[in Japanese]

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We retrospectively evaluated the efficacy of neck dissection followed by radiotherapy by using the clinical outcome in 15 patients (median age: 60 years) with upper cervical lymph node (level II) metastasis from unknown primary carcinoma undergoing curative treatment from 1999 to 2007. The male-to-female ratio was 4:1, and the histopathological diagnosis in 11 patients (73.3%) was squamous cell carcinoma. Clinical N status was distributed as follows: N1, 1; N2a, 4; N2b, 8; and N2c, 2. Of the 15 patients, 13 patients (86.7%) underwent neck dissection and 11 (84.6%), including 2 unresectable cases undergoing concurrent chemoradiotherapy using DOC and CDDP making their condition resectable, underwent neck dissection combined with radiotherapy. Follow-up was from 5 to 72 months (median: 39 months). In 2 of 6 patients, we detected the primary site at the ipsilateral tonsil through tonsillectomy conducted concurrently with neck dissection. Overall 5-year survival determined by the Kaplan-Meier method was 88.9%, and only 1 patient died of metastasis without achieving complete response 29 months after initial treatment. None of the 15 was observed to have local regional recurrence or distant metastasis after initial treatment. These results indicate that neck dissection followed by radiotherapy is recommended for improving the outcome of patients with cervical lymph node metastasis from an unknown primary carcinoma.

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In a study of six cases of odontogenic maxillary sinusitis caused by fractured teeth, we found the following:
(1) The pathophysiology of odontogenic maxillary sinusitis differs in cases in which the pulp cavity is not exposed from those in which it is exposed.
(2) When the pulp cavity is not exposed, dental pulp at the apical foramen is injured, causing apical periodontitis that, in turn, causes odontogenic maxillary sinusitis via apical lesions.
(3) When the pulp cavity is exposed, pulpitis followed by apical periodontitis and apical lesions causes odontogenic maxillary sinusitis.
(4) Physician should thus be made aware of the possibility that fractured teeth may cause odontogenic maxillary sinusitis.

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