In this study, we investigated the efficacy and side effects of superselective intraarterial infusion chemotherapy combined with radiotherapy for oral squamous cell carcinoma (SCC). The subjects were 22 patients with oral SCC treated with this therapy in our department from January 2004 and June 2007. Primary tumor sites were the mandibular gingiva (8 cases), tongue (6), maxillary gingiva (4), and buccal mucosa (4). As the clinical stage classification, one case was stage I, six cases were stage II, two cases were stage III, and 13 cases were stage IV. We performed radiotherapy (total dose: 30–60 Gy) and chemotherapy using docetaxel (superselective intraarterial infusion: IA) and cisplatin (IA or intravenous infusion: IV) and 5-FU (IV). The clinical effects of this therapy were CR 18/22 (81.8%), PR 3/22 (13.6%), and not evaluable 1 (due to complication associated with this therapy). Three patients that achieved PR underwent surgery, and their histopathological responses were grade IV (Oboshi-Shimosato classification). Two of 21 patients developed recurrence. Side effects more severe than grade 3 consisted of lymphopenia in 77.3%, leucopenia in 54.5%, neutropenia in 36.4%, decreased hemoglobin in 22.7% and infection in 27.3% of the patients. Especially, lymphopenia was seen with high frequency in those cases that developed febrile episodes and infections. These results indicate that lymphopenia may be associated with febrile episodes and infections. Because there is no effective drug treatment for lymphopenia at present, it is necessary to monitor lymphocyte counts and manage nutrition to enhance the immune system in patients receiving this therapy.

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We analyzed postoperative complications in patients with mandibular reconstruction using a mandibular reconstruction plate and soft tissue graft. This retrospective study evaluated 22 patients (14 men, 8 women; mean age, 68.0 years) who underwent mandibular reconstruction using a titanium reconstruction plate and soft tissue graft for mandibular reconstruction after mandibular resection. Underlying pathologies were squamous cell carcinoma of the lower gingiva (n=17), adenoid cystic carcinoma of the sublingual gland (n=2), ameloblastoma of the mandible (n=2) and chondrosarcoma of the mandible (n=1). Five patients were treated using chemoradiotherapy and 3 patients received chemotherapy alone. In addition, 13 patients received preoperative therapy (chemoradiotherapy, n=5; chemotherapy alone, n=4; radiotherapy alone, n=4) and 7 patients underwent postoperative therapy (radiotherapy alone, n=6; chemoradiotherapy, n=1). Postoperative complications were seen in 6 cases (27.2%), with screw loosening in 3 patients and screw fracture, plate infection and exposure in 1 patient each. The rate of complications was high at the medial side of the mandibular resection. Incidence of plate complications was higher for patients with sufficient occlusal force (Eichner classification: type B). Measures should be taken to avoid postoperative complications in patients with mandibular reconstruction using a mandibular reconstruction plate.

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