Although some authors have suggested the possibility of spontaneous production of tumor necrosis factor (TNF) in human, there are only a few reports about serum TNF activity in cancer patients. In the present study, TNF activity in the sera of 15 patients suffering from head and neck carcinomas was measured by L assay using L-M cell derived from the murine tumorigenic fibroblast line.
Untreated sera possessed L-M cell cytotoxicity equivalent to 5-80 units/ml of human recombinant TNF (hrTNF), however, major part of the cytotoxicity was lost by heat-inactivation at 56°C for 30min. Meanwhile, hrTNF was not inactivated at 56°C. Moreover, the residual activity of the heat-inactivated sera was not inhibited by anti-TNF rabbit serum.
In conclusion, the sera of the patients of head and neck cancer contained considerable level of L-M cell cytotoxic factor, but did not any detectable level of TNF.

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Clinicopathologic findings on small thyroid carcinomas measuring 10mm or lessin diameter were analyzed in 94 cases. The author divided small thyroid carcinomas into two subgroups according to diameter; ∅≤5mm (classified as minute carcinoma) and 5<∅≤10mm (classified as tiny carcinomas). Characteristics including extrathyroid invasion and lymph node etastasis were examined in each subgroup. In patients with minute carcinoma, very few incidences of extrathyroid invasion and lymphnode metastasis were found but the incidence of local lymph node metastasis was 56.6% in tiny carcinoma. Futher, in the patients with small carcinoma, the incident of jugular lymph node metastasis was 10.6%.
The cancer free rate and survival rate of small thyroid carcinoma showed that the small carcinoma with multiple jugular lymph node metastasismust be treated in the same way as large-sized carcinoma (∅>10mm).

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The wall of cervical trachea is often invaded by thyoid cancer. Out of total 65 patients with thyroid cancer in our clinics, 20 showed tracheal invasions, which were resected together with thyroid cancer.
After resection of the total circumference in 4 patients, end-to-end anastomosis were carried out by the suprahyoid laryngeal release technique, or after window resection in 9 of 15 patients the surgical defects were reconstructed by free transplantation with cartilage-murosa composite graft of nasal septum. In the remaining 3 of window resections the tracheal stomas were closed only by skin closure without any reconstruction of trachea because the defects were small, and in another 3 the deffects were used for tracheal breathing because of total laryngectomy or incomplete removal of cancer of undifferentiated type.
In conclusion, we successfully reconstructed surgical defect of trachea using end-to-end anastomosis or transplantation with composite graft of nasal septum. Anaplastic cancer, however, were not indicated due to poor prognosis.

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Surgical neuroangiography was performed on a total of 14 head and neck tumors: 3 of which with benign lesions (2 angiomas and one neurinoma), and 11 with carcinomas (8 squamous cell carcinomas and 3 adenoid cystic carcinomas).
Concerning a diagnostic role of surgical neuroangiography for these tumors, extent of tumor was clearly depicted as a tumor stain or a tumor brush not only in vascular tumors, but also in a neurinoma and in carcinomas. Especially about a mucosal, a periosteal, and a perineural cancer spreads were demonstrated in detail by the neuroangiography compared to the other diagnostic modalities.
In 9 carcinomas, after the infusion of anti-cancer drugs into tumor feeding arterial pedicles, proliferating peritumoral capillary vessels, which perfused tumor itself, were selectively embolized with gelfoam powder of 40-60μ size in particle until the tumor brush was disappeared under fluoroscopic control.
Concerning the therapeutic role of surgical neuroangiography, postoperative stecimens, which were previously treated by these procedures, showed remarkable coagulation necrosis throughly. Local pain, discoloration and hypesthesia were found as adverse reaction related to the chemoembolization through the feeding pedicle, but all symptoms were disappeared within 2-3 days with the medication of analgesics.
No mention has been made of the utility of the surgical neuroangiography for diagnostic and therapeutic role in the combination cancer treatment of the head and neck. According to our results, chemoembolization cancer therapy through the feeding pedicle seemed to be theoretically ideal from the view point of the antitumor angiogenesis, and practically could be repeated without severe adverse reactions.

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A prospective randomized trial to clarify the effect of radiation field on the local cotrol of early glottis cancer was performed, From May 1982 through December 1985, a total of 93 patients with early glottic cancer were treated at our department with the individualized wedge filtred technique of 4MV X-ray using a shell in order to improve the dose distribution and immobilization during radiotherapy. Patients were randomly allocated to either treatment of group A (radiation field size: 5×5cm²) or B (6×6cm²) which included the larynx using right and left parallel opposed portals. Radiation dose administered was 60Gy in 30 fractions over 6 weeks period. The five-year disease-free survival rates were 93% in group A and 96% in group B (not significant). The better results were achieved compared with historical control and there was no significant effect of radiation field (5×5cm² vs 6×6cm²) on the local control of early glottic cancer by these improved treatment technique. These results were mainly caused by the better-local control control of whole length lesion. Persistent arytenoid edema lasting more than 6 months was more frequently observed in group B (23%) than group A (4%).

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Clinicopathological studies were performed in twenty transglottic cancers. Each specimen obtained by total laryngectomy was processed for study by whole-organ serial section. Paraglottic space involvement was found in all 20 patients, while preepiglottic space involvement, submucosal infiltration, and thyroid cartilage invasion in about half of the patients. So there was a strong tendency to infiltrate deeply in transglottic cancer. In half of the T2 and T3 patients, the invasion of thyroid cartilage was found. Therefore the laryngologist should look for the cartilage invasion described above if the patients with transglottic cancer are treated by radiotherapy or partial laryngectomy. This tumor tends to infiltrate more deeply than supraglottic cancer and the pattern of cartilage invasion in transglottic cancer differs from supraglottic cancer. The invasion of arytenoid cartilage occurred in all the patients with vocal cord fixation, and the invasion of cricoarytenoid joint in 75%. The in cidence of cervical lymph node metastasis was 30%. There was a tendency to infiltrate deeply in the patients with lymph node metastasis. All 20 patients in this study were smokers. Carcinogenesis in transglottic cancer seems to have a close relationship with tobacco consumption.

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Fifty-six cases of leukoplakia of the lateral border of the tongue were examined histopathologically.
Of 56 cases of leukoplakia, 22 cases (39.3%) showed epithelial dysplasia.
The outline of rete process could be classified into the following three types; flattened type, elongating type and drop-shaped type. Epithelial dysplasia was rarely observed in the flattened type. However, 30% of elongating types and 92.9% of drop-shaped types revealed epithelial dysplasia.
In addition, the thickness of epithelium in leukoplakia were also examined in relation to epithelial dysplasia. The atrophic epithelium showed epithelial dysplasia more frequently than in the thickened epithelium.

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Eighteen extranodal non-Hodgkin's lymphomas of the head and neck except for Waldeyer's ring seen at our department from June 1976 to May 1988 were reviewed for their diagnostic problem, classification, pathological findings, treatment results and prognosis. Sites were located at nose and paranasal sinus in 7 cases, palate 5, parotid gland 3, sublingual gland 1, buccal submucosa 1 and larynx 1, respectively.
According to Ann-Arbor classification, 8 cases were Stage I, 5 Stage II, 2 Stage III and 3 Stage IV.
Histologically 14 cases (78%) in our series were classified following Rappaport as diffuse histiocytic, 3 nodular mixed and 1 diffuse lymphoblastic. Detection of the cell surface marker was available in 7 cases, resulting in 5 cases of B cell type, 1 T cell type and 1 Null cell type.
Biopsy had to be repeated more than twice in 2 cases to obtain the correct pathological diagnosis, because of necrotic debris at the nasal cavity and erosive inflammatory change at the parotid region. Thus, carefull removal of the biopsy specimens was of great importance, especially in differential dianosis of Wegener's granulomatosis and other malignancies.
Chemotherapy including ADM and VCR or combination with radiotherapy encompassing the wide field of affected site ranging basically from 40 to 50Gy as total dose were our initial treatment of choice. Relapse rate after the initial treatment was 10% in Stage I and II, whereas 80% in Stage III and IV. It suggested the necessity of the chemotherapy in addition to radiotherapy even in Stage I and II.
Ten years survival rate was 76% according to Kaplan-Meier's method, but relapse have happened in 2 cases over 10 years with bone marrow or other lymphnode involvement.
These results demonstrated importance of long term followup and difficulty in management of non-Hodgkin's lymphomas.

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44 cases of non-epithelial malignant tumors of the head and neck without malignant lymphoma at Department of Otorhinolaryngology, School of Medicine, Keio University from 1962 to 1988 were studied. The age which ranged from 5 months old to 77 years old was widely distributed as compared with head and neck cancer. 25 patients were males and 19 paeients were females. Most of tumors arose from paranasal sinuses and nasal cavity (22 cases from maxillary sinus, 12 cases from nasal cavity). Rhabdomyosarcoma (9 cases), malignant melanoma (9 cases), osteosarcoma (6 cases), neurogenous sarcoma (6 cases) were fequently observed pathologically. In several cases, repeat biopsies were required because their pathological diagnosis was very difficult. Biopsy was done more than twice in the nearly half of cases. Therapeutic procedure for these tumors included surgery, radiotherapy, chemotherapy, immunotherapy and they were used in combination. But surgery was mainly done because they were often resistant to radiation and anticancer drug. We considered effective therapy for rhabdomyosarcoma, malignant melanoma, osteosarcoma, neurogenous sarcoma, which were frequently observed, as follows.
rhabdomyosarcoma: surgery +chemotherapy+radiotherapy
malignant melanoma: surgery+chemotherapy+radiotherapy+immunotherapy
osteosarcoma: surgery+chemotherapy neurogenous sarcoma: surgery
The prognosis was poor with a five-year survival rate of 32%. The recurrent rate was 43% and that of neurogenous sarcoma (83%) was especially high. Metastasis was most frequently to lung and lymphnode. The causes of death in most cases were intracranial invasion and lung metastasis.

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30 cases of adenoid cystic carcinoma (ACC) in the head and neck region were studied. They were arising in 13 major salivary glands (parotid 5, submandibular 4, sublingual 4), 9 nose and paranasal sinuses (maxilla 3, maxilloethmoid 1, ethmoid 3, sphenoid 1, nasal cavity 1), 5 oral cavities (tongue base 2, floor of the mouth 2, palate 1), 1 larynx, 1 external auditory canal, and 1 unkown. The presenting symptoms were a mass without pain in 25%, mass with pain in 17.9%, and pain in 17.9%. Mean duration of symptoms was 22 months. Only three patients had Stage I, each seven patients had Stage II or III, and 13 patients had Stag IV. 23.3% of the patients died of disease, with a mean survival period of 44 months. Histologic specimens were reviewed and divided into 3 subtypes-tubular, cribriform, and solid. 3 patients had tubular subtype, 22 and 5 patients had cribriform and solid subtype. In 25 out of 28 treated cases surgery was done, with 9 of them considered as curative one. Combination chemotherapy with cyclophosphamide, adriamycin, and cis-platinum was done in 9 cases with a response rate of 11.1% (1/9). Radiation therapy was done in 8 cases in total with a response rate of 100% (2/2). Radiation therapy accompanied with chemotherapy containing cis-platium was done in 2 cases with a response rate of 50% (1/2). Cumulative survival rate for 5 and 10 year was 50% (8/16) and 16.7% (1/6) respectively. Factors which appeared to influence the clinical course included 1) presense or absence of metastasis, 2) clinical stage, with absenseof metastasis, and lower clinical stage to have better prognosis.

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Two cases of malignant melanoma (MM), with primary lesions in the nasal cavity and vestibule of the nose were successfully treated with local injection of interferon (IFN). Both cases showed complete response (CR). One case, MM of the nasal cavity was not responsive to DAV therapy and Linac radiotherapy. In this case, local injection of IFN was only effective. And this case had a CR after about 18 months and the number of local injections of IFN-α were 249 and the total quantity was 74, 700×10⁴ IU. The other case, primary lesion of the vestibule of the nose was treated only with local injection of IFN-β. This case had a CR after about 4.5 months and the number of local injections of IFN-β were 115 and the total quantity was 33, 880×10⁴IU. Primary treatment of MM is a wide range excision of the tumor lesion and its surrounding normal tissue. However, when this is not possible due to the diffcult location of the tumor, local injection of IFN may be successfully used in some cases.

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Total or segmental agenesis of the internal carotid artery is a rare anomaly. Cervical portion of the internal carotid artery was abscent in the right side of the patient who underwent radical surgery due to recurrent oropharyngeal cancer. Postoperative venous digital subtraction angiography revealed that the remaining intracranial portion of the internal carotid artery was normally patent and supplied blood flow via ipsilateral external carotid artery. Head and neck surgeon should be aware of such a vasucular anomaly to avoid a disastrous result caused by ligation of the extrenal carotid artery.

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Metastasis of thyroid cancer to the lateral retropharyngeal nodes is unusual. We present two cases of the metastatic spread of cancer of the thyroid to those nodes due to alteration of lymphatic flow resulting from multiple surgical derangement of its normal flow directions.
Case 1. A 66-year-old male patient had undergone surgical treatment for recurrent cancer of the thyroid five times during a 20-year interval. Bilateral cervical nodes were palpable and moreover, posterolateral wall of the mesopharynx was found to be swollen. A CT scan of the region disclosed tumorous masses to the retropharyngeal space. At surgery mteastatic extenstion of cancer of the thyroid to those lymph nodes was confirmed.
Cases 2. A 59-year-old female patient with twice operations for recurrent thyroid cancer in past 20 years complained of nasal obstruction and snoring. A lprge tumor was revealed at the posterolateral wall of the epipharynx extending to the mesopharynx. A CT scan highly suggested tumorous involvement of the prevertebral fascia and completionn thyroidectomy was carried out in association with I¹³¹ therapy.

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There have been many reports on the usefuless of chemotherapy involving cisplatin for squamous cell carcinoma of the head neck. Single radiotherapy has also achieved excellent therapeutic results. In the present study, combined treatment involving multiple drug therapy (including cisplatin) and radiotherapy was carried out in 102 previously untreated patients with squamous cell carcinoma of the head and neck. The total efficiency rate of treatment involving cisplatin at a dose of 100mg or more per body weight and an X-ray dose of 40Gy or more was determined, along with assessment of differences among the total efficiency rate during the period of chemotherapy, the efficiency rate in Stages III and IV and the rate of complete regression (CR) for these stages. The patients who underwent the simultaneous, combined treatment showed a better efficiency rate and CR rate than the patients who underwent the single treatment. These results indicate that the simultaneous, combined treatment was more effective than the single treatment from the viewpoint of the main purpose of combined treatment involving chemotherapy and radiotherapy, i.e., treatment of Stage III and IV carcinoma or radical cure.

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Between 1972 and 1985 one hundred and fifty-five patients with carcinoma of the lower gum were treated with radiation (30Gy/3 weeks) combined with bleomycin (90mg/3 weeks) or peplomycin (45mg/3 weeks). The average age of the 112 men and the 43 women was 62 with a range of 13-85 years.
Twenty-two patients with N2 or N3 disease were excluded and 133 patients (T1-2, N0-1: 80; T3-4, N0-1: 53) were reviewed. Seventy-seven (58%) patients obtained a complete response (CR) (T1, T2: 65%; T3, T4: 47%). Of these with CR, 52 (68%) patients were obseved without surgery. The 2-year local control rate for these patients was 62% (T1, T2: 68%; T3, T4: 43%) and 81% (T1, T2: 88%; T3, T4: 64%) including the patients with subsequent surgery for salvage for recurrence. This was similar results for 25 patients with surgery immediately after CR (88%). Higher CR rate (62%) was obtained for patients treated with BLM combined than with PEP combined (47%).

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Tumor-infiltrating lymphocytes (TIL) were obtained from 11 out of 31 head and neck carcinoma specimens (27 patients). TIL were cultured in medium containing recombinant interleukin 2 (IL-2). Also the peripheral blood lymphcytes (PBL) were obtained from same patients and cultured in IL-2. The cell proliferation, antitumor activity and phenotype of cultured TIL (lymphokine acitvated TIL, LA-TIL) and cultured PBL (lymphokine activated killer cells, LAK) were investigated.
TIL increased by 30-70 days after the initiation of culture ranged from 20.0-344.4-fold (average of 101.3-fold). It was larger than PBL.
LA-TIL had the higher cytotoxic activities, such as NK activity, LAK activity and autologous tumor cell cytotoxicity than LAK.
The vast majority of TIL were HLA-DR+ cells (activated T cells), and in some cases there were large numbers of CD8⁺ CD11^- cells (cytotoxic T cells.).
The proliferation and antitumor activity of LATIL was suppressed by auto-serum from patients. It was suspected that there were suppressive factors against TIL in the serum of patients.
TIL had much proliferative potential and autologous tumor cell cytotoxicity than LAK. So, it was considered that TIL were useful for the adoptive immunotherapy.

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The cellular immunity of the peripheral blood in 43 cases with the head and neck malignancy was analyzed before and after treatments including the surgical extirpation, irradiation and chemotherapy. As parameters of the cellular immunity, lymphocytic blastogenesis (PHA, Con A) and monoclonal antibodies of the lymphocyte subsets (Leu 1, 2a, 3a, 11 and 3a/2a) were employed and these parameters were examined before treatment, after preoperative or radical irradiation and then, 2 months, 3-6 months, 7-12 months and more than 13 months after the completion of the treatment. The results were as follows.
1) All kinds of monoclonal antibodies were significantly decreased after the irradiation therapy.
2) In advanced cases with the tumors of stage 3 and 4, the ratio of Leu 2a/Leu 3a were significantly lower than that in the early cases of stage 1 and 2 before and after the treatment.

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Biopsied cancer tissues from 33 patients with primary squamous cell carcinoma of the oral cavity were examined immunohistopathologically as to the responsiveness of the host against its own cancer cells. We have previously reported that T-cells were predominant over B-cells, and T-cells surrounded the cancer nests, infiltrated at the marginal parts of the cancer nests. We have also noted that the grade of T-cell infiltration in the biopsied specimens at time of diagnosis correlated well with the size of tumor, and the existance of cervical lymph node metastasis. All patients were treated by induction chemotherapy and surgery and were followed up for 5 years. Twenty-five patients were alive 5-years after surgery, 5 patients had died of their cancer and 3 patients had died of intercurrent disease.
In the present study, we have attempted to determine whether the grade of T-cell infiltration at around tumor margins is related to the clinical outcome after surgical excision of the primary tumor and prognosis, retrospectively, Recurrence rate was 14.2% for patients with marked T-cell infiltration, 33.3% for patients with moderate T-cell infiltration and 50.0% for patients with none or slight T-cell infiltration, although the differences noted were not statistically significant because of the small sample size. Patients with marked T-cell infiltration at the tumor margins achieved 100% determinate 5-year survival rate which is better than for patients with moderate, and none or sight T-cell infiltration. Thus, increased grade of T-cell infiltration in the tumor tissues at the marginal parts of the cancer nests was associated with a more favorable prognosis. These results suggested that T-cells might inhibit the development and spreading of the cancer cells.

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Adoptive immunotherapy was applied to 2 maxillary cancer cases and 1 lingual cancer case (squamous cell carcinoma). Peripheral blood lymphocytes obtained through leukapheresis were cultured for 3 days with allogeneic tumor cell line originated maxillary squamous cell carcinoma, and further incubated in recombinant interleukin-2 (rIL-2) to generate allogeneic tumor and lymphokine activated killer (Allo-TLAK) cells. AlloTLAK cells were infused directly into the maxillary artery for the maxillary cancer cases and into the lingual artery for the lingual cancer case. Tumor staged as T3 of one maxillary cancer case completely disappeared after infusion of 4.5×10⁹ AlloTLAK cells. Objective tumor regression was observed in the other maxillary cancer case after infusion of 2.74×10⁹ AlloTLAK and 0.76×10⁹ ATLAK cells. After completion of adoptive transfer of these cells, total maxillectomy was performed. Tumor size of lingual cancer was markedly reduced from T3 to T1 in clinical estimation after infusion of 2.9×10⁹ AlloTLAK cells. This case underwent surgery to remove 1/3 of the tongue along with radical neck dissection. Surgically resected tissues of maxillary cancer and lingual cancer were histologically examined. They revealed tumor degenetration with infiltration of lymphocytes, scavenger macrophages. Side effects were minor. Such as, a slight fever and blood eosinophilia.

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CT scans are able to clearly reveal the extent of carcinoma of the nasopharynx (NPC), so the correct area to be treated is easily determined. Radiation therapy has been and still is the primary treatment for NPC at the authors' institution and most of others. However, CT scans showed that NPC did not always disappear after 60Gy irradiation. We applied surgical treatment to eradicate such residual tumor through a transpterygoid approach. Five patients were operated with this method. One of them died of multiple bone metastases while others are alive with no evidence of disease. Surgical technique of this operation was presented.

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Radiation therapy for early laryngeal carcinoma has produced excellent results. In some cases, however, radiation resistant carcinoma and radiation failures, partial laryngectomy is suitable.
Forty-two patients oft of 402 goottic carcinoma (8.2%) who underwent vertical partial laryngectomy between 1962 and 1981 in National Cancer Centrer Hospital were reviewed.
Primary cases weve 33 patients, radiation failures were 6 and radiation injuries were 3.
In primary cases, 16 patients were T1N0, 8 were T2N0 and 9 were T3N0 at the time of diagnosis. Subgroup of vertical partial laryngectomy, frontolateral was 27 patients, anteriorfrontal was 2, cordectomy was 2, vertical hemilaryngectomy was 2. Four patients suffered local recurrence between 6 and 36 months after initial treatment, but all were salvaged by total laryngectomy. Three patients produced cervircal metastasis within 6 months after initial treatment. Upper deep cervical lymph nodes metastasis were 2 patients and middle cervical 2. All of them were conrolled by radical neck dissection for over 5 years.
Five years crude survival rate was 87.9% (29/33) in primary cases.
Nine cases of fixed true vorcal cocd (T3) were treated by extended frontolateral partial laryngectomy and vertical hemilaryngectomy. If there is few functional troubles, these procedured were occasionally useful for T3 glottic cacinoma. In radiation failures, all of them were rT1N0 at the time of recurrence, and were salvage by partial laryngectomy and following treeatment without major complications. Vertical partial laryngectomy was considered one of the optimal treatment as a salvage surgery for early glottic carcinoma.
Radiation injuries were healed by vertical partial laryngecttomy.

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The patient was a 23-year-old female with adenocarcinoma of nasal cavity. Previously she had resection of tumor by transal approach. But she visited our hospital because of recurrence of tumor. From findings of CT, MRI, and X-P examination performed prior to the reoperation of this time, it was confirmed that the tumor invaded the anterior skull base. The tumor was removed by combined craniofacial approach, and a defect of 3×1.5cm in size was formed in the anterior skull base. An axial galeo-p eriosteal flap, which was based on the superficial temporalartery, was applied for reconstruction of skull base. Moreover a part of the outer-table of calvarial bone attached with the flap was used for bone reconstruction of skull base. After that, from the nasal side, split-thickness skin graft was sutured to the inferior surface. Postoperative results was successul and she was discharged without complication after 6 weeks.
It is considered that this surgical technigue i suseful for reconstruction of defecet in the anterior skull base.

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Posttherapeutic courses of 18 fresh cases of parotid cancer were analyzed. 5 year cumulative and crude survival rate were 56.7% and 63.6%, respectively and 10 year cumulative survival rate was 45.4%. The most frequent causes of death were distant metastasis and local recurrence. Prognosis of the cases with facial nerve paralysis and/or cerviacl lymph node metastasis was remarkably poor. Depending upon histopathological type and extension of the tumor, postoperative radiotherapy combined with chemotherapy was assumed mandatory.
Cosmetic and functional results were evaluated in 8 cases in which postoperative defects after extended total parotidectomy were reconstructed with cervical flap, DP flap, pectoralis major mc flap (PMMC), free rectus abdominis mc flap (RAMC) and free rectus abdominis muscle flap (RAM). Merits and demerits of each flap were as follows. DP flap is superior in color match but is inadequate to fill up the large and deep wound. PMMC is useful in filling up the deep defect and its color match is fair. The demerit is the secondary atrophy of the muscle, the degree of which is unpredictable. RAMC is superior in filling up the deep defect. However it is poor in color match. RAM is the first choice in female subjects who had extended total parotidectomy leaving the facial skin intact. Muscle flap can fill up the large defect adequately and regeneration of the grafted nerve may possibly be facilitated by covering the nerve with richly vascularized muscle.

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Since 1980, we have clinically applied an apatite porous block used as synthetic bone for the reconstruction of mandibular defects. Of the 27 cases treated with this method so far, in recent three years seven cases underwent bridge substitution after segmental resection in which a titanium mandibular reconstruction plate we developed was used for the apatite block. These seven cases were examined.
In a 73-year-old female (M area) examined by autopsy, apatite and bone were completely fussed two years after operation. The histologocal examination of the specimen also revealed fusion of the apatite and bone and new intraporous bone formation in the apatite.
In a 35-year-old male (M area) a mandibular reconstruction plate was removed one year and ten months after operation. The reconstructed mandible is functioning normally. Bone scintigraphy (^99mTc) was useful for the observation of the postoperative clinical course in these two cases. In conclusion, the results of our case study support the effectiveness of our technique for the reconstruction of mandibular defects with apatite porous block using a pure titanium mandibular reconstruction plate.

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Thirty-three patients with squamous cell carcinoma of the upper gingiva and alveolus who were treated at the Department of Oral Surgery, Hokkaido University during 1972-1987 were reviewed in detail. Age range from 31 to 82; 15 males and 18 females. The staging of patients according to the 1978 UICC classification of malignant tumors was as follows: Stage I: 3 cases, Stage II: 10 cases, III: 3 cases, and Stage IV: 17. Twenty-nine patients underwent surgery alone or combined with other therapies for the primary lesion. Four patients received radiation therapy alone. The 3- and 5-year actuarial survival rate were 62.4 percent and 48.8 percent each. In 13 patients, primary tumor recurred after the initial therapy. Regional lymph node metastasis was present in 11 cases at the start of treatment and 2 other cases during the course of treatment. In total, twelve patients died of local failures and/or regional nodal disease with or without distant metastasis.

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We retrospectively examined 26 patients with mesopharyngeal cancer treated in our institution between 1981 and 1988, to evaluate prognostic factors in our planned combined therapy.
The combined therapy, in most instances, consisted of planned preoperative irradiation, totalling 30Gy, and intravenous chemotherapy using 5-fluorouracil, followed by an en bloc tumor resection, radical neck dissection, and primary reconstruction.
The overall 5-year survival rate was 48.8%. The most frequent cause of treatment failure was local recurrence, seen in 4 of all patients. The histopathological effect of preoperative therapy for the primary site was Grade IIa or IIb in accord with the patients who had had local recurrence.
To improve the results of therapy, more intensive preoperative irradiation or chemotherapy, and more extensive tumor resection are necessary especially in advanced cases. Furthermore, it is necessary to control other diseases such as those observed in 40% of 10 patients who died whthin 5 years.

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During the 10 years period from 1977 to 1986, 102 fresh cases of nasal and paranasal cancers were treated in the Department of Otorhinolaryngology, Chiba University, School of Medicine. 28 patients were above 70 years old. Out of them, 24 had maxillary cancer and the remaining 4 patients had cancer of other sites. 54% of patients with maxillary cancer above 70 years old were Stage IV cases in contrast to 37-38% of them bellow 74 years. Out of these 28 patients above 70 years old, 18 patients had pre-treatment medical complications. Cardiovascular complications were most frequent. Maxillectomy could not be done in 7 cases due to severe complications. The incidence of maxillectomy performed was 21.4% in elderly patients in contrast to about 90% in younger age group. The 5-years crude survival rate were 15.9% in patients above 74 years old (28 cases)and 60.7% in the younger group (74 cases). The survival rate of patients without maxillectomy in elderly patients were zero. So it is better to perform maxillectomy even in case of elderly patients as much as possible after treating the complications, if any.

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In recent years, elderly patients with cancer of the head and neck region have been increasing. However, it is not rare that treatment of these cases is impeded by the patient's general condition, complications, environments and advancing age. In 31 fresh cases of cancer of the head and neck region who visited our department at the age of 80 years or more during the past ten years, we analyzed the problems encountered during treatment. These 31 cases accounted for 4.6% of the total 696 cases of head and neck cancer treated at our department over the past ten years. They consisted of 26 males and 5 females. The primary site of cancer was the larynx in 12 cases, the oral cavity in 8 cases, the hypopharynx in 5 cases, the nasal and paranasal cavities in 4 cases, the rhinopharynx in 1 case and the parotid gland in 1 case. We applied radiation therapy to 17 cases, surgical treatment to 5 cases, radiation+surgical treatmentto 1 case and palliative treatment to 8 cases. Primary control was achieved in 19 cases (83%). We think that radical treatment should be actively applied even to elderly patients unless it is impossible.

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Cisplatin (CDDP) is a useful chemotherapeutic agent for head and neck tumor. However, it has many side-effects, of which the renal toxicity is well known. In an attempt to reduce the renal insufficiency of CDDP, we applied the 5 days post-hydration procedure on this study.
We studied 22 patients as head and neck tumor, who were treated with CDDP in our hospital from July 1986 to February 1988 after confirming normal values of NAG, BUN, 24h Ccr and GFR on pre-treatment examination.
The CDDP treatment methods were as follows: Group-A were treated by single injection of CDDP, which were given 2000ml/day as a posthydration or 2000ml/day×5 post-hydration. Group-B were treated by three injections of CDDP which had similar post-hydration as was in A-group. The total dose in Group-A was 50mg/m² and in Group-B was 90mg/m². We used NAG for the index of recovery score of renal function. We measured NAG before using CDDP, every day to 7 days after, the treatment and from 8th day measured it every other day.
Mean days necesary for NAG value to return to nomal in each group are as follows:
1) 8 cases of group-A which received one day post-hydration required 8.0 days. 2) 6 cases of group-A which received 5 days post-hydration required 5.5 days. 3) 3 cases of group-B which received one day post-hydration required 7.3 days. 4) 5 cases of group-B which received 5 days post-hydration required 2.4 days.
From above results, we found that NAG in 5 days post-hydration group had a tendency to recover earlier. In conclusion, we can safely say that using post-hydration for long periods would reduce the renal insufficiency caused by CDDP moreover it will restore renal function.

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It is reported that sometimes there are mature adipose tissue within the parenchyma of the thyroid gland, which is the result of the aberrant parathyroid gland. But mature adipose tissue within the thyroid nodule (called “Adenolipoma or Thyrolipoma”) is very rare. We found only nine definite cases of adenolipoma of the thyroid in the literature. Recently, we have experienced three cases of adenolipoma of thyroid gland. These cases are all females of 70, 58 and 53 years old. The pathogenesis of this entity is uncertain; the common hypothesis is development from adipose tissue incorporated within the gland during embryogenesis. But, The theory of adipose metaplasia of the stromal mesenchymal cells has also been reported.

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In 103 cases of thyroid tumors, we examined imagimg of thyroid tumors with Tl scintigraphy, ultrasonoraphy, and CT scan.
1) Hisopathological examination showed cancer 51 cases in (43 papillary carcinomas, 4 follicular carcinomas, 3 anaplastic carcinomas, 1 squamous cell carcinoma), and benign tumors 52 cases in(26 adenomas, 20 adenomatous goiters, 6 cysts).
2) Ultrasonography were most useful examination for differential diagnosis between benign and malignant tumor in nodular goiter.
3) Tl scintigraphy gave effective imformation in the determination of appearance of neck lymph node metastasis of thyroid carcinoma.
4) In cases of advanced thyroid carcinoma with tracheal invasion, CT scan were useful for evaluation of extent of the tumor in the preoperative diagnosis.

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The relation between histlogical type of adenoid cystic carcinoma and its clinical prognosis was investigated in 16 patients, who were treated in the authors' clinic for the past 10 years.
Most of the patients were female, and sex ratio was 11:5. Age ranged from 19 to 78 years, and the mean age 56.5 years. Tumor was found in the parotid gland (5 cases), submandibular gland (3), palate (3), ear (1), nasal cavity (1), palatinet onsil (1), lingual tonsil (1) and larynx (1).
All the patients were treated surgically, and the removed tumors were classfied hstologically into the solid, tubular and cribriform type. Among these three types, the solid type showed the worst prognosis. The tubular type and cribriform type showed better prognosis as compared with the solid type. However, good results of treatment could not be obtained in tubular and cribriform type when they were with minimum tissue of the solid type.
In order to decide weh clinial prognosis, it was very important to examine the whole section of specimen, carefully. Even if the minimum amount of the solid type tumor was noticed in the specimen, the treatment of this patient should be performed more carefully for the prevention of recurrence.

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The epithelial-myoepithelial carcinoma is generally thought to originate in the intercalated portion of the ductal structures and constitutes about 0.5% of all epithelial salivary gland tumors. A case of epithelial-myoepithelial carcinoma arising in the parotid gland is reported. The patient is a 61 year-old woman, who complained of a mass in the left infraauricular region for five years. The size of the mass was about 7.5×6.5cm. The patient underwent extended total parotidectomy with postoperative irradiation of 60Gy. Histopathological and immunohistochemical examinations established a diagnosis of epithelial-myoepithelial carcinoma. The patient has been followed-up on outpatient bases and is free from local recurrence.

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Three cases of the pleural effusion complicating radical neck dissection were reported and discussed.
Radical neck dissection was performed on the left side neck and thoracic duct was injured intraoperatively in every 3 cases.
In 2 cases, extra cellular Sudan III positive granules were found in pleural effusion. In 1 case, lymphangioscintigraphy showed accumulation of radio activity in the thoracic cavity.
Therefore, pleural effusion seemed to be the accumulation of chyle or thoracic duct lymph.
All 3 cases were healed by the conservative treatment without further complication.

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Ultrastructures of intracytoplasmic granules were studied in granular cell tumors arising from the tongue and back skin. The granules could be divided into 1) primary lysosomal granules, 2) secondary lysosomal granules, 3) multivesicular bodies, 4) myelin-like bodies. Ultrastructural and immunohistochemical results indicate that these granular cells are derived from Schwann cells. It is also suggested that there are metabolic disorders of myelin protein which cause lysosomal dysfunction in the granular cells, and that abundant vesicles in the multivesicular bodies may be related to the formation of both myelin-like and angular bodies. It is tentatively concluded that this lesion is a neoplastic hyperplasia of cells possessing a tendency of differ entiation to Schwann cells.

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We have encountered four cases of submandibular gland tumor, where ultrasonography was useful as a screening examination.
Case 1 and 2: The clinical diagnoses of them were chronic sialadenitis of the submandibular gland. However, ultrasonographic examination suggested the presence of submandibular gland tumor.
Case 3: A mentally retardated patient could only be examined by ultrasonography. The findings revealed tumor of the submandibular gland.
Case 4: The patient was referred to our hospital for suspicion of Sjögren's syndrome. The submandibular gland tumor was accidentally disclosed on routine ultrasonographic examination of the parotid and submandibular gland. All cases had a tumor size of about 10mm in diameter.
Ultrasonographic examination is simple and can disclose the presence of even a small lesion in the salivary gland. The ultrasonography is appropriate method as a screening examination for the submandibular region.

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A randomized controlled study was tried on the squamous cell carcinoma cases in head and neck in order to evaluate the value of long course administration of OK-432 at 10 hospitals. Cancer cases in the pharynx, maxillary sinus, tongue and larynx with stage III and IV were chosen as the subject of the investigation, and divided into two groups as followes: one hundred and two cases were in short course group and administered OK-432 for less than 6 months, and one hundred and seven cases were in long course group and administered OK-432 for more than 3 years. The back ground factors such as the sex, lesion, stage, initial cancer treatment method and it's results were not different between these two groups.
The long course group showed better survival rate up to 2 years (p<0.05) and longer disease free interval up to 2 years (P<0.10) as compared to the short course group. The rate of OKT-3 positive T lymphocytes in the long course group showed lesser decrease as compared to the short course group. The ratio of OKT-4/8 groups were decreased equally in both groups after 18 months of treatment of cancer. These results suggest the clinical effectiveness of longterm administration of OK-432.

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We report a 66-year-old female with multiple primary malignant tumors: malignant lymphoma, transitional cell carcinoma of the urinary bladder, adenocarcinoma of the colon and anaplastic carcinoma of neck originated in the unknown site. Firstly, the patient was treated with antitumor agents for malignant lymphoma. During the course of treatment, carcinoma of the bladder was found by urologidt since hematuria occurred, and she was also treated with ⁶⁰Co irradiation after intra-arterial infusion of CDDP for carcinoma of the bladder. Nine months later, swelling of cervical, intraperitoneal and inguinal lymph nodes were noticed, and some of them were metastasis of anaplastic carcinoma, but the origin of them was unknown. Additionally, she complained of fullness of lower abdomen, and endoscopic examination revealed the carcinoma of the colon, and died of cachexy on 30 months after initial chemotherapy.
We have had 51 cases of multiple primary tumors of the head and neck in our Department from 1978 to 1987. The incidence rate of these patients in all the cases with head and neck tumors was 5.9%, and it was higher than those reported elswhere. The clinical problems concerning diagnosis and treatment for multiple malignant tumors was discussed briefly.

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The Plummer-Vinson syndrome is payed attention as the precancerous lesion of the hypopharyngeal and the cervical legion of esophagus, but that of tongue is uncommon. We report here the squamous cell carcinoma of the dorsum of tongue seems to be derived from the glossitis of Plummer-Vinson syndrome. The case was a female, fifty-four years old, who visited our department because of the lingual pain in 1985. After the examination of blood and isotope labeling, she was diagnosed as having Iron deficiency with both anaemia and tissue damage (IDAD). The main treatments were alimentary therapy and intravenous administration of iron. After the treatment the symptoms except atrophy the papillae lingualis atrophy were almost improved. So, after she was followed up in the city hospital. Six months laterfrom the end of the treatment, as she was pointed out the lingual tumor, she visited our department again in 1987. The induration of 35×25×5mm in size was palpable at the same site of dorsum of tongue as previous lesion. The result of biopsy was welldifferentiated carcinoma. After chemoterapy, irradiation and hyperthermia, biopsy repeated several times proved to be no malignancy. So she is being followed up now.
Not only Plummer-Vinson syndrome but also IDAD and the iron deficiency with tissue damage without anaemia (IDD) may be the precancerous lesion in view of the fact the glossitis due to iron deficiency preceeded cancer in this case. Therefore we think that the suitable diagnosis, early treatment of IDAD and IDD are very important.

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Squamous cell carcinoma of the tongue is the most common malignant lesion seen in the oral cavity. The lesion of the anterior two-third is usually predominant in cases of adults over 40 years of age, and the occurrence of similar carcinoma in younger adults is thought to be quite unusual.
As the etiological factors of the lesion, consumption of alcohol or tobacco, chronic irritation from jaggy teeth and dental appliance and many other things have been pointed out by many authors. But, none of these factors have been clearly identified in younger adults with the lesion.
The lesion predominantly occurs on the lateral border of the tongue having been stimulated by chronic mechanical irritation, so it is possidle that adjacent natural teeth and dental prostheses relate to its occurrence.
During the 10-years from 1978 to 1987, 65 younger adult patients with squamous cell carcinoma of lateral border of the tongue visited the department of Head and Neck Tumor, Cancer Institute Hospital. In many of them, it is suggestive that the chronic irritation from teeth may promote the occurrence of the lesion.
For this reason, we examined those patients particularly about the presence of poor dentition. Especially about the cases with no missing tooth on the affected side, taking impression of the lower dental arch and making plaster study models, we analysed abnormal lingual inclination and lingo-version of teeth using the models. So, in many of the cases, poor dentition could be found and we suspect that this factor might promte the early onset of squamous cell carcinoma on the lateral bordes of the tongue.

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