Background Owing to the increase in the older population and the increased life span, the number of patients with oral multiple primary carcinomas will increase. Predicting the second and third carcinoma clinically is difficult, and the presence of second or third carcinomas is a factor that determines the prognosis of oral carcinoma. In this study, we examined the clinical features of oral multiple primary carcinomas treated in our department. Methods We retrospectively reviewed the medical records of patients with oral squamous cell carcinoma who underwent radical treatment at and were followed by the Department of Oral and Maxillofacial Surgery, Tottori University Hospital from January 2003 to October 2017. Results This study included 261 patients: 241 patients had oral single primary carcinoma and 20 patients had oral multiple primary carcinomas. Oral multiple primary carcinomas showed female predilection and occurred more frequently in the lower gingiva and significantly less frequently in the tongue (P < 0.01). Oral multiple primary carcinomas showed a significantly higher recurrence rate (P < 0.01). The 5-year overall survival of oral single primary carcinoma patients was 88.0% compared with 95% for oral multiple primary carcinomas, with no significant difference (log rank test, P = 0.54). However, the 15-year survival rate dropped to 28.1% in oral multiple primary carcinomas. The cumulative disease incidence rates of metachronous second primary carcinoma from first carcinoma at 5 years and 10 years were 3.45% and 5.36%, respectively. Conclusion Oral multiple primary carcinomas rarely occur in the tongue. The 5-year survival rate showed no difference between single and multiple carcinoma patients, but over longer observation, the prognosis of multiple carcinoma was poor owing to a high recurrence rate. Because of the high recurrence rate and risk of further metachronous carcinoma in oral multiple primary carcinomas, longer-term follow-up is required.

Syphilis is a sexually transmitted disease caused by Treponema pallidum. We report a case of secondary syphilis originating in the oral mucosa. The patient was a 58‐year‐old man who visited our hospital at May 2009. Clinical examination revealed a mass at the right angle of the mouth with a white mass on the tip of the tongue and an indurated ulcer on the left border of the tongue. Magnetic resonance imaging revealed multiple swollen lymph nodes in the bilateral submandibular glands, as well as in the bilateral deep cervical and supraclavicular lymph nodes. Serological examination revealed elevated rapid plasma reagin (RPR) (titer, 1:32) and Fluorescent treponemal antibody absorption test (2+) values. Consequently, the mass at the right angle of the mouth, the white patch on the tip of the tongue, and the ulcer on the left border of the tongue were diagnosed as secondary syphilis. Oral amoxicillin 1500 mg/d was administered for 4 weeks. The oral lesions improved after 20 days of treatment and the RPR titer had improved to 1:2 after 5 months of treatment.

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Congenital factor Ⅺ deficiency is a very rare bleeding disorder, also called hemophilia C. It is autosomal recessive and known to occur in both men and women. It is said that bleeding tendency appears strongly during surgery or trauma in areas with high fibrinolytic activity such as the oral mucosa. The patient was a 44-year-old female who was referred to our department for extraction of her left maxillary second molar.We learned that she had a factor XI abnormality, however the details were unknown so we referred her to the Department of Hematology at our hospital, where she was diagnosed with congenital factor XI deficiency.Under hospitalization, six units of fresh frozen plasma were transfused and the left maxillary second molar was removed. There was no abnormal bleeding during and after surgery, and the patient was discharged the following day. Two years later, she revisited our department requesting extraction of her right maxillary third molar. She underwent the same procedure as before, and there was no abnormal bleeding. Key words: congenital factor Ⅺ deficiency (先天性第Ⅺ因子欠乏症) ， hemophilia C (血友病 C) ，fresh frozen plasma (新鮮凍結血漿) ， activated partial thromboplastin time (APTT) (活性化部分トロンボプラスチン時間) 1) 鳥取大学医学部感覚運動医学講座口腔顎顔面外科学分野 (主任：小谷 勇教授)2) 鳥取赤十字病院歯科口腔外科 (主任：大竹史浩部長)3) 松江赤十字病院歯科口腔外科 (主任：田窪千子部長)

Infective endocarditis (IE) is one of the most common diseases occurring in patients with valvular heart disease (VHD). One of the causes of IE is bacteremia caused by oral jaw infections, including medication‐related osteonecrosis of the jaw (MRONJ) and oral surgery. We performed an extensive surgery for MRONJ prior to aortic valve replacement with severe aortic stenosis (SAS) for IE prevention. In patients with SAS and MRONJ who are being suggested a surgery on standby for VHD, a prior extensive surgery for MRONJ should be considered to prevent the risk of IE.

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