Akihisa Horie

Vertical Ramus Versus Sagittal Split Osteotomies: Comparison of Stability After Mandibular Setback

PURPOSE Intraoral vertical ramus osteotomy (IVRO) offers some advantages over sagittal split ramus osteotomy (SSRO) for treatment of the prognathic patient. The purpose of this study was to compare the postoperative changes of proximal and distal segments after IVRO and SSRO with semirigid internal fixation. PATIENTS AND METHODS Thirty Japanese adults with a diagnosis of prognathic mandible were randomized to undergo either IVRO (n = 15) or SSRO (n = 15) according to an adaptive random assignment procedure. The postoperative changes of the proximal and distal segments were assessed with posteroanterior and lateral cephalograms. RESULTS Compared with the SSRO group, the B-point and pogonion moved significantly posteriorly and inferiorly in the IVRO group from 1 month to 3 months after surgery. At 1 year after surgery, there was no significant difference between the 2 groups in the horizontal and vertical stability of the B-point and the pogonion. In the IVRO group, the gonion deviated significantly laterally from 1 week until 1 month after surgery as compared with that of the SSRO group. There was a significant correlation between the amount of setback and the amount of lateral gonial deviation in the IVRO group from 1 week to 1 year after surgery. CONCLUSIONS Although in IVRO cases, distal segments moved posteriorly and inferiorly immediately after the release of maxillomandibular fixation, the stability after IVRO is equal to that after SSRO with semirigid internal fixation.

Stereotactic radiosurgery may contribute to overall survival for patients with recurrent head and neck carcinoma

BackgroundThe aim of this study is to examine the effect of stereotactic radiosurgery (SRS) in the treatment of advanced, recurrent lesions for head and neck carcinoma both with and without lymph node involvement.MethodsBetween April 2006 and July 2007, 22 patients (mean age 67 years) with advanced, recurrent head and neck carcinoma were treated with stereotactic radiosurgery. All of the patients except one had biopsy confirmed disease prior to stereotactic radiosurgery. Patients included 3 rT2, 8 rT3, and 9 rT4; 8 of the patients had lymph node metastases. Marginal SRS doses were 20-42 Gy delivered in two to five fractions. Starting one month after SRS, all patients received S-1 oral chemotherapy for one year.ResultsAt an overall median follow-up of 24 months (range, 4-39 months), for the 14 locally recurrent patients without lymph node metastases, 9 patients (64.3%) had a complete response (CR), 1 patient (7.1%) had a partial response (PR), 1 patient (7.1%) had stable disease (SD), and 3 patients (21.4%) had progressive disease (PD). For the 8 patients with lymph node metastases, 1 patient with a single retropharyngeal (12.5%) had CR; the remaining 7 patients (87.5%) all progressed. Nine patients have died from their cancer. The overall actuarial 2-year survival for the patients with and without lymph node metastases is 12.5% and 78.6%, respectively.ConclusionsThese results show the benefit of stereotactic radiosurgery salvage treatment for advanced, recurrent lesions, without lymph node metastases in previously irradiated head and neck cancer.

Stereotactic Radiosurgery in Combination With Chemotherapy as Primary Treatment for Head and Neck Cancer

PURPOSE The purpose of this study was to investigate the effect of stereotactic radiosurgery on local control and organ preservation in cases of primary head and neck cancer. PATIENTS AND METHODS In this retrospective study, 14 patients with a mean age of 73 years were treated between March 2006 and September 2007 with stereotactic radiosurgery for the management of primary head and neck cancer. The patients had biopsy confirmation of disease before treatment and all patients were confirmed with squamous cell carcinoma. The staging consisted of T2 (5 cases), T3 (3 cases), T4 (6 cases), N0 (13 cases), and N1 (1 case). Marginal doses were 3,500 to 4,200 cGy in 3 or 5 fractions. The outcome was assessed according to Response Evaluation Criteria in Solid Tumors criteria based on magnetic resonance imaging and positron emission tomography/computed tomography. RESULTS Significant tumor reduction was noted at the third month of follow-up with 5 complete responses and 9 partial responses. At a mean follow-up of 36 months (range, 14-40 mo) the local control and overall survival rates were 71.4% (10/14) and 78.6% (11/14), respectively. CONCLUSIONS These results show the feasibility of using stereotactic radiosurgery for primary head and neck cancer and its potential benefit in local control and organ preservation.

Evidence for the changes of antitumor immune response during lymph node metastasis in head and neck squamous cell carcinoma.

OBJECTIVE This study aimed to elucidate the differences in antitumor immune responses between primary tumors and metastatic regional lymph nodes in head and neck squamous cell carcinoma (HNSCC). STUDY DESIGN The clonality of tumor-infiltrating lymphocytes in tissue specimens from 17 HNSCC patients was examined regarding their T-cell receptor (TCR) repertoires and their complementary determining region 3 (CDR3) size spectratyping. Cytokine expression profiles and T-cell phenotypes also were measured by using real-time quantitative polymerase chain reaction. RESULTS The host immune responses to HNSCC cells, reflected by the TCR repertoire, differed between primary tumors and metastatic lymph nodes. CD8+-T cells and T helper type 1 (TH1)/T cytotoxic 1 (TC1) cell cytokine production in metastatic and nonmetastatic lymph nodes were similar. CONCLUSIONS The antitumor immune response to HNSCC cells changes during lymph node metastasis, and HNSCC cells can escape the cytotoxic immune responses mediated by CD8+-T cells and TH1/TC1 cells. These results suggest that lymph node metastasis might be associated with changes in the nature of the primary tumor antigens.

Radiosurgical treatment of maxillary squamous cell carcinoma.

The authors report their experience of using the CyberKnife system (Accuray Incorporated, Sunnyvale, California, USA), a new radiosurgical device, as a treatment option for squamous cell carcinoma (SCC) of the maxillary sinus. A 66-year-old man with SCC stage T4 was treated using the CyberKnife system.

Sialodochoplasty to treat sialoliths using a microsurgical technique.

ecent progress in endoscopic surgery has facilitated the on-surgical removal of sialoliths from the duct of the subandibular gland.1,2 However, the limitations of endoscopic echniques are: adhesion of stones to the ductal walls, ducts hat are too narrow; strictures; ducts with sharp angles; giant ialoliths, and intraparenchymal stones.1,2 The conventional ntraoral approach cannot help some of these cases because f the narrowness of the visual field, particularly when the tone is located in the gland hilus or intraparenchymally.3,4 he method is influenced by a number of factors that were ointed out by McGurk et al.:3 no limitation of mouth openng, a class II skeletal base where there is retroclination, over ruption of the lower incisors, and so on. For these cases, ubsequent submandibular sialoadenectomy has usually been equired. In an effort to preserve the submandibular gland, we ave tried to remove sialoliths located at the hilus and to do sialodochoplasty using a surgical microscope by an extraoal approach with a larger visual field as an alternative to ubmandibular sialoadenectomy. Between March and October 2005, three patients with tones in the submandibular gland were treated by this ethod at our clinic. All three were secondary cases. It was ot possible to remove the stone in one patient (case 1) by ndoscopic surgery because the stone was adherent to the uctal wall. The other two patients (cases 2 and 3) had been perated on by the intraoral approach at other hospitals unsuc-