About 10,000 patients die of head and neck cancer annually, which is not as widely recognized as breast and gynecological cancer. The head and neck region is complicated anatomically, and most organs in the region have an impact on human dignity. Moreover, extensive surgery on this region is characteristically not compatible with the preservation of function, and patients are extremely worried about cosmetic aspects of the surgery and the possibility of functional loss, as well as being anxious about survival. Surgery, including reconstruction, often requires many hours. Head and neck surgeons are sometimes confined to the hospital for three days in a row: one day for surgery, the next day for postoperative management, and two days after surgery for overnight otolaryngological duty. To make head and neck surgery more widely understood and accepted, it is necessary to create an environment in which “patients attend an academic meeting to be educated, become a coordinator, and educate other patients”. It should be emphasized that “a human has the right to live and die with dignity as a human”, and to contribute to social happiness.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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Fibrous dysplasia is a benign disease characterized by the progressive replacement of normal bone elements with fibrous tissue, and tympanic cavity involvement is uncommon. A 13-year-old female visited our hospital complaining of progressive left hearing loss over 7 years. Computed tomography showed a tumor shadow from the tegmental wall along the short leg of the incus to the middle tympanic cavity. Magnetic resonance imaging revealed low signal intensities on both T1- and T2-weighted images enhanced by gadolinium. The histological examination gave a diagnosis of fibrous dysplasia. The treatment is mainly conservative, although surgery may be required in the future to preserve hearing function and prevent facial nerve complications.

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We have reviewed clinical findings in relation to 9 cases of ethmoid cancer that were treated with anterior skull base surgery at the Department of Otolaryngology-Head and Neck Surgery, Kurume University Hospital from 1984 to 2009.
We analyzed the prognosis, postoperative complications and dural invasion. The results indicate that 5 cases are alive and 3 cases died of the primary disease, with the remaining one case dying of others causes. Complications were observed in 2 cases due to local infection and aspiration pneumonia. Dural invasion was observed in 4 cases.
In conclusion, anterior skull base surgery improved the prognosis of ethmoid cancer. A team approach enabled a safe surgical procedure for anterior skull base surgery.

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Sinonasal papilloma is a benign tumor. But it is known for frequent local recurrence, a tendency to invade to bone tissue and transformation to malignancy. Such characteristics make complete resection of the tumor mandatory.
We outline 62 surgical cases of sinonasal papilloma over the last 10 years. Mean age was 56 years (19-84). Chief complaints were unilateral nasal obstruction in 49 cases (79%). The site of origin was mostly on the lateral wall of the nasal cavity. According to the classification by Krouse, 4 cases were in T1, 27 in T2, 28 in T3, 3 in T4. The pathological diagnosis was mostly inverted papilloma. Recurrences were noted in 11 cases (18%). We operated on all cases. 29 cases underwent medial maxillectomy after Denker and 34 received ESS (6 cases underwent EMM).
Recently, a number of reports have advocated endoscopic sinus surgery (ESS) to minimize invasiveness. But it is difficult to resect the tumor completely by ESS and therefore there is a chance of local recurrence. The optimal approach to appropriate tumor resection should be chosen.

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To evaluate the efficacy of multimodal therapy for squamous cell carcinoma of the maxillary sinus, we analyzed 37 patients in our institute between 1997 and 2007. Multimodal therapy included partial maxillectomy to reduce the primary tumor volume and chemoradiation with intraarterial injection via superficial temporal artery and curative operation. We reviewed the cause-specific survival rate and the recurrence rate to inspect efficacy of the therapy. The survival rates were 89% for T3 tumors, 66% for T4a tumors, 29% for T4b tumors. The local recurrence rates were 0% for T3 tumors, 44% for T4a tumors, 67% for T4b tumors. The salvage rates were 43% for T4a tumors, 0% for T4b tumors. The results indicated the need to consider changing the details of the multimodal therapy to improve the treatment results for T4 tumors.

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Objective: Skull base surgery for malignant tumors is a standard procedure. We performed skull base operations depending on the extent of the skull base range with the basic policy that tumor resection is feasible in an en bloc fashion with negative histological margins.
Methods: Forty-seven patients at Aichi Cancer Center were analyzed for outcomes from January 1, 2000 to December 31, 2009. The median age was 57 years (range 22-78 years). The majority of tumors(52%) involved the anterior-middle cranial fossa. Maxillary sinus (74%) was the most common primary site, and squamous cell carcinoma (66%) was the most common histologic type.
Results: Postoperative complications were reported in 17 patients (35.4%), with CSF leakage 8.3%. The postoperative mortality rate was 4.1%. With a median follow-up of 40 months, the 5-year overall, disease-specific, and disease-free survival rates were 59.8%, 61.1%, 57.6% respectively. The status of surgical margins is an independent determinant of outcome.
Conclusion: Skull base surgery is a safe and effective treatment option for patients with malignant nasal and paranasal tumors of the skull base.
The status of surgical margins is an independent determinant of outcome.

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We investigated 35 patients (30 male, 5 female) with oral-floor carcinoma for prognostic factors. The subjects were patients with an average age of 61.8 (range 38-78) years who had been operated and managed at our hospital from September 2002 to December 2007. The cancer stage was classified as Stage 0 in 1 patient, Stage I in 10 patients, Stage II in 8 patients, III in 2 patients, and Stage IVa in 14 patients. We chose the following surgical procedures for the cancer: 1) Superficial-layer dissection of the oral floor, 2) deep-layer dissection, and 3) pull-through dissection. These procedures were used in 6, 11 and 18 patients, respectively. The overall 3-year survival rate was 74.2% and the disease specific 3-year survival rate was 82.6%. There were no significant prognostic factors among the local factors, such as mandibular bone invasion and the surgical procedure employed. Thus, the presence/absence of mandibular bone invasion does not seem to contribute directly to the prognosis. Therefore, the dissection should be carried out based on the result of appropriate preoperative assessment. A trend towards poor prognosis was recognized in patients who had five or more pathological lymph-node metastases. In contrast, there was no clear correlation between the N Stage and the prognosis. A significant trend toward nodal involvement was observed in patients with submucosal invasion up to a depth ≥ 10 mm. In conclusion, it is important for surgical treatment of oral-floor carcinoma to assess deep invasion correctly and to determine adequate neck dissection.

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Application of microvascular free flap is now favored for head and neck reconstruction following cancer resection. However pedicled flaps still play an important role in reconstruction because of reliability and ease of preparation. The infrahyoid myocutaneous flap (IHMCF) represents a reliable pedicled flap including strap muscles. The major blood supply of IHMF is derived from the superior thyroid artery. We report an 80-year-old male patient with adenoid cystic carcinoma of floor-of-mouth, T3N1M1. The patient suffered severe oral pain, and resection of the primary lesion was performed as a local treatment. Oral floor defects after tumor ablation were reconstructed with IHMCF. After surgery, although partial necrosis of the epithelial flap was evident, the donor site was primarily closed. The patient experienced no complications and recovered without oral pain. We herein describe the clinical course and the technique and critical points of the surgery.

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Recently, transoral resection of the supraglottic carcinoma under microscope or video-laryngoscopy has been reported. We apply a transoral en bloc mucosal resection for supraglottic carcinoma. Seven supraglottic cancers were included in this study. Six were primary cancers and other one was a relapsed case after chemoradiotherapy. There were 2 epiglottic and 5 arytenoid cancers. The resection devices included electrocautery with Colorado Micro Dissection Needle^® or Harmonic ACE^®. The larynx was expanded with a distending laryngoscope or a large-caliber laryngoscope. We have not encountered any post-operative hemorrhage or dyspnea. The patients started their oral intake on the 1st or 2nd day after the operation. There were no local or regional relapses. An adequate choice of the laryngoscope and devices for resection is very important for better exposure of the operation field and bimanual manipulation. The otolaryngologist or head and neck surgeon should be engaged and take the initiative in this operation.

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We reviewed 58 cases of planned neck dissection after concurrent chemoradiotherapy. The rate of pathological lymph node-positive cases was 36%, and no difference was exhibited due to the primary site or the N stage. The recurrence rate was 39% and largely represented by T recurrence. The overall rate of N recurrence was 10% and since isolated N recurrence was only 3%, this demonstrates the efficacy of cervical control. The three year survival ratio was 81% and no difference was exhibited due to the primary site, the T stage, the N stage or the pN stage. Planned neck dissection was an appropriate therapy in light of the pathological lymph node-positive ratio, the high cervical control rate and survival ratio. A theme for future investigation is to identify the cases in which chemoradiotherapy alone can control the tumor and therefore enable a reduction in unnecessary planned neck dissection.

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Over a 15-year period, from 1995 to 2009, seven patients with anaplastic carcinoma of the thyroid gland were treated in our hospital, all of whom were female, ranging in age from 60 to 81 years, with an average age of 70.0. The treatment consisted of surgical resection as the primary therapy in 4 patients, radiotherapy in 5 patients, and chemotherapy in none. The three cases treated by radical surgery were able to return to domestic life. The survival time was 3days-18months (with an average of 8.2 months) and all patients died of the original disease. Two cases died by primary tumor, 4 by metastasis, and 1 by both. Although the prognosis of anaplastic carcinoma of the thyroid gland is poor, if possible, radical surgery may provide better QOL and survival results.

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We describe a 66-year-old man with mucoepidermoid carcinoma arising in the accessory parotid gland. A painless mass in the left cheek had been gradually growing for five years. The patient was referred to our hospital after an incisional biopsy at another hospital indicated a diagnosis of mucoepidermoid carcinoma. Both CT and MRI showed a solid, 18 × 14 mm tumor lying on the masseter muscle, but which did not affect the parotid gland. In light of the clinical background in addition to the radiological and histological findings, mucoepidermoid carcinoma of the accessory parotid gland was suspected. The tumor was surgically removed through a midcheek incision. The buccal branch of the facial nerve and Stensen's duct were involved in the tumor and were sacrificed. The tumor was composed of mucous and epidermoid cells leading to a pathological diagnosis was low-grade mucoepidermoid carcinoma. Slight paresis of the buccal branches resolved two months after surgery. The patient has remained free of recurrence during seven months of follow-up.
The accessory parotid gland is found in 20-70% of individuals and it comprises salivary tissue that is separated from the main parotid gland and lies on the masseter muscle. However, accessory parotid tumors are rare. The frequency of malignant accessory parotid gland tumors is higher than that of malignancies of the main parotid gland tumor, the reported frequency of which is 42-52%. Although the incidence of accessory parotid gland tumors is low, the possibility of such tumors should be considered in a differential diagnosis of a cheek mass.

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We examined the utility of neck dissection on a N3 metastasis in 30 HNSCC patients who were treated from 1999 to 2010. The details of the examination were the site of primary tumor, the T stage, the method of treatment, the survival rate and prognosis. The site of primary tumor included 14 cases of hypopharynx, 5 of oropharynx, 5 of tongue, 3 of supraglottic, and 3 of oral floor. In 30 cases, 21 were treated by operation and post-operative radiotherapy and 9 were treated by chemoradiotherapy.
The overall five-year disease-specific survival rate was 43%, representing 56% for operative cases and 22% for chemoradiotherapy cases. Twelve cases were still alive but 14 cases had died of the primary disease, and 4 cases had died of another disease. We consider that neck dissection against N3 metastasis cases in HNSCC is an effective treatment.

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Salivary duct carcinoma histologically resembles an invasive mammary ductal carcinoma and is a malignant tumor with a poor prognosis. The rarity of this carcinoma has resulted in a lack of consensus on its chemotherapy regimen. In recent years, HER2 overexpression has been reported in not only breast cancer but also salivary duct carcinoma, so we performed an immunostaining on the surgical specimens of salivary duct carcinoma and analyzed the relationship between HER2 expression and the clinical background. As a result, 3 cases were found to be HER2-positive. In salivary gland carcinomas, the HER2 positive rate was 60% in salivary duct carcinomas, 0% in adenoid cystic carcinomas, 17% in mucoepidermoid carcinomas, 38% in adenocarcinomas. For the examination of pathological grade in salivary duct carcinoma, all HER2-positive patients belonged in a pathological high-grade group, whereas all HER2-negative cases belonged in a low-grade group. This result suggests a relation between HER2 expression and pathological grade. It is hoped that a new treatment strategy using the anti-HER2 antibody will be developed for HER2-positive salivary duct carcinoma.

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