We report the treatment strategy and outcome for squamous cell carcinoma of the temporal bone in Kyushu University. T staging was classified by the Pittsburgh staging system. Lateral temporal bone resection was applied to both Ti and T2 cases (n = 5). When the lesion extended beyond the cartilaginous part, chemoradiotherapy was preoperatively performed. For T3 (n = 6) or the anterior lateral type of T4 cases (n = 4) without an extension to dura, internal carotid artery, and metastasis, either subtotal temporal bone resection or lateral temporal bone resection was done following the preoperative chemoradiotherapy. The medial type of T4 (n = 13) was treated by chemoradiotherapy without surgical intervention. Although the number of cases and observation period were not enough, adequate results have been obtained in both Ti and T2 cases so far. Disease-specific 5-year survival rates of T3 and T4 were 80% and 36%, respectively. Operation significantly improved the survival rate in T4 cases.

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Tympanic membrane (TM) perforations can be closed in the outpatient clinic using a variety of materials, such as fascia, fat, connective tissue, paper patches, and Gelfoam. Such minimally invasive surgery or conservative treatment is especially effective when the perforation is small, fresh, and dry. However, in some cases, these procedures fail to close a perforation, mainly because of decreased regeneration activity of the TM at the margin of the perforation. To improve the success rate of conservative treatment, we applied two new methods: using basis fibroblast growth factor (bFGF) combined with atelocollagen/silicon bilayer membranes as a patch material, and using amniotic membrane combined with amniotic membrane.

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We report here a retrospective study of 24 patients with malignant nasal and paranasal tumors who underwent anterior skull base surgery at the Department of Otolaryngology Head and Neck Surgery, Kurume University Hospital since 1984. All patients received surgery by the supraorbital transbasal approach. The criteria of this treatment are : tumor does not involve the cavernous sinus or brain, and intraorbital invasion, if any, is localized to one side, Pathologically they were 19 highgrade malignancies (15 squamous cell carcinoma, 2 rabdomyosarcoma, 1 adenocarcinoma and 1 anaplastic carcinoma) and 5 low-grade malignancies (3 olfactory neuroblastoma and 2 chondrosarcoma). Follow-up period ranged from 3 to 185 months (median 72 months). Facial incision was performed in twenty patients, and combined orbital exentration was performed in 19 patients. Complications were observed in 4 patients (local infection : 2, rupture of carotid artery, sepsis : 1). Fifteen patients died of the primary disease and the causes of death were: local recurrence: 10, distant metastasis death: 3, complication: 2. Five-year cause-specific survival rates determined by the Kaplan-Meier method were 54% (48% in high-grade malignancies and 60% in low-grade malignancies) In conclusion, anterior skull base surgery employed as a team approach is a safe surgical procedure. From our clinico-pathological observation dura was formed to be a strong barrier against tumor invasion. Therefore, if an en block resection of the tumor with dura is possible, it enables complete resection against a malignant nasal and paranasal tumor invading the anterior skull base.

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[in Japanese]

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[in Japanese]

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Partial laryngopharyngectomy (PLP) has not been frequently adopted for hypopharyngeal cancer.Problems of PLP were swallowing dysfunction after surgery and poor safety margin. To preventswallowing dysfunction, we developed a new method of reconstruction in which the supraglottis wasbuilt by using a half of the hyoid bone attached to the sternohyoid muscle pedicle while a wide lumenof hypopharynx was formed with a forearm flap. To improve the safety margin, histopathological examinations in several sites of resected margins were performed during surgery. Five patients withT2 piriform sinus cancers were treated with this surgery. Voice and respiration were well conservedin all patients. Swallowing function after surgery was satisfactory in most patients. Recurrence ofcancer did not occur in any patient. PLP can be an alternative treatment for piriform sinus cancer, especially in moderately clinical stages.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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We report five cases of odontogenic maxillary cyst (three cases of radicular cyst and two cases of dentigerous cyst). All patients were operated on by endoscopic sinus surgery (ESS). Cyst walls were partially extirpated in the case of radicular cyst and totally extirpated in the case of dentiger ous cyst. The causative tooth could be preserved in two of three cases in radicular cyst. In the case of dentigerous cyst, the causative tooth was extirpated in all cases. After the surgery, no recurrence was observed in all cases. The ESS treatment of odontogenic maxillary cyst has an advantage in terms of lower risk of operative invasion and infection. The ESS treatment is useful in cases where a large radicular cyst or a dentigerous cyst has extended to the maxillary sinus or nasal cavity.

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We present 21 surgical cases of malar bone fracture at our hospital between 1994 and 2005. Results showed a male predominance by 2.5 to 1 and the mean age of 45 years old. Arch fractureswere found in 12 cases, and body fractures were found in nine cases. Ten cases were complicated bymaxillary fractures. Patients with arch fractures were approached with a Gilles's temporal incision, intraoral incision, or direct incision on the arch. Patients with body fractures were approached witha lateral eyebrow incision, lower eyelid incision, intraoral incision, and/or direct incision on the arch.Titan plates were used for rigid fixation in 11 cases. For surgery, physicians should try to make smaller and fewer skin incisions for aesthetic satisfaction.

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A retrospective investigation was performed on 33 patients with submandibular gland tumors treated between 1998 and 2005. The tumors consisted of 17 benign and 16 malignant types. Fifteen of 16 malignant tumors were cancerous, and the most common histological type was adenoid cystic carcinoma (33.3). The accuracy of FNAB (fine-needle aspiration biopsies) was 84%, eight of 12 aspirates from malignant tumors were correctly diagnosed by FNAB, for a sensitivity of 66.7%, while all of 13 aspirates from benign tumors were correctly diagnosed by FNAB, for a specificity of 100%. The five-year survival rate calculated by the Kaplan-Meier method was 81.3% in 15 patients with submandibular gland cancer. Pathological neck lymph node metastasis in all NO cases was detected in level 2, so we concluded that supraomohyoid neck dissection might be suitable for NO cases of submandibular gland cancer. To improve the prognosis of submandibular gland cancer, postoperative chemotherapy may be necessary for T3 and T4 cases.

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Plasmacytomas are rare tumors that often appear in the head and neck region. Seven patients with extramedullary plasmacytoma (EMP) of the head and neck were treated at our hospital from 1993 to 2005. The median age of the patients was 60 years (range 23-72), all patients were male, and no patient had lymph node metastasis. Five patients received radiation therapy, one patient received radiation therapy following reduction of the tumor, and one patient was treated with resection of the tumor only. Conversion to multiple myeloma was seen in one patient. Because of the conver sion to multiple myeloma or delayed recurrence, patients with plasmacytomas require longterm fol low-up.

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Sixty-one patients with Basedow's disease except for 1 untreated patient were administered antithyroid drugs by our procedures. Seventeen patients that were well controlled were compared with 12 patients that experienced recurrence after the therapy. Patients under 40 years old when an anti thyroid drug therapy is started; patients whose TSH receptor antibody cannot be changed to nega tive, and patients that cannot receive MMI should be positively considered as to indication for surgery. In 45 patients who received surgery for Basedow's disease, postoperative thyroid functions were within the normal range in 25 patients. Postoperative hypothyroidism was observed in 19 patients, and recurrence was observed in only one patient. Postoperative recurrence should be avoided, and postoperative hypothyroidism should be considered acceptable. Understanding regarding post operative hypothyroidism is necessary in patients who are considered for surgery.

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Hypoparathyroidism after total pharyngo-laryngectomy sometimes induces severe complications. It is often quite difficult to control the calcium metabolism. So it is crucial to preserve the function of the parathyroid glands. It is also significant economically, as we must focus on the preservation of parathyroid glands during the surgical management of hypopharyngeal cancer. From 1999 to 2005, 63 patients with hypopharyngeal squamous cell carcinoma underwent total pharyngo-laryngectomy and bilateral neck dissection with reconstruction using the free jejunum flap. Among them, 52 were male and 11 were female. The mean and standard deviation of age of these patients were 63.2 and 7.7. Forty-seven of these cases had PS cancers, 7 had PC cancers and 9 had PW cancers. We usually preserved the parathyroid glands attached to the thyroid gland by preserving only the superior vessels of the thyroid gland. Inferior vessels were resected for wide exposure of the paratracheal and paraesophageal region. Results of preserving the parathyroid function were evaluated at 3 months after surgery based on the necessity of calcium replacement. In 30 cases (46.0%), the function of the parathyroid glands was preserved and calcium replacement was not needed. In 11 cases, the parathyroid glands were preserved, however, calcium replacement was needed. Preserving the superior thyroid vein might be more important. In 23 cases, the parathyroid glands were totally removed for various reasons. Far advanced primary tumor with bilateral invasion, radical radiotherapy and tracheotomy before surgery often made the preservation difficult.

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Retropharyngeal hematoma with a widened mediastinum is a very rare disease and may progress rapidly and cause airway obstruction. We report an case of a 85-year-old woman with acute onset of neck pain and swelling after sneezing. She received anticoagulation therapy. X-ray and computerized tomography of the neck and chest was performed. This revealed intact great vessels with no evidence of dissection of the aorta and a retropharyngeal hematoma extending from the epipharynx to mediastinum that was compressing the airway. The patient required endonasal intubation by using a flexible fiberscope. Evacuation of the hematoma was carried out under general anesthesia via the cervical approach. Tracheostomy was performed and a corrugated drain was placed in the retropharyngeal space. The patient recovered well after surgery.

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We report two cases of head and neck cancer invading the trachea. Tumor resection and end-toend anastomosis were performed at the same time. One case was a thyroid papillary carcinoma, and the other was metastasis of a paratracheal node that invaded the thyroid, trachea and esophagus. Both patients required long-term intubation because of obstruction of the airway due to laryngeal edema and a tracheostomy was necessary. We can infer from these cases that the causes of severe vocal edema were infection, history of radiotherapy and extensive resection. In addition, it is quite likely that one of the causes of airway obstruction was recurrent laryngeal nerve palsy. Long-term intubation may be considered a cause of laryngeal edema and recurrent nerve palsy. Because it is difficult to estimate the risk of vocal edema, and difficult to know how long intubation will be required, we have to carefully consider the complications related to such procedures.

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