：Odontogenic myxofibroma is a rare and locally invasive benign neoplasm, which is a variant of odontogenic myxomas. Odontogenic myxofibromas contain considerable amounts of collagen fibers, dispersed within a myxoid stroma.The radiographic features of odontogenic myxofibromas are variable, and so it is difficult to diagnose this condition. We present a case of odontogenic myxofibroma in the right maxilla of an 18-year-old woman.An operation was performed to carry out tumor extraction and curettage ; during this procedure, a residual tumor in the pterygopalatine fossa region was noted. This residual tumor was removed during a second surgery via a Le Fort type I osteotomy. The patient has reported no tumor recurrence during the 5 years post-operation. ：odontogenic myxofibroma(歯原性粘液線維腫) ，Le FortⅠosteotomy(Le FortⅠ型骨切り術) ，odontogenic myxoma (歯原性粘液腫) 〔Received Oct. 21, 2016〕 歯原性粘液腫は間葉系の良性腫瘍で，中でも膠原線維の 多いものを歯原性粘液線維腫といい，比較的まれな疾患で ある。良性腫瘍であるが局所浸潤性を有し再発が報告され ていることから，処置法が問題となることが多い。上顎骨 基底部または上顎洞内に進展した腫瘍性病変の摘出は，通 常犬歯窩より行われるが病変が比較的大きな場合は十分な 視野が得られず完全摘出が困難である。今回われわれは， 上顎に広範囲に伸展した腫瘍に対し，犬歯窩より腫瘍摘出， 掻爬術を行ったが上顎洞後上方の翼口蓋窩付近に腫瘍の残 存を認めたため，Le FortⅠ型骨切術を利用してアプロー チ困難な部位の腫瘍の摘出を行い，結果として 2 期的手術 となり，経過良好な巨大な上顎歯原性粘液線維腫の 1 例を 報告する。 患者：18 歳女性。 初診：200X 年 9 月下旬。 主訴：右上臼歯部歯牙の動揺。 既往歴：特記事項なし。 家族歴：特記事項なし。 現病歴：200X 年 4 月初旬より右上顎大臼歯部の歯牙動 揺を自覚するも放置していた。歯牙動揺が増大し，9 月中 旬近在歯科へ受診。右上顎臼歯部の骨膨隆，頰部腫脹を指 摘され近在病院歯科口腔外科へ紹介された。画像検査にて 鳥取県立中央病院歯科口腔外科(主任：木谷憲典部長) ＊ 鳥取大学医学部口腔顎顔面病態外科学(主任：小谷 勇教授)

As society ages and inspection technology develops, the incidence of secondary malignancies has increased. Esophageal and gastric cancers are common for primary tumors of oral secondary malignancies, but, on the otherhand, ML (malignant lymphomas) are rare. We report here two cases of mandibular SCC (squamous cell carcinoma) complicated with ML as metachronous secondary malignancies. In both cases, oral SCCs were aggressive and the clinical courses were rapid. Case 1 was a 62-year-old man who had a past history of CLL (chronic lymphocytic leukemia) /SLL (small lymphocytic lymphoma) and developed oral SCC. Though he had a surgical resection after chemoradiotherapy, SCC recurred just two months post operation. Case 2 was an 83-year-old man who developed oral SCC during treatment for Epstein-Barr Virus(EBV)-positive DLBCL (diffuse large B-celllymphoma) of the elderly. He discontinued chemotherapy and he had an operation for oral SCC. Etoposide was resumed for exacerbation of EBV-positive DLBCL of the elderly ; he is alive without any relapse of oral SCC. Aggressive clinical features of secondary oral malignancies are considered to be closely related to a long-term immunosuppressive state due to ML and chemotherapy.

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