[Laryngeal Papillomatosis: A Statistical Analysis of 60 Cases].

Laryngeal papillomatosis is the most common benign neoplasm of the larynx. Juvenile onset laryngeal papillomatosis tends to recur. In patients with adult onset laryngeal papillomatosis, laryngeal cancer rarely develops. This paper reports a clinical analysis of 60 patients with laryngeal papillomatosis who were treated at our clinic between January 1971 and September 2009. We analyzed the sex ratio, age at the onset of papilloma, type of developing papilloma (single or multiple type), site of developing papilloma, recurrence rate, and therapeutic modalities. Furthermore, the clinical characteristics of the patients with malignant transformation were examined. The patients were classified according to their age at the onset of the papilloma and the type of developing papilloma. The patients were grouped into a juvenile-onset group and an adult-onset group according to their age at the onset of the papilloma. They were also classified into single-type or multiple-type according to whether the initial papilloma appeared singly or multiply. The male to female sex ratios were 1.2 in the juvenile-onset group and 5.1 in the adult-onset group. Among the patients who developed papilloma at an age of under 10 years old, most of the juvenile cases had experienced onset by 4 years of age. Furthermore, the frequency of multiple-type papilloma was significantly higher in the juvenile-onset group, compared with the adult-onset group. The vocal fold was the most frequent site of the papilloma. The recurrence rate in the juvenile-onset group was significantly higher than that of the adult-onset group. A stratified analysis according to the type of papilloma occurrence, however, showed no significant difference in recurrences between the juvenile-onset and adult-onset groups. A stratified analysis according to the age at the onset of papilloma showed that the recurrence rate of multiple-type papilloma was significantly higher than that of single-type papilloma in the adult-onset group. Among multiple therapeutic modalities, vaporization by carbon dioxide laser was the most frequently used. Adjuvant therapy was performed in 6 cases who suffered from multiple relapses. The injection of interferon was performed in 5 cases, and the local injection of cidofovir was performed in 1 case. Malignant transformation of the papilloma was confirmed in 3 cases. The periods between the onset of papilloma and the malignant transformation were 40 years, 14 years, and 3 years. The present study indicates that patients with laryngeal papilloma developing at multiple sites have a significantly higher rate of relapse, even in the adult-onset group. There was no tendency in the period observed between the onset of papilloma and malignant transformation. From the standpoint of recurrence and malignant transformation, patients with papillomatosis should be carefully followed up for a long period of time.

Induction of CD44 variant 9-expressing cancer stem cells might attenuate the efficacy of chemoradioselection and Worsens the prognosis of patients with advanced head and neck cancer.

BACKGROUND: At our institute, a chemoradioselection strategy has been used to select patients for organ preservation on the basis of response to an initial 30-40 Gy concurrent chemoradiotherapy (CCRT). Patients with a favorable response (i.e., chemoradioselected; CRS) have demonstrated better outcomes than those with an unfavorable response (i.e., nonchemoradioselected; N-CRS). Successful targeting of molecules that attenuate the efficacy of chmoradioselection may improve results. Thus, the aim of this study was to evaluate the association of a novel cancer stem cell (CSC) marker, CD44 variant 9 (CD44v9), with cellular refractoriness to chemoradioselection in advanced head and neck squamous cell carcinoma (HNSCC). MATERIALS AND METHODS: Through a medical chart search, 102 patients with advanced HNSCC treated with chemoradioselection from 1997 to 2008 were enrolled. According to our algorithm, 30 patients were CRC following induction CCRT and 72 patients were N-CRS. Using the conventional immunohistochemical technique, biopsy specimens and surgically removed tumor specimens were immunostained with the anti-CD44v9 specific antibodies. RESULTS: The intrinsic expression levels of CD44v9 in the biopsy specimens did not correlate with the chemoradioselection and patient survival. However, in N-CRS patients, the CD44v9-positive group demonstrated significantly (P = 0.008) worse prognosis, than the CD44v9-negative group. Multivariate analyses demonstrated that among four candidate factors (T, N, response to CCRT, and CD44v9), CD44v9 positivity (HR: 3.145, 95% CI: 1.235-8.008, P = 0.0163) was significantly correlated with the poor prognosis, along with advanced N stage (HR: 3.525, 95% CI: 1.054-9.060, P = 0.0228). Furthermore, the survival rate of the CD44v9-induced group was significantly (P = 0.04) worse than the CD44v9-non-induced group. CONCLUSIONS: CCRT-induced CD44v9-expressing CSCs appear to be a major hurdle to chemoradioselection. CD44v9-targeting seems to be a promising strategy to enhance the efficacy of chemoradioselection and consequent organ preservation and survival.

[Surgical approach of lateral temporal bone resection for treatment of head and neck cancer with invasion surrounding the jugular foramen].

We herein present a review of the surgical approach of lateral temporal bone resection (LTBR) in the treatment of 5 cases of head and neck cancers invading the jugular foramen between 2008 to 2013. The patients comprised 3 males and 2 females with ages ranging from 25 to 76 and observation times were between 13 and 22 months. In this study we reviewed the method of operation and treatment. Four patients are alive, but one patient died from the primary disease. Complications occurred including postoperative facial nerve palsy and hearing loss. Although the LTBR with jugular foramen approach can cause postoperative facial nerve palsy and hearing loss, this method would be recommended as a safe surgical procedure for its wide surgical field. We therefore propose that this LTBR technique is useful for patients with head and neck cancer extending to the jugular foramen.

Multimodal approach for cervical esophageal carcinoma: role of neoadjuvant chemotherapy.

AIM: To examine the outcome of patients with cervical esophageal cancer treated by a multimodal protocol. PATIENTS AND METHODS: We retrospectively analyzed the outcome and prognostic factors for 20 patients with cervical esophageal cancer who received multimodal treatment at the Kurume University Hospital between 2003 and 2009. One case of stage I, seven of stage II and 12 of stage III disease (2 T1, 3 T2, 4 T3, 11 T4 and 14 N1) were included. Radiotherapy was administered at a median dose of 60 Gy (range=30-70 Gy). The median follow-up time was 32 months for surviving patients (14-94 months). Platinum-based neoadjuvant chemotherapy (NAC) was performed in 14 cases and all received chemoradiotherapy. RESULTS: median survival was 20 months and overall survival rates at 1, 2, and 5-years were 70%, 60% and 30%, respectively. T-Category, length of the primary lesion, N-category, stage, hemoglobin levels and response to induction chemotherapy were statistically significant predisposing factors for overall survival rate. According to NAC response, 10 good responders (complete response or partial response) showed 2-year survival rates of 80% (5 survivors), whereas that for poor responder (stable disease and progressive disease) was 0% (p=0.006), respectively. Response to NAC was the only statistically significant predisposing factor for increased progression-free survival (p=0.03). Severe acute toxicities of grade 3 or more appeared in 5 patients; two grade 5 (esophageal perforations and lung fistula), one grade 4 (bilateral recurrent nerve palsy), and two grade three (pneumonitis and mucositis). CONCLUSION: Although severe prognosis was identified for cervical esophageal cancer, good response to NAC indicates a good prognosis with organ preservation even for those with T4 tumor.

Multimodal treatment for t1-2 supraglottic cancer: the impact of tumor location.

AIM: To examine the outcome and prognostic factors after multimodal treatment of T1-2 supraglottic cancer. PATIENTS AND METHODS: We analyzed 49 patients with T1-2 supraglottic cancer who received multimodal treatment between 1990 and 2011. Their age range was 43-86 years (median=66 years). Fifteen patients had a T1 tumor and 34 had a T2 tumor (40 N0, 3 N1, 4 N2, and 2 N3). Debulking using transoral laser excision was employed in 25 patients. Neck dissection was performed in four patients. Chemotherapy was administered to 29 patients: intra-arterial infusion in four and systemic infusion in 25. Radiotherapy was administered at a median dose of 64.8 Gy (range=30-70 Gy) with once- or twice-daily fractionation. Median follow-up time was 60 months (range=12-153 months). RESULTS: Two patients interrupted radiotherapy because of a poor response at 30 Gy (T2N2) and 49.9 Gy (T2N0). They underwent total laryngectomy and were still alive without any evidence of cancer 48 and 28 months after treatment, respectively. The other 47 patients (96%) had a complete local response to treatment. Locoregional failure was observed in six tumor sites, and one patient had simultaneous locoregional recurrence. The 5-year local control, disease-free, overall survival, and laryngeal preservation rates were 82%, 74%, 82%, and 90%, respectively. The location of a primary tumor within the supraglottis (epilarynx or elsewhere) was identified as the only factor predictive of progression-free survival by univariate and multivariate analyses (p=0.04). Acute adverse reactions of grade 3 or more were: one grade 3 laryngeal edema, one grade 3 dyspnea, and one grade 5 hematological toxicity (disseminated intravascular coagulation). Among late adverse events, one grade 1, one grade 2 hoarseness, and grade 3 laryngeal necrosis were observed. CONCLUSION: Multimodal radiotherapy produced a good outcome. Localization of the tumor in the epilarynx was associated with a better progression-free survival rate than that in the other parts of the supraglottis.

The difference in relationship between 18F-FDG uptake and clinicopathological factors on thyroid, esophageal, and lung cancers.

OBJECTIVES: The aim of this study was to reveal the differences in clinicopathological factors affecting maximum standardized uptake value (SUVmax) between esophageal squamous cell carcinoma (ESCC), non-small-cell lung cancer (NSCLC), and papillary thyroid cancer (PTC). METHODS: This study consisted of 119 patients with ESCC (n=43), PTC (n=40), or NSCLC (n=36). We investigated the correlations between SUVmax and clinicopathological factors by using Spearman's correlation coefficient and the Kruskal-Wallis test. Multiple regression analysis was used to investigate which clinicopathological factors significantly affected SUVmax in each cancer type. RESULTS: The SUVmax correlated with glucose transporter-1 (GLUT-1) expression in NSCLC (r=0.536, P=0.007) and ESCC (r=0.597, P<0.001) but not in PTC. The SUVmax correlated with Ki-67 expression in NSCLC (r=0.381, P=0.022) and PTC (r=0.374, P=0.017) but not in ESCC. A high SUVmax was correlated with a higher pathological T stage (p-T stage) in NSCLC (r=0.536) and ESCC (r=0.597, both P<0.001) but not in PTC. An elevated SUVmax was significantly associated with pathological lymph node status (p-N) in NSCLC, but not in ESCC and PTC. In multiple regression analysis, p-T stage and GLUT-1 expression were statistically significant factors in ESCC, and p-T stage was a statistically significant factor in NSCLC. In PTC, Ki-67 showed a statistically significant association with SUVmax. CONCLUSION: SUVmax in NSCLC depended on the tumor invasion area; SUVmax in ESCC depended on tumor depth and GLUT-1 expression; and SUVmax in PTC might be associated with cell proliferation. The biological factors affecting SUVmax differ according to tumor type.

Non-surgical multimodality treatment for locally advanced (T3-4) hypopharyngeal cancer: the impact of pre-treatment hemoglobin level.

AIM: To examine the role of a non-surgical multimodality approach in patients with locally advanced pharyngeal cancer who refuse surgery or are inoperable. PATIENTS AND METHODS: Between 2006 and 2011, 19 patients with T3-4 hypopharyngeal cancer received multimodality non-surgical treatment. Out of these patients, nine refused surgery, and nine were inoperable. Their age range was 52-86 years (median, 68 years). Ten patients had T3, and 9 had T4 (two with stage III and 17 with stage IV). Neoadjuvant induction chemotherapy was administered in 11 patients. Hyperthermia was performed in patients with advanced lymph node metastasis. Radiotherapy was administered at a median of 61 Gy (60-61.2 Gy) in conventional fractionation. Concurrent chemotherapy was administered to all patients: through intra-arterial infusion in seven, systemic infusion in 10, or both in two. Median follow-up time was 27 months (range: 6-50 months). RESULTS: At the primary site, 16 patients (84%) achieved a complete response and three (16%) with partial response, resulting in a 100% response rate. Locoregional failure appeared in the form of six local and two regional lesions, and in one case in both types of lesions. Three-year local control, disease-free and overall survival rates, and laryngeal preservation rates were 65%, 48%, 50%, and 83%, respectively. Anemia was the only strong predisposing factor, not only for reduced local control but also for reduced progression-free and overall survival rates. Acute toxicities of grade 3 or more included hematological toxicity in four patients, gastrointestinal toxicity in two, and pneumonia in 6. Late adverse reaction of dysphagia grade 3 was found in one patient, whereas dysphagia grade 4 was not observed. CONCLUSION: Multimodality non-surgical treatment could be a useful option for patients who refuse surgery and have inoperable disease with substantial curative potential without severe adverse reactions.

Effect of laser arytenoidectomy on respiratory stridor caused by multiple system atrophy.

Respiratory stridor in patients with multiple system atrophy is a complication that occasionally causes nocturnal sudden death. Continuous positive airway pressure (CPAP) therapy has been proposed as an alternative to tracheostomy to treat nocturnal stridor associated with multiple system atrophy. However, some patients cannot tolerate CPAP therapy and experience sleep disturbances, even if the pressure is controlled; also, CPAP therapy can be less effective in patients with a narrow glottic opening during sleep. This report describes the effect of laser arytenoidectomy on respiratory stridor caused by multiple system atrophy.

Long-term postoperative vocal function after thyroplasty type I and fat injection laryngoplasty.

OBJECTIVES: We evaluated the differences in the long-term functional results of medialization thyroplasty type I (MT) and autologous fat injection laryngoplasty (FIL) in patients with unilateral vocal fold paralysis. METHODS: Forty-one patients underwent MT, and 73 patients underwent FIL. The voice functions before and after both surgeries were examined by aerodynamic, pitch and intensity, and acoustic analyses. The postoperative voice examinations were performed 12 months (median) after the MT, and 4 years (median) after the FIL. The differences between the preoperative and postoperative parameters were examined with a paired t-test for each group separately. For each variable, a comparison of the effects of surgery was conducted with an analysis of covariance model, with the change between the preoperative and postoperative values as the dependent variable and the preoperative value as the covariate. RESULTS: In both groups, all parameters significantly improved after surgery. In particular, there was a significant difference for the postoperative acoustic analyses. However, the aerodynamic analysis after FIL improved more significantly in comparison to that after MT because of the respiratory handicap. CONCLUSIONS: We found that MT and FIL provided almost the same effectiveness, and that both surgeries were reliable in improving the vocal function in patients with vocal fold paralysis.

Evaluation of overall tumor cellularity after neoadjuvant chemotherapy in patient with locally advanced hypopharyngeal cancer.

The aim of this study is to clarify the prognostic value of the pathological overall tumor cellularity after neoadjuvant chemotherapy for locally advanced hypopharyngeal cancer. In consecutive series of 45 operable patients with locally advanced hypopharyngeal cancer, neoadjuvant chemotherapy by cisplatin and 5-fluorouracil was administered. Pathological image analysis was performed in 30 patients using the large cross-section specimen after total resection to evaluate the overall tumor cellularity. The chemotherapeutic responses were classified according to the pathological grading scale by dividing into four categories; more than 70% overall tumor cellularity in Grade 1, between an estimated 10 and 70% in Grade 2, less than 10% in Grade 3, and no identifiable malignant tumor cells in Grade 4. The pathological grades were taken into account for analysis of the survival. In 30 available patients, 40% had Grade 1 pathological response, 30% had Grade 2, and 30% had Grade 3. There was no Grade 4 patient. The overall 5-year survival rate for these 30 patients was 53.33%. The survival rate (61.66%) for patients with Grade 2 and 3 responses was significantly higher than that (27.78%) for patients with Grade 1 response (p = 0.009). Cox regression analysis revealed that the increasing pathological grade was an independent predictor of a better survival in patients undergoing neoadjuvant chemotherapy. We have shown that the prognosis of patients with locally advanced hypopharyngeal cancer, who had been treated by neoadjuvant chemotherapy followed by total resection, can be predicted by evaluation of pathological overall tumor cellularity from the large section specimen.

Vocal fold stem cells and their niche in the human vocal fold.

OBJECTIVES: Vocal fold stellate cells (VFSCs) in the maculae flavae have many morphological differences from conventional fibroblasts in the human vocal fold mucosa. It is uncertain whether the VFSCs are derived from the same embryonic source as conventional fibroblasts. The purpose of this study was to investigate the stemness of the VFSCs and whether the pericellular matrices in the maculae flavae are a hyaluronan-rich matrix, which is required for a stem cell niche. METHODS: Paraffin-embedded specimens were stained with Alcian blue (pH 2.5) for a hyaluronidase digestion study. Immunoreactivity to antibodies directed to CD44, CD133, Oct-4, Ki67, and telomerase was investigated in 5 human adult vocal fold mucosae. RESULTS: The VFSCs were resting cells (G0-phase) and expressed a mesenchymal stem cell marker. The VFSCs did not express hematopoietic or embryonic stem cell markers. Telomerase resided in the VFSCs. The hyaluronan concentration in the maculae flavae was high and the VFSCs expressed hyaluronan receptors, indicating that maculae flavae are characterized by a certain criterion of hyaluronan-rich matrix. CONCLUSIONS: There is growing evidence that the VFSCs in the human maculae flavae are somatic (mesenchymal) stem cells of the vocal fold, and that the maculae flavae may be a candidate for a stem cell niche that is a microenvironment nurturing a pool of VFSCs.

[A clinical study on cervical tuberculous lymphadenitis: the position of a low invasive needle aspiration procedure for the diagnosis of cervical tuberculous lymphadenitis].

OBJECTIVE: The diagnosis of cervical tuberculous lymphadenitis has been performed by histological examination using excisional biopsy specimens. However a non-invasive diagnostic procedure alternative to invasive excisional biopsy has been required and fine needle aspiration cytology as well the polymerase chain reaction (PCR) technique have become useful modalities. The aim of this study was to clarify the effectiveness of needle aspiration as a less invasive and more rapid diagnostic procedure than excisional biopsy. MATERIAL AND METHODS: Twenty-one excisinal biopsy specimens and 20 needle aspiration specimens were collected from 29 patients who were diagnosed as having cervical tuberculous lymphadenitis. The detection of mycobacterium tuberculosis with a smear microscopy was performed in 20 specimens, with the culture method in 20 and with the PCR test in 14 specimens. The histopathological positive rates, the detection ratio of mycobacterium, the rupture rate of the local skin lesion and the period necessary for diagnosis were compared between the two percutaneous approaches. RESULTS: The diagnosis of tuberculous lymphadenitis was successful in all cases either by cytological examination in 8 of 21 (40%) or with the histological approach in the other 21 cases. The detection ratios of smear, culture and PCR were 20%, 40% and 64%, respectively. The rupture rate of the local skin after the excisional biopsy was higher than that of the needle aspiration procedure (p = 0.05). The period for diagnosis was significantly longer than that of the needle aspiration procedure (p < 0.001). CONCLUSION: As a less invasive method of diagnosis of cervical tuberculous lymphadenitis, cytology as well as the detection of mycobacterium using an aspiration procedure is highly recommended.

Evidence of the local immune status in the human larynx.

We have studied the presence of local immunity in the larynx and its role and development of laryngeal glands in the human larynx. The local immune status in laryngeal secretion or related tissue specimens from the laryngeal ventricle was examined and the results were analyzed between individuals with or without head and neck cancer. Laryngeal secretions or mucosal tissue specimens were obtained during the microscopic laryngeal surgery or at the time of the surgery of the larynx. The laryngeal secretion contained immunological factors such as IgG, IgM, IgA or secretory IgA (SIgA). The mean level of SIgA of the mucosal tissue was low in patients with the benign laryngeal disease and considerably decreased in patients with previous radiation therapy. The level of SIgA in the laryngeal secretion closely correlated to the level of SIgA in the mucosal tissue. From the present study, we confirmed the actual presence of local immune function in the human larynx. Furthermore, the local immune status is affected by either the presence of malignancy or the treatment to the larynx such as radiation.

Relationship between clinicopathological factors and fluorine-18-fluorodeoxyglucose uptake in patients with papillary thyroid cancer.

OBJECTIVE: To examine the relationship between clinicopathological factors and fluorine-18-fluorodeoxyglucose (F-FDG) uptake in patients with papillary thyroid cancer (PTC). MATERIALS AND METHODS: Fifty-four patients were included in this study.F-FDG positron emission tomography was performed before surgery. Immunohistochemistry of glucose transporter (GLUT) was performed using postoperative histopathological specimens. We investigated the relationship between maximum standardized uptake value (SUVmax) and GLUT-1, GLUT-3, and GLUT-4 expression/SUVmax and prognostic risk factors {tumor size, age, sex, extrathyroidal extension, and lymph node metastasis [ly (+)]}. RESULTS: GLUT-3 and GLUT-4 expressions significantly correlated with SUVmax (GLUT-3: r=0.38, P=0.008; GLUT-4: r=0.46, P=0.001), but GLUT-1 did not (r=0.21, P=0.147). The tumor size correlated with SUVmax (r=0.5, P<0.001), but GLUT-1, GLUT-3, and GLUT-4 did not (GLUT-1: r=0.006, P=0.681; GLUT-3: r=0.05, P=0.705; GLUT-4: r=-0.17, P=0.217). Both SUVmax and GLUT-4 expressions were statistically significant with ly (+) (SUVmax: P=0.012; GLUT-4: P=0.018), but GLUT-1 and GLUT-3 expressions were not (GLUT-1: P=0.165; GLUT-3: P=0.499). There was no significant difference between other clinicopathological factors and SUVmax or any GLUT expressions. CONCLUSION: F-FDG uptake in PTC may be determined by GLUT-3 and GLUT-4 expressions and may be related to tumor size and lymph node metastasis of PTC. F-FDG uptake may reflect tumor progression of PTC.

[Voice reconstruction of the recurrent laryngeal nerve after nerve resection].

Our treatment of choice in voice reconstruction for recurrent laryngeal nerve (RLN) resection is concurrent nerve reconstruction. If this is not possible, we secondarily inject fat. We studied postoperative voice function and the feasibility of this voice reconstruction treatment strategy. Subjects were 39 patients with advanced thyroid cancer having the primary lesion resected together with RLN between 2001 and 2007. Of these 39, 9 underwent concurrent reconstruction by directly anastomosing the ansa cervicalis to the peripheral RLN. Fat was secondarily injected in 25 and 5 did not undergo any reconstruction. We found that: 1) Postoperative maximum phonation time (MPT), mean flow rate (MFR) and pitch perturbation quotient (PPQ) in the direct anastomosis group were significantly better than in the nonreconstruction group (p < 0.05). 2) Postoperative MPT, MFR, and PPQ in the fat injection group were significantly better than in the nonreconstruction group (p < 0.05). 3) MPT in the fat injection group was significantly better than in the direct anastomosis group one month postoperatively (p = 0.007), although this finding was reversed six months postoperatively (p = 0.08). 4) MFR in the fat injection group tended to be better than the direct anastomosis group one month postoperatively (p = 0.1), although this finding was reversed six months postoperatively (p = 0.1). We thus recommend concurrent voice reconstruction by direct anastomosis in conjuction with nerve resection.

Effect of irradiation on the human laryngeal glands.

OBJECTIVES: The present study was conducted to determine the effects of irradiation on the human laryngeal glands. METHODS: Light and transmission electron microscopic observations were made. RESULTS: Granular endoplasmic reticula and Golgi apparatuses were sparse in the cytoplasm of serous and mucous cells in cases with a short duration after radiotherapy. The secretory granules in serous cells had decreased in number. The secretory granules were less electron-dense compared to those in non-irradiated specimens, but were electron-lucent. The mucigen droplets in mucous cells were not as numerous as those in non-irradiated specimens. The discharge of secretory granules and mucigen droplets had decreased. In cases with a long duration after radiotherapy, there were some granular endoplasmic reticula and Golgi apparatuses in the cytoplasm. However, the transmission electron microscopy findings of secretory granules and mucigen droplets were the same as those in the irradiated glands with a short duration after radiotherapy. CONCLUSIONS: Morphological changes in the irradiated laryngeal glands influenced not only the amount but also the quality of secretions. The above changes lessened the lubrication of the vocal folds, thus causing a voice disorder to some extent. Local immunity and mucociliary transport were also affected. The effects of irradiation on the laryngeal glands partially altered the laryngeal functions.

Irradiated macula flava in the human vocal fold mucosa.

PURPOSE: There have been no investigations regarding radiation-induced damage on human maculae flavae (MFs) in the vocal fold mucosa (VFM) and on stellate cells (SC) in the MF. The VFM, especially MF, after irradiation was investigated histologically. MATERIALS AND METHODS: The lamina propria of the irradiated VFM was investigated in 5 human adult vocal folds by light and electron microscopy. RESULTS: Fibroblasts in the irradiated Reinke's space (RS) showed no morphological changes. Irradiated RS was composed of fibrous tissue with increased collagenous fibers. Most of the SC in the irradiated MF had dark cytoplasm. The nucleus-cytoplasm ratio was relatively small, but there were few intracellular organelles in the cytoplasm. Some SC showed degeneration. Fewer vesicles were present at the periphery of the cytoplasm. The MF was rather deficient in fibrous components. Elastic and collagenous fibers immediately surrounding SC in the irradiated MF were lower in number than usual, but elastic fibers and collagenous fibers composed of irregular collagen fibrils could be detected at a distance from SC. It was suggested that precursors of collagenous and elastic fibers synthesized by SC were damaged by irradiation. Radiation sensitivity of SC was higher than that of conventional fibroblasts in RS, and SC appeared to decrease their level of activity. CONCLUSIONS: Radiation sensitivity of SC was different from that of conventional fibroblasts. Radiation induced not only changes in the lamina propria of the VFM but also dysfunction of the SC in the MF, and is one of the causes of voice disorders after irradiation.

[Clinical study of cervical lymph node metastasis in maxillary cancer patients].

The clinical characteristics of lymph node metastasis in maxillary cancer patients were analyzed. Thirty-eight (23%) of the 166 patients who received intial treatment at Kurume University Hospital between 1978 and 2003 had cervical lymph node metastasis at the time of diagnosis. The disease-specific 5-year survival rate was 63% in the lymph node metastasis negative group and 18% in the lymph node metastasis positive group (p<0.01). There was a statistically significant correlation between bone invasion and lymph node metastasis in the case of the group with bone invasion of the posterior wall of the maxillary sinus. Cervical neck lymph node metastasis developed in 38 (28%) of 135 posterior-wall-invasion-positive group and in none (0%) of the 31 patients in the negative group (p<0.01). Because distant metastasis is common in patients with lymph node metastasis, postoperative adjuvant chemotherapy is highly recommended.

Efficacy of additional injection laryngoplasty after framework surgery.

OBJECTIVES: The purpose of this study was to clarify the efficacy of additional injection laryngoplasty (AIL) after framework surgery (FS), while also trying to identify which patients or procedures were more likely to require AIL to obtain optimal results and to clarify why. METHODS: Fifty-two patients with unilateral vocal fold paralysis underwent FS (thyroplasty [TP], 23; arytenoid adduction [AA], 18; and AA with TP, 11). The numbers of patients who required AIL were calculated for each type of FS. The voice function after AIL was investigated. Thereafter, the width and the bowing ratios on phonation were measured in patients who underwent AA. RESULTS: The patients who underwent AA required AIL more frequently than did patients who underwent TP. Use of AIL provided better voice function for all patients. The width ratio after AA decreased in all cases, but the bowing ratio increased after AA in 44% of cases. CONCLUSIONS: These results indicate that AIL is an effective treatment for patients who still have a glottal gap after undergoing FS. In particular, patients who had AA frequently required AIL, in comparison to patients who had TP, because of the high frequency of an increased bowing ratio after AA.