森 良之

Streptococci are the most common species in the oral bacterial flora, which are divided into several groups according to the classification of Lancefield. A significant increase in the frequency of necrotizing inflammation and irreversible toxic shock, caused by <I>Streptococci</I> of Group A, has been recently noted. The disease appears in individuals without obvious risk factors, and often becomes serious. In contrast, inflammation caused by β-<I>Streptococci</I> of group F (<I>S. anginosus</I>), however, is usually not frequent nor serious, and has rarely been reported.<BR>We encountered a case of acute cervical cellulitis caused by odontogenic infection. A 20-year-old male was referred to our hospital with severe neck swelling and dyspnea. The lesion had extended promptly to the substernal area through the submandibular space and the cervical region, and S. anginosus and the anaerobic bacteria, <I>Peptostreptococci</I> and <I>Clostridium</I>, were detected.<BR>The lesion in this patient was managed by drainage and irrigation through incisions in the neck, and systemic antibiotic therapy was performed.<BR>In such severe infections, proper drainage and systemic antibiotic treatment are considered to be necessary.

The development of microvascular surgery has made possible the closures of various complicated defects resulting from surgical removal of head and neck cancers. In these days, many kinds of vascularized free flaps can be transferred from various parts of a whole body to the oral and maxillofacial defects. We experienced two cases with recurrent adenoid cystic carcinoma of the right parotid gland and the right buccal mucosa respectively. Case 1 with the lesion of parotid gland was reconstructed with latissimus dorsi-serratus anterior muscle flap with its thoracodorsal nerve.<BR>The development of microvascular surgery has made possible the closures of various complicated defects resulting from surgical removal of head and neck cancers. In these days, many kinds of vascularized free flaps can be transferred from various parts of a whole body to the oral and maxillofacial defects. We experienced two cases with recurrent adenoid cystic carcinoma of the right parotid gland and the right buccal mucosa respectively. Case 1 with the lesion of parotid gland was reconstructed with latissimus dorsi-serratus anterior muscle flap with its thoracodorsal nerve.<BR>Case 2 with the lesion of right buccal mucosa was reconstructed with free vascularized dorsalis pedis flap. Many authors have reported about application of forearm free skin flap to the reconstruction of oral cavity. However, very few reports of dorsalis pedis free skin flap in those areas had been presented. This thin flap seems to be suitable for the reconstruction of the oral cavity. And the dorsalis pedis free skin flap has also the cosmetic advantage of the donor site.<BR>These functional and cosmetic restorations could facilitate the return to the social life of the patients.