Squamous Cell Carcinoma of Maxillary Gingiva Progressing to Disseminated Carcinomatosis of Bone Marrow.

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.

Risk factors for postoperative dysphagia in oral cancer.

With the founding of its Oral Cancer Center at the Ichikawa General Hospital, Tokyo Dental College established a support system for patients and family members that not only provides surgery and other conventional cancer-oriented treatments, but also palliative care, nutritional support, rehabilitation, and discharge support. With this in mind, the present study sought to examine the nature of support for oral cancer patients with postoperative eating and swallowing disorders by investigating these disorders and identifying their risk factors. The study population comprised 75 surviving oral cancer patients (46 men and 29 women) discharged from the Tokyo Dental College Oral Cancer Center following treatment over a 2-year period from April 2009 to March 2011. Risk factors affecting eating and swallowing function were identified by statistical analysis. Mean age of the patients was 67.3±13.7 years. Fifteen patients had stage I cancer, while 25 had stage II, 13 had stage III, and 22 had stage IV. The feeding route at the time of discharge was oral feeding in 74 patients and a combination of oral and gastrostomy tube feeding in 1 patient. The Tokyo Dental College Ichikawa General Hospital has standardized the expert evaluation and rehabilitation of oral cancer patients with eating and swallowing disorders by establishing a multidisciplinary support system from the preoperative stage onwards. In this context, the results of our analysis of factors influencing the ability of oral cancer patients to orally ingest food after treatment suggest that preoperative cancer stage classification, neck dissection, and tracheotomy are all influential factors. Patients affected by these factors require further multidisciplinary treatment, which in turn necessitates more extensive coordination with other medical professionals and community health care providers.

Visual and auditory stimuli associated with swallowing activate mirror neurons: a magnetoencephalography study.

In the present study, we evaluated activated areas of the cerebral cortex with regard to the mirror neuron system during swallowing. To identify the activated areas, we used magnetoencephalography. Subjects were ten consenting volunteers. Swallowing-related stimuli comprised an animated image of the left profile of a person swallowing water with laryngeal elevation as a visual swallowing trigger stimulus and a swallowing sound as an auditory swallowing trigger stimulus. As control stimuli, a still frame image of the left profile without an additional trigger was shown, and an artificial sound as a false auditory trigger was provided. Triggers were presented at 3,000 ms after the start of image presentation. The stimuli were combined and presented and the areas activated were identified for each stimulus. With animation and still-frame stimuli, the visual association area (Brodmann area (BA) 18) was activated at the start of image presentation, while with the swallowing sound and artificial sound stimuli, the auditory areas BA 41 and BA 42 were activated at the time of trigger presentation. However, with animation stimuli (animation stimulus, animation + swallowing sound stimuli, and animation + artificial sound stimuli), activation in BA 6 and BA 40, corresponding to mirror neurons, was observed between 620 and 720 ms before the trigger. Besides, there were also significant differences in latency time and peak intensity between animation stimulus and animation + swallowing sound stimuli. Our results suggest that mirror neurons are activated by swallowing-related visual and auditory stimuli.