Biller's technique (1983) of laryngoplasty is useful for the management of chronic intractable aspiration. The posterior part of the glottis completely closes, not at the glottis, but at the supraglottis. The bilateral arytenoids come into contact at the superior portion of the arytenoid cartilage from the vocal process to the apex. We introduced surgical closure of the larynx for intractable aspiration using this anatomical feature of the posterior glottis in combination with Biller's technique.
The operation procedure is as follows. A suprahyoid-pharyngotomy is performed. To close the posterior glottis, dissection of the mucosa over the superior portion of the arytenoid cartilages from the vocal process to the apex and the interarytenoid notch is performed. The medial mucosal flap, bilateral arytenoid cartilages and lateral mucosal flaps are sutured together at the midline. To close the supraglottis, an incision is made on either side of the arytenoids and aryepiglottic folds. The medial mucosal flaps, the lmina propria of the mucosa and lateral mucosal flap are sutured together at the midline. An incision is made on either side of the lateral border of the epiglottis. The medial mucosal flaps, epiglottic cartilage and the lateral mucosal flaps are sutured at the midline. The suture is closed completely, except for a small openirlg at the top of the epiglottis.
This method archived complete closure of the posterior part of the larynx, thus it securely prevented aspiration. This procedure is a reliable method of closing the larynx that permits retention of the larynx with preservation of swallowing and phonation.

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We analyzed malignant lymphomas of the head and neck region, which contains lymph nodes, tonsils, pharynx and larynx, oral cavity, ocular adnexa, nasal cavity, paranasal sinuses, thyroid gland, and salivary glands. Diffuse large B-cell lymphomas were frequently found in the larynx, pharynx, oral cavity, and paranasal cavity. Ocular adnexa, thyroid gland and salivary glands were MALT lymphoma-dominant. The nasal cavity was frequently involved by NK/ T cell lymphomas with EBV as well as DLBCLs. In conclusion, The though head and neck organs are frequenly involved in malignant lymphomas, there was not uniformity in histological subtype.

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Malignant lymphomas are a heterogeneous group of lympho-proliferative disorders, mainly originating in lymphoid tissues and other extranodal head and neck organs, with different patterns of behavior. The prognoses depend on the genomic/pathologic types identified by the WHO classification (2001), prognostic factors, and the treatment strategy.
According to the WHO classification (2001), malignant lymphomas are divided into 3 clinical groups : indolent lymphomas (follicular lymphoma, marginal zone B-cell lymphoma, etc.), Hodgkin's lymphomas, and aggressive lymphomas (diffuse large B-cell lymphoma, peripheral T-cell lymphoma, etc.).
Indolent lymphomas and Hodgkin's lymphomas have good prognoses, with median survival as long as 10 years, and patients with the early-stage (I and II) disease can be treated with radiation therapy alone with 70% to 90% 5-year overall survival rates.
The aggressive lymphomas have shorter natural histories, but the number of patients cured by intensive chemotherapy +/- antibody therapy is increasing at present. In general, overall survival at 5 years is approximately 50% to 60%. Patients with stage I and contiguous stage II aggressive lymphomas enjoy excellent survival rates when treated with combined modality including chemotherapy (CHOP+/-R) and radiation therapy.
The radiation dose for lymphomas varies from 25 to 50Gy and is dependent on genomic/pathologic type and the organs at risk. Radiation fields are basically limited to the involved regions or extended to the immediately adjacent sites.
Localized presentations of the extranodal lymphomas can be treated with involved-field techniques with significant success. However, the long-term adverse reactions must be considered carefully.
A multidisciplinary approach among head and neck surgical oncologist, hematologist, pathologist and radiation oncologist is essential.

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The number of patients with malignant lymphoma localized on the head and neck at our hospital from January 2000 to December 2002 was 49 including 31 cases of diffuse large B-cell lymphoma (DLBCL), 8 of Hodgkin lymphoma (HL), 5 of follicular lymphoma, 2 of NK/T-cell lymphoma, 2 of Burkitt or Burkitt-like lymphoma and one of MALT lymphoma. Twenty-one (67.7%) patients with DLBCL were treated with CHOP plus involved-field irradiation, and 5 patients with HL were treated with ABVD plus radiotherapy. The range of follow-up was 5 to 51 months (median 28 months). At four years, 46 patients (93.9%) are alive and the estimated rates of progression-free survival of DLBCL and HL were 90.3% and 75%, respectively. The survival curve of the patients with DLBCL reached a plateau one year after the start of treatment. Therefore, the combined modality is regarded as a standard treatment for DLBCL and HL localized on the head and neck. The disease of two dead cases was Burkitt-like lymphoma and NK/T-cell lymphoma, respectively, indicating that our treatment for these high-grade malignant lymphomas is unsatisfactory.

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Nasal NK/T-cell lymphoma accounts for approximately 2% of all malignant lymphomas in Japan. It is an Epstein-Barr virus (EBV) -associated neoplasm and lymphoma cells are thought to be derived from NK cells in most cases. Due to the low incidence of this disease, a standard therapy has not yet been established. Approximately 80% of patients with nasal NK/T-cell lymphoma present with localized disease, and the prognoses for patients with relapse are extremely poor. To improve the outcome of nasal NK/T-cell lymphoma, it is important to establish a more effective therapeutic strategy for localized cases. Anthracycline-containing chemotherapy followed by radiotherapy is not effective for localized nasal NK/T-cell lymphoma. The 5-year overall survival rates for patients treated with radiotherapy alone are only 30-40%. Patients who were treated with radiotherapy followed by or combined with chemotherapy seem to have a better prognosis. Based on our study of 12 consecutively-diagnosed cases in Mie University and a review of the literature, radiotherapy is highly recommended as the first therapy for localized nasal NK/T-cell lymphoma. Recent studies suggest that more than 46Gy is needed to achieve good local control. Treatment planning with CT/MRI scanning is also recommended. Several reports have presented promising results for the efficacy of etoposide in nasal NK/T-cell lymphoma. Moreover, a few but promising results have been reported with concurrent chemoradiotherapy. Concurrent chemoradiotherapy is expected to improve both local control and systemic disease control. Two nationwide, prospective, multi-institutional studies of concurrent chemoradiotherapy for newly diagnosed and localized nasal NK/T-cell lymphoma are ongoing in Japan. Quantification of EBV DNA in peripheral blood in patients with nasal NK/T-cell lymphoma is useful for disease monitoring and prognostication. To improve the prognosis of this disease, close teamwork among otorhinolaryngologists, pathologists, radiation oncologists, and hemato-oncologists is essential in both clinical practice and clinical trial for NK/T-cell lymphoma.

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Malignant lymphoma (ML) of Waldyer's ring (WAL) is a unique subset of non-Hodgkin's lymphoma : diffuse large B-cell histology and localized lesions in the head and neck in the majority of cases. The treatment modality for ML-WAL has long been swaying between radiotherapy (RT) and chemotherapy (CT), but a brief CT followed by RT is now considered to be the standard. An appropriate dose intensity of CHOP regimen in the initial 3 courses of the treatment is essential for increasing the cure rate. The regional RT of 30 Gy to the initial tumor burden will minimize the late RT hazards of secondary malignancies or impaired quality of life.

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We reviewed the current team approach to head and neck cancer in our department, which yields efficacious results especially in chemoradiotherapy and reconstructive surgery. Most patients with head and neck cancer in our department undergo chemoradiotherapy with mutual agreement between an otolaryngologist and radiologist. In addition, radical surgery for head and neck cancer performed by a plastic or gastrointestinal surgeon is on the increase. As a result of the team approach involving multiple departments, the prognosis and quality of life of patients with head and neck cancer have improved. In addition to the doctor, the nurse plays an important role in the team approach as a coordinator of the team.
The most important problem to be solved in our university hospital is how to hold a joint conference among physicians in multiple departments including otolaryngology, radiology, plastic surgery, gastrointestinal surgery, pathology and others. Although it is rather difficult for us to arrange this kind of conference at present because of the discordant time schedules of individual departments, open communication and mutual understanding across the boundaries of each department is essential for the progress of the team approach to head and neck cancer.

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Our Department of Otolaryngology, Head and Neck Surgery has held a joint conference with the Department of Radiology and Department of Plastic Surgery since 2001 for the diagnosis and treatment of patients. This study examined whether this therapeutic system (team practice) contributed to improvement of the survival rate, quality of life (QOL), and medical costs. We examined a total of 38 patients who underwent reconstructive surgery at our department for head and neck cancer before and after the introduction of team practice. The therapeutic factors assessed were intraoperative blood loss, duration of surgery, perioperative complication(s), and survival rate. The QOL factors included the time to the start of oral ingestion, final food form, time to the start of walking, and mean number of days of hospitalization, as well as medical costs.
The results showed that team practice significantly improved the duration of surgery, cervical infection rate, time to the start of walking, mean number of days of hospitalization, and medical costs. It also improved the other items examined, but not significantly. These results showed that team practice was an excellent therapeutic system.

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Our goal of therapy for head and neck cancer is to restore function. Though an exact tumor ablation is the most important of all treatments, we consider minimum invasive surgery to minimize the loss of function. However, because it is difficult to perform such surgery alone between life-medicine and rehabilitation, a team approach is essential to treat head and neck cancer patients as follows :
1) Team for diagnosis
2) Team for cancer therapy
3) Team for rehabilitation
When organizing these teams, the following points should be taken into account.
(1) Existence of one leader who will get information continuously from each staff about the progress of the patient's condition. According to the progress of the patient's condition and judgement of each team leader, the leader will make the final decision.
(2) All the staff from each group should comprehend each other's activities.
(3) Steps in the treatment plan should be stream-lined without gaps.
(4) All the staff should mutually understand each other.
(5) Having a positive attitude toward improving the patient's status.
(6) To make an effort to increase the number of qualified operating surgeons so that many competent surgeons can contribute to a fruitful discussion with their abilities.
At present, although great improvements have been made in recovery of oral function, from the patient's point of view, it is not satisfactory. Therefore, to attain further development with regard to functional recovery, it is necessary to ensure mutual collaboration among all the specialties involved in head and neck cancer treatment.
Furthermore, we would like to give more attention to the mental aspect of the patient.

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Recently, team practice for head and neck cancer treatment has been employed for better outcomes. A coordinated team approach is necessary to meet the varied medical needs of head and neck cancer patients. In our department, the team approach has been conducted as well. We draw up the treatment procedure and if needed, request cooperation from other departments, which include radiology, gastroenterological surgery, rehabilitation, anesthesiology, plastic surgery, orthopedic surgery and otolaryngology. Consultation and cooperation are demanded when necessary and routine conferences will not be held. Problems of the team approach of our department are : sometimes we determine the treatment plan on our own, and make contact with other departments only with a consultation letter without holding a conference and make contact privately.

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The team approach has gained importance in contemporary medicine. Peer reviews between different professionals are crucial to maintain a high quality of medical care. The team approach at the Kitasato University Hospital is presented. Four cases are presented : 1) Joint head and neck tumor clinic of the ENT and radiology departments, 2) Postoperative care of subtotal laryngectomy SCL-CHEP, 3) Joint surgery of the departments of ENT, general surgery, and plastic surgery, and 4) Home palliative care organized by the university hospital.
Three questions were addressed regarding the ideal team medicine : 1) Do we maintain a low profile toward different professionals, which enables a genuine peer review? 2) Do all medical sections have key persons, who show future visions and who are ready to take responsibilities? and 3) Do we push ourselves toward the cutting edge in our professional selves, where no compromise in patient care is made?

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We discuss the role of nurses in providing an ideal medical treatment for patients with head and neck cancer. Nurses play an important role in the treatment course. Nurses and head and neck surgeons and/or oncologists should work together organically.
We decide the treatment plan of each patient by working together, or we inform patients and their families efficiently and repeatedly, and consider their wishes. The discussions help to deepen our understanding of the patients' status and we give training to nurses of otolaryngology-head & neck oncology.
It is crucial for a medical team to trust each other, and this requires good communication among each other. We consider that we can provide patients with good medical care through this approach in the same direction.

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A goal of treatment for head and neck cancer is cure and preserving appearances and functions, for which an appropriate treatment modality including surgery and chemoradiotherapy should be made. Therefore, it is very important to evaluate the tumor response of the chemoradiotherapy for cure of the disease and organ preservation. A histological evaluation by pathologists as well as a clinical evaluation by therapeutic radiologists, diagnostic radiologists, and otorhilnolaryngologists helps an accurate evaluation of the tumor response of chemoradiotherapy. A precise histological examination of the tissue specimen after a surgical resection leads to an appropriate choice of post-surgical treatment. These evaluations should be made not only by clinical reports but also through discussions in conferences, which help the appropriate treatment modalities to be chosen. Medical team treatment for head and neck cancer is necessary for improving survival and organ preservation rates. A medical team including pathologists in addition to otorhinolaryngologists and radiologists would be useful for the treatment of patients with head and neck cancers.

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Team care in the management of head and neck tumors at the National Cancer Center Hospital involves a diverse range of medical staff whose main subject is the head and neck area. The staff include head and neck surgeons, radiotherapists, radiodiagnosticians, medical oncologists, reconstructive surgeons, dentists, and nurses. An important advantage of team care at our hospital is the psychological and palliative care provided by psycho-oncologists, clinical psychologists, and palliative physicians. In this paper we report on the status of team care at our hospital throughout the management of head and neck tumors and discuss several problems and difficulties that must still be resolved.

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This study evaluated the efficacy and toxicity of chemoradiotherapy (CRTx) using docetaxel (DOC), cisplatin (CDDP) and 5-fluorouracil (5-FU), (TPF) and CDDP, 5-FU, Methotexate (MTX) and Leucovorin (LV), (PFML) in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN). Patients received 2 cycles of chemotherapy. We compared it with neo-adjuvant chemotherapy (CTx) followed by radiation (RTx) and concurrent CRTx using TPF or PFML. Leukocytopenia, neutropenia and mucositis were severer in patients using concurrent CRTx than neo-adjuvant CTx followed by RTx. CR rate was better in patients using concurrent CRTx than neo-adjuvant CTx followed by RTx. The limit at which we expected CR in concurrent CRTx was ≤T3 and ≤N2b patients.

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To enhance the therapeutic effect on local control, chemoradiotherapy has been tried in the management of head and neck cancer. However, the optimal method of chemoradiotherapy has not yet been determined. The sequence of each treatment is one of the most important problems. Several randomized controlled clinical trials revealed that neoadjuvant chemotherapy prior to radiotherapy is of limited value, whereas concurrent administration of chemotherapy has a positive impact on long-term outcomes. More recently, concurrent chemoradiotherapy using altered-fractionated radiotherapy has been investigated. Although promising treatment results were demonstrated, frequent severe acute toxicities such as mucositis were also observed in this manner. Alternating chemoradiotherapy might overcome this issue. To establish the optimal sequence of chemotherapy and radiotherapy, well designed prospective clinical trials are required.

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In the treatment of oropharyngeal carcinoma, concomitant chemoradiotherapy using platium-based treatment schedules has yielded better results than radiotherapy alone and has been recently used by an increasing number of institutions.
In the treatment of head and neck cancer including oropharyngeal cancer, salvage operation can be performed when radiotherapy fails to obtain locoregional control in some cases treated with radiotherapy alone. Such feasibility of salvage operation has influenced the decision on treatment modality and radiotherapy tends to be selected as a first-line treatment.
However, salvage operation may be difficult to perform after concomitant chemoradiotherapy using platium-based treatments because the increased damage of the normal tissues by chemoradiotherapy may cause complications for the operation.
Therefore, closer communication and more careful discussion between head and neck surgeons and radiation oncologists has become more important when the first-line treatment is decided.

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This paper discusses 60 cases of untreated oropharyngeal squamous cell carcinoma and 2 cases of undifferentiated carcinoma of the tonsilar region and tongue base, in the period from 1993 until 2003.
As a treatment policy, operation was performed in principle, and in the cases of pN2-3, postoperative irradiation of 44-50Gy was given to the whole neck.
As a result, 41 cases of cancer of the tonsilar region, even advanced cases, could be well controlled, and the five-year cumulative survival rate was 71.2%.
On the other hand, cancers of the tongue base were difficult to control and the five-year cumulative survival rate was 21.5%.
Therefore, the treatment strategy for tongue base must be checked. CR was achieved with a case of T4N2c by an intra-arterial infusion of CDDP three times in combination with radiation of 70Gy. In this case the patient was able to return to work after treatment.
It is thought that concurrent intra-arterial infusion and radiation is a useful method for tongue base carcinoma.

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The purposes of this study were to investigate what is the most effective therapy for oropharyngeal cancer, how to remove the causes and how to prevent patients from postoperative aspiration. One-hundred and ninety-five patients with oropharyngeal cancer received radical treatment at Kurume University Hospital between 1971 and 2001. They were classified into three therapy groups : radiotherapy group, operation group and operation + radiotherapy group. The 5-year local control rate was 64%, and the cause-specific 5-year survival rate was 58%. The most satisfactory result of 5-year local control rate was the operation + radiotherapy group. However, no significant differences of cause-specific 5-year survival rate were found between these three groups. The worst results of the 5-year local control rate as well as survival rate were found in the posterior wall subsite group. In contrast, satisfactory local control rate was obtained with tongue base resection and supraglottic horizontal partial laryngectomy in the anterior wall subsite group. For the lateral wall subsite group, in case where cancer had inraded the tongue base, the patients received resection of half of the tongue base with lateral wall resection, and the larynx could not be preserved in half of the patients could not preserve larynx. In cases with advanced posterior wall cancer, more extended local resection such as by pharyngo-laryngo-esophagectomy was required. In early posterior wall cancers, surgical procedure via the oral or hyoid bone approach seemed to prevent postoperative aspiration. In cases with superior wall cancer, additional surgical margin with postoperative radiotherapy was required to gain a satisfactory local control rate.

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Osteoradionecrosis (ORN) of the mandible is a severe complication associated with head and neck radiotherapy ; however, prevention and treatment of ORN is a still controversial problem. ORN is characterized by a hypovascular, hypoxic, and hypocellular condition resulting in tissue breakdown and bone necrosis. Evaluation of the bone viability is important to treat ORN.
Conservative treatments combined with hyperbaric oxygen therapy should be done initially. In persistent or progressive cases against these treatments, radical resection of the necrotic mandible is indicated. Irradiated mandibles had poor potential of bone viability, therefore, the periosteal blood supply should be conserved and surgical interventions must be minimized to avoid recurrence of ORN.
To prevent ORN, educational motivation of the patient by a radiation oncologist is necessary. Professional oral management, such as spacer, mechanical oral cleaning and topical fluoride application, should be useful to avoid radiation-induced complications.

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F-18-fluorodeoxyglucose positron emission tomography (FDG-PET) has been used for the diagnosis of various cancers in the last two decades. Based on many evidences showing the efficacy of FDG-PET for the diagnosis of cancer, FDG-PET has been accepted for health insurance. Recently, many hospitals have installed PET scanners and the procedure has become a popular diagnostic tool. Delivery of FDG will start soon and the availability of FDG-PET will accelerate.
FDG-PET is useful for the differentiation of cancer from benign diseases, since the uptake of FDG correlates to the proliferation of cancer cells. The uptake of FDG is thought to be dependent on the malignancy of tumor. The ability of FDG-PET in the evaluation of therapeutic effect and detection of recurrence are also superior to conventional imaging modalities.
However, FDG uptake not only occurs in malignant cells, but also in benign lesions such as inflammatory focus and granuloma, which causes false positive results. There are many sites of physiological FDG uptake such as the brain, muscle, tonsil, liver, kidney, urinary tract, intestine, bone marrow and so on.
Amino-acid analogues and thymidine analogues have been introduced for clinical tumor imaging. New radiopharmaceuticals with high specificity to malignant tumors will be discovered to overcome the disadvantages of FDG.

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Radiation therapy plays an important role in the treatment of head and neck cancer. Rapid technological development of radiation therapy in recent years has greatly enhanced our ability to effectively decrease the adverse events. However, the head and neck region is composed of numerous structures, such as mucosa, the tongue, salivary glands, and the mandible. Details of changes of these tissues after radiation therapy are presented, including their pathology, clinical symptoms, and potential treatments.
Relationships between wound complications and radiation therapy are also mentioned.

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Tissue engineering is a relatively new approach for regenerative medicine. According to the concept, the human body can be regenerated by using stem cells, scaffold and growth factors. Among several medical fields, head and neck surgery is one of the most advantageous and pioneering in tissue engineering. Since 1985, we have developed many kinds of tissues and organs using cultured living cells. Ttis paper discusses skin, nerve and bone regeneration usingthe tissue engineering concept, because these tissues can be fully used for head and neck reconstruction.
The first topic is skin regeneration.
We have developed two types of cultured skin. The first one is cultured epidermis and the second type for skin engineering is cultured full thickness skin which is composed of a artificial dermis and epithelial layer. The artificial dermis was fabricated with fibroblasts and collagen gel.
The second topic is nerve regeneration. We have developed a novel artificial nerve tube, which is made of a collagen mesh filled with collagen fibers.
This nerve tube was applied for clinical cases who had been treated by radical neck dissection due to mandibular cancer. The resected accessory nerve was interpositioned by the collagen tube just after resection. One month later, the patient's shoulder movement recovered very well.
The last topic is bone engineering. Resently we have developed injectable bone using culture-expanded marrow mesenchymal stem cells (MSC) and platelet-rich plasma (PRP). The injectable bone has good potential for a cell delivery system for bone regeneration with the advantages of minimum invasiveness and fitness in the defect. If one could transplant the cells by means of injection by syringe, one could augment all the bone defects with autogenous tissue without extensive surgery.
The three types of cultured tissues using tissue engineering concepts, such as skin, nerve and bone, are discussed. From our experimental and clinical studies, tissue engineering products are very useful and have a huge possibility in the field of head and neck surgery.

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In Japan, clinical trials have been so far based on approval initiated by pharmaceutical companies. Investigator-initiated clinical trials have not yet been established.
In this situation, the Translational Research Informatics (TRI) Center was established in Kobe city, Japan, under the Kobe Medical Industry Development Project, in order to support and promote clinical research. The TRI center consists of some research departments, the Department of Clinical Trial Management, the Department of Clinical Genome Informatics, and so on. The Department of Clinical Trial Management (DCTM) is involved in tje organization of clinical trial teams, design of clinical trials, protocol development, and statistical analysis of trial results.
Chemoradiotherapy has been used in an effort to improve therapeutic results for locally advanced, non-resectable head and neck cancer. Improved local-regional control and disease-free or overall survival have been shown in several randomized trials using a concurrent or an alternative approach. Further clinical trials are needed to clarify the most suitable combination of chemotherapy and radiation.
In this paper, the organization of DCTM is introduced as an example for successful clinical trials, and the necessity of team-based clinical trials is discussed.

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Partial hypoharyngectomy was performed in fourty-four hypopharyngeal cancer cases to preserve the larynx. The operation procedures were categorized into four types : Type I, Type II, Type III, and Type IV. Type I was effective for piriform sinus cancer while Type IV was effective for postcricoid cancer, posterior wall cancer as well as cervical esophagus cancer. Reconstructive operation was performed using the forearm flap or free jejunum for Type I, while for Type IV it was performed with free jejunum alone or gastric tube and free jejunum.
Irradiation after the debulking surgery for piriform sinus cancer was performed in seven cases. The results were satisfactory, without the disease recurring and with the patient surviving. Irradiation combined with S-1 is also a promising therapy.
Making a diagnosis of a small lesion with an NBI endoscope is indispensable in the excision of the hypopharyngeal mucous membrane, and it is necessary to make active use of the NBI endoscope. Now that there are more options for the treatment of hypopharyngeal cancer preserving the pharynx, it is important to make the right choice.

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The medical scene in Japan seems to be in confusion concerning medical advice especially ‘notification’. This is partly the result of ignoring Japan's long history and culture, importing just its concept from the West and manipulating public opinion on notification through the mass media.
If too much attention was paid to ‘informed consent’, the doctor would have to kill the patient when a patient says he wants to die.
The patient's words, however, do not always reflect his real intention but may be an emotional sign that the patient wants a doctor to worry more about him. This may be a warped expression of ‘amae’ or emotional dependence peculiar to the Japanese.
In the background of the Japanese who use such kinds of expressions, there is a characteristic religious perspective including Buddhism, Shintoism and so on, which might be hard for Christian Westerners to understand.
Medical advice led by the media is a matter that concerns people in Christian countries based on individualism. On the other hand it is not a matter for Japanese who have been constructing family-oriented regional communities without establishing individualism. It is the relationship with other people that a person asks for the most in a clinical situation such as when the person is faced with his own death.

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With a multislice CT, images of any tomographic plane, such as the coronal or sagittal plane, can be reconstructed easily on CT. So, it is very important to understand the characteristics of CT and MRI for selecting favorable imaging modalities and examination protocols for presumed pathological conditions. This paper discusses utility and important matters of MRI in the evaluation of head and neck tumors, and emphasizes the following points : 1) characteristic signal intensity, 2) limitation of the scan area, 3) motion artifact, 4) spatial resolution, 5) susceptibility artifact, 6) signal intensity of vessels and MRA, 7) signal intensity of fat and fat suppression technique, 8) evaluation of bone marrow and cartilage, and 9) perineural spread.

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In addition to various benign and malignant tumors similar to those of skeletal bones, peculiar tumors occur in the jaw alone, and are called odontogenic tumors. Odontogenic tumors include some that are true neoplasms, some that are hamartomatous, and some that are really a dysplastic condition. In the present paper, the following clinicopathological features of aggressive odontogenic lesions are described : 1) the histological origin and classification of odontogenic epithelial tumors, 2) ameloblastoma and its variants, 3) two types of calcifying odontogenic cysts, 4) ameloblastic fibroma and its variants, 5) cementifying lesions, 6) myxoma, 7) malignant odontogenic tumors, and 8) non-odontogenic lesions distinguishable from odontogenic tumors.

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Since its introduction, spiral computed tomography (CT) technology has undergone continuous and fast technical and clinical development. In particular, spatial and temporal resolutions have constantly increased during the last decade. The main breakthrough for clinical application was the introduction of multislice technology, first with 2-row and 4-row equipment and more recently with 16-row scanners.
Multidetector-row CT (MD CT) has allowed isotropic imaging of the head and neck region, facilitating assessment of tumor spread with high spatial and temporal resolutions with easy transformation to reconstructed planes. Thin structures of the head and neck region can be evaluated sufficiently with multiplanar reformations and three-dimentsonal images. Reformatted coronal imaging is useful in evaluating craniocaudal extension. Although the use of contrast material is mandatory for head and neck tumors in detecting tumor spread, it enables us to evaluate anatomical orientation between the lesion and vasculatures.
Updated protocols and clinical examples of head and neck lesions are also discussed in this paper.

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The anterior wall of the oropharynx plays a very important role in swallowing. Therefore, as the risk of postoperative dysphagia is believed to be high, radiation or chemotherapy are often selected for treatment of carcinoma of this lesion. Nevertheless, sensitivity to radiation or chemotherapy is not so high. In our institute, surgical treatment is mainly selected and it is less invasive than traditional operations. Tumors at the early stage (T1, T2) are resected by a perihyoidal approach, and when the surgical defect is large, a cervical flap is used for reconstruction. All five cases which were operated on from 1999 to 2002 were converted to oral feeding within almost two weeks with no aspiration problem, and no local recurrences developed during the follow-up period. The functional results obtained through these operations justify its use in the treatment for T1 or T2 tumors of this region.

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A 53-year-old man visited our hospital with a mass lesion in the left side of the neck. The patient underwent excision of the mass and intraoperative rapid pathological diagnosis was squamous cell carcinoma, so we performed radical neck dissection. After the operation, the patient received radiation therapy (total 64 Gy) and chemotherapy with CBDCA and UFT. He was followed up to 61 months after surgery without any evidence of recurrence of cancer. This case satisfies the histological criteria established by Martin and Khafif for a primary branchiogenic carcinoma arising in a previously benign second branchial cleft cyst. The management in suspected cases would be wide surgical excision of the tumor including radical neck dissection followed by radiotherapy and chemotherapy.

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Laser surgery can control intraoperative hemorrhaging and enable lesions to be accurately removed since, unlike an electrotome, it does not effect electrocontractility. It can also reduce postoperative pain and dysfunction. This study investigated the efficacy of laser surgery in recurrent tongue cancer following radiotherapy.
Of the total of 105 patients with squamous cell carcinoma of the tongue (T1, T2N0) who underwent radiotherapy at the Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, at some point between 1980 and 1998, 24 (22.9%) experienced local recurrence. Sixteen of these patients underwent surgical removal of the tumor. Of these 16 patients, 8 (4 early- and 4 late-stage recurrence) had partial glossectomy by laser surgery.
Following laser surgery, 2 (1 early- and 1 late-stage recurrence) of the 8 patients died from neck metastasis and another 2 (early-stage recurrence) died from other diseases. The primary and neck tumors are both under control in 3 (late-stage recurrence) of the remaining 4 patients.
Laser surgery for late-stage recurrent tongue cancer following radiotherapy appears to be a suitable treatment, although comprehensive glossectomy with/without radical neck dissection is necessary for early-stage recurrent cases after radiotherapy.

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Lymphoepithelial carcinoma is very rare in salivary gland neoplasms. This case originated from a minor salivary gland is the second reported in the world as far as we could find. In recent years, relationships between cancers and EBV are reported frequently. For this case, EBER (EBV-encoded small RNAs) is positive in the in situ hybridization method and a positive reaction in immunohistochemical examination in LMP-1. In addition, in serological verification, there is a high value in VCA -IgG (FA) and anti-EVNA (FA). From these facts, we recognized EBV infection in this case. Finally, this case was diagnosed as “lymphoepithelial carcinoma associated with EBV”. The first treatment was surgical remedy. After the operation we recommended radiotherapy but he did not receive this treatment, so now we are following up the patient.

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We have demonstrated that ischemia reperfusion of the carotid artery could generate reactive oxygen species (ROS) in the head and neck regions. In this study, we examined the antitumor effect of the ROS against rabbit VX2 carcinoma.
VX2 carcinoma cells were transplanted into both sides of the masseter region. Then, the right carotid artery was temporariy ligated (10min/days, 7 day : ischemia-reperfusion group) or completely ligated and cut (ligation group) 7 days after tumor transplantation. Thereafter, tumor growth was observed and histological analysis using H-E and TUNEL staining was carried out.
The antitumor effect of ROS generated by ischemia reperfusion of the carotid artery was observed in the measurement of the tumor growth ratio and also tumor weight as compared with that of the left-side tumor. Histological analysis revealed a significant number of TUNEL positive cells in the ischemia-reperfusion group as compared with that of left-side tumors and right-side tumors of the ligation group.
These results suggest that ROS generated by ischemia reperfusion of the carotid artery inhibits the tumor growth, possibly because of induction of apoptosis of tumor cells.

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