Pan African Medical Journal 2016;24

The aim of this study was to examine the cytomorphological changes occurring in the buccal mucosa in patients treated with low-level 1,064-nm laser radiation. Seventeen individuals (12 males, five females) 18–24 years of age were included in the study. Low-level 1,064-nm laser radiation was applied to the right buccal mucosa near the premolar region; this therapy was repeated for 10 days. Buccal epithelial cells were collected from the right and left premolar regions of the individuals with a brush before and after therapy. The specimens collected from the left side were measured cytomorphometrically and used for the control group. Student’s t test was used for statistical comparison of the values of the buccal epithelial cells collected from individuals; a p value

An 80-year-old man with cerebral infarction and no neurological deficits was hospitalised for right empyema. Although the patient’s condition improved with antimicrobial therapy and right thoracic drainage, a swelling in his right cheek was observed during clinical rounds. Oral examination revealed ulceration on the right buccal mucosa (figure 1A) with an embedded blue solid matter (figure 1B), which …

Vascular lesions have been classified in two broad categories, hemangiomas and malformations. Encapsulated vascular lesions have not been reported in the oral cavity, but they were described in other sites, mainly in the orbit. Herein, we present a case of an oral encapsulated vascular lesion located in the right buccal mucosa of a 69-year-old male, including histological and immunohistochemical description and a literature review. Key words:Buccal mucosa, hemangioma, vascular malformation, oral cavity.

Oral neurothekeoma or nerve sheath myxoma is a rare benign oral tumour of nerve sheath origin. Historically, this tumour has been subclassified as myxoid (classic), mixed, or the cellular type, depending on the amount of myxoid stroma and cellularity. We present a case of oral neurothekeoma (mixed type) of the buccal mucosa. The tumour was completely excised. No recurrence was detected in the last 3 years after local excision.

Acinic cell carcinoma usually arises in the parotid gland and rarely occurs in the minor salivary glands. We report a case of acinic cell carcinoma of papillary cystic type arising in the buccal mucosa. The patient was a 45-year-old woman who had a painless swelling in the right buccal mucosa. The tumor measured 18×15mm and was elastic hard in consistency. The tumor was excised under local anesthesia. Histologically, the tumor appeared to be encapsulated, and the tumor cells were arranged in papillary and partially microcystic patterns. Immunohistochemical examination showed that the tumor cells were positive for S-100 protein, lysozyme, α-antit rypsin, and AE1/AE3 and partially positive for periodic acid-Schiff (PAS). The histopathological diagnosis was acinic cell carcinoma of papillary cystic type. The postoperative course was uneventful, and there was no evidence of recurrence or metastasis 20 months after operation.

Trichinella spiralis is a parasite which is usually seen in pork-eaters. Most of the trichinosis infections cause little or no symptoms. We report a rare case of a middle aged North Indian male who presented with a painless ulcer in right buccal mucosa which was biopsied and reported as squamous cell carcinoma. Wide local excision was done subsequently which showed encysted larvae of Trichinella spiralis in the deeper skeletal muscle bundles. This article supports the carcinogenic potential of trichinosis and suggests timely work-up and treatment of the parasite.

Eruption of tooth into extraosseous locations is an extremely rare condition. We report a case of a six-year-old girl child with tooth-like structure erupting from the right buccal mucosa. Clinical, radiographic, and histopathologic examination suggested the diagnosis of compound odontoma. Very few cases have been reported so far, where tooth has been located completely in the soft tissue and a variety of names have been used for that condition. A brief review of the literature and the ambiguity in naming the situation is discussed.

Fibro-osseous lesions usually occur in bone and rarely arise from soft tissue in the head and neck region.This report describes a rare case of a fibro-osseous lesion occurring in the buccinator muscle. A 12-yearold boy visited Ehime University Hospital because of a painless swelling in the right buccal mucosa. An elastichard, well-defined mass was observed under the right buccal mucosa.On a panoramic X-ray film and a computed tomography scan, an oval radiopaque tumor, measuring 3×2cm, was observed in the region.A biopsy specimen revealed a fibro-osseous lesion with no evidence of malignancy.We extirpated the tumor with the patient under general anesthesia. The tumor was located in the buccinator muscle.Histopathological examination of the surgical specimen revealed ossifying fasciitis with small foci of metaplastic bone and fibrous tissue.The lesion was not contiguous with the mandible.The patient had no discomfort postoperatively and no evidence of recurrence during 7 months of follow-up.

A 40-year-old-woman presented with swelling and pain of the right buccal mucosa. The swelling protruded intraorally. An incisional biopsy revealed pleomorphic adenoma in the pterygomandibular space. The tumor was surgically removed via a mandibular swing approach. The entire resected specimen was submitted to histopathological evaluation, which showed solid and myxomatous areas, typical of pleomorphic adenoma, throughout the tumor specimen. No recurrence was observed during 3 years of follow up.

Cysticercosis is a common infection that occurs in developing countries. But oral cysticercosis is a rare event and it creates difficulty in clinical diagnosis. A thorough search of the literature showed that there are only 4 cases of pediatric cysticercosis in buccal mucosa. In this report we document a case of cysticercosis in 10 years child who sought treatment for an asymptomatic nodule in right buccal mucosa that has been clinically diagnosed as a submucosal retension cyst.

Myxomas have a common histologic appearance of myxoid ground substance and are classified in group of soft tissue tumors. According to literature myxomas occurring in every decade of life have been reported. Very often intraoral soft tissue myxoma can be misinterpreted as malignant and are difficult to differentiate from the other tumours with myxoid stroma. Of the different variants of soft tissue myxoma, intraoral is extremely rare, slow growing, benign mesenchymal tumour. We report a case of a 22-year-old male who presented with swelling in the right cheek and mass in the right buccal mucosa that appeared gradually over two year. No history of pain over the lesion or bleeding on touch. On intraoral examination a lesion measuring 3 X 3 cm was seen in the right buccal mucosa. Biopsy of the lesion revealed oral soft tissue myxoma. Wide excision with clinically clear margins was done under general anaesthesia. Histopathological report revealed the diagnosis as to be oral soft tissue myxoma. A case of oral soft tissue myxoma is presented for its rarity and for differential diagnosis of localized oral cavity lesions.

A woman in her early 40s presented with a painless ulceration on the right side of the posterior palate, she had an earlier history of similar lesions after the rupturing of blood filled blisters in the oral cavity. On examination, a diffuse erythematous area and ulcers covered with necrotic slough were noticed on the right and left side of the posterior palate and on the right buccal mucosa. On follow-up visit, a large blood filled blister was noticed in the buccal vestibule. We advised routine haematological investigations to rule out any bleeding disorders and direct immunofluorescence of the affected tissue and perilesional areas to rule out autoimmune blistering conditions. Haematological investigations revealed no abnormalities and immunofluorescence testing was negative. A diagnosis of angina bullosa haemorrhagica was made by excluding all other conditions. Symptomatic treatment was given, patient was educated about the condition and reassured.

悪性リンパ腫はリンパ系組織に由来する悪性腫瘍で, ポジキンリンパ腫と非ポジキンリンパ腫よりなる。本腫瘍はリンパ節またはリンパ節外組織に原発するとされている。今回われわれが経験した症例は63歳女性で, 3年前に悪性リンパ腫の診断のもと右上腕部腫瘍摘出術を受けた患者の右頬粘膜部腫瘍の摘出を行い, 病理組織学的に非ホジキンリンパ腫 (Diffuse medium cell, B cell) と診断された。その後ただちに当大学内科で化学療法を実施し現在経過は良好である。悪性リンパ腫の節外より節外への再燃という症例を経験したので若干の考察を加えて報告した。

Proliferative verrucous leukoplakia (PVL) is a rare and specific disease that differs from oral leukoplakia, which is neither a delimited lesion nor a condition.1 A 56-year-old, healthy steel plant male worker reported with a chief complaint of painless white patches on the right buccal mucosa and burning sensation in the same region since 1 year. History and general physical examination revealed no relevant findings and also no tobacco-chewing habit was evident, except for using herbal tooth powder. On …

We present a case of carcinoma ex pleomorphic adenoma on the right buccal mucosa in a 52-year-old Japanese woman. Based on the histopathology, the excised tumor was the non-invasive type, but the majority of the tumor consisted of poorly-differentiated adenocarcinoma cells. We performed proton radiation after the surgery. The patient was well, without evidence of disease, 48 months after surgery. Carcinoma ex pleomorphic adenoma in the buccal mucosa has been reported in only four cases during the past twenty years. Therefore, our case was comparatively rare.

A randomised parallel group comparison was conducted in 36 healthy subjects to investigate changes in the buccal mucosa after contact with buffered chewable acetylsalicylic acid (ASA) tablets compared with unbuffered chewable ASA tablets and compressed tablets of citric acid. Each of the 3 agents was tested in 12 subjects. Following a 6-day run-in period without medication, the buccal mucosa was exposed to the respective agent twice daily for 6 days, the agents being applied to the right buccal mucosa for 30 seconds and to the left for 120 seconds. During the run-in and the exposure phases cytological smears were taken and the keratinisation index determined.

Alveolar soft-part sarcoma is a rare malignant neoplasm of uncertain origin. We report a case of alveolar soft-part sarcoma arising in the right buccal mucosa in a 31-year-old woman.The tumor measured 12×13×10mm. It was elastic soft and had ulceration on the surface. A granularcell tumor was suspected on examination of a biopsy specimen. The tumor was removed with the surrounding tissues. Histologically, the tumor consisted of large cells with eosinphilic cytoplasm. The cells showed distinct atypia and a nest-like arrangement.PAS-positive diastase-resistant needle crystals were seen in the cytoplasm. Alveolar soft-part sarcoma was the final diagnosis. There has been no evidence of local recurrence or distant metastasis as of 1 year 6 months after operation.

The aim of this study was to describe and quantify the therapeutic value of honey in oral mucosal ulcers healing in comparison with Glyceroloxytriester (TGO). We also aimed to biochemically evaluate the healing effects of honey which had been collected from the Blacksea region flora on mucosal ulcers resulting in material loss.Thirty wistar rats (240±30 g) were enrolled in this study. Excisional wounds were performed in all rats for animal oral mucosal ulcer model. They were randomly allocated to three groups: group 1 was treated with Apitherapeutic agent or honey (0,1 ml, 2x1), group 2 was treated with TGO (0,1ml, 2x1) locally, Group 3 served as the control group.Following the surgical procedure on day 7, biopsy specimens were taken from right buccal mucosa and on day 14 biopsy specimens were taken from left bucal mucosa in all rats. Afterwards, hydroxy pyroline levels were measured. Data were analyzed statisticallyThere was no statistically significant difference between Group 1 and 2, and also between Group 2 and 3, but there was statistically significant difference between Group 1 and 3 on day 7. There was no statistically significant difference between Group 1, 2 and 3 on day 14.

The malignant progression of oral leukoplakia has been sometimes reported.In this report, a man with leukoplakia on his buccal mucosa, which was treated with, cryotherapy but later showed a transformed squamous cell carcioma on the same region, was presented. A 55-year-old man visited our clinic with an extended white lesion on his right buccal mucosa. From the biopsied specimen this lesion was diagnosed as leukoplakia. At first cryotherpy was given but a small lesion remained. Nine years after therapy, an oral squamous cell carcinoma was proven from the biopsy of this lesion. Cryotherapy was inure frequently used from 1970 to 1980s.This case suggested that cryotherapy for oral leukoplakia must be applied more carefully, especially when the lesion is large, and needs a long term follow up.

A 24-year-old woman presented with a 5-year history of painless, nonpruritic swelling of her lips (Figure 1). The swelling was initially intermittent but became progressive and persistent. It began on her upper lip and gradually extended to the lower lip and right inner cheek. She was otherwise well and reported no gastrointestinal or respiratory symptoms. Physical examination showed a rubbery, infiltrated, erythematous swelling of both lips; an erythematous plaque on the right cheek; and a cobblestonelike appearance on the right buccal mucosa. The findings of a routine blood workup, including the serum angiotensin-converting enzyme level, were normal. The results of a Mantoux test were negative. A chest x-ray film did not show any signs of lymphadenopathy. Patch tests, including standard, metal, bakery, and dental batteries, revealed no abnormalities. The findings of colonoscopy were unremarkable. A punch biopsy specimen of the buccal mucosa showed noncaseating granulomatous inflammation, confirming the clinical impression of granulomatous cheilitis (Figure 2). THERAPEUTIC CHALLENGE

A case of recurrent pleomorphic adenoma with multicentric satellites is reported in this paper. The tumor occurred in a minor salivary gland in the right buccal mucosa in a 67-year-old man. It was diagnosed on the basis of histopathological examinations of the mass and a swollen cervical lymph node. The diagnosis was recurrent pleomorphic adenoma with malignant transformation 36 years after primary surgery. In this report, the clinical course and histopathological findings are described and discussed.

OBJECTIVE To report a case of lichenoid drug eruption (LDE) probably induced by rofecoxib. CASE SUMMARY A 73-year-old woman was prescribed rofecoxib 25 mg/day for rheumatoid arthritis in addition to other medications on which the patient had been stabilized. Six months after initiation of rofecoxib, linear plaques over the infra-orbital and bitemporal areas of both eyes were observed. Several itchy violaceous papules also developed on her right wrist and dorsum of the left foot. She also had a hyperpigmented macule on her right buccal mucosa. As the skin rash was localized and the patient was initially unwilling to undergo skin biopsy, rofecoxib was continued and a topical steroid was started. One month later, the patient was seen in the dermatology clinic, and the improvement of her skin reaction was significant. A skin biopsy performed during this visit was consistent with LDE. On the next day, her rheumatologist decided to discontinue the offending drug, rofecoxib. Two months later, all skin lesions had completely resolved. No rechallenge with rofecoxib was attempted. DISCUSSION LDE is a rare skin reaction that can be associated with several drugs. Rofecoxib, a cyclooxygenase-2 inhibitor, has never before been reported to cause LDE. An objective causality assessment indicates that rofecoxib was the probable cause of the skin reaction. CONCLUSIONS As of this writing, to our knowledge, this is the first case report in the English literature in which rofecoxib had led to the development of LDE.

A case of oral multicentric carcinoma is reported. The patient was a 51-year-old man who presented with a tumorous nodule at the molar region of the left upper gingiva. The tumor was excised and diagnosed histologically to be verrucous carcinoma. Other tumorous lesions successively arose from the upper anterior gingiva, left buccal mucosa, lip mucosa, right upper gingiva, and right buccal mucosa during the next 15 years. Histopathological examination showed these tumors to be squamous cell carcinomas. They were all treated by local exision, and there has been no further reccurrence. Carcinogenesis caused by “field cancerization” or “field origin of tumors” of the oral mucosa was suggested in this patient.

A malignant fibrous histiocytoma (MFH) arising in the irradiated maxilla is reported. The patient was a 59-year-old Japanese female who was referred to us for arelatively well defined and lobulated tumor extending from the right buccal mucosa to left hard palate. Her past medical history revealed that she had had a squamous cell carcinoma of the right buccal mucosa treated by 145 Gy of radiotherapy 3 years previously.Although the patient underwent a bilateral partial maxillectomy, she died due to extensive local recurrence 14 months postoperatively. Histopathologically, proliferation of atypical tumor cells of non-epithelial origin, i.e., spindle-shaped fibroblastic cells, histiocytic cells and bizarre multinucleated giant cells, were noted. Furthemore, a storiform pattern was also seen in part of the lesion.These features suggested that this case was a postirradiation malignant fibrous histiocytoma.

A squamous cell carcinoma of the buccal mucosa probably arising in the minor salivary glands was reported.About 1 month before presentation, a 65-year-old female noticed a tumor on the right buccal mucosa. It was superior to the right parotid papilla, hemospheric in form, measured 1.4 cm in diameter, and was mobile with an elastic firm consistency. The overlying mucosa was generally smooth. No abnormalities were detected by clinical examination. The tumor was removed along with the surrounding tissue. Histological examination revealed a well differentiated squamous cell carcinoma. Nodular carcinoma cell nests appeared immediately beneath the mucosa. The rests proliferated by replacing the minor salivary glands. Thickening (proliferation) of ductal epithelium was noted in the neighboring salivary glands.Neither recurrence nor metastasis have occurred as of 4 years and 3 months after surgery.

Lipomas are benign mesenchymal neoplasms composedof mature adipocytes, usuallysurrounded by a thinfibrous capsule, that can be found in any part of the human body.1,2 About 20% of the lipomas occur in the head and neck region, out of which oral lipomas comprise of only 1 to 4% of cases.2Oral lipomas are clinically soft, smooth-surfaced nodular masses that mostly are less than 3 cmin size. Typically the tumor is asymptomatic unless bitten or become noticeable because of their size. The buccal mucosa and buccal vestibule are the most common intraoral sites and account for 50% ofall cases.3 Herein, I present a case of a 65 year old male patient with a sessile growth of right buccal mucosa The aim of this paper is to present the importance of diagnosis and treatment of intraoral lipoma.

A 37-year-old male presented with a cauliflower-like tumor in the right buccal mucosa, leukoplakia of the tongue and esophagus, and keratotic papules or plaques on the extremities including bilateral palms and soles, associated with borderline diabetes mellitus and a repeated history of infections. A multi-system keratinizing abnormality was suspected, although no distinct disease category has been found showing similar involvements.

Lymphangioma circumscriptum, a variety of capillary hymphangioma is rarely seen in the oral cavity. We present a case of lymphangioma circumscriptum of right buccal mucosa in an adult patient. The leston was excised completely and mucosal defect was coverd with split thickness skin graft.

A case of angiokeratoma occuring in the right buccal mucousa is reported in this paper.A 17-year-old male visited our hospital with a chief complaint of tumor formation in the right buccal mucosa.The pathological diagnosis was solitary angiokeratoma.The tumor was resected and the remaining tissues were cautierlized by CO2 laser.Recurrence isn't observed at present (three months after).

Multiple primary cancer was first reported by Billroth in 1889. Since then the number of these cases reported had increased year by year, but only a few oral multiple cancers were reported.We treated two cases of oral multiple cancer. Case 1 was a 61 year old male and a synchronous case. He had two lesions of the right edge of the tongue (T3 NO MO) and the left retromolar region (T2 NO MO). Their histological types were both squamous cell carcinomas. The tumor of the retromolar region was excised under general anesthesia and that of the tongue was irradiated by Ra needle after radio-chemotherapy. Case 2 was a 72 year old female and a metachronous case. She had first squamous cell carcinoma of the right buccal mucosa (T2 NO MO) and radiochemotherapy followed by excision of the tumor under local anesthesia. But 3 months later, metastasis appeared in the right submandibular lymphnode and she was received radical neck dissection. Twenty-seven months later after discharge, she had S.C.C.of the right gingiva of upper molar region (T3 NO MO) and that was excised under general anesthesia. No recurrence was seen in either case at present.In addition we reviewed the Japanese literature and found the occurrence was 31 of 2049 cases and 1. 51% in Japan. There were 13 cases of oral multiple cancer that were described in detail and included our 2 cases. Ten of 13 cases were male and average age was 53.8 years in male, 66. 3 years in female. Thirteen lesions (48%) appeared in the most popular site the tongue.

Pleomorphic adenoma occurs most frequently at the parotid gland in the major salivary gland and at the palate in the minor salivary gland. Reports of pleomorphic adenoma in the lip and the buccal mucosa are rare. Two cases of pleomorphic adenoma considered to have originated at the lip and the buccal mucosa are presented. The first was a 52-year-old male in whom tumor occurred in the upper lip. The second was a 43-year-old female with a tumor in the right buccal mucosa. The tumors were surgically removed and on pathological investigation were diagnosed as pleomorphic adenoma case. No recurrence has been reported in either.