A retrospective study was performed on 56 patients with pathologically diagnosed adenoid cystic carcinoma treated at Maxillofacial Surgery, Tokyo Medical and Dental University Hospital between 1965 and 2002. In terms of site distribution, the palate and floor of the mouth were predominantly affected. Twenty-six cases were treated by surgery combined with radiation therapy, 20 cases only by surgery, 6 cases by radiation therapy, and the remaining 4 cases received only biopsy. The overall survival rates at 5 and 10 years were 62.6% and 33.4%, respectively. The overall survival rates for stage I·II cases at 5 and 10 years were 72.9% and 30.9%, respectively, whereas the rates for stage III·IV cases were 51.0% and 15.9%, respectively. There was a statistically significant difference between the two groups. This finding indicates that the clinical stage was the useful prognostic factor. Primary recurrence occurred in 51.1% of the cases and distant metastasis occurred in 65.9% of the cases, and the cases with primary recurrence had a significantly higher frequency of distant metastasis. From these results, it may be suggested that local control is important in the treatment of adenoid cystic carcinoma of the head and neck.

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The current options for mandibular reconstruction are use of metallic plates, non-vascularized bones, pedicled osteomyocutaneous flaps, and free vascularized bone flaps. The use of free vascularized bone flaps clearly provides significant advantages in that it is highly successful, there is an unlimited amount of tissue available, and the harvested tissue can be fabricated to have an ideal configuration for restoration of the surgical defect.
Between March 1995 and April 2006, 59 mandibular reconstructions using free vascularized bone flaps were performed in 57 consecutive cases. Indications for mandibular resection were malignant tumor in 44 cases, benign tumor in 10 cases, and radiation osteonecrosis of the mandible in 3 cases. According to the Boyd's HLC-oms classification of mandibular defects, the most common type of bony defects and soft tissue defects consisted of L-type (74.6%) and m-type (81.4%) defects.
Of these 59 reconstructions, 58 were performed primarily and 1 was done secondarily. Donor sites included the fibula (16 reconstructions) and scapula (43 reconstructions), which were selected considering the bony defect and accompanying soft tissue defect requiring reconstruction, as well as the wishes of the patient. To restore the mandibular contour, 14 vascularized bones had single osteotomy and 3 bones had two osteotomies.
Of 16 fibula flaps, 13 flaps survived, while 2 flaps sustained a partial loss and one flap was a total loss. Of the 43 scapular flaps, 41 flaps survived, and 2 flaps sustained a partial loss. Postoperative mouth-opening was 4.1 cm on average. A total of 18 patients (31.6%) had osteointegrated implants or dentures, and 39 patients (68.4%) had a normal diet. In addition, 41 (85.4%) of 48 patients assessed had satisfactory facial contour postoperatively.
From these results, it can be said that microvascular free bones represent the first choice for mandibular reconstruction.

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Control of cervical lymph node metastases in oral cancer is very important as a prognostic factor. In case of invasion into surrounding tissues such as muscle, bone, mucosa and skin, extended radical neck dissection is necessary to avoid neck failure. We report a case of delayed cervical lymph node metastasis near the hyoid bone treated successfully by chemotherapy with TS-1 and thermoradiotherapy.
A female in her 40's with ulcer of the right tongue was referred to our department. The patient underwent right partial glossectomy. Six months after the surgery, an ipsilateral cervical lymph node metastasis near the hyoid bone was found. To avoid extended radical neck dissection including resection of the hyoid bone and pharyngeal mucosa, we performed chemotherapy with TS-1 (100 mg/day, total 2,800 mg) and thermoradiotherapy (2 Gy/day, total 40 Gy, RF capacitive hyperthermia: 4 times) as a preoperative treatment. The efficacy according to CT scan was classified as partial response. The patient underwent conservative neck dissection without extended surgery and pathological diagnosis of the metastatic lymph node was complete response. There was no recurrence of neck lymph node metastasis 13 months after the surgery.

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Ossifying fibroma refers to a neoplastic growth of fibrous connective tissue that accompanies cementum or osseous hard tissue formation. Diagnostic imaging findings showed impermeable substances of various sizes in well-circumscribed transmission structure.
A female in her 40's with an ossifying fibroma which developed in the body of the mandible on the left side underwent tumorectomy in which the tumor was removed in sections, and favorable results were obtained.
The patient was urged to undergo an immediate reconstruction operation involving segmental mandibulectomy and iliac bone transplant at another hospital, and she was referred to our hospital to undergo a procedure yielding better esthetic results. A 3-D model was constructed based on CT data and surgical simulation was performed to confirm that conservation of the mandible was possible, and the tumor was divided and removed outside the oral cavity. No pathological fracture nor recurrence occurred postoperatively, and a satisfactory outcome was achieved. The minimally invasive treatment prevented esthetic defects and hypoesthesia, which were concerns before the operation.

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