[in Japanese]

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[in Japanese]

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Pustulosis palmaris et plantaris (PPP) is well known to be associated with the tonsils and is quite effectively treated by tonsillectomy. In our study, post tonsillectomy improvement of the skin lesions was recognized in 38 (85%) of 45 cases with PPP. In several clinical or pathological factors, the enlargement of T-cell nodules detected by quantitative immunohistologic analysis of the tonsillar tissues correlated with the degree of improvement. It was reported that T-cell nodules on the tonsillar tissues of patients with PPP are larger than those with non-PPP. Therefore, it was suggested that the enlargement of T-cell nodules re-flects an etiological immune response in the tonsils of PPP patients.
In a flowcytometric analysis, CD 25 positive T-cells increased in the tonsillar lymphocytes from PPP patients. Moreover, in reverse transcription-polymerase chain reaction (RT-PCR) analysis, the mRNA of Smad 7 and CTLA 4, known as T-cell inhibitory factors, were reduced in the tonsillar T-cells from. PPP patients. Taking these data into consideration, it was predicted that the enlargement of T-cell nodules was caused by the proliferation of activated T-cells. In addition, a disordered activation of tonsillar T-cells was related to an auto-immune response in PPP tonsils. Therefore, the factors reflecting T-cell activation in ton-sils, such as measurement of T-cell nodules, may have a predicting value for the efficacy of tonsillectomy in PPP.

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Although many studies have investigated the effects of adenoidectomy on children with otitis media with effusion (OME), it still remains controversial. In this article the pathophysiological mechanisms explaining adenoidal involvement in OME and clinical efficacy of adenoidectomy are reviewed and discussed. Eustachian tubal dysfunction and inflammation of the upper airway are considered to be major factors in the pathogenesis of OME. Several studies have indicated that the adenoids might influence eustachian tubal function as a focus of inflammation rather than its mechanical effect. In addition, the adenoid may be involved in OME as a bacterial reservoir and the major organ for the production of inflammatory cytokines in the nasopharynx. To investigate the mechanisms of the expression of inflammatory cytokines in the adenoid, we observed the influence of the specific inhibitor of NF-kB, TPCK, on the expression of IL-8 in human cultured adenoidal fibroblasts. TPCK inhibited the IL-8 expression induced by endotoxin and IL-1 b, indicating NF-kB may play a crucial role for the expression of inflammatory cytokines in the adenoids.
Next, to assess the clinical efficacy of adenoidectomy for the treatment of OME, the outcomes of 48 children who received both ventilation tube insertion and adenoidectomy simultaneously and 31 children who received ventilation tube insertion alone were compared retrospectively. Two children out of the 48 (4.2%) that received adenoidectomy needed reinsertion of the ventilation tube. On the other hand, seven children out of the 31 (29.2%) that received tube insertion alone needed reinsertion of the tube. This indicates that simultaneous adenoidectomy may reduce the risk of requiring reinsertion of ventilation tube.

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[in Japanese]

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Surgically altering the lateral oropharyngeal wall and soft palate frequently results in velopharyngeal dysfunction.
The soft palate is reconstructed by developing a plane between the prevertebral fascia and superior pharyngeal constrictor in the oropharyngeal resection margin. The pharyngeal myomucosal flap is sutured to the posterior edge of the hard palate and remaining soft palate, resulting in reconstruction of a smaller velopharyngeal space. Then the faucial arch is narrowed by suturing the edge of the posterior pharyngeal wall to the tongue base. Lastly, the raw surface of the surgical reconstructed area is covered by free tissue transfer.
During the past six years, we performed this reconstructive procedure on 22 patients with oropharyngeal carcinoma of the soft palate or lateral oropharyngeal wall.
After reconstruction, we performed the assessment of post-operative function and the patients could perform normal nasal breathing and swallowing without aspiration.

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Purpose. This paper discusses assisting deglutition and articulation through the use of temporal muscle to lift the reconstructed flap of the tongue and pharynx, and to contract with the circumference muscle as alliance motility.
Patients. The cases (1995-2002) were 13 malignant head and neck tumors (oral cavity, eight; middle pharynx, five; free flap, nine; musculo-cutaneous flap, four), unilateral and bilateral were seven and six, respectively.
Method. The resection and reconstruction area were less than half of the persistence, including the base of tongue for tongue, and exceeding mid-line in the soft palate. Temporal fascia muscle of 2-3 cm was elevated and penetrated by way of the deep part of zygomatic arch to lateral part of the pharyngeal wall, and was fixed in the flap. The temporal region wound was approximated for the initial stage.
Results. Postoperative complications were: infection in the temporal region, four cases; broad necrosis of the flap, three cases ; and partial necrosis, one case.
Conclusion. Only insufficient motility was confirmed in temporal muscle transfer. As for the static reconstruction, it may have prevented ptosis of the flap.

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We evaluated the clinical usefulness of 18 F-fluorodeoxyglucose (FDG) positron emission tomography (PET) for the diagnosis and treatment of oral and pharyngeal carcinoma. Eighty-four patients were included in this study. The sensitivity for FDG-PET was 94.6% and the specificity was 78.6%. Compared to Ga scintigraphy for the same patients, the sensitivity for Ga scintigraphy was 37.5% and specificity was 50%. This result suggests that FDG-PET is superior to Ga scintigraphy in detecting cancer cells. The smallest malignant lymph node seen by FDG-PET was 5 mm in diameter. Of five patients with a cervical metastases of unknown origin, it wa possible to dentify the origin in three patients (two tonsil and one gingiva) by FDG-PET. Whole body FDG-PET detected distant metastases (three cases with pulmonary metastases) and secondary cancers (one lung cancer and one colon cancer). After the advanced pharyngeal cancer patients were treated with chemoradiotherapy, FDG-PET was performed. Patients with negative results from FDG-PET avoided surgery and have been alive without recurrence of the disease. FDG-PET in pretreatment is useful for the determination of TNM classification, and FDG-PET in post-treatment is able to evaluate residual cancer cells. Therefore FDG-PET is a valuable tool in the management of oral and pharyngeal carcinoma, although facilities are expensive and its hard to control the cyclotron.

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We evaluated the results of questionnaires on tonsillectomy and adenoidectomy answerd by otolaryngologists, dermatologists, pediatricans and internists. The effective answer rate was 41% (328/787). The indication of tonsillectomy against pustulosis palmaris et plantaris (PPP) and IgA nephropathy was higher in otolaryngologists than in dermatologists and internists. Regarding habitual tonsillitis, the period of conservative treatment was longer among pediatrists than otolaryngologists, . On the other hand, the decision of surgical treatment for OSAS was earlier among pediatrists than otolaryngologists. Otolaryngological indication of adenoidectomy against Otitis media with effusion (OME) was done by the findings of X-rays and fiberscopic findings of the adenoids. From the results of these questionnaires, it seems to be necessary to encourage pediatrists and internists that tonsillectomy is a curative treatment for focal infection. In children, it is important to divide the adequate time for operations regarding habitual tonsillitis and OSAS according to the risk and effectiveness for the child.

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A retrospective case-control study of 71 patients with IgA nephropathy was performed to evaluate the long-term prognostic effect of tonsillectomy. Forty-one patients (19 males and 22 females) received tonsillectomies (Group A) and 30 patients (13 males and 17 females) did not (Group B). These patients were followed up for more than 10 years after renal biopsy. The average age at the initial renal biopsy was29.78 years old in Group A, and 33.0 years in Group B. The average period from renal biopsy to tonsillectomy in Group A was 15.07 months. The average follow-up period was 13 years and 3 months in Group A, and 12 years and 7 months in Group B. The glomerular injuries proved by renal biopsy were more extensive in Group A than in Group B. Renal prognosis after a 10-year follow-up was compared in these two groups.
The clinical remission rate was 24.4% in Group A and 13.3% in Group B, the stable renal function rate was 82.9% in Group A and 70.0% in Group B, and the renal survival rate was 95.1% in Group A and 73.3% in Group B. The renal survival rate in Group A was significantly higher than that in Group B (P<0.05). Althogh renal pathology based on renal biopsy was useful to predict the long-term effect of tonsillectomy in IgA nephropathy patients, past history of tonsillitis, local findings of palatine tonsil, and results of tonsillar provocation tests were not. Our results show that tonsillectomy for IgA nephropathy is of great value clinically, especially for renal survival after long-term follow-up.

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Intra-arterial chemotherapy is useful to improve prognosis and preserve the function of swallowing, and speech in the treatment of head and neck cancer. We report the results of super, selective intra-arterial chemotherapy with the Seldinger technique for 14 cases of advanced or recurrent oral cancer in this paper. The response rate for all cases and inoperable cases was 57% and 78%, respectively. Grade 3 or higher toxicity was neutropenia. No patient developed gastrointestinal or renal toxicity. One of eight PR cases had no previous chemotherapy treatment, and the other seven cases with platinum agent were treated more than six months after the previous treatment.
Super, selective intra-arterial chemotherapy is a consideration for advanced or inoperable cases of oral cancer because of its effectiveness and low toxicity.

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[in Japanese]

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The mesopharynx is divided into four subsites, upper wall (soft palate), lateral wall, inferior wall (base of tongue) and posterior wall. The surgical approach to these sites for treatment causes more or less articulatory and swallowing disturbance. Each institute manages the reduction of surgical invasion and methodologies for reconstructive surgery. Suitable treatment methods against mesopharyngeal cancer still have not been established. In this paper, we present total tumor resections using the inferior hyoid bone approach, a relatively low invasive surgical method, for tongue base cancers T 2 and early T 3 stage. We believe that this surgical method is a relatively low invasive surgical method that promotes early healing, and a low occurrence of serious complications such as fistula. Finally, we conclude that the inferior hyoid bone approach for tongue base cancers is a highly useful surgical method.

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[in Japanese]

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The maxillary swing approach to tumors extending from the nasopharynx to the top level of epiglottis is described. The maxilla, severed from its bony connections, is swung laterally to obtain adequate working space in the naso-and oropharyngeal space. The blood supply to the maxilla is via the attached cheek flap, masseter muscle and great palatine artery. A giant tumor was resected using both maxillary and mandibular swing approach. The wound in the face healed with minimal morbidity.

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In order to understand the mechanism of the recurrence of tonsillar infection, we examined costimulatory factors such as CD 80 and CD 86 on tonsillar lymphocytes. CD 80 and CD 86 were observed more frequently on tonsils infected with tonsillitis more than 4 times per year than on tonsils infected less than 4 times per year (p<0.05). In such cases, the local immune response in the tonsil may deteriorate and tonsillectomy recommended. To evaluate the efficacy of tonsillectomy, we asked patients about episodes of fever and sore throat and how many days absent from school due to tonsillitis before and after tonsillectomy. In a control study, we asked patients that had not undergone tonsillectomy the same questions in terms of present time and at the most serious point of tonsillitis. In the group that underwent tonsillectomy, the days absent from school were significantly less than that in the control group (p<0.05). We investigated the tonsillectomy index, calculated as the number of episodes of tonsillitis per year (maximum) multiplied by the year from the first time tonsillitis was experienced. The index more than 8 means that the number of episodes of tonsillitis will not decrease fewer than 3 episodes of tonsillitis in 5 years later.

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