Hidehiro Matsuura

Depth of invasion as a predictive factor for cervical lymph node metastasis in tongue carcinoma

Many histopathologic parameters in head and neck squamous cell carcinoma have been identified as predictive factors for cervical metastasis. Several studies focused on tumor thickness, and the depth of invasion was suggested to have a relationship to the occurrence of cervical metastasis. Nonetheless, the criterium for elective neck therapy in terms of tumor depth is still inconclusive. Therefore, a retrospective study was undertaken to substantiate the differing results in the literature with our own findings concerning the interrelationship between tumor thickness and clinically suspicious neck, as well as occult neck disease. In addition, the study attempted to identify further predictive factors for cervical metastasis in squamous cell carcinoma of the tongue.

New reconstruction for total maxillectomy defect with a fibula osteocutaneous free flap

The osteocutaneous fibula free transfer with three segments of bone and the peroneal flap was used to reconstruct a total unilateral maxillectomy defect. Satisfactory restoration of three-dimensional facial structure, orbital support, and prosthesis wearing was achieved. The fibula osteocutaneous free flap is a very useful alternative for reconstructing a maxillectomy defect.

Intraoral ultrasonography is useful to evaluate tumor thickness in tongue carcinoma

BACKGROUND A number of studies have reported that tumor thickness (the depth of invasion) is a valuable prognostic factor in oral cancers, especially as a predictor of cervical lymph node metastasis. Accurate preoperative assessment of the tumor thickness of tongue cancer would provide useful information for targeting those patients for whom elective treatment of the neck is appropriate when the primary tumor is resected. No studies have been done measuring the tumor thickness of tongue cancer preoperatively. The present study was undertaken in order to evaluate the clinical usefulness of intraoral ultrasonography as a tool to delineate tumor extent and measure the thickness of tongue carcinomas. MATERIALS AND METHODS Twenty-four patients with tongue carcinoma were preoperatively evaluated with intraoral ultrasonography. The tumor thickness measured by ultrasonography was compared with the measurements by histological sections. RESULTS High-quality ultrasonic images were obtained, and the tumor thicknesses were measurable within 1 mm. There was a significant correlation (P <0.001) between measurements by ultrasonography and histological sections. CONCLUSION Our results demonstrated that intraoral ultrasonography is an excellent method to delineate tumor extent and measure tumor thickness in tongue carcinomas.

Functional reconstruction of a bilateral maxillectomy defect using a fibula osteocutaneous flap with osseointegrated Implants

We have achieved functional reconstruction for a bilateral upper alveolar bone, gingival, and palatal defect that has various problems originating from instability of the prosthesis using the fibula osteocutaneous flap with osseointegrated implants. The flap had three bone segments and two skin paddles. The combined bone segments created the upper alveolar arch, and the skin paddles closed the palatal defect. Nine months later, prosthodontic treatment was performed successfully. Our procedure restored the patient to masticatory function of the upper jaw, intelligible speech, and natural facial appearance. As a result, quality of life of the patient was extremely improved.

The Relationship of Shape of Tumor Invasion to Depth of Invasion and Cervical Lymph Node Metastasis in Squamous Cell Carcinoma of the Tongue

Several investigators have suggested that there is a strong correlation between tumor depth and lymph node involvement in tongue carcinoma. The purpose of this study was to investigate the relationship between the shape of tumor, tumor depth, and lymph node metastasis in tongue carcinoma. Fifty-four patients with T1 abd T2 tongue carcinomas who underwent surgical treatment were included in this study. Tumors were divided into four categories according to their shape of invasion: superficial, exophytic, endophytic, and a combination of endophytic and exophytic. Forty cases of endophytic and combination types were divided into two groups according to the shape of invasion: (1) reductive bottom of invasion (n = 17) and (2) expansive bottom of invasion (n = 23). Tumors with a reductive bottom of invasion showed a variety of tumor depths and had low lymph node involvement (4/17, 23.5%). However, tumors with an expansive bottom of invasion showed deeper invasion and a high incidence of lymph node metastasis (16/23, 69.6%). These results suggested that the macroscopic shape of invasion is a feature that may provide important information about the prognosis of the primary tumor especially in relation to cervical lymph node involvement.

Fine needle aspiration of salivary gland tumors.

The usefulness of fine needle aspiration (FNA) as a preoperative diagnostic procedure was studied in 43 patients with salivary gland tumors. Nine of the tumors were malignant and 34 benign. The diagnostic sensitivity of FNA was 88.9% (8/9), the specificity 94.1% (32/34) and the accuracy 93.0% (40/43). These results indicate that FNA is a highly sensitive and specific screening procedure.

Treatment of malignant melanoma of the lower eyelid using anterolateral thigh flap.

Malignant melanoma is a poor prognostic disease with the potential for high mortality despite early diagnosis and currently available treatment. Surgical judgment pertaining to the extent of primary resection and regional node dissections must be tempered by cosmetic considerations and by the anatomically diffuse pathways for lymphatic spread in certain lesions. We reported a case of malignant melanoma of the left lower eyelid, and presented the surgical excision and reconstruction using anterolateral thigh flap for skin defect. It is evident that comprehensive treatment using radical surgery and adjuvant chemotherapy is necessary for cutaneous malignant melanoma of head and neck areas.