The combination of CDDP and 5-FU is considered first line chemotherapy for head and neck cancer. New analogs of CDDP with reduced renal toxicity, such as Carboplatin and Nedaplatin, are developed. They are useful for outpatient chemotherapy. Docetaxel (TXT) is also active for head and neck cancer. High CR rate for advanced head and neck cancer was obtained with the combination of TXT, CDDP and 5-FU. The clinical evidence of concomitant chemo-radiotherapy against survival and functional preservation is proved in head and neck cancer treatment. Prevention of distant metastasis by adjuvant chemotherapy after definitive treatment also has some evidence. Better prognoses for NAC sensitive patients will be proved as one of clinical evidences. Revaluation of NAC will be necessary with effective regimen such as CDDP + 5-FU+TXT. Clinical evidences are obtained by large comparative clinical trails in USA and Europe. The evidences of chemo-radiotherapy and NAC for head and neck cancer treatment should be studied by comparative clinical trials also in our country.

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The border zone of the surgery of neoplasm arising in and around the ear is the lateral skull base surgery. If the malignant neoplasm involves the middle ear, the mastoid, the dura of the middle or posterior fossa, the carotid artery and the jugular vein, the prognosis drops off significantly. In cases with benign neoplasm, it is sometimes possible to remove them without neurological deficit if the neoplasm involved surrounding area of the temporal bone. Between 1999 and 2001, 13 patients with neoplasm of the external auditory canal and middle ear were treated at the Department of Otolaryngology, Kanazawa University. Seven patients with malignant tumors and 6 patients with benign tumors were registered. Within these 13 cases, two cases (a case with squamous cell carcinoma of the external auditory canal and with giant cell tumor of the temporal bone) were described and discussed about the philosophy of treatment of neoplasm arising from the ear.

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Major lesions occupying internal auditory canal (IAC) are acoustic neuroma, facial neuroma, meningioma, lipoma and hemangioma. These lesions in the IAC initially present otologic symptoms such as hearing loss, tinnitus and dizziness, and then gradually grow up to be CP angle tumors. The most powerful tool for detecting the IAC lesions is MRI, however differential diagnosis between these lesions is still difficult. There are two surgical approaches for the IAC lesions. One is middle cranial fossa approach and the other is translabyrinthine approach ; the former allows preservation of both facial nerve and hearing but the latter does not. The 50-50 rule (PTA ≤50dB, SDS≥50%) is generally used for indication of hearing preservation surgery. Recently, preservation of hearing and facial nerve function are more and more improving by use of intraoperative monitoring of ABR and evoked EMG. We otologists should make effort for functional surgery as well as early diagnosis of small IAC lesions.

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The tumors arising in the parapharyngeal space are relatively rare. The parapharyngeal spaces are difficult regions to resect the tumors due to its anatomical characteristics, including important nerves and vessels. The majority of parapharyngeal tumors are parotid gland origin and neurogenic tumors. There are several surgical approaches to the parapharyngeal space as follows: transoral approach and cervical approach (transparotid approach, transsubmandibular approach, cervical approach with osteotomy and infratemporal fossa approach). In this report five cases are presented, and the relations among the surgical approaches, tumor sizes and their pathological diagnosis are reviewed in the past literature.

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Surgical approaches for jugular foramen tumors and the surgical results were presented. Forty eight cases of the tumors (jugular foramen schwannoma 25, glomus tumor 4, etc.) were removed by the posterior transjugular approach developed by the author, in combination with other approaches.
Results; There was no operative mortality. As to the functional outcomes of lower cranial nerves following surgical removal of 25 jugular foramen schwannomas, the 12th nerve function improved in 4 out of 7 patients who had dysfunction before the operation. In contrast, 9th, 10th, 11th and 12th nerve function deteriorated after the operation in 28%, 24%, 12% and 4% of the patients, respectively. However, vocal cord plasty or feeding gastrostomy or thyroplasty was not necessary in any patients.
In conclusion, the posterior transjugular approach is useful for the removal of the tumor. It is rare for the dysfunction of the 9th, 10th or 11th nerve to resolve after the tumor removal, although preoperative 12th nerve palsy can be improved by the tumor removal.

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Fibrous dysplasia is known to be associated with various endocrinopathy such as true precocious puberty. We will report a case of fibrous dysplasia observed in a 13-year-old girl which developed widely in her facial bones, associated with increased growth hormone levels. Debulking surgery was performed, and thereafter, CB-154 (bromocriptine) was administered to correct increased growth hormone levels in the patient. Subsequently, growth hormone levels were regulated, and no local recurrence was observed as of approximately one year postoperatively.

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For the extirpation of hypopharyngeal carcinoma, in most cases laryngopharyngectomy is indicated because many case of that demonstrate advanced stages. However, in case of localized tumor, partial laryngopharyngectomy can be performed to preserve the laryngeal function. The authors have experienced a case of second-staged reconstruction using hinge flap after failure of forearm free flap reconstruction. The swallowing and phonatory function has preservated with this method. A 51-year-old male was diagnosed to have hypopharyngeal carcinoma of the right pyrif orm sinus (T1N2bM0) and underwent partial laryngopharyngectomy, bilateral neck dissection, and reconstruction of hypopharynx using a free forearm flap. However, necrosis of free flap occurred, we had to perform extirpation of total necrotic flap. To control infections and avoid further complications, we chose the second-staged reconstruction, and at first we performed pharyngeal-cutaneous f istulaplasty. After that, we reconstructed using hinge flap and deltopectoral flap. After all, his laryngeal function (swallowing and phonation) has preserved.

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A case of nasal chondromesenchymal hamartoma (NCMH) with severe orbital deviation in infant is reported. The tumor involved the nasal cavity, ethmoid sinus and floor of the anterior cranial fossa. A 2-year-old male was presented with swelling of the external nose and buccal region, epistaxis, nasal obstruction and severe orbital deviation to upper-lateral direction. He visited our department in February 2001. Magnetic resonance images (MRI) demonstrated a mass in the left nasal cavity, involving the ethmoid sinus and floor of the anterior cranial fossa, and compressing the left orbit with mild exophthlmos. Computed tomography (CT) revealed calcified capsule. An excisional biopsy specimen suggested NCMH. An anterior craniof acial resection using bi-coronal skin incision and hemi-facial dismasking approach was performed, and the tumor was almost totally extirpated except in a small area around the exposed optic nerve. The tumor extended into the ethmoid sinus, sphenoid sinus and orbit. However, nasal septum and anterior skull base were not invaded. The histological examination of the extirpated specimen revealed a final diagnosis of NCMH without malignancy. The patient is free from recurrence of the tumor or ophthalmologic complication 1 year after the operation.

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