Recombinant interleukin-2 (rIL-2) has been administered locally in 20 patients with head and neck cancer. Two complete response (CR) in lower lip cancer and one partial response (PR) in lingual cancer has been obtained.
Intraarterial chemotherapy, performed subsequent to the local use of rIL-2 results in a dramatic decrease in tumor size within a short time, and a high frequency of CR cases is observed.
Local use of rIL-2 is beneficial for treatment of head and neck cancers, and neo-adjuvant immunochemotherapy combining locally used rIL-2 and arterially infused anticancer drugs plays animportance role in a multidisciplinary treatment for these cancers.

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This video shows diagnostic images and craniofacial surgery of the neurinoma detected in a 49-year-old woman, arising in the superior orbital fissure.
Images shown are Rhese's view, tomograms of the superior orbital fissure, CT, 3-D CT, MRI and DSA, which reveal the tumor occupying the superior orbital fissure. It extends into the orbit extradurally and likes to be neuroma rather than meningioma.
Craniofacial surgery for the complete resection of the tumor was performed. An extended frotozygomatic approach was adopted as one of the craniofacial methods. After the frontotemporal craniotomy and the rescetion of a frontozygomatic bony complex, orbital roof was removed for making good exposure of the superior orbital fissure. After complete resection of the tumor, a two-devided pericranial flap was prepared; one was inserted into the cavity from which the tumor was removed and the other in the frontal sinus to protect the intracranial infection.
The patient had no postoperative complications. Visual aquity was improved from light perception to 0.01.

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This study presents the clinicopathological data on 34 cases of adenoid cystic carcinoma (A. C. C.) of the head and neck for past ten years in Tokyo University Hospital. 9 cases were arising in nasal cavity and paranasal sinuses, 8 in parotid gland, 2 in submandibular gland, 9 in oral cavity (3 in floor of the mouth, 3 in palate, 3 in tongue), 6 in other regions. 20 of 34 cases were recurrent. 5 year survival rate was 50%, and 10 year survival rate was 35%. The prognosis of A. C. C. was poor. According to the predominant pattern on histologic examination, A. C. C. was classified to two subtypes, 17 cases of cribriform type and 17 cases of solid type. 5 year survival of cribriform type was 67%, but one of solid type was 29%. The prognosis of cribriform type was significanely better than that of solid type. The sites of origin were closely related to the prognosis. The origin of major salivary glands trended to be better than the others. Chemotherapy (CDDP+THP+CPX) was effective for several cases. Especially, combined chemo-radiotherapy was available of elongation of the life time.

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After single cell suspensions were prepared from formalin-fixed paraffin embedded tissues, the DNA contents were analyzed by flow cytometry in 39 parotid tumors. Nine cases of pleomorphic adenoma, 11 of adenolymphoma, 7 of mucoepidermoid tumor, 3 of acinic cell tumor, 2 of adenoid cystic carcinoma, 4 of carcinoma in pleomorphic adenoma, and 3 of squamous cell carcinoma were examined in this study. DNA index and the proportion of the cells beyond 4SD of G₀/G₁ peak (%>4SD), that indicates proliferative activity of tumor cells, were analyzed.
The results were as follows: 1) The incidence of aneuploidy was higher in the cases of carcinoma in pleomorphic adenoma and squamous cell carcinoma than in benign cases, but there was no stastical significance. 2) The DNA ploidy is not apparently correlated with clinical prognosis.
3) The proportion of the cells beyond 4SD was significantly higher (p<0.05) in the cases of mucoepidermoid tumor, carcinoma in pleomorphic adenoma, and squamous cell carcinoma than in benign cases. 4) Five of 11 patients with high proportion (≥20%) of cells beyond 4SD died of local recurrence and/or distant metastasis within 2 years after the surgery. These results indicate that the proportion of the cells beyond 4SD had good correlation with pathological diagnosis and clinical prognosis of paratidt umors.
It is concluded that the analysis of nuclear DNA contents using paraffin embedded tissues by flow cytometry may give us a useful information on biological behavior and clinical prognosis of parotid tumors.

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A 62-year-old man visited our clinic complaining of abnormal sensation of the throat and a painless tumor in the left upper neck. Examination revealed a large, elastic firm tumor growing from the left submandibular gland region and extending widely to the left parapharyngeal space. A diagnosis of a submanibular gland tumor extending to the parapharyngeal space was made and the tumor was surgically excised through an external neck incision. Six months later, this tumor recurred at the lateral upper neck, which was removed via the same approach as previously done. Histological examination showed “polymorphous adenocarcinoma” arising from the submandibular gland.
The tumor recurred again at the same upper neck so that the patient received radiation therapy for a total of 60Gy to the primary site of the neck, which was followed by chemotherapy of the combination of Cisplatin and 5FU. The response of the patient to these therapeutic measures was quite remarkable and the tumor completely disappeared several months later.
The clinicopathological characteristics of polymorphous adenocarcinoma of the salivary gland are discussed with a review of the literature.

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The distibution of laminin, type 4 collagen and fibronectin in the head and neck carcinoma tissue were examined using immunohistochemical technique (avidin-biotin-peroxidase complex method). We examined 28 primary lesions of head and neck carcinomas before anticancer therapy, and 11 lymph node metastatic lesions with or without preoperative anticancer therapy. Both laminin and type 4 collagen were observed between the carcinoma cell clusters and the surrounding connective tissue. But unlike normal epitherium, they appeared discontinuous, partial or absent in most of the cases. They were observed around the endothelial cells of vessels. In 3 cases no laminin nor type 4 collagen were seen around carcinoma cell clusters. Type 4 collagen was sparesly observed in the connective tissue surrounding carcinoma cell clusters, whereas fibronectin was observed diffusely. Ratio of the length of lamini-positive parts to the entire circumeference of carcinoma cell clusters were measured on a light microscopein each case. Primary lesions of pharyngeal carcinoma and lymph node metastatic lesions had lower ratio than other primary lesions. Primary lesions with the rapio lower than 80% had clinically obvious or subclinical lymph node metastasis, whereas those with no lymphnode metastasis had the ratio higher than 80%.

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During the 21 years period from 1966 to 1987, 175 fresh cases of elderly patients with cancer of oral and mesopharyngeal region were treated in the Department of Otorhinolaryngology, Kobe University, School of Medicin. We analyzed their treatment and prognosis etc. These 175 cases accounted for 24% of the total 742 cases of oral and mesopharyngeal cancer treated at our department during the same period. The primary site of cancer was tongue in 70 cases, tonsil in 19 cases, floor of mouth in 19 cases, etc. The rate in Stage III and IV is 69%. We applied radical treatment to 111 cases (radiation therapy to 85 cases and surgical treatment to 26 cases). The survival rate was different between Stage I-III and Stage IV and otherwise between the cases bellow 80 years and above 80 years. We think that the cases in Stage I-III and bellow 80 years should be applied radical treatment as same as the cases bellow 70 years.

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For the purpose of studying the changes classified by benign and malignant tumors of microheterogeneity of thyroglobulin (Tg) existing in the thyroid tumor, we were able to easily isolate 19STg (mol. wt. 669KDa) and its 12S subunit (mol. wt. 339KDa) from the thyroid tumor, using the system of HPLC. There are two kinds of 19STg, one of its covalently linked with two 12S subunits and the other of its non-covalently linked with them. In order to dissociate 19STg of noncovalently linked type to 12S subunits, it was considered that pH of buffer solution as the elution condition of HPLC and electrophoretic condition of PAGE might be participated. However, in the case of Tg isolated from the thyroid tumor, the containing ratio of 19STg of noncovalently linked type was high, because of the decline of iodine content, therefore, it seemed that isolation of 19STg without containing any of 12S subunits was difficult by auther's method.

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Fourteen cases of maxillary sinus cancer (T₁) were clinically studied. There were 9 males and 5 females with a mean age of 56.7 years. Major, initial symptoms were epistaxis, bloody rhinorrhea and buccal pain. The mean duration of illness was 7.4 months. Plain nasal X-ray disclosed unilateral pathologc shadows in 11 cases and bilateral pathologic shadows in 3 cases. In 9 cases, the cancer was detected by exploratory surgery. In the remaining 5 cases, the tumor was initially regarded as benign, and was later diagnosed as malignant based on pathological examination of tissue collected during operation. The tumor was located in the maxillary ostium region in 10 cases and the upper lateral region in 2 cases, while in 2 cases the site of tumor was unknown. Eight cases were treated by radiation therapy (including intra-arterial chemotherapy). Two cases were treated by radiation therapy plus operation, one case by operation, and the remaining three cases by a combination of radiation therapy, intra-arterial chemotherapy and operation. Tumor recurred in 3 cases.
These results indicate that exploratory surgery is recommended for early detection of maxillary sinus cancer in patients presenting with a unilateral pathologic shadow of the maxillary sinus and 6 months longer of epistaxis, bloody rhinorrhea or buccal pain, and that this cancer should be aggressively treated even when it is at an early stage.

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The middle cranial base is a difficult area in which to gain wide surgical access because of anatomical complexity. We presented two cases with middle cranial base tumors.
The first case presented with a neurinoma originated from the parapharyngeal space which extended into the middle cranial cavity through the oval foramen. The operation was performed with the combined intracranial and extracranial approaches. In the extracranial part, the anterolateral transfacial approach was employed. The zygoma was reflected with preservation of the attachment of the masseter. After the resection of the tumor, the zygoma was replaced using miniplates. The postoperative facial deformity was acceptable for the patient.
The second case presented with a chordoma which originated from the clivus and extended to the nasopharynx and nasal cavity. However, the tumor did not invade into the intracranial cavity. The operation was performed under the anterior transfacial approach. After the osteotomy of the maxilla and palate, this bone complex was reflected to the lateral direction with the preservation of its vascularity. The tumor was widely exposed and subtotally extirpated. Finally, the transsected bone complex was replaced and the facial contour was satisfactorily preserved.
Many different approaches to the middle cranial base have been advocated. We classified these approaches into three groups. The first one is the anterior approach and this is also subdivided into the transantral, transoral and transmandibular approaches. The second one is the anterolateral (transzygomatic) approach. The final one is the lateral approach which includes the infratemporal fossa and transcervical approaches. From our clinical experience and a study of the cadaver dissection, it was confirmed that a wide surgical access to the middle cranial base can be obtained by the anterolateral and infratemporal fossa approaches. However, the approach should be selected by a size, direction of the extension and a histological diagnosis of the tumor.

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Between 1972 and 1986 eighty two previously untreated patients with squamous cell carcinoma of the cheek mucosa were treated at Osaka University Hospital. Of these sixty four (78%) were treated with irradiation (30Gy/15fr/3 weeks) combined with bleomycin (90mg/6fr/3 weeks) or peplomycin (45mg/9fr/3/ weeks, 60mg/6fr/3 weeks). Eighteen were treated with irradiation alone. TN classification was for the combined treatment group; T₁: 7, T₂: 34, T₃: 18, T₄: 5, N₀: 39, N+: 25, for irradiation alone group; T₁: 1, T₂: 10, T₃: 5, T₄: 2, N₀: 10, N+: 8. Five-year disease free survival rates were 73% for the combined treatment group and 67% for irradiation alone group. Excluding patients followed by surgery immediately after irradiation, two-year local control rates were 80% for 46 cases of combined treatment group and 57% for 14 cases of irradiation alone group. After 30Gy of irradiation combined with bleomycin or peplomycin all cases achieved at least partial response. Complete response rates after the combined treatment was 52% (T₁: 7/7; T₂: 19/34 (56%); T₃: 6/18 (33%); T₄: 1/5). Two-year local control rate of the CR cases after the combined reatment was 25/32 (78%). Excluding four cases followed by surgery immediately after CR, two-year local control rate was 22/28 (79%). Five of the six recurred cases were salvaged with surgery, so local control rate after salvage was 27/28 (96%) for CR cases without immediate surgery. For PR cases 10 were treated with further irradiation, 11: surgery, 2: irradiation and surgery, obtaining two-year local control rate of 16/25 (64%). Two of the recurred cases were salvaged with surgery.

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A total of 87 patients with nasopharyngeal carcinoma were retrospectively reviewed from 1970 to 1989. 68 patients were males and 19 patients were females. The mean age was 48 years old. Histologically poorly differentiated squamous carcinoma (35 rases) and undifferentiated carcinoma (20 cases) were frequently observed. There were 73 patients with stage III and stage IV.
From 1982, to 1989, 24 patients received neo-adjuvant chemotherapy (NAC) followed by radiation which consisted of cisplatin-peplomycin (12 cases), adriamycin-cisplatin-peplomycin (5 cases), peplomycin-adriamycin-cyclophospha mile (5 cases), vincristine-methotrexate to-peplomycin (1 case) and cisplatin analogue (1 case). They were performed 2 coureses. An over all response rate of 71% was high. A five year survival of patients with NAC and without NAC were 44.7%, 45.3% respectively. Survival was not significantly improved in patients with NAC as compared those without NAC.

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We evaluated the efficacy of leucovorin calcium (LV) on cell lethality induced by 5-fluorouracil (5-FU) alone or in combination with cisplatin (CDDP) by using HEp-2 laryngeal squamous carcinoma multicellular tumor spheroids (MTS) system. For LV, non-toxic concentration of 10^-5M was used.
For cells in monolayer, 6 and 24 hours exposure to LV increased 5-FU-induced cell lethality approximately 7-and 2-fold, respectively, whereas LV did not influence the effect of 5-FU for MTS. LV's lack of effect on cells in MTS may be interpreted to mean that LV can not penetrate the MTS. For monolayer, simultaneous exposeto 3 drugs, CDDP, 5-FU and LV produced synergistic interaction. However, sequential exposures were marginally synergistic or antagonistic, irrespective of sequence of CDDP first or last. In contrast, CDDP followed by 5-FU plus LV was most synergistic for MTS. Simultaneous exposure was also synergistic, however, 5-FU plus LV followed by CDDP was antagonistic. These results suggest that LV is unable to penetrate into the MTS core to potentiate 5-FU activity. CDDP appears to have enhanced LV penetration into the MTS core. Clinical and pharmacological trials of CDDP first followed by 5-FU plus LV for head and neck squamous cell carcinoma are warranted. The exploration of means to overcome limited penetration of LV appears important for successful treatment of head and neck carcinoma.

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In vitro chemosensitivity was evaluated in head and neck squamous cell carcinomas and thyroid cancers. The inhibition rate of SD activity by the anticancer agents of ADM, THP-ADM, ACR, CDDP, CQ, 5-FU, HCFU was evaluated in cancer tissues obatained at surgery or biopsy.
The inhibition of SD activity in head and neck squamous cell carcinomas were higher than that of thyroid cancers except for HCFU.
The sensitive rates were extremely higher in the poorly differentiated head and neck squamous cell carcinomas than in the well differentiated squamous cell carcinomas.

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Lethal midline granuloma (LMG) is clinical term, and it is histologically composed of Wegener's granulomatosis (WG), polymorphic reticulosis (PR), and malignant lymphoma (ML). WG is an inflammatory disease, and PR and ML are considered to represent a neoplastic proliferation of lymphoreticular cells. Recenti mmunohistochemical and molecular cytogenetic studies suggested a T-cell nature of the proliferating cells in PR. In the present report, a nation-wide study on LMG in Japan is compared with a study from UK, to examine differences in frequencies of each diseases in Eastern and Western countries. A total of 340 cases of LMG were examined. On the basis of histological and clinical findings, these cases were categorized as 68 WG, 129, PR, 92 ML, 44 chronic inflammation not specified, and 7 other related conditions.
The crude frequencies of WG, PR, and ML, per 100, 000 outpatients of ENT clinics in Japan and England were 4, 8, and 6, respectively, and 8, 4, 1, respectively. The predominance of malignant lymphoproliferative diseases to WG in Japan (3.5:1) was in marked contrast to the situation in the UK (1:1.6). Excess of PR among the cases with lymphoproliferative diseases in the Kyushu district compared to other districts in Japan was evident. A review of the pertinent literature suggests a clustering of malignant lymphoproliferative diseases of the nose among Mongolian ethnic groups.

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Multiple primary malignancies were found in 8.9% of 302 patients with primary head and neck cancer diagnosed at our clinic, Yokohama City University Hospital, during the years 1979 to 1988. Out of the 27 multiple primary malignancies, 14.8% were synchronous and 85.2% were metachronous. Five cases were multiple primary malignancies in same organ, twenty cases were double primary malignancies in differenet organ and two cases were triple primary malignancies in differrent organ. Cancers of the tongue and the gingiva of the mandibule occupied 69.2% of index tumors in head and neck region. Multiple primary malignancies without head and neck region were commonly found in the esophagus and the stomach. All cancers of the esophagus were additional tumors. Second cancers following radiotherapy were found in 22.2% of 27 patients with maltiple primary malignancies. Radiation were thought as a risk factor of multiple primary malignancies. Another risk factors were evaluated by multivariate analysis. Sex, age, family history, drinking, smoking, job, education, leukoplakia, DMF teeth index were examined by multivariate analysis. It showed leukoplakia was a risk factor of multiple primary malignancies. Leukoplakia were found in 33% of our series. We thought it was nessesary for patients of oral cancers with leukoplakia to examine the upper digestive tract.

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In 41 cases of squamous cell carcinoma of the head and neck having a metastatic lymph node suspected of being adherent to the carotid artery, the CT diagnosis to determine the feasibility of ablation of the tumor from the carotid artery was studied by comparing preoperative CT picutures, surgical findings and histopathological pictures. The diagnostic criteria in using CT pictures were set as follows: 1) the condition of the arterial wall at the site where the tumor lies adjacent to the wall: and 2), the degree of the tumor enclosing the carotid artery. Result of the study showed that the ablation was feasible in cases where the tumor lay in contact with the carotid artery, and the arterial wall was identifiable to some extent, while the ablation was imopossible with the tumor persisting in cases where the arterial wall had disappeared or the tumor had enclosed the carotid artery by more than harf a round. The CT examinat ion was found useful in making a diagnosis as to the relations between metastatic lymph node and the carotid artery, though the diagnosis was difficult in some cases.

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A 4-year-old female child with complaint of painless swelling in the right side of the neck was reported and it was pre-operatively diagnosed as a branchial cleft cyst from the basis of the clinical course and macroscopic appearance of the neck mass. A cervical cystic tumor was extirpated under general anesthesia. Pathological examination showed normal thymus tissue, cholesterol clefets and granulomas containing Hassal's corpuscels in the wall.
Seventeen cases in Japanese literatures was reviewed and discussed briefly.

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The delayed skin reaction and cellular immunity of peripheral blood lymphocytes in 16 cases with head and neck cancer were analysed before and after adoptive immunotherapy. The following results were obtained:
1. The delayed skin reaction to strepokinase-streptodornase (SK-SD) and SuPs (OK432) was elevated after adoptive immunotherapy.
2. As parameters of cellular immunity, monoclonal antibodies of T cell markers (OKT-11, OKT-3, OKT-8) and also activated T cell marker (OKIa1) were increased after adoptive immunotherapy.
3. The relationships between clinical effectiveness and changes of immunological examination data were not clearly.

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The immunological functions of 60 patients with head and neck cancers and 27 patients with gastrointestinal cancer were evaluated using in vitro natural killer cell (NK) activity, lymphokine activated killer cells (LAK) and OK-432 activated killer cells, as well as by in vivo PPD and Su-PS skin tests. There were significant differences of the above three activities between stage I cancer patients and stage III and/or IV (p<0.05). The PPD skin test corresponded significantly to LAK activity, while Su-PS corresponded significantly to OK-432 activated killer cell activity (r=0.5558; p<0.05, and r=0.4753; p<0.01, respectively). Responses to interleukin-2 and OK-432 of stage IV patients with head and neck cancers were different from those of stage IV with gastrointestinal cancer. These in vitro assays were very useful for the evaluation of immunological function in head and neck cancer patients, especially before any treatments with biologocal response modifiers.

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Recently the reconstructions of the head and neck defects as a result of malignant tumor-surgeries have been performed frequently by free flaps by accompanied with universality of microovascular surgery and the reconstruction has been remarkably advancing. PMMC and LDMC flaps are now being altered by free forearm and rectus abdominis mc flaps and they are now representative free flaps. And so we are like to use them becouse of several merits. But in such a case of requiring not only covering or filling up but also thinking a great deal in function there are remaining very many problems. Particularly the reconstruction of tongue and/or mesopharyngeal large defect from soft palatal defect requiring the functions of swallwing and articulation, is very difficult. Recently volume is emphasizing on the reconstructions of these defects and many reports support efficiency of mc flaps' volume. On the other hand, muscle is becoming atrofied by accompanied with denervation or relieving the tension. And so we are using flap's fatty tissue as the volume to overcome atrophy. Fatty tissue has a litte tendency to atrophy. We tried to exhibit effective function by slight excurtion of remaining tissue by volume supplement. And we named them “volume-reconstruction”. But the case whose. defect is the moving tissue itself, it's the another case. For example, nasal obstruction or close to such condition could be produced by the volume reconstruction. Then we thought about remaining muscle as the motor and tried to perform “dynamic reconstruction” in opposition to the former static, volume reconstruction. We have reconstructed total soft palate by employing free forearm flap with palmalis longus tendon. This tendon functions as a transmission of remaining muscle contracting power to the flap. We experienced 4 cases and they were rewarded with excellent results. We named these reconstruction as “dynamic reconstruction”. We would like to report the results and the indications of these two methods of reconstruction.

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Seventy two cases of laryngeal cancer (glottic, T₁ T₂) were treated from 1977 to 1988 by means of CO₂ laser or radiation or a combination of them. From this follow up study we concluded as follows: 1) Laser surgery results successful outcome as much as or better than radiation treatment for T₁a cases. 2) T₁a cases may be treated without laryngectomy by a combination of laser and radiation. 3) Laser surgery alone or with radaiation treatment may retain larynx for T₁b cases in higher possibility. However large resection on bilateral vocal folds results poor post-operative voice. 4) A careful selection of cases for laser use is required in T₂.

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From 1981 to 1988, 104 cases of laryngeal carcinoma were treated at our departments. Out of 104 patients, the supraglottic type was 28 cases, glottic 76 cases, and subglottic 0 case. Histologically, all cases were squamous cell carcinoma. As to the age and sex distribution, the mean age of patients was 62.5 year-old and the ratio between male and female was 14:1. The policy to select the therapeutic procedure was conservation of the laryngeal function. As a primary treatment, irradiation of 6000 to 7280cGy was applied to most of cases without dyspnea. If residual carcinoma was suspected after irradiation, microlaryngosurgery and biopsy was performed. Based on the results, further treatment was determined. The patients with dyspnea, tracheostomy was done and based on the findings, irradiation or surgery was determined. The five year survival rate was 51.8% (Stage I+II 100%, III+IV 36.1%) in the supraglottic type and 85.1% (Stage 0+I 85.0%, II 84.6%, III+IV 87.5%) in the glottic type. The conservation rate of larynx was 46.4% (Stage I+II 83.3%, III+IV 31.8%) in the supraglottic type and 77.6% (0+I 88.6%, II 66.7%, III+IV 12.5%) in the glottic type. Double cancer was found at 14 cases of all.

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The relationship between mode of tumor invasion in primary lesion and histological finding of cervical lymph node metastasis was investigated retrospectively in 60 patients of squamous cell carcinoma of oralcavity. The materials were classified into three groups; no metastatic group (35 cases), primary metastatic group (17 cases), secondary metastatic group (10 cases). Mode of tumor invasion was investigated by classification of Yamamoto and Kohama. Pattern of nodal involvement and tumor growth stage in lymph node were investigated by classification of Toker (1963) and Honma (1982).
The results were as follows: 1) Total number of metastatic lymph nodes of primary metastasis was 49 and of secondary metastatis was 39.2) Distribution of mean number of metastatic nodes in each grade of mode of tumor invasion was 3.5 in M II, 2.6 in M III, 3.3 in M IV c and 5.3 in M IV d. 3) Metastatic nodes were classified by tumor growth stage into 39 of intranodal proliferation and 49 of extranodal spread. In the cases of grade M IV c, IV d of primary lesion, the frequency of extracapsular spread of tumor in cervical lymph node was higher than in the cases of the other grade of mode of tumor invasion. 4) Pattern C, D of nodal involvement by Toker's classification were found in grade IV c, IV d of the primary lesion. 5) Very clear histologic similarity of mode of tumor invasion between primary lesion and metastatic lymph node lesion was observed. 6) These results suggested the positive relationship beween mode of tumor invasion in primary lesion and mode of tumor growth pattern in cervical lymph node metastasis. Prognosis of patients with extranodal metastasis tended to be poor. Therefore, neoadjuvant chemotherapy, preoperative irradiation and prophylactic neck dissection with primary tumor excision for grade M IV c, IV d is recommended.

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A retorospective study of 28 patients with squamous cell carcinoma of lower alveolus and gingiva was performed to evaluate clinical and histopathological features of primary lesion in predicting regional lymph node metastasis. The grade of T was not always compatible with the incidence of lymph node metastasis. Lymph node metastasis was observed more frequently in tumors which were inspectively classified as ulcerated type (55.6%) than that of tumors of elevated type (30.0%). The relevance between roentogenographic mandibular invasive pattern or degree of mandibular resorption by tumors and lymphnode metastatic incidence was not clear. The incidence of lymph node metastasis in tumors showing small nests invasion (58.3%) was higher than that of tumors with well-defined borderline and large nests invasion (38.5%). 13 patients (46.4%) out of 28 cases had positive regional lymph node metastasis. 35.7% (10 of 28) had positive nodes in submaxillary triangel alone. 10 patients (76.9%) out of 13 cases which had positive regional lymph node metastasis, had positive nodes in submaxillary triangle alone.

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Local injection of interferon (IFN) was performed in five cases of malignant melanoma (MM) of the head and neck. Complete response (CR) was obtained in four cases of them. However a nasal cavity case showed no response to DAV therapy or linac radiotherapy, it revealed CR only with local injection of IFN-α. A case of nasal cavity and paranasal sinus was treated with local injection of INF-β at the site of postoperative local relapse, so it showed recovery only with faint pigmentation. Other cases of nasal septum, nasal vestivule and nasal dorsum showed CR by only using local injection of IFN-β from the start of therapy. Primary treatment of MM is a wide range excision of the tumor lesion and surrounding normal tissue. However, when this is not possible due to the location of the tumor lesion, local injection of IFN may be sucsessfully used in some cases.

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Since 1980 we have fabricated four types of radiotherapy prostheses, such as mould, carrier, spacer and protector, for 104 patients of oral malignancy. Each prosthesis has different function. The carrier accurately keeps radioactive sources in position as indicated by the radiotherapists, and provides the proper distribution of dosage. The protector restricts irradiated area within the tumor, and protects the surrounding normal tissue. The mould has both functions of carrier and protertor. The spacer keeps the distance between the mandible and radioactive sources, such as radium-226 needles or iridium-192 hairpins, to protect the mandible in radiotherapy of tongue carcinoma. The 104 cases confirmed us that in many cases these appliances make radiotherapy widely applied, and that they are very useful to elicit the benefits of radiotherapy.

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10 patients with the ear cancer treated in our department during 16 years were reported.
The tumor site were auricula (4), auricula/external meatus (1), external meatus (2), external meatus/tympanum (2) and tympanum (1).
To classify the ear cancer as the extrinisic or intrinsic ear cancer according to the extension with or without invasion to the bony portion of the meatus is useful for the selection of management and the prediction of prognosis.
There may be close relation, particular in tympanic cancer, between chronic supprative otitis media and intrinsic ear cancer, since 2 of 3 patients with intrinisic ear cancer had the past history of the otitis media.
We chose the radical operation as the main treatment of the ear cancer and its result was almost satisfactory. A 5 year survival rate was 66.7% in all cases.

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