Mandibular reconstructive surgery is an indispensable operative procedure for a patient who received a radical surgery for oropharyngeal cancer to maintain their speech, swallowing, respiratory and masticating function. Serious cosmetic problem appearance would also arise after the craniofacial operation that associate with major mandibular defects. Primary mandibular reconstruction frequently require provision for interoral lining, tongue and as well as lateral wall of oropharynx.Scapular osteocuntaneous free flap is preferred for reconstruction of mandible. Because scapular osteocutaneous free flap has great flexibility in three-dimensional reconstruction and can be combined with other flaps based on the circumflex scapular artery. In this study, masticating function among 20 cases of mandibular reconstruction by scapular osteocutaneous flap were quantitated using dental prescale occluzer system.The postoperative mandibular mastication was dependent on the number of remaining natural teeth, the presence of adhesion between denture and the mobility of remaining tongue. Good mastication are expected in the case of good adherence of denture and remaining natural teeth were obtained. Osteointegrated implants are adequate for total mandibular reconstruction.

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Duing 12-years period from 1984 through 1995, 173 cases with primary carcinona of the tongue and oral floor were treated. In recent years, the rate of cases undergoing partial resection rather than interstitial irradiation is increasing. During the above period, reconstruction was performed in 60 cases using 68 free flaps, and ther ability of speaking, eating and swallowing was examined. In cases operated on for lingual carcinoma and oral floorr carcinoma, their postoperative speech ability was good, but it became somewhat poor when the area of resection was large. In cases undergoing resection including the mandible, there was tendency for their speech ability to become poorer because of limitation in their tongue movement. Eating ability was strongly affected by denture, and most cases undeegoing mandibular resection were obliged to eat soft food or thin porrige. As. pilation was observed in almost no cases

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Reconstruction of the tonsillar fossa and soft palate is sometimes troublesome, because of postoperative deglutition and speech disorder. In this study, we reviewed 84 patients who underwent reconstruction surgery of this area at our hospital during the period from 1977 to 1995. As a result, (1) wide resection causes poor postoperative quality, (2) patients after 1990 shows better function of eating and speaking than patients before 1990, (3) free flap reconstruction has more benefit than pedicled flap because trimming of the free flap is quite easy and it can fit any defect of the lesion. One of the most important things during surgery are not to injure the function of nasophayngeal closure and tongue mobility. In these couple of years, we routinely use rectus abdominis M - C flap after wide resection of the oropharyngeal cancer.

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During the past 20 years the tracheoesophageal(TE) fistulization, the tracheojejunal(TJ) fistulization and the TE or TJ puncture technique were performed on 301 patients, 15 patients and 52 patients, and 243 patients(81%), 12 patients(80%) and 44 patients(85%) obtained fluent and intelligible speech, respectively. Most of patients with primary voice reconstruction had voice capability within 1 month postoperatively, and patients who underwent secondary voice reconstruction with voice prosthesis started speaking on the third postoperative day. The average value of the maximum phonation time in the group of TE speakers, TJ speakers and speakers with prosthesis was 17 seconds, 11 seconds and 16 seconds respectively. The retropharyngeal prominence is formed with the thyropharyngeal muscle and comes in contact with the anterior wall on which the neoglottis is located during TE phonation, while the vibratory source of TJ phonation is located at the stenotic portion produced by the jejunal perstalsis. As far as the swallowing function is concerned, no regurgitation or aspiration was seen at all in all TJ speakers and 88% of TE speakers with the use of bilateral esophageal muscle flaps.

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A total of 225 patients with carcinoma of the hypopharynx and the cervical esophagus were treated surgically between 1986 and 1996 at Osaka Medical Center for Cancer and Cardiovascular Diseases. There were the following three types of defect resulting from resection of carcinoma ; 119 partial (non-circumferential) pharyngeal, including nine with the preservation of the larynx, 91 circumferential pharyngeal and 15 pharyngoesophageal. Our principle of reconstruction was as follows ; Primary closure of the pharynx was indicated when the width of the pharyngeal remnant was more than 2 cm. For the partial pharyngeal defect with the width of less than 2 cm, the radial forearm free flap was utilized (patch reconstruction). And the free jejunal autogreft and gastric pull-up were utilized for the cicrcumferential type and the pharyngoesophageal type, respectively. There were 91 patients who had primary closures, 30 who had free forearm flaps, 57 who had free jejunal autografts, and 13 who had gastric pull-ups. Functions of these reconstructive techniques were evaluated by the interviews to the patients who had more than six-month follow-up. About 80% of the patients in each groups had no disturbance of diet passage ; 74% in primary closure (n=31), 80% in free forearm flap (n=5) and 77% in free jejunal autograft (n=13). More than 70% in each the three groups were able to take a fairely normal diet; 81%, 100% and 77%, respectively. The rates of use of neoesophageal speech in primary closure and free forearm were 58% and 80%, respectively, higher than that of 23% in free jejunal autograft. The only one case of severe dysphagia was reconstructed by free jejunal autograft, which was anastomosed to pharyngeal stump in end-to-side manner. There were two cases of pocket formation in the lower part of patch-on forearm flap, complaining of stagnant feeling of diet; which might result from too wide flap-width. An analysis using videofluorography revealed that neoglottis were located at the remnant mucosa near the lower or the upper anastomosis of free forearm flap and free jujunal autografts. These results suggested that the reconstructive method should be selected with reference to the type of defect, because of no significant difference of functions among reconstructive methods, and the reliability of materials, the simplicity of harvesting and the donor-site morbidity should be considered.

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Among 85 cases with acoustic neuroma, we had five cases with normal hearing and another 5 cases which had radiologically normal internal auditory meatus. All cases with normal hearing had a history of cochleo-vestibular symptom and had enlarged internal auditory meatus. In addition, four cases had canal paraesis and abnormal auditory brain stem response. On the other hand, those who had radiologically normal internal auditory meatus had decerased hearing acuity in the lesion side ear, and four of 5 cases had canal paraesis. Thus a case with acoustic neuroma which has normal hearing could be detected by radiological examinations and audiological tests. Furthermore one should always keep in mind the possibility of acoustic neuroma which has hearing impairment along with canal paraesis.

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Of 536 patients who were treated by radical radiotherapy for early (stage I·II) glottic squamous carcinoma between 1979 and 1994, 97 patients failed locally. Seventy-seven per cent of the recurrent lesions were detected within 2 years. Partial laryngectomy for salvage was performed in 39 patients ; 34 of 58 in Tla, 0 of 8 in Tlb and 5 of 31 in T2, respectively. The cumulative 5-year survival rate calculated from the beginning of irradiation in 97 patients was 85.3 %, which was similar to the rate of the remaining patients controlled by irradiation. The cumulative 5-year survival rates and the cause-specific 5-year survival rates estimated from the date of salvage surgery were 85.5%, 94.0% in patients with partial laryngectomy and those were 76.1%, 97.7 % in those with total laryngectomy, respectively. The acutual laryngeal preservation rates were 82% (32139) in partial laryngectomiees and 33% (32197) overall. It showed partial laryngectomy was effective after failure of radiationtherapy, so it was found to be important to recognize the recurrent tumors as soon as possible.

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We investigated the patterns of cervical lymph node metastasis in the patients with tongue carcinoma who were treated in our institute from 1988 to 1994 and discussed how to deal with the cervical lymph nodes in the patients. The lymph nodes in the submandibular region and in the jugular chain were the main targets of the subsequent metastasis in T1 and T2N0 patients. The salvage rate with surgery was higher than that with radiation therapy in the patients with this type of metastasis. The prophylactic irradiation to the neck seems to be useless because the subsequent metastasis was often observed in the area of the external radiation An en-bloc operation with neck dissection should be conducted for the T2 and T3N0 patients with the tumor invaded deeply into the tongue. A careful neck dissection is required when the tumor invades into the anterior or posterior part of the tongue, or when the lymph node metastasis was found. In these cases, the effort should be made to detect metastasis to the lymph nodes in the other side of the neck.

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Between April 1994 and October 1996, endoscopic endonasal sinus surgery (ESS) was performed on 55 patients in 95 sides of chronic sinusitis. We analyzed post-ESS results of maxillary sinus in the view of CT findings and Fontanelle opening degree after three months follow-up. ESS for maxillary sinus was performed with aspiration of retention pus and opening of Fontanelle sufficiently. In 95 sides that examined a CT improvement degree, adominant improvement case was 34 sides (35.8%) and an improvement case was 17 sides (17.9%). Animmutable or getting worse case of CT findings was recognized to 44 sides (46.3%) of about halves. The maxillary sinus pus pool was easily removed at the time of operation and leaded to an improvement of advaced such postoperative CT findings. The maxillary sinus pathological mucosal hypertrophy mainly influenced to opening degree of Fontanelle. Poor cases of a CT improvement degree were recognized to the case that complicates a bronchial asthma and has an advanced pathological mucosal hypertrophy. Since MRI is useful to get the evaluation of the volume and quality of a preoperative maxillary sinus shadow compared with CT, MRI is an essential examination for the prediction of a result of a postoperative maxillary shadow.

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