A retrospective review of 19 patients treated by horizontal partial laryngectomy at our hospital was accomplished for the period of 1979-1998. The mean age at diagnosis was 64 years, with a range of 52 to 78 years. The distribution of TN-stage (UICC1987) was as follows: T1-one, T2-12, T3-five, T4-one and N0-11, N1-three, N2a-one, N2b-one, and N2c-three. Four patients had received radiotherapy to the neck including the larynx with the dosage ranging from 42Gy to 70Gy. Sixteen patients had standard supraglottic laryngectomy and the remaining three had extended resection including the arytenoid or the base of tongue or the vocal cord. No patients received postoperative radiotherapy. Follow-up was conducted until death or for a minimum of 911 days. The mean follow-up was 1, 885 days.
Primary disease control was achieved in 100% of the patients. Two patients never attempted to swallow after surgery because of early postoperative mortality from severe aspiration pneumonia or cerebral infarction, and the remaining 17 patients were successful in deglutition. None of these patients developed pneumonia and all were successfully decannulated. The average durations of cannulation and of feeding through the nasogastric tube were 29 days (10-92 days) and 34 days (12-108 days). Most prolonged dysphagia was seen in the one whose arytenoids were resected. Chest radiographs and white blood cell counts showed no influence on the respiratory tract due to long-term latent aspiration, in spite of slight aspirations on pharyngogram in 57% (5/7) of the patients. The 5-year crude survival rate and cause specific survival rate were 77%, 100%, respectively. There was no significant difference between the partial laryngectomy group and the radical radiation group (n=81). The causes of death relevant to the respiratory system consisted of 36% (4/11), one of which was severe aspiration pneumonia (78-year-old patient with heart disease).
From the results it was suggested that horizontal partial laryngectomy is useful in tumor control and retaining the laryngeal function in the strictly selected cases.

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We reviewed the records of 30 patients with nasopharyngeal carcinoma who underwent radical RT between 1990 and 1998. According to the 1997 UICC staging classification, 3 (10%) patients had stage I disease, 8 (27%) had stage II, 14 (47%) had stage III, and 5 (17%) had stage IV disease. The histopathology was keratinizing carcinoma (WHO type III) in 9, non-keratinizing carcinoma (WHO type II) in 11, and undifferentiated carcinoma (WHO type III) in 10 patients. The CR rate was 87% in all patients, and it was 63% in patients with type I, 95% in patients with type II, and 100% in patients with type III. Fifteen of the patients were recurrent cases. Four of 5 recurrent patients with type I had local recurrence, and two of them also had distant metastasis. Three (30%) and eight (80%) of 10 recurrent patients with type II or III had local recurrence and distant metastasis, respectively. According to a detailed histopathological review, the cases of type I that had distant metastasis had some component of type II or III, and the cases of type II or III that had local recurrence had some component of type I. According to monovariate analysis, performance status (PS), N-stage, histopathology, radiation field, and response were statistically significant prognosis factors. But according to multivariate analysis, only PS and histopathology were significant. The five-year survival was 17% in patients with type I, and 73% in patients with type II or III. In conclusion, histopathological classification was a significant prognostic factor in radical RT for nasopharyngeal carcinoma. It was considered that cases of type I need locally intensive therapy, and cases of type II or III need systemic intensive therapy. A mixed type with type I and II or III needs both.

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The treatment results of 83 cases of squamous cell carcinoma in the lateral wall of the oropharynx, between 1982 and 1995, were reviewed. The 5-year cause-specific survival rate, and the 5-year local control rate, were 59% and 69%, respectively. In T1 and T2 cases, 5-year rates of the ultimate local control, including patients succesfully treated with salvage operation after local recurrence, were 86% by radiation therapy, and 80% by surgery. T3 cases with ulcer and endophytic broad growth to adjacent area were uncured even by radical surgery. Therefore, such T3 cases should be treated with concomitant chemoradiotherapy. The 5-year absolute survival rate was 49%, similar to the data before 1982. It is considered that the low survival rate was influenced by second primary cancers. Patients with oropharyngeal cancer should be followed carefully as to a second primary cancer, and given therapy that does not reduce the patients' quality of life.

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Ninety-six patients with untreated squamous cell carcinoma of piriform sinus underwent resection of primary lesion and neck dissection from 1982 to 1997 in our hospital. The incidence of contralateral cervical metastasis and factors associated with it were analyzed. The contralateral cervical metastasis was defined as follows: (1) a case of contralateral cervical metastasis histologically confirmed by bilateral neck dissection or (2) a case of the first recurrence to contralateral cervical node observed. The incidence of contralateral cervical metastasis was 32% (31/96). According to the T classification, the incidence of contralateral cervical metastasis was T1: 0%, T2: 18%, T3: 37%, T4: 32% and to the N classification, N0 12%, N1: 13%, N2a: 17%, N2b: 39%, N2c: 100%, and N3: 75%. Cases of T1, T2, and T3 with one or less ipsilateral histological metastasic node showed lower incidence of contralateral metastasis and there was some possibility of omitting contralateral neck dissection. Cases of the primary lesion invading beyond the midline to the contralateral side showed statistically higher incidence of contralateral cervical metastasis than those remaining on ipsilateral side.

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Eight patients with recurrent glottic rT1 carcinoma after radiotherapy were treated with a laser via laryngomicrosurgery. T classification at radiotherapy was one case of T1a, three cases of T1b, three cases of T2, and one unknown case. The period between radiotherapy and recurrence was 7 months to 7 years (mean 25 months). T classification at recurrence was five cases of rT1a and three cases of rT1b. Laser surgery was performed under general anesthesia, and the recurrent tumor was vaporized and excised by laser irradiation. The tumor was controlled by laser surgery in five of eight cases, and no recurrence occurred for between 19 and 97 months (mean 4 years). In the other three cases, total laryngectomy was required due to residual tumor after laser surgery, and one patient died of neck metastasis. The larynx preservation rate was 63% (5/8), and the survival rate was 88% (7/8). A frontoneck subcutaneous abcess occurred in one case as a complication of laser surgery, and it disappeared with medication treatment. No other complications were noted. We concluded that glottic rT1 carcinoma after radiotherapy is an indication for laser surgery.

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From 1980 through 1994, 71 patients with T2 glottic squamous cell carcinoma (SCC) were treated at National Cancer Center Hospital by radiotherapy, partial laryngectomy (PL), and total laryngectomy (TL). The results of the treatment in these patients were analyzed to determine a strategy for management of T2 glottic SCC.
The 5-year, cause-specific survival rate in these patients was about 90%. The local control rates, and the laryngeal preservation rates, were 84% and 84% with PL, versus 47% and 58% with radiotherapy, but the voice quality after radiotherapy was clearly superior to that after PL. The laryngeal preservation rate in patients with T2 radiation-failure glottic carcinoma was just 21%, and TL was required in a majority of these patients. The diagnosis of subglottic extension in patients with T2 glottic SCC was very important to determine any type of treatment. TL should be initially required for patients with widespread subglottic extension. The decision on treatment should be selected by the patient himself after obtaining correct information about each treatment.

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Since the introduction of the speech following tracheoesophageal puncture (shunt) with voice prosthesis, this technique was performed on 19 male patients. All the patients underwent esophageal punctures during primary operation. The evaluation for voice restoration was performed according to the communication in daily life and divided into four groups (excellent, fair, poor, and none). The success rate of voice restoration was 78.9% (excellent group; 57.9%, fair group; 21.0%). Maximum phonation time of the excellent group was over 10 seconds, supporting the evidence that restored voice was excellent in quality. There were no significant differences between Provox2 and Groningen as voice prostheses. Eight out of 19 patients had 13 problems related with tracheoesophageal shunt. However, all the cases were freed from prosthesis removal by an appropriate treatment.

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The clinical classification of vital staining test of oral mucosa to indicate clinical stage of oral precancerous lesions and early carcinoma was evaluated. Ninty cases of oral precancer or any lesions suspected of having early cancer cells underwent surgical resection after the vital staining test. To stain these lesions, 3% iodine and 0.5% toluidine blue solution was used. The iodine solution differentiates epithelial dysplasia from normal mucosa as a dark white unstained area and the toluidine blue solution dyes carcinoma as a dark blue area.
These lesions were divided into four groups based on the findings of the iodine and toluidine blue staining test. After surgical resection, each specimen was entirely examined histopathologically to identify the dysplastic stage for final diagnosis, and the relation between each group and final pathological diagnoses was investigated.
As a result, 85.7% of the lesions in group 1 (both negative) showed only slight dysplasia; 88.0% of the lesions in group 4 (both positive) had severe dysplasia or carcinoma; the sensitivity of the iodine and toluidine blue staining test was 88.0%; and the specificity thereof was 85.7%.
It was concluded that the staining test with iodine and toluidine blue solutions is useful not only to detect oral cancer and reveal its extent but also to indicate the dysplastic stage of oral precancerous lesions and early carcinoma.

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The purpose of this study was to clarify the clinical characteristics of malignant tumors in the oral and maxillofacial regions in order to diagnose malignancy at an early stage and thereby improve the outcome.
Eight hundred eighty-eight patients with malignant tumors were reviewed. The mean age of the patients was 60.0 years, and the ratio of males to females was 2.3 to 1. It was 84.7% of the 888 cases that were squamous cell carcinoma (SCC). It was 70.5% that were referred from dentists (including direct visits). Four hundred eighty-one of the patients with oral SCC who had been untreated underwent investigation of the chief complaint or clinical appearance and tumor size. The chief complaints of 481 patients were as follows: tumor formation, 58.8%: pain, 22.5%. It was 42.5% of patients with a mode of invasion 4D type that complained of pain. The clinical appearance was determined by the classification of Washizu. There was a large number of ulcerative or granulative type tumors. The vast majority of the leucoplakic and erosive type tumors were under 40mm in size and so it was suggested that the appearance of these tumors was pathognomonic of the early stage of oral SCC.

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This paper describes a new method to delineate surgical for tongue carcinoma using ultrasonography.
Materials and methods
Between 1994 and 2000, 75 patients with tongue carcinoma (T1N0M0 39 cases, T2N0M0 36 cases) underwent partial glossectomy. The surgical margin was delineated with our new method. All the cases were followed up for at least one year. Clinical and pathological evaluation of these cases was conducted.
The method to delineate the surgical margin
1. Preoperative examination using ultrasonography
1) A #23G needle was inserted at the midline of the tongue, as on index. The distance from the mucosal surface to the index needle was measured ultrasonically (m).
2) The tumor thickness was measured vertically from the mucosal surface to the maximal thickness of the tumor (d).
2. Delineation of the surgical margin in the operating room
1) The distance from the mucosal surface to the midline was measured with a scale (M).
2) The tumor thickness (D) was corrected as follows: D=d×M/m
3) The deep margin was delineated to be 10mm deeper than the tumor thickness (D).
Results
In all cases, there were no tumor cells at the surgical margins, histologically. Only two cases developed local recurrence; however, they occurred from the mucosal surface.
Conclusion
Our results demonstrated that our new method to delineate the of surgical margin is useful for partial glossectomy.

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We retrospectively reviewed 142 patients who underwent partial glossectomy at the Division of Head and Neck Surgery, National Cancer Center Hospital, and the National Cancer Center Hospital East. We examined the results of per-oral partial glossectomy to reveal an indication for partial glossectomy by the pull-through method. The overall survival rate of 130 patients who underwent per-oral partial glossectomy was 81 percent. There were 13 local recurrent cases. In these cases, four recurred at the base of the tongue, and five at the oral floor. We supposed there was some possibility of avoiding recurrence if these nine patients had been treated with the pull-through method. Meanwhile, in the 12 patients who underwent partial glossectomy by the pull-through method, there was only one local recurrence at the deep region of the tongue.
Partial glossectomy by pull-through method is well indicated for patients whose tumors invade to the base of the tongue or oral floor. Thus, an almost partial glossectomy can be performed by the per-oral method.

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To elucidate application for conservative surgery in advanced oral carcinoma (Stage III, IV), this study retrospectively analyzed our treatment results and prognostic factors in 194 patients with previously untreated advanced oral carcinoma who were surgically managed between 1976 and 2000. The primary site distribution was as follows: 75 tumors located in the tongue; 33 tumors in the floor of the mouth; 54 tumors in the lower gum; 10 tumors in the upper gum; 21 tumors in the buccal mucosa; and 1 tumor in the lower lip. Eighty-four patients were in stage III and 110 were in stage IV. Seven, 55, 48, 84 patients had T1, T2, T3 and T4 respectively.
The 5-year cumulative disease-specific survival rate (5-year SR) for all 194 patients was 63.9%, consisting of 80.2% for stage III and 52.1% for stage IV. The 5 year SR according to mode of invasion (1-3, 4C+4D) and effects of preoperative treatment (response, no response) were as follows: mode 1-3+response, 76.9%; mode 1-3+non response, 74.3%; mode 4C, 4D+response, 64.7%; mode 4C, 4D+no response, 31.0%.
In univariate analysis, 6 parameters (T stage, N stage, clinical stage, growth pattern, histopathological grading and mode of invasion) had significant impact on disease-specific survival. When the data were analyzed by Cox's multivariate regression, three factors significantly affected survival and these were T stage (1-3, 4), N stage (0, 1-3) and mode of invasion (1+2, 3, 4C+4D).
The findings of the present study suggest that patients with low-moderate malignancy grade and good response to preoperative treatment could undergo surgical treatment without oral disorder.

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We discuss 405 patients with carcinoma of the tongue. There were 341 patients younger than 70 years old, and 64 aged 70 or older. The study aim was to clarify the difference between elderly patients with carcinoma of the tongue and another ones. Many elderly patients (76%) had some kind of systemic medical histories. Death from another disease ranked first (40%), and another carcinoma ranked second (23%), as to the cause of death in elderly patients. However, there were no differences as to the staging of patients, treatment, including indication for surgery, and the cause-specific survival between the two groups. We conclude that it is important to discuss medical histories, the hope of the patients and their families, and the social background, in addition to age, when we decide on treatment for a carcinoma of the tongue.

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Malignancy-associated hypercalcemia (MAH) is frequently found in an advanced stage in patients with oral cancer. A retrospective review of oral cancer observed between April 1992 and March 2001, at the Tokai University Hospital, Kanagawa, Japan, was conducted. Twenty-six cases of MAH associated with oral cancer were evaluated. Of these, the site of the primary lesion was tongue (19), buccal mucosa (4), gingiva (1), oral floor (1), and soft palate (1). The peak levels of serum calcium ranged from 12.7-18.7mg/dl. The serum parathyroid hormonerelated protein (PTH-rP) concentration was elevated in every patient. Immunohistochemistry of excised tissues from the patients revealed 23 of 26 specimens were positive for PTH-rP. Thus it seems the MAH associated with oral cancers is equivalent to the humoral hypercalcemia of malignancy (HHM). The average survival period from the diagnosis of MAH was 32.7 days in patients administered hypocalcemic agents (bisphosphonate, elcatonin) and only 17.4 days in untreated patients. As an adjunct treatment, the anticancer drug, peplomycin, was given to 12 previously untreated individuals. The results indicate that peplomycin prolonged survival but not to the extent of the 2 other drugs. Peplomycin could be considered to be a hypocalcemic agents especially for very resistant hypercalcemia.

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Soft tissue reconstruction in extensive composite mandibular defects has great significance for a functional and aesthetic result.
From January 1998 to January 2001, mandubular reconstructions with free composite tissue transfer were performed on 20 patients. Eighteen of them had advanced oral cancer and 2 of them had mandibular sarcoma. There were 12 male and 8 female patients. Patients' ages ranged from 24 to 77 years (mean age was 53). Donor sites included 13 fibular osteocutaneous flaps, 6 scapular osteocutaneous flaps and 1 rectus abdominis flap with costal cartilage. All of the patients who underwent reconstruction with fibular flaps and grafting of second flaps simultaneously for soft tissue reconstruction. The second flap included 8 thigh flaps, 3 rectus abdominis flaps, 2 pedicled latissimus dorsi flaps and 1 omentum. Six scapular bones were harvested with large skin flaps for the intraoral lining and soft tissue augmentation. Aesthetic and functional results were evaluated a minimum of 9 months postoperatively.
Eighty percent of the patients were satisfied with their appearance of the lower third of their face and the other patients required volume reduction. All of the patients, except for the patient who could not postoperatively exercise, could open their mouth more than two fingerbreadths. Normal diet was taken by 75% of the patients whose hemimandibular teeth (including the patient with total glossectomy) were preserved and the other 5 patients took soft diet with the dentures. Speech was assessed as normal in all of the patients except for 2 patients who had total glossectomy.
It was concludes that soft tissue reconstruction of extensive mandibular defects is very important for improveing the quality of life of patients.

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The swallowing and speech functions in patients with tongue cancer who underwent resection followed by primary reconstruction with free flaps, were examined at many hospitals. The brain activities induced by tongue movement or with taste were also examined by using functional magnetic resonance imaging (f-MRI) which has been developed recently for new imaging. The principle of f-MRI is that the brain activities induce the reduction of the brain venous deoxyhemoglobin and eventually enhance the potentials of MRI. The tongue and laryngeal movement were severely disturbed in the extensively tongue resected patients during swallowing, however, the speech production was not always even in these patients. By f-MRI examination, the tongue movement led to the potential of the healthy motor cortex side in the extensively resected patients, and of both symmetrical activation of motor cortices in hemiglossected patients. As for the gustation, even the oropharyngeal gustatory field was resected, f-MRI examination revealed the activation of the healthy gustatory cortex in all patients.

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Purpose: To estimate the influence of function of the reconstructed tongue on postoperative masticatory function
Methods: We assessed postoperative functions in seven tongue cancer patients with reconstruction of the tongue and oral floor, categorized into group A of Eichner's Classification.
Masticatory function was evaluated using the low-adhesive color-developing chewing gum method, and was expressed as masticatory performance (a*: chromaticness). Further, the modified questionnaire of Yamamoto's masticatory grade as to diet was used for a subjective evaluation. Occlusal measurements (occlusal platform area and total bite force) were taken with the Occlusal Prescale. As the function of the tongue, voluntary tongue movements were evaluated by four criteria, and two sensory modalities (touch and heat sensation) were evaluated.
Results
1. Masticatory performance in tongue cancer patients with reconstruction was significantly lower than in normals.
2. Yamamoto's masticatory grade (subjective evaluation) did not agree with masticatory performance (objective evaluation).
3. The occlusal platform area or total bite force in these patients bears no definite relation to masticatory performance.
4. Patients with good voluntary tongue movement showed good masticatory function.
5. Patients with good sensory recovery on flap exhibited good masticatory function.
Conclusion: Mobility and sensation of the reconstructed tongue are crucial factors for postoperative masticatory function.

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The purpose of this study was to propose indication of elective neck dissection for Stage I, II tongue carcinoma. Fifty patients seen between 1985 and 1996 with previously treated Stage I, II tongue carcinoma were reviewed. All patients were treated with partial glossectomy without elective neck dissection. Among these patients, 7 had latent cervical lymph node metastasis. In a multivariate logistic regression analysis, modelately differentiated squamous cell carcinoma of the tongue with tumor depth≥4mm had risk factor for latent cervical lymph node metastasis and overall survival. Therefore, we suggest that elective neck dissection is indicated in patients with tumor depth ≥4mm with moderately differentiated squamous cell carcinoma of the tongue with tumor depth ≥4mm had risk factor latent cervical lymph node metastasis and overall survival. Therefore, elective neck dissection could be indicated in patients with tumor depth ≥4mm with moderately differentiated squamous cell carcinoma of the tongue.

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To determine how surgical treatment of the neck for N0 cases of squamous cell carcinoma in the floor of the mouth should be done, the pattern of occult cervical lymph node metastases was evaluated. The number of N0 cases without local failure from 1970 to 1999 was 53 (48 males and 5 females, average age 60.3 years old). T classification was as follows: T1: 14 patients, T2: 35 patients, T3: 4 patients. Initial treatment consisted of surgery only (29 patients), radiation therapy only (7 patients), surgery and radiation therapy (14 patients), surgery and chemotherapy (3 patients). Elective neck dissection (ENT) was performed in 16 patients. Histological cervical lymph node metastasis was detected in 18.9%, 2 of 16 patients who underwent ENT and 8 of 37 patients who underwent therapeutic neck dissection (TND). Frequency of secondary cervical lymph node metastasis by initial treatment and T classification distinction was not different. The sites of metastasis were level III except one case. The 5-year survival rate was 73.1% in the ENT group and 66.9% in the TND group.
The results suggest that surgical treatment of the neck is not necessary for initial treatment for N0 cases of squamous cell carcinoma in the floor of the mouth.

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BACKGROUND. Management of cervical lymph node metastasis is an important factor for controling head and neck cancers. However, the detection rate of truly metastatic lymph node is approximately 50%. Sentinel lymph node is reported to be effective in breast and skin cancer, so sentinel lymph node biopsy in clinical N0 oral cancer was studied.
METHODS. For 4 patients of clinical N0 oral cancer, peritumoral submucosal quadrants injection of ^99mTc-tin colloid was performed. All patients underwent neck dissection. Before and during operation, it was compared to identify radioactive area using a gamma probe. After surgery, the radioactivity of sentinel lymph node with a well type scintilation counter was compared to that of pathological specimen.
RESULTS. Sentinel lymph nodes of all patients were detected. Two sentinel lymph node were pathologically negative and two sentinel lymph nodes were pathologically positive. False negative of sentinel lymph nodes were not seen.
CONCLUSION. Sentinel lymph node study was thought to be effective for clinical N0 oral cancer. It was suggested that neck dissection for pathological N0 lymph node patient could be avoided by using sentinel lymph node biopsy.

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It has been reported that movement and sense of the shoulder are often disturbed after neck dissection and that this disturbance is related to amputation of the accessory nerve. However, significance of preservation of the cervical nerve is still unclear. Function of the cervical nerve in patients who under went functional neck dissection in the present study was examined. The subjects included 19 patients whose accessory and cervical nerves were preserved, 6 patients whose accessory nerve was preserved, and 10 patients whose both nerves were cut off during surgery. These patients were examined for flexibility of the shoulder joint and trapezius muscle strength and provided information on subjective symptoms through a questionnaire. The results indicted that the cervical nerve had a close relation to flexibility of the shoulder joint and trapezius muscle strength. Therefore, it is likely that preservation of the cervical nerve as well as the accessory nerve contributes to the better quality of life of patients after surgery.

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Clinical courses of 11 patients with metastatic cervical tumor from unknown primary sites were retrospectively analyzed. Histopathological examination of these tumors revealed squamous cell carcinoma in all cases. Neck dissection was performed as an initial treatment in 10 of 11 patients. Eight of these ten patients underwent chemotherapy after operation, one patient was treated with surgery alone and one patient underwent radiotherapy. The primary sites were identified after initial treatment in five cases after operation (oropharynx, 3 cases; hypopharynx, 1 case; esophagus, 1 case). The mean duration between the determination of the primary site and initial treatment of these five cases was 22 months. Distant metastases occurred in two of five cases whose primary site was identified.
The primary site was never identified in the other six patients. One patient who had inoperable cervical tumors and poor systemic status died without radical treatment. The other five patients underwent neck dissection as an initial treatment. The distant metastases occurred in four of five cases and local recurrence appeared in all cases after initial treatment. The prognosis of these cases was poor regardless of identification of the primary site after initial treatment. The five-year cumulative survival rate was 20.0% in patients whose primary site was not identified after initial treatment while 66.7% in patients whose primary site was identified. The difference between the former survival rate and the latter one was not statistically significant. Neck dissection may be of some benefit for these patients. As an initial treatment, further study is necessary to determine the effectiveness of adjuvant therapy such as chemotherapy and/or radiotherapy.

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Resection of a neurogenic tumor in the neck leads to paralysis of the nerve, so it is important to recognize its origin before operation. Most patients complain of only neck mass, so relationship of location among the tumor, the common or internal carotid artery and the internal jugular vein were investigated with CT scans and MR images. Six neurogenic tumors were treated and examined together with twenty-three cases from literature. Vagus nerve origin was found in fifteen cases, sympathetic chain in the neck was found in eleven casses and hypoglossal nerve was found in three cases. The angle at the center of the carotid artery, tumor and jugular vein were taken. This study revealed the tumor originated in the vagus nerve separating these vessels and the angle was more than 90°. While in the sympathetic chain tumor, the angle was less than 90°and it displaced the carotid artery and jugular vein anterolaterally. The hypoglossal neurogenic tumor did not separate these vessels and displaced them posteriorly. In conclusion, to clarify the origin of neurogenic tumor, it is important to determine the location and angle of the tumor, carotid artery and jugular vein with CT scanning or MR imaging.

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Carcinoma of the external auditory canal is a relatively rare head and neck tumor. We evaluated the treatment modalities and outcome of 23 cases of carcinoma of the external auditory canal, who were treated at Kurume University Hospital between 1981 and 2000. The patient's ages ranged from 43 to 85 (average 67). Ten cases were male, and 13 cases were female. Most frequently observed histologically were 17 squamous cell carcinomas, 3 adenoid cystic carcinomas, 1 adenosquamous carcinoma, 1 basal cell carcinoma and 1 anaplastic carcinoma. According to TNM staging proposed by Arriaga, 8 cases were T1 disease, 3 cases were T2 disease, 6 cases were T3 disease, and 6 cases were T4 disease. Lymph node metastas were found in 5 cases. The three-year, disease-specific survival rate, calculated by the Kaplan-Meier method, was 55% for all cases, 100% for the cases with T1 or T2 disease, 50% for the cases with T3 disease, and 0% for the cases with T4 disease. The prognosis of advanced cases was significant poor. Ten patients died of primary disease. To acquire better survival results, the present study strongly suggests that radical treatment is necessary at the initial treatment.

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Most patients with thyroid papillary adenocarcinomas (PACs) have good prognosis but some show postoperative local recurrence or distant metastasis. Extrathyroidal extension (ETE) is known as a risk factor of distant metastasis. The postoperative serum-thyroglobulin (Tg) of the patients had PAC with ETE histologically (pT4 cases) between May 1987 and December 2000 was retrospectively examined.
The subjects consisted of 43 patients, 1 patient was treated with palliative operations and 42 patients underwent curative operations (36 total thyroidectomies and 6 other operations). Simultaneous neck dissections (central compartment or more) were also performed in 40 cases. A metastatic lesion in cerebellum was removed in 1 case. Recurrent nerves were resected in 29 cases, tracheal cartilage in 19 cases, muscle layers of the esophagus or the sphinctor in 16 cases and the other organs in 7 cases.
Postoperative radioiodine therapies were performed in 18 cases. The five-year and ten-year cause-specific survival rates with Kaplan-Meier method were both 97.1%. However, the postoperative serum-thyroglobulin were detected in 17 cases among 35 cases with curative total thyroidectomy.
It was concluded that thyroid tissue remained somewhere in about 50% of pT4 cases even when curative total thyroidectomy was performed.

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Several factors have been proved useful to differentiate patients with papillary thyroid carcinoma into either a low-or high-risk group for cancer death. A referral cancer center like ours treats many advanced cases, where more sophisticated discrimination methods are required. Data were obtained from 604 patients who underwent initial surgery for papillary thyroid carcinoma (T>1cm) during the period from 1976 to 1998. The mean follow-up period was 10.7 years. In all, 32 patients died of the disease. The disease-specific 10-year survival rate was 94.0%. By multivariate analysis, distant metastasis, extrathyroidal invasion, and large nodal metastasis (≥3cm), in older patients (age≥50), and distant metastasis in younger patients (age<50), were significant risk factors. From the results, we defined older patients with any of the three factors, and younger patients with distant metastasis, as the high-risk group, and others as the low-risk group. A total of 498 low-risk patients (82.5%), and 106 high-risk patients (18.5%), had 10-year survival rates of 99.3% and 68.9%, respectively. The original risk group definition was useful to predict the prognosis of our patients with papillary thyroid carcinoma.

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Since 1994, there have been 10 cases (1 male, 9 females, 37-72 years old) of primary hyperparathyroidism at our hospital. CT, ultrasonography (US), and MIBI scintigraphy (MIBI) were undertaken for preoperative imaging of the parathyroid tumor. In 9 adenoma cases, accurate localization was obtained in 6 of 9 cases for US, in 8 of 8 cases for CT, and in 9 of 9 cases for MIBI. After the surgery, laboratory data of Ca and i-PTH were in the normal range. Histopathological diagnosis showed 9 adenoma cases and 1 hyperplasia case. Three cases were associated with thyroid diseases.
This paper presents two cases with rare clinical symptoms. The chief complaint of the first case was hoarseness. Transient recurrent nerve palsy was observed two times in 2 years. During the surgery, the tumor existed just behind the right recurrent nerve. By histological examination, the tumor was diagnosed as parathyroid adenoma. There has been no recurrent nerve palsy since the surgery. The second case had been treated after diagnosis of deglusion for 3 years in a psychiatry clinic. CT and MIBI showed parathyroid tumor just below the right lobe of the thyroid. After surgery, psychological symptoms were dramatically improved.

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Trigeminal neurinoma (TN) usually arises in middle cranial fossa or posterior cranial fossa. However, less commonly, TN may extend from middle cranial fossa to exrtracranial spaces. Three cases of TN extending to both intracranial fossa and extracranial spaces were surgically treated at Tonan Hospital.
The first case arising from the second branch of the trigeminal nerve extended into pterigopalatine fossa, infratemporal fossa and maxillary sinus, and surgery was performed by combined zygomatic infratemporal approach and transmaxillary approach.
The second case arising from the second branch extended up to orbital apex, and surgery was performed by combined orbitozygomatic infratemporal approach and transmaxillary approach.
The third case arising from the third branch extended into infratemporal fossa, parapharyngeal space, middle ear cavity and external auditory canal, and the tumor was excised by combined infratemporal approach, transmandibular approach with lateral mandibulotomy and microscopic otosurgical approach.
TN arising from the second or third branch tends to extend from middle cranal fossa to infratemporal fossa. These tumors have less tendency to show symptoms. Therefore, at the time of diagnosis, these are likely to extend multiple extracranial spaces. For excising these tumors, it is important to understand the exact location and extending pattern of TN by computed tomography and/or magnetic resonance imaging, and an optimal surgical approach should be planned regarding both functional and cosmetic aspects.

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Terminal care for the patients with head and neck cancer is very important, however, few studies have focused on it. This study shows the problems in terminal care of patients with head and neck cancer by analyzing the palliative treatment of 78 patients who died from head and neck cancer.
The problems comprised insufficient disclosure of the terminal illness and little public and familial support. As a result of these circumstances, more terminal patients with head and neck cancer required hospitalization, meaning that it was not necessary for 28% of these patients to be hospitalized. Eighty-two percent of the patients were in the hospital for definitive treatment of cancer, not in a hospice. Furthermore, a longer period of hospitalization is required with an average period of 71 days.

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Sixteen patients with hypopharyngeal carcinoma treated with hyperfractionated radiation therapy from 1996 to 2000 were analyzed. The mean age was 65 years (range: 52-84yrs). The number of patients of Stage I, II, III and IV were 2, 5, 3 and 6, respectively. All patients were treated with 4 MV X-ray using a shrinking field technique (initial field covered whole pharynx and neck). Fractionation was 1.2Gy/fraction, 2fractions/day, 10fractions/week and the mean total dose was 72Gy (range; 66-79.2Gy). Radiation response of hypopharygeal lesion at the end of treatment was as follows: CR: 13 (81.3%), PR: 3 (18.7%). 2-yrs overall survival and local control rates were 69.9%, 63.6%, respectively. In conclusion, the preminilary results of this study were relatively better than those of previous reports, which indicates that hyperfractionated radiaton therapy might be a promising treatment method for hypopharyngeal carcinoma.

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The results of the treatment of three cases of neurogenic carcinoma by stereotactic irradiation (STI) using the micro-multileaf collimator (m3) are presented.
Histopathorogical diagnosis was olfactory neuroblastoma in one case and neurogenic malignant tumor in two cases. Two of the cases were treated with stereotactic radio surgery (SRS), and the other one was irradiated with stereotactic radio therapy (SRT) as radical radiotherapy. All cases revealed complete response without recurrence. There was no serious impediment associated with STI. The results suggest that STI therapy is useful for neurogenic malignant tumor of nasal cavity and paranasal sinus. It will be important to estimate the optimum dose of STI to obtain good results without causing impediment.

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Because the head and neck region is irregular and complicated in shape, dose distribution tends to be inhomogeneous with simple radiation technique. Because of the vicinity of critical structures, constraints that protect critical normal structures may cause insufficient dose distribution in the target volume. We report our easy methods to improve dose distribution in radiotherapy for head and neck cancer.
Large lateral parallel opposed fields are commonly used to treat the primary lesion and cervical lymph nodes. There is considerable dose inhomogeneity in cranial-caudal and anterior-posterior directions with this portal arrangement. The dose difference between 95% and 5% volume target doses was an average of 22% of the prescribed dose, which corresponded to 10.8Gy in absolute dose. We use a three-field technique, adding an anterior-posterior field to lateral fields with a wedge filter, to reduce dose inhomogeneity, which could be decreased to 11.6% and 5.5Gy. The anterior field was shaped to shield the parotid glands as much as possible, and the dose to the bilateral parotid glands could also be reduced.
A three-dimensional treatment planning system, and a C-arm LINAC system with a multileaf collimator, facilitate the use of non-conventional noncoplanar beam orientations and conformal beam shaping while shielding critical structures based on the beam's eye view display. Three-dimensional radiation therapy with this system enables the delivery of a highly homogeneous irradiation dose to the target volume with respect to the maximal tolerated dose to critical structures such as optic pathways.

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The CyberKnife, a medical device for stereotactic radiotherapy, is composed of a combination of a robot manipulator and LINAC. For the treatment of head and neck tumors, this system has been applied. Between June 2000 and January 2001, 18 patients with head and neck tumor were treated with this system because of tumor recurrence, difficulty in surgery or additional increase after external radiotherapy. The median age was 64 years. Primary lesions were skull base (4), nasopharynx (3), paranasal sinus (3), nasal cavity (2), lacrimal gland (1), oropharynx (1), oral floor (1), and buccul mucosa (1), metastatic lymph nodes were found in three. The prescribed dose was 12-38Gy as for marginal dose. The response rate (CR+PR) was 44.4% and local control rate (CR+PR+NC) was 77.8%. The adverse effects were assessed by the NCI-CTC Version 2.0 and observed grade 3 in two cases. Our early experience indicates that this system could to be feasible for the treatment of locally advanced or recurrent head and neck tumor, and for the reduction of adverse effect and maintenance of useful QOL of patients.

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Carbon ion radiotherapy for head and neck malignancies, which has been performed since April of 1997, was analyzed preliminarily. Of 101 head and neck patients who were treated till August 2000, 37 cases with adenocarcinomas were analyzed. They consisted of 13 cases of adenocarcinoma (AC), 16 cases of adenoid cystic carcinoma (ACC), and 8 cases with papillary adenocarcinoma (PAC) of the thyroid. There were 11 males and 2 females in AC, 6 males and 10 females in ACC, and 4 males and 4 females in PAC. Age ranged from 45 to 75 (average, 60 years old) in AC, from 39 to 79 (52) in ACC, and from 39 to 78 (69) in PAC. Target volume ranged from 31 to 484cc (average of 206cc) in AC, from 58 to 530cc (210cc) in ACC, and from 108 to 407 (253cc) in PAC. Thirty-five cases were treated with 57.6GyE/16 fractions/4 weeks, and 2 cases were treated with 64.0GyE/16 fractions/4 weeks. There was no acute reaction more than grade 3 (RTOG/EORTC) in normal tissues, and all of the patients completed their scheduled irradiations. The three-year local control rate (LCR) of AC was 91%, and the three-year survival rate (SR) was 74% by the Kaplan-Meier method. In ACC, the three-year LCR was 100% and the three-year SR was 54%. In PAC, the three-year LCR was 83%, and the three-year SR was 38%. There were 2 cases of lymph node metastases, and 3 cases with distant metastases, in AC. Also, there were 2 cases with lymph node metastases, 2 cases with meningeal spread, and 6 cases with distant metastases, in ACC. In PAC, there were 3 cases with lymph node metastases. These metastases were the main causes of death of the patients.

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To improve local control of oropharynx squamous cell carcinoma and to lessen radiation sequelae by definitive external beam, high dose rate interstitial brachytherapy as a combined therapy or as a monotherapy was begun in 1993. Achieved were 85.1% of the five-year local control rate for 47 lesions in the 46 patients. Five-year cause specific and overall survival rates were 84.5% and 62.6% (minimum/maximum/median/mean follow-up were 1/88/22/30 months, respectively). Transient ulcer was observed in 38.3%. Compared to definitive external beam radiotherapy series, better local control was achieved. Compared to low-dose rate interstitial series, local control and complications were almost equivalent. This treatment modality was considerably superior to external beam radiotherapy in terms of local control. As a clinical impression, xerostomia and taste loss seemed greatly improved.

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Seven cases of delayed airway stenosis after radiotherapy for early staged head and neck cancers during 1989 and 1999 were evaluated (aged 54-77yrs, 6 male and a female). The cases included five glottic laryngeal cancers (T1a, T1b, and three T2), a subglottic laryngeal cancer, and an unknown origin, but strongly suspected laryngeal cancer, with neck metastasis. Radio injury was found from 3 months to 47 months after radiotherapy. ⁶⁰Co for radiotherapy was used in all seven cases, although ⁶⁰Co radionuclide was changed to Liniac in 1997. The total dose was 60Gy for 3 cases, and 70Gy for 4 cases. Tracheostomy was performed in 3 cases due to bilateral vocal cord impairment. Background, treatment, and response to radiotherapy were compared to those of 90 patients of a control group with early staged laryngeal cancer who did not fail radiation injury during the same period. As a result, radionuclide (⁶⁰Co), total dose, cervical surgery, antiinflammatory drugs, laryngeal edema during radiotherapy were risk factors. The intensity and the period of mucositis by radiotherapy was important for indicating delayed airway stenosis.

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Objective
To understand the changes in the sonographic findings of the lymph nodes before preoperative radiotherapy and after preoperative radiotherapy. In addition, we also evaluated the contribution of irradiation for prediction cervical lymph node metastasis.
Materials and Methods
We performed US examinations on 166 cervical lymph nodes (64 metastatic and 102reactive nodes) before and after radiotherapy. We also evaluated the pattern of vascularity and found it to be divided into 3 categories; a hilar pattern, a peripheral pattern and a no-signal pattern. Both previous report and our previous study supported the theory that either the displaced hilar flow or the absence of local perfusion indicates a malignant nature of lymph nodes and therefore, w e evaluated any abnormalities in a hilar pattern.
Results
Irradiation of the neck (22.5Gy or 30Gy) caused an increase of blood inflow into the lymph nodes and better visualization of the peripheral vessels. The incidence of a no-signal pattern decreased from 27% before irradiation to 7% after irradiation. Preoperative irradiation improved the detection of an abnormal hilar flow in the metastatic nodes and the incidence increased from 45% to 74%. If an abnormal blood flow (a no-signal pattern, a peripheral pattern and an abnormal hilar pattern) was a criterion for metastasis, the discriminative power was increased with sensitivity from 72% to 86%, specificity from 64% to 89%.
Conclusion
After irradiation, the reduction of percentage of reactive nodes of no-signal pattern and the better detection of an abnormal hilar flow in metastatic nodes improved the discriminative power.

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There were 21 evaluable cases (22 lesions) who received concurrent chemotherapy with low dose Nedaplatin and radiotherapy, and the diagnosis was head and neck cancer at our institute during the 3 years and 3 months from March 1997 to June 2000.
Approximately 77.3% had advanced cancer, and all cases involved squamous cell carcinoma (SCC) except for one case involving undifferentiated carcinoma of the maxillary sinus.
The 21 lesions of SCC which could be assessed by TNM classification showed clinical or pathological CR at the primary lesions (T).
In consideration of the metastatic lymph nodes (N), 11 for 14 lesions (78.6%) showed CR.
From the results, it is believed that this treatment is an excellent therapy in functional preservation and QOL, though further observation and more cases are necessary.

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A combination of carboplatin (CBDCA) therapy and radiotherapy was used in T2 laryngeal cancer. The subjects were 34 untreated patients with T2 laryngeal cancer, who were enrolled during the period from May 1998 to April 2000. All the patients were male, and their average age was 64.4 years. The dose of CBDCA was properly adjusted so that the AUC would be either 1.5 or 2.0. CBDCA therapy was conducted once a week for four weeks. As a rule, radiotherapy was administered at a dose of 2Gy, with a total of 60Gy to be given to each patient. Of the 34 patients, 29 were eligible for evaluation. Twenty-five of the 29 patients demonstrated complete response (CR) (86.2%). The larynx was preserved in 25 of these 29 patients (86.2%). The complete response rate was 81.8% in those who were placed on CBDCA therapy with an AUC of 1.5, and 88.9% in those with an AUC of 2.0. Regarding hematological toxicity, grade 3 leukocytopenia was recognized in three patients, while symptoms of thrombocytopenia severer than grade 3 were rarely observed. Accordingly, CBDCA therapy with an AUC of 2.0 reflects the optimum dose of CBDCA. The combination of CBDCA therapy and radiology is considered to be an effective treatment for T2 laryngeal cancer.

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To improve disease specific survival (DSS) and avoid laryngectomy in patients with Stage II to IV resectible cancer in the oropharynx, hypopharynx and supraglottis, forty-two cases registered in a phase II non-randomized prospective study on concurrent chemoradiotherapy using Cisplatin (CDDP) from May 1992 to June 1999. Median follow-up time was 42 months (6-118 months). Definitive radiation dose was 66Gy/30F/7.5weeks, except for the cases evaluated for scheduled surgery at 40 to 45Gy. Two cycles of chemotherapy (20mg/m² of CDDP, days 1, 2, 4, 5) were administered during the overall treatment time.
T3-4 was 50% (2 T1, 19 T2, 14 T3, 7 T4), and Stage III & IV was 79% (1 Stage I, 8 Stage II, 13 Stage III, 20 Stage IV). Primary sites were oropharygeal anterior wall (8), oropharyngeal posterior wall (3), hypopharynx (19) and supraglottis (12). Five-year DSS was 81% and 5-year local control rate was 76% in all 42 cases. The complete response rate within 2 months after RT completion was 36/42 (86%) for the primary site and 18/24 (75%) for the neck. The laryngeal preserving rate was 63% at 5 years. These data were compared with those of the control cases treated with RT+Surgery, which has been selected from a historical database for the matched pair analysis. Five-year DSS and laryngeal preservation rate in the chemoradiation group were significantly better (p=0.0263 and p=0.0085) than those (51% and 40%) in the control group, respectively. Only one Grade 4 complication was shown as leucocytopenia and pneumonia but was recovered.
It was concluded that concurrent chemoradiation using CDDP appears to result in distinct improvement of DSS and laryngeal preservation.

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The effectiveness of chemoradio therapy (CRT), which was performed on 31 patients with advanced head and neck cancers of stage III or IV at Kansai Medical University between September 1999 and December 2000, was examined. The CRT consisted of continuous infusion of 5FU (500mg/m²) for 120 hours, prior to drip infusion of CDDP (50mg/m²) for 2 hours and conventional radiotherapy (2Gy/day, 5 days/w).
The 31 patients with these cancers were divided into two groups; a non-operative group (16 patients) and an operative group (15 patients). The patients in the non-operative group underwent CRT (60-70Gy of total radiation dose and two courses of chemotherapy) without surgery. The patients in the operative group received surgical treatment followed by CRT (40Gy of total radiation dose and one course of chemotherapy).
The results of CRT indicated 87.1% of the response rate (RR), and 29.0% of the complete response rate (CR) in the group. The CR rate was lower than in other reports. However, the combination of CRT and the subsequent operation indicated a disease-free survival rate of 61.3% and reduction of the recurrence rate to 17.4%.
Eight of 9 patients of CR after CRT without surgery revealed NED. On the other hand, the results indicated that all 10 patients of PR after CRT showed tumor residue, 9 of 10 patients of PR showed NED after additional surgery. Therefore, it is likely that the patients of CR do not need the additional surgery, however, the patients of PR are strongly recommended the surgery to improve the local control rate as well as survival rate.
Although adverse reactions of CRT on patients included mucositis, leucopenia, thrombopenia and dermatitis, the symptoms ranged within grade 3.

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Superselective two-channel intra arterial chemotherapy was administered 177 times to 37 patients with head and neck malignant tumor, from November 1998 to March 2001, in our hospital. Its side effects and complications were evaluated in this study. None of the patients experienced Grade 4 chemotoxicity such as hematological, renal dysfunction or gastrointestinal symptoms.
Drop out cases of intra-arterial chemotherapy encountered severe complications such as one DIC, one cerebral infarction, one recurrent and glossopharyngeal nerve palsy, and one zepsis.
In case with tumor extension intracranial region or with tumor extension around respiratory tract, further management is required to prevent severe complications.

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The systemic and local side effects of superselective intraarterial infusion of cisplatin (CDDP) for head and neck cancer were investigated. Sixty patients with head and neck cancer were treated with this therapy at Fukushima Medical University between November 1998 and April 2001. The catheter was inserted under fluoroscopic guidance via the right femoral artery in 58 patients and superficial temporal artery in 8 patients. Dose of CDDP of 80-100mg/m² were infused weekly. After completion of CDDP infusion, Sodium thiosulfate was administered by drip phleboclysis, and steroid was administered through the catheter.
As systemic side effects more severe than grade2. anorexia was the most common (27/60). Leucopenia was the second most common (17/60), nausea and vomiting were the third most common (12/60), and other side effects were decrease of creatinine crealance (4/60), anemia (4/60), and thrombocytopenia (3/60). Local side dffects were seen in ten cases: postoperative sequestum of maxilla (3), postoperative diastasis (2), facial nerve palsy (1), partial necrosis of tongue caused to the fatal complication (1), suspected infarction of CNS (2), and alopecia (1).

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Thirty-eight patients with stage III, IV oral cancer were treated by preoperative chemoradiotherapy using superselective intraarterial infusion via the superficial temporal artery. Radiotherapy (total dose: 40Gy) and chemotherapy using CBDCA (total dose: 460mg/m²) were performed daily, followed by surgery. Catheter-insertion of 34 patients was done successfully. Four catheter insertions were not done successfully because of the anomaly of the artery such as common trunk of the lingual artery and the facial artery. The clinical effects were CR in 9 patients (26.5%) and PR in 25 (73.5%), and histopathological effects after surgery were grade III, IV in 10 (29.4%), grade IIb in 23 (67.6%), and grade IIa in 2 (5.8%). The 5-year cumulative survival rate was 67.8%. This superselective intra arterial infusion method could be the technique of choice for the treatment of oral cancer.

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cDNA microarray Was used to identify genes regulated in response to hyperthermia in a low pH culture condition using IMC-3 cells, a human maxillary cancer cell line. cDNA microarray and reverse transcription-PCR (RT-PCR) were performed. Eighteen genes were found to be up-regulated by hyperthermia at a low pH culture. These include genes involved in cell cycle checkpoint control, genes for signal transduction proteins as well as genes associated with apoptosis. The observed change in gene expression may play a role in enhancement of heatinduced cell death in a low pH culture condition.

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The chemosensitivity of head and neck cancer was evaluated based on the diverse function of mutated-p53. Two human head and neck cancer cell lines harboring mutated p53 gene, HSG (Asn30Ser) and TYS (Asp281His) were used. We transfected the cells with luciferase reporter plasmids containing promoter sequence of p53 target genes (p21^waf1 BAX, MDM2). After treating the cells with chemotherapeutic agents, adriamycin, 5-fluorouracil and cisplatin, luciferase activity was measured. In HSG cells, none of the target gene promoters was activated by treatment with the chemotherapeutic agents. However, in TYS cells, p21^waf1 promoter was markedly activated by the chemotherapeutic agents. In both cells, Bax promoter was not activated irrespective of treatment with the chemotherapeutic agents. Under DNA damaging stress, TYS-derived p53 may arrest the cell cycle by induction of p21^waf1, but did not induce apoptosis. Analysis for diverse function of mutated-p53 may help to determine the therapeutic strategy, especially chemotherapeutic strategy in the individual patient with head and neck cancer.

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We analyzed differential gene expression between cancer tissue and dysplasia and normal nasal tissue obtained from a patient with maxillary carcinoma, using a cDNA microarray consisting of about 1000 genes. Genes whose expression was increased or reduced in cancer tissue were almost the same as genes in dysplasia. Three genes (Humig, Diubiquitin, Stat-1) that showed significant overexpression in the step of carcinogenesis, were identified.

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We experienced 2 patients with malignant non-epithelial tumors that developed following an incubation stage of 10 years or more after radiation therapy for cancer of the maxillary sinus. In Patient 1, the primary cancer was unclear, but it was speculated that this patient had been treated for cancer of the maxillary sinus. In Patient 2, cancer of the maxillary sinus had been treated in our hospital. In Patient 1, the secondary cancer was a malignant histiocytoma of the parapharyngeal space. In Patient 2, the secondary cancer was a spindle cell sarcoma in the maxillary sinus.
According to the classification of the probability of radiation-induced cancer after treatment for malignant tomors, the probability was evaluated as A in Patient 2, and B or higher in Patient 1. In the two patients, radiation-induced cancer was strongly suggested. For treatment, extended surgery was indicated, as a rule. In Patient 1, radical neck dissection was performed. In Patient 2, tumorectomy was performed several times. Concerning the prognosis, Patient 1 is alive without cancer, but Patient 2 died of intracranial invasion by tumor. The invasion of the tumor and histological type may have influenced the prognosis. The incidence of radiationinduced cancer is considered to be 1% or less. However, radiation therapy-related late disorder must be considered.

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Almost all malignant tumors in the nose and paranasal sinuses occur primarily in the maxillary sinus, and are pathohistologically classified as squamous cell carcinoma. Transitional cell carcinoma is rare in the nose and paranasal sinuses.
Three patients with transitional cell carcinoma in the maxillary sinus were encountered. Of the 3 patients, it was the primary carcinoma in 2 patients, and metastatic carcinoma from the bladder in the other patient.
The 2 patients with the primary carcinoma in the maxillary sinus, of which the disease stage was T3, underwent excision of the entire upper jaw including the eyeballs. Patient 1 died of metastasis due to delay of radical surgery. In Patient 2, good results were obtained by a combination of 3 treatment (chemotherapy, radiation and operation) methods.
The patient with metastatic carcinoma from the bladder underwent total excision at the time of incision of the maxillary sinus for examination, but died from systemic metastases. Metastasis of transitional cell carcinoma of the bladder to the maxillary sinus is very rare, and it was considered to have metastasized via circulation.

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We report a case of a 68-year-old woman with a sphenoid sinus chondroni a. The patient was admitted to Showa University Hospital after experiencing visual disturbauce for three months. CT films of the facial bone showed a tumorous lesion with calcification that filled the sphenoid sinus. MRI T1-weighted image showed a mosaic pattern and a low-density tumor in the sphenoid sinus. The tumor was determined to be a chondroma, pathologically. We decided to perform intracapsular enucleation, using the transnasal approach, because of the age and general status of the patient and the location of the tumor. During the procedure, we identified the optic nerve through the capsule. Therfore, to protect this nerve, we resected the tumor intracapsullarly. No significant complications were observed. No recurrence has been observed for 8 years since the operation.

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