Mutations in the p53 gene are the commonest genetic alteration in human cancer. We investigated the p53 status in 26 mesopharyngeal carcinomas by using different methodologies.
A single-strand conformation polymorphism analysis of polymerase chain reaction products (PCR-SSCP analysis) was used to detect mutations of the p53 gene in formalin-fixed paraffin-embedded tumor specimens. Two of 14 mesopharyngeal carcinomas showed mobility shifts in exon 5. The samples were examined further by direct sequencing. Results showed that one had a single-base substitution (codon 151: CCC to TCC).
Immunohistochemical staining for the detection of p53 protein was performed. In normal tissues, p53 protein is present in such low quantities that it is not readily detectable by immunohistochemical techniques. Numerous studies have shown that p53 protein accumulation, which is detected by immunohistochemical staining, is a consequence of its stabilization, usually the results of point mutations. Significant p53 overexpression was observed in 15 of 26 tumors (62%). No association was found between p53 overexpression and any of the following factors: site, histological differentiation, clinical stage, tumor stage, clinical response. In clinical stages III and IV, a five-year overall survival of patients with p53 overexpression was 0%, showing apparent contrast to 41.7% for the negative patients. Immunohistochemical detection of p53 protein can be used as a clinical marker predicting the prognosis of mesopharyngeal carcinomas.
A p53 antibody in the sera of mesopharyngeal carcinoma patients was measured by enzyme-linked immunosorbent assay (ELISA). Forty percent of the patients were positive for p53 antibody.
Nevertheless, not all tumors with p53 accumulation lead to the production of detectable p53 antibodies. Serological analysis is advantageous because it does not require tumor sample. Futhermore, it can be used for the follow-up of patients.
It is reported that E6 protein from high-risk human papilloma virus (HPV/type 16, 18) can induce the degradation of p53 and inactivate its function. We assessed HPV-DNA in mesopharyngeal carcinomas by PCR. Seven of 26 patients (26.9%) showed positive for HPV-DNA. An inverse correlation was observed between HPV-positive cancer and p53 overexpression.

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Tactile sensation in the human oral cavity and pharynx is essential for the swallowing function. Medical tests such as video fluorography, electromyogram, and manometric study during the swallowing cannot evaluate the sensation of these areas. In the current study, in response to the air pressure and air-puff stimulation in the human oral cavity and pharynx area, the evoked magnetic response was localized in the Opercula by using magnetoencephalography (MEG). In three cases of tongue cancer after reconstructed tongue flap with PMMC, the magnetic response was also localized in the Opercula. The response in the case of Wallenberg's syndrome was maintained, and in the case of bulbar palsy, it disappeared. MEG is useful for evaluating the sensation in the human oral cavity and pharynx region.

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Nineteen patients with advanced oral and pharyngeal carcinomas were treated with “two-route” intra-arterial chemotherapy by the use of cis-diamminedichloroplatinum (CDDP) and sodium thiosulfate (STS) to preserve oral and pharyngeal functions. In these patients, 100mg/m² of CDDP were administered weekly through each feeding artery of the tumor superselectively at 5mg/min. During the infusion of CDDP, STS at a 200-fold dose of CDDP was injected through a catheter placed in the brachiocephic vein introduced via the subclavian vein. The complete and partial response rates were 12/19 (63%) and 7/19 (37%), respectively. The overall three years survival rate was about 70%. All patients were free of chemotoxicity such as renal chemotoxicity, hematological dysfunctions, and gastrointestinal symptoms. Each chemotherapy could be done weekly on schedule. This new method appears to be very effective for advanced oral and pharyngeal carcinomas.

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Three patients (2 females and 1 male) with vagal paraganglioma arising in the parapharyngeal space were treated from 1978 to 1998. Their ages ranged from 41 to 49 years. The chief complaint of one patient was hoarseness, of another a parapharyngeal space tumor found by chance during a carotid angiography and of the third tonsillar swelling. Through neck incisions, the tumors of the three patients were removed: two of them completely, but a small amount of tumor was left in the third patient. The carotis interna of the two patients were ligated because the tumors firmly adhered to the vessel surfaces. The vocal cords of all patients were paralyzed after the operations, but they had no marked dysphagia.

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We retrospectively studied the diagnostic imaging of 236 parotid tumors treated in our department. On the whole, gallium (Ga) scintigraphy, technetium-99m-pertechnetate (Tc) scintigraphy (with or without lemon juice stimulation), echography, sialography, computed tomography (CT) sialography or magnetic resonance imaging (MRI) is used for a patient having this tumor. We reviewed the results of the various imaging modalities in this patient series to better understand the utility of each modality with respect to the parotid tumors.
With regard to the diagnosis of a malignant tumor, the sensitivity of Ga scintigraphy was 83% and specificity 62%. For evaluating Warthin's tumor, the sensitivity of Tc scintigraphy was 58% and specificity 95%. Lemon juice stimulation improved the sensitivity to 83% and specificity to 97%. The sensitivities of echography, scialography, and CT scialography were relatively low, though the specificities were sufficiently high in regard to the diagnosis of malignant tumor. CT scialography could correctly differentiate the superficial from the deep-lobe tumors of the parotid gland in 80 to 90% of patients. T1-and T2-weighted and gadolinium-enhanced MRI images were not helpful for differentiating a malignant tumor from a benign one, but tumor margins and homogeneity were discriminative factors for predicting benign or malignant tumors with MRI. The MRI characteristics were also helpful in categorizing parotid gland tumors.
Based on these findings and type II quantification, a type of multivariant analysis, we concluded that Tc scintigraphy with lemon juice stimulation, echography, and MRI were sufficient for the diagnosis of parotid tumors.

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Four cases of parapharyngeal tumor were reported. Because the parapharyngeal space is anatomically a complicated structure, the tumors occurred in this space and showed various clinical features. The clinical find-ings of 4 cases of this tumor (three cases of pleomorphic adenoma and one case of schwannoma), including CT/MRI imaging data were reported. The surgical approaches of these cases were described.
We briefly discussed the incidence, clinical findings and surgical approaches of this tumor.

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The thickness value of a flap is an important factor in selecting one for reconstruction. The platyzma flap (PLF), The forearm flap (FAF), and the peroneal flap (PRF), which are thin, were usually used for oral and oropharyngeal reconstruction.
In this paper, we report the results of thickness measurements of these flaps by ultrasonography. Fifty-two volunteers consisted of 22 males and 30 females ranging in age from 21 to 81. We analyzed the relationships between the thickness of the flaps and the age, sex, body weight, and height.
The mean thicknesses were 2.1mm at PLF, 3.9mm at FAF, and 5.2mm at PRF. The thickness values of PLF were significantly correlated with body weight. The thickness values of FAF and PRF were significantly inverse-correlated with the height. Thus PLF was thicker in propotion to body weight. FAF and PRF were thinner in propotion to height. The measurements of PLF, FAF, and PRF would be an indicator to select the best-fitting flap to the reconstruction for oral and oropharyngeal defects.

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It is difficult to differentiate a peritonsillar abscess from peritonsillitis and to determine the most effective route for drainage of pus on the basis of clinical observations. Several diagnostic punctures are often performed, but this procedure is invasive, painful, and has a reported false-negative rate of 12%.
Recently some reports of the clinical use of ultrasonography (US) and computed tomography (CT) in the diagnosis of peritonsillar infection have been published, but no reports of magnetic resonance imaging (MRI) findings have been made.
We performed MRI on 13 patients with clinically diagnosed peritonsillar abscess and peritonsillitis. The results showed that MRI could accurately demonstrate the presence of an abscess, its location, its size and the condition of surrounding tissue. An abscess was identified as a round to crescentshaped homogeneous high-density area along the tonsil on T2-weighted image. On the other hand, peritonsillitis showed an irregular-shaped nonhomogeneous high-density area along the tonsil on T2-weighted image. No differences in radiological intensity between the tonsil, surrounding tissue, and abscess on T1-weighted image were found. We concluded that axial and coronal images on T2-weighted MR imaging should be sufficient to diagnose peritonsillar infections and to determine the most effective route for drainage. Neither T1-weighted image nor contrast enhancement are necessary.
MRI is considered to be a superior diagnostic tool for distinguishing peritonsillar abscess from peritonsillitis and determining the most effective route for drainage compared with US or CT, since it has 100% diagnostic accuracy without radiation or contrast agents.

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The histological change of the epipharynx is affected by infection, mechanical stimulation of swallowing or articulation, humidifier of the airway, and exclusion of dust. It acts as a drainage channel for the mucous secreted by the glands in the epipharyngeal area. Various morphological changes occur because of these functions. In this study, the distribution of the gland in the epipharynx was investigated.
The specimens were collected from 5 autopsy cadavers, 4 males and 1 female, and their ages ranged from 58 to 72 years. Each epipharyngeal specimen was divided into two in the midsagittal plane. Ten epipharyngeal halves were stained by PAS (periodic acid schiff reaction). We investigated the depth and the size of the glands in certain points of the specimens. The results were as follows. The distribution at the superior-posterior wall showed various patterns because of the infection and the affection of the inflammatory cells. The distribution at the nasal side (anterior wall) manifested different patterns in superior, inferior, and lateral walls. Therefore these three walls might yield different functional effects.

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Warthin's tumor is the second most common benign tumor of the parotid gland. Within a six year period, we surgically treated 17 patients with Warthin's tumor.
In this study, scintigraphic findings with Tc-99m-pertechnetate of 16 patients were compared with histopathological features. The frequency of multifocal and/or bilateral involvement was evaluated in all patients. Seven cases of hot accumulation of the scintigraphic image showed a large epithelial component and poor cystic space histologically. Two cases of cold nodule showed a large cystic space macroscopically. Our results suggest that scintigraphic accumulation of Tc-99m-pertechnetate scanning was due to the epithelial component.
Thirty-four Warthin's tumors were numbered in the surgical specimens of 17 patients. The most sites that developed in a parotid gland was 6. Multifocal involvement in the same gland and in the bilateral parotid glands occurred in 7 (41.2%) and 2 patients (11.8%), respectively. Surgeons who treat patients who have Warthin's tumors should consider the high incidence of multifocal involvement in this disease.

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Two cases of hyperfunction of palatal glands and glands in the pharyngeal side of the palate were reported. Case 1 was a 57-year-old male who had postnasal drip.Case 2 was a 68-year-old male who had abnormal feelings on the dorsal surface of the soft palate. Neither had diseases that caused postnasal drip, such as disorder of the nasal cavity or paranasal sinuses. The foamy secretions were seen on the oral surface of the palate and also on the pharyngeal surface of the soft palate. The foamy secretions seemed to be derived from the palatal glands and the same ones in the pharyngeal side of the soft palate. After the foamy secretions on the oral surface of the palate were removed, the new ones appeared very soon. The secretions from the glands in the pharyngeal side of the soft palate seemed to cause the postnasal drip.A ^99mTc-pertechnetate scintiscan was done to confirm the hyperfunction of palatal glands and glands in the pharyngeal side of the palate. The examination demonstrated no uptake of radionuclide by palatal glands and glands in the pharyngeal side of the palate normally, but it did demonstrate intense uptake by the palate in these two cases. The results provided evidence for the diagnosis. No case has ever been reported on a hyperfunction of palatal glands and glands in the pharyngeal side of the soft palate. It is possible that hyperfunction of the glands in the pharyngeal side of the palate may cause postnasal drip and abnormal feeling on the dorsal surface of the soft palate.

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A rare case of the benign mesenchymal tumor in the parapharyngeal space, which contained adipose, bone, and cartilage tissue, was reported.
The patient was a 6-year-old Japanese girl who complained of left submandibular swelling. CT and MRI revealed well-damalcated mass lesion in her left parapharyngeal space. The tumor was transcervically removed en bloc. Macroscopically, it consisted mainly of similar adipose tissue that contained some hard ossous parts.
A histopathological examination revealed that the tumor was composed predominantly of mature adipose tissue that contained trabecular bone, hyaline cartilage, and fibrous tissue.
The bone and cartilage tissue in this case was assumed to be derived from a metaplastic transformation of the lipoma.

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We reported a case of parotid gland cancer treated with high-dose chemotherapy combined with peripheral blood stem cell transplantation. The patient was a 45-year-old male. He complained of hearing impairment and facial paralysis on the right side. CT scan and MRI revealed that the tumor invaded at the temporal bone and cerebellopontine angle. Thiotepa and Cyclophosphamide were used for high-dose chemotherapy combined with PBSCT. As a result, the size of the tumor at the cerebellopontine angle was decreased to 30% of the original volume.

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A case of lateral retropharyngeal lymph node metastasis of unknown origined carcinoma is reported. A 67-year-old male visited our hospital complaining of tinnitus and earfullness on the left side. On examination at the first visit, an unfixed, elastic hard mass with a smooth surface was noted in the right mesopharyngeal wall posterior to the palatopharyngeal arch. Under suspicion of a neurogenic tumor, a surgical resection was performed via an external incision of the neck. A pathological examination showed poorly differentiated squamous cell carcinoma. The primary lesion was not found despite various examinations after surgery. The final diagnosis was lateral retropharyngeal lymph node metastases of unknown origined carcinoma. Radiation therapy (60 Gy) was performed over the entire pharynx and neck. No recurrences have been noted in 3 years since irradiation.

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The postoperative results of 271 cases that underwent tonsillectomy in our hospital during a 5-year period from April 1990 to March 1994 were analyzed. The ages ranged from 3 to 66 with a mean of 18.6. The operation time ranged from 10 to 130 min with a mean of 52.4 min. The intraoperative blood loss ranged from 4 to 485 ml with a mean of 45.7 ml. The more experience of the surgeon, the shorter the operation time. The difference in operation times between surgeons was about 20 min. No major complications occurred from the tonsillectomies besides postoperative hemorrhaging (1%:3 cases). The results show that our surgical technique for a tonsillectomy is safe and easy to learn.

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Purpose: We studied whether an upper airway MRI enables us to find the differences betweer normal subjects and OSAS cases and further to distinguish UPPP responders from poor responders preoperatively.
Subjects: Twenty-four cases treated by UPPP were designated as the OSAS group, some cases (13) in which the postoperative apnea index decreased to not more than 50% of the preoperative apnea index as the responder group, and the others (11) as the poor responder group.Thirteen cases with no abnormality in the upper airway were defined as the normal group.
Method: MR was measured on the median sagittal plane and coronal plane of the pharyngeal cavity.
Results: The length of the hard plate, the length from the top of the tongue to the bottom, the length of the mandible, and the transverse diameter of the pharyngeal cavity were significantly small in the OSAS group.A highly significant difference in the transverse diameter of the pharyngeal cavity was noted between the normal group, the UPPP responder group, and the poor responder group.
Conclusion: We failed to presume whether UPPP was effective by a preoperative MRI, but we were able to distinguish normal subjects from the OSAS cases by the transverse diameter of the pharyngeal cavity.

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